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Haiti 2015 - Day 4

Day 4: It was an early morning as our hospital shift began at 7am. I braided my hair, ate some oatmeal and hopped on the moto to the hospital.  It has been so nice to reconnect with the translators and see pictures of their children.  

Upon arrival to St Therese Hospital the memories of previous years came rushing back. It is difficult to express the degree of disparity in all facets of life between Haiti and the US but particularly in the realm of healthcare.  As I walk past the droves of patients and families one thought continually resurfaces that it all starts with poverty and the subsequent malnutrition.  Just outside the Maternity unit is the pediatric unit. There are three separate pediatric units. The first room is for malnourished babies.  There were probably 10. Many of the mother sit out on the bench and nurse their babies because it is so very hot in the unit. Very little airflow and unbelievable humidity. One woman clearly had AIDS and so did her child. They were both so emaciated.  Her babe lay naked across her lap, lethargic. Both of their eyes were full of life and yet haunted.  One little boy was so protein deficient and malnourished his body had third space all his fluids, so he was so swollen his legs and arms and abdomen looked like they had burns on the them from the skin separating from the swelling. Other children were so emaciated they looked like they had a grey color.  Their little hearts beat so fast some of them get so tired from the effort to live that they let go.  But some get better. A young pediatrician from Ireland had been there since August and was so compassionate with these babies and mothers.  She explained that for the ones that get better there is a program in town that provides the families with peanut butter and it literally is saving lives.  

After giving Fatima and Kimberly a tour of the hospital it was time to get to work.  The postpartum, antepartum and post c/s rooms were all full. They are three separate rooms with about 10 beds in each room. There is no such thing as privacy, no curtains. Few chairs for family. Many family members sleep on the floor next to the their loved ones.  The families must bring them food and water. Many families come from hours away. 

The first woman in labor was having her first baby.  When she first arrived she was three centimeters and working hard. She had good support with her sister, husband and her mother in law.  Most of her labor was spent walking in the hall in the courtyard in from of all the visitors of the hospital.  While she labored beautifully many other women came and went.  Two women came in with post c/s wound infections.  One of then was an abscess and the doctor came and open her incision and put her on oral antibiotics. In the US we would have put a drain in and put her on iv antibiotics.  I hope she does ok.  A woman brought in her baby with polydactal (extra finger) and had tried to tie string around them at home after her home birth but the baby was miserable. The Haitian midwife numbed the fingers, tied them off with suture and removed them with a razor blade.  The babe was calmed immediately after the procedure and the mom was so thankful.  

A woman arrived having pain after falling in the shower on her abdomen.  She was very worried because she had lost her two other children.  She had a c/s with her first and when that child was a year old it became ill. She brought it to the hospital. She was full term with her second at the time and she started bleeding while at the hospital.  They checked heart tones on the baby and they were rapidly dropping but the electricity was out at the hospital so she could not get a c/s and the baby died before the power came back on hours later.  Her first child later died. She was rightly concerned about her current pregnancy. In Haiti after three c/s they tie your tubes even if you have no living children or don't consent. They believe the risk to the mother for future pregnancies is too great. It took two hours to talk one of the two doctors to come in and do her cesarean.  In a country with a population of 10 million there are only 100 obstetricians. Mom did well and baby was born alive but clearly not 37 weeks. I assessed babe to be 34 weeks. She was flaring, retracting, working to hard to breath with too high of a respiratory rate.  She had no creases on the bottom of her feet and weighed about 4.8 pounds.  Luckily Ohio State University opened a low level NICU last year that actually had one of it's four beds open and was able to care for the baby. Just over a year ago that baby's survival rate would have been very low. Baby's here have to be able to suck, swallow and breath to stay alive.

We had a 17 year old girl come in for a post rape assessment. She had to have an exam in order to have her police report filled. She was a virgin prior to her assault. We ordered labs for HIV and syphilis. It broke my heart. There was no emotional support offered for her. There are no services. She was very stoic. 

A woman came in labor with twins and the first was head down so she would birth vaginally.  She was very tearful and rightfully scared. We offered her as much reassurance as possible.  There was a woman in the antepartum unit screaming in pain for hours.  She was 8 weeks pregnant.  She had been diagnosed with h.pylori bacteria which causes ulcers. She had hyperemesis and was having severe abdominal pain.  There was an ordered for two antibiotics to treat her h.pylori and an iv antacid but no pain relief. Her screams were primal.  I assessed her and her blood pressure was dropping her pulse was rising. There was a mobile palpable mass inn her gastric region. You could feel her aorta bounding through her abdomen. It took over an hour to get her pain medication, which did not touch her pain. I eventually ordered an ultrasound to rule out a bleeding ulcer or bleeding esophageal varicose veins.  There was no way to tell if she had just simply eroded her esophagus with the tools available to us but it became very apparent that if we did not find the source of her pain and treat her she would die.  She looked me in the eyes and repeatedly asked to die.  We did the best we could for her and eventually got an internal medicine doctor to come and care for her. I was not able to see the case through as our interpreter were working over at this point and it wasn't fair to keep them from lunch.  So we loaded up our supplies and hopped on our moto taxis back to the house for lunch.  

It was a lot to process so we came home and ate lunch while attempting to cool down.  We spent the next couple of hours sorting medical supplies we had brought and got them put away.  Midwives for Haiti had huge trash bags filled with motes pads donated so we sorted all of those into small packages to give out at mobile clinic. We had beer and relaxed on the patio discussing our thoughts on global property and particularly development in Haiti.  Pippa had invited a midwife named Kate over for dinner who was here with Zami Lasante (partners in health) since august. Wednesday will be here last day here so Pippa made a popover dessert of some kind that was lovely.  Leona's boyfriend dropped into visit with her. He is an engineer from msppp working here for a year from France. They are very sweet together. 

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