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Haiti 2016 - Day 3

Day 3: St. Therese Hospital in Hinche is a difficult place. It is so different from anything we experience in the US.  There are three large rooms for ante partum, postpartum and post/op mothers.  There are 9+ beds in each room and one midwife per room in the day and usually only one in the night for all 3 rooms.  There is no privacy. Out of 9 beds in one room, three had lost their babies exemplifying the high neonatal mortality rate so vividly.  And they lay in their beds next to the mothers with their newborns.  The energy in the space is thick.  The labor unit is still 5 exam tables and one more out in the hallway. Women literally give birth on old exam tables with broken foot rests.  There are no epidural or pain relief medications. Just lists of mag sulfate for eclampsia seizures and hypertension medications to try and save their lives.  

I took three students in the postpartum unit with my interpreter Sheily.  The students are bright and articulate.  One in particular was so compassionate and had critical thinking skills that allowed her to identify causes not just symptoms we were treating.  One mother had delivered the previous morning and was stable.  We reviewed her chart and completed her physical exam, as well as her daughter.  The only issue was she was HIV positive and while she had received her diagnosis 5 years prior and had been on AZT during pregnancy her baby had not received her first postpartum dose.  We spent significant time tracking down the medication for the baby and unfortunately it was already over 24 hours since the birth but she finally received it.  We did extensive teaching with the HIV nurse about continuing the medication for her and the baby and returning in one week to test the baby for her first HIV screen.  

The next patient was a young woman who was 17 weeks pregnant who had come in with severe shortness of breath and a high fever. She also complained of pain in her leg. She was also severely jaundiced but her hemoglobin was 9.2.  She received IV fluid and antibiotics and malarial medication after a positive malaria screen.  She also had an X-ray ordered that was never done but by the time we came on shift her shortness of breath had resolved so we cancelled the X-ray.  We explored what else might be causing her jaundice but with limited lab capabilities we could check liver function of hepatitis screens.  

We also cared for a woman who had come in with eclampsia and her baby had died.  It was her fourth term baby she had lost.  She was on mag sulfate for her seizures and anti-hypertensive meds.  We discussed the importance of monitoring the amount of oral and IV fluid the patient received while monitoring the urine output in the Foley catheter as the kidneys can be impacted.  The student later noticed that the client had not had adequate urine output for the day so we discussed her case and realized after explore her chart someone had forgotten to give her the diuretic medication that had been prescribed.  

Labor and delivery was slow at that point and the students were settled so I returned to the house to meet with six graduate midwives from the Midwives for Haiti program who want to open their own birth center.  Sarah is a midwife from Oregon who has spent a tremendous amount of time in Haiti including a year at the Mama Baby Haiti birth center in CapHaitian.  We discussed everything with the midwives from mission statements and vision, structural needs, supplies, staffing, funding and budgeting.  They were so excited and motivated. I think they will be very successful.  Right now in Hinche women have two choices, home birth with matrons or the hospital.  The birth center could be a special addition in the community where low risk women could relieve clean, safe and compassionate care.  

When everyone returned from their irk from the day we shared our 2pm meal and headed out to tour Papay which is an agricultural education center focusing on eradicating peasant malnutrition.  By teaching better, smarter farming practices people can increase their crop production to provide food for themselves but also their communities.  Everything is used from human waste for manure to old tires from seedlings.  

From there we headed to Maison Fortunate Orphanage.  The girls were so excited when we pulled up.  We spent two hours just playing and loving on these girls.  We brought soccer balls and jump ropes.  They all got lollipops and then we had a dance party.  The kids knew Justin Beiber and Katy Perry. But they loved the whip nae nae. It was a beautiful night.

We returned to the house for communal dinner and worked on lesson plans for the students.  There is always a Haitian beer called Prestige involved.

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