Last Wednesday afternoon, the prenatal nurse, Lori and I sat down with a 15 yo girl who was in for a visit. She had been seen several months ago for her pregnancy and for several reasons, including her age was identified as high risk and encouraged to come back with a family member so the nurse could work with them during pregnancy. The area we are in is very rural and the closest hospital is about an hour away. They wanted this young mama to be to establish care with the hospital so when it came time to deliver she would be accepted and have a chance at a safe and healthy delivery.

The young girl disappeared for awhile and had not been coming for care. The staff here spent quite some time trying to find a neighbor or family member who might know how to find her. They finally got ahold of an aunt and the young girl came back last week for a visit, by herself. When we sat and talked with her, we stressed the importance of coming for care and wanted to know who was responsible for her and who would be supporting her during the birth and after the baby came. We told her we loved her and wanted to do what we could to help her, but that every woman needs a support system. In her immaturity, she was unable to give us much helpful information but ensured that she would come back the next week with an adult.

This Tuesday afternoon, clinic was running normally when the gatekeeper yelled to Lori that there was a pregnant woman coming in who was not good. I ran out in the yard to find a several people carrying a pregnant woman who was not responsive. The laid her on the ground and I took a quick glance between her legs to make sure there was not a baby coming. I could tell she was not well and they were yelling that they brought her in because she kept passing out. We all went into emergency mode and got her into the dressing room. I checked her and established that she was definitely in labor but not close to having a baby. As we were attempting to get a blood pressure, she started seizing. After stopping and taking a closer look, I realized that this girl looked very young. At that point the prenatal nurse came in and we realized that the patient was in fact the young girl we had seen last week. Thankfully we were able to get and IV and some oxygen while drawing up some magnesium sulfate to treat the eclampsia. Her blood pressure was severely elevated and thankfully we had some IV medication we could give for that.

After she was stabilized, we started to come up with a plan. We would need to transfer her to a hospital that is about an hour away to be delivered urgently. Everyone started mobilizing but no one could find a car in the village who could take her in. Lori called the governmental ambulance service but they informed us that the one ambulance for this area was taking someone into Port au Prince and would likely not be available for a couple hours. They asked if we could wait until then. Ha. Thankfully someone was able to take a motorcycle to the next town in and find a car to come out and get her. It was about 30 minutes before a car was able to come for her. Thankfully in that time she did not have any more seizures and I was able to get good heart tones on her baby. We worried about the car trip in, but did what we could and made an IV bag of medication that could be given while they were riding. We wrote a referral letter with her chart information hoping that the hospital would receive her and urgently get her delivered. We saw them off in the back of a truck and hoped and prayed God would protect this baby and mama until they could get care, but honestly we would be surprised if either one of them would come home alive.

What most of you don't understand is that eclampsia is a sever life threatening emergency of pregnancy for both mom and baby. If this incident took place in the US, we would have been back in an operating room and the baby would have been delivered by c-section in 5 minutes.

Yesterday, we did not hear anything from the family about what happened, and we assumed the worst.

This morning, the prenatal nurse had heard through the grapevine that mother was indeed alive and the baby was alive but in an incubator. We were shocked and thoroughly surprised. I had gone upstairs for lunch and when I came down to the office this afternoon everyone was quiet and said we have a surprise for you. I looked in Licia's arms and realized she had a baby in her arms. A big, healthy baby boy.

Here is what we know about what happened between Tuesday afternoon and today. Mom and baby made it to the hospital one hour away where they were told that she was too sick and they needed to go into the government maternity hospital in Port to be delivered. The extended family member who brought the baby said that mom had a vaginal delivery, and by the baby's bracelet we realized it's time of birth was 7:10 on Wednesday morning. Mom is still in the hospital but the "machines" for the baby broke today so he was discharged and told to go back to the clinic that helped them before.

Y'ALL. This is nothing short of a miracle that both mom and baby are alive today. The chart said the baby had meconium aspiration and antibiotics had been ordered. He looks great for us and we will keep him here until mom is discharged and we can make sure they are both safe to go home. I don't pretend to understand the broken healthcare system here in Haiti and why the delivery was so delayed. This is why maternal health matters so much in this country. It's overwhelming to think that this is just one story of thousands of mamas who will deliver in Haiti this year.

For the moment we are rejoicing in His goodness and soaking up all the snuggles with precious Samuel.

Last Sunday afternoon Lori, Licia and I were sitting in the office chatting when the gatekeeper told us there was a sick child outside the gate. Sunday is not a normal clinic day, but the doors at Real Hope for Haiti are always open for urgent care. When Lori and Licia went to the gate, they found a small group of people on their knees praying for a very fragile baby. They took one look at the baby who was pale and breathless and ran back with it to the dressing room and yelled to me to come, "the baby is almost dead." We immediately starting working to get an IV, raise his glucose and put him on oxygen. He had to be stimulated just to breathe every 5 seconds. The baby's mother sat outside the door praying and terrified that her baby was dead. None of us would have believed that 11 days later he is still with us.

Over the next couple hours we sat close, helping him to breathe and learned more about their story. Mom had been to church Sunday morning and some people at her church saw how ill her child was and had heard of a clinic in Cazale that helps sick children. Jolicoeur was born in late January at full term, but has always been small. Mom breastfed religiously but says he has never grown and began to have swelling just a few weeks after he was born. In the week before they came to us, the baby became very sick and stopped taking breastmilk and Mom knew it was time to get help. She spent several days going around to different pediatric hospitals in Haiti, only to be turned away because there were no beds. On his first day with us he weighed 4.1 pounds at almost 4 months old. He was severely dehydrated but his hands and feet were shiny due to serious swelling from malnutrition. He was obviously extremely anemic and has a severe heart murmor. Since that day, he has been stable with oxygen on and continues to breastfeed with supplements through an NG tube. His glucose and fluid balance is constantly monitored and he is up to 4.8 lbs with a decrease in swelling. We are hoping we can continue to get him well so we can send him in for a referral in the coming weeks. 

His mama has stayed very close by his side since the moment they came. She is steadfast and loyal and loves this baby boy so well. We have enjoyed getting to know her and hear more of her story. She is a single mother to 4 other children, her oldest is 16 and the youngest is 2 1/2. They live in a small house in a part of Port au Prince called Canaan. This area was originally a tent city after the Earthquake in 2010 but more permanent houses have been built there now. Since she has been here with Jolicoeur, her 16 year old has been taking care of the other children. On Monday afternoon she called her family and heard that the wind from the storms had blown the tin off the roof of their house and her kids were having to stay with neighbors. She was very upset by this and had to leave Tuesday for the day to go in and check on them. They are all in school at this time so it is important for them to stay there, but she obviously feels the pull of needing to be here with Jolicoeur, as the breastfeeding is crucial if he is going to have any chance of surviving. We have no idea how long they will need to be with us.

I am so amazed by this mother's sacrifice and her fight to do what she can to care for her kids. I would love to be able to bless her with the funds to repair her roof and make sure her other children have a safe place to stay in while she is away. We are in need of $300 for the materials, labor and transportation to cover this for her. I'd love for you to pray for this family and if you are in a position to give money, I know this mama will be overjoyed. 

You can click this link below and give via Paypal to Real Hope for Haiti and your donation will automatically go toward this need specifically.

Little ones to Him Belong

It's late and a rainy breeze is blowing through the open air windows and I can't fall asleep.

There is a line of people sleeping outside the gate who are waiting to be seen in clinic tomorrow, hopeful for healing.

And there is the body of sweet baby girl, bathed and dressed in a white dress who took her last struggling breaths in my arms tonight as I rocked her and sang to her about the hope I have in Jesus.

I get to share in lots of joys when I am in Haiti. I love this country, the vibrant people, the colors and the smells.  There are births and beautiful babies and recovering children and wounds healing and I get to use skills that are long lost at home. I love the adventure, the challenges, and my dear friends who live here full time and the wisdom and grace that just oozes out of their lives into mine. I love how being in this country makes me brave. The joys are some of the highest I have ever experienced on earth. But these joys come with unbearable loads of heartache. Life in this country is complicated. It is twisted and backwards and unfair and maddening and it begs me down to a place that I don't often go where a deep groaning in cries for His redemption.

Baby girl came to us late Thursday afternoon with her young mother after being referred by someone who recognized the gravity of her condition. She was 7 months old and wasting away, severely dehydrated and struggling to breathe. We immediately got to working on her, and Licia with years of wisdom took one look at this child with her mouth full of thrush (a fungal infection) and said "We need to get an HIV test." Two solid lines, clear as day. Our hearts sank and we immediately started thinking about her mother, who was 20 years young, bright and healthy, and hopeful for her only child to be rescued. The staff gently pulled her aside and counseled her, she was unaware of any existing infection and stated she had been breastfeeding her baby since she was born last fall. Two solid lines, clear as day. I would like to say "as you can imagine" but I'm not sure you or I actually can imagine. She was devastated and hysterical and confused and frightened and alone in a strange place with her dying child. She wanted to leave with her baby immediately, she just could not begin to process all that was going on and she certainly could not be dying herself of HIV. The staff was kind and gentle and respected her privacy but explained to her that her baby would likely not make the trip home and if she wanted, we would do what we could to save her. She could stay or she could go and come back at any point, but we wanted to give her baby girl a chance. She agreed to leave her baby and got a phone number where she could reach us. We stabilized baby girl but it was very clear to us all that she was still dying. We prayed for minimal suffering, but also hoped for some peace and reconciliation for mom. She would go home that night and talk with Dad. The next day called several times throughout the day to check on baby. We reported that she was stable and hoped they would come to visit. She and the young father came on Saturday morning and spent a few minutes with the baby, but did not touch her or talk to her, they just watched. I imagine they were and still are grieving how their lives' took a most devastating turn in a matter of seconds on that Thursday afternoon. We have not heard from them since they left. Baby girl struggled over the weekend and it was clear this morning when she started having seizures that the end was close. We did our best to keep her comfortable today and as it neared tonight, I held her and rocked her just hoping she sensed that someone was near. She was fighting hard for air for what seemed like eternity and then finally she was still. No more struggle, no more pain. Her little body that has only known disease in her short time here is finally whole.

Last week I caught a baby who was born severely premature and had a difficult entry into this world. We worked to resuscitate him and got him stabilized without the luxuries of NICU full of equipment and staff. It was exhilarating and miraculous and we were so grateful for this little life God gave us. Baby was doing okay and for many complicated reasons we decided the best thing for baby was to go home with mom and dad who were equipped with all the tools we could give them to care for him. A few days later, baby Wesley died at home with his family in the rural mountains of Haiti.

Complicated, twisted, backwards, unfair and maddening.

The paradox of the joys and heartaches I experience in Haiti is where life is born for me. I love God and sense his unmatched graces in the most real way. I know Him deeper and want to taste every bit of beauty and joy this earth has to offer because He is so good and He is so near to us. And yet, I long for heaven and His ultimate and eternal healing because this world is broken. His beautiful creation and the people He made in His image are groaning for new life, a whole life, apart from this brokenness. He promises us that and all those promises are made true in His son Jesus.

Little ones to Him belong, this is my only hope.

A sack of eggs

To understand the gravity of this story you must go back and read the story of this birth that took place a year and half ago. At the time of the birth, I knew that I had no idea what I was doing. Then I went to Midwifery school and realized that I HAD NO IDEA WHAT I WAS DOING. But God was merciful to us on that day and brought that precious life into our hands. Not a day has passed that I don't think of sweet Jesula and I love my Jesus more.

Licia surprised me this week by giving Jesula and her mom an appointment to come to clinic while I was here. Jesula was dressed in her best white dress and frilly socks for this special occasion. I can't explain the joy in seeing this precious and healthy baby today. Then mom whipped out her boob and started breastfeeding her and it was like total Midwife ecstasy. Not that I am responsible for her continuing breastfeeding for 18 months, but I'd like to think that getting her started those first two days helped. We got to spend some time together and Jesula played and laughed and walked, things I never ever thought this child would do. They passed through the clinic and then we went to snap this picture, but Jesula had fallen asleep so she doesn't look too happy. I promise there were many smiles.





While this was such a joyous reunion, it was also one of the most humbling moments of my life. One of the times I walked past them while they were waiting today, Jesula's mom grabbed my arm. I turned to her and she reached in her bag and handed me this sack of eggs. You see, this is her incredible gesture to say thank you. To me and to Real Hope for Haiti and to God. I froze. How could I take eggs from a poor Haitian woman who lives way up in the mountains when she could feed her family for days on this precious resource? I can't even quantify what this gift would translate to in the world you and I live in. I don't think twice about getting in my SUV and driving to the store to purchase a dozen eggs at home. I couldn't help but think of the woman who poured out her expensive perfume on the head of Jesus. To those watching it seemed silly to waste it when she could have sold it and made more money, but Jesus saw her humility. I told Lori and Licia how uncomfortable I was accepting the gift, and they quickly reminded me to humble myself, for I am no better than this woman with the eggs. We both need Jesus the same.



Lord, I pray for less of me and more of you.

Being with woman in Rural Haiti

Being a Midwife means a lot of things to me. It literally translates to mean "with woman" and being with woman looks different everyday. Sure it means getting to attend births and sharing in the joy that is new life, but sometimes it means screening for cancer, helping women make choices to plan their family, or prescribing blood pressure medication. Other days it means listening to a women who carries many burdens, educating women on protecting themselves in relationships, or walking with a family through the loss of a baby. It means championing efforts to promote healthy lifestyles, healthy families and healthy communities, because women are worth it.  Here's a glimpse of what being a Midwife in rural Haiti has looked like this week.

Each month a new education topic is chosen for the bulletin boards in the patient waiting area in the clinic. Roughly 800 patients come through the clinic each week and as they pass through the line to be seen, a staff person gives a 15-20 minute talk on something relevant to public health education. This weekend I wrote some material and gathered information to create a presentation on "Danger Signs for Pregnant Women." I gave the first few presentations with a translator yesterday so that the staff person could learn the material and now she will give the talk for the rest of the month. We covered topics like eclampsia, hemorrhage, labor dystocia and signs of infections. The majority of women here give birth at home, and most births are not attended by anyone with skilled training. The challenge for me was looking at prevention of  obstetric emergencies and how you deal with them in a place with very limited resources and access to a higher level of care. We work with a very rural population and the closest hospital is 1-1.5 hours away, which makes dealing with potential emergencies very difficult. The best treatment in these situations is recognizing the danger signs early enough to get to a place where they can be taken care of.

One of the patients asked me in front of the group what to do if a woman who lives in the mountains is having a baby come with the feet first? Being from the mountain means you are anywhere from a 1 hr-10 hr walk from the clinic here and even further from a hospital. This is a small glimpse of the dangers women face in Haiti. Praying that this teaching will fall on ears who will share what they have learned and it help save lives of women and babies in Haiti.

Let's catch up

***Don't scroll down if you can't do blood and guts

I have sat down to write an update several times since Friday and each time something more important came up. The weekend was good. I got to work with the community group in their nursery on Saturday cleaning up and filling sacks where seeds will be planted to grow trees that will eventually be planted in the community. That afternoon we went up to the new land to see the progress of the new Cholera Treatment Center which will open very soon. It was overcast that day, but from the back of the CTC you can see this beautiful landscape and the Caribbean Ocean on the horizon. I love the peace and quiet in that place and look forward to many more evenings watching the sunset from this spot.





We have a kiddo who was burned over the weekend after he pulled a pot of hot cereal on him. Sweet thing is the stinking cutest kid and he is already healing nicely but would you continue to pray for his pain that it would be minimized and that he his wounds would continue to heal.



Saturday night we lost sweet Pearalson who was admitted last week. He had severe kwashiorkor and even though all of his fluid came down, his little body had just been through so much that he was unable to recover.

Sunday was spent taking care of the ICU kiddos and a few cuts that came in, and working on an education project I will share later.

Monday was the day of nasty cuts to be sewn up. First thing was a bad machete cut to the hand that a visiting doctor worked on. This little lady fell down and it her face on some kind of branch or stump. That long skinny piece on the left side of the cut is a vein. She busted through all the way to her gums and it took quite some time to clean out all of the pieces of wood inside the cut.










The day was crazy busy and as we finally sat down to do some work last night, an old lady came in who had fallen at her home. She knocked her head pretty bad and kind of made us worried she was having a stroke. She follows here in the clinic for high blood pressure so we kept her overnight and she was well enough to go home this morning.




And the best news of all is that while I was doing some teaching this morning, Licia came and told me that one of her ladies who works in the RC was in labor and she was going to come over. A few minutes later I saw an uncomfortable pregnant lady heading for the toilet. Let's just say I have learned enough to know that means grab your gloves and follow her. She was already pushing and by the time we got her up on a bed the head was on the perineum and we had a beautiful baby girl just a few minutes later! In true Haitian style she recovered and got up and walked home an hour later. This was baby #51 for me and my first baby as an official Nurse-Midwife.

I walked back up to the house to eat lunch after the baby was born and when I walked past the ICU I saw a woman sitting in a chair with empty arms sobbing. She came to visit her baby and found that her Pearalson had died over the weekend. Such as life is in Haiti, the land of contrasts, that in a moment you are celebrating life and the next you ache for the starving child and his mother who simply couldn't feed him. This doesn't ever get easier. Pray for his sweet Mama who goes to sleep tonight without her baby.

In other news, Trey found a baby chick and adopted it for a day until the owner came looking for it.

Wensky

Nadia had a good day and is eating really well. I even got a few smiles out of her after sneaking her some ice chips.

Meet Wensky. He has had a really hard life. Both of his parents are dead and he has two siblings that he has not seen in years. His mother was sick for a long time and was told her illness was not one for doctors but for a Voodoo priest. She died from HIV under their care and Wensky was living with cousins when he became sick a few months ago. He was told to go to the same place his mom did, but he did not want to so 12 year old Wensky snuck on a boat from the island of LaGonave with only $2 in his pocket and found some of his mom friends to help him. He was brought here to Real Hope for Haiti a few weeks ago where they discovered that he too is HIV positive. He weighed 36 lbs and was very near death, unable to walk. He began to eat more and get better little by little, but last week he came down with one of the worst case of shingles I have ever seen. His poor little body is so immunocompromised that he has had a horrible time with it. He is in an incredible amount of pain and has spent almost all of the last few days in bed. We have tried to keep him comfortable with medication so that his body can rest and try to heal.





Pray for sweet Wensky that his pain level will come down. Pray that he will be well enough to go in for further testing and begin ARV treatment this next week. Pray for his appetite, and mostly pray for his little heart. In his 12 short years he has been through more than most of us will experience in a lifetime and we are praying that He will come to know how much God cares for him and how precious his life is.