Friday, October 28, 2011

Sunflower Baby

When I first got to Haiti, I planted sunflowers by the front door of the clinic. Once, when I was growing a school, I planted sunflowers as a symbol of hope and potential and beauty and so I had wanted to do that here too. I wanted flowers by the front door. I watched and waited and they did not grow. I thought the rains were too hard but then one day, when I had quite forgotten them, there they were in bloom. We has fun taking this picture and the mothers thought it was very funny too. A sweet, little sunflower baby.

Wednesday, October 26, 2011

Esthere come morning

Mostly, in Haiti, I spend my days here at MamaBaby Haiti blending my daily routines and relationships into a preparation for the unexpected. I have come to expect soft beautiful sunrises and sunsets and the sounds of animals all around me. I have come to expect the comings and going on the road and the familiar rice and beans served every day at noon.

But I have also come to expect trajedy and hearbreak. I have come to expect that the unexpected and the unthinkable will come to our door and that we will take a deep breath and somehow work it out.

Yesterday we drove, at sunset, to closest ocean shore and stood and watched the young boys go out in their father's fishing boat. We watched their laughter and how much they enjoyed chewing on sugar cane. We noticed the abundance of trees with grapefruit and sour oranges and bananas and the papaya trees whose bark glowed in the waning light. A small girl was catching a crab as her father checked the traps for the next mornings work. On the way home, we waved as we passed from village to village where people of all ages walked the dirt roads, visiting with friends and neighbors, eating outside over fires and selling small things by the road. We watched the teen agers courting and the children playing soccer with a piece of fruit in a dirt worn yard. And we all thought, despite how different ti was from our own life that there was such a goodness to life.

And then a mother comes in with her 8 week old baby who weights 2.3 kg and is covered with red, raw skin and rash for head to toe. The baby is barely alive. She has fed the baby garlic and salt tea for days. We slowly try to hydrate the baby; searching for what some volunteer may have brought here before. We ask questions. The mother had a heart defect as an infant that was never repaired. Her own mother refused the trip to Florida necessary for he surgery or perhaps it was not possible. The mother was told she can not breastfeed because of her heart but nothing else was offered. We try to get her to try to breastfeed but she refuses. She says the baby will die if she breastfeeds it and she believes this very deeply. We get a hold of a pediatrician who is has worked in Haiti for a long time and she says its better to not send a severely malnourished infant to the hospital. We also know that they are given an IV and sent back to us withe no long term solution or food.

So we settle in. She and the baby and a young cousin, sleep and eat and stay her with us. We try to get an ounce in and then two ounces. We bathe her and treat her as the doctor told us while a woman labors in the next room. None of us are sure she will live till morning and each person offers their own silent prayers and hopes and tries to make it better. We have midwives and nurses and a doctor on a cell phone.

Once years ago, I had a foster son from Vietnam who had what this mother suffers from. He could not be operated on because of the war in his country. I can see it all again in the way she breathes and the way she moves and her skin and I think I have seen this untreated heart before. His name was Phouc and he died in our home. The doctors hear tell her there is nothing more to do. I remember when OHSU told me there was nothing to do for Phouc and I should just take him home to die.

And this mom says to us, "Just save my baby. You can not save me." And so we try. I am an hour and half plane ride from Miami. We have our little band here but we are also so alone.

It is morning now and I can see, in my mind, the fisherman pushing their boats out into the sea as they have for hundreds of years; catching fish for the women to sell in the market. Watching the mountains emerge from the dark, lit from behind with a sun still soft and gentle.

Here the baby cries and we have made it through the night.

This baby. Her name is Esthere. And now I will, with all the love I know whoever you are who reads this has for all of us, go down and wash her wounds and feed her. I had to tell someone about her. I have to make her life real. I have to make it important so if you read this perhaps you will say her name today - Esthere- and she will be real and important for however long she or her mother may live.

Sunday, October 23, 2011

Born under the stars

I wake up at 3:00 am and notice how sweet the air; the soft breezes that cool the night. The sky is full of stars and I watch as some shoot across the universe on a journey of their own. I am thinking how lucky I am to watch this with so little effort from my mattress on the floor.

Then, a horn beeping in the night. It beeps and beeps all the way down our road and by the gate and we all run. We grab blankets and gloves and then there right on the road, right under all those shooting stars and a crescent moon a mother gives birth with family and friends and midwives and driver all looking up at the night and then at the baby and thinking how glorious it all is.

In time, she is moved inside and another baby is born and as I walk from place to place I touch and carry and give and feel all the gifts that so many people have given to make all this possible.

Sometimes our steps feel lonely and even frightening but we all know that somewhere out there there are people who are walking with us and offering the simple gift of a blanket that we, thousands of miles away, wrap around a baby born outside on a star filled night.

Perhaps that is what stars are for; to remind us that we are connected by an ever changing night sky that we all can look up at and share no matter where we are.

Thursday, October 20, 2011

Tuesday, October 18, 2011

Jason buries the placentas in the garden

This is Jason but everyone says it like this "jaaaay - son"
He has lived in Cap Hatien for most of his life and lived here at the birth center when it was a half completed house.

He is the one who opens the gate for the women in labor and the one who buries the placentas in the garden after a birth.

Most days, he sits outside the gate with his best friend, "The Boss". The Boss has a cow and Jason has two goats so they watch them and keep an eye on the road, greeting everyone who passes by.

He has many children and grandchildren who come to visit and his girlfriend cooks for us on Sundays.

Here is Jason, with a perfect placenta ready to be buried in the garden!

Sunday, October 16, 2011

In Hait we are use to angles and miracles.

As a midwife, there is the moment the baby is born; the relief and gratitude I feel when the baby cries or lifts their head, eyes wide open to find their mother's face. There are the small. clenched fists and mouths that quickly suckle, a sneeze or cough to clear their lungs.

And while these things, sweet and miraculous are taking place, the uterus, former home of the baby must quickly empty itself of the placenta and return to its almost pre-pregnant size. The uterus, stretched to capacity must shrink down to the size of a grapefruit. It must clamp off the blood vessels that nourished the baby and in this feet of anatomical engineering, it must be careful not to loose too much blood. To do this, it must be empty; nothing can remain.

Mostly this happens. We wait and watch. Here in Haiti, we draw up pitocin before the birth and give it to the mom seconds after the baby is born. As a home birth midwife for all those years, I trusted that this would all work well but here with transport difficult and the women dehydrated and malnourished, we do not. This shot of pitocin, now known as active management of third stage, works well and we all feel pretty confident. "There is so little blood" we comment as we clean up and help the mom to a bucket shower and a clean pad.

And then there is the baby. After so many resusitations, always a happy sigh of relief and then on Friday afternoon, a woman bleeds an hour after birth and no amount of IV"s or medicine stops it. I put my hand inside and pull out hand fulls of blood clots and then in again and again; emptying the utereus and then for a long time holding it in place; rubbing and holding it beneath my hand forcing it to stay hard and small. We offer more medications, the power of a nursing baby and finally hours later it stays hard and the bleeding stops. Piles of laundry, used gloves and blood stained clothes.

We stand and go out into the hall to drink water and feel the fresh air of the approaching night. Another Mom is pushing; she is moving quickly and then there it is ; a perfect baby boy who cries and rests slippery and wet on his mama's breast and then the shot and the quiet wait for the placenta. I am drying the baby, changing blankets, offering the mom water and then the student midwife looks up and says, " the cord broke". I quickly change places and when I pick up the cord it comes off in my hands and there is no other end to be found. I try to reason that the other end must be right there and I can find it but can not. I reason the placenta can come out without the cord. Calm and reason.

We get her up. We give meds, oreintal herbs, Oregon herbs, more meds. We have her stretch and stand and squat but the placenta does not come out and she begins to bleed. For the second time in the day, I reach in to take the placenta out and it falls apart in my hands. I can not imagine what is going on. I feel for the familiar and it is not there. I can not feel what should feel like a placenta.

The Dad carries her to the car and our little team , along with Dad and baby, make our way to the hospital in Cap. And all the way I am holding the mom's head in my lap and holding her uterus in my hand; not allowing it to go soft. Sharon, the nurse, holds the IV bag. The always present holes in the road, seem worst than ever. I am afraid beyond afraid.. Why are there so many cows in the middle of the road. Why is it taking so long? Where did all these dogs come from? Which way to turn? Its so dark. Surely this alley is not the way to the hospital.

And then we are there. People everywhere waiting to get in; people sleeping outside. The Dad carries her in and then I am faced with a Hatien labor ward. Screams, rats, dirt, blood, one doctor for everyone. Rows of women drapped in stirrups withe no support or privacy. Babies waiting on the counters. We tell the Dad to put her on a bed and the very young Hatien doctor removes a small, deterioriated placenta that is more like a broken and deflated balloon.

We can not believe the baby survived and determine that the cord broke off at the base, leaving a large gaping hole in the placenta. There was not enough surface to nourish a baby and yet it did.
The mother should have bled more and yet she did not.

The father says to me, "we are use to angels and to miracles here in Haiti."

While we wait to make sure she won't bleed, Sharon covers babies and we try to help the other women. We get the doctors number and promise to call her. And there are women everywhere screaming. No one listens to heart tones. It is beyond my reason. Another mouse; no running water, no sheets.

And yet a woman, takes me to a washing station and pours clorox water on my arms and washes off the blood that is caked on my arms. I think she is a nurse's aide perhaps. The clorox burns and I am moved by this small kindness in the midst of so much.

I move from anger at the cows in the road, anger at the state of the hospital, anger at the situation in Haiti and then to tears and relief and then gratitude that the mother and baby were alive with virtually no working placenta.

We gather her up and head back to the birth center. This time, she sits with her husband; Sharon and I in the back with the baby. She walks into the center, bathes and gets into bed to bed to nurse and snuggle at long last. I am taken back by her strength and her resiliancy.

In the morning, Jason is sweeping the walks and the air is clear and cool with a soft Hatien sunrise over the mountains. I go downstairs to check on them and the other moms and then the fear and relief and exhaustion overcome me and I cry and cry with gratitude.

Each year hundreds of thousands of women die the world over because there is no trained midwife at their births, because there is no way to transport them to a hospital and no medicine to stop the bleeding.

The women of Haiti understand this risk and travel far to come here.

I feel inadequate and tired but there is team of us here now and others will come and go and when I look out two more women have come in the gate and are walking towards the door in labor. It is Saturday and Delha makes pancakes for everyone and the kids come in to show me their new drawings and the women must be checked in and a minster brings me bags of cocanuts and bananas and a new day begins.

Tuesday, October 11, 2011

"I am tired of Haiti being called the poorest country"

Santo stands up and says,"I am tired of people saying Haiti is the poorest country. How do they even know we are poor? We are not that poor anyway. They just say that." I can tell he is hurt, confused and mad and I guess just tired of hearing this over and over again.

On this particular afternoon, I have asked the Hatien midwives what supplies they think we need and they tell me throw away blue chuck pads. Right now we use washable pads and a wide variety of folded up sheets, towels and blankets; all that are washed by hand and hung in the sun to dry.

I pause and ask where we would get such a thing and when they say the United States, I try to say it is too hard to get that many chucks here and besides there is not a good way to dispose of them. I think of the road sides and streams and beaches all covered with endless litter and sigh.

It is then that he says, "we are not poor."

And for days, I think about his face and how it would feel to have the world call you the poorest country in the western hemisphere, the one with the highest infant mortality, the lowest literacy rate and on and on.

I think how I worked with a woman once who use to say how bad it felt to grow up poor and I remember asking her how she knew she was poor. I said I supposed we were pretty poor but I thought I had everything in the world one could want. I was surrounded by creeks, fields,forests and friends. If there was something better I had no way of knowing. Later, when I could make a comparison I still thought of my childhood as rich with the best of so many things.

When I walk out into my Hatien neighborhood, I see the richness of Haiti. I try to see the world through the eyes of the children I meet. It is warm outside and they play games with friends who live close by in small village communities. They throw water from the pump on each other and laugh at dusk when its time for a bath. They cook and eat outdoors and enjoy an abundance of fruit from the trees around them. When it is dark, they go to sleep or turn on the soft glow of a kerosene lamp. The dirt roads are worn and familiar and everyone calls "bonjour" or "bonswa". On Sunday, everyone dresses up and walks to church and the mountains echo with their faith and their songs.

I see this world and I understand that it is hard to hear that this life; this life so rich with family, church and the sweetness of life is anything but rich.

I try to say that the world measures poverty by schools, health care and clean water; things they all deserve. But I say I also know that there is another way of viewing poverty; the ones of isolation, loneliness, fear and greed.

And I promise, Santo, when we measure wealth by love, generosity, resiliancy and faith you will never be called the poorest country. You may even be called one of the richest of all.

Sunday, October 9, 2011

"My name is Shilou"

"My name is Shilou Oger. I am thirteen years old. I have two sisters and a brother at home. Now I have a new baby brother who we have not named yet. I was chosen to come to my mother's birth because I am the oldest. We took the tap - tap a long way to come here. I had fun helping the midwives and the other mothers.

I go to school. I like to read stories. I like to play hide and seek and jump rope.

Now we are taking the tap tap home again."

Saturday, October 8, 2011

A father kissing his new daughter

I have loved encouraging fathers to be a part of their children's birth. Here, a loving Papa gives his newly born daughter a tender kiss.

A Celebration of Names In Haiti

Through Our Garden Gate
A Celebration of Names In Haiti
Juseline, Maria and Cleanta
Come through our garden gate
Hips swinging, skirts swirling
Sassy, smiling; with periods late.
Miouse, Madeline, and Molemine
Wait by our garden gate
Somber , stretching, silent
Waiting their due date.
Rosana, Rosleande, and Lumane
Knock at our garden gate
Moaning, crying, holding on
Fearful of their fate
Iveline, Denise and Milouse
Fall to their knees and pray
Holding, squatting, calling out
As night turns into day
Dady, Elini and Joudeshka
When despair was very near
Opened up their hearts:
Abandoned all their fear
Nadine, Nadie and Yderline
Nuzzeled, nursed and knew
The joy of newborn babies
Named Merille, Fred and Ginew
Rosemon, Eline and Nadle
Left through our garden gate
Walking, waving, wishing
babies born in Haiti
Would live a bright new fate.

Monday, October 3, 2011

A pink umbrella at dusk

Perhaps in a busy world, it is the last beautiful images of the day that matter most; that linger and help us to make sense fo our world.

Last night, mine was of three young girls huddled close together under a pink umbrella; a new baby in their arms, as a light rain began to fall. I like to walk out to the gate and watch until the new moms and babies are beyond my view; until they turn the corner on the way to their villages.

There were eight births yesterday with so many images throughout the long day; cutting up the plastic table cloth to put under women, cutting blankets up to cover newborns, the thunder, the sweet open eyes of the newly born, the placentas one after the other left at Jason's door to be dug into the garden. The calls to Junior to keep the water buckets full and piles of laundry that had to be brought in half dry from the rain. Labors were short and long; sweet and hard; demanding and full of grace. A kaleidoscope of smells and sounds and images.

The three young girls, under the pink umbrella, arrived with their friend already pushing. They did not come with any grown ups; no mothers or aunts or grandmothers; just three teenage girls. We asked, "where are your parents" and they simply said, " she doesn't have a Mom." We pulled off her jeans as the head was just making its way into the world.

After the birth, they looked with appropriate teenage disgust at the vernix and blood. I don' t think it had occured to them that they come out naked and wet. But in time, they dressed him and the young mom wiggled back into her jeans and was ready to go. We convinced them to stay awhile and nurse and rest. In time the postpartum room was full of new babies and lots of people to visit with. She refused to breastfeed and when we asked what she had planned on feeding the baby she finally took off her bra and brought the baby to her breast with the encouragement of all the other moms in the room.

Then one by one the families said their good byes, newborn heads were kissed and only the three teenage girls were left. Slowly they gathered their things and went outdoors; raising a single pink umbrella, moving closer together and walking down the road.

There are people missing in every family; spaces left that can never be filled. Moms that would have been there if they could. And friends to hold an umbrella when they can't be.

Sunday, October 2, 2011


These beautiful young women came to their friends birth and decided to braid my hair while we waited for the baby to be born.