Wednesday, June 19, 2013

Tents - August 2010

The summer of 2010, most of the women I cared for lived in tents or with relatives.  That summer, it is estimated, that 1.5 million Hatiens were living in tents and that 25% of the population had been displaced.  They were refugees living within their own country; moving from place to place to find food, shelter, clean water,work; the things we all need to survive.

I sat on a small wooden bench and wrote down their stories in medical charts as woman after woman, with the help of translators, told me where they lived and who was left living.  These are standard questions on any health history form;  address and people in your family.  Almost everyone had lost a child, a husband, a sister or parent.  They had no real address.  They were in motion.  They were afraid to go into their houses, if they had them.   One translator told me they set up a tent next to the house and slept in at night.  Others wanted to move a tent into a relatives yard but were not allowed.  Many came from Port Au Prince and many wanted to one day return.  Some came to give birth away from the city and many would move many more times looking for work and stability.

I watched them walk up the hill and wait for their appointment with grace and charm.  They were stunningly beautiful with clean, pressed clothing.  I understood that I never looked that thoughtfully groomed or put together- ever; even with a house, water and electricity.  I

Perhaps, giving birth in a large geodesic dome tent then was not so unusual.  It was clean and private and the volunteers were kind and attentive.  At night it glowed with a soft, white comforting light.  Perhaps it offered some reassurance to the nearby tent communities.  I saw women, babies in arms, slip back into that community.  They walked proudly with their babies as people came out of the tents to admire the new baby who would return to a tent crowded with relatives.  Most often they left with new baby gift bags packed by some school children in a far away country that they carried in a bag over their arm.

By the summer of 2012, the dome birth center was closing down and the 2,891 people who were still living in 36 camps were moved out.  The traditional houses that had four rooms were divided into four sections; one for each family.  Rents for even these small rooms with leaking roofs and mud floors became more and more expensive as the need for housing increased.

I have not yet made my way back to Jacmel.  Friends say that there are no tents in the public square that overlooks the Caribbean and that there is no concrete.  The babies born that summer in a tent and went home to a tent, are three years old.  I know that their chances of being alive are 1 in 4; that even after a safe, clean birth that life in a tent city posed the many problems related to sanitation, camp violence, malnutrition and the well being of the parents.

Here in Oregon, we go camping with friends and family.  When my Vietnamese and Cambodian children were young they would  question why anyone would choose to sleep in a tent.  They complained that they had slept in enough tents in refugee camps. They had slept outside in the jungle under Phal Pot.  They had cooked over many open fires.  But now, thirty years later the camp-out is composed of almost entirely immigrant families and their children who never slept in refugee camps.  Their parents put up tents and cook over fires.  They talk about the foods they loved back home and how their children will never really understand what they went through. Even for them it seems like a long time ago.

I know that in many place in the world, including Haiti, a tent is a shelter when there is no other and not a choice on a beautiful summer week-end.  My tent, light and lovely on a June morning would not do well in hurricanes, storms and many seasons of rain and sun.   I know that many people in many part of the world are waking up in tents because they have fled war or natural disasters.   When the children complain of the heat, my daughter tells of life in the jungle with no water, or shelter or food and how how hot it was then but I can see that this is well beyond their understanding just as it is difficult to comprehend the many intricate reasons why three summers later people, in Haiti, are still living in tents.

Friday, June 14, 2013

Birth on the right side of the river - August 2010

A woman came into the birth center in Jacmel in August of 2010.  It was her fifth pregnancy and she said she was having contractions.  She walked, laid on her side, rested and drank water throughout the day but the contractions never got stronger and it became clear she as not yet in active labor.

When I said she could go back home and come back when the contractions were strong and regular, she said please could she stay.  She said she would sweep, go get water. She would do anything but please she did not want to go into labor on the other side of the river where she lived.  A woman in her village had just died because they could not get her across the river.  She did not have family or friends in the town so I let her stay.  She swept and swept and one day had a peaceful delivery and a healthy baby.  When she left, I thought how now will she get that baby and herself back across that river.  I was imagining a shallow river that one might wade through; not easy in labor but maybe with a baby.  I was not sure.

A week later, someone was going to take me and some other volunteers to see a waterfall and we piled into a car for the trip.  When we got to the river it was high and moving fast.  People were walking across the river with children on their heads.  The water was up to most peoples chests or chins.  It was the only way to get to medical care or even a larger market.  The river was full of passengers walking across the river.  There were no bridges or even ferries.  I thought of the mother who swept the floors so she would not have to risk being in labor in the middle of the night with a river to cross.  I imagined her walking with the baby high above her head.

W did not cross the river in the car and we never saw the waterfall but I came to see that I take the bridges in my community for granted.  We cross them many times a day and never think what our lives would be like without them.  Most of Haiti's rivers do not have bridges, leaving small rural villages cut off from commerce, schooling and medical help.  Many women stay with friends and family and wait for to go into labor closer to emergency medical help but others can not.

The question, in many countries, with rural populations, is if all women should be forced to live in town and wait for labor near a hospital.  These waits often mean leaving family for long periods of time to live in a strange city without any support.  In Alaska women are flown out near their due dates to wait in motels. It is paid for by the government but often family cannot come and the women are isolated and alone.

Of course, building roads and bridges and providing emergency transport would save many babies in Haiti and when those things do not exist some will make it to a family members house and others, like the mother in this story will beg a volunteer who has never seen such a river filled with women and children, to let her wait on the safe side of the river.

Thursday, June 13, 2013

Jacmel - Birth in a Geodesic Dome

The earthquake in Haiti was on January 12, 2010.  It is now June of 2013.  It was only three and a half years ago.  People ask me if they finally got things cleaned up down there. They ask why it is taking so long.

I think back to the day I first work up in Haiti and walked to the birth center where I would be volunteering.  It was a short walk on a dirt road to a field filled with tents of all makes and sizes.  There were large army tents and small camping tents.   It was quiet.  Laundry was hung out on tents but I do not recall cooking fires or soccer games near the birth center.

I was ushered into a large, white geodesic dome that had been constructed as a birth center.  A translator said it came on a boat and that the volunteers worked hard to make all the furniture and the storage area in the center of the dome.  Sheets served as dividers of the small birth rooms and the floor was lined with heavy, black plastic.  It was clean, simple and orderly.   There was some electricity some of the time.  There was no running water and so we were dependent on a large jug of water brought each day.  There was one out house with a door hanging from one hinge.  It looked as if the dome and the collection of tents were set down in a farmer's field. They said that the city's mayor had put them there but that the people in the tents were not suppose to be there.

But from that moment on I devoted myself to prenatal care, births and postpartum visits.  The tents, the field and the lack of basic supplies were a backdrop for long days and nights of work.  It was August.  We slid from mother to mother in pools of our collective sweat, amniotic fluid, blood and new mother;s milk.  I looked up from listening to a baby's heart beat to see a hundred more women waiting in the heat with no food or water.  One after the other for hour after hour; repeating the same small advices and encouragements.

Outside there was a sign that said Burne Sehat Haiti.  This was the organization that first responded to the earthquake but by August it was changing hands again and would eventually be operated by Mother Health International.  I was guided, that summer, by a young Canadian midwife who had committed a year of her life to this birth center in Haiti.  She introduced me to forms, protocols, the birth trays, emergency supplies, tool sterilization and then I was on my own to help as best I could.

By the end of hte first day I had seen over 40 women.  They all had relatives who had died in the quake or of disease.  Almost every mother had lost a child.  I knew nothing about their lives or even their country and its culture.  Exhausted by days end ot nights end, whichever it was, I had little time to walk around.  The sidewalks were a sea of rubble and people trying to dig out.  I did not know where they took it all or where all the cement is today.

The babies who were born that summer will soon turn three.  Some friends visited Jacmel a month  ago and said there was no sign of the cement piles or broken buildings and street. Jackmel is being restored to its fame as an artist town by the sea; a quit place to visit and buy art; a place for the yearly Carnivale.
The central square, that looked out over the Carribean, in no longer home to a sea of tents.  The hotels and cafes are open and one can buy from the best Hatien artists.

I read After the Dance by Edwidge Danicat, trying to understand the place I was but did not know.  When people ask if they finally got things cleaned up I am more amazed that anyone could clean all that up and want to say how amazing to move by wheelbarrow all that concrete and rubble and rebuild one's own house and raise a family.

I am not the same person, I was that first tentative sumer in Haiti.  The birth center dome and all the tents have been taken down and people have moved on.  The first months of emergency care turn into discussions of how to support midwives in Haiti so that they can care for their own mothers and babies.

I see my translator and the young Canadian midwife at a midwifery conference.  The translator became a midwife, herself, and was there to take the North American Registry of Midwives exam.  It was a special reunion on a long journey from translator in a post earthquake camp to taking an exam that is recognized in many states.   The journey from help in a natural disaster to support for the training of midwives.

I think of that field sometimes; the sunrising over the dome and the surrounding tents.  The tents glowing red and gold with a tenderness that would keep me coming back again and again.

Wednesday, June 5, 2013

August 2010..... first night in Haiti

Jacmel, Haiti
August 2010

I waited on the porch of an old French tavern that had survived the earthquake.  It was dark and the rain poured down all around us.  The midwives were still working and it was too wet to make may way up the dirt road to join them.   And so I waited in that dark, not knowing the language or the place where I was to stay and work.  

Behind me were two rooms piled high with donations. There were packages from school children in Maine and medical supplies in damp, deteriorating boxes.  The supplies spilled out onto the porch and served as tables for volunteers.  When the electricity came on, I could see that there was a bulletin board with some information for volunteers along with baskets of teas and protein bars others had left.  The table was scattered with charts, papers, ash trays and beer cans.  Young men talked on cell phones and smoked out in the yard under trees. 

A small lean to kitchen with a propane burner stood out in the garden with a pot of rice and beans for whoever might come home to eat.  The cook had left before the rains began.  

My room looked out over the garden and back yard; a room that surely must hold many stories in its slanting floor boards and shuttered windows.  The bed draped with a mosquito net, was at first, the vision of a canopy bed and not protection from malaria.  It was all a wonder, to me, that rainy night.  I wondered what the midwives were doing and wanted so much to go and be a part of whatever was needed.

When they returned they were wet and exhausted from many births and a long day of doing prenatal care.  They were relieved for another set of hands and I suppose I was relieved to be needed.  They only took licensed midwives and not students.  By the end of my time there would be two midwives from Canada and a newly graduated doctor from France but on that first night I could see that for some time it would be me and the young midwife from Canada. 

I was shown the bathroom and the supply room.  If someone went into labor at night, the guard would wake us and walk me up the road to a geodesic dome that had been built by volunteers.  The hospital was in very bad shape and most people were still trying to build back their homes and lives.  Lying in bed, in the dark, I could not imagine what lay before me.  It was hot, the netting stuck to my skin. The roosters did not seem to understand that we were just going to bed and not waking up.   They called them the 24 hour roosters.  

I thought of my own chicken in Oregon and hoped that they were safely inside and not being eaten by racoons.   I thought of my children and grandchildren; of my many students and all the babies i had caught over the years and all that had brought me there, in that bed, waiting for the earth to turn.  I was not sure if I would be helpful.  I had no understanding of Haiti's healthcare system, the matrones who helped at most deliveries.   I heard the reporters talk about there being no infrastructure to begin with.  I heard the phrase, "build back  better" but I had no understanding of the political and economic forces that were at the heart of these statements.

I had been an ESL teacher for refugee children. I had welcomed many refugee child into my home and family. I had taken a class at Oxford on refugees and forced migration.  I had taken online classes in emergency obstetrical health through John Hopkins University.  I had tried, I thought, trying to reassure myself.  I was not carelessly going into another country. I had made this commitment years ago when my daughter from Cambodia was young.  I would, I told her, go and help people who were in your situation. One day.  She only laughed back then. It seemed a long way away and now here I was.  Fulfilling a promise to a child who no longer cared and perhaps even thought it foolish.

In the morning I went to the porch.  It was light and I could see that most houses were completely fallen down.  Pieces of cement were stacked waist high everywhere I looked.  People were already busy hauling away cement and trying to rebuild.  Across the street, on a hillside, a carpenter built wooden caskets.  Many of them were for small children and babies.  I watched him for some time and then gathered my birth bag to go to the dome and start working.

Tuesday, June 4, 2013

The things I also packed

I first traveled to Haiti, after the earthquake.  I knew very little about the country and was, like many people, going down to help after a natural disaster. It seemed like a good thing to do.  I was told I would be working in a birth center that was located in a geodesic dome in Jacmel.  I knew very, little else.

It was in August, during my brief summer vacation as a principal in Portland, Oregon.  Summer vacations were not fully vacations, however, and I was expected  to take phone calls at all times, even in post earthquake Haiti.  I wanted to work as a midwife, I wanted to be helpful and I wanted to live beyond the endless negotiations and compromises of an American education system that was embedded in elitism and struggles for personal power.  I did not know then, that I would come to see these struggles mirrored in Haiti's own inability to "build back better."   I was boarding a plane to find some part of me that I had lost in a large, urban school district.  Like many people, who went to Haiti, that year, we were looking for ourselves admist the piles of concrete and hoped no one would notice how broken we were.  It was and is embarrassing to admit that our worlds were in spiritual and emotional crumbles, even when we had so much opportunity and material wealth.  I like, many, hoped no one would notice my own fragile exterior.  I was weathering a painful divorce after a 35 year marriage and my children were grown.  The public school I had started to serve diverse populations had been reassigned to a district that could only accept neighborhood children.  The borders were closed to the school.  It felt like the borders being closed to Hatien immigrants.   I felt trapped by the policy that excluded immigrant and poor children so perhaps that summer, I felt that if I could not accept immigrants and refugees in my school, any longer, I would go to them and Haiti was the first opportunity that came my way.

The school I started taught gardening skills and used the outdoors as a place to learn.  We learned in and about the community we lived in.  We were dedicated to service-learning and helping students to think of ways to make their own world a better place for themselves and others.  I had been told, a month earlier, that poor children and children of color did not like nature or gardens or even being outdoors which is why I should be happy to serve a mostly, white, well educated population who gained access to the popular curriculum by buying a house in the neighborhood.  The ability for a young family to buy such a house due largely to generations of inherited wealth and privlidge.

I was aware that for some higher level administrators, a different principal would bring the school more into line with larger district goals.  I wanted us to live fully within each school day; creating a meaningful, healthy place for children to be.  Like many principals, I was under an ever increasing pressure to perform better and better on tests.  it was not enough for the third grade to all pass the test, I was told I  should give it again until everyone exceeded.  I knew they were all enthusiastic readers who loved books and writing stories  about their own young world.   Their feet could not even touch the floor in the computer lab where the test was given.  I knew the testing and the accompanying prescribed textbooks were coming out of Texas and the Bush education policy known as "No Child Left Behind." Many people saw it as a way to keep a class system, that served the very rich in place.  I had no idea how deeply embedded Haiti was in this plan.  If you wanted good test scores, you could not have immigrant children in Florida.  It was necessary to create some children and indeed some countries poor and beholden to empower the wealthy.

When I first went to Haiti,  I packed all this along with sterile gloves, vitamins and syringes.  I also packed a standard US education regarding my country's role in Haiti's poverty.  I knew how to deliver a baby but little, little else about the country I was about to live and work in.  I did not know that the complex social systems I was running away from was duplicated over and over again in all of the world's colonized countries.

I paid extra to get my passport renewed, bought a plane ticket to Port Au Prince and landed in an airport that was cracked and badly damaged.  My own bags were thrown into a car and I made my way through the city and out into the countryside to Jacmel.