Wednesday, June 4, 2014

Returning to LaGonave - June 2014

June 2014

The waiting area at the Fort Lauderdale Airport is filled with Haitians who happily greet one another. They form small, happy groups who visit until it is time to board the plane.  I let the sounds of Kreyol spill over me and drift back into my heart.   I speak in my awkward version of a language that is meant to be rhythmic and full of life.   My attempts are slow and labored as my brain switches gears and looks for the right words.

The people, who wait with me, have the means to travel back and forth and are a long, long way from the mountains of LaGonave.  They have money and a visa.   I wonder if they know what it is like for so many Haitians. But then someone could say that in my country too.   Do they look at me and think- ah a white missionary coming to save the souls of Haiti?  I say I am not a missionary but a midwife and they smile with a shrug.

I am never sure that the Haitien people would put maternal and newborn health at the top of their wish list.   They are ranked the highest for infant and maternal mortality in the western hemisphere but I suspect that data means far more to those of us committed to global maternal health than to the individual person in Haiti.   I remember the Haitien social year doctor telling me the statistics were all part of a plot against Haiti and were not true.   But then US medical people also gave me articles saying that the placement of the US alongside Cuba was also not true and a plot.   The rankings are suppose to make a country want to try to improve; not dig in their heels and defend what they are already doing.

I doubt myself.   I get sick and throw up in a planter in the airport.   Am I sick or is my body rejecting another plane ride and the wear and tear on body and soul I am about to put it through once again.

I had hesitated to come.   I had said I would return if they ever wanted to get mobile prenatal clinics up and going.  It was an offer in the midst of hopelessness.   Your island and your health care system are so broken there is not much of anything I can do to help but if you ever want to have mobile clinics I think it would help.  I also say that it should have village leadership. I picture small, rural maternal/child health councils where women demand that they not be left to die in childbirth.  My mind drifts and I see the women standing up to the powers to be; marching to Port-Au-Prince and demanding healthcare and transport.   I say it must be a grassroots form of care with the matrons, agent santes and lay leaders. 

My last experiences in the hospital in Henche had left me believing that the village system has to be given the tools of education, diagnosis and transport.  We use to debate, which comes first prenatal care or emergency obstetrical care.  Of course we wanted both.  But, we would say, what if we had to choose. I am a midwife and an educator so I chose the village and mobile clinics.  But it is jus tone part of the puzzle that includes prenatal care, a means of transport, a skilled birth attendant and then good care should you need a hospital.   In LaGonave I have offered to help with the prenatal care and transport plans.

In the days, leading up to me leaving I am not sure that the villages have even heard of the new prenatal mobile clinic system, let alone be involved in the planning and implementation.   They cannot even tell me what villages we will visit.  They say the ones on the list are too remote and we will all get tired visiting them.  I try to explain that this is the exact reason why they were chosen. Emails fly and I feel caught.   The premise for my returning was establishing community based maternal health care and no one seems prepared for this.    I think of my gardens and grandchildren and projects I am working on in Portland.   I think how I might cancel my ticket to Haiti.   I do not want to go down and be a white person arguing with the powers to be for the basic medical rights of women in Haiti. 

My piles of pictorial teachings lie in folders. I make graphic plans of how it all could work.  I look at my countless workshop plans.  I have downloaded films.  My approach was to include the lay leaders, the matrons, the agent santes and the midwives.   I was going to try and build teams that solve problems and work together.     I know that I appear casual in my dress and in my manner but I am a person who cannot live a moment without a notebook to write plans in.  I am a planner and they are not.  I have sent my training plan and they send me back shrugs – we can talk about it when you get here.   I sent the plans months ago and I do not want to go without a plan.  I have ten days for this and want every minute to count.   I have not recovered from the eclampsia and
Cardboard box of dead babies from the last trip.   I need a plan.   Was it too many years as an administrator?  Trainings have schedules, start and stop times and plans.   I cannot, it seems, go in without a plan.  I have tried it before in Haiti but not again. 

 But I consider the woman with eclampsia in the hospital bed; in a coma after a five-hour motorcycle ride down the mountainside. They tied her between two men. She had four other children and after the birth had a seizure.  With good prenatal care and a transport plan this did not need to happen.   It is difficult, yes, but can be reduced.  She is a real mother, being held in her husband’s arms for days while she is in a coma.   I felt powerless and I do not want to return to the world of male decision makers who seem oblivious to these deaths and disabilities.  They say to me, “they will never change.”    Did this woman even have a choice?   They say “women in Haiti like having their babies at home.”   I say but they can do that and still have prenatal care and be screened for risk.  We can do so much. 

My sister takes me to the airport at 6:00 am and I throw up in the planter.  The suitcase is four pounds too heavy and I have to repack on the airport floor.  The small gifts for children pour out and I scoop them into different piles.   There are toothbrushes and crayons and handheld lenses a school was disposing of.   I bring very few pieces of clothing.   My sister puts one suitcase in the other so I have one to leave for a family who needs it for storage.   This is a very good idea but there are small things all over the floor; seeds and baby blankets and old window shades to write on.  I smooth the dirt over my vomit and consider it is something I ate and not my hesitation about the trip.

My body says – maybe this is not such a good idea but I stand and smile; take my boarding pass and walk to the gate where I wait for the plane to Haiti. 

It is a short flight.  It is only an hour and a half.   As we fly over Haiti, I see the ring of turquois water and white sands.  It is a greyish brown but as we get closer, I see a patchwork of fields and houses and rivers.  At a certain altitude it does not look so different.   We glide through white clouds and then Haiti comes into focus; the now empty rice fields and houses only half built, muddy rivers and broken roads.  I begin to see what for one moment, flying at a certain altitude I could almost pretend wasn’t there.  There is music as you enter the terminal; always music. Even after the earthquake there was music.   And with this music I accept that despite my resistance I have come home.

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