Sunday, April 10, 2016

Emptying the Catheter Bag - lessons of the heart.

Emptying the Catheter Bags

 Learning and writing about the many ways women in Haiti work together in an ancient network of survival and dignity within a community of friends and family.

I am slowly moving up and down the rows of beds in the hospital.  It is late afternoon and there are few midwives to manage the three busy antepartum, postpartum and post surgical rooms.   There are no machines or beeps or signals when things go terrible wrong.  Just three midwives for the three rooms as well as the labor and delivery area.   Earlier in the day, the rooms are over flowing with students, preceptors and midwives.   By five it is quiet and it is then that the families take over the care and management of the rooms.  

From my sketchbook - Women emptying catheter bags together 

They give advice and offer support.   An elderly man moves form bed to bed, offering words, if not medicine.   I take vitals and write them on a chart I make; circling things that are abnormal.   

The rooms are full of women with catheter bags hanging from women.  It could be a post c-section woman or a woman who is pre-eclamptic and was given magnesium sulphate.  The bags hang from the beds and are almost always full of urine.   The ability to urinate is a critical sign of well being as well as an indicator of advancing disease.   The bags are a measuring cup of urine with lines indicating the volume of urine.  It is suppose to be charted and noted.   But there are not enough midwives or not a clear enough understanding of why it is important to empty them and write down the findings.  I am not sure which or if the two blend together in a relaxed state of neglect.  The blood pressures soar.

I am doing this rhythmically in an attempt at order.  I breathe and tell myself to stay in the present moment.  It is one two hours.   Blood pressure, pule, temperature, amount blood loss, listen to babies, Listen to stories and record my findings.   

The mothers are often attended by their mothers; elderly women from the countryside who sit by their daughters' beds and care for them as if they were at home.   They feed, clean and offer sips of tampico.   They laugh and visit with one another.  

Selfie with a woman who comes to help her daughter at the hospital

And then I look over and done woman is examining a very full urine bag.   I am thinking of the film, The Gods Must Be Crazy.   Another women joins her.  How does it work?   They seem to understand that they are all full and that they need to be emptied.   Do they understand that the urine has no where to go after awhile and it will hurt or could cause infection, regardless of its original purpose?

One woman gets a bucket.  She has figured out the mechanism and empties one bag.  Then other women joiner and they slowly make their way to every bed and empty every catheter bag.   The bucket fills up and the bags collapse and hang empty from their owners.   

After they finish, they carry the bucket outside and return with it empty.   The bucket is turned over and becomes a seat.   Everyone settles back in and sits beside their loved ones beds.   

I am pretty sure they were never given an opportunity to get much of an education in a country in which the ruling class has determined that one can only value an education you pay for.   In the absence of a formal education, they grow wise and kind and funny. They are no nonsense practical and love without any expectation of reward.   The strange bags they are suppose to pee in simple must be emptied.  And so they are.

They help each other.  They are wearing their best clothes.  I smile from my dirt soaked toes to the top of my matted, dust woven head.   When I grow up ( I am nearly 68) I want to be them.   I want to be that smart, that kind and that willing to work with others - not because of any outcome - but just because it needed to be done.  

I strongly suspect that they , like me, think it is much easier and safer to simple pee into the bucket in the first place.  I always got women up to pee in labor.  It emptied the badder to allow more room for the birth and it got the woman sitting on the toilet.  It prevented bleeding.   It got the baby into a better position.  "Go pee and have a few contractions on the toilet, " I said to hundreds of women in labor, as  they wrapped their hands around my head and cried into my hair.   

We laugh and shrug.   

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