When one mother dies.

Every Mother Counts


This is the name of a maternal health organization and indeed the one that is helping to make the new birth center possible.   It helps pay for the education of the midwives and the remodel of the building.  There are t-shirts and water bottles and other things with their logo floating around us as we set up.

It is based on the idea that if a mother dies, there is a terrible ripple effect in the community.   The baby has no milk, the children can't go to school, there is increased risk of sexual exploitation, there is starvation and of course the life time of grief and loneliness people feel when their mother dies so young.  Women work hard in Haiti.  They tend gardens, cook, wash clothes by hand, go to the market and bathe children.  All the work that they do must be done by someone else, if they die.  The oldest daughter loses her childhood.

There is some debate about how far this statement reaches.   Rose had prenatal care at the mobile clinic and delivered her baby safely at home with the help of a local matron.   The matron attended a matron training program.  But here we are four months away from the birth and the community is faced with life without this one important mother, her dazed husband and her children.   The newly installed midwives, are not so sure the nutrition of this four month old baby is their concern.  He was not born at the birth center and there is no formula.  What can be done?

In the USA, the father would get formula from WIC and food stamps.  He could go to a local food pantry or get an emergency box of food.  His children would get a free breakfast and lunch at a school that required no fees or uniform or books.   They would simply walk out of the house, dressed the best they could and go eat breakfast before school.  If they needed clothes, there would be a clothes closet for them to pick out new and gently used clothing.  If the baby or any of the children, needed temporary foster care, it would be provided.

In the USA, we have safety nets.  We all pay a portion of our income to assure some basic services for children who, for many reasons, are in danger.  Most of us, most of the time are thankful for this.

In Haiti, Oliver's Dad is trying to decide what to do with him.  He clearly loves and enjoys his children and does not want to give this baby away.   It has only been a few days, since his wife died.
He asks if he can get him back later or visit him or know how he is doing.  These would all be reasonable requests in the United States.   The translator shakes her head.  

A volunteer offers to help support the baby by sending money each month to the translator. The  baby would have food, clean clothes and above all a good education.   More than that; he would stand a chance at living.

The volunteer midwife and I, standing in the rain, know his chances of living are not good.   Many babies in Haiti never reach their fifth birthday.  In many places as many as 1 in 4 die in the early years.   Their bodies are weakened by malnutrition and the constant infestation of worms that destroy what nutrition they have.   There are all the mosquito born diseases of malaria and dengue.  There are all the kid infections that are easily remedied with antibiotics that are left untreated.   There is untreated water and latrines too inconvenient to use.  

The father is still considering the bad spirits that killed his wife and is not considering the possibilities of parasites and infections and malnutrition.   He is being told his wife's death was not preventable.  It was just fate.  The idea that they can prevent the baby's death is difficult to grasp.

A woman stands with the baby in her arms and insists she should take care of him; that Rose asked her and so he has to stay there in the family Lakou.   It feels unfair, to me, that he should have to choose.

We bring him formula and baby clothes.  But it is not easy to get formula week after week, after we have all gone home.  He comes at dusk, later in the week, and says the baby is crying. He is hungry and the children have no food.   We give him evaporated milk and some protein bars.   He says that on Friday,  he will bring the baby for the translator to take home.   He is sure.   The translator says she will make sure he knows how the baby is and that sometimes there can be a visit but the baby will be legally hers.

He nods and walks out into the darkness that surrounds us.   A woman is in labor.  We turn towards the birth room as he walks away.   The mist is settling in and there is a chill in the air, even thought the days are hot and still.

Diagnosis - Bad Spirits

 I am standing toe to toe with the family and friends of a mother who had just died as the rain beats down on the tin roof and the yard begins to flood  There are two rooms in the house with only one window in each room.  One room contains the male domino players while most of the women and children and older men are squeezed together in the other empty room.   Small children peer down from an upstairs loft.

Children of the Lakou- always ready to greet us and offer a chair after a walk up the trail to do home visits Their mother is expecting a baby in January a the new birth center

The translator is busy negotiating the adoption of the baby.

I am wondering what type of diarrhea  she had and if it could spread to all these people living so closely together.  I try to remember what her husband had said.

No fever.
No blood.
Vomiting.
Her mother had the same thing and died too
She had it for one week

"Does anyone think it might be cholera?" I try to say.

"Bad spirits.  She had bad spirits and they could not get rid of them."

Cholera or dysentary or something else?   They are both caused by crowded conditions and poor sanitation.   Our own country had many serious outbreaks with both diseases.  Cholera was the main cause of death on the Oregon Trail and dystentary killed more soldiers in the US Civil War, than battle.  It killed thousands of babies who were given cow's milk so their mothers could work in the sweat shops of New York City.

We all  remembered the cholera outbreak in Haiti; the one that was traced back to the United Nations Security Forces.  For many years, there were piles of rehydration salts with directions on how to mix it everywhere.   Soap and rehydration salts.

I gave her soap and rehydration fluids.  If we had beds that morning perhaps I might have let her lie down and given her an IV.  But we had just opened and we had no beds.  Later we would blow up an air mattress but that morning we had not yet gotten that far.   We did not yet have IV fluids.  
These things would come but not that day.

I ask the translator to take me to the supervisor for PIH's agent sane program and say again, Maybe cholera?" and he says no, "She had bad spirits."   I figure they should know what cholera looks like as so many people died from it but I am still unsettled and there is the issue of the baby and what he will eat.  I am also there to set up a new birth center.

But I worry that the "spirits" that killed this Mom would impact maternal and infant health.  I began to see those "spirits " as all those things that lead to death and disability hat are not necessarily see under a microscope or can be tested for.   I began to see the "spirits" that killed her while keeping my eyes open for outbreaks or other people with similar symptoms.

As I walked back to the birth center, after my visit, with the agent sante, I began to notice the large number of children not in school.  I  began to see the "spirits" as those things in any society that
any society that deny a mother the ability to feed or educate or get health care for her children.

They had called the "Leaf Doctor" after the woman had come to see me.  He could not save her either.  Dis he turn to him because she could not afford the moto ride to the hospital or because she believed it was spirits he could cast out.

I could have kept her lying in the grass and watched her ads I unpacked.  I could have given her an antibiotic or gently held her head and gave her fluids.  I tell myself I did not know then she would not go to the hospital and that she was going home to die.

The baby is given a container of formula and it is agreed that the baby will go which translator on the week-end.  There are conversations about potential visits and the birth certificate.   Its pins around me and I beignet think that at least the baby will be cared for and live but the spirits were at wow

The road back home - Rose's Journey Into Death

I am not in Cabestore writing this.    I barely had any electricity in Cabestore and no internet.   I kept a journal and made cartoon sketches of the things going around me at four or five in the morning.   I would turn on solar lights and drink luke warm tea from a thermos.    The dogs often woke me up; the dogs and the roosters.

The place where I stayed was guarded by the priest's guard dogs.  The dogs were kept in crates all day.  People would poke them with sticks to make sure they stayed good and mean. The dogs  got in fights all  night long with the local dogs who were always having babies and in  a state of extreme starvation.  

When I first arrived, Frankie warned me that if I went downstairs to the birth rooms at night, the dogs would attack me and eat me.  

"What about the mothers in labor?  Will they eat the mother's in labor?"

I thought I would simply say we cannot have mother eating dogs at a birth center and they would be moved but they were not.   The priest said if I just used the secret code word, they would not eat me.   It was hard to remember and besides he said,  "Do not let any mothers know the secret dog code."

"How will they keep the dogs from eating them if they don't know the code?"   I am persistent.

Fortunately the mother eating dogs only tried to eat one volunteer whose aunt had died and had tried to go down the stairs before they were put in crates for the day.  I yelled the code world as loud as I could and the cooks called them in.   I considered that my accent was spoiling the use of the code word.   It is actually a sound.  Something like "Ta-tee-ta" but I never got it right.

Most nights, the dogs would start ripping a smaller dog apart and a great deal of crying and screaming of dogs would ensue and then the roosters got up and I could no longer sleep and got up too.

It was cold and damp.   The mist hung all around the mountains and  our clothes were wet.  I thought about the babies; the ones who would show up at the clinic with "Night fevers and grip."  

Was it malaria or simply the effects of sleeping on dirt floors on banana leaf mats.  It was so hot during the day but there by my little solar campfire on the upper porch, it was cold and my cartoons were drawn in the half dark.  

The four hour walk to healthcare 

After the roosters came the first people on the road.   The road was once a trail, like the one we take to Oliver's hamlet but now it was the market road and goes to LasCahobas and on to Merbela and Port-Au-Prince.  

The moto could take you out to the world beyond those small hamlets nestled in the side of mountains.  It could take you to healthcare beyond our capabilities.   It was possible.

 I had told Oliver's mother to go to the hospital; to follow that road but we all have been so sick we could barely manage to get to the bathroom and I was asking her to go all the way, on a moto, to town.   It was a forty-five minute ride to the closest small hospital and another hour to the larger one.  She would cross many streams and it was rocky and she had bad diarrhea and was throwing up.  Someone would have to go with her and who would watch all those kids.  

She nodded at me.  She was bent in half and throwing up the rehydration salts.  

Instead she made her way across the field and up the trail that turned into a creek when it rained and laid down in her small, dirt floor house, with all the children, and died.   I remember that her name was a form of Rose.  It was not exactly Rose but the word Rose was in it.  

Rose would have walked that trail.  Neighbors would have come out to say hello and a leaf doctor would be called.

There is a slight incline to get into her yard.  It is not so steep but if you were sick and walked all the way to the birth center and back sick, it would be one more hard hill to cross.  Her house was in a cleared yard.  There was a porch and all around fields of corn and millet with squash and beans tangled in between.   Her children would be naked, as they always were.   What did she see as she forced herself to climb the incline to her house and find a place to die.  

She would not make her way through the yard and down the incline or down the path that turned into a creek with rain or onto the moto or even back to us.  She could not nurse he baby or even hold him. She did not leave that yard on her own two feet again.  Back then I did not know the way to this hamlet or that she was laying there dying.  

I sat by my solar campfire and worried about the dogs attacking mothers and volunteers and how we would manage until the supplies came.  I made lists of things to do to get a birth center up and going. I made signs in Creole, looking up each word and making drawings to illustrate the danger signs of pregnancy.   I know these signs well, by now.

But I know I am also a placed- based midwife; a midwife who considers the geography of the roads, the condition of the soil, schools and the amount land one has to farm.  While I worried about the dogs and the lack of a bed to give birth on, Rose was dying.

Next - What did you say her diahreaa looked like?   Conversations at a funeral.