In January 2014 I volunteered at MamaBaby Haiti, a birth center started by midwives from the U.S. working with Haitians in the year after the devastating earthquake of 2011...
I’m happy to report that things are SLOWLY improving in Haiti! Some newly paved roads, more kids going to school, more medical facilities.... Although there is obvious poverty and many needs, the Haitian people are proud, industrious, and sharply dressed (despite having to wash everything by hand!)
MamaBaby Haiti is a big house and compound which employs 12 Haitians (including 4 midwives, 3 cooks/cleaners, 2 translators, director and assistant, and a guard), provides care for 25-50 births/month, prenatal care to 120-200 women a week, and postpartum care to approx 20 women a week. It’s outside of the northern city of Cap Haitian.
All services are free! Families are asked to pay approx $7/birth for medications including Pitocin (given as a shot after the baby is born to prevent hemorrhage, a good idea given a high prevalence of anemia.) If they cannot pay that is fine, too. All women are given free prenatal vitamins. All women breastfeed and are given the strong message that exclusive breastfeeding to 6 months is best!
MamaBaby Haiti is well-run and does good work. Midwives and midwifery student volunteers are welcomed and really do help. Tax-deductible donations at mamababyhaiti.org keep the place running! (Consider a donation!)
I wish I could show you all some of the sweet families I worked with, but the center has a strict policy of no pictures of patients, which I certainly respect. So, I am including only a picture of the building and the awesome midwives.
French and Haitian Creole When I lived in France in middle school and attended french public schools, learning french was a matter of survival and a huge amount of work! But then in college I focused my efforts on learning Japanese and spent a couple years in Japan, acquired my wonderful Japanese husband and I continue to work with some Japanese patients. All of which has not been great for my french, with few opportunities to resurrect it in Portland OR. However, French is the language of all Haitian schools and Haitian Creole is based in French! So the more education Haitians have, the more french they speak. I find my brain doing archeology into ancient forgotten corners and triumphantly emerging with useful words! And also struggling not to put too many Japanese words into the French sentences, as that is less useful.
I’d been unsuccessful in finding a local Haitian to teach me a little Haitian Creole before my trip, but on 12/31/13 I discovered HaitiHub, an online learning program that I LOVE and became obsessed with, finishing 13 of 16 modules (thought to be a 4 wk program) in 10 days. Haitian Creole is sort of simplified French, with some other random words of different origins thrown in. It does not take long to be able to say some simple things! IF YOU ARE GOING TO HAITI, TRY TO LEARN A BIT OF CREOLE! I think my problem is that because I can say some limited things fairly well, sometimes they expect me to know a whole lot more than I do! Catching some words but missing many is like trying to see pictures in the fog. Still, the translators weren’t always around and I could fake it pretty well at a basic level with the midwives and patients: “Is your water broken?” “Please lie down.” “Would you like some water?” “Good work, Mama!” “Push again!”
Express Arrival Imagine if you will morning prenatal clinic in full swing: our male clinic director and his male assistant dressed sharply at the desk at the entrance, pulling charts, taking blood pressure with an automatic cuff, weighing the women in an organized way, approx 30 women waiting in our waiting area with benches right off the entryway and also on some benches outside, 4 midwives doing prenatals at different stations in the birth rooms (each has 3 beds), including me with Emanuel the translator... When a woman in labor comes in the front door crying out. I rush into the entryway and find her on the floor, in a puddle, as her water broke just then! I help her up, into a room and onto a bed and then catch her sweet 3 kg baby girl about 10 min later! Haitian Midwife Maudelin assists me while the others continued prenatals. Neither mom nor sweet babe have any issues and so they go home about 4 hours later (we require 4 hours, they may stay longer if they like.)
When Are You Due? Mondays are the prenatal days for mamas coming to this clinic for the first time. We take some history and talk with them more (I definitely need a translator to do prenatals). Also, staff from a nearby clinic come and do HIV and RPR (syphilis) tests on all the women, and there are a few positives. The positive RPR women get antibiotic injections elsewhere, are retested and may give birth at MamaBaby if then negative. The HIV positive women can get prenatal care here but must birth at the hospital so they can get medication while in labor.
Many mamas ARE sure of their last menstrual period. But one mama really wasn’t sure, at all. She’d been to another clinic a couple times and they told her to get an ultrasound, but she can’t afford it. So, I tried to approach it from multiple angles: when did you take a pregnancy test? (Negative in May and June but positive in Sept.) How long have you felt the baby move? (Since Sept?) When do you think you conceived? (On March 3... But I said, then you would have had your baby in November...) Every answer gave me wildly different possible due dates. On exam, her fundal height (size of her belly) was 32 cm, suggesting maybe 32-34 weeks, and the baby felt about that big to me, so I told her I thought she was due about the beginning of March. I told her we would also recommend an ultrasound, but I knew she wouldn’t/couldn’t get one, and she’s the exact kind of mama we want to help (single, with limited resources), so I hope she doesn’t show up in labor for a month or more. Several of the mamas whose births I attended did not have a clear due date, which was worrisome for the tall mama who didn’t appear very pregnant but pushed out a 3 kg baby (6 lbs 10 oz, larger than many of the full-term babies there, some of whom were healthy but were high 5 lb babies.) I also delivered a supposedly 43.5 wk baby who looked right on time. Although there were certainly concerns it also highlighted to me how incredibly focused on exact due dates westerners are.
Two Lunchtime Boys Most births have been straight-forward and relatively speedy, but not all: one first time mom arrived with her water broken but no contractions the previous morning, we sent her away to come back when she was in labor, she came back in the evening and was seeming to be working hard... and was 1 cm (cervical dilation). But we kept her since now her water had been broken awhile and she was clearly in labor. She had a LOVELY voice and managed her contractions by SINGING hymns interspersed with “Oh mezanmi!” (literally “my friends” but similar to “oh my!”), “Sauvez-moi Jesus! (Save me Jesus)!” etc... All through the night we could hear her downstairs (many staff and volunteers live upstairs) singing (by morning she was 3 cm), and all through our morning prenatals we all could hear her singing every few minutes (she was 5 cm around noon; they gave her some IV antibiotics)...
Meanwhile another young first time mama arrived at 11 am, 2 cm. Haitian Midwife Rose-Edith said this mama was “for me”; I assumed we’d have a long day of it. So we were all upstairs starting in our delicious lunch of polenta, beans and a bit of chicken stew when I heard my mama sound pushy so I ran down and checked her and she was completely dilated at 2:10 pm! As it turned out the singing mama was complete around the same time, and I was happy to hear her baby cry in the next room as he was born at 2:41 pm, while we were trying to encourage our reluctant pusher, who despite her resistance had her baby boy at 2:52 pm.
Lovalie It had seemed like most mamas didn’t want a lot of touch from us (back pressure, hand holding etc) and they usually had a sister, sister-in-law or mother with them to wipe their brow, get them water, and later do the birth laundry (by hand in the back). So I was surprised when Lovalie, a young 2nd time mama who was tearfully struggling with her contractions alone suddenly embraced me fully with both arms and put her head on my chest (she is short). I held her and we slow-danced through several contractions, but the contractions were spacing out and I thought she could use some rest so I suggested the bed- she laid down but then put her head in my lap with her arms around me still. It was so very sweet! The sounds of the busy prenatal clinic went on outside this labor room, and she had only been 4 cm upon arrival at 9:30, so when she got up to go to the bathroom I started doing 1-2 prenatals, then checking in with Lovalie for a bit, then doing a couple more prenatals... Eventually her partner brought her grandmother to help, and later after school her sister came. Her water broke at 11:15 am and she was complete at 12:15 pm, but then the baby just wasn’t coming down with her pushing hard on the bed; I was wondering if it was a big baby. Midwife Rose-Edith stopped by and suggested the birth chair/stool- Lovalie got on it, had a huge poop, and then had her baby boy 2 contractions later. He had an acynclitic caput (off-center swelling) on his head, so I knew it had been a problem with his position and getting up and having the poop straightened him out!
Haitian Names I’ve been enjoying the names of our mamas and babes. Many are french: last names like Pierre (Peter), Petit Homme (Little Man), Bien-Aime (Well Loved- what a great family name!), Napoleon. Clear bible and french influences: Jesumene, Rosanie, Claricia, Daberline... Many women have not named their baby by the time they leave but a few have and others tell me at postpartum visits: Stanley, Ruth, Johnly, Benchly. But on my last day I tried not to laugh at the first name of one of our mamas, and asked Emanuel the translator if it could have another meaning: “Sandwich”! No, he said, it’s what you eat for lunch. He agreed it was unusual.
Sounds of the Morning
After birth #15 (8 births as primary midwife, 7 births as the assistant midwife, 15 baby exams...) the day before I was leaving, I was thinking, “I’m good”, i.e., really fine with a quiet night before leaving Haiti... But that’s not how it went. We heard the distinctive noises of a Haitian woman in labor arriving at 3:50 am, 4th time mom, 4 cm.... and then a 2nd time mom arrived at 5:05 am, 3 cm. They were on beds in the same room (we had one of the solar lights on in the postpartum room for a new family and the only other one in this labor room where there are 3 beds.) (There is only electricity at the clinic when the generator is on, and gas is expensive so its use is minimized.) It wasn’t long before the contractions of the two women seemed to synch up: “ Ohhh Jesus ohhh mezamni (my friends = oh my) ohhh (clicking sounds indicating sharp pain) aahh ohhhh Sauvez-moi Jesus! Oh sa fe mal (it hurts)! Oh mon Dieu (my God) ohhhh!” sort of in harmony, in waves every few minutes... as our rooster began a call and response with his brethren in our neighborhood and birds began their greetings as orange filled the eastern sky out the windows... And then a 3rd mama (5th baby) arrived about 6 am with her water broken but no contractions, but when we found her blood pressure was 158/110 (very high) and there was meconium in the fluid, Midwife Rose-Edith filled out a referral form and sent her to the hospital. (They do have good relationships with local hospitals.) And so it was like leaving a good movie in the middle when at 7 am I had to quickly change from my scrubs and jump in the back of a “TapTap” to go to the airport...
TapTap A TapTap is a small van (with the side door off) or pickup truck (with a special roof and sides but open back) and they are numerous and provide the majority of public transportation in Haiti. There are some official stops but you can also just flag them down, and request to get off anywhere. They are usually PACKED, and in fact have special bars on the back so 2-4 people can stand on the end and hang on. It costs 10 goude (25 cents) to ride them, and they are independently owned. I had seen one parked at the clinic at night and just recently learned clinic director Santo owns it (or rather, is paying off a loan, a business investment). Turned out there is something wrong right now with the clinic vehicle, a Toyota SUV, so Santo and my luggage rode in the back of his TapTap as I enjoyed the sights of morning “rush hour” in Cap Haitian: MANY people walking, many of them in school uniforms of all colors, women carrying large bundles on top of their heads (they really do that!), a couple men pushing wheel barrows piled high with bananas, MANY motorbikes with 2-3 people on them including more kids in school uniforms, a bunch more TapTaps, a few trucks and a very few private cars. A boy jumped on the back of our TapTap for a short time and Santo just smiled at him.
Goodbye Haiti! I am already looking forward to my next visit!