Letters from Amanda, Day 3 & 4

Is our interpreter really going to adopt the baby she found attached to the placenta in a trash dump 2 days ago?

Day three

Hi guys —
First of all, the 3lb 1oz baby from last night’s email and his mama are both alive! Probably not for too long for him, but he is doing his best…

Anyway, thanks all for your love, emails and support. Sorry for the long narratives but I’m trying to chart my adventure and thought I might share…

Today, was less eventful but no less heart breaking. In the interest of sleep, just a few questions:
- When there is only one oxygen tank, who gets it — the woman with pulmonary embolus or the woman in labor with sickle cell crisis?
- Why do parents have to drop their children off at a feeding center with 20 cribs per room and no stimulation to avoid malnutrition?
- What will happen to the baby I examined, then held this afternoon whose mom died this week of AIDS and TB?
- Is our interpreter really going to adopt the baby she found attached to the placenta in a trash dump 2 days ago?
- Am I ever going to feel clean again?

Love to all
A

Day four

Better than at home

It’s better than delivering at home on the dirt floor….it’s better than delivering at home on the dirt floor… I repeated this mantra to myself time and again as I witnessed the birth today of a 17-year-old eclamptic.

Her family had brought her to the hospital at 38wks when they witnessed her third seizure. Not long after arrival, members of our fantastic volunteer team @midwives4haiti saw her seize yet again. Blood pressures sky high, she was stabilized, given magnesium and her induction was started when no Haitian obstetrician could be found. Her labor progressed rapidly and I transferred her to labor and delivery (aka walked her barefoot in her tattered nightgown through the open air courtyard with 2 family members on each side and a third behind carrying her Foley catheter) when she reached 8cm.

Medical team with local kids at the hospital

On one hand, the scene was like many other unmediated births of a first time teen mom — fast and furious. On the other hand, there was no doubt I was in the developing world. No sheet covered the cracked plastic bed. At the foot of the bed there were stirrups with a bucket in the middle to catch blood, excrement and placentas. The IV dripped on the floor, blood spilled down the bed from her boggy uterus, the baby lay limp.

Our amazing nurses resuscitated the baby, the senior Haitian midwife managed the hemorrhage, I oversaw the medication management, our interpreter orchestrated communication and, in around 20 long minutes, mom and baby were stable.

While at first I looked aghast at the distressed, soiled condition of our surroundings, it quickly settled in that her family’s decision to bring her to the hospital was life saving. At home, on the dirt floor, she would likely seize repeatedly until both she and the baby were dead. Alternatively, if she did make it through labor, she would have died of postpartum hemorrhage and the baby without resuscitation would have likewise met her end. Same story for the other 3 severe pre-eclamptics we have been managing over the last 2 days. Similar story of demise for the patient with the pulmonary embolus we delivered a few days ago…

Photo: View into the hospital ward with prayer team visiting patients

And what happens to the children of all of these dead women who held their families together? Some are lucky enough to find their way to kind relatives but too many find themselves in the feeding center or the orphanage with flies swirling and scabies itching. And yet, we are less than 2 hours from the glitz and glam of Miami.

Delivery conditions in Hinche may be far from ideal, but it’s better than delivering at home on the dirt floor.
Kiss your mother, if you can.
Good night
Love
Amanda