Babies!

Early yesterday morning Sedlin and I were fortunate enough to go observe two deliveries at Dr. Delson Merisier's clinic, and the experience was amazing! The first was a normal vaginal delivery and the second was a c-section, where they let us dress in gown and all and stay in the OR. Both deliveries were successful with healthy babies, one a boy and the other a girl and they were so cute. It was just so astounding seeing the births and realizing that something so small and fragile will one day develop into a full-grown human being. I was also surprised to hear the first mother and baby would have to leave the clinic after 6 hrs, and apparently the support system for learning to care for the baby usually comes from the community or family members like mothers/grandmothers. Clearly the lack of health facilities for newborns and the often absence of proper health education has in part led to Haiti's Infant mortality rank of 159/197 with a mortality rate of 70 per 1000 births. (Most high income countries like the US and European countries have a rate less than 10, thank you wikipedia). I'll be honest and say that for myself sometimes reading stats like that on infant mortality while in global health classes can seem redundant at times and appear distanced to me living in safety in the US, but experiencing those two successful births and hearing how others so often can go wrong really brings the reality of the numbers to life. It also adds to the motivation for conducting this maternal mortality project and the safe motherhood project that others are doing in the hope that the new health center will provide many health needs and educational services to reduce such ridiculous and preventable health statistics.

Here are some pics from the past few weeks:

From left to right is me, Dr. Delson, and Sedlin, ready to enter the OR right behind us for the C-section. Dr. Najita Chakhtoura, an MD ob-gyn from the US working on the Safe Motherhood project, assissted Dr. Delson

The baby girl delivered by c-section

The road next to the hospital after one really long thunderstorm overnight. There were basically like minirivers flowing down some streets, which we at times walked through to conduct interviews

One of the many USAID shelters we see out in the field. Sometimes families of like 7 or 8 or more live inside

A fun Clown's without Borders program at a local school camp (you may think I'm joking but clowns without borders is a real organization!)

A view from the coast which is about an hour walk from our hospital

left to right is Seldin, me, Jen, Nadine, and Steph. The water was incredibly warm and unfortunately couldn't offer any relief from the sweltering heat

Me and our translator Valery (see the resemblance to Eddie Murphy?)

Maternal Mortality Project

So I just realized and must also apologize for the fact that I still haven’t explained what exactly we’re doing in Haiti. As I mentioned earlier, we’re working with Family Health Ministries (http://www.familyhm.org/public/) and they have plans to build a new health center to address many unmet needs of the Leogane community. Recently they broadly surveyed the community to find out exactly what those most pressing needs were and identified maternal mortality as a prominent issue.

So we’re here surveying and assessing maternal mortality and health by using primarily the WHO verbal autopsy questionnaire. Most days we’ll go out into the field with our translator Valery (who looks quite a bit like Eddie Murphy) and ask around trying to find someone with a connection to someone who died during pregnancy or shortly after.

If they agree to speak with us then we administer the consent form and questionnaire. It consists of many detailed questions about the deceased such as demographic info, their symptoms, where they were able to seek treatment, belief of death according to the respondent etc. From there we can highlight common causes of mortality or access to care issues or lack of education in certain aspects. The hope is that once the new health center is developed they’ll know exactly what services are most required and how to most efficiently conduct them.

walking through a tent city (usually we see many more people outside, especially kids)

one of the kids with our hat/shades trying out a new look

So far the community has been very open to our project and almost anyone eligible to participate has agreed to do so. Usually we complete the field portion of the project in the morning when the heat is relatively bearable and then the afternoon is devoted to data input or relaxing. We just recently had dinner with the hospital director Dr. Gladis and starting probably next week we’ll get to shadow physicians and surgeons in the hospital downstairs. We’ll also have the opportunity to work with Dr. Delson at his ob-gyn clinic and observe or help out with any birth deliveries. And perhaps have a chance to volunteer at some school camps. Our project coordinators are also trying to bring in experienced people to talk to us each week such as local Haitian business or microfinance or health workers. The other day we had Fritz, a real estate investor, come give a very fascinating talk about his business and the results of the earthquake and relief efforts and also about Haitian political and social problems.

First week thoughts

It’s a bit discouraging at times walking about the streets observing the endemic poverty of Leogane and the lasting earthquake damage. Every street has some buildings still partly destroyed or abandoned and although the number of tent cities has been decreasing steadily, they still seem to be all around and can feel endless once you enter. Yet despite the relatively meager living conditions (or what we’d subjectively consider meager) that most of the people we see live in, almost all of them appear content and happy. Maybe reasons for this could be attributed to religion/fate or acceptance or not having known any better or something entirely different. But whatever it is I was definitely surprised and I guess it’s a testament to the resolve of Haitians living in a country that’s been through so much political and natural turmoil.

Another interesting discovery was about the two-sided local view on NGO’s and the Red Cross and other aid organizations. They are of course delivering aid and often treating people for free providing a great service for the city, however they also have detrimental effects to other institutions. Dr. Delson and his ob-gyn clinic business, for example, suffered greatly after the earthquake with the huge influx of aid organizations providing free care. His private services, necessary to provide for himself and family, lost many patients to the free care offered by MSF among others. Likewise the local nursing school graduates found difficulty in obtaining stable jobs. While free care from NGOs is a very commendable and necessary service, its also hurting the local health infrastructure that will become the only major health services once most NGOs leave. I have no idea how this could be fixed but it was just something interesting to think about.

On another note I’ve been picking up many basic Creole phrases and am now getting a decent grasp of the language. Speaking is much much easier than understanding due to the fact that local Haitians blow through sentences incredibly fast and blend so many words together. One of my favorite conversational phrases is the common response to “sak pase” which is analogous to ‘what’s up’. People respond “m’ap boule” which is our version of saying ‘I’m chilling’ but, thanks to the lovely weather here, its literal translation is actually ‘I’m burning’ which I found hilarious.

To end with an inspirational thought, I’ve been reading Mountains beyond Mountains by Tracy Kidder, the biography on Paul Farmer. Kidder paints Farmer as a global health and human rights champion and saint, which is exactly what most of us in global health classes have come to know him by. Since he was a med student he’s been completing a lot of admirable global health work in Haiti and other countries. When reading the book I was surprised to find that on one of his first trips here he volunteered at L’Hopital St. Croix, the hospital right below us! (although he did later leave because he didn’t like the patient payment system) Nonetheless it was still quite inspiring to find out this global health hero volunteered right here years ago.

Some pictures from first week

So picture uploading usually takes ages so I'll just pick a few every now and then to post

The hospital above which our guest house is located

One of the views from the roof of the hospital. A great place to cool down with some nice breezes and just look around. We even played soccer up there one day

Road view while walking down the street. I couldn't capture it but a second ago two of the motos were driving in the opposite direction and did like a split-second chaotic u-turn with oncoming traffic

One of the tent neighborhoods we passed. These are found all over the city and it's amazing how peoples' homes are made out of all sorts of different materials making use of whatever they have. We'll be walking through many of these 'neighborhoods' throughout our project.

A primary school we walked by where the director and teachers were completely fine with us entering and meeting the children. All the kids were so adorable and loved having their pictures taken and just yelling "hey you!" at us.

Video of the children singing for all of us!