Sunday, December 29, 2013

Jwaye Nwel

Okay, I'm going to try to make this quick, since we are at the clinic with a woman in early labour and I should really get to sleep, since I don't know when I will have to wake up. I'm all psyched up with excitement, so I'm not tired... yet. Ha. Besides, I have been wanting to write about my Haitian Christmas!

On the morning of the 25th those of us at Sarah's house - me, Sarah, her two foster kids, ages 15 and 8 and her goddaughter, age 2- woke up slow. Sarah and I chatted over sweet mochas with whipped cream and when the girls got up, we watched them open their gifts. It's fun when kids still get excited about balloons and pencil crayons and toothbrushes, as the younger two did! Shortly thereafter, Sarah got a call from a client who had called her twice in the night- her labour seemed to be picking up. We ate some yummy omelette sandwiches, and Sarah headed out to pick the woman up while I went to unlock the clinic and make sure there was a sheet on the bed and water in the pitcher and supplies in the birth tray.

When this mama arrived, it was clear that she knew what she was doing. G waddled in and immediately rested her hands on the seat of a chair, slowly wiggling her hips. Once her intake vitals and the baby's heart rate were done, we just retreated to sit outside the labour room and G's friend sat quietly in the corner of the birth room. An hour and a half later she was pushing, kneeling on a towel with her arms on the bed. We kept quiet as she worked, calmly, still moving instinctively to get her baby out. She only really shouted with two or three contractions. And just like that, another little girl had joined us. Sarah wrapped her up and placed her on the towel in front of her mother. After the placenta came (unaided) G stood up very matter of factly and stretched as if to say, "Okay, I'm done now." Awesome! Amazing. So cool.

With the postpartum looking straightforward, Sarah suggested I go along to the beach with another family, as we had planned. I ran home to get ready and along with D, the 8 year-old, got a ride to the beach from a young guy who works for the clinic doing odd jobs. We rode squatting in the little box of a three-wheeled moto. "Merry Christmas to me!" I thought, feeling so inspired by G's birth, as we zoomed along under a bright blue sky, palm trees and banana plants going by on either side. We joined Nick and Gwenn's family of 12 kids (biological, adopted and foster) at a long table under some palm trees with blue-painted trunks and splashing in the turquoise waves. As soon as I got in the water one of the teenage girls handed me little S, who was quite content to have me hold him and bounce around in the surf for what felt like a couple hours, happy kids careening about us.
We all had a meal together back at the table, which Nick ordered from the beach food lady- plates of fried plaintain, each with a whole fried fish, "picklies" (kind of like cabbage salsa). I chose a bottle of Tampico punch, which is likely toxic, but seemed to suit the context. We swam some more (no mention of the good ol' "Don't eat and swim" idea) and then I sat on the beach with S and watched his dad and a bunch of strangers play soccer until it was time to leave.

After a quick bucket bath at home to get the ocean stickiness off it was time to go to Ken and Maria's for supper. We helped Maria finish making banana bread when we got there, then sat down with their family to have a wonderful meal of homemade pizza and leafy salad- and then cheesy home-made garlic bread and banana cake afterwards! The food and company were just as lovely as the same at lunchtime. We made our way back down the bumpy bumpy road to Sarah's, all singing along with Ellie Goulding "Let it Burn", 2 year old A falling asleep in my arms.

The day wasn't over yet, though! Some of Sarah's friends had invited us to this concert/party at a club near the houseAs we approached, the road was congested with parked cars and partygoers all decked out in their suits and ties and high heels and short dresses.  I was definitely way under-dressed- I had tried to dress as nicely as possible, but in this case that just meant wearing my best skirt and tank top, putting on a bra and borrowing sandals from Sarah, so I wouldn't be in my ratty Tom's or clunky Chacos. I didn't bring going out clothes! I just expected to work and chill out. The party was very interesting. I'm no authority, but it seemed like this was where to find the young and beautiful and well-off in Jacmel. We danced to the kompa style music until about 1:00. Kompa, for my dance friends, is kind of like a mix between kizomba and merengue. You just shuffle left-right, basically. I danced with one of our party who was French and he kizomba-fied it for me. Yay! I didn't expect to be dipping my toes into kizomba here, and it was quite enjoyable. I am hoping to get at least a bachata or two in before I leave, Haiti being neighbours with the Dominican Republic, but time is running out, so we'll see. Anyways, I am starting to ramble and feeling tired at last. I did the 1:00 am check of our labouring mama and fetal heart tones sound good, she's doing fine and going back to sleep, so it's off to bed with me too!

Tuesday, December 24, 2013

Showers (Yes,They Are From a Bucket.)

Many of the best things in life are things are those things after which you long for a good, solid (or should I say liquid) shower. Camping trips are a prime example. Mud fights and ocean swims also come to mind. And now I know from experience that being at a birth tops The List of Amazing Experiences After Which You Just Really Want a Shower.

My first birth was actually two births. I mean, technically I did witness one baby emerge into this world before the other, but the labours were happening simultaneously. We received the first woman, E, a nullipara, at the clinic on Friday at the start of our regular day's work and sent her home in early labour. That day I got to help with post-natal check-ups! I weighed a couple darling little babies, each about a week old, got to use an infant stethoscope to take their heart rates, and did their temperatures. E came back in active labour at 3:30 p.m. After that came about 24 hours of labour support... Hands pressing her lower back, passing her glasses of water, modeling slow breaths, telling her over and over, Ou kapab. "You can do it," and Ou fe byen. "You're doing well." E seemed afraid and resisted giving in to her labour most of the time. When it got tough she would say in a tone of panic, Pa kapab, pa kapab, pa kapab! "Can't do it, can't do it, can't do it!" The moments where she coped the best were the few when she would stand and walk around, leaning on the walls, or the door- Everything I've learned about movement and being upright in labour was backed up by my observations of E. Most of the time she wanted to stay on her back in bed. It had been a long time and she needed to rest, of course, but her progress and coping were clearly much better when she was up swaying and pacing. It was frustrating to observe this and have her resist our suggestions to sit, or walk more, or kneel with her upper body supported. E used two of Penny Simkins' "3 R's"- one of her Rituals was to place my hand low on her uterus during a contraction. She had Rhythm when she would sing and when she would tap her thigh- "patpatpatpatpatpatpat". She seemed to struggle to find her Relaxtion. Tania, the midwife on call that night, let me know that trying to doula Canadian-style may have been responding too intently to E's dramatic reactions (to even the early contractions) for the Haitian context. So I stepped back for a while; just sitting at the other side of the room without looking at her, checking her baby's heart rate periodically and making sure she had water and peed often. This was just after 3 a.m. At about 5 I went and slept on a mat knitted out of plastic bags on the office floor for 50 minutes. The other labouring woman, M, who had been with us (there are two labour/birth rooms in the clinic) since about 10 or 11 the previous night was clearly reaching a new height of intensity in her journey, and I couldn't have fallen back asleep if I wanted to. The power was out that morning, so I lit a pair of oil lamps and placed them in M's dark room. E's labour also seemed to have picked up. Between 7 and 9 Tania was constantly back and forth between the two women- Who would start pushing first? All supplies good to go there? What about here? Where's the Doppler now? M relinquished her daughter to the outside world at 9:25 a.m. after a pretty quick series of pushes. I noted the times of delivery of head, body, placenta. I hadn't been present for any of M's labour (except what I could hear from E's room next door!), and my favourite part of that birth was actually being the one to go tell the dad when he could come in... He looked so excited! When the time came and E started to push, around 2 p.m., she was still resistant and just so, so tense. Here, Tania worked some magic. She explained to E, in the gentlest, most wonderful way that she needed to resign herself to the fact that she was going to give birth, whether sooner or later and coaxed her into relaxing her whole body- squatting forward rather than arching and writhing backward as had been her habit. I'm kind of afraid I will never be able to sound like Tania did in that moment! The whole mood in the room changed when E was pushing. Everyone was smiling and calm, happy that the birth was imminent after all this time. Even though she was still afraid, E would respond so quickly to reminders to breathe through a contraction, or to bring her body forward. She was much more lucid now. We were all so proud as the sweetest baby girl came out. After all those times E thought she was pa kapab, here was this perfect little being: pink skin, big brown eyes that looked just like her beautiful mama's, pouty lips, ready to suckle the second she was placed on mama's chest. That gorgeous babe just skipped the weird-looking newborn stage altogether. Once E and her girl were settled in to snuggle, placenta delivered, it was time to squeeze in lunch. Praise the Lord for those people who brought meals during the labours- it is hard to say how much I appreciated that! Then it was back to work! M and her family wanted to get home and were waiting for us to cut the umbilical cord and Tania to do the newborn exam. At Olive Tree Projects' clinic they usually burn the umbilical cord; it's reduces risk of infection because you don't use any instruments and the opening is cauterized. Maria's daughter and I each held a candle under the cord for about 15 minutes, until it was burnt through, which we both thought was pretty cool! I explained a bit about placentas to Sophia as we did this; she is 10 and wants to be a midwife when she's older. I got to watch Tania do the newborn exam and then I did the baby's footprints with the family and soon enough they were on their way, smiling and thanking us as they went. Amidst all these happenings E had started to hemorrhage and Tania had given her a uterotonic, which seemed to be working. I watched and held E's hand as Tania tried to identify the cause of the bleeding and as she sutured a small tear from the birth. The long and short of it is E ended up staying at the clinic to be monitored until Monday afternoon: she had had a slight fever on and off and her uterus hesitated to contract fully, but eventually it remained firm and her vitals remained reassuring and she and her husband went home with their little one.

While witnessing women give birth was incredible and fascinating and awesome, I was far from shocked. I just felt kind of like, "Yep, that's how it goes!" I got to learn and practice skills which were totally new to me- but after many hours I wondered why I had found them so daunting. I was really comfortable supporting E, and was amazed how she trusted me and allowed me into her space, having met only once briefly in a prenatal visit and considering my minimal ability to communicate in Creole. Following her cues and picking up a couple tidbits from the rest of her birth team was all I had to do. I will always remember the checked pattern of baby blue and navy on white of her sundress, examined in detail as I sat by her bed as she dozed between contractions at 2 a.m. I will remember her husband's incessantly ringing phone out in the waiting area- the ringtone was "Bad Romance" by Lady Gaga. I will remember looking at our contrasting hands, hers resting over mine on her belly, and wondering at how I came to be there, then.

Well, I am up late, so it is now officially Christmas day here in Haiti and I hope you all have a very beautiful day back home or wherever you may be reading from! We have some cool plans tomorrow (think "beach")... though we are wondering if there won't be any women going into labour soon. It's been awfully quiet since Sunday; with 9 women still due in December!

Love,
Julia

Thursday, December 19, 2013

I could get used to this...

 Each morning this week, at 7:30, I've gone over to the clinic with Sarah. Most of the women come in for their pre-natal "rendez-vous" in the morning. When they come in, I take their hand-held record, open up their file from our cabinet and start filling in a new visit record on their forms. I take and record their blood pressure, pulse and weight, and calculate the gestational age of their pregnancy. Then I often go into the pre-natal consultation room during the check-up  and I get to feel the women's bellies for the baby's position, listen to and count the baby's heart rate and measure the fundal height. Today we had a visit from a woman expecting twins! I sit and listen to rest of the consultation.

I understand most of what I hear in Creole, but no one understands me when I try to use simple phrases I've picked up, or when I speak French. Talking to people usually degenerates into a confusing back and-forth in three languages, all we've established by the end of which is that I don't speak Creole. Hopefully I will be able to figure out some important phrases in Creole and the differences from French which are confusing people most.

I could get used to this... Not the language barrier, the clinic work. It's really amazing how quickly something totally exotic and foreign can become normal. I've said this a about a million times regarding Ambue Ari; It's kind of the same thing here. At first I was so nervous that maybe I shouldn't be trusted to do the fundal height measurements or blood pressures (silly on that count since I know very well how to do those)... "Oh my God, what if I get it wrong and they all find realise I'm a fraud!?"  But I've already become so much more comfortable with all the skills I've talked about. "Of course Maria asks me to take the intake observations! Why shouldn't she trust me? ... Of course I can take that fetal heart tone, Sarah... it's 140." It helps that I have been so effortlessly accepted by the staff here- No one makes a fuss about my doing things around the clinic, David and Ghislaine are all like, "Hey, are you cool to stay here by yourself while we run out for a minute?" and Sarah leaves me to my own devices a lot too.

Being thrown in the deep end is my favourite way to learn, but that does't mean there isn't some associated anxiety. Thankfully, I always seem to  get over it quickly.

I haven't attended my first birth yet. By Maria's calculations there are still 12 women due this month!those babies have to come sometime... seems like we may be in the calm before the storm. I am happy to have had at least these few days to adjust before that long-awaited experience begins.

The only thing I am impatiently awaiting right now is a chance to go for a swim in that gorgeous sea. The nearest shore is an hour's walk away, but the beach where you can swim is even farther- ten minutes' drive, apparently. Maybe Saturday I will try to get out there.

Tuesday, December 17, 2013

Day One

Good morning from Jacmel, Haiti!
After a long day of travel, I touched down in Port-Au-Prince just after nine yesterday morning. I made my way out of the airport with Maria, a missionary who works at the clinic and was on the same flight. I was happy to have her there, not only to show me where to go look for our ride, but because she was able to help me carry the ridiculously heavy bag of vitamins! Driving through Port-Au-Prince (in a Toyota 4 Runner piloted by someone named Junior) was exhausting to my senses. After a few nights of disrupted sleep, I just needed a nap by the time we were getting out of the thickest of the traffic. I woke up when Junior started honking around every corner. We had reached a narrow, winding mountain road and he was honking to let potential oncoming vehicles know we were there. This went on for a long time and I went back to sleep. I woke up for the descent into Jacmel, which sits on the south coast in a delta-esque plain. We got dropped off at the clinic, where we met Sarah and Ken, Maria's husband. I spent the afternoon hanging out at the clinic, as Sarah was on until four. We did a couple pre-natals and I got to practice palpation, auscultation, BP's and pulses. After we had driven a woman who had given birth that morning home, Sarah took me to her house, which is where I will be staying. She lives there with a fifteen-year-old girl named Danaelle and an eight-year-old girl named Dada. It's really close to the clinic, which is where I am now, so I'm going to go now! Hopefully I will be able to write bit, but I think I would prefer to find an internet cafe, so I don't feel like I'm hogging the laptop!
Love,
Julia

Friday, December 13, 2013

Yunnan Baiyao

I am DONE! DONE that wretched, I mean... challenging... paper! And DONE my first semester of midwifery! Done with that little stress bubble that had built up in my chest in the past week. :) Now I'm just preparing for my departure to Haiti on Sunday and drinking Echinacea tea in an attempt to prevent the post-stress illness that tends to attack in moments such as these.

Took a little trip to Chinatown with Ariel and Kyle on Monday. We walked into a shop with a yellow and red awning inscribed with complex characters and, in English "Beijing Trading Co.", which smelled of earth and something tangy. Dozens of big glass jars with silver lids filled the wall of shelves behind the counter- each with a different beige, white or brown coloured something in it. Roots, leaves... other things. "I'm looking for Yunnan Baiyao," I said to the lady behind the counter, feeling awkward over my pronunciation of the name. She said she didn't have any right now. We walked up the street into another, nearly identical shop. We waited our turn to talk to the herbalist. I ogled a jar of dried seahorses. They didn't have any Yunnan Baiyao either... Here I was, thinking you could just march into any Chinese pharmacy and pick this stuff up! Yunnan Baiyao is an herbal medicine which is used to reduce blood loss, and as a pain reliever. I was on a mission to get some for the maternity clinic in Haiti, and I was starting to feel like some kind of clandestine/intrepid/savvy Indiana Jones (not a perfect example, but you know what I'm getting at?) character... Searching through a foreign land to find an elusive herb to save mothers' lives! The shopkeepers in the third (nearly identical) shop, just around the corner from the second, were very helpful, and they had dried lizards on sticks in there. The fourth shop... had Yunnan Baiyao! I bought five boxes of capsules and stepped back out into the street, half expecting someone to come up and proposition me to buy some, since it was apparently such a hot commodity...

Since Monday's adventure, I have mostly been immersed my final paper for our Gender and Health course. This is what's going on now:


I've got all the essentials: passport, sunscreen, Chacos, head lamp, bathing suit, DivaCup, anti-malarials (stoked I didn't throw those out when I got home from Ghana!), Grantley Dick-Read's "Childbirth Without Fear", five boxes of Yunnan Baiyao and, of course, two big chocolate bars!

T-minus 33 hours until take-off from YVR! It will actually be Monday morning before I arrive in Port-Au-Prince... I have a 12 hour layover in L.A., which I will be taking advantage of by venturing out Santa Monica or Manhattan Beach. So, the preparations continue... Happy Friday to all and to all a good night!

Monday, December 9, 2013

Helping Hands for Haitian Mamas and Babes

Here we go!!! Thank goodness the blog is reactivated for real this time. 
I just booked flights to spend 19 days in Haiti over Christmas break.

A very important thing has happened in my life since I last wrote on here- since this is my travel blog I will refrain from rambling about my life too much, but to understand this post you will need to know that I got in to midwifery school at UBC, a dream come true, as I feel I am on the path of my life's calling! I'm probably flattering myself to think anyone who doesn't know that is reading this, but I digress...

Not quite two weeks ago, my beautiful classmate, Kristi, passed on a call for help, which she received through the grapevine from an organization called Olive Tree Projects. Olive Tree Projects is run by a young Canadian midwife named Sarah Wallace and operates a maternity clinic in the city of Jacmel, Haiti. The clinic staff is expecting nearly twice as many birthing women in December as they usually accommodate, and reached out to student midwives here to come and serve as an extra set of hands. The organization who had shared this opportunity with Kristi were attempting to secure funding for a volunteers flight.

I immediately said that if it was funded, I would be there. If the money didn't come through, I told myself, I couldn't go. Having just begun some very costly education in the most expensive city in Canada and booked a trip to Europe (finally!) there wasn't much wiggle room on this decision. When the e-mail came on Tuesday after my first final exam of the term that there would be no money for flights I didn't even feel disappointed, because my perspective immediately shifted from "Waiting to find out whether I would be going" to "Okay, I have to go. How am I going to make this happen?". I had prayed that I would accept and embrace whatever the outcome while I waited for the news about funding- lots of people prayed with me!- and thought that it was an "A: money comes in, I go or B: no money, I don't go" kind of scenario. But in true "Julia's life" fashion it was secret option C that God handed me (chuckling all the while, I'm sure, at my attempts at pre-planning).

Secret option C meant "No, you will not have this handed to you, but I have given you everything you need to make a way- all those prayers have been heard". With the confidence of having previously raised an intimidating sum in just over 2 weeks (for Canada World Youth), I shook off some sticky bits of pride like grains of rice and asked my family and friends to send me to Haiti this Christmas. I love how matter-of-fact my parents' reactions were when I called them and announced my intention to raise the money myself. They, in their parently wisdom, mustn't have believed me when I said I wouldn't be going without that funding!

This is when it got really amazing. I created a crowd-funding page to make it easy for people I knew from all over to donate- and they did. I am tearing up thinking about how they did. The page went live on Wednesday night and by Friday night I had received $830. By Saturday night that was up to $1125, just over a hundred dollars short of the cost of the flight! I'm so overwhelmed by the way everyone from Mum and Dad and my closest friends to new acquaintances and people I hadn't seen or heard from in years have responded, not only with donations, but with the kindest and most encouraging words. I don't know how to thank you all enough; it's like I can't even articulate my gratitude in my heart, let alone in writing.

I will write more tomorrow, featuring an elusive Chinese herb and more details of what my time in Haiti may look like. I'm telling myself it's an ink-spilling exercise to help with writing my final paper for the term...

You can find my crowd-funding campaign here if you're interested in helping out with that final $100: http://www.indiegogo.com/projects/helping-hands-for-haitian-moms/x/5640014
Any donations above and beyond what I need to pay for the airfare will go to Olive Tree Projects-I've pasted the link to their website below.
http://www.olivetreeprojects.com/about/