Haiti. first day, first birth

I was surprised to be greeted at MamaBaby by a small bedroom filled with Americans. I’d been told I’d be the only foreign volunteer through my first week in Haiti, but there they were – Patricia and Darren Couch, and Emily Stevenson – and they proved a pure delight.

                          Patricia and Darren 

                          Patricia and Darren 

Patricia is one of the gorgeous souls who founded MamaBaby and who serves as one of its board members. Darren is her hardworking, multi-faceted husband.

Emily is a sweet spirited, tender-hearted new midwife who’s preparing to launch into independent practice in Michigan’s Detroit area.

                     Carmelle and Emily 

                     Carmelle and Emily 

The three ushered me to my bunk and helped me unpack my bags – one hundred fifty pounds of mostly the supplies YOU so generously sent along with me – and then Emily took me on a tour of MamaBaby, introducing me bit by bit to its unique ways from birthing room to bathroom to the two giant silver bowls stacked in the backyard for scrubbing clothes.

Thanks to my long summertimes spent sleeping outdoors at Camp Tuhsmeheta in my late teens, the many short missionary trips I took to the slums of Mexico in my twenties and thirties, my two decades worth of work among the Amish, and the myriad wilderness adventures of my later years, conditions at MamaBaby felt comfortable to me, and even familiar. The screenless windows lined with wrought iron bars, the cinderblock walls topped with barbed wire, the thick-leaved trees heavy with ripening mangos and coconuts, the bunkbeds shrouded with mosquito netting, the cold water bucket baths and toilets unable to tolerate toilet paper, the sporadic electricity, the carefully purified drinking water and strict diet warnings, and the ebbs and flows of an indecipherable tongue – yes, indeed, I felt as though I’d been there before. It almost felt like a homecoming.

The first thing I learned at MamaBaby was that birth and birth work is truly universal. I was there to do what I love to do with women I found I was able to understand and connect with beyond language. Rapidly, a sense of sisterhood budded and blossomed among us.

And, still, there were challenges.

The five midwives of MamaBaby – Rose, Carmelle, Alourde, Alide, and Sophonie – have the place well-ordered and running smoothly. In a country where one in 263 mothers expire in childbirth or the immediate postpartum period and one in fourteen little ones perish before they reach the age of five, these supremely skilled, brave, tireless, truly inimitable women provide cost-free care to hundreds upon hundreds of at-risk families. Each woman lives at MamaBaby for fully three out of four weeks around the calendar – apart from her own family – caring for moms and babies through most of each week day and through a good many nighttimes.

Last year alone they conducted 6,766 prenatal appointments, 1006 postpartum visits, and 108 family planning appointments – besides catching 587 babies.

I understood from the moment I decided to apply to visit that what MamaBaby needed most from me were my funds and my suitcases stuffed with gear. If I could bring a heart minus agenda and expectation along with those suitcases – a heart prepared to serve those outstanding souls as they’d deem necessary – my presence there might be a blessing besides.

So it was for me to learn both the way MamaBaby functions as a whole, as well as how each midwife likes to practice – while working with all my might to get a toe-hold on the fascinating language of Haiti.

Through my first week, if I wasn’t tending to a mom or a baby, or scrubbing the birth and bathrooms, or dashing up and down the stairs for gloves or gauze or doppler gel, I was studying Kreyol like my life depended upon it.

And the midwives, now my beloved new friends, my sisters, with boundless grace and patience – and, yes, with bursts of mirth as I stumbled along in their mother tongue – opened their arms and their hearts and their very special world to me.

As I wrote last week, the first birth I attended was unlike any I’ve ever been part of.

Patricia and Emily and Darren and I were having a breakfast of eggs and plantain when a man bounded into the room to say we were needed at the far end of the road.

Patricia was off and away with a pair of gloves on her hands before I could blink my eyes – guys, guess what? Patricia’s a CrossFitter, too!!! Emily and I scrambled down to the birth room where Emily snatched up a blanket and reached for a vial of Pitocin. I handed her a cord clamp and scissors and told her just to go. I drew up the Pit, grabbed a placenta sack and pair of gloves, and followed.

By the time I arrived, Emily was holding the tiny baby boy whom Patricia had found wrapped in his cord and lying stunned on the cement step his mother had squatted down upon when she realized she’d not get one step closer to MamaBaby. Patricia received the placenta into the sack I handed her, and I knelt next to the shell-shocked mama to plunge my syringe filled with medication into the muscle of her left thigh. Alex, our driver, had the truck at the curb, and we soon had mother and child stowed upon the mattress and underpad that lined its bed, ready to make the trip back to MamaBaby.

And just as we’d gotten the poor soul settled comfortably upon a bed in the birthing room, we were told she wasn’t a client of the clinic since she’d tested positive for both HIV and syphilis, and she would in no way be allowed to recuperate there. MamaBaby has a very strict policy regarding HIV and syphilis, and I understand it completely, but that understanding did nothing to soothe the ache that sprang up into my heart for the slight woman and her little one spread out upon the bed beside me.

I turned from the confusion of voices to look at her.

She made no sound as she clutched her child to her breast and stared past the black bars on the window over her head. I realized she understood the policy, as well as I did – realized she knew she would never have been allowed to give birth at MamaBaby. Every woman in the community understands the rules.

And, yet, she’d tried to come anyway. She’d walked to us from who knows how far, at the mercy of her labor pains and through unbearably hot and dusty streets. Is that why she’d birthed on the roadside? Had she waited at home as long as she dared? Had she hoped to arrive too late to be turned away? I couldn’t blame her for trying. Her alternatives were to birth at home unattended, or to birth at astronomical cost in one of the local hospitals.

I helped her to a drink of water and stroked her painfully thin arm as the folks in charge tried to decide what to do with her – tried to decide whether to send her home or on to a hospital. In the end, she was bundled back into the truck and returned to her home.

Patricia and Emily left to scrub away the blood stains from the distant doorstep, and I stayed behind to clean the birthing room. I cleaned and I cleaned, and I prayed for the stoic soul we’d cared for through so very few heartbeats and breaths.

I’d never even learned her name.

*The photographs of the mother and child in this post are not of the mother and child described within it.

 

Last Morning in Haiti

By Jennifer Gallardo

It is 7:am and we have to leave for the airport in just a few hours. I know I should be upstairs packing, but another momma has come in to the birth room, and I am drawn there like a magnet. This room, vibrant with life, with wailing and singing and moaning. This room, full of blood, and tears, and sweat. So raw and real. I will miss it and I want as much of it as I can get before I get on the plane for home. I also have a selfish desire for an easy birth after the difficult shoulder dystocia birth I just attended, and I want to check in on the two momma’s who just had their babies and are recovering in the birth room as the four beds in the postpartum room are filled.

I walk into the birth room and I look over this new momma’s chart. Intact membranes, 8 centimeters dilated, baby number four, 31 years old, unknown due date but her fundus was 38 at the last appointment just a week ago. She has had a total of three appointments. I walk over to her and she grabs my hand and tells me to massage her back. I sit by her and massage her, listening to her sing a hymn. I notice that she is on the thin size but has a normal sized belly. Things are moving fast and I estimate that she will have the baby within the hour. She loves to sing, and she sings in-between contractions, and wails during the contraction. She is singing hymns in Kreyol. Some I recognize and some I do not. When she wails, the sister of the postpartum mom who had a shoulder dystocia birth shushes her because she wants her sister to rest. Considering that her sister had wailed and moaned for over 18 hours, I don’t think that is fair. I say “Man Manh chante belle” (mother sings beautifully).

Momma sits on the birth stool and drapes her arms around my neck and leans her head on my shoulder. When she feels the urge to push she gets off the birth stool and chooses to lay on her side. As the birth gets closer she lays on her back and gives a big push. Her water breaks and amniotic fluid splashes on the bed and a baby foot pops out. I have a lot of experience with breech babies, and I am brainstorming on how I will help baby come out should baby get stuck, as I am used to momma’s being upright for their breech births, but then the baby just comes out with the next contraction. All of it. I check quickly for gestational age and calculate baby to be about two to three weeks early. I dry baby briskly and she takes a breath and cries. Momma asks with urgency whether it is a boy or a girl. “Fi” I respond. She looks upset and turns her face to the wall and won’t look at her baby.

I am focused on this little baby, when Rose Edith shouts, “Gade!” (Look!) as she points to momma’s belly. I see another baby in transverse position (this means baby is laying sideways, horizontally, which is an impossible way for baby to birth). We have twins! Our work is not done yet. I listen to FHT’s which sound great. I ask for two plastic cord clamps so that I can cut first baby’s cord and leave a plastic clamp on the end of the cord that is hanging out of momma. With the cord cut, baby girl is dried and swaddled and passed off to grandma. I now focus on getting the second baby in a vertical position, either butt or head down. I rotate baby by gripping baby firmly from the outside of momma’s tummy and kneading baby into the correct position with my fingers and hands. Baby no longer looks transverse, and I ask for a glove to check. I check momma and feel a bulging bag. I push up farther and feel through the bag a rump and a foot. I feel the toes carefully to be sure it is not a hand. I feel five small toes and the outline of a foot. I again check position externally, and it appears baby is vertical.

Momma is frustrated with my hands on her belly and rolls away from me onto her side. As she lays on her side and gets a contraction, I watch her belly and see a huge shift happen. Baby moves right back into transverse position, at the same time as momma pushes and clear amniotic fluid bursts out of her, splattering the wall, the sheets, the floor, and the clock I had placed on the bed. I hope that the shift I saw happen on her belly was not really the baby moving back to transverse. I ask mom to let me check her with a vaginal exam, but she does not want checked. Rose Edith pleads with her to let me check her but she will not open her legs. Finally she allows me, as she lays on her back on the bed. I feel an arm and a hand. No cord. With much pleading and explanation, we get momma to get on hands and knees. I have to reach in and find baby’s feet and do a manual extraction, pulling baby out. I put my hand in and follow baby’s back and reach baby’s butt off to the side of momma’s pelvis. As I reach up higher into the uterus for baby’s feet, momma yells and moves away from me, flipping around and sitting on her bottom on the bed with her feet firmly planted on the floor.

I am sure it hurt her for me to reach high into her like that for her baby. I feel so sad for her that she is confused and in pain. I ask her to please let me try again, and Rose Edith is talking to her, but I don’t think she understands the urgency of the situation and is asking us to wait. We cannot get her to change position and we try to find heart tones without success. Rose and I try to lift her off the bed to get her onto hands and knees again so I can get baby, but she begs for us to leave her alone and wait. She pulls away from us and drops to the floor. She sits on the floor on her bottom, with her legs stretched out and closed in front of her. I have the thought that the floor is not clean enough for her to be sitting on naked and I worry about an infection.

I am losing track of time and how long it has been since her water broke and we lost baby heart tones, and I am losing hope. I cannot speak well enough to communicate with her. Rose Edith is trying but without success. I feel a blanket of defeat come over Rose and I as we realize it has been too long for us to save baby. I tell Rose the baby will not live if we do not get baby out NOW. The grandma hears us from the hallway and storms into the room and begins to yell at her daughter that she is not listening to the midwives and her baby will die. The grandma says, you are refusing to push and now your baby will die. I have the thought that now the momma will have this trauma of feeling she is responsible for the death of her baby, as if losing her baby were not enough already.

Our sweet momma begins to wail, and she crawls on the floor towards the bed. Rose and I see a cord and a small white hand hanging out of her. It is too late. Grandma sees it too and says sadly, “Bebe mouri” (baby has died). My thoughts now turn to the mother and keeping her safe. It is too late for this baby, but what is safest for momma? Is it safest to attempt the long car ride to the hospital or do an extraction at the birth center? I look at Rose and ask if we need to go to the hospital and she says yes. I do not have the heart to put my hands inside momma again to get this baby out. We get mom to the ambulance and Rose climbs in. I cannot go as my plane leaves soon.

I walk towards the stairs and pass all the same people who congratulated me and hugged me earlier for saving the baby who was stuck with a shoulder dystocia. Now they look at me somberly. I trudge tiredly up the stairs, feeling numb and depressed. I smell blood everywhere. I shower and scrub the blood off of me. I scrub my skin over and over, trying to wash the sadness and reality away. I get dressed and I throw my things into a suitcase. The men are packing the car and almost ready to leave. I am saying my good-byes to all the staff. A heavy cloud hangs over me.

About 30 minutes have passed since they left for the hospital when Carmelle comes upstairs to tell me the baby was born in the ambulance before arriving to the hospital, so they turned around and are back at the birth center. The momma is in the postpartum room nursing her first twin. I ask whether the second twin was a girl or a boy, and Carmelle tells me she was a girl. I feel relief that the momma didn’t lose a boy that she wanted so badly. Maybe she will accept her live baby girl more fully if the baby she lost was not a boy. I ask to see the baby and Carmelle takes me to the bathroom, where the baby is laying in a placenta pan, right beside the placentas for the day that need buried. I am shocked and upset that this little baby girl has been discarded like this. I run upstairs and get a beautiful quilt. I run downstairs and glove up and fill a bucket with water and I bathe this precious baby girl and brush the blood out of her lovely dark curly hair.

My body is racked with sobs and I cannot stop them. They come stronger and stronger and soon you can hear my sobbing throughout the birth center. I clean her and dry her, and I wrap her in the beautiful quilt. I rock her back and forth and cry and cry, my body shaking and wailing as I sit on the bed of the birth room, which is now full of postpartum mommas. These same women who gave birth and then watched Rose and I try to save this baby, while they lay in bed nursing their new babies, now look at me crying unconsolably. The momma who smiled at me so beautifully in labor, the one with her hair in two buns, she now looks as me with such compassion and smiles at me tenderly as if to tell me it will be alright. I finally get a hold of myself and swallow my sobs. Enough is enough. I cannot go on like this with these women who just birthed watching me.

I stand up, holding this beautiful, blue, cold baby in her handmade quilt. I ask Carmelle if the momma wants to see her baby. Carmelle says yes. I take the baby into the postpartum room and ask the mother if she wants to see her baby. She is laying in bed with her pink little girl, and her eyes light up and she says yes. It is then that I realize the look of hope on her face is because she thinks I have somehow miraculously saved her baby, and that I am about to show her a live baby. As soon as she sees a blue baby she turns her face away and it becomes stony. She pushes her hands at me to tell me to take the baby away, and she turns to her live baby girl and pulls her towards her.

I take the baby to the grandma and auntie. They are outside washing the bloody laundry by hand, squatting by the water bucket and scrubbing, talking and laughing. They stand up and look at the baby and become very somber. They do not want to hold the baby. They ask me to carry her to a room so they can pray over her. We go to the prenatal room, the only private room available, and I hold the baby. They tell me to place her on a chair. They do not touch her. Only later am I told that it is bad luck for them to touch a dead body. They sit around the baby girl and sing “How Great Thou Art” in Kreyol. I step outside the room to give them privacy, and I hum along to the song. Maybe it will comfort me.

Someone comes in from outside and tells me everyone is in the car and ready to leave to the airport. Am I ready? A few more minutes, I tell them. The song comes to an end. The grandma and auntie give me a hug and tell us to bury the baby. They do not want to take her home. I go in and pick her up one last time. I stroke her forehead and give her a kiss. I place her in the cardboard box that Carmelle brought down for me. Carmelle closes the lid. I feel numb. “Fini," (it is finished) I think.

As we drive to the airport through the traffic and the dust I relive each detail of the birth. I should have kept my hands on her belly when she rolled over, so that the baby didn’t go transverse again. I should have tried harder to grab the feet. I should have learned more Kreyol so I could communicate better with the momma.

I wonder if the baby girl that lived will always feel the loss of her sister, with whom she shared the womb. I wonder if she will grow healthy and strong and survive until her fifth birthday in a country with the highest death rate in the western hemisphere of the world for children under the age of five. I think of all the faces that looked at me with compassion as I cried about a baby’s death. Strong, stalwart, kind, serious faces. I suddenly realize that, while I was not the only one who felt grief about this death, I did not see anyone shed tears. I wonder if all the tears have run dry in Haiti from so much suffering and death, and if there are no more tears left to cry.

A stuck baby in Haiti

By Jennifer Gallardo

It is 12:30 in the morning and I bring my computer to the birth room to write about my day in Haiti, as I sit with the eighth momma in labor today. We came home from the beach a few hours ago to find three mommas in the postpartum room with their babies next to them, and four mommas in labor. We only have three beds in the labor room, and one is broken, so one momma labors in the postpartum room and another laboring momma walks in the hallway until Fernando fixes the broken third bed. I put up a screen so he can do so while two other momma’s are in labor in the same room.

No sooner is the third bed fixed when the momma in the hallway comes in and gives birth in it. The fourth momma has her baby too and I get to catch while she births on the birth stool. She is really cute with her hair up in two buns and a beautiful smile. It is her fourth baby and she doesn’t moan or make loud labor sounds, but just smiles at me and grabs my hand to rub her belly and back. I take her picture after the birth and show it to her and she is delighted and says over and over again, “Belle!” The way she reacts to how she and her baby look in the picture makes me wonder if she has ever seen herself in a picture.

Seven babies have been born and we are waiting on baby number eight. Rose Edith is on call tonight and I tell her to go to sleep and I’ll take care of the momma in labor. She says no, but then finally agrees to sleep in the prenatal room next door as long as I promise to wake her up when baby is coming.

As I labor sit and try to write about my day, I only get to type for a few minutes before the momma says to me, “Shitay” (sit) pleadingly, and points to the chair beside her birth stool. I go over and sit by her and hold her hand, and then she commands, “Chante” (sing). I sing every hymn I can remember, in English or Spanish. She sings along in Kreyol as she lifts her hands to the heavens and pleads with God to have this baby. She has watched seven other babies be born today, and each time she breaks out in sobs and wails, not understanding why her labor is so difficult.

Her belly looks bigger than the other mommas who have come in, and I think of all the spaghetti she may have eaten to sustain herself. I remember when I went to the Haitian orphanage the children ate two meals a day of breakfast and dinner. Both meals were spaghetti. The reality in Haiti is that food is hard to come by, and while the majority of women who come through our gates are too thin from not enough caloric intake, some are overweight because of a diet too high in carbs. The ultrasound she had says she is having a baby that is 3,900 grams, which is almost 9 lbs and quite big for a small Haitian woman. This is her first baby. She has been pushing for an hour.

The next three hours are a blur of feeling oh so sleepy but fighting to stay awake, singing and massaging momma, encouraging pushing on the birth stool and in different positions, and checking progress and baby’s heart tones. I have asked the momma’s sister to come in, and she helps with labor support. Baby’s head continues to move down, though ever so slowly. Heart tones are good and strong. Finally, I feel the birth is close enough for us to awake Rose Edith. She comes in sleepily and watches. She checks the baby and says it is taking too long and we should consider going to the hospital. The momma hears the word hospital and pushes harder. The student is in catching position. Momma is so tired and is done with the birth stool, so she pushes while on her back. I am feeling that midwife intuition that I need to be ready for anything. I can tell Rose Edith feels it too. I don’t want to cause an emergency though, so I am just extra vigilant and I eye the oxygen and ambu bag incase it is needed.

The head is finally is born after much encouragement to momma. No rotation with the next contraction. Nothing budges. The student checks for cord and there is none. Another contraction and we encourage momma to push. Again, nothing. I check to see where the anterior shoulder is, and it is behind the pubic bone, in the vertical position rather than diagonal which is the way it needs to be to fit through the pelvis. I try to fit my two fingers in by the anterior shoulder to do the cork screw maneuvers needed to turn baby into diagonal position, but the pubic bone is low and flat and the baby’s shoulder is so tightly pinned against it that my fingers won’t fit. We try McRoberts with corkscrew and suprapubic pressure, to no avail. I ask mom to turn onto her hands and knees and Rose Edith translates. She does so, but puts her head and arms down, which is more like a child’s pose, and the position is making it difficult for me to get the posterior arm out. I can reach it but I can’t get it out. I feel like I am fighting gravity, as I try to deliver it again and again. I try to rotate baby with mom in this child’s pose, and it feels like I am attempting to move a piano by myself that won’t budge.

I have delivered over 1,300 babies, and have had my share of shoulder dystocia’s I have managed and delivered, and in this moment I am thinking of positions that I want momma to get into, but the language barrier is too great. McRoberts didn’t work well for her. Runners pose on hands and knees would be amazing, but how to explain that? I try to get her to stand, and I remember the word “ kanpe” but she and the midwives look at me confused. I have had a lot of success getting a shoulder dystocia out with momma standing and me delivering the posterior arm. Maybe they haven’t witnessed standing births? OK, I have got to get this baby out! Let’s just shoot for getting hands and knees done right! I get on the bed, and get into hands and knees myself, saying, “OUI! OUI!". Then I do child’s pose and say, "NO! NO!” Please tell me they understand? It is ridiculous that I am in the middle of an emergency and I can’t communicate and am resorting to showing them positions when time is of essence. I am at that point where I know if I don’t get baby out quickly, he might not make it.

I watch the student and Rose shout orders to the momma and get her into standing position leaning over the bed. Not what I was asking, but I think it will work. I reach in and deliver the posterior arm with some difficulty, then rotate the baby and pull him out and towards the front of momma, onto the bed as she leans over him. He is white and slippery and floppy. I dry and stimulate him, fully expecting that I will need to resuscitate him by now, as it has taken longer than usual to get him out. I am surprised when baby sputters and takes his first breath before one minute of age. I listen to his heart and it is below 100 beats per minute but rising. I am flooded with relief.

Now to work on the placenta birth. After a long hard labor, momma is gushing blood. We lay her on the bed and give her a shot of pitocin. The student does gentle cord traction as we encourage momma to push, and the placenta is delivered and bleeding is under control. We check for tears and Rose Edith and the student prepare to suture her. This is the first vaginal tear we have had the entire time I have been at MamaBaby this trip.

It is so hot in the birth room that we are all dripping with sweat as if we were in a sauna. I am holding this little warrior baby that I wrapped in an army blanket when I notice my arms and shirt are soaked with blood. I take off my shirt and see my bra has fared no better. I take that off too and hike up my skirt and tie the drawstring around my neck. I wash my arms and hands with soap. There. That’s better. I take a picture, ecstatic that I am holding a living breathing baby and so happy for this momma that she has finally finished with a long tough labor.

It is 6am when I am able to go upstairs and take a cold shower and scrub myself clean of all the blood and sweat. Once out of the shower I stand on the porch, enjoying a gentle breeze, wrapped in my towel. By now the sun is up and we will be leaving for the airport soon, so I decide not to bother with trying to sleep. I head downstairs and can hear the auntie of the little warrior baby chattering to others who are waiting. She keeps saying my name and when I walk down the three men and women in the waiting room stand up and warmly congratulate me and thank me for saving the baby. I take pictures of all the momma’s in the postpartum room and birth room. Nine babies today. We have done a good work today. I feel content.

An Ambulance Ride in Haiti

By Jennifer Gallardo 

It is 6:am when Fernando wakes me because someone important is waiting to meet with me. Shoot. I slept in. I jump up and pull on a skirt and blouse. Today is beach day. Fernando and I are leaving for home soon and I want our staff to have some fun together before we go, and besides, you can’t come to Haiti and not go to the beach at least once. They bring the man upstairs and he is the boss of the minister of health for our area. We have a two hour business meeting where he gives me detailed instructions on what we need to do to become an NGO in Haiti and get all our paperwork in order for the school and the clinic. I am excited. We have tried to do this for years without success. Finally I have a connection that I feel certain will help. He says we can finish everything in just four months and then after our meeting he tells me his wife had her baby at MamaBaby, and he thanks me for opening the birth center to serve the community.

I go downstairs at 8am and there are three moms in labor. One at 4 cm, the other at 3 cm, and another at 7 cm. All primips (first time mothers). Another mom has showed up with a fever and one of our staff drives her to the hospital in the land cruiser. Fernando and I leave to go look at land in the tap tap. We want to see what is out there for a future birth center/midwifery school that we hope to build. I tell everyone we will be back by 10am to go to the beach. We get back at 10am and things are bustling at the birth center. A fourth mom has shown up in labor. Everyone wants to go to the beach, and only one midwife and one midwifery student are supposed to stay behind, so we need a couple babies born before we go so that we aren’t leaving the midwife and student with too many laboring mommas. I disappear into the birth room for a while to help. By noon two more babies have joined us earth side, and everyone going to the beach has taken a quick shower in the one bathroom upstairs that we share between four midwives, three students, and seven volunteers. Twenty-two mamababy staff, students, and volunteers have piled into the back of the tap tap and the Landcruiser….

We are waiting on Rose Edith, who has disappeared into one of the rooms with a mother who just walked into the birth center with a severe headache and blurry vision. I check in with Rose. Everyone is wanting to get to the beach. She is starting an IV on the momma and tells me the blood pressure is 150/96. While I would think it was shockingly high if in the USA, I have the thought that it is not so bad compared to all the other ones we have had this week. Rose says we need get her to the hospital by our tap tap ambulance. I say good call but since she missed the Citadel yesterday, I tell her we will wait for her before going to the beach. The land cruiser leaves for the beach with as many people squeezed in as possible. Everyone else scrambles out of the tap tap and a mattress is placed on the floor of the pick up truck and the momma climbs in and lays down. I tell everyone that we will just take public transportation to Cap Haitian and meet Rose and Claudin there, but before I realize what is happening, everyone, including the husband of the momma, piles back into the tap tap with the momma laying in the middle. I am told to get into the front of the tap tap quickly, and the only way I fit is to sit sideways on one hip, my body facing the door. Off we go to the hospital.

As we near the city one of the midwives taps loudly on the window separating us from the back of the truck. I ask Claudin, who is driving, what they want. He says they want us to go faster. We go faster. Another loud tap tap tap tap, more urgent. I decide I have to see what is happening, so I stand up and turn my body, sitting on my left hip so that I am facing the driver and can see into the back of the tap tap. I see the momma is having seizures… her body shakes and her arms and legs flail. Arms hold her down. Rose Edith and Nadesh hold her head with a rag in her mouth so that she won’t bite her tongue. It appears she has already done so, as there is blood on her face and the mattress. I tell Claudin she is having seizures and we need to get to the hospital quickly. We are fighting traffic. Three donkeys cross in the road ahead of us. Motorcycles and buses and tap taps are in our way.

Tap tap tap on the back window again. Claudin pulls over and asks what they need. Rose Edith says to ask the police for escort to the hospital. We happen upon a police car just ahead, and we ask for escort. We follow them through the twisting busy streets and I feel relief when they pull into a gate that reads, “Hôpital”. I jump out of the tap tap and rush to the back to help pull the momma’s mattress out. Six of us carry it awkwardly into the hospital. Note to self: buy and ship a stretcher to Haiti. We lay the mattress down in the entry room to the hospital, and I stand by it as Rose Edith and Claudin talk to a nurse.

Why does it seem like there is no urgency? I am told to pick up my part of the mattress and head back to our tap tap. I ask why and Claudin tells me that there are no doctors here and that they don’t have magnesium here. Are you kidding me? There is no time to explain to me why. Maybe there isn’t a why. Sometimes hospitals just don’t have doctors? We carry the mattress back into the heat of the day and back to the tap tap… but as we carry it there is discussion about where we should go next. We need to get to Milot Hospital, but do we take our tap tap “ambulance" or hire an ambulance with a siren and a trained ambulance driver? I am confused about what is happening but everyone is too busy to translate for me. Why are we going to Milot? Isn’t Milot by the Citadel and still 30 minutes away?

We set the mattress with the momma on it down on the porch and she moans that her head hurts so much. The decision is made to hire an ambulance driver. Claudin disappears to pay 400 goudes for the ambulance. It seems like everything is in slow motion and there is eternal patience about everything, but we finally load momma and mattress into the ambulance and Nadesh, Carmel, Rose Edith and I jump in. We then begin the wildest ride ever. The siren wails loudly and the ambulance driver has no fear as he plays the game of chicken. There are two lanes on the road, but he makes a third lane, just barreling forward, despite trucks and tap taps and motorcycles coming towards us. People run out of the street, animals are pulled out of our way, and there are times it seems we might just hit the oncoming traffic head on, but they stop or slow down, and we swerve around them and continue forward at over 100 miles per hour. I feel happy that the ambulance ride is matching my emotions, as this whole process has been in slow motion and I wanted it to speed up. We are driving so fast that it seems our own lives are in danger, and rather than feeling fear I feel absolute calm. A woman is behind me seizing and may die at any moment, and all I feel is calm. It is almost as if the entire situation is so unbelievable that there is no reason to get stressed or have urgency because all you can do is the best you can and there is no sense in stressing about it. I notice this about Rose Edith. She always makes level headed decisions and is calm and patient and doesn’t rush. It is something I am learning about Haiti. There are moments where it seems like time stands still and the Haitians are ever patient.

It is then that I am told that all the public hospitals in Haiti are closed due to a doctors strike. They have been closed for two months. This is why we have to transport 45 minutes to a private hospital in Milot. This is why we have had a record number of births each week. I am told that mother’s have been showing up at hospitals in labor and are not being allowed to enter. Three weeks ago a mother and her baby died giving birth just outside the hospital gates after being turned away. It costs $100 USA to give birth at the private hospital. This is out of the reach of so many, that they will beg to be let into the public hospitals, and when denied entry, will just birth outside the gates, in hopes that if they or their baby are dying they will be saved. I don’t know how to take it all in. Many women have no where to give birth, and we are just a small birth center in a country with so much need, and in that moment it feels almost hopeless to me. Suddenly the need for MamaBaby to keep her doors open seems more important than ever. As we fly by the countryside in the ambulance I look out on the land and I imagine us buying one of these properties and building a larger building (it is oh so crowded at times where we are now), training midwives for Northern Haiti so that it doesn’t matter to laboring mothers if the hospitals are closed.

We pull into the hospital driveway and I again jump out and go to the back to help drag the mattress out with momma on it. We transfer the momma over to a stretcher, and she is wheeled into the hospital. This time there are doctors everywhere in their blue scrubs with stethoscopes around their necks. The one who takes the history of our momma from Rose Edith gently chastises her for not carrying magnesium on our tap tap to give incase a mom starts to seizure. Rose is very dignified and explains that the mother walked into the clinic and was not seizing and that her blood pressure wasn’t high enough to warrant administering magnesium at that moment, but that the only indicated action was to transfer care. I can tell that the doctor respects Rose Edith, and that they are having a conversation colleague to colleague. It makes me feel proud of our midwives at MamaBaby Haiti. As we walk out into the hall of the hospital I tell Rose Edith we should carry magnesium in the tap tap. She agrees. Note to self: Make an emergency tap tap kit for the midwives to grab on their way out of the birth center, and put magnesium in it.

We tell the father to call us with updates on his wife and baby, and we leave our phone numbers for him. As I walk down the hospital stairs I have to step around people that are sitting, waiting to be seen. There are lines of people down the hallways and out the doors. I feel gratitude for this hospital in Milot. It is the largest private hospital in Northern Haiti, with 125 beds. It looks clean and equipped and staffed. I am beginning to think that the town of Milot is the Utopia of Northern Haiti.

The ambulance driver takes us back to our tap tap and we continue our journey to the beach. We get to a road that is impassable by our tap tap and we park it and hire a truck with four wheel drive. We all pile into the back of the truck and I am concerned we won’t fit, but some of the staff just straddle the back tailgate and hold on. I pray no one bounces out and I hold on tightly for the 30 minute drive on a bumpy dusty road. We meet up with the rest of our team and arrive at a dock with about 20 boats where we are bombarded by the captains, trying to get us to hire their boat. I let Claudin pick a boat, and all of us clamber aboard. They ask us which beach we want to go to…. Paradise Beach, Isle Beach, Belly beach? We are so hungry, we say take us to the beach that serves food. Belly Beach it is!

We land at a beach with live Caribbean music, and over 100 dancing men and bikini clad women. It seems a bit surreal and we stand in line to order fish and plantains. As we stand in line I see a poster announcing a bikini contest and I suddenly realize that we are here on the same day as the bikini contest. We swim and play in the sand and water as the music beats loudly and the women and men dance wildly. Claudin says to me, “After we get our food we should leave. This beach is too hot!” He is not referring to the heat of the day. I make a joke to our staff, “MamaBaby anpil okipe nan avril!”. They find it hilarious and spread the word about what I said. MamaBaby will be very busy in April. It is funny even though most likely the people who had money to come to the beach today aren’t the same people who will show up at our birth center for care. We laugh and play in the water.

The sun is starting to set and I decide to swim out into the ocean towards it. I swim out with a relaxed breaststroke, staring at the setting sun, until the loud music is soft in the back ground and the people dancing are small little figures on the beach. I can do this because when I was a child my dad would challenge me to swim with him far into the ocean to little islands in the distance, so I am not afraid. The water is clear and I can see the ocean floor, despite it being deeper than I can reach. I feel the warm water wash over my body as I dive as deep as I can before coming up for breath. I flip on my back and look at the beautiful mountains rising up behind me, the sun setting ahead of me, the little boats traveling back and forth to deliver families and lovers and friends to various little beaches. I soak it all in and I wonder how this can be the same day that we were transporting a seizing woman and her baby to the hospital. I hope she and her baby will be ok. I think about how hard our staff works and how grateful I am for them. My thoughts return to the birth center and the two women we left in labor. Maybe more women have come in by now. I turn around and head back to shore. It is time to return to MamaBaby Haiti.

Day of Joy in Haiti!

By Jennifer Gallardo 

I wake up early on the roof to a sky lit up by stars. I lay on my back, feeling a small breeze and the blessed coolness of the morning before the sun awakes. I listen carefully for the sounds that might be coming from the birth room. Nothing. I hear a goat, then a rooster, and then more roosters chime in. I get up and wander downstairs. No momma’s in the birth room. I am happy, because today we go to the Citadel, and an empty birth room means more of us can go! Rose Edith has agreed to stay and babysit the birth center today and someone else will stay tomorrow while she goes on the beach trip.

The Citadel is an icon of Haiti. It is a large mountaintop fortress, one of the largest in the Americas, built from1805 to1820 by over 20,000 Haitians led by Henri Christophe, a key leader during the Haitian slave rebellion. It was built just after Haiti gained independence from France, to protect the new nation against French attacks. Some of our staff and the midwife students have never been to the fortress. It sits at 3,000 ft elevation, stretched along three sheer cliffs. There is excitement in the air as everyone awakens and prepares for the trip today.

There are things to take care of before we leave. By 8:30 am there are over 30 women downstairs receiving training by our nurses, Nadesh and Christian, who are teaching them about cervical cancer screening. I watch them teach. Nadesh makes the women laugh. I take pictures. Fernando and Claudin fix the sink in the birth room, attaching it to the wall, glueing and caulking. It is perfect and I am pleased and bring all the midwives down to show them. We clap our hands and hug each other.

Getting everyone out the door reminds me of home and getting the family to the car for a trip. I finally just walk down the stairs and out the clinic door telling everyone I will wait in the tap tap. That works, and about 10 minutes later there are 13 of us on the porch. We pile into the back of our tap tap pick up truck and take off, with spirits running high. We drive for 45 minutes, first through the city, then the beautiful country side, closer and closer to the big mountain that the Citadel is built on. We drive through Milot, the town at the foot of the mountain, and I am amazed and pleased with what a pretty town it is. The nicest Haitian town I have seen. Paved roads and green street signs on each corner.

We arrive at the tourist center at the bottom of the path to the Citadel, 11 km from our destination, and we are surrounded by potential guides, motorcycle drivers, and horse owners, all of them clamoring for our business. We choose one guide and nine motorcycles (we ask for seven motorcycles but end up with nine). We begin a seven kilometer wild ride up the mountain on the backs of fast moving motorcycles, twisting and turning up steep bumpy roads, finally reaching the upper parking lot. Here we begin our steep 4 km walk up the mountain to the Citadel. We are followed by horse owners pulling their horses, hoping we are too out of shape to walk to the top on our own. I tell them we need the exercise, but they persist and follow next to us. We pass vendors, and musicians, and the midwives and I dance and twirl to music, leaving tips behind. We pass little children playing in front of their stick built homes, sitting at the side of the steep path. I take a picture of a little boy and girl, playing with machetes. Their mother sees me and comes out to take away the sharp knives and gently chastise them. I smile at her, and we have a little laugh together. As a mother, I relate. My children have taken knives and spoons from my kitchen to play with too. We buy fruit from the vendors at the side of the path. We climb higher and higher, and finally the horse owners dejectedly turn around and head to the bottom, in search of other more weary travelers, as they realize we will make it to the top on our own.

We reach the Citadel with its majestic stone walls and sweeping vistas. We explore it’s deep recesses, but we especially enjoy our time on the roof, with the cool breeze and incredible view of Northern Haiti. On the roof they have put up guard rails that weren’t here four years ago. Last time I walked to the edge of the stone walkways where the view was incredible. I look at the guardrail and look longingly towards the end of the walkway and I just know I will regret coming all this way if I don’t walk to the end of it like I did last time. I slip under the guardrail and carefully walk the 200 feet to the end of the stone wall, away from everyone’s chatter, and I sit and look out upon Haiti. Mountains upon beautiful mountains. I think of the Haitian proverb, that beyond mountains there are more mountains. Like most proverbs, the meaning has multiple layers. In its simplest form, it seems to mean that when you solve one problem there will be another beyond it to solve. Or when you surmount a great obstacle it is only to get a clear view of the next one. I like to think it means to keep climbing, keep overcoming, and continue onward in serving others, making a difference in their lives.

We head down the mountain at dusk. When we get to the upper parking lot there are 12 motorcycles and no way for us to tell which were our original nine drivers, as all of the drivers clamor and insist that it was them. I decide it is not worth arguing about and tell everyone just to get on a motorcycle and go. Everyone takes off, and I try to take pictures of us flying down the mountain on 12 motorcyles, but the road is so bumpy that it is hard to get a good photo as I hang on tight with one hand to the bar behind my seat. I finally put the camera away and close my eyes and just enjoy the moment, feeling the wind on my face and in my hair, swaying to the left and then the right, moving fast and holding on.

We return home to two momma’s in the postpartum room and a huge feast. Rose Edith was busy with births while we were gone, and Rossette made a beautiful dinner... one of my favorites. Beef in a red sauce, rice, mashed potatoes, a beautiful salad, passion fruit juice. This is a feast and I can tell that a lot of labor and love went into this meal. We crowd around the table, Fernando says a prayer, and we all eat together, laughing and reminiscing about our day.

It feels like family.

Fourth Day in Haiti and four babies born:

By Jennifer Gallardo 

Morning comes too soon at 6:30 am, when the heat of the sun on the roof wakes me up. I fumble down the stairs after only two hours of sleep and mumble to my husband I need more sleep. I lay down in the volunteer room despite the feeling that I am in a sauna, and fall asleep under the mosquito net. At 8am I awake, wet with sweat. I have Elio coming at 8:30 to translate for me while I take pictures of the mothers and babies that have arrived at clinic. I am frustrated that I have wasted two days of clinic where I could have taken pictures of them. I have plenty of birth room pictures, but forgot about the mommas who come in every day and fill the benches at the birth center, waiting to be seen. Elio and I go downstairs and she explains that I want to take pictures but anyone can say no. The women are not shy about saying no. Those who do not want pictures scoot out of the group pictures, leaving some benches empty. About half of the moms say no to pictures and the other half love to see the pictures I show them of themselves. The birth room is full with three mommas in labor. Today I will miss the births because I have promised to meet with our staff. Each interview takes about 30 minutes and I meet with over 10 people as Elio translates. Every once in a while I run downstairs to take pictures of the midwives and the beautiful momma’s and babies. I love interacting with them and documenting their beauty and strength.

Rasha comes to talk to me and I am delighted to see her. We discuss the Plumpy Sup program that she manages where we have 30 women enrolled. I am so grateful for this program as it monitors 30 or our most malnourished pregnant momma’s weekly and gives them extra calories and nutrients daily through a supplemental nutrition program.

Rose Edith and I get a chance to talk for an hour about the MamaBaby Haiti midwifery school that will start this fall. We are both excited about training midwives who are from the Cap Haitian area as the only other midwifery schools are in Hinche and Port au Prince. Both places are over three hours away by private car, and over seven hours away by public transportation. Word has gotten out about the school, and nursing graduates are already lined up today to talk to me and interview for the six student spots. Our class starting this September and graduating May 2018 will be small, but some day we will have funding for a larger class. I am pleased with the excitement about the school and the number of applicants.

The solar panels are installed and we are excited to test them out tonight! Fernando and one of the men went into town in search of internet that works. Two of the men took the day off from working on the hot roof and rented motorcycles and drove to the beach. It is late afternoon and the interviews are finished. The birth room is empty and the postpartum room is full. There is excited chatter downstairs and my name is urgently called. I look over the porch to see the men have returned. The first one walks in and it is obvious he is in pain. He tells me about the motorcycle accident they were in as I check him over. Nothing needs sutured, but we clean him up, and I feel his clavicle and indeed it is broken. I send Claudin for a sling. Then the other injured one shows up and he needs some sutures. We clean him up and get out the suture equipment and I prepare to suture, when Alourde, one of our midwives, gently pushes me aside and says she wants to suture him. I think she wants to show off her suture skills, which I must say are excellent. I can tell that she is very confident with the needle holder and knows just what to do. I feel pleased.

With the men patched up I head to the birth room again as I hear someone has come in labor, and we have promised Nikki, my niece, that she can catch the next baby. She is finishing up nursing school in Texas, and I invited her to join us on this trip. I am excited to be in the birth room after a day of sitting on the porch talking to staff and doing interviews. I’m also excited to help Nikki with her first baby catch!

The momma is having her fourth baby. I admire her tiger dress. I can tell she is confident and knows what she is doing. I explain to her she can choose whichever position she wants to birth. I lay down and say “kouche”. I get on hands and knees and say “Kat pat”. I squat and say “koupi byen". I stand and say “kanpe". I show her the birth stool and say, “Chita”. The momma looks amused with me, and the midwives giggle. I think they find my Kreyol funny and the fact that I show all these birth positions to women humorous as well. The tiger dress momma progresses quickly and quietly. She chooses to get on the birth stool to push, and I am surprised. I check her and she is complete, and I put pressure on the water bag thinking I will avoid a mess by helping it break now. Evidently, breaking it with your finger is not as efficient as with the amni-hook, as it breaks with a huge pop and Nikki and my scrubs are splattered with meconium. Heart tones are great, and I keep thinking with any push this tiger momma will have her baby quickly but she surprisingly is pushing for a while. She calls Alourde, one of our midwives, over to talk to her. She chatters to her in Kreyol. I can see how much our midwives are loved and respected. I ask Alourde what she needs and Alourde says she wants vaginal massage to help the baby come out. I get coconut oil, and with momma on the stool, I do some gentle perineal massage. I had noticed this tiger momma had prominent varicose veins on her legs, and as I ponder what is taking a while for her baby to come out, I feel prompted to check for any prolapse that might be happening of bladder and vaginal wall. As I do vaginal massage, during a contraction, I put three fingers inside the vaginal canal and hold everything open and out of the way. I feel baby’s head move from high up to down onto the perineal floor and crowning, all with one contraction. I tell Nikki to be ready to catch. She has a baby blanket ready. With the birth of the head copious amounts of meconium pour into the bowl beneath the stool. Momma leans back a bit to birth the body and the baby shoots out into Nikki’s awaiting blanket and arms, with a wall of green amniotic fluid that amazingly manages to splatter everything within a few feet of the mother (namely, Nikki and I). We laugh as we are ridiculously covered from the waist down in green. Baby is green, the floor is green, my shoes are green. I think nostalgically of the chux pads we use in the states, and I think about how we change them out and throw them away when there is just a small amount of blood or amniotic fluid on them. In contrast, this birth happened without a single chux pad, and the bowl under the birth stool didn’t help much as the amniotic fluid and blood missed it, and instead is pooled in slippery puddles of green and red on the tile floor. I find it challenging to walk and not slide. I make a note to myself to send down rags, towels, and chux pads.

After placenta, cord cutting, checking for tears, newborn exam, settling momma in, and many trips back and forth from the bathroom to clean the birth juice off the slippery floor with the one rag I can find, I am ready to be done for the night. I go to the bathroom that is attached to the birth room to wash the green off my arms. I wonder why when I turn on the water I hear water running on the floor. It is then that I notice the sink is hanging off the wall and not sealed to the pipes beneath it. Every bit of water that drains out of the sink hits the floor. Another major fix Fernando needs to make before we leave. I wonder how I will get him into the birth room to fix the bed and the sink when there are always women in labor and it is rarely empty! Before going up to shower and go to bed, I take pictures of our chunky green baby. Nikki’s first catch. I feel content. This was a good day.

Third Day at MamaBaby Haiti

By Jennifer Gallardo 

Rose Edith says goodbye as she heads to do the cervical cancer screening at the hospital that lends us space for this. She is carrying a bucket full of sterilized speculums. Carmel and Claudin transport a momma to the hospital because she shows up for a prenatal with pre-eclampsia. She is 29 weeks and 6 days. Blood pressure 200/140. Plus three protein in urine. Headache and severe edema. We call about the momma who transported last night who had the long labor and the big baby. She had a cesarean section. I hope she was treated with kindness. The birth center is in full motion with prenatals and postpartums lined up and waiting. I find the momma who had come with no shoes and give her a shirt and shoes.

Two first time mommas are in labor, and over 40 women are waiting for prenatal and postpartum visits. Clinic goes into full swing, with midwives and nurses and students caring for the mommas and babies. After appointments all the midwives congregate in the birth room, even though only one is on call to do so. They are visiting with each other and caring for the momma’s in labor. One was checked just two hours ago and was only 4 cm. I pull out the coconut oil and Clary Sage essential oil and start to rub the momma's belly and back with it. The smell of Clary Sage fills the air. The momma who was at 4 cm a couple hours ago starts to push. She is checked and found to be complete. Suddenly, the midwives get really excited about the Clary Sage. They are certain that it is because of it that the momma has dilated so quickly. They spring into action, asking for Clary Sage on their hands. They vigorously rub the other first time momma with the essential oil and coconut oil, everyone laughing and rubbing and showing the momma's how to wiggle their hips as they stand and rock. It is like a birth party. A big communal birth room. I feel happy. Our midwives love birth. They feel called to this work just as midwives all over the world. A common thread ties us together. I can tell the mommas trust their midwives and feel loved by them.

A student is assigned to the birth of the pushing momma, who is now sitting on the birth stool. A cloth pad is laid out on the bed and a metal bowl is under the birth stool. The first two days we had the luxury of one disposable chux pad per mother. I ask for one now, and am told we are out. I think of how we use about 10 per momma in the USA. These take up a lot of space, though they are light. I make a note to myself to make a shipment of 500 chux pads. Maybe they will allow each momma two if they have a large surplus, and this will cut down on the hand washing of all this bloody laundry. I think of how many births they will do without them until they get the shipment. I have already found so many things I feel we need for the birth center to function smoother, that I am concerned the next volunteer coming will not be able to bring it all.

I am assisting the student at the birth. The momma is pushing on the stool and when the student sees the head starting to come she tells the mother to get on the bed and lay down. Before I know it the mom is on her back on the bed, and the head is out, with the student pushing the perineum over the baby’s head. I want to tell her to stop, but I am trying to balance respecting the student with respecting the momma. When she starts to do head traction I cannot refrain and I tell her to stop. We count out a minute. She is anxious to get in there and do something, and the baby’s head is not rotating with the next contraction. She starts to do head traction and I say, “No. Chita! Chita!” asking that she sit the mom on the birth stool instead of pulling on the baby. The student looks confused but finally seems to understand what I am asking, though she looks incredulous that we are having a mother move with a baby’s head out of her. We roll the mom to her side and help her get off the bed, and as she starts to stand the baby’s anterior shoulder is born and so the student tells her to lay down again. She lays down and the baby comes out, though very slowly. Baby is on momma’s belly now, and is doing great, but I feel the student may be frustrated with me for interfering with how she feels comfortable attending this birth.

I am trying to teach that baby’s come out without traction, that mom’s should choose their own position instead of being commanded to lay down, and that changing a mom’s position can be a solution to a baby that is not coming out, but I am questioning if I am interfering too much? Do I have a right to take over the way they are doing the births? I haven’t even seen the midwives do the births because the students have been catching all the baby’s this week. I feel frustrated and wonder if I will ever be able to communicate and teach effectively. I am kicking myself for not trying harder to learn Kreyol. I feel defeated and leave the birth room to take a shower.

I am sitting on the dark porch with my computer, writing about my day, when Rose Edith, one of our midwives, comes up and asks for a massage. I go get my oils from the birth room and she lays on her mattress on the porch (it is hot at night, so the midwives head to the porch, while the volunteers head to the roof). I give her a 30 minute Aromatouch Technique Massage. I feel so much love for her and am grateful for how hard she works to serve the women and babies. She is our head midwife at MamaBaby Haiti. I am happy to serve her in this small way. The massage finishes and she gives me a hug and thanks me. I take a shower. I’m considering going to sleep and missing the second birth as I am falling asleep writing on the computer and I can’t get the internet to kick in fast enough to download a picture to Facebook. Just as I am about to head up the stairs at 12:30 am to sleep on the roof, the student midwife who I was worried I may have offended asks me for a massage. She lays down and I give her a 30 minute massage. Maybe I didn’t offend her after all. I wish I could communicate with her! She gives me a hug and a kiss good night. All is well.

I decide to go sleep in the birth room on the bed in the corner so that I can watch the next birth. I get down there with a pillow and a sheet, and see all the slats have fallen to the floor and the mattress has collapsed. OK. Another thing for Fernando to fix tomorrow. Carmelle is loving the Clary Sage. She keeps asking me for it on her glove and she rubs it vigorously on the momma’s back and legs. It is 1:30 am. Momma has just started pushing. I decide I am going to just watch and not interfere, even if they do head traction! Unless they actually ask for me to help. :) Momma is on the birth stool and when they can see the head she moves to the bed of her own accord. Carmel, one of our midwives, is very energetic and active in the birth room. She rubs and encourages the momma, and she gives her a twisted blanket to hold onto so that Carmel can pull her up a bit during the pushing. I sit a ways off, but as it gets more exciting and they can see a lot of baby head, I pull my chair closer, to the side of the momma. Carmelle is coaching a second student and I keep hearing my name mentioned. I think she is telling her to keep her hands off, because the student looks eager to touch the perineum and baby’s head, but then looks as me, and then Carmelle, and she just lets her hands hover. She yells at the mom a couple times to push the baby out (don’t take this wrong… I am sure she feels this is her job… she is actually super sweet and quiet, so I am surprised to hear her power). I know I said I won’t interfere, but from my chair (while I SIT on my hands) I say, “nómal. yon lot kontraksyon bebe vini”. Of course I am lying, because I can’t know what contraction the baby will actually come, but come it will, that I know. She stops yelling at the mom to push. The baby rocks back and forth for a while. Finally, baby’s head comes out, and then the student looks up at me and says something in Kreyol. I think she is asking me what to do next, so I say “de minit”. I get the phone that is in the room and show her it is 3:30. I say we will wait until 3:32 to do something. I had just taken heart tones, so I am not worried. At 3:31 baby’s head rotates and the students hands are hovering and she wants to get the shoulders out (you can see a tiny bit of shoulder). I show her the clock and say, “yon minit”. She moves her hands away, and then about 30 seconds later, with the nerves of the midwives and students mounting, the baby’s anterior shoulder is born, and then he rotates, spinning that beautiful birth spin, until his face is looking at us and he is born to his belly. At this point, I take the students hands and put them under the baby’s back because I’m worried he will fall on the floor as momma is close to the bottom edge of the bed. She lifts the baby onto momma’s belly. Then the student squeals in delight. Jumps up and down, and proceeds to high fist me with a goopy glove. Carmel is literally jumping up and down screaming “ti bebe a te fé li!” (translation: the baby did it!). The student relives the experience, as she excitedly chatters in Kreyol. I can’t understand every word but I catch that she is talking about how the baby did it himself. She moves her body just like the baby and enacts the scene. They are so excited, and so am I.

It’s 4:22am and I am finally ready to head to the roof. Even if another momma comes in, I will sleep through it, at least until the hot sun wakes me up at 7:am.

Second Day in the Birth Room

By Jennifer Gallardo 

I wake up at 7:30am to the sound of two women in labor. The babies are born before I can make it to the birth room.

At 8:30 am the women start singing with Ginny. I go down and videotape a bit of their singing. So beautiful and touching that they start their clinic day like this every morning. They are singing, “How Great Thou Art” in Kreyol

A second momma labors throughout the day with much wailing. We hear her laboring sounds the entire day. She comes in at 5:30 am at 5 cm and by 6pm she is 8 cm and Rose Edith is preparing to transport her. She does not want to go and the baby heart tones sound great and all moms vitals are normal. I ask Rose Edith if she is willing to wait a while longer. She reluctantly agrees. They are used to small babies here that come out quickly. This small mom had a lot of amniotic fluid, her baby appears large. I stay in the birth room and massage the momma with clary sage and coconut oil. At 8pm the momma is 9 cm… with cervix from 9 to 3 0’clock. I think that is good progress. I imagine this mom may need coaching and pushing on the birth stool. She flails about and wails that she is dying. Carmel, our midwife, shines. She loves on the momma… holding her, rocking her, singing to her. The momma joins in the prayer song at times. At 10:pm Rose Edith says it is time to transport. I ask if we can check the mother again but Rose says no, because she will get an infection as we have checked too much. The mother of the mother, the grandmother to the unborn baby, has joined in on the wailing. This is not my turf. I need to show respect to Rose Edith, our head midwife, so I bow out of the picture. I cannot even speak the language that I need to communicate what I want. My choice would have been to put the momma on a birth stool and do coached pushing, but when I mentioned that to Rose she said she will not tell a mom to push, that a mom must push on her own and have an urge to push. OK, I say. Transport. I smile and hug Rose Edith and tell her she is a good midwife. They call Claudin so that he can take them to the hospital.

The generator turns off suddenly and headlamps and flashlights come out.

Another baby is about to be born, and the students look confused because the mom is on hands and knees. I glove up and step over to be ready to help, and to protect the baby from unnecessary head traction. :) Indeed the students are a bit confused with everything upside down. The head comes out and the student starts to bulb and I say, “no”, then she puts her hand hesitantly on the head and starts to pull, but she doesn’t know which way to pull. I gently move her hand away again and say, “Normal, normal, patience, patience”. Her hands hover and mine do too as we wait a full minute for the next contraction. She is nervous about the wait. The shoulders start to emerge and she begins to pull the baby towards her. I guide her hands to push the baby towards the mothers belly. I am in a better position (to the side of the momma) to grab the baby, so I do, though for a moment it was a tug of war with the student wanting to bring baby to the back of the mom, and me trying to tell her to push the baby to the front of the mom. Baby looks a bit shocky and is slippery and covered in lots of fluid and birth juice. I keep getting handed a bulb syringe and I keep asking for a baby blanket to wipe the face. I finally am handed a baby blanket and can dry baby’s face and stimulate him, and he takes a lusty cry at about 30 seconds after the birth.

The lights have come back on as they refilled the generator with gas. I finally have a chance to look around the room and notice the empty bed from the mom that transported. Just like that. Whisked away in the dark. I wonder what they will do at the hospital and if she will push her baby out or require a cesarean. Concerned that I may have offended someone by taking over their hands and knees birth, I hug the students and tell them “bon travay”. I kiss the mom on the cheek and tell her “bon travay”. When Claudin returns from the hospital I ask him to translate for me and I call Rose Edith and the student to meet. I ask if I offended anyone today and apologize for taking over the hands and knees birth. The student says she appreciates me helping as she had never done a birth on hands and knees, and now she will remember next time that no head traction is needed and which way to catch the baby. Rose Edith gives me a hug and says she is not offended. Phew! A delicate balance between teaching and learning, supporting and sharing knowledge.

I sit here and type this and it is past midnight and the generator is back on and rattles so noisily that I can barely hear myself think. Soon we will have solar panels!

 

I notice so many needs MamaBaby has. The beds need some TLC. The walls could use paint. The whole place could use a deep clean. We need some more furniture. The ambulance needs a little work. I envision a couple years from now, being on our own land, having more than one bathroom for the midwives and staff, having gardens and more space. I reel myself back in. Gratitude for what we currently have. Solar panels being put in. A building to serve women, with running water, a clean bed, and skilled midwives. Very skilled midwives. I am in awe of these women, both the midwives and the pregnant women they serve.

Haiti- Day one with MamaBaby Staff.

By Jennifer Gallardo

 I visit with our staff and give them each their gift. They have written notes welcoming us which are taped to the walls. I write notes with all their names and our names and tape them next to their welcome notes. Then we sit in a circle and chat. They tell me I speak more Kreyol than before. I use my dictionary and fumble through communication. I give them a 30 minutes class on essential oils, which they seem to enjoy immensely (part of their enjoyment is hearing me struggle with my Kreyol). After class I give them deep blue shoulder and arm massages with coconut oil. I believe Deep Blue is now their favorite product and I will need to send them some regularly. They are very happy and said it worked wonderfully on their aches and pains!

Haiti- Day One in the Birth Room.

By Jennifer Gallardo 

No sooner do we arrive at the birth center when I hear they are transporting the mom in labor. I want to know why. Rose Edith, one of our midwives, lets me know that the mother had a blood pressure of 150 over 112, was 5 cm, and had protein in her urine. Good call to transport. The family is upset about going to the hospital. I ask them what their concerns are, and they tell me she will not be treated well at the hospital, and at MamaBaby we are kind to her. Our driver helps her and her family into the back of our "tap tap" `pick up truck and takes them to the hospital.

At 9:pm a new momma comes in, already at 8 cm. I am excited to watch the midwives do a birth, so I put on my scrubs and grab my camera.

“Photo’s? Oui o no?” “Oui…photos” says the mother. The midwives put the mom on the birth stool, then they let me know her water is bulging and intact. Carmel lets me know this by puffing her cheeks up like a blow fish. I feel certain that the midwives are trying to please me by putting the mom on the birth stool and leaving her bag intact, as I have told them before that we should teach the women to give birth upright and that it is not necessary to break every bag of water. Last trip I gave up as I quickly realized that it is a very ingrained cultural custom for the women to lay on their back to give birth, and the first water bag I refused to break drenched me and my shoes with meconium. I am sitting off to the side, out of the woman’s eyesight. The midwives look concerned and tell me she is about to give birth and I should come closer. I tell them I am fine where I am at. They then tell me I am catching the baby. They insist. They are giggling and want to see how I do things. The mom is on the birth stool at the foot of the bed. I glove up and stand to the side of her, a few feet away. They are a little concerned that I might not be close enough for this baby that might fly out. They say, “Closer, she is about to have the baby.” The momma hears them and stands up and lays down on her back on the bed. I smile at her. This is what is familiar to her. The midwives roll a stool to the foot of the bed for me. I sit in it for just a moment, before rolling it to the side of her. Just after I roll it to the side of her the Momma pushes and her bag bursts, splashing meconium stained amniotic fluid all over the floor and bed. I am certain the midwives were disappointed that I didn’t stay where they had put me, as I think the plan was that I would be drenched. They giggled and spoke amongst themselves about me not being in the line of fire. With the next contraction the momma pushes and you can quickly see a little of the baby's head. The student midwives get excited and start shouting urgently for momma to push, and they reach over to pull her legs into McRoberts. I go to the foot of the bed where I can shoo their hands away. “Patience, Patience” I say over and over quietly as I remove their hands from Momma’s legs. Then the head is born and they are concerned I am doing nothing. They shout, “traction, traction” and I make eye contact with them, raise my hand in the halt sign, and say, “no traction. patience”. They smile quizzically. They seem unsure about what I am doing, or rather, what I am NOT doing. I tell them we are going to wait, “Deus minute” and they grab the clock and show it to me, saying it has already been 90 seconds. I think it has been more like 45 seconds, but I can tell they are nervous. The next contraction comes and I make eye contact with the momma as she pushes her baby out to the waist and baby takes a first cry while just halfway born. I take Momma’s hands and place them on her baby and help her lift baby up to her belly. As is often the case here in Haiti, it is hard for me to read her emotions. The midwives ask if baby is “garçon” or “fi” and I reply that momma should find out. They all look confused, and I realize that my preconceived notion that it is empowering for the mother to discover the sex of her baby on her own does not fit in this setting… even mother asks me what her baby is and when I tell her to look she says no. I let them know baby is a “fi”. As I do the newborn exam the midwives ask me what to do as there are no diapers and the mother did not bring any. They say she walked here barefoot on the dusty roads and does not own shoes. My heart wells up with compassion for these women and I stand in awe at their courage and strength.

I have much to learn from the midwives here about their culture and way of birthing. I am so pleased with how hard they work and I can see they really do care for the women and babies and that they are respected and loved in the community.

I finish the newborn exam and am surprised to see another momma sitting quietly on the edge of one of the beds in the birth room. She is at 4 cm and a multip. She said she wanted pictures as well, so I take a picture of her in labor and then leave the birth room as it looks like it might be a while and it seems as if she wants privacy as she wanders into the dark and private corners of the birth center.

I shower in cold water that I wish was even colder. I climb the stairs to the roof, which is a few degrees cooler than the room and catches a breeze, and I lay down by Fernando while he sleeps. I try to sleep. Dogs bark. Roosters crow (hello? It isn’t morning time yet!) Neighbors blast their music. Sleep evades me and I think about the mom that is in labor. I hear a newborn cry. Oh, good! Then I worry, was she relieved I left the room or is she disappointed I didn’t get that photo I promised her? I get up and go back to the birth room, grabbing my camera. She smiles when she sees me (though won’t break a smile for the photo) and says yes to a picture of herself and her baby boy who is laying on her chest.

After I snap the picture the electric goes off. We are shrowded in darkness. Headlamps and flashlights come out, as midwives finish the newborn exam and tuck momma into bed. I notice the neighbors music went silent.

I hear moaning on the porch, and go out to greet an excited poppa, and a laboring mom. I bring her into the birth room. Dilation 2. Blood Pressure 200/140. The midwife checks it too and asks the mom if she has a headache. The answer is yes. She tests the mommas pee. Plus three protein. I go out to tell the poppa they must go to the hospital. He looks like the weight of the world has landed on his shoulders. He puts his head in his hands and cries. He leaves the birth center to collect himself. I hear him tell the guard “I have no money. The hospital will ask for money. How will I pay?”. I go upstairs and take $40 from my suitcase. Tears roll down my face and I send a prayer heavenward. "Dear God, help these women and families.” I give poppa the money, telling him it is for medications and asking him to come back after the birth with the receipt for the birth so we can help him with that.

Two mommas risked out today for pre-eclampsia due to the malnourishment on this island. I go to the roof and lay down. It is 3:30 am. My heart is breaking open for the poverty and struggles I have witnessed today. I pray that I can know the right thing to do and make a difference. I pray that I can make an even bigger difference than what I am currently doing. I finally drift off to sleep, looking at the stars and feeling comforted that someday everything will be made right.

 

 

Haiti- Day One on the Roof

By Jennifer Gallardo

The guys, David, Elijah, and Chris, are easy going, good humored, and kick butt. We land in Haiti and walk down the stairs to the plane, waiting in a long slow moving line, and then join the mob of people pushing and trying to get at their luggage, which is being unloaded into one huge pile. I push my way to the front and grab the handle on one of the 50 lb duffle bags, somehow pressing through the mob of people with it I drag it to the front of the airport. Then I repeat that four times… until we have a huge pile with my five duffle bags and the guys suitcases and things. We try to walk out, as other people are doing, but we are motioned to a table where they proceed to open all of our things and then they call me to a back room and tell me I have to pay $192 to get my things out of customs. It doesn’t seem fair that so many people have left without paying, but after a few minutes of discussion and pleading on my part, I just end up paying the $192 so we can leave. No sooner do we arrive at the clinic when the guys spring into action and join Fernando and Dorian up on the roof.

Midwives do hard work

by Leah Rashidyan, MBH Vice-President, while in Haiti

Today I walked in the shoes of the MamaBaby Haiti midwives. They are receiving special training on cervical cancer screening techniques, so I came to the clinic to provide coverage along with the two MBH nurses. Coverage began the night before so they would be alert and awake for the training, and it was a long night with two births-- which includes doing labor support, catching the baby, helping initiate breastfeeding, moving them to the postpartum room, and then cleaning the birth room! After settling them in, I finally got to sleep around 5 am... Just in time for about 3 hours of sleep. 8am the alarm rings, and it's time to get up and at them for prenatal visits. Today there were 33 patients waiting by 9am... And yet another laboring mom who was just admitted. Bouncing between prenatal visits, labor support, discharge teaching for one mom from last night, while monitoring a newborn who was breathing a bit fast... it was busy. Balancing duties and seeing everyone with one of our nurses was quite a task that took till 2pm. 

Each trip I take I am reminded of the value of prenatal care-- I saw everything from high blood pressure requiring immediate transfer to the hospital for preeclampsia, vaginal bleeding in the third trimester, small bellies needing ultrasounds for evaluation of the baby and the due date, and malnutrition in our pregnant mamas. I am always reminded of the level of critical thinking and problem solving this work requires-- especially in Haiti. And after just a day of doing the work the MamaBaby Haiti midwives do everyday, I am reminded that midwives do hard work. If you are a midwife, had a midwife assist at your birth, or if you know a midwife personally-- I'm sure you know this is true. Now imagine what that hard work looks like in Haiti-- caring for the women who die more frequently of childbirth related complications than anyone else in the Western Hemisphere. It is really hard work. And hard work that wouldn't continue without your dollars and your support.

So thank you. I saw the women who it matters to today. I know how the MBH midwives care for them and their babies. And there is no better way to donate a dollar than to help a pregnant mama have a healthy baby.  

With love and thanks,

Leah Rashidyan-Vice-President, Board of Directors

A nudge to GO!

Written by Echo Zielinski, MamaBaby Haiti volunteer and board member.

Each and every time I get the opportunity to encounter the beauty of Haiti and am able to love on its amazing people, I am left completely changed.

In case you do not already know, Haiti is about an hour and a half flight south of Florida in the heart of the Caribbean. It sounds like a dream to visit (um, the Caribbean!) but in reality, there is a visible contrast that hits you as hard as the humidity. The stunning terrain and palm trees that are surrounded by beautiful warm water is also home to the poorest people in the western hemisphere; a level of poverty that most of us could not even imagine! As you ride into town, your senses are overwhelmed by the number of people in the streets, the smells of cooking food, and the amount of trash that has inevitably taken a huge toll on the country.

However, with just one look into the dark eyes of the Haitians, you quickly recognize the human connection and that these people are just like you and me. Men who want to care for their families, women who want to love their children and provide a better life than what they had, and kids who want to stimulate their minds and bodies with toys and play. Much looks different than the lives Americans live, but when you strip it down to the bones, you will see that the Haitians are strong, bold, courageous people who desire the same comfort and stabilities as you and as me.

If you drive a little further into the country, you will find the oasis that is MamaBaby Haiti. MBH was founded by a group of midwives in 2010 after an earthquake devastated parts of the country. They quickly saw that women and babies were dying too often, and not because of illness or sanitation, but simply due to the fact that they did not have a safe and compassionate place to receive prenatal care and give birth. Normal pregnancies were ending gravely after women chose to stay home because of the costs and travel associated with trips to the hospital. Where there is severe poverty, mothers often have to choose between food for their family or having a skilled attendant at their birth. MamaBaby Haiti believes this is not okay, and it is their core belief that no woman or child should ever die because of where they live. This fact alone is why providing FREE care is one of our biggest commitments and core values.

I did a village home visit for this Mama and Baby a few weeks after she was born. Her mama was extremely thin when pregnant and we wanted to find her and find out if they both had enough to eat or if we should get them on the plumpy'nut medical food program. 

 

After just a few hours at MamaBaby I knew my visit was not going to be a one-time-thing, but that it would forever hold a chunk of my heart and commitment.

I became involved with MamaBaby Haiti after I felt an intense and overwhelming nudge to GO. Since the only way to make change in this world is by God’s people saying yes, I did not overanalyze this charge, but merely started making the arrangements and trusting His provisions. What I found when I got to Haiti has changed my life forever.

Myself and Madam Bwa. She is a community midwife in Shada, the slums of Cap Haitian. 

I saw people I needed to fight for, situations that needed to be illuminated, and my own boldness that I needed to tap into. When I hopped on a plane to head home, I knew that my work had just begun! If there is one thing I am sure of in this life, it is that God does not invite us into these opportunities to make us feel good or to receive a pat on our backs. He invites us because we are literally his hands and feet and he has us here on this earth for far more than our own comforts and joys; we are here to love his people, hear their cries, meet their needs, and most of all, when they are no longer in your sight, to commit to relationships and return to complete the work being done.

I am now on the board of MamaBaby Haiti and every day we are making strides toward thriving Haitian families. Four Haitian midwives run the birth center with the help of eight Haitian support staff members, and a six person volunteer board in the States. We have big dreams for the future, full of healthy mamas and babies, micro-businesses for our families, sustainable gardening and farming, and of opening a midwifery school to train more Haitians to care for their own.

We took down a much needed new stove for the clinic. It is very hard to ship supplies to Haiti so we heavily rely on our volunteers packing needed supplies into their bags to take down! 

This is just a tiny glimpse into what is happening at MamaBaby and in Haiti as a whole. If you read this and your heart was stirred even the slightest bit, it may be because YOU are suppose to GO! If you want to get involved and volunteer at MamaBaby Haiti or find out how you can support us (we run 100% off donations) then please contact us at volunteer@mamababyhaiti.org or sign up for a one time or continual donation HERE.

Each volunteer experience looks different depending on the skills you have to give... there are roles for all different skill levels and opportunities to serve in medical and non-medical ways. Our midwives are always in need of relief from volunteer midwives AND there are ways to serve the birth center and community in other practical ways!

There are also two group trips happening through the non profit Hear the Cry this year (in June and November).To find out more about these go to hearthecry.org/trips

I urge you to take 4 minutes and watch our video "A Mother's Journey". Here you will get a beautiful glimpse into MamaBaby Haiti and the people we serve. 

The Dash Between Life and Death

By Jill Roper

Ever wonder if your calling as a midwife makes a difference? That question comes up a lot when you come to a place like Haiti. The other day we were up to our ears in patients. Clinic had ended and we had three Mama's in labor at the same time. In walks patient number four, fully dilated ready to push out her baby. At her last appointment the midwife was unsure if the baby was breech so asked the Mama to get an ultrasound. Before she could, her labor began. I had taken several day classes on breeches and had done only one surprise footling breech so I was quite anxious to help. I swapped with another midwife so I could help. 

It didn't take long for the butt to appear. The body rose higher and higher until it hit the umbilicus. Out comes the cord. I start the clock. One minute goes by, then two, then three tense minutes. The baby stops moving. The lead midwife starts trying to get the shoulders out and we hit the five minute mark. The room is tense. Another midwife is trying to explain to the Mamahow important it is for her to remain calm. At this point I suggest Mama flips over on hands and knees. As soon as she does the midwife has a much easier time helping the baby out. At around the seven minute mark the head is finally freed. I take a breath and get busy on the baby. On Mama's belly is this little lifeless body. No respirations and zero heartbeat. I call out to the other midwife that there is no heartbeat. She grabs a board for resuscitation. I start chest compressions and start breathing for the baby. At the three minute mark I have a heartbeat but still no breaths. It took around 20 minutes to finally get the baby to take a breath. By this point the baby is very cold so I quickly strip off my shirt and put the baby skin to skin with me. Even though my heart is pumping adrenaline at a rapid pace, I'm calm. I keep talking to the baby. "Come on baby, it's not your time to go, stay with me, breathe little one". Finally the baby is stable and breathing on her own. I wrap baby and put her back on Mama's belly. I stay with Mama and baby checking vital signs. By this point that little one is fully aware of what just happened and starts screaming, trying to get her story out. The baby is inconsolable. Reluctantly I finally pick up the baby and snuggle her close. I talk words of comfort to her telling her yes that was scary but she's safe now. She calms pretty quickly and finally looks at me. Yes little one you are safe. That peak into the other world is gone, you are here safe ready to grow and laugh and run. 

The next morning Mama shared with me that even though she didn't say a word while I was working on her baby her heart was in her throat. The smiles and happy thank you's filled that little room. She was so thankful that her baby lived. Watching that precious little baby nurse at her Mama's breast made me thankful to be here at this time and this place. That space between life and death can be so short, but this time the battle was won. For that I'm eternally grateful.

the Couple

Written by Jennifer Gallardo, CPM, LDM and President MamaBaby Haiti

By 7:30am this morning the line outside our door had grown to fill the outside waiting area, and the sounds of chattering and laughing women drifted up to the porch where I ate my breakfast of grits with vegetables. Now, eight hours later, we are finally finished and sit for lunch. We did 40 new patient visits today! So many mommas waiting patiently…. some lay on their sides on the porch floor to sleep during lunch hour. I have been in Haiti for 10 days and this morning I counted the births that have happened since I came. Twenty-three! Today while one of our mommas was waiting, her husband came up to me and asked me if I could fix his eye, which was swollen and painful on the bottom lid. It was not a stye, so I told him I met Dr. Luckson, an optometrist, on the airplane trip to Haiti, and that he would be holding eye clinics this week. I called Dr. Luckson to find out what village they were in today, and then gave the man money for the trip. Three hours later he came back with medication in hand and thanked me profusely for helping him make the connection with the doctor. What a blessing that Dr. Luckson and I met on the plane! I took the man around the corner of the house and sat him on the steps and told him to wait for me. Then I came back with a huge bowl of grits and vegetables and told him to eat, because he was too skinny. He laughed so hard and said, “You make me laugh, telling me I’m too skinny!” By the time he finished eating, his wife had finished her prenatal. I took a couple pictures of them and promised them Echo would bring them a copy. They were very excited to have their first photo’s taken. This is their first baby, and I can tell they are very in love. I am including photo’s of them, because they are so cute.


Feeding the Children

Written June 15, 2015 by Jennifer Gallardo, CPM, LDM and President MamaBaby Haiti

So, I finally have a little internet to post the story of feeding the children in Shada.  It was a wonderful, wild, and crazy day. We had 290 very hungry children show up to be fed. As you probably know, MamaBaby Haiti’s mission is to lower the maternal and neonatal mortality rate and provide a safe place for Haitian women to receive compassionate and respectful FREE prenatal, birth, and postpartum care at the hands of skilled Haitian midwives. However, we are not just busy with births! We are busy training and supporting traditional midwives in the area, training nurses from local hospitals on how to attend births gently within the midwifery model of care, serving as a midwifery training site for Midwives for Haiti, providing birth control and cervical cancer screening, and seeing how we can improve the life of the people in Northern Haiti. We love volunteers, whether you are an experienced midwife, a midwifery student, or a volunteer with no medical background who wants to jump in and help us with service projects. 

The feeding the children service project was born because I am networking with a well known midwife, Madame Bwa, in the poorest part of Northern Haiti, the slums of Shada, in the city of Cap Haitian. When I asked her how I could help her in her midwifery work, she just wanted me to feed the children in her area. This was my trial run, and we will be doing this project more often with our community volunteer groups (contact us at volunteer@mamababyhaiti.org if you want to join us!). 

Saturday I went to the market with Claudin, the house manager of MamaBaby Haiti, to buy the food. So colorful, loud, and busy! A sea of people and wheelbarrows pushing through the narrow walkway. We rented a wheelbarrow and started with two 25 lb bags of rice, two gallons of oil, then 36 cups of beans, and 60 chicken legs, 4 large cans of tomato paste, bags of carrots, greens, onions, garlic, parsley, and a whole bunch of green vegetables that I don’t know the name of. We took the food for safekeeping to Madame Bwa’s home in Shada, and gave her more money to purchase some food items she felt we were missing. The children greeted us excitedly as we unloaded the tap tap into a wheelbarrow. I watched children fly kites they had made out of sticks and plastic along the river bank of their home. 

Sunday morning I showed up at Madame Bwa’s home to help cook and serve. Madame Bwa had enormous pans, set on huge charcoal fires with a rice and bean mixture, a vegetable soup, and fried chicken legs. We began to set up the eating area, a cement area with cinderblock walls that are chest high, a place where she teaches her classes to the community. We laid blankets on the floor for the children to sit on. 

They began to gather, chattering and playful like puppies. I started taking pictures and they would yell, “Blan, Blan!” as they wanted me to take pictures of them making funny faces, or just posing. A pregnant momma grabbed me by the arm and took me outside of the walls to take a picture of her. Soon I was the village photographer, with promises to print and send the pictures with the next volunteer. People gave me their numbers so I could call them when their picture was brought to Haiti. I took pictures of the children patiently waiting on the blankets. I counted 75 children and thought, “I was told 250! We will have so much food!”. But this was just the beginning.

Once the food was brought out and placed on the cement ground, children came from everywhere. Soon we had a hungry mob of children, and I couldn’t even count how many there were. We kept making plates and handing them out as quickly as they were made. Things got a little crazy as everyone was very loud, yelling and pushing to get some food. It was not at all how I had imagined it would be (rows of children sitting quietly and stuffing their faces). Children would grab my arms (I had 15 clinging to me to the point I couldn’t even walk or move to serve them) and beg to be next. I saw their desperation as the first three huge pans of rice and beans were diminishing. Their panic that they might not get fed. They pushed harder to where I got knocked over a couple times. I kept looking them in the eyes and smiling and telling them they would get fed. To be patient. It took us 90 minutes to empty out the pots we had. 

The crowd dissipated, but there were 40 children left. We had run out of the 250 plates I had brought. My heart sunk, as I saw these children that had not been fed. They looked so sad. I went to Madame Bwa and said, I will go buy more rice, we have to feed them. She told me not to worry, that she had an extra big pan of rice and beans in her kitchen she had made. She told the children to go home and come back with a bowl. They disappeared quickly and then returned with their metal bowls, and they cheered and danced, laughing and clanging their bowls in the air, making music. They were joyous. Madame Bwa brought out the big bowl, and the 40 children pushed and shoved again, trying to make their way to the front. I tried putting them in an orderly line, I tried making them sit. Nothing worked as they were desperate to be fed. They would get their food and run out with it to eat alone. 

Finally, we were at the end. There was no more food. “FinI” Madame Bwa announced. There were about 10 children left who had not been fed. I asked Madame Bwa what we could do? My heart felt broken for them. She brought them around her and told them she would make more food next time. Soon they were playing with my iPhone and asking me to take videos of them playing music and drums on their empty bowls. They would laugh as they watched the videos. I kept distracting them with the photo’s and videos. I kept trying to think of what I could do to feed the last 10 children, but soon more children joined us for the photo’s and I couldn’t even remember which had been fed and which hadn’t. 

I brainstormed with Madame Bwa about how to do it better next time. More food. How to control the crowd. Then we started to leave. One little boy burst into tears about not eating, and his momma came and picked him up. My translator had arrived to help me get back to MamaBaby Haiti, and he gave the boy 75 goods to go buy food. I wanted to find the other nine children to give them money, but they had disappeared. 

I felt mixed feelings. Very happy for the children we had fed. Determined to do this again but better next time. Heartbroken for the nine who went away empty handed. I meet on Wednesday with the Plumpy Peanut non-profit group, that has medical food for kids and pregnant women and want to partner with MamaBaby Haiti. Wednesday afternoon I will see if I can take some Plumpy Peanut to Shada and find some of the children who’s pictures are haunting me. Overall, this was a wonderful service project, and we would love your help to repeat it! I truly think that for many of these children this was the first time in a long time they had a full tummy.

Jill's Story: Part 2

By Jill Roper on November 27th 2013

I was so excited getting to the actual compound that MamaBaby was housed in. What I encountered when I first walked in is called baptism by fire. It would be the theme for the rest of the journey. Life throws us many curves. Some we are prepared for and some we are not. I think my life experiences prepared me for this mission I was on.

Kelli and I walked into the clinic and on the right was the post-partum room. It housed 4 twin beds for use by Mama's who had just delivered their babies. Typically a Mama would stay four hours after the birth. If she birthed at dark we would keep her overnight. One such birth had occurred several hours before I had arrived.

The baby had a hard time at birth transitioning and had to be bagged for quite a while. When we walked in the baby was seizing. There was a quick discussion about the baby and his condition. Now remember, in the U.S. we have 911 to call. An ambulance with trained perimedics come and handle the crisis by transporting the person by ambulance. That is not the case in Haiti. There is no 911 and there are no ambulances. While I watched the situation unfold two Mama's arrived both in labor.

Morgan an American midwife had just arrived the day before and had been at the birth. Kelli assigned me one of the Mama's and Morgan took the other. My suitcases filled with all my supplies had been taken upstairs so I ran to get my instruments. I remember Kelli coming into the room and asking me if I would be okay and calmly said, "sure no problem" where inside I was calming myself down! The orientation would have to wait. In fact, I never did get the orientation. Morgan clued me in as we went along.

Morgan and I quickly became great partners. She is a young wife and Mom who will be traveling to South Sudan with her husband to work out in the bush training midwives. She helped me figure out the forms I needed to fill out and the proper protocol.

Birth in Haiti is nothing like birth in the United States. The current mantra is "Birth Without Fear" which sounds great in the states but is not realistic in Haiti. It has the highest maternal and infant mortality in the Northern Hemisphere. It isn't realistic to tell them not to fear when all around them they see death.

My first Mama was a young woman having her first baby. She came in beautifully dressed in a long flowing dress. Her labor was so hard for her. Typically a cousin or sister or mother would come with a laboring Mom but my first patient was all by herself. These Mama's are so brave in spite of the fear surrounding birth, and she was no exception. She would walk the first flight of stairs in the main room up and down, up and down. I was providing labor support for her by doing counter pressure and we ended up on the floor during the hardest part of her labor. I sang to her, rubbed her back and generally tried to walk with her through all the contractions.

Every four hours or so we would do a vaginal exam to make sure the labor was not stalled. She was only three centimeters but having one contraction on top of another. I assumed it would be a very long night but less than an hour later the baby arrived. My first baby born in Haiti. We would have three more labors back to back that first 24 hours. I loved every minute of it. I was thinking in my head, well this isn't so bad. All the Mama's had relatively smooth births. The first few babies didn't even have a cord wrapped around their necks. I was beginning to wonder what the big deal was in Haiti.

You know that saying, "what goes up, must come down?" My first four births were easy.  That would not always be the case from that point on. I learned to celebrate the births that were "easy" deeply breathing a sigh of relief and thankfulness to God. When things did not go well I earnestly prayed to God for wisdom, strength and above all a clear head. I would need it in the coming weeks.

Jill's Story: Part 1

Written by Jill Roper in 2013

When I got off the plane in Cap Haitian I entered a whole new world. The temperature was blazing hot with enough humidity to fill a swimming pool. There was a little Haitian band on the run way playing music for us as we walked into the "terminal". The room we walked into was shoulder to shoulder. When it was my turn to get to the desk I handed the man my passport and he wanted to know where I was going. MamaBaby is all he understood. He wanted an address and I had no clue. Once through customs I walked into another room that was total chaos. Kelli, the President of MamaBaby was there to greet me along with the director, Santo. Kelli was easy to pick out, she was the only white woman. There was so much yelling going on I was in shock. Kelly told me to come stand by her and be quiet. Not that I had anything to say with all that was going on!

Santo was up at the front of the room with my three huge suitcases and an extra box of supplies opened up on a table. I watched as they went

through all of my things. What I later learned was the Haitian government taxes all things coming into the country, especially supplies brought to help the Haitian people. Apparently after the earthquake crates full of supplies poured into the country and they taxed it all, sometimes thousands of dollars at a time.

It seemed like it took forever for the men to decide what they were going to charge for all my stuff. Thankfully they didn't hunt too hard in suitcases because had they seen all the supplies they would have charged alot more for me to get in. Finally I was told to follow Kelli and Santo out. The sidewalk was lined with Haitian men on either side. It felt surreal.

Once we past the entry way into the parking lot a dozen young men or so flocked around us. They all wanted to carry my luggage. They all jostled to see who would get them. Kelly was walking so fast I was having a hard time keeping up with her. I wanted to yell to her, please don't leave me here by myself. I felt like a little kid again in a busy store trying to find my mommy!

When we got to the car all the young men followed with my bags. That is when a discussion was started as to how much to pay and to whom. Seems that those that walked along side who didn't actually carry my bags wanted to get some of the money too. After another long discussion that I could not understand I turned to get into the car when little boys came up to me. "Please Misses, some money please" I had been warned not to take out a wallet and just have a few dollars I could get to quickly but

I was told to get in the car and there the boys stood, at my window with pleading eyes.

On the outside I looked cool, calm and collected but on the inside I felt like Jonah when he was swallowed by the great fish. I was not where I was supposed to be! Those pleading eyes stayed on me through the glass. I tried to get Kelli's attention saying what am I supposed to do but she was busy trying to get us out of the parking lot. Men flanked the car as we left staying right with us through the airport parking lot.

When we were finally free I breathed a big sigh of relief which didn't last long because we turned onto the main road in Cap Haitian and what I saw stunned me. Years before we had lived in the Azores so I knew what it looked like to step back 100 years into a society that seemed to have stood still. The road was filled with huge pot holes. There were no traffic lights or signs or any rules to go by driving down the road. There were motorcycles that zipped in and out, there were "tap-taps" filled with people standing up in the bed of a pick up trucks and taxis which were like a mini-van crammed with 10 or 15 people. New York city taxi drivers have nothing on the Haitians!

On either side of the road there were little open markets. There were men making bricks, there were women selling bananas and mangos. There were people selling little baggies filled with water and there were children walking aimlessly. There were honking horns and chickens. I just sat in the back seat with wide eyes trying to soak it all in.

I remember praying as we drove that God would use me to be his hands and feet. That I wouldn't do any harm while I was there, that I would be a blessing. I prayed for all the hungry people. The farther we drove the less populated it became. We went through one village after another. We finally turned off the main road and wove our way back to a road that housed MamaBaby.

I was supposed to get a tour of the birth center first. That was the plan and what I learned quickly is there are no plans at MamaBaby. When we walked in the plan for orientation was thrown out the window. I would not sleep for the next 36 hours. That story is next...

 

 

 

Martha's Story: Part 2

Written by Martha Taylor in 2012

Ask any midwife to tell you about her first “catch” and you can be certain she will light up and relay the story in vivid detail.  Mine was a year ago! A beautiful baby girl born to the most loving parents you can imagine. It was one of those perfect home births. On the anniversary of my first “catch” I had another first, my first newborn death.

As the other volunteer and I sat with the Haitian staff waiting for our breakfast soup to cool, a mother knocked at the front gate. The groundskeeper rushed her inside and sent the interpreter to get us. She was in active labor and we needed to come fast! I rushed downstairs to admit her and was horrified to hear her pushing as we wheeled out her due date. This baby was below the age of viability, it would not live if it was born today. “Pa pouse, Manman!”(“Don’t push, Mama!”) We pleaded, hoping to slow things down long enough to collect our thoughts. My preceptor gloved up and an exam revealed that this baby was coming now!  A tiny baby boy slid into this world and out nearly as fast. His little heart beat for about an hour, his only attempts at breathing futile gasps. The room was silent. The only sound came from my preceptor as she announced the baby’s slowing heart rate for me to document. When she felt that the heart had stopped she called me over for a second opinion. How strange to stand over a newborn with a stethoscope and hear nothing.  We wrapped the baby in a homemade quilt sent by someone in the States and at mothers request placed him in a box that once held bags of IV fluid.  In the two weeks since my arrival, our groundskeeper has buried 13 placentas under the banana trees. Thirteen swaddled babies have left this clinic to head home by foot, cars, tap-taps, and sometimes motorcycle taxis.  When I attend a birth in the US, I wonder who this child will grow up to be. In Haiti, I wonder if this child will have the chance to grow up at all. But birth has a way of erasing sorrows, and one is never far away here! Our silent vigil was soon interrupted by the interpreter calling us downstairs to admit a mom who was laboring hard. I checked and found her to be six centimeters. “Why don’t you try to urinate again before the baby is born?” I walked with her to the bathroom and watched her closely as she went. Within seconds she yelped, fell forward off the toilet onto her knees.  I fell onto my knees in front of her just in time to catch the baby who screamed her way into the world. “Happy Birthday, Baby!”  I said, watching her blink her eyes and root for her mother’s milk.

Another sad and beautiful day in this sad and beautiful world!

Dreams transport me across blue water to America. In these dreams I search for grass-fed beef burgers and Johnny Cash theme restaurants. I awaken dazed. I pause and then I remember “This is Haiti.” So far from America yet so close. The interpreter was wearing a “Denver” t-shirt today. I think of the T-shirt’s journey, from China to some touristy shop in the 16th street mall and now here to Haiti. Like a moon rock, that landed here from the outer limits of space. I find myself in the home of a Haitian friend.  Four rooms divided into smaller rooms by cardboard and curtains. Nine people live here.  My friend’s brother greets me “Hello. So nice you are here. Do you like Michael Jackson?” he asks and then serenades me with “We Are the World.”  I sit among Haitians like sardines in the back of a pickup truck taxi (“tap-tap”) the roads are bumpy. I’m the only white face as far as the eye can see. The tap-tap stops briefly. The woman next to me hands a melon to a friend waiting by the road and the tap-tap speeds off again. I hold onto my seat as we swerve around motorcycles and pedestrians. The smell of burning garbage fills the air. Later while walking we pass a group of men playing dominoes by the road. The loser has ears and cheeks covered in brightly colored plastic clothes pins. Teenage girls giggle, daring one another to ask to touch my white skin. People on the street yell out “Blan” (i.e. White). Though I know better than to engage them I fantasize about replying in perfect Creole “White person? Where? I’m a Haitian.”  The ditches on the side of the road are filled with trash and I have to cover my eyes as a storm of dust blows through. I call a truce with the mosquitoes promising to spare them if they spare me in return. It appears to be working though some question my willingness to negotiate with terrorists. Another Haitian friend invites me to be the guest speaker at an English class he teaches. The students are so excited to practice with a native speaker and I’m excited to take a break from being a student of Creole for a while and speak my own language. We go over numbers, body parts and days of the week. I attempt to help them say my name and other words that contain the dreaded “th” sound. They thank me repeatedly and resound what I have heard almost every day here “I hope you will stay in Haiti.”

 

 

 

Martha's Story: Part 1

Written by Martha Taylor in 2012

In Haiti, I fall asleep on my back-- something I have never been able to do back home. Somehow it helps me beat the heat. Overall, I am doing surprisingly well tolerating the heat and other discomforts. I’m sharing a bunk room with the two Haitian staff midwives. Marie and Maudelin. Though our communication is limited (but getting better all the time) I enjoy their company.  Our bunk room is upstairs with several other bedrooms, two bathrooms, a dining room, a living room and two wonderful porches. We often nap on the two couches in the living room and sometimes some of the others that live here drag mattresses out to the porch to sleep. I haven’t tried that yet.

My plans to eat lite and lose some weight here have been thwarted by the talent of our in-house chefs. They make delicious fresh meals three times a day. Often they use ingredients straight from the garden. Today we had a chicken for lunch that was running around in our yard this morning (sorry vegetarians). Our meals are usually rice, beans, vegetables, meat (sometimes) covered in some sort of yummy sauce. For breakfast we had an amazing pumpkin soup. And so far we have had fresh squeezed passion fruit juice with all of our meals!

I spend much of my time with the new clinic director, Mary. She took over the clinic from another midwife in May. She is a CNM from Oregon and a complete delight. She is always willing to answer my questions.  She and Santo (the house manager) met me at the airport Saturday morning. They had no trouble finding me as I was the only white passenger on the plane! Mary and I spent most of the day Saturday sitting in the courtyard of a hotel in Cap Haitian (the town where the airport is) having orientation while Santo ran errands. The ride through Cap Haitian and into Morne Rouge (where the birth center is) was beautiful.  The city was bustling with activity. People working at shops by the road, carving and welding furniture and selling goods. I especially enjoyed the women carrying clusters of sneakers on their heads to sell.

After we arrived at the birth center I spent most of the day sleeping. I needed it and was grateful to be arriving at a quiet birth center. But this didn’t last long. Mary woke me up at 6:30 am Sunday morning whispering “Go get your scrubs….one just birthed and two are close behind.” I washed up and ran down stairs where I assisted with two fast and beautiful births. A baby boy and a baby girl. Both women birthed squatting on birth stools (A first for me). The first sang here baby into the world. It was beautiful.  From the little Creole I could understand I got the sense that it was a song she was making up as she went along, about the pain of birth and the baby that was on the way.

 Mostly I am just watching things at this point, getting an idea of how things are done here with fewer resources. What we wash and use again. What we throw away.

We have great interpreters here. They are mostly younger men who leave the room or turn their heads for vaginal exams or births. Sometimes they just look down at their cellphones, texting while interpreting things like “Do you have any vaginal discharge?” or “Do your nipples hurt?” I love the interpreters. They are respectful and easy going.

It is very very hot here and I’m being courted by several rather persistent mosquitos, but other than that I am holding up well. I have purposefully avoided learning the word for “heat” in Creole. It is better if I don’t have the words to know how to complain about it.

This week the realities of the poverty of Haiti became more apparent as I went for walks around the area with the clinic director and the other volunteer. I found myself feeling so grateful for curbside trash pickup and abundant clean water in the U.S. The problems of Haiti are so complex. Sometimes I reach the point where I just want to lay in bed all day and cry….but then I find myself drying a slippery newborn baby and I remember to hold hope for Haiti.

I experienced the most active birth I have ever experienced this week. Imagine-- if you will-- a dancing naked Haitian woman grabbing me, wrapping my arms around her and having me gently bounce her belly while she moved around the room. Sort of like a labor conga line with small shuffling steps. Then when a particularly intense contraction would hit she would drop to the floor taking me with her. She was beating the heat by dumping cold water over her head as she danced.

Being in Haiti means I have to pay attention to everything, which is good, because recently I came to the conclusion that not paying attention to small details was the source of most of the pain in my life (stressing about forgotten school assignments and bills paid late). Here I must pay attention to how much water I use, what goes into my mouth, when there is electricity and when there is no electricity. I have to think ahead. If I go sit on the porch I have to make sure I take a flashlight or face the possibility of having to make the journey back to my room in the dark. Thank you, Haiti for teaching me to be present!

Yesterday, I received a high compliment from one of the interpreters. He said that I have been more diligent in my efforts to learn Haitian Creole than any other volunteer who has come here. I’m sure I drive the Haitian staff crazy, by announcing my every move in Creole. “I would like to eat food” “Would you like to eat with me?” “I am going to wash my hair today.” “I drank some water” “I am going to the porch to listen to my Creole lessons.” In addition to giving a detailed Creole play-by-play all day I usually sit on the porch with some of the Haitian staff in the evening and ask them innumerable questions about Haitian culture and their lives. I have learned so much from their first-hand accounts.