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.