Truth Without Consequence

The month of November is going to be over soon, thanks be to God. 

I am not okay with November 2018. 

Narline and Adrian's home 

We went to visit Narline and her husband Adrian today. 

Narline is the (formerly) pregnant woman in the Prenatal program that we transported last week Tuesday night. On that night the roads were blocked in several places.  Each road block we were able to move. Rocks and other debris, trees, and market stands were all used in different places along the 35 mile route. On the way back home we had to negotiate with some men a bit but we were let through again. 

This was Narline's first pregnancy. She came into care in her 8th week of pregnancy. She learned about the Maternity Center from a friend.

On the 20th of this month Narline arrived to the Maternity Center in labor. She started labor at 40weeks and 5days, a very average time to have a baby for a G1. 

She labored for several hours, everything progressed as normal.  At first Narline was dilating at an average G1 pace. Nothing concerned us except that baby's head wasn't coming down into the pelvis as well as we hoped.  We tried a few things to see if we could encourage baby into a better position. Midwives and OBs hope and want babies to be actively descending into the pelvis by the time labor is really cooking. The ichical spines are the marker for a baby that is at "0 Station". Narline's baby's head was -2 station. 

(For birth nerds, here is an explanation.)

At 9pm we decided that Narline's baby wasn't coming down and we made a decision to transport her. The secondary reason we made that decision when we did, is that her baby's fetal heart tones had gone up a bit. We were concerned that he was showing signs of stress. 

We are midwives, not doctors, and we do not play games with lives. If we feel there is a risk, we get in the ambulance and we go. 

The ride to the hospital took longer due to road blocks. We brought her into the labor triage area at 11:25pm. 

The next morning when we woke up we called Narline's sister to ask if baby had safely arrived. Narline's sister informed us she had still not delivered.

Around 1pm the 21st Narline's sister finally called to tell us they had gone to do a C/S and the baby had died.  She said they showed her the baby boy and allowed her to take a photo for Narline. Around 2pm she called again to say that nobody had come to tell Narline. She wondered if she was responsible to tell her own sister what happened by herself. 

On Friday Narline was released from the hospital.  Rather than have her come to the Maternity Center where the two other babies born that same day were still in house, we decided to take Narline home. Narline said we could come do a postpartum visit with her today.

Today Narline** told us the following story:

She got to the hospital and was given a bed after a while. She was put on Pitocin.  She remained 7cm and the baby's head stayed high with each check that was done. Around 7am (after being there with contractions for 8 more hours without progress) she asked, "Why aren't we going for a C-Section?"  

The Doctor she asked that question did not at all appreciate being asked that and responded unkindly. She told me exactly what he said but I won't pass it along here because it is terrible and I hope to get to talk to the hospital administrator about this. 

They kept trying for a vaginal delivery with Pitocin. She said her baby's heart was still beating and she was able to hear it on the monitor.  She said all of a sudden things changed and they said, "We have to go for a C/S".  She said she was put under general anesthesia and that it took a while to get her into the OR.  When she woke up she was not sure where her baby was. After a bit her sister came to see her and she asked her sister where the baby was.

Narline has one photo of her baby, whom she named Evan. Narline never held her son. She was given a photo by her sister. In the photo he is perfectly developed, beautiful, with a gorgeous head of curls, and he is lying in a cardboard box. 

I am not sharing this to blame any one person or even the hospital.  
Evan has died and that cannot be changed.  

Haiti lacks a few major things and until it is addressed, nothing will change. 
More Narlines will lose more Evans.

First, there are not enough doctors, hospitals, clinics, or caregivers to meet the needs of the 10 million person population. 

I'm most familiar with the options for women's health. I don't have vast or specific knowledge of how other sections of health care work. I do know that it is frustrating that it never seems to improve. That is a issue to be addressed at high levels; sadly those at the high levels suffer from the illness of corruption. I would love for there to be zero need for non-profits and humanitarian aid groups. I would love if everyone could deliver safely with a caregiver. This is an actual crisis.

Second, there is classism and racism and education-based inter-group bias - which apparently is actually called educationism.  

It is not uncommon at all for patients to be treated poorly.  The rarest thing to find in Haiti is a person that knows what their medical history is and has been given an explanation for why things are happening.  9 out of 10 women we interview cannot tell us why they needed a C/S in a past pregnancy.  Nobody bothered to tell them if it was due to pre-e or a poorly positioned head, or something else entirely. 

The poor are not allowed to advocate for themselves without making an educated person feel threatened. Medical professionals do not share information with patients. It is wrong. The lack of compassion is so painful to observe.  The power differential is beyond unfair.  

Now, you might say that number one causes number two.  I agree.  

Not enough doctors and medical care providers means the ones working are pissed-off and overworked and therefore they behave in inhumane ways. 

Narline knew what she needed, so she asked. That ticked off an educated person and I have little doubt that it played into the final outcome. (Of course I can never prove that.) 

Narline's husband attempted to get answers from the hospital, but the materially poor don't get to be angry. The poor take what they are offered and are supposed to be grateful for it. 

Adrian was told, "It's not our fault. There are too many people here that need care. If there were hospitals in Port au Prince near you, then you wouldn't have come here." 

Narline wants her baby boy, little perfect Evan, to be remembered.  

She loves him very much. 

She carried him 40 weeks and he is forever a part of her. 

**This story is shared with the permission of Evan's Mother, Narline. 

Grease the Wheels and Keep Hoping

It is said that hopelessness is the enemy of justice. 

Also, it is often said, mainly by women we work with at the Maternity Center, "Haiti has no justice". As you read that you might think, well - that's hyperbole - certainly there is SOME justice.  

There cannot be zero justice, right?!?

We first came to Haiti in early 2002. I came one week per month for seven months while I waited for Isaac and Hope to legally be free to come to the USA. After all of these years of meeting and working with average Haitians and hearing their experiences and stories, I am here to tell you that it is no exaggeration.

Justice is a commodity - as in you can buy it if you have the means to do so. 

Because the average Haitian citizen does not always have the means to eat three square meals a day and purchase a sufficient amount of potable water and keep their kids in school. For them there is definitely no expendable income to grease the seized-up wheels of justice.

Earlier this year we helped a young woman file a police report for sexual assault. She described what had taken place in detail over and over many times to interview rooms full of men. The manager of that department of the police was very enamored with my friend, KJ.  He was less interested in helping the young woman filing the report than he was in finding a way to get KJ to flirt with him.  He claimed we could pick up a copy of the report if we returned a few days later. We returned no less than four times, but were  given another (always new and creative) excuse why we could not have a copy of the report we had filed. 

It is said that hopelessness is the enemy of justice.

Last week in postpartum class we talked about abuse in Haiti, specifically sexual abuse and children. I shared a few personal stories and posed a question to the women seated in the room. "If we never talk about it or acknowledge it is happening at an alarming rate, how will it ever change? Can we change what we don't address?"  The next 45 minutes were spent with different new mothers sharing horrific stories of abuse. It was hard to hear what had happened in their neighborhoods. Not one had ever been able to report it to authorities. Not one had seen the abuser face consequences. 

It is said that hopelessness is the enemy of justice.  

On Monday, November 5th a little girl named Love was born with probable (not yet diagnosed) VACTERL association at the Heartline Maternity Center. Due to a connection with a long-time volunteer at a local hospital we were able to go directly to a hospital that would see the baby. Typically, Haitian mothers will visit several if not dozens of clinics and hospitals before there is one that takes on the responsibility of diagnosis and care. 

Our experience of being seen the day we walked into that hospital is atypical. Justice in that way came due to connections, which we are INCREDIBLY grateful for and also no more deserving of than any other person. The hospital sent baby Love for several tests, most of which took 8 days to complete. On Monday the 19th we hope to return to the hospital with all of the results of the tests and lab work they ordered to learn what happens next. Returning to the hospital will depend upon the ability to arrive there.  There are rumors of blockades and protests in the coming days which can easily lock up the entire city and render us helpless to arrive at the hospital. 

Mercifully, baby Love has been peeing, pooping, and eating without trouble or these 8 days would have been entirely different.  Love's mother keeps long socks on her to keep her neighbors from seeing her malformed legs and feet.

It is said that hopelessness is the enemy of justice.

Last night a baby boy named Wisler was born at 6:01pm. His one minute APGAR was 1 and his 5 minute APGAR was 2 and his 10 minute APGAR was 3.  At minute eleven he and his mom were in an ambulance heading toward the closest hospital.  At the closest hospital two female medical professionals began asking good questions, at that point Wisler was 30 minutes old. A male doctor walked up and barked, "Can't you see how many malformations and abnormalities this baby has? You need to go to _____ right now!" (He named another hospital.)

Wisler born 11/16 at 6:01pm

I assured him I did see but that we had always been told they were an excellent pediatric hospital. He dismissed us with a flippant wave and told us to get going. Trying to lighten the mood I asked, "What if the next hospital doesn't like my face, we won't get this baby accepted."  As we turned to walk out of the triage room he said, "There are foreigners there, they will like your face." 

We arrived at the second hospital before baby Wisler was an hour old.  The first medical employee to greet us was annoyed we did not have a NICU at our Maternity Center or a referral letter and she did not especially enjoy the fact that the first hospital had sent us on to her. I explained that breathing for the baby and driving to the hospital seemed like a better use of time and resources than sitting down to write a referral letter.  

Wisler was admitted, for which we are grateful.  The reason he was admitted was because we assured the hospital staff that we can pay for his care.  The average Haitian could not afford the small amount (only $57 USD) we spent last night to get things started. The average Haitian would not have arrived at the hospital in an hour. Public transport takes about two and a half times as long as private. 

It is said that hopelessness is the enemy of justice.

Last night, we returned to the Maternity Center at 9pm with Wisler's mom. In just three hours her entire world turned upside down - technically, she is one of the "lucky" ones, she had the connections needed to help grease the wheels.

** ** **

It occurs to me regularly that those of you that read these social media updates and pray specifically for situations we share and financially support the work of Heartline Ministries are the reason we keep hoping.  Your sacrificial love and concern is hopeful and it trickles down. 

You might imagine we don't read messages or see your donations in the busyness of day to day work in Haiti.  

I want you to know today that we do see you. 

We feel the power of your prayers. 

We are lifted from discouragement by your generous words of love sent via several social media outlets. 

We know we can support the costs of the rare sick baby that needs hospitalization because of your generous giving.

You are the grease to the wheels, you are stubborn in hopefulness  - and we thank you this Thanksgiving. 

To learn more about the work of Heartline Ministries, please visit:

www.HeartlineMinistries.org 

Lastly, meet two beautiful little ladies born in the last 24 hours ...

Nadia and MarieLiah - born 11/16 at 5:24pm

MarieAnoute and yet to be named baby girl - born 11/17 at 12:05 am

Waiting on Love to Arrive

New life has always been a symbol of hope. Birth is a new start. On the wall of our prenatal consultation room a sign reads, "Where there is life, there is hope."  

Midwives have the high and holy honor of being with women as they usher in new life and new hope. 

Last night at 10pm Lovely arrived in active labor. She seemed shocked by the pain. I lost track of the count, but she said, 'Miss Tara, this hurts' approximately 73 times in the five hours she labored before her little girl arrived.  

The only thing to respond, 70 times over, is, "Yes, it hurts. It really does."

Motherhood hurts. 

Whether you have an easy life and all the material blessings or a very difficult life with a focus of just surviving day-to-day, giving birth is only the first painful thing in a sequence of events that has literally just begun. 

It is often said, watching your child grow-up and struggle and develop and become their own person is a bit like living with a piece of your heart outside of the protective wall of your own chest. 

Lovely talked a lot during second stage. In between pushes she told us she wasn't sure she could do it.  Once after a particularly long contraction with focused pushing she said, "Am I done?"  

We said, "The baby is still not out, you're not done but you are getting so close."  Lovely told us that KJ had said that it was a little girl during the ultrasound and that she chose the name Chrislove for her daughter but that she would simply call her, Love.

Lovely pushed Love out at 3:13 and ten sconds on Monday the fifth of November. 

Her labor had started at home on Saturday night and  included the extra hour of "falling back", which hardly seems fair.  

In total she worked 34 hours straight. Her labor took her from evening Saturday, through Sunday and into the early hours of Monday before it was finished with a screaming baby girl called Love.

Lovely watched her heart leave her chest last night. 

As we dried off little baby Love I noticed her left foot was formed abnormally. I quickly covered her with a warm blanket to wait and get a better look later.  Love was placed on her Mother's chest and began to nurse.

When it came time to take Love for her newborn exam and allow Lovely to take a bath and clean up, I lifted Love off her Mom's warm chest and saw that both of her feet had not developed normally. Upon further examination we realized her rectum is abnormal as well.

In those moments the very first irrational thought is, "How can we keep this from upsetting her Mother."  As if that is a thing. Midwife Guerline and I whispered about how to tell her.  My brain was busy trying to tell me maybe I could wait and tell her until after she had a few hours to sleep. 

Moms examine their children, and we knew Lovely would come out of the bathroom to really see her daughter for the first time.We showed Lovely her daughter's gorgeous face and perfect hands, we ooohed and aaahhhed over her. We opened up the blanket and talked about her feet and legs.  Lovely shut down fairly quickly.  The words of reassurance and hope fell on deaf ears, she needed time to integrate what she had just seen.

After we had Lovely and Love moved out of the birth room and settled in her postpartum bed, Lovely's Mother in Law came to me. She motioned that we go outside. Then she asked me how we could hide the baby's legs from visitors. I didn't understand. I began to tell the Mother in Law that the main focus for now was to encourage Lovely to bond with her baby and to begin breastfeeding, with our without her eager willingness we need Lovely to hope for Love. I said, we don't have to hide her legs, she's beautiful.

Midwife Guerline saw that I was not understanding what was being communicated. Guerline explained that Lovely's Mother in Law was concerned people that came to visit the baby would say inconsiderate things and believe the baby had a demon or a curse upon her, but if we hid her legs, they would not see it and therefore would not hurt Lovely's chance of bonding. 

We asked Lovely to let us hope for her until she can hope again. 

Will you please pray that supernatural connection is formed today and that by some miracle we can head directly to the correct people that can help address Love's medical needs in a timely manner. 

I read this last night while we waited on Love to arrive .... 

The deepest darkness is the place where God comes to us.
In the womb, in the night, in the dreaming; when we are lost, when our world has come undone, when we cannot see the next step on the path; in all the darkness that attends our life, whether hopeful darkness or horrendous, God meets us. God’s first priority is not to do away with the dark but to be present to us in it. -Jan Richardson

I pray God comes to Love and Lovely and is present to them now.

I Find It Hard Enough To Just Be Faithful

Everything in the grey smaller font print below is what I wrote in 2011 about measuring success. I am reposting it for a specific reason.

This year I have begun to struggle more than ever with the stress of this work we do. Instead of easily remaining mainly hopeful and joyful I have had to fight hard to try to be that way.

I just got back from 16 days away from Haiti. It was a perfect trip and Troy and I truly rested and forgot about work. During our time away I never ever felt a physical desire to drink alcohol.  We had an occasional glass of wine and beers many nights but it was not the slightest bit driven by stress or compulsion.

Today around 4pm I started thinking about having a drink. My desire was not simply because I wanted some down time with Troy. 

For the last year due to stress and some specific situations we are facing I have been medicating my pain, anger, and stress with vodka and wine.  I rarely ever drink one drink only and I went from drinking a couple times a week to almost every single day in 2018. 

I decided about a week ago that I have to do better. I decided not to drink anything for at least two months and re-train my habits of using two Vodka sodas or Moscow Mules to make myself feel less angry and anxious.  I decided to begin November 1, 2018.

Tonight I am staying in my bedroom because the temptation to pour my nightly stress-reliever is too great. 

* ** * ** *

In this work we often find ourselves wanting and needing to provide progress reports to the kind and generous souls praying for or financially supporting it.

While we understand and desire that accountability and honesty with anyone investing in us or in Haiti, it can sometimes feel quite discouraging and uncomfortable trying to quantify progress or label success.

We (Troy and I) spend many nights sitting together asking ourselves what is being accomplished. Is it good? Do we believe in it? Do we feel good about it? We never want to get in a rut or get so comfortable with ourselves or our routines that we don't examine both our motivation and our trajectory.  We need to be asking ourselves difficult questions.

We have no desire to take donations from our church, family, and friends to live here if we cannot say at the end of the day that we are walking this path with God, being faithful to Him and doing things we feel honor Him and exhibit His love. Some days are really confusing because the things that happen in the course of a day aren't necessarily quantifiable. Some days we fall into bed asking each other "Is it right? Does this matter? Should we stay? Is God in this?" 

American culture likes numbers, efficiency, and strict time-tables.  You've got to be able to prove yourself with stats and spreadsheets. In the sports world a new coach has just a few years to produce a championship team or he's out of a job. Even the American church wants to count how many butts are in the seats and how many people signed on a dotted line marked "follow Jesus" or how many will commit to come to the quarterly membership class.  In theory those are good things to value. Who doesn't want tangible outcomes? I'm not up for debating the rightness or wrongness of any of that today, I'm only saying that those sorts of western pushes for big numbers drive ministries working in other cultures abroad to produce reports that don't necessarily represent total truth.

Whenever I read reports out of Haiti spewing numbers, I read between the lines and wonder if the numbers are less about actual provable outcomes and more to please a culture that demands numbers. Accountability is good. We want it. More than that, we need it.  The question becomes, how do the expectations of one culture fit into the reality of working in another? 

If we actually believed like Jesus did that touching one hurting person truly matters, that going the extra mile for one lost sheep is worth it, we wouldn't need to spend so much time counting and proving and counting and proving. 

I'm thankful to be able to honestly share the struggles and not fold to that pressure of reporting big fancy numbers. The frustration lies mainly in the self-imposed pressures to chart it and prove it matters. 

Troy can spend entire day(s) with one timid and afraid 20 year old recently diagnosed and already ill with HIV helping to advocate for her medical care.  He can be at ease as one day turns into three while waiting to get her the tests she needs and fighting a broken, inadequate, and unfair medical system - knowing that he is not expected to quantify the outcome of those hours  ....  time with one person isn't usually looked at as success nor is it at all impressive when plotted on a spreadsheet  - but it matters and it's Kingdom work.  

Last night I read this in Gregory Boyle's memoir titled "Tattoos on the Heart" - it jumped off the pages and deeply resonated with me:

  

"People want me to tell them success stories. I understand this. They are the stories you want to tell, after all. So why does my scalp tighten whenever I am asked this?

Twenty years of this work has taught me that God has greater comfort with inverting categories than I do. What is success and what is failure? What is good and what is bad? Setback or progress? Great stock these days, especially in nonprofits (and who can blame them), is placed in evidence-based outcomes. People, funders in particular, want to know if what you do "works".

Are you in the end, successful? Naturally, I find myself heartened by Mother Teresa's take: 'We are not called to be successful, but faithful.' This distinction is helpful for me as I barricade myself against the daily dread of setback. You need protection from the ebb and flow of three steps forward, five steps backward. You trip over disappointment and recalcitrance every day, and it all becomes a muddle. God intends it to be, I think. For once you choose to hang out with folks who carry more burden than they can bear, all bets seem to be off. Salivating for success keeps you from being faithful, keeps you from truly seeing whoever is sitting in front of you. Embracing a strategy and an approach you can believe in is sometimes the best you can do on any given day. If you surrender your need for results and outcomes, success becomes God's business. I find it hard enough to just be faithful."

Success, I find it hard enough to just be faithful.

* ** * ** *

I feel the same way I did when I wrote this in 2011.  Success cannot be easily measured and some setbacks are actually necessary to correct a ship that is heading off course.  

The only thing that is different is that now I feel more afraid of my anger and grief than I did then.  

I also feel pretty afraid of choosing unhealthy things to help me with stress.  

I hope if you are a praying person or someone with similar struggles that you could toss up a prayer for me to be healthy and take care of this concern now, before I have an even bigger problem.

I would like to be faithful, but I know numbing myself is not the answer to the pressure of it all.