This month is very exciting for us. We are getting closer and closer to having a completed (printed and in our hot little hands) "How To" manual for the Heartline Maternity Center.
Our model is being shared and we are calling it, "The Starting Place".
The manual contains eleven years of learning things the hard way and the details of the current Prenatal Program, Postpartum Program, Birth Control Program. and Youth/Teen Program. It has taken many years to get here. We first talked about sharing the model in 2013.
We are hosting our first (pilot) class this week with four participants from other organizations also working in Haiti. The participants are helping us find what we forgot and are giving valuable feedback before we go to print.
** See this post for more information about The Starting Place. **
What is it?
It is a technical manual. It describes everything we do, from the beginning to the end. It includes protocols (medical and practice protocols) and tons of administrative details. It includes ways to start small as a prenatal education or birth control program and and grow into a full service holistic birth center offering maternal health care from early pregnancy until months after delivery. It shares a few case studies. It is practical. It is step by step. It includes all aspects: education, relationship, medical, spiritual, physical, cultural, etc., etc. It is a little bit overwhelming.
What is it not?
It is not hundreds of stories or interesting detailed descriptions of the more than 850 women that have delivered at the Heartline Maternity Center. It is not all or only medical and practice protocols. It is not all statistics about maternal health and information you can find by doing a google search.
Each time a new woman starts the Prenatal program, we do a social and obstetric history interview.
Our model is being shared and we are calling it, "The Starting Place".
The manual contains eleven years of learning things the hard way and the details of the current Prenatal Program, Postpartum Program, Birth Control Program. and Youth/Teen Program. It has taken many years to get here. We first talked about sharing the model in 2013.
We are hosting our first (pilot) class this week with four participants from other organizations also working in Haiti. The participants are helping us find what we forgot and are giving valuable feedback before we go to print.
** See this post for more information about The Starting Place. **
What is it?
It is a technical manual. It describes everything we do, from the beginning to the end. It includes protocols (medical and practice protocols) and tons of administrative details. It includes ways to start small as a prenatal education or birth control program and and grow into a full service holistic birth center offering maternal health care from early pregnancy until months after delivery. It shares a few case studies. It is practical. It is step by step. It includes all aspects: education, relationship, medical, spiritual, physical, cultural, etc., etc. It is a little bit overwhelming.
What is it not?
It is not hundreds of stories or interesting detailed descriptions of the more than 850 women that have delivered at the Heartline Maternity Center. It is not all or only medical and practice protocols. It is not all statistics about maternal health and information you can find by doing a google search.
Each time a new woman starts the Prenatal program, we do a social and obstetric history interview.
Often women we work with in Haiti have a hard time recalling and easily verbalizing much of their history. It can take a while to gather the information. It is usually important to ask the questions in a unique ways to get the desired (and hopefully accurate) information.
We are realistic enough to guess that at least half the time we still did not get it all completely accurate because it was neither recalled or shared with that sort of precision.
We are realistic enough to guess that at least half the time we still did not get it all completely accurate because it was neither recalled or shared with that sort of precision.
It is best to ask questions in an assumptive tone. For example, sometimes women assume if we are asking them, "Have you ever had an abortion?" that perhaps we will judge them if they say yes.
Instead we ask, "How many times have you had an abortion?" We can also follow that up and pose that same question in four or five other ways, changing wording to be assumptive.
If the answer is zero they are fine sharing that but if the answer is 10, it helps that I assumed it was part of her history because it removes their hesitation or concern of being dismissed due to an answer that they fear we won't find pleasing.
If the answer is zero they are fine sharing that but if the answer is 10, it helps that I assumed it was part of her history because it removes their hesitation or concern of being dismissed due to an answer that they fear we won't find pleasing.
Daily life is so difficult, it makes survival and the immediate present the priority, which in turn means that recalling history is not an easy task. The blanket term "poor historian" fits pretty well.
Having, knowing, and understanding your own medical history is actually a privilege. Many in the developing world have no idea what happens at medical visits and more often than not nobody takes the time to describe things to them.
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Having, knowing, and understanding your own medical history is actually a privilege. Many in the developing world have no idea what happens at medical visits and more often than not nobody takes the time to describe things to them.
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We interviewed a 37 year old woman.
We asked, "You've been pregnant many times in your life, yes?" She said, "No, only seven."
That's our bad. That's a cultural difference. 7 is a lot to me. Not necessarily true here.
We started at the beginning and walked through each pregnancy and delivery. Her first four children were all born at home in the house she and her husband have always lived. Those four children, two boys and two girls born in 2005, 2007,2009, and 2012 are all alive and well.
In 2010 their home was badly damaged and some injuries happened due to the earthquake but nobody in their home died. In 2013 she had a baby boy born in a hospital that was never well. She described several anomalies and said he died at 21 days of age. She thinks she was under some sort of curse (persecution) during that pregnancy.
In 2017 she described a situation of a breech delivery and her baby's head being entrapped. She said they had to pull and pull to get the baby girl out. The baby was dead upon delivery. She is now in her 11th week of her 7th pregnancy and will be getting prenatal care for the first time ever in her life.
When I finished the interview I said, "Wow. That is a lot of trauma you have experienced in your life. That is really difficult." Tears welled up in her eyes. She nodded slowling in agreement. So often in a culture of non-stop challenge and frequent trauma, there is not time for anyone to fully acknowledge the pain of what has been experienced.
Part of the model at Heartline that we are hoping to share with others, is the importance of empathy.
In 2010 their home was badly damaged and some injuries happened due to the earthquake but nobody in their home died. In 2013 she had a baby boy born in a hospital that was never well. She described several anomalies and said he died at 21 days of age. She thinks she was under some sort of curse (persecution) during that pregnancy.
In 2017 she described a situation of a breech delivery and her baby's head being entrapped. She said they had to pull and pull to get the baby girl out. The baby was dead upon delivery. She is now in her 11th week of her 7th pregnancy and will be getting prenatal care for the first time ever in her life.
When I finished the interview I said, "Wow. That is a lot of trauma you have experienced in your life. That is really difficult." Tears welled up in her eyes. She nodded slowling in agreement. So often in a culture of non-stop challenge and frequent trauma, there is not time for anyone to fully acknowledge the pain of what has been experienced.
Part of the model at Heartline that we are hoping to share with others, is the importance of empathy.
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From the Starting Place Manual - an excerpt from the Philosophy of care section ...
Empathy
Spend any amount of time at a hospital in the developing world and there is one key component to women’s health consistently missing: empathy.
Being a woman in the developing world requires a tremendous amount of grit, resourcefulness, and resilience. But a woman is almost never as vulnerable as when she is pregnant, giving birth, and post-natal.
Trust matters, relationships matter, and empathy is more valuable than we can express. Empathy is communicating a message of great value, a message that says, “You are not alone.” It is rare. As Tara says, “Several of the hospitals in the city where I live, as well as the hospitals and clinics where we’ve worked around the world, who serve the materially poor are lacking the most valuable resource: compassion. Nothing sustainable and life-affirming happens without warm, loving relationships and a lot of compassion.”
It might seem odd to start off the technical manual of Heartline’s Model of Care with a seemingly unprofessional words like “kindness,” “empathy,” “compassion,” or “love” but it has been our experience that this is what truly transforms women. It can bring calm to chaos, hope to despair, connection to isolation, faith to fear. And all of those things matter every day in life but particularly so in birth.
Working in the middle of devastating poverty, one quickly learns that not every story has a happy ending. There are areas of frustration, despair, and brokenness all around us. We cannot fix everything. But we have decided to embrace love and compassion as our philosophy, as much for our patients as for our own souls. This is even more important to us in the face of despair, hurt, wounds, and trauma.
As one small outpost of health and wholeness in the worldwide maternal health crisis, we choose empathy and love and we center love and we practice love. We are committed to excellence, to integrity, to thorough training, to steady competence. But even our excellence of care, our integrity, our training, our competence must be grounded in a philosophy of love. Maternal health has for too long been sidelined and de-emphasized in the world: we believe women deserve not only competent and thorough care but they also deserve dignity, respect, and to feel loved in their most vulnerable moments.
