The month of November is going to be over soon, thanks be to God.
I am not okay with November 2018.
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."
**This story is shared with the permission of Evan's Mother, Narline.
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.
