Well. The last week has been much in the same vein as the previous week, busy clinics, sweat etc. We planted kale, beans, book choy and beets after ripping out the old and untended plants from the shade houses. An agronomist called Luke has planted broccoli and cabbage in the other before we could get our hands on it! So we are looking forward to seeing these plants shoot up before we leave. Already beans, beetroot and kale have made an appearance.
Sharon from St Francois brought a lady here on Tuesday evening – she was about 8 months pregnant and had had a bit of a day of it! Sharon brought her here because she didn’t know what to do with her and as she couldn’t pay, she couldn’t even get fluids at St F (Sharon gets so frustrated – her NGO sends Medicines for free which the hospital then sell through the pharmacy – pretty standard). Apparently the woman’s sister’s goat had got into her husband’s garden and demolished it- as goats do. In a fury the husband had killed the goat. She had obviously got very upset and had fallen over and fainted. Sharon had done a great job of calming her down but she was still experiencing some abdominal pain from hyperventilating. We gave her some love basically, as there was nothing physical wrong with her, some water and food and a bed to sleep in so that she would know that she was near a midwife. Both her and her husband (the goat assassin) slept soundly and went home in the morning looking much better. Unfortunately we cannot say the same for the goat.
Adventures in Cap
We decided after the pregnacare that we had brought ran out that the key need for the clinic is iron. Every single woman is anaemic. So we went into Cap and bought some. Its not very expensive and potentially lifesaving if we give every woman over 35 weeks at least two weeks worth, and the grossly anaemic whenever we first meet them. So that was a little victory for the week as well as the purchase of some Nifedipine and Methyl Dopa for emergency use in cases of severe preeclampsia by Marie. We also caused hilarity by photocopying some of the brilliant breastfeeding posters donated by the wonderful Sally Inch. Everyone in the copying place had a look and a giggle – some things are the same the world over.
We also attended a clinic this week in a slum called Shada. It was pretty indescribable. People living in tiny concrete (if they were lucky) shacks tightly packed surrounded by mountains of rubbish with a filthy river running through it choked with rubbish and debris. It was pretty shocking even compared to our area in Morne Rouge and what we have seen of the rural villages. Urban poverty is always the worst and most desperate. Madame Bois – a semi trained midwife/traditional birth attendant looks after the women there and we observed her clinic during the morning learning a lot about the challenges she faces . Zeenia and Sharon were running their medical clinic alongside as well.
We had asked Madame Bois if it was ok to see all the women together first and do a quick presentation on breastfeeding – putting up some of the posters that we had photocopied on correct attachment as all the women here feed only on the nipple and we are seeing a LOT of dehydrated babies. We had a slightly bemused audience but may have helped in a small way – at least the images are on the wall for all to see! Then we saw lots of babies and bumps. The usual really.. all really anaemic – one really pre-eclamptic woman who we arranged to go a see Sharon for free BP meds. There was a very jolly fat baby with crazy skin tags everywhere including extra little fingers and large mucous polyps in his mouth. I realised as she examined him that he wasn’t following me with his eyes. I think he will probably be blind.
It was sobering indeed. But we managed to give out some iron and some education to every woman so hopefully that will make a small difference. Most of the women we saw were normal but really really anaemic. As they have no money to give birth in the hospital or access any services they stand a good chance of bleeding to death at home. We helped many women to breastfeed, which is one of the rays of light in our days. Seeeinging a baby perk up after a good feed, se a mother’s face as she realises the difference between a good latch and a baby just sucking on a nipple even our translator Emmanuel is getting a bit excited with the changes he sees in babies once they have had one good breast feed.
Nina had the idea to get the kids in Shada to collect some bottles for us (there are a LOT lying around) in return for a small prize (pencil or piece of chalk). We are going to use the bottles to plant beans or corn in and then take them back and give them to the women to plant anywhere they can. The kids were shy at first and then we got hit by a tidal wave of bottles. Rachel was in charge of making the exchange of a bottle for a prize, and at one point there was a fear she may get swallowed out from the melee, but Madame Bois was on hand and hauled her out of the scrum with a giant hug. It was great! Pictures of the sprouts to follow on our return we hope!
Sunday saw Nina up at 6.30 for a labouring woman. It was her 7th baby after 6 normal deliveries at home. One of her children had died from an infected umbilical cord at 10 days (so sad and preventable) but in this part of the world 5 healthy children from 6 pregnancies is pretty good going. Most of the women that we have met here have lost at least one child. It was a strange labour and Marie made the decision to transfer her as there was no descent of the head after an ARM at 7cm. It was a really long process to get her to hospital but I think it was the right thing. With no access to scanning it is impossible to tell whether the baby had some sort of abnormality or whether there was something obstructing descent- potentially a huge fibroid or dead twin? We can see that transferring someone is a hard decision for Marie, but one that she makes often.
A Saturday stroll
Last Saturday we ventured beyond the compound on a well intentioned day trip that turned – rather predictably – into a bit of an adventure. We had been told (by the perspiring retired American physician) that we had to go and see the Citadel Laferriere – the eighth wonder of the world. So we duly arranged to go.
Moses the rather too smooth talking taxi driver picked us up at 7am and we explained that we needed to get some food for lunch and some water. This caused consternation but eventually we made it to Milout – the little town at the bottom of the MOUNTAIN leading to the citadel and whilst constantly discussing how everyone there knows him etc etc etc we managed to purchase one cheese sandwich and some water each – sufficient we thought for the 45 minutes it was going to take us.
To understand the trials and tribulations of the day you have to realise that there are two ways to get to the Citadel (http://en.wikipedia.org/wiki/Citadelle_Laferrière). You can drive up most of the way on a fancy paved road that the Americans built and park and walk from there (around 45 minutes), because we have had quite a busy week and were pretty exhausted this was the ideal option and what we arranged with Zeenia and with Moses. Or so we had thought!
The other option is to walk the full 7 miles ascending over 910 m. So, no. Ha ha!!
Moses, however, had other ideas. Although we were paying him for the whole day he had another customer to collect in the time that we were walking. So he dropped us off at an official looking gate and we toddled off. We started out waving off the mosquito-like men who kept popping out from behind pillars and offering their services as guides or trying to get us to mount their scrawny, tired looking ponies or motos. We struck out bravely on the steep paved road. After about an hour we were still climbing and pondering whether we were just very slow and why we could only still see the jungly mountain looming overhead. After two and a half very, deeply sweaty hours we twigged that wasn’t the short route after all and had a … well, enlivening conversation with Moses who was all righteous indignation. We had to call Zeenia to intervene and tell him to meet us at the 2nd car park at 1pm. We finally reached the fabled 2nd car park after about another 40 mins of steep climb in the by now not inconsiderable heat. Mounting a final assault was a long process – at least we could now see the Citadel – it was so far away and at such altitude that we both wanted to lie down in the road and throw a toddler-type tantrum.
It was, eventually, worth it. And after collapsing in a crumpled heap we walked around and admired whoever was mad enough or perhaps brilliant enough to build such an impenetrable fortress. We both observed that an attacking force would have given up long before we did. The views were extraordinary and although we did take some photos they never ever capture the sheer awesomeness of the view!
So we trekked down again – discovering a whole different set of muscles that had been snoozing during the ascent – and ran the gauntlet of souvenir selling ladies to get to the cars-no small feat. It was no surprise but with a heavy heart we realised that he wasn’t there and wasn’t likely to be. Neither of us had signal on our phones. This isn’t a country where you can just hop in a car with anyone and so this left us with a considerable problem. Luckily we had briefly chatted with a fellow Brit and his Japanese partner up at the Citadel and as they came back to their nice big white World Food Programme landcruiser (snazzy!) we blagged a lift to the bottom. They were both working in PAP (which sounds like a completely different kettle of fish to here) and flew over for the weekend. They had both worked long-term in Bangladesh, Zimbabwe and tonnes of other crazy places so it was a shame the ride wasn’t longer! We found Moses waiting at the bottom – still indignant. We had pretty silent drive home after deciding that we didn’t want to discuss the ridiculousness any further and Zeenia had already told him that they were never using him again. Tired but fuming we arrived back home. The only positive note was that the power was on for the briefest of flirtations so we both got to shower – hurrah!
Showering is always a carefully choreographed dance in the MBH house. We never quite know how long the power will stay on. Showers must be performed with speed and priorities must be considered- for example, I need to wash my hair- must do that first it is more difficult than washing the rest with a bucket and a sponge. If you turn the light on you get about one minute after the power goes off to finish off, before the water pump stops working. There is also the additional concern of the 2nd showered who eagerly awaits the sound of the shower being turned off to prepare herself, towel in hand for a sprint to the shower, a similar considering of priorities and then- if she is lucky a few minutes to relax before the power turns off- or stays on- you never quite know.
We cannot believe we are approaching our final week with so much left to do! Our big goals for the rest of the time here are:
Finish converting the bottles into bean and corn seedlings.
Build two compost heaps out of used tyres to get the garden a bit more self-sufficient – earth is mega-expensive here.
Buy out all the ferrous sulphate (hardcore iron supplements) in Cap.
Have a big breastfeeding session with Marie, Zeenia and some Nurses from surrounding hospitals who will then take some posters to put up in their maternity wards.
So much to do and it seems so little time. The moon is also full at the moment which combined with lots of women 37wks and over may make for an extremely busy last 10 days.