Open your heart to Haiti this Valentine’s day

“Keep calm and cast on” is back!

The wonderful Haitian women and midwives we met have been in our hearts and minds since last August. We were so touched by the midwives and women that we met that we committed to on-going fundraising for both the organisation and a new project to provide free contraception for all women visiting the clinic. This is the single most important live-saving intervention for women, it’s incredibly cheap to provide but simply beyond the reach of most women. A couple of dollars buys a depo injection or condoms and $25 buys a tubal ligation for women whose families are complete.

On Sunday the 12th of February Darn it & Stitch will be open from midday until 4pm with homemade lemonade, tea and homemade cakes available on a donation only basis. There will be Valentine’s cookies and cupcakes available to purchase too for take-home treats for the whole family.

The yarn swap will be the focus of the day. We know that every knitter has a dirty secret; cupboards full of yarn that seemed a good idea at the time but that you will never use… and this is their solution! Bring your yarn and swap it for a new set of inspiration. Basic grading will be done on the day and we suggest donations of £1.50 to £3.00 per swap (up to 3 skeins depending on size). Needles, yarn and basic tuition will be available for those that would like to knit with us for a little while (so please bring your non-knitting friends!).

Anyone interested in donating yarn or popping in to knit with us should email Nina at nina_vanschaick@hotmail.co.uk or search for “mountains beyond mountains” on Facebook.

Come and join us for tea, cake and knitting little red hats!

Darn It & Stitch
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Darn It & Stitch

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DEPO for all!!

DEPO for all!!!!
One fundamentally important legacy that we wanted to leave behind us was to give women the chance to plan their families. This is lifesaving in a country where contraception is costly, myths abound and conception is not always consensual. We earmarked a chunk of our money to buy a bulkload of depo (aka depo provera) contraceptive injections to be offered as part of normal care for all postnates. We are proud to say that here it is and it is already being used in the clinic! We are going to continue to fund this scheme as we feel so strongly that this will make such a significant difference.
Please watch the blog for our latest fundraising events:
                                                                    HERE IT IS!!! This picture makes us so proud.
Depo for all!

A day in Haiti

This is a little taste of an average day for us during our volunteering at MBH:

5am

Wake up time! It’s light on the balcony where we sleep on mattresses under mosquito nets. Even if the sun wasn’t already blazing the dawn chorus started several hours ago – frogs, cockerels and numerous birds, lorries, people on their way to work, cows and dogs.

There were no labouring women last night and we both got a full night’s sleep. We take it in turns to get up and help Marie but always sleep with “one ear open” in case more hands are needed.

We do about half an hour of yoga practice. This is the only time of day we get to ourselves and we decided that yoga was something that was going to help with the intensity of living and working in the clinic.  This is often accompanied by the animated conversations of the women waiting already outside the clinic gate.

6am

We rush to shower whilst the power is on, showering is precarious and it has become a finely tuned art – swift but thorough under the mercifully cold water. The first person to shower always has the guilty thought that an extra second might mean that the power snaps off and your colleague is left with the “bucket” option.

This is the time for blogging and emails home if there is power. The evenings are so short that this is our free time.

8am

Breakfast – mush and fruit. We restock the clinic room with pregnancy vitamins- our stock that we brought with us is soon running low and hygiene kits (a small flannel, soap, shampoo, toothbrush and toothpaste).

9am

Our interpreter Emmanuelle arrives and the clinic begins. We run in tandem with Marie and so two women are seen at the same time. We fully acknowledge this as a confidentiality nightmare- they often know one another. This can lead on occasion to a heated debate where a consultation turns into a bit of a committee event with the other woman putting in her twopence worth as well!!

Sometimes the fan is on for a blessed hour or so. When it clicks off, we both inwardly groan, five minutes later everyone is awash with sweat.

A young primip arrives establishing in her labour. Marie assesses her and encourages her to walk around the garden to help her labour establish and deepen.  Roseline (named changed for confidentiality) dances through her labour, shifting and swaying around the garden accompanied by female relatives. We continue to see women whilst listening to her progress and popping out to listen to the FH every 30 minutes.

Roseline arrives back in the clinic room obviously in good strong labour. We clear the room and make preparations to have a baby. Marie catches a healthy baby boy just over an hour later watched by a terrified dad who is torn between watching his child born and running away.

We help Roseline feed her new son and transfer her to the postnatal recovery area. There are about a million relatives waiting to greet the new arrival. We try in vain to get them to leave her to rest and eventually after washing the birthing linen and her clothes in the back yard the greater part of the relatives leave and just Roseline and her partner are left to enjoy their new family.

14.30ish

We tidy the clinic room and prepare to resume the clinic after a quick lunch trying to catch the hint of a breeze on the other balcony.

We resume the clinic and see approximately another 10 women between us.

17.30

We check Roseline and restock the clinic room for the next day. We discuss the day with Marie – there were things about the birth that we wanted to talk about.

18.00

Time for a shower (if there is power) or a bucket and the ritual application of yet more layers of DEET which means we can sit outside without being paranoid about mosquitos.

We sit on the roof as the dusk falls watching and listening as our little neighbourhood gets ready for the night.  The moon is getting bigger and brighter every night now and we think of all the very pregnant women we have seen today. Anything could happen tonight.

19.30 We have eaten dinner by the light of our headtorches and chatted with Marie, Zeenia and Santo. The power hasn’t come on this evening at all. So its bedtime for us! Hoping for a full night’s sleep we wrestle with our mozzie nets and fall asleep. We keep half an ear open for the creak of the gate.

Pictures!!

So, we are back in the UK and have been flung headlong into our third year of Midwifery training. The clinic seems a million years ago and at the same time we are both still mentally there. A very experienced American midwife is now there and doing wonderful things – please read her blog : http://sarahsojourner.blogspot.com/ and send her your love and support!

There are lots of stories still to be told and we will be sharing them with you over the next couple of weeks. For a start though here are some pictures- double click on them for a larger version (all the women in these images agreed to be photographed and for their pictures to be published online):

Slum area "Shada" in Cap Haitien

A river of rubbish and sewage

A street near the outreach clinic

Beautiful Haiti

Rachel gets a big hug from the undisputed queen of Shada - Madame Bwa, Midwife and mother to many.

Breastfeeding education in the outreach clinic

Rachel doing antenatal consultations in Shada

Clinic with an audience

Wonderful Marie Charles - MBH Haitian midwife

Birthing and clinic room at MBH

A massive breastfed baby!!

Postnatal recovery area with cunning devices for holding up nets - Nina got a bit blue peter. Rachel giving breastfeeding support to a very young mum with a premature baby

Making mum's life easier by teaching her to breastfeed lying down!

Beautiful little prem baby getting stronger by the day thanks to Marie helping her young mum

Disagreements in the UK rarely end with the death of a goat.

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.

Madame Bois

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.

Or not.

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.

A week in Haiti

It seems like a lifetime but we have only been here for a week…. but what a week!!

Journey…

Our flights were fine if a few too many! We survived the dreaded transfer between airports despite being warned by an elderly American missionary Dr behind us in the immigration queue that it was utterly inadvisable due to the small risk of kidnap. It was a bit intimidating to say the least but we knew it was going to be and so braced ourselves. After having to extract our not inconsiderable amount of luggage from a pile – literally a pile with everyone swarming through it – it was like a sort of suitcase armageddon, we piled it all onto one trolley and attempted to push it out of the exit which was no mean feat considering the size of it! As soon as we got out of the airport it was absolute sweaty blinding chaos. about 10 men trying to earn their $1 by grabbing your bag and a million taxi drivers fighting over you. We chose a woman in uniform, standing and looking official- this is a relative term. She lead us to a taxi driver in the car park. He had an ID badge and seemed like a respectable older chap- so we got in the car after paying off the 15 porters, and negotiating the taxi fare, down to a judicious double what it should have been.

The journey was very very short and ended with another cluster of porters hauling our bags out of the taxi before we had a chance to even stop properly. There was quite a nasty fight between two guys over one bag. The domestic airport was not well equipped for our four hour wait. We had to (using a variety of French, sign language and desperation) send someone to buy us bottled water as the only beverage on sale was fruit brandy. Which retrospect would have been apt preparation for the coming flight.  Several ranks of broken chairs and we were initially the only “blan” (all white people) there.  But our stuff got onto the plane (probably because we were four hours early!!) and we sat and played cards and sweated quietly… We met a wonderful 65 yr old missionary called Carol-Ann Truelove – she had lived in Haiti since 1975 and had 24 children (mostly adopted Haitians). She was a midwife and a nurse and her only nod to old age was reducing the amount of long motorbike rides she would endure. She was pretty awesome.

The plane ride was in a word. Terrifying. The plane was so full of luggage at one point shortly before take off Nina didn’t have a seat, a short reshuffle later one was uncovered. It was late afternoon and stormy and even the locals were looking a little nervous – the 12 seater plane dropped clean out of the sky about every 5 minutes and we spent most of the journey in thick cloud which occasionally parted to reveal enormous mountains! Eeeep! Breathing a huge sigh of relief we landed in Cap Haitian airport – which was one not very big building with holes in the side for luggage to be posted through.

M’rive Ayiti nan!

Moses the taxi driver picked us up and we wove crazily through the streets of Cap Haitien. Its very much as we expected, concrete buildings crammed with people and signs and gutters overflowing with rubbish, crazy traffic and lots and lots of people and all under the broiling sun. The road almost unimaginably pot holed, with cars veering clear across to the other lane to avoid minor canyons in the road. It is a question of the smaller the faster with moto’s overtaking cars overtaking taxis overtaking school buses overtaking lorries- in two directions on both sides of the road. We arrived a little travel weary at MBH, sweaty and generally a bit frazzled. The place is big and is inside a compound with a big two storey building,housing clinic rooms downstairs and accommodation upstairs. There are shade houses (like the opposite of greenhouses 🙂 that Rachel and I have taken charge of ripping out and planting again), there are banana and mango trees and tonnes and tonnes of Basil that Dr Zeenia has planted. Things grow so vigourously here! One of the many basil plants is waist height (on Rachel) and almost as wide, the lemongrass could hide a small child within.

There is a family who live in another building. Dupliese is the cook and her husband Jason is the guard, their son Junior does the gardening and is generally handy – there seem to be lots of other relatives and occasional visiting neighbours but until our Kreyol improves we cant put the puzzle together. Rachel and I have a large dormitory style room to ourselves but sleep under nets out on the balcony where you have an amazing canopy of stars and it is marginally less sweaty!

Marie Charles the midwife lives here too and so does Santo the translator. His little 14 yr old cousin is staying at the moment too – she is very sweet, speaks good french and is generally fascinated by the “blan”. We make a welcome distraction from her homework.

Mamas and Babies (and Famn Saj’s)

Marie runs a clinic every day and MBH have got a translator called Elize to work with us which is really helpful. There are generally about 20 women waiting at the gate every morning to be seen so its a long day. She is also on call for any births (we had one during clinic  the other day – just as you do. (Cannot imagine that happening in the UK). Marie speaks French so we spend our days speaking our cobbled together schoolgirl french with her and filling in the bits that we are learning in Kreyol (also sometimes in desperation just saying things in a French accent – worth a go and it sometimes works!). We have asked for some Kreyol lessons from Santo the translator as it will help us get up to speed. We are starting to understand more and more every day as we hear the same words over again in clinic- often the words we hear in English every day when in clinic.

It’s a big shock though. There is no referral system – we see several women each day who really, really urgently need to be in hospital (i.e. a community midwife in the UK would have put her in an ambulance – 2 + of protein and a BP of 240/130). The saddest so far was a 17 year old girl. She was a domestic servant and had no family. She also had quite severe learning difficulties. It sounded like she had been raped and was now about 35 weeks pregnant. She had something called Olighydramnios – where basically the placenta isn’t working well and there isn’t enough water around the baby – the baby was literally outlined clearly and when Rachel and Marie palpated her abdomen neither could feel any fluid. It was almost certainly linked to malnutrition and the prognosis isn’t good, there is simply no way she could afford to go to the hospital. Marie wrote a letter to the doctors there and we gave her vitamins and a bag of food supplements. It was unbelievably depressing- even if we help in the short term, in the long term it is hard to see how she ill feed her child when she cannot feed herself. Nearly all the women we see here are malnourished and about 90% are anaemic. When you ask them how many times they eat in a day they look embarrassed and say that when they find food they eat it.

We also had a girl collapse in the waiting room and she appeared to be fitting but  we were relieved to find she was actually ‘only’ hyperventilating- and had been for a week. She quickly regained consciousness and we did all we could – i.e. Marie cannulated and got some fluids up but she had had chest pain for about a week and her respiration rate was ridiculous, near 100 breaths per minute (try it). She was scared and there was nothing really that we could do. We sent her to hospital on the back of a motorbike with a family member holding her bag of fluids up. That is the reality here.

Marie says that there is someone like this everyday and her heart so obviously breaks every day when she can do so little for them. A lady came at the end of clinic on thursday and Jason let her in thinking she was in labour and should be seen quickly. We quickly realised that she wasn’t contracting but was in severe constant abdominal pain with abnormal abdominal swelling that increased and a low-grade fever that rose as we sat with her, she had also been bleeding that morning. The baby sounded fine but for how long we couldn’t say. Everything closed down on Thursday because of the news of the coming cyclone and so when they tried to find a tap-tap (local transport – a pickup with a sort of hut welded onto the back) for her they couldn’t. Her young husband had apparently been to market to sell a cow and had to wash and change before coming to get her (!) we all sat with her as it got dark and her sister kept calling the husband and telling him to hurry. She eventually was propped up on a motorbike and we won’t know what happened to her unless she comes back and tells us.

But sending these women to the hospital isn’t really any sort of better option. The training of the Drs isn’t great here. It is extortionately expensive to be treated and you have to send your relative to the pharmacy to buy your drugs for you. It’s expensive so they often buy from people on the street. Needless to say there is no way of telling what they are getting in those grubby plastic bags. And if they can’t pay….well. But that is how it is and if you start to focus on all the bad stuff then that is all you see.  It is important to remember that although MBH cannot save everyone, it saves many, giving women a place to birth their babies who would otherwise have nowhere but home to go.

But we are learning so much each day. We are already seeing that there are small things we can do to help in helping Marie access resources and discussing our ‘up to date’ breastfeeding skills. We are also going to one of the slum districts called Chada on this coming Thursday to meet a traditional birth attendant called Madame Bois. We are both very excited about that.

It is amazing that these women have access to Marie’s and soon another long-term American midwife volunteer here, and another Haitian midwife is rumoured to be on the horizon. It is obvious that it makes a big difference.

Thank you for continuing to support us!

The work of MBH is amazing. Please encourage your friends and family to read our blog and donate via their website! They rely on donations for every single thing here. Even the most basic things like prenatal vitamins and iron can make a huge difference to individual outcomes.

We are having some issues with photo uploading at the moment but hopefully in the next post! Watch this space.

Lots of love from beautiful Haiti.

Nina and Rachel

 

A Huge Thank You to…

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