What is it that I am trying to do in this work?

I was just reading one of my favorite bloggers (one of the few I follow), and came across this paragraph that I deeply resonated with:

“What is it that I am trying to do in this work? Is it enough that I (possibly) change the lives some of the women I serve, individually, and moment-by-moment? Have I done enough to encourage fellow reproductive health providers, even when I can only count on one hand the times when I believe I have actually done so? What have I accomplished in the past two years, and what of that can I accept into my heart and good and worthwhile, and what can I let go as worthy work though unsuccessful (as far as I can tell)? What am I able to do in this time, and am I really doing all that I can? How do I reflect on what has happened so far, and move forward?”

(http://www.feministmidwife.com/category/midwifery/#ixzz34IEdVwpt)

This is written by a midwife working in urban America, yet what struck me is the similarity of my feelings… even when I am hundreds of miles away, in a country where XX times as many women die every day due to pregnancy related complications. BUT—what is so incredible to me is the calling of this profession. Midwifery asks so much of you--- for you to have the knowledge and skills, but also to really care about the outcome. To have compassion, to care about each woman you see.

This is really hard some days. Today was one of those days. I was up at 6:30 am, had a meeting at a local clinic at 8, then went to another clinic for a visit, and got to the birth center at 10am. There were 50 patients waiting, and a woman had just delivered, with two of the midwives caring for her and the babe. To add to that, there is an epidemic of this new mosquito borne illness called Chickunguya, which causes high fevers and severe joint pain, and the ministry of health is expecting for 50% of the population to get it. So as soon as I got there I did my little education talk on Chikungunya, checked the temp of all the pregnant mommas who thought they may have it, and started seeing patients.

The hours went by slowly, as my fatigue set in (in 86 degree with 100% humidity) and my blood sugar dropped, I had to remind myself why each patient deserved a smile and all the time she needed. One by one the postpartum visits came in, as I measured and weighed their babies, observed them breastfeeding, addressed any problems. It is seriously one of my favorite things, to do education with moms and newborns. And it is exhausting… cause each time I want to give more of myself, more to them. I want to give them that bit of information that will help them better understand their newborn, better know how to care for them.

And each time those same questions lie in the back of my head, “Is it enough that I (possibly) change the lives some of the women I serve, individually, and moment-by-moment? What am I able to do in this time, am I really doing all that I can?”

I LOVE THIS WORK. Clearly I mean it (it is in caps). And some days being in Haiti doing this work makes me feel very alone in it… but when I read blogs and book and quotes (and have conversations) about midwifery (and with midwives), I am reminded that THIS is the work. That you care too much. That you question if it is enough. That you want women to have better care, and better opportunities, and better lives. And that will never go away (or so I pray).

And I know this isn’t only true for midwives. I know it is true for my wonderful roommates who have given so much of their lives to women and their children here in Haiti… and to soo many healthcare providers who lay in bed at night thinking of some “stranger” they took care of that day.

I guess this is just my way of saying that I think it is okay to have questions. To have doubts. It probably helps us see people as people, rather than as a problem or a burden.

So I will accept it and let go of it, All in thanks. 

Until I start a new day, and meet a new person to care too much about. 

-Leah 

Overdue

So many thoughts, it’s hard to get them out of my head and onto the page. 

An adorable matching mom and baby
at their postpartum/well baby visit

To start, it has been an incredibly good couple of weeks since we last wrote. I (Leah), am absolutely loving being at the birth center and working with the midwives. The last two months have really helped me understand the rhythm of what goes on each day, and I’ve gotten the chance to learn about what the midwives want to review and go over. Some of you know that I was planning on doing clinical education with the midwives, what we call in the states “continuing education.” I am really excited to continue to do this and now have a real grasp on what the midwives want to learn about….

I wrote that first paragraph a week ago. I’m now sitting down again, on a Monday night, to write a post. Tonight I realized that we left for Haiti two months ago today. What a weird feeling it is, to know we have been here two months… so much has happened, so much has been learned, yet it sincerely feels like it has been just a few weeks. In some ways, it feels really good to know that two months can go by so smoothly… in other ways I wish it had gone by slower, especially so I could have learned more creole than what I know at this point! Language learning is so frustrating—especially when you are trying to fit so many new lessons in your brain.

The "Hemoglobin" station. Dab a drop of blood
on the paper and estimate the Hgb by color

The days, the week, go by in a routine now.  Mondays are very busy—at the birth center we see new patients on Mondays, which is usually the busiest day of the week. Today there were 41 new patients, 41 new pregnant bellies and smiling moms visiting the clinic for the first time. Well—not all 41 were pregnant, there was one 49 year old who was convinced she has been pregnant for 2 years—and of course the pregnancy test was negative. But it didn’t matter to her because her last pregnancy lasted 4 years, so basically she will prove us wrong in a couple. You can’t make this stuff up.  Anyway, there were also two births; uncomplicated and peaceful births. When I was leaving the birth center this afternoon, so was the mom who had delivered at 10am that morning. Dad carrying the baby, grandma carrying the stuff, and mama taking her time walking out of the gates. What a happy sight. So after a full Monday of doing patient education on chikungunya (a new mosquito borne epidemic), checking hemoglobins, making birth kits (for the mothers who will deliver at home with a traditional birth attendant, per their choice), and organizing the pharmacy, I headed home. My housemate, Amy, met me at home and we headed out to town to the market. Bought some Chilean wine, gloves for the birth center, canned milk, bananas, mangos (50 cents for 10 mangos—it is the season of course), and our dinner of fried pork and fried plantains to eat at home. Normal, right? It feels like it to me. Amy is going to the states this week for a wedding and to visit her family for about 2 weeks. She will be in California, seeing some of our best friends and staying a night at our old place. It was odd talking about it, as we walked through the Haitian market-- weird because being away from that life makes it feel like it doesn’t exist without me there. Silly, I know, but life here feels so normal now, its almost like I imagine that other life we lived to be on pause. Not that I don’t miss our friends (y’all know I REALLY miss you), this just feels like another life.

Anyway, as I think about the rest of this week, I feel like I know what to expect. Tuesday, Wednesday, and Thursday are usually about 9am-4pm days at the clinic. Prenatal and postpartum visits with births mixed in. Wednesday we will have a midwife meeting in the afternoon and go over some of the ed topics—this week probably talking about skin to skin and doing some chart reviews. Friday is education day, with an infant massage class and a breastfeeding class for moms with babies over 8 weeks. Saturday or Sunday we may go to the beach, or sleep in. And as I spit out my routine, I smile because I really do enjoy it. I like showing up at the clinic and helping with whatever needs to be done next—seeing a mom who has mastitis, or doing a newborn visit, or measuring some bellies, or providing labor support. There is always something, and its always something I like.

Anyway, on to a different Haitian lesson: I burnt my leg getting off of a motorcycle last week and long story short, the burn turned into a bad infection AKA cellulitis. Thanks to my handy grad school resources I was able to self diagnose (purulent vs non-purulent cellulitis?) and get a big gun antibiotic on board (ugh Clindamycin—it is a MRSA infection, yuck). Thank God it is getting better with frequent bandage changes and religious antibiotic compliance. Thanks to my leg I had to miss out on the beach this weekend, which did I mention, the beaches here are BE-AU-TI-FUL. Why share about my sicky leg on my blog? I don’t know, for transparency sake. I mean I am living in Haiti and these things do happen (and its not like there’s an urgent care here). All the cool ex-pats have scars on their inner right calf from a moto burn, so I just had to join the club ;-)

Oh, one more thing that has been on my mind. The other night we went to dinner at this restaurant that had a TV and American cable or something, and a commercial for a weight loss product came on. Do you know how ironic it is to be in Haiti watching an American commercial for pills to make you lose weight? Let me point out that Second Mile Haiti, where Armen volunteers, is a center for severely malnourished children. Sometimes Being abroad can really point out absolutely crazy aspects of your own culture.

Speaking of Armen, her is some of the yogurt!

Alright, well Armen is in bed with something like the flu—with as many mosquito bites that we have gotten, we keep our fingers crossed it’s not anything else. But really, I think its just a virus (congestion, fever, cough, etc). The power has gone out every night for the last 6 nights, and of course tonight our internet is down so this blog will wait until tomorrow. But being disconnected from the web gives you a certain kind of ease—like you really can just relax (and write a blog post).

One more thing—two months hasn’t been enough for us so we have decided to stay a couple more. We have gone back and forth because we are a bit nervous about finances but it just feels like we should stay here a bit longer. For one, we really like it… and at this point it feels like we are just starting to get the hang of language and the rhythm, so why leave now. Probably here till mid-July… so I guess we will see you then friends.

Much love, and enjoy some pics!

Fertile soil from Second Mile's Farm

P.S. Ok, it is Thursday night and we finally have internet, so up it goes. Enjoy the pics, they are a bit overdue cause we took a trip to Jacmel like a month ago but better late than never ;-)

YUM. Fried goat and plantains. Fav Haitian cuisine.

Our favorite restaurant in Jacmel (where we got fried goat and $1 beers)

Water fall jumping!

hipster in Haiti

oh the blue waters of Jacmel

Balcony chillin in Jacmel at historical hotel with our friends we travelled with
(10 hrs+ on busses from Cap to the south coast of haiti)

All In A Day’s Work: From Armen

At the SMH land, chicken coup behind the cow

I should start by saying: please forgive me if it seems that my mind is everywhere… I assure you that it is.  You see, in the states, non-profit work is all about specialization - there is one task, and everything falls into place behind that one task.  I have found, however, that it pays to be a jack-of-all-trades here. 

Second Mile Haiti (the organization I’m here to work with) does have one mission: it is a center for the rehabilitation of malnourished babies and the education & empowerment of their mothers.  The singular mission is to bring severely under-nourished children to a healthy weight while simultaneously educating mothers in basic public health knowledge (everything from hygiene to nutrition) and basic business acumen, culminating in those mothers leaving with a healthier baby and a micro business that enables them to support that baby.  All-in-all, the program is really beautiful and really well executed.  That being said, in almost a month of being here, I have yet to work with mothers or babies… at all.

Which raises the question: what am I doing here?  So… to answer that question, I need to tell you a little more about this organization. Second Mile is a complex organism with multiple ongoing projects that all contribute to the main mission in a variety of ways.  

Agriculture: The land that the Second Mile compound is build on is attached to several acres of  tillable farmland, on which is being grown a variety of staple crops.  These include tomatoes, carrots, onions, cabbage, peppers, cepina (a leafy green plant that is similar to spinach), moringa (if you don’t know about this tree, you need to google it… it’s a miracle tree), corn, sorghum and a variety of beans. This produce is then used in the meals cooked on the land (about 25% of the meals are made with our own produce) and the rest is sold in the markets for a profit which then goes to fund the payroll of Second Mile Staff. My Role: my role in this project is limited - aside from the occasional check-in, this project is managed by a team of gardeners who tend the land full-time.  We will, however, be working on a tracking system to help us calculate how much the land is producing and how much income it is generating (currently we just use pen and paper). 

Baby Alpine goat... no goats milk yet!

Animals: The land has several milk cows, over a dozen goats, and almost forty chickens (there were more, but a large number was recently wiped out by a virus).  We also have a recent addition of bees, which we got the first week Leah and I were here.  The cows provide milk for baby formula, and the chickens provide… well, eggs, which can then be sold or eaten (We’ve eaten a lot of eggs…).  My Role: There are no vets near us, so my role has been to take on part of the research in regards to animal care.  This includes, but is not limited to, animal nutrition, general health, required vaccinations, etc…. before you ask, the answer is no: I have no prior veterinary experience.  However my new favorite book has become Where There Is No Animal Doctor which is a very handy and user-friendly guide to animal care for the layperson.  No joke. 

Construction: There is a never ending list of construction projects to be completed on the land (by the time this is posted, there should be a few videos about construction progress up on YouTube).  Second Mile has a full-time construction boss (‘boss’ is the local designation for anyone with a specialized skill set… so there are construction bosses, and carpenter bosses etc) who is responsible for the multiple construction projects that are happening. My Role: these construction projects require a constant flow of construction materials - rebar, cement, nails, wood, paint, palm fronds (yes, palm fronds) etc.  For this role, I have been buddied up with an original employee of the organization: Harold.  Harold and I use the truck to haul in Palm fronds and take excursions into Cap-Haitian for all other supplies.

Those are some of the various outlets of the organization that I have my fingers in.  On top of all of this, I’ve been working closely with Jenn to create manageable weekly schedule - as you can imagine, with so many components, it’s easy to get distracted with a million little things throughout the day.  I’ll also be working to create their database (a mammoth task in it’s own right) for moms and babies, and making weekly micro videos to update everyone on what’s happening.  As I mentioned earlier, the first of these should be available for viewing by the time this blog is posted… click here to watch it...

The funny thing about all of this is that I am an authority on precisely none of the things I am working on… but neither is anybody else, and I have two resources that most people here don’t: time + Google.  Needless to say the days are full and there’s always a lot of work to be done or roadblocks to be overcome, but it keeps me on my toes, and for the most part, distracted from the little anxieties that come with cultural adjustment… honestly, I’ve never thought I would make a very good specialist, so I kind of love it. 

Things coming up include building a clay/brick oven, bread making, yogurt & cheese making (to sell), and many other things I'm sure...

And now some pictures for your entertainment:

Amy, our housemate, doing the shopping

Three men and an earless goat on a motorcycle... the norm

Easter Day: Streethearts kids at the Second Mile Land... easter bunny brought candy and all!

Where we have our Creole lessons twice a week, right by our place

And this is where we spent Saturday, at Paradi Beach... clear, warm water and fresh grilled lobster!!

What a day with moms and babes

So yesterday started early (for this formerly night-shift nurse)...
Out of the house by 8:20am, took my 10cent ride by public trans (a truck with benches in the back) to the birth center. Got there by 9am, and started measuring pregnant bellies and listening to fetal heart rates within the hour. Now-- about that, seeing "patients". As some of you may know, while doing my midwifery program in the US, I had serious concerns as to whether or not I would enjoy being a "provider" rather than a nurse-- which I thought meant spending less time with patients and more time charting. BUT, I have re-discovered my love for patient education and found that doing prenatal & postpartum visits means time with patients=time for patient education. And here I have all the time I want to answer questions about labor signs (does throwing up mean your water will break?) and assess a new mom's bathing skills (Me: How do you bathe your newborn?, Mom: In water with laundry detergent). Of course, all of this is done with the help of a translator.... and let me say here, I am VERY eager to learn creole. Armen and I started lessons yesterday, and we both reeeeeeally want to be competent in creole. Imagine trying to ask (in creole) how much for a motorcycle ride home, and getting an answer (in creole), and then trying to decide if you can bargain (in creole) for that ride home. It is not easy not speaking the language. It's a good lesson to learn.
Anyway, it was an interesting morning of prenatal & postpartum visits. But it didn't end there... got the chance to do a well-baby visit where the baby had lost over 300grams in weight over 4 days, looked very dehydrated and wasn't breastfeeding well, and when I listened to the baby's heart rate, realized she had a very pronounced heart murmur. One thing led to another and we we're referring her to the hospital for an echocardiogram, which hopefully she will get soon as she is only 4 days old and loosing weight rapidly.
Next thing you know, we have a mom in labor. One thing that has been really wonderful about being in a birth center is that it really has taken the fear factor our of labor. Yes-- skills in birth are VERY important when things go awry, but intervention is rarely necessary for most births. Most of the time you can just be there to support a mom having her baby, just getting the chance to "catch" her baby and re-unite them. So I got the chance to do just that, and even with thick meconium, the baby girl was born easily and I got to plop her on her mom's belly... with some drying and stimulation she perked up, and we didn't even cut the cord till the placenta delivered. To get to be with a mom who has the choice to labor as she wishes, either standing, walking, in the bathroom, or on a bed... and deliver her babe on a birthing stool, that is what is incredible to be a part of... especially in Haiti, a place where mothers are rarely offered this type of labor support. Clearly, I love what is happening here.
Shortly after the delivery, a mom who had been throwing up all day came in and needed an IV, and my nursing skills got good use. And once she was re-hydrated and felt better we sent her home, to come back soon when she had labor pains. 
So finally around 6:30 I got to head home, opting for a motorcycle ride home that would cost me 75cents. It was a quick ride home, and after a long day I was happy to get back to a meal and people who would hear my stories from the day.
All this to say.... I feel so blessed to get to be a part of the incredible work that MamaBaby Haiti is doing in their community. Working with the Haitian midwifes has been such a great experience, seeing from their compassion for laboring mothers and observing their skills in action. I have also been incredibly overwhelmed by the dedication of program directors and NGO's here, seeking to serve Haitians in unique and innovative ways. 
There really is so much to be thankful for. 
Love,
Leah

An introduction to Haiti

My walk to catch my ride home after a day at MamaBaby Haiti

What a week it's been... leaving California was a whirlwind... but in comparison Haiti has been a hurricane. We flew into the Dominican Republic and spent a night there before crossing the border, and shortly after Jen (one of the founders of Second Mile Haiti) picked us up at the border, we made our way to a nearby farm where we got an adorable baby goat... since then we have spent lots of time in the sun, on the farm, a morning on a beautiful Haitian beach, and lots of time figuring out our new job duties. Lots of time at the market too (there is no grocery store here!!) getting food, phones, and a fan. Busy to say the least.

Bee box!

So Armen is in full swing at Second Mile Haiti working with Jen, learning to take care of goats and chickens (and trying to figure out vaccines and parasite meds), planning for a bread oven, helping with the work/planning of the (HUGE) veggie garden/farm, and learning to work with the newly acquired bees (pic to left). We have LOVED getting to see the incredible work that Second Mile is doing with mom's and babies, and learning about the day to day operations. See some pics of whats been is going on lately here.

  

I (Leah) just started at MamaBaby Haiti, and saw a beautiful birth yesterday that made me so glad to be here. Birth in a different culture is really fun to see and participate in, as this young mama sang through her labor pains for hours... and since this is a birth center in its true form, she was walking, eating, and drinking as much as she liked. She even sat and rocked on a birthing ball for a while... and soon after, when she felt she needed to push, she had the caring hands of a midwife to catch her baby. All went well and it was so fun to do what I love (provide labor support!) in a place where women rarely get respectful and compassionate care in labor. Did you know that only 37% of women in Haiti have a skilled attendant at their birth, and that Haiti is ranked 34th highest in maternal mortality rankings worldwide? At MamaBaby Haiti they received free prenatal, labor, and postpartum care, helping identify those who need to be referred to the hospital for high-risk conditions, and allowing low-risk mothers to receive low-intervention, compassionate care at the birth center.

MamaBaby Birth Center- one of the birthing rooms

Anyway, since we will be here several months just wanted y'all to get a glimpse into our lives... but more important than that, a chance to see the amazing grassroots work that is taking place here in the Cap Haitian area, with efforts to serve and empower Haitian women and their families. We are happy here and loving it!

Leah & Armen

Explore. Dream. Discover.

“Twenty years from now you will be more disappointed by the things that you didn't do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover.” 

- Mark Twain