Friday, May 20, 2011

May 20th 2011

I am making the rounds of good byes today. I do not like this, everyone asks me how soon I will return. I feel drawn to these people, I feel like they are forgotten in the marketing of societies who are deprived. How often do you hear of the suffering on the Dominican? Not often I would guess...These people are resourceful, hardworking and dedicated . They have a beautiful tradition, and they take pride in their heritage.

Yet they suffer. The medical skills and supplies mirror what we would have had in 1930. They don't despair and they don't look for a handout.

True Story.

Today as Lisa & I were the only student midwives on the floor,we got a call, the message was we were to meet someone (we didn't know who) in Oncology. at 10 a.m.
I asked my dear friend Rosanny to show us how to get to Oncology. She took us at quarter to Ten and walked us down the stairs, out the door and across the parking lot of the hospital. We were puzzled as to why we were being called there, but went with Rosanny.

No one called out to us, and since we didn't know who we were looking for (or rather who was looking for us) we slowly walked, smiling and waiting for Whoever it was to hail us.

We walked back to the OB dept befuddled at what to do next, when I noticed a sign that said "Oncology" right next door to the OB ward.

We entered into this section and right away recognized 2 Doctors, One was Dra. Soble. She was smiling and waving to us (so we assumed that meant she was the one anticipating us)
She took us on a tour, and used another Dr. to interpret for us. She was showing us all her facilities and then introduced us to the panel of all the specialists in the Dept.
Once she introduced us to all of the Dr's involved in the pain management and GYN-Oncology department, she asked if we thought we could get some supplies, much needed supplies for her department. My reply was, we would love to see a list to know what was needed and we would be honored to attempt at getting items on that list donated to the hospital. (In my mind I was non committal as I wasn't sure how extensive this list was going to be, and how expensive the items would be)

Later that afternoon we received their list:

2 Sphygnomoters
2 Stethoscopes
Prosthetic's (for mastectomy patients)

We were able to deliver the Blood-pressure cuffs the next day.
Along with 2 Stethoscopes.

I am working on resources for the Prosthetic's and wigs (if you have suggestions send them my way)

What an overwhelming list.

I was pained a little knowing that they lack basic supplies when our US hospitals THROW AWAY MILLIONS OF DOLLARS in supplies EVERY YEAR!!!!

I left a piece of my heart in the DR. Something I NEVER anticipated happening.

I dream, scheme and plan to be there again.....


as soon as possible.
With supplies and gifts.

With scalpels
With Chux pads
With Sheets
With CLOROX wipes
With baby Diapers
With Baby blankets
With baby hats
With Onesies
With Emergen-C
Bottled Water

With everything I can give....

Thursday, May 19, 2011

May 19th 2011

On Monday May 16th a tiny baby girl was born at 9:25 a.m. to Maria Danielle a beautiful soft spoken Haitian woman.
This woman had a C-section for Toxemia and Anemia. She was also diagnosed with HELLPS .

I made it a personal goal to get that baby some momma's milk. it took me 3 days. Baby latched on beautifully and momma was thrilled to meet her baby girl.

after the victory of getting baby to nurse, Maria went downhill, she had gotten so ill, she was feverish and had to be hooked up to dialysis, she had several transfusions of blood and was struggling along.

She has not passed any fluids as of today, no urine and looks puffy and yellow.

I put out a plea to my FB family to please pray for her, she is such a sweet momma.

I am so sad to leave, and I worry about Maria, I worry that she never makes it home to her new baby. I worry that when she gets home, she will not have Milk to nurse, I worry that she will not have the money for formula. I worry ....

Wednesday, May 18, 2011

May 18th 2011

May Thursday 18th 2011

We have not been invited to attend births or catch any babies since the initial drama with the "dystocia"

I figured if I was not going to have the chance to catch, (as I was not willing to PUSH myself on the Dr's) then I could spend time in the Nursery, learning how they do their newborn exams, as well as share the Midwifery Model of care in Newborn assessment.

I chummed up to the staff, and really had to work my charm to get them to warm up to me.

With granola bars, flower pens, notebooks, and other goodies...eventually they warmed to me.

We brought with our donations a big pile of surgical rags, I started putting a blue cloth in each isolette that was prepped for a delivery.

When a woman was ready to push, the OB would shout to the Nursery staff "COMPLETO!!" "PEDIATRICS!!" and the staff would then rush into the room with the prepped isolette.

I would nudge my way into the crowd, and stand at the mom's knee, as baby was delivered, I would ask them to delay cord clamping/cutting and place baby on mom's chest, as I wiped baby down and stimulated baby with the blue surgi-cloth.

Once baby was pink I vigorously crying or alert, I would gently transfer baby to the isolette and continue cleaning off baby as we transfered to the nursery. The staff eventually allowed me to take over in the newborn care, I not only administered the required meds and eye drops, but also did a complete evaluation, the staff would then stand over my shoulder and ask me what I was doing, I showed them the reflexes, the hip check, the placement of ears, nose and the passage of each nostril and baby 's suck reflex. They were interested in what I was doing and seemed willing to learn.

We made a great team. And really enjoyed each other's company.
(The granola bars and dum-dum suckers helped)
They asked me about my family, my religion and why I was there. They were very receptive and thrilled to know that we were not assuming superior care, and that we had a respect and admiration for their culture and their skills.

Monday, May 16, 2011

May 16th 2011

(Happy Birthday Allie!)

May 16th 2011
Since Roxanna was late arriving, Heather was flustered with her feeling inadequate in being able to communicate.

We arrived at the Hospital as scheduled to meet with Victor Espenalda, The director of OB/GYN dept. we waited in a luxurious lounge area, with Wi-Fi and a spread of food. We were treated respectfully and kind.

3 hours later we were informed that Victor was in a classroom , as he is an instructor and was unavailable to meet with us.

We were then led to the OB ward and given a quick tour/orientation.

I was under the impression that all the back ground work had been done previously and we were expected. This was not so.

We donned our sterile attire (hat and mask) and met some of the staff of the OB ward. one Energetic Nurse was thrilled with our attendance and invited us right away into a surgery. It was a prolapsed uterus and bladder. The woman lay flat with her arms stretched out beside her, wide awake with a spinal block. she flinched and grimaced occasionally and it seemed she felt some of what was happening. The scalpel was dull, and the procedure was gruesome. Although it was amazing being able to watch and learn, (anatomy at least) it was rough to endure the over 4 hour procedure.

We next were called into our first C-section.

within a few hours time we were in full swing. Heather was invited to attend/catch the first vaginal birth we were present for. Dr. Rico Suave (not his real name) was gracious and kind, he showed how they manually dilate these women, they get to about 8cm and then routinely receive manual dilation for the remaining.

The woman was on the delivery table, in stirrups, and told to push push push... regardless of contractions.

As Heather followed what she was instructed to do, she mentioned to Terri & I as baby was crowning, that this was a sticky baby, and it was going to be a dystocia, she just felt it... baby's head presented and mom pushed (although ineffectively) Dr. Suave started to manually tug and pull on baby to aid in the delivery of the body... Heather hip-checked him and Terri applied Super-Pubic pressure, Heather then called out forcefully for us to flip mom to Gaskin ... (hands and knees) This mom had no clue what we were doing, at this point we had an audience of over 20 students watching.... Terri & I were able to flip mom to hands and knees after a few troublesome moments of trying to get her to understand what we intended...Mom was like a floppy fish, she turned half way, and collapsed on her side, then we picked her up and got her into a good position, baby came out with minor shoulder corkscrew and some pushing. baby was limp and pale.

I followed baby to the nursery, where the protocol was as this:
Baby is delivered, cord cut immediately, baby is passed onto the pediatrics staff and wheeled in an isolette into the nursery (down a short hallway) here they put a heat lamp (similar to a chicken light) on baby and start stimulating and cleaning baby off. They use paper towels and wipe off fluids and vernix...Once baby is breathing and or crying, they run an In-G tube down one nostril and syringe out the contents of the stomach. Then then syringe the other nostril and suction out the contents of the stomach. They check baby over, weigh, measure, administer VIT K and Eye Drops. at this point usually 30 min have passed and baby is chilled.

Before we arrived they put baby in the bed with diaper and nothing else. They often ran out diapers before the supplies were replenished.

We brought with us a plethora of supplies, sadly these supplies would not last more than a month, if they were lucky. This hospital attends over 35 births every month.

The mothers/families are responsible for bringing all their own supplies, Blankets, diapers, formula, sheets for their own beds, even water to drink postpartum.
May 17th 2011

I want to explain a little about how the women birth here in the DR. Some of these women travel by bus for long distances. Some arrive in active labor after 4 hrs on a bus.

The woman checks into the ER and is evaluated on whether she is in active labor, right away they receive an IV,and wait in the general waiting room with 20-30 other patients with various issues.

Once they are engaged in labor, the ER department wheels them into the delivery area (up the elevator) here they are assigned a bed, with no sheets in a room open with no privacy and quiet. This is a teaching hospital, so on average 30 students wander through on rotations twice a day.

the women are told to lay flat, and quiet, not to disturb the residents ad Dr.'s most of the time they whimper quietly and labor silently. occasionally we got a moaned/vocal woman, this woman was usually accosted and encouraged to labor quietly by having her thigh thumped and told "Madame!!" The vaginal checks were.... vigorous.... some Dr.'s were more aggressive than others, but most of them gloved, and checked a woman without warning or consent.

If she was at 8 cm or more, at her bedside they began manual dilation, she was told (loudly) to push push push, as the DR stretched her and pulled and gave her grief over being too loud. If the woman attempted to swat away the DR's hand or beg for them to stop, the Dr's got upset and yelled at the woman.

Once the woman was "Completo" they had her stand up, transfer herself to a wheel chair, and got wheeled into the delivery room.

Here she is told to climb onto a table that is waist high, with no help, other than the brakes were engaged on the wheelchair occasionally.

After the woman in active labor has positioned themselves on the delivery table, in stirrup with nothing but a black trash bag under them . once again the DR's used forceful manual dilation.

I explained yesterday how they handle the delivery of the baby, and the process for taking care of baby after.

Sunday, May 15, 2011

May 15th 2011

Sunday may 15th 2011

Today we woke groggy and cranky, not sleeping more than 2 hrs from all the partying in the streets was pretty rough on the 4 of us.

We had an apt. to be picked up at 8 am at the hotel for a rural clinic.
Dr. Victor Espenalda graciously picked us up, and carted us around for the day.... we met a group of physicians at the Hospital who were volunteering their Sunday to offer services to the rural village of La Esparilda.

We met Jose, Victor, His beautiful wife and their 3 year old son. Jose had a young son of about 21 who was also spending the day with us, luckily for us, Carlos spoke great English!! he was our translator by default for the remainder of the day.

We drove in a very nice Isuzu Trooper through the winding roads and villages on our way to the rural clinic.

When we finally arrived after about 2 hrs passing by banana plantations, rice fields, scrawny cows, and run down adobe homes... we found an unusual number of people crowded together under the trees, when we came to a stop, we asked "what are all these people here for? assuming it was a Sunday service or party....when our car came to a stop, we realized the throngs of people were waiting for us.

Over 75 people were waiting to be seen by the visiting physicians. The women of these villages had walked, drove and sacrificed to arrive at the school house with no water and no power. They had assembled exam rooms by hanging sheets from wires with clothes pins. offering privacy. they had one sheet per bed, and one drape for all of the patients.

They each got a number, and waited in the hot sun for hours for their number to be called.

They were seen by a physician, sent behind the curtain, given a pap smear and exam, the speculum were the same we use here in the US, however they take a glass slide, and use one slide for both tests. then they take that slide, wrap it up into a paper with all that individuals information and stack them with all the other 75 pap slides waiting to be taken back to the hospital for processing.

Then if they had complaints they received free prescription drugs.

These people were happy to have this service provided and were cheerful and happy to wait.

after we saw the 75+ women (as this was exclusively for womens care)
Sometime in the afternoon we were offered fresh fruit cut up and in styro containers.
Then in the later afternoon (we were starving) we were served DR cuisine, something like a corn meal ball with raisins and corn inside. Fried chicken, plantain and more fresh fruit.

We were invited to a beach, Puerto Plata with the physicians, we drove another 35 min to a beautiful, obviously LOCAL beach.... we were without a doubt the main attraction... the only White people around and being 4 White women we stood out like sore thumbs!!

We swam and enjoyed the Caribbean waters, the crazy traditions of these people, they drink pretty much non stop, and the boats are chartered for short trips into deeper water.

The drivers of these boats (sometimes they looked 14 years old) were SCAREY!!!

They almost ran over an elderly gentleman at one point, and were obstinate and rude when folks started shouting at them!

A group of rowdy 15-17 year old boys started gathering around the 3 ladies,Terri, Eve and Tracy, Tracy had enough and got out of the water, Poor Terri & eve were surrounded and being harassed, Carlos and I were a yard or so away chuckling at the torment, finally it escalated to the point they were uncomfortable and they called out to Carlos to come save them. He told the boys to scat....

We swam for a few minutes longer and were done, tired and hot we prepared to drive home.

Jose our host and Carlos his son were amazing, kind, honest, open and very generous, they stopped for us and helped us buy fresh fruit from the stand. Papaya, mango, Pineapple, Oranges, bananas,cantelope and a watermelon . It was a mighty good thing we stopped for this, as that is what we ate for the next 3 days.

We arrived back at our hotel around 6 pm, Maria, Lisa and Heather had arrived safely, although they had been delayed had been bumped on their flights, as they had stand by tickets, and were not to arrive for another 18 hrs.

We had a pow-wow and got some orientation on what to anticipate on the next day.

We were grilled that "when in Rome.... Do as the Romans do" and we retired to bed ready for
the challenge of a new day.

Saturday, May 14, 2011

May 14th 2011

May 15th 2011

I packed up my belonging,s including two HUGE 50 lb totes for donations to the hospital. I was so blessed by the generous giving of others. It was jam packed!!

I checked into the airport, and the attendant was no encouraging, he told me I missed the best flight of the weekend, and it was unlikely I would make it to my destination by Monday...


I happily waited, made calls to my kids, and ensured everyone was doing what they should.

I made the first flight and got off in Dallas. DFW is a HUGE airport, it takes allot of maneuvering to get from one portal to the next. I had my backpack with my personal belongings as well as the laptop, so that all I valued in my luggage stayed with me...

It was allot of sacrifice and saving up for this trip, and a few details really bogged me down.
one: I had to leave a day before originally planned because of flight loads.
two: the signatures I was originally anticipating were in Limbo of NARM rules.
three: the night before I left I spoke to a relative who had spent 2 weeks in Haiti, and some of the information she gave me left me discouraged and anticipating troubles.

This was my first trip alone, and my first trip out of the country (besides a cruise, and in my opinion those don't count!)

There were allot of unknowns... and I was a wee bit nervous!

After I arrived in DFW I waited for 2 hrs and got a seat assignment. the Discouraging words of the original gate agent were now being disproved!

In Miami I had a longer wait, there was a BIG group of youth with matching Tee shirts that said "Orphanage Outreach" I spoke to a few of them and heard all about the program they were attending, they were to teach and help at an Orphanage in DR for 2 weeks. They were all from Canada and were fresh faced and sweet girls.

I shared my desires to adopt with one Older Youth leader, she had received a Grant to attend the Program at Orphanage Outreach, her college took applications and offered an all expense paid summer (3 months) to work at this Orphanage!

After Miami's flight (which I got a seat on the first available and last flight of the night)

I was feeling very blessed!

I arrived in Santiago, made my way through customs and got my bags. They Customs officer wanted to see in the donations bins, and they were curious about the 75 ambu-bags in the box! it was tough to explain with no Spanish skills!!

I successfully made it through the process GOT my first PASSPORT STAMP!!

This was the frustrating part, I didn't have international calling on my Verizon Phone... It was 3$ per minute for calls, so i turned off the calling option.

However this left me at the mercy of the late night Taxi drivers to communicate where I wanted to go and how much I was wiling to pay!


I finally agreed to Hi-Way robbery of 20$ for a cab ride (when we were informed of the last group paid $10) The only taxi driver that spoke minimal English communicated with all the other options of transportation, so no matter who I used the price was the same...

It was a 15 drive to the Hotel Matum, The place was first class and the staff extremely kind and helpful!

I met Tracy Cuneo on the first night I arrived, we visited and settled in for a bit when Eve & Terri arrived from Canada.

It was delightful to meet these ladies, and we bonded and meshed immediately as a group.

We went to sleep in a cool comfortable bed.

Then the FIESTA'S began!!

From midnight until 5 a.m. the party went on in the parking lot and the street market below our window. it was a grand event! the radios and laughter were loud enough and long enough we didn't get a wink of sleep! UNTIL 5!

then the alarm went off at 7 am......