Volunteer Offers Help to Haiti's Mothers-to-Be

Angela Ferrari, a nurse midwife from Massachusetts General Hospital, recently completed a volunteer mission for Project HOPE at Hôpital Albert Schweitzer (HAS), helping to strengthen the hospital's midwife program. While working at HAS, Ferrari made a day trip to Bastien Dispensary, a more rural medical facility that often times refers women with high risk pregnancies to HAS. The following is a blog of Ferrari’s day at Bastien.
Today was the most amazing day. The trip to Bastien went off without a hitch and we left Hôpital Albert Schweitzer (HAS) at 8 am, hot and sweaty already, only to arrive to the cool breeze of the mountain at the site of Bastien Dispensary.

Still, it was an even more harrowing ride than the one from the airport to HAS on my first day in Haiti! From the airport to the area of Deschapelles was a twisting ride of hairpin turns through a mountain road. The ride to the dispensary, on the other hand, was straight up rock much of the way. The very capable jeep rocked us to and fro but must have had decent shocks because it actually seemed fun! What looked hard were the travels of the many, many people making their way up and down the mountainside on the rocks by foot - I couldn't call it a road as it wasn't—it was a path, really. Women with tremendous bundles or baskets balanced on their heads, young and very old alike climbing in the heat without any obvious discomfort or even strain that I could see. I imagined they make that trip often. Most were on their way to the market down the mountainside with their wares.

Arriving at Bastien was like a cool, sweet reprieve. It was nestled into the small dip of a hill and was clean and well organized. The woman who ran the clinic and the RNs who saw the patients for their visits ran a very tight ship and were polite and somewhat forthcoming which surprised me given that my visit might seemingly have no purpose to them and I cannot imagine that I did not seem intrusive. My intention, which I think was lost in translation despite my capable interpreter, was simply to gather an understanding of the care of lower risk pregnant women in the broad referral area of HAS. I wanted to know how women were cared for before they were determined to be high risk or experienced an emergency and therefore were referred to or taken urgently to HAS. Further, many pregnant women without risk had seemed to wander into HAS to deliver over the last week of my stay and I wanted to understand something of their 9 month experience with health care prior to their moments of labor and delivery at HAS. It was my understanding that most women are birthing at home in Haiti and I was confused by the presence of normal birth at the high risk facility of HAS.

The RNs at the dispensary allowed me to sit in on several pregnancy visits and they explained all of their documentation to me and I was truly, truly impressed. Basically, they hope to see their patients 3 times in their pregnancy and they schedule all of the patient’s appointments when they come for their first visit. The tools of the RN’s trade are a fetoscope and a tape measure --they seemed apologetic about their simple tools and the interpreter translated, “This is all they have.” But I am a midwife and I understand that it takes few tools or instruments to give good care as long as providers are skilled. I have noted often that having few tools to your trade makes you develop incredible skills, sometimes far superior to providers with many instruments to depend on. I tried to reassure them they had all they truly needed to give good care!

The first visit I witnessed was of a woman who was just into her second trimester. Her belly was measuring appropriately for her gestational age (with the tape measure just as we use in the US!). She was reporting vomiting but able to eat, and she was checked for anemia by looking at the whites of her eyes. I had seen this assessment of determining anemia and or oxygen carrying capacity of blood, too, when a woman came in with retained placenta earlier in the week at HAS. Again, I was impressed with the few tools you need to give good care. At the institution where I work in the US, we are easily able to send off blood work to the lab to determine anemia and don’t need other ways of assessing anemia. Without easy lab capabilities here in most of Haiti, they are equally able to quickly ascertain whether someone might be low on iron by physical assessment. This is much cheaper than lab work! Lastly it was too early to look for heart tones with the fetoscope and off the table the woman jumped after this exam. This young patient was given a copy of her records and everything was recorded meticulously by the RN’s. HIV and RPR are done as initial lab work and documentation made that she was vaccinated against tetanus.

The second patient was in her last trimester and so it was her last prenatal visit. There was a special "labor planning form" filled out (just as we do for our pregnant women in the US) and I was impressed with how thorough and appropriate it was. First, the RN’s asked where she planned to deliver and noted this information on the form. Most women plan to deliver at home with what is commonly understood by the world as a traditional birth attendant or TBA but here is called a “matrone” and refers to a woman trained in her community with a midwife who attends birth in the home. Occasionally, a woman reports that she will plan to birth at a hospital. I suspect that as the rest of the world has moved toward birthing in hospitals, a small but definite influence is exerted on Haitian women to do this as well and the RNs report to me that sometimes women tell them they plan to birth at the hospital. The form further documented all necessary addresses: hers and the hospital that she would need to go to in case of emergency, most often HAS in the case of the Bastien patients. The form also recorded the name of the midwife, the patient’s due date, and contained a list of meds/supplies the patient would need to get from the hospital in advance to prepare for birth. By the way, going to the hospital to get supplies is no small trek as I had witnessed on the way up in the jeep! It must be a day's journey in and of itself just to get to the hospital. Further, I have no idea how much it would all cost, something else that would make this simple list difficult to accomplish. But each woman must get these supplies as listed so that she would have the supplies ready at the time of her birth and waiting for her midwife’s arrival at her home. This would help ensure a safe birth for mom and baby.

Interestingly, the RNs mentioned to me that the ‘matrones’ currently get their sterile supplies especially for cutting and cleaning the cords of babies from HAS. I had just read about the program started out of HAS in 1960 called the “clean cord cut kit” which was a modification of a WHO program at the time. This program is still sustained by HAS today. In the 1960s’s, along with the vaccination program for pregnant woman, the clean cord cut kits and a public education effort allowed HAS to squelch a tetanus epidemic.

I found that though the maternal and neonatal morbidity and mortality statistics in Haiti continue to be among the worst in the world, excellent programming and care is being accomplished by HAS and in the outlying communities to help combat this staggering reality. I left the cool (relatively speaking of course) hillside of the Bastien Dispensary with the same joy as I had noted many of the women and children displayed who were playing and talking at the well aside the clinic. My heart was made lighter today.

Read more about Ferrari's work at HAS.

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