So... on Sunday, as the hurricane madness was still winding down, we had a third client arrive at the clinic in labor! Melinda and I were still sleeping at the clinic, so we were woken up at about 3:30am by her arrival at the front door. Sarah and Ninotte came, too, so it was all hands on deck! This time, our client came alone, without a mother or boyfriend or sister; we were her only support crew. She already knew Ninotte well, and kept calling her over to hold her hand, even when Ninotte was in the middle of busily writing things on the chart.
We got all set-up as usual in the birth room, with the birthing kit, some "floor diapers" to catch any, um, spills, and a little stool for the client to squat on if she wasn't lying on the bed or standing/walking around. (The midwives are big on changing position in order to keep the baby coming, if things slow down too much.)
Continuing with standard protocol, Sarah started checking the baby's heart tones periodically with the Doppler. They were clearly way out of wack. Melinda had gone back to bed after helping get us settled in and ready, but she heard those heart tones from two rooms away, where she was trying to get back to sleep, and immediately got up and returned to join the party. Within the space of a minute or two, the baby's heart beat would plummet from a normal 132 to a low 72 (or sometimes, very briefly, even less) to 96 to 144 to 84. Then there'd be a few minutes of normal heart tones, interspersed with 5 seconds of 72 bpm again! Needless to say, we were concerned.
Sarah thought that maybe the baby's head could be caught against the pubic bone, which might slow the heartbeat, but it was impossible to know what the problem was. After lots of the midwives' movement exercises, a few more internal exams, and a couple of massages, upwards of 45 minutes had passed. The heart tones seemed to have normalized! We continued on normally at that point, still checking heart tones... but after maybe 5 or 10 minutes, we heard that precipitous, brief drop in the baby's heart beat again.
Finally, Sarah decided that the client needed to be taken to Jacmel's hospital. The three midwives whisked her off in the truck, as I cleaned up the, um, spills. Everyone was back within a half hour, and we heard later that the birth went off without a hitch! Everything was just fine. :)
Throughout the night (or should I say morning) so far, there had been quite a few moments of "Should we take her to the hospital? We aren't properly equipped to deal with certain complications, so we're legally bound to take her in if we see a problem. On the other hand, we know the hospital won't do anything more for her than we will do here, so... should we take her to the hospital??" All of us here know that the hospital occasionally has some more technology to deal with certain complications and issues, but their standard of care is AWFUL. People in Haiti hate going to the hospital, and will sometimes even avoid it at all costs if they can.
I got to see the hospital the next day, when we went to pick up our client (and healthy little baby boy!) and take her home. First, I was just surprised by the drive through town - I thought I had been into the center of town (and maybe I had), but we drove maybe another 10 minutes in the truck, past any part of town I had seen so far, before we got to St Michel Hospital. We only went to the maternity ward, so that's all I saw, but... there really wasn't much to see. We drove up a bumpy driveway, past a few rundown (maybe even abandoned?) little outbuildings, and parked in a gravely parking area. There was one ambulance parked there - a converted van with Ambulance painted on the side.
First, we passed the waiting area for the maternity ward. It was outside the building, just two looong benches covered by a roof that didn't look very waterproof. Those benches were FULL! There were pregnant women, a few of them in the early stages of those tell-tale labor moans and yells, and there were a fair number of various family members, too.
We just walked right into the maternity ward, which was a medium-sized room that simply had a couple of doors to the outside (no hallways or front desks first). No one stopped us or cared. The room had a mostly empty-looking desk on one side, and one authoritative woman standing near it, watching over the other side of the room (but looking pretty bored). The rest of the room was crammed full of beds - only 14 in total - with just enough of a tiny aisle between each one. Every bed was different from the last, in length, width, color, height, etc... some had sheets, some didn't. Almost every single one had a woman in it who had recently delivered or who was laboring away. Most of the beds had a chamber pot next to them (but not quite all).
This room, as well as an even smaller room next door, was the entire maternity ward. The smaller room was the delivery room: it had three beds in a row, without curtains, where women would give birth (and maybe have to watch a woman next to them scream through a delivery before it was their turn). Patients in Haitian hospitals are required to purchase and bring pretty much everything on their own, including sheets, gloves, any medicine and IV bags/needles, etc.
The infrastructure and available tools/materiels/personal aren't the only issues here. One of the main reasons that people try to avoid the hospital is actually how the employees treat the patients. I haven't witnessed it, but apparently, the nurses and doctors just yell at the patients! One of the Haitian nurse-midwives who works here at the clinic has been extensively retrained since she joined the Olive Tree Projects team - not in her medical technique or knowledge, but in her bedside manner. She's come around full circle now, and seems to have improved immensely in how she treats women/patients! :) Unfortunately, she has been getting made fun of, and even criticized, for her newfound kindness towards patients. Can you imagine??
Sarah told me this one story (which is more of an example and not an exception to the norm) of when she was staying overnight at the hospital with a client. In the delivery room, someone else (who Sarah hadn't ever met before) was delivering a baby. She said she needed to get up and walk or change position, but the nurses ordered her to stay put. When she disobeyed them, they said she'd better come back carrying a baby. Sarah went into the room when she heard this and found that the woman had just given birth on the floor across the room from the nurses. They were yelling at her to carry that baby back here, and they weren't interested in helping her because she had gone against their wishes! Sarah helped the woman (who, again, she had never met before) back to her bed with the baby. Everything ended up being fine, but it's just unfathomable to me that nurses would be so mean and unhelpful!!
So that's the healthcare system that Sarah and OTP are struggling to work with, here in Haiti. There are some better hospitals, but they aren't Haitian. The Cuban hospital in Jacmel is apparently pretty good, and can do quite a lot for people (they've got the infrastructure and technology), but they are unreliable in their availability. If you ever try to go on the weekend, or sometimes other times, they'll turn you away because they just don't have doctors then! Most of the times that we've needed to take a client to the hospital, they've been useless, which is a shame because they could be a good hospital if they just tried to have staff around more often.
The truly great hospital "near" Jacmel is actually an hour drive away, in another city: the Médecins sans Frontières (Doctors Without Borders) hospital in Léogâne. If one of our clients needs to be taken to the hospital for any reason, and if there's time to get all the way there, that's always the first choice of where to go. But there is, of course, a risk involved in choosing the hospital that's an hour away, so sometimes we have to settle for St Michel and hope that they can do something good for the client.