Maternity care in Haiti

DSCN0307 For the first time our medical mission team included 2 labor and delivery nurses. We had a few education goals in mind, some of which we achieved and some of which we did not. Most importantly, we established a working relationship with the nurses in maternity, hoping that they will be more receptive to ongoing education in the future. Our main focus was around infant resuscitation after delivery but also included learning about longstanding cultural practices related to childbirth. The nurses encouraged patients to walk and move more in labor, rather than laying in bed. A tradition of soaking in very hot water steeped in herbs in the days and weeks after birth was discouraged due to burns. The nurses were most surprised by the need of the Haitian staff to reuse many of the instruments that we consider disposable. Plastic hooks used for rupture of membranes are soaked in a sterilizing solution and reused until they break. Vacuum instruments used for forcep deliveries are reused until they do not create any further suction. Flies need to be swatted away frequently.

Haiti has no version of health insurance and the hospital must cover its costs in order to continue to function. When patients arrive in maternity they are sent to pharmacy to collect and pay for their needed medical supplies, such as sterile gloves, IV tubing and IV bags and medicines. One patient arrived and was quickly diagnosed with very high blood pressure and pre-eclampsia. In the US she would have been put in a quiet room, IV started with Magnesium to prevent seizures and labor induction. In Haiti, she was sent across the busy courtyard to collect these supplies and then spent her time in a noisy and hot maternity area with other patient’s families constantly coming and going, a woman in the bed nearby moaning during labor and American nurses asking many questions of the Haitian nursing staff. All of this would induce a seizure in most of us, even without pre-eclampsia!

Following the first delivery that was witnessed by our nurses, the baby was soon brought out into the courtyard by a relative to show to other family members, in addition to whoever else was around. The American nurses expressed concern that there was no identification on the baby to link the infant with the correct mother. They received a confused look from the translator and a query as to why this was done in the US. After the explanation regarding infant abduction, the translator was even more confused. “We already have too many mouths to feed and not enough food in this country, why would someone want one more?” Too bad we can’t use all the millions of dollars that we spend on infant security systems in the US to provide food and birth control to a nearby nation.

Now that we have a better idea about what the maternity department can actually use, we are hard at work collecting supplies and donations to be sent with another medical team traveling in January. Although some supplies such as IV solution will always need to be bought, we hope to increase donations so that other supplies can be provided free of charge.
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