Just another ordinary day in Jacmel

Monday May 17th, 8:15AM. Wake up right on time for our morning clinic. Would have loved a couple of extra hours of sleep but duty called in the middle of the night and we had a lovely little boy born at 2:17AM. There are only 2 of us midwives on site right now so clinic days are long and tiring. Monday is our pediatric clinic day. We see 40-50 babies and kids up till the age of three. Basic care and counseling. Lots of colds and coughs and scabies and diarrhea. Each child more precious than the next. It’s a delight to see them healthy with just little runny noses and it is heartbreaking to hold the severely malnourished. Thankfully we are seeing less and less of these cases now…
Resia walks in for care. 35 weeks pregnant, she’s come all the way from the mountain for a consultation. She is expecting her 3rd child and definitely not in labor. I go to assess. She proceeds to tell me she had an episode of heavy bleeding dating back to 5 days prior. Run through my questionnaire. Baby has not been moving as much as he used to. I send her right away to our local hospital for an ultrasound. She comes back an hour later to tell me the ultrasound machine is not in working order…And here we go. This has happened before and has turned out to be a total fib so I decide to go talk to the OB myself and see what is going on. We hop on a moto taxi. A little moped – driver, very pregnant woman and me on board zipping down the hill to St. Michel hospital.Turns out this time it is true. No ultrasounds today. Ask when the problem will be fixed and get the oh-too-common “God only knows” answer. By now it is 2PM and the sun is scorching hot. There are 2 more ultrasound machines in Jacmel –guarded behind the tall walls of the private OB clinics. Our NGO pays for these and at 20$ a pop, it’s not hurting our budget. Fingers-crossed that the machines are functional today. Back on the moped…And zip we go. First clinic is closed for some reason. Second clinic, sigh of relief, is open. At least physically. But after 30 min of waiting, we are told the OB has left and we should return the next day…Resia is so grateful, she promises me she will come back to the 2nd clinic at 7AM to get her ultrasound done. We part ways and I worry all day and night about her and her baby. Partial placental abruptio running through my mind (when the placenta partially separates from the uterine wall…). I hope and pray for a healthy outcome.

Next day, 11AM, Resia comes back with her ultrasound report in hand. I’m at the dome clinic with a mama in labor, first baby, transitioning nicely. Diagnosis confirmed (my worst fear coming true) plus, the report reveals that the baby is compromised…I leave Pamela (our current volunteer midwife) alone with the laboring mom hoping to have enough time to make it to the hospital and back before the birth. And zip, zip, zip…back on the moped and off to St. Michel we go. Today is National Flag day and the streets are full of people and loudspeakers have been blasting compa music since sunrise. Party day indeed. The maternity ward is deserted but I manage to find the OBGYN. Present the case and they decide to keep her under observation. They can’t do anything until they get her lab work done and obviously, since it’s a national holiday, the hospital lab is closed. Resia understands this and says she will go home. The OB non chalantly hands her back her ultrasound results and walks away. I stand in disbelief…I have a mama that doesn’t seem to understand the severity of her and her baby’s situation – she’s about to get onto a pick-up truck and ride the hour long bumpy road back up the mountain where there is no medical care available. She is adamant about going home. And I have an OB who can’t take the time to tell her in creole the reason why she should stay put. The OB is not reacting well to me asking about what his clinical plan is. We have a confirmed partial abruption with a non-reassuring biophysical profile and no-one seems to be too concerned. My hands are tied. I just manage to get the OB to at least explain the situation to Resia and let her walk away informed. I walk with her, back to the house. She insists that she will come back to our clinic if she bleeds again. I ask her to go directly to the hospital instead if that happens. But she keeps insisting. I get a translator on the phone to explain this to her, just in case she is not understanding my creole. She still insists to him that she’ll just come back to our clinic. We part ways after walking together from the hospital. She doesn’t seem to have a care in the world. Smiling and waving bye-bye as she walks down the dusty street to go find a ride back up to the mountain.

Mama’s still labouring at the dome. Have a quick shower and walk up the hill to sit by her in the afternoon heat, taking it one contraction at a time.