giving birth in a disaster zone

Giving Life in a Land Overflowing With Pain

Damon Winter/The New York Times

Doctors introduced Roseline Antoine to her newborn, Kimberly, on Thursday in a tent serving as a maternity ward outside General Hospital in Port-au-Prince. More Photos >

The women shared one of the better medical facilities here — a maternity tent outside General Hospital — but there were not enough beds or doctors. Flies were their roommates, bunching like crows on the intravenous drips, and as for the joy found in most maternity wards, that had been lost to the cracked earth.

“The street where I live, it’s so dirty; there isn’t enough food or water,” Ms. Antoine said. “I’m scared to bring a baby into this awful situation.”

Pulling down her blue dress after giving birth, she added, “I need to find a way to survive.”

The pregnant are an especially vulnerable subset of victims of the quake that has left so many Haitians homeless and desolate. The United Nations estimates that 15 percent of the 63,000 pregnant women in the earthquake-affected areas are likely to have potentially life-threatening complications. For the roughly 7,000 who will give birth in the next month, the risks are even greater.

ARTICLE CONTINUES:

http://www.nytimes.com/2010/01/30/world/americas/30birth.html?ref=us

bureaucracy costing lives, again

Cost Dispute Halts Airlift of Injured Haiti Quake Victims

By SHAILA DEWAN

Published: January 29, 2010

MIAMI — The United States has suspended its medical evacuations of critically injured Haitian earthquake victims until a dispute over who will pay for their care is settled, military officials said Friday.

The military flights, usually C-130s carrying Haitians with spinal cord injuries, burns and other serious wounds, ended on Wednesday after Gov. Charlie Crist of Florida formally asked the federal government to shoulder some of the cost of the care.

Hospitals in Florida have treated more than 500 earthquake victims so far, the military said, including an infant who was pulled out of the rubble with a fractured skull and ribs. Other states have taken patients, too, and those flights have been suspended as well, the officials said.

The suspension could be catastrophic for patients, said Dr. Barth A. Green, the co-founder of Project Medishare for Haiti, a nonprofit group affiliated with the University of Miami’s Miller School of Medicine that had been evacuating about two dozen patients a day.

“People are dying in Haiti because they can’t get out,” Dr. Green said.

ARTICLE CONTINUES:

http://www.nytimes.com/2010/01/30/us/30airlift.html?hp

grad school update

this week emory invited me to have a phone interview, which i had yesterday. i think the part where i asked questions went well-- we had a great conversation and i learned a lot more about emory's program. curriculum-wise, i think emory is incredibly innovative-- they have a totally separate class that focuses on breast feeding management and another class that focuses on genetics and embryology, in addition to offering the family nurse-midwifery degree (family nurse practitioner degree + a nurse-midwifery degree). although i applied to the straight-up nurse-midwifery program, it would apparently be very easy for me to switch to family nurse-midwifery should i get in. and i really enjoyed talking with jane mashburn, the midwifery faculty person who interviewed me-- she described herself as a clinician at heart and talked with such passion about her start as a midwife and teacher.

however, the first part of the interview, where i was answering questions, felt terrible!! everything i said sounded so idiotic to me, and i felt like i was talking in such general and boring terms about why i want to become a midwife. i didn't even mention being a doula until the tail end of the conversation. and the worst part is, there were these looming silent pauses after i said anything-- i'm hoping it was because jane was engrossed in what i was saying and writing down everything, but i'm fearing she was in shock with how horribly i was presenting myself. i should hear about an admissions decision from emory by the third week of february (around the same time as yale).

yesterday, i also met with the powers at be at MGH to discuss the feasibility of doing my summer immersion clinical in haiti. i had gotten the green light before the earthquake, but now, understandably so, they want to hammer down more details to see if it could still work. there are a lot of details to work out, so i'm not holding my breath, but during the meeting i learned that MGH is interested in creating a partnership with a nursing school in haiti. between that and my interest in nurse training models in haiti and supporting nursing within partners in health, the very idea that MGH is even interested in doing something like that only added another layer of consideration for staying at MGH for graduate school...

in the meantime, in addition to sort of paying attention to spring semester of nursing school (loving the pediatrics rotation at spaulding rehab, rather checked out of our nearly exclusively online classes for everything else), i'm starting a haitian creole class at harvard medical school next week and using these free language audiobooks to practice creole at home. whether or not i go to haiti over the summer is irrelevant-- it will be useful to learn some creole no matter what and it's better for the soul than watching cnn obsessively for haiti updates.

importance of nursing in disaster response

for all of the absolutely imperative focus on sending trauma and surgical operating teams to haiti, one important aspect of such mobilization is missing: post-op nursing care. while a lot of nurses with post-op and wound experience have already headed to haiti or are planning to go, so many more nurses are needed, and will be needed for a long time. (it goes without saying that haiti was medically underserved in every sense and major planning needed to happen about how to build better health infrastructure in haiti well before the earthquake) you can have the best surgeons and trauma docs in the whole wide world performing incredible surgeries on people, but if you don't have the nursing care afterwards to change dressings, pack wounds and dole out timely antibiotics, among other things, all that surgical effort was wasted if people die from infections.

two articles today highlight the critical issue of infection following disasters of this magnitude and the importance of nursing care. the first is an overview of infection issues from the globe:

http://www.boston.com/news/health/articles/2010/01/27/infections_taking_hold_of_survivors_in_haitis_squalor/

the second is a reflection written by ophelia dahl, the executive director of partners in health. here is an excerpt in which she specifically addresses nursing:

"Volunteers run about. Some nurses, both Haitian and American are around, but there is a lack of nursing care everywhere. The nursing school collapsed in the quake, flattened between two buildings that still stand. Its rubble holds the remains of the entire second-year nursing class. You can smell the bodies when you walk past. It seems so arbitrary which buildings crumbled; maybe that’s why no one feels safe in any concrete structure."

for the full text of ophelia's reflection, click here:

http://standwithhaiti.org/haiti/news-entry/catastrophe-will-forever-divide-history/

on the ground in cange, haiti

"rising to meet an infinite need"

good piece on partners in health's role in haiti that focuses on cange... accompanied by a video capturing my love and naomie, the pediatric nurse who is so amazing. i didn't know until now that she lost her sister and niece. everyone has lost someone, at least one person, too often more.

http://www.boston.com/news/health/articles/2010/01/24/boston_based_nonprofit_has_been_thrust_into_leadership_role_in_haiti/

split

part of me is here, doing what needs to be done for nursing school, for living life... but most of me, my heart, my spirit, my conscious thoughts and my dreams, is in haiti. in all of the horror, however, the amount of love and support i have received from family, friends and perfect strangers is nothing short of astonishing. and the generosity of so many for the people of haiti is incredible. while i remain cynical about the sustainability of the long-term support of haiti, i know that right now is a moment of unbelievable unity to help in any way a near-destitute country before the earthquake now utterly destroyed.

the part of me that's here made it through my yale nursing interview this morning. i interviewed with angelina chambers, an absolutely phenomenal person with whom i would love to train and work. the interview felt more like a conversation, in many respects-- my interests align closely with hers and we seemed to have a lot to talk about. going to yale today definitely allowed me to picture myself at yale in a way that i hadn't been able to before-- i learned things about the school that exceeded my expectations, most especially the strong relationships between the faculty and students. i should find out in four to six weeks if i get in... in the meantime, i'm still waiting to hear from emory, suny and mgh.

below are links to hope. the first, to a slideshow of the medical care provided to earthquake survivors in cange, haiti. the second, a sweet show of generosity from a librarian in georgia-- one can only pray that others follow his example, and continue to do so for a very long time. both links are courtesy of http://standwithhaiti.org

http://standwithhaiti.org/haiti/news-entry/images-from-cange-providing-medical-care-and-comfort/

http://standwithhaiti.org/haiti/news-entry/our-partners-in-health-cliff-landis-librarian/