Science, Tech & Environment

Hard Lessons for American Midwife Volunteer in Haiti

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Nursing and midwifery students crowd around to observe as midwives help a woman deliver a baby. (Photo: Jenny Asarnow)

Haiti is in desperate need of skilled medical workers, a need exacerbated by last year's earthquake. Many Americans have volunteered to help, but in a place where basic needs go unmet and security is tenuous, those volunteers can find that the skills they have to offer aren't enough.

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This is the story of one American who volunteered in Haiti and the hard lessons she learned.
A Desire to Help

Erin Curtiss is a midwife in Seattle. She is 34 years old, has sharp blue eyes and a raunchy sense of humor. She lives with her two young sons and her girlfriend.

Erin, who runs her own home birth business, recently learned of an American nonprofit organization called Midwives for Haiti. She found it on Facebook.

"I'm being asked to help, and I can help, and so I will help," she said. "And it is just as simple as that."

Haiti has a desperate need for midwives. Women in Haiti are fifty times more likely to die during childbirth than women in America. One big reason is there aren't enough medical professionals to deliver babies.

Erin says she has always wanted to help where she is needed the most, so she volunteered to go to Haiti for one week.

She traveled to a little city called Hinche, in Haiti's Central Plateau. She came to volunteer at the public hospital, where patients are crammed into long rooms with no electricity, and where the windows and doors are open to the air — and the mosquitoes and flies and lizards that come through.

Back home, Erin only deals with uncomplicated pregnancies, but here, women have extremely high blood pressure, anemia, even cholera. These are the sickest patients she has ever seen, and the hospital staff doesn't seem to have enough time for anyone.

Erin came here mostly to train midwives, but now that she sees how much needs to get done, she wants to do more. So she makes a generous offer. She'll work the night shift, when there are fewer midwives on staff.
Night at the Hospital

"There's really so much that doesn't get done here, so I think there's plenty to get done tonight," Erin says as she arrives around 9 p.m.

The maternity ward is completely full. Families crowd the spaces between beds and listen to their radios. Thirty-three women are about to give birth or just did, and there are only two nurse-midwives on duty: Adeline and Denise.

Adeline and Denise are graduates of Midwives for Haiti's training program. They both smile, but they look strained. Adeline says this is their seventh night working. She hasn't slept in a week. "God sent you," she says with a laugh.

Erin and the Haitian midwives deliver a baby. Then Erin checks on the sickest patients.

Around midnight, Erin gives medicine to a woman with dangerously high blood pressure, but it's not working, and she doesn't know what else to do. "I'm almost to the end of the syringe full of meds," she says. "When it's done, I'm going to tell the midwife that it didn't work."

But the Haitian midwives are nowhere to be found. They're asleep in the labor and delivery room. They lay down sometime before midnight. Erin realizes she's on her own.

The hospital is dark. A bunch of young men are standing in the courtyard. A lizard runs up the wall. Dogs turn over trashcans.

Erin goes to check on her patient. As she switches on her headlamp, the light illuminates a bucket — a chamber pot — beside another woman's bed.

"There's a lot of blood in that bucket," Erin says with a gasp. This woman is hemorrhaging. It's one of the reasons so many pregnant women here die.

The woman's voice is faint. She says she gave birth six hours ago — just before Erin arrived. She may have been bleeding that whole time.

"Her uterus is full of blood and probably has clots in there," Erin says. "I'm going to need to get them out."

Erin tries to stop the bleeding, but she's worried.

She is also frustrated — that Adeline and Denise are asleep.

"You would think that there would be some kind of protocol set up for every two hours, somebody does a round," she commented later. "And as far as I could tell, that wasn't happening at all. Here are people who are trusting you to help them, and you've abandoned them."

It's not until after 4 a.m. that the Haitian midwives finally wake up. Erin gets the woman's bleeding under control, but when she leaves the hospital at 6, she is still on edge.

"That was positively horrible," she says. She realizes that her Haitian colleagues are overworked and need sleep, but she can't understand why Adeline and Denise didn't check on their patients, especially the woman who hemorrhaged.
Hard Truths

A few days later, after Erin has gone back to Seattle, the Haitian midwives explain what happened that night.

Denise and Adeline say one of the reasons they slept is simple: they were exhausted. But there's another reason they don't check on the patients at night. They're scared to go into the courtyard where the patients' rooms are.

"We are women, so we can't go out of the labor and delivery room to check on the patients," Adeline says through an interpreter.

"Haiti is a dangerous country," she continues. "We don't have light in the rooms. Even if you had a flashlight, you're two women. After midnight or 1 a.m. you can't check on the sick because of the lack of security." Adeline and Denise say not long ago a girl was raped in the hospital at night.

In a place where women desperately need midwives, these midwives can't do their job right because they don't feel safe.

Later, back in Seattle, Erin reacts to the midwives' explanation.

"That makes me sad to hear," she says. "I was too stupid to be scared."

Erin knew there would be a lot about Haiti she wouldn't understand, but now she realizes that things were even more complicated than she expected. She went to help fix a problem — too many Haitian women die during childbirth — but she found that simply training more midwives isn't enough.

"It doesn't matter what kind of protocols you have set up if you're afraid of being raped," she says. "I don't know what the solution is to that, though."

Erin has returned to delivering babies in Seattle, at comfortable homes where every candle is in place and the perfect music is on the stereo. She is grateful for how easy things are here.

But Erin still thinks about the women she met in Haiti. She knows she doesn't have the answers to Haiti's problems, but she plans to go back and try again.

Jenny Asarnow traveled to Haiti with support from the International Reporting Project.

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