Health & Medicine

American midwife discovers challenges of medicine in Haiti

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Erin Curtiss sits in a hospital clinic in Haiti, where she went to help train more midwives. The country is desperately in need of trained medical professionals. (Photo by Jenny Asarnow.)

Story from The World. Listen to the above audio for a complete report.

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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.

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.

Curtiss, 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 50 times more likely to die during childbirth than women in America and one big reason is there aren’t enough medical professionals to deliver babies.

Curtiss said she has always wanted to help where she is needed the most, so she volunteered to go to Haiti for a 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, Curtiss only deals with uncomplicated pregnancies. In Haiti, 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.

Curtiss went to Haiti mostly to train midwives, but once she saw how much needed to get done, she wanted to do more. So she made a generous offer: She’d work the night shift, when there were fewer midwives on staff.

***

“There’s really so much that doesn’t get done here, so I think there’s plenty to get done tonight,” Curtiss said as she arrived about 9 p.m. one night.

The maternity ward was completely full. Families crowded the spaces between beds and listened to their radios. Some 33 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 smiled, but they looked strained. Adeline said this was their seventh night working. She hadn’t slept in a week.

“God sent you,” she said, with a laugh.

Erin and the Haitian midwives delivered a baby, then Curtiss checked on the sickest patients.

Around midnight, Curtiss gave medicine to a woman with dangerously high blood pressure, but it wasn't working. She didsn’t know what else to do.

“I’m almost to the end of the syringe full of meds,” she said. “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 went to sleep sometime before midnight and Erin quickly realized she was on her own.

The hospital was dark. A bunch of young men are standing in the courtyard. A lizard ran up the wall and dogs turned over trashcans.

Curtiss went 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,” Curtiss said with a gasp.

This woman was hemorrhaging. It’s one of the reasons so many pregnant women here die.

The woman’s voice is faint. She said she gave birth six hours ago – just before Curtiss arrived. She may have been bleeding that whole time.

“Her uterus is full of blood and probably has clots in there,” Erin said. “I’m going to need to get them out.”

Curtiss tried to stop the bleeding. But she was worried — and frustrated. Adeline and Denise were still asleep.

“You would think that there would be some kind of protocol set up for every two hours, somebody does a round,” she said 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 wasn't until after 4 a.m. that the Haitian midwives finally woke up. Curtiss got the woman’s bleeding under control, but when she left the hospital at 6, she was still on edge.

“That was positively horrible,” she said.

She realized that her Haitian colleagues were overworked and needed sleep, but she couldn't understand why Adeline and Denise didn’t check on their patients, especially the woman who hemorrhaged.

***

A few days later, after Curtiss went back to Seattle, the Haitian midwives explained what happened that night.

Denise and Adeline said one of the reasons they slept is simple: they were exhausted. But there was 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 said through an interpreter.

“Haiti is a dangerous country,” she continued. “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 said 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, Curtiss reacted to the midwives’ explanation.

“That makes me sad to hear,” she said. “I was too stupid to be scared.”

Curtiss 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 said. “I don’t know what the solution is to that, though.”

Curtiss 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 she 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.

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