Day one

Friday the 29th of August 2008

I was given a tour of the main orphanage when I arrived last night. I am staying at the guest house, which is on the same property that houses 90 children, under the age of three. I have one room mate, Stephanie, an American women who co-ordinates the orphanage's adoption programme. Our bedroom floor is tiled (easy to keep clean) and there are insect screens on the windows. We have our own toilet, a television and a DVD player and I am able to access wireless internet from my room. I am quite comfortable and very pleased with the staff quarters.

At the orphanage, Several "nannies" are responsible for the day-to-day care of the children in 4 nurseries that re located on the 1st floor of the baby house. The high care nursery is for neonates, sick and malnourished children. Children are grouped in the other rooms according to their ages and how far along they are in their development. The rooms are bright, airy and spotlessly clean. The children swoop in on you when you enter their room. They will cling to your legs, reach up to be held...and if you sit sown you wil not be able to get up...it will take two nannies to extricate a dozen toddlers from you.

There are few facilities for hand-washing, and no-where to isolate children with infectious diseases. Many of these little ones have diarrhoea. This is normal in Haiti. However, the storeroom, here, is full of donated baby care items and the staff do the best they can with what they have. They wash, dress and feed the children, and make sure they have appropriate toys and that they get plenty of fresh air. Unless they are sleeping, the little ones are on mats on the floor or in bumbo chairs.

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Dixie Bickel, who founded and directs GLA with her husband had planned to introduce me to the project, the staff, and children, today. I was to meet with her to talk about what my role here will be over the next 6 months.

The Director, is, of course, a busy lady so I had to occupy myself until she was able to see me. That was not difficult! We usually have a full team of volunteers here, who work one-on-one with the children under 2 years old. There is no-one working in that role just now. With the help of nannies and the office staff, I identified some of the children who were most in need of "TLC" and took them out of their nurseries for a while. I was a bit concerned that I couldn't get eye-contact from some of the babies. They did warm up after a while, though, and responded well to the staff they knew. These are positive signs that the little ones are attached to their care-givers. It is very encouraging to see that in an orphanage environment.

At 10:30 in the morning, I was called to help in the High care nursery. A baby girl (lets call her Alicia) had developed a fever and seizures the night before. The nurses had put in an IV and Dixie had given Alicia steroids, IV antibiotics and fluids through the line. Alicia had suddenly stopped breathing when they had called me.

When I arrived Dixie, who an ITU nurse before she came to Haiti in the mid 1990's, was there with two of the Haitian nurses, and they were trying to resuscitate Alicia. Her chest sounded "gurgly", and we suctioned bile from her airway. It looks as though our baby had aspirated bile into her lungs. She was blue around the lips, floppy and did not respond when I stimulated her.

I learned that this beautiful little girl, with almond shaped eyes and elegant cheekbone was HIV positive and had been sickly ever since she had arrived at God's Littlest Angels. She was not on Anti-retroviral drugs because her CD4 count (the type of immune cells that the HIV virus destroys) was over 200. A count of 200 is when adults are considered to have full blown AIDS. However, children's counts run much higher, and their immune systems are severely compromised long before their count fall to 200. In the developed world, Alicia would have been started on anti-retrovirals long ago, but this is Haiti.

We worked on Alicia for 40 minutes. The solemn eyes of the nannies were on us, and all the while, visitors were coming in and out of the nursery. There is little privacy here.

To everyone's relief, Alicia began breathing on her own. I was asked to give her constant nursing care until she stabilized. The Haitian nurses were not comfortable with resuscitating this child. Children are not resuscitated in Haitian hospitals, therefore, the staff do not know how to give basic life support. I stroked the little girl's forehead and told her that her job was to rest, to use all her energy to get better, and we'd do the best we could to help her.

Alicia never regained consciousness. An hour and a half later, her breathing became shallow, her heart rate dropped and the left side of her chest became sunken. I started resuscitating her again, sent up a prayer and asked one of the nannies to call for Dixie.

The little girl's lung had collapsed. In Scotland we would have put in a chest tube to re-inflate the lung, but there are no chest tubes in this country.

20 minutes later, Alicia was making no effort to breath on her own. There were some tough decisions to be made. There are no life support machines in Haiti. Our baby was showing signs of brain damage, and there was nothing that could be done about it.

The Haitian administrator arrived. The child's mother had not visited for several years, and no one knew where she was. We stopped resuscitation, took out the tubes, switched off the monitor. I drew Alicia close to me, and told her we would all prefer if she stayed, but that it looked as though she was leaving us. 'Don't you worry about a thing baby. You are going to a better place. No one gets sick there, or sore or sad there.'

Alicia had a strong heart, which continued beating for a full 10 minutes after we stopped resucitating her. She would have lived had she fallen ill in Scotland, I don't doubt it.

In Africa, when a child was near death, the staff used to gather to pray over the little one, and sing to her. Others would hold her, rock her, tell her she was loved and that they hoped to see her again in Heaven. The Haitian staff didn't do any of these things.

They say that in Haiti behind the mountains, there are more Mountains. That certainly seems to be true. Similarly, I think that in Haiti, there is sorrow, so deep that you will never reach the bottom.

I suspect people see too many child deaths in this country. Madamn Bernard, the head nurse in the high care nursery, shook her head in despair. No-one wept or wailed in that room. Is this their professional reserve? Maybe. I get the feeling, that the staff protect themselves from grieving too strongly, the many many things they cannot change. 1 in 5 Haitian children never see their 5th birthdays. Alicia was one of them, just one.

Alicia's face was washed and she was dressed in a cream dress, with puffed sleeves. She was photographed; Dixie explained that this was necessary, to prove to any family members who might come, that the baby really did die.

There won't be a grieving rite. There isn't time; GLA provides direct care to almost 200 children. They are all in need of care and attention. An undertaker will be called, and Alicia will be laid to rest. Please pray for the staff, that God will give them strength and courage for their work. It is not easy.

Friday was a tough day, yet, I have seen and heard enough to know I have probably seen a lovelier side of Haiti, where people will do all they can with what they have, to save the life of a beautiful, but stricken child.