Stupid Cupid?

GLA's volunteers, romantics and cynics alike, celebrated Saint Valentine's yesterday. There was lots of food, there was a movie and there were games. Most of the party-goers were still partying until past mid-night.

Haitians really don't buy into commercialized celebrations and so it comes as no surprise to me that February the 14th is not a significant date on their calenders. What does surprise me, in light of several conversations I have had with the nurses and nannies lately, is the faith they put in romantic love.

***

'Miss Susan...' the tone in Miss Magalie's voice suggested she needed my help with something. I looked at her expectantly. '...Do you have a boyfriend?' she asked.
What? The answer was easy enough (I do not have a boyfriend) but the question caught me off guard. Miss Magalie smiled knowlingly. 'You need one. You can't live without one.'
'Why do you say that?'
'Cherie, you are too old to be without a man,' she replied with a warm, joking authority. 'I'm going to start looking for a boyfriend for you.'
'Miss Magalie, you don't have a lot of time,' I joked back, 'I'm leaving soon.'
'When are you leaving?'
'February the 26th. '
'Oh...' Miss Magalie was thoughtful for a moment. '.....Then I'm going to pray for you.'

***

My mouth was wide open. A baby I am particularly close to, a beautiful 16 month old boy, had just pinched Vivianne, a 20-something year old Haitian orphanage worker, on the behind.
'Infidel!' I declared, 'You are obviously chasing all the ladies, not just me!' This sent my tiny boyfriend and all of the nannies into a fit of giggles.

'But Susan,' Marie began, 'All Haitian boys are like that.'
'Unfaithful?'
'Yes,' she said. 'Maybe they have a wife, but they will have girlfriends too. And children with the wife and children with the girlfriends' Rose was smiling but she was also absolutely serious. I frowned. 'That's not good.' It was of those moments when you hear a hint of sorrow in another's voice. You read their story in their eyes, and you sense, just for a moment, the weight of a burden you have never had to bear.

'No, it is not good,' someone agreed. 'Do you get men like that in Scotland?'
'Yes, we have some men like that.'
'Well, in Haiti we have many,' Rose observed.
'And if the men all have children with many different women, the men can't possibly support them all.'
'Exactly!' Rose exclaimed. 'The men come and they go.' I didn't ask why Haitian women put up with that. I think I get it - before there are children, there is male attention, and male attention flatters women everywhere. And afterwards, so long as the errant husband or boyfriend returns to you with some money to feed your hungry children, you probably are not going to ask questions.

One of the senior nannies was sitting quietly in a chair. She looked drawn and she was regarding me with an expression that came close to resentment. 'You don't like our conversation?'
'No, ' she answered, and her face softened, 'but that is because what you are saying is true. All of them,' she said, indicating the babies in the room, and beyond the door,' have been affected by infidelity. They are here because their Mothers can't provide for them. 'And,' she added, 'many of us are here [working at the orphanage] because our children need to eat, and their father's do not take care of that.' She sighed, looking resigned but determined. 'We wouldn't leave our babies if there were another way.'

***

When the women spoke, I got the feeling that they coveted my ears. It is as though once in a while, they have to give voice to their struggle, so that the rest of the time, they can endure it. Oh my goodness, I have so much to learn and so little time left for the learning.

Despite all that they have told me about how relationships work, I know of at least two ladies here who are praying that I will find my Mr right. I also know of two young Haitian ladies who are in new relationships. They are soul deep in the newness and excitement of it all, and their friends and workmates, even the older women, who, given all they have seen and experienced. might be justified in cynicism and resentment, are rejoicing with them.

I find myself thanking God, for all our little boys here who will go to stable families, and learn to love by the example their Fathers set.

But more than anything, I pray that the children of Haiti, those who stay and those who go, will always remember and be inspired by the sacrifices their birth families have made for them, their labours and that phenomenal endurance. If their lives have been touched by poverty and infidelity, they are all ready marked with great love.

Mesi Nova Scotia!

Several boxes of donations arrived on Sunday. One of the staff members here handed me a gift bag with Scottish treats. The bag had my name on it.

The donors were gone before I knew anything about their visit. Since I couldn't thank them personally, I'd just like to say mesi anpil to the Nova Scotia residents who sent me a taste of home. I appreciate their thoughtful gesture very much.

Love Susan

Gastroenteritis

An outbreak of viral gastroenteritis has been sweeping through Haiti this month and for the past 10 days, we at GLA have been feeling the effects of the epidemic, with dozens of babies, volunteers and staff coming down with diarrhoea, vomiting, headache and fever.

Gastoenteritis is one of the most common childhood illnesses world-wide. While in the developed world, symptoms are usually mild and the child recovers without any lasting effects, malnutrition and parasites make Haitian children more susceptible to severe dehydration and other life-threatening complications of diarrhoeal diseases. For this reason, the treatment of acute gastroenteritis is approached slightly differently here, than it would be in Western Europe or North America.

One major difference is that we never do blood draws on children who have diarrhoea and vomiting. In the developed world, clinical chemistry results (levels of sodium, potassium, glucose acid and bicarbonate in the blood) sometimes guide the type of fluids that are given and how quickly children are re-hydrated. These tests though, are unhelpful in here; there are no labs in our area and even if we did send a sample for analysis, it would take up to 24 hours to get the results. That is too long when you are dealing with a child who needs treatment right away.

Although we can't be certain if a child has normal, raised or lowered levels of electrolytes in their blood (all of which can occur when a child has severe gastroenteritis) , it is possible to make a reasonable guess, based on how the child looks and what their vital signs are doing. Assessments such as how moist their skin and mouth is, whether their eyes or fontanelle are sunken and how cold their hands and feet are, also indicate how dehydrated a child might be. For a more objective measure of dehydration, I weigh the children and compare their weight on the day they present to the last weight that was recorded for them. The children here are weighed once a week and this is very helpful when they get sick.

The main focus is then on making sure the child stays well hydrated by replacing fluid, salts and sugars. This is done either with an Oral rehydration solution (ORS) or with IV fluids. In over 90% of cases, we successfully rehydrate our children orally, even when the dehydration is severe. The nurses and nanny's here are very experienced in treating gastroenteritis.

If the child is vomiting, we often give anti-emetics. Although we don't usually do this in Scotland, it is routine, in Haiti, to give oral medications such as Reglan for gastroenteritis and I find that they usually work. I am in favour of this approach because anti-emetics seem not only to help the children feel better but they also make oral rehydration possible. For children who can tolerate ORS, we can then rehydrate them safely and more rapidly than we could with an IV. Typically, we are able to hydrate the children in as little as 4 hours. The majority of children who have viral illnesses are then able to tolerate small amounts of their usual milk formula or familiar foods, and this speeds their recovery.

In other cases, the child vomits persistently or is too sleepy to drink. For these children, IV fluids are usually the best option. During the current outbreak of gastroenteritis, we have had only 1 (medically fragile) child on an IV. That child returned to his nursery 48 hours later, completely recovered.

Another baby was able to drink but just didn't want to. I considered it important for this baby's recovery, to continue feeding him, and so we used a Naso-Gastric feeding tube to rehydrate him. He is now on his regular formula and he is eating well.

Since many Haitian children have or have had parasites which can cause diarrhoea, we give de-worming medications to all children with diarrhoea unless they have been treated have received treatment for intestinal parasites in the previous 6 months. Since many of the bacteria and parasites that affect Haitian children damage the gut and cause lactose intolerance (which makes the diarrhoea worse), our children are often switched to a soy formula, which they continue on for 2 weeks after the diarrhoea stops. These children are also given SMECTA, a French product that binds to the mucous lining of the gut, strengthening its defences against toxins.

We also give pre-biotics such as acidophilus, when we have them. These are proven to help reduce the duration of many diarrhoeal infections. Since most cases of gastroenteritis are viral, we usually do not start antibiotics for diarrhoea that lasts for less than a week. However, because this is Haiti, we are very aware that gastroenteritis is more likely to be caused by bacterial or protozol infections. It is routine to give medications for both types of infection at the same time. After all the children have usually been unwell for several days before they begin antibiotics and by this point, we can be reasonably sure that they need an antibiotic, and we want to make sure that what we give works as soon as possible.

In the 5 months have been here, we have nursed many children through severe gastroenteritis. I am thankful that we have been able to do that, but I am ever mindful of the children who live in impoverished communities beyond our walls. Many of these children drink contaminated water. They are malnourished and full of parasites and they have no access to medical care. For them, gastroenteritis, a condition that is both treatable and preventable can be, and all too often is, fatal.

Ti Marasa

You might remember this little man. He came with his twin brother on New Years Eve. Last Sunday, he was giving me cause for concern. He had profuse diarrhoea and he looked dehydrated.

The week before, he had been moved to the high care nursery where we started IV fluids and antibiotics. I have been watching Ti Marasa (the little twin) very closely since the New Year, because he is profoundly anaemic, and that makes him very vulnerable to infection. On Sunday of last week, the pale skinned baby with white gums had dropped from almost 14lb to 12lb 2oz. Despite the best efforts of a dedicated nanny, he was refusing to drink. He was very tired and his eyes we sunken. We had hoped to avoid having him bounce back to the NICU but it was clear that he needed another IV.

We rehydrated him and started him on another course of antibiotics. Three days later, the diarrhoea was as bad as ever and our paediatrician changed his medications. We were really struggling to get nutrition into him. He wanted cheese puffs (the highly processed kind) and nothing else. We were bringing his brother in to visit throughout the day, in the hope that this would lift Ti Marasa's spirits. It was touching to see Gwo Marasa (the big twin) offer his little brother little pieces of bread. The tiny boy would smile when he saw his brother, but he wasn't making any progress.

I would sit for 40 minutes at a time, trying to get him to drink. He would roll his eyes like he was dying (he was not) and he could let everything dribble out of his mouth. By the end of the 40 minutes (I really couldn't cope with him playing dead for any longer), he would have taken 3-4oz and he would keep it down. We couldn't be sure whether he was feeling nauseated or whether he just didn't feel hungry. It was clear though, that we were dealing with a very strong personality!

He was starting to show signs of zink and B vitamin deficiency on Friday and by that time, he was pursing his lips tightly and absolutely refusing to eat. I strongly felt that he needed nutrition to heal, and we all knew that he would need a blood transfusion before long, if he didn't start eating. Reluctantly, I put a Naso-gastric (NG) feeding tube down and started feeding him an enriched milk formula. His protests about the tube were loud, and his wailing could be heard down in the office and on the third floor balcony for over 1/2 an hour.

He is doing better today and is beginning to eat on his own but he still needs prayers for a healing. I would like to see him catch-up with his brother and I dearly hope that he will not fight all of our efforts to make that happen!