Back In Haiti

I made my way through the chaos of the Toussaint Louverture Airport on Monday, heaving two large suitcases, a heavy backpack and a portable oxygen concentrator. All of the supplies I was carrying were needed to enable us to care for critically ill infants who require CPAP and those who need to leave the orphanage for medical care or investigations at a time when they are dependent on oxygen.

It was nerve wracking having to transport the $3000 concentrator all the way from Pennsylvania, and I was relied that nothing was lost or damaged en-route from the States. It was hot and humid inside the airport hangar where Immigration, baggage collection and customs have been temporarily located. The arrivals terminal was badly damaged during the earthquake. As our plane taxied into the gate area, we saw a partially collapsed balcony and deep cracks in the recently refurbished, freshly painted terminal building.

The flight had been full of foreign aid workers. It was disappointing that the Haitians on board did not applaud when the plane touched down in Port-au-Prince. That is what usually happens. I wondered what this change signified. Had the hope, joy and pride they had for their Haiti been crushed?

Making my way out of the hangar, my eyes fell on a porter. His left shirt sleeve hung limply over a stump above the elbow. They say that there are thousands upon thousands of amputees in this country - earthquake survivors who sustained severe injuries to their limbs. Knowing how negatively Haitians view disability, it was a great encouragement to see this man and know that he was in work, supporting his family through these difficult days. It is my hope that men like him will influence the mindsets that underpin these prejudices.

A few days before, I had been in the Neonatal Intensive Care Unit of a Pennsylvania hospital. It had been a very productive shift. I had had the opportunity to shadow a Neonatal Nurse practitioner and had received information and guidance from the nursing staff, a respiratory therapist, a physiotherapist and a Neonatal Pharmacist . Together, they gave me a holistic picture of CPAP and the care and attention that is needed to provide this breathing support safely and effectively. I practiced setting up the system, I heard about the best way to position infants receiving this breathing support, the problems they may experience and the level of care they are likely to need. I was actually able to see the difference that it made to a premature infant we collected from the delivery room that day.

It was exciting to be back in Haiti, armed with this new knowledge and all of the tubing and the accessories I would need to provide CPAP to Haitian infants.

CPAP

Since the earthquake on January the 12th, we have seen an increase in premature births in our area. Expectant mothers are under a great deal of stress, and this seems to be sending many of them into preterm labour. The result; many babies are being born with low birth-weights and immature organ systems.

At God's Littlest angels, two premature infants have died recently. We believe that they might have lived, if we had been able to provide CPAP to help them breath. With the help of Heather Maeding, a Neonatal Nurse Practitioner from Pennsylvania, GLA has managed to obtain a Bubble CPAP set-up for the smallest babies at the orphanage. There is just one problem - no-one here knows how to use it.

CPAP stands for Continuous Positive Airway Pressure. CPAP is a therapy that provides breathing support for babies who are born prematurely, with underdeveloped lungs. It can also be used to treat infants and toddlers with pneumonia, who would otherwise need to be ventilated in order to survive. The continuous pressure, which is provided through prongs that sit just inside the nostrils, helps keep the baby's airways open. It splints their chest so that breathing is less work. It prevents the lungs from collapsing and facilitates better gas exchange.

Watch this video to see bubble CPAP in action in North America:





Bubble CPAP is a safe, simple and cost-effective way of providing respiratory support to infants in the developing world. It is less invasive that a ventilator and CPAP does not damage infants' fragile lungs in the way that mechanical ventilators can.

CPAP has been shown to dramatically improve the survival of premature babies, born in resource-poor countries. In one centre, 1 in 10 babies died before the introduction of bubble CPAP. Afterwards, 9 out of every 10 babies lived!

As I understand it, even extremely low birth weight babies, weighing less than 2lb can benefit from CPAP, so long as they are making an effort to breath by themselves. Many of the infants who have died at GLA were born at  a weight and at a stage in their development that might have made them good candidates for bubble CPAP

Tomorrow, I am flying out to Pennsylvania, where I will receive some training from Heather Maeding and her colleagues at Saint Luke's Hospital. This training should ensure that I can set up bubble CPAP and care for and monitor the infants we place on this breathing system. I will then pass on this knowledge to our Haitian nurses.

It is very exciting to be able to provide CPAP at God's Littlest Angels. We will be one of the only centers in Haiti to offer this therapy. Few of the existing neonatal or paediatric intensive care facilities in this country are able to ventilate sick babies and children. There are just a handful of Neonatal Intensive Care Units in the sprawling city of Port-au-Prince and most do not even admit babies who are born at home.  Since most Haitian mothers can not afford the costs of a hospital delivery, our drive to implement CPAP really will help minister to 'the least of the least,' babies who are excluded from both government and private health care facilities.

Our Smallest, Sickest Babies

There are over thirty babies at the main house. With so many infants, all together in one place, it makes sense that sicknesses will spread quickly. Since young children's immune systems are not fully developed, it also follows that some infections will make a few of these little one's very sick.

Yet I am constantly surprised, even with good nutrition and the attention of trained nurses and nannies, to see just how unwell so many of our smallest babies become, and how often.

Perhaps Haitian babies are fragile because their mothers are malnourished? Underweight mother's certainly appear to deliver smaller babies, who are more likely to be anaemic. Perhaps it is the environment - warmer temperatures and higher humidity favour the growth of many microbes. Parasites, I am sure, explain many of the illnesses we see. And our babies have been separated from their mothers, which is a source of stress, that might make them susceptible to infection.

Take Luc - he is a month old. He was born prematurely, and initially grew and thrived at GLA. A week after he got here, though, he developed gastroenteritis. He became very dehydrated, and lost weight rapidly. Two weeks later, after a course of antibiotics and treatment for parasites, he is still having trouble tolerating his feeds.

He needs medications to control his vomiting and he can only tolerate small amounts of breast milk, or an expensive hypoallergenic formula. The diarrhoea is improving but he is not digesting his milk very well, and his weight is not increasing. We have sent stool samples for laboratory analysis but our paediatrician is at a loss as to what else we can do for this baby. He weighed 3lb 12 oz when he was admitted. his weight today is 3lb 10 oz.

Three month old Jude is also sick with gastroenteritis. His nanny called me to see him yesterday. He had had several episodes of watery diarrhoea. He was dehydrated and had lost a lot of weight. He was also refusing to feed. Today, Jude has been started on an antibiotic and he is being fed pedialyte and very small amounts of milk through a feeding tube.

Jude was the first child to be admitted to GLA following the earthquake. He was a low-birth weight baby, who was also severely malnourished and suffering from an infection that was causing seizures. His 19 year old mother initially planned to relinquish Jude for adoption. She has since changed her mind. Jude's mother is an orphan and does she is staying here at the orphanage, caring for her baby under the guidance of our nannies and nurses, who will teach her basic skills in hygiene and nutrition.

Today, something remarkable happened; it transpired that 9 weeks since she gave him up, Jude's mother is still producing some breast-milk! Breast milk is easy to digest and has lots of immune boosting cultures. We have convinced Jude's mother to express milk frequently, in the hope of building up a supply. We are calling this 'Jude's miracle'. It really is wonderful to be able to give him small volumes of his mother's milk to support his recovery, at a time when he needs it so much!

Baby Mikerline, our severly malnourished 3 month old girl who was admitted last night weighing 4lb 6oz is looking much better today. She is drinking 1.5-2oz of high calorie formula every 2 or three hours. This should be enough to enable her to grow and gain weight. She is sleepy, but when she is awake, she is very alert. Her mother had to go home to attend to her two year old son. We are feeling hopeful that Mikerline will survive.

Mikerline

Her Name is Mikerline

She arrived filthy, in urine soaked clothes.

She is three months old.

She weighs 4lb 6oz.

She hasn't received a drop of milk since she was a week old.

Eight days after her birth, her father arrived at her home in Kenscoff, a town high in the mountains above Port-au-Prince. He had a grudge to bear against Mikerline's mother. He wanted to hurt her, and what deeper way to wound her, than through the brand new baby, nurisng at her breast?

Mikerline's father removed Mikerline from her Mother's care, and brought her to the home of his new girl friend. Did they have the means to purchase infant formula? We don't know. What is almost certain is that no-one in that house would have had the motivatation to do anything extrordinary to ensure this infants survival. Haitian's are a people ground down by poverty. They are in survival mode most of the time. They are barely able to provide for those they consider their own, and Mikerline was 'the other woman's child'. She was in a very vulnerable position.

'What did they feed the baby?' I asked her Mother, who today, finally found the strength to tell her child's father that their infant was being neglected in his household and that the maltreatment had gone too far. She took the baby home, where neighbours recognized that the child's condition was critical, and directed her mother to God's Littlest Angels.

'Kawosol (sour sop) leaf tea,' Mikerline's Mother answered, in reply to my question about what the baby was fed. As far as she knows, that is all the baby was given.

Tonight, Mikerline is hypothermic. This is a very worrying sign that her body is shutting down. It was difficult to tell her young Mother, that it may be to late, and the baby may not survive.

We all hope and pray that Mikerline will live.

A Fragile Confidence, Further Undermined

Lack of sleep has a way of getting to a person - many people in Haiti have been experiencing sleep disturbance since January the 12th. For those people, last night was particularly unsettled.

9:45 pm: I was sitting in my room, feeling sleepy, when the bed starts to rock with me on it. Aftershocks are few and far between at this point. My heart quickens, my stomach lurches, I look at the clock. One second, two seconds... There is dread in my heart. Will this one stop soon? Will it intensify.

It lasted 3 seconds, felt like a magnitude 3.5. There was silence, and then a wail from the ladies who sleep below ground level.

Up in the nurseries, the nannies were all awake in their beds. 'It wakened you?' I asked.
'Yes Susan, we were all asleep? You.'
'Not quite.'

I had been in the big nursery shortly after 9pm, and everyone had been sound asleep. It had been dark, and still. One or two people were disturbed enough by my coming in, to shift in their beds, but no-one woke.

Now, I looked from crib to crib. There was a light on and a radio was playing. The babies were sound asleep, completely unperturbed, little chests rising and falling. The woman, though, were visibly shaken.

They were on mattresses on the floor. They still will not sleep in their beds, but prefer to sleep close to a door that leads out onto a balcony. In the first days and weeks after the earthquake, the nannies slept on that balcony. I know that should we have another big earthquake, that balcony will probably be the least stable part of the house. I also know that with their mattresses blocking the closed door, the ladies will not be able to get outside quickly. I have told them these things, yet somehow, the thought of being 'close' to the outside, and a more open area gives them a feeling of security.

'Miss Susan, wont you sit with us?'

Downstairs, there were a few tears. I gave hugs, and the best re-assurance I could offer. They told me they understood that engineers had deemed our house structurally sound, but they felt no assurance that it could withstand another earthquake, 'and this isn't over,' they said, shaking their heads. There is despair in some of their eyes.

Their hearts and minds had just began to settle, and now their fragile confidence is further undermined. I can't promise them that another big quake wont come - actually, seismologists consider it a given that at some point, maybe fifty years from now, or maybe within the year, there will be another.

The ladies spoke about their feelings of anxiety. I validated those feelings, and talked about the importance of taking care of themselves, for the sake of their physical and emotional health. I also told them they were in my prayers.

It was twenty minutes past mid-night before we left the living room of the main house to head to 'bed.' I slept failrly well after that, but I am very tired this morning. I know I will not be the only one.

L'ap Koupe Dwet Mwen!

(He'll Bite My Finger Off!)

Twelve month old Peterson came to GLA from an orphanage that was badly damaged during the earthquake. He weighed 9.5lb. There wasn't an ounce of fat or muscle on his bony frame. He was wasting away from malnutrition.God's Littlest Angels had recently been blessed with a small donation of a fortified peanut butter paste that is designed specifically to treat malnourished children. It is called Supplementary Plumpy.

Peterson was sick with pneumonia. He had a fever, stomach pains and chronic diarrhoea. He didn't want to eat, yet excellent nutrition was going to be critical to his his survival and revovery.

Severely malnourished children who do do eat are usually fed with feeding tubes. In Peterson's case, we opened a packet of Supplementary Plumpy. He refused to take anything from a spoon, so one of his nannies dipped her finger in the paste and spread it on Peterson's lips. The baby's eyes widened at the first taste of Plumpy Nut. He took a hold of his nanny's finger, and thrust it in his mouth. 'L'ap koupe dwet mwen!' (He'll bite my finger off) she squealed!'

It was a relief to have found something nutritious that this child wanted to eat. Supplementary Plumpy is made from ground peanuts, vegetable oil, powdered milk, sugar and a vitamine-mineral complex.

It contains just the right balance of nutrients for malnourished children and it is high in energy, with 500 calories in a 92gram pouch. This is useful because it enables children to take in concentrated nutrition at a time when their stomachs have been shrunken by starvation . This can make the difference between life and death in a severely malnourished child.

The transformation in our children who have been receiving just one packet of Supplementary Plumpy daily is very encouraging.

Clercineau On Arrival

......................................................Clercineau Two weeks Later

Jerry On Arrival

..........................................................................................Jerry Two Weeks Later

As supplies of this precious paste, which is difficult to source in Haiti, began to run low at the orphanage, GLA sent out a request to our French Board, asking them to help us obtain some more Supplementary Plumpy. The paste is produced by a French company.

This week, as a result of the efforts of GLA France, we received a shipment of a similar product, know as Plumpy Nut. I had asked for two boxes, I received ten! This is enough to treat 26 severely malnourished children or 53 children who are mildly-moderately malnourished.

From now on, every malnourished child who arrives at the orphanage and who is able to swallow the paste, will be given Plumpy Nut. I am sure that most of them will 'bite our fingers' to get it!

Pray For Luc

'Where two or three are gathered together in my name, there I am in their midst.' (Matthew 18:20).

A week ago, I told you that baby Luc, who was born prematurely and whose grandmother locked him away in a room so that he would die, was sick with diarrhoea, vomiting and dehydration.

I was concerned for Luc. Overnight, he became emaciated, over the week, he became jaundiced and his liver became enlarged.

I am relieved to be able to share that Luc is now much better. He is on antibiotics and IV fluids. He is well hydrated and his liver is decreasing in size. His gastric motility though, the rate at which feeds and medications pass through his stomach, is very slow, and as a result, he is not absorbing more than 5ml of milk every three hours. To support his health and enable him to recover, Luc needs to tolerate around 30ml of milk every three hours.

After 8 days, it is urgent that Luc's body begins to absorb nutrition. Please join me in praying that his stomach and his gut will begin to process milk efficiently. We are giving him a formula that contains pre-digested proteins, as well as medicine to increase the rate at which his stomach empties. We can't do any more for him medically.

We can pray though, and prayer is a powerful tool. We have seen amazing things happen at GLA, through the power of prayer; breath in lifeless bodies, provision of water, formula, food and fuel in the aftermath of January's catastrophic earthquake. For this reason, we pray with faith.

Answer Me, O Lord

Donley, our premature baby boy who arrived from Cazale 2 weeks ago, developed diarrhoea on Monday. On Tuesday he was dehydrated, and had to be started on IV fluids and antibiotics. He perked up within a few hours.

Last night, though, was a hard, hard night for Donley. He was in a lot of pain. This morning, I gave him some morphine. He settled immediately, but proceeded to have seizures. Then, shortly after lunchtime, he stopped breathing and his heart rate plummeted. I managed to resuscitate him with an ambu-bag. Clearly, he was a very sick little boy.....

Donely stopped breathing for a second time early this evening. After several rounds of medication and over an hour of resuscitation, he wasn't making any effort to breath on his own. I prayed repeatedly, yet were no signs of life. We stopped. Clamped off the IV, shut down the oxygen machine, wrapped the baby, and held him.

Colour drained. Heart rate slowed, and had all but stooped, when, all of a sudden, there was a gasp, and another, and then steady, laboured respirations.

Back in the incubator, oxygen on, IV unclamped. Tears. 'Answer me, O LORD, answer me, so these people will know that you, O LORD, are God, and that you are turning their hearts back again. (1Kings 18:37).

The baby opened his eyes and looked from one nurse, to the next. Within a few minutes, his vital signs were normal. Then, just as suddenly as the breath had returned to his body, it left again. The Doctor who was with us couldn't hear a heart beat....Donley gasped, and gasped again, his eyes rolled before focusing again.

'When Elisha reached the house, there was the boy lying dead on his couch. He went in, shut the door on the two of them and prayed to the LORD. Then he got on the bed and lay upon the boy, mouth to mouth, eyes to eyes, hands to hands. As he stretched himself out upon him, the boy's body grew warm. Elisha turned away and walked back and forth in the room and then got on the bed and stretched out upon him once more. The boy sneezed seven times and opened his eyes ' (2 Kings 4:32-35).

It seemed, that every time Donley's oxygen saturation rose above a certain level, all at once, his heart would slow and he would stop breathing.

We can guess at the reason....a cardiac problem, and electrolyte imbalance, maybe something metabolic......but we will never know quite why, Donley died and rose three times tonight, and then died a final death.

An Update On Some Of Our NICU Babies

Yesterday, the day nurse did not come in for work; apparently there was civil unrest in Carrefour and she didn't think that it was safe to travel. I didn't here about that until 11am. The NICU nannies were very frazzled from trying to keep up with so many tiny babies.

Two of them are preemies. Both need tube feedings, and have trouble keeping their temperatures up, especially during recent the cold snap we have been experiencing in the mountians.

Donley came to us less than two weeks ago from Cazale. He has had problems with vomiting and he has not been gaining weight. Changing his formula and altering the frequency and volume of his feeds did not male a difference, but he has done very well since we started giving him medication for the vomiting on Friday. We dress him in several layers of clothing, wrap him in blankets and keep a hat on him. That way, he stays warm and happy.

Luc is our second premature baby. He arrived last week and was doing very well until yesterday, when he became hypothermic and had to be moved him into an incubator. It looks as though he has a stomach upset - he began vomiting last night. Although he was very dehydrated when I saw him this morning, he was all ready tolerating smaller, more frequent of milk. I have just checked in on Luc; he hasn't had any further vomiting today and he looks much better. Premature babies can became very sick, very quickly and so we will continue to monitor this boy closely.

Jerrensia is four months old and she is a very cute baby but also very demanding. She is a favourite among the nannies, which is actually a wonderful thing; Jerrensia has severe club feet and there is a lot of prejudice towards disabled people in Haiti. Many children who are born with deformities end up in orphanages - they are either given up or abandoned by parents who are barely making ends meet, and do not think that they can cope with the long term demands of caring for and providing for a disabled child. I am glad that Jerrensia is so loved by our Haitian staff.

Clercineau is another child, who has a special place in all of our hearts. Today, we celebrated another milestone; Clercineau has now crossed the 7lb mark, weighing in at 7lb 3oz! His personality is definitely coming out. He is quick to smile and he is a real copycat. When we nod, he nods, when we kiss him, he puckers his lips, leans forward and kisses us back.

He has some strong ideas about what is and is not good for him.Being constantly held, or at least entertained, apparently, is good for him, taking medicine, apparently, is not! Thankfully, two year old 'M' is a great help when Clercineau's medication times come round. 'M' has a special way with fragile infants. Clercineau, who is usually so intimidated by bigger babies, seems to understand that 'M' knows how to be gentle. And when 'M' claps and cheers for him, we have no trouble getting Clercineau to take his medicines.

Freezing Rain

'Is it like this where you live?' my roommate asked our driver. we were hopeful that it was just our mountain community living in a cloud. For four days, it has rained without ceasing; sometimes a drizzle, at other times a down pour. 'It is exactly like this in the city'. our driver told my roommate.

On Friday afternoon, we admitted a 2 and a half year old boy. He was wearing fabric shoes, and the were soaked through. His dungarees has acted like a wick. From his feet to his knees, he was wet and muddy, and so, so cold! I thought of the people in the IDP camps or 'tent cities' for internally displaced people, then.

I thought of them again as I shivered last night getting ready for bed. There was a sudden drop in temperature. It was 10 degrees centigrade. In velour PJ's, and under a sheet and a duvet, I was still cold. I reached for a fleece blanket, and wondered whether Haiti's homeless masses had blankets to keep out the cold. I know that some do not even have tents, and I imagine that in this 100% humidity, the blankets, if they have them, will be damp. The ground underneath them will be wet and muddy. Further up the mountain, in Kenscoff, temperatures may even be approaching freezing point. I am sure that many children will become ill from exposure. I do not doubt that babies will die....

It was difficult to sleep last night, with the thoughts that were running through my head. I long for the arrival of the shipping containers, that I know are on the way, containing tents, tarps, blankets and warm clothing. They are so desperately needed.

The Night

'We are hard pressed on every side , but not crushed; perplexed, but not in despair; persecuted, but not abandoned; struck down, but not destroyed.' (2Corrinthians 4:8-9).

Today, actually, for this entire week, I have felt strongly that following anuary's devastating earthquake, I am still in the night. I know that morning is coming, but I am in no doubt that this is a season of 'sowing in sorrow.'

The most challenging aspect of the work I am doing in this season, is that I am doing it under persecution; a persecution that I have been under for several months and that comes from within the community of christian believers.

Perplexing?
Yes!
Do I despair?
Definitely!
Do I feel as though I have been dealt a blow?
Without a doubt! Yet, I am still here.....

I am here because I have been perfectly prepared by a God who allowed me to be persecuted in the past, so that I could live through persecution in 'such a time as this.'

Faith is such a difficult thing. It can take years to see the purpose in God's design. Sometimes, we never do understand, but today, I have been given a gift of insight. Today, past trials are imbued with both meaning and reason.

Today, God is close to me, and he has revealed in no uncertain terms that although he is not in the fire, he will get me through it.

Yes, morning is coming, and I will complete the work that he has ordained for me; reaping in joy.