Susan, are you leaving?

She lives at the main house. She is two years old, and has been very sick, all her life, She is verbal enough to express her needs wants, and concerns. I can see the worry playing in her eyes, and I know where this conversation is going.

'Wildanise went away.' That's a fact.
'Yes, darling,', I say smiling.'She went home with her Mummy.' The toddler nods. Wildanise's adoption was complete. She was united with her adoptive family. This was a happy parting.

'Jerry went away.'
'Yes, he went to Kay B.' She pauses, seems satisfied. Kay B is about a mile up the mountain road. The older GLA children live there. Jerry went to join them.

'Ferlanson has gone.'
'Not yet, daring. He is still here. His Mummy and his brother came to get him. They are staying in my house.' She accepts this easily.

'Mitha went away.' Her gaze is steady and deep. Although it cuts me to the core, I am quick to answer, because I have anticipated the question and considered my response, that yes, Mitha did go away.

Mitha: we miss you!

'She can't come back, but she loves you very much.'
'She loves me a lot?' I am not sure what emotion is under the furrowed brow.
Do you doubt it, little one? Are you confused? 'Yes. She loves you a lot. She does. Yes!' I reassure the toddler confidently. When the next question comes, though,it is so unexpected, and it hits so hard, that it knocks the air out of me.'
'Susan, are you going?'

I hope the pause was not too long. I hope it didn't leave any room for doubt to enter, and trouble her heart. 'No darling, Sometimes I will leave for a little while, but I will come back.'

Two weeks ago, Mitha, a very loving, and much loved GLA nanny, passed away,after a brief illness. She was a devout christian lady, simple and uncomplicated. She loved any child we placed in her arms. If they came sickly and malnourished, if they had disabilities or they just needed the constant, patient love of a Mother to get them through the loss of their own family, we placed them with Mitha. She had a heart for the least of the least, and the shunned.

And now she is gone. Two should be too young to comprehend the permanency of death, but the little ones at the baby house have experienced enough loss in their short lives, to know what it means to lose someone forever.

Please pray for the little ones who miss Mitha, and especially for my sickly toddler, who has been here at GLA for two years, and desperately needs a Haitian passport, and a US visa, so that she can go and join her adoptive family. She needs stability, now more than ever, and she needs first world medical care. There are huge obstacles in this child's path. I don't want her to experience any more loss and change here.

Please also pray for the GLA staff. Last year, a young nanny died, and the ladies who work at the main house fell to the ground and convulsed with grief. They have known Mitha for several years, but many of them lost multiple family members when the earthquake hit in January, and they have grieved so hard that they are too emotionally spent for anything except quiet tears.

Lastly, please pray for Mitha's family. She leaves behind a husband, and two children: her little boy is ten years old, and her daughter is sixteen. Mitha's wage paid for their schooling. There is a chance that they will not be able to return to school when the new school year starts.

Our orphanage director estimates that it will cost $1000 USD to pay their school fees and cover other expenses, related to the children's schooling, If you know Mitha, and she has touched your life or your children's lives, please consider contributing to her children's education fund, which has been set up by GLA, in her memory.

Enduring Strength

'As you do not know the path of the wind, or how the body is formed in a mother's womb, so you cannot understand the work of God, the Maker of all things.' (Ecclesiastes 11:5)
How does a tiny infant, born almost two months prematurely, survive for 8 days without being fed? And when I say he wasn't fed, I mean, he wasn't fed. He didn't receive anything - not a single drop of milk or even water for over a week.

When he arrived, Jeff was severely hypothermic, with an underarm temperature of 90.3OF. His skin was thin, dry, and tightly stretched over his jutting ribs. And yet, Jeff was awake, alert, and he had a strong cry. For some reason I can't explain, Jeff was no-where close to death.

Conventional western medicine doesn't tell us much about how to manage prematurely born infants who come in several days after they are born, dehydrated, hypothermic and malnourished. We know that they need to be warmed, since cold stress causes the acid levels in their blood to rise. However, once they warm up, their bodies oxygen requirements increase, and they have to breath harder and faster to get this oxygen.

Well, once we warmed Jeff, he developed severe apnoea - he stopped breathing for long periods of time, during which he would turn blue. It took a lot of stimulation to get him breathing again.

I was able to run a blood gas on him and check the level of sugar, and electrolytes in his blood. These investigations confirmed what I suspected: Jeff was dehydrated, and he had some metabolic imbalances as a result of this dehydration. His body was trying to correct these imbalances through increased respiratory effort, but Jeff was too weak and tired to keep this effort up.

What did we do? We put Jeff on CPAP to help him with his breathing, while we began giving him fluids to correct the dehydration.

Jeff is a survivor. These photographs show him on arrival, and then 8 days later, weaning off of his CPAP.

It has been my prayer, that God would sustain the fragile infants in our area, until they reach us. When I meet babies like Jeff and Woodson, and Jonathon, enduring what they do not have the strength to endure, there is no doubt in my mind that God is answering my prayers.

Embrace

People have been sending me links to the Embrace website. This company have developed a low-technology, low-cost infant warmer for the developing world, and the people who have been sending me links to the website feel quite strongly that God's Littlest Angels might benefit from their product.



I am very thankful to the caring supporters who thought about our babies when they heard about Embrace. I want you to know that I have done some research into the company and their infant warmer. I have learned that the product is not available to buy at this time, as it is yet to undergo clinical trials that will hopefully determe that it is safe and reliable.

At GLA, we are very blessed to have conventional incubators. However, I imagine that the Embrace warmer would be a good back-up for the times when we experience power outages. It would also be useful to have a portable warmer for the trips we make to hospitals and clinics, in order to transport infants to the orphanage.

Having seen many low-birth-weight babies die from 'cold stress', which, caused their organs to shut down, I don't doubt that a product like this would be useful in the remote and rural area of Haiti. I feel convinced of this when I think of our ex-preterm baby, Junes:

Junes came to us as a bug-eyed infant, weighing 2.25 lb. Although he was able to breath on his own, and suck feeds, he didn't have enough body fat to stay warm. For the three weeks that he was living at home, high in the Haitian mountains, he battled hypothermia.

Today, Junes does not grow and thrive on regular infant formula. We don't know for certain that his poor weight-gain today is down to hypothermia in the first weeks of his life, but we do know that during those three weeks that he was cold, all of the energy that should have been used for growth was being used to generate heat. The growth and development of his vital organs would have been affected at that time.

The information on Embrace's website does not answer all of the questions I have about their infant warmer: can infants be swaddled, or nested inside the warmer for example? It is important for pre-term infants comfort and development, that they are positioned, as far as possible, as they would be in their Mothers' womb.

My best guess is that it will be years before the Embrace warmer is available in Haiti. Once the clinical trials have been completed, it will be piloted in India, and then rolled-out to other developing countries. I have joined the company's mailing list to keep up-to-date with developments. It is my hope that their innovative, thermal sleeping bag will save many tiny lives.

Longing

Towards the end of the week, Woodson, our ex-preterm baby caught his first cold. He was struggling to breathe had to be started on oxygen. We watched Woodson very, very carefully. I am pleased to be able to report that he is doing better today, and only needs a tiny amount of supplemental oxygen, through a nasal cannula, when he falls asleep. If he continues to improve, we will discharge Woodson home at the end of the week. He was due to be born this week. It is very rewarding to be able to send him home as a chubby, thriving 'newborn.'

On Monday, I placed our new little girl, Naila, into Miss Vicky's care. Naila was referred to us by an orphanage in Kenscoff, who were struggling to recover her from her malnutrition. We don't know how old Naila is but we suspect that she might be close to 2 years old. She weighed almost 13lb the day that she arrived. She was very dehydrated and refused to eat or drink. We are told that she was abandoned. No one could tell us her history, but it was clear, from her sorrowful expression and empty stare, that this toddler was in deep mourning.
Miss Vicky is a retired nurse-volunteer, who specializes in providing short-term foster care to children who fail to grow and thrive, not because they don't have enough food to eat, but because they have been abused or neglected. I am all ready seeing signs of improvement in Naila. She is opening up, and beginning to give us eye contact, smile, babble, and play. Naila is a wounded spirit, in a frail body. A spiritual healing will in all likelihood, lead to improvements in her appetite and general health. Miss Vicky is a wise and loving foster mother, and we both agree that patience and kindness, rather than force, will be crucial to Naila's healing.

Gorgeous, and bright-eyed, this 5 month old baby arrived a few hours before Naila did. Hansley weighed 8 lb when he was admitted. Like Naila, he has been placed with us for short-term care, so that he can recover from his malnutrition. Hansley's mother is dead and his young Father left the orphanage with tears coursing down his face. There is something profoundly hurtful about that Daddy's tears, about him loving his baby so, so much, being unable to provide for him, forced to surrender him. I watched Hansley's father from the NICU balcony. His eyes rose up to meet mine. His cheeks glistened with dampness, and then, with bowed head and lowered eyes, he stepped through the gate, which was closed behind him.

Angela was referred to us from another orphanage in the Thomassin area. Angela is 8 months old and she weighs 12 pounds. She comes from an area in the plains beyond Port-au-Prince, and she has been sick with gastroenteritis for some time. Angela had a parasite in her gut that caused severe diarrhoea. By the time the staff from her orphanage arrived here with her, she was severely dehydrated and needed IV fluids.

A line was sited in her foot. I left Angela in the care of the night nurse and returned in the morning, to find the baby's leg swollen up past the knee. The Iv had perforated the vein and the infusion fluid had seeped under her skin. Angels's leg was grossly swollen, hard to touch, shiny and seeping fluid. A few hours later,  the skin on her foot split open due to the pressure of the fluid that had built-up. I was so upset. It is a nursing responsibility to observe IV sites every hour and to remove the lines if there are any signs of redness, swelling, infection or hardening of the vein. Our night nurse had clearly left the child and the teenaged care-giver, who, had accompanied her from her orphanage, alone in a room overnight.

Now, Angela has a serious wound on her foot. The pressure of the fluid compromised blood flow to the skin and the tissues below it. As a result,  these tissues have died and infection has set in. Angela has lost so much tissue on the back of her foot that the surgeon we took her to says that she will need a skin graft. Unfortunately, this baby is too anaemic, to frail and too weak for surgery. We are doing our best to get her weight up and get her strong.

It is my prayer that she will experience a miraculous healing, and that she will not need surgery at all. I feel a heavy weight of responsibility: a child in need has come to us for help. As a result of negligent care, she has sustained a serious and preventable injury. I cannot be in the nurseries 24 hours a day, yet still, yet I am accountable for the nursing care that is delivered in the nurseries around the clock. I am frustrated, because although I strongly feel that the nurse who was on duty that night should be called to account for allowing this injury to occur, and that steps should be taken to ensure this incident is not repeated, it has been decided that the orphanage will pay for the baby's surgical care, but that the nurse is not to be called to be challenged. It has also been decided that no changes are to be made to the way that the staff account for the care that they provide. Although I lead the nursing staff and the nannies, and have a great deal of decision making authority in terms of the care and treatment that the babies receive, I have virtually no authority to change the systems and ways of working that are in place. As a result, some poor practices persist. The excuse that these aspects of care are cultural is wearing thin. I want the best for these babies, the very best I can give, and I sense God calling me to continuously push boundaries, to make things better.

I feel privileged to be able to tend to 'the least of these.' I know that I can speak for all of the staff, Haitian and foreign, when I say that we long for the day when our home will fill up again, with children who need the care and the healing that we can provide.