Handle with Care.

7am: Sonya is arching her back and kicking her legs. Her cry is hoarse and her eyes are bulging. Mme Bernard is with her. Across in the incubator, Sophie's CPAP isn't working.

'1/2 a ml of pulmicort with 2ml of saline,' I tell Mme Bernard, who begins preparing a nebulized steroid to help Sonia with her breathing. As I talk, I check for air leaks or poor connections on Sophie's CPAP circuit. I find the problem - the holes in her cannulaide (a dressing that improves the seal between the CPAP prongs and her nostrils) have become enlarged. There is too much air leak. There isn't time to replace the seal.

My eyes scan the NICU, and fall on a strip of paper stitches on the incubator shelf. I place a stitch across the bridge of Sophie's nose. Mme Bernard laughs as the vinegar solution in which the expiratory limb of the circuit is submerged begins bubbling. 'Degaje! 'we agree. Degaje means to make do. 'Haiti taught me a lot about degaje. I think I am getting good at it!' Mme Bernard can't argue. The paper stitch is a fast and temporary measure that will keep the CPAP running, while I prepare Sonia's IV medications.

Reviewing her chart, I notice that Sonia did not feed overnight, but that she was fairly settled. This morning, she looks much better. The nebulizer treatment is very effective. Her breathing slows and she relaxes. She is bright eyed and looking around. What a beautiful baby, I think to myself.

Sophie's breathing has become more laboured. Mme Bernard tells me that she has a slight fever.

My heart sinks. We have a viral infection in the NICU that is making the babies cough and wheeze. Sophie is so frail. I hope she hasn't caught a cold.

Later in the morning, as I am bathing her, Sophie begins to tremble. The colour drains from her face. Her brow is furrowed. She looks worried, and her eyes have glazed over. Clearly, Sophie cannot tolerate a lot of handling at this point.

Both girls need cardiac evaluations, but the closest pediatric cardiologist, based in Petionville, is out of the country and he is not due to return until the 5th of November. Sonia would probably tolerate a trip to a more distant office, but it would be a risk, and neither Dixie nor I want to take a risk with her. As for Sophie, it may be very harmful, even fatal for her to be off of CPAP for more than a few hours.

Until the 5th of November, Sophie and Sonia are going to need very close monitoring. We are going to have to recognise and treat their health problems promptly, and prevent complications. For Sophie, that means CPAP and no more tub baths. Sonia is getting oxygen and an inhaled steroid to prevent her breathing problems from worsening. Both of these girls will be handled with extreme care as we pray daily for their health and for their survival.