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.' That makes sense.

'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 went 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. And when the next question comes, 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, or too wide. 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 for the caring people 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 determining that it is safe and reliable.

At GLA, we are very blessed to have conventional incubators. However, I imagine that the Embrace warmer might be a good back-up for the times when we experience power outages. It would also be useful to have a warmer like this when we travel 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.

This little bug-eyed infant came to us 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 is 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 stay warm. 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, will 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. Angela has a serious wound on her foot. It has become infected and necrotic andAnglela 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 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.