A Place of Refuge

Tuesday is weigh-in day at the main house, and there was a quiet sense satisfaction in the NICU as each child's weight was announced, then charted in the blue ring-binder.

Sarah: 4 weeks old is up to 5lb 12.5oz
Rosena, 5 months old, has recovered past the swollen stage of her malnutrition. The skin is hanging from her arms and her thighs, but she is gaining weight. She is up to 5lb 13.5oz.
Frantz: 10 days old, arrived yesterday weighing 8lb 12 ounces. His weight today is 8lb 13.5oz.

When Sarah and Rosena arrived, it was immediately obvious to all of us, that our orphanage in the Kenscoff mountains was a life line to them. But why would a gorgeous, fat, healthy and thriving newborn like Frantz need GLA, we had all wondered? Magaly, the Haitian administrator explained:

Frantz was brought here yesterday by his anxious mother. Last week, a premature baby from the same remote mountain community that Frantz is from, was murdered by a Father who insisted that since the date of the infant's birth did not correlate with the date of conception, this child was not his. This week, Frantz' father levelled the same allegation at Frantz' mother. The new mother was tortured by gory visions of her son's future. Our Haitian administrator was equally disturbed at the possibility of what may happen to the baby. Really, it didn't bear thinking about. She couldn't live with herself if she turned the mother and child away, only to hear on the radio a few days later, that the child was dead. Magaly honoured the Mother's request, and admitted Frantz.

So for our newest baby, GLA is a place of safety, and a refuge. I hope that when you are grown, Frantz, you will understand that your Haitian Mother made what she believed was the best choice for you. This was a decision underpinned by phenomenal love and great faith. I hope that you will cling to this. I hope that your mother's sacrifice will be affirming to you. It is a measure of what you are worth.

Be Still And Know........

Early this afternoon, we admitted a tiny baby girl, born outside the Baptist mission hospital, which, is a few miles up the mountain road.

She was born at around 22 weeks gestation. She wasn't fully developed enough to breath on her own. We attempted to resuscitate her, but the un-named infant died peacefully at 3:30pm.

A little while later, the afternoon was drawing to a close and I was sitting out on the NICU balcony, cradling Rosena. I was aware of a tight feeling in my chest. The surge of adrenaline had that had coursed through my veins a short time ago had subsided, leaving me tense and drained, and processing sorrow for a family that had just lost a second baby, concern for the mother, critically ill in the mountain hospital, thankfulness that at least her impossibly tiny child did not live long enough to suffer too much.

I was tired, and my mind was buzzing, when a familiar tune drifted into my consciousness. In a low voice, I sang the well known words of a psalm, set to music.....

'Be sill and know, that I am God
Be still and know that I am God
Be still and know, that I am God.'

I breathed deep, and exhaled slowly, feeling the tension leave my body. Rosena's eyes were fixed on me. I don't sing particularly well, but that didn't seem to matter to Rosena. I was so thankful, for the weight of her in my arms, and for her warmth.

Rosena is better today. I found her much less puffy this morning. Her weight is down. I don't usually celebrate a weight loss in any of the main house children, but in Rosena's case, this is a very good sign of progress. A weight loss means that she is absorbing the protein from her milk. These proteins are crossing into her blood stream, where they are drawing the fluid that has seeped into her tissues, back into her circulation. Her kidneys are getting rid of the fluid that has accumulated. Rosena is responding to treatment.

'My sweet girl, aren't you just so pretty!' A smile teased the right corner of her mouth.

'Yes, oh so pretty, and you are only going to get prettier as the days go by, my darling'!

At this, the smile burst forth, radiating into Rosena's eyes. I have read somewhere, that a smile is one of the best prognostic indicators (of survival) in a severely malnourished child. In babies like Rosena, a smile is so much more than the upturned corners of a mouth; it speaks of a healing body, a will to live, a joy, and hope for survival.

Minutes ago, fatigue had clouded my thoughts. Now, here was the sun!

Blessed Fast

A matter of minutes after the gate closed behind Clercineau, Junes and Saraphina, yesterday, the doorbell rang. A Haitian man with a strange accent carried a baby girl across the threshold. Upstairs in the NICU, word reached us that the infant was very small and very hungry. We sent down a bottle of formula with a nurse.

Madame Bernard returned with a tightly swaddled bundle. Unwrapping it, we found a 5lb 6 oz baby girl with a head of thick, black curly hair. Bloated with fluid, the skin was peeling from her legs and she was extremely pale.

Rosena is 5 months old. She was breast fed for the first 15 days of her life, until her Mother became sick and died, following a brief illness. Rosena was fed plantains after that. Plantains are rich in carbohydrates, but tiny babies lack the chewing and swalling skils that are needed to take in enough plantain to meet their energy needs. Plantains also lack protein

The result: a baby girl who weights a fraction what the average baby her age does. Underneath the swelling, her muscles have wasted away. Rosena is suffering from Protein-Energy Malnutrition (PEM), also known as Kwashiorkor. In all likelihood, Rosena will be completely emaciated once the swelling goes down....if she makes it through the initial phase of her treatment, that is.

Babies under the age of 6 months do not tend to survive Protein-Energy Malnutrition. We hope that Rosena's organs are mature enough to withstand the damage that Kwashiorkor causes. There are some promising signs: Rosena is alert and her body temperature and her blood sugar levels are stable. She also seems hungry. These things tell us that Rosena is absorbing and metabolising the nutrition in her feeds. These are reasons to be hopeful.

There are also some worrying signs that Rosena may be in heart failure - her swelling became worse overnight. This morning, it was so bad that she couldn't swallow.

We are proceeding very carefully with Rosena's care and she is being monitored constantly. We are doing absolutely everything that we can to ensure that she lives. She needs more than good nutrition and good medecine. She is getting that. Rosena is also being held and comforted and prayed over. Her legs and her feet are very tense from the fluid that has leaked under the skin. This creates a lot of pressure, which is painful for Rosena.

May God give you strength and healing my little lady, and may you feel the love of God flowing through us, to you.

In the midst of the sorrow we felt at losing our Cazalle children, God blessed us with you, Rosena. It is my prayer that God will bless you with the gift of life.

Celebration and Mourning

Sarah came off of oxygen on Thursday Morning. She is thriving and she is a beautiful baby, everyone says so! I tend to reply that while my babies often don't look pretty from the outset, they always become beautiful! I am very attached to Sarah. She has needed such intense nursing care since she arrived at GLA three weeks ago that we have ended up spending a lot of time together. This gorgeous little girl has faced and overcome so many medical challenges in her first month of life. I am excited to see what will become of her.

As I look forward to the upcoming week though, not all of the emotions I feel are positive. On Tuesday, the nursery staff and I will wave goodbye to four of our Angels. Three came from a christian mission in Cazale:

Remember Clercineau who arrived in February 2010? He was 12 months old and weighed just over 5lb. His chances of survival were very poor. He is now a 20lb two-year old - gentle, affectionate, sensitive and comical. He comes from a desperately poor family, that will struggle to provide for him. Clercineau's 10 year old sister has been admitted 4 times to Real Hope For Haiti's inpatient malnutrition programme in Cazale. She is the height of the average haitian five year old. It hurts to think of Clercineau struggling with malnutrition all his life, just as his sister has.

Junes arrived the a few weeks after Clercineau, from the mountains overlooking Cazale. He weighed 2lb 10 Oz and and although we had a hard time getting him to grow and gain weight at first, he is thriving now. His Mother was seriously ill after giving birth to him. She loves and adores Junes. I am pleased that he will be reunited with her.

These two boys have been here such a long time. They have long since forgotten their birth families and that makes me sad. We kept them here until we felt confident that they had a good chance of surviving at home. Up until now, the clinic that referred them to us have been overwhelmed with earthquake and cholera victims. The length of time that Junes and Clercineau have been separated from their biological families, though, will make the adjustment to life in rural Haiti hard, especially for Clercineau.

With that in mind, Dixie and I have decided to transfer Sarafina back to Real Hope For Haiti, along with Clercineau and Junes. Sarafina was born prematurely to a Mother who died soon afterwards. Sarafina was very tiny and malnourished when she was send to GLA three months ago for special care. Today, she is healthy and growing fast, weighing over 9lb. Returning to Cazale will allow her birth family to visit her at Real Hope For Hait's rescue centre. Sarafina will probably stay there until she is fully weaned and walking.

The Fourth child to return home will be Wadley. I have absolutely no peace about that. His brother left two weeks ago. We pleaded with his Mother to allow Wadley to stay until his ear infection had gotten better. Wadly has gained 11 lb in three months. He is a handsome, huggable little man, who has marked developmental delays from chronic, severe malnutrition. He has made such excellent progress here at GLA, even since we implemented a special developmental care plan for him just a few weeks ago. When I walked into the nursery this morning, Wadley was eating a bowl of scrambled eggs. 'Look!' he said to me,'they are yummy,' I was stunned and delighted, and overwhelmed by a duality of emotions, the joy, the pride, the sorrow, the dread.

The upcoming week will be like that, It will be all change. We will celebrate some changes, we will mourn others......

Angels Above Her, Angels Below.......

In the two weeks since she arrived, Sarah has been treated for pneumonia, septicemia, and electrolyte imbalances. She has had some miserable days. Her most challenging crisis for us to manage in the NICU at GLA occurred when Sarah developed an irregular heart rhythm and muscle spasms.

We have no access to rapid laboratory services. 'Urgent lab work' in the developed world, means the lab processes the tests that are ordered as fast as they possibly can, often within the hour. In Haiti, it takes a minimum of 24 hours to get 'urgent' lab results back. Our Paediatrician and I could only take note of the signs and symptoms we saw, and use this information, together with the very limited medical history we had about Sarah, to diagnose and treat her.

Sarah was born prematurely, and she had not grown well in her Mother's womb. Her Mother showed signs of malnutrition, as did Sarah, who, hadn't been fed during the first five days of her life, while she was in hospital, but had instead been given IV fluids, that in all likelihood, only contained sugar and water. Low calcium levels are fairly common among babies in Neonatal units, especially in babies like Sarah. Low calcium levels affect the body's electrical conduction system. This can cause, abnormal heart rhythms,'jitteriness' and muscle spasms. We reasoned that Sarah probably had low calcium levels and that we could not wait a day or two for laboratory confirmation of this, but that she needed to be treated immediately.

I rarely get nervous about the limitations of clinical services or medical technology in Haiti. I have gotten used to making do with what we have. I have to admit though, I was anxious about Sarah, as we began treating her with IV calcium. She 'should' have been on a heart monitor. The calcium 'should' have been infused continuously. We had no working heart monitor or infusion pump, though, so we did the best we could. Thankfully, our best efforts were enough to get Sarah's body out of crisis.

On Friday, she was stable enough to come off of CPAP. Yesterday, she completed her course of antibiotics. Last night, she developed cold symptoms and today, she needs suction to clear the secretions from her nose, and oxygen to support her breathing.

At almost 4.5lb, she has grown significantly since she arrived at GLA, but Sarah is still very small and very fragile and she still needs your prayers. I believe that there are angels close-by her, and others above, advocating for Sarah directly before God.