Names, Faces, Stories

All of our children come with a story - a past, a history, life experiences that shape how how they think, feel and respond. We know and are aware of some elements of their personal histories. Other elements, we can only guess at or surmise. Sometimes, we are entirely in the dark.

Three children were admitted to the main house this week. The first to
arrive was Kimberlie. She is chubby, healthy baby girl. Although she weighs in at over 12 lb her mother insists that she is just 4 weeks old. We are not so sure. Kimberlie isn't holding her head up yet -babies usually do this at around 6 weeks of age - yet she moves her little arms and legs like a 3 month old. Maybe it was four weeks ago that the birth certificate was made? She is so big! We do sometimes see big babies - babies that are big not just by compared to their Haitian counterparts, but that are also big by North American Standards. Kimberlie is a very demanding infant. Haitians dote on chubby children, and we suspect that this one has been held a lot. She is perfectly happy when she is eating or sleeping. Otherwise, she wants to be held and entertained. Ssh! Don't wake her!

Our second admission, on Thursday, was 8 month old Emanuella. Her mother told us that Emanuella was a healthy baby. It was obvious looking at her, that this was not the case. Emmanuella has lots of loose skin folds, and seems to have lost some weight recently. She has a cough and an ear infection, swollen glands, a yeast infection in her mouth and fungal infections on her arms and legs. Her stomach is swollen and she has diarrhoea.

Emmanuella was clearly very attached to her Mother. She was the youngest child in a large family and she is grieving just now. As she adjusts to the losses and changes in her life, she needs a lot of attention from the nursery staff.

On Friday, a blessing returned to us. We first met Beni at the beginning of 2010, when he came to us for medical assistance. He was a tiny 5lb baby then, whose mother had died after a long and difficult labour. He didn't have a name, and so GLA supporters suggested names for this baby. Our director chose 'Beni' a name that in Haitian Kreyol means 'Blessing.'

Beni returned home to his father several months ago, strong, healthy and developing well. His Mothers sisters were anxious to care for him and we were confident that Beni would thrive well at home.

Sadly, Beni is back in our care, and this time, his father has relinquished his parental rights. Beni's family tried, they really did, but they are unable to nourish Beni. He is in the beginning stages of Kwashiorkor, with some mild swelling in his hands and feet. He is weak and pale and he has terrible diarrhoea, scarring from bacterial sores on his hands and feet and herpes in his mouth. He needs to heal, to regain his strength and to grow. The nursery staff were very pleased to see him. Beni smiled bashfully at all the ladies who came to welcome him back. Last night, I was told that he was beating the two year olds! I think he is going to do well here!

We pray that these three beautiful children will settle in their temporary home, that they will blossom at God's Littlest Angels, and that they will be matched with adoptive families very soon. There are parts of their histories that we will never know, but it is a privilege to enter into their life stories now.

Princesses

I had a moment on Friday. I spotted one of those Anne Geddes shots - a beautiful, perfectly proportioned premature baby, cradled in her father's hands. My mind drifted upstairs to baby Louna, scrawny and rat-bitten in her incubator and tears sprang to my eyes. She wasn't exactly Anne Geddes material. I was jealous for Louna. I wanted for her, what that baby in the posed shot had. A well nourished mother, excellent health care, a safe, nurturing environment. It wasn't a lot to ask for, but she has lost out on all of these things.

Louna is a very stressed infant. Her premature birth in Site Soleil and the struggle to survive in that noisy and chaotic environment have overwhelmed her. Now, even nappy changes are stressful for her. Researchers have found that pain and stress can affect premature babies brain development well into childhood. Thankfully, we have found that Louna is quickly soothed by swaddling.

Baby Sarafina, I am told, has quite a fan club outside of GLA, but she wasn't really Anne Geddes material when she was born either. A few days after she arrived, this low birth weight baby, who was vomiting and who appeared to have lost weight in the days since her birth, was unable to keep any of her feeds down.

On a hunch, I decided to try a continuous feed, through a feeding tube. I am glad that I did that because Sarafina developed swelling in her feet, that soon spread to other areas of her body. We learned that this fragile newborn had developed a mild case of protein-energy malnutrition. I was full of dread. We have previously lost three tiny infants to this particularly debilitating form of malnutrition. Babies under three months do not tend to survive kwashiorkor, since their organ systems are not developed enough to withstand the damage that protein deficiency causes.

Sarafina was able to tolerate continous feeds. She beat the odds, making her my youngest survivor of Kwashiorkor. She is happy, contented and very alert now and I am so grateful that her mother brought her to us in time. For Sarafina, being admitted to GLA at just that point in the course of her illness, and being carefully re-nourished at that critical time, was life-saving.

Alaine was pretty, when she arrived, compared to most of the premature infants that we see at GLA but she was no Anne Geddes baby. Alaine came from the mountains above Cazale almost 3 weeks ago. She was a late-preterm infant, born in the 8th month of her mothers pregnancy. She was very small and skinny for a baby born at that gestation and we were concerned to hear that she was her mothers 18th child, and that all of her brthers and sisters had died as young infants.

Initially, Alaine was treated for apnoea and she was weak, very sleepy and difficult to feed. It became apparent around a week after she arrived that Alaine had problems with her airway. She needs a constant flow of compressed air through a nasal cannula to keep her airway open so that she can breathe easily, sleep well and suck from a bottle. It seems that a little bit of reflux was making her breathing symptoms worse; milk was refluxing up her oesophagus during and after feeds.

Thankfully, we are able to treat her reflux and Alaine is filling out nicely and really thriving. We hope that she will grow out of her airway problems but it is likely that she will need nursing care for a very long time.

Anne Geddes may not chose these girls as her models, yet, but I think they are beautiful. I have to stay mindful that whatever their earthly fortunes have been, or will be, they are daughters of the most high king, true Princesses who will recieve a rich inheritance.

.....And Two Become Four

'You have a real NICU again all of a suuden', a friend exclaimed last week, when Baby Boy arrived. Suddenly, I had three medically fragile neonates in my care.

Well, Baby Boy lived less than a day and a half, and then, regretfully, three were two again. Applying the 'rule of three's' my friend and I surmised that no more premature babies were likely to be admitted for a while.

Last night brought news. In Cite Soleil, an 800g baby, almost three weeks old, was clinging on to life at home. She had been discharged from St Catherine's Hospital with an NG tube that her mother was struggling to manage. My heart sank. The baby weighed less than 2lb. Since she had survived this long, I assumed that she wasn't extremely premature, but she had to be severely malnourished and severely malnourished newborns tend not to survive.

As I finnished preparing the NICU for Louna, we admitted a 6 month old baby boy. Mario's Mother died 2 months ago. It was immediately obvious to us, looking at his puffy cheeks and peeling skin, that he had been in the care of a father without any real social support network, since his mother had passed away. Mario's father didn't have the knowledge or the means to nourish this fast growing baby, with high energy and protein requirements.

Mario is swollen due to Protein-Energy-Malnutrition, also know as Kwashiorkor. Low levels of protein in Mario's blood have caused fluid to leak out under his skin. 'No, he is not puffy,' the father insisted, 'that's just his shape, he's got a big round face!'

Hearing this I gave thanks inwardly, that his Father had decided to bring Mario here when he did. Like many people, Mario's fahter does not understand that his son is malnourished and in a critical condition. Over the next two weeks, we will attempt to re-nourish this child. We pray that Mario will stabalize. We need to see his weight go down as fluid moves out of his tissues and leaves his body. This will be a very fragile period. We pray that the electrolyte shifts will not be too dramatic and that Mario's organs will be able to process nutrients. Unfortunately, his protein deficiency has compromised his immune system and he will be very vulnerable to infection.

Louna arrived with her Mother early this afternoon. We learned that her mother had spent the last three and a half weeks going from hospital to hospital, seeking care for her tiny daughter. Louna was one of a twin, her brother did not survive, and Louna's mother doesn't have any other children. She has been very devoted to her tiny daughter, and has managed to keep her warm all this time. Last night though, the baby was bitten by a rat, and her mother knows that rat bites could make her fragile infant extremely ill.

I soon learned that Louna had been overhydrated. She has fluid on her lungs, which, is making it difficult for her to breath, so I am giving her compressed air through a nasal cannula to make this easier for her. She is also reciving antibitics, because she spiked a fever this morning.

I have estimated her gestational age at 34 weeks, but I am not sure how accurate these assessment will be in a baby who is almost a month old. Usually they are performed soon after birth. A visiting Neonatal Nurse Practitioner is going to do some more in-depth assessments tomorrow. If Louna really was born at 30 weeks, it is trully a miracle that she survived.

So now, two have become four.............

A warm Hug

on Friday morning, I shared the dreaded news with friends who had been praying for him - Baby Boy had died. I received this response from Colleen.

"Oh, we just prayed for you and him. Knowing he is God's hands makes me smile, free from struggling for breath. You are going to be one busy little "momma" (i know you love each one like your own) when you arrive in heaven, imagine all those little arms reaching for you..remembering the love and prayers you shared with each of them. So blessed are we in the kingdom to have that promise."

To read this was to receive a warm hug. thank you for that colleen! Hopefully, I will make it to heaven, and hopefully, someone up there will make sure that my babies and I recognize one another. I hear we will all look very different in heaven

Regret

In a remote mountainous region, North of Haiti's capital, Port-au-Prince, an expectant mother went into labour a full 12 weeks before her due date.

The mother of 6 made her way down the treacherous mountain path to The Good Samaritan Health Centre in Cazale. There, to the surprise of the clinic staff and the family, the lady delivered not one, but three tiny babies, all weighing less than a kilogram.

A call was made to GLA. Would we accept the triplets for medical care if they survived through to the morning? In the meantime, what could the staff do to keep these three infants alive, given that they had only one oxygen concentrator at the clinic, and no incubators?

Sisters Lori and Licia, their national staff and foreign volunteers improvised to provide oxygen and a heat source for all three babies. They used instant hot packs to keep the babies warm, placing a clear plastic tub over all three infants, piping in oxygen and giving glucose gel rectally to help keep the tiny babies blood sugars in the normal range.

By midnight, the smallest baby, a boy who weighed 1lb 14 oz, was the only surviving infant.

A three hour drive away in Thomassin, not knowing that two of the triplets had died, I was preparing the NICU for three tiny babies, who would all need incubators and CPAP. Alaine still needed an incubator and we would have to do some serious improvisation to care for 4 preterm infants. I knew that, but the efforts of the staff in Cazale spurred me on. They were managing 3 premature babies in far more difficult circumstances. We would make it work too.

I prepared boxes of supplies that I would need to transfer the babies back from Cazale the following day. As I worked, I received news that the little girl in the triplet set had stopped breathing and that she could not be resuscitated. In that moment, I felt my first twinge of regret. The surviving boys would grow up without the sister who had shared their mothers womb with them.

The next day, in Cazale, I found baby Boy B, severely dehydrated but otherwise in good condition. On the journey back to Thomassin, the stressed infant, sucked on my little finger. This soothed him, and it had a effect on me as well. Close physical contact with a newborn, causes a surge in prolactin, also known as the 'mothering' hormone. I hardly knew this infant, but I loved him intensely and I knew I would fight for him with all I had.



Baby boy B did remarkably well, better than expected over the next 24 hours. Cocooned in his incubator, and covered in plastic wrap to help prevent heat and fluid losses from his immature skin surface, he was placed on CPAP. His vital signs were text book, but over the afternoon on Thursday, he was producing only very small amounts of urine. At 6pm, his temperature dropped, and a few hours later, still cool, despite my attempts to warm him, he developed a rash and stopped breathing.

Another twinge of regret - I wished I had started antibiotics on this baby immediately. I had played with the idea of giving them when I collected him in Cazale, wondering if his siblings had died so suddenly because of an infection. In the end, I decided the antibiotics could wait. In North America, it is standard practice to give antibiotics to all prematurely born infants, until it is proven that they do not have an infection. In Haiti, where resources are scarcer, this isn't the case. By the time this baby had received his first dose of antibiotics, he was over 24 hours old. The infection had taken hold. His organs had been damaged by a bacteria I couldn't see. I'll never know if starting antibiotics 4 hours before I did would have made a difference. I am certain, though, that had I instructed the staff in Cazale to give the babies antibiotic injections when we took that first call from them, the outcome might have been very different, for one of them at least.

As the night wore on, I had a familiar sinking feeling in my stomach. Deep down, I knew that this baby would not survive. His lungs were immature and stiff, and although he could get by on CPAP before, fluid was building up on his lungs now, and his kidneys were failing.

I felt that owed it to this baby, to his family and to the clinic staff in Cazale to do everything I could for him now, but the Haitian nurse who was working with me was tired and irritable and did not want to continue resuscitating Baby Boy B.

'Look, he's gone all ready,' she insisted sullenly, raising his arm up, then releasing her hold, allowing it fall limply onto the incubator mattress. She was trying to prove that he was unconscious, but baby Baby Boy startled, opened his eyes, coughed and began to cry. And there was the regret again. I regretted it all...... That his mother had no prenatal care, and that the best any of us could do, was 'retrieve' him, 18 hours after his birth, and that everything we had done really could not guarantee his survival, far from it. I couldn't criticize the nurse too heavily. The infant mortality rate in this country is extremely high. She had seen many, many babies die, and she had become calloused by that. Still, Baby Boy deserved better. He deserved far, far better.

Shortly after mid-night, with his oxygen levels dropping, his heart failing, and signs of brain damage, it was time to stop.

I wrapped Baby Boy in a receiving blanket and held him. There was nothing else to do. I really did regret that. I was so sorry.

Two Tiny Girls

This week, brought two tiny baies into the NICU.

Today was a good day for Alaine, our 2lb 14.5 oz baby, who comes from the Cazale area. She is breathing better, stable on a low dose of caffeine and receiving a puff of air through her nasal cannula to stimulate her to breath. She sucked much better and slept in between her feeds. Yesterday, our Paediatrician ordered some blood tests, to make sure that Alaine doesn't have any bacterial or viral infections. Her mother has delivered 18 babies and all previous babies have died as infants. We want to do everything we can, to ensure that Alaine Survives. On Wednesday afternoon, when I was told that a 2lb baby would be coming from Caazale, I got ready for a critically ill preemie. Instead, we have welcomed a pretty baby, who just needs basic nursing care, and lots of love and patience. It is a pleasure to snuggle her and nurture her.

Sarafina, our low birth weight baby who arrived on Tuesday has not been doing so well. She has been vomiting since the day she arrived and the vomiting has become progressively worse, to the point that Sarafina was mildly dehydrated yesterday. She was on continuous tube feedings for 24 hours and has slowly progressed to two hourly feedings. She seems hungry, but gags when she is feeding and whenever she is handled. We are treating her for reflux. This is a common problem in newborns, especially very tiny ones, who have immature digestive systems. Sarafina is receiving medications and small feeds. We also keep Sarafina as upright as possible, which seems to make her more comfortable. If we don't see an improvement over the weekend, we will try some different treatments and formulas. We hope that Sarafina will feel better soon.

Mercy

Born 5 weeks prematurely, this very low birth weight baby clung to life for a week at home. As the days passed, the infant's already tiny frame diminished. The baby's mother knew of a clinic in Cazale, one that had provided medical care to the family numerous times in the past, but she had no plans to seek help for this baby. There was no point, she told her relatives. I see Alaine's mother in my minds eye, too listless in her despair to even argue with them. Fine, take the baby. It won't change anything.

Alaine weighs 2lb 14.5 oz. The lady who accompanied her from Cazale, up to GLA, told us that the Alaine was not drinking enough. She was weak and she was becoming too tired to suck, but she was alert and moving her arms and legs. She clung to my scrub top, and her eyes met mine. There was a warm rush inside me and with it, protective, and nurturing instincts.

Alaine is her mother's 18 child. All the babies that came before Alaine have died. All of them. Every single one, including a premature infant that came to GLA for medical assistance several years ago, and went home strong and healthy, only to pass away at home. I'm sure Alaine's mother can't bear to attach to baby number 18.

Alaine is in an incubator tonight, struggling to find the energy to suck. I hope that she will be stronger after a day or two of regular feeds. She began having apnoeas this afternoon, which means that she would stop breathing briefly, and her oxygen levels and heart rate would drop. These episodes were frequent enough that they would have disrupted the balance of gasses in her blood if they had continued. To prevent this, I have started Alaine on Caffeine, and she is receiving compressed air, through a nasal cannula.

'We need to ask God to be merciful,' Mme Bernard exclaimed, with far more pathos than she is given to. 'We need to ask him to to save this one baby, this one for her mother.'

Although we have never met her, the anguish that Alaine's mother has known is very real to us. We pray that a year from now, she will have a reason to believe in God's grace, again. We pray for mercy. We plead for this child's life.

It's a Girl!

Although GLA has a long list of families, anxiously waiting to be matched with a baby girl, it is quite rare for a healthy newborn girl, the kind that so many parents dream of, to be admitted to our orphanage.

Today, a precious newborn girl arrived at GLA and my initial bedside exam and tests suggest that she is 'practically perfect'!

Sarafina is an 8 day old baby girl, who was relinquished for adoption this morning, by her mother. Sarafina's Mother was thourally counselled by our head Haitian nurse. Yes, this lady loves her daughter very much, she told us, and yes, she agrees that the baby is beautiful, but no, her circumstances are unlikely to change and she is struggling as it is, to raise her three year old son.

Sarafina was born to a malnourished and stressed mother. As a result, Sarafina's weight gain was compromised in the womb. The skin on her body is loose and dry and Sarafina wears an anxious, and very vigilant expression that signifies that she too, has been stressed by her early life experiences. She will need to be fed on schedule, around the clock to make sure that she doesn't develop low blood sugar. She will also need to be watched carefully for signs of infection.

I feel hopeful that this baby will thrive here. Her head circumference is normal for a newborn, which is a good sign that her brain has been and will continue to develop normally. Her length is also at the low end of the normal range, for a newborn and this means that she was probably not lacking good nutrition for too long in-utero.

With loving care, and excellent nutrition, there is every reason to believe that Sarafina will make a full recovery from her malnutrition, that she will grow and develop, and form the attachments with our staff that she will need to bond with her adoptive family, further down the line.

I was very aware this afternoon, that some of the tests I needed to run would be painful, and I was very careful to make sure that this baby's pain was relieved.

Thankfully, the simplest measures are very helpful to newborns who are in pain. Sarafina was swaddled, given sugar water and a pacifier and she was soothed by holding and rocking until she was calm and settled again.

As I finished feeding our newest arrival her 3pm bottle this afternoon and felt her tense body relax into the crook of my arm, I was glad that the simple things are the things that will probably matter the most to Sarafina, and I was glad that we could provide these simple things.

In The Image Of God

Earlier this week, the wounded howls of an 8 year old boy tore through the nursery. 'I won't stay here! I'm going! I'm going with my Mum and Dad! I'm leaving now!'

There were too many foreigners here, he told me and he didn't want them staring at him and he didn't want anything we had to offer. Our children would be mean to him, our food would give him cholera, and our teachers would surely beat him, so no, he didn't want anything from us! He just wanted his Mum!

Although Sebastien's mother loves him she cannot cope with the demands of caring for her son. Sebastien was born with severe club feet and only began receiving corrective treatment last year. He has external fixators - pins driven through the bones of his feet and lower legs that are attached to metal rods and frames.

It was hard, caring for Sebastien under normal circumstances. Then, the house she was living in become unlivable after last year's earthquake. She has been living in a tent with her three children ever since. Sebastien is wheel-chair bound, his care and therapy needs will extend over months and years, and the family's living circumstances are unlikely to change any time soon. While his legs are in frames, and until he is able to walk, Sebastien will not be able to go to school, since Haitian schools are not accessible for children with disabilities. This is not the life his mother wants for him. She wants him to get the care and therapy he needs and she wants him to have a future beyond that.

Although we understand why his mother has given him up, Sebastien does not. In the days following his arrival here, Sebastien grieved hard. He was distrustful and suspicious, he was sad and angry, and he wouldn't eat or play. He had suffered a lifetime of teasing and shunning and rejection, and now, he would face that reality without his Mum. It couldn't get any worse than this, by his estimation.

Even in his sorrow though, Sebastien could see that there was something different about this place. Although it was not a hospital, there were lots of sick kids here. He counted one with cerebral palsy, and several on daily medications. There was a foreign nurse who was missing a leg, and a nanny who was a dwarf. She had had external fixators when she was a little girl, she told him. We must have seemed like a motley bunch of foreigners and Haitians, caring for children who weren't our own, even chronically ill and disabled ones.

More than once, we saw Sebastien watching us with a bemused and perplexed frown. One day, late in the afternoon at bath time, there was a smile dancing in his eyes, and he decided to share some of his observations with me. 'You bathe the children in warm water here! All through bath time, he laughed from deep in his belly and shook his head. His mood had lightened, just for a little while, but as I changed Sebastien into pyjamas, he grew quieter and more serious again. I was pleased that he had softened his heart and allowed a little bit of joy in but the grieving was far from over, and I knew that his moods would be changeable.

'Take me downstairs, Susan, to watch some television'
'I can do that, but you need to eat first, I told him.
'I'm going to eat again?, he asked incredulously? How many times do you feed the children, here?' I replied that we give them three meals and two snacks every day. His all ready serious expression deepened. 'These kids eat a lot,' he told me. 'They are the only ones.'

As Sebastien accepts a new routine, helping me to hand out supplies, doing rounds of the nurseries with me, and some learning activities, I am preparing him for a transfer to the toddler house. He is adjusting better than I would have expected at this point. Most of the time, he is happy and very engaging.

I pray that in the enclosed orphanage environment, he will find love and acceptance. He needs physical healing but more than that, he needs to know deep in his heart that he is beautiful just as he is, a child made in the image of God. Broken and beautiful.







So God created man in His own image; in the image of God He created him......' (Genesis 1:26)