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.