In Septemeber 2008, I traveled 6000 miles to Haiti's Kenscoff mountains. My mission: to care for some of the orphaned and abandoned, the sick, malnourished and premature infants of this beautiful but beleagured Caribbean nation.

Sunday, 24 June 2012

Losing it - Shamira's Bravery

Shamira, arrived at the baby house withdrawn, and distrustful. Just two years old, she had already learnt to protect her little-girl heart from the sting of rejection. She was brittle-haired and balding, with dry, cracked skin pulled taught over an angular frame. No-one had ever told her she was pretty. She knew in her mind she wasn't a lovely child. Her family had left her with strangers at an impoverished orphanage, further up the mountain road. The staff there didn't even consider her worth feeding every time there was food. That was how Shamira saw it. It wasn't true but she believed the lie.

Five days after arriving at God's Littlest Angels, were she and 22 other children had been transferred by concerned Social workers, she was finally receiving some of the things she needed and deserved. She was sleeping in a new bed, on crisp white sheets. Her caregivers smiled at her often, held her and fed her until her stomach was full. Her ear infection was healing. There were toys and visitors. On that fifth day, a bowl of food, that she said she didn't want was taken away. Suddenly and violently, Shamira snapped, Somewhere deep inside, she believed she was going to lose everything. She began screaming and kicking, clawing and biting.

It was an ugly display, but we were seeing the fury of a toddler whose cries hadn't been heeded for a long time and I wanted her to know that we cared about her hurts and that we loved her. She was in such a state, though, that she couldn't remember why she was upset and she wouldn't allow anyone to comfort her. You won't do this to me, traitor! You wont taunt me with good things and take them away! Let me go!

Shamira needed to be held. She needed to let a grown up help her through this, but any attempts to re-assure her only increased the volume and intensity of the screaming and fighting. I lay her on her stomach, sat at the head of her cot, and told her it was OK to cry and to be angry. Shamira quickly settled. After a few minutes, she pushed up on her arms and looked up at me with a tear-stained face.

'All done?'
Yes, she nodded
'But you cried hard.' Shamira was utterly exhausted and slightly sheepish, but she wasn't going to be scolded this time,
'Your throat must be sore. I bet you are thirsty.'
'You want a drink of water?'

That was not Shamira's first meltdown, but it was the most intense, because now she lets grown-ups hold her when she is angry. We are allowed to soothe her. Shamira is beginning to do something else, she wasn't prepared to to when she first arrived. She is accepting affection, and smiling shyly every time Chantal, her key nanny tells her she is a little doll. Who, me? she seems to ask.  That takes courage. I think that many people instinctively respond to hurt the way Shamira did - we shut down, we get defensive. Yet Jesus said on the mount, 'he who seeks to save his life will lose it.' I wonder if one implication of what he was saying was that, sometimes, our response to our trauma is more damaging than what was done to us in the first place.

Photo courtesy of God's Littlest Angels
Now, Shamira's bravery has opened a door to healing. She  is delighted to be told that she is a doll. She always wanted someone to tell her that. She always needed to know someone thought she was pretty, and  for someone to be enthralled by her.

Wednesday, 20 June 2012

Mercy - An Update On Fedo

For several hours on Sunday, I was afraid that Fedo would not survive. On Monday, his abdomen remained tense, and he was not well enough to be fed. On IV fluids, and without a protein source, the tissue swelling returned. Yesterday, it was worse than ever. I was alarmed and discouraged, knowing that diarrhoea increases the body's protein requirements, and knowing that there was no way that Fedo was going to be able to receive protein for at least a few days.  His limbs were stiff and he cried out in pain whenever we handled him. His left eye was so swollen that he was unable to open it.

The very worst thing was that twice each day, he experienced life-threatening drops in his blood pressure. As the hours passed, we learnt to anticipate these episodes, treating them with boluses of IV fluid. Friends of God's Littlest Angels orphanage, who operate a a rural clinic and malnutrition centre  at the other side of Port-au-Prince, were advising us about his care. I have gained a lot of experience with very young, severely malnourished babies but the Staff at Real Hope For Haiti specialise in the treatment of Kwashiorkor (the type of malnutrition that Fedo has). They explained that children with Kwashiorkor often go into severe shock due to fluid shifts in their bodies.We were all very grateful to them for their wisdom and guidance.

 I continued to pray for healing, but my heart's loudest cry was for mercy for this child. I have seen two deaths from Kwashiorkor in my time at God's Littlest Angels and I couldn't stand the thought that Fedo would suffer, more than he already had.

Overnight, Fedo turned a corner. His cries were different this morning - they were hunger cries. He isn't able to suck yet, but he is taking formula from a syringe and he is digesting it well.

Fedo is not out of danger yet, but he has come a long way. Please continue to keep him in your prayers.

Monday, 18 June 2012

The Call Got Through

‎'Oh, Miss Susan! I was trying to get you on your cell phone but the call wouldn't go through!' Nurse Cami told urgently, before I had even reached the top of the stairs. Her eyes were wide with alarm. Fedo didn't look well to nurse Cami, said. She thought he'd had a seizure, She was sure there were more to come. 
'Don't worry about the cell phone, Cami, the call got through, I reassured her....

Two minutes earlier, I was in my room, when a voice in my head told me to go and check Fedo's electrolytes. It was close to 10pm, I was tired, and I wondered if it could wait till tomorrow. 'You'll regret leaving it till tomorrow,' the voice cautioned. 

As I got supplies ready to check his electrolytes, the baby began to have a seizure. I was able to respond instantly,  because apparently, someone up above has me on speed-dial and although I am inclined to reject calls from unknown numbers, I answered this one ;-)

Fedo's condition is slowly improving but the seizures are a new development. Please remember him in your prayers, as he stabilises and his body struggles to adapt to electrolyte shifts and blood loss, following yesterday's severe intestinal bleed. 

Sunday, 17 June 2012

Fedo - A Father's Day Prayer

He is said to be six months old, but this embattled angel behaves like a much older infant.

He arrived on Tuesday of last week, swollen from from protein-energy malnutrition, with a cough, fever, diarrhoea and a severe case of thrush in his mouth. He wouldn't drink - not milk, not juice or oral re-hydration solution. not from a bottle, a cup or a syringe. I remember arguing half-heatedly with the head Haitian nurse. She knew, that I knew, the baby needed an NG tube, she told me. I did know that, but I still didn't want to put the tube down. Fedo was an older infant. It is painful and distressing to have an NG tube passed. Fedo would fight. Still, he was dehydrated and we could not allow his condition to deteriorate under our care.

Re-signed, and with the tube in my hand, I explained to Fedo in a gentle voice, what I was going to do, and why. He put his hand up in front of mine. The gesture and the facial expression that accompanied it communicated his feelings on the matter very clearly. Stop right there Madam! I am not ok with this! The NICU staff were as surprised as I was. Maybe Fedo was considerably older than six months. Maybe he has just experienced too much in his 6 short months in this world. Maybe he knows too much.

Fedo came during an exceptionally busy week, during which, at one point, the orphanage's Intensive Care room was full to bursting with 15 babies, many of them sick, and a three year old in heart failure. Fedo received a continuous feed, electrolytes, medications and vitamins through his NG tube. By Thursday, his swelling was going down and his infections were clearing up. On Friday, he began sucking from a bottle and smiling. I was thrilled to see this fragile baby healing so quickly. Kwashiorkor malnutrition causes swelling of the tissues, wasting, severe immune-deficiency due to low protein levels in the blood and many together with nutritional deficiencies. Fedo though, was on the path to recovery.

Despite these hopeful signs, Fedo experienced a life-threatening complication related to his malnutrition today. Our orphanage Director checked in on the NICU babies after lunch and found Fedo extremely ill. While she was starting an IV on him, he went into shock and developed severe breathing problems.

It seems as though the tissue wasting that has resulted from extreme malnourishment has affected Fedo's intestines. He developed a high fever and suffered a  gastro-intestinal bleed this afternoon. When I arrived in the NICU, he was unconscious, unresponsive, extremely pale and in such severe shock that we could not detect a pulse.

For over an hour, we worked hard to stabilise him with IV fluids, oxygen and antibiotics. Dixie, the orphanage Director, performed as ice-water lavage to slow the bleeding. As we worked, we prayed, against the terrible fear that Fedo might die in front of us. We advocated hard for this orphaned child, for a healing, preferably in this world, according to your perfect will, Lord

At the time of writing this post, Fedo is in a serious but stable condition. He re-gained consciousness this evening and turned to my voice. His gaze was searching, pained and confused. What is happening to me? Please explain it Miss Susan. In all my life, nothing as terrible as this has ever happened!

We ask that you echo our prayers for Fedo tonight. Our God is the Father of the fatherless. He is Fedo's Daddy and the great physician and I have great confidence in his infinite love and concern for his stricken infant son. Imagine his anguish as he watched his helpless baby suffer. I am thankful to his birth Father, for seeking help and I am hopeful that for Fedo, help has not come too late. Although I recognise that Fedo couldn't be in better hands than in his heavenly father's. I am so, so sorry that his earthly father doesn't have his son in his arms. Today is Fathers Day. No Father should be forced to make the impossibly difficult decision, to give up a child in order to save them.

Sunday, 10 June 2012

Rebecca - Not 'Forgotten'

It seems that something about my shock startled Rebecca's mother out of her cold indifference. Minutes after I announced that Rebecca didn't need her mothers milk, not if her feelings about the baby were so intensely negative, not if our continuing to press for milk was increasing her sense of hostility, the teenage mother sighed and began expressing. She continued to provide milk over the days that followed.

Rebecca, who was born significantly premature and malnourished. Rebecca, who was struggling with a severe viral infection. Rebecca, who had difficulty digesting her feeds. Rebecca, who was so highly stressed that she was producing excess stomach acid and vomiting streaks of fresh blood. Rebecca, who had been delivered in a latrine bucket. Rebecca, the child of a broken mother, with a calloused heart. This Rebecca. with so many odds stacked against her, began to heal and to thrive. 

Rebecca now weighs 2lb 9.5 oz. I have struggled with this tiny, fragile infant. Twice, I weaned her from her CPAP, only for her to become ill with bronchilolitis, then a simple cold, and need more CPAP support than ever before. On the third attempt, I was finally able to get Rebecca off of CPAP and onto a nasal cannula. A constant flow of compressed air and daily caffeine ensure that she continues to breath. 

When I worked in Scotland, it was exceptional for a newborn with bronchiolitis not to need mechanical ventilation. During the long course of Rebecca's recovery, I have learnt a lot about the potential of bubble CPAP, and about it's capacity to save the lives of tiny infants, born in Haiti and in other countries that don't have the personnel or the resources to place them on mechanical ventilators. I sincerely hope that more Doctors and nurses working in hospitals and clinics in the developing world will catch on to the bubble CPAP principle.

Of course, Rebecca is the child that God has placed in front of us, so please continue to pray for her and for her Mother. Pray for continued healing in Rebecca's body, and for her mother's wounded heart. I really believe that all women are called by God to a mothering role; to love sacrificially and to nurture his children. I think that Rebecca's mother denied this part of her nature because she was badly hurt, and overwhelmed - afraid that tenderness would drain her, open her up, and increase her vulnerability. She is now showing concern for her baby and for our other NICU infants. This softening of her heart tells us that our prayers have been heard and that God's hand is on both of his children, the mother and the daughter. He is with them and in them, whether or not they know it, and because of that, Rebecca's mother can not 'forget' her.

'Can a mother' forget the baby at her breast
  and have no compassion on the child she has borne?
Though she may forget,
 I will not forget you!' Isaiah 49:15

Sunday, 3 June 2012

Far From Eden

I believe that their Father God intended them for Eden. A place where the soil was rich and the earth produced bountifully. A place in which they would be safe and nurtured into adulthood and all the days of their lives. Docillia, Shamira and Dabbens though, were born far from Eden.

Last Thursday, at the end of a long day, Haitian social services closed an orphanage in Kenscoff on the grounds that the children there were severely neglected. GLA was asked to provide emergency care for 15 sick babies. At 5pm, I watched from the NICU balcony, as social workers and GLA staff lead 23 children to the common room. The nannies and I counted 1 baby and 2 toddlers. The other children in the group appeared to range from 3-8 years old. Where would we put all of these children, with both houses so crowded?

Downstairs, I assessed the children medically, while others confirmed the identity of each child, photographed them and attached name bands to their wrists. Having received three critically ill, children from this orphanage in 2010, I was aware of the conditions the children would be coming from and I was fully prepared to set up a make-shift hospital ward. I had been praying for these children ever since my precious Geraldine had returned to that house of horrors. I scanned the room looking for her. To my dismay, she was not there.

Most of the children were malnourished, with red hair, spindly arms and bloated bellies.  Two were suffering from protein-energy malnutrition. Several had coughs and fevers. One little boy had healing wounds on his toes that he told me were from rat bites. A few had minor skin infections.  The youngest child, an 8lb baby who we were told was 4 months old was emaciated, severely dehydrated and suffering from diarrhoea and vomiting. He was the only child that needed urgent medical care.

Three of the 23 children have been admitted to the nurseries at the main house.  They are the smallest and frailest children. All three have infections, all are malnourished and all are responding well to special formula milk, plumpy nut and antibiotics. The wounds on the inside though, will be more difficult to heal.

Dabbens has only just began to trust that  there is no need to feed until he is overly full. The day after his admission. he was a fractious baby, with a hungry, desperate cry, who, pulled at his hair and chewed his fist. We would stop feeding him after a few ounces of formula so that we could burp him and he would kick and thrash and arch his back and look at us with pained confusion. The orphanage closure occurred just in time to save his life, but it came a month too late for his dead twin.

Docillia (shown on the left) is three years old and has only just learnt to walk. She is full of smiles and she chatters away with the nurses and nannies. Foreigners who used to visit her orphanage were amazed to see the transformation in her after 24 hours at GLA. We are told that they didn't know she could talk, and that they have never seen her smile before. They have known her for 18 months.

Shamira - We were told that she was 8 months old, but I counted 18 teeth in her mouth, and I suspect that she is at least two years old. Shamira is shy and a little bit withdrawn. she is willing, with trepidation dancing behind  veiled eyes, to accept our care and our tenderness. She can't place her confidence in us yet. Her urgent wails last Friday as she watched me give parasite medication, mixed with yogurt to Dicillia, convinced me that at her last orphanage, some children got food when it was served, not all.

On Friday morning, as I spooned medical peanut butter, specially formulated for malnourished children into a bowl, and began spoon-feeding it to each girl, they exchanged impish, slightly bemused looks. Peanut butter from a spoon - has this lady lost her senses? Shamira seemed to inquire. Raising her eyebrows, Docillia responded with an expression that said, probably, but lets just go with it! In their minds, they had hit the jackpot.

Make no mistake, these are wounded children. Their early life-experiences have taught them that adults are inconsistent and untrustworthy. That they themselves are not deserving of basic care and protection. Not special. Not noticed. Not seen.

Part of the treatment here will be warmth, cuddle-time and lots of positive interaction with adults. You see, we can give these hurting babies all the food they want, and the best medicines,  but without gentle loving care, without touch and physical contact from their caregivers, there will not grow, they will not heal, and they will not thrive developmentally. Apparently, on some primal level, a life without love is a life not worth living.

The nannies and I believe without reservation that each of these little ones are precious to God. Knowing this, we feel privileged to tend to them. To comfort them. To relieve their suffering. To salvage their lives. We have no idea how long Dabbens, Shamira and Docillia will be with us. Will Social Services track down their parents in a weeks time or in a months time? Will the children be declared abandoned in 6 months time and eventually be adopted?

I don't know, and so I feel the same urgent need I felt with Geraldine, to strengthen and heal their bodies and sooth their hurting hearts as fast and as well as we possibly. Meanwhile, I pray for the solution that long-term, will be most conducive to their well-being.

God knows better than I do, what that solution is, in this place, so far east of Eden.