Like Springtime

Ti Fi,

Ill-equipped though your grand-father was to raise a baby, he did not visit the magistrate for a full two months after your Manman died. Surely, his steps were leaden on the way to the court that day. There must have been some level of struggle in his mind, between the desire to hold fast to you, his tiny grand-daughter, and the need to give you up for your own sake. If there had not been such a struggle, why would he have waited?

You arrived at our home, sick and emaciated, parched in body, and with eyes that betrayed a heart, equally parched by grief. A beautiful flower, scorched and uprooted. That was you, Ti Fi. And so I planted you in the garden of my own heart.

There was no relief in her countenance. There were gentle hands to tend to her, there was treatment for her dehydration and there were medications for the fever and infections that wracked her little body. Still, she refused to feed, and was in a state of decline. She needed love, I knew, and an abundance of it. Dixie was in the States with Vivianne, a key member of the Haitian staff. I was tired from the additional duties I had taken on, and yet, a still small voice urged me to open my arms and draw Ti Fi close. And that is how she ended up in my room.

Sure enough, within a matter of days of moving in with me, Ti Fi smiled. They say that the best prognostic indicator (of survival) in a severely malnourished child is a smile. Here it was; hope born in both our hearts.

As the days and weeks passed, I saw a rejuvenation in Ti Fi's spirit that spoke of the miracle of God's creation; the capacity of a child's heart to heal. New growth as in springtime. She began looking at the NICU nannies and nurses with wonder and she became very interested in toys and in her surroundings. Soon, she she found a voice. 'Ah haa haa' (the cutest giggle), Hi nah (a greeting), 'aaah' (to express her delight) and 'hey' (this one is to get our attention.)

Did I mention that she sings too?

She found the strength to sit unsupported, when, a few days before she couldn't even hold her head up. Within the month she was not only weight bearing on her legs but she was "climbing" from my lap to the top of my head, beaming and triumphant.

Yet love alone has not been enough to restore this precious girl's broken body. She has had an NG tube for 6 weeks now, much longer that I am comfortable with. It seems that Ti FI has health challenges, the extent of which we do not fully understand at this point. She becomes breathless when she sucks her bottle or eats from a spoon. Her heart races and she sweats. She is only able to tolerate formula that is comprised of partially broken down proteins, and she must be feed small regular volumes if she is to hold her feeds down.

Her weight gain is slow, even now that the diarrhoea and vomiting are under control. If early indications are anything to go by, it may take three times longer to recover this baby from her malnutrition than I would have hoped.

More time, more work, more patience than I thought I had. More laundry and more frustration than I thought I could deal with. And looking at this precious girl, who has suffered so much sickness, loss and pain, and who is so absolutely brimming with joy, how can I possibly say that I am overburdened? What reason have I to complain?

'I am he. I am he who will sustain you. I have made you and I will carry you...' (Isaiah 64:4).

Ti Fi weighed 8lb and 40z on admission. Today she has gained 3lb. She is becoming chubby, and she is a beautiful, delightful baby who absolutely has my heart.

Ti Fi with 'M' (left). He is my boy, she is my girl and M has whole heartedly accepted Ti Fi as his baby. They are so cute together. He is very protective and will not allow the other children to touch her. He points out a great many things of note to her. Ti Fi, much to M's delight is smiley and responsive.

She seems to have turned a corner this weekend; I haven't used the NG tube at all. She needs continuing prayer for healing. So Lord, heal this precious baby of ours according to your perfect will, and give her for every sickness, every sorrow and every pain she has suffered, a double portion of joy.

Amen

An Update On My "Problem Children"

Sandia Laura's family were unhappy that we would not be able to care for her here. Before we could organise a car to take them to a hospital, her 16 year old Mother left with the baby. We heard that they kept Sandia at home for a day. Somehow, she ended up in General Hospital in Port Au Prince. We do not know what her diagnosis was or what kind of care she received. What we do know is this; a few days ago, Sandia Laura passed away. It is difficult to understand why such a tiny baby should suffer so much in the few days she lived on this earth. We are comforted by the hope that she exchanges all this pain for an eternity in Heaven.

***

Baby Mike became very sick a few days into his stay with us. His abdomen was distended, his colour changed to a deep red, and he began bleeding from his mouth and nose and under his nails. By the time he became ill, we had received devastating news from his Aunt.

Baby Mike's Mother had been carrying twins. Her Labour had progressed so rapidly, that, caught unawares, she had delivered Mike into the bucket she used as her toilet. She was unable to deliver the second twin. She went to a hospital, where she had a caesarian. It was too late for Mike's twin, who died in utero. Mike's Mum died the following day.

We contacted a Neonatal Nurse Practitioner in the USA. She felt that Mike was suffering from an overwhelming infection, possibly listeriosis, which his Mother would have contracted from eating contaminated food.

We learned that with treatment, there was a 20-40% chance that Mike would die. To our great distress, we were unable to site an IV line to give this baby the fluids and antibiotics he needed. It was late at night and there was nothing for it but to provide unconventional care. I gave antibiotics by injection. I then placed a tiny needle under his skin and connected it to a bag of IV fluids. IV fluids were slowly infused overnight. It was not ideal but fluid was gradually absorbed into his system.

The next morning, Mike was alive and crying loudly. We were so impressed by our courageous boy, and as you might understand, desperate to do everything that we could to save his life. Our Paediatrician arrived and managed to start an IV. Things were looking up. The Doctors were optimistic that he might live, and Mike definitely had fighting spirit.

Unknown to us, there was trouble brewing. At home, Mike's Grand-Father was demanding that the women of the family go to GLA and insist that we return his Grand-son to them. We explained that Mike was critically ill, and that he would die without oxygen,. IV antibiotics and fluid. We explained that he was too small and weak to survive out of the incubator, but that in a few short weeks, things might be very different. There was no talking with them. No reasoning.

When they returned the next day with Baby Mike's Father, GLA's hands were tied. We re-iterated to them that Mike would die, but they were insistent that they wanted him home. The Haitian nurses were obliged to remove the IV, take off the oxygen prongs, wrap the baby warmly and hand him over to his family, all the while knowing that death was inevitable for him now.

One of the staff tells me that Mike's parents are not from this area. Their home town is a Voodoo stronghold. Haitians are deeply spiritual people and it is likely that the family believe that an evil spirit caused the death of the Mother and Mike's twin, and that this spirit was still attached to Mike. This being this case, they would have no faith in the power of Western medicine to change a thing.

Mike's Aunt lives a few hundred yards from our gate. Minutes after the family left, as I sat on the NICU balcony cursing his family and grieving for Mike and for them and their country, with its spiritual shadow lands fir its people bound by beliefs that hurt and harm, the steady beat of traditional drums began sounding...

***

Baby D's blood work indicated that she was suffering from a severe bacterial infection. We never did find the source. As the days passed, her colour improved and her heart rate slowed. We kept her on a strong antibiotic for two weeks, so that we could be as sure as we can be that the bacteria that made her sick has been eradicated from where ever it was growing. Baby D is back to her usual happy, smiling self. We will continue to watch her closely.

***

And Ti Fi.... We have had a hard few weeks, but she has turned a corner.Hers is a story for another day.

Problem Children

Last week I was too busy with "Ti Fi" to be updating any blog. Ti Fi was delivered into our arms a week and a half ago. She is around 8 months old and has been in the care of her Grand-Father for the past 2 months. She weighed 8lb 4oz when she arrived.

She was all loose skin and jutting bones. Last Saturday, she began bruising spontaneously and was refusing to drink. She had been having a lot of diarrhoea and was dehydrated.

Malnourished children can bruise due to vitamin K deficiency, lack of clotting factors in their blood or because of severe infections. I examined her thoroughly but did not find any sign of infection. We started her on an antibiotic anyway, just as a precaution. We also started vitamin K supplementation. Thankfully, there has been no new bruising this week.

To be absolutely sure that Ti Fi receives the level of love and attention she needs to set her on the road to recovery, she has moved in with me. She has made good progress; she has gained over a pound, is smiling a lot and has found the strength to sit unsupported for short periods. Needless to say, I am smitten and you will be hearing much more about her!
So that is problem child number one, although I wouldn't call her a problem exactly. Problem child number two arrived yesterday, just as I was looking forward to a quiet weekend. She was born a month prematurely and is from the area in which the orphanage is located. Her Mum brought her to us because the baby was vomiting. She was born on Wednesday and it transpires that she has never passed a bowel motion. It looks as though she has some sort of obstruction in her gut. I placed a feeding tube down her nose and aspirated 70 cc of bile from her stomach. 70 cc far exceeds a new born's stomach capacity.

Sandia Laura is on IV fluids and antibiotics. We are aspirating her stomach contents every two hours to make sure that she doesn't aspirate them into her lungs. We will transfer her to a hospital in the city for surgical evaluation first thing tomorrow morning. Please pray for Sandia. She is stable but seriously ill.

Mike is problem child number 3. He is also from our area and he is an extremely low birth-weight boy, weighing 2lb 4oz and born approximately 10 weeks before he was supposed to make his debut appearance in this world. Mike was born early this morning and he arrived at GLA just after 9am. He was having some difficulties with his breathing at first. and he was very, very cold and had a low heart rate. When I left the NICU, he was warm, pink and crying. I want this baby to live so badly it hurts. God, mature his lungs and give him the strength to live through the next few weeks.

Problem child number 4 is a year old. D had a cellulitis (soft tissue infection) in her leg a few weeks ago. Today, she developed a slight fever and became very, very pale. She was breathing 8o times per minute and had a heart rate of over 200/minute. She is very unsettled and seems to be in pain, but a top-to-toe examination has failed to find a convincing source for the infection. I did a blood draw on her this afternoon and started her on an antibiotic and regular pain medicines. We will have to watch her very closely. We nurses do not like not knowing the cause of a fever in a child.

I laughed when the night nurse came in. She smiled nervously.I smiled back. 'You wont rest tonight,' I told her. 'I didn't rest all day! 'We went on to discuss the babies we (affectionately) refer to as our problem children. Hopefully, they will all be 'good', or, in other words, remain stable over night. This nurse desperately needs some beauty sleep and she wont be getting any if any of her little darlings misbehave.

The telephone in the main house rang, and rang and rang last night. It was 9pm and the office was closed, but the ringing was so insistent (read irritating) that I went to answer the call.

The Mother of one of my NICU babies wanted to visit. I told her that the house was closed to visitors over the weekend. She kept asking, 'If God willed,' could she come in the morning? I wanted to say yes, but told her instead that no-one worked in the office on Saturdays. She could come on Monday, though, 'God willing', to see her baby.

She paused for a moment. 'Is he sleeping', she asked? My heart ached for her then. Her tiny son is happy in our arms but her own saddness will not be quick to fade. She will always wonder what he is doing.

We admitted four new babies this week. Miss Magaly decided that we were going to do blood draws on them that very day. I met each of their Manmans. It is rare for me to have any contact with them at the point that they hand their babies over to us. Frankly, I would rather not be present for that. There was no great show of emotion from any one of the ladies, just a quiet resignation. Circumstance compels them to relinquish their babies.

Two of the babies were very malnourished. This tiny boy (below) is two months old and weighs 7.5lb. His face is swollen with fluid and his skin is depigmented and peeling: he has Kwashiorkor malnutrition. Young infants (statistically) do not have a good chance of surviving Kwashiorkor, but this one is smiling and feeding well. We couldn't ask for more hopeful signs than those. Still, we will manage Baby P conservatively. His immune system will be very compromised and so we are watching him closely for signs of infection. If we treat him too aggressively, and try to fatten him up too quickly at this stage, he could go into multi-organ falilure.

This baby's emaciated body tells an all too common story of starvation. At 12 months, he is old enough to pine for his Mother. Please pray for him. If he adjusts well to the orphanage, I am sure that he will thrive here. He is in good hands. Loving and experienced nannies, who know that he has lost everything, will do many little things to ease his transition. They will will hold him and rock him the way Haitian Mothers do. They will feed him foods that are likely to be familar this week, even supposing they are not the best foods to recover him from his malnutrition. Allready, this frail little boy is reaching for these ladies and allowing them to feed him strange new foods. I am in awe of them.

And we are seeing double, yet again. A gorgeous set of twin boys have joined us in the NICU. They are just 5 weeks old and are happiest when we place them so close that each can feel the warmth of the other. This is brotherly love!

Blessed Be The Name Of The Lord

My mind has been drifting up the mountain to Kenscoff all weekend.

Our premature baby died on Friday morning, too small and too weak. We called her Papa to the NICU and he was present when her heart stopped for the second time. We could not start it again, and the decision was out of our hands. As Dixie removed the tubes and expressed her regret, the Papa put his head in his hands and wept. There are few things more devastating that a Father's cries.

.What will be in that Manman's mind, I wonder, when she undoes the sheet, to reveal the body of her tiny infant. Will she groan? Wail? Tear at her clothes? Fall to the ground? Will she rock her and sing? Refuse to believe? Or, will she hold everything back? I can only guess. I can't really know, but, my mind is drifting off to Kenscoff, to a 26 year old lady, who loved this tiny girl so much, that sick and weak though she was after a difficult pregnancy, she sent breast milk to the orphanage every day, because I told her it was the best thing for the baby and that it might help. Now, Manman's breasts will be full of milk. They will be heavy and they will ache. And perhaps Manman will be left with the insubstantial weight of the baby we called Gabriella in her arms, even after the infant has left them. Grief is like that.

These past three months have been tough in the NICU. Not a single week has gone by without a crisis. First Jonathon, then Baby S. A baby with septicaemia; so sick that we almost most her. A 6 month old who developed bloody diarrhoea and stopped breathing. An HIV positive boy with recurrent pneumonia. Now Gabriella. I try to be positive but in all honesty, I am feeling the strain. We are on an emotional roller-coaster here. Most of our babies do not have mothers. We are not just nurses and nannies to these little ones and by the same token, they are so much more than patients or charges to us. We carry an incredible weight of responsibility in our hearts, and it is really hard sometimes.

"Dee Dee", ready to catch a flight to the States with Dixie, early this morning. She was extremely ill last month with septicaemia but is now well enough to travel for surgery to correct her club feet.

Gabriella died at 8:30 in the morning. Within the hour, another infant arrived in a critical condition. She came from another orphanage in our area. This 11 month old baby was relinquished by her birth family two months ago. She has been refusing to eat for sometime. She developed watery diarrhoea and was so dehydrated when she got here that she was going into shock. We started her on an IV and antibiotics, but she is still refusing to eat. Perhaps she is missing her Mum. Perhaps she is not feeling well, but this baby must eat in order for her gut to heal. If she is not eating by tomorrow, I will have to site a feeding tube. Please remember her in your prayers. We do not know her name and so we are calling her "Fifi" for now. When she is better, she will return to the orphanage she came from.

I am so glad that Fifi made it here and that she arrived when she did. She is being lavished with love and attention. She is not the only one who will be healed.

Then Job arose... and he fell to the ground and worshiped. And he said:

“ Naked I came from my mother’s womb,

And naked shall I return there.

The LORD gave, and the LORD has taken away;

Blessed be the name of the LORD.” (Job 1:20-22).

What a week!

What a week....

It began with the very great honour of preparing Baby S for her marathon trip to Indianapolis. She was escorted out of Haiti by a former volunteer, Anna, who spent a month at GLA, getting to grips with the skills she would need to transport this high-care baby from the orphanage to her host family in Indiana.

We estimated that it would be a 16 hour trip, door-to-door, but of course, Anna and Baby S were sent on their way with enough feeds, medicines and supplies to accommodate potential delays and all kinds of other eventualities. What if Baby S dropped her temperature? I sent a thermometer, a make-shift cap and a hot water bottle. What if she vomited all her feeds? She would need oral rehydration solution. We packed some. What if she choked and couldn't clear her airway? All we had to offer was a bulb aspirator. What if she had a prolonged seizure? We hoped she wouldn't.

When the time came to wave off our precious girl, I knew I probably would never see her again. There was indescribable relief, joy, and celebration, but also a twinge of grief and anxiety. How Baby S would cope with 3 flights, and the changing altitudes was a great unknown. Regardless, we waved her off with smiles and optimism. After all, Baby S needed hope.

Less than a week later, Baby S has come through her surgery and is showing some promising signs. We are still praying for a miracle of healing and we believe that God will continue to show himself in her life.

Later that day, we re-admitted a recent NICU graduate. This 7 month old boy had bloody diarrhoea and a high fever. He was vomiting and dehydrated. We started an IV and antibiotics. Twenty-four hours later he was shaking violently with fever. By Friday morning, he was in a lot of pain. He began having seizures and he stopped breathing. It took almost two hours of resuscitation to get him breathing again. Amazingly, by the end of the morning, he had stabilized. All of our babies are special, but the ones who cheat death become more precious than any words could tell.

Sunday brought yet more drama. On the way home from church, I took a call on Dixie's Cell-phone. A Tiny baby had arrived at the gate. We were grateful for the heads-up. When we arrived home, we found a 2lb 1 oz girl in the NICU. That is just 900 grammes!

She had been born at 7am that morning. Mum is in her mid-twenties and had been hemorrhaging for the past 8 days. She delivered her baby by herself, at home. As Mum left the orphanage early in the afternoon, one of the nannies, who was observing Manman from the pefect vantage point of the NICU balcony, commented that she looked weak, as though she would faint. Sure enough, as I walked outside, this poor lady's legs gave way from underneath her.

The orphanage Director started an IV on her on the ground outside the baby house, because that is where she fell. She was ably assisted by myself and two of the ladies who work in the kitchen. This is Haiti!

Meanwhile, our newest charge, who was profoundly hypothermic, had been bundled into an incubator and started on oxygen. It was clear from looking at her that she was extremely premature.

Baby Gabriella's skin is very pink, slightly shiny and almpost transluscent. The cartilage in her ears is so soft that her ears fold easily, and do not recoil very well. Based on these, and other signs of her physical maturity, we estimate that this tiny baby has a gestational age of 27 weeks. That makes her almost 3 months premature.

Today, Gabriella is in a stable condition, but we are all very aware that this could change on a moment. The next 10 days will be critical. God, preserve her immature organs and protect her from infection. We are all rooting for her.

Someone Watching Over Them

This week, God has been very much present in the NICU at GLA.

One baby who developed a high fever last month and became extremely ill with septicaemia and seizures has been recovering slowly. The feeding tube is out but this little one remains weak. She developed a respiratory virus a few days ago. We nurses had all been so incredibly relieved to see signs that she was getting better and it was worrying to see this fragile baby get sick again, at a point when her resistance to infection was still so low.

Thankfully, our precious girl is improving. Her breathing is slower and less laboured and she is no longer coughing and wheezing as much as she has been. Tonight, one of the Haitian staff praised God out loud for this baby's life. The little lady in question has limb deformities that will require surgical correction. In the few months she has been with us, she has made tremendous progress in her motor development, As soon as she is strong enough, she will be going to the USA for the treatment she needs and deserves. Yes, it is certainly down to him that she has overcome so much.

Last week, we received the crushing news that although we had a surgeon who was prepared to perform Baby S's surgery free of charge, his hospital would not provide the care. Had God spoken? We knew that we could not continue to aspirate cerebral spinal fluid from this baby's head indefinitely. We were at a point where we had to decide either to continue searching for a Doctor and a hospital who would agree to treat our baby, or give up and begin providing palliative care. There was one key question in my own mind: what areas of Baby S's brain were active, and could anyone give us an indication of what her future capabilities might be?

Before that question was answered, a third surgeon, practicing in Indiana, heard about Sabrina and he accepted her case, on the spot, without reservation! This absolutely brings us to our knees!

I can not over-emphasise the urgency of getting this baby out of Haiti. Despite aspirating cerebro-spinal fluid every other day, her head is growing by a centimeter a week. There is a huge amount of pressure inside her head. She is unable to feed, she is vomiting and having seizures. She is also having frequent episodes of hypothermia. Please pray that the hospital administrators will be blessed with merciful hearts, and that they will expedite all the necessary paper work so that GLA can proceed with the US visa process. Time really is of the essence.

So many doors have opened for this little one. Surely, someone is watching over her


Baby S: The Angel sleeps. Isn't she pretty!