Jusmi

Jusmi arrived yesterday. 3lb. 18 days old. Severely dehydrated. Malnourished. Cold. With an intestinal infection. And in shock.

He was born 2 months prematurely at a rural Haitian hospital. The staff there said that there was nothing they could do for him. I am so glad that he made it up to God's Littlest Angels. There is plenty that we can do for Jusmi.

He has needed a lot of intravenous fluid and careful re-warming to get his body out of its shocked state. He needed antibiotics to treat his infection. He had metabolic imbalances that are gradually correcting. As he continues to stabilise, his heart rate and rhythm and his tissue oxygen levels are being monitored continuously. His temperature, blood sugar, his electrolytes and blood gasses are being measured regularly.

The extreme stress this preterm baby's body has been under has the potential to damage his liver, his kidneys and his intestines. I watched the signs keenly. As things stand tonight, Jusmi's blood isn't clotting quite as it should and is only tolerating very small feeds of donor breast milk.


Jusmi is getting the very best medical care we can provide, delivered with the love and tenderness that he deserves. Love and prayer, after all, will be every bit as important to his recovery as the technicalities of what we will do for him.

Please pray for Jusmi's continued healing.

Erline: Compassion's Face

Seven week old Erline was born prematurely. She arrived this afternoon,  weighing 1.14 kg (2lb 8.5 oz). Erline's suffering began the day she was born. That was the day that her twin brother died. It was the day that her own battle began.

Her mother tells us that the baby was discharged from hospital two days ago. She had beat an infection in the Paediatric ward there, and was sucking expressed breast milk from a bottle. I learnt that the overcrowded hospital had sent Erline's mother home when the baby was a week old. Separated from her baby, Erline's mother did not produce enough milk to keep her hydrated, so the baby was given intravenous fluids for several weeks. Today, seeing the loose skin hanging from the infant's stick-thin legs, I struggled to understand why she had been discharged. At just over a kilogramme and suffering from malnutrition, it was unlikely she would survive. The head Haitian nurse explained to me that overstretched hospitals in this country routinely discharge the least critical cases, to make space for sicker children. Erline was one of their less critical cases. 

The baby was mildly hypothermic and slightly dehydrated, when she arrived at God's Littlest Angels today.

Over the next 48 hours, she will be constantly monitored and will need regular blood draws to ensure that her glucose and electrolyte levels stabilise. 

occasionally I receive comments from people who consider the Erline's of Haiti, hopeless causes. I am not sure that I have always answered these people well. If she were yours, wouldn't she be worth it?

We make all kinds of distinctions in this world, creating political and geographical borders; logical reasons not to extend charity and compassion outside of those limits. 

But when it comes down to it, compassion is utterly illogical. Not something we are duty bound to do, but something we can do out of love. Because of people all over the world, I  able to provide care to this extremely vulnerable baby. The compassion of all these people is utterly illogical and because it is freely given and not extracted from them, it is magnificent. 

Today is good Friday. Today I saw Jesus in Erline and I was reminded that if compassion has a lovely face, it also has a suffering face and that for us, the sacrifice involved in extending compassion is a very small thing.

Dachka: An Orchid Transplanted

The first thing I noticed about my new baby were her dainty features. Her tiny eyes have a slight upward slant and are framed by elegantly shaped brows. She has a button nose and although she is pale, her skin in flawless. Her's is an exotic and fragile kind of beauty that took me by surprise, as though an orchid had been transplanted into the nursery. A flush of colour and a faint perfume were my first impressions of her.

The second thing I noticed, a second later, was the flat bridge of Dachka's nose. Next, I saw her low-set ears. I took her bony hands in mine. Turning them over, palms upwards I noted a single crease, cutting straight across each palm.

Dachka is four and a half months old and she weighs 7lb 3.5oz. She is significantly malnourished. First I saw that she was beautiful. Next I saw that she  had Down's syndrome.

Perfection

Our newest boy in the nursery, 7 month old Mackenson has a cheeky [ornery] grin, that inevitably draws smiles both from his nannies and from our visitors.

Mackenson was transferred to us from another orphanage on the understanding that his right ear was  malformed and that this would make him difficult to place. We admitted him on Monday, exchanging puzzled glances as we searched for the malformation we had been told about. We found that the cartilage of his left and right ears formed a different shape. Foreign staff questioned Haitian staff. Did Haitians have any traditional beliefs about the shape of the ears?


Absolutely not we were told. Nannies, nurses and the Paediatrician were all in agreement. This did not constitute a malformation. One lady inviting us to examine her own ears, pointed out that her ear cartilage took on exactly the same shape as the new baby's did. others told us of friends and family whose ears were just the same as Macekenson's right ear. He was like many Haitians, they said.

And the fact that one ear looked different from the other. Was that important?

No! Haitian and foreign staff were in agreement. The difference was barely noticeable. Interesting but not really noteworthy.

A quick review of the documentation that came with the baby showed that he had initially been sickly at his previous orphanage. Not so now. He appears to be healthy and developmentally, he is on track for his age.

We are all made in the image of God, but not exactly like him. We are all different. All known personally to him. All needing his enduring love, his grace and his healing.

Soon Mackenson will be proposed to one of our waiting families who will, without reservation, accept him as their son. They will watch with keen eyes, taking notes of all the ways that he is special and all the ways that he is perfection.

Unfaded Beauty

We admitted a sibling set to GLA's main house late yesterday afternoon. This morning, with the help of a colleague, I recorded their vital statistics.

Anel, the little boy on the left of the photograph weighed in at 12lb 15.5oz and his length was 63cm. 

Wiseline, the little girl to the right weighed 13lb 14oz and measured 68cm in length.

Twins? The colleague asked.
'No.'
She gazed up from the admission paperwork, looking mildly surprised. 

We have been told that Anel is three months old. Wiseline is his older sister. She turned two at the beginning of March!

Her growth is severely stunted, and she is moderately underweight for her height. When I heard that she could barely crawl, I groaned inwardly. Children like Wiseline, whose tiny bodies have endured years of malnutrition can be extremely difficult to rehabilitate. Often, they have chronic health problems,  remain delayed in their development for years, and go on to develop learning difficulties in school.  Now that I've actually seen her though, I am feeling optimistic about this tiny girl's recovery. 

Her general health is remarkably good and she has surprising strength in her spindly legs. She has a good appetite, a brightness in her eyes and an openness to her new caregivers that makes me hopeful. So long as this child doesn't have any medical conditions that have contributed to her malnutrition, the chances are that she will adjust well to orphanage life, and go on to grow and thrive. 

Malnutrition has a way of stealing so much from children. One thing I am sure you will agree Wiseline has not lost, is her beauty. That is unfaded. 

'I will restore to you the years that the swarming locust has eaten' Joel 2:25

Talia

'This baby will give you trouble, Susan!' the Paediatrician declared.

Talia? That little bundle of baby girl sweetness? Trouble?

Sometimes when medical people talk about 'trouble' we are actually describing a patient who presents us with a clinical challenge.

Talia had a deep red colour when she arrived at God's Littlest Angels, the day before. She was 13 days old and the whites of her eyes were yellow. This was a sure sign of jaundice - a condition that occurs when bilirubin levels rise. Bilirubin is a pigment in red blood cells. Sometimes, newborns' livers cannot excrete bilirubin in the first week or so of life and the rising levels of bilirubin stain the skin. Jaundice has to be monitored - high levels of bilirubin can cause brain damage.Although I was concerned to see Jaundice in a 2 week old baby, wondering if this was caused by something other than just an immature liver, by the time the baby saw the Paediatrician the next morning I was not as worried as the Doctor.

 In early December, our orphanage Director arrived in Haiti with donated equipment from a US based medical supply company called Children's Medical Ventures. One of the pieces of donated equipment was a transcutanous bilirubin monitor. This made it possible for us to immediately screen baby Talia, using a painless test to determine whether her  jaundice level was an immediate threat to her health. We already knew that it was not. We had already tested a few drops of Talia's blood, and determined that she had a very high level of red cells in her blood. We had also done a bedside test that screened Talia for signs of infection. That test had been negative.

Over the days that followed, we monitored Talia's bilirubin levels, and observed her carefully. The Paediatrician was pleased by my report that the bilirubin levels were falling, and that Talia was waking for her feeds, tolerating them well, breathing normally and peeing and pooping regularly. The most likely cause of this baby's high bilirubin was delayed clamping of the umbilical cord. The extra cells would have made her blood more viscous and this could have caused breathing problems, as well as damage to her brain and kidneys.

All the signs indicated that although Talia had not had access to medical care, she hadn't suffered any complications. Her condition was temporary and it was resolving. I peeked at her, sleping peacefully in her box crib. I sighed softly, letting the last remnants of the concern I had harboured for her slip away. I am a Paediatric Nurse. I see lots of sick newborns. Lots of newborns with problems. It is always a blessing and a relief to look upon a  beautiful healthy baby.

Talia is no trouble at all........at this point in her life ;-)

Mitigating the Hurt

There are so many things I will never know about the lives our babies lived before they came to God's Littlest Angels. Those unknowns trouble me sometimes. People tend to assume that early traumas, the kinds experienced by pre-verbal infants are forgotten, and therefore unimportant. I think Mothers of adopted children have long come to know, what science is now uncovering - that early experiences of stress and trauma change the structure of babies brains, forging neuronal pathways that trigger a stress response to particular triggers, well beyond infancy, and even into adulthood.

I can make guess about the things our babies have endured from the womb - exposure to malnutrition, to their mother's stress hormones, and  possibly to toxic drugs. Many are then born into impoverished families, in crowded, unsanitary conditions, with inadequate food and shelter, and without access to medical care. They go on, one way or another, to lose their families, and find themselves in an orphanage.

In the past week, two small infants were admitted to the NICU. Oddison is a month old and he has a very low tolerance for discomfort, crying in short, piercing bursts. and trembling with anxiety whenever he is hungry or needing a diaper change. For now, he is unable to trust that his needs will be met. His mother told us that he has lost a significant amount of weight since birth. She was unable to produce breast milk and was only able to afford one can of formula for him. After that, she fed her tiny infant sugar water. He had severe diarrhoea when he arrived and needed to be re-hydrated intravenously. In his malnourished state, he became fluid overloaded on that IV and developed a mild case of heart failure.

I wish I could fix all his hurts, and make up for everything that has been lacking in Oddison's life. Of course, I can't, but at GLA, we can provide a good standard of medical care, and adequate nutrition. There will be people to care for him and hold him around the clock.Neuro-behavioural scientists tell us that stress and it's affects can be mitigated. I hope that we will earn Oddison's trust and confidence. If we do, there is every reason to believe that he will begin to thrive here. Now, having recovered from his diarrhoea, he is ravenously hungry. 

Daphka arrived yesterday. I haven't gotten to know her yet. Our Director tells me that hers was an urgent situation: she was living with her mother on the streets. Although I have been up to the NICU several times to assess Daphka, I always find her sleeping. First impressions - she is well-filled out and has shiny black hair and beautiful clear skin. Not a single worry line creases her brow. I hope that means  she doesn't carry too many hurts.