Stupid Cupid?

GLA's volunteers, romantics and cynics alike, celebrated Saint Valentine's yesterday. There was lots of food, there was a movie and there were games. Most of the party-goers were still partying until past mid-night.

Haitians really don't buy into commercialized celebrations and so it comes as no surprise to me that February the 14th is not a significant date on their calenders. What does surprise me, in light of several conversations I have had with the nurses and nannies lately, is the faith they put in romantic love.

***

'Miss Susan...' the tone in Miss Magalie's voice suggested she needed my help with something. I looked at her expectantly. '...Do you have a boyfriend?' she asked.
What? The answer was easy enough (I do not have a boyfriend) but the question caught me off guard. Miss Magalie smiled knowlingly. 'You need one. You can't live without one.'
'Why do you say that?'
'Cherie, you are too old to be without a man,' she replied with a warm, joking authority. 'I'm going to start looking for a boyfriend for you.'
'Miss Magalie, you don't have a lot of time,' I joked back, 'I'm leaving soon.'
'When are you leaving?'
'February the 26th. '
'Oh...' Miss Magalie was thoughtful for a moment. '.....Then I'm going to pray for you.'

***

My mouth was wide open. A baby I am particularly close to, a beautiful 16 month old boy, had just pinched Vivianne, a 20-something year old Haitian orphanage worker, on the behind.
'Infidel!' I declared, 'You are obviously chasing all the ladies, not just me!' This sent my tiny boyfriend and all of the nannies into a fit of giggles.

'But Susan,' Marie began, 'All Haitian boys are like that.'
'Unfaithful?'
'Yes,' she said. 'Maybe they have a wife, but they will have girlfriends too. And children with the wife and children with the girlfriends' Rose was smiling but she was also absolutely serious. I frowned. 'That's not good.' It was of those moments when you hear a hint of sorrow in another's voice. You read their story in their eyes, and you sense, just for a moment, the weight of a burden you have never had to bear.

'No, it is not good,' someone agreed. 'Do you get men like that in Scotland?'
'Yes, we have some men like that.'
'Well, in Haiti we have many,' Rose observed.
'And if the men all have children with many different women, the men can't possibly support them all.'
'Exactly!' Rose exclaimed. 'The men come and they go.' I didn't ask why Haitian women put up with that. I think I get it - before there are children, there is male attention, and male attention flatters women everywhere. And afterwards, so long as the errant husband or boyfriend returns to you with some money to feed your hungry children, you probably are not going to ask questions.

One of the senior nannies was sitting quietly in a chair. She looked drawn and she was regarding me with an expression that came close to resentment. 'You don't like our conversation?'
'No, ' she answered, and her face softened, 'but that is because what you are saying is true. All of them,' she said, indicating the babies in the room, and beyond the door,' have been affected by infidelity. They are here because their Mothers can't provide for them. 'And,' she added, 'many of us are here [working at the orphanage] because our children need to eat, and their father's do not take care of that.' She sighed, looking resigned but determined. 'We wouldn't leave our babies if there were another way.'

***

When the women spoke, I got the feeling that they coveted my ears. It is as though once in a while, they have to give voice to their struggle, so that the rest of the time, they can endure it. Oh my goodness, I have so much to learn and so little time left for the learning.

Despite all that they have told me about how relationships work, I know of at least two ladies here who are praying that I will find my Mr right. I also know of two young Haitian ladies who are in new relationships. They are soul deep in the newness and excitement of it all, and their friends and workmates, even the older women, who, given all they have seen and experienced. might be justified in cynicism and resentment, are rejoicing with them.

I find myself thanking God, for all our little boys here who will go to stable families, and learn to love by the example their Fathers set.

But more than anything, I pray that the children of Haiti, those who stay and those who go, will always remember and be inspired by the sacrifices their birth families have made for them, their labours and that phenomenal endurance. If their lives have been touched by poverty and infidelity, they are all ready marked with great love.

Mesi Nova Scotia!

Several boxes of donations arrived on Sunday. One of the staff members here handed me a gift bag with Scottish treats. The bag had my name on it.

The donors were gone before I knew anything about their visit. Since I couldn't thank them personally, I'd just like to say mesi anpil to the Nova Scotia residents who sent me a taste of home. I appreciate their thoughtful gesture very much.

Love Susan

Gastroenteritis

An outbreak of viral gastroenteritis has been sweeping through Haiti this month and for the past 10 days, we at GLA have been feeling the effects of the epidemic, with dozens of babies, volunteers and staff coming down with diarrhoea, vomiting, headache and fever.

Gastoenteritis is one of the most common childhood illnesses world-wide. While in the developed world, symptoms are usually mild and the child recovers without any lasting effects, malnutrition and parasites make Haitian children more susceptible to severe dehydration and other life-threatening complications of diarrhoeal diseases. For this reason, the treatment of acute gastroenteritis is approached slightly differently here, than it would be in Western Europe or North America.

One major difference is that we never do blood draws on children who have diarrhoea and vomiting. In the developed world, clinical chemistry results (levels of sodium, potassium, glucose acid and bicarbonate in the blood) sometimes guide the type of fluids that are given and how quickly children are re-hydrated. These tests though, are unhelpful in here; there are no labs in our area and even if we did send a sample for analysis, it would take up to 24 hours to get the results. That is too long when you are dealing with a child who needs treatment right away.

Although we can't be certain if a child has normal, raised or lowered levels of electrolytes in their blood (all of which can occur when a child has severe gastroenteritis) , it is possible to make a reasonable guess, based on how the child looks and what their vital signs are doing. Assessments such as how moist their skin and mouth is, whether their eyes or fontanelle are sunken and how cold their hands and feet are, also indicate how dehydrated a child might be. For a more objective measure of dehydration, I weigh the children and compare their weight on the day they present to the last weight that was recorded for them. The children here are weighed once a week and this is very helpful when they get sick.

The main focus is then on making sure the child stays well hydrated by replacing fluid, salts and sugars. This is done either with an Oral rehydration solution (ORS) or with IV fluids. In over 90% of cases, we successfully rehydrate our children orally, even when the dehydration is severe. The nurses and nanny's here are very experienced in treating gastroenteritis.

If the child is vomiting, we often give anti-emetics. Although we don't usually do this in Scotland, it is routine, in Haiti, to give oral medications such as Reglan for gastroenteritis and I find that they usually work. I am in favour of this approach because anti-emetics seem not only to help the children feel better but they also make oral rehydration possible. For children who can tolerate ORS, we can then rehydrate them safely and more rapidly than we could with an IV. Typically, we are able to hydrate the children in as little as 4 hours. The majority of children who have viral illnesses are then able to tolerate small amounts of their usual milk formula or familiar foods, and this speeds their recovery.

In other cases, the child vomits persistently or is too sleepy to drink. For these children, IV fluids are usually the best option. During the current outbreak of gastroenteritis, we have had only 1 (medically fragile) child on an IV. That child returned to his nursery 48 hours later, completely recovered.

Another baby was able to drink but just didn't want to. I considered it important for this baby's recovery, to continue feeding him, and so we used a Naso-Gastric feeding tube to rehydrate him. He is now on his regular formula and he is eating well.

Since many Haitian children have or have had parasites which can cause diarrhoea, we give de-worming medications to all children with diarrhoea unless they have been treated have received treatment for intestinal parasites in the previous 6 months. Since many of the bacteria and parasites that affect Haitian children damage the gut and cause lactose intolerance (which makes the diarrhoea worse), our children are often switched to a soy formula, which they continue on for 2 weeks after the diarrhoea stops. These children are also given SMECTA, a French product that binds to the mucous lining of the gut, strengthening its defences against toxins.

We also give pre-biotics such as acidophilus, when we have them. These are proven to help reduce the duration of many diarrhoeal infections. Since most cases of gastroenteritis are viral, we usually do not start antibiotics for diarrhoea that lasts for less than a week. However, because this is Haiti, we are very aware that gastroenteritis is more likely to be caused by bacterial or protozol infections. It is routine to give medications for both types of infection at the same time. After all the children have usually been unwell for several days before they begin antibiotics and by this point, we can be reasonably sure that they need an antibiotic, and we want to make sure that what we give works as soon as possible.

In the 5 months have been here, we have nursed many children through severe gastroenteritis. I am thankful that we have been able to do that, but I am ever mindful of the children who live in impoverished communities beyond our walls. Many of these children drink contaminated water. They are malnourished and full of parasites and they have no access to medical care. For them, gastroenteritis, a condition that is both treatable and preventable can be, and all too often is, fatal.

Ti Marasa

You might remember this little man. He came with his twin brother on New Years Eve. Last Sunday, he was giving me cause for concern. He had profuse diarrhoea and he looked dehydrated.

The week before, he had been moved to the high care nursery where we started IV fluids and antibiotics. I have been watching Ti Marasa (the little twin) very closely since the New Year, because he is profoundly anaemic, and that makes him very vulnerable to infection. On Sunday of last week, the pale skinned baby with white gums had dropped from almost 14lb to 12lb 2oz. Despite the best efforts of a dedicated nanny, he was refusing to drink. He was very tired and his eyes we sunken. We had hoped to avoid having him bounce back to the NICU but it was clear that he needed another IV.

We rehydrated him and started him on another course of antibiotics. Three days later, the diarrhoea was as bad as ever and our paediatrician changed his medications. We were really struggling to get nutrition into him. He wanted cheese puffs (the highly processed kind) and nothing else. We were bringing his brother in to visit throughout the day, in the hope that this would lift Ti Marasa's spirits. It was touching to see Gwo Marasa (the big twin) offer his little brother little pieces of bread. The tiny boy would smile when he saw his brother, but he wasn't making any progress.

I would sit for 40 minutes at a time, trying to get him to drink. He would roll his eyes like he was dying (he was not) and he could let everything dribble out of his mouth. By the end of the 40 minutes (I really couldn't cope with him playing dead for any longer), he would have taken 3-4oz and he would keep it down. We couldn't be sure whether he was feeling nauseated or whether he just didn't feel hungry. It was clear though, that we were dealing with a very strong personality!

He was starting to show signs of zink and B vitamin deficiency on Friday and by that time, he was pursing his lips tightly and absolutely refusing to eat. I strongly felt that he needed nutrition to heal, and we all knew that he would need a blood transfusion before long, if he didn't start eating. Reluctantly, I put a Naso-gastric (NG) feeding tube down and started feeding him an enriched milk formula. His protests about the tube were loud, and his wailing could be heard down in the office and on the third floor balcony for over 1/2 an hour.

He is doing better today and is beginning to eat on his own but he still needs prayers for a healing. I would like to see him catch-up with his brother and I dearly hope that he will not fight all of our efforts to make that happen!

A Living Victory

This gorgeous little boy arrived at GLA last August. He was 9 months old and weighed 10 lb. His bony frame was covered in scars and his ashen face was dominated by huge ears. He was not a pretty sight.

He has underlying health problems that make it difficult for him to gain weigh. As 2008 drew to a close, he was having diarrhoea almost every day and he had problems keeping his formula down. To make matters worse, he was not able to tolerate foods that were thick, or lumpy. He was not recovering from his malnutrition, but I was not ready to give up the fight.

We treated him for parasites. We gave him antibiotics to treat bacterial and protozoal infections, and drugs to help reduce the vomiting. Despite all of this, we saw limited improvement in his overall condition.

That changed when we started him on a hypoallergenic formula. It appeared that my little man was sensitive not only to lactose but also to the proteins in milk-based and soy-based formulas.

By December, the nannies and nurses noticed he was 'beginning to change.' The diarrhoea had settled and he was no longer vomiting. He was gaining half a pound every week. His hair was growing in and his skin was taking on a warm glow. He began to pull him self long on his belly, and a few weeks later, he was too active to join me for our weekly bible study.

I love this little man's shy smile. I love his peals of laughter, and the light in his eyes. I love that I have to tell him it is not OK to reach over and steal the bottle from the baby in the next crib. In short, I love this boy. If it were possible for me to take him home with me, I would, but since it is not, I have faith that God has something better in store for him.

I am watching over his health carefully and deliver doses of TLC everyday, along with the medications and supplements he receives. Mine is not the only heart this boy holds. He has a volunteer on the balcony who thinks he is wonderful, and an experienced nanny who is working on transitioning him onto the regular nursery menu. She does a wonderful job of getting fluids and nutrition into him on the days he is not feeling well. Although this little mans health remains fragile, I believe that we have broken the cycle of malnutrition and ill-health and that is quite a victory!

He has a fever tonight and is vomiting, but he weighs 18lb now and I believe that he will be feeling better in a few days. Please join me in thanks-giving that we have access to the medicines and the formula he has needed. May God continue to provide all we need for our children. May he bless this little man with a healing. May he continue to grow and thrive, and may love forever dominate his life.

Delivered

We don't know how old this little man is. We don't know which part of Haiti he come from. We don't even know his name.

Late on Monday morning, there was a commotion in front of our house. Our Gate Keeper, Abraham, came into the office in an agitated state. Abraham explained that he had just had been confronted by a group of neighbours. A baby was laying outside our gate, alone. The baby looked ill. The neighbours were all talking at once and their voices were raised. They were gesticulating and they were emphatic that he, Abraham was to do something.

The baby was laying on a towel that had been spread out on the ground. No-one had picked the baby up. To pick him up would have been to claim responsibility for him. The neighbours did want the responsibility of an abandoned baby. Poor Abraham didn't know what to do; he had never known anything like this to happen before.

Inside the baby house, it quickly became apparent that this tiny boy's mother had spoken with a staff member a short time ago. She had been told that we could not admit him because Mum didn't have his birth certificate of her own ID papers. She was told that she would have to return home to get document.

If she had come a day later, the Haitian administrator, seeing that this child was extremely malnourished, would have admitted the boy right away, sent the boy's Mother to get the necessary papers, and given her money for the return journey. But Miss Magalie was not on-site on Monday, and so one of the newer staff members was dealing with the admissions.

The baby was silent and wide-eyed when GLA's social worker bent down and lifted him off the ground. An hour or so later, the head nurse asked me to check him over.

I estimated that he was over a year old. With spindly arms and legs, a bony head and wasted buttocks, it was clear that he was suffering from severe malnutrition. The baby was weak but he watched me with big, shining eyes.

Some of the nannies think his Mama was cruel to leave him. I am with the other (larger camp), who believes that this was not so much an abandonment as a deliverance. The Momma didn't have money to feed her baby. She certainly couldn't afford a second trip here. She knew that to return home with him would be certain death for her son. She loved him deeply, and she acted with the same faith and desperation as another mother, several thousand years ago, who laid her baby in reed basket and sent him adrift on the River Nile.

So far, this little man's recovery has been unremarkable. He has a voracious appetite and after just 7 days with us, he is all ready filling out. We are seeing a little more flesh on his bones, and even the hint of a double chin. Much to our delight, a precious personality is emerging. This boy likes to be held and he likes to snuggle. For my part, there is no describing the feeling I get when he reaches up, or when he lies with his head on my shoulder, and sings.

A Double Blessing

A few days before the New Year, we received a double blessing in the form of a set of twin boys.

The little man on the left weighed 13lb when he was admitted and his brother weighed 16lb and was walking. Both boys are very thin. The smallest twin, though, is several centimeters shorter than his brother, which may be a sign that he has been malnourished for longer period of time.

In Haiti, where daily life is often a struggle to survive, many families are unable to cope with the burden of not just one, but two extra mouths to feed when twins are born. Consciously or otherwise, mothers tend to favour one baby over the other. The favourite twin is given a bigger share of the family's food supply. The other twin is neglected. This is a harsh reality, and it is not my place to judge, but it hurts me. Deeply. And it stirs up a fierce emotion I can't name.

We can 't know at this point, whether favouritism made one of our boys three pounds heavier than his brother. If after a few months, the the size-gap narrows, a great many heads will nod.

In the week since they arrived, both boys have gained a pound. This is remarkable given that they were refusing food when they first got here. The boys are receiving high calorie supplements, and Medika Mamba, which is a blend of ground peanuts, powdered milk, sugar, oil, vitamins and minerals. Their progress is a testament to all we are are able to do for them here, and to the loving care they have received from Jocelyn, a wonderful nanny who works in the big nursery at the baby house.

I am grateful that these boys were not born into a family that is living heart-deep in voodoo. If they had been, one of the boys would certainly have died; voodooists belief that the birth of twins brings a curse upon the family that can be broken by the sacrifice of one twin's life.

No, we rejoice that both boys have lived, and that they have arrived at a place where people of faith will treat them equally, believing that that each boy is equal in the sight of God.