A Touch Of Christmas' Magic'

There are things about Sperancia, who just turned two, that worry those of us who work with her. Sperancia is afraid of many things, and she often shows signs of extreme anxiety. There are two working theories about Sperancia. One medical professional who assessed her thinks that she might be on the autistic spectrum. The other suspects that she has been abused.

When I took Sperancia up to the third floor balcony yesterday, to open Christmas gifts with the other baby house children, I did so with reservations. Sure enough, seeing the large group of babies up there, she sensed that something out of the ordinary was happening and she began to howl.

I lifted her up onto a wicker sofa, wiped her tears, and, pressing my hands either side of her face, re-assured her that everything was all right. Staying close-by, I invited her just to watch, as the other little ones tore through the brightly coloured tissue paper, to reveal teddy bears, dolls, and soft balls. With her thumb in her mouth, Sperancia observed them intently.

One boy cheered as he unwrapped a fabric book. Another, Elverson, backed away from the teddy bear that he had unwrapped, doubt and trepidation dancing across his face. What was that thing? Would it move? He didn't want to be close to it if it did!

The owner of the fabric book swapped gifts with Elverson. There was no prompting. The older boy was not afraid of teddy bears, but he recognised and responded to the fear of the younger boy with an empathy and grace that touched me.

Sperencia watched the other babies unwrap their gifts. Peterson was so awed by what he was seeing and experiencing, that his mouth gaped open. He has never seen so many toys just appear like this! Other children, like Wislande, seemed to be more interested in the wrapping paper than the toys. There was laughter as Wislande impishly feigned alarm, threw her toys away, and erupted into a fit of giggles when the toys were fired back towards her.

Sperencia was perfectly calm when I extended my arms and asked if she wanted to come down from the sofa to join us on the tiled floor. Sperencia reached back. She was ready.

With help, she tore off the tissue paper, and underneath, she found a panda. I was unsure how she would react. We do not keep soft toys in the nursery. An unfamiliar furry bear might precipitate a melt-down from her. She looked from me to the Panda. Realising the opportunity 'oohhed' and 'aahhed'. Sperencia, taking the que, brought the bear to her chest in an embrace, and patted it. 

I was sure that the next gift she unwrapped would break the spell. It was a red-haired barbie doll. Sperencia is deathly afraid of Dixie Bickel's two year old, red-headed Grand-daughter...... To my surprise, Sperencia stroked the dolls hair, and explored it's moving limbs. Then, picking up the barbie, she broke out into a wide grin, and toddled away from me, doll in hand.

I can't know exactly what it was that soothed Sperancia's heart yesterday. I get the feeling it wasn't so much about the gifts, as it was about the mysterious, miraculous spirit of God, a heavenly Father who knows her and a saviour sent to heal all kinds of brokenness.

The Best Teachers

I have some of the most wonderful and special children at the main house. Yes, I am biased, but I am also right:

Take Merudjy, for example. She is two. She has a nickname, 'Piman', which means 'pepper' in Kreyol, as in chili pepper. They say little girls are sugar and spice. Well, Piman has a bit more spice in her than most little girls!

One night, several weeks ago, we held a joint birthday party, for Merudjy and for Michno. The older babies were enjoying cake and sprite dowstairs, in the dining room. There were balloons and there was singing, and the party was flowing well, fun and festive, until, for no apparent reason, Merudgy reached over and slapped one of her little guests!

My heart sank. It was her party, but I couldn't let this go. Merudjy was removed from the table, and reprimanded. I made it brief, but I told her she had to say sorry. Back at the party table, Loveson was told that Merudjy would like to give him a hug, to make up for the slap. Merudjy drew close, raised her hand, and, smack!

Time Out!

Two minutes later, the scene was repeated. Loveson was indignant.

Time out, and take three:

Not to be twarted, I restrained Merudjy's hands this time. Seeing the opportunity, Loveson reached across, and made a grab at Merudjy's cake. Merudjy squirmed let out a hoarse cry in protest. 'No, Loveson, don't provoke her,' and there was stiffled laughter from the adult guests.

'Say sorry Merudjy.' Her eyes, though were stony, her lips were tight.

'You are a nice girl. You need to be nice.' Merudjy barely shook her head. Her eyes were piercing. She was not sorry.

Honestly, I wasn't quite sure what to do next. As I considered my next move, out of the corner of my eye, I saw Loveson take a spoonful of cake, and extend it towards Merudjy. A reward for bad behaviour? I am a principled person, yet something told me not to interfere this time. I closed my mouth, and watched the scene unfold. There was absolute silence around the table, as all of the guests watched expectantly.

Merudjy's expression softened. She looked at Loveson, whose eyes were smiling across at her. Merudjy opened her mouth, and allowed her friend to spoon feed her the cake: forgiven without apology.

'Merudjy,' I whispered, 'give him a hug now, darling.' And she did. Grace had broken through her obstinacy, in a way that reprimand, reason and time out had not. Loveson had extended grace, Merudjy, for her part, had accepted it. I had intended to teach these little ones about repentance and reconciliation. Instead, I was the one who had learned the lesson.

Loveson went home to France in October, and later this week, Merudjy and 5 other little ones from the main house, will also leave, in time to spend Christmas with their adoptive families in France.

I will miss them so much. Each and every one, leaves an impression on me, as real as a thumb-print and as utterly unique.

A Shot In The Darkness

"In the Lord I take refuge; how can you say to my soul, ‘flee as a bird to your mountain; for, behold, the wicked bend the bow, they make ready their arrow upon the string, to shoot in darkness at the upright in heart." (Psalm 11: 1-2)

In the midst of the political unrest that plagued Haiti this week, we were visited by two tiny sojourners. Jacob was the first to arrive on Monday, born three months prematurely and weighing 1lb 9oz. He had several birth defects, including a severe cleft lip, and deformations affecting his nose, eyes, ears and hands. I was touched by the love of his family, who, travelled from Petionville to Port-au-Prince, before doubling back and making their way up the mountain, to us, after being turned away by hospitals in both cities. How could we give Jacob anything but the best care we could offer?

Jacob was not breathing when he arrived, and his heart was barely beating. After a successful resuscitation, Dixie and I made several adaptions, that made it possible to run our nasal CPAP equipment with a facial mask. Little Jacob had no nasal passages, so nasal CPAP was not an option for him. He passed away in the early hours of Tuesday morning.

Stephie arrived late on Friday afternoon. She had been born six days earlier, around 4 weeks before her due date. Her twin brother died in-utero. Stephie's s family are heart-deep in voodoo, so instead of taking her to a hospital, they took her to a voodoo priest. The priest tied a fetish around the baby's arm, and sent her home. By the time Stephie made it down the mountain to GLA, she was only just clinging on to life. Her Aunt explained that they had given her only

water to drink.

This 2lb 13 oz infant was dying from malnutrition: so cold that we could not get a core temperature to register, she was swollen from electrolyte imbalances and a protein deficiency. Stephie had a metabolic acidosis from burning fat for energy. Being so tiny, she had used up her sparse reserves, and her blood sugar was dangerously low.

Stephie was warmed and given a bolus of dextrose. She deteriorated to the point that she needed compressed air to prevent apnoeas, then oxygen, and finally CPAP. We knew from the outset that Stephie was fragile. We gave her small volumes of milk and IV fluids, as part of a plan to slowly correct her electrolyte imbalances - rapid correction would have caused brain swelling.

Sophie's protein deficiency caused her blood clotting mechanisms to break down. She developed what we think was a stress ulcer - probably the result of cold stress - and although Dixie and I tried everything we could think of to stop the bleeding, and although we pleaded with God for her life, Stephie bled out, and died at mid-night.

I am tired of burying babies. I have buried five in the past month. Discouraging thoughts are the arrows shot in the dark. Today, they miss their target.

I am mindful that each tiny fragile infant, however short their time with us, teaches us something - a novel or unconventional way of treating problems with the medicines and equipment that we have. A reason to reflect....... What did we do well? What could we do differently next time? Is there anything we don't have, that we could get, that might help a baby in a similar situation?

As of the early hours of this morning, we are now on a mission to research the options and obtain a plasma volume expander, that we could use as a blood substitute in future emergencies. We are too remote for blood transfusion to be feasible in these situations but there are life-saving alternatives that we could store here at GLA.

So I persevere in the work that God has called me to, with a new hope in the battle against discouragement. We are fighting a good fight. I desperately want the next Stephie to live.

A Prayer On My Lips

This week, with relief and joy, we witnessed Sonia, Maudlin and Bobo make full recoveries.

Geraldine gained 3 lb in 10 days. We had hoped that the staff at her orphanage would allow us to keep her until January, so that we could ensure that she made a complete recovery from her malnutrition. It was humbling to hear their decission: they preferred to take her home. Geraldine has returned to an instituation that doen't even have the basics. Their water supply is comtaminated and they lack sufficient supplies of food and baby formula. They have no medecines and there is 1 staff member for every 14 children.

At GLA, we have no right or authority under Haitian law to challenge the decision to discharge Geraldine against our advice. We taught Geraldine's care-giver how to make a high calorie milk formula for her, and we provided some vitamins to keep her healthy. We urged the orphanage to bring her back if she becomes sick again, or loses weight. We offered to provide emergency medical care to their other children. We hope that they will come to us for assistance in the future. I also spoke with a US-based missionary organisation about the possibility of installing a water filtration system at Geraldine's orphanage - this would cut their mortality rate significantly.

I know that that we are incredibly fortunate at GLA. I think back to the care that Geraldine received in her time with us. I can honestly say that it parallelled the care she would have received in a hospital in Europe or North America. Never before have I sent a child out of our gates to such a bleak future; the reality for most Haitian orphans is miserable poverty, hunger, malnutrition, sickness and abuse. I know that in all likelihood, this reality has and will be Geraldine's.

Knowing this, I waved Geraldine off with a smile on my face, pain in my heart, doubt in my mind, a prayer on my lips.

A Sobering Thought

We have an outbreak of Vomiting and Diarrhoea at GLA's main house - the first since our new water treatment system was installed. Symptoms are developing over a course of 2-3 days. The diarrhoea is severe and oral rehydration alone has only been sufficient treatment for a few cases. Today, I have several children on antibiotics (including 4 newborn infants) and two on IV fluids.

Sonia was so dehydrated that I was afraid I wouldn't be able to get a working IV line into her. Thankfully, IV fluids and antibiotics helped her recover rapidly. This baby had had a difficult two weeks. She had a respiratory infection and was on oxygen for 10 days. She came off of the oxygen on Thursday and went up on an IV the same day. She had her echocardiogram last week and we are waiting for the results, and hoping that they will reveal something that we can do to relieve Sonia's symptoms. Her breathing has been laboured ever since she came to GLA and she gets very tired when she sucks on her bottle. We suspect that these difficulties are related to a heart condition.

I was worried when Maudlin developed diarrhoea and vomiting. His mother received no antenatal care, and as a result, the pregnancy continued, unmonitored and he was born showing signs of significant, intra-uterine compromise. He weighs less than 4lb. He was unable to tolerate his milk feeds and he was jaundiced. In the developed world, we take few chances with sick newborns, and in countries like Haiti, where low birth weight babies, like Maudlin, are born very weak, and with immune systems compromised by malnutrition from the time they are in their Mothers' womb, we take even fewer chances. Maudlin was always going to be susceptible to infection during the neonatal period. I was concerned that this infection had the potential to overwhelm him.

Maudlin was started on IV antibiotics right away. Over the weekend, he has been able to tolerate continuous feeds of a milk formula that has been specifically developed for infants with gastroenteritis. This formula is easier to digest and has higher levels of specific nutrients that have been proven to shorten the course of diarrhoeal illnesses. Maudlin's milk feeds are being delivered through our new feeding pump. If we didn't have it, Maudlin would have needed an IV, and without the nutrition from his milk, he would have taken much longer to recover.

I received an anonymous message from someone who would like to try to obtain another feeding pump for GLA. You can click here to see the make and model of the pump that we currently have. I would certainly appreciate another pump - it is always useful to have back-up equipment in a country like Haiti, where there are no technicians on hand to fix faulty medical equipment.

Meanwhile, tiny Bobo is struggling with a bad cold. He is unable to drink from a bottle and is on oxygen and receiving tube feeds. I really hope that he doesn't catch gastroenteritis on top of this.

I was talking to Dixie Bickel, who is currently in the states, a few nights ago. I was worried. A few days before, we had received news that the Baptist Mission Hospital had received its first confirmed cholera case. The hospital is just 5 miles away. As I struggled to keep up with the sick kids I had, it was painfully obvious to me that if we received a single case of cholera, we would not be able to contain the spread of the disease. Lack of space would make that impossible. Dixie shared my anxieties. We are in the process of implementing a very strict cholera prevention protocol and we are trying to obtain a several dozen doses of DUKORAL, an oral vaccine against the strain of cholera bacteria that is causing the current outbreak in Haiti.

Pray with me that by God's grace, these measures will protect our staff and children from this life-threatening illness. These past 10 months have been filled with incredible trauma and grief for all of us at GLA. Through it all, God never left us. He has protected us. He has faithfully provided. He has blessed us beyond anything we could even think to ask of him. We take none of that for granted. We know we can't afford to.

Uncomplicated

Our new baby boy is an uncomplicated little man. Or at least, despite a high risk pregnancy, and an unassisted labour and delivery, his nursing care needs are relatively uncomplicated.

Born full-term, but very small, weighing just 3lb 14 oz, (5lb 8 ounces is the minimum birth weight that is considered normal in a baby born after 37 weeks), he arrived a matter of hours after his birth. He is the son of a severely disabled teenager, who lives at a large and poorly resourced orphanage, that is located less than a mile from God's Littlest Angel's main house.  His blood sugar was low and he was hypothermic. Like many low birth-weight babies, Maudlin did not have enough body fat to generate heat. I knew it was likely that he was using all of his energy in an attempt to create metabolic heat, and that he hadn't received enough milk to maintain normal blood sugar levels. There are other reasons though, that a high-risk newborn might have low blood sugars, and a low body temperature. I worried that he might have an infection. I worried that his blood supply might have been compromised during the birth process. If that had happened, he might certainly have low blood sugars and hypothermia, but seizures and organ failure were also a possibility. 

A few hours after he was admitted, Maudlin was in an incubator, and had taken a small milk feed. His temperature and blood sugar were both within the normal ranges. I had fully assessed him and the results of my nursing assessment were encouraging. 

As we warm hypothermic babies, we monitor them for breathing problems, for heart rhythm irregularities, and for blood pressure and blood sugar instability. Maudlin was stable and appeared healthy. His lungs were clear and his heart beat was strong. His muscle tone was normal, his abdomen was soft and there were no signs of infection or congenital abnormalities. I counted 10 fingers and 10 toes. He was sleepy, and he had a weak suck, but he was drinking.

So Maudlin wouldn't need CPAP, or an IV, or antibiotics or even a feeding tube. You are very red, I thought, I hope you don't have polycythemia - a condition in which a high concentration of red blood cells can make newborns blood viscous. Occasionally, this can cause breathing problems and seizures. More commonly, it causes newborn jaundice. The bedside test I ran suggested that Maudlin did have a high concentration of red cells, but not high enough to cause symptoms. Maudlin was unlikely to need any special treatment, we would just have to keep him warm, monitor him and make sure that he stayed well hydrated, so that his blood did not become too thick.

Two days after he arrived, Maudlin still has to be wakened for feeds every three hours, but he is drinking well from a bottle. Recently, we have admitted three infants with chromosomal abnormalities and we have cared for some extremely sick children. This has made me hyper vigilant. I can't help looking for problems. I am glad that in Maudlin's case I didn't find any serious or complex issues.

Sorrow, and a Beautiful Experience

Erick died late on Thursday morning. His blood sugar dropped and there was a faint smell of decay emanating from him. Although I knew that he probably would not survive, I had hoped that he would. He was hungry, and eager to eat and he was very alert, right up to the moment that he stopped breathing. I am haunted by the memory of his startled eyes, fixed on me, and that look of alarm giving way to absolute trust and wonder, as I help him close, and spoon fed him. I am very glad to have been given the chance to hug Erick and rock him in those last hours and minutes. The suddenness of his death, though, has left me stunned and despairing.

Woodley and Geraldine, who came to us last week from a local orphanage, no longer have diarrhoea, but they continue to vomit. Geraldine became hypothermic on Thursday morning and wasn't able to tolerate even an ounce of milk, every hour. On Wednesday night, I gave medications to help with the vomiting, and the worker from Geraldine's orphanage, who has been staying with her, syringe fed Geraldine 20 ml of oral rehydration solution or formula every hour. By the morning, Geraldine was dehydreated and her caregiver was exhausted. Geraldine needed glucose, fat and protein to bring her body temperature up, as well as fluids. An IV was not going to be enough.

Previously, the only option that would have been open to us would have been to put Geraldine on a warming bed, start an IV and give her very small volumes of milk. Last week, though, I received a feeding pump from the latest shipment of relief supplies. This made it possible for us to rehydrate Geraldine rapidly, by giving oral rehydration solution through a feeding tube, at a consistent rate, controlled by the pump. Most children tolerate this method of rehydration, even if they vomit the fluids that they drink.

Once Geraldine was rehydrated, I was able to begin feeding her. I set the pump to deliver formula at a slow rate, round the clock. She quickly stabilized and was able to rest for the day, while receiving all of the liquids and the nutrients she needed to recover. Geraldine has gained a pound since Thursday

'Miss Susan, will you please give me something......a gift.' her nanny asked.'
'What kind of gift?' I asked, feeling slightly suspicious.

' A photograph, Miss Susan?' the nanny asked softly. A photograph of Geraldine, and that machine that is giving her milk.' The nanny shook her head and smiled. 'I have never seen anything like that before, and the nun who is in charge of our orphanage doesn't believe me when I tell her what is being done for Geraldine.'

I nodded, and we both smiled.

'Will you please give me a photograph, so that the nun can see for herself? This is a great thing! It is a beautiful experience!'

Sometimes, I look at children like Erick, Frandline, and Geraldine, and I experience a pang of guilt. I feel guilty that my babies and I are so blessed, while they are not. We can turn on a tap, and clean, pure water flows out: their families struggle to haul filthy water from contaminated rivers and streams. I can chose almost any type of formula for my babies and they can drink as much as they want, and often as they want: theirs will go to bed hungry tonight, hoping for something to eat tomorrow. When my babies are ill, I have medications, IV supplies and oxygen right here: there is no Doctor in their village and there are no medicines. A hurricane whips through Haiti. We are untouched, while they drown in flood waters, and die in houses, crushed by landslides.

As Geraldine's nanny spoke, though, my guilt faded away.The love of God was poured into my heart. I understood, deep in my soul, that while poverty and misery broke the heart of our Lord, he wanted to bless his children with good things, and I was to rejoice in our blessings.

As I send up prayers of thanksgiving, to a God who has provided all of our needs, my heart aches for the children who are hungry and cold, those who are without shelter, for the sick and the dying, and for bereft mothers, grieving the loss of precious children they could not sustain.

We are under the shadow of his wing, but my little ones are no more precious in God's sight than the other children of Haiti. I am keenly aware that we are blessed, and I am glad for all that we have to share with children like Geraldine. I am glad that we are able to give them a beautiful experience.