Bon soir zamis! Today rounds were cancelled as there have been 2 neonatal deaths this week from meningitis and the unit has been racking their brain as to what the common factors were. One of the babies was born with some signs of compromise and went straight to NICU. The other baby was vigorous and thought to be in good health until he began seizing the day of discharge. I don’t know if there is a common etiology between these two babies or not– I mean they were low risk and both born to primips (women who are giving their first baby) with no known medical problems. In any case, one thing we do in the US is GBS prolphylaxis. All pregnant women get tested at 34-36 weeks for GBS (a common bacteria that if colonizing the genital tract could cause neonatal infection) and if positive they are treated with penicillin (or an equivalent) in labor. This is impossible here. Many of these women never have a single prenatal visit and present for delivery and are “presumed to be term”. I can’t even count how many times I’ve come across that reading through my dossiers. Michoutas and I were discussing our frustrations of the recent occurrences and throwing some ideas around. One thing she said was being considered was a clinic at St. Damien for pregnant women in the 3rd trimester so they can regularly screened for hypertensive disorders which are so prevalent here and GBS. Also, screening for domestic violence is crucial here. The overwhelming majority of the 150 charts I have gone through thus far have screen positive for IPV, which we know can escalate during pregnancy. The problem is that many of these women do not want to seek care. There is a lot of myths and passed down legends on pregnancy and childbirth that are impossible to debunk. These women would prefer to deliver at home with the old woman who lives down the street and delivered all the other children on the block. I don’t know if any of the above would have changed the outcomes but I think they are good ideas.
I’ve heard many myths from the maternity team regarding deliveries and postpartum. For one, elders in the family beat new mothers with palm fronds after delivery to help with milk let down. OUCH! (I know some of my aunts were subjected to the same beat down after their deliveries). Also, there is the belief that they need to stay insulated and cannot cool off postpartum to preserve their pelvic organs. Moms cover themselves from head to toes with blankets and sit on a warm bucket. The warmer the better. Mind you it is 95 degrees out and humid as heck. I swear I can see the equator from my bedroom window. Also no sex for 3 months. I’m cool with that since none of the women here leave with contraception. They receive counseling but they have to wait until outpatient. I wonder how many of these women follow up? The cultural differences are incredible.
Remember Dina (other favorite 11 year old)? Her father has become very ill. He cannot walk and is having fevers and headaches. I’m concerned he may also have meningitis but there is a serious issue with access to healthcare here. Even if there is a nearby hospital, the cost is horrendous and you will wish you died when all is said and done if you don’t have the means to afford it. So he has been laying sick for 3 days now. I even offered my services (trying to expand my scope of practice to men, ya know?) but he needs antibiotics and an LP which I cannot do. It is very hard, Dina has been crying and I wish there was some way to help. Unfortunately the healthcare system in Haiti is severely underdeveloped, there is no insurance, rules, or regulations to protect the patient. So incredibly frustrating.
Side note, I am feeling much better from my illness yesterday. I got home from work with honey tea waiting for me and concerned friends and family. Still not 100% but definitely functional!