Haiti can be a difficult world, both for visitors and for its citizens, especially woman. The unique smell of the country hits you as you deplane; an odor of slightly rotten fruit mixed with burning garbage and body odor. By the next day the odor has faded into the background and you don’t recognize it again until you visit once more. Your feet hurt at the end of a long day on concrete floors in the hospital and your sleep is interrupted by the incessant crowing of roosters, no matter the time of day.
Women in this country live with all this and so much more. As I was told by a Haitian doctor today, “When the choice is between the life of the mother or the baby, we choose the mother because she is needed to keep the rest of the family together”. Woman are expected to get married and have children but pregnancy comes with unique problems.
Although freely available, birth control has many misperceptions and is not frequently used outside of marriage. Thus, women become pregnant and try to terminate unwanted pregnancies with the use of misoprostol that can be bought from street vendors. They are often only partially successful due to inadequate dosing or unknown gestational age of the pregnancy. A young woman I met yesterday was one of the unlucky ones – her membranes ruptured and she started bleeding but has not yet miscarried her 4 month fetus that still has a heartbeat. Because abortion is illegal in this country, no intervention can be considered unless she has a life threatening infection or the baby dies.
Severe pre-eclampsia is very common in this part of the world, due to genetics and underlying hypertension that is not well controlled. We rounded on three patients today who are all around 7.5 months pregnant with very high blood pressure. Babies have a good chance of survival here after 33-34 weeks. Delivering these babies now will save the mom but almost certainly result in the infant dying. Each day we have to reconsider the risk of continuing the pregnancy, especially if the woman has other children at home to care for.
Women who live in the mountains many hours walk from any health care center often labor at home with the assistance of their female relatives or a lay midwife (Matrones). When labor doesn’t go as expected, they are carried for hours to the hospital. In November, a slight 18-year-old arrived after 2 days of labor and no progress. Her baby was dead and a cesarean was needed to deliver the infant. A week later she returned with a serious infection that required removal of her uterus to save her life. Now she has a fistula(opening) between her bladder and vagina where she is constantly leaking urine, even with a catheter in place. The surgery to repair this is very difficult and often not successful. She can no longer have children and will probably carry a urine bag for the rest of her life.
As I have written about before, cervical cancer is very prevalent in Haiti due to a lack of screening or knowledge about the disease. We have already had to inform 2 women, ages 31 and 41, that their constant vaginal bleeding is due to large cervical tumors that are too advanced to remove. One woman has a hemoglobin of only 4 (normal is 12-14). Both will leave young children orphaned.
I am only a visitor in this country that I have grown to love for its tenacity. The physicians, nurses and midwives that are here full time caring for these women are my heros. I can learn as much from them as they may learn from me.