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.

An Update From The Issolation Room

'She needs someone to Mommy her,' Dixie said, first thing this morning 'She needs someone to hold her a lot.' She was talking about Geraldine, a baby that arrived at GLA last week, in a critical condition.

Geraldine is severely malnourished and weighs 9 lb, no more than some European and North American newborns. Geraldine, though is not a newborn. We were initially told that she was 9 months old, but when her birth Mother visited yesterday, we learned that she is actually 12 months old. Her dry, loose, yellow-tinged skin and bony frame tell a story of extreme starvation.

The IV is out and she no longer has diarrhoea, but Geraldine has been refusing to eat. The nanny who is with her says that she doesn't eat at home either. A combination of micro-nutrient deficiencies and chemical imbalances brought on by neglect and starvation can cause loss of appetite in malnourished children. There is a deep longing in the baby's eyes, stronger even than her apathy.

At Geraldine's orphanage, with just one care-giver for every 14 children, physical affection and coaxing are luxury commodities. Today, though. I indulged this sad little girl's desperate longing. This is a baby who will not recover without a lot of love and patience. I gave her medical peanut butter and Pediasure every three hours. Each feeding took around 40 minutes. I held Geraldine close and allowed her to suck the peanut butter paste from my little finger and sip at her pediasure. This is the only way I can get her to eat. At the end of feeding time, I held her up on my shoulder. She nestled her head against my neck, clinging to my scrub top. I hope and pray that we can get Geraldine past food refusal, before she returns home.

Next to Geraldine, baby Woodley has completely recovered from his illness. He drank 22 ounces of formula and had two bowls of corn meal porridge today, over a 9 hour period. He is sitting up in his crib, playing with toys and babbling in a sing-song voice.

At the back of the isolation room, 3 month old Erik is asleep in his bassinet. This emaciated, 5lb baby came to us from Cazale. The staff at the malnutrition centre there are inundated with cholera patients and asked GLA to admit this infant so that he can get the care he needs, in an area that is not currently impacted by the cholera epidemic. It is rare for babies to contract cholera, but as a precautionary measure, Erik is being kept apart from the orphanage children, for now.

Erik is in a very poor condition. he has some facial swelling and he is bleeding under his skin and from his intestine. His limbs are stiff and he is unable to suck. I fed him with a medicine dropper this afternoon and had to stimulate him to swallow. It is possible that Erik's malnutrition has caused some brain damage.

He is on a hypoalergenic formula, that is easier to digest than typical infant formulas. I hope that it will improve nutrient absorption and reduce the strain on his liver and kidneys. Sometimes, severley malnourished children die from organ failure when they begin to recieve nourishement - their damaged organs cannot process nutrients. I am also giving Erik an electrolyte supplement to help with the swelling, together with vitamins and minerals to improve his blood clotting and boost his immune system.

Erick and Geraldine both come from from extremely impoverished backgrounds, to which, they will have to return. If they survive and recover, it is highly likely that they will become sick and malnourished again once they leave GLA. This is the time for prayer. It is the time to hold tight to faith and to resist discouraging thoughts.

'Now hope does not disappoint, because the love of God has been poured out in our hearts by the Holy Spirit who was given to us.' (Romans 5:5)

Bobo

He is affectionately known as 'Bobo.' When he was admitted two weeks ago, he was 2 months old and severely malnourished, weighing just over 4 lb.

He has several birth defects: there are depigmented rings around the iris of both of his eyes. The bridge of his nose is flat and he has a tongue tie. His fingers overlap, his feet are clubbed and he had a urological abnormality.

We wonder if Bobo has a chromosomal disorder. We suspect that some of his internal organs might be affected. He has a high pitched cry and he can be very difficult to console, which, may be a sign of neurological problems.

'He is going to be one of your babies,' the nannies and nurses declared.'

'I'll take him.'

The fragile babies are always gifted to me by the staff here. It is difficult for them to bond with children that may not survive.

'We have seen worse,' Nurse Claudia commented, to no-one in particular when she set eyes on Bobo. She is right - we have seen sicker, more malnourished babies than Bobo and we have nursed babies with far more severe deformities.

I believe that despite their reservations about him, Bobo is winning some of his nannies over. This afternoon, as nanny Ginette cooed and clucked over him, Bobo rewarded her with a smile. It was his very first!

We had assumed that Bobo's very obvious eye defects would impair his vision, but he is giving eye contact, watching our expressions intently, following our movements, and best of all, he is smiling at us!

We are surprised and delighted and we have decided to be hopeful about this baby.

I Grieve For The Living

On Monday morning, my Haitian colleagues expressed the belief that I was in shock. They said that I had invested too much into caring for Sophie, to be coping as well as I seemed to be in the days following her death. I told the ladies I was ok, because I knew we had done everything that we could for Sophie, and I told them that I was rejoicing for her, because I was absolutely convinced that she had gone to a place where there was no more pain, and no more suffering.

Today, I am in shock, but I greve for the living and not the dead. On Thursday evening, 3 critically ill babies were admitted to GLA from an Orphanage in a nearby town, located high in the mountains. The missionary who brought them told us that an outbreak of gastroenteritis at that orphanage, had all ready claimed the lives of two infants, earlier that day.

Frandline was the last to arrive, deathly pale, gasping for breath, and so cold that her temperature would not register on a thermometer. The medical team who has been with her had been unable to get an IV line in. Frandline had a large, distended abdomen and she was comatose. While Dixie worked for almost two hours to try to find a vein, I started Frandline on oxygen, and pushed large volumes of fluid through a needle that a Dr had placed into her thigh bone. After boluses of saline and dextrose to bring her blood pressure and blood sugar up, we were relieved to see Frandline regain consciousness.

Was she out of the woods, one of the missionaries who brought her asked? I was sorry to have to tell the lady that Frandline's condition was still critical. Her pulse oxygen levels were low despite receiving large volumes of supplemental oxygen, her blood pressure had not stabilised, and she was vomiting altered blood and faeces. We had to place an NG tube down, and aspirate Frandline's stomach contents to prevent her from aspirating. We suspected that the baby had a perforated intestine, or an intestinal obstruction. She needed a surgeon but there was rioting in Port-au-Prince and in Petion-ville, so it was not safe to travel. We poured ice water down the NG tube. It was the only thing that might stop the bleeding. I was struggling to replace the fluid she was losing. The baby was profoundly anaemic and needed a blood transfusion. She couldn't have one tonight.....

Dixie eventually got a working IV line into Frandline's scalp. It was close to midnight when I left the nursery. Frandline's  body was still in shock. Her temperature was in the normal range and she was awake, but glassy eyed. Her oxygen levels were fair, and her breathing was only slightly laboured.

At 7:30 the next morning, Frandline stopped breathing, and her heart stopped beating. We were unable to resuscitate her.

In the next room, 9 month old Geraldine, who had also been admitted the previous night, was lying listlessly in her crib. The emaciated baby was lethargic and her body temperature was dropping. She needed to eat but was unable to tolerate even small volumes of oral medications. I was very concerned about this little one. Hypothermia is a very worrying sign in a severely malnourished child. Hypothermia can be a sign of severe infection. and organ failure. It can also cause organs to shut down. I dressed Geraldine in extra layers of clothing. I drew blood, and changed her IV fluids, based on the results of the tests I ran, using our portable blood gas analyser. I gave her IV antibiotics, medications for vomiting and vitamins. I put ointment in her eyes, which, were swollen and oozing puss.

I held a bony hand in mine. The baby was so cold. I looked over at Woodly, a 9 month old boy, from the same orphanage. His body was swollen from malnutrition, and his eyes were gummy. He had profuse, watery diarrhoea but his condition was not critical, so we were rehydrating him orally. He had a searching gaze. He whimpered and extended his arms towards me. I couldn't help thinking, that maybe Frandline was the lucky one. Hers was a horrible death, but it was over.

When these children are well enough, they will go back to an underfunded, and under-resourced orphanage, where the water is contaminated, where there isn't enough food to go around, where there are few medicines, and even oral rehydration solution is in short supply. Their suffering is not over.

It is the living I grieve for, not the dead.

Engraved On The Palms of My Hands

We suspect that Sophie had Trisomy 18, also know as Edward's syndrome. It is a 'lethal' chromosomal disorder, one that is 'incompatible with life'.

Certainly, most children with Edward's syndrome are miscarried, or still born. Only 5% survive labour and delivery and only 1% live beyond their first birthdays. Yet.......yet there is something unfair, and unjust and cold about the term 'incompatible with life' It infers that there was no hope in Sophie's life, and no point to it.

She was with me for two weeks, that was all, but in that time, through caring for her, I learned many things:

I learned to diagnose problems I couldn't see - subtle signs of poor gas exchange in her lungs, or a decrease in her cardiac output.

I learned to think outside of the box and to make use of what I had to treat particular problems Sophie was experiencing, like giving epinephrine to bring her blood pressure up and increase the volume of blood her heart was pumping with each beat, when I saw the signs that she needed this. I would never have thought to use epinephrine, except in a resuscitation, but it was a temporary fix that might buy us time, and stabilize another child in the future......

We didn't have an IV line, and so I researched alternative ways of giving particular medications that Sophie needed, with surprising results. This knowledge didn't save Sophie, but it made her more comfortable, and it might save another child..........

I came up with modifications to the CPAP that allowed me to do things that I would not have thought were possible. Although these modifications did not affect the final outcome in Sophie's case, I am fore-armed with a strategy that might save the life of a critically ill baby at some point in the future.

In Sophie's last hours, sick though she was, she was drawing in air with tremendous force, leaving deep depressions in between her ribs. Her blood oxygen levels were 'incompatible with life', yet her heart was beating at a steady rate of 150 times per minute, which is normal for a newborn baby. This was the instinct to survive, and it more than that. It was strength despite fragility, it was the will to to live, it was Sophie's remarkable spirit, fighting against the odds. What a privilege, to care for such a phenomenal little girl!

I am in no doubt that much of what I do here, from this day forward, will be influenced by Sophie. So you see, if her life was short, it was not without purpose, and she has left her mark, just as God intended.

'I will not forget you! See, I have engraved you on the palms of my hands.' (Isaiah 49:15-16)

Sophie Got Her Miracle

At 2:30 am this morning, Sophie Dora passed away.

Looking at her now, there can be absolutely no doubt in my mind that Sophie got her miracle. Her face has filled out, and she is radiant. As tangible as a rainbow after a storm, this is my sign, not just of God's promise but of the fulfillment of that promise.

Rest in peace baby girl x

Believing and Miracles

Sophie's Condition has continued to deteriorate. Last night, I spent 3 hours in the NICU with Dixie, trying to stabilize her. Sophie's oxygen levels were dangerously low and she was having severe breathing problems.

Had it not been for my nursing notes, the events of today would have been a complete blur to me. The details are not important: the bottom line is that Sophie is seriously ill. She is receiving 15 litres of oxygen through her CPAP, along with medications to keep her blood pressure up and to treat seizures. We suspect that Sophie has a life-threatening chromosomal disorder. Sending her down to her cardiology appointment tomorrow, with only 3 litres of oxygen would almost certainly prove to be fatal.

Medically, we are doing everything that we possibly can, but Sophie has suffered today, and seeing that, I have began to pray, 'Not my will, but thine, oh Lord.'

I believe that in the next 24 hours, Sophie will receive a healing, a wonderful miracle, that in all likelihood, will be performed in heaven.

This photograph was taken a few days ago by Susie Schulke, our updates co-ordinator. I cannot photograph Sophie today, at a time when she is so sick. I just can't.

Holding My Breath

A Knock at my door at 6:30am brought worrying news. By the time I reached the NICU to see why Sophie's oxygen saturation monitor was alarming, her oxygen levels had dipped to 45%. The oxygen had become disconnected from her CPAP. The colour had drained from her body, her mouth was open, her eyes were staring and she was gasping.

The night nurse documented in Sophie's chart that she had cried a lot during the night. She seemed to be in pain, the nurse thought. Her heart rate was high and her breathing was laboured. As of mid-day today, Sophie was still working hard to breath. Her heart rate continued to race. She had not cried. When I did a heel prick to check the levels of oxygen and carbon dioxide in her blood, she barely even grimaced.

As the days pass, Sophie's heart rate climbs, and her blood gasses deteriorate. As I continue to pray for a miracle, I prepare my heart for the ever more likely possibility, that Sophie will not survive. This morning's episode is a stark reminder of just how fragile this baby is. Please continue to pray.

Keep Praying!

Sonia's condition has continued to improve over the weekend. She is receiving a nebulized steroid, twice an day, and hasn't needed any drugs in her IV since Friday. I took the IV line out today and I expect that she will be off of the oxygen very soon.

She looks so peaceful when she is sleeping, as this shot of her (left) shows. She is a very sweet and contented baby.....until she gets hungry. She is perfectly capable of working herself into a frenzy if someone doesn't bring a bottle soon enough. I am learning to be alert for her hunger ques before she starts kicking and flailing, arching her back and turning purple in the face!

We have seen a very gradual improvement in Sophie's general condition since I switched her to 100% oxygen. She remains unstable - the oxygen levels in her blood are still below the normal ranges and the oxygen level reaching her tissues drops rapidly if her CPAP becomes disconnected. I increased the pressure on her CPAP slightly this afternoon, to see if that would improve the gas exchange in her lungs and reduce her work of breathing. It did not. Actually, it caused a deterioration. There is nothing else I can do medically for Sophie at this point. I am very concerned about this baby. She needs a lot of prayer.

Learning to Walk In The Dark

Sonia and Sophie have complex health problems, some we know about, others we cannot see. As I prayed this morning, I told the Lord that I felt as though I was walking in the dark.

Yes, and you are getting better at that. Am I not teaching you well? An interchange between God and Moses, drifted into my mind.

'So the LORD said to him, “Who has made man’s mouth? Or who makes the mute, the deaf, the seeing, or the blind? Have not I, the LORD? Now therefore, go, and I will be with your mouth and teach you what you shall say.”' (Exodus 4:11-12).

Just as he was Moses mouth then, he is my eyes today. This morning, Sophie's had a greyish tinge to her skin. The oxygen probe on her foot read 99%.

She needs more oxygen.

When her tissues are 99% saturated with oxygen?

The blood gas will be your proof. But first, turn up the oxygen.

Now, before anyone gets worried about me, please note that the conversation above is in italics, not speech marks. I am not hearing voices. I am conceiving thoughts in my head. I believe that those thoughts are God-breathed.

I increased the oxygen and drew a blood sample so that I could run a blood gas. This showed that Sophie's blood oxygen levels were low and that she was retaining carbon dioxide in her lungs. By the time I left the NICU, Sophie was pink again, she was stretching her limbs, batting her arms and crying in her incubator. It was feeding time!

Our i-STAT machine allows

us to monitor the blood

chemistry of critically ill

infants.

My eyes are not all-seeing; his voice leads me in the darkness.

I strongly suspect that Sophie's circulatory system is not functioning normally at all. I pray that if she also has underdeveloped lungs, that she does not have a lethal genetic syndrome. I still have hope that Sophie's problems can be treated, or that she might 'grow out' of them and be able to come off of her CPAP.

Doubt

Sophie barely woke up today. She slept for most of the day, and when she did wake, she seemed just barely to be with us. She looked exhausted. She hardly moved or cried. As I watched her lying so still, doubt crept in. For how long was she oxygen deprived before she got here. Is she brain damaged? Could that explain why she is so unstable? What on earth is wrong with this baby? Can I fix it? Who am to think for a second that I can?

I am getting tired. Doubt and dread cloud my heart, at times. I question, why? There are so many things I cannot see and do not know as I work with Sonia and Sophie.

This morning and again in the afternoon, I sat in the NICU and enjoyed some cuddle time with Sonia. She nestled close to me, and her pupils shone like beads of mercury as her eyes scanned my face. I felt her weight, and her warmth in my arms and I sighed. It was a moment, in which all was right. Sickness and disability did not figure. I was holding a baby. I don't want to make it into anything more than that. My feelings for her were warm and tender. In those moments, it was enough to hold her and love her. My mind was still, my heart quiet.

Handle with Care.

7am: Sonya is arching her back and kicking her legs. Her cry is hoarse and her eyes are bulging. Mme Bernard is with her. Across in the incubator, Sophie's CPAP isn't working.

'1/2 a ml of pulmicort with 2ml of saline,' I tell Mme Bernard, who begins preparing a nebulized steroid to help Sonia with her breathing. As I talk, I check for air leaks or poor connections on Sophie's CPAP circuit. I find the problem - the holes in her cannulaide (a dressing that improves the seal between the CPAP prongs and her nostrils) have become enlarged. There is too much air leak. There isn't time to replace the seal.

My eyes scan the NICU, and fall on a strip of paper stitches on the incubator shelf. I place a stitch across the bridge of Sophie's nose. Mme Bernard laughs as the vinegar solution in which the expiratory limb of the circuit is submerged begins bubbling. 'Degaje! 'we agree. Degaje means to make do. 'Haiti taught me a lot about degaje. I think I am getting good at it!' Mme Bernard can't argue. The paper stitch is a fast and temporary measure that will keep the CPAP running, while I prepare Sonia's IV medications.

Reviewing her chart, I notice that Sonia did not feed overnight, but that she was fairly settled. This morning, she looks much better. The nebulizer treatment is very effective. Her breathing slows and she relaxes. She is bright eyed and looking around. What a beautiful baby, I think to myself.

Sophie's breathing has become more laboured. Mme Bernard tells me that she has a slight fever.

My heart sinks. We have a viral infection in the NICU that is making the babies cough and wheeze. Sophie is so frail. I hope she hasn't caught a cold.

Later in the morning, as I am bathing her, Sophie begins to tremble. The colour drains from her face. Her brow is furrowed. She looks worried, and her eyes have glazed over. Clearly, Sophie cannot tolerate a lot of handling at this point.

Both girls need cardiac evaluations, but the closest pediatric cardiologist, based in Petionville, is out of the country and he is not due to return until the 5th of November. Sonia would probably tolerate a trip to a more distant office, but it would be a risk, and neither Dixie nor I want to take a risk with her. As for Sophie, it may be very harmful, even fatal for her to be off of CPAP for more than a few hours.

Until the 5th of November, Sophie and Sonia are going to need very close monitoring. We are going to have to recognise and treat their health problems promptly, and prevent complications. For Sophie, that means CPAP and no more tub baths. Sonia is getting oxygen and an inhaled steroid to prevent her breathing problems from worsening. Both of these girls will be handled with extreme care as we pray daily for their health and for their survival.

I Asked For Prayer......

I asked for prayer: I asked for insight into what Sophie and Sonia needed, This morning, that became perfectly clear - Sophie needed more oxygen, and Sonia needed more lasix. Both babies got what they needed and we saw marked improvements in them, over the course of the day.

At 7am, the power on the second floor went out. The circuit was overloaded. I have never experienced power failure due to overwhelming demand at that time of the day but to prevent further occurrences, I turned off the air compressor and increased the oxygen on Sophie's CPAP. Yesterday, Sophie was pale, floppy and listless. Her jaw was so slack that she could not keep her mouth closed. I had to fashion a home-made chin strap, to keep her mouth closed, so that the pressurized gasses driving the CPAP would not escape. I had serious misgivings about Sophie and the deterioration I was seeing in her.

A few hours after switching her to 100% oxygen this morning, I noticed that Sophie was pink, that her her muscle tone was normal and that she was awake, alert and sucking on her hands again. I turned the air compressor back on and reduced the oxygen, leaving it at a higher percentage than it has been running at before we lost power.

It is now 10:30 pm. I am just back from the NICU. The night nurse called me around 8:30 to review Sonia, a beautiful, chubby baby with a chromosomal disorder that has serious effects on her health. Her airway was closing up and she could barely get air down into her lungs. I gave her two nebuilizer treatments and IV steroids. Initially, she was not responding to treatment. She is on IV fluids again, so that she can rest overnight. Unfortunately, I had to site another IV, since they would not run thorough the line that I have been using for her drugs. She has settled to sleep now, which, I think, is just what I should do.

Multiplicity

A multiplicity of challenges: that is what baby Sonia is facing. She was assessed today by Dr Nathalie, a Haitian Pediatrician who visits the orphanage every Tuesday. We reviewed her treatment since arriving.

She has been treated for conjunctivitis, possible septicaemia, and pneumonia. She has a very distended abdomen, that could be a sign of digestive tract problems. Yesterday, she developed croup symptoms, and needed steroids and nebulizers to ease her barking cough and open up her swollen airway. She had been fractious and irritable, up until that point. She went on to have a settled day, and I was so glad!

The morning brought some further improvements. Sonia's breathing had improved to the point that she could be taken off of CPAP. It was wonderful to see her round baby face, without all of those tapes and tubes. The new day, also brought new challenges, though. Sonia's face and eyes were puffy, she had gained weight and there was fluid on her lungs again. We strongly suspect that She has a heart defect.

Really, Dr Nathalie, do you think there is a single organ system in her body that is working properly?' I sighed.

It is wrong, wrong, wrong, that babies are born sick. Sonia had a multiplicity of health challenges, that demand a high level of medical and nursing care. She needs constant observation, and I am sure that will continue to be the case over the following days, weeks and months.

I believe that that Sonia and Sophie are here so that, 'the works of God should be manifest,' in them (John 9:3). Thank you to all of you who are praying for me and for these babies. May I be a channel of his love and his healing to them. May I have eyes to see and anticipate their needs, and all the knowledge, wisdom and skill I need to minister to them, for his glory.

Amen

Rewind

Rewind to Friday Morning: Sophie Dora has very mild retractions under her ribs, meaning that even with some respiratory support, she has to work slightly harder than normal to draw air into her lungs.

She deteriorated a few nights ago and had to be started on supplemental oxygen. I turned that off just over an hour ago, to see if she could manage without it. She is a few feet away from me in the incubator. The babies are napping. The NICU is peaceful, but as I watch the rise and fall of Sophie's chest, I am troubled. Her respirations have quickened. She may need oxygen again soon, I think to myself. Sophie's respiratory symptoms are not improving, even though she no longer has fluid on her lungs.

Suddenly, the baby is breathing harder and deeper. Her oxygen level falls. As I walk towards her, she is all ready turning blue, and by the time I reach the incubator, her heart rate is dropping. I turn her oxygen back on, but for an hour after this episode, Sophie is floppy. I draw blood to check her blood gas levels. Sophie barely reacts. The blood gasses are abnormal. I had to try her off of oxygen - if I hadn't I would never have known the limits of her coping - but looking at her now, it dawns on me that something is going on inside her body that I don't fully understand. That something is a very real threat to her life.

When I assessed Sophie on Tuesday morning, I had heard a loud heart murmur. It is becoming apparent that this little girl's heart condition is likely to be significant. Over the weekend, I tired removing CPAP and giving Sophie supplemental oxygen. She managed just 2.5 hours, before her oxygen levels and her heart rate began to drift downwards. She was almost full-term when she was born. Her lungs should be mature. She should not need CPAP at this stage, but she can't manage without it. Without both CPAP and oxygen, Sophie quickly destabilizes.

Tonight, her anxious Mummy asked why the baby still had breathing problems. This child is incredibly precious to her parents and to her extended family, and I think they all ready know that something is wrong. I was gentle and direct. 'Yes, I think we have to investigate that. Lets have the Pediatrician do a thorough examination. And lets see what she suggests.'

Sophie's Mum had been incredibly emotional lately, and that of course, is to be expected of a new Mother of a sick baby. There were no tears during this conversation though. Just straight questions, requiring clear and honest answers.

'If Sophie has a heart problem, can it be fixed?'
I hope that it can. I really, really do.

Friday Afternoon

'There is a beautiful baby girl waiting outside for you, Miss Susan, fat and pink! She is 6 days old!' Since they told me that she was 'for me' I knew that the baby had been placed in our care pending adoption, and that she would stay at the main house until her adoption was finalized. I could not contain the smile that spread upwards and reached my eyes.'You see Vivianne, Miss Magaly said, playfully nudging Vivianne, Miss Susan is happy, very happy!'

'Send her up to me,' I said. I was still smiling, and yes, I was very pleased by the news. I have admitted dozens of babies to out main house nursery. There is always a sense of anticipation.

Ten minutes later, there were a pangs of grief, where joy should have danced. The baby was pretty, yes, but she was not pink, she was pale. So very pale. She was working extremely hard to breathe. I noted her small, upwards slanting eyes, short neck, and a deep crease, cutting straight across the palm of her hand. Sonya had many of the physical features of Down syndrome. Her toe mails were clubbed, a sign of chronic oxygen deprivation. Even on oxygen, Sonya was blue and her oxygen levels dipped frequently. The baby gazed up at me listlessly. She was floppy. A blood test showed that she was retaining carbon dioxide in her lungs and that the acid levels in her blood were rising. She was critically ill.

Anywhere in the developed world, a baby as sick as Sonya would placed on a ventilator. I had a sinking feeling...... Even if we could find a hospital that would ventilate her, Sonya would never survive the journey down the mountain. Then it occurred to me; we could put Sonya on CPAP. Baby Sophie, who had arrived three days earlier still needed to be on the system. Could we run two? I had the equipment to do that. I would have to make some modifications to the second system to make it operate with the equipment that I had. I didn't know if the circuit would support two CPAP systems. I would have to make it work. Sonya was exhausted. I had no idea whether CPAP would help her, but it was her only chance of survival.

The NICU was highly charged with the activity involved in getting a second CPAP circuit up and running. By the grace of God, a NICU nurse from Canada had arrived the week before, and she was on hand to help with the intense work of getting Sonya onto CPAP, stabilizing and monitoring her. Four hours later, Sonya was on CPAP, IV fluids and IV drugs, She was breathing easily, sleeping peacefully and her blood gasses were almost within normal ranges. I was extremely tired, but elated! I would need this victory to get me through the weekend. One CPAP baby is a lot of work, and now we have two, and both are on IV's and need tube feeds and constant attention and observation. Right now, GLA's NICU is being pushed to the very limit of its capabilities. I will admit to being overwhelmed at times this weekend, and I will share more details about that soon. I am also in awe tonight, though, at what our medical capabilities are, and at what we have been able to do for these babies.

Sophie Dora

Sophie-Dora made a dramatic entrance into the orphanage at 3:30 am, on Tuesday morning. I was woken from a deep sleep by loud knocking at my door. Someone was calling my name. It was Laurie Bickel. 'The UN and Haitian Police have arrived with a baby from General hospital. They say that she needs oxygen.....' We knew there was unrest in Port-au-Prince. We knew it was not safe to travel a night, and glancing at the entourage that came with this 4lb infant, we also knew that unlike most of our patients, this one had connections.

Sophie was born on Saturday, around 4 weeks early at a private hospital in the city. She had breathing problems and was unable to feed from a bottle. The hospital she was born at did not have facilities for pre-term infants. Only the embattled and under-resourced government hospital would admit her. Sophie-Dora's mother watched on in alarm as her baby became weaker and began having cyanotic spells, during which, she turned blue. Sophie's Mother knew one of our GLA nurses. She was aware of our medical capabilities and, in her estimation, her baby's best chance of survival was to transfer her to us.

Sophie was extremely pale when she arrived. She had fluid her left lung. Babies are born with fluid filled lungs/ It is possible that this one was too weak to breathe deeply enough to clear this fluid herself. We put her in an incubator and started CPAP to help with her breathing. she is receiving antibiotics and tube feeds. At Sophie's gestational age and weight, the greatest risks to her health are hypothermia, feeding problems and infection. We have seen some very encouraging improvements in Sophie's condition. This morning, she is alert, sucking on her hands and crying 15 minutes before her feeds are due.

I am very thankful to everyone who made it possible for us to obtain the medical equipment that we have, and for everything we can do for some of Haiti's most fragile newborns.

Reality Bites

Summer is fading away, daytime and night time temperatures have dropped and there are heavy rains every afternoon. The change in climate has ushered in an epidemic of colds , ear infections, and tonsillitis. We currently have 11 miserable babies on antibiotics, pain medication and decongestants. I have had a very busy week assessing and re-assessing sick children, forming treatment plans, prescribing the drugs they need, and monitoring and caring for all of these babies.

Most of them are recovering, but my little Peterson, who was admitted in May for medical assistance, has had constant fevers for 4 days. He is on two antibiotics and he needs Tylenol and ibuprofen around the clock to control his pain and his fever. He has a very poor appetite and I am feeding him every two hours to make sure he stays hydrated and that he gets the nutrition he needs to recover.

Peterson is a medically fragile infant. Although his Mother planned to take him home with her, I think she knew that his chances of survival were very poor in Carrefour, which, is a very impoverished district of Port-au-Prince. To survive and thrive, Peterson would have to be monitored by a multi-disciplinary community medical team, and his mother would need substantial financial aid in order to care for him. This kind of medical and social care network probably will not be realized in Haiti for at least a decade. Peterson's mother relinquished him for adoption a week ago.

The harsh reality that gnaws on my mind this week is that there are thousands upon thousands of Peterson's in Haiti. Many of them will die. I know, of course that my responsibility is for the children in front of me.

Sometimes I think that in my attempts to be positive and hopeful in the blog sphere, I succeed only in sugar-coating reality. If I am brutally honest, Peterson might not survive his health challenges, even at GLA.

Tonight, as I laid him in his crib, I took in his spindly limbs and ashen skin. I could still feel the heat of his feverish body in my arms as I watched him shake his head back-and-forth-back-and-forth-back-and forth. There was no hiding from it; this baby is very weak, and emotionally scared from a short life of neglect and abuse. We will give him the best medical care we possibly can. I will advocate for him, I will hold him and hug him and caress him and pray over him. But will my medicine and my love be enough? I don't know. I just don't know.

Bye Bye Jeff!

He came to us weighing 3.5 pounds. He was 8 days old and he hadn't been fed since he was born. He was dehydrated, hypothermic and struggling to breathe. We sent him home this week.... He weighed almost 7lb!

Jeff was our second CPAP baby, a living breathing miracle. He came so far in his sojourn, with us, at GLA's intensive care nursery. We will miss Jeff, but we are pleased to have been able to send him home, strong and healthy, to his family.

Had his Mother carried him to term, Jeff would have been born right around now. Many Haitian babies are born weighing 5lb or less, so Jeff is bigger, better nourished and more robust than many of his contemporaries. His young Mother, who was sometimes less than thankful for our work with Jeff and with her, was all smiles and gratitude when she left the orphanage with him.

I believe that we have made a difference in his life - to his chances of going on to live a healthy, productive life. I think that to some extent, Jeff's Mother appreciates this too!

Developmental Assessments

This week, I did health and developmental assessments on some of the babies at the main house. One of the babies I saw was 6 month old Darline. The information from my assessment, together with formal medical and psychological examinations will help our orphanage staff to match this gorgeous baby girl with a family on our waiting list.Darline came to GLA 2 months ago. At 8 lb, she was significantly underweight. She also had recurrent fevers, that were caused by a mild bacterial infection. My assessment of Darline last week was overwhelmingly positive. I noted that her general health was good and that she had gained almost 5lb since we admitted her to the orphanage in July. Her eating and sleeping patterns were normal for an infant of her age. She was strong, bright, alert, sociable, engaging and doing all of the things that a 6-7 month old infant should be doing.

'Focusing on people and objects and following moving objects through a 180 degree angle.......

Turning in the direction of a shaking rattle and recognising her name...........

Smiling, cooing babbling and giggling........

Rolling from her stomach onto her back and from her back onto her stomach. Sitting. Weight-bearing on her legs. Holding her own bottle. Reaching in all directions and grasping toys. Shaking a rattle. Bringing her hands and her toys to her mouth and chewing on them (this is considered a important aspect of babies development. They learn a lot through the sense of touch).'

Yes, Darline is doing all of those things. She is strong, healthy, beautiful, happy and developmentally, she is right on track. It is very encouraging to see the wonderful progress that she has made in her short time at GLA. There are many, many families who request healthy baby girls. Darline will not have to wait. Somewhere out there, a family is waiting and ready to accept her proposal!

Some of our children, though, have special needs and are not so easy to place. One of the babies I assessed this week did not turn her head to the sound of a shaking rattle. She did not respond to louder noises either. Unfortunately, I won't be able to send her for a hearing test. Our Pediatrician tells me that none of the audiologists in Haiti have the equipment needed to screen for hearing loss in children under the age of four. They are not prepared to cover the the cost of the apparatus (around $6000 USD). At this time, I have concerns about the hearing of four of our main-house children. All I can do is observe them and hope that GLA and their partner agencies will find families for these babies, despite the uncertainties we have about their current hearing and about their development.

Life-Giving Water

Every morning, just before 7am, I go up to the nurseries to take care of some early morning chores. One of the things I do is prepare special diets for babies that have milk-protein allergies or severe lactose-intolerance.

Many of the children in our care suffer from repeated and prolonged episodes of diarrhoea. This is often precipitated by exposure to viruses, bacteria, and parasites in our drinking water  that cause infection, diarrhoea, vomiting, and damage to the wall of the gut that make our children intolerant to lactose and more vulnerable to other intestinal infections. Lactose intolerance causes stomach cramps and more diarrhoea, which, impairs their ability to absorb nutrients on an ongoing basis, leading to malnutrition and impaired immune function. Chronic diarrhoea is debilitating and it is a real and present threat to children's health, If I suspect that a child's diarrhoea is being caused by or being made worse by lactose intolerance, I put that child on a lactose-free diet, so that diarrhoea and stomach cramps do not impair their appetite and their recovery.On Friday last week, I was excited to see our new water filtration system in operation at GLA's main house. Our previous filtration system was only able to treat our drinking water. We used untreated water for washing clothes, and dishes and for bathing. All of the water that came out of the taps was untreated and many people contracted diarrhoea and vomiting from this untreated water. Many of Haiti's water sources are contaminated, and at GLA, we regularly see the effects of water-borne disease.

Earlier this year, Donley, a premature baby died at GLA, from complications of gastroenteritis. Last year, we had to perform CPR on another infant who became critically ill after contracting diarrhoea. Then, in March, Baby Luc, a low-birth weight, baby became severely malnourished during a bout of diarrhoea and vomiting that almost cost him his life.

Our new water filtration system comes from Water Missions International, an organization that produces mini water treatment plants for communities in the developing world. Their system has the capacity to treat 10 gallons of water every minute. This means that we will now be able to treat all of our water through a highly effective process of filtration and chemical disinfection. The cost of running this apparatus off of our diesel-powered generator: less than $3 USD per 1000 gallons.

Up until now, we were fortunate just to have access to clean drinking water. The majority of the Haitian people are not so lucky. Many Haitian children are habitually sick from drinking contaminated water. Some become so weak from illness and malnutrition that they die.

It shouldn't be this way. I am giving thanks today, to the God who has increased our blessings, and made it possible for us to improve the health of our children. It is my hope that we will see a significant reduction in water-related disease at this orphanage, over the coming weeks and months. It is my prayer that one day soon, every Haitian child will have access to safe drinking water.

'Nice' Clothes

'Here are some nice clothes for you', Miss Bernadette told one of our young, resident Mothers. The younger woman raised her head and looked down her nose at the scrub sets Miss Bernadette was extending towards her.

'Mesi'(Thanks), the tall, short-haired woman replied, in a low voice, and with an empty expression. Clearly, she was anything but grateful. Miss Bernadette is only a few years older than the sullen young woman in front of her, but she was anything but discouraged. Her smile was unwavering, and her tone was warm. 'We do not wear shorts in this house,' Miss Bernadette explained.

The 'nice' clothes, nursing scrubs, were to replace shorts that were so short that they exposed the woman's thighs. She nodded, lowered her eyes and took the scrubs from Miss Bernadette. Now she understood: they might not be stylish, but all of the nursery staff wore them. The ladies here were making it easy for the young mother to conform to their standards of modesty. As a guest in this house, she was willing to conform to those standards.

Many foreigners consider Haitian fashion backwards. Haiti is a country in which women outside of the cities and the city suburbs prefer to wear skirts and dresses, which are usually knee length. Men are rarely seen out in public topless, and shoulders, busts and mid-rifts are not display. I like that.

Of course, Western fashions do have an influence in Haiti. At God's Littlest Angels, our Haitian staff are exposed to dozens of Christian missionaries as well as visitors from Europe and North America. Many of these Western Christians have far looser standards of modesty than the Haitians do. One of the things that impresses me about the ladies here, and about Haitian Christians in general, is that they hold fast to their own standards. I love that and I respect that. After all, the ways of the world are always changing, but as Christians, we are not supposed to be 'of the world'. Instead, we are called to honour a God who is the same yesterday, today and forever.

As Bernadette clocked off shift tonight, wearing a knee length skirt and a short-sleeved blouse, I remembered her exchange with our resident Mum, and I was proud of her. I wish I had told Bernadette how pretty she looked. Maybe she doesn't need my encouragement, but I think she deserved it.

Susan, are you leaving?

She lives at the main house. She is two years old, and has been very sick, all her life, She is verbal enough to express her needs wants, and concerns. I can see the worry playing in her eyes, and I know where this conversation is going.

'Wildanise went away.' That's a fact.
'Yes, darling,', I say smiling.'She went home with her Mummy.' The toddler nods. Wildanise's adoption was complete. She was united with her adoptive family. This was a happy parting.

'Jerry went away.'
'Yes, he went to Kay B.' She pauses, seems satisfied. Kay B is about a mile up the mountain road. The older GLA children live there. Jerry went to join them.

'Ferlanson has gone.'
'Not yet, daring. He is still here. His Mummy and his brother came to get him. They are staying in my house.' She accepts this easily.

'Mitha went away.' Her gaze is steady and deep. Although it cuts me to the core, I am quick to answer, because I have anticipated the question and considered my response, that yes, Mitha did go away.

Mitha: we miss you!

'She can't come back, but she loves you very much.'
'She loves me a lot?' I am not sure what emotion is under the furrowed brow.
Do you doubt it, little one? Are you confused? 'Yes. She loves you a lot. She does. Yes!' I reassure the toddler confidently. When the next question comes, though,it is so unexpected, and it hits so hard, that it knocks the air out of me.'
'Susan, are you going?'

I hope the pause was not too long. I hope it didn't leave any room for doubt to enter, and trouble her heart. 'No darling, Sometimes I will leave for a little while, but I will come back.'

Two weeks ago, Mitha, a very loving, and much loved GLA nanny, passed away,after a brief illness. She was a devout christian lady, simple and uncomplicated. She loved any child we placed in her arms. If they came sickly and malnourished, if they had disabilities or they just needed the constant, patient love of a Mother to get them through the loss of their own family, we placed them with Mitha. She had a heart for the least of the least, and the shunned.

And now she is gone. Two should be too young to comprehend the permanency of death, but the little ones at the baby house have experienced enough loss in their short lives, to know what it means to lose someone forever.

Please pray for the little ones who miss Mitha, and especially for my sickly toddler, who has been here at GLA for two years, and desperately needs a Haitian passport, and a US visa, so that she can go and join her adoptive family. She needs stability, now more than ever, and she needs first world medical care. There are huge obstacles in this child's path. I don't want her to experience any more loss and change here.

Please also pray for the GLA staff. Last year, a young nanny died, and the ladies who work at the main house fell to the ground and convulsed with grief. They have known Mitha for several years, but many of them lost multiple family members when the earthquake hit in January, and they have grieved so hard that they are too emotionally spent for anything except quiet tears.

Lastly, please pray for Mitha's family. She leaves behind a husband, and two children: her little boy is ten years old, and her daughter is sixteen. Mitha's wage paid for their schooling. There is a chance that they will not be able to return to school when the new school year starts.

Our orphanage director estimates that it will cost $1000 USD to pay their school fees and cover other expenses, related to the children's schooling, If you know Mitha, and she has touched your life or your children's lives, please consider contributing to her children's education fund, which has been set up by GLA, in her memory.

Enduring Strength

'As you do not know the path of the wind, or how the body is formed in a mother's womb, so you cannot understand the work of God, the Maker of all things.' (Ecclesiastes 11:5)
How does a tiny infant, born almost two months prematurely, survive for 8 days without being fed? And when I say he wasn't fed, I mean, he wasn't fed. He didn't receive anything - not a single drop of milk or even water for over a week.

When he arrived, Jeff was severely hypothermic, with an underarm temperature of 90.3OF. His skin was thin, dry, and tightly stretched over his jutting ribs. And yet, Jeff was awake, alert, and he had a strong cry. For some reason I can't explain, Jeff was no-where close to death.

Conventional western medicine doesn't tell us much about how to manage prematurely born infants who come in several days after they are born, dehydrated, hypothermic and malnourished. We know that they need to be warmed, since cold stress causes the acid levels in their blood to rise. However, once they warm up, their bodies oxygen requirements increase, and they have to breath harder and faster to get this oxygen.

Well, once we warmed Jeff, he developed severe apnoea - he stopped breathing for long periods of time, during which he would turn blue. It took a lot of stimulation to get him breathing again.

I was able to run a blood gas on him and check the level of sugar, and electrolytes in his blood. These investigations confirmed what I suspected: Jeff was dehydrated, and he had some metabolic imbalances as a result of this dehydration. His body was trying to correct these imbalances through increased respiratory effort, but Jeff was too weak and tired to keep this effort up.

What did we do? We put Jeff on CPAP to help him with his breathing, while we began giving him fluids to correct the dehydration.

Jeff is a survivor. These photographs show him on arrival, and then 8 days later, weaning off of his CPAP.

It has been my prayer, that God would sustain the fragile infants in our area, until they reach us. When I meet babies like Jeff and Woodson, and Jonathon, enduring what they do not have the strength to endure, there is no doubt in my mind that God is answering my prayers.

Embrace

People have been sending me links to the Embrace website. This company have developed a low-technology, low-cost infant warmer for the developing world, and the people who have been sending me links to the website feel quite strongly that God's Littlest Angels might benefit from their product.



I am very thankful to the caring supporters who thought about our babies when they heard about Embrace. I want you to know that I have done some research into the company and their infant warmer. I have learned that the product is not available to buy at this time, as it is yet to undergo clinical trials that will hopefully determe that it is safe and reliable.

At GLA, we are very blessed to have conventional incubators. However, I imagine that the Embrace warmer would be a good back-up for the times when we experience power outages. It would also be useful to have a portable warmer for the trips we make to hospitals and clinics, in order to transport infants to the orphanage.

Having seen many low-birth-weight babies die from 'cold stress', which, caused their organs to shut down, I don't doubt that a product like this would be useful in the remote and rural area of Haiti. I feel convinced of this when I think of our ex-preterm baby, Junes:

Junes came to us as a bug-eyed infant, weighing 2.25 lb. Although he was able to breath on his own, and suck feeds, he didn't have enough body fat to stay warm. For the three weeks that he was living at home, high in the Haitian mountains, he battled hypothermia.

Today, Junes does not grow and thrive on regular infant formula. We don't know for certain that his poor weight-gain today is down to hypothermia in the first weeks of his life, but we do know that during those three weeks that he was cold, all of the energy that should have been used for growth was being used to generate heat. The growth and development of his vital organs would have been affected at that time.

The information on Embrace's website does not answer all of the questions I have about their infant warmer: can infants be swaddled, or nested inside the warmer for example? It is important for pre-term infants comfort and development, that they are positioned, as far as possible, as they would be in their Mothers' womb.

My best guess is that it will be years before the Embrace warmer is available in Haiti. Once the clinical trials have been completed, it will be piloted in India, and then rolled-out to other developing countries. I have joined the company's mailing list to keep up-to-date with developments. It is my hope that their innovative, thermal sleeping bag will save many tiny lives.