Mesi Saint Margarets!

When a missionary worker is moved on from their position, it is important that they train others to take over their duties. Often, the tasks that they undertake are very specific and the missionary worker is  the only person within the organisation who truly knows their job. At the point I left Haiti, I had not had the opportunity to go through this handover process and I was concerned, as many of you were, by the impact that this would have on infants receiving care at nurseries in the Kenscoff mountains. A financial donation from Saint Margaret's Roman Catholic Church in Stirling, though, made some closure possible.

The stewardship of people's financial gifts is a serious responsibility. Following some careful thought, prayer and wise advice, I came to the conclusion that when spending the available funds, I should strike a balance  between meeting the immediate needs of Haitian babies and investing in their long term care.

During International Breastfeeding Week, I undertook some continuing professional development that helped forge a a plan to allocate my church's money in the most impactful way: I was reminded that there is a two week window period, following the birth of a baby, in which breastmilk supply is established. If the infant is born too small or too weak to suckle at the breast, the supply must be stimulated in other ways. The best way of achieving this is through a combination of mechanical expression with a hospital grade breast pump, followed by hand expression. Research demonstrates that regardless of the size or gestational age of a newborn, the long-term success of breast feeding depends on achieving an optimal level of production by the 14th day of the baby's life. Mechanical pumping and hand expression induce the milk let-down reflex and empty the breasts completely. This effectively  stimulates the supply and can result in  the production of 750-1000ml of breast milk by the end of the critical  14 day period.

Additionally, hospital grade breast pumps are the only pumps that can safely be used by multiple mothers and they are the most durable pumps on the market. Armed with the facts, I made my decision - a second hand hospital grade pump and some spare milk collecting systems were purchased for the orphanage I worked at. With the help of the Vanderewell family, the system was hand delivered to the orphanage by a volunteer. A visiting nurse has since confirmed that the pump is already in use and the the mother who is currently using it is producing volumes of breastmilk that greatly exceed her own baby's requirements. She and many other mothers,  will now be able to produce as much milk as their babies need, for as long as they need it. This will have a significant impact on the survival rates of babies, after they leave the nursery, since premature babies in Haiti are discharged into environments in which formula milk is not a safe or viable alternative to breastfeeding.

The breast pump would be difficult to top, in terms of meeting babies immediate needs and investing in their future health and development. The idea that followed, though, also met these criteria. I learnt about a new CPAP cannula. Neonatal colleagues in the USA had introduced it into their units. They told me that the cannula made CPAP easier to manage.  I did some research and learnt that the RAM cannula looked liked an ordinary oxygen cannula and could be applied without pinning and strapping it to a hat or fixing it to the baby's face with harsh adhesive tapes. As a result, skin breakdown and nasal septum damage (common risks with existing systems) were virtually eliminated. Was it as safe and effective as the prongs I had previously been using, though, and would it work with the equipment I'd had in Haiti? Yes, I was told. Additionally, the new cannula was preferred by many parents and nurses because the babies looked more normal without bulky CPAP tubing in front of their faces and because it was easier to place babies on their parents chest for Kangaroo care, when the RAM cannula was used, instead of a traditional CPAP prongs.

I wrote to a company, requesting product samples. I was sure that the availability of these cannulas would increase the likelihood that the CPAP programme I started in Haiti would continue without me. I was recently given several boxes of the cannulas, entirely free of charge, by the company that manufactures them. As a result, I have decided to share the cannulas among NGO's that provide nasal CPAP to sick and prematurely born babies in Haiti. Real Hope for Haiti and the Haiti Hospital Appeal are among the charities that will benefit. They are thankful that the generosity of a Scottish church and a California-based medical supply company  have paid forward to them.

The RAM cannula is a nasal interface, designed for use with CPAP and other non-invasive ventilation systems.  It is sized specifically for young and prematurely born infants and can be used without the tapes that can damage  newborns' fragile skin. Photograph courtesy of NEOTECH.

Since the Ram cannula's were donated,  funds that had been allocated to meet the health and childcare needs of Haitian babies still had to be spent, in full.  It did not take long to find a good use for they money that had been raised: an individual donor had given me a cheque, which she asked me to spend at my discretion. One afternoon, I read a facebook post, written by missionary friends who worked at Real Hope for Haiti in Cazale. Two children had attended their rural clinic in desperate need of specialised surgery and an appeal had been launched to ensure that these children received the care that they so desperately needed. Both children were successfully treated. A seed sown faithfully by a donor from my own church helped to make this possible, covering 10% of the the children's initial medical fees. Below are remarkable photographs of one of the children, before and after her treatment. 

Renia arrived in at Real Hope For Haiti with a severe neck swelling that was beginning to obstruct her breathing.

Renia after treatment

With the  remaining funds, a liquid iron supplement was purchased. Iron deficiency anaemia is a significant problem among Haitian children and one that can have an impact both on their health and long-term mental development. Oral therapy is expensive and in all the time I was in Haiti, it was never possible to provide the long courses of treatment that are recommended by European Paediatricians. I was able to source a liquid supplement in bulk: a solution that will extend the benefits of this treatment to many children.

I am sure that the members of Saint Margaret's Roman Catholic Church did not expect their donations to stretch quite as far as they did, multiplying and spreading across Haiti!

A Pita - Until Later

Over the past few weeks, I have done lots of thinking, and lots of praying, and lots of talking with the people close to me. Still, I can't seem to find the words for what I have to tell you.

Friends, I left Haiti at the beginning of July. With great sadness, I have to tell you it has been decided that I will not be returning to God's Littlest Angels, not because I don't want to return, but because it has been made impossible for me to do so. I know that this news will come as a surprise to a lot of people.

So many of you have such a stake in what I do in Haiti. Some of you have prayed for me and my sickest 'angels', some of you have given money and raised funds to provide supplies and equipment for the Neonatal  Unit, others provided specialist medical advice and therapies for the babies, and, when I was very ill earlier this year, some of you quietly donated to cover my medical expenses. Those expenses were covered in full. I am thankful, beyond words, for each one of you, however you have come alongside me.

Many of you tell me that you are so grateful for my blogs and for the stories and insights I have shared about my work in Haiti. Many of you recognise that I built something at the orphanage, specifically at their neonatal unit in the Kenscoff mountains - I built on the capabilities of the unit to provide excellent care to prematurely born and severely malnourished infants, that is true. The bigger truth though is that without all of you, and without God, none of it would have been possible.

There are two main concerns that the people seem to have when they hear my news: I would like to reassure you all that although I have had very significant health problems this year, I have had excellent medical care in Scotland. Although I have some ongoing medical, issues they are not serious enough to prevent me from returning to Haiti.

The second area of concern people have is whether I will continue my medical ministry elsewhere in Haiti.

Believe me, I am grieving the loss of  many many things. I have lost Haiti, my work there, and my relationships there. I would never have chosen to leave so abruptly, and I want nothing more than to be back in Haiti. My nursing expertise, though, is very specific, restricted to the care of infants and children, and, in Haiti, particularly to the care of very young, severely malnourished, sick and preterm babies in a very resource poor, but relatively privileged environment. Yes, I did a good job, but I did it with clinical haematology analysers and monitoring equipment. In another setting, I might well be lost. So you see, as much as you appreciate what I did near the mountain village of Fermathe, there won't be any non-governmental agencies beating my door down and bombarding me with offers of paid work.

I hope that one day, I will be in a position to return to overseas medical missions in a full time capacity. Maybe, short term opportunities will open up for me. For example if anyone wanted to introduce a low technology bubble CPAP to their neonatal or Paediatric unit, clinic, hospital, orphanage or medical centre in Haiti or elsewhere, I could certainly provide advice and ongoing support with that.

For now, I ask for your prayers as I continue to heal and adjust to some massive changes. Pray for me as I try to find a way forward that will strengthen my nursing capabilities. I fully believe that all babies and children, whether they are in Haiti, or in Scotland or anywhere in between deserve the very best nursing care. Excellence is what I have always aimed for. I will continue to actively pursue excellence, I promise you that.

A pita (until later) and with love and gratitude

Susan

Losing it - Shamira's Bravery

Shamira, arrived at the baby house withdrawn, and distrustful. Just two years old, she had already learnt to protect her little-girl heart from the sting of rejection. She was brittle-haired and balding, with dry, cracked skin pulled taught over an angular frame. No-one had ever told her she was pretty. She knew in her mind she wasn't a lovely child. Her family had left her with strangers at an impoverished orphanage, further up the mountain road. The staff there didn't even consider her worth feeding every time there was food. That was how Shamira saw it. It wasn't true but she believed the lie.

Five days after arriving at God's Littlest Angels, were she and 22 other children had been transferred by concerned Social workers, she was finally receiving some of the things she needed and deserved. She was sleeping in a new bed, on crisp white sheets. Her caregivers smiled at her often, held her and fed her until her stomach was full. Her ear infection was healing. There were toys and visitors. On that fifth day, a bowl of food, that she said she didn't want was taken away. Suddenly and violently, Shamira snapped, Somewhere deep inside, she believed she was going to lose everything. She began screaming and kicking, clawing and biting.

It was an ugly display, but we were seeing the fury of a toddler whose cries hadn't been heeded for a long time and I wanted her to know that we cared about her hurts and that we loved her. She was in such a state, though, that she couldn't remember why she was upset and she wouldn't allow anyone to comfort her. You won't do this to me, traitor! You wont taunt me with good things and take them away! Let me go!

Shamira needed to be held. She needed to let a grown up help her through this, but any attempts to re-assure her only increased the volume and intensity of the screaming and fighting. I lay her on her stomach, sat at the head of her cot, and told her it was OK to cry and to be angry. Shamira quickly settled. After a few minutes, she pushed up on her arms and looked up at me with a tear-stained face.

'All done?'
Yes, she nodded
'But you cried hard.' Shamira was utterly exhausted and slightly sheepish, but she wasn't going to be scolded this time,
'Your throat must be sore. I bet you are thirsty.'
Yes
'You want a drink of water?'
'Oui.'

That was not Shamira's first meltdown, but it was the most intense, because now she lets grown-ups hold her when she is angry. We are allowed to soothe her. Shamira is beginning to do something else, she wasn't prepared to to when she first arrived. She is accepting affection, and smiling shyly every time Chantal, her key nanny tells her she is a little doll. Who, me? she seems to ask.  That takes courage. I think that many people instinctively respond to hurt the way Shamira did - we shut down, we get defensive. Yet Jesus said on the mount, 'he who seeks to save his life will lose it.' I wonder if one implication of what he was saying was that, sometimes, our response to our trauma is more damaging than what was done to us in the first place.

Photo courtesy of God's Littlest Angels

Now, Shamira's bravery has opened a door to healing. She  is delighted to be told that she is a doll. She always wanted someone to tell her that. She always needed to know someone thought she was pretty, and  for someone to be enthralled by her.

Mercy - An Update On Fedo

For several hours on Sunday, I was afraid that Fedo would not survive. On Monday, his abdomen remained tense, and he was not well enough to be fed. On IV fluids, and without a protein source, the tissue swelling returned. Yesterday, it was worse than ever. I was alarmed and discouraged, knowing that diarrhoea increases the body's protein requirements, and knowing that there was no way that Fedo was going to be able to receive protein for at least a few days.  His limbs were stiff and he cried out in pain whenever we handled him. His left eye was so swollen that he was unable to open it.

The very worst thing was that twice each day, he experienced life-threatening drops in his blood pressure. As the hours passed, we learnt to anticipate these episodes, treating them with boluses of IV fluid. Friends of God's Littlest Angels orphanage, who operate a a rural clinic and malnutrition centre  at the other side of Port-au-Prince, were advising us about his care. I have gained a lot of experience with very young, severely malnourished babies but the Staff at Real Hope For Haiti specialise in the treatment of Kwashiorkor (the type of malnutrition that Fedo has). They explained that children with Kwashiorkor often go into severe shock due to fluid shifts in their bodies.We were all very grateful to them for their wisdom and guidance.

 I continued to pray for healing, but my heart's loudest cry was for mercy for this child. I have seen two deaths from Kwashiorkor in my time at God's Littlest Angels and I couldn't stand the thought that Fedo would suffer, more than he already had.

Overnight, Fedo turned a corner. His cries were different this morning - they were hunger cries. He isn't able to suck yet, but he is taking formula from a syringe and he is digesting it well.

Fedo is not out of danger yet, but he has come a long way. Please continue to keep him in your prayers.

The Call Got Through

‎'Oh, Miss Susan! I was trying to get you on your cell phone but the call wouldn't go through!' Nurse Cami told urgently, before I had even reached the top of the stairs. Her eyes were wide with alarm. Fedo didn't look well to nurse Cami, said. She thought he'd had a seizure, She was sure there were more to come. 
'Don't worry about the cell phone, Cami, the call got through, I reassured her....


Two minutes earlier, I was in my room, when a voice in my head told me to go and check Fedo's electrolytes. It was close to 10pm, I was tired, and I wondered if it could wait till tomorrow. 'You'll regret leaving it till tomorrow,' the voice cautioned. 


As I got supplies ready to check his electrolytes, the baby began to have a seizure. I was able to respond instantly,  because apparently, someone up above has me on speed-dial and although I am inclined to reject calls from unknown numbers, I answered this one ;-)


Fedo's condition is slowly improving but the seizures are a new development. Please remember him in your prayers, as he stabilises and his body struggles to adapt to electrolyte shifts and blood loss, following yesterday's severe intestinal bleed. 

Fedo - A Father's Day Prayer

He is said to be six months old, but this embattled angel behaves like a much older infant.

He arrived on Tuesday of last week, swollen from from protein-energy malnutrition, with a cough, fever, diarrhoea and a severe case of thrush in his mouth. He wouldn't drink - not milk, not juice or oral re-hydration solution. not from a bottle, a cup or a syringe. I remember arguing half-heatedly with the head Haitian nurse. She knew, that I knew, the baby needed an NG tube, she told me. I did know that, but I still didn't want to put the tube down. Fedo was an older infant. It is painful and distressing to have an NG tube passed. Fedo would fight. Still, he was dehydrated and we could not allow his condition to deteriorate under our care.

Re-signed, and with the tube in my hand, I explained to Fedo in a gentle voice, what I was going to do, and why. He put his hand up in front of mine. The gesture and the facial expression that accompanied it communicated his feelings on the matter very clearly. Stop right there Madam! I am not ok with this! The NICU staff were as surprised as I was. Maybe Fedo was considerably older than six months. Maybe he has just experienced too much in his 6 short months in this world. Maybe he knows too much.

Fedo came during an exceptionally busy week, during which, at one point, the orphanage's Intensive Care room was full to bursting with 15 babies, many of them sick, and a three year old in heart failure. Fedo received a continuous feed, electrolytes, medications and vitamins through his NG tube. By Thursday, his swelling was going down and his infections were clearing up. On Friday, he began sucking from a bottle and smiling. I was thrilled to see this fragile baby healing so quickly. Kwashiorkor malnutrition causes swelling of the tissues, wasting, severe immune-deficiency due to low protein levels in the blood and many together with nutritional deficiencies. Fedo though, was on the path to recovery.

Despite these hopeful signs, Fedo experienced a life-threatening complication related to his malnutrition today. Our orphanage Director checked in on the NICU babies after lunch and found Fedo extremely ill. While she was starting an IV on him, he went into shock and developed severe breathing problems.

It seems as though the tissue wasting that has resulted from extreme malnourishment has affected Fedo's intestines. He developed a high fever and suffered a  gastro-intestinal bleed this afternoon. When I arrived in the NICU, he was unconscious, unresponsive, extremely pale and in such severe shock that we could not detect a pulse.

For over an hour, we worked hard to stabilise him with IV fluids, oxygen and antibiotics. Dixie, the orphanage Director, performed as ice-water lavage to slow the bleeding. As we worked, we prayed, against the terrible fear that Fedo might die in front of us. We advocated hard for this orphaned child, for a healing, preferably in this world, according to your perfect will, Lord

At the time of writing this post, Fedo is in a serious but stable condition. He re-gained consciousness this evening and turned to my voice. His gaze was searching, pained and confused. What is happening to me? Please explain it Miss Susan. In all my life, nothing as terrible as this has ever happened!

We ask that you echo our prayers for Fedo tonight. Our God is the Father of the fatherless. He is Fedo's Daddy and the great physician and I have great confidence in his infinite love and concern for his stricken infant son. Imagine his anguish as he watched his helpless baby suffer. I am thankful to his birth Father, for seeking help and I am hopeful that for Fedo, help has not come too late. Although I recognise that Fedo couldn't be in better hands than in his heavenly father's. I am so, so sorry that his earthly father doesn't have his son in his arms. Today is Fathers Day. No Father should be forced to make the impossibly difficult decision, to give up a child in order to save them.

Rebecca - Not 'Forgotten'

It seems that something about my shock startled Rebecca's mother out of her cold indifference. Minutes after I announced that Rebecca didn't need her mothers milk, not if her feelings about the baby were so intensely negative, not if our continuing to press for milk was increasing her sense of hostility, the teenage mother sighed and began expressing. She continued to provide milk over the days that followed.

Rebecca, who was born significantly premature and malnourished. Rebecca, who was struggling with a severe viral infection. Rebecca, who had difficulty digesting her feeds. Rebecca, who was so highly stressed that she was producing excess stomach acid and vomiting streaks of fresh blood. Rebecca, who had been delivered in a latrine bucket. Rebecca, the child of a broken mother, with a calloused heart. This Rebecca. with so many odds stacked against her, began to heal and to thrive. 

Rebecca now weighs 2lb 9.5 oz. I have struggled with this tiny, fragile infant. Twice, I weaned her from her CPAP, only for her to become ill with bronchilolitis, then a simple cold, and need more CPAP support than ever before. On the third attempt, I was finally able to get Rebecca off of CPAP and onto a nasal cannula. A constant flow of compressed air and daily caffeine ensure that she continues to breath. 

When I worked in Scotland, it was exceptional for a newborn with bronchiolitis not to need mechanical ventilation. During the long course of Rebecca's recovery, I have learnt a lot about the potential of bubble CPAP, and about it's capacity to save the lives of tiny infants, born in Haiti and in other countries that don't have the personnel or the resources to place them on mechanical ventilators. I sincerely hope that more Doctors and nurses working in hospitals and clinics in the developing world will catch on to the bubble CPAP principle.

Of course, Rebecca is the child that God has placed in front of us, so please continue to pray for her and for her Mother. Pray for continued healing in Rebecca's body, and for her mother's wounded heart. I really believe that all women are called by God to a mothering role; to love sacrificially and to nurture his children. I think that Rebecca's mother denied this part of her nature because she was badly hurt, and overwhelmed - afraid that tenderness would drain her, open her up, and increase her vulnerability. She is now showing concern for her baby and for our other NICU infants. This softening of her heart tells us that our prayers have been heard and that God's hand is on both of his children, the mother and the daughter. He is with them and in them, whether or not they know it, and because of that, Rebecca's mother can not 'forget' her.

'Can a mother' forget the baby at her breast

  and have no compassion on the child she has borne?
Though she may forget,
 I will not forget you!' Isaiah 49:15

Far From Eden

I believe that their Father God intended them for Eden; a place where the soil was rich and the earth produced bountifully. A place in which they would be safe and nurtured into adulthood and all the days of their lives. Docillia, Shamira and Dabbens though, were born far from Eden.

Last Thursday, at the end of a long day, Haitian social services closed an orphanage in Kenscoff on the grounds that the children there were severely neglected. GLA was asked to provide emergency care for 15 sick babies. At 5pm, I watched from the NICU balcony, as social workers and GLA staff lead 23 children to the common room. The nannies and I counted 1 baby and 2 toddlers. The other children in the group appeared to range from 3-8 years old. Where would we put all of these children, with both houses so crowded?

Downstairs, I assessed the children medically, while others confirmed the identity of each child, photographed them and attached name bands to their wrists. Having received three critically ill, children from this orphanage in 2010, I was aware of the conditions the children would be coming from and I was fully prepared to set up a make-shift hospital ward. I had been praying for these children ever since my precious Geraldine had returned to that house of horrors. I scanned the room looking for her. To my dismay, she was not there.

Most of the children were malnourished, with red hair, spindly arms and bloated bellies.  Two were suffering from protein-energy malnutrition. Several had coughs and fevers. One little boy had healing wounds on his toes that he told me were from rat bites. A few had minor skin infections.  The youngest child, an 8lb baby who we were told was 4 months old was emaciated, severely dehydrated and suffering from diarrhoea and vomiting. He was the only child that needed urgent medical care.

Three of the 23 children have been admitted to the nurseries at the main house.  They are the smallest and frailest children. All three have infections, all are malnourished and all are responding well to special formula milk, plumpy nut and antibiotics. The wounds on the inside though, will be more difficult to heal.

Dabbens has only just began to trust that  there is no need to feed until he is overly full. The day after his admission. he was a fractious baby, with a hungry, desperate cry, who, pulled at his hair and chewed his fist. We would stop feeding him after a few ounces of formula so that we could burp him and he would kick and thrash and arch his back and look at us with pained confusion. The orphanage closure occurred just in time to save his life, but it came a month too late for his dead twin.

Docillia (shown on the left) is three years old and has only just learnt to walk. She is full of smiles and she chatters away with the nurses and nannies. Foreigners who used to visit her orphanage were amazed to see the transformation in her after 24 hours at GLA. We are told that they didn't know she could talk, and that they have never seen her smile before. They have known her for 18 months.

Shamira - We were told that she was 8 months old, but I counted 18 teeth in her mouth, and I suspect that she is at least two years old. Shamira is shy and a little bit withdrawn. She is willing, with trepidation dancing behind  veiled eyes, to accept our care and our tenderness. She can't place her confidence in us yet. Her urgent wails last Friday as she watched me give parasite medication, mixed with yogurt to Docillia, convinced me that at her last orphanage, some children got food when it was served, not all.

On Friday morning, as I spooned medical peanut butter, specially formulated for malnourished children into a bowl, and began spoon-feeding it to each girl, they exchanged impish, slightly bemused looks. Peanut butter from a spoon - has this lady lost her senses? Shamira seemed to inquire. Raising her eyebrows, Docillia responded with an expression that said, probably, but lets just go with it! In their minds, they had hit the jackpot.

Make no mistake, these are wounded children. Their early life-experiences have taught them that adults are inconsistent and untrustworthy and that they themselves are not deserving of basic care and protection. Not special. Not noticed. Not seen.

Part of the treatment here will be warmth, cuddle-time and lots of positive interaction with adults. You see, we can give these hurting babies all the food they want, and the best medicines,  but without gentle loving care, without touch and physical contact from their caregivers, there will not grow, they will not heal, and they will not thrive developmentally. Apparently, on some primal level, a life without love is a life not worth living.

The nannies and I believe without reservation that each of these little ones are precious to God. Knowing this, we feel privileged to tend to them. To comfort them. To relieve their suffering. To salvage their lives. We have no idea how long Dabbens, Shamira and Docillia will be with us. Will Social Services track down their parents in a weeks time or in a months time? Will the children be declared abandoned in 6 months time and eventually be adopted?

I don't know, and so I feel the same urgent need I felt with Geraldine, to strengthen and heal their bodies and sooth their hurting hearts as fast and as well as we possibly can. Meanwhile, I pray for the solution that will be most conducive to their long-term well-being.

God knows better than I do, what that solution is, in this place, so far east of Eden.

Jackson and Judeson: A Prayer for Motherless Children

They arrived last Saturday night, in the arms of an Aunt and Uncle, who each rocked one of their newly born nephews. With glazed eyes, the infants' relatives shared the boys tragic story: they had set off from their remote mountain village that morning with the twins. The labour had progressed without event, but immediately following the birth of the second twin, the mother, a healthy 32 year old woman, took a deep breath. It would be her last. The mother was dead. They family could not explain it.

Jackson and Judeson weighed 4lb 8.5oz and 5lb 1oz on arrival to the nursery. They hadn't been fed since birth. Both were slightly cool. Judeson's blood sugar was dropping, and Jackson, the smaller twin, had a very. very low blood sugar. We warmed the boys and gave them sugar water, followed by a bottle of warm milk. Jackson was too sleepy to suck and was having mild breathing problems, so he received a feed through a tube, and was placed on a modified bubble CPAP system for a day.

It is obvious looking at them, that these boys are identical. The only way to tell them apart is the difference in size and skin colour -  each boy goes through different shades of yellow, as they overcome jaundice. It is special to have identical twins in the nursery. This is the first set of identical twins we have had at GLA in several years. Since they shared not just a womb, but an amniotic sack, the boys are bed-sharing for now. Everyone agreed that was appropriate. For the Haitian staff, their sense of wonder about these beautiful babies has increased  due to an anomaly that, being identical, they share. Each boy has 12 fingers, instead of 10.

Did that mean that they had a triplet?

'Why, yes, Susan! You're so smart!' one nanny exclaimed. Haitians believe that polydactaly (having extra fingers) is a sign that a pregnancy started as a twin pregnancy (in this case it was a triplet pregnancy, so they believe.) The babies engage in a fight in utero, that ends with one twin consuming the other. As a sign to the parents and family members or this battle and it's outcome, the victorious twin gains extra fingers from the vanquished twin.

In a country in which infant mortality is very high, these extra fingers provide reassurance to the family. The child in their arms is strong. He or she has already proven that. The family experiences a feeling of pride, and increased confidence that their tiny baby might survive.

Despite this reassurance, the Haitian staff were very concerned when they started work on Friday morning. The were severely dehydrated. The nursing notes read that they had fed well. There was no mention of diarrhoea or vomiting, but we soon learned that diarrhoea and vomiting is just what they had. Judeson, the largest twin was the sickest. His weight was down 12% from the previous day. His brother had lost 10% of his body weight. I had to start IV's on both of them.

As I re-sited one of those lines this morning, I felt a twinge of sadness. The boys mother had been healthy. She had safely delivered two infants into the world, despite the odds. Despite poverty and lack of prenatal care and despite not having a skilled birth attendant present during her labour. If she had survived, she would have nursed the boys, but she was not given the chance to do that. Now she was dead and the boys were orphans. They were also very sick.

I know, of course, that God can redeem the loss for Jackson and Judeson, and of course, I am going to ask you to pray for them, and all my sick, motherless children on this Haitian Mothers Day. The twins mother made the ultimate sacrifice for her sons last week. It was a sacrifice that cost her her life. I have to believe that her legacy of love will live on in them.

Rebeca

It has been a busy weekend, with 5 very sick babies - 4 of them being tiny infants in GLA's NICU. For now, let me tell you about one of them. Let me tell you about Rebeca:

I was recovering from my surgery when she arrived. Rebeca was  born around 2 months prematurely, and she weighed a mere 892g (1lb and 15 oz.) She was  barely breathing when she arrived, with a pulse oxygen level of 37% and a falling heart rate. She needed immediate resuscitation and careful post resuscitation care on the night she arrived. Since then, her NICU stay has been anything but smooth. She has been resuscitated no less than seven times. In addition to many of the usual problems that premature babies face, including immature lungs, an immature brain and digestive problems, Rebeca has a chest wall deformity known as Pectus Excavatum, which, is a depression in the sternum, or breast bone. Hers is fairly wide defect, and I suspect it presses on her lungs.  Our poor baby contracted a respiratory virus that caused bronchiolitis, a condition that is often fatal in premature infants and newborns. This was further complicated by pneumonia and by fluid overload (the result of an IV infusion that was not monitored in my absence (officially, I was still out of action).  Rebecca didn't gain weight when she was ill, and as a result, she remains very weak, and is still on CPAP, over two weeks after we admitted her.

Last week, her mother suddenly left the orphanage for several days. Rebeca was producing lots of stomach acid at that point, and did not tolerate the switch to formula feedings very well. I was so relieved to see her mother return on Friday. I greeted her and asked her, please to express some breastmilk right away. The Mothers eyes darkened and she stormed away from me, returning 30 minutes later with a very small volume of milk.

That night, she refused to express at all. Saturday morning, we re-iterated that Rebeca had digestive problems that could be helped by her mother's milk and that could worsen on formula milk. The Haitian nurses and I emphasised that breast milk was recommended for all small babies, and that it was especially important for premature babies, far superior than anything that can be bought in stores anywhere in the world.

The nannies did all the things for this mother than Haitians believe will enhance milk production in lactating women. They made special meals for Rebeca's mother and encouraged her to rest and take care of herself. Still, Rebecca's mother was adamant, she had no milk, and she wasn't prepared to sit for 10 minutes at regular intervals throughout the day to re-establish the excellent supply that she'd had before she went home.

We were exasperated by 7pm that night! Rebeca's mother is in very good health. She is tall by Haitian standards, she is fat and she is eating us out of house and home. We had asked nothing from her, except breast milk for the baby. Did she really want us to give formula, knowing this could compromise her daughter's frail health?

We encouraged, we coaxed, we cajoled, we reasoned, and then came some tough talk.

'She's not my responsibility,' Rebecca's mother exclaimed sullenly. 'You're telling me that because I gave birth to her, I have to produce milk for her? It was God who decided to give her to me!'
'No', we told her. 'You have made choices, now you are a mother.'
But the words were not striking the mark. We were faced with a hostile teenager, with empty eyes, who sneered, and outright refused to express milk for her baby. The milk she said wasn't there. The milk that hit staff members three feet away, whenever she squeezed her nipple.We softened the approach.

'The baby is hungry. Look at her flailing her arms. And because she's crying, her oxygen levels are going down. You've been through a lot to get help for her. We've been through a lot. She's still sick. We know you want her to live. And clearly, the baby has a strong will to live...'

Miss Cammi was cut off abruptly. 'A will to live?' the mother said, spitting the words out of her mouth as though they were something foul.'Well, I don't know why she wants to live! I delivered her in my toilet bucket!'

I was stunned motionless and  defeated. And it wasn't the words, it was they way they were spoken. Not just the fact that the baby was born in a toilet, that happens sometimes. But it was the disregard for this beautiful and precious soul. The tiny life in the incubator, in the corner of the NICU.

I turned to the Haitian staff. Maybe this baby didn't need her mothers milk as badly as we thought. Too much bittterness. Too much hatred and resentment.

Today is Haitian Mothers day. Mothers Day is supposed to be a celebration and  rightly so, because all mothers make sacrifices, and a loving mother is a golden thing. Today, though, i am painfully aware, that motherhood does not come to all women by choice. For some, mothering is a struggle, and the mantle of motherhood, a very heavy burden.

'

Awake and Alive!

 The anaesthetist called my name. I snapped awake, and was almost instantly aware of a gurgling sound, then the sense of my breath being sucked out of me. I froze. I remember coughing and gagging as the tube was removed and then the bitter taste of bile in my mouth. Then, in Kreyol, 'Ok, ok, a new gown.'

As they changed me, I felt a deep ache low on my right side, and I heard my surgeon reassuring me that it was all over, but that the appendix had ruptured. 'You don't feel any pain, do you?'

'Oui'. I did

Immediately, I was given pain medications in my IV line. As the medication was being injected, I began to shake violently.

'What's the matter?' a voice enquired

In my grogginess, I answered in English, through chattering teeth. The voice didn't understand. 'Pardon?'

'Fwet! Fwet! Fwet!' I answered. (Cold! Cold! Cold!) 

'Ok!' The voice was a friendly one. Blankets were piled on top of me and the shaking stopped. 

I was so glad that I spoke and understood Kreyol. Although my Doctors spoke excellent English, the hospital nurses spoke none at all. It would have been a very frightening and bewildering hospitalisation without a very good knowledge of Kreyol. My language abilities failed me only once during that hospitalisation:

Through in the recovery room, I continually fell into such a deep sleep that I would stop breathing. The pulse oximiter would startle me awake as my oxygen levels dropped.  'Are you ok, my dear?'a nurse asked, coming to the head of my bed. 'I keep losing my breath I answered.' Her forehead creased into a frown. Try as I might, I could not think how to say, 'I just keep forgetting to breath', in either English or Kreyol!

There were tears. I had been under anaesthetic for three hours, but anaesthetised people, however long they have been out, wake up feeling as though only a second has passed. As a result, the terror I'd felt in the minutes before I went under, was still fresh in my mind. 'I was so scared,' I kept saying. Crying hurt my stomach, so I just had to stop,  not an easy thing to do, with such strong emotions swirling inside me.

 I had been frightened but I had received competent care from the people in the operating room, within the technological limitations they were working under, and my God had guided the hands of my surgeon, all the while, holding me in the palm of his own hand. And I was alive! My Grandfather had died, almost as far away from home as I was now, and in this third world country, I was awake, and aware post surgery, and for the first time in two days, it seemed possible that I might live.

Around the time that James Westwood died, his best friend, a man who was almost closer than a brother to him, had a terrible nightmare, in which my Grand-father was torn away from him, screaming and wild eyed, and left alone on a remote beach. James had suffered the same pain and the same isolation and the same terror in the same state of loneliness that I had. For me, though, the last goodbye I had said to family and friends as I headed back to Haiti after the Christmas holidays wouldn't be forever. I would see them again in this world. I was so grateful for this. So grateful that there were no words to express it.

Do Not Fear

My Haitian hospital experience was for the most part, a comfortable one. Laying under crisp white sheets, in a freshly painted, air-conditioned en-suite room, I gave thanks for the graces I had been given. Like most ex-pat workers in Haiti, I did not have an insurance policy that would cover surgery and hospitalisation, in-country. Government travel warnings make it all but impossible to obtain insurance for travel to Haiti. This being the case, I was mentally preparing myself to endure surgery and recovery at the Haiti Baptist Mission Hospital. I had visited this center shortly after the 2010 earthquake, and had found a set up very like that of a World War One field hospital. The Haiti Baptist Mission was primitive;  this private hospital in Port-au-Prince was one of the country's best.

The journey there, along Haiti's torn and pot-holed roads had been a jarring one and an exercise in enduring pain. I made it through the journey by extending my arms down against the car seat in an attempt to splint my inflamed belly as best as I could, while our Haitian Paediatrician, who, insisted on personally escorting me downtown for lab work and investigations, urged her driver to go slowly and avoid the bumps. The poor man did the best he could but there is no avoiding the bumps on our mountain road!

I gritted my teeth, grimaced and grunted through a painful sonogragram, mindful  that had these diagnostic tests been performed 24 hours earlier, when my pain had been so bad that I hadn't been able to stand up straight, the procedure might have been absolutely unbearable. At a dingy clinic in the Chanmp De Marrs district of the city, the only clinic that was able to fit me in on an emergency basis, the diagnosis was made. I had a severely inflamed appendix and should go directly to the hospital.

I had been slightly dehydrated when I left God's Littlest Angels but from mid-day onward, I had been instructed to stay strictly nil by mouth.That meant no fluids, and no medications. Hearing this, I had pleaded for an injection  of something for nausea, before I left the orphanage, but the Paediatrician said there wasn't time for that.  Several hours in the Port-au-Prince heat had taken it's toll on my body. I was completely parched by 6pm that night, when I was admitted to the hospital. I remember pleading with my surgeon, in the admissions office of the Canape Vert Hospital, to give me a glass of water. Just a little one. Maybe a few sips, or at least some ice chips? I'm sure I was quite pitiful. The surgeon look at me fondly, shook his head, laid his hand on my shoulder and told me I would get all the fluids and medications I needed intravenously.

The nursing care I received in that hospital harked back to an earlier time; nurses in starched white uniforms wore caps pinned to their hair and delivered particular care, under the leadership of a matron. Matron checked in on each and every patient daily, including on Sundays.

On admission, an IV was quickly inserted and I was given potent IV pain medications, three IV antibiotics and a liter of IV fluid. As the Doctor explained to me that I was not well enough for surgery, I had a flash of insight into why my Grandfather might have died. It is unlikely he would have received IV fluids during the course of his illness. If he was given antibiotics before surgery, which I doubt, they certainly would not have been as powerful as the ones I was being given now. I was in the hands of a skilled surgeon, and an attentive nursing staff; he was treated by a General Practitioner on a remote Island in the South Atlantic Ocean. His surgeon was a man, who, was known to practice while under the influence of alcohol. James Westwood barely stood a chance. I knew this, as I slipped into a  delirium of dancing lights and fire-work displays. 'Do you feel up to talking?' a  visitor asked one day. I smiled and shook my head slowly. 'I don't talk now. I just dream.'

The next morning, my pain killers had worn off, I was being prepared for surgery, and I was in more pain than I could bear. The infection was advancing throughout my abdomen and my peritoneum and the slightest movement or the lightest touch to my abdomen sent pains shooting throughout my belly and up into my chest and shoulder. My Anaesthetist stopped by to check in on me. Recognising that I was suffering, she smiled understandingly. 'It's almost over, I'm here,' she reassured me.

My transport to the operating suite was truly agonizing. I remember wincing as the trolley went over bumps along the route. Flat on my back, moving at  a speed I could not control, nauseated and dizzy. I was gripped my terror, and all confidence in God and my surgical team suddenly abandoned me. I was sure I was going to die! I wanted my Mum!

I was wheeled directly into the operating room, where, I was strapped to the operating table, arms outstretched and legs extended. Being restrained in that position intensified both my pain and my fear. To my horror, a male operating room assistant then began partially undressing me to attach ECG leads. Despite the gentle handling and reassuring humour of the Doctors and nurses, I could not shake the feeling that I was about to be crucified in this austere, brightly lit room. All kinds of thoughts raced through my mind about what was going to happen next. As lovely as the staff tried to be, I was not soothed. They offered no explanation for anything that they were doing to me. The nurses on the inpatient unit had been reprimanded by the surgeon: according to the order he had written, I was to have received 3 liters of IV fluid overnight, not 2. Now, I wasn't even stable enough for surgery, he complained, but the surgery would have to go ahead because there was no more room for delays.

'Why did they start an IV in that vain, anyway' an operating room nurse snapped. 'It's not suitable for re-hydration!'

'Her veins were shut down, yesterday,' the anaesthetist answered. 'They weren't good at all.
'Oh, she was sick yesterday,' the nurse shot back. 'Well, she's much worse today! Today she barely has a blood pressure at all!' Then, turning to me, and patting me on the arm, and reassured me, 'we'll find another vein, Cherie. Pa pe.'

Pa Pe . 'Do not fear.'

As the nurses worked to get a more reliable IV line into me, I looked up at the ECG monitor. Oxygen saturations in the low 90's. Heart beating at a steady 76 times per minute. oh, that was ominous! A day ago, my heart had raced at over 130 beats a minute at rest, in response to the infection. Today, I was critically ill, and my heart wasn't responding, not to the infection, and not to the fear that raged through me. I knew then, that the infection was beating me. It was a moment of cold clarity, in which I realized that I was dying. Dying was not just an invention birthed in my mind, by terror. It was a very real possibility, and I couldn't fight it. I wouldn't win. I was blind with panic, desperately reaching for father God. Where are you, now! Why have you left me? Why?

It was then that snatches of bible verses drifted into my head, spoken in a voice I perceived rather than heard. 

I will never leave you, nor forsake you. I will be with you unto the end of time. 

Do not fear. Do not be dismayed

Yes, he saw me, He knew, and he understood that I was in pain and that I was very, very afraid. He had endured far worse agonies. He had sweated blood. This, though, what was happening to me, was not a crucifixion, not a punishment and no-one intended to hurt me or shame me. He had been punished. They had intended to wound him, and to utterly humiliate him in the process. His suffering had been holy and it had brought me to God. Now, he was here to help me bear my suffering. I have taken on your infirmities, and I can bear your fear. I am a man of many sorrows. Give yours to me.

God had me where he wanted me and his eyes were on me. His spirit had had discerned the prayers I was too frightened to pray. Now, his face was turned towards me. He was telling me he would be be with me always.

Though I thought I was alone for a few, terrifying minutes, I never was. If suffering had to come, at least, I knew, I would face it with my God. Come what may, whether I lived or whether I died, I was going to be OK.

The anaesthetic was injected into my IV line.

'The mask has oxygen, breath gently.'

And with that, I drifted mercifully into oblivion.

Note: James Westwood was born on the 15th of May, 1927. Today would have been his 85th birthday. Happy Birthday Papa!

Dreams And Visitations From Father God

'The LORD will guide you always; he will satisfy your needs in a sun-scorched land and will strengthen your frame. You will be like a well-watered garden, like a spring whose waters never fail.' (Isaiah 58:11).

Late morning on April the 30th, I was filling out vaccination cards at the nurses station, directly in front of the NICU. I reached for my glass, found it empty and sighed with a faint longing. I would complete the documentation, because I wanted that out of the way, but my mouth was dry. A few minutes later, my head was aching and my sense of malaise was growing. Suddenly, I missed home. Homesickness comes in ebbs and flows to expat workers and I have learned to accommodate it, along with all the highs and lows that go along with my work here. It's when I am feeling unwell though, that I struggle the most with the distance between me and and my family in Scotland. At a time when I want, need and would  benefit from caring gestures, I must do without them and I must take care of myself. I feel so alone at those times.

Absent mindedly, feeling weak and nauseated,  I reached again for the red plastic tumbler - the empty red tumbler, and found it half full! ' There were few things I would have appreciated more at that moment than that icy cold water, to ease the pain and settle the nausea..'and the water doesn't taste Haitian, it tastes of home,' I told my Facebook friends at lunchtime. It was the last most of them would hear from me for a week. 

Mesi Bondye!! I didn't understand the reason for this little act of loving kindness, but I was confident that was what it was. A gesture of compassion from a loving father. I had taken some aspirin. The  headache  had lifted and I enjoyed a mid-day meal of pasta and pesto sauce. As my shift came to a close, a vague discomfort in my upper abdomen shifted lower in my belly, and became a dull ache, but I made it through to the end of my working day with a smile on my face. I joked with the nannies and chatted with the volunteers over dinner. 

At 8pm that night,  I was suddenly gripped by a sharp and severe pain in my belly, and I seriously contemplated whether that glass of water had somehow been contaminated on route from heaven. Later, I came close to posting something to that effect on my Facebook page. I had been violently sick and the pain had pain eased, but I was tired, and I couldn't be bothered logging on to my laptop. I fell asleep, waking sometime around mid-night with a high fever that caused my muscles to rigor. I had suffered from frequent migraines since before I was a teenager. Debilitating though they could be I'd had to learn to live with them. As a result, I could bear the pain I felt now.

I developed diarrhoea. It was not severe, but there were signs that it was caused by a bacterial infection. I didn't believe in taking to my bed. I did believe in the capacity of my body to heal itself, which, had always been remarkable. However, the exhaustion and lethargy I felt during those days was incredible, like nothing I had ever experienced. I reasoned that the long hours I had put in stabilizing Jusmy, followed by a week of night shifts that I had pulled to cover staff sickness, one of which, backed onto a day shift, had drained me.  I started a protocol for travelers diarrhoea. It consists of oral rehydration solution and an antibiotic. Diarrhoea is such a common problem in the developing world that it is not considered necessary or practical to visit a Doctor and obtain stool cultures before antibiotics are started. Doctors provide the guidelines for self-treatment and nurses and travelers commence treatment by themselves, and seek medical help if their symptoms worsen. The pattern of my fever strongly suggested that I had a bacterial infection.   I knew well enough that my immune system was not handling the infection this time. I knew well enough that I better not try to work anymore than was absolutely necessary, so, I swallowed the pills and I took to my bed. 

My fever climbed over the days that followed,  and my dreams became increasingly more vivid, brighter than techni-colour. I remember flying over the ocean in a flying saucer, being amazed by the depth and intensity of its blue shades. I remember being aboard a ship. I remember standing on its deck, and feeling a strikingly cold, briny wind lash me. Thank you! Thank you! I was so hot. So, so hot!

On Thursday Afternoon, I lurched between delirium and lucidity,  and developed some worrying signs that suggested I needed medical help. The pain had moved very low in my pelvis on the right side, and my abdomen was tender. I realised that I hadn't eaten for 3 days. I'd had no appetite. Despite Almost 72 hours on antibiotics, my fever had not broken, and diarrhoea was still a problem. It hurt to move, it hurt to breathe. Miss Vicky, an American nurse, walked by outside my room. It was raining heavily. I couldn't muster a deep enough breath to call out to her. Something was wrong. I suspected appendicitis. I told my roommate I needed to see a Doctor. She grimaced. I knew it would be dangerous to drive down the mountain in this weather. Tomorrow, we agreed. Tomorrow morning. 

That night, I dreamed I was standing on a road that cut through a heavily wooded area. Soldiers were marching that road, to the horizon and beyond. A man appeared beside me. He looked as though he was in his 60's. He had soft, white curly hair and an impeccably kept beard. He was of average height and he had a muscular build. He was was wearing a tartan shirt and blue jeans. Resting his foot on a tree stump, his aura was at once relaxed and commanding. Smiling at me he made a sweeping gesture with his arm. 'How many men do you think I have there,' he asked, motioning to the soldiers that marched over a snow-capped mountain on the horizon.

'I don't know I replied, It was an awesome sight, and my mind struggled to grasp the magnitude of it 'Maybe 10,000?' I guessed.

'I've got 70,000 men out there,' the man told me. His face was beaming with pride, 'Every single one is exactly where I want them. And you,' he declared, his eyes shining, 'You are exactly where I want you.'

And then I woke up.

I was feverish, yes, and extremely sick, but I took the dream seriously. I noted than my pain has decreased significantly from the day before. I recognised that a sudden release of pain might mean that my appendix had ruptured. I understood that soon, fecal contents and puss would seep into my abdominal cavity, the lining of my digestive tract and eventually cross over into my blood stream. 

Upstairs in the NICU, a pulse oximeter and blood test confirmed the seriousness of my condition. If my CRP is more than 100, I know I need a Doctor, I told myself. CRP (C-Reactive Protein) is a marker of inflammation that usually increases significantly with severe infection. A result of over 100 would be concerning, given my symptoms. My CRP result was greater than 210. It was so high that our portable analyser was unable to measure it. My CRP was off the scale!

I had an overwhelming infection. My heart was beating 165 times per minute and my tissues were poorly oxygenated at just 86% following the walk upstairs. 95-100% is considered normal. 85% is considered pre-terminal. Five minutes later, my oxygen levels were hovering at 88-91%. I knew there was little time to lose. I knew that my life was in danger. Convincing my colleagues of this, though, was another matter. I made two attempts to persuade my room mate, who worked in the office, that I needed to be transferred to the city for urgent medical evaluation. My colleagues, though, had other plans for the day - matters to be dealt with that they believed were more pressing. In a last ditch attempt, I asked my room mate to write down my vital signs and to call my boss, a Registered Nurse, who was in the Dominican Republic. I was certain that she would tell the staff that taking me to see a Doctor in the city had to be the priority. But no,  an adoptive family was to appear before the local judge to get approval to adopt the child who had been matched to them. There weren't enough drivers or vehicles. I was told I would have to wait. I had no fight left in me......I should call Mme Bernard...... I needed oxygen and IV fluids.......I should call Dr Nathalie on my cell phone. She would understand....... My phone was just out of reach...... I would get it in a minute....

I fell asleep. I woke, I got up to use the bathroom. My mind was drifting. I forgot about the oxygen, and the fluids, and Mme Bernard. I fell asleep again.

Thankfully, my heavenly father, the warrior king, commander of the troops and the God of the universe had me in the palm of his hand at that time when I couldn't take care of myself; when there was no-one else to take care of me. He and showed me his divinity and his sovereignty but also his tenderness. He had me right where he wanted me. That's what he had said.

Deep Thoughts, But No Words

In the mid 1950's James Westwood, a young father from Alloa, in Central Scotland,  left his wife and three year old son, and set sail on assignment with a merchant shipping company. Thousands of miles from home, on the Atlantic ocean, he fell seriously ill. It would be three days until his ship reached inhabited land, with a resident Doctor.

On the 1st of May 2012 at shortly after 10am in the morning, the man's granddaughter, me, a young nurse serving at an orphanage in Haiti's Kenscoff suddenly felt unwell. Over the afternoon, I developed a set of vague symptoms; a migraine, slight discomfort in my upper abdomen, along with nausea  and lightheadedness. By 10pm that night, the pain had moved to my lower abdomen. I spiked a fever and began vomiting. A busy orphanage schedule, and torrential rain prevented me from receiving medical treatment urgently. Three days after the pain started, the grand-daughter was admitted to a Port-au-Prince hospital.

Details of James' condition at the time of surgery are scant, but I, having developed a severe intra-abdominal infection, was suffering from peritonitis. I had been in septic shock for 24 hours when I underwent surgery for removal of a perforated appendix.

James Westwood died shortly after his surgery. He was 29 years old. He died, and I survived and I am somewhat awestruck, and humbled beyond belief, thinking deep thoughts that over the next few days, I will try to put into words. Somehow.

Many Hands Extended - Thank you Calvary Reformed Christian Church

Over the past few weeks, I have been very aware, more so than ever, that the staff at God's Littlest Angels in Haiti are not alone in our efforts to care for our babies at the orphanage's main house.

That fact was underscored two days ago, when my precious baby Jusmy choked on his morning medications, stopped breathing, turned blue, and needed basic resuscitation measures to help him recover.

Mme Bernard and I lept into action, suctioning the baby's airway, and turning on the new oxygen concentrator machine. The oxygen concentrator arrived a month ago, and was, I knew, donated by Calvary Christian Reformed Church in Michigan.The oxygen concentrator is the shown on the bottom right of this shot.

Two of GLA's children attend that church. When he first came the orphanage, one of these children,  Aiden, was recovered from malnutrition in the main house nurseries. Two years after their children arrived home in Michigan, Jeff and Marrisa Brinks were mindful of the children GLA continued to nurse to health and they encouraged their church  to support our work in the intensive care nursery.

Calvary Reformed Christian Church also donated a syringe pump (shown on the incubator shelf). This arrived in Haiti the very day that GLA received the call about Jusmy - a malnourished, baby, born prematurely with a severe cleft lip and palate. We were able to use that syringe pump to infuse a lipid solution and antibiotics at a controlled rate, to stabilise this extremely fragile infant.

It was a great encouragement to the NICU staff and to me, to realise the warmth and appreciation with which these pieces of equipment were given. In turn, we would like to encourage the Brinks family and their home church with the knowledge that Jusmy, who, was critically ill when he was admitted to God's Littlest Angels, is doing very well. This baby, who was turned away from the hospital in which he was born as a hopeless case, is re-gaining his health, growing and gaining weight in our NICU in the Haitian mountains.

Your generous donations helped to make that possible. The oxygen concentrator and IV syringe pump are gifts that will pay forward, long after Aiden and Samara have forgotten their time with us, giving hope and life to many babies.

No, the Haitian and foreign staff are not alone as we care for these children. There are many hands extended out to them. Thank you for being those hands.

With heart-felt gratitude

Susan, Jusmy and the NICU staff

A Letter Home

Stabilising Jusmy was a tough job for an orphanage in the Haitian mountains.

Jusmy came to us as a 3 week old premature boy with a cleft lip and palate. He was extremely malnourished and suffering from an infection. For several days, we wondered if his heart had been too weakened by starvation to continue beating.

The picture below was taken this morning. No more wires and tubes.

Jusmy, nestled in his incubator

Although I had to be in the NICU until 1-2am for the first week he was with us, I was not working alone. Jusmy received very particular attention from our Haitian nannies and nurses, while our staff and volunteers and supporters all over the world sent up prayers on his behalf. It seemed that God had already answered those prayers, before they were even offered.

The day that Jusmy was admitted, Jean Bell, who manages the US office flew into Haiti. This was a blessing for two reasons. Firstly, Jean had expertise as a former ICU nurse that she was able to share with me. Secondly, she was carrying with her a portable breast milk pasteuriser, that was donated by a friend and by members of my church in Scotland.

Jusmy was so frail and so ill, that he wasn't able to tolerate formula milk. We gave him IV fluids and intravenous lipids. Since his mother reminded in hospital and was unable to produce breast milk for him, we also started Jusmy on small amounts of donor breast milk, which was safely pasteurised in a low technology, but scientifically backed system, purchased from a company in England. The single bottle breast milk pasteuriser resembles a thermos flask. It allows us to treat up to 200ml of donor milk at a time. The pasteurised milk is sterile but most of the antibodies along with other immune boosting substances the nutrients and the digestive enzymes in the milk are preserved.

The single bottle pasteuriser, donated by friends of  our Haitian babies in Scotland!

Although he arrived in a critical condition and we had to advance his feeds very slowly, Jusmy's weight increased from 1.34kg to 1.92kg in 10 days! So thank you to the milk donor and to Irene Gillies from Brechin, and the tea ladies at Saint Margaret's Roman Catholic Church in Stirling. Thank you also, Jennifer.  Your gifts have meant life and hope for a tiny, and gravely ill infant. The best thing about the money you donated is that it will keep on giving. The breast milk pasteuriser will allow God's littlest Angels to treat donor milk for many babies over the years to come.

Three Three Pound Babies

Last night, Jusmi took a turn for the worse. He was not responding to his antibiotics and was still showing signs of infection. At 4pm his IV line stopped working and had to be re-sited.  His heart rhythm had been abnormal over the past couple of days, as his electrolyte levels stabilised. Now the rhythm was extremely irregular. His heart wasn't  pumping enough blood to his tissues. His metabolic imbalances worsened and his body went into shock.

Although I treated Jusmi as well as I possibly could, it was a very anxious time. The treatment of preterm infants who have been without medical care for several weeks and who are sick and severely malnourished is a specialised field. I have spent hours researching what is known about the management of infants like Jusmi. The truth is, there are lots of gaps in the knowledge base. I find myself drawing upon theory, guidance as well as the opinion of experts from different fields. Filling the gaps is often a judgement call.

Knowing this, and knowing that Jusmi's heart, one of his  most vital organs was failing, and that I couldn't do everything that a fully resourced Neonatal Intensive Care Unit would do to help him, Iwas fully aware of how precarious his situation was. I worked, watched and prayed. Worked, watched and prayed.

As I was talking about Jusmi's care with Jean Bell, who is a former intensive care nurse, we heard that a 3lb baby girl, from our area had been discharged from hospital that day. Could the mother bring the baby by for a check up in the next couple of days?

I didn't want to see the baby in a few days, I wanted to see her right away! She had been discharged from an excellent neonatal unit outside of Port-au-Prince. It is several degrees warmer down there, I was concerned that she would get cold now that she had moved up the mountain. A few days from now, the baby might be profoundly hypothermic.


At 8pm last night, with Jusmi still in a serious condition, Christy arrived. She was slightly cold, and she had a low blood sugar. We began treating her. Two hours later, the baby was warm, pink, and chewing on her hands.

No, you are not seeing double! Christy (shown on the left) and Erline are the same size, and exactly the same weight. With three babies needing incubators, and space in the NICU for two incubators, we had to improvise. These girls are not twins but they are incubator sisters.

This morning, Christy was started on antibiotics for diarrhoea. She is doing very well. Erline, who has gained over 300g since she was admitted last Friday is learning to breastfeed, so that she will continue to grow and thrive when she is big enough to leave us. My little man, Jusmi, is doing better now that his antibiotics have been changed. As the hours pass, my confidence grows. Maybe this one will live.

I really hope that he will.

Jusmi

Jusmi arrived yesterday. 3lb. 18 days old. Severely dehydrated. Malnourished. Cold. With an intestinal infection. And in shock.

He was born 2 months prematurely at a rural Haitian hospital. The staff there said that there was nothing they could do for him. I am so glad that he made it up to God's Littlest Angels. There is plenty that we can do for Jusmi.

He has needed a lot of intravenous fluid and careful re-warming to get his body out of its shocked state. He needed antibiotics to treat his infection. He had metabolic imbalances that are gradually correcting. As he continues to stabilise, his heart rate and rhythm and his tissue oxygen levels are being monitored continuously. His temperature, blood sugar, his electrolytes and blood gasses are being measured regularly.

The extreme stress this preterm baby's body has been under has the potential to damage his liver, his kidneys and his intestines. I watched the signs keenly. As things stand tonight, Jusmi's blood isn't clotting quite as it should and is only tolerating very small feeds of donor breast milk.


Jusmi is getting the very best medical care we can provide, delivered with the love and tenderness that he deserves. Love and prayer, after all, will be every bit as important to his recovery as the technicalities of what we will do for him.

Please pray for Jusmi's continued healing.

Erline: Compassion's Face

Seven week old Erline was born prematurely. She arrived this afternoon,  weighing 1.14 kg (2lb 8.5 oz). Erline's suffering began the day she was born. That was the day that her twin brother died. It was the day that her own battle began.

Her mother tells us that the baby was discharged from hospital two days ago. She had beat an infection in the Paediatric ward there, and was sucking expressed breast milk from a bottle. I learnt that the overcrowded hospital had sent Erline's mother home when the baby was a week old. Separated from her baby, Erline's mother did not produce enough milk to keep her hydrated, so the baby was given intravenous fluids for several weeks. Today, seeing the loose skin hanging from the infant's stick-thin legs, I struggled to understand why she had been discharged. At just over a kilogramme and suffering from malnutrition, it was unlikely she would survive. The head Haitian nurse explained to me that overstretched hospitals in this country routinely discharge the least critical cases, to make space for sicker children. Erline was one of their less critical cases. 

The baby was mildly hypothermic and slightly dehydrated, when she arrived at God's Littlest Angels today.

Over the next 48 hours, she will be constantly monitored and will need regular blood draws to ensure that her glucose and electrolyte levels stabilise. 

occasionally I receive comments from people who consider the Erline's of Haiti, hopeless causes. I am not sure that I have always answered these people well. If she were yours, wouldn't she be worth it?

We make all kinds of distinctions in this world, creating political and geographical borders; logical reasons not to extend charity and compassion outside of those limits. 

But when it comes down to it, compassion is utterly illogical. Not something we are duty bound to do, but something we can do out of love. Because of people all over the world, I  able to provide care to this extremely vulnerable baby. The compassion of all these people is utterly illogical and because it is freely given and not extracted from them, it is magnificent. 

Today is good Friday. Today I saw Jesus in Erline and I was reminded that if compassion has a lovely face, it also has a suffering face and that for us, the sacrifice involved in extending compassion is a very small thing.

Dachka: An Orchid Transplanted

The first thing I noticed about my new baby were her dainty features. Her tiny eyes have a slight upward slant and are framed by elegantly shaped brows. She has a button nose and although she is pale, her skin in flawless. Her's is an exotic and fragile kind of beauty that took me by surprise, as though an orchid had been transplanted into the nursery. A flush of colour and a faint perfume were my first impressions of her.

The second thing I noticed, a second later, was the flat bridge of Dachka's nose. Next, I saw her low-set ears. I took her bony hands in mine. Turning them over, palms upwards I noted a single crease, cutting straight across each palm.

Dachka is four and a half months old and she weighs 7lb 3.5oz. She is significantly malnourished. First I saw that she was beautiful. Next I saw that she  had Down's syndrome.

Perfection

Our newest boy in the nursery, 7 month old Mackenson has a cheeky [ornery] grin, that inevitably draws smiles both from his nannies and from our visitors.

Mackenson was transferred to us from another orphanage on the understanding that his right ear was  malformed and that this would make him difficult to place. We admitted him on Monday, exchanging puzzled glances as we searched for the malformation we had been told about. We found that the cartilage of his left and right ears formed a different shape. Foreign staff questioned Haitian staff. Did Haitians have any traditional beliefs about the shape of the ears?


Absolutely not we were told. Nannies, nurses and the Paediatrician were all in agreement. This did not constitute a malformation. One lady inviting us to examine her own ears, pointed out that her ear cartilage took on exactly the same shape as the new baby's did. others told us of friends and family whose ears were just the same as Macekenson's right ear. He was like many Haitians, they said.

And the fact that one ear looked different from the other. Was that important?

No! Haitian and foreign staff were in agreement. The difference was barely noticeable. Interesting but not really noteworthy.

A quick review of the documentation that came with the baby showed that he had initially been sickly at his previous orphanage. Not so now. He appears to be healthy and developmentally, he is on track for his age.

We are all made in the image of God, but not exactly like him. We are all different. All known personally to him. All needing his enduring love, his grace and his healing.

Soon Mackenson will be proposed to one of our waiting families who will, without reservation, accept him as their son. They will watch with keen eyes, taking notes of all the ways that he is special and all the ways that he is perfection.

Unfaded Beauty

We admitted a sibling set to GLA's main house late yesterday afternoon. This morning, with the help of a colleague, I recorded their vital statistics.

Anel, the little boy on the left of the photograph weighed in at 12lb 15.5oz and his length was 63cm. 

Wiseline, the little girl to the right weighed 13lb 14oz and measured 68cm in length.

Twins? The colleague asked.
'No.'
She gazed up from the admission paperwork, looking mildly surprised. 

We have been told that Anel is three months old. Wiseline is his older sister. She turned two at the beginning of March!

Her growth is severely stunted, and she is moderately underweight for her height. When I heard that she could barely crawl, I groaned inwardly. Children like Wiseline, whose tiny bodies have endured years of malnutrition can be extremely difficult to rehabilitate. Often, they have chronic health problems,  remain delayed in their development for years, and go on to develop learning difficulties in school.  Now that I've actually seen her though, I am feeling optimistic about this tiny girl's recovery. 

Her general health is remarkably good and she has surprising strength in her spindly legs. She has a good appetite, a brightness in her eyes and an openness to her new caregivers that makes me hopeful. So long as this child doesn't have any medical conditions that have contributed to her malnutrition, the chances are that she will adjust well to orphanage life, and go on to grow and thrive. 

Malnutrition has a way of stealing so much from children. One thing I am sure you will agree Wiseline has not lost, is her beauty. That is unfaded. 

'I will restore to you the years that the swarming locust has eaten' Joel 2:25

Talia

'This baby will give you trouble, Susan!' the Paediatrician declared.

Talia? That little bundle of baby girl sweetness? Trouble?

Sometimes when medical people talk about 'trouble' we are actually describing a patient who presents us with a clinical challenge.

Talia had a deep red colour when she arrived at God's Littlest Angels, the day before. She was 13 days old and the whites of her eyes were yellow. This was a sure sign of jaundice - a condition that occurs when bilirubin levels rise. Bilirubin is a pigment in red blood cells. Sometimes, newborns' livers cannot excrete bilirubin in the first week or so of life and the rising levels of bilirubin stain the skin. Jaundice has to be monitored - high levels of bilirubin can cause brain damage.Although I was concerned to see Jaundice in a 2 week old baby, wondering if this was caused by something other than just an immature liver, by the time the baby saw the Paediatrician the next morning I was not as worried as the Doctor.

 In early December, our orphanage Director arrived in Haiti with donated equipment from a US based medical supply company called Children's Medical Ventures. One of the pieces of donated equipment was a transcutanous bilirubin monitor. This made it possible for us to immediately screen baby Talia, using a painless test to determine whether her  jaundice level was an immediate threat to her health. We already knew that it was not. We had already tested a few drops of Talia's blood, and determined that she had a very high level of red cells in her blood. We had also done a bedside test that screened Talia for signs of infection. That test had been negative.

Over the days that followed, we monitored Talia's bilirubin levels, and observed her carefully. The Paediatrician was pleased by my report that the bilirubin levels were falling, and that Talia was waking for her feeds, tolerating them well, breathing normally and peeing and pooping regularly. The most likely cause of this baby's high bilirubin was delayed clamping of the umbilical cord. The extra cells would have made her blood more viscous and this could have caused breathing problems, as well as damage to her brain and kidneys.

All the signs indicated that although Talia had not had access to medical care, she hadn't suffered any complications. Her condition was temporary and it was resolving. I peeked at her, sleping peacefully in her box crib. I sighed softly, letting the last remnants of the concern I had harboured for her slip away. I am a Paediatric Nurse. I see lots of sick newborns. Lots of newborns with problems. It is always a blessing and a relief to look upon a  beautiful healthy baby.

Talia is no trouble at all........at this point in her life ;-)

Mitigating the Hurt

There are so many things I will never know about the lives our babies lived before they came to God's Littlest Angels. Those unknowns trouble me sometimes. People tend to assume that early traumas, the kinds experienced by pre-verbal infants are forgotten, and therefore unimportant. I think Mothers of adopted children have long come to know, what science is now uncovering - that early experiences of stress and trauma change the structure of babies brains, forging neuronal pathways that trigger a stress response to particular triggers, well beyond infancy, and even into adulthood.

I can make guess about the things our babies have endured from the womb - exposure to malnutrition, to their mother's stress hormones, and  possibly to toxic drugs. Many are then born into impoverished families, in crowded, unsanitary conditions, with inadequate food and shelter, and without access to medical care. They go on, one way or another, to lose their families, and find themselves in an orphanage.

In the past week, two small infants were admitted to the NICU. Oddison is a month old and he has a very low tolerance for discomfort, crying in short, piercing bursts. and trembling with anxiety whenever he is hungry or needing a diaper change. For now, he is unable to trust that his needs will be met. His mother told us that he has lost a significant amount of weight since birth. She was unable to produce breast milk and was only able to afford one can of formula for him. After that, she fed her tiny infant sugar water. He had severe diarrhoea when he arrived and needed to be re-hydrated intravenously. In his malnourished state, he became fluid overloaded on that IV and developed a mild case of heart failure.

I wish I could fix all his hurts, and make up for everything that has been lacking in Oddison's life. Of course, I can't, but at GLA, we can provide a good standard of medical care, and adequate nutrition. There will be people to care for him and hold him around the clock.Neuro-behavioural scientists tell us that stress and it's affects can be mitigated. I hope that we will earn Oddison's trust and confidence. If we do, there is every reason to believe that he will begin to thrive here. Now, having recovered from his diarrhoea, he is ravenously hungry. 

Daphka arrived yesterday. I haven't gotten to know her yet. Our Director tells me that hers was an urgent situation: she was living with her mother on the streets. Although I have been up to the NICU several times to assess Daphka, I always find her sleeping. First impressions - she is well-filled out and has shiny black hair and beautiful clear skin. Not a single worry line creases her brow. I hope that means  she doesn't carry too many hurts.