January 9, 2012

Get Karen to Haiti! Support Local Midwives Serving Women in Earthquake-Ravaged Region

Weeks after the Jan. 12, 2010 earthquake decimated Haiti’s health infrastructure, Karen Feltham, a certified nurse midwife and nursing instructor at Binghamton University, traveled to Fond Parisien, Haiti, to provide support for pregnant and laboring women at a local birth center.

Two years later, she is returning — leaving today to spend 10 days working alongside the two local Haitian midwives that staff the HCM Maternity Clinic, a birth center that serves more than 2,000 women a year. While the midwives provide the best care possible under difficult conditions, outcomes for mothers and babies could be improved with additional training and support.

Karen’s trip is sponsored by Circle of Health International, which works with local health care providers in crisis- and disaster-struck regions to ensure access to quality reproductive, maternal and newborn care. Like all COHI volunteers, Karen is donating her time, and COHI is fundraising to cover the transportation to Haiti (about $800 in airfare and local travel) and room and board on the compound where the birth center is located (about $300).

Here’s where you come in. For as little as $10, you can help send Karen to Haiti. Want to donate more? Please do so! Numerous gifts are available as perks for donors who can offer $20, $35, $50 or more.

Circle of Health International - images from Haiti

Training drills like the one shown (left) help ensure safer births in unsafe times. Women in areas of crisis or disaster often struggle to secure basic reproductive health care. The Fond Parisien Birth Center (right) serves more than 2,000 women a year, providing critical care.

It’s all part of the Get Karen to Haiti campaign that Our Bodies Our Blog and other bloggers involved in improving maternal health are participating in for the next two weeks. Hillary Boucher and Jeanette McCulloch at BirthSwell have more information about the collaborative effort.

Your donation can make a huge difference. According to COHI:

Birth Centers like the one at Fond Parisian provide a model of care for other areas in Haiti and around the world, where maternal mortality is at the highest rate in the Western Hemisphere, with 630 deaths per 100,000 live births (compared to 11 deaths per 100,000 births in the US).

The midwives at the Fond Parisien birth center have received training in supporting women in low-risk births, providing care in common emergencies, and are developing protocols for when to transfer to other emergency medical facilities. But unlike their peers in the U.S. and in other industrialized societies, they do not have access to the latest research or journals, conferences where they can share skills, or even family support.

Karen took a moment as she was preparing for her trip to talk with Our Bodies Our Blog about her birth philosophy and why she’s returning to Haiti now (see below). Her goals are specific:

* Review existing protocols for managing emergencies and deciding when to transfer to the local hospital. Provide clinical support and skill-building where it could improve outcomes for Haitian women and their babies.

* Run emergency drills using improved protocol for complications most likely to be seen at the clinic, including shoulder dystocia and postpartum hemorrhage.

* Improve monitoring processes so that the clinic can evaluate their existing protocols and make improvements based on evidence, not just anecdotal understanding.

We hope you’ll consider supporting Karen’s efforts in Haiti and visit COHI’s Facebook page to follow along on Karen’s journey. You can learn more about COHI’s efforts in Haiti on its website.

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Our Bodies Our Blog: You first visited Haiti after the earthquake. How did that experience affect you and your commitment to expanding access to evidence-based care?

Karen Feltham: Arriving in Haiti, especially Port Au Prince, was overwhelming. I kept thinking of how long the earthquake lasted, counting in my head and imagining the earth shaking and the buildings falling — the world changing in 30 seconds. What was that like? Homes become rubble, the living-dead. It has changed everything for me, in a way. Anything can happen, in any instant. It might sound funny, but I run through worst-case scenarios in my head and with my family. Where will you go? Where will we meet?

Witnessing the work of countless NGOs and volunteers was inspiring, as well as a bit maddening. There was (and is) really good work happening in Haiti. There are excellent providers and logisticians providing great, life-changing (and life-providing) services. And that is inspiring.

At the same time, I think that there is a feeling of, “Anything is better than nothing.” I have seen that lead to a neglect of clinical standards.

OBOB: Why are you returning now?

KF: The organization that I volunteer with (Circle of Health International) is completing their work there and turning over the operation of the clinic to a local organization. This is a nice opportunity to re-connect with midwife colleagues who I had worked with previously. My goals for the trip are to run emergency obstetric care management drills, review core competencies, and always to reinforce and encourage the midwifery model of care.

Also, skilled birth attendants at delivery (and fewer pregnancies) definitely lower the maternal mortality rate. The international community is expecting quite a bit from newly trained midwives, and midwifery is a tough job. In the United States, a licensed midwife is more likely to begin independent practice with the benefit of collaboration and experienced colleagues. And so, I feel a commitment to providing something similar to this midwife team.

OBOB: How does your birth philosophy inform your volunteer efforts?

KF: I absolutely believe in the power of kindness and how it can be transformative, even revolutionary. Think of what women bear, here and elsewhere — assault, abuse, submission. I can’t change a country’s infrastructure, health care and education policies. But I can listen. I can provide the most gentle pelvic exam and the most respectful atmosphere.

If my touch is the first that a newborn feels, then I promise to make it a gentle one. If my voice is the first that she hears, then let it be welcoming. This is what I can bring, a reminder that excellent clinical skills are essential, but that kindness is life-changing. At least that’s what I think, and it’s the best that I can offer.

OBOB: You’ve identified three goals for your time in Haiti. Can you give readers a sense of how those goals will be achieved?

KF: I’m not sure how each day will unfold. One must be very flexible in these situations. But I’m certain that each day will be very full. My volunteer partners and I will run through management of the obstetric emergencies; postpartum hemorrhage and shoulder dystocia — the “what-ifs.” It’s so valuable to run through what everyone does in these situations, and then do it again.

Also, each day will include conferencing with the midwives, which involves reviewing clinical cases and addressing whatever concerns that they might have, along with symptoms, diagnoses, and procedures they have questions about.

OBOB: Have you incorporated into your teaching at Binghamton any experiences or lessons learned from working alongside midwives in Haiti and Nicaragua?

I guess that every experience influences every other, even in subtle ways.

I teach at the Decker School of Nursing at Binghamton University in both the graduate and undergraduate programs. I love working with nursing students! They are amazingly good people. One of the courses that I teach is in global nursing. So many students are interested in really making a difference but don’t know where to begin. I try to share a bit of my own experience and encourage each individual student to find their own way. I believe in the ripple effect of good work.

Also, one thing I try to do intentionally with students is to blur the line between “us” and “them.” Haiti and Nicaragua are very far away, and it’s easy to think that the people, clinicians and patients are so very different from us. I try to refer to clinical cases that I have seen elsewhere and good clinical work and speak to the shared experience between provider and patients that happens everywhere.

Health care is what happens between midwife (and doctor and nurse) and patient. It doesn’t happen at the upper levels of the bureaucracy. It’s the thing that takes place between two people. And that is true in Ithaca, N.Y., Fond Parisien, Haiti and Managua, Nicaragua.


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