A labour of love

I’ve begun to find my morning routine at Jude Ann. After squeezing past the friends and family members and other various supplicants at the gate, and after a one-glance appraisal of the courtyard and the relative density of pregnant women therein (we’re always busy, but are we less busy or more busy today?), and after depositing my bag and various papers in our tiny office, I go directly to the lab. It’s ten steps down the corridor past our office, and the corridor–already narrow–is made even more narrow because there are usually people waiting on a bench for the nurse who does HIV counselling and testing, a necessary step before accepting them as a blood donor. The donors are friends and family members of women who have been told that they may need surgery, or who have been diagnosed with anemia.

My first stop is the lab because I want to check our blood bank. I don’t know much about clinical laboratories despite being nominally responsible for supervising this one. It’s a completely different entity than the biochemistry/molecular biology labs that I worked in years ago as a undergraduate student. Regardless, I say hello to the lab techs, look at the whiteboard which tallies our inventory, and open the fridge to see how many units of blood are inside. It varies from about five to twenty.

Last I checked (on Saturday), we were short on type A. We are always short on anything Rh negative. But in general, lately, our blood bank has been doing fairly well. This is good because if one of our patients is desperately in need of a transfusion that we can’t provide, it means that someone will spend a lot of time and energy trying to borrow a unit or two from elsewhere. That’s why I check: if someone is going to spend their day chasing blood, it’s best to start early. And it’s never guaranteed to be a fruitful search.

And when I say “severe anemia”, I really mean it. We regularly have patients with hemoglobin levels in the 40′s (normal in women is about 120 or higher; most people will tolerate anything above 100; and research trying to balance the risks and side effects of transfusion against the risks of anemia suggests to hold off on transfusion if hemoglobin is 70 or higher). One patient, for whom we were trying to find some O negative, waited four days with a hemoglobin of 30 or so because my trip to the Haitian Red Cross ended in futility. (Eventually we found a donor for her, and she improved and was discharged in good condition.)

I am toute a la fois doctor, doula, bed manager, hospital administrator, blood bank supervisor. It depends on the day’s most pressing issues, which means most often I am bed manager and blood bank supervisor. I had expected, when I received my medical degree, to be a pretty flexible generalist, but I don’t think I had exactly foreseen this.

Hopital Jude Anne, in first and subsequent impressions, is a noisy place, both inside and out. We’re located at the corner of a very busy intersection with lots of cars and pedestrian traffic and sidewalk commerce. Loud, insistent honking, then, and lots of bustle, and the bustle intensifies the closer to the hospital gates you approach.

Inside, I’m afraid, there’s a lot of screaming. The courtyard is filled with women–the density varies, but it is almost always full–and many are in various stages of labour. We don’t have labouring beds for them, or much analgesia to speak of, and one-to-one nursing care that is the standard at home is a laughable concept. We receive a lot of patients and the daily struggle is to find a way to provide them proper medical care despite the volume.

The noise and busy-ness increases inside the actual building, because it is on the first floor where we have triage beds and delivery beds, about six each. Midwives follow the labour and deliver whoever needs to be delivered. On really busy days, we have deliveries on the floor where clean pads are spread. Thank goodness our cleaners are pretty efficient.

Triage is for assessing women who arrive with particular complaints. Often they wait for hours to be seen, since everyone comes in the morning, unless they arrive with something impressive: convulsion, massive bleeding, baby half (or fully) out. Today, we had about five patients who had seized, that I know about; and I didn’t spend much time in triage today at all.

Dr. Wendy Lai is starting her 2nd mission with MSF in Port-au-Prince, Haiti, with a focus on emergency obstetrics.

She has worked with MSF in the field, previously in a primary health care project in Shabunda, the Democratic Republic of Congo (DRC).