Livet med Leger Uten Grenser - Time so say goodbye
Dato: 28. mars 2023
There is some kind of a sweet innocence in being human- in not having to be just happy or just sad- in the nature of being able to be both broken and whole, at the same time.
– C. JoyBell C.
DIPSer Anca Heyd har alltid hatt en drøm om å kunne bidra inn i Leger Uten Grenser og gi livreddende nødhjelp der det trengs mest. Siden 2020 har hun jobbet med feltarbeid både i Afghanistan og Jemen, og i år gikk turen til Haiti.
Foto: Anca på sykehuset i kledd uniformen sin
Litt om Anca Heyd:
Anca Heyd er legespesialist i fødselshjelp og kvinnesykdommer, og jobber som medisinsk rådgiver i DIPS. Hun kommer fra Tyskland, og hadde 14 års praksis fra klinisk arbeid og 4 år i ulike ledende stillinger i Helse Nord bak seg før hun kom til oss. I mange år har hun hatt en drøm om å kunne bidra inn i Leger Uten Grenser og gi livreddende nødhjelp der det trengs mest. I 2020 satt Anca satt seg på flyet ned til Afghanistan for å jobbe med feltarbeid. I 2022 gikk turen til Jemen. Og i 2023 falt oppdraget til Haiti.
Fra Leger Uten Grenser sine hjemmesider kan man lese at landet Haiti befinner seg i en alvorlig økonomisk og politisk krise. Helsevesenet er på randen til kollaps, og det er mange helsebehov som ikke dekkes. Haiti er et av de fattigste landene i Amerika, og landet har flere ganger blitt rammet av naturkatastrofer. Ti år etter det katastrofale jordskjelvet i 2010 og 2021 er helsevesenet på randen til kollaps. Det er mye vold og i september 2022 brøt det også ut kolera.
Blogg 3: Time so say goodbye
Bloggen er på engelsk.
Carnival in Coteau. These guys stopped for a nice chat and a photoshoot.
It’s calm today. It’s carnival, an official day off, and I am not at the hospital, unless they call me. It seems to me that everything moves slowly, perhaps because it is such a big contrast to yesterday evening, when everybody was dancing and singing in the streets. Or because I am in a special mood. I am leaving in four days, which makes me both sad and happy, like always.
I am really looking forward to going home. This time I missed my family a lot, and sometimes it felt like I was here too long, like it would never end. Then there is this other part, the part where I am looking around and thinking: “I will miss it”. I will miss the people, the friends I made here, the sun, the warmth, the smiles, the work. I am lucky though. With the carnival holiday I have the time to reflect, to make “memory pictures”, to say goodbye.
Carnival in Potapiman.
Tour to the Cages of Jean Marie
I started this morning with a tour to the Cages of Jean Marie. Those are told to be the biggest cages on the Caribbean Islands, and they used to be a tourist attraction. Now, unfortunately, the steps leading down to them are in a really bad shape, with planks missing and the iron that keeps them completely corroded. So, we are not allowed to go into the cages. But still, I love the little hike up to the cages. They are in the hills, just a 30 min walk from our house.
The stairs don´t really look inviting.
The first part of the walk the route is following a big, paved road that is leading to the local water reservoir. Halfway up, there is a special house, always worth looking at. It is completely round, with a big round veranda on the upper level. It is behind a fence, so the ground level is difficult to see, but it looks like there are rooms at the center of the circle, surrounded by a round corridor. It’s a very interesting concept and I wonder who or if somebody is living there. I have never seen anybody. The upper part of the road is surrounded by fields, where goats are searching for something edible.
A little mountain village. you could here the dsinging from the church up here.
It is the dry season, so green leaves are scarce. Then, at the reservoir the road suddenly stops. In front of the house at the top a small path meanders along the hillside. It is barely visible, the only thing one can see is that there are slightly more stones on the path than in the surroundings, and that somebody has been walking there. This is the path to the cage.
View from my favorite place, the entrance of the cage. Today the sea is a wonderful turquise.
The more upwards one climbs the more beautiful it gets. More and more trees are lining the path, providing mostly welcome shadow and muffling all noises. The view over the city and the sea is breathtaking, always visible to the right. My mood changes every time a walk the path, and for each step I take I get calmer and more relaxed.
Entrance to the cage Marie-Jeanne.
The entrance to the cage is locked, by big iron gates. But in front of it there is a little platform of stone. This platform is my absolute favorite place, except perhaps the terrace of our house. It merely invites you to sit down and take a break, a real brake from all struggles, the world, and this is exactly what I am often doing. Sitting there is like meditation.
My good friend Aimé and me at the entrance of the cave.
Today the sea is a wonderful turquoise, floating over into blue and green shapes further on. The sun is reflecting on the water, making it look like sparkling stars. I am sitting behind a front of green leaves. The only noises I am hearing are birds singing nearby and the “baa” “baa” of the goats in the little forest. Now and then one can hear a noise from the city downhill, the roaring of a motorbike or children’s laugh. And sometimes, if you are listening carefully, even the singing from the church.
Sunset tour in the hills of Coteau.
Walking the streets
I let my thoughts float. What will I miss? I will certainly miss the breakfast and afternoon on the terrace. Bathed in the warmth and light of the rising or setting sun. Also, the walks to and from job. I still love them, although I also see the other side now, the one that is easily overlooked. The young girls for example that are not going to school, but instead are following the younger siblings, bearing their belongings, and making sure they arrive safely.
I never get enough of this.
Or the ones selling goods at the side of the road. Those are the ones that often help the family, are responsible for the household, the poor and illiterate ones.
Or One can also see young boys leading the donkeys to the mill. They are still school age and the work seems way too hard for them. The young men gathering at the corner. I realized that this sight isn’t necessarily a happy one. Those are the boys that have finished school and don’t have any work to go to. Instead, they are gathered in in the street all day, talking, listening to music but without any real future perspective.
New life everywhere.
Then there is this man, I don’t really know what to make of him. He might be around 50. He always reminds me of the song, streets of London, because all he is doing, all day, is walking the streets. Literally. He wears beige trousers, that are way too big for him. They are not closed, instead he is holding them up with one hand. He has no underwear, nor other clothes. The upper body is always bare, and he is barefoot. With the trousers in his hand, you can see him everywhere, every time. Up and down the street!
He doesn’t seem to be with us, he is not responding to any greeting, nor any smile. I think he is somehow lost in his own world. But somebody must be looking after him because he seems well fed, and the trousers are quite clean.
On the other hand, I have my favorite people, people that I see nearly every day, sometimes even looking for them. To see them somehow comforts me, gives me a sense of being home, and brings me closer to them. There is for example this young boy. He must be about 16. He walks to school every day, holding a little girl, maybe 5 or six in the right hand. He always looks very serious, rather angry, never smiles, never greats. I think the girl might be his little sister, and I think he hates it taking her with him. But he nevertheless never let go of her.
Painting on a building. I think it might be the courthouse, but it isnt in use now. Damaged in the earthquake 2021.
Then you have this other boy, also around 16, in his black school uniform. He clutches a little pink handbag in front of him, a little-girl-bag full of sequins and glitter. But he wears it proudly. I cannot other but admire him for this. He is always greeting friendly.
But my favorites are a father and his daughter. She might be 3 or 4 years. He is cycling and she is standing on the middle pole, holding tightly around his neck, her school skirt and ribbons waving in the wind. I love this sight. The love they mirror. Last week I waved to her, and she waved happily back😊 When I am returning form hospital, on my way back, I often meet this other little girl. She might be 3 years old, maybe 4. She seems to be waiting for me. When she sees me, she runs into the house to get her little brother, and then they come to hug me, her small dirty hands tightly around my neck. My heart is melting every time.
Work at the hospital
Then there is the work at the hospital. I did a lot of teaching, both formal trainings and bedside teaching. And it was always a highlight. We would discuss together, train, practice, talk and laugh. Everybody contributed. I like that the staff here does not accept blindly what I am saying. They are questioning it, giving examples from their experiences, or bringing cultural thing in that may play a role and that I didn’t consider. I will miss those discussions and I will mis my colleagues.
Not the ones speaking the same language, but the ones sharing the same feelings understand each other.
Training for shoulder dystocia. Everybody is in. It was amazing!
The patients made a huge impression on me
But what really makes an impression, what really stays with me for the rest of my life are the patients, their stories, those moments that are deeply carved into your heart. They even break it sometimes….
One of those stories happened just a few days ago. The young doctor at the hospital called me at 7 in the evening. In one of the districts’ health center, they had a pregnant woman with eclampsia. Information was scarce, but apparently, she had had seizures for 3 days.
We sent an ambulance to get her, and I asked the doctor to call me when she was nearby. Four and a half hours later the patient was finally here. When I entered the room, she was sitting on the bed. She was extremely agitated, fighting heavily with her sister who desperately tried to hold her down. The ambulance had found her in the yard, in front of the center. There was nobody in the center to take care of her, so she was lying on the ground having severe seizures. They managed to get her in the ambulance and gave her Magnesiumsulfate to stop the seizures and drove to us. At the admission they gave her a urinary catheter to control the urinary output.
She had a massive proteinuria and a pretty high blood pressure. This was an eclampsia. Still, I had to calm everything down a little bit, to get more information. I asked the sister to let her go and rather tell me what happened. The girl was pregnant, they thought she might be at term, but they didn’t really know. She lived with her mother. The sister had only visited when she found her seizuring. She had had intense headache the day before, and 4 longer lasting attacks with seizures during the day.
We asked the mother how old the girl was, and she told us she was born in 2004. This is when it hit me. I finally understood why I had this tight feeling around the chest all the time.
This girl was one year younger than my daughter, and something in her behavior reminded me of my daughter. She had no similarity with her, no physical at least, but there was something in the way she was fighting for her right to be left alone, in the way she acted. I couldn’t help, I saw my daughter in her, a feeling that stayed with me for the rest of the night. It didn’t make things easier…
They worried if they had to pay for the c-section
She wasn’ t really conscious, we could see that she did not understand what was going on, but once left alone at least she had calmed down. We gave her medicine for the high blood pressure, and I did an ultrasound. It was clear that she needed to deliver as fast as possible, but I still hoped that we could go for a vaginal delivery.
A c-section for an 18-year-old is something that should be avoided, if possible. The baby was still alive, which was a wonder. But unfortunately, it was a breech presentation, and it was severely growth restricted. Which meant the head was big, around 36 weeks, while the body was really small, corresponding to 32 weeks. No way the baby could be delivered vaginal, the head would get stuck. So, I called for a c-section.
The sister asked desperately if it would cost anything, they did not have the money to pay. It was only then that I really looked at her and the mother, and realized how poor they must be.
The mother seemed old, a small thin lady. She could not have weighed more than 40 kg. She wore an old dress of undefinable color, her dirty feet sticking from plastic flip-flops. Her hair seemed uncombed. When she heard about the c-section she simply crouched down in the middle of the room and just stayed there. I think she had some kind of breakdown. I led her to a bench outside admission room and laid her down, told her that everything would be fine, that we would take good care of her daughter and that she didn’t need to think about the money.
My heart broke a little more every minute
We took the girl to the OT, where she panicked again. Four people were trying to hold her down while she was crying, fighting, casting her wild eyes around. I watched, my heart breaking a little more for every minute, even if I knew that she wouldn’t remember anything of this the next day. In the end they gave her something to calm down and the managed to give her the spinal anesthesia.
But now her blood pressure stooped to 80/60. A stoop like this is extremely dangerous for the baby in a mother with preeclampsia. Because the placenta isn’t working well and there isn’t enough pressure to get the blood into the baby. And I was thinking: This baby is dying, now!
I knew that this baby had had a lot of stress already, during the seizure attacks, that it somehow had survived. But this… I didn’t even bother to check the heartbeat, I just washed as fast as possible, and we opened up the belly. The neonate nurses were already in the room, ready to take care of the baby. We delivered a tiny baby girl, barely more than one kilo, and she was completely lifeless. No breathing, nothing.
The nurses took her they started reanimation at once. The rest of the c-section was easy. Too easy. The mothers blood pressure was 80/40 so low, that she didn’t even bleed. This can be tricky, because when the blood pressure rises again it can start to bleed in places you didn’t see. So, we were very careful to make sure everything was well tight up.
The situation for the baby was bad
The situation for the baby was bad. When they stopped reanimation, after 10 minutes, according to the routines, it had started spontaneous breathing. However, when I came to look at it 1 hour and 20 minutes later (I let the young Haitian doctor do the operation, her first ever), nothing had happened.
She was on oxygen, but even with that her saturation was very low. There was no tonus, no reactions. Her eyes were closed and she was breathing heavily with long pauses in between. She had a severe asphyxia, her brain was severely damaged. The only thing we could hope for her was that it would die fast and peacefully.
I asked the pediatric doctor to give her only palliative care, which means keeping her close to her mother and relief any pain if she had one. But he was young, and he didn’t understand or wanted to accept the truth. He absolutely wanted to take her to neonatology intensive care unit, to try everything and to take the decision about palliative care next day when all the team others of the team were there. I didn’t want to fight with him, and I gave inn. I so regret this! Until this day today.
I should at least make him lay the baby on the mother’s chest, at least for some minutes. She still wasn’t conscious, but I think it would have mattered a lot, both for her and the baby. Because the baby girl died just 20 minutes after they took her with them. She died alone, never got to feel the mother. Nor did she get to feel her baby.
We are simply mothers
It took the young girls two days to regain full consciousness, but she recovered, completely. Only, when she heard that the baby was dead, she didn’t want to see it. I understand that I think it might have been too much. She was after all just 18 and had just escaped from death.
I couldn’t say whether she was sad or not, she didn’t show and I didn’t manage to reach in to her. But I do know that our psychologist had talked to her and that they are always doing a good follow up. He would help her if she needed help. Before I let her go I made sure that she understood that she needed to come early in next pregnancy to get the secondary prophylaxis with aspirin, the medicine that would prevent her from getting severe preeclampsia next time.
During the 3 days that the young girl stayed with us I met the mother many times. She was walking inn and out the room bringing food to her daughter, taking care of her. She looked completely different. Still small, thin, old, but her dress was clean, newly-washed (patients and their caretakers have the possibility to wash their cloth on the premises). Her hair combed and taken back in a knot. And she was smiling every time I met her. Greeting me happily. I even heard her sing once.
And I thought: you and me, we are the same. We could switch places; I could be you and you could be me. We are simply mothers, caring about and for their children, mad with fear when they are ill and happy when they are ok. No matter where in the world. I somehow find this thought comforting.
I really hope, from all my heart, that the situation in Haiti will change at some point, that the people will get peace to live their lives, to grow, to develop. And that this girl finds some hope for her future. She and her mother have a special place in my heart.
But hoping," he said, "is how the impossible can be possible after all.
– Marissa Meyer, Heartless
I will miss this place and the people.
Sunset nr. 3265
I made lots of bracelets - gift for my colleagues when I am leaving.