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Livesay Haiti -

This month is very exciting for us.  We are getting closer and closer to having a completed "How To" manual for the Heartline Maternity Center.

Our model is being shared and we are calling it, "The Starting Place".

The manual contains eleven years of learning and the details of the current Prenatal Program, Postpartum Program, Birth Control Program. and Youth/Teen Program. It has taken many years to get here. We are hosting our first  (pilot) class this week with four participants from other organizations also working in Haiti.

**  See this post for more information about The Starting Place.  **

What is it?
It is a technical manual. It describes everything we do, from the beginning to the end. It includes protocols and tons of administrative details. It includes ways to start small as a prenatal education or birth control program and and grow into a full service holistic birth center offering maternal health care from early pregnancy until months after delivery. It shares a few case studies. It is practical. It is step by step. It includes all aspects: education, relationship, medical, spiritual, physical, cultural, etc., etc.  It is incredibly practical. It is a little bit overwhelming.

What is it not?
It is not hundreds of stories or case studies or interesting detailed descriptions of the more than 850 women that have delivered at the Heartline Maternity Center. It is not all and only medical and practice protocols. It is not all statistics and information you can find about Maternal Health by doing a google search.

Each time a new woman starts the Prenatal program, we do a social and obstetric history interview.  
Often women we work with in Haiti have a hard time recalling and easily verbalizing much of their history. It can take a while to gather the information. It is usually important to ask the questions in a unique ways to get the desired (and hopefully accurate) information.

We are realistic enough to guess that at least half the time we still did not get it all completely accurate because it was neither recalled or shared with that sort of precision.
It is best to ask questions in an assumptive tone.  For example, sometimes women assume if we are asking them, "Have you ever had an abortion?" that I will judge them if they say yes.
Instead we ask, "How many times have you ended a pregnancy?"  We can also pose that same question in four or five other ways, changing wording to be assumptive.

If the answer is zero they are fine sharing that but if the answer is 10, it helps that I assumed it was part of her history because it removes their hesitation or concern of being dismissed due to an answer that they fear we won't find pleasing.  
Daily life is so difficult, it makes survival and the immediate present the priority, which in turn means that recalling history is not an easy task. The blanket term "poor historian" fits pretty well.  Having and knowing your own medical history is actually a privilege. Many in the developing world have no idea what happens at medical visits and more often than not nobody takes the time to describe things to them.

* * * 
We interviewed a 37 year old woman. 
We asked, "You've been pregnant many times in your life, yes?"  She said, "No, only seven." 
That's our bad.  That's a cultural difference.  7 is a lot to me.  Not necessarily true here.
We started at the beginning and walked through each pregnancy and delivery.  Her first four children were all born at home in the house she and her husband have always lived. Those four children, two boys and two girls born in 2005, 2007,2009, and 2012 are all alive and well.

In 2010 their home was badly damaged and some injuries happened due to the earthquake but nobody in their home died. In 2013 she had a baby boy born in a hospital that was never well. She described several anomalies and said he died at 21 days of age. She thinks she was under some sort of curse (persecution) during that pregnancy.

In 2017 she described a situation of a breech delivery and her baby's head being entrapped. She said they had to pull and pull to get the baby girl out. The baby was dead upon delivery. She is now in her 11th week of her 7th pregnancy and will be getting prenatal care for the first time ever in her life. 

When I finished the interview I said, "Wow. That is a lot of trauma you have experienced in your life. That is really difficult."  Tears welled up in her eyes.  So often in a culture of non stop challenge and frequent trauma, there is not time for anyone to fully acknowledge the pain of what they have experienced.   Part of the model at Heartline that we are hoping to share with others, is the importance of empathy.  
* * *

From the Starting Place Manual - an excerpt from the Philosophy of care section ... 

EmpathySpend any amount of time at a hospital in the developing world and there is one key component to women’s health consistently missing: empathy.
Being a woman in the developing world requires a tremendous amount of grit, resourcefulness, and resilience. But a woman is almost never as vulnerable as when she is pregnant, giving birth, and post-natal.
Trust matters, relationships matter, and empathy is more valuable than we can express. Empathy is communicating a message of great value, a message that says,  “You are not alone.” It is rare. As Tara says, “Several of the hospitals in the city where I live, as well as the hospitals and clinics where we’ve worked around the world, who serve the materially poor are lacking the most valuable resource: compassion. Nothing sustainable and life-affirming happens without warm, loving relationships and a lot of compassion.”
It might seem odd to start off the technical manual of Heartline’s Model of Care with a seemingly unprofessional words like “kindness,” “empathy,” “compassion,” or “love” but it has been our experience that this is what truly transforms women. It can bring calm to chaos, hope to despair, connection to isolation, faith to fear. And all of those things matter every day in life but particularly so in birth.
Working in the middle of devastating poverty, one quickly learns that not every story has a happy ending. There are areas of frustration, despair, and brokenness all around us. We cannot fix everything. But we have decided to embrace love and compassion as our philosophy, as much for our patients as for our own souls. This is even more important to us in the face of despair, hurt, wounds, and trauma.
As one small outpost of health and wholeness in the worldwide maternal health crisis, we choose empathy and love and we center love and we practice love. We are committed to excellence, to integrity, to thorough training, to steady competence. But even our excellence of care, our integrity, our training, our competence must be grounded in a philosophy of love. Maternal health has for too long been sidelined and de-emphasized in the world: we believe women deserve not only competent and thorough care but they also deserve dignity, respect, and to feel loved in their most vulnerable moments.

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Livesay Haiti -

Why is she talking about this again?


She is talking about this because it eventually becomes a thing for half the population. By all means, please, don’t read this if it does not apply to you. 
If you will ever, in the history of always and forever, know a female that is age 40 to age 55, it applies to you.  

Those that know zero females that are currently that age and they also think everyone they know will die at age 40, you are free to leave now. Sorry about your loss.
My doctor recently told me perimenopause is a term that pharmaceutical companies made up.  He said there is before menopause and you know, NORMALish life, and then there is menopause - like you are done forever with bleeding and having a cycle. 

Uh.  Okay???  So the years in between are not called anything?

Whatever, I am talking about this thing that apparently is only created by Big Pharma.  It is a thing to me because I am in that middle time where I am unsure of what the heck each day will be because I am more like a yo-yo than any human thing. 
I feel it is my duty to prepare all of my 20 and 30 something friends for what is to come.  I know that you are tempted to read this and think, Ah, she’s just being over the top and silly. No.  No,  Not what I am being.  I am being real with you. Dead.Serious.Real.
Okay, so first, you’re going to gain some weight in the middle section of your body.  You’re going to think, “Am I imagining this?”  You’re going to realize you are not.  It’s not a big deal, because you have shit to do and some extra adipose tissue is not going to stop you from being totally amazing.  It might cause you to leave your top button undone on your jeans.  That’s all.  No big thing. Carry on.
Second, you are going to go from having your periods at an interval you can predict, to having them whenever.  Maybe you’ll have them every 15 days, then take 60 days off, then that will be boring and it will toss you a new and exciting surprise that is not at all a pattern.  

You don’t get to move away from (Big Pharma created) perimenopause until you miss 12 whole months in a row of having your period.  
Everyone says that once you are done with this middle time, it gets easier. Everyone better not be lying.  If I live through the next five years and eventually reach true menopause, I expect life to be glorious non stop.
Third, you are going to do so many embarrassing things and people are going to mock the heck out of you. Those people are your family and maybe you don't even need them. Who's to say?   

If you do not have thick skin, get to work on changing that. Go drag your hands and feet over hot coals. You are going to need the thickest skin to endure your idiocy and the mocking material it will provide your loved ones.
EXAMPLES that Have been said to have happened - 
1.  You might get up one morning early and put your contacts in your eyes.  You might then leave the house and go do a little bit of work or some errand or something of that sort.  You might come back home and jump in the shower.  You might rub your eye wrong and one contact in your eye will twist up funny.  You will maybe call your husband to come take that contact to the case on your dresser.  After you shower and get dressed you might walk over and put the contact back in your eye.  About two minutes later you might go over to the dresser and start to look for your contact, because you think you cannot see and you need it.  You might say to your husband, who might have the name Troy, "Hey, did you put my contact in here when I asked you?"  That husband might say, "Yep. I did."  Then, I have been told, you might tell him he did not.  You might act like a jerk and say, "Well, it is not here."  Then you might really dig yourself in deep and just claim he must have dropped it.  THANKS A LOT you might say.  THAT WAS MY LAST RIGHT EYE contact I had.  Then maybe your friend, who sort of knows you well might say, "I think you put it in your eye again already."  Then, maybe you'll see that the contact is in your damn eye already. Then you will go bake yourself some humble pie while you eat crow.
2.  You might need to use a calculator to do some math on an accounting report and you might repeatedly open up your phone and start using the dialing pad of your phone to add numbers and then after you put in twenty six dollars and you go to find the add button you'll be so confused because the place where you dial your phone does not have that function. You'll switch to your calculator but that will not be something you only do once. You might need someone to tell you to just stop using your phone as a calculator because it is too frustrating for you.
3.  You will write yourself notes.  You will think you are brilliant to be writing it down to help you later.  That's hilarious. You are not brilliant. You are bad at writing reminders that help you remember. Your notes section of your phone will be filled with meaningless incomplete and unhelpful blurbs such as: 
  • Contact Knoxville person, knows Anne and Melissa
  • Umba dra umba tab
  • Cold sore - Valtrex - risk HSV ensephalitis
  • The wart something dot com
  • Crying out for justice
  • Civil engineer design waste water pump station
  • May 19
  • Taco burrito what you got in that speedo?
  • Things I can't handle for 400, Alex
4.  Perhaps you will get a gift certificate for your 46th birthday for a store you love. You will buy your favorite smelling lotion at 8pm on a Friday night.  Maybe after that you will use the lotion on Saturday morning around 10am and then maybe you'll never ever know where it went and you will never see it again.  You are a person that loses $10 of brand new lotion.  If your kid did that, you'd be uber ticky about it.  So don't tell your kid you lost brand new expensive lotion.  Make a call to the hotel you stayed at and listen as the front desk person acts like you are an idiot to want to know if you lost lotion in their hotel room.  LOTION?? Uh. Okay, I'll check lost and found. He doesn't understand so just give him grace after you swear under your breath.


GIve thanks for your clear mind and sensible surroundings

Livesay Haiti -

Leaving to do an errand today looked like this:

Wake up. Toss clothing on. Get in truck to go to Maternity Center. Go pick up person that needs to be brought somewhere.  Pull out of Maternity Center driveway. Realize I don't have paperwork for the appointment.  Pull back in. Go grab paperwork.  Just kidding. Spend ten minutes trying to remember where paperwork is.  Sweat tons of balls while frantically searching for paperwork.  Find paperwork. Go to my truck with paperwork where person waits.  Pull out to leave again.  Look down, see that I have left with the only key to the ambulance because that was where paperwork was. Pull back in to put key back where it belongs inside the Maternity Center.  Go back to my truck. Pull out.  Realize I have all the money and the ambulance might need to leave while I am gone and might need some diesel.  Pull back in. Go back to get key to ambulance. Open it, put money for diesel in ash tray. Lock it. Go back to my truck. Open door to my truck and realize I have the damn key to ambulance in my hand again. Go put it back.  On fifth attempt to leave, we leave for real.  This is hormonal nonsense perimenopause brain fog.  It is so much bullshit.

I am now sitting in an office in Haiti where they think I should wait for their internet to be fixed in order to pay them.  I have been here two hours for the appointment and they never attempted to fix their internet in the two hours I actually needed to be here and was wanting to pay the bill.  Now that I need to leave here they think I should pay the large bill but they still don't have the internet to do it. They feel like my time is not valuable and I should just wait until whatever time it is that the internet starts working again. 

I don't agree.

If I go totally and completely insane, please know there is no mystery.  It happened because this place  (earth - and - haiti) is (was) working hard to make it happen. 

Retrieval Plan

Livesay Haiti -

I am so grateful to Paige.  She is a truth teller.  She is no poser.

Instead of telling me how easy it is to handle all the kids and their needs, she is telling me that she cannot keep all the things straight.  

She could easily be breezy about it and act cool. Instead she says that keeping each one and their needs straight is a lot and that if her brain, only 23 young years old, cannot remember it all ... CERTAINLY, I am doomed at my age while in the throes of perimenopause fog.

I love Paige for saying this.  There is nothing more gratifying to me than to hear that she thinks it is kind of a challenge.  

For now, Haiti is very calm. I cannot control when or if that changes.  I assume this relative calm will not be forever. I do miss my people so much. I need them back.

Perhaps when I was a young mom I did not know things about time.  I am not young now.  I know there are limited blink of the eye days and lightening speed years left with the home. 

I saw how fast the first two left and the time is closing in on the next group.  I have to have Lydia and Phoebe in my physical presence every day possible. 

All that to say ...

I am going to go retrieve the three youngest of these five children of mine in less than ten days and my life is getting better by the minute as the time to go get them draws nearer. 

My two boys holding Paige's two boys - Magical

We were face-timing with our kids in El Paso and Lydia told us how she "on purposely" ate lunch early so that when they went to Chipotle for dinner last night, she could eat an ENTIRE burrito because she would be so hungry by the time dinner rolled around. She reported (with disgust) that she could not eat a whole burrito -- and that it was a frustrating to her because it was a "waste of hunger".

Memory Lane

Livesay Haiti -

Geronne has lived with our family since August of 2008. We have known her since January of 2006.
She takes about 10 days off all year, even though we beg and plead with her to go anytime she wants.
**I** need a break from us - and I am part of us.

I can only imagine her misery at being embedded into this family.

I finally talked Geronne into taking time off.

The kids are gone, there is not a lot to pick up. They aren't being inconsiderate in the kitchen six or seven times a day. The laundry is diminished to less than one load a day. It is a perfect time to take a break from all Livesays and Port au Prince.

G, keeps our house going and is the **only** reason we have any order in our lives.  I love her dearly and we get along 85% of the time.  If we are not getting along it is usually because I asked the kids to clean something and she hates when they clean. 

I am not sure if it is because their work is so half-assed compared to hers or if she thinks I am a bad parent to make my kids do MANUAL LABOR.  We go head to head on that topic a few times a week, which proves neither of us is willing to back down. Like ever. I will never ever be okay with kids that don't do a dang thing.  Geronne will never ever be okay with my kids doing things less perfectly than she can.

** ** **

Last week, after dropping the cleanest most perfectionist housekeeper in the world off, I asked KJ if she would be okay if I went down memory lane and drove down the road we used to live on when we first moved to Haiti.

(Geronne's family is all out there and we met her out there in the first year we lived here.)

Now that 10 years have passed since I lived there, I thought I could do it without feeling sad or like I wanted to vomit. I have not done my best work at letting go of the painful things that happened there.

I think I have done some work.  Just not exceptional work.

We drove down the two mile road and I told her stories about different people we knew and things that happened while we living out there. She is the best listener, she either was interested or she really pulled off faking it.

Of course there are dozens of silly and funny and wonderful things that happened out there. 

I tripped over a sketched out and unpredictable goat while on a jog and fell flat on my face in front of tons of people. Noah walked out onto a very high and narrow ledge at age two and scared the crap out of us while we all stood on the ground far below willing him to freeze.

We hiked a lot. We could get to the beach in 20 minutes. I allowed topless women to visit Troy when he was sick because topless women were no big deal out there. We made frantic calls to the veterinarian in the USA and found out how to get a dog to vomit. We forced our Mastiff puppy to puke up rat poison, he narrowly escaped death. We had hilarious language mishaps and misunderstandings. Plus a thousand other odd and funny things.

The tough things always stand out more in memories, which maybe actually only says something about me and is not a gen. pop. problem at all. 

At that first place we lived in Haiti a lot of things changed about our family and about each of us as individuals.

  • I stopped thinking I could simply trust male Christian leaders without question. (Whoa. So much to say)
  • I stopped thinking missions was only about doing good. ( Whoa. So much to say.)
  • I started to understand Haitian culture. (Whoa. So much to understand.)
  • We fired someone that really needed her job but was really stealing a lot. Neither of us had ever done that before. (Whoa. It sucked.)
  • We had threats of physical harm made against us because of firing her.
  • We had weird stressful relationships with leadership.
  • Troy got Malaria 6X, Dengue Fever once.
  • I got Malaria 2X and Dengue Fever once.
  • Britt got Malaria and Dengue Fever.
  • Hope sliced her leg wide open from shin to kneecap. (An ER Doc friend of Troy's was visiting and fixed her up.)
  • We learned we would adopt again.
  • We learned we were pregnant. (The most read post of the last five years - is here - about that.)
  • One of my children was repeatedly badly harmed there. 
  • My marriage was tested.  Mainly we learned that hosting guests 3 out of 4 weeks a month is not super good for a marriage and big family. 
  • My theology was turned upside down. I stopped believing that nothing bad would happen to me if I loved Jesus and tried to do good. That was so dumb and obviously I was a moron but I did arrive with a massively jacked-up theology.

So much happened in those two years and nine months of living the village Haiti life. I could write for days just about those first years. 

The one story that most defines our time out there involves the mystery of God's provision or protection or just the mystery of EVERYTHING.  I say mystery because I know people that didn't get the outcome we got and I find that mysterious. I am not better than them, my faith is not greater. It is a mystery to me that Lydia's life was spared --- but I live in the tension of that sort of mystery every day here.  Some prayers are answered and some are not. Some babies live and some babies die.  Some moms in Haiti find care and many many do not. I'm a mystic and my theology does not give answers to those things like it once did. I believe God is good and that good and evil are at war. That's all I need to know. Love God love others, live in the tension. The end.

Lydia had been born in Minnesota.  I returned home to Haiti with her after the rest of the family because I was moving our oldest daughter, Brittany, to Baylor University.  I returned home to Haiti in mid January 2008.  The other kids were home, Troy was home, we had a friend/nanny helping us with our kids because we also had our niece in our care, so we had three kids under 18 months old. (Phoebe, Lydia, Annie).

I had been home a week when I noticed Lydia was running a fever and seemed a bit off.  She was not terrible and she is my seventh child so I wasn't in panic mode. I had seen some fevers.  I made a mental note of it and thought, 'I'll just see how she seems tomorrow.' I have always been a wait and see Mom. 

A few hours later the phone rang.  My friend Jen called.  Jen explained that she had a situation she needed out of and asked if we could please consider coming to Port au Prince to get her.  I could tell by Jen's tone that she was asking because it was necessary.  I told Jen I did not know where Troy was but I would see if he could drive to Port to get her.  Back in those days, at that organization, I was not allowed to drive. After all, I am merely a woman.   <eyeroll emoji>

I found Troy and he agreed we could leave in a while and go get Jen, about two hours away from where we lived.  I called Jen back to let her know it would be awhile, As an afterthought I said, "Oh hey, Lydia has a fever, do you think that's anything to worry about?"  Jen asked a few questions and requested that I come to Port au Prince with Troy and bring Lydia with us.  Jen said she could at least look at her and decide if she needed anything else before we were two hours outside the city again.

Troy and I finished what we had to do and left for Port au Prince. 

We got to Jen and picked her up.  Jen took a look at Lydia and asked us to go right to a hospital.  Once to the hospital Jen did her uber-professional-but-assertive-and-smart-act. (It is not an act as much as it is a way of being.) Jen helped steer the Doctor there toward a spinal tap / lumbar puncture to check for Bacterial Meningitis.  The test was positive and Lydia was immediately admitted.

For four nights I stayed with Lydia in Port au Prince and Troy was outside the city doing his job.  On the fifth night I was getting SO lonely.  Wanting to be helpful, Jen came to stay with me for the night.  That night we were sitting and talking and just about to share a pizza.  We discussed what a long hard week it had been but Jen thought it likely that we would be discharged after seven days.  As we were talking Lydia started seizing. 
Jen and Lyd 
On a Friday night, it turns out hospitals don't necessarily have Doctors in them, at least not in Haiti.  Jen kicked me out of the room in a loving way and took charge of the situation. She yelled for staff to get the right meds to stop the seizure.  She directed the staff as they attempted to get a new line into Lydia. It happened as fast as it could in Haiti, which was not fast enough for Jen or I -- but she was able to get the seizure stopped. A whole crap ton happened after that all that never would have happened if Jen had not been in that hospital. Somehow Jen demanded and got the Radiologist back to the hospital to look at a scan of Lydia's head.

While I drove down the road to the village we used to live, chatting it up with KJ, I remembered the miracle of everything that happened in January 2008.

BECAUSE Jen called for a ride - so because she called -  I decided to mention Lydia's fever - so because I mentioned it Jen said bring her in - so Lydia got the right diagnosis very quickly instead of a day or two later - so she got antibiotics and care - so then when all is going well - the night there just happened not any doctors at the hospital - that night Jen would choose to help relieve my loneliness - so because she was there on that night she could stop a seizure that no other employee at the hospital was prepared to stop themselves. 

BECAUSE all that ...

Our kid lived, our kid had no hearing damage, and we were spared a devastating loss. 

A trip down memory lane is rough on the tummy, but man, it is also beautiful.


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