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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?


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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.


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