The journey from Haiti’s capital to my new home takes 50 minutes by helicopter. We land right beside the ocean at Port-a-Piment in southwest Haiti. A month has passed since Hurricane Matthew. Plastic sheeting is everywhere and from the air you can see the mass destruction.
Medecins Sans Frontieres/Doctors Without Borders (MSF) has been in Port-a-Piment since the fourth day after the hurricane, but maternity care has been a bit slower getting off the ground because it hasn’t been as urgent as caring for cholera patients and providing clean water and emergency healthcare.
When I reach the hospital, I’m greeted by lots of smiles. The staff are happy to finally have a midwife. They tell me, “We don’t need to keep our fingers crossed anymore for no complicated births.”
It’s 10:30 a.m. and I go straight into my introductory briefings. By 11:00 a.m. I’ve been called to the maternity room: There is a woman in labor.
The maternity room is airy, with an old ceiling fan and lots of light. This is a good start. The woman, Milaud, is having contractions. This is her third baby, at 29 years old.
I soon find out she has been at the hospital for three hours already. I’m told there has been no change in her progress and I decide we should break her waters. Milaud consents. I offer to support the nurses on duty, Maud and Louise, as they do the procedure. But they run out of the room, telling me, “Next time, next time, Madame!” So I carry out the procedure myself.
After a lot of hard work on Milaud’s part, support from us and plenty of clean drinking water, Benjamin is born. It’s not the easiest birth I’ve facilitated, but Benjamin screams and lets us all know he is happy to be here.
Together, we deliver the placenta and I’m feeling rather smug that after five hours we have welcomed a little baby into the world. It’s only the ninth baby that has been delivered at this MSF-supported maternity ward.
Then Milaud starts bleeding. Where on Earth is the blood coming from? It’s like a tap has been turned on. The uterus is firm, I cannot see a vaginal tear that needs suturing, the placenta appears complete. Oh hell, I’m thinking. It can only mean one thing: a cervical tear.
I ask Maud to put up an I.V. drip and ask her to increase the flow. I ask Louise to get me a light and some sterile gauze. I’m starting to sweat and I feel a little out of my depth. Maud checks Milaud’s vitals – she’s stable – and we put in a urinary catheter. I find the source of the blood loss. I close the tear with my fingers and sterile gauze and call for the doctor.
I’ve seen this specific obstetric complication twice in my career, once in London and once in the Democratic Republic of Congo. Both times, the women needed intensive care and blood transfusions. In both cases, the women needed an operating theater, general anesthesia and a doctor trained in gynecology emergencies. Right now, I don’t have any of these.
It is getting dark and we need to stabilize Milaud and arrange for a private ambulance.
Dr. Roland, a 32-year-old Haitian doctor also employed by MSF, comes to my rescue. I put on my goggles and my colleagues in logistics bring in the biggest cylinder of oxygen known to humanity.
Together, she and I manage to put three separate sutures in Milaud’s cervix, something neither of us has ever done before.
I make up a pad of cotton wool covered in a piece of gauze so I can see how much she is still bleeding. Not too much. I am confident. Her vitals are stable. We give her some more oral analgesia and water.
And then, it’s like the tap has been turned on again.
Milaud has already lost so much blood that I start to really worry. We decide we have to get her out to a gynecologist, one hour away by car. She begs me for food, but I can’t give her any as I’m sure they will give her a general anesthesia. My mind is racing. What if she bleeds out en route?
Seven and a half hours after arriving in our maternity ward, Milaud, baby Benjamin and Milaud’s sister left the MSF ward and were on their way to Port-Salut where a Haitian doctor, Dr. Stevenson, who runs the local hospital, would greet her and save her life.
Later – two days after probably the most memorable first day in a new job – Milaud and Benjamin came back to the maternity ward in Port-a-Piment. Sitting on the hospital’s small metallic chairs, Milaud looked tired and weak. But she beamed over her tiny baby. She gave me the prescriptions from Dr. Stevenson and I prepared her medications while we talked.
Now I’ve been in Haiti for almost two months, and I’ve had a lot of complicated cases. Some didn’t have happy endings – there have been stillbirths and women dying. I still can’t quite believe what happened on my first day – it was so intense, as was the whole first week. I think it has calmed down a bit now or maybe I’ve just become conditioned to what it’s like here. There’s still a lack of resources and a lack of trained staff.
A version of this story originally appeared on Medecins Sans Frontieres.