Monday, December 6, 2010
Expert midwife uses creativity and skill in Haiti
In the sequence above, Dr. Trout (right) and fellow volunteers are ready for the drive into the countryside of Hinche, passing large groups of displaced people to arrive at the prenatal clinic after crossing a stream and climbing a hill.
Dr. Trout, 2nd from left, outside the maternity ward at Hopital Ste. Therese de Hinche where she and colleague Megan Donaghy delivered a baby girl, seen with mother at right.
Separated from patients in the hospital, those who were infected with cholera were cared for in roughly a dozen cholera tents (left) around and on the hospital property or a makeshift ward in the church, right. As Dr. Trout entered the church she found a man who had recently died, only 12 hours after the onset of symptoms. Later, seeing his body on the ground where deceased victims were placed with no covering, she used a paper gown that she brought on the trip to cover him.
As cholera overwhelmed its victims in the Ste. Therese compound, Dr. Trout was part of at least one miraculous outcome. Mirlinda, above, is a 4-year old girl with severe dehydration from cholera who the day before had collapsed just after a medical volunteer finally gained intravenous access. She was rehydrated and was well enough to sit up-- IV fluids still infusing-- and sip at oral rehydration solution.
Records are an integral part of health care, even in Haiti. Here, Dr. Trout used her preparation in statistics to assist a local volunteer with Midwives for Haiti in developing spreadsheets and entering data from a birthing log to be able to better track outcomes and evaluate programs.
“I never felt more proud to be a nurse”-Dr. Kim Trout
Villanova, PA, November 30, 2010— A cold drip of a shower, a functional mode of transportation and intravenous access in a dying dehydrated child were just a few of the things that Kimberly Trout, Ph.D., CNM, a certified nurse midwife and assistant professor at Villanova University College of Nursing, was grateful for over the Thanksgiving holiday when she volunteered for a week with the organization Midwives for Haiti. Being involved with the Haitian people and their dire situation was an experience that affected her deeply, even after 23 years as a professional. “I never felt more proud to be a nurse,” she notes.
Haiti is the poorest country in the Western hemisphere. According to Midwives for Haiti, 76% of all deliveries are done by non-qualified persons, contributing to the highest infant and maternal mortality in the western hemisphere. Fifteen percent of newborns have low birth weight and 25% of the children suffer from chronic malnutrition. Dr. Trout volunteered to deliver babies and educate Haitian women in providing prenatal care and skilled birth assistance. The need for help is even greater in the post-earthquake country with a population increasingly succumbing to cholera, a waterborne disease that can dehydrate and kill within hours.
Dr. Trout and Megan Donaghy, CNM, RN, a colleague from their midwifery practice at Pennsylvania Hospital in Philadelphia, landed in Port-au-Prince with supplies for their clinical work and donated neonatal stethoscopes. Dr. Trout also brought donated demonstration supplies for the students such as incision and breast models, as well as hand sanitizer; vitamin, calcium and iron pills; and bed sheets donated from the College staff and faculty so birthing mothers would not have to lie on cold plastic atop a metal litter. Women who are giving birth are to bring their own sheet and bucket to the maternity ward.
After reloading supplies onto an overcrowded van (their first vehicle had a flat tire) they began the 3-hour trek north, over mountains, to their home base, Hinche, 60 miles away in Haiti’s central plateau. They were soon crossing over rocky streambeds by foot, arriving at the mobile prenatal clinic in Fonbren and to see 21 patients before having to depart due to the threat of flood rains. Dr. Trout, fluent in French and accompanied by a Kreyol interpreter, performed prenatal exams and did health promotion teaching there. While the women receive worm and malaria prophylaxis as well as tetanus shots, complicating their lives is the potentially fatal danger of cholera, now rapidly spreading through the countryside with about 1900 deaths thus far. The women live with no reliable water supply, electricity or sanitation, and wash in the rivers and streams.
Later that afternoon Dr. Trout visited an orphanage in Azile run by the Daughters of Charity, where she hugged and played with children who were there for treatment of malnourishment. “Patty-cake was a favorite game of the kids, and many just wanted to be held,” she recalls. The days that followed were spent at Hopital Ste. Therese de Hinche. While Dr. Trout planned to help mothers deliver babies, she spent more time where the greatest need was—in the surrounding cholera tents and makeshift cholera ward in the church where they averaged two deaths each day. She assessed countless patients for dehydration and started or ran IVs to keep patients alive, hanging IV bags from tent ties. “Basic nursing skills were needed the most,” she explains. Luckily, the team was able to gain IV access on 4-year old Mirlinda, who was near death but rebounded after a day of fluid and electrolyte replenishment.
An equally happy occasion occurred with the birth of an infant girl in the maternity ward inside the hospital. The laboring mother was having severe back pain and with no analgesics, benefited from Dr. Trout’s expertise in using sterile water papules (small injections of sterile water under the skin in the lower back to interfere with pain perception and ease labor) for pain relief. “Low-tech” created a more pleasant and safe birth experience for the mother than she would have had otherwise.
When not caring for patients, Dr. Trout was asked to consult with a volunteer with Partners in Health on additional topics to include in teaching modules for community health workers and new mothers. She advised including recognition of and treatment for breastfeeding complications, umbilical cord care and caesarean-section wound care. Additionally, she aided her interpreter from Midwives for Haiti in organizing an electronic record for statistical analysis of birth data. That work is ongoing.
Dr. Trout’s dedication to safe and healthy pregnancies and births for mothers and babies is evident. Not only does her passion and compassion benefit patients in Philadelphia but now in Haiti as well. For her, the benefit flowed both ways. Like others who have felt the pull of Haiti, Dr. Trout simply says, “I want to go back.”