I am an OB/GYN physician who practices medicine in rural Northern California. I recently returned from my second volunteer medical mission to Haiti where I worked excruciatingly long hours performing surgeries and providing other medical care for women. I want to tell you just one of the powerful stories that has occupied my heart and mind.

Let me provide the setting. The two-bed emergency department was noisy and crowded. It adjoined the ten-bed medical/surgical department and the four-bed ICU, without much separation. There were too many patients and not enough beds. Some patients were sitting in chairs between the gurneys and others were lined up outside the hospital with their chief complaint and vital signs taped to them on a piece of paper, but that is a story for another day.

I asked the translator to bring a screen for some privacy while I found a paper gown to use as a sheet to cover Sarah. In past missions, I have found it easier to perform an ultrasound than to ask a lot of questions to try to determine a woman’s last menstrual period. The translator explained to Sarah what I am doing as I performed an ultrasound with a scanner that was not designed for obstetrics–but it is all we had (and it is more than we had on my last mission here). She was about 14 weeks pregnant, but there were no fetal heart tones I expected to see on ultrasound.

I asked her questions, through the interpreter. “When did the bleeding begin?” “When did the pain start?” The story kept changing and the answers were conflicting. A Haitian surgeon tried to help. He told me she said she had had a D & C elsewhere and subsequently developed pain and bleeding.

I have been taking care of women for many years and I follow my instincts. I told the medical student who had been shadowing me that I was suspicious that something was missing in Sarah’s story. I asked the translator to translate my words exactly, “What did you put up inside your vagina?” Finally, the truth. She had inserted a medication called Cytotec and taken some orally as well.

Port-au-Prince Market

I ordered medication for Sarah to help with the pain of her contractions. She needed a bed. I checked the isolation room. As I looked in, I remembered the 24 year old young man who lay dying of AIDS, yearning to see his mother, who never came. I shook my head to clear it. The bed in the isolation room was empty, so I arranged for Sarah to be placed in there.

I did not want Sarah to be left alone. The nurses were too busy to leave the Emergency Department, so I assigned the bright young Haitian medical student the task of monitoring this scared teenager. Luckily, the student also spoke English, so I gave her very specific instructions to check Sarah’s vital signs, time her contractions, and call for help if there was heavy vaginal bleeding.

Two young men were now at Sarah’s bedside. I could not tell who was the partner and who was the “cousin,” so I let them both stay in the room.

The teenager labored while I cared for other patients, checked on her intermittently, and gave her more pain medication. She delivered the gestational sac intact and the family wanted to see it. After some questioning, they were satisfied that she was no longer pregnant. It was 11:00 p.m. and even though we needed the bed, it was unsafe for the Sarah to go home through the streets of Port-au-Prince.

The following morning, I found a “fatherly” translator and asked him to talk to the two young men about using condoms for birth control. I counseled Sarah about caring for herself during her recovery. She had been through a lot and definitely did not want to repeat the experience. I told her to say “NO!” if her partner does not use a condom. They were all laughing now at my emphatic gesturing. In the previous four days, I had done three emergency D & C’s on young women for incomplete abortions. Unlike Sarah, these women were hemorrhaging. I wondered how many of these had been self-induced.

There is little or no access to birth control in Haiti and a lack of education for young people. There is so much need. I have done a lot, but it is not enough. I return to my home in California with renewed conviction in what people are able to accomplish when we work together for a common purpose. I am determined to raise the funds that will enable me to go on my next medical mission. Don’t underestimate the things that we can do.

One mother dies every 90 seconds

The children have a 14 times higher rate of dying before the age of 1 year.  Many of these children end up in orphanages or are sold into prostitution.

Women die in childbirth from 5 major causes:

• Hemorrhage after childbirth
• Infections
• Hypertensive disorders
• Obstructed labor
• Unsafe abortion

THESE DEATHS ARE PREVENTABLE

Maternal deaths worldwide have dropped by one third over the past 20 years. (according to WHO) There are things that have been proven to be effective:

• Strengthening hospitals and health care centers to assist pregnant women
• Training more midwives
• Education and better access to family planning

No one should have to endure what this young girl went through but with little access to health care this is a common practice in Haiti. This can only be changed with education and better options for birth control.