Tuesday, October 15, 2013

Nadege and Structrual Sin

Nadege and David--October 4, 2013 (Photo by John Carroll)
Nadege and David–October 4, 2013 (Photo by John Carroll)
The other day I visited Haitian friends in Laboule which is a neighborhood
in the mountains up the road from Petionville. Laboule offers very beautiful
 views from its cliffs overlooking Port-au-Prince.
During my visit, my friends asked me to check the blood pressure
of one of their neighbors, Nadege.
Nadege is a 35 year old poor petite woman who lives in a two room
shack with her five kids. She offered me her right arm and held the
manometer in her left hand for me. Her blood pressure was 180/110.
This elevated pressure is not uncommon in Haitian women.
So I put her on some low dose hydrochlorothiazide and told
her I would come back and recheck it in a couple of days.
Two days later I rechecked her blood pressure and it was down
 to 160/90. Not perfect by any means but better. She was very
grateful for the home visits. It is always embarrassing to me
when poor Haitians express their gratitude especially when I
know that I am not doing near enough for them in the first place.
During much of this home visit, Nadege was holding her
solemn one year old son David. He is the youngest of
Nadege’s five children. I asked Nadege if David was
born at home or in a hospital. She replied that he was
born right here in the shack. I asked her if she had a
matron (local midwife) with her for the delivery and she
said no. When I asked if there was ANYONE with her
when she delivered David, she said no. She had delivered
David alone on the floor of the next room.
I asked her to show me exactly where she had delivered
David and so she pulled the curtain that led into her bedroom
and we walked a couple of feet from the main room into the
small adjoining room. And at my request Nadege sat down on
the floor with David and showed me where she delivered him.
After David was born Nadege cut the cord herself and gently
placed David on the floor. Nadege said the placenta delivered
on its own but that she “filled a bucket with blood”.
When I questioned her further she stated that she had delivered
some of her other four kids at a hospital and others at home with
a matron. Nadege’s answers were all matter of fact with no drama
or self pity. She showed no emotion. Nadege seemed to be just
as indifferent to her circumstances as the rest of the world is to her.
Haiti has a very high Maternal Mortality Rate (MMR).
MMR is defined as the deaths during pregnancy, child birth,
or within 42 days of delivering a live baby per 100,000 births
for a given year. For the year 2006, Haiti had an MMR of 670
while the United States was 11. Maternal mortality rates are
still underreported and frequently misclassified. For example,
if Nadege had bled to death during her delivery, would her death
have been reported to Haitian officials?
Major causes of MMR are severe maternal bleeding, infections,
unsafe abortions, eclampsia, and obstructed labor. Most
maternal deaths around the world are avoidable and should 
be classified as stupid deaths.
Over 90% of maternal deaths occur in “developing countries”.
The US Joint Commission on Accreditation of Healthcare
Organizations calls maternal mortality a “sentinel event”
and uses it to access the quality of a health care system
in a community or country. And in Haiti the horrendous
MMR accurately reflects its horrendous health care system.
Nadege had no prenatal care with David. She would have
had a difficult time traveling over Haiti’s roads to access a
clinic with qualified staff and equipment. Plus she has no
money in the first place to accomplish this. And who
would have taken care of her four children? All of her
neighbors are poor. So she had David at home. Alone.
From the magazine America: “The Catechism of the Catholic
Church defines the common good as “the sum total of social
conditions which allow people, either as groups or as
individuals, to reach their fulfillment fully and more easily.”
There are three elements in the common good: respect 
for the fundamental and inalienable rights of the human person, 
the social well-being and development of society, and the stability 
and security of a just order.”
And when one ignores the common good we are guilty of
structural sin. Listening to Nadege and being in her home
made it very clear to me how one commits this sin.
Pope Francis writes about the culture of indifference that
desensitizes us to the suffering of others. We are able to
look away and not see the Nadeges in our society.
And from America, “Pope Francis’ words about the
“globalization of indifference” echo the poignant
observation of Pope Benedict in his encyclical
“Charity in Truth” (2009): “As society becomes ever
more globalized, it makes us neighbors
but does not make us brothers.”
John A. Carroll, MD