Tuesday, November 22, 2016

Culture Trumps All

The longer we are in a place that is a second/alternate culture to us, the more we recognize the power of culture. 

When I think back to our first months and years living in Haiti.  I always want a do-over with *THIS* experience level and THIS slightly better understanding of cultural norms and language.  Oh my word, the heartache we could have saved had we known what you cannot know until you sort of kind of know it.

My paradigm is different than the paradigm of the women we are working with at the maternity center. The communication required to hopefully end up understanding one another is always "challenging" and oftentimes frustrating.

Just when I think I kind of sort of get it, it becomes apparent that NOPE, I don't.

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A few months back a teen named Nadege delivered her son and because of the extra support she needed she stayed in our postpartum room for a week or more. When it was time to bring her home I asked if she could commit to come for visits each Tuesday to be sure her son continued to gain weight. She told me she wanted to come every Tuesday but her aunt wasn't going to allow her to stay any longer at her house.

When we dropped Nadege off we asked Nadege's Aunt if there was any way at all that Nadege could stay with her until the baby was about three months old. We explained wanting to be sure they established solid breastfeeding habits and that the help to a teen mother would be invaluable. The Aunt convincingly assured us that it would be no problem to allow Nadege the three months before asking her to go live elsewhere outside the city. 

Four days later, on a Saturday, there was a knock at the Maternity Center gate. Nadege  was stopping by to say goodbye before heading into the countryside to live with other family. She said her aunt agreed to keep her to get us to leave but that her aunt immediately asked her to make her plans to leave after we were gone.  My preference is always truthful communication, I would have dealt with the real answer had it been offered. We have no word from Nadege and hope she and Emmanuel are doing well.

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Recently we announced a requirement for staff at the M.C.  If horrid traffic or any host of things will cause an employee to arrive more than five minutes late for their scheduled shift, they are required to call and let us know so that one of us living nearby can run over and cover for them until they arrive. (Being late is allowed - because Haiti. But, please, just call.) Everyone nodded in agreement that calling when late was a fair request. Three days later a nurse was 30 minutes late to her shift and that evening another nurse was 20 minutes late. Neither of them called. They were presented with written warning and another explanation that not calling when late is not acceptable and could lead to loss of wages or termination. 

It caused defensiveness and upset but we managed to deal with it and clarify that the rule of calling when late was actually going to be enforced. (Rules without enforcement are pretty much the way of the world in these parts, so human nature says - TEST IT.)  After the little bump in the road, life went on and everybody seemed good. 

Last week (a month after the incident) one of the two nurses asked to talk about that day of being written up. She said that she felt it was unfair and not right that I did not make it clear what would happen if the call was not made. She said, yes, I asked for a call but I did not clarify what would happen if the call was not made.  I was so confused. I said, "Ok, well... Now you know what will happen."  

She shook her head and said, "No, you don't understand. I should have known what consequence would happen prior to it happening."  We went round and round discussing my American way of being and her Haitian way of being and that we would likely see things differently quite frequently.  

In the end I agreed that if some rule is put into place in the future it will also be made clear what happens if the rule is ignored.  SIGH. 

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One Thursday earlier this year, I walked  in and was immediately greeted by Marilene and her Mom.  Marilene was a very memorable expecting Mom.  We tend to quickly know the young women with a strong Mom or Aunt in the picture.  I greeted Marilene's Mom and she told me she came along with her daughter to ask why she had not delivered the baby yet.  I said, "Because she is only 28 weeks pregnant." She immediately disagreed and I asked if we could please wait and talk after class.  

Nirva is the most experienced nurse on staff, I asked her to meet with Marilene and her Mom to hear them out and then help explain how long pregnancy lasts and why we believed Marilene was 28 weeks.  Because Marilene had been spitting, (spitting is the sign of pregnancy in Haiti) Mom believed she was much further along than 28 weeks. Nirva couldn't get anywhere and brought them to KJ.

For thirty minutes every staff member tried to share facts and ultrasound results and measurements and information but Mom said she saw the signs of pregnancy longer ago and that the baby should be coming at any moment. Nirva (nurse standing in the doorway with white skirt) laughed and said, "Uh-oh - KJ nan GWO match" (KJ is up against a tough opponent.) 

Education is everything but beliefs (mine too - yours too) are held tightly and it's difficult to trust others. It appears to be difficult to listen too. This can become a problem if Mom decides to go find (and pay) a country doctor or midwife to induce labor based on bad information. Premature babies don't do so well.

One of the challenges of providing care in a materially poor country where folks don't and haven't had access to excellent care and excellent education is convincing said folks that what we are sharing is true.

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In November we have had a bit of a butt-kicking.  Several difficult cases have arrived in just a short time.  One of those cases is a 37 week - 16 year old with text-book Pre-Ecclampsia.  The "mother-in-law" (they are teens, not actually married, but she gets this title) has the power in the family and seems not to believe that her son's girlfriend is in need of bedrest. The last two weeks have been spent begging two area hospitals to take this case. Using the expert advice of the two OB/GYNs that consult with us on difficult cases, we attempted an induction, but if failed to produce contractions. The hospitals have protocols and criteria that they don't follow when they are overworked and too busy. It  then becomes a game of chess deciding what move to make next.  The only problem is, the game is not fun and the game involves the life of a baby and a young mother.  The game suck and we don't enjoy playing it.  GRACIOUSLY, last night, on try number THREE, one of the hospitals that had previously turned us away, took the young girl into care.  We are hoping and praying for a phone call today with news of a good outcome for her after many many days with classic Pre-E blood pressures.   Hope and pray with us, please.

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The RE-DO Haiti election was held Sunday. How it went, depends upon whom you ask. We await official news  -- and unofficial news.