Friday, March 22, 2019

Slow and Steady Wins the Race

(Picking up where I left off on my recent Instagram/FaceBook post...)
Waiting for Ultrasounds

The Process of Growth

All new endeavors are overwhelming at the beginning. Growing at a slow, but steady pace can help you become well established as you begin to provide women with excellent maternal healthcare. There are many ways to build a maternal health program, no one way is correct. In order to make it less overwhelming for you as you dream of your future impact, we want to talk about the slow and steady way the Heartline Maternity Center model was built.

The Maternity Center began 12 years ago. (2007)

At the beginning we simply met occasionally with 15-20 pregnant women to talk about pregnancy and basic health issues. It was similar to a support group and was meant to be a supportive and friendly learning environment.  About a year into the meetings we started distributing Prenatal Vitamins and Iron supplements. We began taking vitals each week as the women arrived and started recording their weight, pulse, and blood pressure each week before class. About two years into the weekly class gatherings, two certified midwives moved to Haiti to begin doing full prenatal visits. We were careful not to offer anything beyond the training and experience of the staff. The two midwives began seeing the women for prenatal care after program each week on the same schedule an OB/GYN or Midwife would do visits in North America. Prenatal care and regular consultations were provided at Heartline, but the client still needed to deliver at home or find a hospital.

During the first two years we also offered a class for women to attend after they delivered. We began holding classes for pregnant moms on Thursdays and postpartum moms and new babies on Tuesdays. The evaluation of the postpartum class created a deep sense of community amongst new moms who were perhaps doing things differently than their own mothers had.

About three years into the program we began to offer labor and delivery services. Before we could offer these services we needed to be sure we could cover the Maternity Center with a staff member 24/7 365 days per year. Sadly, many clinics and hospitals in Haiti don't deliver babies on weekends or at night. We think that's nonsense! We made sure to have two skilled and trained midwives on staff before we began to offer that service.

About four years into the program we realized that we needed to keep women after delivery for longer than the six hours that is customary in low resource countries. We added postpartum care with around the clock care providers for as many days as each individual mother and baby needed.

In the fifth year we began offering a birth control program. Prior to that we provided education on child spacing and methods of contraception, but had yet to provide contraception at our facility.

In our sixth year we were gifted an excellent Ultrasound machine. Several staff members received training to perform U/S. We began to use U/S during interviews of newly pregnant women. This allowed our due dates to be very accurate. Often times LMP (last menstrual period) is uncertain.

As we continued to grow, we added approximately 10 pregnant women a year to the prenatal program. As we increased the number of prenatal program participates, we also increased staff. This brought us eventually to our max number of 70 to 75 pregnant women in our care at one time. As one woman delivers, a newly pregnant woman takes her place and begins the weekly classes and prenatal care in her first trimester.  

As we became more experienced and hired more medical professionals we also began to take on slightly more complicated pregnancies. In the early years all women with pre-existing hypertension, asthma, or gestational diabetes were risked out of our care. As we have grown we have been able to take on more of those clients and we risk out less women than we did at the start. (Of course, there are still women that must be referred to higher level care with a Doctor.)

As we grew, we established both medical and practice protocols. We hired more staff and went from zero Haitian medical professionals (just two Americans) to seven Haitian medical professionals, employed full time with insurance and benefits.
Five newly pregnant women receiving contract to join the Prenatal Program
 Overall, it has taken us 10+ years to hire and build up a staff that is fully on board with the mission and vision of the maternity center, and to grow into what we believe is our full capacity as a maternal health program.

Prenatal Class March 21, 2019

We don't aspire or plan to grow our numbers to more than 70 to 75 pregnant women at a time (this ends up to be about 120 babies born in a calendar year). The high quality care, education, and focus on building trusting relationships is part of the reason we have such great outcomes. We believe the high provider to client ratio is an essential part of the model of care. In order to provide excellent care we know we cannot keep adding more women. We believe quality over quantity ascribes dignity and honor to each woman we care for.

Because we don't plan to grow, we know the only way to keep reducing maternal and newborn mortality is to share the model and equip others to take it and run with it.

Please let everyone you know (that is working at an organization that is attempting to help with women's health) know that we are offering a class and manual about how to build this program and save Moms and Babies from PREVENTABLE death.

Sunday, March 17, 2019

Filling the Ocean


Fòse moun fè sa yo pa vle fè se tankou esye plen lanmè ak wòch

Forcing people to do what they do not want to do is like trying to fill the ocean with rocks.
Meaning : You can not force people to act against their will. 

On Saturday we readmitted a baby girl that had been discharged earlier in the week. She was born March 8, 2019.

Saturday the baby arrived to the Maternity Center 102.6 degrees, dressed in heavy layers of warm clothing. When weighed, we found she was down from her discharge weight of Tuesday. She appeared to be dehydrated. All other vitals were normal. 

Dr. Jen  (the Pediatrician that advises us on all sick babies) was available and we talked about getting IV antibiotics started and keeping them in house for seven to ten days. 

We got the baby out of all her clothes and asked that she nurse so we could see how she was doing with breastfeeding. She seemed desperately hungry as we watched her eat. 

In the time I was preparing the medicine and talking to Jen the baby ate voraciously. When she was done we supplemented her with additional milk. The change in her was immediate and I began to wonder if perhaps she was not sick, but simply hungry.  We talked with Gracie's mom about how the nursing was going and when the fever had started.  By the time I took Gracie back from her Mom, she was back to a normal 98 degrees Fahrenheit.

Another hour later, all vitals remained totally normal. We asked Gracie's mom if we could please re-admit them for several days to help get the breastfeeding back on track. We've seen that sometimes young mothers get home and don't end up nursing enough due to other people in the house not realizing that every two hours is very necessary for a small new baby. She agreed and we wrote up our plan for pumping and feedings and gaining weight. Midwives Nadia and Frèdelyne were on board and the plan was set. 

After everything was calm and stable I posted an Instagram picture on my personal account with an update on baby Gracie and a thank-you to all the donors that donate and make the Maternity Center run.  

About three hours later the young Dad of Gracie and his mother (Gracie's Paternal Grandmother) came to visit at the MC.  They were upset that Gracie was down to her diaper and asked why we did not have the baby dressed. The two midwives on duty explained everything about too much clothing causing fevers and shared our concerns about the weight Gracie had lost and the need for some additional feedings to be added in for the next several days.

Long story short, the Grandmother and Father of baby Gracie talked Gracie's Mom into leaving AMA (against medical advice) with Gracie.  They believe that Gracie has a curse on her and that it is something that can be handled without us. 

We explained that we strongly believe that more than anything, she was not eating enough and was dressed in too many layers. They would not hear those concerns and packed up their things and left the Maternity Center. 

The director/fundraiser in me knows that this is not a success story.  
Yes, I'm that BRIGHT.  

As much as we do to work on education in our classes, there are times when the power of superstition or culture or family dynamics cannot be overcome.  Many, even most perhaps, women that come for prenatal care end up believing in what is shared and taught - but not all. 

I suppose it is a weird time to ask you to consider becoming a monthly donor of Heartline Ministries. Rather than do that, I want to share our values with you. While it is not specifically noted, I would add that we also value being truthful and open with our donors.


At The Maternity Center we value:
  • Compassion: we treat all of our clients with respect, love, and kindness.
  • Joy and celebration: we make room for joy, laughter, and singing as a form of spiritual care.
  • Excellence of care: we deliver the best possible care and maintain the highest standards of midwifery.
  • Honesty and integrity: we are truthful and open with our clients and with one another.
  • Affordability and access: we are committed to serving women who would not otherwise have access to high quality midwifery care.
  • Empowerment through education: we educate women because we believe that their empowerment will change the world.
  • Personal relationship: we work to connect with each woman by name and by story in order to best serve their diverse needs.

We are discouraged by what happened with baby Gracie yesterday, we hope and pray that she will be okay and that she will grow up to be loved and honored. We fight to remain hopeful because we know hopelessness is the enemy of justice.

"...With hope because hopelessness is the enemy of justice.
With courage because peace requires bravery.
With persistence because justice is a constant struggle..."
(Source: The National Memorial for Peace and Justice in Montgomery, Alabama)

Wednesday, March 13, 2019

Why Am I Here Again?

Sister visit!!!

The weight of (my) responsibility is something that I handle quite well-ish 82% of the time.  

That is to say, I am upright and can speak to you about it with some level of professionalism. You may not even know that I sometimes find it a bit suffocating. 

It is just 18% of the time that I need to consider a half an Ativan, deep breathing exercises, sobbing hysterically on my bed, or getting on an airplane.  (Vodka is no longer on the list of options.) 

I am always aware that there are things that the infrastructure of this country literally won't allow for; certain injuries that cannot be dealt with quickly enough  - or at all. I am always aware that my phone can ring any time day or night and something medically intense is happening and staff will be looking to me to come make the call about what to do. I am always aware that if nurses or midwives quit or don't show up, those shifts are going to need to be covered. I am always aware that while birth can be made safer, it is never ever risk free and until a Mom and baby are about 24 to 48 hours out, things can turn south without warnings or signs in advance. When that happens, the decisions fall to just one or two of us. I am always aware that situations here can change on a dime. (Or a gourde for that matter) One minute you might be sitting in your truck totally in control and thinking the day is going to be normal, and the next some huge thing is unfolding before your very eyes in traffic. (Recently KJ and I drove up upon some sort of weird situation - it equalled two guys being killed by the cops. The dead men were laid across one another in an X shape in the intersection to make a statement.  The statement to me was, "Holy Cow, this place is unpredictable and sometimes freaky!" I think to others it maybe meant something else.  Anyway, we managed to be there at the wrong time and saw the human X display.)

So, on the days where I am operating out of the insanely overwhelmed 18% I really do need to talk to myself about calming the heck down and just taking things one at a time as much as that is possible.  (And also, just realizing most of this is not within my control in the first place so I try to remember I don't have the option to fix most things.) 

Yesterday was crazy. Nothing terrible, just one situation after the next. I got into it with our security guard and from there it just continued to be conflict and challenge. By the time 4:30 arrived and it was time to go pick up my sister from the airport I was fried.

Troy came with me to the airport, because he is a wonderful human and he has a sixth sense about when I might snap. Perhaps he wanted to be the driver, in order to protect us all??? 

On the way home I asked him to stop at the store. I wanted to run in and buy apples and bleach.  I planned to get the gross yellow stains in the armpits out of a few of my white t-shirts.  The apples have nothing to do with that. 

I got in the store, saw that the only apples they had were the gross kind.  I kept walking and realized I did not know what the other thing I wanted was anymore.  I went up and down a few aisles to see if my old-lady brain would kick it up a notch and maybe I'd remember.  Finally I had to admit I was going to wander around aimlessly unless I asked Troy.  I called Troy from inside the store.  He answered from the parking lot and reminded me, "You are there to buy bleach, Tara."

When I came out of the store Troy and my sister waved obnoxiously at me from the truck, told me their names and treated me like an Alzheimer's patient.  

It's the new shtick, mocking my non-functioning short term memory.  

Unfortunately, I always give them more material.  

We pulled out of the parking lot and I couldn't find my phone.  We pulled over and I searched my purse. Troy called my phone. No ring in my purse. I went back in the store and talked to the cashier of the line I was in. She said she had not seen it. I asked at the service-desk of the store. Everyone was helping the forgetful old lady find her phone.  

I put my hand in my purse again to grab a pen to write down my information if it was found ... and VOILA,  turns out it was found. 

Why am I here again?

Saturday, March 09, 2019

Bacon or Sex: One of life's most important questions!

I recognize that I am a fairly laid back parent.  

I think some would even call me, "permissive". 

I was not always this way.

Call it what you will, I've been at this for 29 years and I've lost my will to fight. 

I tried rigid and conservative.  I tried medium chill.  Now I am trying "you're an adult soon, so this is how it it is".

All that to say,  I had no issue allowing my teenagers to see A Star Is Born, which is rated R.   They watched it with another 18 year old friend and their teacher.

(Sidebar: I am still a strict freak about Internet hours - they don't get more than a few hours a day until they live somewhere else on their own.) 

I know some of you gasp at that.  It's okay. They are okay.  We live in a very thin place in the world, they see the effects of injustice and they understand sexual assault and manipulation and abuse of power within relationships. They know about consent and equality too. An R rated movie is tame compared to real life. I have always wanted my kids to know what is real. I cannot help them navigate life if they only know rainbows and puffy clouds. 

My 29-year research project has led me to the conclusion that parenting styles and the outcomes a particular style might produce is less consistent than a roulette wheel. 

That to say, one LITERALLY has nothing to do with the other.  Good parents have hard kids. Bad parents have easy kids. Etc. Etc. Vice Versa. Everyone is just rolling the dice.

A parent that is strict may end up with two sons in jail.  Another parent that is medium chill ends up with one drug addict, one mini Mother Teresa (Saint Teresa of Calcutta), and one honest hard worker making $20 bucks an hour in middle management while being a good Dad to his kids. Some permissive parents have one off the rails and one solving world hunger. 

All that to say, I neither take the credit nor the blame for my kids. 

I love them unconditionally and attempt deep relationship with each of them as individuals - (that feels key to me, they are so different) -and that's my priority - but if my style of discipline and guidelines and/or support end up creating a problematic adult, I say, "Yeah. I rolled the dice just like you guys."

NONE of that is my point.  

My point is to tell a hilarious story.

Isaac and Hope watched A Star is Born with their teacher Stefanie. Stef told me that when the scene came where a beautiful breakfast was being served to Handsome Brad and Gaga the Lady the kids were thrilled with the sight of the fancy breakfast with thick strips of Bacon.  

When Brad and Gaga got up to leave the table to make love, having not eaten the Bacon yet, the kids lost their minds in utter disbelief.   


They exclaimed to Stef, "Nobody would leave bacon like that, would they???"

Faced with a difficult decision, Stef told them the truth, a couple in love might actually choose to make love over eating breakfast. 

Isaac and Hope Livesay  (but especially Isaac) wish to go on record with this:  

Bacon is their priority. 

Kids with Scott Salvant last week :)

They hope it is yours as well.

Thursday, March 07, 2019

Working Women - Working For Women

I wrote about an inspirational working 
woman in celebration of
Friday, March 8, 2019.

Please go read about her HERE


Tuesday, March 05, 2019

Discover Humanity

We live in a fearful world.  

I suppose my opinion could be dismissed by many, but I'd like to share it none the less.  That's what blogs were created for, yes? 

People are awfully fearful of one another.  We tend to make decisions quickly about folks we feel are unlike us. There is a lot of them vs. us stuff going on in this day and age. 

There are legitimate things to be concerned about, don't get me wrong. I just don't think we are generally worried about the truly frightening things.

The fear of people that are different than us seems to have irreversible momentum.  

I read Twitter and listen to the way things are portrayed in the news and I see a whole lot of fear and even more hype.

I don't want to be afraid of people that believe or relate or experience life differently than I do.  

More importantly, I don't want to raise children that are fearful of differences.  

I'm sharing this new film to show you that people in Haiti are just people. We all want the same things. The media shows mainly the negative things, they don't necessarily work too hard to see the nuanced picture.  

There is always more than meets the eye.

Dear Livesay Family-
As the first destination on our newly-launched global project Discover Humanity (, we came to Haiti in December and created a short film about the life and culture we experienced there. 

The goal of the Humanity project is to create cultural, human-focused short films that capture a real look at life in every country of the world. These films also offer local people the chance to share a message with the rest of the world. 

Creators of the Humanity project
+1 323 617 2928 (WhatsApp)
YouTube channel: