I spend my days now in the mobile prenatal clinic in a corner of the arranged room performing ultrasounds on our new patients and follow-up ultrasounds on some of our 2nd trimester patients. The room tends to be quiet. You might find the expectant mother craning her neck to see if she can discover the sex of the baby before I tell her.
It’s a magical space really where anything is possible; every twist of my wrist slices a new ultrasound plane which allows me to look at the growing baby and make a difference in the lives of both mother and baby.
Mimsi International is founded on three principles: dignity, empowerment, and vitality. And what goes on outside of the ultrasound room is a unique combination of all three of these. Over the last six months, the Mimsi community volunteers (now 9 of them) have learned much of what is necessary to deliver quality prenatal care: blood pressure monitoring; fetal Doppler assessment; fundal height measurement; urinalysis; and STD screening. They present patients various topics like the signs of labor and the mechanics of breastfeeding.
They invite the women to simulate what they have learned in front of one another. Finally, they treat them with such respect, ushering them into the nurses’ unit and protecting their privacy with number like the one below for a patient we found to have HIV. But what’s really cool is to see how they expand themselves in integrity, responsibility, performance, and leadership. A typical morning goes like this:
We arrive at the site where the church hall is opened to let us in. The volunteers have enrolled the pregnant women to support them in getting the clinic going by sweeping the space free of dust and other trash.
Then the volunteers take the church benches and rearrange them to create a space where they can receive the patients and take roll. Two other volunteers set up the space of the laboratory, where all of the point-of-care services take place. The other volunteers break down the luggage with the equipment and set it up so that the clinic is completely equipped; we are up and running within 15 minutes of arrival.
Then the team huddles. The chief nurse Antoinette, who is accountable for the mobile clinic, divides the team into posts: administration; laboratory; ambulatory pregnancy-testing team; patient care; and ultrasound (that’s me for right now).
Each head of post becomes accountable for the performance of that post. What I have been noticing recently is how quickly they can identify breakdowns in their performance (like a backup in the laboratory testing) and then can resolve the issues with little confusion or upset (increase the number of laboratory staff by lending a person from another post). The following story reflects how this teamwork saves the lives of some babies in the clinic:
During the course of the morning, a woman arrives for a free consultation. She is in a hurry and desires to be seen first so she can get to the market to sell her merchandise. Her pregnancy test is positive, and she is immediately welcomed into the Mimsi family, a prenatal card filled with her name and pertinent information.
She sits awaiting the laboratory for her screening. However, in that very moment, the head of the laboratory post suffers a crippling migraine and has to rest. This leaves only one person to perform all the laboratory studies.
In about 30 minutes, the throng of patients languishing in the reception area awaiting laboratory evaluation gets loud with several pregnant women in the hot Haitian sun threatening to leave. The team steps up and sends two other volunteers from other posts to the laboratory to alleviate the back-up. The woman in a hurry to go to market stands to leave; however, one of the volunteers takes her discretely by the arm to the laboratory before anyone in the reception area can see this and declare their dissent of this preferential treatment.
She is tested; she is then brought to me to have her ultrasound expeditiously done, while her laboratory screening tests develop. During her ultrasound, I am pleased to discover that she has twins; both are growing very well. I show her the ultrasound image, and she immediately sees what I am about to share with her. “I had a dream I was going to have twins!” she declares. And then the curtain to the ultrasound area opens up. The chief nurse enters and shows me the results of her laboratory testing: HIV test is positive.
HIV is unfortunately more commonly discovered during pregnancy because women get universally screened here in Haiti when they receive prenatal care. Those, however, who don’t seek care can transmit the virus to their babies unknowingly. In fact, in comparison to women who are known to have the virus, HIV-positive women who deliver at home without IV antiretroviral medications like AZT have a 25% risk of transmitting the virus to the baby. The percentage goes up if her viral load is higher than 1500 viral copies per milliliter of blood. So, knowledge of her status allows a caregiver (in this case, Mimsi International) a unique opportunity to empower a woman around what HIV infection is, how we can control it, and what we can do to decrease the risk of her babies being infected.
I can see the eyes of the volunteer are brimming with tears, which I tell her to wipe away because we have done a really good deed for this woman who would have left without the news that she is pregnant with twins and that she has a new diagnosis of HIV infection. The patient takes the news of her infection quite well; she has many mouths to feed in addition to these twins, so staying alive becomes a priority. She agrees to be referred to the free HIV clinic in the city. The Mimsi volunteer’s quick response to the breakdown in the laboratory to improve its performance saved this woman’s life and the life of her unborn twins. We set up a protocol to care for our patient and establish the date for her scheduled induction of labor or scheduled C-section.
I am excited to see where else the volunteers will expand as they navigate through the communities we serve with integrity, responsibility, performance and leadership. Thank you for reading.
Winfred S Tovar, MD
“Go to the people. Live with them. Learn from them. Love them. Start with what they know. Build with what they have. But with the best leaders, when the work is done, the task accomplished, the people will say ‘We have done this ourselves.’”