(The following story contains subject matter and visual images of a graphic nature; the subject matter may cause emotional discomfort. The family of the woman whose story is presented here has given us permission to share this information so that it may empower others. The names have been changed to protect the identity of our patients.)

Marie Jeanne returns from the Mimsi clinic, advised to prepare her bags for transport to the hospital. In the clinic, found to have a blood pressure to be 160/100, she is brought to the nurse, who evaluates her and finds her to be in active labor at 39 weeks. Analysis of her urine reveals trace protein, and the patient denies any other symptoms than the periodic contractions in her belly. We advise her to deliver this 9th baby boy in hospital. Concerned for her risk at age 39 of having a seizure or stroke from her blood pressures and her high risk of bleeding, Marie Jeanne follows our advice.

Leaving her house bag in tow on the back of a motorcycle, she returns to the clinic for our transport to the hospital. Labor hastens. In the middle of passing through a ravine, Marie Jeanne has the urge to push. She squats down and delivers her son. According to the motorcycle rider, Marie Jeanne suddenly starts reporting that she cannot catch her breath. She begins breathing rapidly, coughing up “phlegm”. The sounds are loud. She stops breathing 2 minutes later, falls back in the ravine, and dies. She never holds her son.

The next day, we arrive in the savannah at a cement-block structure, where in the front yard, there is a hole several feet deep newly dug. Several men and women are milling about on the front porch, trying to decipher who we are and possibly what we might contribute to them in their time of loss. I introduce my team and me; then I request to see the baby first, having brought Similac formula, diapers, clothes, wipes, bottles, and other baby paraphernalia the family might need.

At this time, a young woman—to whom we have provided prenatal care and who has just recently delivered a healthy little boy—walks up humbly and introduces herself to me as Marie Ange. Marie Ange takes me and the chief nurses to the adjacent hut where I am greeted by the family of the baby’s father, who has taken in the newly orphaned, nameless orphaned boy. In the wake of the father’s death two weeks prior (from a cattle stampede) and the mother’s death the evening before, an uncomfortable silence shadows the inner walls of this home. In the center of the living room sits the baby’s father’s sister, a woman in her early 50s with the face of a woman who has lived twice as long. The newborn lies on his back on her lap, sucking down sugar water the old woman has prepared in times like these.

Marie Jeanne’s newborn son on his aunt’s lap taking sugar water

The aunt releases the baby so we can examine him: we notice that the baby is showing some signs of dehydration, despite the old woman’s noble and wise actions in this home of low resources. I return the baby to the aunt and encourage the family to make Similac formula for the baby boy, while we arrange for a suitable wet-nurse. It’s the only chance for a newborn in the savannah outside of Les Cayes, Haiti.

Marie Jeanne’s body in the corner of a room in her house

Then I visit Marie Jeanne’s home to find her body shrouded under a white sheet awaiting burial. The family uncovers her: Her face points towards a blue basin to collect the white froth like that of a cappuccino that continues to pour from her mouth for many hours after her death. The placenta remains in place, evidenced by the long umbilical cord still tethered to her leg winding its way up her skirt.

Pushing back tears, I close my eyes and imagine what it must have been like for her to deliver her baby and suddenly not be able to breathe.

Marie Jeanne’s mouth and the bucket is filled with the frothy foam (called pulmonary edema) that fills her lungs and drowns her after delivery

Her blood pressures must have made it difficult for her heart to manage the sudden boost of blood returning into her circulation after her baby was born…Marie Jeanne sinking in plain air under the water in her lungs…an experience we might have avoided had she made it back to the clinic and then to the hospital. I shake my head and walk out.

I then encounter Marie Ange, very much alive and standing outside the house with a forced grin on her face. The nurses of Mimsi have been speaking to her. They arrange for Marie Ange to wet-nurse our orphaned newborn. Her other baby is 2 weeks old and growing beautifully. We provide her a $20 stipend to supplement her already low caloric intake for the month, which buys her a substantial amount of food.