Welcome back, reader!

I chose the best career path ever: the life of an obstetrician/gynecologist (OB/GYN).  It has been an extraordinary journey and I want to share with you the “Top Ten Reasons to be an OB/GYN”:

  1.  Women are the best patients: they are great listeners; they are highly motivated to take their medications; and they are great at keeping most of their appointments.
  2. For an adrenaline junkie, like me, the events in an obstetrical suite move really quickly and challenge the obstetrician to make sound snap judgments during an emergency.
  3. We get to share the good feelings with a family after delivery of their baby.
  4. It’s the only field of medicine where your friends can never be short of jokes.
  5. We are the one field that can wear “pajamas” outside anytime, anywhere because we are always on call.
  6. I get to be the first person that a baby experiences outside the womb.
  7. It’s the only field where yelling “PUSH” to a woman actually yields the desired effect.
  8. As long as people are having sex, you have job security.
  9. When you’re asked about what you do for a living, you leave people speechless by saying, “I help bring life into the world all day long.  What do you do?”
  10. So you can do this with the babies you deliver

So, you can imagine the trauma that I experienced when I hurt my back in October 2012: I herniated a disc in my lower back, leaving my left leg weakened and numb for 2 years.  Even after physical therapy, acupuncture, and back surgery, the severe pain in the lower back has made it difficult to return to the work to which I dedicated much of my life and which I loved so much.  SO in defiance of my physical state, I created Mimsi International in the hopes of making the best of difficult situation.

In many ways, the pregnant women in the rural areas of the developing world are crippled by their untenable situation.  They make less than 80 cents a day; they have little food or clean water; and they live in areas that often dozens of kilometers away from the nearest clinic, let alone hospital.  These women have to make the best of their deplorable circumstances when they get pregnant, and they have little room for error when choosing how to live their lives with new life growing within them.

Here’s the story of a woman I shall call “Olivia,” a 46-year-old woman who came to one of our Mimsi mobile prenatal clinics in the mountains.

Olivia lived in a little hut with her husband and 10 children, ages 23 down to an 18-month-old.  She had heard about Mimsi International and our work with young woman who wanted to have pregnancy testing; so she brought her 21-year-old daughter to us, who happened to be pregnant.  During the daughter’s evaluation, Olivia slumps against the wall, blaming her fatigue on a lack of menses and the “change”.  Quick thinking of the volunteers resulted in a pregnancy test which revealed that Olivia was indeed pregnant.  An ultrasound revealed that she was pregnant with not just one or two babies BUT three babies!  A triplet pregnancy in a woman of her age with her means living in the area where she did spelled a disaster, and without Mimsi being present she would never have known that she was pregnant, let alone with triplets.

Olivia, however, was the ideal patent.  She arrived on time for her rendezvous with Mimsi; she received monthly ultrasounds for the triplets’ growth; she grew well with the nutritional supplementation we provided her and her daughter.  Mimsi trained her to recognize the signs of labor and to call our hotline if she ever experienced any symptoms of labor.  I even gave her my number to call me in Brooklyn, if she couldn’t get in touch with my nurses on the hotline.  We communicated her case with the hospital and prepared the Labor & Delivery suite for a triplet Caesarean delivery, in case the delivery occurred while I was out of the country.  She got to 32 weeks gestation without any sign of preterm labor or pre-eclampsia (a condition marked by elevated blood pressures, protein spillage into the urine, and risk for seizure, stroke, and death).

But at 32 weeks and 2 days, her circumstances showed us that indeed they were not trifles.  At 8pm one evening, Olivia started to have contractions.  Her husband worked in another village and had not returned home that night; he had the only cell phone for the entire household.  Her children could not leave the house because in the dead of night there were no lights to guide them to their neighbors’ homes.  So Olivia labored until 5am when the husband returned to see Olivia sweating profusely from the painful contractions.  Mimsi was finally called at 5:30am and a vehicle sent to her home to pick Olivia up and transfer her to the hospital.

When they arrived at 7am, Olivia, awaiting the nurse’s arrival, squatted involuntarily in the parking lot and delivered the first triplet on the ground. The nurse who didn’t check her prenatal card took her in not realizing Olivia still had two other babies inside waiting to be born.  As she cleaned off the first triplet, Olivia pushed again while on the delivery table, dropping the second triplet into the bucket 4 feet below her.  The nurse ran back to Olivia to catch the third triplet in time.

After delivery of the placenta, Olivia didn’t receive any anti-hemorrhage measures like IV Pitocin or Hemabate (two common medications given to cause the uterus to contract and stop bleeding); consequently, Olivia bled heavily until she was grey from low blood volume.

In the end, we lost the triplets as a result of the traumatic vaginal delivery they endured.  The first, a little boy, lived for 7 days; the second, a little girl, lived for less than 20 hours likely dying of head trauma from the fall into the bucket; the third, another little boy, died on the second day from respiratory collapse.  We almost lost Olivia as well, but Mimsi was able to find a family member who could donate blood to transfuse Olivia.

She is with us because of that transfusion and only because of it.  She is deeply saddened by the death of her triplets because she had hopes they would live; but she also realizes how close to death she came.  Now Olivia is one of Mimsi’s ambassadors sharing her story with other young women and encouraging them to seek pregnancy testing if they have any doubts so they can enter into prenatal care.  She acknowledges that without us she might not have been alive to return to care for her ten children at home.

“Olivia” after delivery of the triplets. This is not color enhanced; she really is this grey after her postpartum hemorrhage

Mimsi learned a lot of lessons with Olivia’s pregnancy and delivery.  I regret not being able to save Olivia’s triplets.  The Mimsi team of community volunteers and I think about what was missing in our protocols so that such a thing doesn’t befall another woman in our care; we have come up with many interventions we could do like creating a mobile prenatal care clinic and equipping it with a delivery table and medications necessary for all types of deliveries.  I think in the end we will have to build a maternity hospital equipped to receive pregnant women and premature babies, but we are a long way away from that project as a new nonprofit organization.

Most of all, I am grateful to have had that back injury back in October 2012.  Without it, I would not have created Mimsi International.  In the face of my obstacle, I defied my physical limitations and created an organization that is making a difference for women in rural Haiti, saving the lives of mothers whose lives would have been lost without us.  And now these women are facing their obstacles and saying “YES” to prenatal care for themselves and others.  They travel from kilometers to hear Olivia speak and to receive free prenatal care we provide.  To those who believe they aren’t creative, I say that creativity is an act of defiance: if you defy what limits you by committing to something greater than yourself, then you shall discover a creativity that knows no boundaries.  There is no greater gift than witnessing the transformation of this community of women, and the journey continues.  #BestCareerEver !

Prenatal clinic participants awaiting consultation

Thank you for reading.

Winfred S Tovar, MD