Midwives For Haiti

UNIVERSITY NURSING PROFESSOR TRAINS BIRTH ATTENDANTS

Nursing professor Cara Osborne, left, and honors student Kelly Toner discuss efforts to train midwives in Haiti on Feb. 21.
Nursing professor Cara Osborne, left, and honors student Kelly Toner discuss efforts to train midwives in Haiti on Feb. 21.

— Cara Osborne first visited Haiti in March, eight weeks after the 7.0 earthquake ravaged the Caribbean nation. The capital city of Port-au-Prince looked like the set for a post-apocalyptic movie, she recalled, with rubble everywhere and people living in the streets.

The University of Arkansas nursing professor had planned her trip before the earthquake struck.

She was there with Midwives for Haiti, a nonprofit organization that trains Haitian women as skilled birth attendants.

Osborne thought she’d be helping pregnant women with their labor and delivery. Instead, she found herself pressed into service as an administrative liaison, meeting with Ministry of Health officials and negotiating logistics such as housing for U.S.

volunteers.

“I was there and they needed help, so that’s what happened,” she related in the rolling syllables and flattened vowels of her native eastern Kentucky.

Osborne is an experienced nurse midwife with a doctoral degree in public health fromHarvard. That combination makes her a valuable asset to Midwives for Haiti, said Nadene Brunk, the certified nurse midwife who started the program in 2006.

“She immediately had an understanding of what we were doing and why it was so important,” Brunk said. “You can’t go to Haiti and not be moved to do something. ...

“Cara got off the plane … and started delivering babies.

She also jumped into hospital administration that first day.”

Osborne continues to be involved as both an on-the-ground instructor and a technical adviser to the board. She made trips to Haiti in August and January and stays in close e-mail contact with the board. Midwives for Haiti is based in Richmond, Va.

“Cara’s been a good spokesperson for us. Her doctorate in public health lends credibility to what we’re doing,” Brunk said. “She’s also worked on our curriculum ... and gotten the Frontier School of Midwifery and Family Nursing (in Kentucky) involved.

“We consider her part of the board. She’s putting a lot of energy into furthering the project.”Trained Midwives Save Lives

The need for skilled birth attendants in Haiti is great, Osborne explained. The nation has the highest rates of maternal and infant mortality in the Western Hemisphere. Unskilled midwives - local women who help other women through labor and delivery - are out of their league when complications occur.

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Cara Osborne shows off the new jeep acquired by Midwives for Haiti as a mobile prenatal clinic.

The most common causes of death are avoidable with proper diagnosis and intervention, Osborne said. Students in the Midwives for Haiti program are trained to recognize common obstetrical emergencies such as postpartum hemorrhage, obstructed labor and eclampsia. They monitor the mother and baby through birth to catch complications when they begin. Women with risk factors are encouraged to come to the hospital when their labor starts.

The program is centered at the Ste. Therese Hospital in Hinche, about 60 miles north of Port-au-Prince. A mobile prenatal clinic reaches women in outlying areas of the central plateau. Trained midwives provide prenatal care and education, along with vitamins, medicine and treatment for common conditions such as tuberculosis, malaria, worms and high blood pressure.

“Patients are coming to us in better shape,” Osborne said. “They’re in better physical condition when they go into labor. The best case scenario is avoiding the complication entirely.”

Midwifery students are women already trained as “auxiliares,” a designation equivalent to a licensed practical nurse in the U.S. They receive an additional 12 months training as skilled birth attendants, or “auxiliare sage femmes.”

“Sage-femme” is the French word for midwife. It translates literally as “wise woman.”

Some 30 Haitian women have graduated from the program since it started in 2006, Brunk said. All are employed. Some work through Midwives for Haiti at the Ste. Therese hospital. Others are employed by other hospitals andnonprofi t groups.

The graduates meet criteria set by the World Health Organization for skilled birth attendants, Brunk said.

“The data is out there: having skilled birth attendants doing prenatal care and labor and delivery makes all the difference between life and death for mothers and babies,” Brunk said.

A Learning Experience

Osborne has learned as much from the Haitian women she works with as they have learned from her, she said.

“My tolerance for frustration has grown,” she explained. “I’m a doer. I like to make a plan and execute it. In a place like Haiti, that’s just not possible.”

On her first visit, she turned on the faucet in the hospital sink but no water came out. The thought of delivering a baby without water was so foreign to her she still can’t find words to describe it.

Yet the baby was coming and she had to carry on. The experience gave her a glimpse into the kind of hardships Haitian women live with every day, Osborne said.

“Haitians are geniuses at figuring out how to make things work. They have so little, yet they manage to do a lot with really nothing. ... It’s been a real lesson in equanimity - fi nding peace in this storm of chaos and frustration.

“You recognize that life goes on. Babies are born. People fall in love. ... People die. There’s a lot of life happening in Haiti - with or without the things we think we need.”

The 31-year-old said it never occurred to her to be frightened during thosefirst chaotic days in Port-au-Prince.

“I felt that I had absolutely no right to be upset or scared or traumatized. I was going home to a life of convenience,” she said. “I couldn’t do anything about the rubble or people living in the streets. But I could deliver the babies safely and teach the mothers how to breast-feed.”

Osborne is happy to have found an international organization she cares so deeply about, she said. She spent six months in Jamaica as a graduate student working for the Clinton HIV/AIDS Institute of the William J. Clinton Foundation. The international work was deeply fulfilling, she said.

Yet as the mother of two young children, working overseas seemed impractical. Osborne moved to Northwest Arkansas with her husband in 2007. Marcus Osborne is senior director of health care business development at Walmart Stores. The couple’s children are 6 and 3 years old.

Cara Osborne taught online classes at the Frontier School of Midwifery and Family Nursing for three years, traveling to the Kentucky university for clinical classes. She joined the staff at the University of Arkansas in August, where she teaches nursing classes and researches maternal and child health.

Honors College student Kelly Toner is working with her to create a training module for Midwives for Haiti volunteers.

“I had wanted for a long time to find the project that’s a good fi t for me,” Osborne said about her nonprofit involvement. “Once I went to Haiti, I knew this was it. I’d found it.”

Our Town, Pages 1 on 02/27/2011

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