Arkansas Nursing Professor Helping Train Nurse Midwives in Haiti
Cara Osborne holds Aiden, a Haitian baby delivered in January on the U.S.S. Comfort after his mother lost a leg in the earthquake. Osborne first met Aiden and his mother in March.
FAYETTEVILLE, Ark. – A University of Arkansas nursing professor is helping train Haitian nurse midwives in an attempt to lower the number of mothers and babies who die during childbirth in the impoverished Caribbean country.
Cara Osborne joined the faculty of the Eleanor Mann School of Nursing in August, a month during which she also spent two weeks in Haiti with an organization called Midwives for Haiti. It was her second trip this year to teach Haitian women being trained as midwives, and she plans to return several times next year.
"When you have a limited amount of time and resources to give, training Haitian women to take care of Haitian women makes a much larger impact than delivering babies for a few days and leaving," Osborne said. "In the accompaniment model used by Midwives for Haiti, the organization works alongside Haitians to accomplish something they want. In traditional medical missions, there is always a question: Are they sustainable? What happens when the volunteers leave?"
The Virginia-based program makes her work in Haiti worthwhile, Osborne said.
"It's altruistic to us but it's really important to them," she said of the Haitians. "They are losing their mothers, their sisters, their daughters."
She saw babies and mothers die while she was in Haiti in March and August. Although the first trip was less than three months after the 7.0 magnitude earthquake in January, Osborne said the conditions she saw were not caused by the catastrophe.
After spending a couple of days in Port-au-Prince, the nation's capital where the earthquake damage was greatest, the Midwives for Haiti team worked in the town of Hinche in the central plateau region of the country.
"The government-based hospital has no electricity and no running water," Osborne said. "Once a day, water is brought in and used to fill 5-gallon buckets. It's used to clean. There is no drinking water or food for patients. Their families must bring them food and water.
"The conditions at the hospital were basically the same before the earthquake," she continued. "The only effect on Hinche was an influx of people to the area and possibly a few more supplies because of the international aid."
Osborne, who earned doctoral and master's degrees in maternal and child health from Harvard University, also is serving as a technical adviser to the board of directors of Midwives for Haiti. She became involved in the group while teaching for Frontier School of Midwifery and Family Nursing in Kentucky.
"I have been aware of things in Haiti for a long time," Osborne said. "I've been waiting for what seemed like an appropriate use of my skill set."
In addition to her training and practice as a nurse midwife and experience as a teacher, Osborne has worked in the programmatic side of public health programs, consulting for the Clinton HIV/AIDS Initiative of the William J. Clinton Foundation.
The August trip to Haiti included two faculty members and two students from Frontier School, two home-birth nurse midwives from San Francisco and a Haitian-American nurse who served as translator.
"Our purpose is to decrease their ridiculously high maternal and child death rates by training nurse midwives," Osborne said. "Students must have graduated from high school and had 12 months of nursing training that would be equivalent to our licensed practical nurse education. Then, they spend a year in the Midwives for Haiti program."
The Haitian students learn basic emergency obstetric procedures in the midwifery course.
"Deaths of mothers and babies are commonly due to postpartum hemorrhage, obstructed labor and pre-eclampsia," Osborne explained. "These are not conditions somebody should die from. Obstructed labor is not even typically considered an emergency here in the United States because we have ready access to cesarean section."
In Haiti, the majority of births occur at home, and if there is a problem, a woman may have to walk several hours to a hospital following what is often days of labor.
"By the time they arrive at a hospital, often the baby is dead and the mom is in bad shape," Osborne said. "The hospital usually has a single operating room and a single obstetrician."
Many nurse midwives in the United States work in hospitals or free-standing birth centers while some deliver babies at the family's home, Osborne said. Nurse midwives are trained in the management of normal labor and serve as the primary care provider throughout the pregnancy and birth.
"The general philosophy of midwifery is that childbirth is a natural process, not a disease," Osborne said. "Nurse midwives' patients can have anesthesia and a full complement of services. The nurse midwife is more hands-on involved in the labor than most physicians, and the birth itself is not considered an emergency as long as everything looks good."
Osborne described the emotions that come with working in a place such as Haiti.
"It's really hard to see such disparity," she said. "It’s so different from how things work in the United States. We don't lose moms and babies often, and when we do it's a tragic event for the families and the health-care providers because we are so used to being able to save people."
In Haiti, knowing it isn't uncommon for babies to die makes it worse for her, Osborne said.
"It's no less horrible for Haitian mothers, but the expectation is that babies will die. I think about it all the time. I'm always churning around ways to make the situation better, and I feel like there is something people of all professions can contribute."
Contacts
Cara Osborne, assistant professor of nursing
Eleanor Mann School of Nursing
479-575-5770,
cxo004@uark.edu
Heidi Wells, content writer and strategist
Global Campus
479-879-8760,
heidiw@uark.edu