-in a world where death lurks in the shadows
AT THE top floor of the Maternity Ward of the Georgetown Hospital, new mothers feed contentedly sucking babies. It is a cheery and bright place. There is the smell of flowers, brought in as gifts, in the air. Some new mothers have visitors who congratulate them, and there are smiles all around and coos of delight as the healthy newborns, some with fingers in their mouths and  tucked in bright new towels, are  gently passed from hand to hand.

These babies will soon be heading home.

But not so far away, on the same floor, behind doors locked and closed against visitors, exists a very different world.

It is a grim place.

It is a world where the lights are dim, and tiny premature babies in incubators cry or try to cry through undeveloped lungs;  where  newborns,  some   barely weighing 600 grams,   fight  respiratory distress, HIV, jaundice, liver and kidney problems, and struggle against infections, renal problems and hydrocele, in the first fight of their lives.

It is a world where death lurks in the shadows, patiently waiting to reap an occasional  harvest.

It is the Neo-Natal Unit, or simply the NNU.

Mrs. Elizabeth Puntous is a Canadian citizen and a Registered Nurse living here in Guyana with her husband,  Richard, who is on a Canadian International Development Agency (CIDA) assignment.

She had been visiting Guyana on and off over the past dozen years, but decided to stay here fulltime three years ago.

Mrs. Puntous and her husband live at Eccles, on the East Bank Demerara, and a year ago, she decided to assist staffers at the Regional Hospital at Diamond, also on the East Bank, on a voluntary basis.

Then, a little over three months ago, she decided to do a similar voluntary stint at the Georgetown Hospital prior to returning home to Canada, Richard’s assignment due to end in early July.

It was then that she learnt of the NNU.

Last week, the French-speaking Canadian told the Chronicle how she had fallen head over heels in love with the work of the NNU, and how sad she was that she had to leave the little ones, those tiny fighters who tried their best to survive with the deck of cards that fate had cruelly dealt them.

“Working at the NNU, even though it is a sad place,” she said, “I felt happy; fulfilled. As a nurse; as a person, being at NNU was the first time in my life that I felt that I was in the right place. I thank the Georgetown Public Hospital Corporation (GPHC) for giving me the opportunity to work with premature babies. I pray that when I return to Canada, I will get to continue my work to help these babies.”

Mrs. Puntous leaves for Canada within a month, at the conclusion of the assignment of her husband, Richard Couture, with the Guyana Environmental and Capacity Development Mining Assistance Project (GENCAPD).

According to available medical literature, full-term infants are born 38 to 42 weeks after the mother’s last menstrual period (LMP).

These are the lucky babies.

Prematurity occurs when a pregnancy lasts fewer than 37 weeks, and so, premature infants, known as ‘preemies’, come into the world earlier than full-term infants.

Causes of premature births include the mother’s lifestyle choices during pregnancy: Smoking, drinking alcohol, using drugs, eating poorly, not gaining enough weight, exposure to physical stress, and poor prenatal care.

Sometimes  the cause is not within the mother’s control. She could have had a hormone imbalance, a structural abnormality of the uterus, a chronic illness, an infection, or several other things that could lead to a premature birth.

Pre-term delivery is more likely when a woman is over age 35, under age 19, or is carrying multiple fetuses.

And sometimes the cause is simply unknown.

The effects are, however, immediately obvious.

Full-term babies  usually weigh more than 2,500 grams (about 5 pounds, 8 ounces), whereas premature babies weigh anywhere from about 500 to 2,500 grams.

And these babies are afflicted with numerous health problems.

For example, they lack the body fat necessary to maintain their body temperature.

They have to be kept in incubators.

Other problems include having undeveloped lungs and other body parts, and infections. They have to be taken to that room with closed and locked doors, the NNU, if they are to get a chance at life.

Elizabeth Puntous said her stint at NNU of the GHPC was a roller coaster ride of sadness and  happiness.

The obvious dedication of the staff there; the  ups and downs;  the joy and feeing of accomplishment, of seeing beloved patients reunited with  parents; the sadness of losing another.

Oh!

There was ‘Baby G’.

She remembered ‘Baby G’; will never forget ‘Baby G’:  A little girl, a little over 600 grams in weight with hands as tiny as the finger of an adult; a ‘preemie’ getting a bad start in life with Fetal Alcohol Syndrome (FAS).

The mother apparently had drunk alcohol at some point in time during the pregnancy, or perhaps many times during the pregnancy, and as the science says: Whatever mommy drinks, baby drinks.

“A glass of wine, a beer or a cocktail — whatever you eat or drink while pregnant goes directly through your bloodstream into the placenta,” Mrs. Puntous said.

And so, ‘Baby G’ was born with FAS.

“Baby G; she was tiny. Her hand was so small like the finger of an adult. Looking after her, it was difficult to find a vein. Many times she tried to cry, but could not. Her lungs had not fully developed. That cry, that sound she made cannot be described. It was more animal than human. It was sad.”

She nursed ‘Baby G’ for weeks, and also nursed hopes that somehow, the little girl would make it; would survive.

However, it was not to be.

She and the others at NNU had done all they could, but it had not been enough.

‘Baby G’ held on to life in NNU for almost three months, but eventually succumbed.

“I grieved! It broke me to see her in her little wrapped-up bundle being taken to the mortuary,” Puntous said.

Some of the symptoms of FAS and some from which ‘Baby G’ suffered are as follows:

Small body size and weight; slower than normal development and failure to ‘catch up’; deformed ribs and sternum; curved spine and hip dislocations; bent, fused, webbed, or missing fingers or toes; limited movement of joints; small head; facial abnormalities; small eye openings; skin webbing between eyes and base of nose; drooping eyelids; failure of eyes to move in same direction; short upturned nose; sunken nasal bridge; flat or absent groove between nose and upper lip; thin upper lip; opening in roof of mouth; small jaw; low-set or poorly formed ears; organ deformities; heart defects or heart murmurs; genital malformations; kidney and urinary defects; central nervous system handicaps; small brain; faulty arrangement of brain cells and connective tissue; mental retardation — occasionally severe; learning disabilities; short attention span, among others.

Some people say that a pregnant woman can take a drink every now and then, once she doesn’t take too much. The question is: Who or what determines what is not too much?

Which raises the question of the role of mothers-to-be and fathers as well during pregnancy.

Mrs. Puntous noted that many of the ‘preemies’ she saw at NNU during her three-month stint were born to teenaged mothers.

“These girls in the main did not seem to be aware that having children at too early an age could be bad for both their health and health of the children.”

How about the fathers? “As for the fathers, I did not see many around NNU, if any at all,” she said. Most of the women with ‘preemies’ didn’t know what was happening, she said.

“They didn’t  understand what had happened to their babies. Some of them said that they had not even known that they were pregnant. These young girls were clueless and… scared.”

Some were also very, very poor.

Puntous felt so happy that she soon began to make little diapers, little bed sheets, little gowns and dresses for the babies fighting for their lives in the NNU.

The little garments also came in useful for those little fighters who had lost the battle; who had flown away with the angels.

Then there was ‘Baby D’: Mother HIV-positive; too ill to look after him. ‘Baby D’: A fighter from Round One.

“He was sweet-tempered; always cheerful. Tiny, but a fighter from the first bell. Everybody liked him. He stayed at NNU for three months; growing well; responding to treatment well, and then his mother started feeling better and she and his grandparents came and said they wanted him, and we handed him over. And they took him away. Don’t know where he is, but I think that he is doing well.”

The ‘Baby D’ and other moments made her feel the sense of usefulness, of fulfillment as a person and as a nurse.

She continued to grapple with life at the NNU with even greater enthusiasm.

The problem with ‘preemies’, she said, “is that there are too many teenaged mothers. They deliver the most ‘preemies’. The older women, with two or more children: Not many. Some teenaged moms get help from their parents, but with younger ones without support of parents: Many problems. There is need for much education. How to care for babies; what to look for; how to know when all is well, or when something is going wrong.”

She said, though, that generally, the women with babies in NNU are always on hand to feed their babies, if this could be done, or to interact with the babies, play with their fingers, talk to them; important little things that helps the baby to develop the will to live.

Life at NNU is more challenging when birth is by Caesarean section, or when mothers are to ill to assist, or when the baby is so ill that it cannot be brought out to the mother.

Those ‘preemies’ who cannot ingest breast milk are fed intravenously, but also benefit from the presence of the mother at frequent intervals.

Puntous was sad that she did not see as many fathers as she expected to see around the NNU during her stint with the Unit. She said that it had been a pleasure to work with staffers there.

“It is a tough job, but the doctors and the nurses, oh, they work hard; they are  very dedicated  to work to try to save the babies with limited resources.”

She said that in her opinion as a trained nurse, there were many challenges the NNU  should try to overcome.

Visitors are limited to mothers and staffers only.  But the babies in NNU are very fragile; they are susceptible to infections, and there is need for sustained efforts to make their environment safer and even more safer with the passage of time.

This includes increasing the sterility of their environment. “They are human beings; very special human beings; they   need all the  support; all the help they can get.”

For those fighters who lose and who fly away with the angels, the burial of a ‘preemie’ is an option that many parents accept, Puntous said.

She could not say whether this has always been the case.

The only regret she has is that she found out about the NNU too late.

“I came here three years ago, and have to leave within a matter of weeks.  If I had known about NNU when I first came, I would have volunteered to work there since then. That is my only regret as I say goodbye to Guyana.”