Haiti Day 6 - Memories Remain

My first email I received this morning was from the State Department advising Americans not to go precisely where I was headed, Delmas 60. The neighborhood along with Petionville were planning demonstrations/protests. I asked Braden to stay in our host's home so I would know he was safe.  

When we arrived in Delmas 60, the only sounds were from radios blaring news about the election. Eventually, noise from protestors echoed in the background while I was seeing the instability of the past few weeks presenting with each patient. There was a woman who came in for depression. The political tremors were triggering PTSD from losing three family members in the earthquake five years ago. The result was an emotional earthquake. She wasn't alone. Another woman with acute panic nearly fainted in the office as she recalled thinking someone was going to invade her home last night amidst rioting. Two patients were unbelievably thin with sunken cheeks as they had stopped eating due to stress. A young girl told me she didn't want to go home because she was scared of the unrest. A little boy was picking his skin open thinking his deceased mother was trying to hurt him. Today was not a day for seeing a lot of people, although we still treated 40 patients. We tried to console and heal in other ways. Teaching breathing and relaxation exercises may seem woefully inadequate but we had very little else to staunch the emotional wounds we were seeing.

As we were leaving, the roads were filling with people. At the top of one of the streets we could see a mob of people pushing one another forward. We had some roadblocks from other motorists trying to turn around in narrow rocky streets, but we made it back to the house with little difficulty. Later, we were all (Braden too) able to go the afternoon clinic without any problem.

In the U.S. we use the word "disease" for certain illnesses, but in Haiti the term must be changed to "dis-ease". They have more than their share of illnesses, but it's the dis-ease that is really harming so many right now. It is the memory of so much loss (loved ones in the earthquake, their voices and votes drowned by corruption...) that remains on days like today. I have nothing in my bag to treat this dis-ease. I can only watch as the memories consume them. 

Haiti Day 5 - The One You Never Forget

A child that lives in one of the toughest places in Haiti needs a wheelchair. The boy came in carried by his mother but usually walks on his knees to get around. His crippled legs permanently bent and his knees swollen from his mode of ambulation, he charmed me with his broad smile instantly. He wasn't afraid of strangers, in fact he seemed to revel in his ability to draw you in. He came in to be evaluated to see if he could get an organization to donate a wheelchair. He and Braden laughed and made faces at each other while I measured his body, checked his range of motion, etc. His eyes seemed to dance even though his feet could not. I only spent 15 minutes with him but he stayed with me throughout the day. His joy was ever-present.

We managed to see over 50 patients today between two clinics. There were so many children, including some challenging pediatric cases. I will post the picture of the rash on one girl's legs. If any of you recognize it, please send me a message. She gets the rash around this time every year. It itches and is painful. 

There was also a 56yo woman with new onset breast pain. Thankfully, we were in a clinic where I could do a breast exam (the other clinic is an open room). She had a solid mass and was in a lot of pain. There was no redness, rash, warmth, fever, etc to suggest a more benign cause such as infection. Fortunately, mammograms can be done in Port-Au-Prince. I gave her an order to have one done. I saw the same fear in her eyes that I have seen in so many women through the years, including my dear friends. I could only hold her hand for a moment before the next patient came in.

We finished the day at the church clinic. In the past three days I've treated about 150 patients and some of our medications are running low but we will give everything we can until it's gone. I can't thank you all enough for providing me with the tools to help so many people. From gauze to ibuprofen, it's all being used.

Goodnight from Haiti...

Haiti Day 4 - Little Blessings

We started the day at a clinic in Delmas Area of Port-Au-Prince. It was a lot more relaxed with a good flow of patients and the sweetest little babies. There is something about seeing a child bouncing around in their mother's arms as she desperately tries to explain how sick they are that gives you the giggles. I've been there too many times myself. "I swear he was vomiting with a fever out in the waiting room..." It is a blessing that babies bounce back faster from illness than mothers. 

There was a few more cases that will worry me into the night. A woman with cold hands and a heart rate in the 120s. There were two women with sudden weight loss, weakness, cough, and reporting fevers that only come at night (CBC, rapid malaria test, HIV, and PPD ordered). I'll see them on Thursday to follow-up.

We saw 25 patients in the first clinic, went back to the house briefly for lunch and then proceeded to the next clinic back at the church. It was very busy. After 3.5 hours we saw another 35 patients. I won't lie, my sunny disposition was a bit spoiled by the end. I just wanted to not think anymore. We rode back tired and ready to collapse into bed. When we got back, however, I smelled something wonderful. My favorite Haitian-style oatmeal! It was the best comfort food ever. As we sat at the dinner table, we shared our favorite part of the day. I loved the babies. Sharon loved the morning clinic. Braden laughed and recalled a gentleman who came into the clinic for urinary pain. When we asked the patient if he had any sexual partners, he replied "No, but I have sex everyday." Oh boy...

Laughter, bouncing babies, comfort food. Even the toughest day can't shake those little blessings that keep us moving forward.

Haiti Day 3 - Happy to be Exhausted

Today started with advisement not to return to PAP until afternoon. The Ministers decreed to give themselves a raise plus a "gift" by taxing the middle class and poor (not the wealthy) to the tune of $50,000US per Minister (43 of them). So, the people of Haiti fought back with a strike. As the US State Department says "Even peaceful protests may turn violent..." So we were mindful to return when things started to calm down. We made the trek back after noon and started clinic at about 3pm in Port-Au-Prince. Over 100 people had been waiting to be seen since 7:00 in the morning. They were patient and smiling, nonetheless. 

There wasn't any electric lighting in the church where we worked. However, with only 2.5 hours before sundown we still saw 30 patients. Patients who were bilingual volunteered to translate to help their friends and family. What an inspiration to see people who had spent all day waiting and then continue to stay to help their community.

Hypertension was by far my greatest concern. Some pressures were over 220/120. With no anti-hypertensive medications, the best I could do is educate them on dietary changes and follow up with a doctor if they could afford it. Several of these people had prior strokes. 

I also had several little ones with allergies and sniffly noses, but one little girl (8yo) had chronic pain from sickle cell crises. I gave her some Tylenol and educated the family on hydration. She was beautiful and brave.

I also had a very sad case of a woman that was cachectic, shrunken to skin and bones, short of breath. She had gone to a hospital but they were unable to discover the cause of her illness. My guess is cancer, but where it is hiding is anyone's guess. Her lungs were clear, however, TB or HIV are very possible differentials. She had significant conjunctival pallor and clubbing of her fingers. I could only give her something for pain and iron pills.

I didn't have a lot of time to take pictures today, but I would have loved to have pictures of my son working the suitcase pharmacy and my friend Sharon (a super nurse) working her arse off trying to keep up with the triage of the deluge of patients. By the end of the evening, we were using a tiny Coleman lantern I brought and people's cell phone flashlights to see patients. As tiring as it was, I am happily exhausted and ready to go to sleep.

Tomorrow we have two clinics to visit. Wish us luck, pray, think good thoughts. It all helps.

Haiti Day 2 - Resilience

Today started with the sounds of hundreds of happy voices singing and clapping in a church across the street. I started my blog with this because, only a few hours later, Frisner drove us through the heart of Port-Au-Prince. I had never been there before so I only know what the earthquake left behind. I had never seen the once-great Catholic cathedral filled with Sunday morning parishioners. Only rubble remains, but those voices singing and clapping permeate the city even still.

When I asked Frisner (my host) what he was most proud of as a Haitian, he told me "our history and culture". Frisner described a Port-au-Prince that was the jewel of the Carribean. He spoke of architecture that was unparalleled anywhere in this part of the world. As we drove through town, he pointed out places that I had seen on news reports from after the earthquake. We saw a once-great Catholic cathedral, now in ruins. Other places which represented heartbreaking devastation now held friends gossiping and children playing. We drove through Carrefour and stopped at the ASAD clinic that we will be working at this week. It has a window that overlooks some of the tents meant to be temporary housing. After five years, they can no longer be considered temporary. They are homes to approximately 100,000 Haitians. Looking across the tents with clothing, parts of toys, and small charcoal cooking bowls strewn on top, you can feel one or two ways: sadness or awe. I felt both. It's never easy for those of us living in comfort to see other human beings living the most difficult of lives and not being able to change their fate. However, across the street were three children waving to my son, Braden. They had the sweetest little faces that crinkled up every time he waved back to them. The tent cities are a reality but it doesn't define the people living in them. I saw what many people don't know about Port-Au-Prince...it's still breathing, pulsing with life, pushing onward, creating more history.  It's a tragic scene, but the people living there keep on keeping-on. 

We drove out of town to a place with very few buildings. It was the epicenter of the earthquake. Even here, where every two story building was destroyed, Haiti is climbing out of the rubble.

We went up and over the mountains to a seaside town called Jacmel. We walked down to the waterfront. It had a beautiful mosaic path with sculptures quoting Rene Depestré. My favorite sculpture was of three hearts: one broken, one small but whole, and another oversized and filled to the brim. The sculpture summed up what I learned about Haiti today. No conquerors, dictators, corruption, or natural disaster can take away the resilience of the Haitian people. They are filled to the brim.

Haiti Day 1 - The Kindness of Strangers

Today I trusted that all that is good in the world (God, Universe, the Force- for my my Star Wars chums) would bring my son, my friend and I safely to one of the more unstable parts of the world. Haiti held it's elections this week. With allegations of voter fraud, there is general unrest in the population including riots and protests. We didn't know what to expect, but what we found was kindness.

We landed this afternoon in Port-Au-Prince (PAP), Haiti, with donated supplies and medications. There was a very good chance that customs officials were going to confiscate or charge a "tax" to bring them into the country. The thought of whether they would steal our supplies or charge a tax too high for me to afford weighed on my mind all day. As we waited for our bags, I anticipated  the confrontation with customs. It never came. We walked out of the airport and into the welcoming arms of one of most gentle people I have ever met, Frisner Pierre. He is a professor at one of the few universities in PAP and is dedicated to bettering his country through education. He had the biggest smile on his face and called out our names, one by one, as if he had known us all of his life. He helped us to his car where we met with my next connection, Rachel Zimmerman of We Care Haiti. She had purchased antibiotics and liquid medications at wholesale cost for our trip. She and her right-hand man, Duckenson, helped load the car. When I went to pay her, she told me an anonymous donor had paid for them already. Wow. She then lead us in a prayer in the parking lot. For those of you that know me, praying openly is not in my comfort zone. And yet, here I was holding hands with strangers whose compassion and kindness had drawn them to work in the poorest nation in the Western Hemisphere. Really beautiful people living their faith. Tikkun Olam - repairing the world. 

When we drove to Frisner's home, we wove through the insanity that is Haitian traffic and arrived at a serene setting at the top of a hill. A lovely home with everything set up for us. We had a great meal of fish, chicken, vegetables, rice, lentils (Haitian hospitality is really amazing). We had a lovely conversation and the kindness continued.

After dinner, we began to unpack all of the supplies and donations we had been given. It was pretty overwhelming. How could so many people have donated separately to create the miracle I was seeing before me? We started the arduous task of separating the medications and packing them with instructions in snack bags. It took most of the evening but we have our first clinic day meds ready. Tomorrow we will rest in Jacmel (coastal town) prior to starting in the clinics on Monday.

Goodnight to all of you kind, beautiful, people in my life. I feel blessed by all of you.

Haiti Day 14 - The Final Day

I apologize ahead of time. It's my last day here and it was great, so it's a little longer than usual.

It started with a gentleman coming in for a chief complaint of headache. I won't lie, he smelled pretty bad. He smelled like he had been working in the fields with manure on a wet day. I tried not to be impolite and proceeded with working him up for the headache. My interpreter asked him if he was brushing his teeth and then leaned in to see if the smell was his breath. It wasn't. He them asked the patient if he had any recent cuts or sores. He did. He lifted his pant leg and the room filled with an odor I cannot describe. I have a picture below of the wound. He fractured his leg five years ago and had surgery to repair it, then never followed up. The wound took a while to clean, bandage, get a taxi (motorcycle) and I sent him to the hospital.

Shortly after, a woman came in with her child. He had a cold and would be okay. She said she also wanted to be seen. Over the past few years she had developed pain in her right breast, now it was firm and painful and she was losing weight. I did a breast exam hoping for the best, but ended up sending her to be examined by a specialist. There isn't breast cancer screening here, so I couldn't even use the word mammogram as no one knew what that is. I just told her she needed an X-ray and I was concerned about the possibility of cancer. As I looked at the 5yo boy beside her, I silently prayed I was wrong.

The next interesting case was a young man who had a motorcycle accident in the past few weeks resulting in an open fracture of his foot. He went to the hospital but didn't get the follow-up care that was recommended and now couldn't walk on his injured foot. I told him I could only treat the pain but he needed a specialist ASAP to see if there was any hope of repair, otherwise he likely have a permanent disability. He is only 19yo.

I also had a 24yo man who had fallen in a field with a puncture wound to his chest from a piece of wood. The wound was now closed and healed over but he was having severe stomach pain, unable to lay down and it hurt to breathe. I could barely put a stethoscope on his rigid abdomen. He was in so much pain. I also sent him by moto taxi to the hospital.

I also had some great cases that showed me that we can make a difference in a short period of time during a medical mission. The woman with crazy high blood pressure came in for follow-up and was ecstatic with her newly thinned ankles and hands. She said she pees a lot but feels so much better overall. Her blood pressure is now 140/102, a big difference. And a little boy who I believe had pneumonia last week followed up and was not the limp, lethargic boy I met. He had recovered quite well and there were smiles all around the room as I told them his lungs had improved.

When I got home I got to spend time with a lovely American group staying also with Edelin (arrived last night). They are working with CFI to help educate over 800 students and maintain the orphanage I visited earlier in the week. They are extremely dedicated to helping the children of this region in addition to projects in Jacmel, Haiti on the coast.

Finally, over the past two weeks I had been searching for a boy with cerebral palsy who had been to the clinic when the last Peacework Medical team was here and needed a walker. One of my patients generously donated a walker to bring with me to Haiti. Today I found the boy and was able to deliver it. Seeing him use it for the first time was truly a miracle to see.

Tomorrow I will say goodbye to this town and all of the people who have transformed me, healed me, and allowed me to smile and laugh effortlessly. I know we go on mission trips to give, but I can't ever give them what's been given to me. I can't give them the peace and stillness, the newness that I am leaving with. I want to thank all of you who have followed along, offered words of encouragement, and given your own time to be part of this journey.

Haiti Day 13 - Winding Down

I started my day down the street holding the hand of a grieving woman I had met the day before. Her mother died at 2:00am. If you read yesterday's post, you know the elderly woman's heart was weak and she had stopped eating/drinking, her vital signs all telling of what was to come. After leaving her home I checked on the teenager who was not feeling well across the street. I joked that I thought she was better last evening since she wasn't home when I came to check on her. She didn't like the joke. Onward on my stroll, a young man was introduced to me by the interpreter. He had a furuncular rash on his chin and was hoping for something to take. I promised to send him some medicine after work. The interpreter requested I check on the chief of police who had a rash, as well. It was a mild fine papular rash and looked consistent with contact dermatitis. I promised to send medicine for him, as well. I had to draw the line at this point. No more visits unless confined to the home, otherwise they need to come to the clinic. As soon as the words were out of my mouth, a man was yelling "Blan! Blan" and walking after me down the street. He had a stomach ache. I told him to come to the clinic. A crazy way to start the day.

The clinic itself was slow and easy today. No exciting cases with the exception of a young man who had gone blind after "a bad headache and then my eyes went away." He wasn't kidding his eyes were literally sunken into his head. Weirdest thing I've ever seen, like someone popped the anterior chamber of his eyes. ?Glaucoma. He reports an occasional headache now and then but otherwise just had a stomach ache today. After seeing patients, we tried to inventory the pharmacy. It took the rest of the afternoon and we still have a couple of hours to go. Imagine estimating the number of pills (all sizes) in one gallon plastic bags. It is extremely important to know the needs of the clinic and we found ourselves woefully short on children's antibiotics and ibuprofen. 

After we got back, I looked at my things and decided it was time to pack and determine what I would be leaving behind. I am leaving my scrub pants (I saw some of the kids at the orphanage wearing other donated scrubs - adjustable for all sizes), t-shirts, and I know it sounds cringeworthy but underwear also. I've seen so many scraps of bras and underwear that it would be silly to take mine with me. On the other hand, I'm bringing home my special paintings from yesterday, a carved box, heart-shaped stone, and stone carving of a woman holding a child (made by the art teacher Jean Jean). I was able to fit one suitcase into another and will carry my medical bag with me. Now, I only have goodbyes left for tomorrow and I will leave on Saturday morning. 

Summing up Day 13: Dreading saying goodbye.

Haiti Day 12 - House Calls

This morning I started the day at one of Edelin's neighbors' home. It is more of a two room dwelling (approximately 6' x 12' ) with a curtain for a door. In the back was a teenage girl writhing in pain. She was burning with fever. She had been to a local hospital the day before and received antibiotics and Tylenol. I also found another set of pills with the other medications and discovered the likely source of her epigastric pain - uncoated aspirin. I gave her some Tums and asked her to take the other medications. She was advised to stop the aspirin. I would check on her later that day.

Once at the clinic, it was a drowsy day that allowed me to care for yet another burn victim, this one was a 4yo boy who backed into the cooking fire. He was a bit more "resistant" to treatment, but I managed to get it cleaned and bandaged. His mother decided to be seen since she was there. I'm glad she did. Her blood pressure was 204/130. She said she had usual aches and pains but otherwise felt fine. Carleen, the Haitian NP said she sees this fairly often. I started her on blood pressure medication and strict low salt diet. She will follow-up with the baby tomorrow. Oy!

After the patients were seen, we worked on organizing the pharmacy area. Donated or purchased medications were in suitcases ready to be placed on the shelves. It was like a treasure hunt finding some really great things we needed. The pharmacy is now in tip top shape and user friendly.

On the way home, we stopped at a home being built for a blind man. He was very excited although he couldn't see the structure. I had to capture his face on camera. He was so happy.

Once we got back, I went to check on the girl I had seen this morning. The (typical) teenager was feeling better and was not at home! Another neighbor saw me and asked me to see her relative. I went into a small home and in a back unlit area was a very thin frail old woman. The family was worried because she had vomited this morning and now refused to eat or drink. I touched her skin which was below normal temperature. Her blood pressure was 80/60 and heartbeat was somewhat irregular. Her stomach was nontender. Her legs had 2+ pitting edema. I informed the family that her heart wasn't well and I didn't have any medication other than Tylenol. They wanted to give her something, so I gave them a couple of tablets (more for them than her). They were advised to try and encourage her to get even small sips of fluids and try to eat if she could. I will check on her tomorrow, but am quite concerned about her.

I went back to my room in a somber mood but things improved rather quickly. There was a meeting of children learning to paint at Edelin's home. I met with them and they all stood to introduce themselves. The teacher and some of the children had artwork they wanted to sell so I bought some great creations by budding Picasso(s).

After getting back to base, Dawins, Ava and I had a dance contest which I inevitably lost. Dawins had some serious moves for a 5yo and apparently disco is no longer in style which went against my score.

Summing up Day 12: So many ups, downs, and in betweens today. I look forward to being home with my family in a few days but the realization that I won't be able to make house calls in a few days is hard. Being able to practice medicine without the politics and limitations has been truly liberating. I just wish I could use my license in the same way at home.

Haiti Day 11 - And The Rain Came Down

Today was a très cool day at the clinic. I rode on the moto with my three compadres. It was market day so four adults on a moto was nothing exciting. I saw not one, but two pigs literally hog-tied and being held on a moto by two people. Everyone seemed to be carrying a chicken. I couldn't stop smiling to myself. We reached the clinic and it was full of people. It was going to be busy like the market.

I saw a 21yo man with white floaters in his eyes and loss of vision over the past three years. Pupils reacted only minimally on exam, check out the size of the pupils  (even with flash and a light shining from the side) and zoom in to see the anterior chamber. He had some ?major illness 3 years ago that caused his body to feel "paralyzed" and persistent body pain. He started to gradually lose eyesight afterwards. He never had a health examination for the prior illness. There was not much I could do at this point other than treat his pain. His mother agreed to take him to one of the local hospitals to see a specialist.

I also had an elderly gentleman with knee pain for 22 years after a fall from a horse for which he did not receive care. His knee was highly abnormal. He said he also had scrotal pain for the past 22 years after the fall. Each testicle was firm, approximately 18-20cm in diameter without nodules, fluctuance, hydrocele. He did not want a specialist evaluation. He was given Tylenol for pain. I have a picture of the knee only :-)

There was a lot of high blood pressure to treat. Haitians have a very high salt diet. It is not uncommon to have many patients with a diastolic pressure >100. I used up my amlodipine but still have plenty of HCTZ. I do a lot of dietary counseling for this (decrease salt, etc) but, like the U.S., the patients don't seem so interested.

I also had follow-up with the burn victim and little girl with the eye problem from last week. Check out the pictures.

After seeing patients, we set ourselves to organize the pharmacy. It was a lot of work but we got most of the suitcases unpacked from the prior team and at least some of the medication organized. When we were almost done, the rain started. Then, a torrential downpour started and it still hasn't let up. Edelin came to get us as the moto was unlikely to get up the muddy hills with four people. The drive home was crazy even in the SUV.

Since I got back I have been soaking up the floor with towels in between trying to separate a rather large bag of "papa" aspirin from the "baby" aspirin which we found on the pharmacy shelf today. Despite what it may sound like, I feel pretty zen. The water's not hurting me, the aspirin activity kept my mind zeroed out. As my friend Jay Chamberlain always says "It's all good."

Summing up Day 11: The chronic presentation of diseases that could have been treated had the patients had access to care still kind of blows my mind. When I get home, I promise to schedule a physical :-)