Friday, January 13, 2012

Haiti #7 - Au Revoir

Dear Friends,

Happy New Year!

I returned to Phoenix 2 weeks ago and am still startled by how quiet life is here; how clean and organized the streets are and how civilized we are to each other.

A few loose ends from my last blog: our Thanksgiving dinner was wonderful! The two women who daily prepare our two meals, had purchased a turkey from the States, not a cheap or easy transaction, and prepared it as tenderly as my mother would have. The women brought mashed potatoes and gravy, ham, green salad, cranberry sauce, black olives, sweet potatoes and cookies. And the turkey was on a special platter with red ribbons on its legs. They brought a Christmas tablecloth and red plastic plates, napkins and plastic ware and were dressed in their Sunday best.

We were speechless and teary. These women prepared a feast for a holiday that they know very little about and do not celebrate, for a group of people that they barely know but smile at twice a day. All we could say was, "Oh my God, Thank You!" There were no leftovers!

A month later, Project Medishare was awarded a grant through the American Red Cross that will enable the hospital to remain open and functioning for another year. A collective 'Thanks God' could be heard throughout the hospital.

I have struggled to know how to articulate the end of this chapter of my Haiti life to you. And today, January 12th, is the second anniversary of the earthquake, a day that is now a 'holiday' of sorts, a day of reflection and prayer in Haiti.

In his book 'The Rum Diary' by Hunter S. Thompson, there is a quote about his time in Puerto Rico which struck me as describing present day Haiti and some of my conflicted feelings:
"But I knew that I was coming to a point where I would have to make up my mind
about Puerto Rico. I had been there three months and it had seemed like three weeks.
So far, there was nothing to get hold of, none of the real pros and cons I had found
in other places. All the while I had been in San Juan I'd condemned it without really disliking
it. I felt that sooner or later I would see that third dimension, that depth that makes a
city real and that you never see until you have been there a while. But the longer I stayed,
the more I came to suspect that for the first time in my life I had come to a
place where this vital dimension didn't exist, or was too nebulous to make any difference.
Maybe, God forbid, the place was what it appeared to be-a melange of Okies and
thieves and bewildered jibaros."

Haiti is a hard place. People who have spent time in Haiti, the Middle East and India say that Haiti is the worst. Life is cheap. People are loud and course, frequently dishonest, unwilling to be accountable and responsible for their actions. Critical thinking is not a cultural value; nothing works or is easy.

I know that I became loud and rude because that was the easiest way to communicate to accomplish anything. I frequently thought that the Haitian people were their own worst enemies and that I was working harder on their country then they were. I kiddingly said that my 'edit button' was disconnected because words came out of my mouth that appalled me!

I had to consciously work on NOT accepting complacency as the norm because it became very easy to think, "TIH-This Is Haiti: people suffer. They are hungry and thirsty and they live in a hellhole but until their government takes charge and causes a systemic change in the culture, nothing can be done." I did not like feeling this way.

Sometime in December, I walked into the ER and saw a sheet covering a dead body on one of the two gurneys. I casually asked, "Who's this? How long have they been here and when is the body being moved?" As I recall, I said all of this as I walked thru the ER out the back door.
Covered bodies on gurneys were the norm. Mothers brought babies to our gate that were already dead or were dying, asking us to help and there was nothing to be done. Children died all of the time from totally preventable infections that were not treated due to lack of access to medical care and came to us too late to save them.

A friend asked if I was depressed while I was there? No, not really. I was just resigned to it all, frequently throwing my hands up in despair My heart is not in Haiti like it is in Hawaii or Viet Nam or Nigeria or even Japan a place that I have yet to visit, but I seem to be called to be there, for whatever reason.

But just when I was convinced there was no hope for this place or these people, I would be touched by a patient or family that would simply say 'Merci.' I saw heart-warming strength and courage from people just to maintain their dignity.

Cator is a man in his 30's who has been a paraplegic in a wheelchair since 2004 due to gun shot wounds. When the earthquake occurred, he and his family escaped their home as it crumbled around them. He and his wife and their two school aged children moved into a tent but there was only one mattress so Cator slept on the concrete, giving the mattress to his wife and children. Unable to easily turn on the concrete, Cator developed 7 deep to the bone, pressure sores. Essentially at death's doorstep from malnutrition and infection, his wife somehow managed to get him to our hospital where he has lived and thrived for 16 months while his wounds have been surgically repaired and he has strengthened his body.
His wife visits every day and his children come after school. It was his children that Jo and I played Santa for on Christmas Day, surprising them with large red stockings packed with wrapped gifts. I gave his daughter a small pillow that someone had left me, thinking that it was a 'girlie' type of gift, something special. But she gave it to her dad so he would be more comfortable laying on his stomach after surgery. And we gave his son a harmonica which he promptly played, sitting next to a 20 yr old patient who is paralyzed from the neck down.
That was Christmas.
Was there any laughter or 'fun' times? Absolutely!
I worked as a staff nurse in the ICU Dec. 24-26 due to lack of staffing. When I agreed to work for 5 months at the hospital, it was assumed that I would return home before Christmas but I chose not to. It didn't feel right to go there to assist but leave when the staffing need would be the greatest. Besides, I wanted to see what Christmas was like in Haiti.
Christmas, specifically Christmas Eve, is the biggest holiday in Haiti. People go to church, visit each other or just walk the streets. We were told, "Be prepared, everybody is out all night, walking around, drinking and getting crazy." They were not wrong.
Christmas Eve, I sat in our Logistics Office with Toni and Jo, two of our physicians, Howard, one of our long term Paramedics, and Scott, a volunteer physical therapist, drinking coke and Barbancort Rum, which is 1st class Haitian hooch. We laughed and told stories as I watched Santa on NORAD, and we collectively laughed at the stone-cold sober ER doc who kept coming in, asking advice on how to handle all of the people who were at the hospital gate requesting to be seen in the ER.
I am told that the more I drank, the louder were my announcements about Santa's journey:
SANTA'S IN MOZAMBIQUE! SANTA'S IN SCOTLAND! Jo, who is from Oxford, England kept telling me that she did not believe in Santa Claus but she did change her tune once Santa landed in Oxford, which I loudly proclaimed to her!
Somewhere around 11pm, Howard the Paramedic asked if I wanted to take a walk outside the gate. Due to safety, none of us were ever allowed outside of the hospital gate unless we were in an authorized vehicle. BUT it was Christmas Eve, the streets were alive and I was with Howard.
Howard appeared at the hospital about a year ago, requesting to volunteer as a Paramedic. We don't pay Howard but he always has cash and I suspect that he has an outside job. I used to think that he was a mercenary but now I think that he is security for the mercenaries. He is vague about his life, refuses to have his picture taken but works hard and then disappears for a few days. So I felt very secure walking out with Howard. Besides, I didn't have to ask anyone's permission because I am the one who usually gives the permission!
We walked down all of the dirt 'streets' outside the hospital, wishing folks Joyeux Noel as they looked startled to see two blancs walking by their doors. People smiled and sang and danced up and down their streets. We followed some singing up some concrete stairs and found a group of people singing in Creole and swaying to the hymn “Crown Him with Many Thorns.” I know this more as an Easter song but it was pure and heartfelt.
What a wonderful experience!
We returned to the hospital laughing as the guards questioned how we managed to 'escape' out the gate. I went to bed in the call room on the roof as Santa was arriving in Argentina. The ER staff continued to see a steady stream of people with gun shot wounds, stabbings, asthma attacks and women delivering babies throughout the night.
And Santa must have come to Haiti because I woke up with new Christmas socks!
Another gift from my time there was to live in community with other longterm Medishare employees. Six of us shared four apartments about 15 minutes from the hospital. We shared food and drink and clean laundry, supporting and looking after each other. From our roof we could see the Caribbean in the distance and if we didn't look down onto the pancaked homes below us, the area looked like a tropical paradise island.
During my 5 months, I became the Godmother to Daniella and Gabriella, newborn twin daughters of Saentil, one of the ICU nurse's. And honorary Godmother to Christian, newborn son of Katia, another ICU nurse. I attended the wedding of Marie Sonia FanFan, another nurse at the hospital who assisted me in teaching and coordinating the 30-40 nursing students who rotated thru the hospital on a monthly basis. Another nurse, Medalie, and I share the same birthday of January 17th and we frequently laughed about sharing our day with Betty White and Michelle Obama. It pleased Medalie to know that she bore a passing resemblance to Mrs. Obama.
I was given a surprise going away party by the hospital staff a week before I left. I truly had no idea that anything was being planned much to the delight of the planners which gave credence to the fact that I frequently had no idea what was occurring, period.
The staff sang and danced and prayed and showered me with gifts. I was stunned and humbled. Pasteur, one of the Housekeeping men, showered and changed into dress clothes, prominently wearing a tie depicting a Twin Towers pre-Sept. 11th New York skyline as a way to say Thank You to me and America. The party ended with everyone singing 'How Great Thou Art" in French-Breathtaking!
I was honored to be invited into the lives of all of these people.
Do I think that my time was in vain? No, I do not but I am under no illusions that my presence and work will have a long lasting influence. I do know that lives were saved by our presence; and nursing care greatly improved thru the efforts of many people who patiently and consistently taught and mentored the nursing staff.
I started to use words and phrases like "dignity," "patient safety," "assessment," and was thrilled when the nurses actually gave a comprehensive shift report and signed their nursing notes! Priceless!
I do not pretend to know what will 'fix' this country so these above observations are from my little corner of hell or paradise, depending on the view. Much has been written about Haiti these past few days and I commend some of these writings to you:
1. HAITI: The Aftershocks of History by Laurent Dubois-reviewed by the NY Times January 1, 2012
2. Huff Post GLOBAL did an excellent article today, January 12th, on Haiti's history and current issues.
The author talked about the Toyota dealership in Port-au-Prince, that sells all of the white Land Cruisers to all of the NGO's. I rode in one of those vehicles twice a day.
3. The New York Times have had several recent on-line articles about Haiti which are truthful and comprehensive.
4. Project Medishare, the organization that I work with, has several YouTube videos about the hospital and earthquake relief. Last night I watched the 30 minute video which made me cry out of sadness for everything but pride of being involved in such an effort.
Lastly, I could not have done this and would not have done it, without Veronica's support and agreement for me taking of for 5 months to do whatever. 5 months is a long time.
Thank You to several people who returned to Haiti because I was there, bringing me money, protein bars and a touchstone of sanity and strength: Sharyne, Jane, Lorna, Emily, Erica, Myra, Jamie and her dad and Kirk in spirit.
And Thank You to all of you who prayed for my safety, sanity and health. You accomplished all three! Will I return to Haiti? Oh probably.

Thank you for traveling with me,


Thursday, November 24, 2011

Haiti #6 - Tiger and Fiona

Dear Friends,

November 15, 2011

I am sitting in a motel in Miami, preparing to return to Haiti in the morning. I flew here Sunday afternoon to attend a meeting about the future of Project Medishare’s involvement at Hospital Bernard Mevs in Port-au-Prince. I was scheduled to return to PAP this morning but slept thru my 9am flight (oops!) so I have spent the day in my jammies, watching mindless HGTV and Sesame Street. Today, Big Bird introduced the letter H for Habitat. I could have tried to book a later flight today but sometimes my fatigue scares me so I chose to hang out with Big Bird instead in my habitat at the La Quinta Inn East.

So many of you e-mail me, asking me how I am doing and how is my life and I truly do not know what to say. My hours blur into days which blur into weeks and I totally lose track of time. I had no idea that next week was Thanksgiving. October 31st, I went to Mega Mart, PAP’s local WalMart of sorts and their Christmas decorations displays were constructed. I was stunned. And the decorations were cheap and imported, none representing Haitian life. And the overhead speaker was playing ‘It Is the Most Wonderful time of the Year.” I wonder if the people even listen to the words?

Halloween and Thanksgiving are not celebrated here and I see no indications of Christmas. I’m told that before the earthquake, people decorated their homes and surrounding trees and foliage, with lights. They don’t have Christmas trees and don’t really understand decorating with ornaments but they do exchange some presents with family and friends.

But since the earthquake, all that has changed. “People are still so sad. So many people were killed, so many gone that no one wants to celebrate” according to Philip, our lead driver. No one is even speaking of Christmas and no one has requested the day off.

Wednesday, the night before Thanksgiving!

Another 10 days gone and I cannot account for them. Everything blurs now. Many of the employees have malaria and typhoid but luckily, no cholera. Two patients have died of rabies because there is no rabies vaccine in the country. Two others have died of tetanus. People who had an infected tooth now have massive facial cellulitis because they delayed treatment or used home remedies. Lots of gun shots and stabbings, some make it, some don’t. We have daily deaths due to untreated hypertension resulting in massive strokes; most of these people are between 35-55. There are daily admissions of people being hit by cars, falling out of tap-taps or young men falling out of trees trying to pick fruit. Most don’t make it. Cause of Death: born in Haiti. What a depressing paragraph.

Tomorrow we will have a turkey dinner on real plates and not out of Styrofoam containers. The catering company who provides the volunteer meals, bought some turkeys to make us dinner. I’m wondering how it will be prepared and in what form it will be presented: chunks, slices, mashed? And if the omnipresent creole sauce, beans and rice will be the sides?
And Tiger and Fiona? Veronica came to visit for 12 days and we spent a night at the Olafson Hotel, a grande dame of a hotel. Through the years it has been a war hospital, military headquarters, dictator du jour headquarters, abandoned and now a funky little hotel that plays some roaring Caribbean music on Thursday nights.

Almost all dogs in Haiti are medium sized, light brown and not vaccinated. Not unlike the dogs in Africa, India, SE Asia. Perhaps it is 1 father and thousands of mothers, who knows? I do know that most dogs here are assumed to be rabid and looked upon as animals, not family members to be fawned over.

Except Tiger and Fiona. They are LARGE, dark brown bull dogs who are owned by the Owner/Manager of the Olafson Hotel. They obviously own the place because they lumber along, sleeping everywhere! Fiona has obviously had many litters of puppies because her chest is almost dragging on the floor. They are old and start slow, tapering off. They are clean, vaccinated and wanting to be petted, planting their bodies under every hand that reaches out.
They also have a pal, a small, fluffy thing that I thought was a mangy cat but is a small, fluffy dog. Just appeared one day, no name and thinks that Fiona is her mom. Fiona moves 3 steps to take another nap and small, fluffy dog Velcro’s herself to Fiona, bouncing along. Their antics are the “floor show” during dinner on the veranda. Why is this my title? I couldn’t think of anything else; but mainly because these dogs and Veronica’s visit brought me a few moments of joy and silliness.

Thank You to all of you for your love, support and presence in my life. Have some mashed potatoes and gravy for me. Any maybe a few black olives.


Thursday, October 6, 2011

Haiti #5 - Hangin' With The Dragons

Dear Friends,

The original title of this diatribe was "Some days I am the bat, some days I am the ball." Which is still true. But in the last few weeks, as I have left the Logistics office to round on all of the nursing units, I have found myself saying, "I am going out to slay the dragons."
I was trying to slay one dragon an hour but that was a bit lofty. I now try to slay one dragon a day or at the very least, wrap them on the snout. Sometimes their tails hit me and some days we just coexist. Some seem to be smaller, some are cuter and some just sneer. And I am not sure who is winning.
This has been a hard few weeks. The grant money from the International Red Cross that funds Project Medishare, will be finished by Dec. 31st, but apparently the money will really be gone by Dec. 1st. Consequently, we layed off 20% of the staff on Sept. 30th. Doctors, nurses, translators, housekeeping. At one point I was so overwhelmed that I'd wished that I had been fired because I would have gladly left. Part of me still wants to.
Gaby, the Administrator and myself, sat and chose most of the people to be layed off, understanding that their income of $300/month was the only barrier to being homeless. Gaby was laid off one week later..
We met with all of the departments and told them about the layoffs and then the stories started. "Please, Madame, my husband and baby were killed in the earthquake, I will have no way to feed my children if I am let go." 'Please Madame, Please..."
We did not lay off the woman who told us this story.
Then one of the Haitian nurses was kidnapped for a day, luckily physically unharmed. And then the Lab spilled sulfuric acid at 11am one day but didn't say anything until 4pm even though they were coughing with watery eyes. The Lab was closed but no one thought to pull the wood off of the windows or put in a fan to ventilate the area.
During this time, Maxie, a young woman who I had taken care of in the Field Hospital was readmitted for Sickle Cell Crises. The family recognized me, greeting me with hugs, "we lost track of you." Because the Lab was closed, we had no idea how anemic she was. When we were finally able to get get some lab results, we sent the boyfriend to the Red Cross at the General Hospital, to get her a unit of blood. As the boyfriend was carrying in a unit of blood a couple of hours later, Maxie went into cardiac arrest and died. She was 22 yrs old and had just been accepted into Law School in New York. This was a totally preventable and needless death and I feel sick even thinking about it.
I thought that school started a month ago but I guess it started for everyone this past Monday. Uniforms needed to be made, black shoes and backpacks bought. Several of the hospital employees cannot afford all of this so a few of us sent money to the schools to pay the bills.
In that same vein, our hospital seems to be one of the few teaching hospitals left for nursing students so I now have 40 students divided into 6 hour shifts, doing their clinical rotations. And I have had to turn students away.
Two weeks ago, I noticed a little girl standing outside the inpatient HIV unit at the hospital. This is not a unit that we staff but it is right in the middle of the hospital so very visible. I smiled, she smiled and we became pals. Her mother was the only patient in the 5 bed unit so Milianne and her grandmother just moved into the unit with the mom.
I initially did not see the mom, only Milianne and her grandmother sleeping on the concrete floor of the unit. Milianne started to run to me and say "mange", she was hungry. So I adopted the 3 of them for a few weeks, giving them blankets, pillows, egg sandwiches from the street vendor, and clothes to Milianne who was half naked.
One day, Milianne pulled me into the room and their was her mom laying on the bed, only whispering "merci" to me. I felt like I was looking at the face of God and had to look away because it was so powerful.
Incredibly, the mother improved and the 3 of them left the hospital last week. And Milianne had new uniform skirts, black shoes and a backpack. Her smile was beautiful.
I am very tired so this is very brief. This is a very hard place.


Wednesday, September 14, 2011

Haiti #4 - RIP

An elderly woman was hit by a car today. Brought into us, with major trauma and died 20 minutes later. No ID, no name, no one with her. The staff put her into a body bag and sent her to the morgue where she will be sent to General Hospital and cremated. Will anyone notice that she didn't come home?
Alexon died today. He was a 16 yr old boy who was stabbed with a knife while riding on the back of a motorcycle. He developed meningitis, improved on antibiotics but rapidly deteriorated over 24 hrs and died. His mom never left his bedside. The doctors think that there was poison on the knife.
The hospital is running out of money. All of the once daily meals for the staff have been stopped and as of yesterday, all of the patient meals have been stopped. Unfortunately, there are 7 patients in our long-term Spinal Cord Unit who have no families to bring them food, including Katiana, the 11 yr old who is a paraplegic from a wall falling on her. Several of us will start to contribute our food stipend to feed the patients.
A woman asked me for some 'glo' today, water, as I walked by her. She is the mother of one of the ICU patients, a young man who was involved in a MVA/Motor Vehicle Accident and is now paralyzed from the shoulders down. She wears the same white t-shirt every day that says, "To the best teacher, Mrs Barry, Christmas 1995, a denim skirt and a navy blue Easter Sunday type broad-brimmed hat. I have been giving her some food and water these past days but understand that in the greater scheme of things, I really shouldn't. Others see me do it and ask for some also. A scuffle can easily occur in seconds. But she was thirsty so I turned around a gave her one US dollar which will get her 4 small bags of water. Everyone is hot and thirsty here.
Rest In Peace Alexon and Little Old Lady.


Sunday, September 4, 2011

Haiti #3 - Common Sense Is Not Necessarily Common

Dear Friends,

Perhaps you are wondering where the above title comes from? There is absolutely NO WAY to fully explain daily life here so Gaby, the Administrator, has created this mantra: "Common Sense is not necessarily common, Logic is thrown out the window and we strive to always be 10 minutes ahead."
Whenever I want to start a sentence with "It would make sense if..." I have to stop because those words make no sense here. I have to resist throwing my hands in the air, thinking that the Haitian people are their own worst enemies. Absolutely nothing is easy here and I am sometimes overwhelmed with the difficulties of daily life. and yet a whole nation manages to survive, barely, and so must I.
For Example:
#1: Marie-Claude, one of the long term Haitian nurses, let a very sick patient into the clinic area at 7am one morning against the instructions of the gate guards. There was no doctor in the hospital so the Triage area was closed for 1 hour until a doctor arrived and the guards were instructed not to let anyone in.
But Marie-Claude didn't want the woman to lay on the street at the clinic gate. I totally understand this and applaud her for this. But after she brought the woman in and laid her down on the concrete, Marie-Claude LEFT the hospital for 1 hr "to do something" asking the guards to watch the woman. Benoit, who I affectionately call the 'grim reaper' because he is responsible for taking the bodies to the morgue, found this poor, moaning woman and immediately ran to the first person he could find, Gaby, the administrator, who got me and we comforted the woman, etc.
The next day, Gaby and I sat down with Marie-Claude to discuss this situation and to give MC a 'letter de blame,' a very serious action that can lead to termination and revocation of an employees certification, etc. MC was obviously very upset, repeatedly explaining why she did what she did. I repeated that she had abandoned the patient and would have been responsible if the woman had died. MC: "but she didn't die." Me: "but she could have and you left her alone and left the hospital, on work time." MC: "but she didn't so it was OK." There was no way that we could explain this to her.
#2: The EKG machine was put outside because the LOW BATT light was on, just meaning that it had to be plugged in. A nurse thought that it was broken so she put it outside and out of the way. Then it rained. HARD. And then it was broken.
#3: The C-arm, an x-ray machine, is broken and needs a $21,000 part to repair it. I guess it was in the way in the OR area, so someone pushed it into the parking lot to get it out of the way. Where it was almost broadsided by the truck that empties the port-a-potties. I rescued it and had it pushed into the corner of the x-ray dept.
#4: August 15th was a country-wide holiday here. No one could tell me which holiday but they all knew that it was a holiday and didn't really want to work. After some thought, I realized that August 15th is the Feast of the Annunciation, a Roman Catholic feast day. No one goes to church to honor it, but they all want it off.
Hospitals are 24/7 institutions which has been a difficult concept to teach here but the staff is improving with their attendance on Sundays and the night shift. Two weeks ago, on August 15th, two of the just arrived volunteer doctors asked me if they could go to the beach because "nothing was happening at the hospital."
I was taken aback by this request because they had only been here for 48 hrs. I wanted to say, "Hello, you are here to be of service for 1 week and just because the operating room nurse are not sterilizing your instruments as quickly as you would like, is no reason to declare this place a disaster and go to the beach."
In stead, I politely said 'No,' and that they were needed here, especially because one of them was an Orthopedic surgeon and people are always falling out of trees/trucks/motorcycles and breaking their bodies. And we are currently the only real hospital open because the General Hospital is on strike, again! Also, there was no driver, gas or car available for the 3 hr round trip. OK they said.
One hour later, I could not find them. I would later discover that they had gone to two of the workers, an X-Ray tech and a Wound tech, offered them food and gas money and had these two employees drive them to the beach. The explanation by the employees: our work was done and IT WAS A HOLIDAY so we went to the beach. Sadly, this made total sense to me. Other than leaving work for 4 hours, without permission, and thinking that they were getting paid for it, I understood. I also assume that these doctors gave each of these men some money for their time. These men make $300/month, so of course they are going to take $50-$100 for a ride to the beach. Besides, their work was done and IT WAS A HOLIDAY! These two men truly did not think that they had done anything wrong.
As a follow-up: One of the doctor's was sent home because leaving without permission is grounds for termination from here and the two employees were suspended without pay for 1 week, a great hardship for them. The second physician the Orthopedic doc, profusely apologized, unlike the first physician and we desperately needed him to do some 8-10 surgery cases/day so he stayed.
And it goes on and on and on.
SEASONS: The kids have returned to school so there is a steady parade of different colored uniforms walking by our gate. And the obligatory matching hair ribbons that are so cute. I am told that only about 50% of the children ever go to school and 50% of those in school never complete it due to finances.
We have managed to remain relatively unscathed by 2 hurricanes but we still have a few more months of the Hurricane Season and we are still having 2-3x/week torrential rains. And nightly lightening shows with some thunder. It remains hot and humid and sometimes I am really tired of being hot and sweaty.
There is still no Prime Minister because the Parliament does not agree with any of President Martelys choices so the government is at a standstill.
There seems to be an increase in armed robberies, stabbings and gun shot wounds, based on our ER business. And two police officers were shot and killed the other night and brought here so it was a bit rowdy at our front gate.
And there have been 12 kidnappings and 1 murder of some local Haitian folks. Consequently, all of our tours for the volunteer staffs have been canceled and we are only allowed out to go to the UN in an UN car. Is there a Kidnapping season?
The other evening, a 7 yr old little girl was brought to the hospital by two men. The story was that 'TaTa' had walked to the store on her own and been hit by a car. Luckily there was only a minor cut on her forehead. Two men saw the accident, scooped her up(?kidnapped) and brought her to us. Not out of any great sense of kindness but because they knew who the driver was and wanted us, the hospital, to pay them for the information. As we are saying No, that we will not be bribed, the driver and his buddies show up at the gate and a melee ensues. One group of men wanted to re-kidnap the girl and take her to the police station to get money from them in exchange for the information. We laughed saying that we assumed that the police had much more discretionary income than us.
While the boys were rowdy at the gate, we whisked the little girl into the Logistics office where her laceration was sutured and she could be fed. She was silent and obviously terrified. Our Social Worker attempted to get some info from the little girl but it was difficult. She only knew her name and her siblings names, not her address, anyone's cell phone number or even her mothers real name.
Two hours later, a woman shows up claiming to be the mom but later admits to being the aunt, TaTa identifies her and one of our drivers sneaks them out the back gate to go to the police station to file a report. Our main concern? The aunt will beat TaTa for creating such problems for the family.
Children are constantly dying here. A four old little boy died from complications of asthma last week. His grandmother was with him when he died and went "nuts," throwing herself all over the Peds unit, hallucinating, yelling at God. She eventually had to be restrained in a chair for her safety. Two nurses drove her home to the tents where they found the little boys mom who had delivered a baby a few days before. they told the mom about the death and then quickly returned to the car before a mob collected. The mothers wailing could be heard as they drove away.
The family could not pay for a funeral so the body was taken to the General Hospital where it was cremated. I still picture two of our Housekeeping men carrying this olive green stretcher with this little body covered in a light blue blanket. Does it still bother these men to carry a body or have they done it so many times, it is just a normal part of life? I don't know.
I held the door open the other night for one of our Transporters who was carrying two rolled up blankets in his arms. They were dead babies.
And today, a woman was driven into the hospital with a dead baby half-born and hanging out of her.
This past week, a Haitian American Pediatric surgeon from LA flew here to operate for 3 days. There were three Pediatric surgeons in Haiti but they were killed in the earthquake so Dr. Ford comes here every quarter to operate on the most desperate cases.
On a lighter note, it is football season and I have decided that I will go to the UN bar every Sunday to watch some football and have a beer.
Talk with you soon.


Tuesday, August 23, 2011

Haiti #2 - A Few Weeks Later

Dear Friends,

It is Sunday, August 21st and I am starting this blog as I am finishing a 30 hour work marathon at good 'ol hospital bernie mevs. I am awake but that is subject to change at any moment.
One of my greatest revelations in this job is that many of the volunteers that sign up to come down here for a week or so, particularly the nurse's, decide 48-72 hrs beforehand, that they cannot do it. No reason given, they just cancel or just never get on the plane and never call. I had no idea people could or would do this! I understand the fear and the fleeting thought of not getting on the plane but NOT DOING IT? I had no idea and it's rude AND it screws up my schedule!
This week, 4 nurse's did the above; 1 additional nurse flat out told me that she could not and would not do night shift. And that if I made her do it she would "go nuts" and she would return to the airport immediately. Based on how nutso she was in bending down from her 5'10" frame into my not so big face, I switched her to day shift.
And then one of the ICU nurse's got sick sooooo, I worked a 12 hr night shift that turned into a 15 hr shift because 1 of the patients tried to die. For you non-medical folks, people frequently "try to die" during change of shift. Maybe they think that we are not paying attention to them and it is their only opportunity to get some peace and quiet. I don't know but it happens all of the time. Change of Shift is always "the bewitching hour."
And then, because we are starting some major construction this week, there was a scheduled 1-2 hr power outage in the ICU/ER/OR for some electrical something. And then one of the visiting surgeons had a "fit' about something, summoning me to the courtyard about some impending natural disaster. Please keep in mind that this was ALL BETWEEN 6-7AM ON A SUNDAY MORNING!!!!!! I told the surgeon that I was busy with a woman who was DYING and could not speak to him right now. "Hurrumph" he said and stormed out. Whatever.
A natural disaste in Haiti? Please be more specific. As it turned out, one of the housekeepers in the OR/Recovery room, had mopped the floor with Formaldehyde. Huh?
So here I am, 30 hrs later: dirty, sweaty and tired...
...I have had a 3 hr nap now and am ready to go. Unfortunately, the woman who was trying to die, did die several hours later. It was peaceful.
I have been keeping notes the past 2 weeks for this blog and after looking at the notes, I realized why I never was able to write a blog about my Jan-Feb 8 week visit here: there is no rhyme or reason to my words. No outline or witty repartee; just events that feel schizophrenic and chaotic which is what life is like here.
In the interest of my sanity and based on some of the questions that you have asked, I am going to attempt to outline a few subjects about my life here:
1. Typical day: it begins with the 5:20am barking dog and the roosters in the trees. (I am so not a morning person.) We may have electricity based on the City Power gods and gas for the generator. We have water that comes from cisterns up to large holding tanks on the roof. Because no one has lived in my apartment for months, my water smells like rotten eggs. I guess I have to take longer showers to empty the tank for fresh water and after 3 weeks, it does smell a BIT better. The water is not safe to drink so I have to remember to keep my mouth shut while showering. And to wear flip-flops in the shower because the bathtub has permanent 'nastiness' on it. A driver picks us up at 7:30 or so and I am at the hospital for the next 10+ hours. Two nights a week I stay at the hospital in a small call room on the roof. There is no barking dog so I actually sleep better there than at the apartment.
2. What do I do all day? Sometimes the nursing units have run out of water because 'Jimmy, the water guy' is not there yet and I have to find him. Or the volunteer nurse's are frustrated with the night Haitian staff because they intermittently sleep during the night and need to talk. Or the volunteer nurse's are upset with Haiti. That's a much longer conversation. Or there is no toilet paper or hand sanitizer and Chantelle, the cleaning lady, has locked the main door to administration so she can mop the floor. Or there is no toner in the xerox machine and we have no way to xerox anything, as in, no consents for surgery. There is no place to buy toner here and I guess that we can't fly down toner because of terrorism or something. And the concept of writing MASTER in yellow hi-liter, does not exist here. So we hand wrote a consent and the next day, the administrator sent someone out to make copies, from what I have no idea. And we now have toner but I don't know where it came from.
Sometimes I need to reserve some medical beds for impending surgeries and there are no beds. Or people resign. Or people need to be fired. Or Benoit, the 'grim reaper' who manages the morgue, which is just a series of gurneys in the back, in the sun, is on vacation and no one has picked up the bodies. Or, or or...suddenly it is 6 hrs later. And then it is 10 hrs later. I guess I should be able to account for my time better.
Pauline, the previous Haitian CNO, did resign last week. Unfortunately, she gave me minimal information on her files, paperwork, etc so I have been attempting to decipher all of this while conducting job interviews for nursing positions. Did I mention that everything is in French? Thank God that Sister Somebody taught me some high school French because I can read a bit but I usually need to have a translator with me.
3. What do I do for fun? In Haiti? There are no stores here as we know them, except food stores. All clothes are bought on the street. If there are movie theaters, I am not aware of them. Two weeks ago, 5 of us from the house, went food shopping. We receive 1 meal a day at the hospital so I have had little need to buy 'real' food anywhere. If I do buy food, it is at a local food store which is cheapish and sufficient. I forget the name. It serves the purpose.
BUT it was Sunday so we had one of the drivers take us to the neighborhood of Petion-ville, the high-rent district up the hill, to the GIANT foodstore. It was like another world.
Many local Haitian folks were there but they must be employed to pay those prices. Lots of embassy and NGO folks. Great assortment of foods but very expensive: $7 for a mango. $10 for OREO bits, etc. They even had bottled Starbucks Frappacino's but if it is expensive in the States, can you imagine the price there? $11!!!!
I bought a pink rubber bathmat, made in China, with a label describing it as "Beautiful Niceness."
The most fun item that I bought was......liquid soap! Be still my heart! It is clear and has the scent of white tea and ginger or white ginger and tea, not really sure. This is really quite exciting because we wash our hands with only hand sanitizer so my treat, is to wash my hands once a day with REAL soap and water! So exciting!
The other fun thing that I did, was go to a hamburger joint in Petion-ville, called HANG and have a real hamburger. I even wore a dress! Great food but it gave me diarrhea for 2 days. Oh well.
And sometimes, I have one Prestige beer in the evening. In fact, I was out of cold beer the other day which was close to being an emergency according to Big Dave and Adrien, the guys who live in the apartments.
If I were to buy a beer from the street, with US dollars, even though I would have to send one of the men out to buy it, they would still have to pay the 'blanc price, the 'white price' because it is US currency. Using Gdes. the Haitian currency, a beer would cost 25 Gdes, about 75 cents. If a US dollar is used and I buy it, 1 beer is $1.25. It is $2 at the UN bar and $6 in a hotel. So, of course, I give money to the guys and they buy the beer.
The hospital is a dry campus which means that one just quietly asks the guards to walk out a buy the beer. I gave a $10 bill to Adrien, not really knowing about high finances, and he returned with a 12 pack. His seller is named Spider.
Haiti is a hell-hole and conservation and recycling are unknown concepts here. BUT the one item that they do collect and conserve is beer bottles. I knew this but I was unprepared for Spider to come into the hospital, find me and ask for his beer bottles back, 3 days after I had received them. Not satisfied with my response that I had only drank 2 beers since I had received them, he went to Adrien, in the Logistics office (how do these guys know where the Logistics office is?) loudly expressing his dissatisfaction with my lack of empties. His eyes got really big when I said that I had only drank 2 of them in 3 days. Mon dieu!
I now have 8 empties because Adrien and Big Dave have each had a beer. I hope Spider is appeased.
I am here to be in the hospital so time off or days off are not really thought of, we're just here.
3. Street Scenes: In my last blog, I described the 19 small streets that we drive up and down, to get to the hospital. I am also starting to recognize some of the regular street folks.
There is the woman who I hear but do not see, every morning, loudly yelling out what she is selling. I am thinking that it is bread which she would be carrying on her head. She repeats her refrain every 20ft or so. She 'sounds' in her 40's-50's, slender bordering on malnourished, poor, wearing a dress and flip-flops.
There is the Happy Birthday truck and the Titanic truck. These are water trucks that drive to peoples homes and fill up there cisterns with water. One truck plays Happy Birthday and the other truck plays the theme song from the Titanic, as they drive down the streets.
There are police cars everywhere and UN trucks with men with big guns, at many intersections. The police randomly stop cars, asking for registration or some other paperwork. I think. Whenever I ask our driver about this, they suddenly do not understand English. Everyone is assumed to be dishonest and corrupt here and it is assumed that everyone steals, so I am wondering if the police are collecting money from the cars. No money, no driving. We are never stopped or questioned because we have a sign in the window, saying we are on administrative business. Plus, having a blanc in the car, in the light of day, usually means the driver will not be shaken down. After dark is another story.
Most of the clothes that are worn here, are originally from the US or neighboring countries. Best t-shirt:: man wearing a bright yellow shirt WOMEN FOR McCAIN!
4. Weather: it is god-awful hot and humid and smells like garbage. And as I write this, Hurricane Irene is about 24-36 hours away from us. We have had some great quick moving Caribbean evening storms that produce steamy rain and humidity. Unfortunately, because there is no sewer or drainage system here, a rain like that causes flooding and twice the hospital has been flooded, especially in the Pediatric unit. Most of the hospital is built up small inclines but many areas are not so everything floods. Sandbags do not exist. We just watch the rising torrents of water and clean up the mud and debris afterwords.
5. Contributing to the smell of garbage is the huge piles of garbage at every other corner. This is not a few bags strewn about, this is 20ft of garbage in both directions from the corner, about 3-4 ft deep with mongrel dogs rummaging thru the muck. The piles are frequently on fire. The piles get bigger and bigger and then one day, they are gone! Then they start all over agin.
6. Speaking of fires, I have never seen a fire truck here. There are police everywhere but no fire stations or visible equipment.

And Then There Is The Rest:
In my last blog, I spoke of a very sick 14 yr old girl whose father promised to kill everyone if she died. She did die peacefully with an older brother at her side and her father was OK when the brother called him. The Pediatrician and myself each contributed 500Gdes, about $12.50, to transport the body home in the north.
Last week, I assisted with a transport of 2 children and their mother's, to St. Damien's hospital for some head CT's. One child was a 14 yr old girl who had fallen and hit her head. She laid draped over her mother and aunt's laps. The other child was a 3 month old little boy with a slightly large head and bilateral clubbed feet.
Gideon was the driver and had a tape of church music playing during the ride. As we drove/bounced the wrong way down streets to avoid huge potholes, UN trucks and the general chaos of the streets, the women began to quietly sing with the music. I turned and smiled at them and they sang louder. I cannot describe to you the spontaneous melodies of their voices. All I could do was close my eyes and smile and pray. It was a holy moment.
A week later, an adult patient was desperately in need of O- blood which rarely is available here. For 1 week the Haitian Red Cross looked for blood to no avail. For you medical folks, the patients Hgb was 3.6. For you non-medical folks, the results should minimally be 10 and 12 would be better.
As it turns out, one of the volunteer nurse' had O- blood and she had taken a special liking to the baby with the clubbed feet. The surgeon wanted his patient to have blood before he operated and the nurse wanted the surgeon to fix the clubbed feet SO a deal was struck: 1 pint of blood for 2 fixed feet. And it was done and the mother just sat there and smiled.
Last week, we admitted Tatiana, an 11yr old little girl who had a wall fall on her and who is now a paraplegic. Her parents are dead and she was "dropped off by soneone." This girl is 11 but looks like to be 9 or 10. In Haiti, the kids look younger than their age and the adults look much older. She had been raped and has gonorrhea. Fortunately, she is not pregnant or HIV infected.
Ferla, our social worker, had decided to go to the girls village to see if anyone could care for the girl, when a man showed up who said that he was the girls step-father. Based on how he attrempted to caress her and how she cringed, we are suspecting that he has been raping her.After Ferla spoke with him, he left and has not returned.
All of the ICU nurse's have adopted Tatiana. She has a chest brace on until her spine can be stabilized so a few nurse's put her into a wheelchair, took her outside, found a hose and gave her a bath and washed her hair. Gaby, the administrator, bought her some barrettes and braided her hair. I found a Barbie doll with some clothes and some other 'girlie things' and in the last few days, she has actually started to smile.
After her spine is stabilized, Ferla will attempt to find a rehab place for her. But after that, who knows?
I have much more to tell you but it is now the 23rd, my 23rd day of working, and I am finally tired. Hurricane Irene has missed us and we are happy.
Talk with you soon.


Saturday, August 6, 2011

Haiti Week 1

Dear Friends,
As many of you know, I have agreed to a 5 month 'assignment' as the Director of Nursing at a small hospital in Port au Prince, Haiti. This is the same hospital and organization, Project Medishare, where I have been volunteering since April 2010.
I was at this hospital for 2 months in Jan-Feb of this year and again for 1 week in May. Each time I was asked to consider returning to do nursing education, which I agreed to do. And then in June, I was offered the Chief Nursing Officer (CNO) position; perhaps I flapped my jaws one too many times about things around here and now I am here. Yikes!
I flew to Miami on Friday, July 29th and had dinner with Gillian, the Project Medishare rep who flies between Miami and PAP to try and get this 'little engine that could' hospital up and running. Dr. Barth Green, the director of Medishare has the goal of making this the only trauma/critical care hospital in all of Haiti and after a year this dream may actually happen. It can't and won't be 1st World, due to local education and lack of pretty much everything here, but it may be 2nd World or we will all die trying.
Gillian talks faster than I can think and is quite an imposing presence even though she is only a few inches taller than me. Therefore, when she said: "Don't stress about this, take a month to figure it all out, you'll be fine" I thought, "uh-huh." "And, oh by the way, here are the things I would like you to focus on:
1. Monday, we are starting to bill for all triage visits. Check on this and tell me what's happening and how we can make it better." I didn't dare tell her that numbers are not really my best subject.
2. We just put correct airflow into the Operating Rooms (it wasn't there before?) and I am not sure if the rooms are being cleaned properly after each case. Should the walls be washed down? Find out and implement it, will you?'
3. The Bitar Brother's are going to start performing quite a few private patient surgeries to bring in revenue. We will need more staff, investigate it will you? And we are going to be knocking down a wall to move the patients into their private rooms which are currently volunteer sleep rooms. Follow-up please."
When I told her that two of my struggles during my Jan-Feb 2 months stay, were to not shut down to the omnipresent misery around me and to not be so distrustful of everyone in Haiti (if they are nice to me, do they want something from me?) she replied, "don't trust anyone."
Yes ma'am, I said. Ay carrumba!
Saturday morning, the 30th, I arrived at the American Airlines terminal, and stood in line for 45 minutes, as the only non-Haitian, while a group of 30+ volunteers teens and adults from the Miami Vineyard Christian Church, were checked in for my flight. And for 45 minutes, several of the in-line Haitians complained in Creole, about the volunteers taking their seats on the plane. I later found out that 7 of these Haitian people did not have tickets and were flying stand-by so I assume, very much wanted these volunteers to not check in.
When I was finally called to the counter, a Haitian older woman (easily 100) was moving VERY SLOWLY in front of me. I waited and was immediately yelled at by the man with no seat who was breathing down my neck. I looked at him and said that I didn't want to HIT HER!
Great, I'm loud and rude already.
My bags weighed 52 and 58 pounds respectively and so the AA lady told me to remove some things and weigh them on the scale. I took out a pair of sandals and all of the sanitary napkins that I was bringing for any patient that needed them. That was my 2 pounds but the woman looked so embarrassed that these bright yellow sanitary napkin packages were laying all over her luggage scale, that she let me put them back in! And she did not recharge me for weight because I had been charged in Phoenix. Woohoo!
Then there was the TSA lovefest: a body scan, then having all of my carry-on luggage checked because I had a large bottle of cough medicine that had to be checked "for fumes" and a candle that...I have no clue. Surly bunch. And in the process, I lost a sandal. Damn!
Our flight arrived in PAP at the same time as an Air France Miami flight and baggage claim, which is chaos at its best, was nuts, just plain nuts. So with 500+ passengers, 1000+ pieces of luggage, 2 fully functioning carousels, and skycaps of sorts saying, "I take care of you" to freshly bathed, wide-eyed volunteers standing with their mouths open like dead fish, it still took 45 minutes to even find the door out. And I knew where I was going! Then I was pounced on by the gray-shirted men (they used to wear plaid shirts, I was momentarily confused), "Madame I help you" but was rescued by Phillipe, the hospital driver who also had to fight off the gray-shirted men because he wasn't wearing a gray shirt but a green t-shirt.
Does it look any better here? It does. The Immigration/Baggage claim area is brighter; there are more advertisements on the walls and the a/c seemed to be working. Some tents are gone and the streets had less garbage and rubble in them but the streets remain gutted with holes and pancaked buildings are still everywhere. It is hot, dirty and gritty and everyone looks very tired.
The hospital is still here. My fear was that I would drive up to the hospital and think, "I can't stay here for 5 months, it's terrible here." But I didn't have that reaction, it was more one of overwhelming fatigue. I was met with open arms by everyone I knew and received 2 requests from nurses to change their schedules within the first hour. That was after I was asked to go into the ER and help with 2 gunshots that had just been brought in. Blood everywhere but the volunteer group this week consists of a group of EMT's so they were loving it.
Of course, they wanted to do x-rays on both of the patients at the same time which is laughable. Gotta wait, there's only one space in x-ray and one very slow moving tech. That's after you go down the ramp off of the ER and try not to lose the gurney with the momentum, (almost took out a little old lady in a wheelchair on that one!) push the gurney thru the parking lot, dodging the non-responsive man who is being carried up the ramp by his limbs and then up the ramp to x-ray, dodging the guys in their wheelchairs.
Too much fun!
There was also a 1 week old baby brought in by his mother saying, "something wrong." The baby had been born at home and based on its symptoms probably had tetanus. There is no test available here for this but the mom said whatever was used to cut the umbilical cord was "just around." The baby also tested positive for HIV so the mom was going to be tested. After two days in the Peds unit with gradual deterioration, the mom took the baby home to die.
I am living in an apartment building about 15 minutes from the hospital. There are 6 apartments each with 2 bedrooms with some basic furnishings including a shower curtain with fluorescent green, orange and red tulips. I have been told to not freak when my queen-sized bed falls apart during the night. Apparently a part is missing.
My bedroom has a/c which is obviously electricity dependent. When I arrived at my apartment Saturday evening after spending 6 hours at the hospital there was no city power and thus no water because the water pump needs power. I sat in the dark on the roof with the other Medishare employees and played with Ariel, the house dog who desperately needs a bath. I went to bed smelling like Haiti dirty dog sweat. That was after I found my sheets and blanket by using my headlamp.
With all of the windows open for ventilation, I woke up at 5am Sunday morning courtesy of the rooster who lives next door and then the barking dog. Still no power or water-this could be a long 5 months. The on-site generator that we have in the courtyard did have enough gas in it to give us 1 hour of power and water then it died. But I got a shower during that hour!
Another 4 hours at the hospital, just hanging out, talking to people. Our driver to take us home that evening was Michelet who said his wife was at the OB hospital about to deliver their second child. But she was getting tired and couldn't push anymore. He was frantic with worry so myself and the other 2 people he was driving home, told him just to drive to the hospital and we would call for another car to take us home. Rachel, our volunteer coordinator, suggested that she and I both go into the hospital so I could evaluate if this was becoming a problem labor and possibly transfer the wife to our hospital. "OK" I said thinking "I don't birth no babies."
La Chanterelle Hospital is the main OB hospital for PAP. I have no idea how many women can labor at one time or even how big the building is because it was dark and there were very few lights in the parking lot or the walkway into the hospital. The cars in the parking lot were blaring Haitian music from their radios; there were people in the shadows, mainly women, probably relatives, just sitting and talking.
Michelet managed to talk fast and get us past the guards and we walked into this building that looked like a prison. The walls were painted dark green half way up with white paint to the ceiling. But the top 2 feet of the walls were open with bars on them, I assume to let in some air but the screaming and the smell were pretty unnerving. The floors were clean though.
There were women everywhere! Laying on the floors, the benches, in chairs mainly behind metal doors that also had bars on them. Our presence, two "petite blancs" caused people to either look up with dazed eyes or come to the doors to look at us.
We found Michelet's wife laying on a bench, moaning and rocking. When she saw Michelet, she stood up but fell to her knees. She was too weak to walk but wasn't far enough into labor to merit a bed yet. Or an IV for hydration or medication to move the labor along. She was just like all of the other wailing women so we left and another driver took us home.
Michelet's wife delivered a healthy baby boy and mom and baby were home 20 hours later.
Monday, August 1st, was my first day of school so to speak. Unfortunately, Pauline, the woman whose job I am taking because she is being moved into a coordinator position, had not been officially told this, she thought I was "just coming to help her." Oops! Therefore until the Administrator tells Pauline about the changes, hopefully tomorrow, I am just wandering about being vague about what I am doing. This is so typical, communication is not a strong suit here and things can get confusing very quickly.
This week, there is a group of Pediatric surgeons who are here to asssit with scheduled elective procedures, primarily hernia repairs and circumcision's. and Monday is the day that one of the Drs' Bitar (identical twins and I can't tell them apart yet) see's patients in their office in the main admin building. So along with terrified, screaming little boys tugging at their moms, there are at least 50 people lined up sort of, at the door of this 1 story, door always open, main building. Several people have large grotesque growths visible on their faces or chests and the smell of gangrene is unmistakable. And they all just quietly sit until attended to.
The main focus of the day for everyone has been Tropical Storm Emily that is churning to the east of us. Projections have it either slamming us or at least nipping at us quite a bit so we are stock piling supplies. If this storm does hit us, the 7 of us who are living here, will move into the hospital and sleep on cots somewhere.
Again I say, just too much fun!
That evening, the 7 of us walked down the street to to a small cafe called 'Joyce's Corner.' The distance is literally one-half block and we passed 7 pancaked buildings and one abandoned, windows blown out, partially crushed car. 6 of the 7 houses have been abandoned and greenery is growing thru the rubble. Amazing.
Then we started with the 'power on, power off' game that lasted until we all returned to the hospital Tuesday morning. City power on, then off, generator on then dead. Roosters awake every hour, barking dog awake at 5am. Kathleen very tired, hot and sweaty.
The drive to and from work consists of 19 turns onto gravel roads with rocks and piles of garbage everywhere. Some garbage piles even have greenery growing out of them. Plus the potholes that could swallow a volkswagen. Men are pushing wheelbarrows with odd pieces of metal. They are dripping sweat and their ribs are visible below their skin. There are small groups of women with straw hats, sweeping dust and rubble off of the street. but most of the time, they are sitting in the shade, their feet and brooms sitting on top of their flip-flops.
Tuesday, we met with Pauline and discussed the new org chart. Never an easy conversation but hopefully it will be OK.
Wednesday morning, Pauline resigned. Hmmm...
It is now Friday morning of my first week of my Caribbean Semester Abroad. As you know, TS Emily did not hit us and as they say here, "thanks God."
Some of the patients I have seen this week: a 17 yr old girl in beginning heart failure probably from Rheumatic Heart Disease. She probably has TB outside of her lungs but we can't get her the right meds so will transfer her to an HIV clinic who will treat her. But she's not HIV+, hopefully they won't care. she is young, hopefully she will make it but she probably needs a heart transplant.
A 14 yr old girl who was in a car accident in the countryside. The parents did not want to bring her to the city for care but her sister's father (not hers) "kidnapped" her and brought her to us. The girl is obviously neurologically damaged and will not survive. The decision has been made to pull out her breathing tube and see how long she will survive breathing on her own.
BUT her father found out that she was here and has threatened to cut off everyone's head if she dies. I just escorted a judge to Peds so he can talk to the doctor's and determine legal custody.
A woman in her 30's brought in with dilated pupils, probably suffering from neuro-syphillis. she died a few hrs later in the ER.
An 11 yr old girl walked in yesterday with her mom with a tumor growing out of the right side of her head, It was the size of a softball. She spent the night in Peds because the neurologist was to see her today. She died this morning.
A 28 yr old man in heart failure from Rheumatic Heart Disease. He needs a transplant but will be put on some medications that will make his breathing more comfortable and give him some quality of life.
A woman,maybe in her 40's, who was brought to the hospital in the back of a police car from the city of Gonaive, north of here. She had broken her leg a week ago and was casted by some clinic. But the family did not know how to care for the cast and now it "smelled" so they brought her to us. We had no room to admit her and suggested that the family/police take her to MSF-France (Doctor's Without Border's) but I guess the family refused. When I returned here he next morning, she was still sitting in the back of the police pick-up. I have no idea where she slept/ate/used the toilet. Later I saw her in a wheelchair.
A lot of tragedy here.

Talk with you soon,