It's All About the Olives - Haiti September 2010

Dear Friends,

As some of you know, this trip to Haiti was spontaneously scheduled one very hot July day. I had just returned from 5 weeks of working as a camp nurse in northern Arizona, had taken a quick 5 day trip to Seattle, it was 110 degrees outside and I wondered, "OK, what's next?" I was restless and hot and trying not to be crabby. On a whim, I called Project Medishare in Miami, the organization that I had traveled with in May, to inquire about openings. There was a nurse opening for the week of August 28-September 4th and I said "yes." I was confirmed in 5 minutes and it felt right.

Project Medishare, through the U of Miami Medical School, had been working in Haiti for 17 years, mainly in the outer areas of Port a Prince (PAP). In PAP, they had been working at a very small hospital, Hospital Bernard Mevs, that is located on a muddy side street about 20 minutes from the airport. With the impending hurricane season, declining patient census and need for such a large facility in the tents, Medishare broke down the tents and moved a very scaled down operation into the Bernard Mevs facility. Most of the Haitian employees followed the move.

Hospital Bernard Mevs is owned and operated by 48 yr old identical twin brother's, Jerry and Marlon Bitar. They are Lebanese descent, born and raised in Haiti. They are both general surgeons who trained in France, returning to Haiti in 2000 to establish their practices. English is their second language but they are fairly fluent. They speak to each other in French, I suspect occasionally squabbling like all siblings do; they are quite funny.

Unlike 'the tents' which were American run within Haitian constraints, the Hospital is Haitian run and we are there to supply extra help and to assist in educating the staff. Previous to the earthquake, the hospital was just a small, general hospital. When Medishare joined the Bitar brother's, and moved in their machines and the capacity to give critical care services to babies, children and adults, the hospital became the only critical care hospital in all of Haiti. General Hospital, the main hospital in PAP that was able to give some degree of "complicated" care, was severely damaged in the earthquake. Walls are missing and beds can be seen from the street. The Bernard Mevs Hospital building only sustained minimal minor damage, so remained opened when most other hospitals were damaged or destroyed necessitating their closing. Never underestimate the power of rebar to keep a building standing!

The Bitar brother's performed greater than 900 surgeries after the earthquake, setting up the Recovery Room and general wards, in small tents in the hospital courtyard because everyone was too afraid to be inside the buildings. They have been interviewed on CNN by Dr. Sanjay Gupta. The brother's dream is that within the next 18 months, the Medishare volunteers will be able to teach the Haitian staff how to care for critically ill patients and for the Haitian staff to be able to totally assume this care and operate the hospital.

I spent the next 5 weeks e-mailing PJ, the head Pharmacist at the hospital, inquiring about needed hospital supplies, etc. Each volunteer is allowed 2 50lb suitcases and 2 carry-ons. I decided that all of my clothes and personal articles would fit into the carry-ons and I would use the large suitcases for supplies. PJ gave me a list of needed supplies: sheets because there are no sheets on the patient beds unless the family can bring some in; chocolate covered Pop Tarts; wire hangers, Parmesan Cheese and olives for martini's, preferably with garlic in the center! Olives for martini's? I thought that Haiti was really struggling? I assume that you are reading these words with the same quizzical look on your face as I did when I read them.

The hangers and Parmesan Cheese are used for barter and as a Thank You to one of the local families who helps PJ. They have spaghetti every morning for breakfast but Parmesan Cheese is not available in Haiti. I brought 6 small bottles with me. You get more 'bang for your buck' if you have small bottles vs large bottles. Greater barter potential. The Pop Tarts are for some of the long term staff and volunteers that are sick of rolls and peanut butter for breakfast. I can only find Organic Pop Tarts which seems like an oxymoron to me but what the heck! They are heavy by the way. Must be all that nutrition!

And the olives. All of the medicine that Medishare uses comes from donations in the States but there is no consistency in the donations. During August, PJ was out of Vancomycin, a potent IV antibiotic, which was needed to treat some brain abscesses. The doctors would attempt to treat the man with other medications but Vanco was the needed drug. Twice PJ had lent the medication to Sean Penn's organization, J/P HRO, but she had to "borrow" it back. And as a last resort, she had walked out onto the streets to barter for some Vanco. She had one small bottle of olives left and was able to barter for a few vials of Vanco. Could I bring more olives? My life became "all about the olives."

For those of you who haven't had the need to shop for or purchase, olives, with garlic, an education: Not every store sells them and not every store has them with garlic. And when I did find the olives, they were not cheap! Or light! (Thank you Laurel for suggesting Whole Foods, my 6th store!)

And, then there is the packing so as to prevent breakage. I couldn't put them in my carry-ons because they are greater than 3oz (thank you TSA) so they had to go in the center of my 50lb bags. Have you ever watched what happens to our luggage? Other than Southwest Airlines, which lovingly cradles our bags, according to their commercials, our bags are tossed about like ping-pong balls! Soooo, each little precious bottle of olives was wrapped with bubble wrap, taped, put into the center of my rubber boots, which were padded top and bottom with pillow cases and the pillow cases taped in place. The boots were positioned between sheets with padding so the boots did not bump into each other. I also had concerns that if any of the jars popped open, my luggage would be full of olive juice. And there are no laundry facilities at the hospital. As I said, it became "all about the olives."

I also packed about 60lb of sheets and pillowcases, bungee cords, duct tape, sanitary napkins, toothbrushes, pens, etc., anything that could be distributed to the patients and their families. The linen was graciously given to me by so many friends after I sent out an SOS e-mail before I left. The pillowcases will be used specifically to hold and cover the babies.

As much as I had been told by previous teams, that the hospital was very different than the tents and everyone really missed the tents, I was really looking forward to getting off of the airport grounds and into the city to view it for myself. I had not had the chance in May and wondered what it really looked like.

Friday August 27th

I only slept about 6 hours the night before because I was so excited about returning to Haiti. If I didn't breathe or look at them wrong, each of my large bags weighed 49lb's. I was hoping that they would look and feel "slim" at the airport and not cost anymore than the $25 dollar fee. They "squeaked by" but my 2 carry-on's were too big so they were checked also. But for free! I know that some people have feelings about people who carry on their carry-on's, fully knowing that their bags are too big to be carried and will be checked for free, but this was not my intention. I really thought that they would fit SOMEWHERE near my seat. Oh well.

I flew to Miami via Dallas on American Airlines. During the flight, I met a young woman, Marie from Jamaica, who had just completed an 8 week summer job, working as a receptionist at a hotel near Lake Powell in northern Arizona. This was her first time traveling out of Jamaica and she was anxious to return home to complete her studies as a teacher to "give back to my people." She was hungry so I bought her lunch and introduced her to coconut flavored M&M's. What a delightful young woman!

I stayed at the Miami International Hotel, located in the International Terminal. What a genius idea to locate a hotel for people schlepping in and out of Immigration after an international flight! Had a snack of conch (fish) soup and a cold beer and repaired to bed.

Saturday August 28th

Up at 3am after 4+ hours of sleep, to be at the Gate by 4am to check in and meet the team. There were about 30 of us, mostly doctors and nurses with a few Occupational and Physical Therapists. Three of the MD's and one of the nurses, were Haitian-American and were returning for the first time since the earthquake. One of the MD's had not been back in 40yrs! All 4 of them spent the week processing and emotionally dealing with what had happened to their home. Most of the time they just looked very sad.

Besides the 30 of us, the 757 American Airlines jet was filled with Haitians or Haitian-Americans, many of them returning from shopping trips based on their carry-on's of new bedding, microwaves, cookware, etc. These are obviously the people with money who have the freedom to come and go. I was told that anyone with money left after the earthquake and only the "poor" people were left in PAP.

I sat next to a man who had just completed a month's visit in Boston, to see his wife and newborn twins, Valentine and Valentina. After the earthquake, the wife was able to somehow get a visa and move to Boston to stay with a relative but the husband has only a 30 day visa and must return. All of his family survived the earthquake but lost all of their possessions, including their home. He presently lives in a tent. I will hear so many similar stories this next week.

90 minute flight to PAP, arriving at 8:30am. From the air, the island looks green and lush and the Caribbean Sea a deep blue. But then as we made our final approach to land, we flew over the harbor and all I could see were the tents: from the waters edge, into the city, up the hills. Miles and miles of tents. Approximately 1-1.5 million people are living in the tents, 1/3rd of PAP's population. More about the tents later.

I could also see the airport grounds where the original Medishare/Field Hospital/MASH Unit hospital tents had been, and where I had worked and lived in May, and were now just large patches of grass and rubble. About 20,000 people were treated there, many lives saved and so many lives lost there, so many tears and so much laughter just to maintain sanity and now, Poof! gone. Hopefully, it will never be needed again. I guess all is impermanence.

Walked down the plane stairs to the waiting trams and taken to Immigration and Baggage Claim. My God it is hot and humid! The Immigration people and all of the Haitian people for that matter, are expressionless, just stamping the passports and motioning us on. The area looks a 'bit' better than in May. There are baggage handlers who will retrieve our luggage off of the one moving carousel if we pay them $2 US. But first we must get a cart which involves a few more US dollars to the woman who gives us the slip to walk about 2 ft to give to the guy who gives us the cart. Are these people just tired, hot or 'just over us?' They are barely civil to us let alone cordial. After 7 months, we come and go and they stay; I guess I'd be 'over us' too. They need us but hate that they need us.

Several of the volunteer's have never been out of the US so this whole experience is pretty disconcerting to them. Fortunately, there are Medishare folks about to shepherd us thru the chaos of walking out the door into the blinding sun and constant yelling by the men on the street. Being warned about asking any of the street men for help, we all push/pull/carry our 2 50lb bags and 2 carry-on's to a waiting truck where they are unceremoniously THROWN into and on top of each other. MY OLIVES!!!!!!!!!!!!

Walk to a parking lot and find the vans to transport us. Picture 30 people, mostly pale, white skinned Americans, in scrubs, bopping along like little ducklings, trying to look like we are not afraid of the large groups of men standing all about, ogling us. Especially the young, tall blond nurse's in our group. Good thing that I am short, I just walked in the middle of everyone!

This place looks just like Africa! Historically, everyone is from Africa but this truly still is Africa. I wasn't expecting this. And all along the roads, on any previously open parcel of flat land, are the tents. Miles and miles of tents. No distance between them, hardly any air between them. Clothes lines with laundry. Red Cross port-a-potties. UN Peace keeping Troops driving around in the chaotic traffic. What a mess.

And the traffic. I am told that the traffic was terrible pre-earthquake but since then, it is almost non-navigate-able. Pancaked buildings seeping onto the streets; piles, hills really, of rocks and rubble. Small columns of cinder block bricks being built on top of rubble or on top of partially damaged buildings. Everywhere. The cars and tap-tap's just drive around the piles and huge potholes, frequently hitting each other and anything else in their paths. If not for the people going about the activities of daily living: waiting for a tap-tap (small bus), buying food at the market, etc, the earthquake could have occurred last week.

There is no evidence of earth moving equipment and no visible place to put the rubble. The last statistic that I read is that 2-3% of the rubble has been removed and it will take 3-5 years to remove all of the rubble. I believe it. People look hot and are moving slowly. They look exhausted. God, what a terrible place.

Arrived at the hospital which is located on a side street, about 20-30 minutes from the airport. This street, as with most streets, is narrow, gravel covered with potholes. There has been minimal rain but the street is muddy and many of the potholes are filled with water. There are no sidewalks so people walk thru the muddy streets dodging moving vehicles and other people. Both sides of the street have vendors selling food, clothes, pharmaceuticals, cell phones, shoe repair services. The air is hot and smells like Lesotho with its constantly burning garbage fires.

We are deposited into the courtyard, are luggage following in the truck and AGAIN unceremoniously thrown onto the hot cement in the courtyard. I am continuing to mourn my olives and possibly melting Pop Tarts but cannot check on them yet.

We are introduced to the hospital staff, each other, and then given a tour. Highlights of the hospital tour: 1. If you hear gunfire, stay inside. 2. Dominoes Pizza does deliver but will not if there is any danger of Fire, Flood or Kidnapping. Alrighty then.

The hospital is behind a large, orange colored metal gate, now bearing the sign of Project Medishare/University of Miami. The hospital compound is a series of one story, dirty, lime green, very small buildings with a centralized courtyard. If it sounds pretty, its not.

There is a small building that is the pediatric building, an L-shaped house really, which can comfortably hold about 18 patients including incubators and cribs. Presently, there are 35 babies and children, several of the babies are 2-3 in a crib. This does not include at least 30 parents who also sleep next to their children, either on their cots, leaning against their cribs or under the cots and cribs. If they cannot fit in any of these spaces, the parents, mostly women, sleep on cardboard, on the concrete outside the door.

In a separate building there is a ramp leading up to a 4 bed ICU in a room with boarded up windows, connected to a 2 bed ER which is connected to a 10-12 bed Medical/Surgical step down unit. The ICU families sleep on cardboard on the ramp. The step down patient's families sleep on the floor under their loved ones beds/gurneys.

The 2 room Operating Room suites and 4 bed Recovery Room areas are adjacent to the ICU. This is the only area that has running water in the entire hospital; of course, there needs to be water in order for it to run, which occurs about half of the time.

A separate building has a general 12 bed Medical-Surgical unit, mostly caring for spinal cord injuries from the earthquake. There are 4 young men who are quadriplegic and have been abandoned by their families; it is assumed that they will live there for the rest of their lives. Connected to this unit is the Radiology Dept. which has portable X-Ray and Ultrasound machines, both of which are presently broken. And then the lab which is able to do some VERY BASIC lab tests when you can wake up the lab tech. More on that later.

Behind the ER/ICU are 5 sleep rooms for the volunteers, 3 of which have their own bathrooms/showers. See above reference to running water. Outside of our sleep rooms, are 15 port-a-potties for the patients' families and for all of the nurse's to empty patient's bedpans, reusable suction containers, etc. into. Yes, it is nasty. There is also a small area with occasional running water, for the families to wash themselves up and to bring large bowls of water into the hospital, to wash up their loved ones. The morgue is also right there as are a few very small living areas for long term volunteers.

A separate small building has some offices and a "cafeteria" which does not serve food but does function as a 'de facto' break room. This area is usually air-conditioned but when it is not, mosquito netting wrapped around ones body like a sarong, is needed for comfort.

There are armed guards at the gate, carrying what I assume are AK 47's. If someone approaches the gate, the guard questions them and lets them in if the request is legitimate. If not, the person is turned away. We are the only hospital in the area and the "American " hospital so many people approach the gate. If the request is not due to trauma, imminent delivery of a baby or another urgent care matter, the person is turned away. The hospital does run a daily walk-in clinic of sorts, seeing about 150 patients/day, mostly headaches and gastric complaints starting with the earthquake. And those with HIV/AIDS which are approximately 2-20% (depends on who you ask) of the population.

After the tour, we all find our names on the sleep rooms, collect our luggage which has been watched over by an armed guard, meet our roommates, find our assigned units, meet the outgoing staff's and assume patient care. This all occurs in a 2 hour span; pretty amazing, I say.

But first, THE OLIVES!!! I am happy to report, all of them arrived safely intact! The Pop Tarts were OK and not too mushy. PJ was dancing in the courtyard!!!!

There are 7 of us in my sleep room: Jeff, a Nurse Anesthetist from Miami who would leave mid-week, upset that he was not doing "real" earthquake work and was not being treated "appropriately;" Micaela, an RN who was in charge of all of the clinical nursing functioning when we were in the tents. She is only 28, now pursuing her PhD from the U of Washington and smart for days. She is assigned to the ER and is what I want to be when I grow up! Carol, an RN, from Sewanee, Georgia. She is an OB nurse but because there is no real Maternity section in the hospital, she will be working in Peds. During the next week, Carol will personally deliver four women who come to the hospital gate. Noelani, an Occupational Therapist from the Big Island of Hawaii who has lived on the northern Arizona Navajo Reservation for the past 7 years, even building her own hogan. Knowing my love for Hawaii, you can imagine how thrilled I was to meet her!

Jenn, a Physical Therapist, 6 ft tall, from San Diego, married to an European League basketball player from Bosnia. During the next week, she will organize a soccer team composed of all of the patients with amputees, the first of its kind in Haiti. And Jane, an RN from Louisville, Kentucky. In her early 60's and the matriarch of 9 siblings, she was openly defying all of her families wishes by doing this trip. Talked in her sleep a lot, including long conversations with me of which she had no memory. Very funny!

I will be working the 12 hour night shift in the ICU, 7p-7a, with Venice. She is the Haitian-American nurse who is one of the staff returning for the first time. She also speaks Creole which will be a god-send for everyone. There are always translators around but this will be much easier. The 12 hour day shift positions will be worked by 2 nurse's, Kelli and Lauren, both of whom have only been out of school for 15 months. Yikes! I don't know that I could have done this with so little experience. They will struggle during the next week.

The four of us receive report on the only ICU patient that we presently have, Kelli and Lauren start work, the old team leaves and Venice and I go back to our rooms to try to get some sleep for a few hours. Which of course, I cannot do. I am waaay too excited and there is too much to see and do!

Venice and I report to the ICU at 7pm. We receive report on Bed 1, Jeumme, a 22yr old man who was hit by a car 10 days ago. There was head trauma and he is the person who has needed the Vanco that I spoke about previously. He is on a ventilator but is responding and somewhat awake. The doctor's know that there has been some brain damage but cannot yet determine how much. Venice will assume his care because she will be working with the Haitian nurse assigned to him.

One of our tasks for the week, is to work with the Haitian nurse's who are assigned to the ICU, assessing their competencies and continuing to teach them ICU nursing care, that has presumably been done by all of the previous teams. We were also told that hospitals in Haiti don't have a night shift as we know it. The nurse's would leave out any needed medications for the night and LEAVE or DISAPPEAR SOMEWHERE AND SLEEP! We were told that ALL of the Haitian staff will attempt to sleep at night and to go find them after an hour or so!!!!! And this is how it was our first night, and every night, for that matter. The American staff was just stunned! How do we mentor and teach when the staff is gone for half of the 8 hours? There is no apparent urgency on their parts when the ventilator alarms go off or a patient yells in pain. How are we supposed to do this and how are the nurse's ever going to be able to assume care? The patient's will die! Even with Venice's ability to speak Creole, our nurse still slept for 3 hours in a chair in the ICU. This will never work.

With only 1 patient, I was pretty bored. I missed the tents with the energy, the trauma's, everything. I knew that this trip would be different but... Only a few people came into the ER during the night. A man who was robbed and hit over the head with the butt of a rifle. Lots of blood everywhere but thankfully, no internal injuries. The rest of the night, the Haitian and American staffs' slept. Hmmm...

Sunday, August 29th

Slept 6 wonderful hours courtesy of eye patches, ear plugs, my sleeping bag under the a/c and pharmaceuticals. Noelani and I have started to share a cot. My cot is right next to the bathroom door which means I get bumped every time someone uses it and hear everything that occurs. Noelani sleeps against the wall across the room and forgot her sleeping bag. So, she works days and uses the bag, I work nights and use the bag. And my original cot becomes a catch-all area. Heaven! This also means that we receive 2 extra meals a day because the nice Haitian man who delivers our twice a day styrofoam meals is confused about who is living where. Sorry.

The meals are OK. We receive a cold meal about 11am; usually a sandwich or egg salad. And at 3pm we receive a hot meal of meat, a starch and a salad of some kind. Today's meal is potato and cabbage spicy soup which Venice says in a Haitian delicacy that her mom will only make at New Year's. It is wonderful!

The meat is either brown or chicken. The brown mystery meat could be: beef, lamb, goat, or pig. It is small chewy pieces, doesn’t smell bad and tastes OK. So I guess it's OK. The chicken is really small but edible.

The extra meals are not for us. Jane is working in the unit with the 4 quadriplegic men who have been abandoned by their families, plus one man who fell out of a tree and one who was hit by a flying fence. The families of these men have no extra money to buy additional meals so all of these men have no food except the once daily hospital provided meal. Jane takes the extra meals, combines them and feeds the SIX men at night. They are thrilled! But what happens when she leaves?

Just after waking up and surveying the meal delicacies, PJ comes in and asks if I would like to take a trip to JP/HRO, Sean Penn's tent city. Yes! Still wearing the scrub top and shorts I have worked in(no sense in changing), I brush my teeth and jump into the van with PJ. She is going to the tent city to talk with the pharmacist about "sharing" drugs.

JP/HRO is on the grounds of the most expensive country club in PAP. After the earthquake, Sean Penn approached the club's owner, a man from the States, and asked if he could take over his 9 hole golf course country club for the tents. The land would have been taken over by the government anyway, for people needing shelter, as was all non-occupied land, so why not give it to Sean Penn? The owner agreed and JP (the last name initials of the co-creators last names),HRO (Haiti Relief Organization) was created.

The Country Club is a 30 minute ride up through PAP and up hills to a beautiful view of downtown PAP, the harbor and the Caribbean. Wow! Driving through the streets, I sees more pancaked buildings, rubble in the street and people walking everywhere. Slowly. There is some building occurring and some clean-up is apparent but no earth moving equipment or any building equipment is seen.

Sean Penn is in the States right now so we met Beth, the nurse who is running the clinic for the tents. 55,000 people live in tents on the 9 hole course. There is a mayor, some form of government, schools (1 built and operated by Israel Aid) and the least amount of violence and violence towards women than any of the other tent cities. Security is provided by UN Peace Keeping Troops, mainly from Brazil and Bangladesh.

Beth gives us a tour, culminating in the clinic that overlooks the tents down the hill. Two Peace Keepers are sitting on a bench, eating their lunches, looking out to the Caribbean. They look like boys but when I ask to take their pictures, they stand up and very seriously grasp their REALLY BIG GUNS and stare at the camera. At ease, they had beautiful boyish smiles.

The clinic sees 1500 patients/week. Up to four days ago, there had been four Haitian doctor's working in the clinic. But two of the doctor's gave medications that caused two babies to die so they were fired; and the other two left because they "couldn't stand it anymore." So Beth and her staff are continuing on until a couple of doctor's start this week.

Do you remember watching MASH when they would show Battalion Aid? This clinic is Battalion Aid and our hospital is the MASH unit. The clinic is a very large open tent with several litters (cots without legs) on top of large containers. Everything is dark green so I am wondering if some army donated all of the supplies.

The x-ray tent is next door and it currently has the only functioning x-ray machine in Haiti, that can be used for non-paying patients. But the very expensive machine dosen't move! So, when taking an x-ray, four people hold the edges of the litter and move the litter for each picture. It works!

Our visit has become a transport visit. There is a 6 year old little girl who is having severe abdominal pain; the x-ray is not showing any abnormality so our hospital has agreed to assess the little girl. And because there is a nurse who can transport, (ME????) we leave with the little girl in her parent's laps and return to Bernard Mevs.

Kudo's to the driver who tried to avoid most of the large potholes to prevent more pain to the little girl. Return to the hospital, give report on the little girl to the ER staff and head to take a shower. The little girl will be admitted for observation.

7pm-We still have only one ICU patient, Jeumme, who has been there for 11 days. His brother Michel, visits off and on during both shifts, living and sleeping the rest of the time on pieces of cardboard outside the ICU. Michel speaks English Fluently and is ALWAYS wearing a clean, folded with creases, white t-shirt. I so want to ask him how he manages this but it does not seem appropriate.

With only Jeumme as our patient, I have very little to do, so I wander over to Pediatrics to help feed the babies. There are 39 babies/infants/kids and two nurses and they need help. I used to work in the Nursery and I am excited to go back.

With 39 babies, there are parents everywhere! One mother is sleeping under the crib, holding her baby. For several nights, the nurse's have attempted to get the baby into the crib so they can administer an IV medication but the mother refuses. So the nurse just crawls under the crib and administers the med.

I got to feed 3 babies and it was so much fun! I first fed Baby Richardson who is in an incubator due to prematurity and possible neurological issues. The incubator portholes, that are usually covered with some type of plastic, enabling an adult's arms to go thru them, are covered with cardboard so I have to put down the entire incubator door and hope that he stays warm. I cannot imagine that anyone ever gets cold here but that may just be me.

Baby is sooooooo cute with a thick head of tight black curls. As I am feeding him, Carol, one of the Peds nurse's, tells me to beware of something possibly running over my feet. They have seen a mouse running about, "so don't be afraid." I name him Henry but I never see him.

Next is Johnny, in a very small crib. He is also a preemie but his head is "shaped a bit oddly" so I am assuming there is some issue going on. I get to hold him in a blanket while I feed him. And Henri, a preemie who is under Bili-lights to reduce his jaundice. This Bili-lite is really a small suitcase that can be set on any surface. Open the suitcase, put the baby in, plug in the suitcase, and there is light! I am told that this type of light is used in many Third World countries. Genius!

As I am finishing feeding the babies, Carol asks me to stay because Bethany, the other nurse, is going to transport a baby to the General Hospital. While I have been in Peds, a baby was brought into the ER having a presumed asthma attack or something similar. ER gave the baby a breathing treatment which helped but he baby needs to be on continuous oxygen for the next day or so. At 39 babies, we cannot admit anymore so it is decided that the baby will be transported to General Hospital in central PAP. This is the hospital that I mentioned above, that was severely damaged and has beds visible from the street. There is no ambulance available so Bethany with the baby's parents, ride in a pick-up truck driven by one of the Medishare guys. Even though a pick-up truck is considered "too dangerous to be driven at night" there is no other vehicle available so they rode in the truck. She returned an hour later saying, "Don't ever make me go back there." When Bethany arrived at the hospital, she and the family were directed to the Peds unit. When they all walked in with the baby, the one and only nurse, for 40 babies, simply said, "There's no room." Bethany left the parents sitting on an outdoor bench, holding their baby.

Against all reason and advice, Bethany rode in the back of the pick-up on the return ride to the hospital "for some air." "I know that it is scary out there and I saw lots of shadows moving around, but I didn't care."

As I returned to ICU, I saw Michel speaking with an older woman who was sitting against the wall. I smile and Michel motions me over and introduces me to his mother. She has sat there for 11 days and has only seen her son once! She cannot bear to see him as he is. I am stunned and a bit angry at the medical teams. Has no one asked about the mom? Has no one seen her outside?

I tell her that Jeumme is awake and moving around in the bed and that he looks OK. I hold out my hand and she gradually gets up and walks with me into the ICU. I ask her thru Michel, to please not collapse at the bedside. There is very little room between the bed and the wall and there is no neurosurgeon available if she hits her head. Jeumme recognizes his mom and she cries as she holds his hand. She mumbles things to him in Creole, then starts to wail and Michel leads her outside. I hope that I have done the right thing by bringing her in. I later see her sitting against the wall, arms raised, wailing and praying.

I spend the rest of the night tidying up the ICU and assisting some of the translators in covering up the one and only ICU window, with black garbage bags. Everything that we say or do can be heard from the courtyard and there is no way to prevent it. But at least the garbage bags prevent faces in the window.

At 6am, Jeumme starts to have some real respiratory issues, despite being on a ventilator. When someone has these issues, they usually require suctioning from their breathing tube but his machine is not working well. Neither is the second machine that we find. And the third machine is working only a bit better. How in the world are we supposed to take care of someone when we don't even have the basic supplies. THIS IS CRAZY AND WRONG!

We stablize Jeumme and I ask Day Shift to get the suction machines repaired. I am tired and I'm going to bed.

Monday August 30th

I slept eight hours and felt much less angry at the world. I also started to hand out some of the supplies that I brought with me which always cheers me up.

7pm-There are now 4 patients in the ICU. Bed #1-Jeumme, is about the same but not nearly as awake as last night. And the 3 suction machines are still sitting between the beds. Not touched, not repaired.

Bed #2- Soledad. She is 19 yrs old and has been sick since February with various systemic infections. Her care seems to have been hit-or-miss and she is now laying in bed, head arched backwards, intermittently screaming in agony. Her skin is sloughing off from a drug reaction.

Bed #3-Jeannel-27 yr old man who sustained 2 gun shot wounds: one in the right arm and the second in the right abdomen, scraping his buttock. He had surgery today to repair his right arm which now has large iron pins protruding from his arm. He is very uncomfortable.

Bed #4-Leger. 68 yr old man who fell off a ladder and hit his head, 24 hrs ago. He has no feeling below his waist and is starting to tire and not breath well. Both the CT scanner and the main x-ray machine are broken so there is no way to determine if he has had a neck fracture. I am caring for bed's 3&4, Venice has bed's 1&2.

At 2:00am, Jeannel starts to complain of increasing abdominal pain. This pain is different than the general discomfort that he has been experiencing and no amount of pain medicine that I am giving him, is helping the pain. His is becoming disoriented and his vital signs are becoming unstable. Something is not right and I am concerned.

I woke up Negar, our Chief Medical Officer who wanted to x-ray his abdomen. But there are no x-ray capabilities. I drew some blood for lab tests but had to bang on the Lab door for 10 minutes to wake up the Tech. Negar decides to call Dr. Eddy, the surgeon on call, to ask him to see Jeannel. But first, we must find the security guy who has the phone to call Dr. Eddy. Then get the phone to Negar to talk with Dr. Eddy. Dr. Eddy agrees to come in and a driver is sent to get him.

But the driver got lost and for three hours Jeannel's pain increased until the driver could get the doctor to the hospital at 5:15am. It was terrible and I was afraid that Jeannel was going to die. Several family members were at his bedside and were beside themselves with frustration and worry. Jeannel was in the Operating Room by 5:20am and would be there for 8 hours.

At the same time, Leger was put on a breathing machine because he became too tired to breath on his own. Despite the breathing tube, Leger remained alert, nodding his head appropriately to questions asked in Creole. Which made the on-going discussion about future x-rays, even more difficult. 68 is considered "old" in Haiti, usual life span is 55, and financial resources are scarce. Should limited money be spent on an old person who is already a paraplegic and has no chance for any rehabilitation because it dosen't exist? But he is awake and following commands so maybe it would be worthwhile to spend the money to assess if there are any fractures that could influence him eventually going home.

3am-I hear the roosters as I walk outside to empty urine containers. The air is warm and moist.

5am-The flies appear. This happens every morning and will continue until sunrise. Flies, houseflies, "just appear" and are all over the patients. I wish that I had brought my fly swatter.

After Jeannel went to surgery, Leger's niece came in and we washed him up together. When she thought that I wasn't looking, she would take the already used disposable wipes and clean herself.

This discussion about Leger will continue on Day Shift. If the decision is made to do the x-rays, Leger will need to be transported in an ambulance, to one of the PAP Radiology places. Micaela and I volunteer to go on the transport if needed.

After report to Day Shift, I decide to venture outside with Noelani and two of the translators, to get some breakfast. The streets are dusty and muddy. There are vendors in cars and trucks many stopping to set up their stalls and yell at people to stop by. There is an altercation at the hospital gate between 2 men about a motorcycle. We get our rolls with peanut butter and banana's and return to the hospital.

Tuesday August 31st

Slept 5 hours when I am again woken up by PJ, asking if I would like to go to Heartline Ministries. This is an organization that has housed women and children since the earthquake; and has employed women to make purses and other products to be sold. This gives the women some skills and some money to be able to eventually live on their own. Besides sheets that I have brought for the patient beds, I have brought sheets with patterns to be donated to these women. PJ wants me to bring the sheets and personally donate them to the women. Yes!

But by the time the driver arrived, we drove thru traffic, etc. the women had already closed up shop but I was still able to donate the sheets to the couple that run the organization. I also had a chance to meet some of the women, their children and a few very large, mangy dogs. This is a beautiful place that sustained minimal damage. This trip was also an opportunity to drive thru an area that seemed to be barely damaged by the earthquake. There were mainly large, single family homes that were probably privately and appropriately built. What disparity in this country!

Driving back to the hospital, I was able to film about 90 seconds of one of the tent cities and will post it on my blog.

6pm-Arrived back at the hospital to see white smoke pouring from the generator and everyone standing outside, including all of the Medishare "higher-ups." The white smoke did not mean that there was a new Pope, the generator had died! Which meant that there was NO power in any of the hospital. And there is NO emergency generator. Uh-oh.

I ran in and took a shower, planning on going into work early because No power means that the nurse's are manually breathing for the ventilator patients. Then the water stopped.................. Oh, this is going to be a fun night

Walked into a dark ICU at 6:30pm. The only light is coming from flashlights and headlamps. On the list of needed supplies for this trip, is a headlamp. The Bosh-Smith Family had very kindly given me a new head lamp for this trip which I had worm ONCE before I lent it to Dr. Eddy so he could see to operate on Jeannel. So now I ask about my headlamp and nobody seems to knows about it. I am not happy.

No electricity means no a/c and it is Hot. All four patients have relatives standing next to them, fanning them with cardboard. A barely audible symphony of movement. The sweat is saturating our clothes and rolling off our faces.

At 7pm, a patient is brought into the ER who goes into cardiac arrest. No one can see anything until a car is pulled up the ramp and the headlights are shown in. They are really being shown onto the 10 patients in their beds next to the ER but close enough. The patient dies and is quickly taken to the morgue while it is still daylight.

Over the next several hours, favors will be called in and an emergency generator will be borrowed for the hospital. By midnight, we will have large lights outside of our doors, enabling us to at least see our hands in front of us. It is cooler with some fans but very noisy. The ventilators have back-up emergency batteries that last 30 minutes so every 30 minutes they are switched out and recharged. In between times, we bag/breath for the patients. Everyone is very hot and sweaty but still laughing!

While all of this is happening, Jeannel is starting to vomit bile. When he went to surgery at 5:20am this morning, Dr. Eddy found 3 pints of blood in his abdomen from a liver laceration. Apparently the bullet "did not just graze the abdomen." A major abdominal surgery (Billroth II) was done. And now he was vomiting bile which is not good. His vomiting became projectile and as I stood holding the basin for him, his aunt stood next to me humming 'Amazing Grace.' All Jeannel could say was, “Mis a me.“ I am spelling it phonetically but it means, “Oh my God.“ Dr. Eddy was called back in.

At the same time, a man was brought into the ED who had been stabbed in the neck. There was blood everywhere. It looked like a massacre! Fortunately, no major damage was done. A miracle.

Dr. Eddy arrived at midnight and determined that Jeannel will not need surgery. We manipulated some tubes and Jeannel felt better. I hope this doctor knows what he is doing. I ask him about my headlamp and he smiles sheepishly, "I have no idea." It's midnight, I'm hot and sweaty and this man is speaking to me in beautifully French-accented English and all I can say is, "If you find it, keep it." "Merci" he smiles. There are no headlamps available in Haiti, other than the ones that are worn by the volunteers, so I am assuming that Dr. Eddy has never had a lamp; this is my contribution to to the Haiti Medical Society.

2:30am, Leger goes into cardiac arrest. With distant ambient lighting, we resuscitate him. I wake up his niece who has been living sleeping next to the trash can to give her this news. She will lean over his bed the rest of the night.

4:30am, a woman comes into the ED with a huge abdominal mass. She will need surgery asap.

5:45am, a woman comes to the hospital gate, in a Tap-Tap, about to deliver a baby. The Tap-Tap pulls up the ramp as people scatter with their cardboard pieces; the woman is put onto a board and carried into the ER. Carol comes running over from Peds and at 6am a beautiful baby girl is born! Everyone clapped, including all 10 of the patients and their 10 family members who have barely slept all night. AND THEN the guard calls in that there are two more women at the gate, about to deliver. Go Carol! Go Carol!

Venice has managed to sedate Soledad in Bed 2. I find her mother asleep, slumped in a wheelchair outside and bring her inside to an empty cot. Leger's blood pressure has fallen but he remains awake and following commands. The discussion will continue about having x-rays done.

I return to my room at 7:30am and there is no water. I take off my socks because I can't stand the smell and fall asleep in my dirty, sweaty scrubs. Carol is still delivering babies.

Wednesday September 1st

Slept 3 hours and was awakened by Lauren to tell me and Micaela that Leger is being transported NOW. OK. Brush my teeth, put on clean socks and head back to the ICU just in time to jump into the back of the ambulance that has been borrowed from JP/HRO. As I said in my Facebook posting, this was the ultimate E ticket ride! With lights and sirens, Micaela, Jessie, an x-ray tech and myself, flew threw the streets of PAP. I would bag, Jessie would hold the cardiac monitor and Micaela would give IV medicine every time Leger's blood pressure fell which was every 10 minutes or so.

Breathing for a patient usually involves both hands but one hand was needed for the death grip on the handle! Sometimes I had to let go of the handle to preserve the breathing tube and Leger would just look up at me. I would say, "Bonjour, it's OK" and he would look back at me as if to say, "who are you kidding lady?" He never looked frightened, amused really. We flew over and around piles of rubble, intersections, cars, you name it! I wonder how people feel when they hear a siren?

If someone has money, medical care is available and attainable here. We drive to a Radiology center that has no visible damage, freshly painted walls, real leather furniture, outlet covers, a receptionist and two x-ray rooms. Amazing! The CT and X-ray are done, fairly appropriately by US standards, and we reverse our 'joyride' thru PAP. At Leger's expense, I had a great time! And he kept smiling.

After returning Leger to his #4 spot, I returned to my room and slept another 4 hours, in the same clothes. Yuck! Up at 5pm to find out that while I was asleep, two people were brought into the ER, suffered cardiac arrests and died. The SWAT team was called to assist our security and subdue a relative of one of the people who died. And all of the doctor's have gone on strike in PAP because they have not been paid in months. We are the only open hospital.

I need a shower!

Since our generator died and we borrowed one, we have been on city power. We use the generator during the day and city power starting at 5pm. Which seems to mean that we also 'enjoy' the rolling 'brown outs' starting at 6pm. Along with the 'brown outs' we also are starting to have 'water outs.' I just shake my soapy head as I stand in the shower and watch the light and water fade away. And come on. And fade away...

On my way to the ICU, I start collecting cardboard boxes for the families who are living outside on the ICU. This has become my evening ritual and I feel a bit like a dumpster diver but that's OK. The families tear up the boxes to create a bed of sorts on the concrete. Thank God there has been very little rain so far.

AND Jeumme's mother has been visiting him several times a day! I am so excited about this! She greets me with a beautiful smile outside the ICU and says "Merci." I have been carrying around a small ladies head scarf that I had brought with me, thinking that I would give it to someone along the way. I pull out the scarf and handed it to her. Yes, we both cried.

Jeumme is no longer responsive and is getting "the look", the look of someone who will not make it. Oh God.

Soledad has been started on new IV medications and is no longer screaming in agony. These are commonly used IV meds in the US and if she had been in the US, she hopefully would have been appropriately diagnosed and not suffered like this. I feel sad and angry at how much she has suffered. Her mother continues to sleep slumped over in a wheelchair if we can't find her a place to sleep. I gave the mother a "girl bag" of toiletries the other night and she periodically comes in, smiles the most beautiful smile at me and says, "Merci." A mother's love.

Jeannel is feeling much better and is getting feisty with me. He is an engineer by profession, so by definition, has money and privilege and is used to having things his way. He's bigger then me but I'm standing so we agree that he will follow my directions and be respectful and nice.

Leger is the same. Unstable blood pressure and unable to breath on his own. The Haitian Nurse's continue to sleep a good portion of the night as do most of the Haitian staff. How do these folks sleep on concrete at an angle or slumped over in chairs? I know that many of these people live in tents and take 2-3 Tap-Tap's to get to work; maybe they are just exhausted from living.

At 1am, a 5 day old baby having a seizure, is brought into the ER from J/P HRO. We have limited Valium and the Pediatrician, who is just starting his second year of residency in New York, does not know what to do. The staff wakes up PJ who finds more Valium and "talks" the resident through the babys' treatment. We have no cribs available but there is no place else to send the baby so he is put in a crib with another baby. As a reminder, there is no running water in this facility except in the OR, so anytime a patient is touched, we use hand sanitizer. It is a credit to the entire staff, that there is no infection break-out.

At 4:30am, the gate guard calls in that a mother is about to deliver at the gate. The doctor and nurse go running out and there are two small boned, emaciated men, pushing a wheelbarrow that is carrying a woman who has just delivered a baby. The baby, still attached to the umbilical cord, is laying between her legs. There is an older woman and a little boy, about 8 yrs old, with them. I was returning from the Pharmacy and walked over to the scene and just stood there silently as did everyone. All the doctor could say was, "this is amazing." The scene was so pure, so humble and so desperate. We helped the woman onto a board and carried her into the ER. Carol came running over from Peds and cut the cord. There were no clothes for the baby so she wrapped him in a blue chux, the blue pad we put under people if they are incontinent of urine or stool. Carol handed the baby to the mom but the mom would not hold the baby or look at it so she handed the baby to the grandmother. According to the grandmother, the mother has "never been quite right in the head," and has AIDS. The grandmother, so emaciated herself, held the baby and smiled and cooed like any grandma. The little boy was skinny and dirty but very polite to all of us. He is illiterate, no money for school, and possibly also has AIDS. I offered him my leftover rice and beans from dinner and he "inhaled" it. So I found more food for him and his grandmother and that was consumed immediately. I later turned around and the little boy had fallen asleep on the dirty tile floor. I ran back to my room, found a new sheet, and put it over him. One of the nurse's had brought some extra baby clothes with her so she dressed the baby boy in the only sleeper that she had left, a fluffy pink one. We gave the family more food and sanitary napkins for the mom and the family slept for a few hours. Then they all left and walked home, wherever it was.

6:20am-Leger attempts to die but we resuscitate him again.

This was a very emotional 12 hours for the entire staff. After giving report to the day shift, I walked outside to see the sun and Jeumme's mother was standing there wearing the scarf that I had given her. She smiled, put her arm around my waist while grabbing me with her other hand, and walked me around to the area where the families wash up. She took me to her son, Michel, who was sleeping against a wall and woke him up so she could talk with me. Thru Michel, she told me that so was happy and "all was good with God." "It's good, it's OK" as she raised her eyes and arms to the sky. She thanked me for caring for her son (even though I hadn't really) and wished God's blessings on me. I obviously could not tell her that her son was dying so I thanked her and walked away, watching her laugh and smile.

I frequently wonder why I do these trips. What's my purpose? Am I really doing anything? Maybe I was here to help Jeumme and his mom to be together at his death. I don't know.

I returned to the ICU to speak with Micaela who was organizing an ethics committee meeting in the next hour, to discuss continuing aggressive treatment on Jeumme. It was obvious that his neurological status was diminishing but without any available testing equipment, there was no way to determine his present and future status. I said to Micaela, "The mom is ready. She has made a 180 degree change and she is ready."

This is Thursday morning, when did that happen?

Thursday September 2nd

Slept 5 hours and as I sat up to go to the bathroom, I found a note on my pillow, telling me that Jeumme had died peacefully about noon. I immediately went over to the ICU to find his mother and brother but they and Jeumme's body had already left.

I returned to my room and Jane was sitting up. She had been woken up 30 minutes earlier with screaming coming from the ICU. When Jeumme died, his mother, brother and uncle were at his bedside. The mother and uncle were OK but Michel went berserk, screaming, attempting to take Jeumme's body. Jeumme's father and two brother's were killed in the earthquake, and a second brother had died two months ago from earthquake related injuries. And now Jeumme. And Michel was the only son left. Security had to take him outside and settle him down.

Not able to sleep, I decide to wander over to the Logistics Office to look for the Director of Nursing. I have some thoughts on nursing education at the hospital and I am wondering if she is open to some feedback. I find Stephanie, the Director and as I am flapping my jaws about nursing issues, she asks me if: 1. I want a job at the hospital and 2. Will I will meet with the Medishare Administrator, Gillian, who is responsible for hospital operations? She is in PAP now but returning to Miami on Friday. I agree to meet Gillian the next day.

6pm ‘brown out’ and ‘water out’ but I have showered at 5:30pm. THEY will not get me!

Bed 1 remains empty. Bed 2-Soledad has been transferred to the Step-Down Unit and her mom is sleeping on the floor next to her. Bed 3-Jeannel is still in pain but doing much better. He will sleep during most of the night. Bed 4-Leger is still there. There are no apparent fractures but he still has no feeling below his waist and is unable to breath on his own. and no one quite knows what to do.

9pm-A 22 yr old man is brought into the ER complaining of severe abdominal pain. He had his appendix removed last week and has not done well since. It will later be determined that the appendectomy was "botched." "Botched?" How does this happen?

We have no more Sharps Containers. Those are the large, red plastic containers that we put all of our needles and syringes into. Even in the tents, we only put the needles into the containers and not the syringes, so as to preserve space. Even with the syringes in the trash, we have no more room so every small plastic container available is holding syringes with needles. Needles are sticking out of everywhere! I had requested containers from Supply but they have only sent cardboard boxes that are not appropriate. That means they don't have any appropriate ones available either. So, I batted my eyelashes at one of the Medishare guys and he took a large Hazardous Waste Container, cut a hole in the top, duct taped down the sides and called it a Sharps Container. Yes!

The ICU was fairly quiet all night but with the Doctor's on strike, ER was hopping with everything: dog bites, stab wounds and other wounds from fights, etc. etc. etc. But no more newborn babies.

Friday, September 3rd

Slept 5 hours, getting up at 1pm to meet Gillian. I am assuming that these are my last moments of sleep until tomorrow night in Miami. Brushed my teeth and wandered over in my 18hr old dirty scrub top, shorts and a sweatshirt, thinking, "I agreed to meet these people to say what exactly? How presumptious of me to agree to meet with 'the suits' and share my thoughts on how to improve their little corner of paradise. Oh well."

I meet with Gillian who is talking faster than I can even think. Then one of the Bitar brother's walks in, then the other, all of them saying, "Oh my God, we knew that there were issues but had no idea that it was this bad. Would you come back and help us teach the nurse's if we can find some money?" Huh? I told them that I would think about it. The Brother's Bitar even kissed me goodbye. I should have showered!

Spent the next 2 hours giving away everything that I had intended to, packed and ate my last styrofoam container of brown mystery meat with brown rice and beans. The previous evenings, the city power grid went into their rolling brown out's at 6pm but today it was 4:30pm. The hospital's begged/borrowed and stolen emergency generator kicked on but only for the patient care units so our sleep rooms very quickly became little sauna's. And then the water went out! "Oh no no no no no no" I say, NOT AT ALL AMUSED! But then poof it was on long enough for night shift to bathe and then, no more. We laughed and joked and said very bad words, but what about the people who endure this everyday, in this hospital, the streets, the tents?

Every other Friday, the long term volunteers have a bar-b-q with real food: normal sized chicken, brown meat that can actually be defined, salads, and drinks. Volunteers from other NGO's come over and the time is used as a TGIF event. One of the men brought his guitar and with several of the translator's in tow, went from unit to unit, singing for the patients and families. The atmosphere was light and there was much laughter from everyone. The families were amazed, smiling, clapping out in the courtyard. This is the video that I posted on Facebook. These are also the times that I am reminded why I love doing this work and how privileged I am to be able to meet and spend time with all of the people that I do. Priceless!

All 4 of the patients are quiet and resting. Solidad's mom, Dorce Antonine, comes in to thank me for the little goodie bag that I had given her and requests to have her picture taken with me. She is so slender, skinny really, with premature gray hair and is wearing the same dress that she has had on for 3 days but her smile is lighting up the room. Solidad is awake and eating and knows her mom. Dorce points to the sky and thanks God and us for caring for her daughter. And then she gives me a hug and walks out of the door. I just shake me head. Solidad will be transfered to another facility tomorrow but her mother leaves her phone number with Venice, asking that I call her before I leave Haiti. I have not done it but I must.

The rest of the shift is spent telling Jeannel that he really is OK and is going to live despite his pain. He says that I am mean because I keep STRONGLY encouraging him to deep breath and cough to prevent pneumonia. I tell him that I have been called worse and I know that he will secretly miss me. And I can see that he secretly smiles at me. Funny guy!

And cleaning up Leger who had not had a bowel movement since his admission 6 days ago. But due to my insistence that he was having increased abdominal pain and really needed to poop, was given medication(Lactulose) and was now POOPING HIS BRAINS OUT! FOR 5 HOURS! What can I say?

There were a few ER admissions for broken bottles over the head, a gentleman having a severe asthma attack and a young woman, 9 mos pregnant but only dilated to 1cm, SCREAMING her head off in pain. Carol again comes running over from Peds and in her best southern drawl, sweetly tells the young lady that she has hours to go, will be OK and to go home. The woman stops screaming, gets off of the gurney and walks out.

And the cutest little baby girl, brought to the ER by her dad, wearing her best pink finery, with a huge abdomen. She had worms. Her dad was given some medication and they went home.

And then there are the men vying for Venice's attention. Venice is tall, slender, quiet, soft spoken, Haitian-American and very alluring to the young Haitian male employees. All week they have been coming in to assist us but it is really Venice that they speak to and just hang around. She truly does nothing to lead them on but they are like little love-sick puppy dogs. So funny! This, their final night, is their last chance to...we don't really know. But they all want time with her which she gives to them in 15 minute increments. I am hysterical as they wander in, she sits with them and lets them talk and then they leave. She just rolls her eyes and tells them that she will not be their Facebook friend or any other kind of friend that could result in an American visa. Nice guys but way out of their league.

At 7am, we give our final report and walk out the door. My friend Kat is arriving today from Seattle so I know that our patients will be in good hands. We take pictures with the ER staff, complimenting each other on what a pleasure it has been to work with each. And it has. These are great people!

Saturday, September 4th:

No opportunity to sleep after giving report to the day shift nurse's. The new volunteer group is landing as we speak so all of us who are leaving must be packed and out of our cots by 8am. I am mostly packed but am avoiding putting my large bag of unspeakably sweaty, dirty laundry into the suitcase so as to not contaminate the suitcase; it's not mine. But first, I get brave and venture out of the hospital gate, all by myself, to buy some breakfast. Two small roles with peanut butter==$1. Probably paid too much but...what is a dollar in the scheme of things? Also walked down a few vendors to an older gentleman who sells bottled Coca-Cola. I had bought one from him the other day, accompanied by two of the translators, who gypped him out of some money during their haggling transaction. I felt really bad about it so walked down and handed him a dollar, smiled and walked away. He looked stunned. I'm sure that he didn't remember me but it was the principle of the whole thing.

The entire time that I was outside of the gate, the hospital guard was watching me, motioning me to return. Even in the light of day, it is not safe for me to be out alone.

I found Jeannels' family, folding up their "beds" of cardboard and sheets and gave them a final report on his night. They discussed whether they should try to transfer him to the Dominican Republic or to the US, "he has a Visa now" for better care. I suggested that he was not stable enough to be moved anywhere and transferring him to the US would involve a private jet with a nurse on board. I know that this family has money but not that much. They understood. I think. I hope.

Back to the sleep room for a shower and change into “real” clothes. The water was on, woohoo, and I must confess, I showered for longer than 2 minutes. Even put on some make-up and earrings! I had been up since 1pm Friday and foolishly laid down for about 1 second before I realized that it was A VERY BAD IDEA. Keep moving Kathleen, you can sleep tonight in Miami.

The new group of 45 people, arrived at 9:30am, clean and fresh but already sweating a little; tired looking and a lot scared looking. At 11:30, I returned to the ICU to assist Kelli and Lauren in giving an orientation to the six new nurse's, two of whom looked stunned. Just stunned. I hope that I didn't scare them.

I returned to Jeannel's family, still living along the fence, to say goodbye. Jeannels' father, Mr. Louis, is in his 70's and has slept every night on a small mat, next to the fence, within earshot of the ICU, in case his son needed him. Mr. Louis took off his hat, put his hand on his heart and said, "Thank you for taking care of my son. May God's blessings be always upon you." I just shook my head and cried. Such gratitude in the middle of such pain.

All 30 of us loaded up into 2 vans, laughing and giggling as many of the patients and families waved to us and yelled "Merci." Some looked very sad or just resigned. What were they thinking? We were leaving and they weren't and probably never would. We were going back to America, their dream. I was crying as we drove out as Jeannel's family and I waved to each other.

20 minute ride to the airport as I sat in the middle of the front seat, my legs positioned over the ?heater under the seat. Oh, to be cold again. Watched cars either trying to hit each other or trying not to hit each other, hard to tell. Chaotic airport scene with uniformed men attempting to help us. I was dragging a suitcase that was literally half my height but I was bound and determined to not let go of it. I became quite adept at saying, "No, no, no." They were not happy with me.

Metal detector, bag weighing, immigration, metal detector, up the stairs, down the stairs, take off the shoes, put on the shoes, walk to the gate, que up for a seat assignment even though I thought that I already had one. Wait in line............ you get the idea.

With still 2 hours before our plane left, about 20 of us found a small cafe and purchased some 'real' food: hot dogs, sandwiches, fries and cold beer. There was a TV on with some MTV type videos, sung in both English and French. And then, one by one, the heads fell to the table, exhausted. I wish that I had taken a picture of all of these heads, mostly night shift folks who had been up for 24 hours, flat on the tables. Pure exhaustion and pretty funny looking! Micaela and I made it to the seats at the gate before our heads went down. I think I slept about 2 minutes(really!) before my row was called. I actually felt a bit refreshed.

We flew on an American Airlines 757, packed with Haitians or Haitian-Americans and the 30 of us. Anybody who can leave this place, does. The remaining folks have no choice but to stay. I sat next to a Haitian-American man who left Haiti several years ago, moved to Miami and started an export business of American donated clothes being sent to Haiti. He was at his PAP home during the earthquake and described to me, the terror of the shaking, and the sounds of crashing brick and screaming people. His home was partially damaged but no one was killed.

"There was no government before the earthquake and most certainly, no government now. They don't even know how many of us live in this country. When the earthquake occurred, the government moved in and took over one of the Drug Lord's house's up in the hills. The Haitian people feel powerless and unable to do anything. Thank you for asking and caring" he said. "Without the Americans, I do not know what would have happened. We would not have survived without God's help and your help."

You are welcome! There are no other words!

90 minute plane ride through a rain storm; sit on the tarmac because of lightening which means no planes can move in or out; finally get a gate and shuffle off to Immigration.

If you have ever spent time in Miami's airport, you know that it is LARGE, REALLY LARGE. We landed at Gate 50 and Immigration was through 4 halls, 3 moving walkways, 2 flights of stairs, and around a couple of surly looking guards to 36 lines of people waiting to go through Passport Control. 18 lines for non-US residents, 18 lines for US citizens or residents. The lines are long and quiet with minimal restlessness. People look tired but are patient, shuffling and reshuffling their travel documents.

All 35 lines appear to be moving in an expedient manner. Most folks seem to get thru in 30 seconds or less except MINE. Either there is a new INS employee at the desk or I am in the line with all of the terrorists! It took 40 minutes to process the 7 people in front of me. And of the 7 people, 5 were pulled out for further questioning. The young Asian man in front of me kept shifting from foot to foot; I am hoping that he was concerned about possibly missing a connecting flight, or he had to go to the bathroom, or he was a terrorist. I am hoping that it was #1 or 2. He was pulled over.

I made it through in 15 seconds; I guess that I don't fit the profile.
Again, down a hall, around the corner, down the escalator, around a corner to baggage claim. Pull my suitcase off of the carousel and take one escalator to the International Hotel that is in the International Terminal. Again I say, what a brilliant idea to put a hotel convenient to international travelers.

It is now 10pm and not daring to lay down because I have now been up for 32+ hours, I find an open restaurant and have a meal of conch fritters(a local fish) and a Bailey's Irish Cream on the rocks. The restaurant is so quiet and clean. One hour later I laid down on my bed and all I could think of was, "Mattresses are flat! I never realized this before."

Sunday September 5th:

12 hours after I laid down, I was awakened by the cleaning lady pounding on the door, asking me in perfect Spanglish, if I was leaving today. I mumbled something and she went away. I slept another hour and woke up feeling like I had been hit by a truck. For 8 days, I had worked 12 hours on, 12 hours off, never once really feeling tired. Now, I could barely move or think.

I also had not had any coffee in 8 days. The only coffee available was Nescafe(bleech!) But even to have that, I would have needed water. And if I had had the water, I would have needed electricity for the microwave to heat the water. And then I would have needed a cup. Life is way too short to hunt and forage for this everyday. So off I went to find a cup of coffee. And thanks to the advertising gods, Starbucks and Dunkin' Donuts were right next to each other. I had one of each, thank you very much.

I flew from Miami to Charlotte, meeting and talking with Naomi, a woman who I had met in the security line. She was born in Suriname, raised in Venezuela, Aruba and Switzerland. She attended boarding school in South Carolina; worked as an EMT and firefighter; and now was employed by a global communications company in Caracas. She speaks 5 languages and was on her way home to Kansas City. We discussed globalization, discrimination, immigration and her struggles of being bi-cultural: dark skinned from South America but not sharing the Black American struggles. We agreed that we had figured out the answers for the worlds' ills, in only 90 minutes, if only someone would listen to us! Great fun!

Five hours later I was home in Phoenix. Be it ever so humble...

Sometime during the night, I woke up to go to the bathroom and I was totally disoriented. I thought that the small floor fan next to the bed, was a suction machine. And why was there light coming from the right side of the room when the port-a-potties were on the left? It was 5 minutes before my disorientation cleared.

Follow Up:

1. Jeannel spent a few more days in the ICU and then was transferred to the Step-Down unit. He was discharged home 3 days latter thanking us for caring for him and pushing him.

2. Leger was unable to breath off of the ventilator so the family decided just to take him home to die. The doctor's pulled out his breathing tube, loaded him into the back of a pick-up truck and he died on his way home. Rest in Peace Leger.

3. I gave away all of the linen, most of my scrubs, and two small suitcases. I returned with a small purse and the 2 large suitcases inside of each other, filled mainly with dirty laundry. When the earthquake occurred, the entire freshmen nursing class at the University, was taking semester exams. Most of the University was demolished including the entire class and several instructors. Additionally, many upper level nursing students and most of all of the medical students were killed. And then there were all of the medical staff's that were injured or killed at work. The nurse's that we worked with were primarily living in tents. Their clothes were clean but tattered. Thru several conversations, many of them agreed, with bright smiles and tears, to take our scrubs. "Don't worry, we can wash them!" They were thrilled!

4. As of October 1, Project Medishare will have no more money to operate the hospital . They are hoping for a grant thru the International Red Cross which apparently has millions of donated money that has not been distributed as yet. No reason given. If the hospital closes, the people will die from lack of care. Partners in Health did break ground this past week to build a 332 bed hospital, in central PAP, that will have critical care capabilities. Tentatively, it will open in late 2011 but there is no staff presently can care for these patients.

5. Tropical Storm Matthew that passed over PAP last week, destroyed most of J/P HRO’s Battalion Aid tent and all of the volunteer tents. No one was seriously hurt. Hundred’s of the tents in the tent cities were destroyed because they have thinned with the persistent sun.

This has been a very different trip for me. The camaraderie and collegiality of working "in the tents" as part of a MASH unit, is gone. I was aware of this before the trip but I was still disappointed.

I am tired and discouraged. Haiti is a sad, tired, desperate place with no apparent functioning government. Only the volunteer organizations and the churches are supporting the people. The people are tired, grieving and without hope of anything changing or improving. They seem hopeless but are not helpless. I cannot blame them. At the same time, whenever I spoke to any of the Haitian people with my simple "Bonjour", I was always given a gracious smile and spoken to. They have the whitest teeth!

FAQ:

1. Where is the money? Everyone is asking this and no one knows. There is minimal rubble removal and rebuilding, and all of the rebuilding that I saw was being done with the same cinder blocks and mushy sand cement that was used pre-earthquake. There are no building codes and no routine use of rebar. if there is another quake, these buildings will collapse.
2. Has anything improved? See #1.
3. Were you able to use the sheets? As I mentioned earlier, I sent out an e-mail to several friends, asking for some used sheets that I could take with me on this trip. I assumed that I would get “some” BUT it never occurred to me that our third bedroom would start looking like Macy’s Linen Dept. with all of the donations!
I was able to take pieces from every donation that I received and I will send the remaining sheets with some people who will be volunteering in November. THANK YOU SO MUCH for your generosity. I cannot tell you how thankful the families of the patients were, to have clean sheets on their loved ones beds. I would frequently look at the sheets, knowing who gave them to me and just smile.

I have been asked to consider returning to the hospital for an extended period of time, to assist in teaching the nurse's to eventually be able to give the level of care that the American nurse's are presently giving. I am honored to be asked but have too many pro and con thoughts to make a decision now. I just don't know.

I know that the title of this letter is "It's all about the Olives" but it should really be: "This is a barely surviving country, 90 minutes south of one of the most powerful countries in the world."

Thank You for traveling with me.

Kathleen