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.
Kathleen
Tuesday, August 23, 2011
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,
Kathleen
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,
Kathleen
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