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