Full Circle

Almost 11 years ago I first came to Hospital Albert Schweitzer, Haiti with 3 American physical therapy students. Over the next 3 years, a total of 6 students came here with me. They were all great people and I hope they learned something about this place and the people here. For the next five years I came alone to work and teach the staff and volunteers here, and once with a work team and once with a professional colleague. Now for the past 3 years, I have come to teach Haitian students in the Rehabilitation Technician Training Program. The circle has been completed. Now I am teaching students from Haiti in Haiti. This is as it should be. Haiti is not the place to train American students; we can do that at home. Haiti needs experienced clinicians to share their knowledge with the people here and to learn many lessons in return.

Today was my last day with the students this year. They were all very gracious as I reviewed their clinical evaluation with them and wished them all well. We had a small party after lunch and they sang good bye to me in a wonderful multi-part harmony. I have never had a good bye quite like that before.

Musings

As my time here draws to a close, a few random thoughts on various things . . . . .

Parkland all over the world
Since I have been here, I have witnessed the long reach of Parkland to help burn patients all over the world. Yesterday in morning conference with the medical staff, one of the surgeons gave a presentation on care of burns. Among his slides were references to the Parkland formula for burn resuscitation. A visiting volunteer Emergency Medicine MD from Illinois immediately spoke of the Parkland formula when I told him where I worked. I used web material from Parkland to teach my Rehabilitation Technician students the rule of 9's. I am using my own knowledge from working in Parkland PT to teach the students how to work with the many children here who have suffered a burn. Knowledge from Parkland spreads far beyond the boundaries of Dallas County.

The mind is willing, but the body is wearing down
I always come here with great enthusiasm to do as much as I can in the short time available. I soon find, though, that I have to slow down. The constant heat, inside and out, drains my energy. By mid afternoon I am dragging and in the evening I am grateful that we are not on daylight savings time so that it will soon be dark and time for bed. The comforts of home will be much appreciated once again when I return.

Clean, plentiful, drinkable water
Never take it for granted.

The Haitian Nurse was right
And I was wrong. I was certain that the surgeon had asked me on rounds to prepare the patient for discharge as soon as possible. There was an order in the chart to discontinue the IV; the Surgery Resident confirmed the order. The IV was interfering with our gait training with crutches and we needed to get the patient ready to go. But there were more words in the chart on another page with a different color paper, and my interpretation was wrong. Things move more slowly here. The patient will likely be discharged tomorrow if all goes well, not today. The IV needed to stay in today. After the surgeon confirmed that the Nurse had, indeed been correct to leave the IV in place, I immediately went to her and told her that she was right and I was wrong, and that she was a very good nurse. Even though she did not speak English, it was clear that the message was understood. Just to make certain, I went back later in the day with a translator and told her again.

Two more days in the hospital with the Rehabilitation Technician students, then this weekend to work with the next team of teachers who will take over on Monday. I leave here at 4:00 AM Monday morning for the trip to Port-au-Prince, then Florida, then home.

Slow Day

After a wonderful storm yesterday afternoon, we had a comfortable evening and night for a good long sleep. It is now 5:30 and this has been a lazy day for me recovering from the inevitable traveler's intestinal blues. Except for one short walk to stock up on Sprite, I have pretty much sat with a computer in my lap or napped on the bed under a fan all day. Now it is only 30 minutes until evening water and a cooling shower. No rumble of thunder yet, so it looks like this will be a hot night. From what I hear, it is as hot in Dallas as it is here, so this is a good time to be in Haiti. Hope you all are staying cool.

It's always the children

That you remember. My colleagues know that I am not a 'pediatric physical therapist' in the USA, but I become one in Haiti. As usual, there are several children here with burns. One was burned over a year ago when an 18 year old girl threw gasoline on him, then lit a match. Even with a translator, I cannot begin to fathom that story. He was cared for in another town until recently and still has large open areas and severe contractures of the shoulders. He will need a plastic surgeon if there is ever one available here. Another little boy lays in bed with his eyes swollen shut. The family first reported that he had been in a motorcycle accident, then later changed the story and said that he had been shot in the face while playing with a gun. Small pellets are still visible through the skin. He has apparently lost most of his vision and needs and Opthamologist, but there is none here. A 13 year old lies in bed with no movement in his legs. His face and body look like those of an 8 year old; the only clue to his real age are his long legs. He was first diagnosed with malnutrition, easy to see as you count every rib and bony prominence, then TB, then after a seizure, TB meningitis.
Yet the smallest gift can cause such joy! Yesterday the students gave a balloon to 2 of the children and played with it as part of their therapy. After the students left, the 2 toddlers continued to play happily with this wonderful new toy. I brought along 150 balloons, but it is never enough . . . .

Rhythms of the Day

Cool early morning. In Haiti the rhythms of the day are always with you. No artificial climate control. The morning is cool and still. Sunrise coincides with the clock, not daylight savings time. Much better to have early light in a hot climate. As the sun gains strength, the heat begins to build, along with the humidity. You begin to sweat, lightly at first. Then in the afternoon, the sweat begins to pour. Yesterday on the crowded ward it seemed almost uncontrollable as I wiped my face again and again and my scrubs began to stick to every part of my body. Then, at this time of year you begin to listen for that first rumble of thunder. So far there have been only 3 days when it did not come. The thunder gets louder, the wind picks up and the temperature begins to drop. Then it rains, then pours. On some days the thunder is accompanied by huge streaks of lightening and crashes that rattle the house. Sitting in this breezy old house built for the tropics, it is a delight to feel it blow through. By the time the rain ends, the sun is going down. It is cooler. It is time to sleep. The clock matches the sunset; no waiting for dark.
I will go home and gladly crank up my air conditioning in the Dallas heat. But one of the pleasures of Haiti is appreciating the relief that rain and dark bring to a hot humid world.

Happy Fourth of July from Haiti

This has been a long day and I am one pooped blan (foreigner in Kreyol, derived from the French blanc). Fortunately, the rain is cooling everything off quite readily.

This was the first day for the Rehabilitation Technician students in the clinic. I worked with 3 of the students on the hospital ward amidst the chaos of families and an overflowing pediatrics ward with children and babies spilling out into the hallway. Each of the 3 students worked with one child today who had been burned. They did remarkably well, especially with the 2 younger children who delighted in the one on one attention of these young adults who "played" with them while encouraging them to stretch out painful burned limbs.

Writing up a note to describe what they had done was another story and this process was painfully slow. I suspect that the Haitian educational system thus far has not encouraged them to do much narrative writing and they struggled to put together a coherent description of their work.

After we returned to the new Physical Therapy Dept in the courtyard, an outpatient arrived late in the day. She had been in the hospital earlier this year and had become profoundly weak, arriving by wheelchair today. I found a note in the chart from one of the staff Rehab Technicians, so I asked her to work with the patient along with the students. She did so and I was delighted to see the Haitian staff member asking the students questions as they worked. The woman stood up to a walker, and then was able to walk a short distance with a slightly wobbly gait. She was thrilled; she had not walked since January 22. Very good ending to a long day.

The real Haiti moment came, though, as she left the hospital. She was tired to we sent her to the front entrance to exit in a hospital wheelchair. We gave her a walker to take and use at home. As we left for the day, we found her at the front door uncertain how to get the wheelchair down the 3-4 steep steps there; there is no alternate exit. So, one of the students backed the wheelchair down the stairs to meet her ride waiting on his motorcycle. The young man driving the cycle hoisted her onto the seat side saddle. Her daughter straddled the seat behind both of them, and with one hand on her disabled Mother and the other holding the walker, they took off! I only wish I had gotten a picture.

May you enjoy everything you have been given tonight. Happy Fourth of July.

Technology Pushes Forward

On this cool Sunday morning, I have enjoyed my usual multiple cups of coffee and the New York Times. The campus now has a system called "Hotspot" that allows you to buy wireless access in various increments. I have been using it all week, in addition to my iphone for which I purchased a special plan for roaming coverage in Haiti. Now I admit that I would have much preferred the feel of an oily paper in my hands that I could look through and select pieces that looked to be of interest. But I was able to quite easily download multiple articles from the Times to ponder along with my coffee. A typical Sunday morning ritual.

The first year I came here, we paid $10 to send home one satellite FAX. I kept a written journal. By the second year, there was some access to a shared email program that involved putting your message on a disk to be sent out later when the satellite phone was activated. Then, an "internet cafe" opened in the administration building and you could wait patiently for your internet email program to open. The last 2 years, there has been wireless coverage in the library for visitors during selected times each day. This was the point that I went from a personal journal to an on-line blog. The system, though, was prone to sudden breakdowns and a long blog or email could easily be lost before it was posted or sent. Now there is "hotspot" available in the guest houses and it has been quite reliable other than during the height of the huge thunderstorm yesterday--no surprise for a wireless system.

The Haitian people now make wide use of cell phones and there are digicel dealers on every corner. No TV coverage that I know of here yet in Deschapelles, but with internet access so widely available, that is becoming less important. Entertainment can be downloaded. CNN is always there for news.

Yet, with all of this, cholera still contaminates the water. The UN, the overflowing number of NGO's and the Haitian government cannot provide the people with simple clean water. From what I understand, the UN has finally admitted that sewage produced by troops from Nepal was accidentally dumped in the wrong place and this was the source of the cholera outbreak. It is clear that this was a mistake, but it is not clear at what point in the process this happened or who actually did it, as contractors were involved.

As we wash and rinse EVERYTHING in chlorox solution, including fresh food, it is hard not to despair.

For those of you asking me about signs of progress

Many of you have asked me if there has been any progress in Haiti since the earthquake. I can say with certainty that there has been progress in Physical Therapy at Hospital Albert Schweitzer. When I came here in 2000, the space allotted to PT was a small corner spot in the Nursing Director’s office. Over the next few years, PT gained a closet to hold supplies and a moveable table that was placed out on the porch to see out-patients. Then, in the summer of 2009 there was finally an actual room for Physical Therapy. Now 2 years later, there is an even larger space that has been divided off from the courtyard and includes a storage area for supplies.

In 2000, I was asked to bring crutches and did so in 11 long boxes. During the next few years, the people at HAS made due with a number of different experiments in crutch provision including some bulky wooden ones made on site, forearm crutches rather than axillary (very hard for fracture patients to use), and many times crutches were in very short supply. When I was here 6 weeks after the earthquake, we had to put together mismatched pairs to send the patients home. Now the storage room holds many pairs of new crutches, both wooden and aluminum still in the packaging.

The storeroom also holds many other supplies that in the past were donated periodically, then would run out. There are extra wheelchairs--one of the hardest items to find for a patient 10 years ago.

So all the international attention has done some good. There is physical evidence of progress in place.

The most important progress, though, is in the staff. In 2000, there was one part time volunteer Swiss Physical Therapist here, along with her husband who was on the staff as a pediatrician. Before she left, she trained Mary Jane Carraway, an American RN and also a volunteer, to do basic physical therapy treatments. For many years, Mary Jane did an excellent job of providing access to basic physical therapy care, along with the help of visiting volunteer PT’s. Before Mary Jane left, she trained 2 Haitian RN’s to take over the Physical Therapy service and they did so until 2009. In January, 2009, the Rehabilitation Technician Training Program that had formerly been in Port-au-Prince moved to Hospital Albert Schweitzer. Then in the fall of 2009, a Haitian Physical Therapist was hired to run the Physical Therapy service. Finally! Physical Therapy had officially arrived at HAS. In January, 2010, 3 of the Rehabilitation Technician graduates also joined the staff, just in time for the earthquake. Today the Haitian Physical Therapist Director of the Dept. continues to work with a staff of 3 techs and many visiting PT’s teaching in the Rehab Tech training program.

The resources that many of you have given have been put to good use. There can be progress in Haiti.

The rain

Yesterday afternoon we had an incredible thunderstorm. Huge streaks of lightening, crashing thunder, wind blowing and the temperature dropping within minutes. A tropical thunderstorm is a powerful reminder that Mother Nature is in charge and we are at her mercy. After 3 nights of wonderful storms, there has been none yet today. The difference is very uncomfortably noticeable. It is hot, steamy, a difficult night to sleep after 3 very comfortable ones. The mosquitos are out in force tonight; no rain storm to wash them away. The tropics, Haiti.

I washed the lettuce in chlorox

If a waitress in Dallas told you this as she served your salad, I am guessing that most of you would get up and leave. Those are the words, though, that our cook said to us (more of less in translation from Kreyol) as she served us a small salad for lunch yesterday. With the outbreak of cholera in this immediate area, all fresh foods are suspect. The tomatoes have had a chlorox wash, too. Maybe my teeth will be whiter by the time I leave . . . . . . . .

The Classroom

The classroom for the RTTP students has changed again this year and is now in the building shared by administration and the malnutrition ward. Unfortunately, it shares a common wall with the malnutrition ward, so the sound of babies crying is a frequent accompaniment to the general noise of people talking and chairs and beds being scraped across the floor. The room has windows on one entire side with worn out screens, one ceiling fan slowly turning and little air circulating. By mid-afternoon it is an oven, as are most places in the hospital and the houses, too.

Despite this, the 6 students this year are asking a lot of questions as we study wound and burn care and are doing their best to stay alert in the heat. By 2:30 to 3:00 we all give up. The students go home and I go on to other experiences.

There are so many other experiences that I am not sure which ones to share. So will do some short pieces and you can decide which ones sound interesting enough to read.

Inside the cholera ward

You can't really grasp the scope of the outbreak until you go inside. The old gift shop, a relatively small building with several rooms that are windowless, is crammed full of cots for patients suffering from cholera; 168 as of this morning. The cots are almost too close together to walk between. As with the hospital, family members crowd around to provide all the general care for the patients. Only purely medical tasks--IV's, injections, medications are done by the staff. Keeping the patient clean, changing the diaper is the job of the family. In addition to the building, there are 6 white UNICEF tents, also full of patients. The sickest patients, though, are in the building, including two tiny rooms with babies and toddlers. Patients wait outside to be evaluated and possibly admitted. Some have an IV running while they wait.

The Haitian staff and a few foreign MD's and RN's who have come to help are exhausted. MD's and RN's with experience in the developing world are needed NOW. Contact information may be found on the Hospital Albert Schweitzer website.

The housekeeping crew in gloves and rubber boots work endlessly to keep the floors clean of the worst contamination. Despite best efforts, trash piles up outside--empty bottles, used gloves. The soles of our shoes are sprayed with chlorox as we leave. Incredible.

More later about the first day of teaching, the students and the hospital.

So much to tell . . .

Back in Haiti for less than 24 hours and already so much to tell. Had the easiest time ever at the airport--short line for immigration, almost efficient. Porter found my bags immediately. Out the door and down the walkway to look for the Hospital Albert Schweitzer driver. That is when the adventure began. Was happy to see a Haitian man holding a Hospital Albert Schweitzer sign who quickly grabbed my luggage cart and we took off through the parking lot, soon joined by another "helper." A short way out, I looked closely enough to see that the man with the sign had an airport badge and was therefore NOT the HAS driver. As we got further and further away from the airport, I finally demanded that they STOP until I could see the real HAS driver; otherwise, I was returning to the enclosed airport exit area. After much negotiating, one helper going ahead to supposedly find the driver and a couple of false starts, a van slowly began to pull toward us. It turned out to be the HAS van. Adventure #1 completed.

We bumped over to the HAS Port-au-Prince office a short distance away, at times almost swimming through pouring water (see previous entry). If we had stalled in one of those lakes of brown water, I'm not sure if I could have forced myself to step out and walk away. Fortuntely, the ancient well worn van seemed to be able to swim and we arrived at the office. We picked up 6 more riders, then headed out Highway 1 on a long, hot journey.

Adventure #2: It began to rain, then pour. Beautiful streaks of lightening across the sky. People running for cover, motorcycles struggling and stopping where there was shelter. "We went on. The discouraging part came as we went through several towns in the rain. Water poured down hillsides into the street carrying along great globs of garbage, including glass bottles of all sorts. How any vehicle could swim through what we did without cutting open a tire, I do not know. But we drove on. We made it to Deschapelles.

As we pulled up by the hospital, the large while UNICEF tents holding cholera patients came into view. The old gift shop has now become the cholera ward since a fresh outbreak with the start of the rainy season. It is overflowing; hence the tents. My house mate who has been here for several months tells me that the Haitian staff are becoming worn down by the influx of these patients--with very limited facilities for their treatment and general ignornace in the population about how to prevent transmission. Lots of handwashing this visit. Filtered water with chlorine. Indoor and outdoor shoes. And hopefully good luck . . . .

Speaking of my housemate--I was delighted to met Kim, an American PT who is here working with the new PT Dept on administrative organization, as well as public health and other issues related to the disabled. She has much interesting knowledge to share and we are already trading insights and thoughts on all things Haiti.

Adventure #3: At 7:30 this morning, Kim led us up the side if a nearby mountain to a wonderful morning view of the Artibonite Valley. Looking down at nature, it is hard not to believe that there cannot be hope for Haiti.

Finally caught a shower at noon; running water only 3 hours per day (6-7 AM, 12-1 PM and 6-7 PM). Now unpacking many supplies, planning for class tomorrow with the Rehabilitation Technician Training Program students and preparing to take a look around campus and the hospital. Bottom line, it feels very good to be here. I am glad to be back in Haiti.

Back in Haiti!!

Smoothest time ever at the airport. Now at the HAS office in Port picking up others for the hot dusty ride. The van already made it through wheel deep I assume sewer water. Taking Off. Too bumPy for more.

Mother Nature is trying to help get me ready for Haiti

Yesterday it was 104 degrees in Dallas, hotter than Port-au-Prince. Predicted high for Dallas today is 102 degrees; Port-au-Prince 95 degrees. Seems a little strange that I'll be going to Haiti to cool off!

Getting ready

Just got back from Target buying bug lotion, cheap pack of washcloths and all manner of supplies. Now at the Apple store getting the ancient iBook ready to go. Leaving on June 26 for 3 weeks.