Friday, July 15, 2011

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.

Wednesday, July 13, 2011


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.

Saturday, July 9, 2011

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.

Wednesday, July 6, 2011

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.

Monday, July 4, 2011

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.

Sunday, July 3, 2011

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.