Sunday, November 11, 2012

With overflowing gratitude

I returned home from Haiti 4 days ago. These past 4 days have flown by quickly as I readjust to everyday life. My gratitude is renewed for EVERYTHING we have been given, starting with clean water out of the tap every morning. The shock of commercial Christmas ads all over the television, radio and in the stores is wearing off. Thank you all for your support. I hope that some of you who have not may one day make the journey to Haiti.

Saturday, November 3, 2012

What is the same?

Because this blog posts the most recent submission first, please do not read this item without also reading the previous post—What is new? They are intended to be read together. Faded discolored Mickey Mouse sheets that once provided happy comfort for a child most likely in the USA now cover the bed of a severely ill Haitian woman. Our cast offs flow into this country, often given away by various foreign organizations and groups. While this seems generous at first glance, it deprives local Haitians of the opportunity to make and sell these goods. Our cheap used American clothing has almost eliminated the job of tailoring here. Reduce/Reuse/Recycle. The first is the most important. We may recycle here for the Haitians to reuse our goods of all kinds, but the very BEST solution is to REDUCE our usage and let these people make and sell what they need locally. There is still trash scattered almost everywhere and even bright young Haitians drop their wrappers and bottles on the ground. Clean water remains a challenge and the threat of cholera still hovers. Cholera was not a problem here until foreigners came in large numbers to ‘help.’ The climate still makes my soul weary by the end of the day. Productivity and afternoon heat are almost mutually exclusive, something that go go go Americans struggle to grasp; some never do especially those who bluster through a short term stay. Many people offer to help, but not for long. Sustained commitment is needed the most.

What is new?

The next 2 posts will be a collection of images and thoughts—What is new? What is the same? I will start with what is new? On the wards, there are 2 large new metal sinks with foot pedals to control the water! There has also been liquid soap in the dispenser on most days. This is a huge step forward for hand hygiene. There are no paper towels, or towels period on the wards for staff. So previously after turning on the faucet with your dirty hands, you had to touch it again with your clean hands to turn it off. Now the water turns on and off with a foot pedal! I carry a washcloth in my pocket to dry; the Haitians swing their hands to air dry. The Internal Medicine doctors now stand outside the closed door to the TB isolation area to discuss those patients on rounds, rather than in the rooms. There is no mechanism for airborne isolation in an open air hospital and the only difference in the TB rooms is a fan that weakly pulls air out into the courtyard. Usually it is turned off. Standing outside is a small precaution that may make a difference for people with frequent exposure to TB patients. The Haitian Physical Therapist here pulled up images from a scan done elsewhere on a patient on her iPhone to show to the MD treating the patient. With no information from the original hospital that treated him, this was a wealth of information. When I gave one of the Rehabilitation Technicians working with me on the ward several suggestions about what to do with a patient, he chose family training first! Exactly as I would hope that any American student or young clinician would do in the same situation. The Haitian Physical Therapist and Technicians are freely giving away the squeeze balls and small squeezable airplanes that I brought here to use for hand exercises. In the past, these items tended to be hoarded in a place where so many have so little. Multiple out-patients are being seen in the PT department at one time. They have 4 treatment tables in an area set up for them that also now includes parallel bars. We started with one portable treatment table on the back porch of the wards. One of the Rehabilitation Technicians asked a question of the visiting blan MD in morning conference, displaying a tremendous increase in confidence. There is a small hotel now in Deschapelles! We had a grand tour this morning and it is quite comfortable. It is providing much needed jobs and may decrease the burden on campus of visitors who only want to visit briefly and are not providing services to the hospital. The Rehabilitation staff and administration displayed excellent flexibility in rescheduling the planned time for the seminar that I presented when the situation called for a change. The old deserted Club Med on the beach has been remodeled and reopened as Club Indigo that I enjoyed last weekend. It provides rest and recreation for the mind and body of those working here and much needed JOBS. I could almost become a Republican here when it comes to pushing the importance of economic growth—but not quite. Remember to VOTE on Tuesday. I voted early before leaving with thanks to my friends from DAI who provided the info on how to do so. Hanger Prosthetics which opened shop at Hospital Albert Schweitzer after the earthquake providing limbs for amputees post quake is now also making orthotic (brace) devices of all kinds and sending their staff to teach the Haitians how to do so. By setting up shop, I do not mean that Hanger is making money here. They have made a HUGE humanitarian gift of materials and personnel to HAS Haiti. The hospital has a new CEO whose energy seems boundless, matched only by the Swiss Medical Director, Dr. Sylvia Ernst. She has an extremely kind, but firm realistic grasp of the situation here.

Thursday, November 1, 2012

Continuing Education in Haiti

Today I began the first half of the continuing education program on stroke originally planned for last Saturday. (Flexibility of mind and spirit is an absolute necessity in Haiti.) There were 12 Rehabilitation Technicians in attendance from the 3 classes that I have helped to teach in 2009, 10 and 11, as well as the Haitian Physical Therapist in charge of the department. They were a GREAT group--just what any instructor would want. They listened, asked questions, and participated in the activities that I had planned. This was all done through a translator making their patience even more admirable. We all had a good laugh with the 2 Techs who agreed to take part in the demonstration of dysarthria (weakness of the muscles producing speech). Both techs stuffed 6 pieces of hard candy in their mouths, then they tried to rapidly repeat a sentence in Kreyol. The effect was quite amusing in these healthy young people, but served the purpose of demonstrating the difficulty that may be experienced by their patients. No patients were scheduled during the 4 hours of the program, but just by chance one out patient came in after missing his appointment last week. He was suffering from a stroke and his treatment served as an excellent demonstration of many of the things I had been talking about. As we debriefed afterward, the students had been quite attentive to the problems that he presented. Tomorrow brings the second half of the session and I am in need of some down time to restore my sagging energy level. These bright young people answering questions make the work well worth it. More about the campus and hospital this weekend.

Tuesday, October 30, 2012

Beyond the mountains there are more mountains

Today I went on an incredible journey into the mountains of Haiti along with 2 of the young Rehabilitation Technicians from the Physical Therapy Dept at HAS. We walked to the homes of 5 patients that the Technicians visit through their community rehabilitation program. It is beyond my ability to really convey the entire experience. So what I will focus on is the work of these bright Haitian Techs trained at Hospital Albert Schweitzer. We found every patient sitting outside their tiny homes either on simple straw chairs or on the ground. All of them have great difficulty walking, 4 of them supposedly due to stroke, although only two had what I would call a ‘classic’ presentation. I sent an email to a few friends this morning stating that I hoped to have the creativity to help these people in their homes. I quickly found that I had little more to add beyond what the Technician had already found on previous visits. I watched as the Techs tried to gently coax these people to get up and walk, checked their blood pressure, encouraged them to take their meds, cleaned the wounds and changed the bandages on one man’s foot and reviewed the exercises that had been given to them to try to help with their problems. Some were cooperative with the concept of exercise, some were not. Some were using the equipment given to them, some were not. All were barefoot on the rocky ground and in the mud. All four stroke patients need shoes and an AFO (ankle foot orthosis). Hanger Prosthetics and Orthotics is now able to provide AFO’s on the HAS campus. For these people far up in the mountains, though, that is a world away. So as we walked today, the Haitian proverb, Beyond the mountains there are more mountains, became reality. After visiting one patient, the Tech pointed to a narrow path winding up in front of us on the next mountain and asked if I could climb it to see the next patient. We did and from the lower elevation, it looked as if we would be on top of the range when we got to the next home. We were not, Beyond the mountains . . . . . . . . . Beyond the geographic truth of this proverb is the greater reality of the mountain of obstacles that these people face every day as they struggle to survive. Their endurance is far beyond mine. The children play happily with no toys as we would imagine them. We heard their voices ringing out from a school high atop one mountain as they recited in unison. Another school we passed was vacant. We came upon school age children who were not in school. One small girl cried out with fright when she saw me, probably the first ‘blan’ (foreigner) she had ever seen. She hid behind the legs of her brother, not much older than she. Looking at her to try to smile and communicate only frightened her more, so eventually her small brother carried her out of the yard. All of the children in that yard seemed to have slightly bloated bellies. We kept walking, over 6 hours in all plus time in the HAS van on roads so rocky and rutted that I am amazed that any vehicle could manage them. When I turned on my iphone to take a photo at one home, I was surprised to hear the familiar ping of arriving email. In this remote place, we had cell reception. Later we would lose it as we descended. I have a few pictures for those of you who want to see them when I return. All were taken with permission of the person or in a way that hides the identity of these vulnerable people. My iphone camera could not capture the sweeping mountain view that was often in front of us. But I will never forget this day.

Sunday, October 28, 2012

Many conversations that span the world

In Haiti I feel as if I converse with people a much greater percentage of the time than I ever do in the USA. Part of this is due to living in a group house which now holds American, Swiss, German and Haitian guests on campus. It is this very diversity that leads to an almost constant exchange of ideas, stories and plans. So one of the Americans just made a Prestige run and this, combined with our 6 hour hike in the mountains, is slowing my mind and body to a crawl. I hope that you are all well. I enjoy your news and feedback; email is the best route: Many thanks to all of you who have helped me to be here and to take care of all things at home. Sleep well.

Many thanks

I must express my thanks to Dr. Patricia Smith and Dr. Karen Kowalske, both at UT Southwestern. I used a combination of their slides on stroke for my presentation in morning conference on Friday. I received many kind thanks from those present. One of the best moments for me was when Nathalie, the Haitian physical therapist in charge of the physical therapy program here, asked a question. It was an EXCELLENT question that should have already been on one of my slides. For the benefit of the physicians present, she asked how long post stroke was it appropriate to refer a patient back to Physical Therapy for further treatment. My colleagues at Parkland know that we struggle to educate physicians on this very issue at home! She nodded eagerly when my answer was exactly what I say at home and exactly what she hoped to hear for the physicians at Hospital Albert Schweitzer. We were in full agreement in 2 very different places.

The Wrong Stuff

Moving back to the hospital, let me talk a little about well intentioned people who have sent ‘the wrong stuff’ (Read The Jumble of Haiti post first if you have not done so already.) After the earthquake supplies of every kind poured into Haiti. Many of these were life saving and worth every penny of the effort that was needed to get them here. However, some groups who probably lacked local experience and local partners also sent things that are not needed in Haiti. I saw an example as soon as I walked into the hospital last week. All along the walls in the corridor are multiple groups of tub benches, with their legs taped one to another to prevent them from being moved away one at a time. Tub benches are used for elderly and handicapped people in America to help them sit safely in the tub to shower. Now remember—most Haitians have no indoor utilities. Even here on campus with utilities there are no bathtubs, only showers. So a great deal of effort and shipping space was used to send something that the people do not use. They bathe at a well or in the river; not a tub. Fortunately, the Haitians are clever to use the benches for seating for families in the hospital. However, chairs for this purpose could have been made locally using the same funds that were used to ship the virtually useless tub benches. Local partners!!!! Sending what we THINK other people need is not the answer.

The Jumble of Haiti

That is the best way I can think of to describe all that has happened this weekend—the experiences and the range of emotions that goes along with them. Yesterday a group of us hired a private tap tap to go to the beach for the day. This was a “luxury” tap tap with boards along the edge of the bed to make narrow benches and a railing attached to the sides that hit you in the mid-back at about T12. It is a wild windy ride as trucks of all sizes, motorcycles, bicycles, people on foot, dogs and goats all roll along and across the road. The most frightening moments are when the driver begins to pass a vehicle with another approaching in the opposite direction; sometimes it is very close!!! We seemed to have several animal lovers in the group as we held our breath when dogs tried to cross the road within almost inches of being hit. We went to Club Indigo, which I think is the remodeled version of an old Club Med that was closed down for many years when I was first here. You are able to pay a fee and enjoy the facilities for a day without renting a room for the night. It was quite luxurious, especially for Haiti, including a huge buffet that we feasted on for lunch. It was quite empty when we arrived in the aftermath of the hurricane blowing through this area and leaving behind days of rain. However, as the day went on many more people arrived to enjoy the beautiful day. The waves were CRASHING into the shore, with some debris on board washed out by the rain. It looked very inviting and I was anxious to jump in. After thinking, though, for a few minutes I realized that I am not that strong as a swimmer and those were BIG waves. So I found and rented a life jacket. It was great fun to roll over the waves until I realized that each one was rolling me a little further out to sea! Again remembering that I don’t swim that well and also realizing that the poorly made life jacket was somewhat choking me around the neck, I began to swim back in. Obviously I made it. Later I found that the debris in the water was down the front of my suit. Enjoying the beach at this comfortable resort does tend to lead to one of the emotions I frequently experience in Haiti—guilt. The facilities, the plentiful food, so far out of reach for the vast majority of Haitians. I never completely get over it, but I tell myself that: 1. I am using vacation time to work here and some rest is ok. 2. I am helping the Haitian economy with every service I buy including things as small as tipping the man that led me to the life jacket vendor. 3. I will work extra hard when I return to the hospital on Monday. 4. I will try my best to spread the word about the potential in Haiti. We all slept well last night after a day in the sun after enjoying the arrival of Dr. Bob Carraway from Florida, a wonderful friend from my early years in Haiti. He was accompanied by, of all people, 2 Cardiologists from UT Southwestern in Dallas. So now I have come all the way to Haiti only to find 2 people from the same campus where I work every day!! Small world. This morning at 8:30 AM, Dr. Carraway led us on a hike up into the mountains to the Hospital Albert Schweitzer Clinic at Bastion. It is a small rural clinic that provides crucial services for people far from other resources. It is the end of the rainy season and everything is a lush green, so it was a beautiful walk that also provided a close look at the world where rural Haitians live. Tiny houses with no utilities—water, electricity or gas. Crops growing on small patches of land where the soil is deep enough to sustain them; much of the ground is rocky and eroded. We passed a church with the people joyfully singing. We passed many people walking down the mountain in flip flops or barefoot with large bags and baskets balanced on their head. They were walking with a speed and ease that we ‘blans’ could never match. Dr. Sylvia Ersnt, Swiss physician and current Medical Director at HAS, accompanied us. After a short distance, the sole of one of her 10 year old Nepalese hiking shoes partially detached. Undaunted, she secured it with an elastic bandage that she happened to have with her. Shortly afterward the same thing happened to the other shoe and she secured the second shoe with a plastic bag. Both solutions did not work for long as gradually the entire sole detached. People began to propose solutions and we stopped to take out the laces and lash on the sole of one shoe while retying the elastic bandage on the other. This soon failed. Then we used a Swiss army knife to cut a hole in the sole to lace the laces through to keep the sole in the correct place. This failed also, as the soles slipped forward as she walked. The final solution was a motorcycle that passed by, miraculously, this far up in the mountains. Dr. Ersnt bargained with the driver who left, dropped off his rider, then returned to take her back down the mountain. Off she went down the steep mountain on the back of the motorcycle, no helmet of course. She made it back, although with cramps in her hands from gripping the cycle!

Saturday, October 27, 2012

Bright sunny day!!! Off to the beach!

Life is good. However, we are riding in a tap tap, so pray for my safe arrival. For those of you new to Haiti, a tap tap is an open truck of some sort with passengers riding in the back, often sitting on the edge of the bed. It beats anything at Six Flags hands down! Had a wonderful leisurely breakfast with my housemates and the new CEO dropped by to chat. Switzerland, Germany and the USA were all represented. This is one of the very best parts of coming to HAS, this connection with so many people. We will also have an international crew in the tap tap including some Haitians. I did do a little work this morning on some more handouts for the students, as with roosters and people up at dawn it is impossible to sleep late. More people arriving tonight so I will have a roommate and the house will be full. Hope all is well in the USA.

Friday, October 26, 2012

The trip is always an adventure

Well, one more post as the internet seems to be moving a little faster; people probably giving up and going to bed. So the AA flight Dallas to Miami was uneventful. The saga really began at the gate in Miami waiting for the flight to Port au Prince. It went something like this: AA Agent: The plane that was scheduled for flight 833 is unable to fly into Port au Prince because they are having some weather there. Thoughts to self: You were going to put us on a plane that can't fly through bad weather!!! This does not sound encouraging. And maybe you need some PR training on how to make somewhat more soothing announcements. AA Agent: Please move to gate 20; your flight will take off from there. Thoughts to self during long wait: It looks like I may be spending the night in Port au Prince. With a hurricane blowing through the Caribbean, the late arrival and a mountain range to drive over to get to the hospital, a late night ride through Haiti does not sound like s good idea. AA Pilot once we are finally on the plane: We're going to fly toward Port au Prince, but the weather is uncertain so we may not be landing there. Thoughts to self: Great! The next closest place will be Cuba. Another island in the Caribbean with a hurricane blowing through!!! AA Pilot several times: Please return to your seat and keep your seat belt securely fastened. Well, to shorten the story, we did land in Port au Prince in blowing rain. The Hospital Albert Schweitzer driver was still waiting along with several other people in the van. With help from a wonderful American Vetinarian who lives in Haiti and was on my flight I finally connected with the Hospital driver and off we went. There are 2 roads and we took the newer one that begins to climb over the mountains just outside of Port au Prince. And ran into-----the thickest fog I have ever seen along with the rain. I really don't know how the driver managed. I was in the front seat and I could not have driven that van. There are quite a few signs on that road with a Z on them. That indicates the shape of the upcoming road. There are few 'thrills' like a Z turn in thick fog in the rain in a van with a huge truck approaching in the opposite direction in Haiti. Fortunately, I sent out several quick text messages and emails (another new thing in Haiti) asking for fervent prayers for safety. They worked. We arrived on campus around 10:00 PM. So I will try one more time to post. As usual in Haiti, all plans have already changed twice. I am not teaching tomorrow. IF the sun comes out (haven't seen it yet), we might go to the beach so things are looking up. Good night!

Education is the key

Well, this is my second attempt to get this piece to pusblish and the last whether or not it works. Internet very, very slow. This has been a whirlwind 2 days and there is much to tell. The late hour, the bottle of Prestige and the Haitian pizza are going to take me down very soon, so I will start with the best news. Over the past 2 days I have been delighted to see the work of the bright, energetic young people who I have helped to train as Rehabilitation Technicians over the past 3 years, 2009, 2010 and 2011. They are using the 'hand up' that was offered to them to work in their community here at Hospital Albert Schwietzer and in 3 remote clinics in the mountains. They have welcomed me back to Haiti with warmth and good humor. For all the people who keep asking me how things are going in Haiti, this is the answer. Offer education and skills to the young people and they will build their future. I hope this will post. Good night!

Sunday, September 30, 2012

Preparing to return 2012

Sitting in Whole Foods using their wi-fi to see if this ancient but sturdy little iBook will make it for another trip to Haiti. May do it all on the iphone this year, but it sure is easier to type on a keyboard. That comment is showing my age! This year I will focus on continuing education for the Rehabilitation Technicians and the Physical Therapist at Hospital Albert Schweitzer. Three of the 6 Rehab Technicians on staff are currently working in the community clinics fulfilling a long desired goal of moving toward community based rehabilitation. I will arrive on a Wednesday and leave 2 weeks later on Wednesday, allowing 2 Saturday teaching sessions that will not interfere with the regular work week. Back to work on my class notes. Let's see if this little computer has the ability to post.