In the Port au Prince airport

Looking forward to the life of luxury that we all live at home. Amazed, once again, by the gratitude expressed by the Haitians for doing so little. I hope there was some 'drop in the bucket' that helped someone along the way. See you soon!

Deep in the countryside, high up in the mountains

Today I traveled to the Bastien Dispensary, a small community clinic run by Hospital Albert Schweitzer, high up in the mountains. I left immediately with one of the Rehabilitation Technicians to visit patients in their homes. This is where you see the real Haiti. It is both fascinating and heartbreaking to see the poverty there. Many children watched as we visited the patients, children who often were old enough to be in school but were not. (Later in the day we did see children along the road in school uniforms, an encouraging sign that some are in school.) One patient had many family members gathered around and was doing well. One man was totally alone on the dirt floor of his small home. He told us that he did not have money for medication or food. The Tech called his family in Deschapelle to ask them to come and help him; this phone call from the mountains is an amazing improvement of the last few years. We saw 6 patients who ran the gamut from pain in one shoulder to leg weakness that caused her to collapse when she attempted standing. All of the patients and/or their families said thank you as we left. I hope that, at the least, we may have provided some human contact and a ray of hope. For the children who giggled as they accepted a piece of candy from the 'blan' stranger, I hope they see that these strangers can be their friend. For most of the kids I think I was, at least, a little entertainment for the day.

Looking back at the earthquake and forward to next time

Today in Conference the one of the Haitian physicians did an excellent presentation on Disaster Response related to the earthquake in 2010. He noted the need for planning should another such disaster occur and stated that he was working on a plan for HAS. There was a spirited discussion afterward with many good comments made. Only one set of comments was not translated into English; these involved frequent use of the word blan (foreigner). Without being able to understand the specifics, I could feel the frustration that was created by the overwhelming outside response to the quake, likely too often without Haitian input. I believe that this frustration is fully justified. If you are interested in learning more, read "The Big Truck that Went By: How the World Came to Save Haiti and Left Behind a Disaster." (That title may not be exactly right but google will find it.) Don't come to Haiti until you have read it.

The rats must be afraid of 'blans'

Today is a Haitian holiday and the Physical Therapy Department is closed. So to try to be useful this morning, I went to the PT Dept to have a look at the storeroom and try to do a little organizing. My major goal was to find a box large enough to serve as a coffin for Ted. Before you gasp in horror, let me state that Ted is the name given by the Haitian Techs to the full size (fake) skeleton that was used for teaching the Rehabilitation Technician program during the 3 years it was active here. Ted has been sitting in various corners of the department for several years and was gradually falling to pieces. His spine was bent almost in two. No one was using him anymore. I did find a big box and was able to take Ted off his stand and store him and the stand in it. I strolled out into the courtyard and in my best broken Kreyol asked a Haitian visitor to the hospital to help me for one minute. He did and we hoisted Ted to a top shelf to rest in peace. The next step was to move the stuff I had taken out of the big box that held Ted to some other box. This required several hours of moving and juggling stuff in the storeroom. By the end, I was coated in dust and sweat. Fortunately in all my poking around in dark corners long neglected, I did not uncover any rats. It is likely that some at least pass through there now and then when it rains. Fortunately, the rats must be afraid of blans (foreigners). None bothered me this morning.

This blog site that I'm using must be in California

All the time postings are 3 hours earlier than it is here in Haiti, even though the time showing on this computer is central standard time with daylight savings (one hour different).

I won't be doing this when I get back to work in the USA

This afternoon after teaching all morning, I was puttering around at Alumni House when one of the Haitian Doctors knocked at the door. She said that a patient with spinal cord injury had just arrived at the hospital and she needed a cervical collar. She had called Sabine, the acting Haitian Director of PT (regular Director is off at a Conference in Canada), who is in Port au Prince this weekend. Sabine told her that I had a key to the Physical Therapy Department where the cervical collars are stored. (There really isn't a security force here with a set of master keys, so keeping track of keys can be a challenge.) I jumped into a pair of scrub pants (we are asked to wear slacks rather than shorts inside the hospital as a sign of respect) and headed out the door. The Doctor and I unlocked the PT Department and pulled down the box of donated cervical collars. We fished around and found 3 styles that looked like they might fit the patient. Unfortunately, none of the 3 are really intended for the type of rigid immobilization that is needed at this early stage post injury. But they were what was available. We took them to the waiting area at the front of the hospital where the patient lay very still on a treatment table. We carefully placed the collar. The Doctor asked me to help move the patient off the table by the door on to a rolling cart that would be his bed. The cart was bare metal; no mattress. I told her that this would not work; this paralyzed patient would be in immediate danger of skin breakdown. I thought I had seen some extra cart mattresses piled in an inner courtyard, so I left to try to find one. I found several carts in better condition than the one intended for the patient--in such good condition that I strongly suspected these were the ones reserved for surgery. So I went back to the overnight ward where I had seen one cart piled high with 3 pads. I took the top one. Now a Haitian family member doing this might have been questioned. But an older 'blan' (foreign) woman doing this was overlooked. The pad was too wide for the cart, but we used it anyway with one side rail left down and the mattress extending over the edge (refer to previous blog about safety posts for how acceptable this would have been in the USA). We slid the patient over to his bed. He appears to be completely paralyzed. Time will tell if this injury is permanent, but life for this man is likely forever changed . . . .

More about the Pain Seminar Today

When I posed the question to the Rehabilitation Technicians, "What can you use in your Physical Therapy Department to treat pain in your patients?", the immediate first answer right out of the gate was EDUCATION. WOW! This is an enviable response that my American colleagues who teach Physical Therapy at the University level would like to hear from their students. The first thing we can and should do is educate the patient. Too often we get lost in the latest remedy without letting the patient know what is happening to them. The second answer I received to this question was "our hands." They went on to state all the techniques that can be completed with their hands from exercise to mobilization to massage. All of these things relieve pain. There are a million gadgets out there, but none as adaptable as the human hand. This answer is also right on target for anyone studying physical therapy. In Haiti, day to day practice and experience with a multitude of patients are powerful tools for improving performance. I see that more and more in these young Technicians every time I come.

Hungry for Knowledge

Today I taught a seminar on Physiology and Management of Pain to the Rehabilitation Technicians at Hospital Albert Schweitzer. I have been a teacher for this wonderful group of young Haitians during their basic training at HAS several years ago, and for continuing education seminars over the past few years. I could not ask for a better group to teach. There were attentive to the very end of the almost 5 hours we were there, when the body finally tires of sitting in one place. What I most appreciated, though, was their participation. When I posed questions, they ANSWERED and discussed each topic at length. There was no 'dead air' with a question left hanging in the room. They are hungry for knowledge and this is one of the best gifts we can bring them, and the main reason that we continue to send visiting Physical Therapists here. There is a working Physical Therapy Department now at Hospital Albert Schweitzer and foreigners are not needed to treat the patients. We are needed to teach those who don't have constant unlimited access to the internet, seminars, journals and other forms of continuing education that we take for granted. We are so accustomed to the sea of information around us that often we want to be entertained more than taught. This is not the case in Haiti. Now I know that my colleagues are rolling their eyes at the topic today. I am certainly not a pain specialist. However, in Haiti, I have always said that I will do what is needed, so when I was given pain as a topic, that is what I prepared. Fortunately, I had some immediate and very knowledgeable assistance from my friends Julie DeVahl and Ross Querry, both faculty members at the University Of Texas Southwestern Medical Center at Dallas. I thank them both for sharing their expertise; I could not have done the seminar today without them! So, in a sense, they have been teaching here, too.

There are no patient safety posts in Haiti

Today during rounds on the ward, I stepped back to see what commotion was going on in the hallway. There was a man on the floor struggling to get back up on his own power, clearly not succeeding. He had the characteristic piece of tape on his forehead marking him for surgery that day, which means he had had no recent food or water. Now in a facility in the USA a patient on the floor, even one gently lowered without impact, would set off a HUGE chain of events. Multiple staff would quickly rush to his side. There are set procedures for checking the situation before moving the patient. After the patient is moved to the appropriate place (back to bed, on s stretcher), a long chain of paperwork begins online to document what happened, review this documentation at multiple management levels, then put in place safeguards to prevent another incident. All of this is well and good. The intention is for the best care. But there is a totally different cultural context to this type of event in Haiti. As we briefly watched the man struggle, one of my Haitian colleagues told me that in Haiti when someone faints, it is believed that they should get back up on their own. (There was not time to elaborate more.) I also know from experience that in Haiti families are the primary persons responsible for getting a patient in and out of bed, not the staff. After the patient almost fell on a second attempt, the Haitian staff called out to the family to HELP HIM, which they did. He was returned to bed and checked by the medical staff. A totally different chain of events, which can easily be MISinterpreted as lack of caring or ignorance. It is neither. Cultural beliefs run deep. It takes time and empathy to change them and maybe for us to also learn that a hyperactive reaction is not always the best response.

Yesterday in Liancourt

Yesterday after morning conference at the hospital, I left with one of the Rehabilitation Technicians to travel to an outlying clinic run by HAS in the nearby town of Liancourt. We both boarded the same motorcycle behind a driver who took us down the 'corridor' (main drag in Deschapelles) to the main road. There we climbed into a 'tap tap' (open bed of a pick up)along with several school children in their uniforms for the short trip to Liancourt. We arrived at the clinic and went to the small closet size room designated for Physical Therapy. The Tech muttered "it's already hot" as we walked in the door. He was right. I was tempted to start whistling the theme from Bridge Over the River Kwai as the tiny room felt like the sweat boxes where the British officers were kept early in the movie. The fan hanging on the wall could not be used. It had a very frayed cord what would have likely set the plaster wall on fire. I broke out into an immediate full body sweat. However, over a period of time, the sweat began to evaporate and do its cooling work. I felt, not cool, but at least reasonably comfortable. It no longer felt like an unbearable sweat box. The patients began to come in a steady stream with their entire clinic medical record on well worn index cards. They sat on the treatment table without a sheet. We worked with them one by one. I hope we did some good.

Running out of new crutches

I was afraid this would happen. The first year I came here in 2000, we were asked to bring crutches as these were often in short supply in Haiti. In 2000, a kinder and gentler American Airlines and TSA let us bring 11 long skinny boxes full without submitting them to any screening that I could see. Over the years, the hospital got crutches from various places and for a while made their own crude wooden ones that were almost impossible to adjust. Then the earthquake struck. International aid poured in, especially for victims of the quake who suffered amputation. Suddenly the hospital had an unlimted supply of new, adjustable aluminum crutches to replace the old worn out wooden ones discarded from other places. The supply lasted quite a while. Now, though, it seems to be ruuning out. Used crutches are being recycled. The green Sierra Club part of me is in favor of recycling, but the point is that it is being done because there are no longer any new ones. Or they are locked in a warehouse somewhere. This one small item may not seem important, but I see it as symbolic of how the world views Haiti. There was a great outpouring of supplies and help after the quake. Sadly, though, the world has moved on. There are disasters elsewhere and Haiti is left with scarce resources once again.

Missing piece in a complex puzzle

On Friday, the rehab Tech and I worked with a patient and her family to prepare to go home that day. The day before, a visiting Ortho Team had done a complex surgical fixation of her left elbow. As we talked to the family about her history, we found that she had a stroke a short time ago. The family had been taking her to a clinic for Physical Therapy treatment post stroke. They did not have a wheelchair. As they carried her up the ramp outside the clinic, they dropped her leading to the severe fracture of her left elbow. Her right side is paralyzed from the stroke. She now has only one functioning extremity--her left leg. It is a terrible irony that the family was carrying her up a wheelchair access ramp because they had no wheelchair when she fell. Helping in Haiti is a complex puzzle. With all good intentions, someone set up the Physical Therapy Clinic to offer treatment for her stroke. With all good intentions, someone built a wheelchair access ramp so that she could go into the clinic. After the quake, many wheelchairs were donated to Haiti and some of these are probably in a warehouse somewhere. The missing piece of the puzzle is that the wheelchair never got to the patient, with tragic consequences as a result. She is now almost completely helpless. One wheelchair could have prevented this sad chain of events.

Hopefully the Medical Evacuation service

will take me all the way to Dallas instead of dumping me in Florida. JUST KIDDING. However, after 8 hours of walking today in the Haitian sun, I could use a short stay on the Parkland Burn Unit for some TLC. There is no sweat proof sunblock out there; this is a myth of the suntan lotion companies. I am chicken fried, and after about 8 glasses of water and 2 Sprites, about ready to crash. My roommate, an Internal Med Doc from San Francisco, and I left at 5:00 AM to hike up the mountain side and see the sunrise. After coming down for a brief breakfast break, we left for a LONG hike to Verrette Falls and back. It took about 7 hours. My young friend and our Haitian Guide probably could have done it in 6, but I was moving VERY SLOWLY by the time we finished. We finished by taking a tap tap ride for the last 3 miles from Verrette to Deschapelles. The tap tap let us off where the main road attaches to the 'corridor' that leads to the hospital. Our guide seemed to know that I was wiped out and so he hailed 3 motorcycles and we took a short ride up the corridor to our house on campus. That was my first time on a motorcycle in Haiti. It is never to late for the first time!

Dads are the same all over the world

My translator is the new Dad of a 4 month old boy. Today during a quiet moment, he asked me how many "milestones" there are for children. To back up a little, my translator worked for over a year to help interpret in the Rehab Technician Training program here at Hospital Albert Schweitzer. He heard lots of pediatric lectures about developmental milestones. At first, I started to give a half way intelligent answer (I am not a pediatric specialist!) about physical vs. cognitive vs. other types of milestones. Then suddenly it hit me! That was NOT what he was asking. I stopped and slapped him on the back and told him, "Relax new Dad. Your baby will reach all the developmental milestones just fine." He grinned. That was what he was looking for.

If my Parkland colleagues could be a fly on the wall . . . .

They would be choked with laughter watching me here. One of the things I enjoy in Haiti is s t r e t c h i n g out of my usual comfort zone to areas in which I have been trained, but seldom practice at home. I am actually quite grateful (don't tell them) for all I have learned from everyone I work with. I could use several of them here--an OT with hand skills would be especially useful for the 2 patients with a diabetic hand and middle finger amputation that I have seen in the past 4 days. Orthopedic trauma, burns, complications of diabetes, stroke, head injury and on and on can all be found here along with things we seldom see--leptospirosis, typhoid, long term TB. I could use help with foot problems, and always children with burns. So, my friends at work, if you would like to ship Stef and Beth down here, feel free to do so!

Slowly the body adapts

Today was the first day at the hospital that I did not feel like I had been run over by a truck all day. I am adjusting to the heat, the change in time zone, the food, the noise, the struggle to communicate, the back and forth pace. I have made one concession to my body and my age for which I am feeling great guilt. The days here are long. Conference with the entire team begins at 7:00 AM sharp. It is hot and I am sweating through my shirt by the time ward rounds end around 9:00 AM. The day ends at 5:00 PM with one hour for lunch. Ten hour days, 9 hours at work. I am cheating. I am taking 1 1/2 hours for lunch. That extra time to relax and recharge is really helping. My friend who is in charge of the Physical Therapy Health Volunteers Overseas program here reminded me that the staff is probably glad to have me out of their hair for a little while in the middle of the day. She is probably right. Visitors can get old fast . . . . .

Stream of consciousness

As I read the last post, I realize that is sounds like a rather crazy stream of consciousness with topics changing from sentence to sentence. This is not the way it was written. I did use paragraphs to start new topics. However, there is something about the blogger software that allows no more than 2 spaces after a period (.). Spaces between paragraphs disappear. Everything runs together, which may actually be appropriate for Haiti as everything including your thoughts tends to run together in the heat. What I will do, though, to appear less crazy is to write short one topic posts. So the blog will appear to change from stream of consciousness to hyperactive. Whatever.

Slowly, slowly, S L O W L Y

Getting back into the rhythm of Haiti. It is a slower pace. The heat saps my energy. There is more noise, more distraction all around you. The sensory feedback can be overwhelming. Much is the same, but change marches forward. I am working off a portable 'hot spot' sitting here on the table. My iPhone works here for local and international calls, email, texts, internet. This sounds trivial until you calculate how recently this was possible here. Fifteen years ago even a phone call was almost impossible in Deschapelles. The Haitian people are slowly taking over more and more of the work of the hospital. There are fewer 'blans' (foreigners). I no longer need to do the work. My role is to teach, to expand skills, to bring new ideas. This is as it should be. Teach a man to fish . . . . . More later, but I wanted you to know that I am well and thinking of all of you who helped me get here and are carrying on while I am gone.

Back in Deschapelles

Enjoying a beautiful morning that is rapidly getting warmer. Yesterday was the usual unending journey beginning with my alarm clock at 3:00 am and ending with arrival on Hospital Albert Schweitzer campus around 6 PM. More later when I can hopefully get Internet. On the iPhone for now.