In Port au Prince

The car arrived at 5:00 AM this morning to bring us in to Port au Prince.  After a bone jarring ride, with fortunately only a couple of major traffic jams, we made it and I am in a hotel for the night.  The hospital brought us to Port a day early as the State Department has sent out warnings about possible mass demonstrations this weekend.  They wanted us out of the country by then.  So I should be home tomorrow barring any last minute blockades immediately outside the airport.  I am very close, so fingers crossed.  See you soon!

Challenges on the campus

There are always challenges, even as HAS moves slowly forward over time.  X-rays are now viewed on line on computers mounted on the wall.  No more bulky films to post on a lighted box.  This morning, though, the system was down so we did not get to view X-rays on rounds.  Many of the beds on the wards have been replaced by rolling stretchers.  There have never been electric beds; these are far too difficult to maintain.  But the old metal beds with the metal bar that allows you to raise the head of the bed like a pool lounge chair were quite serviceable. It is unclear where many of them have gone; perhaps finally worn out after 60 years of use.  The rolling carts all have side rails for safety as they are designed for patient transport from one area to another.  Unfortunately, many of those side rails are long stuck in the upright position.  This means that the only way someone can enter or exit the bed is at the foot of the cart.  Even when the side rails go down, it is still quite a drop to the floor for someone standing up for the first time after surgery or on crutches.  Our rehab staff have complained about this, as it is make harder to mobilize people out of bed.  And prolonged time in bed brings a host of complications.  And so it goes . . . .

Chloroquine Dreams

Last night brought vivid chloroquine dreams.  I always take chloroquine for prevention of malaria starting a few weeks before, during and after returning from Haiti.  One of the side effects of Chloroquine is hallucinations.  In milder form, this manifests a vivid dreams.  Several other people that I have met here have remarked on this effect.  Or my synapses may just all be melting in the heat.

Actually it was sleep

It is always amazing to me that the Haitian patients are able to sleep in the hospital.  It is hot. The ceiling fans give little relief. It is crowded, especially in the Observation Ward where this incident occurred. You can barely squeeze in between the rolling carts that serve as beds. It is always noisy. So—the medical team approached an older man, spoke to him and touched him. No response. Thinking that he might be a stroke patient that we would be treating later, I gave him a light sternal rub. His eyes flew open and he awoke with a start. Actually it was sleep. . .

Enjoying a lazy Saturday

After sleeping in incredibly late until 6:20 AM, I rolled out of bed.  It was still reasonably cool.  We made our own breakfast, something that we can do in this old house with only 3 of us (see earlier post on 'Roughing It').  We had fresh bread that we picked up yesterday from a boulangerie on the way home from Liancourt.  It was hot and fresh and we enjoyed a helping yesterday the minute we got back to the house.   In Kay Alumni where we usually stay, the Haitian staff make all the meals for up to 10 or more people.  We eat lunch and dinner there.  The food is simple but plentiful and there is always a tiny bit of guilt in my head about eating comfortably in a country with so much food insecurity and so many hungry people.  There is a 4th Health Volunteers Overseas person on campus right now.  She is an OB-Gyn who has worked in many places in the developing world.  We have had long discussions with her about Hospital Albert Schweitzer and similar places in the world.  The native and foreign people that you meet and interact with here are one of the most intriguing aspects of the trip.  We took a walk down the "corridor" (main drag) and campus late this morning and I was drenched in sweat by the time we finished.  It is hot and still; tropical heat.  Don't be too alarmed by the State Department warnings if you are reading them.  All is quiet out here in the country.  I'll see you in a week.

Off to the community

Today we will go to a community clinic in a small town near here (Liancourt). From there we will spend the day walking to patient homes. This is the heart of Haiti, seeing patients in the reality of their own homes. Have a good day and remember that you will spend tonight in a “palace” compared to so much of the world.

I could use some help out here

To all of my younger colleagues--I could use some help out here.  There are so many needs for education and you have the energy, skills and youth that are fast fading (or gone) for me!  Yes, you do have to use your vacation time and pay your own way.  It is expensive.  It is also one of the most incredible things that you could choose to do.  Tired of what feels like the rat race at work?  Try doing it in 90 degree heat with no running water in your house when you come home to shower.  Think our unfunded patients are difficult to set goals for?  Try thinking about gait training for someone who walks down the mountain on something more like a goat trail than a path to get to the hospital.  Or ADL evaluation for someone who scrubs their own clothing clean in a bucket of cold water and cooks over an open fire.   I always call Haiti my "gratitude fix."  I come back with renewed awareness of all the little and big things that we take for granted every day.  I am definitely not a better person than any of you.  You all contribute to the human race in ways large and small.  I just want to invite you to try doing it HERE or any of the many other places in the world that Health Volunteers Overseas (HVOusa.org) serves.  Whatever your interests, someone needs your help.  Someone who doesn't have anyone else to do it.   If not us, who?  If not now, when?  Think about it!

A very successful meeting

After morning in the hospital, we spent the afternoon sharing a meal and meeting with all the Rehabilitation Technicians in the Physical Therapy Department.  All of these wonderful young people attended one of the 9 month programs to train Rehab Techs that Health Volunteers Overseas and Hospital Albert Schweitzer sponsored in 2009, 2010 and 2011.  I had all of them as students.  Once again, today, I was amazed by their insight into their work and their dedication to using the skills that they learned.  They are essentially high school graduates with vocational training to do their work.  Just a little education can change people so much.  Why can’t we remember this in the USA as we argue about opportunity for all!  

Haitians are incredibly strong

This morning we accompanied the Doctors and Physical Therapy Staff as they made patient rounds on the wards with the Surgery and Medicine patients.  As we did so, I am always struck by how incredibly strong the Haitian patients are compared to many of us in America.  WARNING:  IF YOU ARE NOT A HEALTH CARE PROFESSIONAL YOU MAY WANT TO STOP READNG NOW.  The descriptions are somewhat graphic and are intended to resonate with my medical friends—so much the same and so much different.  I watched as a surgeon pulled the bandages off a patient with an open colostomy put in place after discovering a tumor in her abdomen during surgery.  The bandages had been “compromised” and I won’t describe the condition of her sheets.  These will be washed later by her family in the courtyard outside the hospital using cold water and scrubbing them by hand with soap; patients bring their own sheets.  With the bandages off, the surgeon proceeded to sit her up on the side of the shaky rolling cart that served as her bed.  He then removed the tape from her nose and pulled out her NG tube.  I’m not sure why; perhaps to visually check if it was clear.  A few minutes later, he inserted it back into her nose again and taped it down.  After we left, her family came back and it looked like they were going to gather up the sheets.  I can only hope.  One bed over, another surgeon was using a razor blade to debride an ulcer over the trochanter.  He said the tissue was too necrotic to be sensate and this must have been true, as she didn’t flinch.  We looked at an open wound post guillotine AKA; it will need further surgery.  The Haitian Physical Therapist argued for going ahead with a hip disarticulation, as the residual limb would be so short that fitting a prosthesis would be almost impossible.  Given that the other limb is cool to the touch, ambulation for the patient is probably unlikely so he may be better off with a short femur to help with sitting balance.  However, leaving a short femur may lead to a wound that won’t heal, eventually necessitating a hip disartic, so it may be best to limit the number of potential surgeries from the start.  Familiar but terrible decisions to have to make.   Finally we saw a patient in kidney failure.  Dialysis is only available in Port au Prince (and maybe a couple of other places, but not here) and the cost is far, far beyond what most Haitians can afford.  So I asked one of the visiting young MDs if many Haitian patients lived to Stage IV kidney failure where dialysis is the only way to survive or if they succumbed in stage II or III.  She said that a few younger patients with no other complications did live briefly in stage IV.  Those with cardiac or other problems do not.  So much the same, especially with our unfunded patients at Parkland; so much different.  

Roughing it a bit

Well, this trip brings a slightly different accommodation experience than the last few years.  For many years now, we have stayed in Kay (House) Alumni which was built in the early 2000’s for guests on campus. In my first few years here, most houses on campus had water for only 3 hours a day—6:00 to 7:00 AM, Noon to 1:00 PM and 6:00 to 7:00 PM.  We alternated taking showers and filled up buckets to be able to—no other way to put it—flush in the intervening time when needed.  In later years, Kay Alumni acquired a tank for the house.  The tank fills with water during the 3 hours that water is available on campus so that there is a supply of running water 24 hours a day (unless the house is very full and everyone goes crazy taking a shower outside the 3 hour windows).  This trip we are in Kay 11.  This is a wonderful old house, one of the original ones on campus built by the Standard Fruit Company many years before the hospital existed.  There are 3 of us here from Health Volunteers Overseas and we asked to be in this house so that we could have more space and quiet to work with the Haitian staff for meetings and planning, and for a meal or two.  Only catch—Kay 11 has no tank.  So we are back to 3 hours per day of water.  Right now we are cycling through the shower and filling the buckets.  We are eating our meals in Alumni House, so there are few dishes to wash, but the few we have are much more easily done when the water is running. (Leaving them dirty risks more bugs.)  We do have a refrigerator which keeps our beverages “coolish” but no gas for the stove and no coffee maker.  So we are alternating making early morning runs to Alumni for coffee.  Not exactly the Wild West, but another reminder of all the small comforts we enjoy 24/7/365 in the USA.  Sleep well.  

Safe Arrival

Yesterday brought a metaphorical smooth journey to HAS, once again.  I say metaphorical because the final portion over land from the airport in Port au Prince to the hospital was anything but smooth!  The last leg of the journey from St. Marc to Deschapelles seemed to be one unending pothole.  It is the end of the rainy season and it seems to have been extra hard on the roadway this year.  No sign of the problems in Port that the State Department has been posting almost every day.  Ten hours sleep as we "fell back" along with everyone else; much needed after 3:30 AM arrival of Uber yesterday.  More later.

Preparing, once again

Today marks final preparations before Uber arrives tomorrow morning at 3:30 AM to take me to DFW for a 5:00 AM flight.  The ultra early flight was the only way to catch a connection that gets me to Haiti in time to make the long drive to Hospital Albert Schweitzer (HAS) in Deschapelles before dark.  There has been some unrest in Port au Prince relating to increased taxes on gasoline.  We may have to take some detours along the way to get to the coastal highway that takes us out of town.  We will have an experienced Haitian driver from HAS, so I anticipate that the worst case scenario will be some delays.  Keep me in your thoughts and prayers please!