tag:blogger.com,1999:blog-50076964180625206302024-03-12T16:20:06.302-07:00Haiti UpdateUnknownnoreply@blogger.comBlogger119125tag:blogger.com,1999:blog-5007696418062520630.post-84673468372602581942018-11-15T09:06:00.003-08:002018-11-15T09:06:59.207-08:00In Port au PrinceThe 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! Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-13041107896204667072018-11-13T14:10:00.000-08:002018-11-13T14:10:33.494-08:00Challenges on the campusThere 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 Many of the beds on the wards have been replaced by rolling stretchers.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 . . . .Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-70393594618303859872018-11-13T13:55:00.002-08:002018-11-13T13:55:33.116-08:00Chloroquine DreamsLast 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. Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-59245975095099150982018-11-12T14:30:00.000-08:002018-11-12T14:30:12.934-08:00Actually it was sleepIt 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. . .Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-32779073477402071832018-11-10T10:40:00.000-08:002018-11-10T10:40:11.301-08:00Enjoying a lazy SaturdayAfter 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. Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-84084547112147406902018-11-08T05:02:00.001-08:002018-11-08T05:02:34.989-08:00Off to the communityToday 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.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-19772425144572802712018-11-06T14:44:00.002-08:002018-11-06T14:44:47.874-08:00I could use some help out hereTo 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!Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-14469336056446528552018-11-05T15:36:00.000-08:002018-11-05T15:36:23.021-08:00A very successful meeting<div style="-webkit-text-stroke-color: rgb(0, 0, 0); -webkit-text-stroke-width: initial; font-family: "Helvetica Neue"; font-size: 11px; font-stretch: normal; line-height: normal;">
<span style="font-kerning: none;">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! </span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-42210467881328218362018-11-05T08:30:00.000-08:002018-11-05T08:30:34.909-08:00Haitians are incredibly strong
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<span class="s1">This morning we accompanied the Doctors and Physical Therapy Staff as they made patient rounds on the wards with the Surgery and Medicine patients.<span class="Apple-converted-space"> </span>As we did so, I am always struck by how incredibly strong the Haitian patients are compared to many of us in America.<span class="Apple-converted-space"> </span><b>WARNING:<span class="Apple-converted-space"> </span>IF YOU ARE NOT A HEALTH CARE PROFESSIONAL YOU MAY WANT TO STOP READNG NOW.<span class="Apple-converted-space"> </span></b> <u>The descriptions are somewhat graphic and are intended to resonate with my medical friends—</u>so much the same and so much different.<span class="Apple-converted-space"> </span>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.<span class="Apple-converted-space"> </span>The bandages had been “compromised” and I won’t describe the condition of her sheets.<span class="Apple-converted-space"> </span>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.<span class="Apple-converted-space"> </span>With the bandages off, the surgeon proceeded to sit her up on the side of the shaky rolling cart that served as her bed.<span class="Apple-converted-space"> </span>He then removed the tape from her nose and pulled out her NG tube.<span class="Apple-converted-space"> </span>I’m not sure why; perhaps to visually check if it was clear.<span class="Apple-converted-space"> </span>A few minutes later, he inserted it back into her nose again and taped it down.<span class="Apple-converted-space"> </span>After we left, her family came back and it looked like they were going to gather up the sheets.<span class="Apple-converted-space"> </span>I can only hope.<span class="Apple-converted-space"> </span>One bed over, another surgeon was using a razor blade to debride an ulcer over the trochanter.<span class="Apple-converted-space"> </span>He said the tissue was too necrotic to be sensate and this must have been true, as she didn’t flinch.<span class="Apple-converted-space"> </span>We looked at an open wound post guillotine AKA; it will need further surgery.<span class="Apple-converted-space"> </span>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.<span class="Apple-converted-space"> </span>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.<span class="Apple-converted-space"> </span>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.<span class="Apple-converted-space"> </span>Familiar but terrible decisions to have to make. <span class="Apple-converted-space"> </span>Finally we saw a patient in kidney failure.<span class="Apple-converted-space"> </span>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.<span class="Apple-converted-space"> </span>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.<span class="Apple-converted-space"> </span>She said that a few younger patients with no other complications did live briefly in stage IV.<span class="Apple-converted-space"> </span>Those with cardiac or other problems do not.<span class="Apple-converted-space"> </span>So much the same, especially with our unfunded patients at Parkland; so much different. <span class="Apple-converted-space"> </span></span></div>
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-81643633729795754452018-11-04T16:18:00.000-08:002018-11-04T16:18:59.163-08:00Roughing it a bit<style type="text/css">
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<span class="s1">Well, this trip brings a slightly different accommodation experience than the last few years.<span class="Apple-converted-space"> </span>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.<span class="Apple-converted-space"> </span>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.<span class="Apple-converted-space"> </span>In later years, Kay Alumni acquired a tank for the house.<span class="Apple-converted-space"> </span>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).<span class="Apple-converted-space"> </span>This trip we are in Kay 11.<span class="Apple-converted-space"> </span>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.<span class="Apple-converted-space"> </span>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.<span class="Apple-converted-space"> </span>Only catch—Kay 11 has no tank.<span class="Apple-converted-space"> </span>So we are back to 3 hours per day of water.<span class="Apple-converted-space"> </span>Right now we are cycling through the shower and filling the buckets.<span class="Apple-converted-space"> </span>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.)<span class="Apple-converted-space"> </span>We do have a refrigerator which keeps our beverages “coolish” but no gas for the stove and no coffee maker.<span class="Apple-converted-space"> </span>So we are alternating making early morning runs to Alumni for coffee.<span class="Apple-converted-space"> </span>Not exactly the Wild West, but another reminder of all the small comforts we enjoy 24/7/365 in the USA.<span class="Apple-converted-space"> </span>Sleep well. <span class="Apple-converted-space"> </span></span></div>
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-11723510060763635292018-11-04T05:31:00.002-08:002018-11-04T05:31:55.090-08:00Safe ArrivalYesterday 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.<br />
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-45316029117756958062018-11-02T09:16:00.001-07:002018-11-02T09:16:21.886-07:00Preparing, once againToday 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!Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-11900073204662837682017-10-23T14:56:00.000-07:002017-10-23T14:56:33.273-07:00Changed and the sameToday we spent much time catching up on all the changes at Hospital Albert Schweitzer. There is much construction going on with enlarged and improved areas for Emergency care and short overnight stays for those who present with problems that can be resolved without formal admission. New Haitian staff members have joined the team, as well as those who have been here for many years. The leadership, medical and support staff positions are increasingly held primarily by Haitians. <br />
As always we have been widely and warmly welcomed; always among the most gratifying of experiences for me.<br />
Always the same--the heat and the dust. Great billowing clouds of dust that blew through our vehicle last night as we made the trip here sans AC. <br />
The hospital is overflowing with children, almost half the space seems to be taken up by them. Infants, toddlers, kids seeking care and compassion. I have always thought that if you can walk by and not be moved by them, you probably need a heart transplant. <br />
Many changes, much the same. Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-85435277100012187672017-10-22T07:37:00.000-07:002017-10-22T07:37:53.925-07:00With thanks to my First Unitarian friendsWith deep thanks to many generous donors from The First Unitarian Church of Dallas, I am off to Haiti again. Thanks to you, patients will have their blood pressure measured accurately before seeing the doctor, germs won't stand a chance after surfaces are sprayed with a bottle of clorox solution, pillows will be easily wiped down between each patient in the PT Department. And my colleague and I from Health Volunteers Overseas will be able to hold a day long off site planning seminar with the entire staff of the PT Department, complete with delicious Haitian food, cold Coca-Cola, and some time to relax and play. We hope to spark their imagination to set their own goals for the future, not what we might want for them. Our goal is for the staff to take charge of their own destiny as Hospital Albert Schweitzer moves increasingly toward predominantly Haitian control. Being able to set up an entire planning day is a much appreciated gift, thanks to all of you. Enjoy the service this morning. I'll be in the air but thinking of you as you gather together. Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-86382696224724031032016-06-05T16:25:00.001-07:002016-06-05T16:25:43.691-07:00The last 3 postsThe previous 3 posts were 'cut and paste' copies of emails from 3 of the Rehabilitation Technicians who attended the 2 Saturday Seminars on stroke (CVA) that I taught on this visit to Haiti. These wonderful notes are the reason and the reward for going to Haiti. I am home. Thanks to all of you who have been following on this journey. Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-5007696418062520630.post-32867693828688996732016-06-05T16:18:00.003-07:002016-06-05T16:18:56.340-07:00A final email note from another Rehab TechDear teacher Judith , i cant imagine how you still sacrifice your life to help people in Haïti specialy the reabilitation techs in HAS ,i wanted to tell you ,in the exame : we havn't anything new ,only the techs supposed to read and understand befor giving anwer ,it was an easy exam .I think that you had good travel,thanks for your help and the time you spend ,we're watting you soon ,God bless you !!!!! And familiesUnknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-26239320228247573322016-06-05T16:17:00.001-07:002016-06-05T16:17:17.913-07:00Another email note from one of the TechsI'm happy about all your help in HAS.Thanks for teaching with us on CVA .Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-32870781638162592882016-06-05T16:14:00.003-07:002016-06-05T16:14:52.183-07:00From one of the Rehab Techs a few days after the 2 Saturday SeminarsHi my jyduth proffesseur, I'm happy to thank you for your successful learning, small gifts, I steep with my notes but I need to try harder, I know without doubt that you stay has a few days still in haiti, I think you're going to retoure Friday I already tell you good tripUnknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-5788844100195527742016-05-29T13:15:00.001-07:002016-05-29T13:15:47.653-07:00Who to help?Just a short walk around the area today brought me into contact with multiple people asking for help. Many of them have picked up my name. They tell me some scenario where they have interacted with me before; sometimes I remember. One man was caught up in his own story. He told me I had helped him when he was a child of 8. I asked him how old he was now, did the math and let him know that I had not been coming that long. It was not me. Who knows if some 'blan' did help him as a child. I have already purchased all the Haiti souvenirs I will ever need. So I have finally learned to say a firm no when asked about looking at paintings and other art to sell. Often the request changes to just give some "help." I tell them that I am here to help at the hospital. I am sorry but I can't help them today. As I walk away, most of them are still pleading . . . .Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-45505192023820065712016-05-29T07:27:00.000-07:002016-05-29T07:27:00.119-07:00There is progressPeople often ask me if I see any progress in Haiti, given the crushing problems that often dominate the news. Yes, there definitely IS progress. Many things are better here at Hospital Albert Schweitzer including their greatly expanded Physical Therapy services. The most enjoyable progress for me is easy internet access. I am spending Sunday morning enjoying one of my most favorite pastimes. Reading the New York Times online, especially the Magazine section. I've been at it for about 3 hours, with short breaks for various small tasks. More time than I would usually spend at home holding the actual newspaper in my hands. Ironically my stay in Haiti is showing me that I may be able to give up the newsprint version and go all electronic subscription. Not quite ready yet, especially when reading in bed where a glowing laptop slows, rather than hastens, sleep. Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-25912369930213407462016-05-27T16:48:00.001-07:002016-05-27T16:48:39.206-07:00Possibly flying home without benefit of American AirlinesNew post from the United States Embassy in Port-au-Prince: "The Embassy would like to inform U.S. Citizens that this weekend’s weather promises to be stormy and overcast, throughout the country. Temperatures will probably decline this Sunday, May 29. Forecasters are monitoring a disturbance that has a chance (approximately 70%) to become the second storm of the Atlantic hurricane season." It goes on to state, “Environmental conditions are expected to become more conducive to a tropical cyclone or subtropical by this Friday or Saturday, as the storm moves to the West-North-West or Northwest towards the southeast coast of the United States.” The drop in temperatures sounds good. The possible hurricane, not so much. So we'll see what blows through. Keep an eye out for me in the sky sans AA. Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-60330191623208896502016-05-26T07:06:00.002-07:002016-05-26T07:06:46.215-07:00Today is a Haitian HolidaySo I am enjoying a lazy morning. We had a wonderful crashing tropical storm last night just at dark that cooled off the air for the entire night; great sleeping. At 10:00 the 2 Physical Therapists at Hospital Albert Schweitzer have asked to meet with me to work on their new stroke evaluation form. This is their day off!!! Would you agree to go in to work on your day off to complete a project with a visiting guest??? Just something to think about if you ever go to a place far away to offer your help and expertise. Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-78163389448077740982016-05-24T16:45:00.000-07:002016-05-24T16:45:17.658-07:00This one is for my Parkland colleaguesSo this afternoon, I was invited to work with a stroke patient along with the Department Director. We were going to complete an evaluation together. But the Director had a sudden burst of activity to take care of. We started working together, then she was called away for a 'minute' which stretched into a much longer time. The sweet older lady waited patiently until I finally decided that I needed to just move ahead with the treatment. I finished up what the Director had started, then did some walking and realized the patient needed work on balance. So I did a FULL BERG BALANCE TEST--my first complete one in Haiti! My colleagues at Parkland are rolling their eyes far back in their head. Tomorrow, who knows? Maybe a Fugl-Meyer?? Some things never change. Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-5007696418062520630.post-43682893666691427942016-05-24T16:39:00.000-07:002016-05-24T16:39:01.290-07:00Thousands of small decisionsAs I went through the day today, it struck me how many decisions there are to make from moment to moment. I am here to teach and leave knowledge behind. The formal Seminars are the easiest. Then it is clearly my job to present and draw the listeners into the material to examine it and learn (rather than memorize). But the clinical teaching is harder. When to offer a suggestion; when to stay silent. How hard to push to help with the work load. How much to just let the day flow and wait to be given an invitation to join in. Keep me in your thoughts and thanks to all who have written. Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-5007696418062520630.post-11403798046147052872016-05-23T17:41:00.000-07:002016-05-23T17:41:26.193-07:00Hot and happyThat pretty well sums up the morning. The 7:00 AM conference featured a presentation by a visiting MD on surgical transplants. It seemed to me like an unlikely topic in a place that does not do them, but it was quite interesting and garnered a number of questions from the staff. The speaker gave a history of transplantation reminding us that the first step in the process was actually blood transfusions. Hospital Albert Schweitzer does, of course, do blood transfusions, so this was a very good way to make the connection to a topic that might otherwise seem far removed. From conference we moved to morning rounds, then to the Physical Therapy Department to see patients. I was most happy to be assigned the task of mentoring 3 of the Techs on the treatment of 3 different stroke patients. This was an excellent follow-up to the Saturday seminar, and exactly the patient population that I enjoy working with the most. I was definitely hot and happy. I lingered so long with 2 of the patients that the Techs fell a little behind in the morning schedule. So the Director asked me to see one of her patients as the place was overflowing with people. It was a very interesting case that I can best describe as antalgic posture due to an external injury to the hip when a wall fell on the patient. She came in via wheelchair leaning far to one side on the uninjured hip. After some strong words from the Physical Therapy Director, a little exercise and some coaching, she eventually walked out on crutches. I'm not quite sure that is quite what the patient expected to happen this morning in Physical Therapy, but it was a good outcome. The afternoon was more mellow and slow and featured a wonderful tropical rainstorm that ended and has now started up again. Perfect for sleeping which I will undertake quite soon. Good night!Unknownnoreply@blogger.com0