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.

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.

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.

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.

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: JudithHembree@earthlink.net 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.