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!

Changed and the same

Today 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.
As always we have been widely and warmly welcomed; always among the most gratifying of experiences for me.
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.
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.
Many changes, much the same.

With thanks to my First Unitarian friends

With 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.