Sunday, November 7, 2010

The Journey Home

The Journey Home

It was difficult to sleep Monday night. I had a fun evening with Shar and Vern reminiscing about our time in Haiti. Vern will remain in Haiti two more weeks and then the Hanger Clinic will close down over the holidays. The technicians will remain. After the first of the year, the Hanger prosthetists will return with a head prosthetist remaining for 3 months at a time while others rotate through for two weeks of service. Shar will remain until Sunday when she will return to northern California. It will be a tricky road home for Shar as she must dodge Hurricane Tomas . . .

Nevertheless, it was difficult to sleep Monday night with the wonderful memories of my time in Haiti racing through my head. The thought of the two and a half hour drive to Port Au Prince was enough to make me wonder if I would safely arrive at the airport in time. The trip can take 2.5 – 3 hours or more depending on weather and road conditions. I woke up at 4:00 am and pulled a few things together. The van arrived at 6:00 as we left Dechapelles with a car load of folks from Dechapelles who had business in Port Au Prince. The sun was barely up and we were off. It wasn’t dark so the driving was fine. The only challenge we had was the glare of the sun as we headed eastward down the mountain.

Just after passing through the neighboring town of Verette, we noticed the road was clogged with people. On the right hand side of the road and ditch, we could see a horrible scene. A tap tap had just overturned and was lying on its right side. There were people, chickens, bags of rice, and other things strewn about. Fortunately, no one was seriously hurt. People at the scene appeared to have things under control so our driver proceeded around the scene. A patient in the cholera ward once told us that to be well in Haiti you need medicine and God! How true. A safe tap tap and driver are also a must! A quick prayer was said for those on the road and for our continued safety on our journey to Port Au Prince. The rest of the trip was uneventful but beautiful as we continued to watch the sun rise and enjoyed the beautiful mountainous scenery. The road down into Port Au Prince was spectacular as we saw mist rise from the huge salt water lake and the vision of Port Au Prince in the distance.

As we drove into Port Au Prince, the city and people were coming back to life. People, cars, and tap taps were everywhere. We made several stops to pick up or drop off items or people. Finally, the driver and I were the only ones left in the van and we were on our way to the airport. I had plenty of time before my plane would leave! I reached the airport around 8:30 and was able to enjoy some last minute sunshine and live music from an area across from the airport. I waited in line at American Airlines, checked in for my flight, and was ready to cross over through immigration when my friend Giulio arrived to say goodbye. Giulio is a member of the Italian Carabinieri peace keeping forces here in Haiti. He has been stationed in Haiti for the last year and will be heading to Kenya in January or February. It was fun to visit and see each other even if it was for a short time. We had hoped to get together a couple of times but a huge mountain range, limited transportation, and a cholera outbreak prevented any other visits! The airport visits at the beginning and end of this trip were short but fun. Then it was time to go . . .

Although it is wonderful to return home, it is always hard to leave Haiti because of the beautiful people and friendships that are made here. I will miss the goats and roosters outside my window, the beauty of the mountain top, the moon and the stars at night, and most of all the wonderful people I was able to meet and work with during my time in Dechapelles and Haiti. A huge piece of my heart will always remain in Haiti! It is true. My suitcase will be heavy as one of my patients had previously warned me and that is just fine. I am carrying home the hearts of my patients and the people I had the privilege to meet and work with once again. I have been able to serve and be served by amazing and brilliant people here in Haiti. These souls are a bright light over Haiti – like the sun, the moon, and the stars. We are all made better – like a light filling a house - because of the challenges we face and encounters we experience working together with each other.

Piti piti plen kay: A little lamp (or light) can fill the whole house.

Monday: Last Day at Hanger Klinik

My Last Day at the Clinic

Monday was my last day at the clinic and we were very busy with the car load from Catholic Medical Missions Board from Port Au Prince. Cennix arrived with about eight patients. We organized who was who and what their needs were. We had one new patient, Chery, the futbol (soccer) player on the Zaryen (Tarantula) soccer team in Port Au Prince that my friends Cedieu and Wilfrid started. Chery would be getting his leg fit. We had casted him last Wednesday. The other patients needed various adjustments so Vern was a busy prosthetist. We decided to start with a group class on the basics of wearing a prosthetic leg, wearing schedule, and other important things. We then worked with the patients to see how each adjustment would affect the patient’s gait. We had great fun!

Monday and Tuesday of this week are actually holidays here in Haiti so we had a skeleton staff with Vern being the only prosthetist. Miriam was on duty as security guard. Shar and I were the PTs on duty. In the afternoon each of the prosthetic technicians and Rosaline, our office coordinator, all stopped by to wish me safe travels on Tuesday. Miriam was too sad to stay and say, “Goodbye.” Instead she told Rosaline to tell me she not to forget her and that she will see me in April. The team all shared with me how wonderful it was to work together. Rosaline told me how I brought hope to many people here and showed them there is a light over Haiti. She, like my dear friend Cedieu at Medishare told me that those who come to Haiti to help people rebuild their lives are like a great light over Haiti. There were many hugs and I was told I am expected back in April!

Later Monday night, Rosaline stopped by with a gift of hand woven placemats that she had made and painted. She even included the pistachio shells from the bag I brought for everyone to share earlier in the week! Nothing is wasted here in Haiti. It was a very fun last day at work. I especially like Clair’s words from the South Africans of never saying goodbye. Instead, people say, “I see you just now!” May our paths cross again!

A Hike to Sacred Ground & Then Coffee

Sunday: Hike to Two Trees and Coffee with Ian

We woke at 4:30 am today to get ready to hike up the mountain again to the sacred place called Two Trees. The nurses, Shar, and Brandon the photographer with Project Hope and I made our way up the mountain in the dark. It was not easy as there were several paths to choose from, but we found our way after I chatted with a couple of Haitian nurses going home after their night shift. We followed the path up the mountain until there was a woman walking barefoot up the mountain with a water jug on her head. I felt a bit like the blind leading the blind as it was only my second time up to this spot. This woman with the water jug would walk then wait momentarily to be sure I knew which way to go. At the top she wanted me to take her picture and simply show her the photo on my camera. She then set the jug of water down and began her prayer ritual of greeting the four corners of the earth. She recited her prayers and sang. It was definitely a sacred moment.

There was a huge misty cloud hanging over the valley this week which made it difficult to see the entire Artibonite River. Nevertheless it was beautiful. The sun finally peaked its head out around the eastern mountains and greeted the cusp of a moon that remained momentarily in the sky. The colors were spectacular – pinks, purples, blues, and grays mixed with the white clouds over the green valley. Breathtaking! There was not as much activity at the community well this week so we made our way down without the many kids who had joined us the week before. We made it home in time for a breakfast of pancakes, fruit, and coffee. Then it was time for a quick shower which was occupied by three of the Haitian nurses so a quick dip in the pool had to suffice.

Then only other pressing agenda item was a date for coffee with Ian at 7:30 am at the Mellon home. We were changed and began our 10 minute hike down the mountain on the other side of the hospital to the Mellon home. Ian greeted us and we had coffee on the veranda. He had a great deal going on with the second in command from the CDC at his house. Nevertheless, Ian made time for us. He told stories about his family and how he had been one of Paul Farmer’s teachers at the University. Then we had a tour of the Mellon family garden. Levi was a Haitian man who grew up with Ian here in Haiti. Levi is an agricultural specialist. He has transformed the limestone hills surrounding the Mellon home into an organic and lush garden. His garden is based on the terracing principal of three levels of plants and trees specifically designed to create shade and nutrients for each other. Levi creates cutting and grafts of plants for other Haitian to plant at their homes. The garden was spectacular. We were then shown the meditation spot which served as the final resting place for Dr. Larimer and Gwen Mellon, Ian’s mother and step father. It was a very special moment to be shown this part of the garden and to hear the wonderful stories Ian shared with us. Shar and I were each given 2 grapefruits by Levi. We thanked Levi for his gift of the grapefruit and more importantly for his gift to the people of Haiti for his agricultural talents.

We had a mellow rest of the day by the pool. I was able to finish reading the book, The Girl with the Dragon Tattoo, and then caught up on some limited email. I will begin to pack tonight as tomorrow is jammed with patients. I hope to also get in one more swim under the moon! A team from Bangladesh has arrived so life continues to be very interesting!

Tim Timly's Tap Tap

Saturday: A Private Tap Tap Ride to St. Marc

Saturday was our trip to St. Marc. We loaded the private tap tap rented by Vern the head prosthetist. Tim Timly was our driver. Jill, Jane, Joyce, Alysia, Nora, Emily, Paul, Vern, Janet, Shar, and I boarded the tap tap which was more like an open truck with seats on top of the cabin and along the sides of the truck bed. We were off with the wind blowing through our hair and the sun beating down on us. After about a 40 minute ride we were in St. Marc. We were able to see the beach there and it is little wonder why there is cholera in the region. Nevertheless, we tried to take pictures despite the great amount of garbage and raw sewage dumping into the ocean. We bought some stables which for me was coffee to bring back home. Then we had lunch at the Deli Mart. Shar & I were living dangerously and ordered a Presidente! We felt a bit like traitors, but enjoyed the beer anyway! We ordered cheeseburgers and fries. The burgers came without cheese. The chocolate cake we had for dessert was stale but it was chocolate! Then we all piled back into the tap tap for the return trip. Just as we arrived home Tim Timly’s tap tap had a flat tire! Luckily we were home. Then it was off to the pool for a relaxing swim. Dinner and a short visit to the prosthetists’ house was how Shar and I capped off our evening. Janet, Vern’s wife and Paul the prosthetist were leaving at 4:00 am so we stopped by to wish them well. All in all a great day!

Gait Training in Haiti - A Great Friday!

A Great Friday: Gait Training in Haiti!

Today we were expecting only about two of our patients to return to the clinic as many had been sent home due to the cholera outbreak. We were pleasantly surprised as a van pulled up with two boys from an orphanage in a neighboring town arrived with Ann their caretaker. One of the boys was 6 and the other 16. The 6 year old had to relearn how to get his prosthetic heel down first and then keep his knee straight when he walked after some adjustments. He was a quick study. The other young man had a PFFD situation of some sort where he had one regular sized leg and one mini leg. This challenge did not bother him, but without prosthesis, he would suffer terrible hip and back pain. His prosthesis looked like a there were two feet in bunk bed position. Cosmetically it looked odd, but could easily be covered by pants. Functionally, there was no stopping this kid! His adjustments involved enlarging the top foot to accommodate for his growth since last April. He also needed inches added to his pylon as he had grown taller overall since last spring. The next thing we knew a man arrived on his horse for an adjustment which involved re-gluing his cover. This man’s goal was to be able to walk up the mountain to his house – typical gait training here in Haiti!

After we organized everyone and were sure they were safe on level surfaces, we were off in mass to the tennis courts where we were able to practice gait on the lines, sidestep, tandem walk, retro walk, then run, then walk on the wall around the tennis courts, over the tennis net, and under it. We played follow the leader with close corner turns. It was an exciting and fun time. Several other patients also showed up making for a fun morning.

After lunch things were pretty slow. I was able to have a Creole lesson with some of the lab workers, check email, and go for a swim. It was a great end to a wonderful week.

The nurses from Mass General are working hard in the hospital. The Haitian nurses I live with are now catching onto the fact that we need to fill the rain barrel between 6:00 – 7:00 am and pm if we all want water for showers. Nevertheless, it is great to jump in the pool at the end of the day! Tomorrow our adventure to St. Marc begins at 10:00 with the prosthetists.

The UN Helicopter

The UN Helicopter

Today Jo (a long-term PT here from England) was able to celebrate huge victory as the UN helicopter came to pick up three of the patients with spinal cord injuries here at Hopital Albert Schweitzer. The patients were being transferred to St. Boniface in southern Haiti where there is a rehabilitation center for folks with spinal cord injuries. We were all waiting for the sound of the helicopter which came around 9:30 am. It was an amazing site as we heard the hum of the chopper blades as the UN helicopter began to descend onto the precise coordinates of our soccer field.

Jo had worked so hard to confirm the coordinates with the Germans who were the last group to land a helicopter here. People from all over our compound and beyond ran to see what the excitement was all about. Suddenly a brown cloud of dust engulfed us all as the helicopter gracefully settled on the soccer field. It was a beautiful machine. The rear doors were opened and patients were transferred from the open bed trucks onto the helicopter. It was beautifully coordinated.

We even had time to take pictures and meet the pilots, Alexander and Vladimir, who were from Russia. Alexander was recently in Afghanistan and was now sent to Haiti for a “vacation” job. Vladimir will be taking over Alexander’s position in a month. The pilots were very proud of their work and pleased to be in the service of humanity. Had a blast practicing what little Russian I knew from my PT work back home. Once the patients, wheelchairs, and other equipment were loaded, Jo jumped in to care for the patients and they were all off! As fast as they had come, they were just as rapidly on their way to St. Boniface! An amazing morning for sure! For patients who have spinal cord injuries, life becomes a death sentence as there are only two rehabilitation centers in all of Haiti – IF you can gain access. What an amazing gift of advocacy Jo has given these patients. The rest of our day was spent working with patients on gait training in the prosthetics center. An awesome day altogether! Today was about providing others with the gift of hope. From the valiant coordination efforts of Jo to our Dream Team here in the Hanger clinic we bring hope to others. It is hope that makes us live, just as the Haitian proverb states: Lespwa fe viv.

Clinic Under the Mango Tree

Wednesday: Trip to Port Au Prince

Wednesday morning bright and early we met at the prosthetists’ house for our trip to Port Au Prince to do some castings at the Catholic Medical Missions Board Orphanage called New Life. Vern (head prosthetist), Paul, Clair, Evinor (our translator), Jaffar (our driver), and I were off for the three hour ride down the mountain to Port Au Prince. Once in Port Au Prince we wound our way through skinny back roads that resembled muddy alley ways surrounded by high walls. Somehow Jaffar knew exactly where to go. Once we arrived, we learned we would be working under a beautifully full mango tree. It was shady, cool, and lovely. We had the possibility of doing five to seven patient castings but only two patients showed up. I also worked with a small boy who had CP.

I had brought the medical dictionary with me in the off chance that I could find someone going to Medishare to deliver it to my friend Cedieu. Cedieu is the prosthetic technician who works at Medishare. He also works as a PT technician and is so hungry to learn. He had asked me to bring the dictionary down for him. In his down time, Cedieu coaches a soccer team of men who are amputees called the Zaryen or the Tarantulas. Unfortunately, I had no way to get to Medishare. I called him and he asked permission to come to our center to pick up the dictionary but was told he must stay at Medishare to work.

One of the patients we were casting looked vaguely familiar. He was quite an athletic looking young man. As he was being casted Clair told him he must come to Dechapelles to be fit for his leg on a Monday or a Thursday. The patient said he cannot come on Thursdays, Fridays, and Saturdays. Clair thought this was an odd schedule to have for work. She asked him what kind of work he did on those days. The patient replied that it was not work he was doing but his soccer practice with the Zaryen (Tarantula) Soccer Team! He was NOT going to miss his soccer practice for anything! Aha! I had seen his picture! He knew Cedieu! He agreed to take the medical dictionary to Cedieu. I thought he would do on it Thursday for soccer practice. Within an hour after the patient left our mango tree clinic, I received a call from Cedieu thanking me profusely for the dictionary. Our patient had a mission and had gone directly to Project Medishare to deliver my dictionary to Cedieu! What an amazing coincidence! Being in Haiti can seem so isolated at times and yet we can also feel so connected.

Since we were done early, we were faced with a 3 hour ride back to Dechapelles without lunch. I had mentioned to the group that we are so close to the MINUSTAH Deck Bar & Grill – we should stop there for lunch. Tales of burgers and fries were enticing. We found directions and were off to the UN. The Deck is entirely a different place at noon compared to the more laid back dinner club of my Medishare days. Today the Deck was packed full of people from all over the world in their uniforms, speaking many different languages. It made for great people watching! I began to wonder why everyone was there and what stories they might share. Someday an ethnographic study of the Deck would be so interesting! My Italian friends were busy driving ambulances and were unable to join us for lunch. It was just not the same place without Giulio and Paolo! Then on our way out of Port Au Prince, we stopped at a supermarket to get Clair’s “rhum” - 5 Star – the best in Haiti. We made it back to Dechapelles to jump in the pool just before dinner.

Clair and I visited the prosthetists for her last night in Dechapelles. We did not want to say goodbye, so we resorted to the South African phrase of “I see you just now,” to mean that we hope our paths will cross again! We hope to see each other in Amsterdam for the World Confederation of Physical Therapy conference in June! We spent the night star gazing and then Clair was off in the morning at 4:00 am for her 25 hour journey back to Scotland. I am now living with 6 Haitian nurses in our Kay Dunn #11 house. There will be another physician joining our group tonight. We also have a team of nurses from Mass General Hospital here to assist with the cholera patients. The numbers of patients with cholera are dwindling and the folks from CDC are here investigating possible causes of the outbreak. They have narrowed things down to the possibility of eating seafood from the rivers and the possible bad water source. They will continue to investigate the stories of people with and without cholera to see if they can pinpoint the root cause. Many here simply say, “Don’t eat from the same area where you pee or poop!”

Our translator shared with us that many people from his community thought the cholera outbreak may have been caused by the Blancs. They felt the Blancs may have come and poisoned the water to kill off the Haitian people. The Haitian people had once used that tactic to chase the French colonizers away from Haiti. Now the Haitians feared this cholera outbreak was payback. Our translator told members in his community that the Blancs have come to help not hurt the Haitian people.

A Tarantula in the Shower!

Tuesday Morning: Selfish but Fit!

This morning at 4:00 am I went into the bathroom only to find a huge tarantula in our shower! Yikes! “Bon Noir,” I told it! “Souple leave before 6:00 am!” At 5:30 am it was still lingering in the shower! They say you can shower with tarantulas because they are afraid of the water. Instead of a shower, I decided it would be better to take a very early swim under the moon and watch the sun rise. It was a cool morning for Haiti but lovely for a Minnesota gal. The water was clear as glass. I entered the pool under the almond tree. As I swam there was steam rising from the water. The moon was in the western sky and the sun began to make its majestic appearance in the eastern sky. The final glow of the moon through the almond tree was beautiful as I snuck one last glance at the moon. Swimming laps this morning was much better than sharing the shower with my friend the tarantula! Face it - I can be selfish at times! Although there is controversy as to whether or not bug nets are effective for the prevention of malaria, I love the safe little space it creates around me as I sleep!

Our team has changed a bit with Luke and others from last week returning home. Sharryn is the new PT from California who has joined us. Clair leaves Thursday morning.

A Good Day in Haiti

Saturday and Sunday: What is a Good Day in Haiti?

The weekend was a mixture of relaxation and hard work. It was a time to do laundry, to nurse Clair back to health, and to assist in the hospital. There was no prosthetics clinic on Saturday as we sent patients back to Port Au Prince. We have one patient returning on Monday that we know of for sure. Many people continue to arrive each day at the hospital being carried in by family members. Although there is a steady stream, it seems more manageable now. Perhaps we are just getting used to the many needs. Nevertheless, we continue to see patients get better. I even manage to use my Spanish skills from time to time. One patient today was a pregnant woman who complained of terrible toe and leg cramps and a headache. We chatted in Spanish. I taught her some stretches and low trunk rotations to relieve her pain, explaining the pain was like a crying and hungry baby. Using small rotations of her bent knees, she could diminish the pain. She must also drink the rehydration solution which will prevent any muscle cramps and headaches. She said she is due to deliver her baby any day. She then let me feel her baby move. An amazing gift.

My Creole is continuing to improve as well. I do get a certain bye being a Blanc. We make sure IVs are running properly, that patients understand that drinking is important even if they tend to vomit at first. Vomiting does not mean the water is bad – just that their systems have been infected by the bugs from the river water. The patients fear the leg and foot cramps and headaches of dehydration. It is when we help them understand the connection between dehydration and those symptoms; they then begin to buy into the importance of drinking. It is truly amazing to see so many souls on the brink of death eventually sitting upright the next day beginning to return to their reality of life.

One patient from the other day could not be found. Debbie and I did not know where he was. We wondered if he had passed. Preparing ourselves for the idea that death is a part of a cholera epidemic, we were pleasantly surprised to find the man had been moved to the recovery wing of the hospital. He was sitting up chatting and smiling. Now this is a good day in Haiti!

A Hike to Sacred Ground

Saturday Morning: Up the Mountain to Two Trees

The prosthetic and physical therapy teams decided we would hike up the mountain to watch the sun rise today. This task involves waking up quite early so we can be on the road by 5:00 am. We met up at the prosthetists’ house and began climbing the mountain. We kept climbing and climbing! It was dark so flashlights were a must. It also appeared to be rush hour as many people were heading up to the well to get their daily supply of water and a bath in. The well had a pump and was the center of community life as folks gathered to visit, bathe, or collect water. Children and adults alike were everywhere. We had not even completed a third of the trek yet! As we continued onward, more and more barefoot kids joined our group.

The footing is extremely rocky, steep, and slippery. Nevertheless we forged ahead. As we reached higher spots, we would pause momentarily to catch our breath and let our screaming thighs calm down. Although there are many paths up the mountain, it was comforting to know that we were in a group and would not let each other get lost. The local children seemed to know the routine quite well and happily guided us up the mountain. When we reached the top, we could see the entire Artibonite Valley in front of us. There were mountains surrounding it on all sides with a muddy looking river meandering its way through the green valley. Far below was the water tower of HAS. We stood in awe of the raw beauty before us. The full moon in the western sky was still hanging around, a bit sheepish to give way to the sun. A mist on the valley becoming visible below made it clear the sun would soon be banishing the moon from the heavens. The two would both be present together for only a moment in the sky before the moon would have to leave its place in the sky and tuck behind the western mountains.

We learned that this place called Two Trees is sacred ground. People come here each morning to pray and sing praises to God. (There has also been much similar singing at night which we can hear as we lie in our beds since the cholera outbreak.) The singing of a couple of ladies added to the ambiance of the moment. Haiti - beautifully difficult.

Suddenly, at 6:00 am on the dot, the sun began to peek through the distant mountains. Shades of purple, browns, and greens of the mountains gave way to the bright orange fire ball of the sun. Slowly the sun began to show it face with exquisite glory. The views were spectacular. We continued to remain in this sacred spot enjoying the view, the time, and each other. The children from the villages below continued to entertain us and wanted many pictures to be taken. Then reality hit us and we had to come down from the steep mountain. Two of the young teenage girls each took one of my hands and walked me down the steep rugged mountain paths. It was nice to have the company of these girls for balance but it turned out they were using me for balance as well! They removed their fancy sandals for the decent and preferred traversing the rugged slopes barefoot. For me, Keens rock!

Cholera Outbrreak Confirmed

A Cholera Outbreak for Sure: Dye Mon, Gen Mon

Yesterday afternoon we learned that the US State Department is now on the ground in Port Au Prince. Anytime there is a possibility of an epidemic anywhere near the US – the State Department sends troops in to help control the flow of traffic and restrict movement back to the US. There are rumors that the main road to the Artibonite Valley will be shut off. We will not have access to Port Au Prince. We are unclear if new teams will be allowed in or if we will be allowed out. More news will follow later today (Friday, Oct. 22nd).

Apparently, the center of the trouble is near St. Marc which is on the road to the beach as the road makes a hairpin turn back toward Port Au Prince. We hear rumors that up to 2000 people are now infected. Unfortunately, too many wait too long to come to the hospital. Many are severely dehydrated and have sunken eyes. They appear to be a shell of a human, yet they are brought in to the hospital for care. All the nurses can do is hang IVs and encourage drinking oral rehydration fluids. There is the familiar blend of body odor, diarrhea, and vomit that pervades the air. It is not unlike the scent of sweat and body odor that hung in the air after the earth quake at the tent hospital in Jimaní last February. Back then the smell which might otherwise be considered offensive became a sign of survival. Now, the mixture of sweat, body odor, vomit, and feces represented a fight against death as these weary souls clung to life.

After our shift in the prosthetics center, Claire and I headed back to the hospital to see how we might best serve the weary staff and patients. People were coming from near and far. It was quite crowded in front of the hospital with family members peering into the sick wards where 20-30 dehydrated people lay on gurneys hooked up to IV fluids. One family member was allowed in to care for each patient. If there were no family members, the patient would be at the mercy of a busy staff to receive the badly needed tasks of personal cares.

Clair and I helped MJ and Debbie – an NP from New York. We assisted with the rehydration of the patients. Each patient is given a quart-sized Styrofoam container which we fill with filtered water that has been mixed with rehydration salts. We then go and encourage our patients to drink. “Bezwen bre dzlo.” “You need to drink water,” we tell them. We have plenty of gloves so we are safe. Many of the Haitian are quite fearful of getting the disease and are wearing masks even though cholera is not spread by airborne pathways – just contact oral fecal transmission. We love the gloves and hand sanitizer!

We occasionally hear the commotion of screaming and yelling once someone outside hears of the passing of a family member as they mourn. Quite luckily it is not very often that this occurs. Nevertheless, there are patients everywhere on the portal between life and death. It is truly miraculous what one bag of IV fluids can do. Many patients’ family members seek me out as the IV bag hanging by their family member runs low. I am able to get the nurses to replace the old bags with new ones. We move from bed to bed encouraging our patients to drink, assisting them to a sitting position if they are able. Otherwise, we simply raise their heads and shoulders in our arms and assist in getting the cup to their thirsty lips.

Occasionally, some vomit. Others defecate. Housekeeping moves in with a mixture of bleach and ammonia to clean the floors and we clean the patients and their beds. We often do not know if we are walking in vomit or feces as our patients are so ill. Although it may sound terrible, it is sacred work we do. Cura Personalis. The looks of gratitude we get from patients are amazing. They know they must drink but it is so difficult. With the care we are giving, it seems many of these souls are called back from death into life. They become reborn. Again, Haiti is beautifully difficult. How much suffering there is here and yet how the people cling to life!

That evening we were invited to the Mellon house for dinner with Ian and his wife Lucy. Ian is the son of the couple who started the Hopital Albert Schweitzer (HAS) here in Dechapelles. His parents greatly admired Albert Schweitzer and his work in Africa. Larry Mellon went to medical school in his mid forties and his wife Gwen completed a medical technology degree. They opened Hopital Albert Schweitzer in 1956and their home was spectacular. It seemed odd to be going to a dinner when there was so much going on in the hospital. Yet, it was important to take care of ourselves, too. We hiked under a full moon on narrow paths through the woods, across a bridge over a small stream, and through a fenced in pathway to the Mellon home. It was spectacular with textured stone walls, wooden floors, and cedar framed windows which open onto the Artibonite Valley. We had time to visit and learn what might next happen.

The Health System of Haiti was proposing that the hospitals at two neighboring towns of Verrette and Petite Riviere become the headquarters for the cholera patients. It was proposed that by noon on Saturday all patients with cholera should be moved to these two hospitals. Unfortunately, these hospitals are very small. The problem of containing the situation in this way was that patients who are not stable cannot be moved by noon the next day! If new patients arrive at our gaits, we cannot turn them away. Again, it is good to have plan A, B, C, and D here in Haiti. Dye mon, gen mon: Beyond the mountains, more mountains. And so it goes here in Haiti.

Cholera Prevention & Holistic Care

Cholera Prevention Plan & Holistic Care

I am back at work today and thankfully am much better. We have only three patients left at L’Escale and are trying to figure out how to get our patients on the bus back to Port Au Prince tomorrow so they can avoid the epidemic. There will be a big meeting today at 11:30 am to determine what will happen. Our greatest challenge is the fact that many patients are streaming into the hospital after waiting a bit too long after having symptoms of vomiting and diarrhea. Nevertheless, patients receive IV fluids and encouragement to drink. Unfortunately, it is difficult to know what body fluids are sweet and which feces as the diarrhea produced is so clear. (So sorry about the graphic details.)

Holistic treatment is important. We are doing a great deal of education with our patients that the well at L’Escale is not fed by the river and that it is good water. We teach about the river water having the cholera bug in it which makes the water unsafe. We also teach that if family members are caring for someone who is ill, they must wash their hands or they could also catch cholera if they touch their face or mouth after touching contaminated materials. Wearing gloves is crucial. We are also encouraging the patients to use the filters in the houses in L’Escale. We teach about boiling, filtering, or treating the water. This morning as Clair and I walked to the clinic, our gardeners asked us how we like the Artibonite Valley. We told them we liked it very much. They then immediately warned us not to drink the water from the river. They are very sweet to take care of us!

It was great to be back at work today even though we have only 3 patients. There is some talk of a possible quarantine of this region of the country with no one getting in or out for a while. I will find out more information later today. Could be that my trip to Haiti could be extended . . . maybe until Nov. 14th.

Our patients finished their gait tasks which included obstacle courses at the tennis courts. One young man who had a hip disarticulation even walked the 2 foot high rock wall around the courts and then proceeded to navigate behind the backboard on a small 2 inch ledge! Talk about function and it is incredible to think of the energy cost of walking! He is brilliant! Our goal today was to get as many patients send home to Port Au Prince as possible. We also connected they up with the Israeli team at General Hospital for follow up in a month. Virtuous Reciprocity in action! One last patient remains here and we will finish things up with him on Monday. We will then have a limited supply of patients due to a possible quarantine so we plan to run a week long education program for the prosthetic/PT technicians and translators.
No more bon bons as well. We don’t know what water is being used to cook with so our Bon Bon Lady is finding very little business prospects today.

Vern (our head prosthetist) thinks going to the beach may not happen this weekend as we must go through St. Marc which is apparently the epicenter of the cholera outbreak. He says that it would be quite possible that people may commandeer the tap tap we will be riding. The beach itself is fine. The problem is that we must go through St. Marc to reach the beach. One never knows what can happen if people feel trapped and become desperate. Haiti is beautifully difficult.

Getting Sick in Haiti - Not Fun!

Getting Sick in Haiti - Not Fun!

After lunch on Wednesday, my stomach began to feel quite sour. I made it through the afternoon – but just barely. Feeling ill when in a foreign country is not fun. I tried to take a nap and hoped my stomach would settle down. After about an hour and a half I got up and decided to hike down the hill to Alumni House for more water. Not feeling well is not an excuse for not staying hydrated! The possibility of needing an IV here at the hospital is not something I wanted to consider. We seem to be having a Cholera outbreak. Cholera is spread by contact with oral fecal contact. Many patients had come in to the hospital yesterday and today with vomiting and diarrhea. I made it back to Kay Dunn and drank some water. Suddenly I did not feel so good. The bathroom was not a place to go if you feel like vomiting with our limited flushing capabilities! I went out front of the house to sit down. Suddenly the smell of burning wood for charcoal hit my nostrils increasing the eruptive feeling of my stomach. In the next instance I found myself projectile vomiting in front of the house. Luckily, no one was home I thought. Suddenly, the Haitian doctor who rooms across the hall from me came running out to check on me. He was very concerned and took a history of what was going on with me. He thought I should go right to the hospital. I laid out my reasons for resting up here in my own bed. He reluctantly agreed that I could remain here but said if things became worse, I should go to the hospital. I went to bed, missing dinner altogether. Morning came and brought with it incredible body aches. Ibuprofen could barely touch the pain. I ended up staying home and sleeping all day. I did try a bit of fruit for breakfast, missed the talk on cardiomyopathy by Dr. Bob Caraway, and slept all morning. I am feeling better and even tried a bit of lunch. Will try to head over to the library to catch up on email where it is cool.

Although the CDC will be out tomorrow, it is highly suspected that we are indeed in the midst of a cholera outbreak. The internet says there are 1500 confirmed cases and 120 deaths from it in the Artibonite region where we are located. Patients are streaming into the hospital tonight. Many are being placed in overflow areas and out onto the patio to sleep on benches. Will see what tomorrow brings.

Monday - Tuesday - Wednesday

Monday – Tuesday – Wednesday

Monday was graduation day for our patients from last week. We did the group walk, exercises, and rugged terrain ambulation. Then the bon bon lady came and we bought bon bons for everyone to celebrate being done and the graduation of many of our patients. Certificates and gold medals were issued. Photos were taken and it was a festive day. Our new group of patients arrived on Tuesday and we did evaluations and education sessions and then our therapy sessions began. After some collaborative work tweaking things to get the sockets and legs fit, we were off traversing the rugged terrain which represents the rugged terrain that Haitians must traverse in their everyday lives. I also called the materials man at Hopital Albert Schweitzer to see if I could get a few planks to build a small bridge to better simulate conditions that Haitians must navigate in their daily activities. After our trip on Sunday to Le Petite Riviere, it was clear we need to do more challenging gait training with our patients! We do challenge them by asking them to navigate obstacle courses, ramps, stairs, and the rugged terrain around the clinic. Yet we need to do much more!

On Wednesday, the Israeli team from General Hospital in Port Au Prince came with 8 – 10 patients. It was great fun to share ideas across nationalities. The Israeli team comes here with their patients when they have no prosthetists. We have been invited to bring our patients to General Hospital in Port Au Prince when we have no prosthetists at Hanger in late November and December. It is pure reciprocity. The therapist and physician have invited me to come to Israel for 3 weeks in the future to learn about their system. I wonder how I can work that into scholarly activities!? The Israeli team needed some crutches and canes which we happily provided. The Israeli physician spoke about what wonderful collaboration we have and the wonderful character of people who come to Haiti to serve the people. He said it is a true life of virtuous reciprocity where we all provide for each others’ needs. The physician also shared his story of growing up in the Holy Land. He shared how much progress has been made in Israel in the last 50 years and how lucky he was to witness that as he grew up. He shared that Mark Twain wrote about what a desolate place Israel was back about 150 years ago. Twain described the land as desolate and barren and felt nothing productive would ever come from this part of the world. The Israeli physician said that it was incredible to see Israel now with its beauty and lush plants. It is truly a Holy Land. Seeing the change in his own country gives him hope for Haiti and its possibilities. Yesterday was an amazing and fun day.

Wednesday afternoon, Clair and I learned from our patients that there was no water in L’Escale. The patients were looking for buckets to bring back water with them. Apparently, someone had come by and stolen the buckets to the water filter systems in each house. The filters (which were more valuable in some minds were left behind.) It took a long time for us to get the problem resolved. We did get it resolved! Earlier one of our patients asked to bring a broom back to L’Escale so he could sweep the shower area. He felt it was unsafe and dirty. What a productive and take-action man!

We again spent time in the pool with the new team members to debrief. Then it was dinner and off to do an interview for the Physicians for Peace photographer. Finally, I made it to the library in time for a storm to blow in knocking out our internet. I then ran out of minutes on my new Haitian cell phone – as calling the US is quite expensive! It is much better to get calls from the US! Life in Haiti is beautifully hard with nothing easily done.

Shaun, our director is always so busy coordinating many things. I hope we can relieve some of his worries. He jokingly asked me when St. Kate’s will open their Haitian campus here! My mind is racing with possibilities! He has planted the seeds so we will see what happens!

A Leisurely Sunday - NOT!

A Leisurely Sunday – NOT!

Last night (Saturday) we spent some time with the prosthetists on their last night watching a movie and visiting. Then it was to bed around 10:00 pm. On Sunday I woke up bright and early as the heat prevents us from sleeping in. Our showers run from 6:00 – 7:00 am and pm only. Time for a shower and to wash out some clothes before breakfast! Clair and I were hoping to go to the beach but our plans for a ride fell through. Instead we were able to accompany Dr. Bob and his wife MJ (short for Mary Jane) to Le Petite Riviere where they wanted to visit Marco, a dear friend. They have lived in Haiti for 5 years and Dr. Bob has been involved in Haiti for over 30 years. We felt safe to be with Dr. Bob & MJ Callaway. We were excited at the prospect of getting off campus and seeing a bit of the real Haiti. Indeed we did!

Our adventure began just after breakfast of spicy eggs, bread, and coffee. We then walked through Dechapelles through the open market to the tap tap stop. In the market there was everything one could imagine for sale – even pig entrails hanging out to dry! Nevertheless there were spices, fruit, meat, clothing, and many other things. We hiked to L’ Escale where our patients stay when not in the Hanger clinic as they await their legs, receive therapy, and become competent with their new limbs. Our patients were excited to see us. Clair and I are thinking about coming here in the afternoons to do more rehab if the patients get sent home early.
We then wove our way through the country side hopping over rocks in streams and through fields to the main road where our tap tap stop was located. Soon a tap tap arrived and we were on our way to the crossroads to Le Petite Riviere. We had wall to wall people loaded onto the tap tap and we were off. MJ told us to be sure to hang on! It was one of our first moments in Haiti were we were not sweating buckets! We enjoyed beautiful scenery, the wind blowing through our hair, and then it happened! We heard an ugly clunk and suddenly the tap tap began to waver a bit. MJ commanded us to hang on and get down. Luckily the driver was able to control the tap tap to a stop. What we did not notice that Dr. Bob did notice was that the right back wheel came off and went rolling down the road ahead of the tap tap. We all dismounted from the tap tap to inspect the situation only to find that the wheel that left us all behind originally did not have lug nuts holding it on! Or, perhaps they had come loose! Fortunately, there were no injuries. Lesson learnt is to inspect the tires for lug nuts on all wheels before mounting the tap tap. We only had about a quarter mile to walk to the cross roads.

At the cross roads we took a moto taxi to the river crossing. Clair and I were on one moto and Dr. Bob and MJ on another. We told the driver “duesma” which means drive slowly! “Slowly” it seems has different meanings depending on the age of the moto driver! After a few minutes, we had to portage a small foot bridge that was about 15 feet above a ravine with a river flowing beneath it. It was quite rickety! Pictures will follow when posting my blog! Not knowing the way back meant there was no chickening out - we had to continue forward! On the other side we hiked down to the river where we had a choice of the barge cabled to an overhead wire or a boat where the crew had to bail water out as the boat crossed the river. We chose the safe route on the barge! When the barge reached the other side of the river, it was about four feet from shore in knee deep water. Several local men demanded that they give us a piggy back ride to shore! Clair, MJ, and I were then carried to shore. Dr. Bob decided this would not be the manly thing to do so he removed his running shoes and waded in! We then hiked up the hill to the town of Le Petite Riviere. Dr. Bob and MJ met their friend Marco. Clair and I were given directions to the fort and the cathedral. The cathedral was easy to spot and then we began our hike up the mountain. After a 25 minute hike we reached the top of the mountain where the old fort was sitting. We were provided with a glorious view of the Artibonite Valley. It is easy to see why the slaves chose this spot to place their fort to defeat the French! One could see for miles in all directions!

Clair and I hiked down the mountain in search of a coke! No cokes were to be found until we reached the bottom of the hill in town by the cathedral. We were so excited to find 2 cokes at one of the shops. Next, all we needed was a bit of shade. We were told we must drink our cokes at the stand. We eventually were allowed to cross the street and sit in the shade to finish them if we returned our bottles. Never has a coke tasted so good! When I returned my bottle & cap – there was much laughter! We did not want to disappoint and we returned everything!

We then met up with Dr. Bob & MJ, visited a short while with Marco. Dr. Bob saved one of Marco’s daughters many years ago so he and his friends are treated like royalty. Dr. Bob then led us off to the river via a more sane bridge and we hiked to the river barge crossing. This time however, we took the leaky boat back! I guess we felt lucky and the barge was otherwise occupied. We reconnected with our moto drivers and headed to the crossroads to catch another tap tap back to Hopital Albert Schweitzer. A very full tap tap wanted us to join them which we declined! When the next empty tap tap arrived we mounted and even had seats! We made sure to check that all wheels had lug nuts before hopping on! We forgot to tap at our stop and then got off at the main Hopital Albert Schweitzer entrance. This return route was different than our original departure route. The road is at a high incline and is full of rocks. Walking in Haiti requires that one look down at the ground so as not to fall. Looking at the ground does not necessarily mean you will not fall! The story behind the rugged roads is that the original folks who built the hospital wanted to keep tourists away and keep the hospital for the local people who needed it most. The roads were never graded or paved. Yet, it is a challenge to gain access to the hospital!

After our four hour adventure, we made it home for lunch and had time for a dip in the pool! Next was time for reading and relaxation in preparation for the upcoming week. Next week we hope to go to the beach with a group of folks where we can rent a private tap tap which is much safer than the public one! Even though we did not make it to the beach for swimming and lobsters cooked at Club Indigo (the popular beach), we had a most interesting adventure – one that we would not want to have missed. In Haiti it is always good to have plan A, B, C, and D!!!

The Bon Bon Lady

The Bon Bon Lady

Each morning we have quite a substantial breakfast. Yet around 10:30 we start to hear the grumbling of our stomachs! Luckily, the Bon Bon Lady arrives. She sells bon bons or what resemble banana bread cookies she has just baked. They are wonderful and cost only 10 gourdes. They are safe to eat and we tend to take turns buying bon bons for each other! We really missed the Bon Bon Lady today on Saturday as she has a day off.

Changing Money

Changing Money

Yesterday I had an opportunity to change $20. Clair led me to the mysterious window in the hospital where it is possible to exchange USD for Haitian Gourdes. We enter a small room and wait. There are 2 chairs to sit upon if you are lucky enough to have a small or no line. There are 2 windows with shutters and bars that are too high for any type of public negotiation. A name is called, the shutters open, and a hand passes money through the bars to a person on the other side of the corner. Apparently there is a wall separating the two rooms.

There are the two other windows – one square and one round tinted black with a small door on the other side of the glass. There is also a small slot for money and other items to be passed back and forth. The windows are likely not really tinted black. It appears there has been a black garbage bag taped to the inside of these windows. We don’t really know when someone is back behind the window.

To exchange money you approach the round window and knock. Then you wait. And wait. Eventually the shutter door behind the window opens and you slide your USD through the slot at the bottom of the window. Then you wait and wait some more. A paper eventually is sent back to you to sign. Eventually money is slid back to you as you wonder what will happen and if you will ever see any money ever again. Both Claire and I received our money. It was so dirty it was difficult to see the denominations! I now had money to add to our Prestige collection. For 210 Gourdes one can purchase 6 Prestige beers! That is about 50 Cents per beer! I also now have money for the beach!

Saturday's Physical Therapy Session

Saturday’s PT Session

Today we were able to sleep in as we did not have to be at the clinic until 9:00 am. It is funny how the heat and the daylight make it easier to wake up early. In our house, we have water for a cold shower between the hours of 6:00 – 7:00 am and 6:00 – 7:00 pm. The rest of the time we take a bucket shower which is completely adequate and refreshing. (It is amazing how much water we waste back home!) Today there was not rush for a shower and I still made it down to breakfast by 6:30. Pancakes and fruit made for a delightful breakfast, in fact, my favorite all time breakfast here. We have no syrup but the guava preserves add a wonderful taste sensation. The coffee with crème and sugar is also an incredible staple despite the heat.

We walked over to the clinic and waited for our 6 patients to arrive from L’Escale which is the community down the road where the patients are housed while awaiting their limbs. Clair and I decided to have the women walk around the block out in the community to practice their community reintegration. We paused at the half way point to sit down momentarily on the low wall in the shade. Pictures and a bit of dancing also occurred! One patient was just finishing 9th grade. The other 3 were older women. We proclaimed it to be the parade of the femn valiant or the valiant women. The walk took about a half hour and we made sure that everyone rehydrated when all were safely back at the clinic. It was great for the women to be out in mass and for others in the community to see these women walking. Two of the men remained behind to work with Luke. We then broke into small one-on-one sessions with each patient working on functional activities like balance, gait training, and strengthening exercises. Although we have the normal PT equipment such as parallel bars, balls, theraband, stairs, ramps, and a plyos ladder, we also have our patients do function activities such as carrying things like a jug of water or boxes of things on their heads as they navigate the clinic. Anywhere in Haiti it is clear that balancing items on one’s head as people navigate from one point to another over rustic terrain is the norm. No ice or snow to deal with – just rugged terrain.

We were playing catch with one of our older women and she decided to get tricky. She passed the ball between her legs, around her back, and then she tossed me the ball. Eventually, she became even trickier and as she passed the ball between her legs, her face took on a mischievous appearance. Suddenly, she passed the ball up under her shirt and began to walk around like a young pregnant woman! It was hilarious! She then feigned that it was time to have her baby. She very functionally dropped down to the ground and gave birth to our soccer ball. We were then told to cut the cord! Everyone howled with laughter! We then practiced falls recovery with everyone in the padded cubical that Clair and I put together the other day after washing down the mats. All in all it was a fun and functional morning. We said goodbye to our patients and went back to the Alumni House for lunch. The rest of the afternoon we were off so we spent time in the pool.

Tonight will be very low key and I am looking forward to a good night of sleep. I thought I was coming down with a cold, but the fresh juice we have with every meal seems to have killed any bugs attacking my system. I hope to get on the internet tonight!

Returning to Haiti - October 2010

Arriving in Haiti. . .

I made it safely to Haiti. Upon leaving the airport the Italians met me and made sure I used their phone to make contact with the Hopital Schweitzer to check on when the driver would be coming. Luckily they were able to stay with me until the van arrived about an hour later. It was nice to catch up on things. I then had an amazing drive through the mountains for about 3 hours. But first, we wove our way through Port Au Prince (PaP). I think I saw many back roads and alleys as our driver completed his delivery route. It was like a national night out with people everywhere gathering around fires cooking, selling things, and just plain hanging out. Of course there are tents everywhere. Then after about an hour and some stops for pickups and deliveries we found out selves on the outskirts of PaP and began our ascent up the mountain range. The site of lights from Port Au Prince was very beautiful. It was getting dark by 5:30 so it was probably good not to see the switchbacks! It was a scary thought that we would be navigating the mountains in the dark! Nevertheless the sights were breathtaking. We wove our way carefully though the mountains for what seemed like hours.

There is a headlight language between the drivers who flash their lights to communicate when to pass or not and if there is oncoming traffic or accidents. We only saw one motorcycle accident on the way up. To make the ride up the mountain more interesting – lightening began to flash throughout the sky making for an impressive light show. Occasionally, the road switchbacks below were lit up – YIKES! Then as we began our descent it began to rain – quite hard. We crossed a bridge that had a rushing river below. The bridge was actually covered in about 3 inches of water. There was not any distance between the rushing river and the ridge deck! Luckily, the driver was very familiar with the road and conditions. He knew if it was safe to cross or not. Once on the other side of the river, we stopped to see if we had a flat tire. Luckily we did not! We eventually made the 2 hour trip in a good 3 + hours as we wound back up the mountain.

The campus of Hopital Albert Schweitzer is beautifully rustic. I am staying in a room in an old plantation house. I share the room with a young American woman who is studying biodiesel fuels and working in agriculture. There is a tree here in Haiti that produces nuts that can be ground up to make diesel fuel. Amazing! The idea is that someday Haiti will become self-sufficient for its own fuel. There are also two men staying in the same house – another American agricultural worker and a physician/surgeon whom I never see. It is nice for sleeping as the main guest house is full of the others. It is a little more quiet in House 11 (Kay Dunn #11) my home away from home. We are grateful to have the surgeons staying with us as one of the PTs went hiking and got a spider bite which became infected leading to cellulites. The surgeon was able to open it up and let the infection drain! Ugly! But Luke (our co-PT) is lucky because he now has no health insurance after graduating from PT school in May. He is actually getting the best care here in Haiti – because the MDs know what to do here with these tropical issues as opposed to back home. (Gotta love my mosquito net!)

We start our days with breakfast around 6:30 am and rush off to the library of Hopital Albert Schweitzer for Grand Rounds and usually a presentation by some visiting physician or local physician. Yesterday we heard a talk by a famous physician from Philadelphia who works in the area of global health and malaria prevention in pregnant women. He spoke on the issues for babies who get malaria from the placenta. Pregnant women seem to be at a greater risk for getting malaria from mosquito bites than others. Today’s talk was by the Israeli physician who was in charge of setting up the hospital for Israel after the earthquake. His talk focused on the Ponseti technique on casting for kids with club feet. We are so lucky to hear about so many interesting talks. Nevertheless, things do get lost in the translation.

After the grand rounds and talk, we head over to the Hanger prosthetic center and begin our day working side by side with the prosthetists and patients. It is an amazing opportunity to model the Dream Team in action. Currently, Hanger has one prosthetist here for 3 months. Others rotate through for 2-3 week commitments. There are 4 prosthetists here with us now. They are so awesome and their work is their passion.

Our PT team consists of a new grad named Luke from New York, Clair from South Africa and Scotland, and myself. We also have another PT (Jo) who is also from England. She works in the hospital. It is such good work that we are doing and it is difficult to describe the excitement of our patients when they are fit with their limbs. Often, here in Haiti, patients receive their limbs and immediately are up and walking. Nothing like what might happen back home practicing balance in the parallel bars for days before walking! Generally, here it is one pass through the bars and the patients are off navigating ramps, stairs, and uneven terrain. It is so much fun to see our patients gain confidence in their new limbs reclaiming their capabilities and abilities. We have opportunities to practice in the gym, out on the veranda of our building, and of course on the natural rugged terrain of Haiti. It is like giving birth to a new soul once the patients realize the possibilities that life will now hold for them. We even set up obstacle courses at the local tennis court!

Then to make things even more amazing and brilliant is the fact that there is such strong support among all the patients. Today one lady decided my patient needed the support of the “valiant women” or femn valant present to help her get going. They gathered all the women along the parallel bars and began an impromptu ballet class just to let this woman know that she could bear more weight on her new leg. Great fun! Of course, we incorporate dance whenever we can! Today we also fit a little guy about 10 years old with a new leg and he was then off being a kid jumping off the veranda to fetch the toy car he was given! We also fit a young man with bilateral below elbow prostheses and again we witnessed the rebirth of an amazing young man. We practice the basics of weight shifting, walking, balancing, navigating stairs and ramps, and recovery after falls. Clair and I also washed down the clinic. It gets quite dusty!

We all have meals up at the Guest House so it is amazing to hear everyone’s stories from the day. At the end of the day we try to take a dip in the pool onsite. It is refreshing yet warm! The power of the sun is so hot here. We do find it refreshing to be wet from pool water even if it is warm versus being soaked in sweat! Last night the prosthetic team and PT team were invited to Shaun’s for dinner. We had a lovely time bonding as a team and enjoyed some great food native to Haiti. Shaun’s house was decorated with Christmas lights and candles. We again had interesting conversation and company. These prosthetists are a great team as are the PTs here.

Friday, August 6, 2010

Pictures: Arriving in Haiti

Medicine in Haiti - a painting at the Bernard Mevs Hospital Project Medishare



A beautiful sunset in Haiti.


An innovative incubator in the NICU/PICU



The PT Techs with Sue



Becky, Sue, and Dr. Leah in the tap-tap.



Becky & Sue with the Italians

Team debriefing over dinner at The Deck Bar & Grill


The Deck Bar & Grill: UN MINUSTAH was the site for evening meals and debriefing.



Al, Wilfrid, Sue, Catherine (reporter for the Toronto Star), and Randy (photographer)
Prosthetics Team: Cedieu (Translator & Tech), Duvor (CP from the DR), and Wilfrid


Emmanuella, Sue, and Wilfrid: Friends for Life!
Emmanuella and Wilfrid are wonderful peer mentors for others with amputations showing life continues after amputation even in Haiti.


Sue and Vangine, translator from the IMA Hospital in Jimani were able to reunite.


Jimani Family: Sue with Strahly, MaKenzie, and Wilfrid.


Al, Sue, and Naoki at Healing Hands for Haiti's Guest House


Team Rehab after a water gun fight!



Wound care (in the dark) with Ted RN & Sue PT


Physical Therapy Department: Go Rehab!!!!!

Directions to the Bernard Bevs Hospital Project Medishare. No problem! It is easy to find!


Hospital Medishare at Bernard Mevs Hospital site in downtown Port Au Prince.


Sleeping quarters for the rehab team are a bit cramped but cozy! We each have plenty of space acutally.

Luckily polka dot suitcases are easy to find! We make our way to the waiting vans.

Sue with Brett - our logistics guy- as we gather up our luggage. It was a bit crazy!













































Monday, August 2, 2010

Left My Heart in Haiti . . .

Our last day was filled with packing, seeing patients, saying goodbyes, and transitioning to the next team. We had another water fight with our patients with spinal cord injuries.

We had time to visit with the PT Tech staff who continued to say what a good team we were! They had begun the week making it clear that they leave at 4:00 when their day is over. The workers make $10 USD a day not matter what their job is. If they are late to their shift, they must make up the time that day. Workers also receive a meal and training. By Wednesday, we found the PT Techs staying longer and longer. They wanted to learn all that they could from us. Apparently we made learning fun!

Two of the PT techs reflected on what they had learned during the week. We helped them learn their anatomy but they also learned much more. They said that even when they were in another part of the clinic doing wound care, they would listen to me work with the patients. They heard laughter and saw smiles. They and the patients were able to experience joy which is a rare commodity in Haiti they told me. Furthermore, they shared that from watching and working with me this week, they learned it is most important to build a rapport with your patient before anything else. We have to work with the whole patient (and their families) not just broken bodies they said. PT is much more than that! They "get it" they said! PT is their passion. And that is why they love what they do for their fellow Haitians. If your work is not your passion, it is not good for the patients they said. What great insights!

Later, one of the PT techs told me that I am an important part of Haiti’s history because every time Wilfrid tells his story, he always talks about Sue PT who was his first PT. PTs give hope when there is not much hope around. Without PT, Wilfrid says he would not be able to walk and help others. He is now married and has a baby boy! He hopes to make Haiti proud as he participates in a future Paralympics!

Vangine my translator from Jimani returned on Friday and spent the day helping me translate. It was good to be working with Vangine again. On Saturday,we had time to re-tell the story of how Vangine went to find Wilfrid and Emmanuelle in the refugee camp at Love-a-Child in Fond Parisien so they could be fit for their prosthetic legs with Dr. Bob Gailey in early April. A prosthetic limb in Haiti means giving someone back their life. Wilfrid is often asked if he is a big boss man to have such an amazing leg! He says no and explains that his job is now to show others and all of Haiti that there is life after amputation. Wilfrid has now been able to get married, be a dad, and have a productive job as PT/OT/Prosthetic Tech. Wilfrid, Vangine, and Cedieu told me I am a busy mom because I have a big family of my American boys and now I have a family of my Haitian boys who love working as PTs. Another teary moment!

One of the Haitian residents is working at Medishare to complete his medical training. On the day of the earthquake, he had a very bad headache so he stayed home from school. His entire group of classmates and professors were killed that day in the quake. He is the only survivor of that class of future doctors. It is wonderful to see the passion he has for medicine. The weight he carries must be enormous. There are so many stories. . . Resiliency! It is good to listen. Creativity counts in Haiti! Things move forward slowly.

Eventually, we had our last ride across town to the airport. The Haitian airport is always a crazy experience. I was carrying an extra bag back with a broken ultrasound and parts to an x-ray machine that needed repair. (I was a mule!) The old suitcase it was packed in was not so mobile as the wheels were broken and there was no handle. Adding to the chaos was the fact that last week several volunteers had to stay an extra night in Port Au Prince as too many seats had been sold on the airplane. We were all a bit worried about getting a seat on the plane. All seats were basically “stand-by.”

Finally, one of the Haitian-Canadian physicians had us all do the self check-in rather than standing in the long line to the counter. The problem was then what to do with our luggage! Would it really be taken to the plane if we left it in the lobby by the check-in kiosk? Everything turned out just fine! When we made it to the other side of security/immigration, we enjoyed one last Prestige beer. We still did not have seats and were told we would be called up by name. One of the physicians from Chicago – Dr. Vanessa – was called up. She was told she would be upgraded to first class with 6 of her friends. She grabbed several of us and we waited for our boarding passes!

Once on the plane, we all seemed to realize how tired we were. As the plane took off, it hit us that we all had left a huge piece of our hearts in Haiti. We were a good team – a “Dream Team”. We learned so much from our patients, our Haitian colleagues, and each other.

The muled suitcase was handed off to the appropriate contact in the lobby of the La Quinta Inn with all parties wearing their sunglasses! It was a bit like a spy movie - although we did exchange contact info!

At our final dinner together in Miami at the Cuban restaurant, we enjoyed Cuban food, sangria, and live music. . . We then began planning our reunion trip!

Piti piti plen kay: A little lamp (or light) can fill the whole house… Our hearts have been filled with the light of love from the Haitian people we were honored to serve.

MINUSTAH: The UN Deck Bar & Grill

UN: MINUSTAH or the Deck Bar and Grill

Although we are given a sandwich mid morning and a Styrofoam plate of rice, beans, and a small piece of meat in the early afternoon, we all enjoy a morning cup of coffee if there is water and our suitcase food. We are typically so busy working with patients that we do not have time to eat.

We so look forward to the UN’s restaurant called The Deck Bar and Grill. The Deck will send a car to the hospital which will drive us across town to the UN so we can eat dinner at the Deck which is really more like a crazy cafeteria. This restaurant is located up some stairs on a deck. It is somewhat covered on the periphery with awnings and open in the center. Cafeteria tables and chairs are crammed into the space the size of a 20 by 30 foot room.

To add to the atmosphere, the owner, Hans, has assembled a tubular system which produces a cloud-like mist. It is refreshing after you climb out of the crowded car, climb the stairs, and order your food. You then receive your receipt which you must take directly to the kitchen/grill window. Food is then prepared and your name is called out when your order is ready. It is easy enough – but you will not get your food if you do not follow this procedure! The food is wonderful and best of all – safe to eat – even the salads! The Deck has been a great place to debrief and process the day’s events. We also get to meet folks from other countries who are the peace keeping forces here in Haiti.

One night the hose system running the misty steam broke above my head and began spraying all over. I was soaked! So was Becky! Anywhere else in the world being sprayed by water in a restaurant would have been a disaster! Here in Haiti, however, it was so refreshing! Our showers had not been working that day as water just dribbled drop by drop from the shower head at the hospital. We had worked so hard and it was so hot that day. . . When the misting tube burst at the Deck, we enjoyed a community shower providing entertainment to the Italian SWAT team as the hose system was patched and re-patched several times! Nevertheless, we met some great folks and enjoyed a bit of gelato or ice cream in martini glasses with the Italians! A definitely great night! Who would have thought that a shower that day was possible? Ice cream as well!? An amazing perk! Becky and I were able to communicate pretty well with the Italians by speaking Spanish with an Italian accent! It was a fun night!

On our last trip to the UN a friend of one of the nurses brought his tap-tap by for us to ride to the UN in style! An amazing experience we all agreed . . . until we realized that all of the surgeons were with us as well! We had treated many Haitians who had been in tap-tap accidents during the week. Yikes! Luckily, there was no accident! We came home in the UN van – just to be safe!

Making Haiti Whole Again

Thursday and Friday seemed to pass like a blur. We were awakened to the sound of a mother mourning the passing of her daughter in the spinal cord unit on Thursday morning. The night before we heard the similar wailing as a baby in the PICU had passed. The loud mournful screams seemed to remind us exactly of where we are – in Haiti – a place that is trying to move forward toward survival and yet is mourning its proud history. The reality that life is not fair and that it is too short is quite clear when you are living in the reality of Haiti. The Haitian people have much to teach us as they begin to rebuild their lives and their country. It is certainly not fast work that can be measured by our American units of productivity, yet things are moving forward. Many times we fail to see the progress.

Both Thursday and Friday were spent working in the outpatient clinic. When time allowed or necessitated, I also helped out in wound care with Becky. In the outpatient clinic, my patients had afflictions such as low back pain, shoulder pain, strokes, old fractures, crush injuries, stiff hands or other body parts, and wounds. Each day there are always the babies who are not reaching their motor milestones brought in by parents who hope for their child to become a “normal child.” There is much education on handling skills that happens. I try to constantly include the PT techs teaching the what’s and why’s of what we do – empower parents – NOT remove the children from the arms of mom or dad so that only we can handle the kids! Instead, it is about the parents being the experts with regard to their children and supporting them not our egos.

Our outpatient clinic also has space for outpatient wound care and the ortho consults. In this way, if we have a question for the orthopedic doctor, he is right there! He occasionally has questions for us so we work quite well as a team! We may even discuss medications and their interactions with the Haitian or American ortho doctors! The Haitian doctor is open to learning all he can! What a wonderful dialogue to be a part of as a PT! Incredibly fun! Working together made for lighter work! There is a saying in Haiti that when many frogs pee, the river rises – Pisi capu, augmente la riviere – meaning that in community we can accomplish more than one alone can do. . .

One little girl who came to the clinic looked like she was about 5 or 6. It turned out she was actually 15! She had received an amputation of her right leg below her knee after the earthquake. She had terrible phantom limb pain. One of the other therapists was working with her and called me over to look at a spot on the toe of her sound leg that looked black. She was not sure what it was. Lighting was not perfect so we took a closer look. It appeared to be a blood blister. Her toe only hurt if we put pressure over the black spot. It turned out she had no light touch, sharp-dull differentiation on her foot, her lower leg, and her thigh. She did have proprioception at her great toe. The patient had been wearing a pink plastic crock shoe that was a bit large for her small foot. We called the ortho doctor over to be sure about the blood blister and to see what we might do to manage the patient’s phantom limb pain. We did a great deal of education on foot care with the patient and her mom. We found a new pair of shoes in our closet that perfectly matched her “Hello Kitty” outfit (and also fit quite well!). The patient understood her exercises and the importance of NOT going barefoot as she lacked protective sensation meaning she would not feel it if she stepped on a sharp piece of glass or nail. She understood the need to protect her sound foot and leg. She did not need an infection to set in to her sound foot.

Other patients who were carpenters or manual laborers who wanted to get back to work but were limited by back or shoulder pain. Other patients were involved in clearing rubble from their neighborhoods. My manual skills of using Mulligan & McKenzie techniques came in quite handy! Even myofascial and trigger point releases work marvelously here with the inured backs, necks and shoulders.

One lady was unable to lift her right (dominant) arm above 90 degrees. Her goal was to be able to reach overhead. She was extremely tender to touch. I was able to get to learn about her life as we “played” together in therapy. After some Mulligan manual work and some cervical retraction & extension (“don’t kiss me” and “dump truck exercises”), she began to smile and laugh at the idea of an ugly, stinky man wanting to kiss her and her not wanting to be kissed! When she did her exercises, she was quite the actress and even made the yucky face! Eventually, she was able to lift her arm over head. She began to sing and dance her gratitude. She hugged me and said she would be praying to God that I might have a lot of intelligence so I might heal others. It was not that I was not smart, she explained, but just that I would need endurance as so many people in Haiti need physical therapy. She then left - sending God with me and asking me to heal others in the way she had been healed today.

Another patient, a young child, came to clinic with a wound on her toe. It was quite infected and there was no covering on her wound. The patient and mother had walked to the clinic earlier that morning. The wound dressing had fallen off but they continued forward toward the clinic anyway. The wound was the result of a rat bite. Becky has encountered many rat bites among her wound care patients.

Another wound patient had an external fixator on his right arm and a funny looking loop hanging out of the skin graft of his left elbow region. We were told it was a simple stitch that needed to be removed. In Haiti nothing is simple! When the team went to snip the stitch and remove the loose sides, the stitch would not slide out. Instead, there was a huge infection with pus. To make matters worse, the stitch was anchored internally to the underneath distal ends of the skin graft and would need to be removed surgically. The “dissolving” stitch did not dissolve and would not be easily removed. The patient was put on the surgery schedule for Monday to release the two distal end stitches underneath the graft.

Then a little boy, seven year old Alex, came to the clinic with his godmother from another refugee camp. He had been playing with a gate which closed taking off his finger tip of his 4th finger. Someone at the other camp tried to reattach the finger. When I un-wrapped the finger, the tip was completely black. It was dead and there was no perfusion to it. Ortho was consulted and agreed that a very small amputation would need to occur. Unfortunately, Alex had just eaten around 1:00. It was now 3:00 and he could not be put under for the surgery. Simply providing a brachial block would be too traumatic for him, so Alex and his godmother were to come back the next day. Surgery was scheduled for 7:00 am but the godmother could not get Alex to the clinic on time due to traffic issues. When she arrived, she found me and gave me Alex to care for. We found Dr. Eric and Alex eventually had his fingertip amputated – but only enough to give good coverage to the finger tip. Amazing work! Alex will even have a short nail. The day before, it was thought the finger would need to be amputated between the PIP and DIP. Wonderfully, Alex had a longer, more functional finger than it was thought possible! Little by little progress is made.

Another man came in with a lateral shift and low back pain. He was my next patient. He walked in with much back pain and left walking erect and with minimal to no pain. He would then rid a tap-tap home. Riding a tap-tap is like piling many people and occasionally animals into the back of a covered truck with some folks hanging out the back, and sides. (Not sure a tap-tap ride was the best for this guy but he had to get home.) He came back my last day to show me how much better he was and we progressed into some lumbar stabilization exercises! He thanked me for healing his body and soul. He told me that when I return home, my suitcase was going to be very, very heavy because I would be carrying the hearts of my patients with me! He gave me a hug and held tightly onto me as he told me he would see me again somewhere sometime in the future. He told me part of my heart would always stay in Haiti with my patients. It was a moment to blink back tears. He then gave me a blessing and went on his way.

Eventually, we made our way to the spinal cord unit to assist the therapists there. We managed to get everyone outside in the fresh by hot sunshine and have a water fight. Everyone was given a plastic squirt gun and the hunt and search began for Hannah OT. Eventually, Hannah was soaked, the patients worked on their wheel chair mobility skills dodging in and out of the parked vehicles and other obstacles such as our water purifying system which we affectionately call the silver bullets! Not only was this activity physical/occupational therapy, it also served to build community and instilled the idea that there is life after spinal cord injury – even in Haiti.

We were overloaded with inpatients and outpatients in need of wound care on Friday. We all stayed late to complete our list. Just as our last inpatients arrived in the PT gym for wound care (just to get them out of the hot med-surg unit) we were all set to go. Then the lights went out. Luckily Nurse Ted RN, Sandy PTA, and I pulled out our headlights and we were still in business helping Becky with wound care! Another example of teamwork at its best! We also felt a bit like frogs as the rain began to pour down outside!

Coming through security on my way back from Haiti, I was asked by one of the TSA agents if I have been in Haiti and how many times had I been there. (Of course, the fact that I was wearing my Haiti necklace and UN T-shirt seemed to give my travel destination away!) When I replied that yes, indeed I had just returned from Haiti, the TSA agent asked me if I had seen much progress in the country. She stated that everyone she talked to was really disappointed in the lack of visual change. I shared with her that yes, in fact things are changing but not as fast as Americans would like or expect to see! Although there is much rubble and devastation which remains with regard to the infrastructure, there were certainly small steps forward being made. I told her it depends on your perspective! It is like the Haitian proverb, “Piti piti swazo fe nich!” She smiled and said, “Yes, I understand what you are saying. It will take a long time for Haiti to be whole again. Thank you for your work in my country.”