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.”