My last day.
Today was the day that at one point a while back, I had hoped would come very soon. But once it came, I dreaded it.
We said our good-byes not only to each other, but to some of our favorite patients, Haitian doctors/nurses, and our beloved translators. The translators were a phenomenal group or smart, helpful young men who made our jobs possible and who were with us for every patient encounter. Many of them go home to a tent at the end of a long, tiring day of work...a day that earns them a mere $12. IMC gave us $300 for being here - which is both generous and embarrassing. I gave each of the 10 translators $20, as certainly they're more deserving of it that I. I go home to a job that I both complain about, and take for granted. Many do not have jobs anymore now that we are gone, and are fearful of their future that at just 20 years old, should be bright and full of opportunities and dreams.
Before I left Boston two weeks ago, everyone said to me that I would meet some incredible people on this trip. I was a bit skeptical, as I am convinced that I am friends with or in love with or am the daughter/sister of the most incredible people this world has even known. Which is still true...but – they were right. I have met some truly passionate, selfless people who truly embody the notion of "service before self".
I think I will leave this country with tears in my eyes and a heavy heart. I have been blown away by the sadness, destruction, and corruption. But I have also been equally impacted by the resilience of these people. For no matter how difficult their lives truly are, they have risen above. And whether we are here or not, they will persevere. I never once heard anyone complain about how difficult their lives are. Now I fully realize that we back home may have difficulties in our lives, but the people here undoubtedly have difficult lives. But there is a sense of pride the Haitian's have for their country - the very country that has robbed them of everything they have. I find that ironic, and beautiful.
Thank you to all of you who have taken interest in reading my stories from Haiti – I feel that conveying to you these very vivid and real events and emotions every night makes this even more of an enriching experience for me. Even if I feel that my effort here was futile at times, I will, at the very least, leave knowing that I have given an unbiased, raw, and real account about life here. It isn’t pretty. It isn’t polished, and it isn’t edited. But I think we would all agree that being informed and opening our eyes to the world around us, whether it is pleasant or not, gives us a chance to change ourselves or change the world in which we live.
Au Revoir, Haiti. And thank YOU for what you have given me.
PS - thank you to those who have been moved to ask "How can I help?" - please email me at gsbeverstein@hotmail.com and I will give you information about other great organization here that are doing really good things for this country, and will guarantee that your donation will be well spent.
Haiti
Wall graffiti we drove past every day: The image is of the country of Haiti crying
Tuesday, June 29, 2010
Sunday, June 27, 2010
Haiti - Day 13
Final thoughts from Haiti...
Tomorrow is not only my last day at Hospital Universite Etas D’Haiti, but it is International Medical Corps last day as well. The emotions are so unbelievably mixed, as we look back at all that we have seen and done here and realize that although we have done so much, there is so much more that we wish we could continue to do. But, our work is finished – now, we leave behind a Hospital that is exactly the same as we found it, and take what experiences we have had here and live our lives just a little bit differently.
We have just two patients left in the ICU. The only ICU in Haiti will officially close tomorrow. All of the other 16 patients either died, or went home to die with their family so they don't have to pay the morgue. One patient is a 20 year old kid with a neck mass so large that it is protruding through his skin, and has compressed his airway down to the size of a straw. Each day it gets bigger, and each day we try to provide the family with some hope that a throat surgeon will fix him. But we know that the likelihood of that happening is next to nothing. TOmorrow he will go with his family and try to somehow get to the Dominican Republic to find a surgeon there. Meanwhile, all the way across the room you can hear him gasping for air with every breath.
Our other patient is a young man with a brain mass. Well, we think he has a mass based upon his symptoms, but we don't actually know with 100% certainty because we haven't see a CT Scan yet. His parents, who are there with him 24 hours a day, sold some of their personal belongings and spent their life savings to be able to afford the $250 to get a CT Scan for their son. We strongly urged them to not do this, as it will not, unfortunately, change any outcome, as there are no neurosurgeons in the entire country. So even if he does have a brain mass, he will still just go home with his family to die.
This is the kind of stuff we have seen on a daily basis. How can any of this be acceptable? But we didn't come here thinking that we could change these problems. These problems existed long before the earthquake, and will keep right on happening.
90,000. That is the number of patients we saw and treated since January. That's more than a busy trauma ER sees in one year. Many we saved. Many we didn't.
But - in all honesty, despite all of the good we have done and the hope we have given and the lives we have touched, we are leaving this place exactly how we found it. Nothing has changed. Nothing we contributed has been sustainable. But you can't have sustainable change without societal change...and the societal problems in this country are hundreds of years in the making, and will take another hundred to fix.
And as i'm typing this, it's pouring rain outside. Right now, millions are hovered in shoddy tents with dirt floors and blankets for beds. And I'm in my air conditioned hotel room on a kind sized bed listening to my IPod. Life just isn't fair.
Tomorrow is not only my last day at Hospital Universite Etas D’Haiti, but it is International Medical Corps last day as well. The emotions are so unbelievably mixed, as we look back at all that we have seen and done here and realize that although we have done so much, there is so much more that we wish we could continue to do. But, our work is finished – now, we leave behind a Hospital that is exactly the same as we found it, and take what experiences we have had here and live our lives just a little bit differently.
We have just two patients left in the ICU. The only ICU in Haiti will officially close tomorrow. All of the other 16 patients either died, or went home to die with their family so they don't have to pay the morgue. One patient is a 20 year old kid with a neck mass so large that it is protruding through his skin, and has compressed his airway down to the size of a straw. Each day it gets bigger, and each day we try to provide the family with some hope that a throat surgeon will fix him. But we know that the likelihood of that happening is next to nothing. TOmorrow he will go with his family and try to somehow get to the Dominican Republic to find a surgeon there. Meanwhile, all the way across the room you can hear him gasping for air with every breath.
Our other patient is a young man with a brain mass. Well, we think he has a mass based upon his symptoms, but we don't actually know with 100% certainty because we haven't see a CT Scan yet. His parents, who are there with him 24 hours a day, sold some of their personal belongings and spent their life savings to be able to afford the $250 to get a CT Scan for their son. We strongly urged them to not do this, as it will not, unfortunately, change any outcome, as there are no neurosurgeons in the entire country. So even if he does have a brain mass, he will still just go home with his family to die.
This is the kind of stuff we have seen on a daily basis. How can any of this be acceptable? But we didn't come here thinking that we could change these problems. These problems existed long before the earthquake, and will keep right on happening.
90,000. That is the number of patients we saw and treated since January. That's more than a busy trauma ER sees in one year. Many we saved. Many we didn't.
But - in all honesty, despite all of the good we have done and the hope we have given and the lives we have touched, we are leaving this place exactly how we found it. Nothing has changed. Nothing we contributed has been sustainable. But you can't have sustainable change without societal change...and the societal problems in this country are hundreds of years in the making, and will take another hundred to fix.
And as i'm typing this, it's pouring rain outside. Right now, millions are hovered in shoddy tents with dirt floors and blankets for beds. And I'm in my air conditioned hotel room on a kind sized bed listening to my IPod. Life just isn't fair.
Saturday, June 26, 2010
Haiti - Day 12
We are officially done with our work in the Emergency Department, and are in the ICU only. It seems as though our lives have come to a screeching halt.
For the past 12 days for me, and 5 months for IMC, we have been tirelessly seeing anyone and everyone who has come to the HUEH Hospital. In fact, we have seen and treated 90,000 patients since January 13th. We have been in over our heads and besieged by the breadth and depth of illness here. And yesterday, we stopped this tireless effort in the ER, and passed the torch to the Haitians.
It is completely depressing to look over at the overwhelmed ER. They have only one physician and one RN, which is nowhere near enough. Patients are laying on the ground, as all of the beds have been filled. IV lines hang dry. People are moaning in pain. Foley bags are filled to the brim with urine. Full bedpans with flies lie everywhere. It looks as though the patients are receiving little to no care, and many of them will ultimately die there.
This is all happening while we are sitting around in the adjacent ICU. There are 5 of us for 6 patients. But our hands are tied. We have been told to not reach over to help them, as they need to start to take on what we have started. But to compare what we can provide, with our educational backgrounds, resources, and sheer manpower, isn't a fair comparison. However, we realize that we can not stay here forever, and at some point, we must leave.
That time is now. And it's harder than ever.
Being that we have only 6 patients, and plenty of hands, I walked over to the nearby re-feeding tent, where approximately 10 cribs line the perimeter of a hot, fan less tent. In each crib you'll see a cherubic Hatian baby in one various stage of the refeeding process. For a myriad of reasons, these children have been identified as malnourished, and are bought here to go through an intense feeding and weight gaining process. Many, towards the end of the cycle, look plump, happy, and healthy with a full head of hair and a robust smile. Others are frail and skeletal, barely able to hold their heads up. Most of the babies are orphans, as their parents either just left them at the doorstep and abandoned them, or couldn't care for them, or died in the quake, and a few are there with their mothers.
At first glance, my eyes welled with tears at the image of emaciated children with big heads bloated bellies. But after seeing the beautiful, plump outcome, and to see all of the good that they are doing to target these beautiful kids, I became happy. It was an hour of bliss, and exactly what I needed. It was a reminder that although there is a lot of misery here, there is a lot of good happening as well.
PS - Not sure what happened to my little girl from yesterday, as she went to the Pediatric Ward. We can only hope from here...
For the past 12 days for me, and 5 months for IMC, we have been tirelessly seeing anyone and everyone who has come to the HUEH Hospital. In fact, we have seen and treated 90,000 patients since January 13th. We have been in over our heads and besieged by the breadth and depth of illness here. And yesterday, we stopped this tireless effort in the ER, and passed the torch to the Haitians.
It is completely depressing to look over at the overwhelmed ER. They have only one physician and one RN, which is nowhere near enough. Patients are laying on the ground, as all of the beds have been filled. IV lines hang dry. People are moaning in pain. Foley bags are filled to the brim with urine. Full bedpans with flies lie everywhere. It looks as though the patients are receiving little to no care, and many of them will ultimately die there.
This is all happening while we are sitting around in the adjacent ICU. There are 5 of us for 6 patients. But our hands are tied. We have been told to not reach over to help them, as they need to start to take on what we have started. But to compare what we can provide, with our educational backgrounds, resources, and sheer manpower, isn't a fair comparison. However, we realize that we can not stay here forever, and at some point, we must leave.
That time is now. And it's harder than ever.
Being that we have only 6 patients, and plenty of hands, I walked over to the nearby re-feeding tent, where approximately 10 cribs line the perimeter of a hot, fan less tent. In each crib you'll see a cherubic Hatian baby in one various stage of the refeeding process. For a myriad of reasons, these children have been identified as malnourished, and are bought here to go through an intense feeding and weight gaining process. Many, towards the end of the cycle, look plump, happy, and healthy with a full head of hair and a robust smile. Others are frail and skeletal, barely able to hold their heads up. Most of the babies are orphans, as their parents either just left them at the doorstep and abandoned them, or couldn't care for them, or died in the quake, and a few are there with their mothers.
At first glance, my eyes welled with tears at the image of emaciated children with big heads bloated bellies. But after seeing the beautiful, plump outcome, and to see all of the good that they are doing to target these beautiful kids, I became happy. It was an hour of bliss, and exactly what I needed. It was a reminder that although there is a lot of misery here, there is a lot of good happening as well.
PS - Not sure what happened to my little girl from yesterday, as she went to the Pediatric Ward. We can only hope from here...
Friday, June 25, 2010
Haiti - Day 11
My medical ailments continue here in Haiti.
I have self diagnosed myself with having the Giardia Parasite that is most commonly contracted through drinking contaminated water. Among many of its hallmark features, (I'll spare some of the lovely details) are sulfer-tasting belches. Yep, I got ‘em. And as if this wasn’t enough, I accidentally fell asleep last night without remembering to douse myself in deet, as I usually do before I shimmy under the covers. After a long day of feeling lousy, I passed out in an Ambien induced coma, and had a nice long, 7 hour sleep…
…until I awoke at 6:00am, feeling rather itchy, and rather lumpy.
I looked in the mirror to discover that I was covered with mosquito bites (at least I hope that the bites came from a mosquito, versus some other less desirable insect). 121 times over (and probably more as I can’t count the ones on the back of my neck), covering my face (I look horrendous), neck, arms, and hands.
After I fashioned a fine bag with cut out eyes to throw over my head, I pulled myself together, yet again, and hopped on the bus. I should have used my better judgment as once again, I could hardly stand up straight without feeling dizzy. It was a unanimous decision that I should be sent home. It probably had more to do with the fact that once people took a look at my wretched, pale, mosquito infested face, no one wanted to come within 3 feet of me. But regardless, back on the bus I went. I lasted a total of about 2 hours – better than yesterday – but at least I got to have some patient contact this morning.
Unfortunately, the one patient contact I had was not a pleasant one.
Overnight, the ER admitted a very small 3 year old girl, who was laying on the gurney with her mother. She had not yet been seen my any medical staff, so I took her chart and began to investigate why she was there. Aside from a ratty diaper, the girl was completely naked. I could tell just by looking at her that she had an obvious cognitive and developmental delay, and markedly stunted growth.
She whimpered a bit and looked uncomfortable, but she was by no means cry or looking in obvious distress.
Through the help of my translator, the woman conveyed to me that her daughter was having vaginal bleeding. Immediately concerned and suspicious, I got my head lamp and proper supplies. I removed the diaper and was horrified to see that she was ripped from top to bottom…from her urethra to her rectum. It was a bloody, macerated mess. This, of course, elicited a horrific scream from the little girl, and I realized that if I was going to get a more thorough exam then we would have to make her more comfortable. We gave her some ketamine (like we did for the little boy who needed his forehead sutured) , and our stomachs churned when we discovered that she had been so brutally assaulted that her injuries involved her colon/large intestine as well. She would need immediate surgery to repair this hole in her bowel, before she became septic. The chances of her getting this surgery immediately is almost slim to none, as I have seen dozens of people over the past 10 days require emergency surgery that never receive it, and are left to die, right in front of us.
Makes a million mosquito bites and an intestinal parasite seem like nothing.
I await the return of my colleagues tonight to find out what happened to her after I left.
I end with an article sent to me by my Uncle Ralph yesterday, posted in the New York Times. It discusses Haitian women who are brutally assaulted and raped, and subsequently left to die. Many do, but this one woman didn’t. She tells her story; a story that is frighteningly similar to thousands of violated young girls and women, not only in Haiti, but throughout the world.
http://www.nytimes.com/2010/06/24/world/americas/24haiti.html?sq=haiti&st=cse&adxnnl=1&scp=2&adxnnlx=1277402434-+6wVGrwcN+WbEixM+2o3KA
I have self diagnosed myself with having the Giardia Parasite that is most commonly contracted through drinking contaminated water. Among many of its hallmark features, (I'll spare some of the lovely details) are sulfer-tasting belches. Yep, I got ‘em. And as if this wasn’t enough, I accidentally fell asleep last night without remembering to douse myself in deet, as I usually do before I shimmy under the covers. After a long day of feeling lousy, I passed out in an Ambien induced coma, and had a nice long, 7 hour sleep…
…until I awoke at 6:00am, feeling rather itchy, and rather lumpy.
I looked in the mirror to discover that I was covered with mosquito bites (at least I hope that the bites came from a mosquito, versus some other less desirable insect). 121 times over (and probably more as I can’t count the ones on the back of my neck), covering my face (I look horrendous), neck, arms, and hands.
After I fashioned a fine bag with cut out eyes to throw over my head, I pulled myself together, yet again, and hopped on the bus. I should have used my better judgment as once again, I could hardly stand up straight without feeling dizzy. It was a unanimous decision that I should be sent home. It probably had more to do with the fact that once people took a look at my wretched, pale, mosquito infested face, no one wanted to come within 3 feet of me. But regardless, back on the bus I went. I lasted a total of about 2 hours – better than yesterday – but at least I got to have some patient contact this morning.
Unfortunately, the one patient contact I had was not a pleasant one.
Overnight, the ER admitted a very small 3 year old girl, who was laying on the gurney with her mother. She had not yet been seen my any medical staff, so I took her chart and began to investigate why she was there. Aside from a ratty diaper, the girl was completely naked. I could tell just by looking at her that she had an obvious cognitive and developmental delay, and markedly stunted growth.
She whimpered a bit and looked uncomfortable, but she was by no means cry or looking in obvious distress.
Through the help of my translator, the woman conveyed to me that her daughter was having vaginal bleeding. Immediately concerned and suspicious, I got my head lamp and proper supplies. I removed the diaper and was horrified to see that she was ripped from top to bottom…from her urethra to her rectum. It was a bloody, macerated mess. This, of course, elicited a horrific scream from the little girl, and I realized that if I was going to get a more thorough exam then we would have to make her more comfortable. We gave her some ketamine (like we did for the little boy who needed his forehead sutured) , and our stomachs churned when we discovered that she had been so brutally assaulted that her injuries involved her colon/large intestine as well. She would need immediate surgery to repair this hole in her bowel, before she became septic. The chances of her getting this surgery immediately is almost slim to none, as I have seen dozens of people over the past 10 days require emergency surgery that never receive it, and are left to die, right in front of us.
Makes a million mosquito bites and an intestinal parasite seem like nothing.
I await the return of my colleagues tonight to find out what happened to her after I left.
I end with an article sent to me by my Uncle Ralph yesterday, posted in the New York Times. It discusses Haitian women who are brutally assaulted and raped, and subsequently left to die. Many do, but this one woman didn’t. She tells her story; a story that is frighteningly similar to thousands of violated young girls and women, not only in Haiti, but throughout the world.
http://www.nytimes.com/2010/06/24/world/americas/24haiti.html?sq=haiti&st=cse&adxnnl=1&scp=2&adxnnlx=1277402434-+6wVGrwcN+WbEixM+2o3KA
Thursday, June 24, 2010
Haiti - Day 10
Well, it's been a bit of a rough 24 hours...
Last evening, while completely immersed in a great book, I began to feel some rumblings in my stomach. You may, in fact, have felt or heard these noises all the way back in the States. It was just the sinister precursor to what was an abysmal night either on or in front of the toilet. I slept very little, and when it came time for the alarm at 6am, I washed my face, donned the scrubs, and desperately tried to pull my aching, pale body together. I still really wanted to go to work. Today was our last day staffing the ER, as we pull out tomorrow to allow for the Haitian staff to take over. Going forward, we're just in the ICU, with the intention of making a gradual departure out of the Hospital by the end of next week.
I hopped on the bus, and lasted only about an hour at the hospital. I was just too nauseated and light headed to be of any help. Everyone insisted that I leave once I was caught slumped over in the chair with my head between my legs. I came back to the room, and 10mg of Ambien later, I awoke feeling somewhat better. I still haven't eaten all day, as I'm still tasting last night's dinner, but I may attempt to mosey down later for a little rice. I'll be fine. I hope this was the worst of it...
The unpleasantness of this was slightly compounded by the fact that right before I began to feel ill, Collette and I realized that some things from our room had been stolen. Chris's international phone that he had let me borrow, and a total of about $50 cash, were gone. It's not that big of a deal - at least we still have our passports and stash of chocolate (: Seriously - we really aren't that upset about it. $30 goes a long way here. Heck - someone maybe needed it to get his loved one out of the morgue.
Here's to good sleep tonight and better health tomorrow!
Last evening, while completely immersed in a great book, I began to feel some rumblings in my stomach. You may, in fact, have felt or heard these noises all the way back in the States. It was just the sinister precursor to what was an abysmal night either on or in front of the toilet. I slept very little, and when it came time for the alarm at 6am, I washed my face, donned the scrubs, and desperately tried to pull my aching, pale body together. I still really wanted to go to work. Today was our last day staffing the ER, as we pull out tomorrow to allow for the Haitian staff to take over. Going forward, we're just in the ICU, with the intention of making a gradual departure out of the Hospital by the end of next week.
I hopped on the bus, and lasted only about an hour at the hospital. I was just too nauseated and light headed to be of any help. Everyone insisted that I leave once I was caught slumped over in the chair with my head between my legs. I came back to the room, and 10mg of Ambien later, I awoke feeling somewhat better. I still haven't eaten all day, as I'm still tasting last night's dinner, but I may attempt to mosey down later for a little rice. I'll be fine. I hope this was the worst of it...
The unpleasantness of this was slightly compounded by the fact that right before I began to feel ill, Collette and I realized that some things from our room had been stolen. Chris's international phone that he had let me borrow, and a total of about $50 cash, were gone. It's not that big of a deal - at least we still have our passports and stash of chocolate (: Seriously - we really aren't that upset about it. $30 goes a long way here. Heck - someone maybe needed it to get his loved one out of the morgue.
Here's to good sleep tonight and better health tomorrow!
Wednesday, June 23, 2010
Haiti - Day 9
I'm coming down the home stretch!
It was another busy day (this is a reoccurring theme). It was actually one of my busiest days yet, as I had 7 little nursing students following me around until noon. I tried to keep them busy, stimulated and interested, and I think they had a good time. I used as much French as I could (most educated Haitians can speak French in addition to their native language of Creole) but had to resort many times to my excellent hand gestures. They actually taught me a thing or two - yikes! it has been a long time since I have done bread and butter nursing, which is what we were doing today. it was mostly a morning of teaching, and then when the students left at noon, I switched back to the ER.
It was a very sad afternoon in the ICU yesterday, while I was having my afternoon off. We have had this young kid, just 15 years old, who developed a severe, acute renal disease (Acute tubular necrosis) several weeks ago. He was already in the ICU when we arrived last week. This serious disease requires patients to have dialysis, as their kidneys have failed. Dialysis is vital to their survival. If patient's miss a day of dialysis, then they can develop horrible systemic problems that involve every vital organ. He got dialized a few times last week, and was doing relatively well...
In fact, Dr. Ansell, an MD from Rush Medical Center in Chicago who is on our team now, had arranged through his clout and heart and passion for this kid to fly to Chicago and receive a kidney transplant from his brother. His family just had to get to Miami, and they would take care of the rest. All he needed was a few more dialysis treatments, and he was all set for his life saving surgery.
And then last weekend came.
He was to have his dialysis on Saturday afternoon. We waiting all morning for someone from the dialysis "clinic" to come get him. No one came. We waited all afternoon. No one came. We made calls. We had our director work on it. We had family check into it. Night time came, but no one from dialysis did. Sunday morning rolled around, and he began to have some mental status changes. The lack of any organ or machine filtering his blood of waste and toxins was building up to lethal levels, and was now affecting his brain. He became encephalopathic, and the need for dialysis was now greater than ever. All day Sunday came and past, and the kid never got dialized. Monday he was critically ill and had at this point suffered brain damage.
Finally, the dialysis folks came to get him on Monday afternoon, but it was too late. He had suffered a severe stroke, and by Monday evening, he was nearly dead. He required intubation, and remained on a ventilator overnight.
Yesterday afternoon, while I was floating in the pool, the decision was made to unplug the ventilator and to let the family take their son home to die, instead of passing in this catacomb of a hospital. You see, if someone dies at the actual hospital, they are taken directly to the morgue where the family has to come by the next day and pay $25 to take the body home. ($25 is a ton of money here). Instead, we let the family take him home to die in peace.
We discovered today that the dialysis team just decided to not work this weekend. Just didn't show up. Maybe they weren't getting paid...who knows. The point is - how can one ignore the complete irony of the family having to pay the ones responsible for killing their son?
This story makes me sad, and angry. This is just one example of many that reflects how messed up the system is here. We wait and wait and just watch people die. It is a horrible thing to know that at some times, our hands are tied, despite our passion and best efforts. This was a life that we were going to save, and for many reasons that are hard to explain or accept, we didn't.
It was another busy day (this is a reoccurring theme). It was actually one of my busiest days yet, as I had 7 little nursing students following me around until noon. I tried to keep them busy, stimulated and interested, and I think they had a good time. I used as much French as I could (most educated Haitians can speak French in addition to their native language of Creole) but had to resort many times to my excellent hand gestures. They actually taught me a thing or two - yikes! it has been a long time since I have done bread and butter nursing, which is what we were doing today. it was mostly a morning of teaching, and then when the students left at noon, I switched back to the ER.
It was a very sad afternoon in the ICU yesterday, while I was having my afternoon off. We have had this young kid, just 15 years old, who developed a severe, acute renal disease (Acute tubular necrosis) several weeks ago. He was already in the ICU when we arrived last week. This serious disease requires patients to have dialysis, as their kidneys have failed. Dialysis is vital to their survival. If patient's miss a day of dialysis, then they can develop horrible systemic problems that involve every vital organ. He got dialized a few times last week, and was doing relatively well...
In fact, Dr. Ansell, an MD from Rush Medical Center in Chicago who is on our team now, had arranged through his clout and heart and passion for this kid to fly to Chicago and receive a kidney transplant from his brother. His family just had to get to Miami, and they would take care of the rest. All he needed was a few more dialysis treatments, and he was all set for his life saving surgery.
And then last weekend came.
He was to have his dialysis on Saturday afternoon. We waiting all morning for someone from the dialysis "clinic" to come get him. No one came. We waited all afternoon. No one came. We made calls. We had our director work on it. We had family check into it. Night time came, but no one from dialysis did. Sunday morning rolled around, and he began to have some mental status changes. The lack of any organ or machine filtering his blood of waste and toxins was building up to lethal levels, and was now affecting his brain. He became encephalopathic, and the need for dialysis was now greater than ever. All day Sunday came and past, and the kid never got dialized. Monday he was critically ill and had at this point suffered brain damage.
Finally, the dialysis folks came to get him on Monday afternoon, but it was too late. He had suffered a severe stroke, and by Monday evening, he was nearly dead. He required intubation, and remained on a ventilator overnight.
Yesterday afternoon, while I was floating in the pool, the decision was made to unplug the ventilator and to let the family take their son home to die, instead of passing in this catacomb of a hospital. You see, if someone dies at the actual hospital, they are taken directly to the morgue where the family has to come by the next day and pay $25 to take the body home. ($25 is a ton of money here). Instead, we let the family take him home to die in peace.
We discovered today that the dialysis team just decided to not work this weekend. Just didn't show up. Maybe they weren't getting paid...who knows. The point is - how can one ignore the complete irony of the family having to pay the ones responsible for killing their son?
This story makes me sad, and angry. This is just one example of many that reflects how messed up the system is here. We wait and wait and just watch people die. It is a horrible thing to know that at some times, our hands are tied, despite our passion and best efforts. This was a life that we were going to save, and for many reasons that are hard to explain or accept, we didn't.
Tuesday, June 22, 2010
Haiti – Day 8
The day that I never thought would come, came.
I got the afternoon off.
As soon as I had heard that I was the lucky nominee of this coveted honor, I gladly accepted. When I got back to the hotel, I nearly jumped right into the pool with my scrubs on. I nearly had one foot in the water when I noticed a large sign that explicitly said “no scrubs on in the pool”. Darnit. It's a good rule, actually. If all of us did that, there isn't enough bleach and chlorine that can kill what's on us at the end of the day. Instead, I peeled them off in my room, grabbed my towel and an icy cold Prestige, and dove in.
All afternoon I laid by the pool, took two naps, read my book, and wrote this blog. It was just perfect. I looked in the mirror and hardly recognized the rested, rejuvenated, sun kissed person who was staring back at me.
It’s a bit ironic that this time off came on a day like today, as today, more than any other day, I really looked forward to going to work. My mindset has shifted quite a bit from just 5 days ago. And even as wonderful as this time away is, I’m already feeling that I’m actually kind of missing it. This “thing” has totally grown on me, and I can at least begin to understand how some people have come here to volunteer for 2 weeks, and months later, haven’t left yet.
I feel a bit wimpy being completely wiped out after 6 and ½ straight days of work, but honest to God this is the hardest work I have done in my entire life; probably more mentally than physically. IMC actually requires that we take at least one day off, and it is hard for many to do because we get so immersed in what we are doing. It is a bit hard to leave, as you feel that you’re not only abandoning your critically ill patients but your cohesive group of coworkers. But alas, this is very necessary.
The driver took me home on a different route, as we drove past the Parliament building and Presidential Palace so I could see a bit more of the city. Many of us have seen this now infamous image of the crumbled domes and collapsed surroundings of the palace, where President Rene Preval once resided. I hear that he and his wife now live in an army barrack near the Airport.
This down time of the afternoon has allowed me to really reflect on the past 6 days; how I have felt, what I have smelled, the lessons I have learned, and the atrocities I have witnessed. It is difficult to put many of it into words, but I think anyone can read the stories and see the pictures and formulate their own feelings.
Here are some staggering statistics about both pre and post quake Haiti, that I have learned over the past week. I think it helps to illustrate why this country has as many problems as it does and helps me understand what we’re up against:
* About 85% of all Haitians live in poverty.
* Most Haitians live on $2 or less per day.
* 50% of Haitians are illiterate. I learned this just yesterday, as I was explaining to a young man how to take his antibiotics. I handed him the bottle of pills, on which I had written “un grain, trios fois de jour” (one pill, three times per day). He stared back with obvious confusion and shame on his face. My translator explained to me that he could not read. I felt more ashamed than he did
* 80% of college graduates from Haiti have emigrated, mostly to the US
* Only 30% of Haitians have access to basic health care. Thirty percent? Wow...
* Poverty has forced at least 225,000 Haitian children to work as restavecs, which is essentially a form of slavery, as they perform free labor for their 'owners'. The children are sent away by their parents who are unable to care of them. Many of the restavec children are abused.
* Half of the Haitian children do not receive their childhood vaccinations. A child should never get the measles, or the mumps, or diphtheria. But I’ve seen it. There are reasons that there are vaccines for these diseases…they are horrible and deadly.
* Even before the January earthquake, nearly half the causes of deaths in Haiti have been attributed to HIV/AIDS, Tb, and diarrheal disease (typhoid and cholera)
* Ninety percent of Haiti’s children suffer parasites and waterbone diseases as a result of a lack of clean water
• The January earthquake immediately claimed the lives of 230,000 people, most of whom were ultimately buried in mass graves. 300,000 were injured, and they estimate that 30% of these later died from their injuries.
* One million people were made homeless.
* This one hits a bit closer to home; Haiti’s Nursing School (the one and only) completely collapsed during the earthquake. It was located right outside of our Hospital. I have attached a picture of what was once the building, but is now a pile of rubble and a new tent. The majority of the faculty was killed, along with more than half of the students, who were still in class that late afternoon on January 12th. The building was so horribly collapsed, and therefore, it was nearly impossible to reach any of the survivors or bodies. The stench grew to be so horrific that hey had to burn what was left.
This morning, we had the privilege of having 6 adorable, precocious nursing students join us in the hospital. They are among the remaining survivors from their class, so in essence, all 6 of them are the future of Haitian Nursing. They are shy, eager, sharp, and so darn cute in their white pinafore blouses and skirts. I want one to wear back home.
I’ll close with one final story from the day. You can see pictured to the right a beautiful little Haitian boy, who came in through the ER, with his mother (we think), and a laceration to his forehead. The boy was apparently misbehaving, and therefore his mother threw a bottle at his head as a form of punishment. The boy was completely petrified…not only of the surrounding ER atmosphere, but of my lidocaine-filled syringe. It took 4 of us to hold this little guy down. He, of course, like any normal child would, fought back with his life and thrashed around in hopes that he could win the war against the needle. During his fight, his mom beat him…right in front of us. She slapped him and hit him because he was scared. Heartbreaking doesn’t describe this.
We took a break from the action, and I played with him a bit and took his picture several times to show him the image on my digital camera. He loved it. I asked him if he was in school today, and he told me that he doesn’t go to school. He is probably a child restavec. Knowing that, and witnessing the public violence displayed by his mother, what kind of future does this child have?
Seeing that this wasn’t going to be easy, and not being able to stomach witnessing mom beating him more, we resorted to an intramuscular injection of Ketamine right in his thigh. This is a short acting sedative that is wonderful for doing minor procedures in kids. Within minutes, he was higher than a kite and fast asleep, and his forehead was beautifully and carefully sutured closed. He work up with a smile, holding a shiny new nascar toy that he “zoom zoom”-ed along the edge of the filthy, blood stained cot on which he laid.
Hear his story. Look at his picture. An image and tale that is tragically reflective of so many many children here. Don’t you want to take him home with you, too?
I got the afternoon off.
As soon as I had heard that I was the lucky nominee of this coveted honor, I gladly accepted. When I got back to the hotel, I nearly jumped right into the pool with my scrubs on. I nearly had one foot in the water when I noticed a large sign that explicitly said “no scrubs on in the pool”. Darnit. It's a good rule, actually. If all of us did that, there isn't enough bleach and chlorine that can kill what's on us at the end of the day. Instead, I peeled them off in my room, grabbed my towel and an icy cold Prestige, and dove in.
All afternoon I laid by the pool, took two naps, read my book, and wrote this blog. It was just perfect. I looked in the mirror and hardly recognized the rested, rejuvenated, sun kissed person who was staring back at me.
It’s a bit ironic that this time off came on a day like today, as today, more than any other day, I really looked forward to going to work. My mindset has shifted quite a bit from just 5 days ago. And even as wonderful as this time away is, I’m already feeling that I’m actually kind of missing it. This “thing” has totally grown on me, and I can at least begin to understand how some people have come here to volunteer for 2 weeks, and months later, haven’t left yet.
I feel a bit wimpy being completely wiped out after 6 and ½ straight days of work, but honest to God this is the hardest work I have done in my entire life; probably more mentally than physically. IMC actually requires that we take at least one day off, and it is hard for many to do because we get so immersed in what we are doing. It is a bit hard to leave, as you feel that you’re not only abandoning your critically ill patients but your cohesive group of coworkers. But alas, this is very necessary.
The driver took me home on a different route, as we drove past the Parliament building and Presidential Palace so I could see a bit more of the city. Many of us have seen this now infamous image of the crumbled domes and collapsed surroundings of the palace, where President Rene Preval once resided. I hear that he and his wife now live in an army barrack near the Airport.
This down time of the afternoon has allowed me to really reflect on the past 6 days; how I have felt, what I have smelled, the lessons I have learned, and the atrocities I have witnessed. It is difficult to put many of it into words, but I think anyone can read the stories and see the pictures and formulate their own feelings.
Here are some staggering statistics about both pre and post quake Haiti, that I have learned over the past week. I think it helps to illustrate why this country has as many problems as it does and helps me understand what we’re up against:
* About 85% of all Haitians live in poverty.
* Most Haitians live on $2 or less per day.
* 50% of Haitians are illiterate. I learned this just yesterday, as I was explaining to a young man how to take his antibiotics. I handed him the bottle of pills, on which I had written “un grain, trios fois de jour” (one pill, three times per day). He stared back with obvious confusion and shame on his face. My translator explained to me that he could not read. I felt more ashamed than he did
* 80% of college graduates from Haiti have emigrated, mostly to the US
* Only 30% of Haitians have access to basic health care. Thirty percent? Wow...
* Poverty has forced at least 225,000 Haitian children to work as restavecs, which is essentially a form of slavery, as they perform free labor for their 'owners'. The children are sent away by their parents who are unable to care of them. Many of the restavec children are abused.
* Half of the Haitian children do not receive their childhood vaccinations. A child should never get the measles, or the mumps, or diphtheria. But I’ve seen it. There are reasons that there are vaccines for these diseases…they are horrible and deadly.
* Even before the January earthquake, nearly half the causes of deaths in Haiti have been attributed to HIV/AIDS, Tb, and diarrheal disease (typhoid and cholera)
* Ninety percent of Haiti’s children suffer parasites and waterbone diseases as a result of a lack of clean water
• The January earthquake immediately claimed the lives of 230,000 people, most of whom were ultimately buried in mass graves. 300,000 were injured, and they estimate that 30% of these later died from their injuries.
* One million people were made homeless.
* This one hits a bit closer to home; Haiti’s Nursing School (the one and only) completely collapsed during the earthquake. It was located right outside of our Hospital. I have attached a picture of what was once the building, but is now a pile of rubble and a new tent. The majority of the faculty was killed, along with more than half of the students, who were still in class that late afternoon on January 12th. The building was so horribly collapsed, and therefore, it was nearly impossible to reach any of the survivors or bodies. The stench grew to be so horrific that hey had to burn what was left.
This morning, we had the privilege of having 6 adorable, precocious nursing students join us in the hospital. They are among the remaining survivors from their class, so in essence, all 6 of them are the future of Haitian Nursing. They are shy, eager, sharp, and so darn cute in their white pinafore blouses and skirts. I want one to wear back home.
I’ll close with one final story from the day. You can see pictured to the right a beautiful little Haitian boy, who came in through the ER, with his mother (we think), and a laceration to his forehead. The boy was apparently misbehaving, and therefore his mother threw a bottle at his head as a form of punishment. The boy was completely petrified…not only of the surrounding ER atmosphere, but of my lidocaine-filled syringe. It took 4 of us to hold this little guy down. He, of course, like any normal child would, fought back with his life and thrashed around in hopes that he could win the war against the needle. During his fight, his mom beat him…right in front of us. She slapped him and hit him because he was scared. Heartbreaking doesn’t describe this.
We took a break from the action, and I played with him a bit and took his picture several times to show him the image on my digital camera. He loved it. I asked him if he was in school today, and he told me that he doesn’t go to school. He is probably a child restavec. Knowing that, and witnessing the public violence displayed by his mother, what kind of future does this child have?
Seeing that this wasn’t going to be easy, and not being able to stomach witnessing mom beating him more, we resorted to an intramuscular injection of Ketamine right in his thigh. This is a short acting sedative that is wonderful for doing minor procedures in kids. Within minutes, he was higher than a kite and fast asleep, and his forehead was beautifully and carefully sutured closed. He work up with a smile, holding a shiny new nascar toy that he “zoom zoom”-ed along the edge of the filthy, blood stained cot on which he laid.
Hear his story. Look at his picture. An image and tale that is tragically reflective of so many many children here. Don’t you want to take him home with you, too?
Monday, June 21, 2010
Haiti - Day 7
It was yet another hot, frustrating, exhausting day in Haiti...
There were many many deaths today, including that of a young 7 year old boy (kids deaths are really awful). Many deaths more or less anticipated, and others were sudden and unexpected. This beautiful young boy with soft brown skin and long eyelashes was carried in by his mother, who said that he had been ill for about a week; sick with a fever, not playing much, kind of lethargic, etc. When he came to us, he was barely responsive and had very labored respirations. The boy had many abnormal clinical features; he was a very thin and underdeveloped 7 year old. He had a very large liver that we could palpate. He had enlarged lymph nodes in his neck and in his arm pits. He had sores on the roof of his mouth. Simply put - he looked toxic. We got an IV in him and gave him some fluids and antibiotics, because everyone here has something infectious that responds to an antibiotic. He did well for a while, but a few hours later he began to drop his oxygen saturation. He suddenly stopped breathing and went into cardiac arrest. We tried to resuscitate him for 30 minutes or so, but because of all of his swollen lymph nodes, we could not intubate him. He died right in front of us with his wailing mom and did right by our side.
He probably died of HIV. Undiagnosed and untreated HIV. He was only 7.
We see so many newly diagnosed HIV cases. It presents in such occult, insidious ways that it require us to put many pieces of the puzzle together. Many are adults, but some are kids too. Yesterday a young, 16 year old girl came in through triage complaining of an earache and throat pain. She looked awfully anorexic, pale, and toxic. I took one look in her mouth and saw a white furry coat of oral thrush. There is no reason why a 16 year old girl should have thrush in her mouth...only if she is immune suppressed. We took a blood sample, and she came back positive for HIV. Nearly half of our current patient load are HIV positive. When untreated, HIV is rampant, scary, and deadly. The way that people die here from HIV doesn't happen nearly as often in a developed society, as back home, we have the proper screening tools, medications, technology, and resources to fight it. But not in Haiti.
On the ride home, while staring out the window at the hundreds and hundreds of tents homes fashioned atop garbage, rubble, and human excrement, I reflected on the day and thought to myself how people here lead such difficult, difficult lives. Their lives are a constant struggle for a myriad of reasons. And even in death, they struggle. Their death, from what I have seen in the past 6 days, is a slow, painful battle. They can't even die in peace. For the one moment in their life when they leave this earth to enter a new place, can't they just go in peace?
There were many many deaths today, including that of a young 7 year old boy (kids deaths are really awful). Many deaths more or less anticipated, and others were sudden and unexpected. This beautiful young boy with soft brown skin and long eyelashes was carried in by his mother, who said that he had been ill for about a week; sick with a fever, not playing much, kind of lethargic, etc. When he came to us, he was barely responsive and had very labored respirations. The boy had many abnormal clinical features; he was a very thin and underdeveloped 7 year old. He had a very large liver that we could palpate. He had enlarged lymph nodes in his neck and in his arm pits. He had sores on the roof of his mouth. Simply put - he looked toxic. We got an IV in him and gave him some fluids and antibiotics, because everyone here has something infectious that responds to an antibiotic. He did well for a while, but a few hours later he began to drop his oxygen saturation. He suddenly stopped breathing and went into cardiac arrest. We tried to resuscitate him for 30 minutes or so, but because of all of his swollen lymph nodes, we could not intubate him. He died right in front of us with his wailing mom and did right by our side.
He probably died of HIV. Undiagnosed and untreated HIV. He was only 7.
We see so many newly diagnosed HIV cases. It presents in such occult, insidious ways that it require us to put many pieces of the puzzle together. Many are adults, but some are kids too. Yesterday a young, 16 year old girl came in through triage complaining of an earache and throat pain. She looked awfully anorexic, pale, and toxic. I took one look in her mouth and saw a white furry coat of oral thrush. There is no reason why a 16 year old girl should have thrush in her mouth...only if she is immune suppressed. We took a blood sample, and she came back positive for HIV. Nearly half of our current patient load are HIV positive. When untreated, HIV is rampant, scary, and deadly. The way that people die here from HIV doesn't happen nearly as often in a developed society, as back home, we have the proper screening tools, medications, technology, and resources to fight it. But not in Haiti.
On the ride home, while staring out the window at the hundreds and hundreds of tents homes fashioned atop garbage, rubble, and human excrement, I reflected on the day and thought to myself how people here lead such difficult, difficult lives. Their lives are a constant struggle for a myriad of reasons. And even in death, they struggle. Their death, from what I have seen in the past 6 days, is a slow, painful battle. They can't even die in peace. For the one moment in their life when they leave this earth to enter a new place, can't they just go in peace?
Sunday, June 20, 2010
Haiti - Day 6
I have decided to focus on mostly positive things tonight, since I feel like each of my previous posts have been riddled with depressing, heavy stuff. I think I truthfully believed for the first time today that we're actually doing some good here, and even if we save one life and lose 10, that's still one precious life saved. There is good in that.
To start off the day, I lived out a real life version of 'Home Alone', although Home Alone in Port Au Prince is a tad more petrifying than Home Alone in a Mansion in Winnetka Illinois. Our morning routine is that we all gather to eat breakfast of chewy cornflakes at 6:30am, and then head on the bus at 6:50 to arrive at the Hospital at 7:00. After I finished my meal, i quickly ran upstairs to use the bathroom (I would have to be desperate to use the bathroom at the hospital), and came down just 5 minutes later to discover that the bus left without me. I'm not sure what was more disappointing - realizing that it was gone, or realizing that no one seemed to notice that I was missing. "Surely they'll get down the street and everyone will realize that they forgot me", I reassured myself. 30 minutes later, there I stood, like a dummy, in the same place where I realized that I had been ditched. Just me, and the 3 security guards with their combat boots and machine guns slinged across their chests. I asked them if I could take their picture, hoping to lighten the situation a bit and make them smile.
They didn't smile.
I decided at that point that I should leave to call David, the logistics director of IMC to tell him that my colon couldn't wait this morning, and apparently the bus couldn't either. I also contemplated throwing on my swimsuit and laying out by the pool, but I resisted the temptation. I called David, who arranged to pick me up, and one hour later, I was there. No harm done.
There was the usual barrage of sadness and frustration today, but there were some good things and pleasant surprises as well. My favorite patient with the cervical fracture was able to get transferred from our Hospital to the Medishare hospital. Medishare is completely created and staffed by health care workers from Miami FL who set it up near Haitian Airport. They have a traveling Neurosurgeon there this week, who is willing to try and take on the surgery for this patient. I cried when I heard the news, and cried when he left. So did he. We (I can't take credit, it was our coordinator) helped facilitate this transfer and gave him the only hope and chance that he deserves.
This is a testament to the fact that there are good people in this world. Good people who believe in helping others and who can provide hope in situations that seem bleak and hopeless.
Lunch time came. I lucked out and had peanut butter in the MRE packet that was given to me. MRE stands for 'Meals Ready to Eat' and are used to feed soldiers in the army. We eat MREs for lunch every day. My MRE today was Clam Chowder and Vegetable Lasagna, which are both prepared in a mushy consistency, eaten at room temperature right out of the pouch. I regurgitate just thinking about it, but when it comes around to one or two in the afternoon and I'm desperately hungry, I would hurt someone if they tried to take my Clam Chowder. I covet it as if I haven't eaten in weeks (it kind of feels like that, actually). But today, my pack had peanut butter, which was truly the best luck of all. I wouldn't even share it, that's how bad I wanted it.
Following a long and exhausting day, we hopped back on the bus, where all I can do is stare out the window,and rock back and forth a bit as if I have suffered a traumatic brain injury. Following a refreshing shower, a wonderful phone call from Chris, and a Sunday night buffet dinner by the pool with a live Haitian band playing joyful music, life seemed so much better and I was able to use my words again. Having a cold beer with my fellow co workers and recounting stories of the day, while sharing a laugh or two, is entirely therapeutic.
And - the crowned jewel of the day was being able to say a quick hello to my parents and a Happy Father's Day to my Dad. Perfect.
Tonight I'm going to sleep with a smile.
To start off the day, I lived out a real life version of 'Home Alone', although Home Alone in Port Au Prince is a tad more petrifying than Home Alone in a Mansion in Winnetka Illinois. Our morning routine is that we all gather to eat breakfast of chewy cornflakes at 6:30am, and then head on the bus at 6:50 to arrive at the Hospital at 7:00. After I finished my meal, i quickly ran upstairs to use the bathroom (I would have to be desperate to use the bathroom at the hospital), and came down just 5 minutes later to discover that the bus left without me. I'm not sure what was more disappointing - realizing that it was gone, or realizing that no one seemed to notice that I was missing. "Surely they'll get down the street and everyone will realize that they forgot me", I reassured myself. 30 minutes later, there I stood, like a dummy, in the same place where I realized that I had been ditched. Just me, and the 3 security guards with their combat boots and machine guns slinged across their chests. I asked them if I could take their picture, hoping to lighten the situation a bit and make them smile.
They didn't smile.
I decided at that point that I should leave to call David, the logistics director of IMC to tell him that my colon couldn't wait this morning, and apparently the bus couldn't either. I also contemplated throwing on my swimsuit and laying out by the pool, but I resisted the temptation. I called David, who arranged to pick me up, and one hour later, I was there. No harm done.
There was the usual barrage of sadness and frustration today, but there were some good things and pleasant surprises as well. My favorite patient with the cervical fracture was able to get transferred from our Hospital to the Medishare hospital. Medishare is completely created and staffed by health care workers from Miami FL who set it up near Haitian Airport. They have a traveling Neurosurgeon there this week, who is willing to try and take on the surgery for this patient. I cried when I heard the news, and cried when he left. So did he. We (I can't take credit, it was our coordinator) helped facilitate this transfer and gave him the only hope and chance that he deserves.
This is a testament to the fact that there are good people in this world. Good people who believe in helping others and who can provide hope in situations that seem bleak and hopeless.
Lunch time came. I lucked out and had peanut butter in the MRE packet that was given to me. MRE stands for 'Meals Ready to Eat' and are used to feed soldiers in the army. We eat MREs for lunch every day. My MRE today was Clam Chowder and Vegetable Lasagna, which are both prepared in a mushy consistency, eaten at room temperature right out of the pouch. I regurgitate just thinking about it, but when it comes around to one or two in the afternoon and I'm desperately hungry, I would hurt someone if they tried to take my Clam Chowder. I covet it as if I haven't eaten in weeks (it kind of feels like that, actually). But today, my pack had peanut butter, which was truly the best luck of all. I wouldn't even share it, that's how bad I wanted it.
Following a long and exhausting day, we hopped back on the bus, where all I can do is stare out the window,and rock back and forth a bit as if I have suffered a traumatic brain injury. Following a refreshing shower, a wonderful phone call from Chris, and a Sunday night buffet dinner by the pool with a live Haitian band playing joyful music, life seemed so much better and I was able to use my words again. Having a cold beer with my fellow co workers and recounting stories of the day, while sharing a laugh or two, is entirely therapeutic.
And - the crowned jewel of the day was being able to say a quick hello to my parents and a Happy Father's Day to my Dad. Perfect.
Tonight I'm going to sleep with a smile.
Saturday, June 19, 2010
Haiti - Day 5
I’m happy to report that it was a much better day today for many reasons. I slept well, paced myself and made an effort to drink more water, and I believe I have come to terms a bit more with what is the reality here, and what we are, and are not, capable of. This doesn’t necessarily make it any easier, but it makes it less traumatic for me.
It was another day of really sick patients. Some have traditional diseases like we have in the US, such as Congestive Heart Failure, Pneumonia, Kidney Infections, Acute Surgical issues (gallbladders, appendicitis, etc….), but when these patients finally come to the hospital, their diseases are ten times worse. Again – there is no concept of primary care here, and no diseases are prevented or treated. And, we see some pretty uncommon and rare diseases that we don’t often see in the US…such as Typhoid, Dengue Fever, Dysentery, Tb, and lots of HIV. Many traumatic injuries are the result of violence and assaults and traffic injuries, as there are no traffic lights or rules.
We didn’t get breakfast today – not sure of the logistics behind that - but I successfully managed to prevent myself from panicking. We headed to the hospital, and I came back to some patients that I had said good-bye to when we left just last night. There is one patient that I have really taken a liking to and whose story is tragic. Early yesterday morning, this young businessman was outside with his family, and he was hit in the back of the neck by a piece of heavy, falling debris. The force was so great that it not only fractured his cervical vertebrae, but severed his spinal cord. He was immediately paralyzed in all four of his extremities and laid motionless, but still with a pulse and the ability to breathe, and a perfectly functioning brain. He was carried in by family, and after an xray (thankfully it was working yesterday), we all viewed his horrific image. What this kid undoubtedly needs is surgery to fuse his spine to prevent further spinal cord damage. But that kind of surgeon and that kind of surgery and the rehabilitation to support it just doesn’t exist here. So – here he lies, flat on his back in the ER, with a tube in his bladder and a diaper on because he can not control his bowel or bladder, and is essentially waiting to die. If we sit him up, he will damage his unstable spinal cord and could die instantly. Maybe that would be better than the slow, painful death he will face, laying flat on his back in the corner of a dark, putrid ER with a fever of 105.0. And every time I check on him and ask him if he needs something, he says, “no, merci, ca va bien” (no thank you, I’m fine) and asks how I am. Sometimes I just have to walk away because I don’t want him to see my tears.
At some point in the early morning, a frightened young woman came up from behind me and tapped me on the shoulder, and handed to me a swaddled bundle of bloody blankets. I could sense that something was wrapped inside. As I peeled back the layers, I discovered a very tiny tiny baby inside. He wasn’t crying, but I could see his small lungs retracting, very rapidly. He was born this morning at 27 weeks – an age that is barely older than the age where babies are considered viable. Mom was fine, but she was confused and scared, so she came to the ER. We checked her out, and her baby, and miraculously they were doing just fine. Can you imagine a woman in the US walking for miles and miles, just a few hours post op and completely alone, to find help for her baby?
Around lunchtime I sutured the arm of a 10 year old kid whose mother slashed him with a knife as a form of punishment. I saw a man who’s right testicle was the size of a football, as he has not had anyone to look at his large inguinal hernia in over 3 years. We admitted dozens of other sick sick patients…most stayed, some died. I have never put anyone in a body bag before. Until this week...
How did Haiti become so neglected? It's a long, complicated history, with a long, complicated list of problems. When will Haiti ever rebuild?...
Time for bed.
Love,
Gretchen
It was another day of really sick patients. Some have traditional diseases like we have in the US, such as Congestive Heart Failure, Pneumonia, Kidney Infections, Acute Surgical issues (gallbladders, appendicitis, etc….), but when these patients finally come to the hospital, their diseases are ten times worse. Again – there is no concept of primary care here, and no diseases are prevented or treated. And, we see some pretty uncommon and rare diseases that we don’t often see in the US…such as Typhoid, Dengue Fever, Dysentery, Tb, and lots of HIV. Many traumatic injuries are the result of violence and assaults and traffic injuries, as there are no traffic lights or rules.
We didn’t get breakfast today – not sure of the logistics behind that - but I successfully managed to prevent myself from panicking. We headed to the hospital, and I came back to some patients that I had said good-bye to when we left just last night. There is one patient that I have really taken a liking to and whose story is tragic. Early yesterday morning, this young businessman was outside with his family, and he was hit in the back of the neck by a piece of heavy, falling debris. The force was so great that it not only fractured his cervical vertebrae, but severed his spinal cord. He was immediately paralyzed in all four of his extremities and laid motionless, but still with a pulse and the ability to breathe, and a perfectly functioning brain. He was carried in by family, and after an xray (thankfully it was working yesterday), we all viewed his horrific image. What this kid undoubtedly needs is surgery to fuse his spine to prevent further spinal cord damage. But that kind of surgeon and that kind of surgery and the rehabilitation to support it just doesn’t exist here. So – here he lies, flat on his back in the ER, with a tube in his bladder and a diaper on because he can not control his bowel or bladder, and is essentially waiting to die. If we sit him up, he will damage his unstable spinal cord and could die instantly. Maybe that would be better than the slow, painful death he will face, laying flat on his back in the corner of a dark, putrid ER with a fever of 105.0. And every time I check on him and ask him if he needs something, he says, “no, merci, ca va bien” (no thank you, I’m fine) and asks how I am. Sometimes I just have to walk away because I don’t want him to see my tears.
At some point in the early morning, a frightened young woman came up from behind me and tapped me on the shoulder, and handed to me a swaddled bundle of bloody blankets. I could sense that something was wrapped inside. As I peeled back the layers, I discovered a very tiny tiny baby inside. He wasn’t crying, but I could see his small lungs retracting, very rapidly. He was born this morning at 27 weeks – an age that is barely older than the age where babies are considered viable. Mom was fine, but she was confused and scared, so she came to the ER. We checked her out, and her baby, and miraculously they were doing just fine. Can you imagine a woman in the US walking for miles and miles, just a few hours post op and completely alone, to find help for her baby?
Around lunchtime I sutured the arm of a 10 year old kid whose mother slashed him with a knife as a form of punishment. I saw a man who’s right testicle was the size of a football, as he has not had anyone to look at his large inguinal hernia in over 3 years. We admitted dozens of other sick sick patients…most stayed, some died. I have never put anyone in a body bag before. Until this week...
How did Haiti become so neglected? It's a long, complicated history, with a long, complicated list of problems. When will Haiti ever rebuild?...
Time for bed.
Love,
Gretchen
Friday, June 18, 2010
Day 4 – Haiti
Today was completely and utterly overwhelming. Not only did I not stop to use the bathroom or eat all day long, but each new patient was sicker than the next one, and we really had no answer to anyone’s problems. In short, it was just a shitty day.
We arrived to the hospital to discover that all of our fans were stolen overnight. The hospital is staffed by MDs from Boston Hospitals overnight, but of course they’re not in every room at all times. Someone walked out with the 4 fans that keeps us alive during the day. We realized from the moment we arrived that the day was going to be difficult. And it was. Many deaths, many unsolvable problems.
It was just heavy and sad from beginning to end. And – I’m ready for bed early, so this will be a short blog. I hope to sleep well and write more tomorrow.
Love
Gretchen
We arrived to the hospital to discover that all of our fans were stolen overnight. The hospital is staffed by MDs from Boston Hospitals overnight, but of course they’re not in every room at all times. Someone walked out with the 4 fans that keeps us alive during the day. We realized from the moment we arrived that the day was going to be difficult. And it was. Many deaths, many unsolvable problems.
It was just heavy and sad from beginning to end. And – I’m ready for bed early, so this will be a short blog. I hope to sleep well and write more tomorrow.
Love
Gretchen
Thursday, June 17, 2010
Haiti - Day 3
Today we were up bright and early at the Hospital D’Universite Des Etas de Haiti, ready to take on more than we’re equipped to handle. I have to admit that I’m already feeling a bit exhausted, just after two days, which is unfortunate because I’ll be doing this eleven times more. Certainly the heat has sucked the life out of me, as I’m much more alive and functioning in an environment much like Lambeau Field in the middle of December. And, it’s the emotional exhaustion, already, of seeing one sick patient after the next, dying from something that is completely preventable, and would be considered completely appalling if someone in the US received this level of care. It’s hard to come to terms with this.
I had some revelations today…first, I am able to use my French a lot down here, which is great. What’s not so great is that everyone stares back at me with a blank expression. Apparently I have completely lost my French finesse and no one can understand a word of what I’m saying. That’s also partially because people speak a French Creole, but nonethess, I need an interpreter. Second – Haiti is a violent, hostile place. We see one gun shot wound and stabbing and assault after the next…even in broad daylight, in the middle of the day. It’s no wonder that we are forbidden to travel out of the confines of this hospital or the hotel, and we’re literally shuttled back and forth with guards and security. We have all heard that Haiti is not a safe place, but certainly after January 12, this has indeed become the case, as most people have nothing and want everything from their neighbor.
I arrived to work to find the lady who, just 16 hours earlier I had drained the fluid off of her lung, now laid dead in a hallway, with her grieving family by her side. She died in the “Tb Hallway” where seriously ill and seriously contagious patients are seriously neglected. She died overnight, and apparently just couldn’t breathe on her own anymore. But she died from what I consider to be a completely preventable death. Back home, she would have been in an ICU, with a million drips and nurses and alarms and medications, and certainly on a breathing machine. But in Haiti, this kind of death happens a thousand times over, and is considered to be “acceptable”. Here, we have no nurses, no breathing machines, no alarms, and very few medications. It is very hard to accept something like this.
The problems in this country are innumerable. It was corrupt even before this happened. But it’s hard to know how and if it will ever rebuild. There is so much human suffering here that it is difficult to witness, and for the majority of the time, remain helpless. The reality of not being able to “fix” any of these problems is settling in a bit, and while that is disheartening, I also have to remind myself that if thousands of people continue to just give a little bit at a time and contribute to the greater good, then there is possibly some hope for Haiti. Someday…
Time for bed and vivid Malarone dreams...
I had some revelations today…first, I am able to use my French a lot down here, which is great. What’s not so great is that everyone stares back at me with a blank expression. Apparently I have completely lost my French finesse and no one can understand a word of what I’m saying. That’s also partially because people speak a French Creole, but nonethess, I need an interpreter. Second – Haiti is a violent, hostile place. We see one gun shot wound and stabbing and assault after the next…even in broad daylight, in the middle of the day. It’s no wonder that we are forbidden to travel out of the confines of this hospital or the hotel, and we’re literally shuttled back and forth with guards and security. We have all heard that Haiti is not a safe place, but certainly after January 12, this has indeed become the case, as most people have nothing and want everything from their neighbor.
I arrived to work to find the lady who, just 16 hours earlier I had drained the fluid off of her lung, now laid dead in a hallway, with her grieving family by her side. She died in the “Tb Hallway” where seriously ill and seriously contagious patients are seriously neglected. She died overnight, and apparently just couldn’t breathe on her own anymore. But she died from what I consider to be a completely preventable death. Back home, she would have been in an ICU, with a million drips and nurses and alarms and medications, and certainly on a breathing machine. But in Haiti, this kind of death happens a thousand times over, and is considered to be “acceptable”. Here, we have no nurses, no breathing machines, no alarms, and very few medications. It is very hard to accept something like this.
The problems in this country are innumerable. It was corrupt even before this happened. But it’s hard to know how and if it will ever rebuild. There is so much human suffering here that it is difficult to witness, and for the majority of the time, remain helpless. The reality of not being able to “fix” any of these problems is settling in a bit, and while that is disheartening, I also have to remind myself that if thousands of people continue to just give a little bit at a time and contribute to the greater good, then there is possibly some hope for Haiti. Someday…
Time for bed and vivid Malarone dreams...
Wednesday, June 16, 2010
Day One and Two – Haiti
Today, Wednesday, was my first full day in Haiti, as I arrived yesterday around 1:00 in the afternoon. As I gathered my luggage and passed through customs, I was greeted by the staff of International Medical Corps, the Non-Government Organization that has sent me here, as they escorted me to the van to whisk me away to the Hotel. Unbeknown to me, I was on the plane with several other IMC volunteers, including 3 women from Brooklyn (An MD, NP and RN) who were extremely friendly, and we became quick friends with each other. It was nice to have a few others to share this initial “where the hell am I” experience with.
En Route to our destination, we passed through the streets of downtown Port-Au-Prince and saw first hand aftermath of the January 12th destruction. It is as if the earthquake happened last week. Collapsed buildings, demolished schools and stores, and piles upon piles of rubble is strewn everywhere. We passed by and miles of tarps and metal slabs, called ”tent cities”, that people have fashioned to now call their homes. It’s really jaw dropping…not only to see this unimaginable devastation, but to realize that there is still much destruction as there was 5 months ago. And - there are no clean up efforts in site
We arrived to the Park Plaza Hotel, which is right in the heart of the destruction zone, and has been essentially taken over by expats that have converged on Haiti to volunteer. It is an embarrassingly nice place to stay, and has been virtually unaffected by the January 12th earthquake. What I mean by embarrassing is that it is a little slice of paradise enclosed in a concrete wall, that is surrounded by miles and miles of poverty, tent cities, and destruction. I feel a bit guilty for being put up here, but i appreciate its beauty at the same time. It's probably akin to a 3-star hotel in the states. After we got relatively settled in our rooms, we headed to the hotel pool for a dip in the 90 degree water, that was just slightly cooler than the 100 degree temperature in the air.
I’m in Haiti.
Following an afternoon nap and IMC meeting at 6:00pm, I socialized a bit with my new fellow volunteers, had a delicious Haitian meal, spent a long and unsuccessful attempt at trying to connect to the internet and Skype with Chris, and went to bed exhausted, and excited…
I awoke my first morning in Haiti feeling refreshed and well rested. I skipped the shower, as I knew I was in for a long, hot, and sweaty day. Man alive, was it ever.
I was assigned to work in the ER, to see and treat patients with the other MD. Between the 2 of us, we saw and triaged 60 patients, which I hear is considered to be a slow day. We were booked solid from 7am until we closed the doors at 4. The working conditions are truly abysmal. The stench is horrific. The supplies and resources are frighteningly limited. And the patients are among some of the sickest that I have ever seen. But, they are also some of the most warm, friendly, and grateful patients I have ever seen as well. I think I lost about 10 pounds of sweat, as it reaches over 100 degrees in the hospital. I have yet to pee today…
We are seeing less and less of the injuries from the earthquake, and are now seeing more chronic diseases, and the aftermath of something more devastating than the earthquake itself; a lack of any sort health care system in Haiti. Primary care and preventive medicine are essentially nonexistent, and this government was corrupt even before the earthquake struck. There are very few Haitian nurses in this hospital, as the government stopped paying them last October. It scares me to think that we, the organization running this hospital, will be gone in 12 days, but, it is also amazing to think of the good we have done while we have been here, and I already feel that sentiment from the 10 hours I spent there.
We saw and treated patients straight until 5pm. I personally performed more procedures in one day of work than I have from several years of work back home. I sutured about 10 lacerations, some more complex than others and all of which should have been performed by someone who really knew what they were doing, and performed 3 thoracentesis procedures (draining fluid off of the lungs through a large needle). The great thing about this procedure is that the before and after is quite dramatic and satisfying (patient barely able to breathe, and then following the tap, resting and breathing comfortably). Just about half of the patients we see have TB, and I’m almost certain that I’ll pick it up while I’m here. There is only so much one can do to protect themselves…
All in all, it was an overwhelming day... Mentally and physically. We have no days off, as we work through the weekend, so I know that I have to put my head down and just plow through. I have to say that I let go of a little bit of that guilt, as we came back to a cool air conditioned hotel room, with a swimming pool and a fully stocked bar that serves icy cold beers. It felt good after a long day, and I think I'll appreciate these amenities more and more. There is really no other option than to work long and hard days, and that’s exactly what I came here to do.
More stories and pictures (hopefully) to follow.
I am safe, happy, and will go to bed feeling right about being here.
Love and miss you all.
G
En Route to our destination, we passed through the streets of downtown Port-Au-Prince and saw first hand aftermath of the January 12th destruction. It is as if the earthquake happened last week. Collapsed buildings, demolished schools and stores, and piles upon piles of rubble is strewn everywhere. We passed by and miles of tarps and metal slabs, called ”tent cities”, that people have fashioned to now call their homes. It’s really jaw dropping…not only to see this unimaginable devastation, but to realize that there is still much destruction as there was 5 months ago. And - there are no clean up efforts in site
We arrived to the Park Plaza Hotel, which is right in the heart of the destruction zone, and has been essentially taken over by expats that have converged on Haiti to volunteer. It is an embarrassingly nice place to stay, and has been virtually unaffected by the January 12th earthquake. What I mean by embarrassing is that it is a little slice of paradise enclosed in a concrete wall, that is surrounded by miles and miles of poverty, tent cities, and destruction. I feel a bit guilty for being put up here, but i appreciate its beauty at the same time. It's probably akin to a 3-star hotel in the states. After we got relatively settled in our rooms, we headed to the hotel pool for a dip in the 90 degree water, that was just slightly cooler than the 100 degree temperature in the air.
I’m in Haiti.
Following an afternoon nap and IMC meeting at 6:00pm, I socialized a bit with my new fellow volunteers, had a delicious Haitian meal, spent a long and unsuccessful attempt at trying to connect to the internet and Skype with Chris, and went to bed exhausted, and excited…
I awoke my first morning in Haiti feeling refreshed and well rested. I skipped the shower, as I knew I was in for a long, hot, and sweaty day. Man alive, was it ever.
I was assigned to work in the ER, to see and treat patients with the other MD. Between the 2 of us, we saw and triaged 60 patients, which I hear is considered to be a slow day. We were booked solid from 7am until we closed the doors at 4. The working conditions are truly abysmal. The stench is horrific. The supplies and resources are frighteningly limited. And the patients are among some of the sickest that I have ever seen. But, they are also some of the most warm, friendly, and grateful patients I have ever seen as well. I think I lost about 10 pounds of sweat, as it reaches over 100 degrees in the hospital. I have yet to pee today…
We are seeing less and less of the injuries from the earthquake, and are now seeing more chronic diseases, and the aftermath of something more devastating than the earthquake itself; a lack of any sort health care system in Haiti. Primary care and preventive medicine are essentially nonexistent, and this government was corrupt even before the earthquake struck. There are very few Haitian nurses in this hospital, as the government stopped paying them last October. It scares me to think that we, the organization running this hospital, will be gone in 12 days, but, it is also amazing to think of the good we have done while we have been here, and I already feel that sentiment from the 10 hours I spent there.
We saw and treated patients straight until 5pm. I personally performed more procedures in one day of work than I have from several years of work back home. I sutured about 10 lacerations, some more complex than others and all of which should have been performed by someone who really knew what they were doing, and performed 3 thoracentesis procedures (draining fluid off of the lungs through a large needle). The great thing about this procedure is that the before and after is quite dramatic and satisfying (patient barely able to breathe, and then following the tap, resting and breathing comfortably). Just about half of the patients we see have TB, and I’m almost certain that I’ll pick it up while I’m here. There is only so much one can do to protect themselves…
All in all, it was an overwhelming day... Mentally and physically. We have no days off, as we work through the weekend, so I know that I have to put my head down and just plow through. I have to say that I let go of a little bit of that guilt, as we came back to a cool air conditioned hotel room, with a swimming pool and a fully stocked bar that serves icy cold beers. It felt good after a long day, and I think I'll appreciate these amenities more and more. There is really no other option than to work long and hard days, and that’s exactly what I came here to do.
More stories and pictures (hopefully) to follow.
I am safe, happy, and will go to bed feeling right about being here.
Love and miss you all.
G
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