More thoughts from the trip...

Sunday, March 5

There was a demonstration on the road to PAP on Friday, which delayed the ambulance taking Dieunelson to the hospital. He died during, or shortly after, surgery. The news of our sick little boy was heartbreaking, and a rough way to start the day. Haitians deal with death on a daily basis. This is not an exaggeration. Dieunelson was lucky he had a clinic his family could take him to. He was lucky there was a Pediatrician and ER Physician and Sonographer available to make such a rapid diagnosis. He was lucky that Pastor Delamy is so committed to his people that he made multiple phone calls to get him to the nearest hospital, and called in multiple favors to get him an ambulance ride into PAP. He died anyway, which is a hard pill for us to swallow, but so many Haitians are not as lucky as he was. This is what we talk about, when we are crying over our first patient of the week, and we know we have hundreds more to treat.

We spent the morning at the church in Deobedou (sp?), listening to their choir, being introduced to their community, and sharing our stories of why we come to Haiti. After a quick lunch, we headed down to the clinic and took care of patients until 5:30pm. I was so happy to start working in the clinic, even if for only a few hours. For the rest of the week, I will spend the morning in the clinic, and the afternoon working with the Midwife (Mde. Bluette). Most of us hiked up the hill, above the compound, just in time to see the sun setting beneath rain clouds. Tonight’s meeting was longer than usual, as we discussed any problems we encountered in the clinic, and problem solved for tomorrow. It’s almost midnight here, and I’ve just finished designing a new Ultrasound Report document for use in the clinic. Hopefully, it will improve patient records and create better communication between the Physicians and Sonographer. Another long day filled with disappointment and joy and laughter and gratitude and exhaustion. I’m headed to bed. Bonswa.

Tet Ansanm! Solidarity! (Heads Together!)

Monday…

It rained most of the night, and into the morning, so we all had to skip our morning walks and rooftop coffee. By far, the absolute best thing about today was reuniting with Madame Bluette, after a 2-year separation. Imagine two women excitedly chatting away, in a language the other does not understand, repeatedly hugging and smiling their faces off…all while the translator tries to keep up. It was wonderful. The week before we arrived in Haiti, there was another HFH team in Terre Blanche, with some Medical staff to help in the clinic. Our first day of clinics was slower than most of us have seen here, and that may be a good thing. Our hope is that the community is getting healthier, and the clinic is now offering consistently good medical services, which means that we are seeing mostly specialty and emergent cases. We have no clear idea of the weather outside of Terre Blanche, so the rain may have made the roads more challenging, but if our patients are willing to stay home, it means that they are not very ill. Once again, a good sign that the community is getting healthier. There are many Board Members from HFH on this trip, and there has been a lot of discussion about positive changes being made in the current programs. HFH has always been of the mindset that programs are implemented with the primary goal of being taken over by the Haitians. Sustainability and Independence. So, even a slow day at the clinic is a very good thing. The latest hurricane that hit TB last fall had wiped out most, if not all, of the crops. HFH made an aggressive push for funds, to buy rice and beans to feed the poorest in the community, and many of us were anxious to see how the community was faring. In prior blog posts I have talked about the Agriculture and Microloan programs HFH has been working on with the community. Yesterday, some of the Board Members met with the Agriculture Committee, and shared the high points with us at the evening wrap up. When the crops were wiped out, the Haitians truly believed that they were going to die of starvation. The Agriculture Committee approached the HFH Board with a proposal, borrowed money to buy seeds, purchased seeds and distributed them to local farmers, and have had multiple successful harvests since the last hurricane. Their repayment plan consists of donating back a percentage of the harvest to the Te Foyer, TBs Community Health Program. Not only was the plan successful, it was formulated entirely by the Haitians, and they now have the pride of saving their own community. Most of the team spent the evening together, grading the pre and post test from the Medical Conference. This is a relatively simple process, that requires much of the group to be done efficiently, and always ends in hilarity and fits of giggles. It’s a great way to end the day.

Deye mon gen mon. Beyond mountains there are mountains. (or) It’s always something. (or) It’s just one thing after another.

Tuesday…

The wind is still in full force. The Haitians have been bundled up in all their clothing, while the Blancs were so happy not to be sweating, it was a great source of laughter for all of us in the clinic. Today seemed to be a day for Inpatients, we are keeping 4 patients in the hospital tonight. Having patients stay in the hospital changes everything in our daily schedule. On a routine day, we meet, have breakfast, start clinics, break for lunch, back to clinics, attend (or present) the didactic lecture, eat dinner, have a wrap up meeting, free time, then bed. It’s a packed day. With Inpatients, you must add rounding with the physicians and nurses, medicating and checking on patients, to an already busy day. This mostly falls on the nurses and physicians, with the rest of us helping where we can. I was supposed to train with Bluette this afternoon, but it never seemed to happen, which was frustrating for us both. Tomorrow I will spend the morning with her and her patients, and scan for the clinicians in the afternoon. Monday through Thursday, once the clinic is closed for the day, we get together with the Haitian providers, clinic staff and translators for an hour. The first night, we all introduce ourselves and talk about the flow of the clinic for the week. Tuesday and Wednesday, two of us give a short didactic lecture, as an opportunity for continuing education. I offered to give an ultrasound demo, and tonight was my night. After a long day, I felt like an opportunity to try some ultrasound would be a fun change of pace. I spoke for about 15 minutes, a greatly diluted version of how ultrasound works, and then gave a quick demonstration. After some coaxing, quite a few of the staff decided to give it a try, and it was fantastic! They started spurring each other on, shouting instructions and suggestions, laughing with each other and cheering each other’s success. It was such a fun way to finish a long day of clinics. After dinner, most of us headed back down to the annex, to round with the inpatients. Two of the patients will be moved to other facilities tomorrow, and we will see how the other two look, after a night of fluids and medication. The wind, which calmed down quite a bit during the day, is now back in full force. Sleep will be a challenge tonight, but I’m going to give it a go. Wish me luck! ;)

Chita tande, marche we. If you sit, you hear, if you walk, you see.

Wednesday…

So much for sleep. Ugh. The wind was crazy, one of the patients was wailing loudly throughout the night, the dogs were barking, more wind. It’s gonna be a long day. The morning started with rounding on Inpatients, along with a follow up ultrasound, then seeing OB patients with Bluette. Training Bluette has so many challenges. At the start of her day, she goes out to the patient waiting area for the clinic, and collects all of the pregnant women that need Midwife care. She does not know how many patients she will have, from day to day, and additional patients arrive throughout the day. This is the same for the clinic, because the patients come from other towns and villages, and must find transportation to get to us. In a perfect training world, Bluette will bring a patient in, give her a physical exam, and then we practice ultrasound. Ultrasound training takes time, and that becomes problematic, because our patients must plan for transportation home. Often, her patients arrive without having eaten anything, in case they need lab work. After much discussion and problem solving at the end of our training day, we’ve decided that tomorrow Bluette will try to get her patients into the lab as fast as possible, allow them to eat, and then we can practice scanning, while they wait for their lab results. During lunch, some of us went over to the new cafeteria to see the school children getting lunch. When I was here two years ago, lunch was served in a small room of the schoolhouse, 50 students at a time. Now, there is a large, new cafeteria, with brightly painted tables and benches, and enough room to serve hundreds at a time. TB feeds close to 1,000 students a day, and it is often the best meal of the day for these kids. The cafeteria has a paid cooking and serving staff, the kitchen has more stoves, and there are more plates and utensils available now. It’s a wonderful sight! We joined a few members of the Agricultural team and walked over to Madame Mischou’s home, to see her garden and talk about the Te Foyer. I have talked about her and this program in the past, she is the master gardener/farmer of TB, and runs a community health program for mothers and their children. It’s always great to see her and her family, they are so welcoming and generous. The afternoon was slammed in the clinic. Lots of job security for me! J I see a lot of pathology here, and I’m constantly writing notes to myself, so I remember what to study when I get back in the US. By the way, dinner was delicious tonight! The ladies who cook for us always do an excellent job, and the carnivores on the team are usually overjoyed with the chicken, beef and goat dishes that they make for us. I do not eat meat, so I enjoy the side dishes, fruit and salad, which is plenty. Tonight, the ladies made cornbread, which is almost more of a pudding…heavenly! Just a little sweet, crusty edges, dense, not quite gooey center. It’s also mango season, so there is really nothing more I could ask for! Our evening wrap up went well, and I’m off to bed early.

Gwo vant pa lajan. A big stomach isn’t money. Appearances can be deceiving.

Gwo vant pa gwoses. A big stomach isn’t pregnancy; don’t jump to conclusions.