Staying up tonight to answer emails before I have to leave early a.m., going back to the USA for Easter with family. Many of these emails from people who responded to ND's fervent calls to service issued to alums last week. While we're working very hard to hire local healthcare providers, the need is so great and so urgent, that we must keep staffing the hospital however we can. Our rotating teams have been phenomenal.
A young woman in critical condition might be declining now. Already watched a 1-yr old girl code tonight. They did everything they could.
Visited several IDP camps today on a sort of reconnaissance trip for a friend seeking some information about camp coordination & management in Leogane. I asked to speak with the committee chair at each, was always offered a chair. They each told me of organizations coming to do some piecemeal work (build a latrine, or a water source), but all said they lacked direct, continual presence--empowerment of their leadership. I don't know the truth, though they seemed genuine, and not likely concerned positively or otherwise about a small girl with a flouncy skirt & frizzy hair. I don't look like a very official humanitarian.
But whatever the intentions of help, things are bad now... awful crowded lines of flimsy tarp shelters. Unsurprising so much malaria, presumptive typhoid. A doc suggested the girl who died earlier perhaps had meningitis. Wonder where she lived. I suppose it's basically all the same here.
And, just now, a rushing and pounding commences. Steady hard rain.
Wednesday, March 31, 2010
Sunday, March 28, 2010
Mobile Clinics, and Camps
"These pills are for when your chest gives you acid."
"Drink this when your back hurts"
"Here is aspirin for everything that makes you feel bad."
Mobile Clinic. Or rather, a public bus to Port au Prince, with a marchan lady standing in front selling treatment for all things that make us feel bad.
Just another innovative point of care. Who needs our pharmacy?
Robenson and I took the bus to Portail Leogane and searched awhile for places to make cheaper hospital record photocopies (no dice). The congenial craziness of this combined bus stop and market area: life as if January 12 had just been a day. Except that the stadium across the road houses one of the country's largest IDP camps. And as we walked up Champ Mars to catch a tap-tap, we passed on along more camps...right in front of the palace. "Oh man, it's the first time I've seen this," Robenson said as he stopped to take a cellphone photo.
We then went to the "Log Base," where the UN runs its logistics, where major agencies have their national offices, and where expats meet for cheeseburgers. Had lunch with Joe from the ND Kroc Institute, now serving as country director of American Refugee Committee. Great idea-generating discussion, with some concrete action items. Ready, go.
Joe took us to a camp that ARC manages, called Terrain Acra--named so because near the factory run by a Haitian bourgeois, Monseiur Acra, who once wanted to collaborate with ND on fortified salt efforts. But by its proximity to a factory, it receives acid run-off. And sits in a floodplain. "We've got to get these people out before the heavy rains or this will all be gone," Joe echoed Sean Penn.
Finally to the airport to meet the new team. All people, all luggage arrived safe & well.
Good day.
"Drink this when your back hurts"
"Here is aspirin for everything that makes you feel bad."
Mobile Clinic. Or rather, a public bus to Port au Prince, with a marchan lady standing in front selling treatment for all things that make us feel bad.
Just another innovative point of care. Who needs our pharmacy?
Robenson and I took the bus to Portail Leogane and searched awhile for places to make cheaper hospital record photocopies (no dice). The congenial craziness of this combined bus stop and market area: life as if January 12 had just been a day. Except that the stadium across the road houses one of the country's largest IDP camps. And as we walked up Champ Mars to catch a tap-tap, we passed on along more camps...right in front of the palace. "Oh man, it's the first time I've seen this," Robenson said as he stopped to take a cellphone photo.
We then went to the "Log Base," where the UN runs its logistics, where major agencies have their national offices, and where expats meet for cheeseburgers. Had lunch with Joe from the ND Kroc Institute, now serving as country director of American Refugee Committee. Great idea-generating discussion, with some concrete action items. Ready, go.
Joe took us to a camp that ARC manages, called Terrain Acra--named so because near the factory run by a Haitian bourgeois, Monseiur Acra, who once wanted to collaborate with ND on fortified salt efforts. But by its proximity to a factory, it receives acid run-off. And sits in a floodplain. "We've got to get these people out before the heavy rains or this will all be gone," Joe echoed Sean Penn.
Finally to the airport to meet the new team. All people, all luggage arrived safe & well.
Good day.
Saturday, March 20, 2010
The Space Between
From the philosophy of DMB: The space between the tears we cry is the laughter that keeps us coming back for more.
I'm in the States for about 36 hours, and it feels like a space between: held in suspension away from where I believe I am. Reality is there. Sheepishly, I admit I don't know much else of the world right now beyond this little island. Only in between things do we have space to think about what's happened.
*New life: in the last 48 hours, three very premature babies. One born last Friday fought gallantly for 4 days, through her mother's abandonment, until we finally transferred her to the U Miami Medishare hospital in PaP. More to follow on her, we only hope. Another born in our hospital entrance when her mother abrupted, caught by a nursing student, died in a doctor's arms less than 24 hours later. And finally a mother nearing birth of an early baby, who we proactively sent to Medishare on way to airport this morning. Protect the fragile. Yesterday, CNP formally opened a stabilization center for severely malnourished in one wing of the hospital. Anticipating a full ward. Nurture the future.
*Resilience: walking to the partially condemned HSC building, Gary remarked it was his first time passing that way since the quake. We were right by his school, which collapsed killing at least a hundred. He was the only one in his class to survive. As I started to show the docs inside the hospital building, motioned he could wait in the yard. Confident reply, "I'm not afraid to enter."
*Comfort: when a weak moment found me crying in the yard outside, Roosevelt called, having seen me on his way home. Came right over. Gave me a good hug and clearer advice in Creole than I could have heard from anyone.
*Victuals: not much can beat Tampico & rum on the roof. Soothes every challenge. Allows for the perfect morsel of irreverence.
*Faith: woke at 5 a.m. this morning with steady rain pattering my tent. And people were still singing outside.
*Fear: no sooner than entering the hotel lobby tonight, see Anderson Cooper reporting with Sean Penn, who has an organization working in the T/P camp in Petionville. Academy Award winning actor frantic and pleading. The rains are coming. And, he said, things are about to get a lot worse.
Please don't forget. People need a space to live.
I'm in the States for about 36 hours, and it feels like a space between: held in suspension away from where I believe I am. Reality is there. Sheepishly, I admit I don't know much else of the world right now beyond this little island. Only in between things do we have space to think about what's happened.
*New life: in the last 48 hours, three very premature babies. One born last Friday fought gallantly for 4 days, through her mother's abandonment, until we finally transferred her to the U Miami Medishare hospital in PaP. More to follow on her, we only hope. Another born in our hospital entrance when her mother abrupted, caught by a nursing student, died in a doctor's arms less than 24 hours later. And finally a mother nearing birth of an early baby, who we proactively sent to Medishare on way to airport this morning. Protect the fragile. Yesterday, CNP formally opened a stabilization center for severely malnourished in one wing of the hospital. Anticipating a full ward. Nurture the future.
*Resilience: walking to the partially condemned HSC building, Gary remarked it was his first time passing that way since the quake. We were right by his school, which collapsed killing at least a hundred. He was the only one in his class to survive. As I started to show the docs inside the hospital building, motioned he could wait in the yard. Confident reply, "I'm not afraid to enter."
*Comfort: when a weak moment found me crying in the yard outside, Roosevelt called, having seen me on his way home. Came right over. Gave me a good hug and clearer advice in Creole than I could have heard from anyone.
*Victuals: not much can beat Tampico & rum on the roof. Soothes every challenge. Allows for the perfect morsel of irreverence.
*Faith: woke at 5 a.m. this morning with steady rain pattering my tent. And people were still singing outside.
*Fear: no sooner than entering the hotel lobby tonight, see Anderson Cooper reporting with Sean Penn, who has an organization working in the T/P camp in Petionville. Academy Award winning actor frantic and pleading. The rains are coming. And, he said, things are about to get a lot worse.
Please don't forget. People need a space to live.
Sunday, March 14, 2010
A Different View
This vignette comes from a great primary care doc with us last week:
"After clinic today which ended at 3 PM I was called over to the ER to see a 16 yo girl with a fever--mute, delirious and, having been recently diagnosed with and treated for malaria, seemed to the folks handing her over to me to be suffering from cerebral malaria--a potentially deadly complication. My assessment suggested otherwise, even though she was febrile. It was a very hot day and she was so agitated that the stress alone could have caused a low grade fever. She was very tachycardic and hypervigilant, looking left and right, in an absolute panic. It was very scary and I wasn't sure what to do, with no ability to do lab tests, x rays or even a malaria test because our reagent ran out. I went with gut instinct and gave her Ativan, first under her tongue and then through an IV.
Through a Creole translator I determined from the neighbor who brought her in that the girl's friends, his children, thought she had been "mystified"--a voodoo belief that someone has been turned into a soulless zombie. Sure enough, with some hand-holding and gentle coaxing as the Ativan kicked in, the girl made a turn around and started talking for the first time in 5 days! I got the history that she went through a similar illness right after the quake lasing 10 days. She had seen several dead bodies and wouldn't speak or interact for almost two weeks.
She then said her first words to me, through the translator, "After the earthquake, all I could think about was my school (destroyed--all schools still closed even now). Today, the earthquake happened again. But this time I thought I was dead." Her cerebral malaria was in actuality PTSD. All medical assessments down here are made in the looming shadow of a recent severe disaster.
It's easy, coming from the States, to forget and view symptoms through a faulty lens that wants to "medicalize" everything and apply the old familiar thinking to a totally unique situation. This took me 8 days to fully appreciate and now I'll be leaving, passing torch to some fresh recruits to learn their own unique lessons."
"After clinic today which ended at 3 PM I was called over to the ER to see a 16 yo girl with a fever--mute, delirious and, having been recently diagnosed with and treated for malaria, seemed to the folks handing her over to me to be suffering from cerebral malaria--a potentially deadly complication. My assessment suggested otherwise, even though she was febrile. It was a very hot day and she was so agitated that the stress alone could have caused a low grade fever. She was very tachycardic and hypervigilant, looking left and right, in an absolute panic. It was very scary and I wasn't sure what to do, with no ability to do lab tests, x rays or even a malaria test because our reagent ran out. I went with gut instinct and gave her Ativan, first under her tongue and then through an IV.
Through a Creole translator I determined from the neighbor who brought her in that the girl's friends, his children, thought she had been "mystified"--a voodoo belief that someone has been turned into a soulless zombie. Sure enough, with some hand-holding and gentle coaxing as the Ativan kicked in, the girl made a turn around and started talking for the first time in 5 days! I got the history that she went through a similar illness right after the quake lasing 10 days. She had seen several dead bodies and wouldn't speak or interact for almost two weeks.
She then said her first words to me, through the translator, "After the earthquake, all I could think about was my school (destroyed--all schools still closed even now). Today, the earthquake happened again. But this time I thought I was dead." Her cerebral malaria was in actuality PTSD. All medical assessments down here are made in the looming shadow of a recent severe disaster.
It's easy, coming from the States, to forget and view symptoms through a faulty lens that wants to "medicalize" everything and apply the old familiar thinking to a totally unique situation. This took me 8 days to fully appreciate and now I'll be leaving, passing torch to some fresh recruits to learn their own unique lessons."
The System
Great teams last week. All rallied together, stuck together. Yesterday, our peds nurse and peds anesthesia (leaders of med & surgical teams respectively, but no prior acquaintance) worked calmly and confidently together to resuscitate a premie. Completely in sync. Our Haitian staff stepped up to the plate to run our improved clinical flow. It was a privilege to watch. They "own" their work. They care.
Rode on the back of the surg team's truck as they departed for their private flight home. I was supposed to have a rendevous in PaP but was canceled last minute, so ended up at airport. Fine, would be helpful, I assumed, as the ND plane was bringing in another 2000+ lbs supplies. I was naive.
Our Haitian program administrator and I stood in the warehouse terminal as the goods were brought in by airport staff. And quickly... they started asking. Tents. Please give me a tent. Give one tent, to me. Then I made a stupid young white girl mistake, nodding to our Admin "He's in charge."
That changed everything.
They hounded him--not physically threatening, but with angry implications: he is Haitian and he won't help other Haitians. Nothing farther from the truth.
He yelled the explanation to me in English. So I jumped to try to regain control, as forcefully as I could, speaking angry Kreyol. And he launched into a speech (a beautiful one, actually) about all he and his Haitian compatriots did for Leogane when there was no help. They made the first planes land, and they've kept it going since then, with no rest.
None of his valor or compassion shielded the blows now. It wasn't fair.
We made it to the truck, and loaded. Kept track of everything. I tipped as well as I could. Outside, the police hounded us. Same questions. Why must a little blan girl, me, have to stand in the center of a police huddle: practically yelling that it's their job to protect, that the whole country is kraze nèt, broken, and that the supplies were going to people in need?
They accepted. Perhaps were never truly agitating. But damage done, nonetheless, to a person who has only ever wanted to help.
And why only an etranger, a stranger, in this land has authority?
White.
Rode on the back of the surg team's truck as they departed for their private flight home. I was supposed to have a rendevous in PaP but was canceled last minute, so ended up at airport. Fine, would be helpful, I assumed, as the ND plane was bringing in another 2000+ lbs supplies. I was naive.
Our Haitian program administrator and I stood in the warehouse terminal as the goods were brought in by airport staff. And quickly... they started asking. Tents. Please give me a tent. Give one tent, to me. Then I made a stupid young white girl mistake, nodding to our Admin "He's in charge."
That changed everything.
They hounded him--not physically threatening, but with angry implications: he is Haitian and he won't help other Haitians. Nothing farther from the truth.
He yelled the explanation to me in English. So I jumped to try to regain control, as forcefully as I could, speaking angry Kreyol. And he launched into a speech (a beautiful one, actually) about all he and his Haitian compatriots did for Leogane when there was no help. They made the first planes land, and they've kept it going since then, with no rest.
None of his valor or compassion shielded the blows now. It wasn't fair.
We made it to the truck, and loaded. Kept track of everything. I tipped as well as I could. Outside, the police hounded us. Same questions. Why must a little blan girl, me, have to stand in the center of a police huddle: practically yelling that it's their job to protect, that the whole country is kraze nèt, broken, and that the supplies were going to people in need?
They accepted. Perhaps were never truly agitating. But damage done, nonetheless, to a person who has only ever wanted to help.
And why only an etranger, a stranger, in this land has authority?
White.
Sunday, March 7, 2010
Firsts
I helped take care of a miscarriage for the first time tonight. Mother came in with abdominal pain, doc sat and questioned her, we heard the fetal heart tones (wow!). But then she vomited, and started bleeding, and not long after, I was handing her 12-week-old to a family member wrapped for burial. Remembering the image "10 week abortion" flown continuously on a banner around campus last spring, inciting people: you're with us, or you kill babies. Yes, life is precious, and fragile. Blocks fall, and people die. No hospital, and the mother with pre-eclampsia dies. Take the broad view of life, and also the 3-inch view of one who never had a chance to live.
On a lighter note, Dan's team arrived on the ND-donor jet. To return from the hospital and see old friends--Kevin, Lars, Randy, Dan--doing a fire-man unloading the 2000lbs supplies they carried, along with many new faces of the next team. Great. First fresh week.
On a lighter note, Dan's team arrived on the ND-donor jet. To return from the hospital and see old friends--Kevin, Lars, Randy, Dan--doing a fire-man unloading the 2000lbs supplies they carried, along with many new faces of the next team. Great. First fresh week.
Saturday, March 6, 2010
Call night
Twins are being born. A nurse just endured an ectopic, attentive husband watching. A 19-year-old and her 3lb baby, both making tentative steps toward life. Yet a toddler fights an infection with a quarter of his body burned.
No one misses a beat. Medical providers, staff. They do not only what they must, but what they should. Hopital Ste Croix field hospital, 6 tent domes with an outpatient clinic at the adjacent nursing school. Born out of desperation and a desperate desire to help. Teamwork. Intensity. Passion. To accompany people here as they re-imagine healthcare in their community...
The Episcopal Bishop blessed the hospital today, urging us forward.
Fr Jenkins and a Notre Dame delegation just finished 2 days of seeing its roots here, strong before January 12, and began reaching for deeper engagement.
In the rawness of tonight, and for many many after, we are on call.
- Posted using BlogPress from my iPhone
No one misses a beat. Medical providers, staff. They do not only what they must, but what they should. Hopital Ste Croix field hospital, 6 tent domes with an outpatient clinic at the adjacent nursing school. Born out of desperation and a desperate desire to help. Teamwork. Intensity. Passion. To accompany people here as they re-imagine healthcare in their community...
The Episcopal Bishop blessed the hospital today, urging us forward.
Fr Jenkins and a Notre Dame delegation just finished 2 days of seeing its roots here, strong before January 12, and began reaching for deeper engagement.
In the rawness of tonight, and for many many after, we are on call.
- Posted using BlogPress from my iPhone
Wednesday, March 3, 2010
Second night
Still night, with a light breeze that passes a bit through my tent. A few others in the yard still speaking in outside voices, but no different from a dorm hall.
First steps here: onto a jet bridge in PaP! Somehow loses a bit of charm not having to walk across the tarmac. But formal arrivals/baggage is in a hanger a few hundred yards from the bridge, bc some of the building unsound.
Reuinions are blissful, so I've loved reconnecting with some, and meeting new. People tell their "story" readily...so much loss.
Could see the PaP damage is immense, but Leogane is so much worse. The entire city is homeless, many under sheets. And injuries, no longer acute, but painful and disabling. A friend from the Childrens Nutrition Progam said mothers are afraid their milk has gone bad from the trauma&stress, so they hesitate to breastfeed. Malnutrition is and will be huge problem.
I went to the OCHA / UN health cluster mtg today, rep of HSC field hospital. Amazing to see all the players, working hard to coordinate. But, it's basically managed chaos.
Breeze picked up, less still, but anyhow, night!
- Posted using BlogPress from my iPhone
First steps here: onto a jet bridge in PaP! Somehow loses a bit of charm not having to walk across the tarmac. But formal arrivals/baggage is in a hanger a few hundred yards from the bridge, bc some of the building unsound.
Reuinions are blissful, so I've loved reconnecting with some, and meeting new. People tell their "story" readily...so much loss.
Could see the PaP damage is immense, but Leogane is so much worse. The entire city is homeless, many under sheets. And injuries, no longer acute, but painful and disabling. A friend from the Childrens Nutrition Progam said mothers are afraid their milk has gone bad from the trauma&stress, so they hesitate to breastfeed. Malnutrition is and will be huge problem.
I went to the OCHA / UN health cluster mtg today, rep of HSC field hospital. Amazing to see all the players, working hard to coordinate. But, it's basically managed chaos.
Breeze picked up, less still, but anyhow, night!
- Posted using BlogPress from my iPhone
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