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."

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.

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.

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.


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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!

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Haiti, again

In December 2006, I read Paul Farmer's Uses of Haiti, a full year before I first traveled to the country. I started this blog to begin learning to think as Farmer does, asking tough questions about a nation, which has been used and suffered abuse for so long. Haiti has a hold on me. I'm on my way back now.

More soon from Leogane.

It's the things that have such a hold on us that they can break us that are worth dropping everything for