Shucks, missed Michelle Obama! But good of her to drop by.
Today, I went to a meeting for the Cellule d'Urgence et de Reconstruction de Leogane (CURL), the committee I mentioned in my last post that formed to bring local voices to this effort. I strained to use my Kreyòl to understand the French; not perfect, but am almost sure I understood this message "It is Easter, the season of rebirth. We are grateful to the blan who understand that."
We also stood for a moment of remembrance. April 12 had passed, the 3 month mark.
In the hospital later, I told a woman she had advanced breast cancer. I didn't realize I was the one to break the news, for one of the docs had passed her to me to work on referral options. In discussing these, I just mentioned it, "because you have cancer, you would need medicine after surgery." Her eyes sharpened, "O, m gen kansè?"
Apologizing, trying to be present, explained the rest: she doesn't have many options. Go home, or mastectomy with no adjuvant chemo, or find a private oncology clinic she can't afford. She explained, "I don't have money since the movement January 12. I can't know what I will have now. God gives us this."
A large tarped wooden structure went up last week, the first major building to be rebuilt in Leogane (many more trucks & heavy equipment around now, exciting!). What was it? The church, built new around the altar that survived.
I can't even imagine the faith of people around me right now. I'll never have it, but I'm glad they do.
Tuesday, April 13, 2010
Not by the Book
The Delco broke down Saturday, so our 24/7 climatized field hospital was without power for a longer period than the usual couple hour lapse while gas is being purchased each day. We moved all temp-sensitive meds to one room, essentially dismantled the OR, made a huge mess in the ICU (clean-up is tomorrow's project!). Our guys worked very hard in steaming heat to diagnose the problem, with the best tech in town consulting the best in the country. Heck if I know how it works; they do.
But a foreign vol approached me with better ideas, "They don't really do things by the book here, do they?" I could only glare and dash off to one of the other 5 pressing tasks.
Later this morning, had a meeting with Dr. Desir. Got to talking about the committee founded by his brother, on January 13. Since that day after, a group of local professionals have been liaising between the government, UN OCHA, and all humanitarian organizations to orient the response toward what the people here want. Desir showed me maps, described some of the forthcoming detailed plan--the vision for Leogane. Continuously, since the day after... working for their comrades struggling to survive. I sat back, in quiet awe.
Listen to us, he was emphatic. It is for us to decide.
When I accompanied Joe and American Refugee Committee on a IDP camp assessment last week, we quickly realized the aid groups in charge knew little: directing us to "priority" camps that no longer exist. The complex excel matrices, updated as of last week, are inaccurate and inefficient. In contrast, met up with a young Haitian member of a civil society organization who had handwritten reports of 110 camps in the area and guided us directly to them. Spot on.
The temptation to label Haiti as chaotic and backward is admittedly there. Sometimes things just don't work, and that's frustrating to us bleeding hearts. So I have to catch myself often: be patient, it is not for me to decide.
Let Haiti write its own book.
But a foreign vol approached me with better ideas, "They don't really do things by the book here, do they?" I could only glare and dash off to one of the other 5 pressing tasks.
Later this morning, had a meeting with Dr. Desir. Got to talking about the committee founded by his brother, on January 13. Since that day after, a group of local professionals have been liaising between the government, UN OCHA, and all humanitarian organizations to orient the response toward what the people here want. Desir showed me maps, described some of the forthcoming detailed plan--the vision for Leogane. Continuously, since the day after... working for their comrades struggling to survive. I sat back, in quiet awe.
Listen to us, he was emphatic. It is for us to decide.
When I accompanied Joe and American Refugee Committee on a IDP camp assessment last week, we quickly realized the aid groups in charge knew little: directing us to "priority" camps that no longer exist. The complex excel matrices, updated as of last week, are inaccurate and inefficient. In contrast, met up with a young Haitian member of a civil society organization who had handwritten reports of 110 camps in the area and guided us directly to them. Spot on.
The temptation to label Haiti as chaotic and backward is admittedly there. Sometimes things just don't work, and that's frustrating to us bleeding hearts. So I have to catch myself often: be patient, it is not for me to decide.
Let Haiti write its own book.
Thursday, April 8, 2010
Flooding
The ND house just flooded. Survived a 7.0 earthquake to have clogged drainage pipes. Torrent, a good foot of water on second floor, inches on first. Kristina came to get me as just starting to doze in downpour. all hands on deck: pails, brooms,
towels, mops. Sean started to rig a FEMA tarp for future runoff. Back in tent, only minor seepage.
G'night.
towels, mops. Sean started to rig a FEMA tarp for future runoff. Back in tent, only minor seepage.
G'night.
Raining, pouring
Just dashed to my tent in a downpour. Hard hard rain, feel it above, around, and below. Am dry, unlike almost everyone here. How many ways to rock and beat people?
Monday, April 5, 2010
A Longer Story
Roselin traveled 80 km to reach us, in the back of a furniture truck. A connection at a hospital in Pierre Payan asked to refer her and another patient to our hospital, saying the patients needed surgical and wound care they could not offer. I accepted.
Several men had to carry Roselin inside on an improvised plank stretcher. We learned this 30-year-old woman had been crushed in the earthquake, and paralyzed from mid-back. At some point in the horrible aftermath, she had lain for a long period without being turned, and so developed a very large sacral decubitus ulcer. Just before the transfer, her previous hospital had attempted to surgically repair her raw sore with a skin flap.
But upon first examination, our two lead surgeons found that solution hadn’t worked. Her flap was highly infected, necrotizing. So they took her straight to the OR, removed the flap, de-brided the sore. And with great creativity, they jimmy-rigged a “wound vac” using tegaderm and a suction canister. The negative pressure would keep her wound clean & drained, and potentially encourage some natural shrinkage until they could attempt another closure. An absolute best effort in a complicated situation. Still, her first days with us were precarious as she battled fever and confusion, teetering on the edge of sepsis, possibly death. “She would have died if we hadn’t gotten to her when we did,” one of the surgeons remarked.
Roselin pulled through. Her mother stayed with her most of the time, “nou pa gen lakay.” We don’t have a home. Roselin’s brother, Fezen, was also often present—clearly devoted to his ailing sibling.
And so, for more than two weeks, our nurses turned her every four hours. Cleaned around her bandaging when the vacuum seal became soiled and started to break. Propped as many pillows and blankets as we had to offer comfort. Sat with her family. Easily our most challenging patient to care for, literally back-breaking sometimes. “But she’s been my favorite patient. I love her,” one nurse said. Roselin felt the care, came to know all the nurses by name, and often tried to communicate even without an interpreter. She knew me, and I usually couldn’t pass her bed without catching her eye’s subtle beckon—must stop to talk.
But things were becoming difficult. The ulcer was getting bigger, not better: 2-cubic feet across and through her back—gaping, raw. We couldn’t offer what she needed, lifetime 24/7 care. I started making calls to all referral contacts I could find: Handicap International, Hopital Paix, Adventiste. One became promising, requesting details on her case, saying “we just need to line some things up, give you a definitive answer tomorrow.” This hospital, in Port-au-Prince, was offering to take her for wound care, and then send her all the way north to Sacra Couer in Milot, where there supposedly exists a long-term rehab program.
Several tomorrow’s past, and I gave a quick pestering call on each. Until finally a tomorrow that said “we got hit hard with urgent care last night; we just can’t take her…”
Of course, we were facing the same: more acutely ill and injured people, constantly. Perhaps the anticipated infectious disease boom has arrived, from a homeless country living in squalid camps? Perhaps we’re simply now treating the baseline injuries, burns, and ailments—things that in pre-January Haiti would likely have gone ignored? I believe it’s all still disaster relief: acute insult reveals chronic suffering.
The staff doctors conferred: Roselin’s prognosis was terminal. Even in the States, her wound might beat our best-in-the-world care. And here in Haiti, even if she survived this acute insult, what is the chronic? More bedsores, surely. More infection and suffering. No rehabilitation.
Following clinical consensus, we sat with Roeslin, mother Julienne, and brother Fezen. We explained, slowly. To the questions of what could be done, we answered that even in the “Ozetazini,” long life was probably not possible. Stopping antibiotics and aggressive treatment would be most comfortable. All pain medicine she needed. All comfort possible. I offered two options, “We can keep you here, and care for you until the end, or we can send you home.”
It was a hard moment… probably don’t need to describe.
Fezen spoke on behalf of family, needing to think and talk to each other. Of course, all the time you need. “We don’t have a home,” he reminded. I told him that if he wanted to go, we’d make them a home.
Left them over the next couple days. Roselin was quiet, sometimes murmuring to herself. Fezen stood in the entrance corridor, reading a small Bible. He then came to me: home, as soon as possible.
Found 2 tents, gave them to him the night before departure, showing how to pitch them. And called Maltesser, an NGO that has an ambulance, pleaded for its use to drive the 2 - 3 hours it’d likely take to reach Tabarre in traffic. Found a cot, pillows, sheets, kerlex and dressing coverage, pain medicine. Sent them off. In the last moment of eye contact before I stepped out of the ambulance, Roselin looked calm, but also blank.
Nothing is predictable here, and this day no different. When the Maltesser ambulance driver returned, he said “the brother told me to take her to a hospital, so I did.”
Were they trying for a hospital closer to home for her comfort care, for her dying? Perhaps. More likely the decision was hope for better treatment. And now, what? Is she being turned every four hours, and kept clean? Is she comfortable? Or is she just receiving antibiotics to keep sepsis at bay? What now?
What should have been done for her? The docs & nurses did their job, offered their very best care. So then, what should I have done?
That was a week ago. I intended to write this story on Good Friday. Now it’s a day after Easter, and I don’t see Roselin’s resurrection. I guess I just hope she somehow finds it.
Several men had to carry Roselin inside on an improvised plank stretcher. We learned this 30-year-old woman had been crushed in the earthquake, and paralyzed from mid-back. At some point in the horrible aftermath, she had lain for a long period without being turned, and so developed a very large sacral decubitus ulcer. Just before the transfer, her previous hospital had attempted to surgically repair her raw sore with a skin flap.
But upon first examination, our two lead surgeons found that solution hadn’t worked. Her flap was highly infected, necrotizing. So they took her straight to the OR, removed the flap, de-brided the sore. And with great creativity, they jimmy-rigged a “wound vac” using tegaderm and a suction canister. The negative pressure would keep her wound clean & drained, and potentially encourage some natural shrinkage until they could attempt another closure. An absolute best effort in a complicated situation. Still, her first days with us were precarious as she battled fever and confusion, teetering on the edge of sepsis, possibly death. “She would have died if we hadn’t gotten to her when we did,” one of the surgeons remarked.
Roselin pulled through. Her mother stayed with her most of the time, “nou pa gen lakay.” We don’t have a home. Roselin’s brother, Fezen, was also often present—clearly devoted to his ailing sibling.
And so, for more than two weeks, our nurses turned her every four hours. Cleaned around her bandaging when the vacuum seal became soiled and started to break. Propped as many pillows and blankets as we had to offer comfort. Sat with her family. Easily our most challenging patient to care for, literally back-breaking sometimes. “But she’s been my favorite patient. I love her,” one nurse said. Roselin felt the care, came to know all the nurses by name, and often tried to communicate even without an interpreter. She knew me, and I usually couldn’t pass her bed without catching her eye’s subtle beckon—must stop to talk.
But things were becoming difficult. The ulcer was getting bigger, not better: 2-cubic feet across and through her back—gaping, raw. We couldn’t offer what she needed, lifetime 24/7 care. I started making calls to all referral contacts I could find: Handicap International, Hopital Paix, Adventiste. One became promising, requesting details on her case, saying “we just need to line some things up, give you a definitive answer tomorrow.” This hospital, in Port-au-Prince, was offering to take her for wound care, and then send her all the way north to Sacra Couer in Milot, where there supposedly exists a long-term rehab program.
Several tomorrow’s past, and I gave a quick pestering call on each. Until finally a tomorrow that said “we got hit hard with urgent care last night; we just can’t take her…”
Of course, we were facing the same: more acutely ill and injured people, constantly. Perhaps the anticipated infectious disease boom has arrived, from a homeless country living in squalid camps? Perhaps we’re simply now treating the baseline injuries, burns, and ailments—things that in pre-January Haiti would likely have gone ignored? I believe it’s all still disaster relief: acute insult reveals chronic suffering.
The staff doctors conferred: Roselin’s prognosis was terminal. Even in the States, her wound might beat our best-in-the-world care. And here in Haiti, even if she survived this acute insult, what is the chronic? More bedsores, surely. More infection and suffering. No rehabilitation.
Following clinical consensus, we sat with Roeslin, mother Julienne, and brother Fezen. We explained, slowly. To the questions of what could be done, we answered that even in the “Ozetazini,” long life was probably not possible. Stopping antibiotics and aggressive treatment would be most comfortable. All pain medicine she needed. All comfort possible. I offered two options, “We can keep you here, and care for you until the end, or we can send you home.”
It was a hard moment… probably don’t need to describe.
Fezen spoke on behalf of family, needing to think and talk to each other. Of course, all the time you need. “We don’t have a home,” he reminded. I told him that if he wanted to go, we’d make them a home.
Left them over the next couple days. Roselin was quiet, sometimes murmuring to herself. Fezen stood in the entrance corridor, reading a small Bible. He then came to me: home, as soon as possible.
Found 2 tents, gave them to him the night before departure, showing how to pitch them. And called Maltesser, an NGO that has an ambulance, pleaded for its use to drive the 2 - 3 hours it’d likely take to reach Tabarre in traffic. Found a cot, pillows, sheets, kerlex and dressing coverage, pain medicine. Sent them off. In the last moment of eye contact before I stepped out of the ambulance, Roselin looked calm, but also blank.
Nothing is predictable here, and this day no different. When the Maltesser ambulance driver returned, he said “the brother told me to take her to a hospital, so I did.”
Were they trying for a hospital closer to home for her comfort care, for her dying? Perhaps. More likely the decision was hope for better treatment. And now, what? Is she being turned every four hours, and kept clean? Is she comfortable? Or is she just receiving antibiotics to keep sepsis at bay? What now?
What should have been done for her? The docs & nurses did their job, offered their very best care. So then, what should I have done?
That was a week ago. I intended to write this story on Good Friday. Now it’s a day after Easter, and I don’t see Roselin’s resurrection. I guess I just hope she somehow finds it.
Sunday, April 4, 2010
Mad Farmer Liberation Front
Beyond just the obvious final two words, I think this poem is a profound Easter message...:
THE MAD FARMER LIBERATION FRONT
by Wendell Berry - 1991
Love the quick profit, the annual raise,
vacation with pay. Want more
of everything ready-made. Be afraid
to know your neighbors and to die.
And you will have a window in your head.
Not even your future will be a mystery
any more. Your mind will be punched in a card
and shut away in a little drawer.
When they want you to buy something
they will call you. When they want you
to die for profit they will let you know.
So, friends, every day do something
that won't compute. Love the Lord.
Love the world. Work for nothing.
Take all that you have and be poor.
Love someone who does not deserve it.
Denounce the government and embrace
the flag. Hope to live in that free
republic for which it stands.
Give your approval to all you cannot
understand. Praise ignorance, for what man
has not encountered he has not destroyed.
Ask the questions that have no answers.
Invest in the millenium. Plant sequoias.
Say that your main crop is the forest
that you did not plant,
that you will not live to harvest.
Say that the leaves are harvested
when they have rotted into the mold.
Call that profit. Prophesy such returns.
Put your faith in the two inches of humus
that will build under the trees
every thousand years.
Listen to carrion - put your ear
close, and hear the faint chattering
of the songs that are to come.
Expect the end of the world. Laugh.
Laughter is immeasurable. Be joyful
though you have considered all the facts.
So long as women do not go cheap
for power, please women more than men.
Ask yourself: Will this satisfy
a woman satisfied to bear a child?
Will this disturb the sleep
of a woman near to giving birth?
Go with your love to the fields.
Lie down in the shade. Rest your head
in her lap. Swear allegiance
to what is nighest your thoughts.
As soon as the generals and the politicos
can predict the motions of your mind,
lose it. Leave it as a sign
to mark the false trail, the way
you didn't go. Be like the fox
who makes more tracks than necessary,
some in the wrong direction.
Practice resurrection.
THE MAD FARMER LIBERATION FRONT
by Wendell Berry - 1991
Love the quick profit, the annual raise,
vacation with pay. Want more
of everything ready-made. Be afraid
to know your neighbors and to die.
And you will have a window in your head.
Not even your future will be a mystery
any more. Your mind will be punched in a card
and shut away in a little drawer.
When they want you to buy something
they will call you. When they want you
to die for profit they will let you know.
So, friends, every day do something
that won't compute. Love the Lord.
Love the world. Work for nothing.
Take all that you have and be poor.
Love someone who does not deserve it.
Denounce the government and embrace
the flag. Hope to live in that free
republic for which it stands.
Give your approval to all you cannot
understand. Praise ignorance, for what man
has not encountered he has not destroyed.
Ask the questions that have no answers.
Invest in the millenium. Plant sequoias.
Say that your main crop is the forest
that you did not plant,
that you will not live to harvest.
Say that the leaves are harvested
when they have rotted into the mold.
Call that profit. Prophesy such returns.
Put your faith in the two inches of humus
that will build under the trees
every thousand years.
Listen to carrion - put your ear
close, and hear the faint chattering
of the songs that are to come.
Expect the end of the world. Laugh.
Laughter is immeasurable. Be joyful
though you have considered all the facts.
So long as women do not go cheap
for power, please women more than men.
Ask yourself: Will this satisfy
a woman satisfied to bear a child?
Will this disturb the sleep
of a woman near to giving birth?
Go with your love to the fields.
Lie down in the shade. Rest your head
in her lap. Swear allegiance
to what is nighest your thoughts.
As soon as the generals and the politicos
can predict the motions of your mind,
lose it. Leave it as a sign
to mark the false trail, the way
you didn't go. Be like the fox
who makes more tracks than necessary,
some in the wrong direction.
Practice resurrection.
Friday, April 2, 2010
Tout moun ap soufri grangou
[All people are suffering hunger]
Hating to follow an uplifting post with one much less so, but after just watching this video, can't but share it. Produced by Partners in Health and the Institute for Justice & Democracy in Haiti. Need to learn more, but is what I started to hear at camps a couple days ago:
Hating to follow an uplifting post with one much less so, but after just watching this video, can't but share it. Produced by Partners in Health and the Institute for Justice & Democracy in Haiti. Need to learn more, but is what I started to hear at camps a couple days ago:
Haiti IDP Camps video 2 from Adam Stofsky on Vimeo.
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