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Saturday, November 27, 2010

The Unexpected--Nichole's Story

(Nichole)

I don't really know where to start,


Everyone that I have talked to post Haiti has told me that Haiti is like a drug--it stays in your heart forever. I have to say now after I have experienced Haiti for myself, that statement is very true! Since I've been home I think about it EVERY day... The people... Love... Compassion... Thoughtfulness... Pain... Sorrow... Heartaches...  All of it runs through me every day. I ran through every emotion possible while being in Haiti. Before going I tried to prepare myself for what I was going to see, feel, and live through. I thought I had, but I was wrong.....

I live in Stayton OR, a small farm town where you can't walk out of your house without seeing someone who knows your name.   With the small town comes a small hospital. I work as a clerk in the case management office (discharge planning and social services). Every morning I walk out of my warm house, get in my car and drive five to eight blocks to get to work. I interact with patients who have houses and cars, food and medicine--things we have easy, everyday access to in the states. I work only a half a day and get to enjoy the rest of my day with my kids without a worry of when we are going to get our next meal, drink clean water, or find a clean set of clothes or shoes that fit us.
Walking out of the Port-au-Prince airport a different reality slaps me right in the face. My eyes open, and my heart sinks into my chest. I will never forget the first Haitian face I seen outside the gate of the air port, a little boy--no more than eight years old-- who looks me in the face and says "Sister, please help. I'm so hungry... just a dollar please?" My boss Debbie, who was walking with me, whispers "You can't...just keep walking." So I turn my head with tears in my eyes and keep walking. Debbie explains later that everyone lined up at the fence are watching, they would have seen me give that little boy money, and I would have been the target for countless more requests for a hand out. The heartache starts just ten feet outside the airport door. I know then this is going to be harder than I thought.

Driving through Port-au-Prince on the way to the mission, I don't see anything I am used to in my town. Roads are without lines down the middle, potholes are everywhere,  I see no stop signs. People are without adequate clothes or shoes on their feet, some are dirty but yet still most of them wear smiles on their faces. I learn quickly that Haitian people, despite all they don't have, are all in all happy.  We don't have that at home. Always smiling, laughing, living life the best they know how, everyone I meet is so grateful and appreciates every little thing we do for them  or give them. They amaze me!

At the mission, I am no longer a clerk of a small town hospital. The first day I was a "runner" working out of the post op. I also learn how to clean operating instruments, part of the surgery tech/first assist job. I work my ass off that day doing whatever I can do to help. it pays off in my favor. That night Dr. Higgins, the surgeon on the trip, announces they need help with the first assist position. The next morning, he throws me right in there, and that is my home for the rest of the trip. I loved it! Between Dr. Higgins and Jonathan, the OR tschon the trip, I learn much. I am encouraged everyday to keep going into the OR. I am told I found my calling, and I believe it myself. I feel like I am actually doing my part to help the people of Haiti. Walking away from Haiti I discovered what I want to do with my life---for that I am thankful.

With the joy of everyday there also comes heartache. In our week of being in Haiti we lose three beautiful babies. This for me was hands down the hardest thing I deal with.  For me, after the third one I am ready to go home. I learn that night our culture is nothing like theirs. Sabine names the third baby David , because he is a fighter. We both work on getting him clean and bundled up. There are four of us on staff that hold David and show him love before he takes his last breath of his short, little life. After my turn, I go to the roof top, my favorite place at the mission, and cry harder then I have yet on this trip. All I want to do is go home and hold my two amazing kids.

So many emotions run through me when I think about Haiti,  it's  hard for me to put into words. All I can really say is that I will never forget their faces and the way that they have changed my life.

I have never seen so many thankful, gracious people in my life... Coming home is the hardest part of the whole trip. Back to selfishness, ungratefulness, and people that take the smallest things in life for granted everyday. I'm not saying I am perfect or that I don't act this way myself, but my eyes are open now.  Haiti has forever changed me,and my outlook on life itself! And for that, thank you, Haiti. Until next time.

Nichole

Monday, November 15, 2010

Monday, November 15th, 2010--Home

(Doug)
On Saturday, most of us go into Port-au-Prince, just to see the city.  Most of the first timers are appalled at the conditions there--the crowding, the garbage, the rubble.  I see some good things.  The city is alive again.  People are out walking the streets and going about their normal business.  Everywhere, by hand, little by little, rubble is being dug away, buildings are being repaired.  Much has been done since January.  Unfortunately, most of the rebuilding appears to be just replacing buildings in the exact same spot as the old ones--no plan towards re-inventing the city, making it better, but I know I expect too much.  The tent cities are still everywhere.  We go all the way up the mountain.  At the top, we can see all of Port-au-Prince laid out below us, a sight both awesome and awful.  On the way back, the driver of one of our vans has a family emergency and so can't take us back to Fonds.  I volunteer to drive.  Driving at night through the streets of Port-au-Prince is an exercise in patience and depth perception.  Traffic lanes are merely a suggestion, cars and trucks often approach head-on, intersections are a game of who wants it more, and sudden stops are the norm.  Potholes also help keep me jumping.  It's another experience I won't soon forget.
Saturday night, everyone is tired.  We drift off to bed or gather in knots of 2 or 3 to talk.  Sunday is a long travel day.  The Oregon group is heading out Monday, so we've said our goodbyes the night before.  The day starts a 3:30 am Central time, Fonds-->Port-au-Prince-->Ft. Lauderdale--> Dallas-->Kansas City.  The team says our last goodbyes and everyone splits for home.
Chantel and I talk on our way home.  We know that people will ask us "How was it?"  That is a very difficult question to answer, especially in a sentence or two.  It was a lot of different emotions and experiences and even smells.  Chantel says she can still smell the OR there.  We were exhilarated, crushed, torn, inspired, entertained, drained--at different times, and sometimes all at the same time.  It is too much to process, much less relate to someone who wasn't there.  What did we do there?--what did we accomplish?  Chantel says something that rings true to me.  She says that whatever level of medical care that she was able to give to the patients that she tended, when she was finished, they knew that she loved them.  That echoes what Betty Prophete, our host at the Haitian Christian Mission said.  Her highest praise for us was that the people that we treated said that they could tell we cared.  I don't proselytize about my faith much.  It's not how I'm wired, but one of my dear friends told me to not get caught up in myself, to allow God to work through me and give him the glory.  I've tried to do that this week.  I've tried to open myself to the experience and just let it flow.  I'm very proud of our team and our approach this week.   I would serve, and probably will serve, with them again.  I want to thank them and to thank everyone at home who supported them and everyone who supported all of us.  This was not a one man show, by any means, and I will work on my fellow team members to get them to share their stories.

God Bless

Doug

Saturday, November 13, 2010

Saturday, November 12, 2010--Choices--David's Story--Our Story

(Doug)
What happens in Haiti, stays....
Our lives are full of choices, some momentous, some minuscule.  Haiti has a way of holding up a mirror and forcing us to examine the choices we make.  The realities here are harsh, The contrasts between those who have and those who have not are stark. There is a great temptation to write Haiti off, to think that the choices that we make, good or bad will make no difference in the life of this country or our lives in the real world.
Yesterday, we took a mobile clinic to Thoman, up in the mountains.  It was gorgeous there.    The weather was cool.  We saw 125 patients in a little more than 4 hours.  It is a really good day.  We feel like we make a difference in a few lives, and the people are very appreciative.  It's our last day of work, and it feels like a good way to end it.
I haven't discussed the work of the surgical team very much this week, mainly because I've been pigeonholed on the medical side, but Dr. Ted Higgins and his crew have been slogging through a demanding schedule.  I'll try to get someone from that team to post on their work.
When we finish with our clinic and in the OR, we all take a while to relax and unwind and celebrate the week, the joy and the sorrow.  In a lot of ways, it's been more relaxed than previous trips for me.  I haven't been called upon to see the volume of patients that I have before.  It has also brought some struggles with our very ill patients.  For the first time in a very long time this week, a patient under my care has died, and 2 in one week is something I have not experienced.
I've spent a lot of time questioning the choices I've made with those patients in particular, but with all my patients as well.  Did I make good decisions? how could I have done things a little better?  Did I do too much, not enough?  People talk about second-guessing like it's a bad thing.  To me, it's just an acknowledgement that I am not fully formed yet, that the clay from which I am molded has not yet hardened.  I am still learning and trying to become better every day.  Meritsky taught me much about malaria.  You can bet that I read all I could about it after he died.
In Thoman, I see a 2 year-old girl who had fever about every other day for two weeks, had lost weight and  would go between shaking chills and sweating.  Given my experience, it's not hard to suspect malaria, and I make a special effort to adapt our adult chloroquine to a form that a 2 year old could take.
Friday night shows  us that Haiti and her medical problems were not finished with us.  While the rest of us relaxed, Sabine was busy with a 27 year old, Eric, who'd been laying in the hospital for 2 days with typhoid and now had some respiratory distress.  There is also a woman who is pregnant, maybe 25 weeks along, who had ruptured  her amniotic fluid, the bag of waters, and  about to deliver.  When I hear that, my ears perk up.  After all, that's what  I do....but I am quickly reminded that  I have no ventilator, no round-the-clock ICU nurses, no surfactant, the medicine that helps premature lungs stay open.  In the US, at a properly equipped hospital, that's a better than even bet for survival.  Then I dismiss that thought.  I can't do a 25 weeker here.  I decide to put it out of my mind.
Sabine is busy.  I come to keep her company, and we discuss Eric.  I make some suggestions.  Technically, he's out of my age range, but he could have been my patient when I started practice. The premature baby has been delivered and not resuscitated.  Another woman, this one at term has come in laboring, her second baby. I try to hang with Sabine for a while, Chantel comes down as well, but I am beat.  I go to bed.
She wakes me up sometime later.  I am sleeping hard, so I am confused and it takes a minute or two for things to start to make sense.
Chantel and Sabine are watching Eric, who is uncomfortable most of the night, but relatively stable, when they hear a splash and a baby cry from the shower.  They scramble in there and the baby is delivering.  The umbilical cord is wrapped around the neck, but they manage to extricate the baby safely and he is fine and healthy.  In the aftermath, the Haitian midwife makes a horrifying discovery--the premature baby, alone now for four hours, is breathing on its own. He's cold and looks terrible, but he's still alive.  Sabine rushes to wake me up.
As I wake into what is in some ways my worst nightmare, my mind is reeling.  I get there, and what I see,confirms my fears.  He is still alive, but he won't be for long.  His fingers and toes are starting to turn black, a sign that bad things have been happening with his oxygen.  I weigh my options.  After examining him, I feel confident that he is about 32 weeks gestation, much older than we had thought.  The possibilities flash through my mind.  I want to do everything.  I want to bring this child back from the edge.  If I was in my home hospital, this wouldn't be a question.  Here, I have to think about the oxygen tank that is being used for the 27 year old, the ventilator that I don't have.  The labs that I can't draw to track electrolytes, the Neonatal Intensive Care Unit where I can't send him.  He is dying.  He will die.  I feel certain that I can delay it, but I can't turn the tide in our favor.  I shake my head.

I can feel the pulse in my temples.  My face is flushed.  My answers become clipped, tight.  My voice is quiet and measured.  Sabine and Chantel know what this means.  I am not the type to scream and throw tantrums.  I'm not exactly sure where my fury is directed the most.  Myself, for not making sure I was there at the delivery, just in case--or for not doing everything I could, or for being so helpless...the delivery team, for setting aside the baby without resuscitation, without calling me to examine him...Haiti, for being so poor and lacking in heath care resources and so difficult to deliver adequate care...at God maybe...how can he allow so much sorrow to be visited on one place?  I feel nauseated.  I have to leave.  I sit on the steps outside the mission building for a long time.

Inside, the parents don't hold the baby.  It's not something I understand, but here, when children die, the parents don't hold them.  He is bathed, Sabine names him David.  Chantel holds him until he takes his last breath.
Our decisions stay with us.  Being a 32 week premature infant is a survivable condition, even in Haiti.  It's not guaranteed, it's not even easy, but it can happen.  This one is on us.  I can't blame God or Haiti.  Just as we can't expect to save everyone here, we also can't use that as an excuse to not try when we can.  There has to be the same standard of care as at home.  The level of care, we can't match here, not yet, maybe not ever, but out decision making cannot be so clouded by despair that we fail to try.  I can't tell you what may have happened had I started with David 4 hours earlier, maybe nothing different, maybe a slightly longer but  more painful life, maybe a life of disability, maybe a healthy life.  I can't tell you what would have happened, but I can tell you I should have been there, and I should have tried.  I owed David that.
I know that this week I have presented three stories of sorrow tempered only by Sabine's story of joy, but I don't want to give anyone the impression that this has not also been a joyful trip. The team members have been fantastic.  as I sit here typing on the roof of the mission, I can hear the children playing soccer in the courtyard, laughing.  The view from here of the lake and the mountains beyond is fantastic.  the people I see, as I have said before, smile when they see us.  They do not hang their heads.  They do not dwell on the sorrow.  Haiti is Sorrow and Joy, Joy and Sorrow..  If I could take away one thing from this week to apply to my life, it would be Chache lajwa.  Look for the joy.
Why are we here?  Because the need is enormous.  Are we able to  address the need right now?   No, but here in Haiti, you build a house brick by brick.  One brick doesn't make the house appreciably bigger or stronger, but little by little, the house gets built.  This week, we've added another brick.  At home, you can add a brick by contributing whatever it is you can...service, money, kind words, prayers...we can use them all.  This week has been as I had both hoped and feared.  Last time was so overwhelming, and I was so bolted down, that I did my job and did not allow myself to live the sorrow and joy.  This time I have.

What happens in Haiti...stays with us.

Chache lajwa.

Doug

Friday, November 12--Katie

Hi there. I’m Katie. This is my blog. I am not a blogger. This is actually my first blog. Doug may have opened me up to a whole new way of communicating, but first, let’s just see how this turns out. This is also my first Mission Trip. Haiti November 2010 was just that for a long time… the title to what would be an experience I taught myself to create no expectations for. I did not want to expect too much, in case it didn’t live up to my grander ideas, but I didn’t want to expect too little either, in case it completely blew my mind in every aspect, every day. I can honestly say, that sitting here typing this as we drive through the rough roads of a poverty stricken country, that the latter is definitely my experience thus far. I do not believe that I am in any way naïve, but coming here and seeing the things I have, has made me realize that my eyes have not been completely open to what is happening outside my fluffy pillow of a life in the States.




This week so far has been exhausting both physically and emotionally. I have been astonished, sympathetic, angry and frustrated with the Haitian people. I have been tired, excited, giddy, discouraged and compassionate. I have been a student and learned from some of the best professionals in the medical field. And I have taken the reins and taught others what I know. I have had many “firsts” since I have been here: my first experience communicating in a foreign language, my first time placing an IV, my first time taking the first assist position in surgery with Dr. Higgins, and my first time feeling completely helpless and broken as I watched a 2 year old boy pass away in the arms of his mother. The last one, at the time, I felt I could have gone without witnessing. But now, I realize that the baby’s fate was sealed, and we did nothing less than everything we could think of to change that fate. So while it was one of the most heart wrenching things I have ever seen, it has only made me a stronger on my journey in my mission to help the people Haiti.



There is some irony here as we continue to drive, now through the rolling green mountains of Haiti, to get to a small village to treat those that may have not had medical attention in over a year. There is so much richness in the beauty of the land and the faith, resilience, and optimism of the people. I have to sometimes remind myself how little they have, as far as possessions go, that in my world are things nobody goes with out. Little luxuries like clean water, food, soap, shoes, medications and a bed to sleep on or a roof over your head. I honestly don’t know what I will do when I get back home. In two weeks I will be sitting around a big table of food with my family in my comfy home celebrating Thanksgiving. What will I do? Will I spoil myself once more and buy myself a new outfit for the occasion and eat until I am fully sustained… I can sit here and honestly say I want to change, but am I really capable of giving up on the lifestyle of spoiled greed I have grown-up in? I know. I realize I am a step ahead of others. I am here, in Haiti. I am volunteering and helping in every way I can. But I still feel egotistic and \indulged. I thought when I came here I would have so many questions answered, which is true, but I did not realize I would come up with so many more. I will be thankful though: thankful for the wonderful and enlightening experience I have had, thankful for the AMAZING new friends I have made and the connection we now share, thankful that when I see my beautiful niece and other children in my life I know that they will never be robbed of the things young children are here, and thankful that my mother and father have provided me with a fruitful life and loved me unconditionally and that my sisters and I will never be separated by deficiency and poverty. I have to thank Haiti and its’ people for giving me a great gift. And while I am not for certain exactly what it is or how it will affect me quite yet, I know it was due to being here and learning from them. So, until I figure that out, and until Doug’s computer quits acting whack, I have to say I am officially done with my first blog now. I hope you enjoyed my thoughts… because they may be the reason we can no longer blog on this computer… oops.



God Bless,

Katie O’Laughlin

Thursday, November 11, 2010

Thursday, November 11--Meritsky

(Doug)
Chantel just wrote about an hour's worth of blog and then lost it because of the Internet connection.  I won't write too much about the day yet, because it is her story and she was doing a great job telling it, so I hope I can convince her to type it again. So briefly, we had a travelling clinic today to a town just on the other side of Port-au-Prince.  It was a town with a school, so right away you know that the overall health will be better because the school kids get fed every day.  I had a great day.  I only saw about 40 kids, most of them not  that sick.  At the end of the day, I  had a line of about 6 pre-teen to teenage school kids left, and I had a good time, talking and joking with them.  They are as smart and sarcastic as any middle school or high school kids back home, so we had fun.  Plus, any child who is lucky enough to go to school, they learn French, so along with Kreyol, I had French to fall back on if I couldn't think of the right words.  When we got back, we briefly took care of a 2 year old boy named Meritsky who had been walking around with fever for 2 weeks, but over the prior 5 days he had stopped making urine.
The mosquitoes search through the air for their next blood meal.  they can sense the heat of a body, they can smell carbon dioxide and a chemical that we all give off called Octenol.  When they bite a person infected with malaria, a small number of the malaria parasites move into the mosquito's stomach. The mosquito now has malaria. The parasite develop within the mosquito, change form, and move to the saliva glands.  The mosquito goes on the hunt, again.  This time when it takes its meal, the parasites are injected with the mosquito's saliva into the person being bitten. The parasites find the liver, and may stay there for months, or weeks, changing form yet again, but then they move into the blood an start to multiply within red blood cells.
That's when the fever and headache start.
Classically, with malaria, there are cycles of  sudden coldness followed by shaking chills and then fever and sweating lasting four to six hours the cycles occur every 2-3 days, but there may also be a less pronounced, almost continuous fever. Children with malaria frequently exhibit abnormal posturing, a sign indicating severe brain damage, probably due to increased pressure inside their head.
Severe malaria is almost always from Plasmodium falciparum infection, and usually arises 6–14 days after infection.  Children are particularly vulnerable.  Renal failure, sometimes called blackwater fever, can occur when the kidneys are overwhelmed with the hemoglobin released from broken red blood cells.
Meritsky comes to the clinic about 2 hours before when get back.  He is posturing.  He has periods of rapid breathing followed by long pauses.  The team here does what they can.  He gets IV's started, fluid is given to restore the circulating blood volume.  Intravenous antibiotics are administered.
When we arrive back, we rush to see him. After looking somewhat better, he is largely unresponsive.  We do what we can.  Since his kidneys have shut down, the fluid that has been given accumulates in his lungs.  He starts to lose his ability to keep his oxygen level up.  The same looks that we traded a few nights ago with Jeff are passed around again.  The truth is, he came in too late, and we don't have the tools in place to save his life.  We provide supportive care, but he deteriorates quickly.  The blood test result comes back.  He has malaria.  We wonder aloud why we didn't get him sooner, but that is the reality of Haiti.  Although effective medicines exist to treat it, and the whole team is taking medicine to prevent it, the reality is that to the people who live here every day, such things are almost unimaginable luxuries.  They are so used to working without a net, to having nowhere to go, that they don't go anywhere.  Their children survive or they don't.
Meritsky is two.  He is very small for his age, maybe 20 pounds, but his mother says he has always been lively and energetic.  I think of the smiling, happy children I have seen today.  One was seen in the hospital for anemia, told she had anemia and malaria, and sent home with vitamins.  Two weeks later we see her and she is still having fever.  We give her the medicine that will cure the infection.
We will not intubate Meritsky.  There will be no mad dash through Port-au-Prince.  We wrap him up and give him to his grandfather. His mother is in pieces, wailing "Wai!Wai!Waaaaiii!" which to us sounds like "Why?Why?Why?"  which is what we want to ask.  Everyone is in tears, again.
Why is such a good question to ask and such a hard one to answer.  I guess my answer is my support of the Haitian Christina Mission and continuing to try to raise money and awareness through Missouri Haitian Relief Fund.  The people have become aware that there is a continuing presence, so the sicker people and children are finding us.  Next time, maybe, we will have a ventilator. maybe an ambulance.  In a year or two, maybe an expanded hospital.  The need is great.  We do what we can.  The rest is in God's hands.
Meritsky's grandfather and mother walk out into the night, taking him home.

Doug, Fond Parisiens

Wednesday, November 10, 2010

Wednesday, November 9--Bittersweet--Dubinsky's Story

(Sabine)
I wake up at 6:30 in the morning after going to bed at 2am waiting on Jeff's parents to pick him up. Ecclesiates chapter 3:1-8 is on my mind the second I woke up. I get dressed quickly and head down the stairs to go and see if Jeff's parents had picked up his body from the hospital when I was greeted by Dr. Emmaneul. "He's gone, his dad came to pick him up at 3 am and took him home. He wanted you to know that he appreciated everything the doctors and nurses tried to do for him." I had hoped that everything that had happened the day before was a horrible nightmare but the words that came from Dr. Emmanuel reminded that yes, baby Jeff is dead.

I lead devotionals that morning...I read from Ecclesiates chapter 3. Most of the team is greatly affected by the death of Jeff. I encourage them to go out in clinic today and try to save as many lives as possible knowing that we have no control over making the final decision on who gets to live and who dies.

The clinic is very busy in the morning, and I decide I would see patients today. As I am walking to my consultation room, a woman sitting on a bench calls my name and asks me if I had remembered her. She says to me in Creole "I am Dubinsky's aunt, remember baby Dubsinky the one you helped take care of when you were here in June?" How could I forget baby Dubsinky?...a 2 month old little boy who weighed less than 5lbs. I remember how I and some pretty amazing physicians and nurses worked through out the day and night to save his life. We drove all over Port Au Prince with him looking for a hospital that would admit him just for a blood transfusion. I remember all the doctors and nurses pulling late night shifts to make sure he received his formula every 2 hrs through a tube we put in his nose. I remember crying when he came back to us with all his beautiful curly locks shaved off because they placed an IV in his scalp so that he could receive a blood transfusion. I also remember the anxiety I felt leaving him on Sunday morning to fly back to the States not knowing if I will every get to see him again, wondering if he will make it through.

Dubinksy, June 15, 2010, photo by Eric J. Anundi


How could I not remember? I ask her how he was doing and if his parents were doing fine. She tells me that he has gained a lot of weight and is doing great. She comes and finds me after her 3 month old daughter is seen by Doug to let me know that she will tell his father that I am in town, so he can bring him by for me to see.

As the day goes by, all I can think about is seeing and hold Dubinsky. Around 2pm, his father brings him in to be seen by Doug for just a basic well baby exam. I barely recognize my handsome baby boy. His sunken in cheeks that I remember are now full, his pale skin is a beautiful brown color. The baby that was too weak to even open his eyes is staring at me, making beautiful strange faces. His father hands him to me, and the second I hold him, I experience pure joy and love. I take my pointer fingers and run it over every facial feature. His once skeleton like fingers are now chubby, with a strong grip. His hair still has not grown back where they shaved his head, and I can see the site where the IV was placed. I do my best to hold back my tears but am unsuccessful. I hold him believing that he is not real. I bring him to see Debbie, a nurse from Oregon who also worked tiredlessly to keep him alive. She holds him for a while and is thankful that he is a beautiful healthy boy.

I sit with him and hold him for another 4hrs just staring at him as he sleeps. His father comes to me and tells me that it is getting late and they must go. He tells me thank you again for everything we did for Dubinsky and wants me to let the other individuals who took care of him that he is grateful. At this time I am have trouble letting go of my precious baby boy. The father assures me that he will bring him back for me too see when I come back to Haiti. I give Dubinsky a kiss good-bye on the forhead and cheek then I return him to his father. I say good-bye and quickly head to the pharmacy to let all the tears that I had been holding back flow.


Today I mourned the death of an 8 month old baby boy and celebrated the life of one who was very close to death, but now lives in full and beautiful health. Thank you, Dubinsky.

Sabine

Tuesday, November 9th, 2010--Restoration

Today was the sunny day after the storm.  Today I saw maybe 35 patients before lunch and only 4 or 5 after lunch, Then I got to do one of my favorite things--play soccer with the kids.  Kids, in this case, because they are all 15-20 years younger than me. I can't really compete with them one on one with touch on the ball or passing, but I play more physically than they expect me to, and I make them pay when they ignore me.  I get five shots on goal, 1 goes in.  they argue about everything, every goal, every out of bounds.  It's just part of the fun.  I may be breathing just a little harder than these boys, but it is giving me joy.
This morning when we told the rest of the team about Jeff, I stressed to everyone that although we may have seen a more difficult side of Haiti through our experience, they could not let that define their experience.  The people of Haiti have suffered much.  They suffer everyday.  Most of the people we see here have lost family in the earthquake.  Probably all have lost family members before their time, but no one hangs their heads, or if they do, they do it privately.  What we see when we look at them is joy. They are happy to be alive, happy to be here.  Most of them have houses and possessions that most of us wouldn't take if it were given to us, yet the Haitians we see can still find the joy.  chache lajwa--look for the joy.  That's what I want to do this week.  Look at the people who should be scarred and see the joy radiating from their faces.  this is different than I saw in January.  Then, most of the people we saw were just in shock.  They could not function really on a human level.  The light was gone.  those were some dark days.  I am glad to see the light is back.
Today I saw more ear infections and pneumonia than I see in a week at home.  I don't know why it is, but even simple illnesses are more severe here.  Overall, though the patients I've seen so far are healthier than the ones in the last 2 trips.  That probably has to do with a medical team being here nearly every week since January instead of only 4 times in the year.  Sabine has a story to tell.  I will try to get her to tell it.

Doug

Monday, November 8, 2010

Monday, Nov 8th, 2010...Where do you go....when there's no place to go?....Jeff's Story

Woodley "Jeff" Meriska is a chubby 8 month old with big cheeks and short braids all over his head. It has been an easy morning.  I've seen only 30 patients, some of them sick, some of them not.  We are just about to pack it in for lunch when Jeff is rushed into my room.  He is having a seizure.  His arms and legs are shaking rhythmically.  His eyes are rolled back in his head.  His mom says that he's never had a seizure before, that over the last 3 days he's had a fever and a cough, but this morning when she went to get him, he was doing this shaking.  That is bad news because it means that he is in status epilepticus or uncontrolled seizure.  Short seizures, less than five minutes, are usually harmless, but the longer they go on, the more ominous they are.  Status epilepticus for more than 45 minutes has a 90% mortality rate.
Jeff comes to us after more than 4 hours.
The first order of business is to stop the seizure.  Chantel loads him with the anti-seizure medicine Dilantin by intramuscular injection because Jeff is a difficult IV stick.  Then Burney Miller, one of our two anesthesiologists, gets an external jugular line in, and we give Jeff Versed, a different anti-seizure medicine.  The seizure stops.  Jeff, though, isn't looking good.  He is posturing, meaning that his body is stuck in a rigid position, a sign that all is not well with his brain.  He also has very tight "crunchy" breath sounds. We suspect pneumonia and/ or meningitis.  We don't have a way to check for either, no X-ray or spinal taps are available so we give him antibiotics , just because we want to start treating again.  A little while later, he starts to go into a seizure again, so we give him another dose of Versed.  This again quiets the seizure, but between his lung problems and the seizure medications, he deteriorates and starts to need more support for his breathing,  Now we are bag-mask ventilating.  He doesn't improve, so we intubated.  Dr. Lori Borella, our anestesiologist gets in an endotracheal tube, with considerable difficulty.  She later tells me it's the most difficult pediatric airway she remembers.  He still does not oxygenate very well, so we give him some more seizure medication and a muscle relaxer.  We continue hand ventilating him for a while,  In the meantime, we discuss where we might go to get some more help.We finally get word that we might find some help at a hospital run by University of Miami on the other side of Port-au-Prince, an hour and a half drive away.  we pack him up in an ambulance run by the local Mennonite Mission, and we are off.

Rush hour traffic in Port-au-Prince is an experience in itself, cars and trucks and motorcycles and pedestrians everywhere, continously cutting each other off, merging in, suddenly stopping. Our ambulance driver Matt seemed very mild mannered and calm, but he drove like a madman, very skillfully, but fast, sliding the ambulance into spaces and changing lanes with inches of clearance.  The traffic does not respect the flashing lights and sirens, but it yields to the sheer daring of the driver.
Hand or bag ventilating means that we are essentially breathing for Jeff.  If we don't compress the bag rhytmically, he doesn't breathe.  I find after about an hour that I don't have to think about ventilating him, my hand has fallen into a rhythm, and is working on it's own.  We have to put a little tension on the tube to keep it from obstructing, and we have to guard Jeff from the constant bumps and swerves.  We plow through Port-au Prince, car by car, intersection by intersection, and finally arrive at the Miami Hospital.  As soon as we open the doors, the head shaking starts.  They need to check,  who did you talk to when you called.  Doctors, nurses walk past the ambulance , glance in, then avoid eye contact.  some do stop, talk with us briefly, and regard Jeff with sad eyes.
Finally, Autumn, the acting Chief Medical Officer, appears and tells us that they can't help us, that we'll have to try a different hospital Petits Freres et Soeurs, a pediatric hospital that we already sort of passed on the way.  One that has been less that helpful to our teams in the past.
We have been hand ventilating Jeff for 2 hours.  My forearm starts to ache.  My hand starts to cramp.  Sabine, Erika, Chantel start to take turns.Erika we've met just last night, is a nurse from Santiam Hospital in Stayton, Oregon. She and Chantel watch Jeff tirelessly, though both are to an extent, carsick.  Sabine talks to Jeff's father, who has come with us.  Jeff has a 5 year old sister.  He is the only boy.
45 minutes later, We are in Petits Freres et Soeurs.The Doctor there is not pleased, but we are arrriving with an intubated baby, and we are nearly out of oxygen.   We get a bed in the ER.  We look around, and there are desperately ill children around us everywhere, with IV's, oxygen.  None is as sick as Jeff.  The doctor says that they have one ventilator, and she will have to check to see if it is being used.  45 minutes later, she gives us a choice: there is no available ventilator.  We can stay there and hand ventilate Jeff ourselves, teach the father to do it, or take him somewhere else.  As soon as they swap out our oxygen tanks, we leave.  They agreed to give us oxygen, we think, to get rid of us.  We have been hand ventilating Jeff for 4 hours, by far the longest I've ever gone.  30 minutes later, we arrive at the third hospital.  Sabine goes in.  We don't take Jeff inside, just continue to take care of him in the ambulance.10 minutes later we have our answer.  Our only other option is the City Hospital.  no one wants that.  We head back to Fonds Parisiens.
Matt explains that this is an all too common theme in his work. He is here on a one year mission as part of the Mennonite church.
We arrive back at the Haitian Christian Mission.  We have been hand ventilating Jeff for 6 1/2 hours.  He is starting to wake up.
Inside, as he wakes up and starts to fight the bagging, I have a decision to make.  I know his lungs are compromised. I know he's had some sort of brain insult.  I don't know the severity of either, and I have no way of knowing except for my eyes, ears, and hands.  My preference would be to keep him intubated, on a ventilator, and follow him with serial x-rays and measure his blood levels of carbon dioxide and oygen.  I don't have that open to me.
The other option is to give up my secure airway and see what he'll do on his own.  It's possible that he will do better on his own.
We watch him.  He is vigorous, coughing.  He opens his eyes and seems to be moving purposefully.  I decide to extubate, to pull the tube.  We are excited.  He looks good.  He is keeping his oxygen level up.  We had hand bagged him nearly 8 hours.  I watch him for a time, then head to bed, planning on taking the 2 am to 6 am shift.  If anything goes wrong in the middle of the night, I'll get awakened anyway.  Maybe now I can get 3 hours of sleep. I am tired.
Jeff is tired, too.  His lungs are very stiff, and it takes all his strength.  Then his strength is gone.  I am blogging, this blog, when they come and get me.  They've been looking for you, I rush down.
Lori has been watching him.  As he tired out, he went into respiratory failure.  Jeff simply couldnt keep up with the work involved.  Lori tells me she tried to intubate again, but was unsuccessful.  We are back to hand bagging, with a mask, to keep him alive.  His lungs are bad.  Where do we go from here?  There is nowhere to go.  I knew that this was a better than average possibility when I started this.  Jeff, if there was ever a time to rally, buddy, this is it.  I stroke his cheek.   His skin is so soft. Chantel comes down.  She was going to sleep until the 2 am shift.  She looks at my face and tears start to well up.  I look around, everyone who has been invovled with this baby all day is around the bed--Lori, Sabine, Chantel, Erika, me.  "Does anyone have any other ideas" No one does.  We continue hand ventilate, to bag.  The father goes to get the mother.  Our plan is to continue bagging until the parents get back, so they can hold him.  We bag.  At this point, if I could will that my life would transfer into his body, I'd do it.  The parents aren't back.  We bag.  Jeff's oxygen level starts to decrease, slowly but inexorably.  I can't bring myself to stop bagging while his heart is beating.  We disconnect the tubes, the monitors.  I continue bagging. Chantel periodically checks his heart rate and calls out the number. No miracle is coming.  The parents have not returned.  We disconnect the oxygen.  Chantel listens and calls out the number.  Then she listens and just shakes her head.  I listen.   There is no heart beat.  "Time?"  "11:17pm."
We spend a lot of time holding him.  We talk about the day, what went right, what went wrong, what was frustrating.   Sabine tells us that the father said he was very grateful that we were there.  That he could see how frustrated we were and how much we cared.  We talk, holding him, waiting for the parents to come back.  Finally, we need to go to sleep.  It's 2 am and there are patients in the morning.  We wrap Jeff carefully and place him into an isolette in a quiet corner of the hospital.
We find out in the morning that the father came in about 3 am and took him home.  He was grateful.

Woodley "Jeff" Meriska  March 1st, 2010-November 8th, 2010.

Doug

Sunday, November 7, 2010

November 7 KC->Dallas->Miami->Port-au-Prince->Fonds Parisiens

Long, long travel day today.  We made it into Port-au-Prince about 4:20 pm locally (same as Eastern Time), and made our way through immigration.  All the team members and all the bags made it safely.  We paid $60 to bypass customs.  Even then, I got grabbed by a customs guy who wanted to inspect my bags.  That wasn't happening, I decided, so I crept away from him when he was distracted and merged with the crowd.  We paid another $40 for baggage guys to help us navigate through the phalanx of people trying to "help" us with our bags.  $40 bought some ferocity from our protectors, and it was probably worth it considering the value of the meds and equipment we had.
Then we waited for our ride, and waited because only one van and one truck showed up, not enough to carry all of us and our baggage.  Finally another truck came from PAP, and we were off.  By that time it was dark, so I couldn't see a lot of Port-au-Prince as we drove.  This was probably a good thing for a lot of our first timers.  I don't know if they would have been prepared for the site.  I was pleased to see some bustle in the city streets at night.
I wasn't prepared for the rush of emotion that I got as we drove through.  Last time, in January, just after the quake, the devastation was so immense and so raw and so immediate, that my mind just refused to process it.  All I could do was focus on what was in front of me, the patient at hand.  When I came back from the trip, people would ask me how it was, and I didn't know how to describe it.  "Intense" was a usual answer, but that was vague and unsatisfying.  The truth is, it had to be vague, because I never really allowed myself to let it soak in.  Today, I could really feel the loss, all these people who were still left standing.  For the first time, I am afraid.  I am afraid of what I am going to see, afraid that it will cause me despair.  I know I can help the people I  see,  I have the tools, the meds, and the experience to do take care of a lot of children.  But I guess i feel like I am wrapped up in the story  now.  It's hard to separate, and I don't really want to.  I want to feel it this time, but that makes me afraid.
This place is so insane--ridiculously hopeless, but at the same time holding so much joy.  It's hard to express in description, so this week, I think I'll try to focus on stories.  I think that's the only way to encapsulate the experience.
Doug, from Fonds-Parisien

Touchdown DFW

One of the things that's a pain about going to Haiti is the amount if stuff we have to slog to the airport and through the airport.  All of the KC team made it on the plane.  Several of our carry-ons didn't.  Well they made it but had to be checked at the gate.  That's what happens when you are trying to maximize carrying capacity.  One of out team members who was to meet us in Miami had a family emerhency and so won't be able to make it.  Our prayers go out to her.  The team from the Dominican Republic will also not be able to make it.  We will meet the Oregonians in Miami.  The Coloradoans are already at Fonds, having arrived Saturday.
Doug

Friday, November 5, 2010

Last minute things to do

I've got a list.  Wednesday, Sabine, Chantel and I packed up about 350 puonds of meds and supplies.  Sabine's brothers, Lesly and Guesly Dessiuex, just returned from a trip with FAME last week, and they had a very busy and intense time.  They had many extremely ill patients and had to perform full codes (cardiopulmonary resuscitation) on 4 patients.  they didn't have enough of several different medications, so we have taken their advice to heart and will arrive stocked to the teeth with heavy-duty medications and equipment. So more packing, personal packing, travel insurance for the team, going to the bank, mailing out thank you's, picking up personal meds, already did an interview for the paper, checking the status of Hurricane Tomas (it's passed), driving Sabine crazy with a bunch of little things...I'm not really a logistics person, so I feel a little fractured right now.  I've recieved a ton of support and well wishes from everyone.  Thank you so much for your thoughts and prayers.  I'll do my best to post as often as possible, and I'll make others post, as well.
Doug