Ke Nou

Tuesday, November 8, 2011 Fond Parisien/Gonaive--No Guardrails

2011-11-14T10:27:00.003-06:00

Doug
Gonaive is a little village to the northwest of Port au Prince, a two and a half hour drive. I have not been here since my first trip to Haiti, October 2009, prior to the earthquake. Memories tug at me as we drive to the village of Saint Marc and drive on further up. I remember a poor village, where many children were malnourished . I remember being relieved when I saw Gonaive has a school. A school means schoolchildren get to eat. This village has not been visited by a mission team since our last time here.
We arrive. It is a forgotten village, a poor village, and I hope things are not too desperate here. Living in this village is like careening down a twisty mountain road, mere inches from going over the edge, and there is nothing to stop the fall, no guardrail.

Guesly
Erika returns with her assessment: The patient’s cervix is 7 to 8 cm dilated and almost completely thinned out. This is her third pregnancy. I look around me in this dark cinder block church with primitive wiring for electricity powered by a generator. The roof is corrugated aluminum sheet held with sparse wooden trusses The church is dim with light creeping in from a few well crafted fenestrated cinder blocks. The floor is a mixture of dirt and large sharp rocks which remind me where I am with every step. I think we might have to deliver her here. I make my way to an unfinished alcove behind the altar. It is the only area that is semi-private.. As I enter the room, I see a women in her late 20’s to early 30’s lying on a oversize trash bag which covers most of her trunk on the unforgiving rock. Her feet and sandals are darkened to the color of the dirt; her dress is pulled up over her belly. She moans with each contraction. It has been almost five years since I finished residency , I know delivering children is far beyond the scope of medicine I want to practice. Haiti does not care about my preferences and brings unexpected and inconvenient challenges with each mission trip. This is Erika’s second trip to Haiti and already she knows to expect the unexpected. But it is not so much the unexpected that is the problem. The problem is that there is no system equipped to handle the unexpected. If we, the intermittent and temporary mission teams, are the best response, then the system is broken. To change the high morality and morbidity of newborns and their mothers, the whole system must be fixed.

“Dokte, dokte- nou gen yon maman ke vini avek yon tibebe ke mouri nan vant li!”* I am sitting in the dining room playing a game called Qurko with my sister Sabine and Ouyse, a family resident from Kansas City, when I hear the call of one of the translators. I spring to my feet, and grab Cory Miller, an OB-gyn resident from Columbia Missouri. We rush downstairs to find a women in the operating room, lying on the surgical table. At first glance, I can tell something is not right, something beyond the moans with every contraction.. Her appearance is off. Her face was swollen like someone suffering an allergic reaction, but I know that is not the case. The swelling is also encompassing her arms and legs. She is lethargic and remains still until a contraction stirs her to thrash and moan again. I asked her name and age. In Creole, she tells me she is 19 years old and 8 months pregnant. She continues to answer questions in a soft, anguished voice as I translate for Cory who does not speak Creole. We both notice her husband is not present in the room but waits outside in the lobby area. She explains that she lives in the mountains past a place called Fond Varette. As she speaks, I start to understand how difficult her journey has been. Fond Varette is a mountain where we often hold mobile clinics. The terrain to the small village is very unforgiving and painful. It has no mercy for people or vehicles. The road is very dusty because it runs along a dry riverbed. It has ruts due to erosion from repeated heavy rainfall and haphazard road construction. The drive itself is a slow climb on a road built to handle one vehicle but often carries three to four lanes of traffic. When I ride on it, I always hope I am on the vehicle closest to the mountain, not the vehicle on the outside where the edge falls off to a several thousand foot drop. No guardrail will arrest the fall. Traveling that road in the middle of the night in the back of a tap-tap is terrifying to imagine, even for someone who is not eight months pregnant. As I think this, she tells us her story.
On Friday, the mother developed a fever and noticed ther baby was not moving. The next day, she developed sudden abdominal pain,causing her to double over, and she began bleeding from her vagina. Her husband urged her to go to the hospital. This is their first baby; they just married a year ago. They went to see a local midwife, but she refused to see the mother. They waited. By Monday, the pain and contractions are unbearable. They make the harrowing trip down the mountain.
After Cory and I both assess her it was clear there is no fetal heart beat. Her unborn child will not have a chance to fight for his or her life. Our minds turn to treating her current potentially fatal medical condition. She arrives with severely elevated blood pressure and swelling. She had a condition called preeclampsia, and if it is not treated she could rapidly develop eclampsia which could endanger her life. Preeclampsia is a hypertensive syndrome that occurs in pregnant women after 20 weeks gestation consisting of new onset, persistent elevated blood pressure. Eclampsia is the progression of the disease process with initiation of seizure. I defer to Cory’s expertise concerning the treatment and management of this condition. My concern is whether an emergency c-section will be needed to remove the dead baby in her belly. Cory and I decide to awaken the surgical crew and Dr. Higgins, the general surgeon who practices in Kansas City. Dr. Cory and Dr. Higgins perform the surgery. Once the baby is delivered, it is clear he has not been alive for some time. Around the placenta is old clotted blood. The placenta has separated prematurely from the uterus, a condition called placental abruption. This condition is rapidly lethal for the baby and very dangerous for the mother. Her condition is not uncommon, and if recognized and treated, the risk to mother and baby can be minimized. That requires good pre-natal care which the patient failed to get because of location she lives, the scarcity of physicians, the lack of education, and a health system that only provides care to those who could afford to pay. Since eighty percent of Haitians are poor, all those pieces rarely fall into place, and this outcome is all too common.

Doug
We name the baby Esau. It was clear from the moment he is handed to me his earthly journey was over before his mother ever came down from the mountain. He is tiny, less than 5 pounds. He is limp. He has lividity in his skin, the blood pooling due to gravity after death. I listen to his heart, and this formality confirms what I already know. I wonder if he could have been saved in the US. I don’t know. I certainly have seen babies stillborn at my hospital. But the survival rate of a child living until the age of two is fifty times worse in Haiti than the US. Mothers are 100 times more likely to die in childbirth.
We pray over Esau, welcoming him into this world, and wishing him well on his journey out of it. That night he is buried next to David.

Guesly
We cannot have the baby here. I think this as I look around the rural Haitian church. There are no sterile instruments, only dental floss to tie off the umbilical cord. My mind drifts back to only eight hours ago when we had to tell a 19 year old mother that not only was her baby dead, but we had to have an emergency operation. We cannot deliver here. Doug, our pediatrician, concurs with this. I realize the pain of delivery would be far from the only pain she would suffer with no comfortable place for her to lay, increased risk for infection, and the possibility of unforeseen complications which could even lead to death of her unborn baby. I think if we were closer, I would take her to Fond Parisian where we have trained staff and emergency equipment. Even in Haiti, we can have a situation where the likelihood of survival can be improved, but we are several hours from the hospital, None of us did think she would make it. I can imagine her delivering driving eighty miles per hour in a street packed with cars, motorbikes, bicycles, and pedestrians. Fortunately, we are told of a location five minutes drive away with a trained midwife. clinic. Without a second thought I tell Erica to get the mother, and she and Sabine drive her to that clinic.
Haiti must change in this modern age. It cannot continue to operate in a fashion that does not respect or treasure human life.

Doug
Gonaive is better than I had hoped. We have a long, but good day. There are two or three very ill people, and we do what we can for them. In general, these people are managing. As Guesly says, it is hard to appreciate that Haiti, as a governmental system, is living up to its role as protector of the people, to provide that safety for those weak, in danger, and at risk. It is indeed hard to see where there is enough value given to human life. For now, though, this forgotten village is continuing on its road, on the edge, without a guardrail.

*"We have a mother that came with a baby that died in the womb"

Monday, November 07, 2011 -- Ghosts of Port au Prince

2011-11-08T20:59:00.001-06:00

Doug
Today we travel to a church in Port au Prince for a mobile clinic. Guesly and I accompany a medical team from Bethel Church, in Washington. This is the first time I’ve actually worked in Port au Prince since the January 2010 trip, when we set up clinic at a school where the main building had collapsed, entombing close to 30 students. We worked there in the eerie wake of those lost but not quite gone children. Now we arrive at a resurrection of sorts. This church building was destroyed in the quake. It is, as are so many buildings in Port au Prince, in the process of being rebuilt. In this shell, I wonder, how many were lost? What ghosts still linger? I’m not talking about the fantastic, tortured shades of cinema. It’s the everyday ghosts. The memories that intrude. The old places, down in rubble. The rubble now cleared. The faces still fresh in the mind that will never be seen again. Every one a husband, a grandmother, a sister, a child. So many lost, so much loss. The scars that are everywhere--on the land, on the buildings, on the bodies. I still can see the haunted look on the faces of everyone we passed in the days after the quake. When I talk to survivors, “Where were you when it happened?” the look returns. The ghosts still just beneath the surface. Guesly and I will see that today.

Guesly
“Doc mwen gen dolor nan pe’m.” The old lady sits across from me in a makeshift church made of cinder block. Steel rebar sprouts from the ceiling and walls. This is our mobile clinic, this church where privacy is gives way to the children peeking through the many cracks in the walls. Again the patient says in “Doc mwen gen dolor nan pe’m.” Creole. Her statement brings me back to reality, the reality of being in Haiti again for another mission trip. This is the first time I am back in Port au Prince, working in a clinic since we were here after the earthquake. The images from the earthquake remain vividly in my mind, through the images from the TV screen and in images from my own memory after leading a medical team to help with relief efforts. I remember all the rubble from the crumbled buildings. I remember the sheer number of buildings destroyed, and I remember the sense of hopelessness in the Haitian people’s faces. Today, I see little remaining of the rubble. I see more normal activity, the hustle and bustle of life in Haiti, which would be considered completely chaotic for anybody living in the States or elsewhere but is welcome and comfortable here. After a few seconds that felt like several hours lost in my thoughts, I ask “Ki kote ou gen dolor, madam?” “Where do you hurt?” She explains in Creole that every day she has pain, tingling, and numbness down her left leg. She describes pain that has stolen her sleep and that grows worse below her knee. She says her pain started over a year and a half ago. As she speaks I begin to think of a laundry list of questions I need to ask to find exactly the source of her pain. When she is done talking, she patiently answers my questions as she sits, well dressed in her Sunday best, a white handkerchief wrapped over her head. Her facial expression appears fatigued like a person who has lived several hundred Sundays and has yielded to the hardship, poverty, gifts, and hopelessness that comes with being born in Haiti. .
After I have asked my questions to satisfy my need for information and develop my differential, I begin to examine her and the suspect area. Finally, I kindly ask her to lift her dress enough so I can see her leg and knee. What I see catches me completely by surprise. I should have thought of this in my differential, but my observation of her started with seeing her walk through the court yard with a considerable amount of large rocks strewn about like a river bed. Even I had difficulty maneuvering without spraining an ankle, but from what I saw she had no trouble walking. She was slow, but that is not uncommon for her age. I recall this as I am staring at what has appeared from under her dress. It is not her own leg. It looks completely different than her other one, and I realize it is artificial, prosthetic.
Her voce soft and gentle, she begins to talk about what people call in Haiti “the event.” ”When the event occurred on January 12, 2010, I was in my house when suddenly it shook and I fell, and the house fell, and I was trapped underneath the rubble…” She smiles to reassure me, but I see through it that she has lost more then her leg Her eyes glaze, and I sense that I have brought back a flood of painful memories that she would rather keep hidden deep in her subconscious as her left leg was hidden underneath her dress. As we talk, she explains that her lower leg was crushed, it was removed, gone, but some days she feels tingling and pain all the way down her leg to the ankle as if it was still there and had not been “cut off.” I place my head down for a second, again reliving the memories of my time spent after the earthquake.
I remember a little girl I saw, just 11 years old, whose father had argued that he did not want “ them” to cut his daughter's legs off so that she would never be whole. “Them” referred to the various foreign doctors that came to help with earthquake relief efforts whose efforts to saves lives meant amputating limbs from crush victims. The Haitian people equated seeing the foreign doctors to losing arms and legs. They had real fears in that time that seeing “them” would destroy their wholeness. The 11 year old’s leg was leg became infected after being crushed, and there were concerns that the infection could be make it way into her blood stream, which meant she lost her leg or lost her life. Either decision came with a terrible price. In the end the earthquake cost the daughter her leg, but not the family their daughter. I know this woman now sitting in front of me must have faced the same awful choice.
I explain to the patient she is experiencing what is called phantom pain. This could be a syndrome in itself as many people who had limbs amputated suffer from these symptoms. Patients often feel as though their leg is still present, causing them pain to the point of being debilitating. Phantom pain can be helped if the patient is placed on medication that decreases the pain signals generated from damaged nerves. She appears to be satisfied with my explanation and wonder about the medication. I explained to her that unfortunately I did not carry that medication with me and she would need to travel to Fond Parisen where the mission hospital and clinic has a limited amount. After some further discussion, I give her prescription for Tylenol as I did not have any narcotic with me and it is hard to find in Haiti. She says a polite thank you “doc” , and promises to try to go to the hospital in Fond. Fond Parisen is the home of the mission hospital I travel to while in Haiti. It is about an hour from the church in Port au Prince but could be 4 to 5 hours with traffic.
After my encounter I begin to think how far in time it seems since I was in Haiti to help treat earthquake victims, yet how is seems like yesterday to the Haitian people who were afflicted and who continue to seek treatment for their injures. I wonder if that little girl is suffering from similar symptoms and if she will seek treatment as my patient today. Already the world has forgotten or is forgetting about Haiti. The news is always looking for the next sensational story. But the people in Haiti cannot forget. They continue to suffer. Their lives are forever changed. The need for healing will surpass my time and my generation. Do not forget about Haiti as the need for help is just beginning.

Doug:
So much is better. So much has healed, but the scars, the ghosts persist. Phantom limb may be a good way to think of it. It’s as if the whole body of the people of Port au Prince has lost a limb. The body moves, the people move about and get along the best they can, but they still feel it, every day. They feel them, the ones they lost, the ones we lost, every day. It’s been a good, tiring clinic. We head back to Fond Parisien to regroup and restock, and leave the city to its ghosts.

Port au Prince, November 7, 2011

Landed and (hopefully) Grounded

2011-11-07T20:41:00.001-06:00

We arrive Sunday after a long travel day. Late, we are delayed in Miami, we land in darkness. We breeze through customs. I don't know if we are getting better at this, the wheels are used to being well greased, or my tolerance for the chaos is just higher. All the bags make it. Outside the airport, making the way to the vans, the darkness is a new experience. Port au Prince airport at night is eerie and vaguely threatening. I shrug it off, I wonder what I would think if it was my first time here. /the trip to Fond Parisien is quiet. I have time to think about the strange flow of events that have brought me back here again. I keep thinking back to an appointment I had last Thursday. It was a routine well check wit my patient Audrey, an 8 year old who I have seen since birth. She is delighted to see me, and she has brought a paper grocery bag with her. In it are many treasures: stuffed animals, books, bubbles, two boxes of macaroni and cheese, and various other small things that are important to an eight year old. She has printed a big note

"My name is Audrey. I have saw the Earthquake. I have some stuff for you. Please share with your friends." Almost two years ago, she was touched by the plight of the people of Haiti. At 6, she thought "what would I want, if I were in Haiti." So she gathered the things that make a six year old happy. And she saved them. She also collected some money and saved that. She was looking for some way to get it to Haitian children. She finally realized that I was going back to Haiti and brought it in to her appointment. I could barely read it in front of her without tears welling up. Just thinking about it now, I feel the same way. It's that purity of generosity, of a will to help, that is the wave that I have ridden, once again, to this place.
I raised a lot of money after the earthquake, and I've spent nearly all of it funding 5 mission trips, and it's not because I am a good fundraiser. I stink at it. I have a hard time asking people for money, so the money that has been donated came from people like Audrey, who still have Haiti on their hearts, even nearly two years later. I just had a family send me a check whose father had been a missionary to Haiti, and he had always wanted to share the experience with his family, but he dies before he could. So they are sending me along in his memory. In a way, then, he is with me. All the team members who have shared this mission previously are with me, as well.
So thank you, Audrey, and thank you everyone who continues to support us despite my ineptness in asking for it. I believe in what we are doing. The people who come with us are the wave riders, and you are the wave. This week, I want to make it worth it. I want to use Audrey's bag and everything in it in the best way possible.

Doug 11/6/2011

Why We Keep Going

2011-09-06T07:40:00.068-05:00

We are planning our next trip to Haiti, from Nov. 6-12. It is such a whirlwind. We need so much. We have to find medications and supplies. We need money. We need nurses (especially pediatric nurses). I find it amazing that this will be Ke Nou's (and Missouri Haitian Relief Fund's) fifth trip.

What keeps us going? Why do we keep going back?

On the one hand, that answer is easy: the need is so great. The people we serve don't stop getting ill once the cameras are no longer trained on them or their country. The earthquake was terrible, but the need was tremendous before the quake, and it continues as the rubble still is being cleared. We see that every time we go. We save lives on every trip.

The second answer is that we are trying to build something: Each time we go, we want to leave the clinic and hospital in Fond Parisien more capable of responding to the need. Also, with each trip, hopefully one more team member gets the bug to return to serve again.

Third, it is personal: to me once I've seen the look in one child's eyes, I cannot unsee it. Once I have opened my heart to these people and this place, it always is with me. I really have no choice. I need to go back.

Here's the thing: We don't do it for thanks. We don't do it for recognition. We go because our lives don't make sense if we don't go. We do it because when we are there, in this desperate place, all the pieces come together, and we know we are exactly where we were meant to be, doing what we were made to do. We are alive.

People here in the States will come up to me and thank me for what I am doing. I understand why they do. I recognize that I am doing something that many are unable or unwilling to do, and people recognize that our work is needed, but I always feel a little awkward when I hear the "Thank You" or when someone is trying to tell me what a great person I am for going on mission trips.

Thanking me for going on mission trips is like thanking me for breathing oxygen. I do it because I have to. Ask anyone who truly has it in their heart, and they will tell you the same. Praise for what I do, in a strange way, makes me feel more humble. I often tell people, in reply, that I am only a vessel. I only play a very small part, doing the work that has been given me. That's all I want to be. I don't need this to feed my ego. In fact, I have seen, unfortunately, people for whom it is one big ego trip. They are tourists. That is not what I want to be. I want my work to mean something. My name and face can disappear in the wake of what I have done.

And yet....it does make me happy when people see that our work is worthwhile. Because the more people are behind us, the greater chance that someone will be moved to help out: with money, with supplies, with volunteering...anything that keeps this machine going. And we need it. Fundraising was easy after the earthquake. Now we are operating with less and less of a cushion. So if you feel gratitude for what we have done, recognize that you do not have to be a spectator. You can share in our mission. Maybe you can join us physically in a future mission. Maybe you can join us by sharing financially. Any gift can extend our common reach and can allow the mission to live on. Always, we are working so that we can continue to work. And we will continue to keep going. Because we have to. It is how we are made, why we were made.

Doug

Ke Nou Haiti
c/o Missouri Haitian Relief Fund
PO Box 873
Jefferson City, MO 65102

Closure--Melinda Dessieux

2011-08-31T06:32:00.007-05:00

I can hardly sleep the night before the flight. It could be from excitement (or the fact that I am having a hard time keeping anything down), but after 23 years have passed, I am finally going to the place my family calls home. After watching Haiti on television, actually being there is very interesting. On TV, all you sense is misery, and all you can see is extreme poverty--yet when I arrive, I find so much more. There is a certain spirit among the people of

Haiti

that makes life…. so much more enjoyable and makes me truly appreciate life for what it is – an adventure.

I am home the moment I step off the airplane.

I never thought I would enjoy rubbing little children down with permethrin cream, take pleasure in instructing a mom on how to use an inhaler with her son, or use juice (pedialyte) to persuade a 6 year old into taking a worm pill……but I do. I know that some of the patients that were seen at the off-site medical clinics would not have had any medical care or access to medical care for a while. Even the medical care provided at the clinics is limited by the amount of resources available, yet that is never an obstacle. Everyone on the trip has a ‘get it done’ mind set: From creating a makeshift pharmacy to using a car as the power source for a nebulizer.

The day before we leave, we are able to go to the orphanage that is down the street from the mission, and I have so much fun there. The children are so polite, and I fall in love with a 7 month old named Gigi. Her mother passed away during birth. Her grandmother, unable to take care of her, gave her to the mission because she knew that Gigi would be well cared for. Despite the situation she was born into, Gigi is the happiest baby I have ever met. She is loved and adored by everyone she makes eye contact with, especially me.

I did not expect to be touched during this trip, in my mind I thought I knew everything there was to being Haitian…Man, was I wrong. Many of us wake up every day and take for granted the blessings God has set before us. Prior to this trip I was unsure about what I wanted out of life--I definitely would be fibbing if I said I was deliberately searching for the answers to my life--I can honestly say, though, that this trip has inspired me to redirect my focus to the simple things in life. Simple things like teaching a child patty cake or dancing on a roof top surrounded by mountains and a lake….or waking up to a guy praising the Lord on a bullhorn (okay maybe that wasn’t simple). This country is absolutely beautiful and amazing. Since I have been back to the States I feel like a foreigner.

I love my experience and I hope everyone experiences something like this at least twice in their lifetime.

The time and money that I donated with Ke Nou was nominal in comparison to what I had the opportunity to experience and the lifelong friends I acquired. If there is one thing I regret, it is that I did not have the ability to do and give more while I was there. Ke Nou, thank you for a truly enlightening experience.

Melinda Dessieux

Reflections--Jeanne Boudreau

2011-07-16T18:39:00.000-05:00

Myriad emotions sweep over me upon returning home on Sunday. I am happy to be safely home enjoying the simple pleasures of clean water, hot shower, cool air and my own bed. I have put my life on hold for an incredible week in Haiti and feel sad the experience was over so quickly. It is going to take some time to process all that I saw and experienced.

My expectations going into the trip are open ended and influenced by what I have seen on TV. I am not prepared for what I see in Port-au-Prince. The reality of the earthquake’s impact is still evident, even though some of the rubble is cleared. The seething mass of humanity living in such squalor overwhelms me. I will never forget the smell of the rotting burning garbage mixed with diesel exhaust. Nor will I forget what I see: the knotted traffic, the dusty roads, the pathwork tent cities, the press of people, ehe brightly colored Tap-Tap's loaded with passengers , or the motorcycles, often triple or quadruple loaded weaving in an out of traffic. It puzzles me how they all are able to survive. I try to imagine living in a tent and what a normal day is like here. Interspersed in the crowds are well dressed people, women in bright colors, and men in clean white shirts and ties. I wonder how they are able clean their bodies and wash their clothes. We drive through the market where the semi trucks from the Dominican deliver goods to the people. People are everywhere buying goods to resell. Women carry their purchases on their heads. The streets are lined with individuals selling their merchandise. I wonder where people get the money to purchase these goods to sell and how their customers have money to buy them. They appear to be very resourceful and able to survive. They go about their lives and seem content. This is so much for me to absorb and understand!

Once we leave the city, I am surprised by the vast expanse of land and the beauty of the countryside with the mountains, lake and ocean. I observe many contrasts as we journey through the land. There is the treeless side of the mountains vs. the forested side of the mountains. I see small villages with cinder block houses and then elegant homes in the hills. The tent cities cluster in the midst of affluent areas. There is so much evidence of extreme poverty everywhere, but somehow people have cell phones, even in the poorest of villages. I feel anger at those people who have acquired wealth at the expense of the poor people and the corrupt government unable to help their people. To me, it seems so hopeless. I wonder how the Haitian people feel about the situation.

The highlight of my week is my experience with the Haitian children. As a non medical person my responsibility is to oversee Vacation Bible School. I am informed before I leave that I could expect anywhere from 200-400 children. This is a bit of a surprise to me since I am only planning for around 50 children. I take a duffel bag full of supplies which I hope will be enough for everyone.

The translators and some of the medical team join me and my 2 granddaughters for our first session. We journey up a rocky winding narrow road to a remote farming village in the mountains. These villagers make their living growing vegetable in terraced gardens on the steep hillsides. The mountain side has the appearance of a patchwork quilt.

We are greeted by about 40 children on the steps of the church. I think to myself, this will be a piece of cake. This all changes very quickly as word of our arrival spreads rapidly as we are setting up.

The children pour though the doorway and make their way to the wooden benches. They are amazingly orderly. The translators assist me in telling a bible story. They sing one of their songs to us and I think I will teach them “Jesus Loves Me”. To my surprise they already know it and sing it to us. I do teach them one song. We pass out coloring pages of various Christian symbols and one crayon to each child.

They all share their colors and produce some very colorful pictures. We also make a large circle and play pass the “hot potato” with a soccer ball. Everyone loves the game and do not want to quit. We leave the first day feeling we had a successful day but began making plans to meet the challenges of the second session.

Once again we made the journey up the mountain. This time we are better organized. We keep the children outside until we have set up separate work stations in the church. We divide the children up by age groups and let each group in one at a time. They are very orderly and waiting patiently. Each person on the team is assigned to a group and does some simple crafts with each group.

The last of the groups consists of about 40 older children, predominately young boys, who I take to an adjacent building. I have to quickly come up with an activity for my group. Thank goodness I brought lots of tissue paper and pipe cleaners, string and balloons. Believe it or not these children enjoy making folded tissue flowers. They also have fun playing “Stomp the balloon”. Each child blows up a balloon and ties it around his ankle. We allow 10 people to play at a time. I join the group with another team member for the first round. Thanks goodness my balloon is popped quickly before I got hurt. It was a rambunctious group. The translators and the pastor do a good job of controlling the children.

After all activities are over, we gather in the church. One of the translators is a great singer and leads the group in song. We offer a parting prayer and leave. The women of the village have prepared roasted fresh corn for all of us. As we are leaving, I felt the presence of God in this beautiful place. His spirit has truly been with us all during these 2 days in the mountains of Haiti. I feel at peace. I will never forget the experience. I hope to return, God willing!

Jeanne

Perspective--Lindsay Otto

2011-07-16T15:28:00.002-05:00

One week has gone by since returning home from a trip I have always longed to be a part of: a mission trip to assist other people that are less fortunate than me. The medical mission trip to Haiti with the Ke Nou Haiti Team is a truly unique and eye-opening experience. I am fortunate to have been accompanied by my sister and some of my CRMC co-workers/friends.

I will never forget the scenes outside the bus window as we make our way to the Haitian Christian Mission (HCM) on our first day. Despite trash in the streets and tent cities, Haiti is a beautiful country. I am surprised to see a picturesque mountain view with a lake as well as pretty flowering trees. I am feeling anxious to see where we would be staying during our time here, since I know running water and electricity are scarce, but as we arrive at HCM, I am again surprised to see such a nice place. After meeting Betty (Ed. Note--Betty Prophete, who, alongside her husband Pastor Etienne Prophete, founded and maintains Haitian Christian Mission) and seeing the kindness and peace in her eyes, I know that we will be safe staying here as we complete our work.

We unpack, take a tour of HCM, walk through a small tent city, tour a woodworking shop, and ride up on the mountain to see the new HCM project: housing facilities for families that lost their homes in the earthquake. After seeing how people lived: crammed up in tattered tents with no privacy and no escape from the weather conditions; the homes the HCM is building seem like what every family in Haiti longs for. It means a roof over their heads and some sense of safety. It is really humbling to think about what a “nice house” means to an American compared to what a “nice house” means in Haiti. Americans want a two-car garage, extra bedrooms, walk-in closets, etc. The Haitians feel so lucky to have a concrete block home with three small rooms, open windows (no glass), no electricity, and the hopes of running water to come soon.

We meet some children who are fortunate to belong to a family living in one of the new homes. This is our first contact with Haitian children. They are so happy! It is so hard for me to be unable to communicate with them through words due to the language barrier. But, I soon realize that a smile is universal – I smile at them and….. they smile back. Yes! It is great to see them smile!

Our first day of clinic goes well. I work in the pharmacy and quickly learn how to make-do with what we had for medications and supplies. I am able to interact with some of the patients by applying creams, giving shots, teaching mothers how to administer medications – all via assistance of our wonderful translators! I feel like we are positively impacting the lives of the patients we cared for, and I am uplifted and ready for the rest of the week!

The best experience for me on this trip is on Wednesday. While half of our group goes on a mobile clinic trip, the other half heads up into the mountains to a small church building to have “bible camp” with the children. We arrive to see a large group of children waiting for us. The group quickly grows to about 200 children. Jeanne, Doug’s mom, has activities planned for the children which they thoroughly enjoy. It is not easy to keep them organized, but it’s great to see them having fun. I have my camera and take pictures of the children. When I show them their picture on the camera, their eyes light up! I wonder if they had ever seen the image of their face in a mirror before or had ever seen a picture of themselves. With the help of the translators, we teach them how to sing a new song, and WOW! I almost have tears in my eyes when the children’s voices rang loud throughout the church. They are so happy!

The following days include another clinic at the mission and a mobile clinic at a church in a remote village.
Patients that appear 80 years old have never seen a doctor before and don’t know their birthdate. Farmers are farming crops on steep mountain-sides in the heat with no machinery, only manual labor and a shovel. A patient whose hand is severely cut does not even need pain medication after having to drive for 2 hours to get to a medical facility. Women (and sometimes men) are carrying loads of goods on their heads for miles and miles. Children are playing soccer and running on gravel with no shoes. These people are tough!

As our week comes to an end, I begin to realize that while we are helping many, there were many others we could not reach. The patients that receive medical care are the lucky ones. Not many get access to healthcare. Riding in the bus on our long trips away from HCM and looking out across the fields of tents, ill-appearing animals, and earthquake destruction; I begin to feel so blessed to live in America. On our way home from a clinic one night it’s getting dark and I can see people around their tents and walking down the streets without any lights. I feel my heart sink and I feel a sense of sadness and loneliness that I have never felt before.

But, when speaking with the people and talking with some of our translators, they voice they love their country and do not want to leave. I guess they are happy, they don’t know any different way of life besides what they are living now - survival.

I know that this trip has changed me. I will never forget these images, and anytime in the future when I am having a hard day or feeling down, I can count on these images to help me realize that there are people – not only in

Haiti

, but MANY throughout this huge world- that are not as fortunate as me. I feel that this mission trip has opened my eyes to what it really means to be happy. Things cannot make you happy. Truly it is relationships with people, being loved, having peace in your heart, having faith, being healthy, and giving to others that makes a person happy. The Haitian people don’t have to have all the luxuries that we Americans take for granted to be happy.

I really believe that the HCM is a wonderful organization who is doing great things for the country of Haiti. I hope that they continue to receive sufficient funding to continue their work providing medical clinics, supporting the orphanage, and constructing the much-needed homes.

Well, this is my first time blogging…..and I cannot believe that I have written this much already and still have so much I could say about this trip. I thank Ke Nou Haiti for allowing me to participate in this trip and I am glad to have made some new friends with some of the team members. I hope that I can participate in another mission trip again soon, but until then I will keep the Haitian people in my prayers that they continue to survive, prosper, and keep smiling J

Lindsay

Change--Ashley Doyen

2011-07-14T19:22:00.003-05:00

There are few experiences in life that you walk away from a completely changed person. The week I spent in Haiti is one of those experiences.
I was told to have no expectations and go on this trip with an open mind. I really have no idea what to expect, even if I try. I have never been out of the country prior to this trip.
As we walk out of the airport, Haiti hits me head on. The warm weather, the faint smell of charcoal in the air, car horns blasting, and most of all, the overwhelming number of people all speaking loudly in a language I don’t know. I instantly feel very vulnerable. Stimulation comes at me from every angle. It is all I can do to keep moving and not just sit down to take it all in.
The translators from Haitian Christian Mission are with us, guiding us toward the vans waiting to take us to the mission. I don’t know it at this point, but I will come to know the translators as my guardian angels acting not only as my link to this unfamiliar land, but also as protectors from any naive cultural mistake I might make.
We make it to the vans and pile in for what will be one of many very close, very bumpy rides. The ride through Port-au-Prince brings all the images from the television to life. The devastation left in the earthquakes wake is still present a year and a half later, not only in the piles of rubble, or tents pitched along the side of the road, but in the eyes of the people who watch us intently as we pass by. The sharp realization that I know nothing about loss and suffering compared to the people of this country tightens my chest and takes my breath away.
Already my perspective on the concerns of my everyday life has changed and I have been in Haiti for less than an hour. I start to worry I am in way over my head. I take a deep breath and start to pray. It is this technique that carries me though the rest of the week as I am pushed to grow in more ways than I thought possible.
The first day of clinic at the mission I am thrown into the role of triage nurse. I am physically shaking as I sit down with my translator and he calls the first name. Sure--it’s simple--take a set of vitals, talk with the person for a minute, get the chief complaint, and send them to the line to see the doctors. It sounds easy enough, but it is made complicated having to work through a translator.
I get to know and trust the translators I work with very quickly. They help catch the little things that could be the difference between diagnosing a cold or something more serious in the early stages.
It’s intimidating seeing so many people so quickly. The doctors only have limited time with each person. I feel responsible for getting them enough information to help them make a quick, yet accurate, diagnosis. I am still feeling a little timid when a man sits down with his 2 year old son. The boy is asleep, it’s very hot outside. Most of the kids, even if they are sleeping, stir or fuss when I take their temperatures. Not this little guy. He doesn’t move. I learn though my translator that he has had diarrhea and a fever for the last 5 days. I take his temperature, 104.6 degrees. I take them back to see Doug (the pediatrician with our team) right away. He is severely dehydrated and an IV is started in him right away. Maybe I know how to triage after all.
When we don’t have clinic at the mission, we head out to towns that have no means to seek out health care, so we take it to them.
The most memorable trip is our journey to Jacmel. This is a town way up in the mountains. It takes us over 5 hours to get there, so we are up and on the road before the sun comes up. I squeeze into the back seat squished in the space between the two actual seats making it 4 people in a row meant for 3. To say the road is bumpy is an understatement. All things considered, my heart is filled with joy as we drive through the beautiful Haitian land. The scenery is breathtaking.
It is uncomfortable conditions such as the back of the van that push me to dive in and get to know the members of the team really well. We bounce feelings and emotions off each other, share stories, laugh, cry, and before I know it I am developing friendships that will last long after the smell of burning trash leaves my nose.

4 people in a row meant for 3

I am honored with a first hand account of what it was like during the actual earthquake. A strong sense of pride for the country shows through in every story I hear.
By Friday we have really figured out how to work together well. It is our busiest, most successful day. It is a mobile clinic in a smaller farm village. We see almost 200 patients. They are all so kind and grateful. Really, looking back I don’t think I come in contact with one angry person all week long. Everyone, no matter their circumstances is just content.
I leave Haiti feeling very much the same. It is hard for me to leave. Sad goodbyes are said at the airport in Haiti, and again in Florida, and then again when we all part ways in Kansas City.
God called my heart to Haiti, and then He opened my eyes to all the opportunities to do good there. Words can simply not explain all that I learned, the ways that I grew, and the unforgettable memories, the confidence that I have gained and connections that I have made.
Haiti touched my heart. I long for the day I am able to return.
-Ashley

Friday, July 8th, Droulliard

2011-07-11T15:05:00.000-05:00

Mobile clinics are our team's house calls, on a whole village. To prepare, we have to pack with us all the medicines that we think we might need, without packing the whole pharmacy. We leave behind our oxygen and lab and hospital beds. We can and do start IV's and give medicine IV or by injection.

We pack the night before, then get up early depending on where we are going. For Jacmel, that meant 4 am, for Droulliard, it's only about a 45 minute drive. Once we get to the village, we set up in the local church, which is the only place that has enough space to accommodate that many people. The pews are long wooden benches with backs. The village pastor sends people running for desks from the school for the triage nurses to interview and collect vitals. In triage, the nurses speak through their interpreters, asking about why they are here, what problems they have had in the past, and the other things that put the visit in context. We depend heavily on our interpreters. It is more than knowing how to speak both languages. When a patient says "Mwen gen grip la. (I have the flu.)", the translator has to understand and convey that she is not diagnosing herself with Influenza A, nor is she saying she has nausea, vomiting and diarrhea, which is what people in mid-Missouri mean by "the flu". She is saying that she has been having congestion and drainage in the nose. The translator has to pick up on that. They have to have enough medical knowledge to know what we are asking and enough facility with the language to get someone who has no medical knowledge at all to understand. It can get very frustrating, and they are not perfect, but they do a good job.

We rearrange the pew benches to make L shaped sections where patients sit in line waiting to see the provider, a physician (me or Gracia Nabhane) or nurse practioner (Sabine), and set up the pharmacy at the altar, blockaded by benches. The pharmacy itself is medications spread out, organized by kind with IV start kits and supplies for mixing things.

Once the patient slides towards me on the bench,

"Avanse. Avanse."

"Papye, Souplé. (Paper, Please)"

I skim it. "Li gen lafyèv? depi ki lè?"

The mother looks at my translator Max, clearly I have a horrible accent. Max says "Li gen lafyèv? depi ki lè? (She has a fever? For how long?)"

"Depi twa jou. (3 days). Epi li gen grip la. (and she has the flu (runny, stuffy nose)"

Me again "Eske li gen yon vant fè mal? (does she have a belly ache?)"

"Wi, li gen vant fè mal. (yes she has a belly ache) e li gen vè. (and she has worms.)"

"li te gen vè nan twalèt li? (She had worms in her poop?)"

"Wi, e (several words I don't understand)"

I look at Max. "She said she is coughing up the worms, also."

I examine the girl, telling her what I want her to do: "zòrèy,lòt zòrèy (ear, other ear), louvri bouch ou (open your mouth), respire, anko, anko, anko (breathe, again, again, again)" She has an ear infection, I prescribe an antibiotic, worm medicine, Advil for pain and fever, and chewable vitamins. Always vitamins. Even in this village, which looks relatively well-fed compared to where I have been. I write it on the paper.

"pote papye a nan famasi a. (take the paper to the pharmacy.)"

"Avanse. Avanse."

"Papye, Souplé."....

As always, there are a couple that throw me. One is a two-year-old who looks healthy, although her face doesn't look quite right, not quite normal, and she is the size of a six-month-old, and she can't walk yet....and she has a whopping heart murmur. Imagine someone with a lot of saliva in their throat, making a hissing sound, 60 times a minute. That is what her heart sounds like. I ask her mom if she has been hospitalized. Through the interpreter, I get that she was in Port-au-Prince hospital for a month after being born because mother had been thrashing so much in labor that she fell out of bed, and when she did that, she hit the baby's heart and made it not work well. They did an x-ray, but is was normal. I ask about an echocardiogram, then have to describe it through the interpreter, and it doesn't sound like one was done, but the doctor assured her that the heart would heal.

I don't know how to put together her story, and I don't know exactly what she was told, but this baby has a heart malformation and probably a genetic syndrome. She certainly didn't injure the heart with her thrashing, I don't know the next time Dr. Serge Geffrard, the pediatric cardiologist, with Project Haiti Heart, will be down seeing patients at HCM, but I take her name and information so that we can hook them up, giving the mother all kinds of precautions that I pray she will remember. and some vitamins, and some worms medicine.

"Avanse. Avanse."

"Papye, Souplé."....

At some point after three, the bus must have unloaded more children. At about 4, a 12 month old, who is not wearing a diaper, empties his bladder on my shirt and scrub bottoms. This is not altogether unheard of in my everyday life, but I usually have some way to clean up and a fresh set of scrubs on stand-by. I have neither today, and 25 patients still lined up to see me. I keep going. I see the kids with colds. The teens there for entertainment. I see them all, happy both that I am busy, and that they are not particularly ill. Everyone gets their meds. Everyone gets their vitamins, their worm medicine.

And mumps...Did I mention I saw a boy with mumps?

Doug

Wednesday, July 6, 2011 Simonette

2011-07-11T10:40:00.000-05:00

Yeah about the delay in the blogs, The Internet connection has been playing a cruel game with me. It only seems to be active when I don't have time to sit down and blog. or when I am too tired. I guess the good news is that the events of this trip have not been as life and death compelling. I think I may have lucked into a "normal" mission trip. In Simonette, on the outskirts of Port-au-Prince, near Cite Soleil, the notoriously dangerous slum, we have our trip today. We came here in November. In fact, we were the last team here. There are ways to tell how poor a village is. In Haiti, dogs aren't often personal pets. They aren't eating Puppy Chow. They hang out in the village and live off scraps. The less food the people have the less scraps. the less scraps, the skinnier the dogs. There are some skinny dogs here. And red headed children. The hair color is significant. These are dark skinned people. The hair on the head is naturally dark. That color comes in the form of melanin. Melanin is dark from, or black, if there is enough of it. There is one absolute requirement in the body's production of melanin: protein. No protein, no melanin. In people of Irish descent who are redheaded, they simply lack the genes to produce melanin. Here, they lack the protein in the diet. It's called Kwashiorkor, or protein/calorie malnutrition. If you see a child with spindly legs, big belly, and red hair, they are not getting enough protein rich food. Fortunately, there is no child here in extremis, none that is starving to death, none with terrible infections. Most of the children, though have scabies, and we liberally coat them with permethrin cream, which kills the scabies mite. I get scabies, too. I have picked it up at some point this week. Permethrin cream is used liberally by the team tonight, as well.
Today, I find some recompense for the tragedy of our November trip. I diagnose a girl who has malaria, and she is not that sick yet. She will be cured. This won't come back to haunt another team down the line.
It is a bittersweet day. On the one hand, despite being hungry, the people here are not that ill. On the other hand, they are hungry, and today, we didn't bring any rice, which means the day is far less chaotic for us, but there will be empty bellies tonight for the children in the village.
Doug

July 5th Jacmel, Sud-Ouest, Haiti

2011-07-08T21:12:00.002-05:00

Today we awoke at 3:20 to make for Jacmel. Jacmel itself has a population of about 150,000. Although it was spared the major damage of the 2010 Haiti Earthquake, it did sustain damage, including the collapse of half of its hospital. It was a long drive, 6 plus hours. On the way there, Ali, my baby, my 15-year-old baby, was tired, so she snuggled. In my experience, 15-year-olds are good for a quick hug if you are lucky, but not much into snuggling with their Daddys, so I was happy that she used my shoulder for a pillow. I could remember so clearly Ali as a newborn, sleeping in our bed. I would lie on my side, curled up around her, hyperaware of any movement she makes, not sleeping much, but content to protect and keep her. I feel much the same today. By leaning on her, I am not resting, but keeping her head from flopping forward. I am content.
Did I mention the trip is long? The scenery, though, that we pass through is amazing, up over the mountains. It is beautiful, a totally different world than the city below. This is where you can understand where terms like Mountains Beyond Mountains come from. The air in the mountains in chilly, upper 60's. the road is a rollicking 1 1/2 lanes of switchbacks, sheer drop-offs and blind turns. All taken at 50 mph. Dramamine is used liberally.
In Jacmel, proper, we buy rice at the market 80 pounds. We then travel to the church.
Haitian churches are not the same as the church you attend. They are open air. In the smaller towns and villages, they are spare. Although Jacmel is large, we are in what I guess could be called a suburb. Not a rich one. The timbers are all roughly hewn from the logs they started as. The post and beams and benches look like some Hollywood prop designer's exaggeration of rustic.
Today we are giving out rice. This means that we will be busy later on, once everyone has heard. These kids are cute. There are some ear infections, a lot of colds, a couple of kids with pneumonia, almost everyone has "vent fe mal" or stomach pain. Towards the afternoon, I get the teenagers who aren't really sick at all, they just want some entertainment. They goof off and are silly about my limited Kreyol, but we have a good time. Since none of these kids is particularly sick, I have time to reflect that a large part of my purpose here is to sift through all the healthy kids and find the ones who are truly ill. Without a lab. Without X-rays. So the ones who are in extremis are not difficult to spot. It's the ones that may be starting to get something serious that I am concerned about. Early malaria, early typhoid. I don't want to miss those. I may be the last to see them before they really get sick.
Then there is the two that will haunt me: the 9 month old who is the size of a 4 month old who otherwise looks well, and the 12 month old with the heart murmur that sounds abnormal, but otherwise looks well. At home, both would be referred, both would be worked up. Here, I talk to the mother of the 9 month old for about 20 minutes through the interpreter, talking about all the things I want her to watch for. With the 12 month old, I take the name and number down to put on the list for the next time the Pediatric Cardiologist comes down on a trip.
The rice is gone. We've seen about 100 patients, not too much of a workload, but with the drive starting at 4 am, by the time we get home at 8:30 pm, we are exhausted.

Made it, unpacked, culture shock

2011-07-03T23:48:00.002-05:00

I forget how strange it is to step out into a Third World country the first time. To me, the chaos of making it through customs, the throng at the airport, the smell of charcoal smoke in the air--even the rubble and trash and dizzying bustle of traffic and people--is familiar, but there are a lot of heads on swivels. Haiti is different and shocking, especially Port-au-Prince. I notice the little things: how everyone is curious, unselfconsciously so, about us. Not in our face at all, but everyone takes a look at us, only the children shout out "Blan!". We are here. With all our baggage. The ventilator, a piece of equipment that is $30,000 new, is safe. We tour the campus of the Haitian Christian Mission, then we eat, beef stew. It's delicious with potatoes, plantains, and dumplings. I've already broken a food rule: I bought fried plaintain I'm Port-au-Prince from a street vendor. It was incredible. I think hotboil kills all germs ever, right? After lunch, we unpack and clean the pharmacy. The pharmacy is a mess. It takes us hours, then dinner, then we eat again: roasted chicken. After dinner, we meet as a team, talk about the next day, and everyone scatters for bed. Except Sabine and me. She finishes the pharmacy, and I reconstruct the ventilator. Then I blog. I'm falling asleep as I do it. I'll sleep under the stars tonight, clinic starts in the morning.
Doug

On the plane

2011-07-03T06:08:00.000-05:00

We made it. Everyone, all the bags. Next stop: Port-au-Prince.

Today is the day

2011-07-02T01:45:00.006-05:00

Okay, so it's still late Friday night for me. I'm finally done packing. I got a ventilator today! I hope I won't have to use it, but I am glad it will be there. It is taking up all or part of 4 duffel bags, but it is totally worth it.

I guess I don't know how I am feeling right now. I am excited and a little nervous. My last two trips were very stressful and emotional. so now I'm drawn to my first trip when it was all new, and I felt so inspired. The first impression is always the lens through which you look. I want to see Haiti like I did that first time. I know Port -au-Prince will still be a wreck. I will look at it again through fresh eyes, or maybe eyes that remember what is was like when they were fresh. The voices and faces of those who have joined me in the past will again be with me. I wish they were there in body. That said, I am very excited about this team. Sabine will again be leading and has already done a great job, and I have my family here who will get to see what I have come to love, and a big, excited, Capital Region contingent. So maybe they can all help me see it anew. Last time I wnated to tell stories, I want this time to be about drawing the scene, bringing you here not only visually, but viscerally. That is what I will try to do this week.

As promised the team that will accompany us:

Julia Asmar -- Student

Quinn Ayres -- Med. Assistant

Alyssa Borchelt -- Nurse Assistant

Ali Boudreau -- Student

Doug Boudreau -- MD- Pediatrician

Jeanne Boudreau -- Arts

Melinda Dessieux -- Nutritionist

Sabine Dessieux -- FNP

Ashley Doyen -- RN-CC

Amanda Helton -- RN-CC

Molly Magoon -- RN-CC

Gracia Nabhane -- MD-Pulmonologist

Judy Njeri -- RN Student

Lindsay Otto -- RN-CC

Kelly Prenger -- RN-CC

Olwyn Ross -- RN- Wounds

Chache Lajwa!

Doug

Upcoming trip: July 2nd-10th, 2011

2011-06-20T12:51:00.000-05:00

It is that time again. I am trying to sort through all the details that I am responsible for on this trip, and I am not even the team leader. This is an exciting trip for me--well they are all exciting--but on this one, three generations of my family are going: My mom, my niece, and my daughter. I will post a full roster to come.
Doug

The Unexpected--Nichole's Story

2010-11-27T09:07:00.003-06:00

(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 15th, 2010--Home

2010-11-15T14:51:00.002-06:00

(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 12, 2010--Choices--David's Story--Our Story

2010-11-13T07:46:00.009-06:00

(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

2010-11-13T05:30:00.003-06:00

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--Meritsky

2010-11-11T23:29:00.004-06:00

(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 9--Bittersweet--Dubinsky's Story

2010-11-10T23:00:00.008-06:00

(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

2010-11-10T18:32:00.002-06:00

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

2010-11-08T23:46:00.008-06:00

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

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

2010-11-07T22:11:00.001-06:00

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

2010-11-07T08:58:00.001-06:00

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

Last minute things to do

2010-11-05T14:27:00.001-05:00

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

Our Bible Verse

2010-10-31T22:29:00.002-05:00

Pa bliye, se pou nou fè sa ki byen,
se pou nou yonn ede lot.
Se ofrann konsa ki fè Bondye plezi.
--Ebre 13:16

And do not forget to do good
and to share with others,
for with such sacrifices God is pleased.
--Hebrews 13:16

Upcoming Trip: November 7th, 2010

2010-10-31T20:36:00.001-05:00

Exciting news! we are heading back to Fonds Parisien! This will be the third trip sponsored by Ke Nou Haiti / Missouri Haitian Relief Fund. Team members for this trip will be:
Sabine Dessieux

Melinda S. Meyer

Kathryn Maureen O'Laughlin

Amy Louise Vaughan

Burney Alexander Miller

Nancy Elaine Miller

Rosemary Wamaitha

Douglas Boudreau

Chantel Marie Green

Rebecca Johnson

Lynn William Lyons

Edward Francis Higgins Jr.

Kimbrough Higgins

Rebecca Higgins

Olwyn Janette Ross

Jonathan Barter Stivers

Peggy Taylor

Jana Lynn Gottino

Mackenzie Davin

Lori Borella

Erika Lentz

Tina Griener

Debbie Turrell

Lonnie Miller

Darci Baptiste

Jennifer Allen

Nichole Shobe

Cecilio de la Rosa

Ivelisse Cedeño

Jean M. Constanzo

Giselina Pierret Pierre

Marcia M. Colon

Ana Antonia Santana

Jesús Cedano

José Batista

Nelson Julio Morillo J.

Orestes Carlos José Suero

The word from the Haitian Christian Mission is that is is very busy with very ill patients. The last team was working sometimes through 2 am. We will really earn it this time. I will try to post each day we are there, access permitting.

Doug

2010-06-17T23:06:00.002-05:00

I apologize for slacking on the blog but the past couple of days have been really busy. I have gone to Port Au Prince every single day this week except for yesterday. This past week we have seen a lot of sick babies in the clinic. A 22 month old little girl weighing only 5.7kg and a 1 1 1/2 month old handsome little boy that weighed on 1.6kg. I have been to the General Hospital twice and to a pediatric hospital 3 times and all in PAP. We have sent 4 babies so far to Love a Child for nutritional support. We admitted a baby yesterday with fever and pneumonia, who is doing much better today.

Today we had a young gentleman carried into the clinic by some strangers and his cousin. The man whose name is Antoine was getting to a bus when a piece of luggage on top of the bus fell and hit him at the back of his neck. Antoine was unable to move his arms or legs but he could feel us touching him. He made a make-shift backboard using a wooden place and a C-collar by taping his head to the plank. We transported the patient to the University of Miami hospital only to find out that they had no x-ray machine when we arrived there. We got back in the car and drove for another 15 min to the General Hospital on very bumpy roads. The General Hospital had an x-ray machine but it could not used because there was water all over the floor in that building.

It has been just one thing after another this week. So as I was telling Antoine that we were leaving he looked at me and said "are you guys leaving me? Thank you for all you have done and please tell all the other people here that came thank you.....Pray for me and I will pray for you." As I was in the process of translating this to the other members of the team I broke down and started crying. I explained everything that was going on to his family and said good-bye to him one last time. I gave them my number and told them that we would be back to visit him on Saturday when we were in PAP.

The General Hospital where we left him, has no neurosurgeon on board and no neurologist. The American resident at the hospital told us that all they could do for this patient was give him steriods, a C- collar and time. So he has to wait, it just seems unfair.

Well things look the same in PAP. The government has not done one thing. Tent cities are all over the place. Not one piece of rubble has been cleared out, not even at the national palace.

I also will not be able to post any pictures because my camera has disappeared since Tuesday. I will ask other team members to post pictures to share with me and I will post them up at a later date.

Bienvenue a Haiti

2010-06-14T20:02:00.004-05:00

Well I made it to Fonds Parisien safely around 6pm last night. My trip to say the least has been quiet interesting. I will start off with my experience at the Kansas City airport. I packed three bags full of medications all weighing under 50lbs of course. When I arrived at the airport I was told by the "polite" agent that Haiti currently has a bag embargo and I am not allowed to take more than two bags. So I was forced to leave medication behind that could have been used to help many people.

The flight to Haiti was a little bumpy. We ran into some turbulence and the plane dropped several feet a couple of times. All over the plane you can hear the Haitian people screaming " Jezi! Jezi! Jezi!" Then they started praying and singing Haitian songs. Let's just say there was a huge round of applause and cheering when the plane landed in PAP.

The airport was what I remembered it to be, hot and muggy with no sense of organization. When I made it past immigration, Edwens Prophete was standing there waiting for me and the other four individuals I meet at the PAP airport that were for Colorado. It took us about an hour to find our luggage on the carousel. Like any third world country money talks, so we were able to pay one of the agents $20 to bypass customs. We made it past the chaos outside the airport, people trying to grab your luggage and carry it so that they can charge you for carrying it. Two other guys from HCM were able to meet us outside and protect us from the craziness. PAP was a little more lively than what it was in January. Vendors were back on the streets selling items, music was blaring from the radio's and there was what seemed to be laughter in the streets.

Well I feel like I have written enough already about my day yesterday. I will post a blog about my day today, tomorrow. We were suppose to do mobile clinics starting tomorrow but the clinic we were going to couldn't host us so we will go on Wednesday.

Thank you for your support, I and the people of Haiti thank you.

P.S. We have a massage therapist on this trip and I think I will take advantage of her.

Sabine's Trip

2010-06-09T09:42:00.002-05:00

Yesterday, I delivered about $1200 worth of meds to Sabine, as she is going back to Fonds this Sunday for a week. She will also have funds to purchase food to distribute to the people that they are able to serve and to pay for food and interpreters. I have re-invited her to author this blog (it seems she forgot she was a blog author) So hopefully she will be able to send updates and pictures (are you hearing me, Sabine?) from Haiti.
She will have to tell you who is making up the team, and what they are going to do. We pray for the success of the team and their safety on this trip, and I wish I was going.

Sabine's Story

2010-02-03T20:38:00.000-06:00

Sabine Dessieux is the younger sister of Guesly Dessieux. She is a Nurse Practitioner living in Kansas City. She left Haiti when she was 5 and last visited when she was 12. Since Guesly is like a brother to me , Sabine is my new sister, complete with the steady stream of sarcasm. She also kept a blog for her church, which sponsored her trip, her blog can be found at http://www.leawoodumc.org/ under "Sabine's Story".

Home

2010-02-03T15:57:00.002-06:00

I am home now. This is going to take some time to process and recover from both physically and emotionally, but I feel like I have benefitted from this experience immensely. Both on the macro scale and on the personal scale, I have truly realized that no one person can make it alone. Whether we want to admit it or not, we are all dependent on each other. The people of Haiti have been knoocked down, and they need our help right now. As a physician going into Haiti to help out, I was not a one man show. We saw the one man show. He talked a good game, ate the mission's food, changed a couple of dressings, and rode off into the sunset, barely leaving behind a footprint. My show depended on Dr. Guesly Dessieux to arrange the trip, I depended on Etienne and Betty Prophete to give me a place to sleep, food to eat, interpreters to talk, and a clinic to work in. I relied upon my felow team members to organize the pharmacy, to get patients ready to be seen. I also relied on my "5 moms" on the trip who would get after me for being too skinny and make me eat, who would help me find my pens, stethescope, passport, bed, whatever I needed at any particular time. (Full disclosure: like most men and even more doctors, I am not an excessively detail oriented person.) I relied on my wife and family who suddenly had to deal with me being gone for 10 days. I depended on my employer Capital Region to let me go and also to supply me. I never even asked, I just said I was going and I needed medicine and supplies and I needed it tomorrow. I also depended on the generosity of countless donors and support people. I will actually list everyone individually, but that will have to wait another day...I'm still sleep deprived. My point is that I have a lot of people telling me what a great thing it is that I have done, but I am only the smallest part of something much larger than myslef, and I alone would never have been able to accomplish anything. This is what being part of the human race is about.
Our final tally was about 2300 patients seen in 8 days, not bad for a spa vacation.
Our task is not finished, though. We will be returning to Haiti. We will be continuing to raise money. I think we have a good network in country and we will be able to see our money and efforts directly going to help haiti stand back up on her feet. The needs will be great in the upcoming months for physical and occupational therapists and mental health professionals. I will continue to keep everyone updated on our progress and plans.
Thank you,

Doug Boudreau

Monday, February 1, 2009--Last clinic, Leaving Haiti, Santo Domingo

2010-02-02T07:03:00.013-06:00

This morning we saw 300 patients. By this time, even exhausted after a week of working and poor sleep, we are very efficient.

Everything has started to blur together. The team is exhausted--physically and emotionally. We pack up to go, but our bus does not arrive. Our back-up plan is to ride the HCM bus across the border and catch the Greyhound from Jimani. As we fight the traffic through the border market, we see our charter bus passing the other way and flag it down. It takes us 90 minutes to make it through the border, then it's a 6 hour bus ride to Santo Domingo. There is little conversation, we are simply too tired. The best part of the day is my first hot shower in more than a week. The amount of dirt that I leave on the bottom of the shower is appalling.

Sunday, January 31st--Port-au-Prince

2010-02-01T22:51:00.045-06:00

Today we went to Port-au-Prince. Fortunately, there has been a lot of clean-up of the streets. Bodies no longer block the roads. There are tent cities everywhere.

As we entered the city, we could gradually see more and more signs of earthquake damage. The effect was staggering. Along the way, we saw a seven story building that had been totally reduced to a pile of rubble. One of our translators told us that 130 people were still inside, their bodies unrecovered. As we drove in, there was more and more rubble, every block had collapsed buildings, sometimes an entire side of the street.

It's one thing to see it on television, but to drive past block after block, unending, the scope of the situation really starts to weigh on you.

The energy released in that 35 seconds is incalcuable in human terms, probably on the order of 30 nuclear bombs exploding under the crust of the Earth. The devastation on the human scale is likewise hard to comprehend.

All week long, we had been hearing individual stories of terror, heartache and loss, now, at Ground Zero, it is almost too much to take.

We see the Presidential Palace and the Catholic Cathedral in ruins.

Tent cities were everywhere. Fifty thousand people at each city. The conditions have been getting more and more deperate as the waste piles up. Broken people lay in the tents. Children have gone days without food or water. At the same time, there are signs of the city coming back to life. People are on the street conrners hawking their goods again, or selling fried plantains, even souvenirs like wood sculptures and paintings are again on display. After looking most of the morning for a place to help out, we finally happen on a primary school that collapsed in the quake. The main school building is just a facade in front of a pile of rubble. We are told that class was in session, and about 25 children were in the building when the earthquake hit. Their bodies lie there still, under the tons of rubble.

Around the school building is a courtyard ringed with low buildings that were the dormatories. These buildings are now housing around 100 people displaced by the quake.

This is where we set up shop. We work quickly, the team is in maximum efficiency mode. In 2 1/2 hours, we see about 250 patients.

The people with immediately life threatening injuries from the earthquake have now either been treated or have died. What we are seeing is either long term illness that had been neglected or new infections--communicable disease that has started to spread due to dispacement, crowding, poor water, and lack of food. From my work station, the school building is constantly visible, and I keep thinking about how it would be if it were my son or one of my daughters under all of that brick, concrete and stone. Then I think of all the collapsed buildings that I've seen today--thousands, and all the sons, daughters, brothers, sisters, mothers, and fathers now entombed in them. This morning, as we were riding the bus towards Port-au-Prince, we had church of sorts, and one of the doctors with us told us of a patient he has been treating at our hospital at Fond-Parisien. She and her twin girls were home when the Earthquake happened. Their house collapsed around them, and she was trapped in the rubble for 2 days. Her twin girls died in her arms. Dean asked her if she was angry at God for what had happened to her. She said she was not angry. She was grateful to God to be alive and knew that she was spared bacause she has a purpose, a task in life that she hasn't done yet, and she will always have two angels with her as she goes through life.
The Port-au-Prince that I knew is gone, and this new Port-au-Prince has changed me. We walk through life confident, even arrogant that we can pretty much handle anything, but seeing this reminds me that life is fragile and fleeting.

Saturday, January 30th--Easy day today, Port-au-Prince tomorrow

2010-01-30T23:58:00.003-06:00

Today the second team came down...newbies...clinic was light, only about 150 patients. Tomorrow we are going into Port-au-Prince. I'm really of two minds about seeing the city. Edwens, Pastor Etienne Profete's son, got here today with team 2 and went into Port-au-Prince. He told me when he saw it he was overwhelmed.
Well I'm going to bed. I'll update, with pictures, tomorrow.

Friday, January 29th--Fonds Parisien, Love a Child, Jimani

2010-01-30T06:40:00.004-06:00

The internet was broken yesterday, so I couldn't post. We again saw many, many patients. One that sticks out to me is an 18 month old who had been sick last summer with a fever and had an "attack", which probably means a seizure. He was very sick, his mother said. Then he stopped walking, and he hasn't walked since. When I see him, he has contractures of his legs and hands. Seeing him, I think of all the opportunities he would have had, would still have, if he were in the US. We would have been immunized against the most common forms of meningtitis. If he got it anyway, he could have seen prompt and appropriate care. If he developed, as he has, problems arising from having meningitis, he would have recieved developmental evaluation and intervention. Each day we see between 200 to 400 patients.
Yesterday, I also see a 12 month old whose belly had swollen up at home and has been vomiting everything he eats. When I see him, his belly wasn't swollen, but he looks pretty punky, so I admit him to our mini-hopital for some IV fluids. He does pretty well overnight, and we were going to discharge him, then his belly blows up again, he is very lethargic. He develops a mass on the right side of his abdomen and passes a bloody stool. For those of you playing along at home, the answer is a condition called intussuseption, a condition where the small intestine telescopes into the large intestine. To fix it, you need radiology, and if that section of intestine starts to die, you need a surgeon.

So we call the USS Comfort, who say to take him to the LZ at the Love a Child field hospital and they will pick him up by chopper. We race there,and the chopper never comes.

We sit there for 3-4 hours trying to get the comfort to come, but they never do, so we pile into an ambulance for Jimani, Dominican Republic, where thankfully, there is a pediatric intensivist and a general surgeon.

Also thankfully, in this time, the intussuseption has reduced itself..
So we get to go home, but the border had closed, and the DR border guards were having none of it. Fortunately in our travels, we had met Jose Quinones, a special attache to the US Embassy from the Coast Guard who had all kinds of juice with those border guys, and he got us across, then took us home. On the way, he has to check out a group of orphans from a Haitian orpahnage who were being shepherded by a mission group who was now trying to go across the border without the right papers. It turns out, they need some medical care, and are not allowedto cross the border, so they will be coming to see us tomorrow.

Wednesday 1/28/10 Haitian Christian Mission

2010-01-28T04:07:00.001-06:00

One thing I forgot to say yesterday is that the rest of the team, the ones that stayed home, saw 300 patients. Today everyone stayed. Word has gotten around about our presence here. This morning, the first patients started arriving at about 2 am. By 6 am, the porch was full. At 8 am, when we started, we had to open up the church next door as a triage area because there were 300 people there already. The day was crazy busy. We did not have enough translators, so most of the day I worked without one. Guesly worked in the same room as me, so I had him when I got stuck, but my Creole has improved to the point that I can get through most visits alone. Just imagine your doctor with a 3 year old's vocabulary, and you begin to understand what a challenge it is for them to go through, seeing me. There is an awful lot of pneumonia and asthma like illness in the patients who are coming from Port-au-Prince. it's probably due to all the dust from the Earthquake, speaking of which,I felt my first real deal earthquake today' People around here are very jumpy about the aftershocks. It was a 4.1, enough to shake a little, but no damage. With all the medicine that was donated by the hospitals or bought from money donated to us, we are definitely able to handle sicker patients, and do a better job than the last time I was here. 9 hours and 522 patients later, we were finished.
Well,most of us were finished. we are developing a census of inpatients that need tending overnight, so our nurses are rotating shifts to care for them 24 hours a day. The nurses working nights are still up and working the next day after maybe a couple hours of rest.

Jimani, dominican Rebublic, Tuesday, 1/26/10

2010-01-27T06:00:00.002-06:00

Today, I went with a part of our team to a field hospital, opened in response to the earthquake, south of Jimani, Dominican Republic.

View Larger Map
This hospital started as a medical mission clinic/OR, not as a hospital. It had apparently seen little use untilthe earthquake hit and it was cimmissioned as a hospital. The old orphanage, the building to the left in the map, serves as the less critical area as well as ER/triage. The building to the right (marked with A) is where the OR's and ICU is. In the first several days of opening, hundreds of operations were done. Today, I got to see it when it has calmed down a bit. The first thing that struck me was the number of amputations. It is one thing to hear of amputations being done, and another to goto the children's rooms and see them laid out for me 3 at a time.

My first patient was a 2 1/2 month old baby girl named Noreus. She was found ubder the rubble of a seven story building in Port-au-Princem shieded by the body of her mother and several other adults.
Her aunt had taken her to several Aid stations over the days and all had not been able to see her. Noreus was only taking water, about 4 ozz. per day for several days. When she got to Jimani, she was glazed over, dehysrated, and feverish. She would not wake up or eat. She also had a bad lacerationon her thigh and a very large, infected pressure sore on her right buttock.
*****WARNING*****

Below is a graphic,disturbing image of her injury

The team here slammmed some IV fluid in her, started powerful antibiotics, and took her to the OR to remove dead, infected tissue from her wounds.
This morning she is alert and happy. Her thigh wound is closed. Her buttock wound is open, with dressings applied. The wound is very deep. Her right leg will not move on it's own. She has no reflexes in that leg.
This hospital at the edge of the Dominican republic has alot to teach us about this disaster. First, that effort to save lives, even in difficult situations, can be effective. The people running and staffing the hopital at Jimani have been managng an extremely chaotic situation and still attending to the needs of many people, way more than the original purpose of the building. On the other hand, I can also see some of the waste that goes into this kind of relief effort. The side of the building of the hospital was overflowing with supplies. Boxes were stacked so high that the bottom rows were getting crushed. No one there knows exactly what they have out there. There is a central problem with medical aid efforts like this. Who comes to help? For better or worse, it's the "Rock Stars" of medicine, the lightning rods for attention--the doctors and nurses. Doctors, tend to think of themselves as a self -contained show. We don't see that our efforts depend on someone to organize our stuff, to keep the instruments sterile, to make sense of all the medications. We recognize that we need nurses, of course. They are our hands and legs, but we underestimate the need for them, too. Seeing how things are here convinces me that I should have brought with me 2 nurses, a pharmacist, someone from central supply, someone from housekeeping,and a physical therapist.

Which brings me to something else I figured out, seeing all the amputees, I realized that this will be an amputee generation in Haiti, and disability will be common. The time to intervene will be in the next few weeks to months. The next wave of aid workers needs to be Physical Therapists, Occupational Therapists, and Prosthetists. These people are hoing to stop dying of their injuries and start trying to live with their disabilities. The news crews are going to go soon, but the need will not dry up.

Landed

2010-01-26T14:48:00.000-06:00

On the ground in Miami. There is so much to process from this trip. I'll add pictures to previous blogs and add some details tomorrow.

Thankful

2010-01-26T05:12:00.003-06:00

I just took a shower. Here at the Mission we have no hot water. The hot water side of the taps are not even hooked up.
I am no fan of cold water, except for drinking. I won't go swimming in a pool that is less than 85 degrees. I don't take sold showers. But I took one this morning. As I was feeling, not really sorry for myself, but somewhere along the lines of not happy, I thought of all the people, thousands of people just miles away who also didn't have hot water. Nor did they have running water. Nor did they have clean water, even to drink. For days, months, years, a aifetime, maybe. So now as I'm sitting here, dry, in fresh clothes. I am comfortable. I smell good. I realize that even here, I have it cush. I will eat today. I will drink clean, safe water. I am protected. So while, when I get home, I am not going to start taking cold showers, nor will I be swimming in 80 degree water, I can maybe be thankful for what I have.
All right, gotta go, I have an 8:00 tee time. And, can you believe it, no golf carts. At least we have caddys.

First Day in Haiti--The Border is Wide open

2010-01-25T17:13:00.003-06:00

We drove all night, sleeping somewhat. Absolutely no trouble at the border, we were waved right through, no passports, no searching of the bags, no missing duct tape. We arrived at the mission about 7:30 am and unpacked and unpacked and unpacked. then we started seeing patients...Well everyone else did...I had a spa appointment that I didn't want to miss, then I supervised for a while, then I took a nap. I was kinda bummed because the jets on the hot tub weren't really working. Anyway (everyone else) ended up seeing about 190 patients. Not much, but not bad for the first day, and I got a mnai-pedi out of the deal. We will be hopefully more organized tomorrow, and it looks like part of the team will be able to go to Jimeni in the Dominican Republic where a field hospital has grown up out of tents and is handling a lot of acuity.
For everyone worried about our safety, here in Fonds, things are about the same as they were a few months ago, very calm. No soccer today, maybe tomorrow.

2:14 am Sunday--Santo Domingo

2010-01-25T00:22:00.000-06:00

We are packed up and waiting for the bus to drive up to Fond-Parisien. We just had Hot showers, the last in a while. Customs was a breeze in L'aeropeurto. We found out, as expected, that in Santo Domingo everything is more expensive than usual, everyone is trying to chisel their piece out of the massive increase in traffic. The price is never the price, and the price is cheaper si se habla espanol. Anyway, off through the mountains. The first group made it through the Haitian border and customs and is in Fond, organizing what they have so far. Our group has a massive amount of stuff.

Welcome to Miami

2010-01-24T09:27:00.001-06:00

We are safely I'm Miami. Most of the other group that's ahead of us in Santo Domingo has left for Fond. Guesly is staying back to wait for us. We will be stating the night in Santo Domingo since we found out the border closes at 6 pm. Well, part of the night. We'll get up at 2 and drive for the border to be in Fond tomorrow.

On the way

2010-01-24T02:18:00.001-06:00

Driving to the airport now. Guesly's flight has just left Miami. We will catch up with him tomorrow, I mean later today.

Packing

2010-01-23T14:25:00.003-06:00

We have way more stuff here than we have space to take it. I would gladly pay $200 extra for the airline to allow me to take everything.

Where we are Going

2010-01-23T14:18:00.001-06:00

We are going to the Haitian Christian Mission in Fond Parisien. The map from google maps:

View Larger Map
The pointer is on the main building which houses the clinic in the lower level and living quarters in the upper. The large building to the left is the Church. Behind those two buildings, you can see the school buildings separated by a concrete courtyard. The building off to the right is the new OB/Gyn clinic/hospital/OR.

Trip Information

2010-01-22T01:15:00.002-06:00

1. It is important that the group has a master list of all the medical supplies and medications. That way when you get to the Dominican Republic you will know what else you want to purchase there. I learned from a missionary there that it is very easy to buy medical supplies in the Dominican Republic. Many stores even take credit cards or you can get pesos from an ATM. (Let me tell you, it is not like that in Haiti. J) Narcotics are the only things you need a prescription for. So please send a list of all the medical supplies and medications you are bringing to Eva at evamaria14@yahoo.com. She will be compiling the list. You cannot take expired medications.

2. In case you have not already checked into this it is recommended that you get the following vaccinations before travelling to Haiti: Typhoid, Hepatitis A, and Tetanus. You should begin taking a malaria prophylaxis right away.

3. Please send me, through this e-mail, emergency contact information. Give me someone’s name, phone number(s) and e-mail address. The Oregon group is bringing two satellite phones and there is a computer with internet at the mission compound, but I’d let your families know communication back and forth still may be limited. Feel free to give my e-mail address and cell phone number ( 503-302-1822 503-302-1822) to family members.

4. Groups normally give HCM $30 a day per person to cover food, transportation and translator costs so upon arriving in Fonds-Parisien, you all will give the directors $250/person totaling $4000. Additional money will be needed to cover ground transportation costs and purchases in the Dominican Republic. This doesn’t need to come out of your own pocket. Bring whatever donations you have received.

5. Each passenger can bring two checked bags up to 62 inches (length+width+height) weighing no more than 50 lbs, and one carry-on up to 45 inches (length+width+height) weighing up to 40 lbs. You can also bring a personal item, ie. backpack. Often teams use military style duffle bags as their checked luggage because they are light, flexible and can be brought back more easily.

6. Here is a suggested packing list:

· Clothes for 10 days-- humid weather in upper 80's. Scrubs or long pants for working. Shorts are acceptable for men when not working. Usually the mission asks that women wear skirts when not wearing scrubs, but I’d say this is a special circumstance being so last minute. Knee length and sleeveless shirts are fine.
· Tennis shoes for walking
· Flip flops--if preferred when not walking far
· Toiletries--keep in mind carry-on fluid restrictions (2 oz. or less, pass through security in it's own ziploc)
· Towel
· 2 rolls toilet paper
· Bug spray
· 1 roll paper towels
· 2 boxes 1-gallon ziploc bags
· 3 boxes sandwich ziploc bags
· Wet wipes
· Hand sanitizer
· Stethescope, otoscope, and other medical equipment (Don’t assume anything you need will be there.)
· Sunglasses
· Hat
· Sunscreen
· Reusable water bottle
· Protein bars/other ready to eat food (can be purchased in the DR also)
· Consider mosquito net
· Malaria prophylaxis
· Pepto-bismal tablets (plan on 2 BID for traveler's diarrhea prophylaxis)
· Passport
· 4 photocopies of passport--1 for each bag, 1 for team leader.
· A set of clothes for church, nothing fancy, a nice shirt will do

7. Here is the list of the group members:
1. Guesly Dessieux, Family practice dessieuxg@yahoo.com
2. Doug Boudreau, Pediatrician boudreau@mail.crmc.org
3. Paul Neumann, Family practice doctor.neumann@gmail.com
4. Dean Yeager, Family practice Tami@meritel.net
5. Charles A. Woodridge, Pediatrician quas68@yahoo.com
6. Lori Borella, Anesthesiologist Lborella@santiamhospital.com
7. Sabine Dessieux, FNP sabine1079@hotmail.com
8. Adam Maurer, Paramedic Amaurer@santiamhospital.com
9. Juanita Culver , RN Jculver@santiamhospital.com
10. Genny Baldwin, RN Gbaldwin@santiamhospital.com
11. Debbie Turrell , RN dturrell@santiamhospital.com
12. Clark Yoder, RN, operating room Cyoder@santiamhospital.com
13. Eva Brogan, RN, operating room evamarie14@yahoo.com
14. Amanda Gutwein, RN algutwein@liberty.edu
15. Amy Hilt, RN AHilt001@yahoo.com
16. Debbie Sands, LPN, Pediatric nurse—Jefferson City docsands@embarqmail.com
17. Mary Deeken, MD, Pediatrician--Jefferson City, MO deekeneven@aol.com

Welcome to the Haiti Medical Mission Trip Blog

2010-01-15T19:31:00.002-06:00

Hi all, I created this Blog to help keep you informed of the latest plans for the Mission Trip, which is still a long way from being realized. You are welcome to post your own comments and questions, as well. Thanks for all your help and support with this mission.
Doug Boudreau