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Nov 2013 - St. Vincent's Trip

Sunday, April 13, 2014

Keys

Keys are an interesting phenomenon in Haiti.  The medical clinic we work in has 4 rooms along one side of the building, and a long classroom along the other side with a pharmacy room at one end.  A central hallway divides the two halves of the building, which is entered through one main door.  All these rooms have their own key.  Then there is the library, which we use as a nursing station and/or teaching room.  And finally Pere Sadoni's office, which sometimes contains the scale for weighing (?) and often we store our supplies in there overnight.

Upon arriving at St Vincent's a curious game begins, usually headed by John who has played Find The Key many times.  It goes something like this.  John asks Jean Robert, our Haitian guide and interpreter, if Madame Noel has arrived at the school yet.  She is the pharmacy tech and has a key to the pharmacy, as well as one or maybe two of the small clinic rooms.  Until she arrives, we can't unload our suitcases full of medications and supplies, like gloves, alcohol wipes, medical record cards.  Then there is a separate key to the first clinic room, which John has to get from the school administrator Mr Johannes.  If we have a nursing team or have more than one doctor with us, we need all these rooms to move patients through.  Mr Johannes is a busy man, often on the phone or trying to do the hundred things it takes to get the school day started.  Tracking him down can take 20 minutes or more, especially on days when John's inquiries are answered with, "Oh, he just left.". "When will he be back?". "We don't know!". Sigh.

John also has to set up the scale and the HemoCue machine, for checking hemoglobin/iron levels.  The scale is locked up in various places on different days, and he has to run an extension cord into the library to connect to the power source.  That is, if they have bought gas for the generator that day.  Finally Pere Sadoni's office has to be opened by his secretary, unless Marie Carmelle happens to have THAT key.  Marie Carmelle is a cook at St Vincent's and is always around.  Oh, and did I  mention that between one trip and the next, the owner of these keys often changes, and the staff doesnt know WHO has the particular key we need.  One might think that a master set of keys would be available, or that one person would be the keeper of all these keys.  Or that at least the keys would be kept on the premises. Rather, one must wait for each of these individuals to arrive at the school.  The fact that Madame Noel is arriving late today, or no one has seen Mr Johannes yet nor knows when he is expected to arrive, does not appear out of the ordinary to the school staff.  Many a morning we have stood in the school courtyard, unable to start clinic, because one or more of these keys is unavailable. I have learned to use this time to visit with the children, or sit with Marie Carmelle and practice my Kreyol.  "We're on Haitian time" is a familiar expression among the Americans.

I have decided that being in charge of a key confers special power on a person, and in Haiti perhaps that power is one of the things they can control.  I have also learned that saying "We start clinic at 9" is a relative rather than absolute statement.  Depending on who has the key...


Susan Nelson

She Left Her Teeth in Haiti

The CBU nursing team did a fabulous job this week.  Not only did they do checkups on 140 kids(and 35 adult staff), they had a Diabetic teaching session and a High Blood Pressure teaching session for many of the teachers.  Creating patient brochures in Kreyol to explain diet and how high blood pressure or diabetes affects your heart and kidneys.  I felt our medical clinic had advanced to an entirely new level.

The most fun teaching class had to be the TOOTHBRUSHING CLASS.  Making giant teeth with plaster of paris poured into egg crates, Linda (CBU nurse), glued these onto giant pieces of red construction paper, and used silly putty for plaque and yarn for dental floss.  The kids loved it!

When she was finished with her demonstration, Linda gave her TEETH MODELS to Elizabeth, the school nurse at St Vincent's. Later on the plane ride home, as we traded stories about our week together, the other nurses teased Linda, saying She Left Her Teeth in Haiti.

Susan Nelson

Friday, April 11, 2014

Kalico Beach

Today was our last full day in Haiti.  Spent at Kalico Beach, a fabulous beach resort about 1.5 hours north of Port au Prince, with crystal clear water, brightly tiled seating areas and almond trees full of fruit.  Oh, and plenty of mango rum punch.  

Uzoma (our cardiologist) asked us 1)  do you plan to swim IN the water, 2)do you see the jelly fish in the water, and 3) those buoys out there in the water, do they have a net to keep out the sharks?  
We did see the jellyfish, they were beautiful, but we tried to stay away from them.  And there are no sharks (that I know of).  Uzoma surprised us by joining Ashley and Brittany in a skiff, rowed over to the coral reef by Haitians so they could snorkel.  

Tasty buffet lunch followed by the hot bus ride back to the guest house.  It is Yolanda's birthday and Dr Sue arranged for a cake.  All sang Happy Birthday on the rooftop, then the laughter and sharing of stories continued into the late night, including hip hop dancing to someone's CD player.  This is called DECOMPRESSION and it is an essential part of the trip.

Sorting and packing up the week's supplies included an interesting assortment.  Mardi Gras Beads, fingerstick lancets, one glucometer, unused bottles of Rocephin, expired meds collected from St Vincent's pharmacy, plastic soda bottles used as sharps containers (full of TB syringes), the Hemocue machine with cuvettes, thermometer probes,  a few coloring books and craft materials that we did not have time to use with the kids yesterday.   Papers with kids' names, receipts from the pharmacy, scribbled phrases in Kreyol, the prayer booklets that Edie made for us to use for morning and evening prayer. 

Scooping up the memories of our week in Haiti.

Susan Nelson

Not enough time

One of the realities of working in Haiti is the need to adapt or adjust your plans to the circumstances.  Yesterday we planned to have clinic for the remaining children who had not yet been seen by the nurses, and to read the TB skin tests on the folks who had them placed on Monday and Tuesday.  After lunch, the CBU Nurses planned a demonstration on proper tooth brushing (using giant teeth models made from plaster of paris in an egg crate- with yarn for dental floss!).  Then we would hear the Bell choir perform for us and Mackenson would play his guitar.  After that we were prepared to throw a carnival for all the children, having stuffed plastic easter eggs with mardi gras beads and cut clown faces out of cardboard the night before.

An overly ambitious agenda, we realized in retrospect.  First of all, the kids were not in school today, which meant that we couldn't read many of the TB skin tests we had placed.  However, Jean Robert had arranged for the kindergarten class to come back, with all their parents, and there were 40 precious children in their uniforms, ages about 3-7, lined up on benches waiting to see us when we arrived.   We managed to close up clinic about 12:30, despite several adults continuing to straggle in, asking to see the doctor.  Each trip we have to turn people away on the last day, or else we would never leave.  I feel bad  about this, but as I said it is one of the realities of working in Haiti.

We did manage to have the tooth brushing demonstration  despite a delayed start and several interruptions.  Linda, the CBU nurse in charge of this activity, deserves a medal for patience and persistence.  This demonstration was for the resident students who live at St Vincent's, about 60-70 kids in age range from 5-22+.   The prize for having your teeth swabbed with fluoride was getting in line to get a new pair of flip flops.  Dr Trzynka ("Magic Sue" has been her nickname from me this week) fitted each child, with two flip flops or only one, pink sparkles for girls and hopefully big black flip flops for the older boys.  Although the boys don't seem to care what color they get as much as the girls do!  

The Bell Choir performed for us in the music room, which has only one door and no windows.  No electricity yesterday, which means no light in the room.  So 18 Americans, and about 30 Haitian children crowded into this room around the rectangular tables where the choir had their bells.  And began to sweat. Even the Haitians were sweating, which means it was really hot!  Vickie danced with one child, Barbara and Yolanda wept and I held hands with Frenel and Jean Marc, while the choir played Oh Susanna, followed by a piece by Haydn, and then Geraldo played guitar and Mackenson led the crowd in a song about "thanking the Lord for all He has done for us".  As we all slowly melted. 

Released from the oven, we split up into two groups.  Sherye led the girls into a room for bra fitting, having brought a couple dozen bras from the states.  This has been a very popular activity on previous trips!  The boys played with Memphis Grizzlies basketballs brought by Vickie and Ashley.  It was like any other basketball free for all, except that on closer look you realize one boy has only one leg and another has no fingers on his right hand. 

 Others of us gathered up our supplies, including the carnival items that didn't get used.  Sigh.  Suddenly it was 4:00 and time to go .  Not enough time. I was the last one on the bus because when it was time to leave I didn't see Frenel, and I was not walking through that gate without saying goodbye.  One of the other students went to find him for me.  As I gave him a hug, I told him to study hard, keep learning his math, history, science, and geography, and that I would see him in November. 

On the bus, Barbara and I agreed that the children we saw  today , from the choir, to the boys playing basketball, to Clauricianne using her sewing machine (did I mention she has no hands, only one finger on her left "stub")  are proud of their talent and their country, they have their whole lives ahead of them.  They are not ashamed of their handicaps.   In a country where handicapped children are left to starve or forced to beg in the streets, St Vincent's gives their students an education and a chance to use their skills to make their lives and other's lives better. 

And there is plenty of time for that.
 
Susan Nelson

Thursday, April 10, 2014

Climbing the Waterfall

Early morning on the bus at 7:30 AM, to drive to Mirebelais and see the new University Hospital built by Partners in Health.  Apparently 30 million US dollars to build the hospital, mostly private donations, however the 8 million dollars annual operating budget comes from the Haitian Ministry of Health.  The public hospital opened 13 months ago and has 360 beds.  Any patient can come to the outpatient clinic or ER and it costs 50 gourdes, or about $1.25 US to get an identity card.  With that card, the patient has access to all the medical services including maternity care, emergency care, outpatient visits, X-rays, labs, inpatient hospital services,  even physical therapy.  They see about 600-800 outpatients per day.  56 doctors are on staff, all Haitian, with the occasional American specialist volunteer.  They do 1000 prenatal visits per month and 250 deliveries, most by midwives except for the C sections.  Apparently their emergency C-section rate is quite high, due to eclampsia and other high risk conditions in the patients who come to their doors. 

The hospital is also a training facility for residents in pediatrics, internal medicine, and surgery, and has 14 new residents (of 250 applicants) who started this year.  
Our tour was given by Annie, a Duke University grad who is hoping to apply to medical school this fall. She is spending a year working as a public relations/"external visitors" coordinator at the hospital complex.   She is fluent in Kreyol, French and English.  Quite impressive, and what an opportunity for an aspiring doctor to see the opening of this new facility. 

After our tour, we drove to Saut d'Eau Waterfall, known as "Sodo" in Kreyol.  I encourage any readers to look this up on the internet to see images of this beautiful place.  After paying a $5 entry fee, you walk down stairs (about 5 stories in height) and come to the base of a waterfall.  Several team members decided to rest at the bottom of the falls, and watch the rest of us climb up the rocks to the top of the falls.  Of course, our climb was aided by Haitian young men who do this all day long.  It was reminiscent of Dunn's River Falls in Jamaica, although not so high.  My guide was Peter, and he had a grip of iron.  There was no fear of falling as long as he had hold of me, and I managed to get myself to the top, laughing and shrieking most of the way at the cold water and the exhilaration of it all.
Reaching the top, several of us perched on the moss covered rocks and felt the cold spray on our heads and our backs.  The sunlight glittered through the spray and we could see the cliffs around us, covered with trees whose roots were exposed so that the cliffs looked like mysterious caves.  Haiti has such beauty, and it was wonderful to behold this magical place.  We waved at our friends down below, posed for the camera and generally had a fabulous time. Not being hot was  exhilarating in itself.  Most of the week we have felt like we were living in an oven. 

Climbing back down, I slipped once in the mud, but it was soft and there were no injuries.  We tipped our Haitian guides and then sat at the bottom of the falls, enjoying the view and the coolness.  A couple of the guides were put out because they got a smaller tip than the others, and one boy in particular stood a few yards off and pouted and stared at me for 20 minutes.  However, eventually he gave up and went over to Brittany and Ashley, who had climbed back into the pool of water at the bottom of the falls to pose for more pictures.  Brittany speaks a little Kreyol, and she kept shooing this boy away, insisting she did not need his help, knowing he would want another tip if he did help her.  Ironically, as she was climbing out of the pool she fell forward onto her knees.  Again no injuries, just embarrassment.

We left our lovely spot and set off to find a place to eat lunch.  The first restaurant that had been recommended to us had chained doors; at the second we were turned away by the hostess who said "we have no food today", but sent us to Las Vegas Restaurant around the corner.  Actually the sign on the door said Las Vegas Restaur.  We figured they ran out of room on the sign.  The doorway was marked by cords with shells hanging in straight lines, sort of reminding me of the door beads on my daughter's bedroom door.  Inside we found 5-6 tables, ordered mango juice (and some had Prestige beer) and Haitian  Legume.  Ashley tried to order spaghetti with hot dog, which was actually on the menu, but the only items available were Cabri (goat) or Legume.  I ordered the latter, which turned out to be sort of a beef stew with potatoes, okra, carrots and shredded goat instead of beef.  Also beans and rice.  Very tasty.  All that and the mango juice came to $7 US.   Also we were in and out in less than an hour, which is record time for eating in a Haitian restaurant.  Usually when we eat at the Plaza Hotel (as we did last Sunday after church), it takes 3 hours to be seated, order, be served, and pay the bill.

While we ate lunch, the driver went to get his tire fixed (another $5) and then returned to join us in the meal.  His name was Noel, and we appreciated his careful driving on the windy roads.  Our last trip to Jacmel was terrifying because the driver drove on the wrong side of the road around blind turns, frequently facing an oncoming MACK truck or school bus.  This time there were only the usual  Haitian terrors of motorcycles squeezing between our van and an oncoming vehicle, or goats crossing the road directly in front of us, forcing us to full brakes from 60 mph. I advised my fellow passengers, "Don't look out the driver's side of the vehicle or the front window. Enjoy the scenery on the right side of the bus.  Or look down at your feet!"

During the drive back to the guest house, about 1.5 hours, we quickly heated up inside the van with no air conditioning.  Windows open at 60 mph is fine, but sitting in traffic in 100 deg weather is quite toasty.  Vickie and I kept looking at all the tent cities and concrete houses on dirt scrabble graveled areas and thinking how hot it must be to live inside one of those.   

Back at the guest house, a cold shower never felt so good!  3 bottles of water later I started to feel my body temperature returning to normal, but only by sitting in front of a fan with wet hair.   We spent the evening cutting out clown faces, stuffing plastic easter eggs with mardi gras beads, and blowing up basketballs for the kids to play with tomorrow. Memphis Grizzlies basketballs, by the way.  Memphis comes to St Vincent's, and those kids will absolutely flip over the basketballs. 
We hope to see a few kids/adults in the morning clinic, finish reading the TB skin tests we placed on Monday and Tuesday, and mostly enjoy some play time with the kids.  Mackenson has promised to play his guitar for us and perhaps we will even get to hear the blind handbell choir.

Leaving on the last day is always hard for me, but it gets easier the more often I come down. I realize that I will be back, and my family will still be here to greet me when I return.

Wednesday, April 9, 2014

Out of Aspirin

It's 9 PM and we are winding down at the end of a very busy day.  Sitting on the rooftop of the guesthouse, we traded stories and were grateful for a cool breeze, starlight and someone playing the trumpet nearby. Very Haiti. The power went out about 8 PM, so inside the guest house is very stuffy with no fans working.  All stumbling around with flashlights, trying not to bang our shins on the furniture. John was actually in the shower when the lights went out. Another Haitian adventure. 

Stories of today included Vickie improving her sign language, with help from the deaf teachers. One of them corrected her when she tried to sign "Good Morning" and kept on correcting her until she got it right.  Barbara and Yolanda from CBU held a diabetes and hypertension teaching session with two different groups, about 22 teachers in all. They prepared brochures in Kreyol explaining proper diet, common questions about these diseases and even diagrams of the body organs that are involved.  I was very impressed, even stunned, at the professional presentation and the materials in Kreyol.   We actually diagnosed a new onset diabetic today among one of the school's staff. I hope to use these materials for future trips since it is difficult to find such educational medical material in Kreyol.

Brittany (the pharmacist) and I walked with Jean Robert to the pharmacy this morning. We ordered all our medication from a local Haitian pharmacy. This has the advantage of having the medicine delivered directly to the school, rather than us hauling so many suitcases from the US.   Also it puts money into the Haitian economy. Unfortunately, this pharmacy did not deliver half the medicine I ordered. So yesterday while we were working in the clinic, Brittany kept telling me we were out of amoxicillin (and other antibiotics), out of blood pressure medicine, and did not have any aspirin!  SERIOUSLY?  

A one mile walk through the streets of Port au Prince is an experience in itself.  It's like walking through Walmart in the sense that anything and everything is for sale on the street   Car stereos, mattresses, books, dresses and jeans, coconuts and mangoes. We walk in the street because the sidewalks are occupied by the vendors.  We squeeze as close as possible to the cars parked on the street, because other cars are honking as they drive past us, motorcycles whiz by and trucks blare their horn to make us jump.  Jean Robert takes us both by the hand when we cross the street, just like a father. 

Arriving at the pharmacy, we were ushered into a back office, grateful for the air conditioning.  Through Jean Robert, I tried to ask the clerk why my many emails had gone unanswered, why the medicines they promised had not been delivered, why I had to waste a morning coming to their pharmacy, a morning I could have been seeing patients in the clinic.  I suppose it was no surprise that he denied everything, gave no explanation, and made no apologies.  What did I expect?
He did promise to deliver the remaining medications to the school tomorrow.  The only item he had in stock for me today was enalapril (a blood pressure medicine). So we left with 1000 tablets of enalapril.  A mixed victory at best.

This afternoon I saw a few familiar faces in the clinic, but the nursing team did most of the work.  They have done check ups on 120 kids in the past 2 days. Ashley did the hemoglobin sticks on many of the younger children, so John was happy not to be the only bad guy for once.  He told me tonight that he shared his lunch with Clauricianne.  Of course his lunch consisted of peanut butter crackers and water, but shared it was. Clauricianne has no hands, and we have always been amazed to see her do things like write, use a phone, or make jewelry. Still, John was surprised to see Clauricianne drink from a plastic cup of water without spilling a drop.

Tomorrow we travel to Mirebelais, to see the University Hospital built by Partners in Health, Paul Farmer's organization.  Afterwards we will see Saut'd Eau Waterfalls, a scenic site where I am told you pay $5 to get in and $1 to the boy who helps you climb the falls. Sounds just like Dunn's River Falls in Jamaica. What a treat that will be.  Our guest house manager, Gail, encouraged me to take the team there.  She made a remark that surprised me. She said our teams always come to Haiti and do only work, never taking time to see the countryside.  I suppose she's right. I feel compelled to spend as much time as we have with the kids at St Vincent's. But in the last few trips we have started taking a "beach day".  Seeing the beauty of Haiti is important, especially for first timers.   I find all of it exhilarating,   And hopefully after climbing the falls tomorrow I won't need to take an aspirin.  

Monday, April 7, 2014

FIRST STEPS

Today was our first day at st. Vincent's.  Four of our team were first time visitors.  For the rest of us, it feels like coming home to enter the gates and be greeted by familiar faces and big smiles. The kids run up and greet the people they recognize, like family. 

The CBU nurses set up their stations to do check ups. Which included height and weight on all the children, vital signs and hemoglobin. All this data will be entered into a database, to compare with previous trips. We see, for example, that Dieumene is no longer anemic, compared to previous measurements. Dr Trzynka gave this young woman a stern lecture last time she was here about taking her vitamins regularly. On the other hand, several of the teenage girls are more anemic than on previous visits. We also found several kids with worms, which is unusual for the school. We learned that the water treatment filtration system has been out of service for some time, and we wonder if these facts are related. 

Tiffany, one of the CBU nursing team, had a unique experience helping Dr Jenn do physical therapy. Jenn was here with Dr Khumalo
in January, when he repaired several foot and limb deformities. One of these children is named Christina Jean Paul. Christina is 16 years old,  was born with club feet and has been in a wheelchair her entire life. Dr Khumalo operated on her left foot last August, and her right foot 3 months ago.  Today Jenn showed Tiffany how to stretch Christina's legs and ankles and encourage her to begin to put weight on her feet. Then it was time for Christina to stand up. With support of each arm, Christina stepped forward and took THE FIRST STEPS OF HER LIFE.  Tiffany told us later she did not realize at the time that Christina had never walked before. It was only afterwards she learned the full story, and was overcome by the knowledge that she had helped a child walk for the first time in her life. The first person she called was her mom!  Nice to know, as a mom, that even when our daughters are competent professionals, they still reach out to share their most intense experiences.  

Dr Ibe, our cardiologist, saw one of our kids with a heart murmur. I have followed 3 kids at St Vincent's with heart murmurs for several years, and it has been my dream to bring a cardiologist to Haiti to evaluate them, figure out if they need further testing or maybe even corrective surgery. We rented an EKG machine, begged and borrowed an ultrasound, and brought all that equipment with us. So Dr Ibe had his own cardiac diagnostic unit set up in the clinic. He tells me that Michel, one of the children he saw today, has a hole in the septum (dividing wall) between her left and right ventricle, which is what I suspected. My tentative diagnosis using only my stethoscope!  The good news is that she does not have any enlargement of the heart or problems with her lungs. So she does not need surgery. What a gift to be able to tell this child's mother that she will survive into adulthood and does not need special treatment. Tomorrow Dr Ibe will see the other two children and give us valuable information about them as well.

As I write this post, Dr Vickie, our microbiologist, has been cutting out clown faces to use at a carnival activity tomorrowwith the children. The CBU nursing team is making plaster of Paris giant teeth for a demonstration on proper tooth brushing.  Dr Ibe has been giving an explanation to Ashley and Brittany about EKGs and what they mean. Jenn is finishing her billing for her private practice in Memphis.  We read Compline with Drew just before he went to bed, since he is leavingtomorrow to return to Memphis.

Tomorrow another clinic day. Another adventure on our bus with the rear bumper dragging in the street, and the door that doesn't always open.  Hoping the power is on at the school tomorrow (we paid for gas today to run the generator), and that we have clean drinking water.  Knowing we will see smiles and friendly faces welcoming us like family. 

Susan Nelson

Sunday, April 6, 2014

IT IS EVENING

It is evening and folks are either typing on their Ipads, typing on someone ELSE's I pad (I am borrowing Ashley's) or drinking Prestige beer and visiting with each other. Some have already gone to bed. There is no running water at the guest house this evening, so many sweaty unhappy team members.     Jenn and I have found comfort in our room with the fan going. Thank goodness for electric power!   Sherye just broke out the snacks, with granola bars and small jars of peanut butter. Sort of a slumber party for grown ups. 

Tomorrow is our first day with the kids at St Vincent's.  I can't wait.