Epiphany

For the first time in the 8mo I have spent in Haiti I have lost a lot of hope. Before I always had so much hope that the work we are doing is good, and Haiti will change. I thought it was so important to do primary care and help the people one by one. But now I've realized we need public health education so that we can help a large number of people and make it sustainable.
This epiphany was spurred on by Ryna, AJ, Dustin and I taking a group of 9 patients to an HIV program in PPX. The gov. provides the HIV meds for free but only at certain locations, since our number of HIV patients has been increasing lately, we have decided to take a group one day every month. After arriving at the hospital program we had to wait in three different lines, followed by a trip to the lab, into an office, around the building to make a file, back to a different office, and ending in the pharmacy. Times 9 patients, not fun. Though we had informed each of our patients that they were HIV positive, each one stated that they did not they had HIV. Even though we had told them multiple times. Many of the patients did not believe or understand the HIV education they got at the other hospital. One continues to state she does not have it because she does not have a rash or diarrhea; though she has tested positive three times. Another one who's husband died a month ago in our hospital d/t HIV still states he contracted HIV because someone put a powder on his chest.
It is so frustrating!! I don't know what the problem is, either the patients don't want to learn or have a hard time learning. Haitians are not stupid but if you don't go to school it is hard to even know how to learn. I just wanted to scream HELLO!! You need to listen and learn how you get HIV and most importantly how you can spread it to others. And HELLO the government needs to be teaching the people, and enticing them to get treatment and education. I never want to go back to that program b/c it was so crazy and overwhelming. I can't imagine how the Haitians feel, I got to arrive in a car, and probably got some special treatment b/c we know some people there, but to go through that by myself without any health knowledge would be so confusing. Added bonus there is no prevention in Haiti. People don't even know about prevention, and even if they do they can't do anything about it. In Passe Catabois you can't even buy a condom. People don't even know about the importance of handwashing, or clean water, or safe sex. Blah! Haiti needs to re-evaluate healthcare in a big way. Haiti has serious issues regarding healthcare. I mean we need to start from scratch here. Can you imagine not even knowing these basic things? I am excited to go home and try to think of creative ways to teach public health in Haiti.
Updates: the clinic was pretty mild last week. We had one small child with meningitis who went home and died the next day. Of course later that day I had a hypocondriach moment and thought that I also had meningitis! Minor panic. On Saturday, I delivered a premature baby girl who had died in utero. It was the mother's third baby that she had delivered dead. Horrible. I can't imagine that pain. The family did not want to take her home to bury her because of the costs, so she went in the latrine. And we had another baby come in who had the umbilical cord fall off and was bleeding. Michel stitched it up and she is all better!!
On a truly happy note. Chaniaka, the 5yo with heartfailure went home yesterday. She is playing and dancing and singing! She is a little miracle child. So there is still hope in Haiti.

Bats, scabies and blood

Sorry for not blogging recently, I left Haiti two weeks ago to attend my brother's graduation from Wake Forest which was followed by a family vacation in the Blue Ridge Mountains(where Dirty Dancing and The Last of the Mohicans was filmed)! It was gorgeous and really fun. Of course I did not return to the states empty handed; I came back with ringworm and scabies!! Sorry to all the family and friends I hugged while I was home! :) The good news is Annelies told me that you know you are a good nurse when you have had scabies! Yippee!!
I returned to Haiti last Monday with my brother. It was good to be back and see everyone. Unfortunately, three of our patients had died while I was away. One of them a 54yo TB patient with HIV; who I expected to die. As well as a 14yo girl with TB, who I completely did not expect to die. And saddest of all our little baby Ivnelle who had been staying with us died in his mother's arms. I was heartbroken. Honestly, it feels as though everyone dies. I have questioned if I have that affect, like everyone I try to care for dies. Sometimes it is so hopeless and disc0uraging, it feels like we aren't doing any good.
This was followed by Tuesday morning, a 1yo with respiratory problems died at the hospital. And Wednesday morning I was awoken for an ambulance in which a 14yo boy with diarrhea and vomiting was unconscious. He died within an hour of arriving. WELCOME BACK! It has become heartbreak after heartbreak. I enjoyed being at home and not having to worry about who would die next.
But there is happiness and joy as well! Chaniaca, the 5yo girl with heartfailure is doing much better and will come home on Thursday after 3months! She is a little miracle and victory for us! And I really enjoy all the volunteers that are here with us! They are quality and it is awesome to live in community with them!
Ok patient of the week a 53yo man came in and said he was peeing blood. In reality, he had blood dripping from his penis. He then wanted to emphasize this and squeezed his penis which caused a faucet stream of blood to come out of his penis onto our chair! Sick me out!! By far the most disturbing penis case I have seen, and that is really saying something!!
Animal update: The other day I went to the toilet, and there is a window behind the toilet. I heard a noise and their was a rat pushed up against the screen!! Not ok!! Worst story of all is last night my brother heard a noise in his room (he has been sleeping with the door open). He decided to investigate and saw a BAT hanging down from the bunk bed in his room! He was on a different bed thank goodness! But the bat was eating a cockroach!! Freaky!!! He know sleeps with the door shut!

Supermom's

Last weekend we had the little girl stay with us, and she died on Sunday morning but we cared for her Friday, and Saturday. Then on Tuesday we decided to NG tube one of the babies at the hospital. The baby is 3mo, he has HIV and his mom is also sick in the hospital with HIV. Tuesday evening he looked very bad, sunken eyes, vomiting a lot etc. He looked like he was near death, we asked the mom if we could take him home so we could tube feed him in the night. But his mom was afraid he would die, and she wanted to be with him when he died. So I had a sleepover at the hospital. I stayed in the room of one of our malnourished kids and I woke up throughout the night to give the baby milk. Since then he spends most of his days and nights with us. I take half the night shift and someone else takes the other half. Last night Ryna took him for me so I could sleep which was really good because I am sick now. All of this is so relevant for the week leading up to mothers day. Someone said to us that we like to take in babies because we aren't moms yet. And I said no its the opposite, we aren't moms yet BECAUSE we have taken in babies. We have a glimpse of the reality of what it takes to be a mom. And do not even get me started on how upset I am that I have seen the reality of childbirth, the thought of going thru labor is the most terrifying thing I can imagine. Seriously, the hardest work of my life has been the times I have had to care for a baby. It is a job without rest, it requires the energy of a Mexican jumping bean(Ryna's words), and it takes the patience and love of Jesus(and I really mean that)!! Whenever I care for a baby I have a new appreciation for my mom, especially since rumor has it I cried pretty much constantly! And don't even get me going on what a hot mess my sister was(love u emagirl)!! I always say when I am down here I want to gain some of AM's superwoman powers, but whenever I have a baby or kid with me I wish my mom was here to give me some of her supermom powers! Everyone says their mom is great, but if you know my mom you know when I say it its true. Its hard for me to take in a baby, because I know I can't measure up to my mom!! She would have the baby bathed, dressed nicely, worked all day, cleaned the house, and made a meal for the neighborhood. Yesterday, I didn't have the energy to clean the baby puke off my pants (he projectile vomits sometimes)! But to all the moms, if you have managed to keep your sanity and not killed your child then you are amazing!! And I hope I am as good of a mom as you are, and like 1/10 as good as my mom!!! :) Also, a quick shout out to the dads, I know for sure I refuse to be a single mom because its too hard without the help and support of the baby daddy!! Nothing harder than being a parent, NOTHING!!!!!

　

Here we go again

We had a low key week, followed by a hideous weekend. I can't even remember anything in the week worth mentioning. Except that a married couple Annelies(Holland) and Dustin(US) came last weekend! They have been a great addition to our team, and Dustin is the reason we have internet! Now we are definitely our own little community, 6 people living here at the guest house along with a team of 5 Americans from CA. They are a pretty low key team which has been nice. And the team includes Dustin's parents, his mom is a wonderful cook! Its been so nice coming home to good food!! She even made chocolate cake in Haiti!!! Yippee!!

Unfortunately, Friday afternoon we had a really sick 4yo come in with bloody diarrhea. She was so weak she could not hold her head up. The dad refused to stay in the hospital with her so we decided to take her home. Friday night she stayed with the MD and his wifey and she was doing ok, she even walked to the toilet, and she talked a little. Then mid day Sat. she became unresponsive. We could not get an IV in her Friday, or Sat. But we did NG tube feed her, after we put the tube in yesterday she was a little better. When we pulled fluid out of the tube we saw old blood, each time we tube fed her. Then she had another bloody stool, but the real problem was she started have lung problems breathing fast and hard with what sounded like pneumonia. Last night I had her until 2:30 AM, then Annelies took over. At about 11PM she started to cry out, which scared me a lot because I realized I have never heard a kid cry like that and live. I woke Ryna up because I was scared, but we could not do anything except give her lots of pain medicine. Then at 4:30 Annelies woke me up and told me that the little girl was dying. I went into the room and she had vomited old dark blood everywhere. She died within a half hour.

Yesterday, a lady came in labor, and she had a note from another clinic saying she had been pushing for 12hrs and the baby could not be delivered vaginally! 6th kid. The mom was ok, as was the baby's heartrate. Michel who said we could use the vacuum to get the baby out. He used the vacuum and got the baby's head out but the shoulder got stuck. It was horrible. We tried thrusting her legs into her chest, and then we had her stand up. Finally after what seemed like forever the baby came out, but she was dead. We did CPR but could not revive her. It was really sad. The worst part is that to do a burial in Haiti is really expensive and the families cannot afford it so when a baby is born dead many times they throw the baby in the outhouse. Which is what the family did yesterday. That is poverty beyond imagination, when your option is to throw your kid in the toilet to save your family from drowning in debt. Its just horrifying all around.

On a brighter note, everyone is the hospital is doing well! We sent some patients home healthy, which is a victory!! And my little friend Orisnel, the 27lb 12 yo went home feeling much better. We admitted some new patients a mother and 3mo baby with HIV. And another women with HIV and heart failure. Plus a new TB patient who I really like, but she is 26yo and weighs 63lbs. We have three malnourished kids who actually drink the milk, except for one of them. But they are all doing well! So good things are happening as well. And our patient who we took to Paul Farmer is also good!! There is hope!

　

　

Paul Farmer Here I Come

We have had a TB patient that we think is resistant. He started treatment last summer with me, and then stopped treatment. He is 21yo, and finished with 2mo txmt and is still so sick, I think he is almost 6feet tall and weighs 96lbs. HELLO!! AM said we need to take him to Cange, which is where PIH, Paul Farmer's hospital is! I was like yippee! B/c I think this is his only chance to live, and maybe I get to see Paul Farmer! My hero!!! My entire week basically revolved around this trip so this is all I'm gonna blog about!

Here is how it goes.

Number of hours spent in the car total 14hrs (Please keep in mind Haiti roads are the worst in the world)

Number of times I caught air as we went over a hole in the ground: I cant remember because I have brain damage from the bumps

Number of times we almost got into a car accident with a goat: 1000 (that is probably only a SLIGHT exaggeration)

Number of times I complained about being hot(excluding the car ride): 0 b/c Cange is in the mountains and its cool

Number of times I was super impressed by Cange, and thought about Paul Farmer: too many to count

Overall, the trip was amazing. Cange and the hospital there is sooo impressive. Its like a little resort in the mountains, just a beautiful isolated hospital. They seem to do a good job, and everything is free. They let us stay there, and gave us food. We stayed for two nights! It is seriously surrounded by mountains, and is just beautiful. I am so happy I got to go there, the only let down was Farmer was not there, they said he left right after Easter. I was like oh man, soooo close. But I am happy I got to go on an adventure in Haiti, and I am really excited b/c I think they can really help our patient. Plus when I return to the US I am going to bring the sputum of our patient's sister, who is in our hospital for TB. They are going to test her for TB resistance, and I am going to bring it to them. So now I consider myself an insider and future employee of PIH! :)

Also, I had a frog sit next to me last night while I went to toilet! Once again, can I get a little privacy!

My Own Horror Movie

Sorry for the lack of blogs and emails! Trust me I wish I could have been in contact with the outside world!! Don't feel ignored, and don't give up on me, I need your prayers and emails now more than ever!! The past few weeks have been difficult. Haiti is such a source of joy, and peace for me. But it also breaks my heart more than I can handle sometimes. Today, Ryna and I were awoken at 5AM by the sister of one of our TB patients, Acdonel. She said he was vomiting blood. By the time we walked to the hospital he was dead. I was near hysteria, people had to calm me down. Last night I sat and talked with him and we laughed. He had been here 4 weeks and was improving, he was walking, and last Sunday he went to church! He was one of my favorite patients, after Ryna and I did rounds I was talking to Ryna about how much I liked him and that I just wanted to hang out with him. He was just a source of joy for everyone in the hospital, and his death was so unexpected. He is just hard describe, he was just an amazing person. I have never been so sad and upset over someone dying, I'm sad he's gone. Then later today at clinic I delivered a baby that was dead. The mom was seven months pregnant, and had not felt the baby moving. We did an ultrasound and realized the baby was dead, so we induced labor and today she delivered him.

On a more encouraging note we have had several deliveries that have been really good. On Sunday, I delivered a baby which is becoming my favorite things to do. Friday night we had a mom laboring with twins. Dr. Michael checked her and she was only dilated to a 3 so we went home and told them to call us if she felt the need to push. Within 45min the guard was at my house saying one of the twins had already been born. I tried to run to the clinic, of course rolling my ankle on the way b/c the path is all rock, and almost throwing up because I had just finished eating. By the time I got their there were two baby girls chillin on the bed!

Also, we had a team from Ryna's church come, and they were awesome! Just super faithful and encouraging! Plus they made awesome food, and just made me laugh a lot which I appreciated! The one downfall was one guy on the team really like the grape soda here which is similar to Dimatapp cough syrup, or poison!! So that was seriously sickin me out!! And also, I had a spider in my shower! I decided to show mercy and let him live but then he started crawling up the wall directly behind my head! Which was a serious problem, so I tried to kill him, I knocked him down where he played dead and after a few minutes he started walking again! So then I got really mad and really killed him!

Now this is the real story I need to tell, but this is not for everyone. This story will freak you out, and maybe haunt you so stop reading if you cant handle it. This is also the incident that destroyed my friendship with Ryna b/c she woke me up and brought me into this world of terror! JJ, we are still friends!! We admitted a baby to the hospital for dehydration. We put a tube in, and were rotating doing feedings. Our favorite thing to do. Ryna went to do an 11o'clock night feeding. I was awoken by her running into the room basically crying. She told me that while doing the feeding she saw something move in the baby's mouth. Then she looked in and the back of the baby's mouth was filled with blood and worms. So we went to the clinic got a bulb syringe, and some tweezers to try to remove the worms. There were probably a hundred worms, we probably got 20 out. They had dug a hole in the baby's gums, and had also dug holes in the back of the baby's mouth inside the cheek pockets. While I was plucking the worms out, one came out the baby's eye. It was seriously worse than a horror movie. Its midnight, its dark, and you are pulling worms from a 5mo baby's mouth. Over the next few days we pulled out like 20 worms a day, the mom got most of them out b/c she would see them rise out of the holes and grab them out. I think overall only one came out the eye, and 5 came out the nose. We tried all different things to kill the worms, but we couldn't get them out b/c they were in the back of the baby's mouth. After a few days the mom pulled out a few dead worms but soon after the baby died. I think the worms had gotten into its sinuses and into its brain. We could tell the baby was probably brain dead bc he clenched his fists and would not open them again, and his eyes were not responsive. I think they were maggots, but I don't know. One night I brought 9 of them home alive and tried all different things to kill them, but not even bleach would kill them. Anyway, that is the worst experience of my life! And I can not even hear the word worms anymore. I literally had nightmares. The baby died the day before Acdonel our TB patient died. Then on Sat. a 13yo boy died of Pneumonia. So basically this week I feel like what are we doing here, everyone is dying and its so awful and unnecessary!! My heart hurts, and my sadness is so overwhelming. I hope next week is better. And please send out some prayers!

Seriously?

My week in review:
Sunday: Rob is back! Yippee!!
Monday: In the morning a medical team of 52 people came and stayed at our house until Thursday. Pro: medical and dental care for so many people. Con: Sharing my kitchen and most unpleasantly my bathroom with 52 people.
Monday PM: I had to tell one of our patients, 30yo young man, who had been shot randomly with a bullet that went thru his arm, into his chest and struck his spinal cord, that he will never walk again. I sat with him for an hour as he cried and told me he wanted to die. Its hard enough to earn money in Haiti but when you can't walk, and you have a small family what can you do?
Tuesday: A pediatrician from the team saw our 1.85kg baby and told us she has Trisomy 18, and will not survive. We then had to tell the mother, and it was really sad. It was difficult for us because the MD said she has 95% chance of dying but maybe we could NG tube feed her for a year. But we are not equipped to do that here, she would have to live with us, use so many supplies, at some point need a feeding tube put in her stomach and still probably die. It was a heartbreaking decision to send her home.
Wednesday: I went to give Erebendi his afternoon milk and he was holding his arms and breathing hard. The mother said he is not good and that he has let go. We loaded him up on antibiotics, and pain medicine. About 2hrs later he seemed better, he was wanting to drink water. We went home to eat dinner and got called to the hospital with the news he had died. I can't put into words how I feel about that.
Thursday: We also found out Wednesday that one of our TB patients and his wife have HIV. We told them Thursday morning.
Friday PM: Ryna came into the room and announced to me that their was a spider IN my bed. This spider was the size of a big chocolate chip cookie. Bigger than a Reeses Peanut Butter cup (Its been a hard week I have chocolate on the brain!) So I flung him out of my bed and killed him! But what a way to end the week! I mean seriously!