Monday, March 12, 2012

Some more photos from the trip we wanted to share! We'd love to have the opportunity to serve again if we they'd like to have us back! Working at Adventiste was a great experience!

Sunday, March 11, 2012

This is the first post in a few days because internet service at Adventist has been down for awhile. (Rumor has it that someone forgot to pay the bill - shh!!) As always, the week has flown by way too fast and sadly it's already time to return home. But again, as always, we're all happy to see friends and family again.

On Wednesday night there was a magnitude 4.5 earthquake. We only felt it as a slight vibration where we were, but it very understandably caused a lot of concern. Everything seems OK here. Then on Thursday there was some unrest downtown with public display of strong sentiments for and against President Martelly; apparently there was a claim that he was born in Italy and was not a Haitian citizen which seemed to finally settle down a bit after he spoke in front of the UN and showed his Haitian passport.

So we had a mildly nervous couple of days but everything's OK. Looking back on the week there have been some encouraging signs of progress here in Haiti... organized teams of workers sweeping the streets. Stoplights. Road crews pouring concrete. It gives you a lot of hope for the future of Haiti and we look forward to seeing even more progress the next time around!

On our last working day, Friday, we all tag team our way through clinic, and Pat and Beth excise a ganglion cyst from the wrists of two patients, who also happen to be hospital employees. One's dorsal (back of your wrist), and one's volar (front side of your wrist). They do them under local anesthesia, which often (even at home) is a touch uncomfortable, which we usually supplement with "OK, breathe deep." Unfortunately "breathe deep" anesthesia only works if one understands "breathe deep"! Despite that, they both do great afterwards and in fact the first lady works right afterwards, helping out with the surgery right after hers! Quoth Pat E.: "I don't think I'll ever again do a case where the patient then circulates the next case."

As on previous trips, we visit Franz Bastien's family's orphanage on Saturday and visit with the children. For me this is always the high point of the trip! If someone needs a second and third washout of an infected femur fracture the week we're there, as necessary as that is, it might not give them that much immediate joy. In fact it gives them a lot of immediate pain. But visiting the kids, playing Changez Movement with them, and handing out joys and treats is both fun for us and gives the kids a lot of immediate joy. Just one more reminder to them that despite living on a dusty concrete floor with siding for a roof and sleeping multiple kids to a bunk smelling of pee, they are not forgotten and someone outside their four walls, the outside world, cares about them. Pat E. and Beth have made up about 50 little packs of pens and notepads and brought a bunch of beanie babies. Tom has brought a bunch of soccer balls so the kids don't have to play soccer with an empty pop bottle. I've got the leftover flipflops and shoes we couldn't fit in our bags on our last trip - thanks to Tom Slater and Paige Saunders, who couldn't make it this time, but are there in spirit (everyone asks about them ... where's Tom? where's Paige?). And again as previously, it's hard to leave. There are little things I'll never forget. The flies buzzing around three dirty toilets - three toilets for 45 kids. The complete, rapt attention the kids give you when we get up in front of the class to address them - so well behaved! Handing out packs of nuts (thanks Leah Otterlei!!), and watching one 5-year-old boy, without being asked, share his with a little girl who didn't get one. So touching!

Haiti's never followed daylight savings time before, but this morning Nathan informs us as we're getting ready to leave that the president's decided that they'll start following DST all of a sudden. So our ride to the airport is leaving now, which isn't 6:30am, but 7:30am. We throw our gear together (which is a lot lighter after leaving some food and clothes behind) and load it up onto the hospital's truck for the ride to the airport. Liz's flight is at 9, whereas the other six of us have the noon flight, so she takes off earlier. (Priya left for Ft. Lauderdale last night so the group of eight is now seven). We pass by the large open air market on the coast road from Carrefour to Port-au-Prince. Mounds of trash the size of Rhode Island. A thick miasma of rotten fish that I swear one breath of is the equivalent of smoking about 7.5 cartons of cigarettes. A huge canal filled with styrofoam containers, so huge you could make a bounce house type play palace out of it - you know, the kind they have at McDonalds, except multiply that times 4 or 5. Folks chopping up chicken and goat with big ole meat cleavers making me so glad I don't eat meat even back home, let alone here. Lots of mixed feelings as we ride back. Feeling good about helping people ... feeling humbled by what others are doing, and how much more they've sacrificed than we have. Wanting to go home ... but wanting to come back and do more.

When we arrive, after dodging the skycaps (watch out - let them touch one bag and they own it, and it takes a buck to get it back) and artists hawking their canvas paintings, we see Liz in the checkin line, a mere five minutes ahead of us in the line despite having left for the airport an hour ahead of us! We feel kinda bad about it and joke that even if our line overtakes hers we'll let other people pass us so she can still beat us to the gate and feel like leaving an hour ahead was worth it. We say bye to Liz again. The other six of us will split up later, some in Miami, some back in Minneapolis.

Sitting in the American airlines departure gate area lounge is a world apart from the large unfinished warehouse we arrived in last week. There's coffee and we all promptly get some. I unabashedly turn in my membership in the Man club as I buy a girlie iced espresso blended fufu type concotion (they call it the Rebo Frappe) and drink the !@# out of it. The other guys are playing Euchre, and as much as I really miss having my butt handed to me in a sling to the sounds of derisive laughter at forgetting the rules, I decline (wait, I thought hearts were the trump suit ... so the jack of diamonds is a trump card too? and it's not a diamond anymore?).

Haiti has left us all with lasting impressions. Despite the mixed emotions, some things aren't mixed. The people are beautiful, both inside and out. The country despite the poverty and trash has a lot of natural beauty. As we all split up, Priya back to project management and an uncertain future in trauma at DePuy, Liz back to nursing at Hennepin County, Fil back to Macallan TX for Teach for America, Tom back to Michigan state to study medicine, Pat and Pat back to our orthopaedic surgery practices, Kris back to putting people under anesthesia at Hennepin County, and Beth back to assisting and setting up surgery at an ambulatory surgery center, we're all going back to our normal lives, but a little different as a result of having our horizons widened a bit. Taking back some lessons home. First but not necessarily foremost, learning to be flexible - you can really get by in the OR and outside the OR with simple things and a bit of resourcefulness (like the hip spica cast table we improvised out of a board and few boxes). Appreciating what you have. Appreciating that everyone has something to offer you. Appreciating that everyone's an expert in something and knows more than you about something. Realizing what really matters in life, and how happy you can be with how little material stuff. Realizing that the dream of a life we all live back home isn't reality, it's an unsustainable fantasy world that the rest of the people on this planet can only dream of. These lessons that are different for each of the eight of us I'm sure, about what's important in life and how we'd all like to grow as a result of this brief sojourn in this beautiful country.

Wednesday, March 7, 2012

Wednesday! Hard to believe the week's already half over. Our fearless local leader here, Nathan Lindsey, is now back which is nice cause he's always been a welcome face to return to and you just get this feeling that with him at the helm everything, despite the chaos, will somehow end up all right. He leads morning huddle today. A Time reporter in Afghanistan remarked that one smelled like Camembert cheese after a week without a shower, which is how we all smell this morning in huddle after only a morning without water, it's that humid. Which foreshadows some more odors to come today ...

Wednesday is clubfoot clinic day, which Francel (our local orthopedist here) heads up with Jacques, the cast tech. In the meantime Pat and Pat share the other clinic room, along with Liz, Priya, Tom, Fil, and an interpreter, jammed into a tiny room packed tighter than a Tokyo subway at rush hour. Somehow it all works out and we make our way through a hallway's worth of patients who've all been queued up since 7:30am. As Fil and I inject a knee and thread our way to the sharps container in the back, we're hit by a malodorous ton of bricks wafting from an elbow that the other' Pat's just undressed. After he pulls the pin and cleans the pus and treats it with some silver nitrate things get a little better and we all regain consciousness and return to work. Fil remarks that "every Haitian kid I see is the absolute cutest kid ever ... until I see the next one" and that's totally true.

I stay behind in clinic while the other Pat goes off to the OR to do some surgeries that he added on from Monday's clinic. (Tuesday and Thursday were already booked full before we got here.) In the middle, of course, we take 5 minutes to shove down a plateful of rice and beans. Tom is looking rather cachectic so Priya takes it upon herself to make sure he's well fed by filling his plate with her rice. The food is actually rather good. I wonder if that's because it's nice and salty ... which may explain the juicy cankles we are all now starting to sport after a few days here. Hmm...

After the OR and clinic, Jimmy Decilia (he's from Brooklyn but has lived here in Haiti for the last 5 years) tells us about the nearby orphanage he and Joe McIntyre sponsor. We all walk down to a local market and buy a poop-ton of rice, dry spaghetti, and oil, load it into the back of a tap-tap, and drive about a mile up the road to the orphanage ... well almost to the orphanage. The last 100 yards is an uphill climb up a rocky path that the producers of Survivor must have engineered to weed out the weak, by adding obstacles such as fine slippery gravel and piles of trash. And did I mention we're each carrying a big sack of rice, spaghetti, or a crate of cooking oil? Once we get to the top however it's totally worth it: an orphanage of 15 smiling kids who are just the cutest things and so grateful to have friends to play with, sing with, and pretend kung fu with (yeah, I know, you just gotta play along). Way up here above the rest of Carrefour I can totally see how one would get the impression that the rest of the world has forgotten about you.

After the orphanage we hang out on the rooftop with some sodas enjoying the sunset and watching the moonrise. You can see a little bit of the bay from here and the surrounding countryside. The juxtaposition of the abject poverty and the incredible natural beauty is nothing less than striking. The rooftop's also a good place for the paler ones among us to suntan and for Priya to show off her Yoga moves.

Priya and I remark how people back home think we're being selfless for doing this, but we're really not. Compared to the guys who live down here and are helping out long-term, full-time, like Joe and Jimmy with their orphanage, Nathan and Amy with their hospital, and of course all the other long-term volunteers at Adventist, it's nothing. Moreover we're the ones who benefit - by helping our understanding of the world beyond our own borders, beyond the tiny fraction of us lucky to live a nonsustainable fantasy life at home that some people think is all there is to the real world. As we're walking through the alleys back to the hospital from dinner tonight, Celeste, a Haitian-American nurse down here with us, stops to chat with a fellow who's standing under a lamppost reading. Why? Cause he's a senior in high school studying to get into dental school, and there's no electricity at home.

Tuesday, March 6, 2012

March 6, 2012

Its Filip and I's (Liz) privelage to narrate the blog today.   We started the day with breakfast, met Celeste, a Haitian OR nurse who is from New York but she comes back here regularly for volunteering.  Fil beat everyone to the shower at 5am, followed by Priya, who is always awake by 5.  I should mention that comparing this trip to our first trip here in July of 2010 after the earthquake, a lot of things have changed.  First of all, the weather is PERFECT this time of year.  It's a breezy 85 degrees with the beautiful sunshine, no rain yet, beautifully comfortable nights, and minimal mosquitos (mostly because we have our very own personalized bug magnet catchers with us: Pat Yoon and Priya Prasad).  Driving through Port-au-prince was also very different than in 2010.  Post-disaster streets were cluttered with rubble piles, and endless rivers of trash filled water.  The memories were so vivid as we were driving through PAP this time.  The streets were very clean, the sidewalks were swept, the air was more clear, the jail was being rebuilt, the gates on the schools were built up...standing from the roof of the hospital I could see the city clearly.  I do not remember that being visible 2 years ago.
9:00am; Pat Ebeling in the small procedural room, tore-up (no pun!) a Carpal Tunnel case
9:00am; Pat Yoon in OR#2 removed 8-plates on a knock-knee/bow-legged four year old cutie that him and Francel (Haitian Ortho Surgeon) had fixed on their trip 6 months ago.  Tom (med student) scrubbed in with Pat, and he actually gets all the credit for removing the screws and the 8-plate.
Side-note; Filip might not know how to speak Creole, but he has found a mutual language to communicate with some of the haitians...He and Jean Joel both speak spanish having many deep involved conversations.
I might add that Beth (Scrub Tech) has really been a rockstar in the OR, she and Pat E. work really well together, and my guess is that she can scrub for just about anything.
10:00am; Pat E takes care of a toe amputation from crush injury, and the patient woke up from it and requested Cortisone shots in both knees and his back, easily done.

Priya was all over signing us up for random assignments from Emily to make ourselves useful...Me, Tom, Fil, and Priya organized the last of the medication (almost out of Morphine, but we have a huge stock of Ketamine and Solu-medrol...wonder how that happens:) I have to say, Priya has quite the organization skills and she is very good at directing us:) In the meantime, the surgeons were taking off a hip-spica from a 3 year old and replacing it with a new one as her hip displasia was not healed according to the XRAY (that took us 3 hours to get b/c we had to call Franz from home...)

1:30pm; removal of beads in an infected hip
3:30pm; biopsy of a tumor

our day in the OR ended 6pm adn we are exhausted, relaxing on the roof of the hospital in the breeze

So, this is Haiti! ...a game of Eucher and out for some nice cold ones....!!!!!!
Until Next Time,

Sunday, March 4, 2012

It's been a long time coming but it's good to be back!

Well, it's been six months since we've been back here, but it's been our lucky break (haha) that the guys down here at Adventiste have allowed us to come back! Thanks for being one of the paltry few - er, I mean one of the distinguished, discerning readers - who've chosen to follow us. This time the team is a little different. Liz Slauson (those loyal readers who've been following from the beginning will remember her of course!), an RN in med-surg at HCMC; Fil Drambarean, her brother-in-law (and currently doing Teach for America in Macallan, TX); Pat Ebeling, an orthopaedic surgeon (and my buddy from residency) at Twin Cities Orthopaedics in Burnsville and also at the Veterans Affairs); Beth Ward, his scrub tech (and one of the few meat eaters the group); Priya Prasad, a project manager at DePuy trauma in Miami; Tom Wechter, a second-year medical student at Michigan State and the younger brother of one of our current residents at the University of Minnesota, John Wechter; and Kris Kline, a nurse anesthetist from Hennepin County Medical Center. Somehow, it's not quite the same without Tom Slater, who's been on all of our other trips. But he's with us in spirit, and it's good to see that Beth has taken over his mantle and has brought beef jerky and the other Pat is sporting a bandana, albeit a little less sweat-stained than Tom's.

The trip down gets off to a rather inauspicious start. Kris somehow reads on his ticket that we arrive in Miami at 11:25 and figures that's a good time to show up for the flight from Minneapolis to Miami. I forget that I've just had a temporary crown put in (sheesh, you hit 40 and everything starts falling apart!) and it comes loose when I chew into a piece of gum during our layover.

Fortunately once we hit the ground in Port-au-Prince, things fall back into place. Those of us from the Twin Cities meet up with Tom and Priya who arrived just ahead of us, and we hook up with Adventiste's driver Richard for the ride to Adventiste. The entire day, we've been wondering what Tom looks like. He's from Michigan and none of us have ever seen him. We figure he was a college wrestler so he must look like John - 6'1", big huge cauliflower ears, and wide as a truck. Imagine our surprise when he's built more like Pat and I. There's a cool breeze in the air (relatively speaking of course; "cool" means you can breathe it and only discern a touch of burning trash smell) and we spent the next few hours setting up our army cots, jury-rigging our mosquito netting, and catching up with good old friends! Long-term US volunterrs Emily Rivas and Randy, our Haitian interpreter Frantz Bastien (whose mom runs the orphanage we visit), and Jacques the cast tech all make us feel super welcome.

Loyal readers from Trip 1 might remember us hitting the ground running as soon as we arrived. The same thing happens tonight when some poor chap comes in with a closed tibia-fibula fracture after a rock hit his leg, i.e., he broke his leg. Fortunately, it's not too displaced (meaning it lines up pretty good) and his compartments are soft and it's closed (meaning no wounds and no bone poking through), so appropriate for non-surgical treatment.  The two Pats tag-team putting him into a long-leg cast. As I'm chatting to him trying to get the story in my broken Kreyol, he subtly informs me that he does speak English.

We discuss afterwards that had this been back home, most surgeons would have recommended surgery - an intramedullary nail to essentially shish-kebab the pieces together. Not, as you might suspect, because it's a better treatment that's not available here (on the contrary, we can and do do lots of nailings here), but because people back home are financially incentivized to do more surgery. Pat and I still would have done the same thing, because a cast is exactly all this guy needs. It's certainly what I would have wanted if it'd been me.

Thursday, September 29, 2011

A bottle of Coke

Thursday. Today's a surgery day so it's time to put those rollerskates on. Up at 5:45, shower (I don't know why I bother because you get sticky again in about 3.2 seconds after you get out), and down to the lab to retrieve our young patien'ts blood sample to take down to General Hospital to get a crossmatch so they can find the correct type of blood for him. Fortunately Randy, who's an electrician back home in Yakima, WA but the de facto local jack of all trades guy here at Adventist, has volunteered to bring it down to the General for us and pick up the blood so we can keep operating. As the day goes on, we're wondering how his quest is going ... until we find out it's for a patient at the MSF hospital. We suspect the staffers at the General assumed he was from MSF, and gave him the MSF guy's blood. And we're not about to give our guy the wrong unit of blood. Well, I feel a little unsafe about operating on our poor guy without blood ready to transfuse him with - he broke his femur 8 months ago and you know it's going to be a bloody mess taking it apart and putting it back together. So unfortunately for our guy, it means another chat with him explaining that I'm sorry but the General sent us the wrong blood and it'd be safer for him to wait till tomorrow. It's a conversation, unfortunately, that you have to have with folks a lot here. Fortunately he's really understanding, shrugs, and start to tuck into the sandwich sitting previously untouched at his bedside - happy that he can now finally eat.

Tonight it's raining farily hard. This is the rainy season so it rains most nights here. Pat Ebeling has a hankering for a Diet Coke so we put on our shells and venture out down the street with Jimmy in search of a convenience store. There's a pretty big one just off the main road that runs parallel to the coast and connects Carrefour (where we are) with Port-au-Prince. As we walk down the side road that connects Adventist with the main road, rivulets of water are running down the gutters, washing away piles of trash. You try not to think about what your feet getting wet with. But it's hard not too. You don't flush poopy TP down the toilet here, but rather throw it in the trashbin. The hospital burns its trash, but a lot of people simply dump it on the sidewalks. Yup, that's what you're walking through. As we approach the main road, these little rivuelts converge into a huge flowing brown river running alongside the busy thoroughfare. There's no overpass, no underpass, no raised blocks of stone to cross the road with like they had in ancient Rome. As we walk up and down the sidewalk looking for a way to cross, we see more streams of brown sludge feeding into the brown river. A ripe, putrid stench wafts up to us and suddenly I really don't want to eat or drink anything. So get across the Port-au-Prince road tonight, you'd have to wade through the brown river, dodging cars, in the dark, with pouring rain. Folks are doing it left and right - wearing flip-flops. It's tantalizing to see the convenience store across the street - so close, yet so far. We turn back. There's a small mom and pop stand on the way back to Adventist with bottles of Star, the local brand of cola, and we pay 8 Haitian dollars for 2 bottles, or 1 US dollar. Sounds like a small price to pay for avoiding the big brown river. Even now, warm and dry inside the hospital, we're bathed in a fetid miasma of sewer gas. Well, at least it goes well with the Star cola.

Wednesday, September 28, 2011

Due credit

Well, Ruth, Beth and I are all back from Haiti General Hospital where we gave a unit each so Fidel (not his real name) can have his surgery tomorrow. It was an interesting experience. Adventiste is fairly close to being back to normal now, but there was a time early on when there was a mini-tent city out on the grounds, and indoors there were lots of patients who had to sleep on cots out in the hallways. We may have thought that was a little inconvenient for the patients - until today when we saw patients on cots out on the sidewalk at the General. Again, somone's always got it worse. So we get our blood pressure and hemoglobin checked, and fill out the standard questionnaire you fill out anywhere when you give blood. We all must be a little dehydrated cause Beth's hemoglobin is 12 and mine is 16, both of which are high for our normal values. Unfortunately we forget to bring the crossmatch sample of our patient's blood so we can donate for him but we can't pick up his units until tomorrow when we come back with the sample. One of those things you take for granted back home, because it's someone's job to do that, and a whole sequence of events automatically happens when you write "type and crossmatch 2 units of blood" and "transfuse 2 units of blood." Here, you do it all yourself and it gives you newfound appreciation for systems and the people that make up those systems back home. We're all a little nervous about giving blood in Haiti but the whole process actually goes really, really smoothly and by the books. We make sure to let them know we're there to give blood for Fidel (not his real name) so he gets credit for 3 units of blood. My tech was really good about sterile technique and gracious enough to pose for a photo op. The three of us are in and out within an hour. Unfortunately, Randy's a bit late with our ride back so we wait about an hour. At dinner a few nights ago somene had talked about the five languages of love. Well, tonight we learn about Ruth's seven levels of annoyance. When applied to a situation like this when you're waiting for someone, this scale would range from a very mild level I (Someone's late picking you up, but you're at home - annoying, but at least you're at home so you can go to the bathroom and watch TV) to the absolute maximum, level VII. We figure that waiting for a ride for an hour on a street curb with a random dude peeing on a wall in front of you and you don't speak the local laguage and you're a tad dizzy from just having given blood and being a little dehydrated might not be a level VII, but is a bit past level I. At any rate Randy shows up, we're very thankful for the ride, Fidel (not his real name!) gets to have blood ready for his surgery tomorrow, and it's all good!

It's been good having Pat Ebeling here cause there's enough to do to keep two docs busy. For example, today before we left to go give blood we got to run clinic and OR simultaneously. Normally, any normal orthopaedic surgeon would rather be in the OR than clinic, but today I feel like I dodged a bullet as the first case turns out to be what Jeff Brewer from HCMC (self-described "just a low-life tech") likes to call a Horrendo-plasty. It's four or five hours of rebuilding this kid's foot. The plan changes a bit right before surgery since most of these cases were booked a few weeks ago by other docs and they keep getting pushed back to the following week because OR's are always being overbooked because there's just so much to do. But the foot looks great by the end of the case, as I see when I poke my head in on a 5-minute break from clinic. Speaking of clinic, today in clinic I had a lot of fun. It was super busy, always go go go, people lined up in the hallway all waiting to see you, a bit chaotic, sometimes with two people trying to edge their way through the door at the same time. Most of them have been there since 7am since it's first come, first served. But everyone's super polite, really appreciative, well-dressed, and very understanding of having to wait for up to seven hours. I also get to meet the oldest person I've met in Haiti, a 101-year-old lady with left hip pain who fell last week but luckily didn't break anything. Must be made of some pretty strong stuff!

Tonight we get a call from Charlene, who's left Adventiste for Bernard Mevs / Project Medishare hospital. They have a poor chap there who broke his hip about 4 weeks ago and was seen at one of the MSF hospitals. Unfortunately they don't havethe means to fix him there so they're wondering if they can transfer him to us tomorrow. Of course we can take him, and in general the sooner the better with this sort of thing, except for two factors: (1) the roads here are bad enough and dangerous enough during the day that getting someone to us at night is probably a bad idea, and (2) it's already been a month since he broke it. So he's coming down tomorrow. We got a full slate of surgeries already, but this is something you just gotta do and take care of, and somehow we'll make it work.