Well I thought after this summer, this blog would be done... but I am slowly realizing that talking about Haiti, processing the work we do in Haiti, and most importantly the work of building sustainable health infrastructure and lasting, equal partnerships is a continuous project and has a long way to go. Haiti work has been going about 1,000 miles per hour ever since I returned home from my previous trip 3 weeks ago. From ordering surgical supplies, to setting up projects for first year medical students, to funding applications, to data entry for our HIC work to begin writing our Dartmouth Infectious Disease Dept. paper, to random Haiti lectures that I've been finding myself in, I feel like every time I turn around Haiti keeps sneaking up on me. I never want to be the person who makes assumptions - after all that's how lots of people working in global health have gotten themselves in trouble - but I wonder if this is how it is with hard patient cases or working in other countries for other people too? If there's that one place or that one patient, that no matter how busy your class or clinic schedule and extracurricular responsibilities, you can try to push them towards the back of your mind, but then all of sudden, bam! It hits you like a truck when you least expect it.
Today we had two Dartmouth physicians who have worked in Haiti present on some of the work they've done there after the earthquake and beyond. I felt the emotions come out of left field when one of the physicians asked a Haitian colleague we were skyping with during the lecture presentation: "What do you do when you have to tell a patient who needs dialysis there's nothing you can do for them because they had the unfortunate fate of being born in Haiti?" This Haitian physician had trained in other countries and worked in France for awhile and previously had access to dialysis equipment and now he was working at the new hospital in Mirebalais and had no access to any of these resources...
My mind instantly went back to a handful of patients in Haiti - first to the Type I diabetic patient my age in Les Anglais. I walked through how she would eventually go into DKA coma and not make it to the next regular primary care clinic visit. I told her how if she were in the US, the doctors would have been able to give her insulin to prevent her dismal course. I think patients everywhere deserve the dignity that comes with telling them the truth. Luckily this time when I spotted a similar patient in Fondal, we were able to get her access to care - in fact I was in the middle of giving her the dismal outcome when miracles happened to intervene and she is now on long-acting insulin thanks to a persistent translator - but to learn more about this special case, you'll have to read Caitlin Foley's blog post:
http://chiadventures.blogspot.com/
Then my thoughts moved to another patient from this past trip that's been on my mind a lot lately - an approx. 60 y.o. female patient who had late stage cervical cancer. It's crazy how I've heard about lots of little kiddos not making it because of diarrhea and malnutrition and then this one women who is by Haitian standards "old" really got to me. She was a patient of Dr. Judy (one of our fabulous ob/gyns who is helping lead our women's health initiative charge). We explained to her that she needed radiation treatment and even then there was no guarantee for good outcomes. The biggest problem - Haiti doesn't have radiation treatment options - Mirebalais has chemotherapy, but no radiation. I searched for options for her and took down her information so I could look when I returned home... the end result was what we had all kind of expected - there weren't a lot of options. One because she was living in Haiti and two because she didn't have a lot of money. When we originally told her we didn't think there were a lot of options, her response was: "So am I just supposed to lay down and die?" That's when I decided to involve Bill, our photojournalist. There is something very powerful about an individual being able to share their story with others. And not in a poverty porn type of way. No, Bill took the time to show people in the states that this woman was not a victim of poverty and disease, but a heroine, someone much stronger than I could ever be and someone who deserves to know that she's inspiring our volunteers and our women's health initiative programs to keep going and not give up despite all the bumps we hit in the road. If she didn't get miraculous radiation treatment, we felt she at least deserved to have her story heard and validated, because I've found from many difficult conversations in Haiti that this can be very powerful for patients...
And then I started thinking - why does a refrigerator and some insulin need to be a miraculous situation, why does oncology treatment that we offer in the states have to be seen as a "miracle" too tough for the mountains of Haiti - why can't it became the norm? Why do patients only a 90 minute flight from Miami, FL not have access to routine pap smears - why should catching cervical cancer early and treating it be considered a foreign concept - an option available only for "the haves" and not "the have nots"?
And this brings me to another classmate's question presented during today's lecture: "How do we make work in Haiti sustainable? Do you think it's sustainable now?" My honest opinion is "yes and no." Sadly Haiti is a land of 10,000 NGO's and still has the least number of healthy productive life years per person (See Global Burden of Disease Study: http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-insight). Why is that? I feel like I've already mentioned it in other blog posts, but why aren't organizations stopping and asking if what they're doing is more sustainable? Treating diabetes and hypertension can prevent many patients from needing dialysis in the first place. Sometimes good intentions aren't enough, sometimes good intentions also have to be intentional and analytical. I used to think this was a common sense idea held by the majority, but sadly I think we have a long way to go. I am not saying it's not possible, but I think we have to start asking ourselves what do the communities we're working with truly need? How can we sustainably build economies and public health infrastructure and primary care initiatives that create communities where insulin isn't a miracle and clean water isn't something that the Culligan man drops off to the white volunteers at the local guest house in Port au Prince.
And so today brought up a lot of Haiti emotions and questions for me. Somehow Haiti and all the things it has taught me keeps sneaking up on me, but I think this is showing me how it's important to take time to process powerful events - whether that event is working in the mountains of Haiti, caring for a special patient in Iowa or Vermont/ New Hampshire, or committing to helping marginalized populations in inner City Boston, Chicago, or worldwide. And I think this is something I neglected to do a few months ago when I found out about how my special patient from this summer wouldn't be there the next time I visited Les Cayes or Les Anglais:
I found out from Dr. Abby about Baby Joseph's death the night of my Term 1 finals and so naturally I did what any medical person feels they have to - briefly let it register and then push it to the back of my mind and continue on with my studies, because at the end of the day I need to learn all this material to pass. To graduate. To get the end result of a medical career in global health... But when I drove through Port au Prince 4 weeks ago on my way to La Digue and Arcahaie, a wave of emotions hit me out of left field. The same feeling I had today sitting through this lecture presentation. So "Renal Hearts and Minds" lecture met it's goal - of connecting our hearts with our minds... It got the emotions running and got me thinking about how to do it better. Obviously intensely pouring resources into one mother and baby situation wasn't the solution. Sure it was heart-felt and well-intentioned. But it wasn't intentional or sustainable. Why does Haiti have the highest infant and maternal mortality rates in the Western Hemisphere? Why is it that despite all these blan caring about individual Baby Joseph's and their moms, the rates aren't getting dramatically better? What's the most sustainable way to build community-wide infant and maternal health systems? Now the dilemma is finding the answers to all of these questions. I think the NGO, Community Health Initiative explains it best - we, I, will keep asking questions, stay up late ordering medical supplies and answering classmates questions, skip weeks of class to check on primary care clinic patients, remember those special patients, and work on community empowerment, so that simple things, like insulin and maternal health care, don't have to be considered miracles or reserved only for "the haves" group... We will keep intentionally, sustainably, continuing onward, "Until the Work is Done..."
Friday, January 31, 2014
Wednesday, August 28, 2013
C'est Ayiti
This weekend I have begun preparing for trip reports and presentations. I am finishing up my blog and trying to wrap up the last of my summer research data collection. This weekend, I tried to explain to a few friends what living in Haiti for the summer was really like. Fortunately, I am blessed with some great friends up here at Dartmouth. Both were patient and understanding when at certain topics and during certain stories I was at a loss for words. After all, for the last 3 weeks each time someone asked me "So how was Haiti?" I found myself giving the same, automatic, one-word reply "Good." I think that's because I am slowly realizing just how hard it is to put Haiti into words. To truly explain to someone who has never been there, what living in Haiti (even if it's just for a few short weeks) is really like. And even when I can find the words to describe my favorite (and not so appreciated) parts of Haiti, I am hesitant to share. I think that's because I also realize that not everyone is capable of listening to my stories and summer thoughts in the way that I need them to. A piece of advice I gave to all new volunteers that I worked with in Les Anglais this summer was to call me if they ever needed someone to talk to, but more importantly if they needed someone just to listen. Because as Dr. Abby put it so perfectly - not everyone understands and many aren't at that point to listen in the way that you need them to.
So for my last blog post I am going to try my hardest to explain how I see Haiti and how I see my summer now that I have had 3 weeks to reflect on and process it. When I tell you that Les Cayes, Haiti is a place that would often reach 120+ degrees F with heat index, you might ask - why would anyone ever want to live there? Sure there were days I was drenched in sweat, when I thought between the air conditioners at the hospital breaking and my wearing scrubs (which in case you are wondering - yes whoever invented scrubs clearly never worked in the tropics), I was surely going to pass out. Yes in my first week I got burnt by getting off a motorcycle (moto) taxi the wrong way and because I didn't have bandaids, I got creative on how to treat my own burn. Sure my apartment was bug infested. And yes, until the heaven-sent Les Anglais team brought me bug spray hand outs, there were night where I would swat bugs off me, until I became too tired and then I would just let the bugs (fleas, ticks, other louse family members?) crawl on me as I fell asleep. Sure there was the time (after a few weeks of mostly 2 meals of lots of rice each day) that I missed American cereal so much that even though the bowl had a handful of ants swimming in it, I ate it - ants and all (extra protein?). And of course, there were those weeks at the hospital and clinic where I saw more death and disease burden, than many might see in their lifetime.
But if those were the only parts you take away from my stories, then you forget that Haiti is so much more than that to me. It's more than the buggy, beans and rice (ok so mostly just rice) filled days. It's more than sending patients home with nothing more than bad news and a "sorry, nothing I can do." It's also been a summer where I hiked through beautiful rainforest, climbed part way up mountains, and relaxed on the beach. I got to cliff jump into the Caribbean. I learned how to dance compa when the doctors from HIC took me out to the discotheques on the weekends. I rode enough moto taxis that by the end of the summer I was riding them like a true Haitian - sitting sideways in a skirt and sans helmet of course. I was able to attend a wedding, a graduation, a wedding anniversary celebration, and sadly, a funeral visitation. But, best of all, I became a part of a wonderful Haitian family (see post on "Saying Good-Bye to Family"). I experienced so much in just 7 weeks, that it's hard to share all of my stories in my blog. And the overall experience? It was joyful and frustrating and sad and wonderful and miserable all at the same time. That's when I realized why it's been so hard for me to describe Haiti to someone who has never lived there for a bit. Because Haiti is so many different things at once.
There were certain situations that happened at HIC hospital that would leave the nurses and doctors that worked there at loss for words. Situations, sometimes unimaginable to those of us who live this sheltered life in the states. And when the nurses and doctors didn't have a good reason for why the situation happened, they would turn and look at one another, shrug, and say "C'est Ayiti." Yes, indeed, "This is Haiti." So I think from now on, when people ask me how my summer trip was and I am not ready to give the long answer, the one full of stories - good, bad, unimaginable - or I don't think they are ready to hear it, I think I will just tell them the truth. How was living in Haiti? "C'etait Ayiti." "It was Haiti..."
So for my last blog post I am going to try my hardest to explain how I see Haiti and how I see my summer now that I have had 3 weeks to reflect on and process it. When I tell you that Les Cayes, Haiti is a place that would often reach 120+ degrees F with heat index, you might ask - why would anyone ever want to live there? Sure there were days I was drenched in sweat, when I thought between the air conditioners at the hospital breaking and my wearing scrubs (which in case you are wondering - yes whoever invented scrubs clearly never worked in the tropics), I was surely going to pass out. Yes in my first week I got burnt by getting off a motorcycle (moto) taxi the wrong way and because I didn't have bandaids, I got creative on how to treat my own burn. Sure my apartment was bug infested. And yes, until the heaven-sent Les Anglais team brought me bug spray hand outs, there were night where I would swat bugs off me, until I became too tired and then I would just let the bugs (fleas, ticks, other louse family members?) crawl on me as I fell asleep. Sure there was the time (after a few weeks of mostly 2 meals of lots of rice each day) that I missed American cereal so much that even though the bowl had a handful of ants swimming in it, I ate it - ants and all (extra protein?). And of course, there were those weeks at the hospital and clinic where I saw more death and disease burden, than many might see in their lifetime.
But if those were the only parts you take away from my stories, then you forget that Haiti is so much more than that to me. It's more than the buggy, beans and rice (ok so mostly just rice) filled days. It's more than sending patients home with nothing more than bad news and a "sorry, nothing I can do." It's also been a summer where I hiked through beautiful rainforest, climbed part way up mountains, and relaxed on the beach. I got to cliff jump into the Caribbean. I learned how to dance compa when the doctors from HIC took me out to the discotheques on the weekends. I rode enough moto taxis that by the end of the summer I was riding them like a true Haitian - sitting sideways in a skirt and sans helmet of course. I was able to attend a wedding, a graduation, a wedding anniversary celebration, and sadly, a funeral visitation. But, best of all, I became a part of a wonderful Haitian family (see post on "Saying Good-Bye to Family"). I experienced so much in just 7 weeks, that it's hard to share all of my stories in my blog. And the overall experience? It was joyful and frustrating and sad and wonderful and miserable all at the same time. That's when I realized why it's been so hard for me to describe Haiti to someone who has never lived there for a bit. Because Haiti is so many different things at once.
There were certain situations that happened at HIC hospital that would leave the nurses and doctors that worked there at loss for words. Situations, sometimes unimaginable to those of us who live this sheltered life in the states. And when the nurses and doctors didn't have a good reason for why the situation happened, they would turn and look at one another, shrug, and say "C'est Ayiti." Yes, indeed, "This is Haiti." So I think from now on, when people ask me how my summer trip was and I am not ready to give the long answer, the one full of stories - good, bad, unimaginable - or I don't think they are ready to hear it, I think I will just tell them the truth. How was living in Haiti? "C'etait Ayiti." "It was Haiti..."
Dr. Cleonas, of course showing me up and working harder than me, even on my last day at HIC :)
He was a great mentor. As for the doctor and pharmacist below. They were so much fun to work with and I miss them both already. They took me under their wing and showed me how great living in Les Cayes can be.
Miss Neptune ran a tight ship at the clinic at HIC, but she and I got along very well. I respect her for how organized she kept the clinic and how at the end of the day, while she was tough on her employees, it was because she really cared about the patients.
And then of course there is this little guy. My summer in Haiti definitely wouldn't have been the same without Baby Joseph.
Saying Good-Bye to Family
Even though the transition from Port au Prince to Boston in a day was hard, the hardest transition for me, surprisingly, was when I had to leave Les Cayes for Port au Prince. I took a morning bus ("transport chic") to Port au Prince to stay in a nice guest house in Village Theodat. Village Theodat is located very close to the airport, and I knew that with a Saturday morning flight to Miami, I didn't want to risk driving from Les Cayes early in the morning, get stuck in standstill traffic in PAP, and miss my flight. The bus ride experience was great (see post "Tout Moun Se Moun") and I really didn't mind the long wait at the bus stop (my driver who was picking me up got stuck in Port au Prince's notorious traffic) - I think Haiti, by operating on tropical time, made me a bit more patient and go-with-the-flow.
The part after the bus stop is what was hardest.
Village Theodat is not like the rest of Haiti that I had come to know during my summer stay. It has beautiful guesthouses, with multiple stories - all with new tile, huge kitchens - that serve 3 meals a day - lawns with pretty flowers that are watered regularly. All of this sits inside a nice gated and guarded community. The gated community probably houses more expats and visiting mission teams than it does Haitians. And so, in a way, when I traveled to Village Theodat on that Friday, I felt like I had traveled all the way back to the states.
I say this, because I think it's important that if I wrote about my summer stay and what I learned while living in Haiti, I should also write about my experience of leaving Haiti. I feel that by writing about what I experienced while leaving Haiti, shows yet another handful of lessons I learned from Haiti. Also, I think this post might be an important learning tool for others who have or are considering visiting Haiti. I want them to know that Village Theodat, with its manicured lawns and fancy guest houses, complete with cool, well-ventilated rooms, is not the real Haiti. And if this is the only part of Haiti that one experiences, then they are missing out on some of the best (and my personal favorite) parts of Haiti.
Like the part where you become fully integrated into the local Haitian society. Where Haitians are no longer "people you have come to help," but are your co-workers, your patients, your coffee and mango and Sprite suppliers, your moto taxi drivers, your friends, and best of all, your family. I have visited Haiti before. I have attended Haitian church services, I have heard Haitian patients' stories. But never before have I got the blessing of becoming part of Haiti. Thursday night as I prepped for my Friday departure to PAP, Edward and Djeune surprised me by treating me to dinner at a local restaurant on the beach. Then they took me to the hospital so I could spend an hour cuddling with and saying good-bye (for now) to Baby Joseph. During that hour, one of my favorite nurses came up to me and told me "I can tell you love him a lot." Really, the nurses and my Haitian family were not making the saying good-bye part any easier. I told her how I had to leave the next morning, because sadly in order to pass medical school, I had to go back and start my 2nd year of classes. She tried to convince me just to take him with me. I told her how he already had a mom, that I was a student and unfit to provide him with a home in the states. She accepted my "C'est complique" finally. I thanked her and the other nurses for all they had done for me and Baby Joseph. We exchanged hugs and then she went back to work (partly I think because she didn't want me to see that she was tearing up a bit - proof once again that "Tout Moun Se Moun"). Eddie arrived with the Land Rover, so I said my last good-byes to Baby Joseph and Mom. I told her that Pastors Brian & Yivonne would be there to talk to her and that when she gets home Hypole would check in on them. I told her I would receive updates on them and that the next time I get a chance to get back to Les Anglais, I would come visit their family and catch up. She seemed a bit reassured by that, but I could tell she and I both felt a bit nervous at leaving such a large burden (of taking care of a sick baby like Baby Joseph in such a resource poor situation) up to one person - her. We exchanged hugs, and then I headed home to pack.
The family and I exchanged good-byes and logistics about my early-morning departure over a cake I had purchased as a thank you. The very-asleep boys even got up so they could say good-bye (and of course because they heard the words cake). I packed and looked through summer pictures and packed some more. The morning arrived quick and I was reminded once again how spoiled I was - Leila, the servant, had gotten up early to make me hard boiled eggs, bread, and coffee so I could have breakfast before I left. I gave her a big hug, and even though she was tough woman, I managed to get a true smile and a "Good-bye Cherie" out of her. Edward drove me to the bus station and along the way we chatted about my summer. He told me that he was sad that I was leaving because Lance (the youngest of my Haitian brothers) was a picky eater before I got there and by the end of the summer he would clean his plate because he "wanted to be just like Christine." Seriously, they weren't making my saying good-bye any easier. He helped me get checked in at the bus stop and we said our final good-byes.
Again, Edward continued to do a good job at being my Haitian Dad by providing me with some more last-minute wisdom. When I said my good-bye, he smirked and said he didn't need to say good-bye, because he knew me well enough to know that I would be back to Les Cayes before long. And when I did, that I would always be welcomed to stay with my Haitian family. I think that was one of the neatest parts about my entire stay this summer. That I now have a second family. I say have and not "had" because I think Eddie is right. The best part about family, is that while it's tough to leave, you never really say good-bye to family. Because even though I am back in the states now and Edward, Djeune, the boys, and Lidi are still in Les Cayes, we are still in touch (via email) and there is the understanding that whenever I feel the need to head back to Haiti, I will always have a second home waiting for me.
The part after the bus stop is what was hardest.
Village Theodat is not like the rest of Haiti that I had come to know during my summer stay. It has beautiful guesthouses, with multiple stories - all with new tile, huge kitchens - that serve 3 meals a day - lawns with pretty flowers that are watered regularly. All of this sits inside a nice gated and guarded community. The gated community probably houses more expats and visiting mission teams than it does Haitians. And so, in a way, when I traveled to Village Theodat on that Friday, I felt like I had traveled all the way back to the states.
I say this, because I think it's important that if I wrote about my summer stay and what I learned while living in Haiti, I should also write about my experience of leaving Haiti. I feel that by writing about what I experienced while leaving Haiti, shows yet another handful of lessons I learned from Haiti. Also, I think this post might be an important learning tool for others who have or are considering visiting Haiti. I want them to know that Village Theodat, with its manicured lawns and fancy guest houses, complete with cool, well-ventilated rooms, is not the real Haiti. And if this is the only part of Haiti that one experiences, then they are missing out on some of the best (and my personal favorite) parts of Haiti.
Like the part where you become fully integrated into the local Haitian society. Where Haitians are no longer "people you have come to help," but are your co-workers, your patients, your coffee and mango and Sprite suppliers, your moto taxi drivers, your friends, and best of all, your family. I have visited Haiti before. I have attended Haitian church services, I have heard Haitian patients' stories. But never before have I got the blessing of becoming part of Haiti. Thursday night as I prepped for my Friday departure to PAP, Edward and Djeune surprised me by treating me to dinner at a local restaurant on the beach. Then they took me to the hospital so I could spend an hour cuddling with and saying good-bye (for now) to Baby Joseph. During that hour, one of my favorite nurses came up to me and told me "I can tell you love him a lot." Really, the nurses and my Haitian family were not making the saying good-bye part any easier. I told her how I had to leave the next morning, because sadly in order to pass medical school, I had to go back and start my 2nd year of classes. She tried to convince me just to take him with me. I told her how he already had a mom, that I was a student and unfit to provide him with a home in the states. She accepted my "C'est complique" finally. I thanked her and the other nurses for all they had done for me and Baby Joseph. We exchanged hugs and then she went back to work (partly I think because she didn't want me to see that she was tearing up a bit - proof once again that "Tout Moun Se Moun"). Eddie arrived with the Land Rover, so I said my last good-byes to Baby Joseph and Mom. I told her that Pastors Brian & Yivonne would be there to talk to her and that when she gets home Hypole would check in on them. I told her I would receive updates on them and that the next time I get a chance to get back to Les Anglais, I would come visit their family and catch up. She seemed a bit reassured by that, but I could tell she and I both felt a bit nervous at leaving such a large burden (of taking care of a sick baby like Baby Joseph in such a resource poor situation) up to one person - her. We exchanged hugs, and then I headed home to pack.
The family and I exchanged good-byes and logistics about my early-morning departure over a cake I had purchased as a thank you. The very-asleep boys even got up so they could say good-bye (and of course because they heard the words cake). I packed and looked through summer pictures and packed some more. The morning arrived quick and I was reminded once again how spoiled I was - Leila, the servant, had gotten up early to make me hard boiled eggs, bread, and coffee so I could have breakfast before I left. I gave her a big hug, and even though she was tough woman, I managed to get a true smile and a "Good-bye Cherie" out of her. Edward drove me to the bus station and along the way we chatted about my summer. He told me that he was sad that I was leaving because Lance (the youngest of my Haitian brothers) was a picky eater before I got there and by the end of the summer he would clean his plate because he "wanted to be just like Christine." Seriously, they weren't making my saying good-bye any easier. He helped me get checked in at the bus stop and we said our final good-byes.
Again, Edward continued to do a good job at being my Haitian Dad by providing me with some more last-minute wisdom. When I said my good-bye, he smirked and said he didn't need to say good-bye, because he knew me well enough to know that I would be back to Les Cayes before long. And when I did, that I would always be welcomed to stay with my Haitian family. I think that was one of the neatest parts about my entire stay this summer. That I now have a second family. I say have and not "had" because I think Eddie is right. The best part about family, is that while it's tough to leave, you never really say good-bye to family. Because even though I am back in the states now and Edward, Djeune, the boys, and Lidi are still in Les Cayes, we are still in touch (via email) and there is the understanding that whenever I feel the need to head back to Haiti, I will always have a second home waiting for me.
The family celebration for Edward and Djeune's 5th wedding anniversary. The photos tell the story so well - they were some of the sweetest people I have ever met.
Why is Peak Macaya Haiti's Last Remaining Cloud Forest?
My last weekend in Haiti was a 4 day weekend. Dr. Robin and I decided to take advantage of the four day weekend by visiting Peak Macaya. If Carnival des Fleurs meant both of our clinic's would be closed, we weren't going to waste our time sitting at home. She took care of all of the details - her driver, Robinson, would take us in the Land Rover. We would leave early in hopes of getting up to the base camp in the national park and fitting a good hike in before coming back down the mountain and heading home to Port Salut by nightfall. That way I could go on the adventure, but also get to go to the mobile HIV clinic in Les Anglais that happened on Monday. Having survived this adventure, I have a feeling I will think twice next time Dr. Robin offers to take me on an excursion. Her adventures are not for the faint of heart.
There were a handful of times when the vehicle was climbing up the mountain that I was pretty sure we were going to roll down the side of the mountain to our doom. It now makes sense to me why only about 4 groups of non-locals visit Peak Macaya annually. The drive up the mountainside was enough to convince me that was my first, but only, time I will be visiting Haiti's last remaining cloud forest.
However, once we reached base camp, I will admit now to Dr. Robin that the pee-your-pants drive up the ridge was worth it. It was like taking a walk into the past - getting to see what Haiti used to be and could be again if we begin to work on the deforestation issue now. Our first stop, before base camp, was Citadel (fort) platoon (spelling?). Unlike the other Citadels around Haiti that have become much more tourist-based and refurbished, this fort seems to have been essentially untouched since it was used during the Haitian Revolution in at the beginning of the 19th century. During the slave revolt, the Haitians had it so well engineered that many of the bunkers within the fort have secret passageways and escape routes. However, after being thankful for surviving the drive up the mountain, Dr. Robin and I decided to leave secret passageway exploring to those who are truly adventurous and moved on (via another bone jarring 2 hour ride) to base camp.
I could now spend the rest of this post telling you about how we only made it part way up the mountain - it's a 2 day hike to summit. We could talk about how ridiculous Dr. Robin, Mark, Olga, and I looked arriving with zero camping supplies or food - we paid our tour guide and his wife to rent two tents from them and have a prepared dinner. We could talk about how much I enjoyed getting to camp overnight, even though it meant I needed to miss participating in the one day HIV clinic in Les Anglais the following day. Or how the tour guide welcomed us into their home and made us feel like family. And even though I can't remember his or his wife's name now, it's so nice knowing how should I ever decide to explore Peak Macaya again, I will have a place to stay before beginning my hike. I could tell patient stories from our mobile clinic that Dr. Robin ran that evening once we realized that many of the people in the town had never seen a doctor in their life - after all, it's 3+ hour drive down the mountain to Cayes. Who knows how long the walk would be.
But instead, I would like to spend a paragraph contemplating and asking you why Peak Macaya has to be Haiti's last remaining cloud forest. Why a country that used to be green and lush and full of tropical rainforest now looks like a dessert. Sure, I understand that many Haitians rely on charcoal from the logging industry and charcoal factories to use for cooking because gas stoves are too expensive. And yes, I understand that if a family living in poverty has to worry about growing crops to provide for themselves, their last concern would be going green and planting a bunch of trees. But then I watched the CNN videos below and realized that deforestation and desertification doesn't have to be the final chapter in Haiti's agronomical history. That there are ways to not only stimulate enthusiasm, but also local economies by getting Haitians to plant more trees. That once locals realize that their agricultural production will increase, that they can chop down half of the trees they plant and make money, but still keep 50% there for helping the local environment, once there is increased awareness that everyone benefits, things will start to change. However, it's going to take more effort, more education, and of course more trees. During a recent conversation with a classmate, we were joking about how NGO's could start helping in more valuable ways. I suggested that instead of bringing down old clothes, next time a volunteer arrives in Haiti, they should bring a little tree to plant. And while at the time it was a joke, maybe now I am thinking that wouldn't be such a bad idea...
http://edition.cnn.com/video/data/2.0/video/world/2013/07/04/going-green-haiti-planting-trees.cnn.html
http://www.cnn.com/video/?/video/world/2013/07/05/going-green-haiti-trees-flooding.cnn&iref=videosearch
There were a handful of times when the vehicle was climbing up the mountain that I was pretty sure we were going to roll down the side of the mountain to our doom. It now makes sense to me why only about 4 groups of non-locals visit Peak Macaya annually. The drive up the mountainside was enough to convince me that was my first, but only, time I will be visiting Haiti's last remaining cloud forest.
However, once we reached base camp, I will admit now to Dr. Robin that the pee-your-pants drive up the ridge was worth it. It was like taking a walk into the past - getting to see what Haiti used to be and could be again if we begin to work on the deforestation issue now. Our first stop, before base camp, was Citadel (fort) platoon (spelling?). Unlike the other Citadels around Haiti that have become much more tourist-based and refurbished, this fort seems to have been essentially untouched since it was used during the Haitian Revolution in at the beginning of the 19th century. During the slave revolt, the Haitians had it so well engineered that many of the bunkers within the fort have secret passageways and escape routes. However, after being thankful for surviving the drive up the mountain, Dr. Robin and I decided to leave secret passageway exploring to those who are truly adventurous and moved on (via another bone jarring 2 hour ride) to base camp.
I could now spend the rest of this post telling you about how we only made it part way up the mountain - it's a 2 day hike to summit. We could talk about how ridiculous Dr. Robin, Mark, Olga, and I looked arriving with zero camping supplies or food - we paid our tour guide and his wife to rent two tents from them and have a prepared dinner. We could talk about how much I enjoyed getting to camp overnight, even though it meant I needed to miss participating in the one day HIV clinic in Les Anglais the following day. Or how the tour guide welcomed us into their home and made us feel like family. And even though I can't remember his or his wife's name now, it's so nice knowing how should I ever decide to explore Peak Macaya again, I will have a place to stay before beginning my hike. I could tell patient stories from our mobile clinic that Dr. Robin ran that evening once we realized that many of the people in the town had never seen a doctor in their life - after all, it's 3+ hour drive down the mountain to Cayes. Who knows how long the walk would be.
But instead, I would like to spend a paragraph contemplating and asking you why Peak Macaya has to be Haiti's last remaining cloud forest. Why a country that used to be green and lush and full of tropical rainforest now looks like a dessert. Sure, I understand that many Haitians rely on charcoal from the logging industry and charcoal factories to use for cooking because gas stoves are too expensive. And yes, I understand that if a family living in poverty has to worry about growing crops to provide for themselves, their last concern would be going green and planting a bunch of trees. But then I watched the CNN videos below and realized that deforestation and desertification doesn't have to be the final chapter in Haiti's agronomical history. That there are ways to not only stimulate enthusiasm, but also local economies by getting Haitians to plant more trees. That once locals realize that their agricultural production will increase, that they can chop down half of the trees they plant and make money, but still keep 50% there for helping the local environment, once there is increased awareness that everyone benefits, things will start to change. However, it's going to take more effort, more education, and of course more trees. During a recent conversation with a classmate, we were joking about how NGO's could start helping in more valuable ways. I suggested that instead of bringing down old clothes, next time a volunteer arrives in Haiti, they should bring a little tree to plant. And while at the time it was a joke, maybe now I am thinking that wouldn't be such a bad idea...
http://edition.cnn.com/video/data/2.0/video/world/2013/07/04/going-green-haiti-planting-trees.cnn.html
http://www.cnn.com/video/?/video/world/2013/07/05/going-green-haiti-trees-flooding.cnn&iref=videosearch
After we finally made it to the top of one of the less-fun ridges to drive up. We stopped and got out of the land rover to kiss the ground. What amazed me most was how red the soil was. I wonder if that's how all of Haiti was before all the deforestation and erosion happened.
The 4 photos below are all of Citadel (Fort) Platoon. Any history buffs would have loved to see all the remnants of how the Citadel must have been 200 years ago during the Haitian War for Independence.
These bunkers were the ones that supposedly had secret passageways associated with them. Maybe we will save that adventure for a return trip to Peak Macaya. Then again, probably not...
The 4 photos below are all of Citadel (Fort) Platoon. Any history buffs would have loved to see all the remnants of how the Citadel must have been 200 years ago during the Haitian War for Independence.
This photo above, for some reason, kept reminding me of a scene from Jurassic Park. I kept waiting for a little dinosaur to be feeding behind one of the large boulders.
The benefit of the scary drive - even at base camp we could see the entire plain that Cayes was situated on. We could even see all the way to the ocean :)
Per usual - USAID started spending money and then didn't follow through. This building was supposed to function as housing for agronomists and national forest protection reserves. Instead, it sits there abandoned because they never finished it. This is why I am thankful the roads one has to take to get to Peak Macaya are so bad. I know that the day an easy-to-drive-up road is built, the logging companies will start to chop away at the 2% of rainforest Haiti has left.
Below is a photo of our rainforest tour guide. He chopped through the path with his nice little machete and knew that cloud forest like the back of his hand. I was very impressed. He is standing by a natural spring. He promised us it was clean and we could rehydrate if we were thirsty. So of course Dr. Robin and I made him drink from it first. Once we confirmed that he didn't drop dead from it instantly, we too drank from it. And as far as we know neither of us suffered from any severe intestinal irritability :)
When I asked him if I could show his photo with people back home, he said of course. He told me he would love it if I told more people about Peak Macaya. He thinks the people from the town at the base camp, where he lived, could really benefit from adventure tourists visiting and stimulating the local economy - after all, Dr. Robin, Olga, Mark, and I saw a lot of malnutrition in our one evening of mobile clinic there. So as promised, I hope you all can now see how beautiful and adventurous Haiti's last remaining cloud forest is.
Sunday, August 25, 2013
Where Should All the Orphans Go?
Throughout different points of my summer I have had small conversations with different groups, volunteers, blans, and Haitians about the new policy in Haiti concerning the Hague Convention. In the recent months, Haiti has started tightening its rules on orphanage standards and creating more regulations for international adoptions. Since medical work in Haiti is more my area of familiarity, whenever I met groups working in Haiti on orphanage projects, I asked for their input on the topic of the rules. In order to start complying with international standards for orphanages and adoptions set at the Hague Convention, Haiti has been cracking down to try to close all orphanages that are in poor condition. I wanted to know from groups and long-term volunteers if they thought this was good, bad, possible?
What's been interesting is that several groups I chatted with didn't know that the Hague Convention existed. Some didn't realize (as I didn't when I first started working in Haiti a couple years ago) that many orphans in Haiti are not true orphans at all. Many are poverty orphans - given up by their parents - in hopes that the child can receive free schooling and a couple of good meals each day. And this makes the situation even more complicated. How can couples abroad really know that their adopted child is a true orphan and not a poverty orphan? How can they know if they are giving a parentless child, a chance to have parents, or if they are actually taking this child away from their parents, and their country?
As was the theme for my last couple of weeks in Haiti, one of the best pieces of advice on the subject came from a wise pediatrician from Port Salut. She finally made me think about the importance of building trusting relationships during childhood development. And how when each week there is a different team of blan coming to play with the girls and boys at the orphanage it becomes tough for the children to learn from example, how to be in a loving, trusting relationship. After all, many of us learned how to trust others because of what our parents provided for us. We knew that if we were hungry, mom or dad would fix us a peanut butter and jelly at 10pm if we needed it. Or if we couldn't sleep at night and were scared, we knew where their bedroom was to go wake them up and ask to be tucked in again. If teams come and go, then where are these children's constants?
I think my Haitian Dad, Eddy, had it right. When I found out that he didn't allow international adoption out of his orphanage, only local adoptions, I was surprised. Apparently when a NGO from the US agreed to help him build the orphanage, he said, "Okay, but people will only come here to help the girls at the center to receive food, clothes, and an education. There will be no international adoption, because taking the children away to America, that doesn't help fix Haiti." I think Eddy's viewpoint is very mature. When there is a problem, the best way to fix the problem is to face it. To work towards making the situation better, not by running away. If the girls at the center received an education, learned english, science, music, and a trade and then were adopted out because they were poverty orphans, that doesn't change Haiti. That only means Haiti has one less person in it. So Eddy makes a great point - how can we empower future generations to work towards building a stronger economy and a more educated generation?
In my vision for Haiti - perfect would be that there would be no need for a ton of orphanages in the future because there would be no poverty orphans. Good would be that orphanages across Haiti switch to my Haitian dad, Eddy,'s model. That international adoption is left for children who are true orphans. And that those children who are true orphans are put into a loving home, where the parents try to incorporate Haitian culture into the child's upbringing. And sadly, bad is the model I saw all too often in my 7 weeks in Haiti - team after team coming through to "visit orphans and play games with them for a week." Without any intention of teaching the girls and boys a trade, without teaching them science and math or english so they could attend a higher education possibly one day. So they could have the chance possibly at having a paying job once they turned 18 and their parents could no longer rely on the orphanage to supply them with a couple of meals a day, some clothes, and a chance at some sort of an education. Worst - that would be some of the orphanages that the government is working to shut down. Ones where people are making a small fortune by charging a lot for international adoption of children who aren't true orphans. Ones where the conditions are bad enough, I wouldn't send my roommate's and my dog there to live.
I am sure some of this criticism is hypocritical. I am sure that there have been many times in my work in Haiti that I have done more harm than good. And I know plenty of adoption cases from Haiti that were done right. Where the whole family is supported (not just the adopted child) by the parents from the states. Where the child goes back to Haiti regularly to visit their first set of parents. But I am going to challenge anyone reading this post, anyone who has worked or is thinking about working in Haiti, especially in orphanages, to investigate their motives for working there. If one is truly interested in working to fix the problem of "Where Should All the Orphans Go?" then they need to ask themselves if they are going to Haiti to truly help to resolve the problem or if they are going to make themselves feel good? Because one week of "playing with and visiting orphans" just like a one-time dose of anti-hypertensive meds for a Haitian patient doesn't really ever change the real problem.
http://www.nytimes.com/2012/12/05/world/americas/campaign-in-haiti-to-close-orphanages.html?pagewanted=all&_r=1&
What's been interesting is that several groups I chatted with didn't know that the Hague Convention existed. Some didn't realize (as I didn't when I first started working in Haiti a couple years ago) that many orphans in Haiti are not true orphans at all. Many are poverty orphans - given up by their parents - in hopes that the child can receive free schooling and a couple of good meals each day. And this makes the situation even more complicated. How can couples abroad really know that their adopted child is a true orphan and not a poverty orphan? How can they know if they are giving a parentless child, a chance to have parents, or if they are actually taking this child away from their parents, and their country?
As was the theme for my last couple of weeks in Haiti, one of the best pieces of advice on the subject came from a wise pediatrician from Port Salut. She finally made me think about the importance of building trusting relationships during childhood development. And how when each week there is a different team of blan coming to play with the girls and boys at the orphanage it becomes tough for the children to learn from example, how to be in a loving, trusting relationship. After all, many of us learned how to trust others because of what our parents provided for us. We knew that if we were hungry, mom or dad would fix us a peanut butter and jelly at 10pm if we needed it. Or if we couldn't sleep at night and were scared, we knew where their bedroom was to go wake them up and ask to be tucked in again. If teams come and go, then where are these children's constants?
I think my Haitian Dad, Eddy, had it right. When I found out that he didn't allow international adoption out of his orphanage, only local adoptions, I was surprised. Apparently when a NGO from the US agreed to help him build the orphanage, he said, "Okay, but people will only come here to help the girls at the center to receive food, clothes, and an education. There will be no international adoption, because taking the children away to America, that doesn't help fix Haiti." I think Eddy's viewpoint is very mature. When there is a problem, the best way to fix the problem is to face it. To work towards making the situation better, not by running away. If the girls at the center received an education, learned english, science, music, and a trade and then were adopted out because they were poverty orphans, that doesn't change Haiti. That only means Haiti has one less person in it. So Eddy makes a great point - how can we empower future generations to work towards building a stronger economy and a more educated generation?
In my vision for Haiti - perfect would be that there would be no need for a ton of orphanages in the future because there would be no poverty orphans. Good would be that orphanages across Haiti switch to my Haitian dad, Eddy,'s model. That international adoption is left for children who are true orphans. And that those children who are true orphans are put into a loving home, where the parents try to incorporate Haitian culture into the child's upbringing. And sadly, bad is the model I saw all too often in my 7 weeks in Haiti - team after team coming through to "visit orphans and play games with them for a week." Without any intention of teaching the girls and boys a trade, without teaching them science and math or english so they could attend a higher education possibly one day. So they could have the chance possibly at having a paying job once they turned 18 and their parents could no longer rely on the orphanage to supply them with a couple of meals a day, some clothes, and a chance at some sort of an education. Worst - that would be some of the orphanages that the government is working to shut down. Ones where people are making a small fortune by charging a lot for international adoption of children who aren't true orphans. Ones where the conditions are bad enough, I wouldn't send my roommate's and my dog there to live.
I am sure some of this criticism is hypocritical. I am sure that there have been many times in my work in Haiti that I have done more harm than good. And I know plenty of adoption cases from Haiti that were done right. Where the whole family is supported (not just the adopted child) by the parents from the states. Where the child goes back to Haiti regularly to visit their first set of parents. But I am going to challenge anyone reading this post, anyone who has worked or is thinking about working in Haiti, especially in orphanages, to investigate their motives for working there. If one is truly interested in working to fix the problem of "Where Should All the Orphans Go?" then they need to ask themselves if they are going to Haiti to truly help to resolve the problem or if they are going to make themselves feel good? Because one week of "playing with and visiting orphans" just like a one-time dose of anti-hypertensive meds for a Haitian patient doesn't really ever change the real problem.
http://www.nytimes.com/2012/12/05/world/americas/campaign-in-haiti-to-close-orphanages.html?pagewanted=all&_r=1&
Some of the buildings at Eddy's orphanage and the beautiful view surrounding it.
Friday, August 2, 2013
Tout Moun Se Moun
The other day an American asked me if I felt safe living here in Haiti. Even though this person was visiting on a short 1 week, large blan team trip - they wanted to know how it's been different living here alone; living completely surrounded by Haitians and embedded in Haitian culture. I remembered a saying Dr. Chris once told me: "Tout Moun Se Moun" - We are all human beings or literally "Everyone is someone." So sorry Dr. Chris to steal your thunder and wisdom surrounding the Haitian proverb, but your thoughts on the subject were so good, I had to make them the title of this blog post.
Today as I slowly started my journey back to the developed world, there was a cute situation that made this Haitian Creole phrase ring very true for me. I took Transport Chic (a high end tap tap/ transport bus) from Cayes to Port au Prince. Note to self - if I ever need to travel from PAP to Cayes again I never will need a driver! For only $10 US I made the four hour+ trip and all of my suitcases were safely guarded on the roof. When our bus load got dropped off at the station in downtown Port au Prince, I realized it was going to be awhile for the guest-house driver to pick me up. Traffic in the capital, per usual, was awful. A little old woman and I befriended one another. She put her suitcases by mine and we shared a few words in Creole. We agreed to help one another keep watch over our belongings - while she went to rest on a bench in the shade and while I went to get an iced 7-Up. At one point during my turn watching our belongings in the sun, she told me "Cherie (Dear), I can watch our bags for awhile if you want to go sit in the shade." I explained to her how I live up north and was soaking in every last ounce of sun I could. She laughed and we joked about how she wanted to keep from getting darker and stay out of the sun, while I, as a blan, was the opposite.
Eventually, we maneuvered all of our things into the shade and sat together. She told me how her daughters lived in Port au Prince and they were going to pick her up, but were also running late. We chatted a bit more about our families and then her daughters arrived. She introduced me to them both, as if we were long-time friends. She asked where the grand-children were, and the cute excited exclamation she made when she found out she would get to see them once they got home made me smile. We said our good-byes and wished one another well on our respective journeys.
So while I sat there and waited a bit longer for my driver, I realized that it really is true: "Tout Moun Se Moun." No matter where you live in the world people are the same - they're people. They help one another out at bus stops. They share stories about family. They watch over one another's suitcases so one can cool off with an icy 7-Up. So to answer the question - "Do I feel safe here?" "Do you feel safe at home in the US?" Because if the answer to that question is yes, then you've already answered your own question. Because once one realizes they are the same question, I think that's when one really begins to understand the meaning of "Tout Moun Se Moun."
PS I really wish I had taken a photo of me surrounded by Haitian suitcases in the sun. Once some people saw me sitting on my suitcases at the bus stop, they started saying "Put your suitcase by the blan, it will be safe there." I thought it was funny - if I am safe enough to be considered a free security guard because nobody would dare hurt a blan, I think that really goes to show how safe I am here.
Today as I slowly started my journey back to the developed world, there was a cute situation that made this Haitian Creole phrase ring very true for me. I took Transport Chic (a high end tap tap/ transport bus) from Cayes to Port au Prince. Note to self - if I ever need to travel from PAP to Cayes again I never will need a driver! For only $10 US I made the four hour+ trip and all of my suitcases were safely guarded on the roof. When our bus load got dropped off at the station in downtown Port au Prince, I realized it was going to be awhile for the guest-house driver to pick me up. Traffic in the capital, per usual, was awful. A little old woman and I befriended one another. She put her suitcases by mine and we shared a few words in Creole. We agreed to help one another keep watch over our belongings - while she went to rest on a bench in the shade and while I went to get an iced 7-Up. At one point during my turn watching our belongings in the sun, she told me "Cherie (Dear), I can watch our bags for awhile if you want to go sit in the shade." I explained to her how I live up north and was soaking in every last ounce of sun I could. She laughed and we joked about how she wanted to keep from getting darker and stay out of the sun, while I, as a blan, was the opposite.
Eventually, we maneuvered all of our things into the shade and sat together. She told me how her daughters lived in Port au Prince and they were going to pick her up, but were also running late. We chatted a bit more about our families and then her daughters arrived. She introduced me to them both, as if we were long-time friends. She asked where the grand-children were, and the cute excited exclamation she made when she found out she would get to see them once they got home made me smile. We said our good-byes and wished one another well on our respective journeys.
So while I sat there and waited a bit longer for my driver, I realized that it really is true: "Tout Moun Se Moun." No matter where you live in the world people are the same - they're people. They help one another out at bus stops. They share stories about family. They watch over one another's suitcases so one can cool off with an icy 7-Up. So to answer the question - "Do I feel safe here?" "Do you feel safe at home in the US?" Because if the answer to that question is yes, then you've already answered your own question. Because once one realizes they are the same question, I think that's when one really begins to understand the meaning of "Tout Moun Se Moun."
PS I really wish I had taken a photo of me surrounded by Haitian suitcases in the sun. Once some people saw me sitting on my suitcases at the bus stop, they started saying "Put your suitcase by the blan, it will be safe there." I thought it was funny - if I am safe enough to be considered a free security guard because nobody would dare hurt a blan, I think that really goes to show how safe I am here.
Tuesday, July 30, 2013
Be Careful What You Wish For...
Thursday I got to take a few hour break from my medical record data collection to spend time with real patients. But instead of being super happy about getting to take part in patient's care, instead of feeling proud that I was helping patients navigate the hospital system here, I am feeling disappointed in myself. Again, Haiti continues to throw corny proverbs in my face that seem to be much truer here than in my sheltered life back in the states. I had hoped the whole week, last week, to get to sit down with more patients and hear their stories. I was hoping to get a few good case studies that I could use in my presentations when I get back home. I already have a few presentations scheduled and so I figured the infectious disease teams, medical students, and NGO volunteers back home would find walking through a patient case or two much more interesting than a bunch of medical record system data collection. I am not saying I was standing there with my fingers crossed that a bunch of sick HIV+ and TB-infected patients would have to come to the hospital last week. But if patients with severe conditions waltzed through the doors of HIC, I was ready. Questions set. Computer in hand, ready to take notes and photos.
And then my wish came true. Thursday, a very sick HIV+ baby was referred from Dr. Robin at Port Salut. Since she has become a new friend and a fellow blan working in Haiti, I told her I would sit with the mom and dad while they were admitted. I promised to take care of any questions they or the doctors and interns might have had about the baby's condition. And so I sat and listened to what the doctors had to say. And the more I listened, the more frustrated I became. They had me take the baby to go get a chest x-ray and while the pediatrician looked at the results, the interns took all of the vital signs. They listened to his chest. They asked the mom about the baby's symptoms. The more questions they asked, the more it became clear to me - they didn't read a word of referral chart that Dr. Robin had prepared for them, even though she took the time to write it in Creole for everyone. Baby had a bad pneumonia of some kind, was HIV+, and had O2 sats of 45% without oxygen (it improved when he was on oxygen). He needed oxygen, to be prophylactically treated for PCP pneumonia, and potentially other supportive care. Dr. Robin's clinic didn't have the ability to house inpatients because her clinic had just opened in November. So she sent him to me. But it was becoming clear to me that the doctors and interns were treating this baby like a new patient who just walked through the door, having never seen a doctor before. I showed them the papers again and explained, he needed oxygen. The doctor exclaimed - "non, pas maintenant." I questioned why he "didn't need oxygen now" and was told that he had a viral pneumonia and there was no need for oxygen. Hmm... so that's why I hear the baby grunting in respiratory distress? And peer-reviewed research has shown that even radiologists in the states, despite all their training, cannot accurately tell a viral pneumonia from a bacterial pneumonia. Yet, somehow with one look and a quick listen, this doctor tried to? I advocated some more for the patient, talked with the mom, and then left the hospital feeling like I was fighting a loosing battle.
Friday morning I tried my luck one more time. A different doctor told me the patient didn't need either bactrim or oxygen. He told me the patients O2 sats were probably 90%. "Hmm, really? Does your unit have an O2 saturation monitor?" "No." "Then how do you know his sats are 90%?" "I just know. They're probably 90%." So now we are magically guessing patient's vitals... Awesome. After Dr. Robin and I had a few different conversations Thursday night and Friday morning, it finally looked like the best option was to give baby and mom oxygen and transport them home to Port Salut. Their medicines would be delivered to their home, Dr. Robin's clinic staff would do home visits to check in, and we would hope for the best during our Sunday away at Peak Macaya. And so Friday I participated in the battle between the pediatricians at HIC, saying the baby was receiving appropriate care, and Dr. Robin, telling them what baby really needed. I normally try to blend in at HIC and not use phrases like "Well, in the US we would do it like this..." But Friday, I had to take Dr. Robin's and the patient's side. I knew if care would continue as it was, that the baby would not make it through the weekend. Heck, even if care turned around, he had been deprived of correct oxygenation for so long who knows what type of condition he would be in.
As if the HIV baby's care fiasco wasn't enough, Friday I found out that Baby Joseph and his mom were both diagnosed with TB. Luckily, one of the TB doctors I work with at the infectious disease clinic did a wonderful job of seeing them right away, as soon as Dr. Cleonas and I started to suspect it. It turns out that mom had TB in the past and now it's back in full swing. She received medicines in the past for TB, but I didn't have enough time before clinic closed to ask her if she stopped treatment early (it's the first item on my to-do list once clinic opens tomorrow).So my four-day weekend ends with feeling a little guilty for both patients - for not putting the incessant-cough-for-3-weeks pieces together, for not thinking that a negative PPD screen would not be accurate enough to rule out TB when the baby is malnourished, for not trying harder and demanding oxygen and bactrim, for wishing to get to participate in more HIV and TB patient care. The only difference between the two patients over the 4 day weekend - Baby Joseph is still alive and fighting, the other baby isn't. So I guess I have two case studies now. Complete with blan vs. Haitian healthcare dynamics. Complete with a discussion about the HIV+ baby's father's frustration with the care they received at the hospital and his own slew of guilt. Complete with the deep insights I and the baby's parents received from Dr. Robin yesterday at his visitation. So now that I have my two cases, I have a new wish this week - that no new HIV or TB cases walk through HIC's doors...
Baby Joseph's mom and him, soon after they found out about their new diagnoses. She was so happy that Dr. Cleonas and I were concerned enough about her and her baby that we came to find her at the TB clinic. She happily agreed, not only to have her photo taken, but to let me share her and Baby Joseph's information for a case study. Looks like I could learn a thing or two about simple happiness from my patients...
And then my wish came true. Thursday, a very sick HIV+ baby was referred from Dr. Robin at Port Salut. Since she has become a new friend and a fellow blan working in Haiti, I told her I would sit with the mom and dad while they were admitted. I promised to take care of any questions they or the doctors and interns might have had about the baby's condition. And so I sat and listened to what the doctors had to say. And the more I listened, the more frustrated I became. They had me take the baby to go get a chest x-ray and while the pediatrician looked at the results, the interns took all of the vital signs. They listened to his chest. They asked the mom about the baby's symptoms. The more questions they asked, the more it became clear to me - they didn't read a word of referral chart that Dr. Robin had prepared for them, even though she took the time to write it in Creole for everyone. Baby had a bad pneumonia of some kind, was HIV+, and had O2 sats of 45% without oxygen (it improved when he was on oxygen). He needed oxygen, to be prophylactically treated for PCP pneumonia, and potentially other supportive care. Dr. Robin's clinic didn't have the ability to house inpatients because her clinic had just opened in November. So she sent him to me. But it was becoming clear to me that the doctors and interns were treating this baby like a new patient who just walked through the door, having never seen a doctor before. I showed them the papers again and explained, he needed oxygen. The doctor exclaimed - "non, pas maintenant." I questioned why he "didn't need oxygen now" and was told that he had a viral pneumonia and there was no need for oxygen. Hmm... so that's why I hear the baby grunting in respiratory distress? And peer-reviewed research has shown that even radiologists in the states, despite all their training, cannot accurately tell a viral pneumonia from a bacterial pneumonia. Yet, somehow with one look and a quick listen, this doctor tried to? I advocated some more for the patient, talked with the mom, and then left the hospital feeling like I was fighting a loosing battle.
Friday morning I tried my luck one more time. A different doctor told me the patient didn't need either bactrim or oxygen. He told me the patients O2 sats were probably 90%. "Hmm, really? Does your unit have an O2 saturation monitor?" "No." "Then how do you know his sats are 90%?" "I just know. They're probably 90%." So now we are magically guessing patient's vitals... Awesome. After Dr. Robin and I had a few different conversations Thursday night and Friday morning, it finally looked like the best option was to give baby and mom oxygen and transport them home to Port Salut. Their medicines would be delivered to their home, Dr. Robin's clinic staff would do home visits to check in, and we would hope for the best during our Sunday away at Peak Macaya. And so Friday I participated in the battle between the pediatricians at HIC, saying the baby was receiving appropriate care, and Dr. Robin, telling them what baby really needed. I normally try to blend in at HIC and not use phrases like "Well, in the US we would do it like this..." But Friday, I had to take Dr. Robin's and the patient's side. I knew if care would continue as it was, that the baby would not make it through the weekend. Heck, even if care turned around, he had been deprived of correct oxygenation for so long who knows what type of condition he would be in.
As if the HIV baby's care fiasco wasn't enough, Friday I found out that Baby Joseph and his mom were both diagnosed with TB. Luckily, one of the TB doctors I work with at the infectious disease clinic did a wonderful job of seeing them right away, as soon as Dr. Cleonas and I started to suspect it. It turns out that mom had TB in the past and now it's back in full swing. She received medicines in the past for TB, but I didn't have enough time before clinic closed to ask her if she stopped treatment early (it's the first item on my to-do list once clinic opens tomorrow).So my four-day weekend ends with feeling a little guilty for both patients - for not putting the incessant-cough-for-3-weeks pieces together, for not thinking that a negative PPD screen would not be accurate enough to rule out TB when the baby is malnourished, for not trying harder and demanding oxygen and bactrim, for wishing to get to participate in more HIV and TB patient care. The only difference between the two patients over the 4 day weekend - Baby Joseph is still alive and fighting, the other baby isn't. So I guess I have two case studies now. Complete with blan vs. Haitian healthcare dynamics. Complete with a discussion about the HIV+ baby's father's frustration with the care they received at the hospital and his own slew of guilt. Complete with the deep insights I and the baby's parents received from Dr. Robin yesterday at his visitation. So now that I have my two cases, I have a new wish this week - that no new HIV or TB cases walk through HIC's doors...
Baby Joseph's mom and him, soon after they found out about their new diagnoses. She was so happy that Dr. Cleonas and I were concerned enough about her and her baby that we came to find her at the TB clinic. She happily agreed, not only to have her photo taken, but to let me share her and Baby Joseph's information for a case study. Looks like I could learn a thing or two about simple happiness from my patients...
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