Balancing Act

A few hours ago, us girls were sitting on the floor (because we don’t have enough chairs to all sit at the table) and I asked what time it was to see if it would be absolutely ridiculous if I just went to bed. When we found out it was 9pm, we were all kind of excited about sleeping. Then the power came back on and we were suddenly rejuvenated.

Adam likes to say he’s an “extreme humanitarian.” I think the ‘extreme’ part comes from the fact that we live a life of extremes. Extreme action or extreme boredom. This past week was the first that I feel like I had such a good balance of the two. Sunday morning we had the opportunity to go to church. This was the first time that happened because we don’t have any transportation on the weekends. We’ve gotten to know some of the staff at MTI (a faith-based organization) on a more personal level and when we asked about churches in the area, they offered to come pick us up. So Leah, Ashley, and I walked to the end of our road to catch our ride. Thank goodness I threw a skirt into my suitcase at the last minute. Sometime before the amazing music started, Alex (our ride) asked if anyone was going to be watching the football games that afternoon. Luckily for me, I was sitting down when that happened. Luckily for everyone else, church was about to start. I had literally been praying for days that I would end up at Hotel Ibolele to watch the championship games. I pretty much didn’t think that would possibly happen, and I’m pretty sure the people that kept hearing me pray about it didn’t think it could happen either. But after Alex asked and Leah and Ashley had to respond because I couldn’t speak, we arranged for him to pick us up later in the afternoon to go watch the games. At Ibolele.

We had a wonderful time (or I did, at least) watching the Packers thoroughly trounce the Bears. (Let’s take a moment to relish the victory…I know all you Eagles fans will begrudgingly join me.) Then Alex suggested we go to another place to watch the second game. I forget what it was called, but he told us as we pulled into the parking lot that it’s the place where most foreigners get kidnapped. Awesome, thanks for sharing. Apparently we were safe because we didn’t bring a security brigade to announce our arrival. At that point I didn’t care as long as they had food.

Sometime during the second half of the game when we’d finally eaten and I was again able to be happy and speak to people, Alex got a phone call. Apparently one of the volunteers at GRU had been in an accident with a moto and broken his femur. (Forget cholera, we now have an outbreak of femur fractures.) Then Leah got on the phone with Corinne, the medical director at GRU (who is ironically not medical) to get the details and see how we could help. After a few discussions with her and a call to Adam (still in the States), we arranged to pick the volunteer up the next morning and take him to the airport to be flown to Miami, with the possibility of me going along on the flight. Leah and I returned to the rest of the group and she was catching them up on details. “Blah blah blah … IS THAT BABY DOC?!” Sure enough, there he sat a few yards away. So for anyone who read that he’s been arrested or that he’s hiding in the mountains, disregard that. He’s eating shrimp with former US Congressmen.

Monday morning we set out early to make sure we would be on time for his 1pm flight out. It’s good we did, because we sat in traffic on the road up to Petionville for nearly 2 hours. That road is kind of like 95. Every 5-10 minutes you get stuck in a traffic jam for no apparent reason. While we were sitting there, we discussed how it would probably be ridiculous and pretty painful to bring him back down that way to the airport. Mark, who used to work at JPHRO, mentioned that they have a landing zone. So Leah called someone else we know who used to work there to see if that was a possibility and then called the Germans. The Germans were actually there already for some other reason and they agreed to wait for us.

When we finally got to the hospital, it was kind of like playing a video game to get into his room. We talked to the receptionist, who called someone and then let us go up a flight of stairs. Then we talked to the receptionist at the top of those stairs, who called someone else. Then the doctor appeared and we talked to him, and then we were shown where his room was. Aaron, a GRU staff was with him at the time of the accident, and he walked out of the room to meet us. He looked exhausted, the first time I’d ever seen him that way. Then Mark and I went in to assess the volunteer. The whole situation was even weirder because we’d just seen this guy a few days before when we gave him a ride from the airport back to GRU. I was checking him out and when I got to comparing his legs I found that the calf and foot on his broken leg were much cooler than the other leg. That’s when he told me that he was feeling “pins and needles” in his foot. I conferenced with Leah and Mark in the hallway. Compartment syndrome…pain, pallor, pulselessness, paresthesia… I had no idea what to do, because they teach that the treatment for that is a fasciotomy, so I’d have to cut this guy’s leg open. I offhandedly mentioned that I wished I could just call Brenden and be like, “Please help me!” Next thing I know, Leah is handing me the phone. “It’s Doc.” He made some more practical suggestions. “I know, I know,” I told him, “I know just enough to kill somebody.” When Brenden was here he’d frequently shake his head and comment on how new nurses know just enough to kill someone. That may have had something to do with the fact that I automatically assume something is a tumor or an aneurysm…

Anyways, we thought we’d try loosening the straps on his external fixation device. So Mark held traction on his leg while I opened the straps, and thankfully that seemed to help.

While Mark and some other strong people were loading him into the truck, I asked Aaron about what exactly happened. Apparently, the two of them were standing on the side of the street talking to the driver of a Mack truck. A moto drove between the truck and them, and must’ve accidentally jerked his wrist or something. Aaron said he couldn’t remember. But the moto hit the volunteer at a high speed and threw him into a pole, breaking his femur in three places. We got him to JP with no trouble. The only issue was that the Germans had their logistician with them, who was taking up a seat in the helicopter. I realize that it was literally a three minute flight from JP to the airport, but it was going to take our truck 30 minutes at absolute best to get there, and if there wasn’t a nurse to go along to the States, he’d be up a creek. But Leah somehow weaseled me in, and then managed to get herself in, too.

The plane taking him to Miami arrived shortly after we did. I talked briefly with someone who told me there was no nurse with them. I didn’t really feel like flying to the States and having to try to figure out how to get back, but the patient needed someone medical with him. So I was talking with the pilot and came to discover that she really didn’t want to take me along. She told me that there were people waiting in Miami to take him right to the hospital. “Okay…so…what about if something happens between Haiti and Miami?” I asked. She responded to this by telling me that she had a physical therapist with her. Good, how very helpful. I had a miniature conference and minor freak out with Leah because I couldn’t decide what to do. In theory, he was stable, having minimal pain, and would be fine on the flight. But I can’t really bank on “in theory.” The pilot kept saying, “Well, it’s your call, but I’d rather not…” So I eventually decided I’d stay and give report to the PT. He was very gracious and listened to everything I said. At one point he said to me, “I’ve read about compartment syndrome…is that a concern?” I’m pretty sure I laughed at him. So I gave the patient another dose of pain medication, gave the x-rays, hospital chart, and my own ghetto charting on a scrap piece of paper to the PT, and sent them off. In retrospect, I still have no idea if I made the right decision. Should I have pushed more and not cared about offending the pilot? Who knows? We got word from the PT later that the patient did just fine on the flight and was awaiting surgery. Later that night, Leah and I were talking about why that particular transfer felt so much more exhausting than the rest. He was, essentially, one of us. None of us know this guy very well at all, but we’ve worked with him and his team, and we know what they do on a daily basis.

The next day we were up early for another transfer. We were going to Medishare to pick up the femur patient from the previous week and take him to meet German Air 2 so they could take him home. After a slight miscommunication at the hospital where an EMT thought she lost the patient, he walked out to us on crutches. He was obviously still in quite a bit of pain, and they really went to town putting the staples in his leg, but we were amazed that he was walking. It was pretty sweet to actually be able to help send a well patient home for once, especially one we’d taken to the hospital when he was broken.

We were pretty excited about Wednesday. We had appointments scheduled, and Leah and I were finally getting to meet with the directors at We Advance to iron out some details. We’ve been trying to pin them down for weeks and we’d finally been successful. So the plan was to walk down the street to change the bandage on our neighbor boy’s head at 8:30, get to a warehouse to pick up supplies at 9:00, have the supplies, Mark, and our new volunteer Irene out to We Advance by 10:15, meet with Aleda and Alison before their own meetings began, then head over to the airport to pick up Adam. At 7:15, Leah’s phone rang. It only woke me up, but it was G and I can’t talk to him. So I had to wake Leah up (not an easy task) and get her to call him back. I was trying to ignore it, but then I heard her say that she was going to talk to me and call him back. Apparently, G had run out of gas and had to push his truck home the night before, so he couldn’t come get us. I’m not sure why he didn’t think of calling us the previous night, but whatever. So we called him back and told him he needed to get here somehow, take our gas can, go buy gas, then get it in his truck and come back. A little while later, Ashley walked into our room and said, “Guys? G just pulled up on a moto…” There was nothing else to do but laugh.

So after successfully missing all our scheduled appointment times, we headed over to the warehouse. We were picking up cots and two exam tables. The Haitians put the exam table into the back of our truck on its wheels instead of upside down, which just made the ride all the more interesting. But now I can add to my resume that I can successfully balance an exam table in the back of a truck in traffic while drinking a bag of water.

Thursday and Friday were more filled with running errands. We went to another warehouse and did some supply drops. We also had the chance to just hang out and walk around the neighborhood, buy sodas, and buy street food, hang out with our street food lady. Friday we also got another volunteer, a Canadian paramedic. Adam didn’t want her to be sitting around the house bored all weekend (since we have no transportation), and Irene is only here for a week, so we wanted to get her involved in as much as possible. So Leah tried calling some other people we know to see if we could borrow their truck for Saturday so that some of the team could go out to Cite Soleil to work on setting up the We Advance clinic. She couldn’t get through.

Saturday morning we got a call from the head nurse at Medishare. She had a patient who needed blood and wasn’t able to find any, so she called us. Then Leah had me call the nurse back to get the report on the patient. Apparently, there was a woman in her 30s who was septic and had a hemoglobin of 4 (it should be 12). She was on oxygen and not doing well at all. The Red Cross was closed. The woman had the blood type AB+, which is the universal recipient, so she could get any type of blood. First of all, we had no access to blood. Second of all, even if we decided that DIRT was going to donate blood, we had no vehicle. I asked the nurse, “So, she’s AB+?” “Right.” “Okay, so then anyone at Medishare should be able to give her blood, yes?” She responded, “Well, today’s our turnover day, so the staff has to go to orientation.” I’ll leave the story at that, because I have no further productive words on the subject.

Soon after that, Leah got a call back from the people with the vehicle. They were willing to let us borrow it for the day, and after Leah gave their driver directions, he headed over. Mark, Irene, and Kyle (our newest Marine – we’ll soon have all of Bravo company down here) were about to leave when Leah got another phone call from Fabienne at the MTI clinic. She passed it over to me. A young woman came in and they suspected she was having a miscarriage and she had a fever and needed transport. So we jumped into the truck instead and headed over.

When we were getting close to the airport, Adam got a call from the Germans. So we pulled in there first and picked up a 16 year old with a tumor that was pushing his eye out. And I mean, literally pushing it out. It was covered with a cup, but one of the medics showed us a picture, and it was sticking out from his head a good 2.5 inches. I can’t even describe it. So we took him to Medishare, then headed to the MTI clinic. When we got there, they told us they had another woman who was 7 months pregnant and possibly had cholera. So we loaded them both up.

And thus ends another week in Haiti, complete with candlelight dinner because our inverter still doesn’t work…

Textbooks & Toolbelts

I started writing this to post at one point last week, and then we left Le Plaza (the place we go to get internet when our power is out) and I figured I’d finish it later. Then things got crazy. So here’s two blog posts in one – congratulations to anyone who makes it to the end.

I was having a conversation with one of the volunteers earlier this evening, and he asked if I’d ever seen really crazy stuff when I was here. I told him that there wasn’t anything that insane, just some people that would come into the clinic after machete fights every now and then. He looked at me for a little then responded, “Do you realize what you just said?”

My return to Haiti has been fairly calm thus far, considering the things that happened this fall. Global DIRT is working on setting up an EMS, so we’ve been overrun with logistical work. Actually, I don’t think “overrun” is the right word, because it implies that there’s action. This morning I rolled out of bed and went to the kitchen where Adam (DIRT director) began giving some sort of dissertation. He’s so ridiculously smart and his brain never stops working, and quite frankly, it’s pretty overwhelming. So he rambled on for a very long time, most of it went over my head, and then I got bored and started thinking how helpful it would be to have a textbook for his mind. The further I went with the textbook thought, the more I felt like I was sitting in an 8am Monday morning Nursing Theory class – hoping I got the important parts and figuring that between Leah and her friend Ashley (she arrived Saturday and is here to help us out for about a month), I’d get the general idea. So we’ll see if the numbers I worked out for this budget are what I was supposed come up with.

I did get to play nurse a few times in the past week. Tuesday afternoon we were driving somewhere to pick up some thoracotomy kits (those would’ve been helpful in the Saint-Marc clinic). These situations get kind of fuzzy and slow-motion in my mind, but I remember hearing a crash and then a seeing a bus more or less ramp the sidewalk. Two full buses and a water truck collided somehow a few hundred feet in front of our truck. No one was seriously hurt, which was amazing since the people were packed in the vehicles like it was a clown car. The most dangerous part was probably me walking around in all the broken glass with my flip flops on.

The next day was the anniversary of the earthquake (and also my 100^th day in Haiti). Some of our team was going to a new clinic in Cite Soleil to meet with the founders and take pictures and things like that. On the way there, we came across marches in the streets. Thousands of people streamed past our truck, singing and dancing. It was actually mildly disconcerting because I’m pretty sure they could’ve carried us and our vehicle away if they wanted to. Anyways, we got to the We Advance clinic before everyone showed up so we went back to Sister Marcella’s clinic (where we started our string of cholera night shifts) to visit. She wasn’t there, but Leah, Sully, and I looked around the clinic for a little and talked about how strange it was to be back under different circumstances. Then we returned to We Advance and waited. We were waiting to set up a dome which is going to be used for triage and supplies. The truck carrying the various dome parts, however, got caught in a ditch. Typical. So a few hours later, they began the 30 minute process of setting it up. While we were standing around, one of the clinic founders called me over to look at this little boy. He had stitches in his forehead which looked completely healed and ready to come out. I gladly would’ve removed them just to kill time, but we eventually heard (though not from the kid himself) that it happened Sunday. Whether it was the Sunday four days prior or 11 days prior we’re not really sure. But either way, I suppose, he healed nicely.

When we finally left Cite Soleil, we were really hungry and tired from standing in the sun all day. So on the way back to Le Plaza to pick up the rest of our team, we stopped for street food. After everyone had their supper, Sully went to start the truck and nothing happened. The guys looked under the hood and messed around with it for awhile. Then some random Haitians appear out of nowhere carrying a new car battery. It sounds strange, but things like that happen here all the time.  

Saturday I went out to an orphanage in Kenscoff, an area up in the mountains, with some people we know from another organization. We ended up walking the last ½ mile or so because the hills were too steep for the truck. Between another nurse and myself, we saw between 60-70 children. We started out doing well-child checkups, but eventually it turned into treating only symptoms. Everyone got treated for worms and given vitamins, and I also gave out some antibiotics. Someone said we should get shirts made that say, “I’m not a doctor, but I play one in Haiti.” So true.

Part Two. “It’s really quiet around here” is a phrase that makes pretty much every medical professional, or at least nurse, want to club the person who says it. I’d been saying it for a good ten days, trying to get something to happen because I can only be cooperative with office work for so long. It finally worked.

This past Tuesday, we got in contact with German Air Two, these random helicopter pilots who transport patients. I’m sure someone else in the DIRT house knows how this happened, but I missed that memo. I just go where I’m told. The day started far too early, which is probably why I missed the details. Adam was wandering around looking for someone’s phone, muttering something about a car accident and a helicopter. Apparently, there was an accident up north and German Air Two was transporting the patients down here to us, and we’d then transport them to the hospitals. So Leah, Ashley, and I went with our driver to this field behind the UN base. We think it was some sort of driving school, because there were a few cones and people making laps. There were also various cows strewn about. Adam and Jon, a paramedic who was volunteering with us for about 10 days, went to a different location to wait for the other patient. Before they left, Adam warned us about how much stuff was going to be flying everywhere when the helicopter was landing. That was a bit of an understatement. It was like a dust storm. When I could manage to open my eyes, I could see maybe a couple inches in front of my face. I don’t know how long that actually lasted, but I started to get worried that I wouldn’t ever be able to see again.

The dust eventually settled and the patient and a priest emerged. This priest was also a doctor – kind of a curious combination, but it made for some interesting discussion. The patient was stable and could walk by himself, he just had a cervical collar on. We took him to the hospital and I stayed with him while he got x-rays. Getting a polo shirt off someone with a neck and shoulder injury when you can’t just cut it off because he probably only has that shirt is kind of difficult. But good news everybody, the patient still told me I’d make a good wife.

Wednesday we were to be meeting German Air Two again. This was supposed to happen at the airport. Unfortunately, it wasn’t going to be until the afternoon, and Adam had to fly back to the states. He’s the one with the capabilities and connections to be in restricted places or at least get away with things. So Leah, Jon, Ashley, and I headed to the airport hours early to get details worked out and hope we could get permission for various things we intended to do. First of all, let me just say what I got through airport security with. I was carrying a combat trauma bag that Brenden left with us. That’s what I bothered to put through the x-ray machine. In my pockets I had scissors, needles, a penlight, thermometer, a pen, and my phone. Leah and Jon talked to some security people who led them away to talk to a director so we could attempt to obtain permission to pull our pickup truck right onto the tarmac. Ashley and I waited inside the airport for a little while. At one point I got a text from Leah that served as report on our patient – that was definitely a first. Especially since it originally came from nonmedical personnel who said the patient had been “nbo since last night.” I’m going to go ahead and assume she meant “npo” based on the fact that the patient told me he was hungry and “nbo” doesn’t mean a thing to me.

Before too terribly long, Leah and Jon were back. The director decided to waive the paperwork we would’ve needed to do, and we had G (our driver) pull the truck up. While we were waiting for the Germans to land, we discussed the other call we’d gotten from them en route. Apparently after they dropped off the first patient, they wanted someone to ride with them to go pick up a baby. Jon and I decided we’d assess the femur patient and then decide which one of us was going to go along for the baby. I decided that I didn’t care much either way. I am really excited about potentially getting to be in that helicopter at some point, but then I also remember that unfortunate helicopter incident in Hawaii last summer. Moving on…

The helicopter landed with much less flair and flying debris than the previous day. We greeted the Germans then Jon and I went to assess the patient. Before we could that, however, we were physically lined up by the pilot for pictures. When they opened the door to transfer the patient, we saw a cast on the patient’s foot. We looked at each other, a little confused, because we’d just heard that he had a fractured femur. When we actually got him out, we saw that the cast was only on his foot, and the flight medic told us that it wasn’t necessary because the patient did not have a foot injury. Jon did a brief assessment, then we loaded him into the truck and I began my own assessment while Jon took off with the Germans.

This patient was a young man who had been in an accident 11 days prior. He was driving a moto that got hit by a car. According to him, the doctor wanted $2500-$3000 American to do surgery and he didn’t have that, so the doctor did nothing. This guy’s leg wasn’t splinted at all. His femur was turned out and very swollen. Long bone fractures like that are really dangerous because you can lose a lot of blood, and with this bone broken, it could tear the femoral artery. So this guy was lucky. He also wasn’t having a lot of pain, considering the injury. My guess was that this was due to the fact that he had so much swelling that the nerves were more or less squashed, and my madre confirmed that this was a legit possibility. Nevertheless, we transported him to the hospital, where he has now had surgery and is doing well. Hopefully he’ll be able to walk again.

We were on our way back in the truck when we get a semi-frantic call from Jon in the helicopter. We were expecting it to be more of a routine health problem and transport (yes, a routine bowel obstruction), but the baby was not doing well at all. The three of us were stuck in traffic on the way to meet him back at the airport and there was no way we were going to get there in a timely manner. My dad always jokes about slowing the car down enough for someone to jump out. That’s pretty much what happened. Leah was still on the phone, the two of us jump out of the moving truck and start running to a guy I’m yelling at because we hope he’s a taxi. Taxis are just so much faster because, in general we’ll say we have a two lane road. Most of the time it’s three wide. The motos just ride between the lanes of traffic, weaving in and out as necessary. So we were racing to the airport, and Leah was on both of her phones trying to find a place for this baby, or at least ask if we could land a chopper at a hospital, and Jon called back so I was on the phone with him. Basically, we redirected the moto driver about three times before eventually ending up back at the airport. The helicopter had landed about ten minutes before, and there was randomly an ambulance there, so the baby left with them. We have no idea why they showed up there or who sent them.

There are so many more stories I could tell from this week, but believe it or not, I really am trying to keep this short (mostly because I’m supposed to be doing office work and writing emails…but I guess when your office is a rug you can be a little more flexible?). Anyways, yesterday morning we were transporting supplies and a volunteer to work at the We Advance clinic for the day. Leah, Ashley, and I intended to drop him off then head over to Le Plaza to have an office work day since the internet has been off at our house for three days. But while we sat there waiting for someone to unlock the clinic, Leah got a call from someone working with Medical Teams International. They have a clinic out in a village somewhere and they had a child come in who was really sick with cholera. About this time, the director arrived and we more or less threw supply boxes and were like, “Okay, thanks, peace out!” I had scrubs in a bag with me so I ran inside quick to change, and they joked that I was being a cholera superhero changing in a phone booth. Anyways, we didn’t have any IV solution or tubing for this child, so we ran up the road to Sister Marcella’s, where we had visited again that morning and she gave us what we needed.

After some confusion regarding where we were going, we arrived at the MTI clinic. I find it odd that it was so much easier to connect with people in Saint-Marc where the directions included goats and big rocks than it is here in Port where there are road names. But while we met the people working at the clinic and got report on the little boy, they started asking us if we would come back and transport another patient. He came in with what they suspected was TB as a result of HIV/AIDS and was projectile vomiting blood. So we agreed to come back for him. Our little cholera patient was perking up fairly well by the time we were en route, and only tried to climb out of the truck once. He was pretty angry with me because I wouldn’t let him drink all the water he wanted. I might be used to cholera and be able to spot it in someone’s eyes from a mile away, but its been awhile since I’ve been vomited on and I haven’t really missed it.

After dropping off the patient at St. Damiens, we went over to Grass Roots United to pick up supplies to transport a TB patient. While Ashley was in the container looking for things, one of their volunteers came up to the truck to show us an injury. He had a nice slice on his arm from sheet metal. It needed just a couple stitches. I had been waiting for this moment for months now. There were only two of us who were medical, and I had seniority, since Mark, our new volunteer, was only certified as an EMT a few weeks ago. EMTB’s aren’t qualified to stick people with anything. Unfortunately, we really had to get back to the MTI clinic. I told him I’d come back after our transfer. He asked, “Isn’t it kind of useless after an hour or so?” Quite frankly, I have no idea what the answer is to that because nurses don’t do sutures. My only point of reference was the time I got stitches after a butchering injury, and my family wouldn’t take me to the hospital until more help could get there so I was exposed to the elements a good 7 hours before I got stitched up. But I just told the volunteer it would be fine and that I’d be back.

The clinic had closed down by the time we made it back, so a nurse and a pediatrician had gotten permission to ride along with us and get picked up somewhere. We determined that we didn’t really need the masks and isolation gowns we’d brought along, but then we also thought we might be able to get our truck through the ferocious Port-au-Prince traffic more effectively if we looked intense. Maybe ridiculous is a better word choice, since I have now seen pictures of myself dressed for airborne precautions with sunglasses on in the bed of a pickup truck. Nevertheless, the transport went smoothly and there wasn’t a whole lot of traffic.

We were on our way back to the MTI house to drop off their staff and stop by Grass Roots when we stopped by the airport to return bottles to a lady we had bought drinks from the night before. There was a large crowd gathered, and they started yelling and running towards us. In retrospect, it was probably not wise for us to do what we did next, but we seem to have a fleet of angels wherever we go, so we all jumped out of the truck and ran to the crowd. They were yelling about a stabbing. We found a young man on the ground who had a bloody hand. Then we saw a 2x2 on his chest. Apparently he’d been stabbed with an ice pick. Leah was controlling the crowd, and according to her they were very respectful. I still thought they were really loud, but I was trying to hear breath sounds. We got him onto our backboard, secured him with our ratchet straps, and loaded him into the truck which G had pulled around. The doctor began assessing the injury and I was cleaning his hand. It appeared that he may have grabbed the pick to try to stop it, because he had lacerations between his fingers and onto his palm. I did a ghetto wrap job with the stuff I could find in the CLS bag. The problem with having a combat trauma bag is that it’s usually not practical for every-day injuries. Although I guess if getting stabbed with an ice pick is an every-day injury, you just can never be too prepared.

So basically, the entrance wound was very tiny, about the size of the tip of a pinky. However, we didn’t know how far it went in, or what it hit. The doctor was monitoring for signs of a pneumothorax. Mark kept trying to wake him up and keep him talking, and I was trying to figure out if he was bleeding internally because his extremities were cool. We arrive at the hospital only to discover that they have no beds. The doctor with us was talking to one of the staff and asking if they could at least do a chest x-ray. Unfortunately, their machine was broken. Awesome. But it gets more awesome. It was then that the MTI nurse told us she’d gotten a phone call from one of their directors and that she and the doctor were to stay at the hospital and wait to be picked up. I was feeling okay until the doctor was saying things like, “This patient is going to die before he gets to the general.” She asked me if we had a big needle. This is where the CLS bag comes in handy. Brenden had shown me the decompression needles and given me a crash course in using one. But that was a month ago now, and there was no way I was going to remember in a moment of panic. So before hopping out of the truck, the doctor reviewed with me what to do and what to keep looking for. It was kind of like sweet-hearted slap in the face. I already knew this stuff, I just needed to calm down.

The patient had been starting to get tachypneic (breathing too fast), and was also having brief periods of apnea before we left Medishare. However, he stabilized a bit and remained stable enough during the transport. Again there was very little traffic, uncharacteristic for that time of day in Port. The doctors at the general seemed a little bewildered about exactly what to do with him, and were kind of looking to us for orders. I might be white, but I’m still just a nurse. Leah and I looked at each other and had one of our trademark “non-verbal communication” conversations. We weren’t sure how long we should stay with the patient, but she then told them that we were just doing the transport and the patient was in their hands now.

After that, we finally headed back to Grass Roots (GRU). It had been hours, and it was way past the time when G gets off, but I felt bad because I told the guy I’d come back. When we arrived, however, they were in the midst of a meeting. Leah had tried to call the two directors to let them know we were coming (they have a strict evening visitor policy), but they never answered. So, hopefully the injured guy doesn’t feel like I abandoned him. And once again, the suturing is elusive.

If for some reason you just can’t get enough of Global DIRT stories or you want a different perspective, feel free to check out Leah’s blog

http://www.dirtyinhaiti.wordpress.com

She has a video of this week’s first transports. I’m not yet that technologically advanced.

Picture Poacher

The thing about being a nurse is you don't have time to take pictures of your work. But here's my attempt to add some pictures I stole from other people. I'll probably add more later, but I've now grown impatient with waiting for pictures to upload.

 Little boy in the Cite Soleil clinic. This child bit me four times while Brenden was putting in his IV.

 Back in the 5th Section of Saint-Marc. We were two hours off the main road doing cholera education. This is how the people traveled to see us - through the river of cholera water.

 Front room of the clinic in Cite Soleil. This was intended to be an oral rehydration area, but ended up being an IV overflow area.

 Twins in St. Damien's clinic. I thought we ought to "adopt" them, but some other people didn't really think that was a good idea.

Global DIRT team working hard at St. Damien's.

Boomerang

Usually when I feel like things are slow and start wondering what in the world I'm going to write about, something crazy happens. No such luck this time.
My commitment with EMM ended shortly after Thanksgiving. The clinic had closed and I felt that I was supposed to stay in Port and continue the work I was doing. So I got to spend a week in the frigid 'PA weather and then I came back to the warmth to continue working with Global DIRT. While I was gone, the team spent a few days working in the mountains in conjunction with a Mennonite clinic (go figure). When I got back, we started putting plans in place to return to take supplies. And then they announced the election results. This may or may not have been a divine intervention of sorts since my only helicopter experience involved me vomiting for over half of it, and a supply run into the mountains would be around three hours.
Since the results were announced, we've been more or less trapped in our house. There really isn't crazy stuff going on in our area, as we're right by the Embassy and the UN base, but our driver wasn't wanting to come get us and anywhere we'd want to go wasn't necessarily as safe as our house. We did manage to venture out one afternoon, and it was pretty quiet. We only encountered one blockade by the palace and saw lots of evidence of burned tires, but none actively burning.
So the most excitement we've had recently involves the resident rat. This rat has been living here longer than I have. Traps are ineffective thus far because he's too big for them. Did anyone else know that rats fly? Because this one likes running through the house and leaping off the balconies. One of the volunteers that's here now is petrified of rats, and one night around 4am we heard all this scuffling from downstairs. They managed to trap him momentarily but their efforts with a knife, broom handle, and mosquito swatter were ultimately unsuccessful. But I guess it's good to keep him around for the entertainment factor.

Hurricane No Mas

I have lived in the same house my entire life. My only moves were to college and to camp, so that made the last two months pretty interesting. A few weeks ago, Leah and I were returning to our house from YWAM when I got a phone call from one of the guys we were running the ambulance with. He was working with a group in Port-au-Prince and wanted our help since they were getting ready for the hurricane. A few days before, I had found out that the clinic I was working at was going to be permanently closing in the next few days. After obtaining permission from our various organizations, we agreed to go.

By the time the hurricane actually hit, it had downgraded to a tropical storm and changed course. We got lots of wind, rain, and a little bit of flooding, but nothing like what had been feared and predicted. Our team was riding around in two ambulances (or technically one ambulance and a bread truck) and we checked out the various tent cities around the capital to make sure everything was okay.

After the hurricane, it was back to being on the lookout for cholera. There are an incredible number of rumors and ridiculous reports going around and so we almost can't be very sure of whats going on. However, at the beginning of last week, we got a call that there was a nun in Cite Soleil who was running a cholera clinic and needed help. I believe it was the UN who referred to this area as the worst ghetto in the western hemisphere. So naturally we had to go check it out. Doctors Without Borders (MSF) was currently working there from 8-3 each day (I suppose if you have cholera you get better by 3pm?) but she had no night shift and MSF was planning to leave by Saturday. We went to see the nun Tuesday afternoon and we talked and told her we'd give her a call. We didn't just want to run in, due in large part to security issues. However, after returning home that day, we decided we would take over the night shift. After calling Sister back, about an hour after we left, we found out that MSF was pulling out completely, leaving only the Sister and another nun with the patients. Brenden and I spent the night working with one other doctor who happened to be in the area for a few days and one other nurse, with Leah to translate, and another marine serving as security. Four medical personnel for 60 patients. We worked 16 hours that night, losing only one patient shortly after we got there. And we've spent every night since then working at the clinic, though our team has now expanded as a team of four people arrived back with the executive director a few days later. I may actually be without some words for once, but with working 12-16 hours every night for the past week, I haven't had a lot of time to process. Oh, but before anyone worries, we feel completely safe. The nun has good standing in the community and that covers us since we're working with her. Leah and I, of course, realize that the Lord surrounds that place each night while we're there. But we don't even give a thought to the situation, so there's no need for anyone at home to be worried either. 

The house we're staying in doesn't have electricity or internet, hence the lack of updates. But this afternoon we stopped at a restaurant/hotel to get their wifi. And now its about time to get back and put on my bleach covered scrubs and head out to the ghetto. I love my job.

Semper Fi

For those of you who thought my newsletter was ridiculously long...

So about five minutes after I published my last post, I received a call from Leah. She was out in the ambulance with Duncan and Corina (a nurse on the DTS who volunteered to help us out) and wasn't going to make it back in time to meet this medical team who was coming to the base to see if there was anywhere they could help out. She quickly briefed me on what to say to them since she's really good at sounding professional and like she knows exactly what's she talking about even if she has no idea. That's not one of my skills, however. So I rehearsed everything she told me and felt fairly ready for these people to show up. And then they showed up. It wasn't actually a medical team, but two people from Grass Roots United. I was told that they'd heard we had a transportation issue. After I tried to explain what was going on with our ambulance and how we really just needed more people to help us run it, they seemed a little confused. It didn't appear that they'd be able to help us out, but they gave me some suggestions for protocol and left me with phone numbers, a stretcher, and some boxes of oral rehydration salts (ORS). A whole lot of information was thrown at me and I felt sort of like I'd been bulldozed. Before they left, Brenda started talking about marines. I must've missed some of the vital information in this particular part of the conversation, because then she was asking if I wanted them and saying they could sleep in the yard if they needed to. I was fairly confused about why I would need marines and didn't really want to be responsible for them showing up unannounced, even if they were "only a little foul-mouthed," so I told her I'd talk with Leah first.

The rest of the afternoon was a little crazy. There were YWAMers out in the 5th section (an area in the bush that no one else goes into) and Terry called the ambulance phone telling us he was bringing us sick people. When they finally got out to us (the ambulance couldn't go that far in), they weren't all that sick so we just gave them ORS. We did have some crowd control issues, and had to put up a fuss to make sure that no more than four people got into the ambulance. Its hard enough to move around in that vehicle on the bumpy dirt roads when its empty, so trying to dodge patients AND all their family members just wasn't going to work. 

We had a bit of a break around suppertime. Leah gave a very detailed explanation about how people needed to step into the kivets of Clorox before coming into the base (because apparently me saying, “You know, like when you go into a chicken house” wasn’t a good enough explanation) and also told people about washing clothes if they were in contaminated water (or vomit, in our case). So after supper, Duncan, Corina, and I set to boiling our clothes and it was hilarious. I won’t expound on the event, since it was probably a “you had to be there” kind of moment, but know that it involved us stirring our cholera clothes with a broom handle.

Leah was in contact with Brenda more throughout the day, and at some point she informed Duncan and me that we were receiving these marines. The part of the conversation I must’ve missed was when she said they were field medics, and that’s why they were relevant to our situation. We had no idea what exactly we were going to do with them since we didn’t really know what we were doing ourselves, but decided I’d take the 6am-noon shift and we’d see if they wanted to split up.

They finally arrived around 11pm, and I was looking quite professional, draped across three chairs in the cafeteria. We fed them and talked briefly; they’d been working at the hospital since the early morning hours, and we’d been awake as well so we were headed to bed. I think I’d been in my bed five minutes when Leah’s phone rang and she said we had a call. Thankfully, Audrey had let us use her dryer for our clothes. We ran outside and I was trying to figure out if Ronald (our driver for the night) had woken up both marines (I missed their names during our introductions and Leah is so bad at remembering names she doesn’t even try). I figured it was silly for them both to come when they’d already been awake 24 hours. One of them might as well sleep since I was going out.

Thankfully, that message never got relayed. Our call was to a clinic in Bocozel, out in the 5^th section. We don’t really know who called us, or why they called when they were already at a clinic. Upon arrival, we loaded two ambulatory ladies into our ambulance and gave them some ORS. There was also a little boy who looked quite unwell. Sometime during all of this, Leah came back out and told Riaan and Brenden that they might want to check out the inside of the clinic. I stayed with the patients, with Ronald guarding the ambulance. The next series of events was kind of ridiculous and is a little bit of a blur (and I’m working on leaving out details), but at some point, the ambulance doors flung open and I was told to kick out the two women. They were replaced by a nonambulatory guy with his hospital gown on backwards. The guys were officially on a mission, muttering things about a peeing guy, and Leah quickly told me that this place was a huge dark room absolutely filled with people just laying everywhere. I worked on fixing backwards gown man’s IV line after Brenden pushed the clot through and they went back inside. They triaged this place in a matter of minutes. The next time the ambulance doors opened, I heard Riaan asking for someone to help him carry this man into the ambulance. All the Haitian spectators literally backed away, saying “He’s dead, he’s dead,” even though he wasn’t. So Riaan picked this man up and he simultaneously began to have diarrhea and pee all over the place. I was trying to move backwards gown man so they could put that patient on the other end of the stretcher. Within two minutes of putting him in the ambulance, Brenden was checking for a carotid pulse. He was gone. That patient was taken out and immediately replaced with a tiny woman who began seizing as soon as they laid her inside. The rest of our team quickly got in the ambulance, and the guys set to work as we took off. They were absolutely phenomenal. By the time we arrived at the hospital, all patients were stable and had working IVs. Then we went back to Bocozel for Round 2.

Riaan and Brenden already had some people in mind when we got back to the clinic, and I decided I was not waiting in the ambulance this time so I checked out the one woman they pointed out. Her family members kept shutting off her IV because they said the medicine was making her sick. This happened three times. We opened it and returned and found it closed. At some point, we happened to notice that her normal saline IV bag had “KCl” written on it. Bad. We took her with us, along with another woman. Little potassium woman was having some minor tremors on the way to the hospital. We passed on the information to the MSF staff at the hospital, wondering if that may have been why our lady from the first transport was seizing. Throughout the week, we continued to make trips to Bocozel. We took more people who were given potassium and gave them different fluids en route to the hospital. One morning we found an unresponsive child, and when the doctor told us “No, he’s just sleeping,” while I was doing a sternal rub and Riaan was flicking his foot, we snatched him up as well. We broke out the pediatric ambu bag for that ride, but thankfully didn’t need it.

Our team continued on as the sun came up on our first night. We picked up a critically ill man who was lying along the road on a mattress, along with a little girl. When we got back to the base shortly after 6am, Riaan commented, “Well, we had a nice run there of critical, critical, urgent, critical…”

One morning, Riaan, Duncan, and I were out. We had a call, which somehow didn’t turn up, I’m not sure exactly what happened, but we started walking down a different road while the ambulance was turning around. We found a little girl lying along the road who was pretty sick. Duncan and I worked on starting an IV while Leah and Riaan kept walking down the road to check out what looked like another clinic. We took the little girl to the hospital then returned because we were pretty wary of any clinics that just appeared. When we walked in, we were immediately greeted by someone from Samaritan’s Purse. We explained about having the ambulance and numbers were exchanged as they were in need of transportation in case some of their patients were in more serious conditions. He (Justin) asked if we could help out for a minute by starting IVs in one of the treatment rooms. They were using an old school building as a rehydration clinic. The room we entered had about 16 camp beds in it and we went to work. The staff kept thanking us and saying that we were sent at just the right time. After a little bit, Riaan and Leah went out on a call while Duncan and I stayed to help.

Towards the door sat a lady in a blue dress. They had discontinued her IV and she was waiting for her dose of antibiotics and the teaching they were giving before discharge. She was trying to talk to me, I think telling me she didn’t feel well. She said she needed to go to the bathroom and I told her that was fine. Patients had been walking themselves to and from all morning. She got up and left. A few minutes later I looked outside the door and saw her sitting on the ground. I started heading for her as a staffer approached her. He asked if I’d take her to the bathroom. A tiny, gruff Haitian nurse was helping me as well. Walking her there was a bit tricky, as we had to go up steep steps to actually get into the bathroom. When we were walking back to the room, she sat down on the ground again. I gave her a moment, and then the Haitian nurse pulled her up and we kept going. After a few steps, she collapsed, though she didn’t lose consciousness. I started yelling for Duncan. The great thing about yelling in the medical profession is that you always get more people than you asked for. We carried the lady back into the room to the bed and tried starting another line on her. It took a little while, even though she’d already been given two liters of fluid. After her third bag was up and running, she rolled over onto her side with her arm and head hanging off the side of the bed. Haitians get into the weirdest positions to be comfortable. This actually causes a lot of problems when you’re in an ambulance. Nevertheless, she was happy in that position, so we left her and continued frantically working. I glanced at her periodically, but between the girl who was quite possibly possessed and the other patients who kept calling me, I didn’t go over and check on her. Then I heard MaryAnn (SP nurse) say, “I think I need some help over here!” She asked me to help her move the lady in the blue dress onto her back. I don’t remember what happened next, but then we were listening for heart sounds and MaryAnn was saying to the patient, “I’m sorry love, I’m so sorry.” I closed her eyes and walked away.

We had a ridiculous number of divine appointments with our ambulance throughout the week. Some other stories were in my newsletter (talk to my mama if you didn’t see it and want to). During the middle of the week, we were preparing a report about our protocols, patients, and other such things. To that point, we had transported 50 patients, losing only one en route, and having two pass between the time we were called and when we arrived. Wednesday we went out into the 5^th section to do reconnaissance and take any patients who couldn’t get out. The whole team went out, thus throwing off our shifts a bit. I included this story in my newsletter, but some people I was talking to were unaware of our current situation so I’ll briefly repeat it. We got back to the base later in the evening, and I volunteered to stay on call for Corina, who ran the noon-midnight shift, because she wanted to rest. I would’ve slept in the ambulance and gone on every call if they had let me. Apparently I’m an adrenaline junky? Anyways, Leah, Brenden, and I were in the kitchen around 930 when a call came in. Corina still wasn’t down, and I wasn’t going to make too big of a question about it or I’d have to stay home so I just immediately ran and got dressed. We were walking out to the ambulance when she appeared. Shoot. I was still going to ride along with them just because, but at the last minute decided I should stop making a big deal about it and just wait until my shift at midnight.

A little while later, I was sitting in the office talking with a friend when another staffer knocked on the window. He and Bryan had a quick conversation, then Bryan grabbed my arm and told me we were going out because the ambulance had been in an accident. We ran out to the cafeteria where the same message was being given to Riaan. About that time, Kevin (Audrey’s husband) drove around in his truck and we all jumped in. Long story short, everyone inside the ambulance was fine other than a few bruises. In fact, we think we’ve been hurt worse just riding in it on a normal run. Corina said that while she was rolling around, she felt like she just kept landing on soft things. The ambulance did not, in fact, flip like we originally thought. When it was pulled out the next day, they found that it went up an embankment and then slammed back down into the ditch, which is why they felt like they were rolling. However, not a single light was broken on the ambulance. Nearly everything was still on the shelves behind the doors, which we’d taped shut earlier in the week because they refuse to stay closed, and that was fairly useless due to the bumps. All of this and the fact that everyone walked away was “highly improbable,” as Riaan said. The only question in my mind is whether whatever soft things Corina was rolling around on were angels or the hands of the Lord.

Our team was all pretty bummed out about the loss of our ambulance. Bummed out is an understatement, actually. I worked with critically ill cholera patients all week but didn’t cry until I saw our wrecked ambulance. We took Thursday to rest and then continued to do some teaching out in the 5^th section on Friday. We’re still waiting on the possibility of another ambulance. The director or president or someone at JPHRO was going to Port to talk to the Haitian president about getting us one, but we haven’t heard anything yet. It’s definitely hard to sit around and wait. When we found the ambulance phone on Thursday, we had 21 missed calls, and that was really tough.

In the meantime, we’re trying to find other ways to entertain ourselves. Brenden spent Sunday afternoon helping me practice my suturing on a banana. We also got these fun things from some organization we’ve been in contact with to start lines on people in their sternum if they’re really dehydrated and we can’t get a regular line in. Brenden offered to let me use one on him, and I initially said no because it’s essentially 10 stabilizing needles and then a barb that goes in your chest. But then I changed my mind. Unfortunately, so did he.

That was the week of cholera in a nutshell (yes, that was the nutshell version). I am thankful that I haven’t had to boil clothes in 5 days. Now we wait. Wait for an ambulance, wait for direction, wait for the possibility of a hurricane. Blessed be the name of the Lord.

Sharp Cheese

Yesterday, Duncan and I were in the midst of a serious conversation when I heard a strange noise. I looked over and saw a mouse in our sharps container. I have no idea how he got in there, but it provided our comic relief for the day.
Wednesday morning we were sitting in the clinic, and Duncan or I had probably just muttered something about being bored, when I got a phone call. It was from the YWAM director here, and he was saying something about being at the hospital with a mob of people. He gave instructions to scrub down the clinic and get it ready to take people, just in case. These people were all presenting with severe vomiting and diarrhea. It took us about an hour and a half to clear out a section of the clinic to use as a quarantined area, get supplies ready, and mop. The head nurse bleached the floors and wiped them up herself. As soon as we were finished, a man was carried in. He had a blood pressure of approximately 50/30. We were able to hook him up to two IVs and stabilize him. Two more patients were brought in as well, but were in much better shape. We began rehydrating all of them, then transported them to the hospital.
The past few days have run together a bit, so I can't remember the exact order of events. Sometime very early Thursday morning, Leah heard a helicopter, which indicated that international people were now aware of our situation. And after checking the news websites, we found that the World Health Organization was indeed investigating. I went to the clinic, and we saw an incredible amount of people, simply because they couldn't get into the hospital if they were not presenting specific symptoms. And then it rained again. During the afternoon we simply sat in the clinic. I was pretty frustrated that I was sitting in a chair in an empty clinic while people were dying in front of the hospital gate. Duncan and I discussed this some (he's the practical one) and decided all we could do is make ourselves available for whatever comes.
Yesterday, I believe they gave the official word that we are dealing with cholera. I was on my way to the clinic when I got a call from Terry (director) asking how things were looking at the clinic. He quickly explained that he was setting up some sort of ambulance service and was wondering if Duncan and I could provide care. The clinic staff was fine without our help, so we ran around trying to gather supplies we thought we could possibly need. Then we set out to pick people up who couldn't get to the hospital. Over the next three hours, we picked up four people. We started IVs on three of them as they were severely dehydrated. Thankfully, there was no diarrhea in the ambulance, although a fair amount of vomit was spewed forth. Awesome, as vomit is the one bodily function I don't do well with. But I only gagged once. When we got to the hospital and the ambulance doors were opened, there were people standing there filming us. It was a very strange experience.
We continued to pick people up during the evening until about midnight. Leah and I had decided earlier that we were just going to spend the night at the base. We have no idea how long this will last, so Duncan and I are a little stressed about coming up with a long term plan. But for today we've decided to take shifts. There is a DTS team here from Kona, and there are two nurses on that team who agreed to help us if they are able. The girl who may be going out with me on my shift is also a new graduate. She said she does know how to canulate, but not on Haitian skin. Insert sarcastic comment here. So on our team, I will be the experienced one.
Mom, I know its apple pie filling day at home, and I really dislike cooking and all domestic chores, but perhaps you'd like to switch places with me for today?
Oh, and an update on Velouse, since some of you have been asking. Last weekend, Leah, Audrey and I went to the hospital to see her, but she was nowhere to be found, even after a nurse walked around calling her name. Monday morning she waddled into the clinic. So no baby yet, but I will be sure to update on that.