Progress in a Troubled Country

Haiti has been in the news again lately, and not in a good way. By now many of you reading this are already well aware of the kidnapping of the 17 North American missionaries from Christian Aid Ministries, and don’t need more details on the story from us. However, since you are concerned and interested in the clinic and our lives enough to read this blog, I thought I’d update you on how this situation affects us and our work here.

First and most importantly, we’re at a safe place up here in Oriani and do not feel like we are in any immediate danger. Our clinic is still open normal hours and we have a full house of patients every day. However, the area where the 400 Mawozo gang operates, and where the CAM missionaries were taken, is right along the main route that we take into Port-au-Prince to buy most of our clinic and household supplies. Even though these kidnappings have been happening to Haitians for a long time already, the fact that Americans were taken brings things a bit closer to home. For now, we are staying put here “on the mountain” and avoiding travel down to Port until we know now the CAM situation shakes out. We are hoping and praying with the rest of you that all 17 hostages can be released safely and without ransom money being paid, and that the country can become a safer place for Haitians and foreigners alike.

While we wait for news of the kidnappings, we also have a very concerned eye on the fuel situation in Haiti. For quite a while already fuel has been hard to find, because the country's petroleum distribution port in Martissant is in a heavily gang-controlled area and trucks are not able to come and go freely. However, in the last week or so things have gotten even tighter, with little or no gas coming out of the port and most fuel stations empty. For several days now there has been absolutely no gasoline or diesel available at any pumps near us. Fuel is available sparingly in street markets at the exorbitant price of at least $10 or sometimes $15 USD per gallon.

Needless to say, a world without fuel is a very small one indeed. Beyond not being able to travel by vehicle, we also have spotty cell phone service because most of the cell towers are powered by diesel generators and therefore not able to function normally. We use solar power at the clinic but occasionally on cloudy days we need to run a small gasoline generator. These days we are holding on to our last few gallons of gas in case of emergency. Our lawns grow high and weedy because we aren’t running the mower anymore. Many trucks sit idle in market, unable to haul produce to the city. Motorcycle taxis are still available but the cost is rising with the price of black market gasoline. Market today in Forè, usually a packed chaotic affair with thousands of people, was subdued with very little truck traffic in and out.

There is no telling where this fuel situation is going. Will it be tomorrow or next week or next month before gas becomes available? Nobody knows. For now, we’re adjusting our routines as necessary and just waiting to see where the next days take us.

Ok, enough negative news. The good news is that the clinic continues to operate normally and we are able to treat between 40 and 70 patients daily. If you remember our cleft palate baby, Jhonky, I am happy to bring you up to date on his progress. He came several weeks ago, continuing to gain weight and develop normally. His next follow-up was yesterday, and again he showed remarkable weight gain. His birth weight on August 10 was 3.2kg, and yesterday he weighed 5.2 kg (11.4 lb) at 10 weeks old.

As you can see, he is alert and healthy, developing well. We will monitor him for another month or so before arranging his operation at Hospital Bernard Mevs.

Another interesting case we saw recently was a young man with his 4th and 5th fingers on the left hand injured in a knife accident. We took him to the clinic to clean and assess the wound. The 5th finger was fully amputated at the base of the nail, but the 4th was only partially amputated and we felt there was hope of him retaining it if we could get him to definitive care. The family was very hesitant about going to Port, but I was able to get them to agree to at least call around and check hospitals. Unfortunately, the three best options I tried did not have surgeons available, so the family told us to just do what we could. We worked for several hours and were able to trim back both fingers into stumps that were able to be closed with sutures.

He tolerated the procedure very well and came back the next day for wound care. The surgical sites looked good and we scheduled him for daily dressing changes, but unfortunately he quit coming and dropped off our radar completely. This is all too common here and we’re not sure of all the reasons. We can only hope that the incisions continued to heal well and he is doing fine.

One last story. A lady in labor presented to our house after hours, and as we sometimes do, we let her labor here on the porch. Everything progressed normally and some time later a beautiful healthy baby girl was born. She took a breath and cried, but unfortunately soon after her airways became blocked with thick secretions and she went into severe respiratory distress. We vigorously stimulated her but were able to get only a very weak response. We quickly realized we needed to get her to the clinic asap, so Ang wrapped her up and jumped on the moto that had brought the lady. The driver took off thru market and I followed shortly on our moto, with the new mom sitting side-saddle behind me. By the time we got to the clinic, Ang was inside with the baby and thank God, she was breathing normally and had a strong healthy cry.

We monitored her for a while and did some deep suctioning, removing a lot of secretions from her airway. She continued to stabilize and we were eventually able to send her home with the family. Just another reminder of the dangers of childbirth and another reason to be thankful we just happened to be in the right place at the right time. Had the baby been born at home, who knows what the outcome would have been.

If you’ve made it to the end of this very long post, congrats. That’s all for today. Keep us, and this country, and in particular the 17 CAM missionaries, in your prayers. We know there will be a way!

Small Miracles

It was a Friday afternoon, one week ago. The clinic had closed around noon and we were home getting ready to leave for the prayer service at Frè Dieuna’s house, which was a long walk away. Sure enough, as it usually happens, there was a knock on the gate at about exactly the time we needed to leave. It was a woman in labor. We ushered her onto the porch to do our initial assessment, and she told us she was only 34 weeks along and had been having pain for several hours already. Our assessment confirmed that she was in labor, which made us quite concerned due to her early gestational age. We felt like she should deliver in the clinic where we have better capabilities to take care of an early baby, so we arranged that the other nurses would go to the service and I would take the patient to the clinic and monitor her.

I scanned the mom with our Butterfly IQ+ ultrasound and according to measurements she was around 31 weeks along. We didn’t have much hope that the baby would make it, but there are very few affordable hospitals within driving distance that would be able to care for a baby born that early and besides, it was already too late to transfer her. Fast forward several hours, and she was progressing very slowly. The other nurses came to the clinic when the service was finished and we started swapping out, some staying to monitor the mom while the rest went home for supper.

While we were keeping an eye on the first mom, a second lady came to the clinic in labor. This was a younger girl who was pregnant for the first time, and unfortunately she had drank ginger tea, which is a folk remedy commonly given here to “heat up” labor pains but which usually ends up causing a myriad of problems, including nonstop abdominal pain even between contractions. Thus this girl was in a lot of discomfort even though she was quite early on in her labor. We assessed her and sent her home to continue laboring on her own.

Finally around 9pm we started oxytocin on the first lady to speed things up a bit, and at 10:00 she finally delivered. Her baby was born “en caul”, meaning she was still wrapped entirely in the amniotic sac. In addition, the placenta was delivered at the exact same time as the baby, something I had never seen before. Imagine our surprise when the baby let out a nice loud cry immediately and began breathing on her own with no problems! She weighed only 1.57 kg (3.45 lb.), but was otherwise in good shape. Our biggest concern was her hesitancy to breastfeed and some grunting she was doing while breathing. We did what education we could and gave her an appointment to come back the following Friday. We sent her home not knowing if we would see her again or not.

The baby on Day 1.

Friday morning came and we scanned over the patients gathered at the clinic, but there was no baby to be seen. Our hearts sank as the morning went by without them showing up. We assumed the worst, that the baby had obviously not made the week. We were finished with consults around noon, so the nurses and I went home for lunch except for Ang, who stayed to work a bit in the pharmacy. It took her a while to get home, and when she walked in, she announced, “Guess who showed up to the clinic right after you left?” Yep, you guessed it. The baby!

Apparently the little girl is a little fighter and is doing well! She weighed 1.49 kg (3.28 lb) so had lost a few ounces, but that is to be expected for the first week. But she is breastfeeding and developing normally. Praise God for small miracles! Like Ang said, “It was worth staying late over lunch for that!” We will continue to monitor the little girl and hope that she continues to grow and develop.

After one week.

God Set You Here

One Thursday morning in August, a young man came to our clinic carrying a bundle of blankets. Inside was a tiny baby, only 24 hours old. It was a little boy named Jhonky, and the young man carrying him was his proud daddy, named Augustin. It took us only one glance at the baby’s face to see why he had come to us: he had been born with a cleft lip/cleft palate. In North America, this would have likely been detected on prenatal ultrasound and plans made for referral and surgery as soon as possible, but here it came as a total surprise when he was born. Dad was a simple mountain man, 24 years old with one older child. He came from an area called Gwo Cheval, about a 30 minute motorcycle ride away from our clinic. He was looking for help.

Our first concern was whether or not the baby was able to breastfeed. A cleft palate can make it very difficult for a baby to coordinate the critical sequence of suck/swallow/breathe that is so vital to nutrition and survival. Dad assured us that the baby breastfed fine, and the baby did appear comfortable and well-cared for. That took some of the urgency out of the situation, but it remained very important to get this baby to definitive care and scheduled for surgery as soon as possible. We knew that Bernard Mevs Hospital in Port-au-Prince has a cleft palate program, so I put in a message to the head nurse, a woman named Maggie. She replied that yes, the hospital was able to take care of this baby, but unfortunately the volunteer medical teams from North America that have previously come into the country and done these operations are no longer coming in because of the unrest and volatile political situation in Haiti. Therefore, the hospital is no longer able to offer this service free of charge. The operation itself would be 30,000 Haitian gourdes, or about $300-$350 USD at the current exchange rate. There would be office visits and laboratory fees to consider as well. Such a small amount of money compared to what we are used to paying for medical care in the States, but a price still far too high for this dad to come up with.

My heart knew what the right thing to do would be, but I also knew that offering to help this family would invest our clinic for the long run and may end up costing more than expected. I reached out to our board of directors in North America, seeking approval to sponsor this child and to look for donors to help cover the cost. They agreed that it was a worthy cause and they felt the way was open for us to move ahead and help this family wade through the hospital and operation process. I had planned to post the case to our website in hopes of finding some funds, but within a couple of hours the board came back to me with the news that they had already found enough pledges to cover the entire amount! I was amazed and humbled by the quick response and was so glad I could let the dad know that help was on the way. We made plans to take the baby to the hospital the following Monday for a consult with the pediatrician and meet with Nurse Maggie to be enrolled into the cleft palate program.

Early Monday morning Augustin met me in front of the clinic, carrying baby Jhonky all wrapped up against the morning chill. We made it to Bernard Mevs in good time and were number 6 in line to see the pediatrician. As usually is the case with Haitian healthcare, the visit ended up taking a good share of the day, but I won’t bore you with details. In the end we covered the important bases: we met Miss Maggie and received instructions for the cleft palate program, consulted with the pediatrician, and got labs drawn. They want Jhonky to be several months old before scheduling him for the operation, and in the meantime he can follow up in our clinic to ensure he is gaining weight appropriately. We packed up and headed back out of town, visiting as we drove. Augustin promised to keep in touch until his next appointment in our clinic, and he has done so. One week ago he called to tell me he wanted to bring us some fresh cow’s milk, and before long he showed up with not only a jug of milk, but also a sack of potatoes and some fresh field corn. He had walked on foot, carrying all this on his back. He assured me it wasn’t too far, if you take the shortcut through the ravine. He sat on my porch and we visited for a while before he set off to walk home. He expressed his great thankfulness for the help he was receiving, and he repeated over and over how he could have never managed to pay for the surgery and wade through all the bureaucracies of the hospital visits without us. All I could say was, “That’s what we’re here for. God put me here in this time to help people like you.” It makes me think of the song that repeats the phrase, “God set you here, God set you here…”

Today was Jhonky's first follow up appointment in our clinic. Augustin showed up right on time with him, all bundled up in the same blue blanket as the first visit.

He was awake and alert and appeared well cared-for and well-developed. He is still breastfeeding well and takes a bottle occasionally, and his weight had gone up from 3.2 kg to 3.97 kg. His vital signs were normal. We sent him home with a follow-up for the 8th of October. We hope and pray that he will still be doing well and gaining weight.

We sincerely thank each of you, even though we don’t even know all your names, who reached out and helped this family in their time of need. You can be assured your funds are being received with thankful hearts. We will keep you all posted as we move through this process together. Please continue to pray for Jhonky and his recovery.

Pa Ka Pale

An American nurse working at Confidence Health Center learns that some things aren’t what they first appear. Or rather, some things aren’t what they first sound like. Like any other language, Haitian Creole has many figures of speech and nuances. It’s only a matter of determining what these are and what the real meaning behind them is. This is a continual learning process, and even after working in the clinic for a year or two, one still has to sometimes sit back and say “Excuse me? You say what?”

Here are a few examples:

L’ap manje mwen. The literal translation of this is “It’s eating me.” As in: “I was chopping grass with a machete and accidentally sliced my foot open. Now it’s eating me.” Ok, exactly how is your foot eating you? Further questioning reveals that the foot is, in fact, hurting. It’s hurting bad. It’s eating me. What I need is some pain medicine and a bandage and maybe it won’t eat me anymore.

Depi anvan ye. This reply comes to the question, “Since when have you had this rash? (or this pain, or this wound, etc.) The patient frowns and thinks. Finally the answer comes: “Depi anvan ye.” Well, directly translated this means since before yesterday, so it is very little help to the nurse conducting the assessment. Yes, I can see that this foot has been infected for a long time. Definitely since before yesterday. But when exactly? A week ago? A month? A year? The patient nods. Yes. All of the above. Sometimes they clarify: “Pou plizye jou.” For many days. Ok, never mind. It’s not that important. We’ll forget about trying to find out exactly how long it’s been. Sigh.

Doule anba kè. We hear this multiple times per day. Almost every patient complains of this, both young and old. It means “under my heart is hurting.” Sometimes under my heart is “burning” specifically. I need Tums and omeprazole. I have heartburn.

Li poko gen laj. This is the occasional response we get to the question, “How old is your baby?” Mom frowns and shakes her head. “He doesn’t yet have age.” Well of course he has age, he’s right there in your arms! What age is he? When pressed for details, mom might be able to remember the date of birth. Calculating off of this, you can deduce that the child is 2 months old. But in the view of the mom, he doesn’t have age yet. He’s just a baby. A newborn. Nothing more and nothing less. Age doesn’t matter.

Pa ka pale. These words seem innocent but they usually carry a story. Translated, this is simply “cannot speak.” As in: “We were in the market and left our sister home alone. When we got back this afternoon, we found her lying in her bed like this. She can’t speak.” You bend to examine the patient, and indeed, she is lying flat on her back with her eyes closed, not speaking. Whether or not she actually can speak is not argued. You can try to coax words out of her, but the family is quick to assure you it won’t work. You’re wasting your time. She simply can’t speak. Her breathing is normal and unlabored. Her vital signs are normal. Her eyelids flicker when her eyelashes are brushed, giving the indication that she is conscious and aware. But nothing you do or say will get her to speak. What is the deal? The first time the American nurse encounters this, many wild possibilities come to mind. Has she had a stroke? Seems unlikely, considering she’s 18 years old and in apparently good health. Did she have a seizure and is now in a post-ictal state? She has no history of seizures. Was she poisoned? Is it tetanus? You question the family, as they are the only ones currently able to contribute to the story. They shrug and maintain their story that nobody was home and therefore they have no idea what happened. However, as you continue questioning and probing the issue, the pieces of the puzzle start falling into place. The details come little by little, but in the end you get the gist of the problem. It seems that the girl was not, in fact, alone all day. She had a visitor, a neighbor girl who does not get along with her. They had problems between them, and the conversation got hot, and words were flung around like rocks. There were a few blows exchanged. And then the girl became like this. She can’t speak. Hmm… is she just angry? Yes, the family nods their heads sagely. She is angry. That is all? She can’t speak because she’s angry? Um-hm. Yep. Looks like it. Ok. Well, not much we can do about this! We can give a little something to calm her down, but this is a personal problem and medicine isn’t going to cure it. Yes, the family agrees. It is a mind thing. A problem with her spirit. She needs to forgive her neighbor. We give a little sedative and some gentle counseling and send them on their way. Sometimes the “pa ka pale” sickness strikes because of grief. I recently went to the house of a neighbor lady that had recently buried her son. She was lying in bed, staring at the wall. She couldn’t speak. I checked her over and eventually gave her a injection of diazepam, a sedative. A few hours later when I passed by, she was sitting up, smiling and able to speak again.

Mwen pa ka monte mòn. This complaint usually comes from an older person. The average age in Haiti is startlingly young, but occasionally we’ll get a patient who has passed the mark and is still with us. They usually don’t know their age exactly, but their hair is gray and their normally smooth face is lined with wrinkles. They peer at you with rheumy eyes and squint when you speak to them, having difficulty understanding your American accent. You ask what is wrong? The answer: “Mwen pa ka monte mòn.” Um, excuse me, you can’t climb mountains? “Exactly. When I’m walking home from work in the evenings, I find that I can’t climb the mountain. I get short of breath.” Well, that certainly is a problem, considering that you would be hard pressed to find 100 feet of level ground within walking distance of here. There is literally nothing but mountains here, so if you find that you suddenly can’t climb mountains, you’re in a hard place. But we patiently educate the patient on the natural process of aging, that maybe when you’re 70 years old and have done hard manual labor every day of your life, it’s normal to feel a little tired when hiking these mountains? I mean, I’m in the prime of life and I still sometimes feel like I’m going to give out, hiking up a particularly steep place. They smile and nod their understanding. We give them vitamins and some oral nutrition solution. Go home, papa. You’ve earned your rest. Maybe you will be able to climb a few more mountains yet.