I wonder what younger me would have thought of me now… wiping a water drip from the roof off my laptop and sipping fresh passionfruit juice out of my Contigo mug. It’s another day at the clinic, and, since this one doesn’t seem to be as busy as most, I will try to give an update.
I wonder how the little malnourished girl is doing that we saw yesterday. 14 months, body edematous from lack of protein, 6.5 kilograms, skin peeling leaving angry red patches, weak cry. I wonder if the mom understood when I said we didn’t have a medication to fix this. I gave her some beans, strict instructions, vitamins, cream, and a return appointment.
I wonder what the hundreds of spectators thought when a helicopter buzzed the town and settled down by the soccer field. Haiti Air Ambulance paid us a visit to establish a landing zone. I think most were entranced by the chopper while I only had eyes for Larissa, who came running to hug me as soon as the blades slowed. We hadn’t seen each other since before we were both married, despite living only 100 kilometers apart (by road; much shorter as the crow helicopter flies). Larissa is a flight nurse for Haiti Air and has seen many places of Haiti inaccessible now to the average white person.
I wonder if the lady we saw yesterday went down to Fond Parisien for an ultrasound. She came Wednesday evening… bleeding after what we understood to be a spontaneous abortion of one of her twins. She said she was four months along, after the midwife encouraged her not to lie to me. The midwife also told her to let me cut off the protective string she had from the medcin fey (leaf doctor). The amount of blood worried us. Our ultrasound skills were tested. Haiti Air said they’d put us on the pending for tomorrow morning when it wasn’t cloudy. I prayed and had flashbacks to when Jay and I futilely did compressions in that same room on another mom who had delivered one twin and bled out in front of us. Thank God the bleeding slowed now. We kept her overnight and by the morning we had expert advice resulting from sending the ultrasound report to Haiti Air. Her bleeding had stopped, and the pain wasn’t so bad. We encouraged a ‘real’ ultrasound from a bigger hospital. The husband said the road to Fond Parisien was washed out. We told him we heard motos were getting through. Eventually they left, leaving us to wonder.
I wonder what before and after pictures would look like on the neck wound Jonathan debrided a few weeks ago (see previous post). They got to the DR, found a good hospital, and the brother reported back to us that it has mostly healed. I wonder if the two other large leg wounds we are currently treating will turn out as well. One was healed and then the clinic closed, he says, and it got worse. Another young man has had a leg wound for a decade, since a bad accident. They are both young and keep coming for dressing changes and treatment, so there is hope. (The accident one involves broken bones not healed straight, poverty, and lifestyle factors that do not promote healing). I wonder.
I wonder, wonder, wonder what I should have done. A mother tried to get a consult for her child on Prenatal and Vaccine Day. (We try to encourage people to use the Catholic clinic or the Forèt clinic those days while we see children and pregnant ladies only.) I sent them to the Kay Mè, about a 3-minute walk away. Sister Rosalia introduced us to her doctor when she visited last time, making us hopeful that the quality of care there would be at a professional level. The mom went and the baby was seen and treated. On her way home she stopped by our clinic to check on her friend. And the baby died here. If I had only triaged better. If only the ‘doctor’ had kept them. If only the mom had come the day before. If only. Others assured me that the baby would have probably died anyway. But a dark shadow covered my day after that.
I wonder what people think of my halting Creole as I give a prenatal class every Wednesday morning. I roll out my little laptop on the bright blue and pink ultrasound cart (see pic of cart on previous post) and give a 45-minute class for the all the pregnant ladies sitting on benches in the foyer. I heave a sigh when I can put on the video about danger signs in newborns and give my voice a break. And does anyone have a wide screen monitor to donate for this? They squint at the laptop and hang on to every word as the video plays. Seeing new information enlighten their faces and watching them read the (minimal) handouts I have in Creole is rewarding. My translating skills accompanied by Google still find alterations when I get friends to edit. Examples of new information for them is that colostrum is good, not spoiled, even though it is yellow; you should only give milk or breastfeed for 6 months, not sugar water or solid food; ginger tea is bad for the mom and baby in a delivery; alcohol affects the fetus, and more.
I wonder what will happen to Abigael. Her mom gives her sugar water instead of milk and so her skin is peeling off despite our creams and exhortations. The mom walked off in a huff after I told her that we would see her if she waited for a consult like the other patients. There were 3 or so patients ahead of her. “I have cream at home and it’s not helping” she was heard to mutter as she stalked out. I wonder if I had run down the road after her with an expensive can of formula if that would have made any difference in the outcome. Does anyone want to fund a formula program so we can justify buying more of these life-changing cans?
I wonder how much Clarithromycin costs to make. We have had some patients test positive for H. pylori and this antibiotic is in the recommended treatment regimen. Well. Jonathan priced it out and the cheapest price was 146,875 Haitian goud for 2500 pills (~$1,175USD). The first quote he got was about 50,000 goud more. This is almost 20 times more than similar amounts of any other meds we purchase. After that is the transporter fee, etc. We will try to use an alternative antibiotic. Speaking of money… more and more people are coming and saying they can’t pay the consult fee of 300 gouds, which includes meds. This is less than any other clinic we know of, as most have the patient pay for meds after they pay the consult fee, and I hear complaints that they are losing patients to us. Frè Wili, our receptionist, faces the poverty problem multiple times a day… can they actually not pay? Are they lying? Are they poor enough to warrant a pass? How many times have they not paid? Thank you to all you donors who allow us to serve the community whether they can pay or not.
I wonder what my husband thought of the story I told him when he got back from a few days in Port au Prince. How strange men came to our house in the dark and tried to get me to leave with them on their moto… oh, just another night in the life of a nurse on this mountain top. Jonathan was in Port too. I told them to try Yolette’s house, as I’m not on call as per my contract. They had tried, they said, and no answer (She is smarter than I am, apparently). But then I heard a voice I knew… Frè Bartelomi was with them and had led them to my house. From the sounds of it, a lady had had a serious stroke this in the afternoon and, because of the rain washing out the roads, they only got here in the evening. With Frè Bartelomi’s promise to come with me, I bumped down our rocky road on the back of a strange moto, wrapped in my fluffy dressing gown (which is completely acceptable wear here at that time of night, don’t judge). I realized we couldn’t do much for the patient, although the grown sons insisted. I ran some labetalol and got the pressure down, but it soon climbed back near 200 systolic again. No response from the patient, laboured breathing, oxygen low despite an NPA, vomit crusting her mouth, long past the golden hour of stroke response. I started introducing the sons to the fact that she was going to die… they were in denial, but one soon realized what Frè Bartelomi and I were saying was how it was. One stayed in denial for a while, arguing that God could do anything, telling me what an active woman she was, married to a prophet, etc. I gently told him that maybe his mom’s work here was done, and her soul was being called to be with Jesus. He was still telling us how this was his brother’s fault as they loaded her back into the Land Cruiser. I wonder how that funeral planning went.
I wonder how much the hungry month of May played a role in all the strokes we saw back-to-back-to-back… hunger, stress, no money for meds… any or all of the above.
I wonder why 36 hours of rain and wind caused the animals here to drop like flies… goats especially, also pigs, horses, and cows. No one really has shelter for their animals, and many suffered losses of gardens as well. We were lucky… we had food in the house that day (many didn’t), our gardens seem to be mostly ok, and only one little goat died.
I wonder how Jonathan and Julie feel now that Quentin and Christelle have left for North America. I am impressed by the advances they have made with the language. Jonathan’s expertise is noted in the clinic and things seem to be running well.
I wonder if the son of one of our CHF patients still thinks I should have checked his mom’s prostate like he asked me too.
I wonder if there were still bullets in the infected eye I saw this morning, a result of gunshots from a gang in December.
I wonder what will become of the CHF patient I was just called to consult, edema ++ and O2 of 65%.
I wonder if the mom of the baby we have on oxygen understands enough to give him meds at home.
I wonder if I will ever go on a walk and have in my backpack every pill, syrup, cream, condom, etc. that people ask me for along the way.
I wonder what will happen to Natalie, Fabris, Mafi, Midelove, Sonsonn, Yvna, and many more. So many more.
I wonder…Nurse Carmina
