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Medical Journals

E-mail updates from April 2010 Medical Mission – St. Monica’s Catholic Church, Duluth GA.
This week, a team of 26 doctors and nurses from St. Monica’s headed down to Hinche for an 8 day medical mission. Updates from their trip will be continually posted at this site, courtesy of St. Monica’s in Haiti, which supports Pere Bourdeau at Sacre Coeur.

Whitney Clinic at Sacre Coeur, run and supported by St. Monica's.

DAY 7 (4/24) – Final Day:
Jim sent his “End of Mission Report” tonight by text:

“1094 total seen for the week, 122 today and only worked ‘til noon. Over 200 seen in dental (not sure if this means today) with numbers still being tabulated. Today, mostly desperately poor seen.”
As in past mission trips we have seen that people realize that the Americans are leaving and they rush over trying to be seen. This used to be much worse, in the beginning the trips were once a year, people were truly desperate. We now have a talented, full time physician in Dr Dagerus who takes excellent care of the local population when the team isn’t there. There are generally 3 trips per year now; the large one in Feb, the “specialists” go in June and a small group goes in Oct, mostly to do staff evals and prep for the Feb team. We also have a commitment from St Therese Hospital to see the Whitney Clinic patients without excessive cost in exchange for us providing them with needed supplies and meds. (WIN/WIN situations are ‘good things’ as Martha would say.)

I did ask for more info for my report and I was told their vans leave for PaP at 5:30am and there wasn’t anything else to tell. That’s it for this trip, it has been my pleasure to provide these updates for you and I hope they were helpful!

DAY 6 (4/22)
Tonight’s update is a result of several texts throughout the day from Jim, I’ve corrected spelling and inserted some explanations for medical terms but otherwise this is what he sent me:

Work hard and play hard. It’s funny but every minute seems to be accounted for. Bells ring at 5am. Mass at 6. Breakfast at 7. We shop from the market ladies in the courtyard after breakfast. Clinic and dental open at 8. We rotate shifts for lunch, taking about 30 to 45 minutes. See patients till 5 or 6. Clinic and Dental shut down and cleanup and pharmacy does inventory. Dinner at 7. End of day report, where each department reviews the day. We break up at 9pm so half the team can go to the Evichy (the Bishop’s residence) to sleep. And start again tomorrow. In between we try to accomplish little things. Peds and nurse visits to the azeal (the sisters of mercy orphanage). Trips into Hinche for the newbies. Lollie and me checking on our three ultra-poor families. By the end of the day, we feel like we’ve worked a week!

Between seeing patients, we saved a life. Ultimately, we saved too many to count, but this guy was about to die now. 50 year old guy with underlying lung disease, likely emphysema, with acute exacerbation (really bad flare up.) Using accessory muscles, tachypneic (breathing very fast), shallow, raspy breaths. Oxygen satuation at 82% (you really don’t want to be much below 95%) Dr Dagerus quickly identified the crisis and ordered 15mg decadron iv push stat (a potent steroid to rapidly decrease swelling) and nebulizer treatment. Guy takes the nebulizer but doesn’t break and says he’s gonna pass out. (Not enough oxygen to the brain.) We hurry him to the table in my room because the head elevates, but the guy’s breathing is so bad he has to lean forward to get the air in. I order continuous nebulizer therapy and slowly the oxygen climbs into the 90’s. Heidi does some cupping therapy and the guy’s saturation goes to 97. We push another 10 mg decadron and eventually the guy is breathing room air at 100% saturation. Breathing is slow, deep and comfortable. Great teamwork!

Barb and I ran a cardiac intensive care unit. 50 year old lady comes in respiratory distress with bilateral lower extremity edema (we talked about this yesterday, swelling in both legs, circulatory failure indication). Triage rushes her to table and they get an ECG showing anteroseptal infarction (severely damaged heart muscle). Dr Dagerus gets her a beta blocker (cardiac med), aspirin, lasix (water pill) and sublingual nitroglycerin (opens up the blood vessels for better blood flow everywhere). Her blood pressure is 200/100 (normal is 120/80). We push the emphysema guy off my table because he’s looking better and get her on (This is my favorite line in the whole text!). I get Barb over and we start managing the patient. We use nifedipine (blood pressure med—very old but very potent) high dose, more lasix, iv morphine and high dose aspirin and dose nitroglycerin under the tongue every 5-10 min. Eventually stabilize her. Talk to her family. Multiple year history of exacerbations like this, 1 week in hospital to stabilize and 1 week out. No meds at home for maintenance. We get Sandra Jean Louis over to do an echocardiogram on the lady. Her Ejection Fraction is 20 percent (fraction of blood pumped out of ventricles with each heart beat. Normal is 50-65%). Left ventricular hypertrophy, right atrial enlargement, left atrial enlargement, left and right ventricular dilation, tricuspid, mitral and aortic regurgitation (all valves leaky), all severe, global hypokinesis (decreased muscle activity in the heart). Atrial septal aneurysm, pulmonary hypertension. Everything that could be wrong, is, she’s gonna die. We start multiple meds, all for home use. Explain to the family how to care for her at home. Tell them for refills, to come to the clinic but leave her at home. Again great teamwork, highly skilled and professional, better care than local hospital, preventative, acute and palliative (end of life care). Cannot imagine a better crew.

Last text of the day:
Catherine, just finished seeing patients. 265 today. Our dogs are barking! Pugel looks like he was dragged 10 miles by a team of mules. His second to last patient at 5:15 was a mom and 5 kids. Lisa is standing over me now asking again about a complicated heart patient. What a day!

They will get up tomorrow and do it all over again…..

That’s it for tonight; let’s pray for some rest for them.

DAY 5 (4/21)
This one will be brief—the phone kept cutting out on us.

They saw 225 patients today, many of which were interesting and complicated:

**There was 6 year old male with abdominal tumors that they are trying to get sent to another facility. Here is a description of the place where they are trying to have him treated:
“Zanmi Lasante (“Partners In Health” in Haitian Kreyol) is PIH’s flagship project – the oldest, largest, most ambitious, and most replicated. The small community clinic that first started treating patients in the village of Cange in 1985, has grown into the Zanmi Lasante (ZL) Sociomedical Complex, featuring a 104-bed, full-service hospital with two operating rooms, adult and pediatric inpatient wards, an infectious disease center, an outpatient clinic, a women’s health clinic, ophthalmology and general medicine clinics, a laboratory, a pharmaceutical warehouse, a Red Cross blood bank, radiographic services, and a dozen schools. ZL has also expanded its operations to eight other sites across Haiti’s Central Plateau and beyond. Today, ZL ranks as one of the largest nongovernmental health care providers in Haiti – and the only provider of comprehensive primary care, regardless of ability to pay, for more than half a million impoverished people living in the mountainous Central Plateau.”

**There was 13 year old girl with edema (swelling) from her toes all the way up to her groin. She was sent to St Therese Hospital in Hinche, because they could not determine the reason for the edema. 73 year olds do this kind of thing—not 13 year olds! Their circulatory system ought to be more than adequate to return fluids back into the rest of the body, so something was definitely wrong!

** They saw the return of the burned patient from yesterday and continued debriding her wounds. This was made much easier by the narcotics obtained from Sr Mary! Another burn patient was seen today, an infant who had fallen into a fire. As you probably know, many Haitians cook over open charcoal fires and this child fell into one. Jim said the burn was over about 20% of her body—which is quite survivable, although obviously painful and may cause scars.

In other news:
**Dennis Andrews fixed the broken internet and ethernet connections, so those are back up and running. This is one of Dennis’ specialties and I think they have been waiting for him to fix this!
**There was a band tonight, consisting of a 3 string banjo, a guy playing the bongo drums and someone with a cowbell (whom I would have gladly strangled by the end of the phone call!)
**I got to speak with Fr Bordeau, who said to tell everyone “hello” and that the team is “very busy.” Jim has corroborated this statement and I have seen several Facebook postings about others being exhausted as well. You may want to plan on your family member taking a very long and well deserved NAP on Sunday.

That’s it for tonight; hopefully I get Jim tomorrow before the margaritas.

DAY 4 (4/20)
Sorry tonight’s update is so late. I asked Jim for an update at 8:20pm and he said they were debriefing. I suspect they had just started because he finally called me at 9:30pm.

I’ll start with the ending to the PaP saga. Barb and Jim did get to meet with CARITAS today and they were able to consign the current shipment and all future shipments over to them. This is a very BIG deal. Jim says when people ask who is in charge—the answer is the government is! He can tell by the amount of paperwork that has re-appeared! CARITAS will do all the paperwork for them and even pay the $900 fee to get the current shipment “out.” He asked about writing them a check and they told him no, that was their mission—to assist NGOs in navigating this process in Haiti. Thank God someone is, because last year’s med shipment about killed us….don’t ask!

They also met with a representative from Prophalab, which is a large pharmacy in PaP. They worked out some details with billing that had caused some snags over the last year. Various other NGO’s use our clinic as a delivery point for their orders—yet they are the ones to be billed, not us. Once that was worked out—they donated a bunch of insulin (which is a big cost saving for us…that stuff is expensive!) and others meds were purchased for Whitney Clinic.

Jim says Sr Mary is trying to transition away from the medical treatment business, so she asked them to take any meds and supplies they wanted back to Hinche as well—another big freebie, since many medical teams had stayed there and left things since the quake. He said she wants to focus more on education.

She may want to start with how to brush your teeth. Dr Bart and Kate spend all day yesterday and half a day today providing all needed dental care for the entire village living in her soccer field. They did this outside, under a tent! Remember there are an estimated 1000 people living in this “village.” Not bad for a day and a half’s work.

Sandra and Mark spent the day doing ultrasounds. They identified someone with polycystic kidney disease, which has now been treated. They also saw a pregnant lady about 5 months along and reassured her that everything looked fine. Baby was ok and looked like a girl. They will do ultrasounds in Hinche the next two days and then we will lend them to the Partners in Health facility in Cange on Friday. Sandra is a skilled ultrasound technician, so we have to share the wealth while she is in country.

They finally left and headed back to Hinche around 2pm.

In the meantime in Hinche, Heidi and Anna were seeing many complicated derm issues. One of which was a person with a very recent burn that was quite severe. They were able to get it cleaned up and debrided (removed the dead tissue—essential to keep it from getting infected and to allow it to heal.) This can be a VERY painful process, and Jim says the narcotics he got from Sr Mary will come in handy as they will need to continue to debride this wound.

Dr Lisa saw an 87 year old man with an acute MI (essentially having a heart attack right in front of her!) and stabilized him enough to get him over to St Therese Hospital where I believe he is doing ok. Jim pointed out that this is thanks to the two working EKG machines at the Whitney Clinic—the only working EKGs in the Central Plateau area. (I may be misquoting here—but I swear that’s what he told me!)

Since Dr Bart and Kate were gone, Agnes and Dr Rhonda ran 4 chairs of dental patients all day long. By the way, Dr Rhonda went on our first medical mission in 2000 and has now returned 10 years later for this one. Welcome back! Dave Lockhart also returned to his roots and was a dental assistant all day long, which is what he did on mission trips in the “old days.” Jim says he fell back into the routine very quickly.

Dr Dagerus, the Haitian MD who staffs the clinic all year long, got the vaccine fridge up and running!!! This means that the Vaccine Program that we planned ten years ago will finally come to fruition. As of May 2010, Whitney Clinic will be an “Official” government sanctioned Vaccine Center. Yipppeee!! Our vaccine nurse went though her training and everything is ready to go.

A few other notes….
Who knew how much technology would come in handy? Yesterday Jim drove Dave nuts because he was sending him pictures of derm stuff from his iPhone in PaP to show to Heidi (the derm guru) in Hinche, so she could tell him what it was and how to treat it. We could never have imagined that 10 or even 5 years ago, (the pictures I mean, driving Dave nuts has always been easy for Jim.)
Also, Barb is being named Nurse of the Year by the AJC!!! Look for the announcement in May. Jim couldn’t contain himself and had to announce it.

So I think that is enough for tonight. Goodnight.

DAY 3 (4/19)
Hinche update:

Spoke with Dave Lockhart tonight:

It was a busy day today. They saw 190 medical patients and 24 dental. Scott said that he saw the sickest patients today, since he’s been coming down. They saw a number of very high fevers and a broken arm. They had to give some patients IV antibiotics and IM (intramuscular) antibiotics. Yesterday they saw a 4 year old that had his heart on the right side and today they saw an 80 year old with the same condition.

One thing that was very evident was a lot of people that they saw were affected by the earthquake. There are a lot of people in Hinche that were displaced by the earthquake. Many families have twice or triple the amount of people living in their homes. Budu, Fr B’s driver (who took the PaP team into the capitol today) now has 8 people living in his house! Another lady came after they had already shut down for the day. Dave said she had three kids with her and told him her arm was broken. He escorted her in and while they treated her, he found out that the children belonged to her sister, who had been killed in the earthquake.

Monica’s experience in pediatrics from working at Children Healthcare was invaluable. Rhonda in dental was a rock star, along with Agnes and Julie, who were greatly appreciated. They all missed Bart, Kate, Jim and Barb but the clinic ran smoothly even without them.

Dave said some of the newbies went to the orphanage today and appeared to be quite affected by the experience. I asked if someone who had been there before had gone and could tell if the census had greatly increased, but he said they couldn’t spare the staff, so only newbies went. Mark will probably go later in the week and we’ll get an update on that. This orphanage is run by the Sisters of the Poor, which is Mother Theresa’s order.

The weather is hot and sticky, which is typical for this time of year. This is why they prefer to go in late January or February.

They now have a team mascot, Itchy the cat. Per Dave, it’s very sweet and friendly, but he’s sure they’re all getting fleas!

For those who asked, Lollie will give us a full update on Mme. Jacqueline and family on Wednesday.

People have asked for news from home, specifically about Dancing with the Stars and Idol. Not being one to watch those show regularly, feel free to send me any updates regarding these that you think are appropriate. I assume some people must follow Survivor as well. I forgot to tell them about the CMA’s (again, not something I follow), so I’ll do that tomorrow.

Update From Port auPrince (PaP):

Jim finally called. They left at 5am and arrived about 9:30am. They have meetings tomorrow and plan to leave around noon to head back to Hinche. He and Barb had meetings scheduled today with a pharmacy that they get meds from in country, unfortunately the person was not available and the meeting was re-scheduled for tomorrow. They is also a meeting with CARITAS tomorrow. This is a Catholic Haitian based charity that will be receiving their big meds shipment from the Netherlands in a month or so. They are also hoping to get help in getting their current container released. It is full of over-the-counter meds and other supplies and has been in PaP for over a month! (This is not uncommon, it’s just frustrating.) Alliances that had been made before the earthquake are no longer, chiefly because several of those people died in their ministry buildings during the quake. Unfortunately this means some amount of starting over.

Bart and Kate were a big hit in Sr. Mary’s camp at Matthew 25 House (last count ~1000 people living in her soccer field.) Jim said they saw more than 20 people and I will assume most needed extractions. Jim says there have been plenty of medical people rotating through the camp but no dental!

There is a person at the compound making prostheses and Jim has video of a girl dancing that they knew from right after the quake, when she had her amputation. He and Barb also went to the orphanage for special needs kids and found everyone well cared for and in good health. They had last been there in October and some of the kids had been sick and needed a doc at the time. Not so this time. I cannot find the picture from October. I did attach a photo of the front gate of Matthew 24 and of Sr Mary for your viewing pleasure.

Sister Mary Finnick of Matthew 25 House

I think that is it for tonight! Until tomorrow…

DAY 2 (4/18)
Jim just called, saying they had just finished clinic and pharmacy was not quite done yet. He didn’t have the number of people seen yet, but said that Triage “rocked” and Pharmacy “rolled.” Things came together like a well oiled machine: Dr Lisa ran her area like a mini ER, Anna Summerlin saw all kinds of patients and Heidi was in great demand for all the derm issues. Dr Scott saw a kid with a ventral-septal defect (a hole in the heart) who will be connected with ChildSpring International for surgical repair. Remember, this clinic was only for parish staff, interpreters and security staff. Tomorrow is when the rest of the town will begin to filter in. And the town has supposedly tripled in size since the quake, so the numbers could be interesting!

Jim also pointed out Fr Jack may some competition in Fr Etienne (Fr Bordeau’s assistant)! Mass started at 8am and ended at 10am. I asked if that was all homily, and he said that although the homily was extensive, there was also a baptism and possibly a confirmation. Mark is not yet with the team, so some of the details were sketchy. (Mark speaks Haitian Creole fluently, Jim relies on remnants of high school French and 10 years worth of mission trips!)

On that note, Jim, Barb, Bart and Kate will be leaving at 6am to go back into PaP to stay with Sr. Mary at Matthew 25 House. Here’s a link about them (this is where Jim, Barb and Mark stayed after the quake and where our tents we collected went) . As medical and dental team members they will attend to any patients she needs them to treat. They will also meet up with Mark Coughlin and Sandra Jean-Louise and bring them back to Hinche on Tuesday morning when they return. Sandra has family in Pap and Mark has various health projects going on throughout the country that he is responsible for, so they flew in separately. Of course I didn’t know this when I reported last night that the team was complete!

I passed on the various messages I received, when I get answers I will send them on.

Told them still no flying in Europe, the Braves and the Hawks won and the Dawgs lost their freshman QB due to an arrest for underage drinking! He actually asked me about Dancing with the Stars! Told him I’d have to get back with him on that!! Who knew that was the “news” they wanted!
Until tomorrow…..
PS: Just got a text, they saw 109 patients today.

DAY 1 (4/17)
They’ve Arrived:
Jim texted multiple times today with little updates. They arrived in Port auPrince (PaP) at 10:04am. I asked how it was and he replied “the usual chaos at the airport but we’ve loaded into 2 vans and are prepared to start driving.” About the road quality: smooth as silk to Mirabalais, cobblestone-like and bumpy after that. At 2:56: “Arrived safely at Sacre Coeur.”

He called tonight while they waited for dinner. (Lunch was spaghetti noodles w/ hotdogs, tuna salad and salad) He doesn’t know what dinner will be.

They put all the people in two vans and all the luggage (2-3 pieces per person) on top. He says that doubled the height of the vans!! One length of rope held all the bags and all of it stayed on top, they didn’t lose anything, to Jim’s amazement. (He says he videoed it but it won’t “send” today, he’ll try to get it to me tomorrow.) The roads seem to be “pre-paved,” whereas 10 years ago (they’ve been flying up at least the last 8 years) they were dirt. Some areas were paved even past Mirabalais, no rhyme nor reason to it that they could tell, for which areas “deserved” to be paved ahead of others. There is no daylight savings time there either, so it is 1 hour earlier than here.

They found the clinic and mission buildings in great condition and all set up for them upon their arrival. So everything is ready to go for tomorrow. There is no power at the Sacre Coeur compound or the bishop’s residence right now because diesel is very difficult to procure. On the black market it is going for $6 US per gallon, when the usual price is $2.20 US. I was able to explain that one: the tanker from Venezuela was late in arriving this month, it had been waylaid in another Caribbean country and should be there today or tomorrow, with half a month’s worth of fuel. Until then, gas station owners are rationing everyone to 5 gallons a piece. He said Dave Lockhart was able to purchase 2-3 days’ supply of diesel, so they will have power to run the clinic tomorrow.

They will attend mass at 8am and then start seeing patients after breakfast, around 10:30am tomorrow. It will be only parish staff and family, security and translators allowed as patients. General public will start on Monday! Jim says Fr Bordeau looks good, he has lost some weight and is exercising! Also, Michael Coughlin has arrived from MA, so the team is now complete.

Jim did ask for any updates from home, of which I basically had none. I told him I will do better tomorrow, they like to hear the news in the world. Europe still cannot fly is basically all I knew. Told him we had our parish picnic today and fun was had by all. If anyone on this list has messages for a team member, just get them to me each day by 6pm and I will pass them on. This used to be more important, but as I’m sure you’ve noticed, cellphone coverage in Haiti is excellent and text message get through the best. Regardless, feel free to email any messages and I will pass them on!

Have a great evening, you friends and family members will most likely be asleep well before you are tonight, they’ve had a LONG day!

This Journal, written and submitted to us by Dr. Sam Slishman, an ER surgeon from Albequerque, New Mexico, offers a sobering snapshot into life right now in Hinche and the difficulty of determining exactly ‘how to help.

Slishman’s final entry upon returing home

5a Exit strategy..
Awoke to a warm shower and a functional toilet seat. Found quite an oasis for the night in PaP. We headed back down the long steep hill into town and learned a little more. Apparently trucks routinely lose control and crash en route to town. I’m told one lost control and killed 30-50 this morning.

10a Rendezvous..
Met the remaining Op Smile team who left Hinche a few hours prior, and we boarded the nicest bus I’ve seen in all Haiti en route to Santo Domingo.

1p Fond Parisien..
On the way out we stopped off at another medical site, an orphanage turned into a tent city/hospital. Nice buildings, but everyone sleeps outside for fear of the next quake. I had a mind to stay briefly, but the combo of work needs at home, my mosquito bite count, the dust and sweat, and Mom running out of nails to bite, I remained on the bus headed out.

Later we crossed the border between Haiti and the Dominican Republic.
I’ve never seen such disorganized commotion. Just as chaotic as downtown PaP but compressed into a 1-2 lane dirt road. Our bus got through without a scratch.

I’d been told that there would suddenly be forest on the DR side. But truth is, it looked pretty similar. Kinda dry like California in summer.

8p DR..
Arrived to Santo Domingo and found I was already missing Haiti. I get it now why so many do gooders head there. They feel useful and appreciated.
What I don’t know is whether my mind’s a little skewed by some observational bias.. Are Haitians nice to “blondes” in Haiti mainly because most blondes in Haiti are nice? Who in their right mind would vacation in Haiti with DR windsurfing and paved smooth roads right next door? Perhaps we nonmilitary foreigners are received well because we appear clueless and nonthreatening, we’re generally here to help, and we’re a potential source of something free. Don’t know. But seeing Haitians interact with each other makes me think more likely they’re just generally good people who’ve endured a lot. I’ll stick with Occam.
8a Homeward..
Debated staying in the DR a few days by the beach. But mentally can’t swing it. Just want a shower, shave and a nap.

2p Flight thoughts..
Said goodbye to all my new Op Smile friends and now flying back. I’m told when people return from trips like this a little depression hits that gradually subsides. I don’t think I’m headed that way. Frustration is a better term. I feel like I can see solutions in all directions.
Whether they’re nuts or not doesn’t matter. Solution delusions are my curse.

Many opportunities exist to help out in Haiti. I’ve been invited back for more missions with Op Smile, which I’ll consider. I do like it that some countries don’t need Op Smile any more because they’ve trained local docs to do the cleft palates. That’s real systems change. But truth is, I’d like to think entirely about infrastructure now, here and there. It’s the biggest bang for buck. I’m not just saying this for my buddy Pat, but I truly believe that the Haitian cell tower industry has done more for Haitians than any missionaries or medical squads in 500 years. Haitian cell towers appear to be the only part of the infrastructure actually working well. Even remote towers near Hinche looked incredibly strong and well maintained. Without communications, the Op Smile team would still be stuck in the DR, and I never would have known there was a nurse at Matthew 25 requesting a load of donated meds from Americares 3 weeks ago.

If some deity handed me the wheel for a day, I’d assign each country that wants to help one part of the infrastructure and then teach local Haitians to build it. The US might teach road building. Germans.. solar panels. Holland.. wind farms. France.. plumbing? China.. e-bike manufacturing. Australia/Tasmania.. reforestation and logging. Port au Prince went through something horrible. But it now has the advantage of a clean slate. It’s the etcher-sketch approach to city planning and reform. Level it and start over.

But I’m still amazed by how little heavy equipment activity I saw on my tours through PaP. At this point I wouldn’t spend another dime on water, beans or rice trucks or anything related. Sounds harsh, but from my vantage point, the current approach is just feeding the healthiest bears, plugging the streets and slowing migration to rural areas. On our downtown tour our guide said something like “the problem is all the single males just walking around with nothing to do.” I agree with the first half of the statement. But I’ve never seen a place with more to do. If the US has $350mil to burn on Haiti, there certainly is a labor pool. And I don’t buy that these people don’t want to work. I’ve never seen any people work harder.

An Op Smile anesthesiologist friend who grew up in Haiti and now practices in the US said something that’ll stick with me in reference to Haitian and America poverty. To paraphrase.. Noone’s really starving in the US and pretty much everyone has a roof over their head. If you want medical care, you’ll at least get seen in the ER. Americans below the “poverty line” are often obese, smoking and walking around with cell phones. Noone’s really poor here in comparison with Haiti. But he defines poor and poverty differently. He says poverty is a “lack of hope that tomorrow may be better than today.” With that definition I think Americans can learn some things from Haitians.

I guess for me the trip was worth it. Can’t say I accomplished much for others. (That truck took out more people than we operated on all week.) But I’ve got some clarity. Haiti’s worth helping. Thanks to friends of EPC for helping out.

11p Home..
Here in a safe, warm home, visiting loving folks about to get a night sleep .. on the San Andreas.

Final Journal Installment with supplement from Operation Smile team at St. Therese Hospital in Hinche

630a Early city walk..
Nice to see the Op Smile folks interested in walking the town. I took em to the guts of Hinche today to see the cathedral and to cross the main bridge out. It’s comical to watch 10 foreigners walk the streets. I wonder where I land on the unaware scale. When I run or walk I feel like I’m playing hockey.. weaving around motorcycles, mules and grandmas.

I commented to my LA friend that it’s possible school in Haiti has its advantages. Kids here just seem happy. They’re playful, physically fit, and seem to walk with pride. And the toys made by the little kids blow me away. It’s like they’re all auditioning for the Little Rascals.
Everything from plastic baggie kites, to toy cars out of motor oil bottles and tin cans. Stories emailed to me describing Hinche just don’t line up with my reality. I think I’m liking the open medical wards too.
Families are completely intermixed now with orphans getting attention from neighboring moms and friends helping with wound care. The hospital’s become something like a college dorm for some patients.

9a Wheel spinning..
After return we spent hours feeling pretty ineffective. But at least the pregnant woman from last night finally got her c-section and survived. I wondered last night how I’d feel today if she died.. guilty, ambivalent or pissed. By 11 the Op Smile orthopedist and I were wrestling a femur fracture in the OR. Pretty interesting repairing month old fractures.

A little more wound care later in the day, another ortho case, and shirt peddling for Frandy’s aunt. I’m a rotten salesman for my own stuff, but as her marketing agent, I’ve unloaded $400+ of her wares. Relatively calm enough day overall and Op Smile seems to be winding down their mission.

Later some local residents asked me to see a young unconscious guy in the ER. Apparently he was caught stealing, was beat about the head and dropped off by police. He died after a couple days on a cot. Not many options available for head injuries.

5p Holiday?..
Apparently tomorrow has been declared a day off for prayer one month post quake. It’s not clear if operations will continue since hospital staff will get the day off too.

Almost time to consider my next step. Nearly all the earthquake injuries I met over a week ago are much further along and I think I’ll be ok heading out whenever some new folks appear to take the torch.

10p Entertainment..
Wrapping up the day, it seems my couch has been hovering over a rat all night. He just made himself known with a mad sprint to the window.
Haven’t watched TV in 2 weeks and don’t miss it a bit. Wild Kingdom runs
24/7 here.
630a River bed..
Another great walk along the river bed with Op Smile folks. The river really is the life blood of the town. Countless folks stream back and forth with jugs of river water balanced on their heads. Many piles of large stone, crushed rock and sand exist all along the river. A few vehicles and motorbikes parked in the stream too for washing. Running along the river alone, I feel comfortable. But accompanied by 10 “blondes” (foreigners) snapping away, I’m uneasy. But all the locals and blondes seems to like it so I should just lighten up.

9a Last OR day.. despite the holiday..
Finally casted a girl with bilateral femur fractures. It wasn’t clear how the orthopedist wanted to treat her until today and I’ve been chomping at the bit to get her legs dealt with. I mistakenly dropped one leg while the ortho doc was casting it. Not far, but it hurt. Felt guiltier than I’ve felt in a long time. The ortho doc jumped to my psychological rescue telling me about an guy years ago with an unsplinted ankle fracture he sent down a ramp on a wheelchair who ended up in a heap. He’s a good guy. After a short bit the patient was back to her normal cute self and I got a nice thank you letter from her and her Dad. Seems I’m forgiven.

Cute kids definitely get more attention here which always launches me back into my evolutionary thinking. I try to get to the quiet ones tucked in the corners, but hearing a playful “Sim!” yelled across the room followed by a stream of happy Creole inevitably gets the play time.

After the casts, headed into the OR to help with a broken humerus and later another femur. More month old fractures. The bones are like puzzle pieces that got soaked in the rain. Happily this was the last of them.
We’ve dealt with all the major quake fractures. All 7 splints
I brought were used, and some a few times.

Patients at Hospital in Hinche are joined by a feathered visitor (see window) picture by Dr. Sam

9p Starfish..
Op Smile did a wrapup meeting tonight with all sorts of clapping and story telling. Pretty nice vibe. A real cumbaya. Unfortunately they brought up starfish toward the end and my sails went flat. Ahh well…
Still good folks and I hope we’ll stay in touch. I’m grateful they showed up and took me and many others under their wing for the week.
630a Another lap..
Everyone likes the river bed/city loop. On return, the Op Smile leader and anesthesiologist flew out leaving the rest of us to check wounds one last time, and come up with a wound care and PT training plan for local staff.

It’s incredible how much progress we’ve seen in a week. The hospital is significantly decompressed now and we feel like local staff will be able to handle the load now.

I thought I’d be dealing mainly with infectious disease, malnutrition and heat related problems, but by coming out to Hinche it’s been a pretty select population of wounds and fractures.

8p Crystal..
The local surgeon brought us to a Hinche disco named Crystal for some dance and drink. Standard disco.. loud. Never thought a Hinche disco was in my future 2 weeks ago.
6a Heading out..
Said goodbye to Father Bourdeau and Frandy’s family and other friends at Sacre Coeur. Really hoping I’ll be able to help Frandy out with school.
Also did a lightening rounds on any remaining patients. Don’t think I’ve ever had this much followup before. Even a few tears here and there.

My LA plastic surgeon friend and I left before the rest of the Op Smile team to visit some friend of his in PaP. We were driven to town by a couple security guards and later escorted around Port au Prince by an Op Smile anesthesiologist friend and his cousin who owns the security company. Never felt so safe.

2p PaP tour..
What we saw in PaP is tough to describe. I saw some of it on my first day, but this was a guided tour through downtown hell.. in an ’09 Land Cruiser. I can’t imagine it ever being rebuilt. I also saw my first water distribution truck. Absurd. It was survival of the fittest with primarily strapping young men getting the water.

Our guide told me his story. He runs a security company and was driving during the quake. Because his building had been burnt down 6 years ago, he had rebuilt a stronger fortress which shows not a crack today. But looking out his office, 50 yards away he now has a view of the mountains because the neighboring 5 story structure had flattened. His wife has/had and appliance store downtown. He went to protect the store and broke his arm during combat with looters. He shot a couple before the 82nd Airborne arrived to assist.

4p Up the mountain..
Our guide brought us to his house which is more impressive than any I’ve seen in all Haiti. 6 hours of philosophical conversation after that followed by an incredible night sleep. I’m trying to convince his wife to level her appliance store and start the reforestation movement from the center of hell. She’s intrigued, but likely just humoring the “blonde” weirdo.

Parting gem: If you walk into a hardware store seeking razor wire for the top of your fence, you ask for “democracy”. When the US military set up shop years ago they surrounded their compound with razor wire, and they were spreading.. you guessed it.

To begin with, it is hard to describe how poor this town of Hinche is and how these people are surviving. There are dirt roads with rocks that make even walking to the hospital difficult. Once we lose daylight we can barely see the hallways of the hospital which are all outdoors.

The patients have no sheets on the beds or pillows unless they bring them from home. Their families bring them food. Partners in Health, the phenomenal group that we we’re partnered with, are now supplying food for the patients, since their recovery is hindered by their malnutrition. We are giving them all of our power bars, especially to the children.

It is very hot here and there are 30 people in each ward with no privacy, no running water, not even a cup of water for them to drink. They don’t have much, yet they never beg or ask us for help. They speak French Creole, which is not a written language, so it not easy to translate. We have wonderful translators–young students from Port-au-Prince who can’t attend school since their University is destroyed. We are paying them $4.00 per day to help us and we are giving them food.

We have some sad stories that are tearing our hearts out. A little 4-year-old was brought in last night who was burned over 85% of his body from a petrol fire in his shack, I have never seen such severe third degree burns (the worst level) and it happened 3 days ago. He has had no pain meds and nothing to eat or drink. The only area that was not burned was where his underpants were worn. We brought him to the OR , gave him morphine and removed his dressings stuck to his body. The surgeon and I and anesthesiologist and nurse who cared for him soon realized that there was no chance of survival and we needed to help this little boy have the least amount of pain possible.

He is in a ward tonight and our nurses are giving palliative care and hospice. Telling the mom was extremely difficult but as we we all cried and prayed in the OR, we want him to be in a better place. I will always remember the loving care that our surgeon and team gave to this little boy, coating his body with silvadine to ease his pain and wrapping him in soft gauze.

In the U.S., he would be in the best burn care facility ever. Operation Smile did call the USNS Comfort but they do not care for burns on the ship and there is no other hospital that can care for him. It is hard not to find solutions for their suffering, since that is what we are trained to do.

The local people had a memorial today for all of the patients who have died here since the earthquake. Last night we heard crying and chanting at 3:30 a.m. because someone died.

We are becoming very attached to some of our young patients and it is heart wrenching to watch them sitting in bed for a month now. Our favorite little boy Jonel left with his grandmother today with his fractured femur. He lost his mom and dad in the earthquake and we don’t know how she will be able to raise him.

He laughed heartily when I showed him to Harrison Ford and Harrison just tickled him and showed such compassion to all of the patients. Harrison Ford is a true hero for helping Operation Smile and did not want any press whatsoever.

On the other hand, we have NO crutches or walkers for the children and adults who have fractures and amputations, so they lay in bed every day. We sit every night after we finish in the OR and just talk about what we need and how we can improvise.

We have bonded beyond belief and we will stay friends for life because of what we have seen. These people need long term relief such as the help of one of our teammates who is a physical therapist who is helping get them out of bed to walk again. She is having some men make crutches out of old junk, broken chairs and anything else she can get her hands on.

No one has gotten sick because we are not really eating very much. We have a small breakfast in the morning made by a local woman. Yesterday we had spaghetti with a strange sauce. Then we get our main meal at 2:30 p.m. which is very different every day. Yesterday we had rice, beets and potatoes and goat. Today we had sandwiches for breakfast with cheese, ham and a pink mayonnaise mixture.

We get a thick soupy pot of something at 8 p.m.–but we sneak it over to our little patients. Now that we know that we only get one meal a day, we make sure we eat everything at 3 p.m. I bought 4 large jars of peanut butter and 4 boxes of Ritz crackers and that is our evening meal.

I just pray every day that we can continue to help these people and make a difference. I feel honored to be a part of this relief effort and I thank Operation Smile for allowing being here. After 32 missions, this is the one that will stay with me and remind me of how much I have to be thankful for every day in my life!

– Norrie Oelkers, Clinical Coordinator in Hinche

Newest Journal Installment:

930a Harrison..
The first group from “Operation Smile” (not Project Smiles) was flown in this morning by Harrison Ford. It was an Indiana Jones landing with a single prop plane on a gravel runway. Quite a show that drug out all the folks in town. The new team seems to be chomping at the bit to do useful work after such a long delay getting here. I’m relieved they’re around.
They spent some time looking at my wound photos which seems to be making them even hungrier to dig in.

My buddy Frandy has joined along as well. He got a Harrison handshake too which I’m happy about. I let him borrow my computer to surf the internet during rounds. When I got it back, he’d been surfing the UNM website. Good sign.

11a Rounds..
Up to now, patients for me are defined by their locations and wounds.
The oncoming team is asking obscure questions that I’ve barely considered.. such as names and histories. I’m relieved to assume follower status. Funny to hear the new team debate dakin’s solution vs.
water vs. saline vs. saline+betadine. I’m pretty sure these wounds would eventually do fine with goat urine dressings, but I’m happy to learn.
Also funny to hear the nurses ask about drug allergies. Noone in Hinche is allergic to anything, and if they are they don’t know it since they’ve never tried it…either that or allergic genetics were selected out years ago here.

1p Second Op Smiles team dropped..
Apparently a third load of nurses remains in Santo Domingo awaiting their flight tomorrow.
They have a small film crew too. Everyone’s very energetic and I’d consider joining them for future missions, although I do enjoy my free agent status. I wonder what goes through the patients’ heads meeting team after new team, all snapping countless photos. At least I’m feeling like the patients know my face now and sometimes specifically ask for me (the guy with the Morphine).

Interesting watching the new team interact with the local surgeon.
They’re already exasperated. A septic woman I’d never seen is in the ICU now. Apparently she needs her gangrenous arm removed. The new team is ready tonight, but can’t access the OR.

6p Shirt peddling..
Frandy’s aunt embroiders scrubs. I bought a couple a few days ago and figured some of the nurses might like them too. They snapped up a bunch and Frandy’s aunt is ecstatic. I’ve become her marketing agent.

8p Yibber yabbering
..the rest of the night. Everyone’s ready to dig in full force tomorrow.
7a Early up.. late start..
Harrison delivered the 3rd and final team and then did a lap through the hospital. Stardom is odd but intriguing. I find I’m a shy paparaz.
Others.. not so shy. But when Harrison sat next to the patient with 2 of my splints, I couldn’t help myself. Hopefully his agent will give me permission to post some shots. Here’s a link for Op Smile:

10p Full steam..
Operation Smile had been waiting for this moment all weekend. The OR was humming and we finally started attacking some of the problems I’d been worried about the last few days. Too much to write about. But by end of the day I had a sense a lot of folks were much improved. Happily the team brought casting materials too, which meant we could deal with the majority of femur fractures. All the fractures splinted with sand bucket and plaster boots are liberated. Frandy’s doing long leg casts with me now.

8p Wrapped up..
Everyone’s still abuzz. They’re all meeting and talking about tomorrow’s plan.. and reviewing photos of Harrison.
7a Morning river run..
I’m realizing this wave of medical dynamos won’t give me a moment in day light to chill. So only time to exercise or see Hinche is early, which meant a run by the school and along the river today. Anyone who thinks Haitians have high unemployment due to laziness hasn’t been to Haiti.
It’s just that noone’s counting. From child to elder, everyone is toiling. Nothing’s happening fast with hydraulics, but they’re all busting their humps. I saw numerous guys breaking larger rocks into smaller ones.. women doing laundry in the river.. kids walking pigs.
Surprisingly I don’t think I’ve seen anyone smoking. Still haven’t felt threatened in any setting either.

9a Wound care resumes..
The team has a swing. Nurses are fired up. Surgeons are grafting and closing up amputations quick. Unfortunately, tensions are rising with the local surgeon however, and it seems he won’t permit OR time before 830a, after 5p, or on the weekend. The visiting surgeons are getting pretty hot. I suspect money’s a factor somewhere in there, but not clear where. I wonder what would happen if an earthquake hit Albuquerque or nearby and Danish docs showed up to operate at UNM or any other local hospital.

Middle of the day a kid showed up with bone sticking out his shoulder.
He’d been like that for 2 weeks. Not a whimper and he’s able to put on and take off his own shirt. I’ve never seen anything like it. And to hear that someone was found alive after a month.. Humans 2.0.

3p STSG..
Got to help out on a skin graft. I was unaware the OR was air conditioned. Suddenly I’m liking surgery.

Busy busy day.. but still time for a little more analysis.
Is it possible that the rescue efforts in Port au Prince are making the situation worse? Has anyone talked about placing all relief efforts outside PaP. The only thing I’d send to the city would be heavy equipment to clean up destroyed or crumbling buildings. Many residents there are using/guarding their houses by day and sleeping in cars by night for fear of a repeat quake. If they have the delusion that help is around the corner, then maybe they’re less likely to bite the bullet to relocate. Moving’s tough, but if I lived there I’d view PaP as radioactive. I know that’s impossible for many, but if a woman with bilateral leg amputations can find her way to Hinche, then it’s clear these people have their ways.
6a Morning group stroll..
I convinced the Op Smiles team they needed to live a little and see the town. The only time to do it is early morning so we headed out to walk the same path I ran yesterday. Amazing to watch how folks interact. I’ve made friends with a plastic surgeon from LA. He walked the path in scrubs. Picture an LA surgeon in scrubs being helped across a stream by
3 naked Haitian kids. These Op Smile folks really are wonderful people.
I’ll definitely try to work with them again elsewhere.

9a Derailed..
We’d planned to address the remaining ortho cases and maybe do some burn care. But we’ve discovered a kid in the hospital with 85% burns from a fire Sunday. He’s now on palliative care. Earthquake victim care is mostly positive. A month out, most survivors are healing and just need a little boost. But the constant background stream of serious sad pathology never ends.

Spent the rest of the day in the OR working on closing a couple amputations and a femur fracture. The surgeons are good folks. It’s like med school without the tuition or angst. Really enjoying being the gravy.

7p DJ Frandy..
Turns out my buddy is also a DJ. He set up his gear down at Sacre Coeur and we listened to his favorite French/Creole hits with Catholic church music competing in the background. Every day I’m more and more impressed by this kid and his family.

10p Dilemma..
An anesthesiologist and I were asked to come see a pregnant preclamptic woman in distress. When we got to her, we were then asked to leave to let the local OB resident handle it. The OR is locked and we have few supplies which might help. We’re both on the verge of packing up and heading out. Local politics is thick. Unfortunately, we can’t just jump ship knowing other patients await operations this week. Tough. I’ll probably head out when Op Smile does.

Dr Sam sent this picture with his latest batch of journals - appears to be a specimen of local Hinche wildlife


Previous entries in chronological order, beginning January 30, 2010

We’re off..
Nice sendoff this morning by McD’s family and Manjeet. Despite my
resistance, Manjeet’s care package of sweet and spicy prantas really hit
the spot. American Airlines stepped up as well by waiving the $100 fee
on our 200+ pounds of medical supplies and gear. So seems like a good

Flying out..
Do moths joke about docs headed to Haiti?
Having read the blogs of some other docs in the last couple weeks, I’ve
been thinking about what I’m doing and why I’m writing. How much can I
possibly help to fix a place that was broken prequake? And why would
anyone want to read yet another Haiti doc blog? This doesn’t feel like
philanthropy or altruism. I suspect we’ll be able to help a few folks
along the way, but I’m too aware of my droplet size compared to the
bucket. Disaster tourist and ambulance chaser comes to my sometimes
cynical mind. Maybe that’s me. Guess I’m just chronically drawn to the
“unsolvable” problem. In this case I want to see how a system might be
built from rubble. As for this writing.. That’s for Mom. But if I get
some other people thinking and wound up and interested in helping then
maybe the droplet might expand. Who knows.

Jacksonville to St. Simons..
Landed in Jacksonville and picked up by Tod, Michelle’s brother-in-law.
Michelle’s a dynamo. I’m finally putting faces to email names now.
Michelle organized the Americares donation and has become the nerve
center of this ill defined NGO “op”. We spent last night with Michelle’s
family and had a dinner that we’ll probably think about for a long time.
Michelle’s mother is Diane, who we’ll meet soon. She’s a 70+ year old ex
Navy nurse who headed to Haiti a couple days after the quake. They tell
me she’s the show. It’s always refreshing to meet people who believe
that every little bit counts.. and then live it.

St. Simons to Ft. Pierce for refuel..
Awoke in St Simon’s pretty wound up. Bloody cold for Georgia, but think
I’m happy to soak up a little chill. Michelle arranged a 6 seater
King-90 plane with 2 retired Delta pilots named Ron and Glen. Great
guys. They’ve already suggested they might be able to fetch us in a few
weeks. Another man on the plane named Beaver runs a ministry in Haiti
and has been there many times. Shows not an ounce of worry. Almost seems

Feeling like Forrest Gump. I have a hunch EPC lessons learned will get
me further than anything medical in my head.

To Caicos..
Another refuel. Beautiful little island I’d never heard of or pronounced
before. Driving right sided cars.. on the left.. using US currency..
part of Britain.. selling “Comida” at the stores with Spanish on the TVs.

To Port au Prince..
Interesting landing at the “small airport”. Supplies piled everywhere
around military and UN tents. Said goodbye to our star pilots who are
headed back for a night in Caicos. Seems that mission/angel flights
leaving from Ft. Pierce is the way for outsiders to get into Haiti
without the military or large NGO angle. Met Diane and got first views
of the rubble. Seems folks are digging out a fair bit, but generally
chaotic appearance in all directions. Definitely noone threatening
though. Smiles all over the place. Delivered supplies to a former
hostel/catholic missionary type place. 3 hours of mass going on in the
backyard. Set up our tent and then found myself doing the first useful
thing besides supplies delivery…. plumbing. No shower pre Sam..
showers post. The pump was cavitating and needed some simple tweaks. Hot
diggity, we’ve got water. Thank you EPU.

8pm and all quiet on the streets..
I mean really quiet. But folks in the hostel are as happy as any I’ve
seen in years. They’ve all got the look of a hard working community with
a mission. Tomorrow we’ll do rounds on the neighboring tent city. Seems
our timing is perfect, with prior docs leaving tonight and new ones
arriving Tuesday. Some talk of a little outreach clinic work later in
the day.

I think there’s a market for a do gooders craiglist that matches able
bodied volunteers with hungry NGOs.

A free cold beer in the mission found me too somehow. Don’t know if I
can say this representing EPC, but it may have been the best beverage ever.

10p tent time..
We’ll see if the morning wakeup comes from roosters or morning mass.

7a awesome sleep..
Roosters never slept.
Temp is very tolerable and not even bad on the bug count.
Amazing what a nice little oasis we seem to have. Rounds soon, right
after community eggs.

9a wound care..
The hostel sits next to a tent city with everything from kids flying
kites, to amputations, to women crying with toothaches.
Amputations seem to be healing pretty well overall. Removed some
sutures. Started a few antibiotics. Treated a sore tooth. Otherwise
enormous lines of common colds, “dizzy, head hurts, belly hurts and
vaginal itching.” Very very low acuity after the wound clinic. A
merciful breeze brought us to 3pm.

3p “outreach”..
Nice group of young folks trying to coordinate other NGOs and happy to
have a couple docs to drive around the city to places in need. They
chose a place to park and along came the masses. Seems that most of the
ortho trauma is long since dealt with in-hospital or migrated elsewhere.
The same lines of “dizzy, head hurts, belly aches” found us. Truth is, I
think the locals just wanted a chance to interact with the martians from Albuquerque. I broke off and started recreation therapy with some of the kids by playing soccer with a tennis ball. McD looked on with envy, although I probably sifted away half his patients.

Dr. Sam plays soccer with young friends in PAP

Late in the tennis ball soccer match a large 50+ year old emerged from
his steel gated home wearing nothing but underwear and dress shoes and socks. He waved me inside his 6 foot gated sealed-off home. I entered with trepidation, but knew deep down I could outrun him in his business attire.
Inside the compound I think I saw all the old monitors and
chairs that EPC has received and regifted to the Vietnamese family
across Cardenas through the years. He proceeded to unveil an enormous testicle which was either epididymitis or cancer. I gave him a pile of Bactrim and told him to “see his doctor” if it didn’t help (lame, but I’d left my testicle saw behind). He left grateful and we were showered with a round of God bless yous.

The drive through Port au Prince was illuminating. Life definitely goes
on. I didn’t see a front end loader anywhere the entire day. A few folks
chipped away with hammers. But otherwise folks just seemed to work
around the rubble.

Don’t know what to think about the US military or UN presence. I’m sure
they’ve done some wonderful things, but resentments abound here. The UN
is generally considered the agency with the best and cleanest equipment
and nicest helmets. Not an ounce of aggression was visible on any of the
streets we passed and I definitely felt no moments of fear in any
setting. But maybe it’s just the knowledge of Hummers rumbling that’s
keeping the peace. Who knows. But if I was running the US or UN
marketing campaigns, I’d do a major push for tents and soccer balls.. on
top of anything else they’re doing. When the rains start, folks in the
sheet cities (“tent city” is a misnomer), are gonna get soaked. And I’ve
met countless kids who’d join any religion for just a few soccer balls.

6p The road to Hinche..
On arrival from our outreach there stood Father Bordeau and 3 other
strapping dudes anxiously awaiting our transport to Hinche. We had no
idea they’d be there. McD thought possibly tomorrow.

We packed in minutes, piled our gear on top of boxes of supplies, the
dudes covered it with a tarp, we bid Diane and our hostel adieu, left
our tent behind and were off in a Toyota headed to the hills.

The 120k, 3 hour tour followed a road that exceeded all our
expectations. We never fully submerged, but I’m sure the miracle truck
will need new shocks in a week.

930p Hinche…
Dinner is served. Met Father Etienne. First time eating goat… followed
by a magnificent cold shower. Tonight I’m Catholic.

5a Cathedral bells..
.. rang square in the middle of my head. No longer Catholic.

Breakfasted and made discovery that Tuesday is a major Catholic
festival.. 40 days after Christmas. So instead of heading to the
hospital, we found ourselves in a 3 hour mass in a neighboring town
called Los Palis, followed by a one hour feast. Picture 2 unshaven,
unshowered dudes in scrubs instructed to walk down the center aisle to
the very front of about 500 Haitians dressed in their Sunday best in an
overflowing church. The size of the ceremony and choreography was super
impressive. Everything from bishops, to dancing kids, to papayas to
goats. When we headed back to Hinche we had a payload of about 12 kids
in the pickup bed hitching a ride.

After returning to the rectory we helped out in the clinic a slight bit
by tuning up 2 broken EKG machines and then passed out. Later took a
walk with a nice kid who had to leave his university in freshman year
because of the quake. I’d like to find him a university gig back in the
states if possible. He brought me over to San Terese Hospital where we
got a look at the conditions. Surprisingly a bad day in San Terese is a
relatively OK day in India.. 3 weeks out anyways. Maybe not so many
caregivers, but patient numbers weren’t staggering by any means. We’ll
meet the staff and relief workers in the morning and see where we can
slot in.

830a digging in..
Pretty much spent the day doing wound care and resplinting femur
fractures. A full day of work, and it’s clear that hell visited Haiti 3
weeks ago. Incredible how tough these people are. Horrendous wounds get
barely a whimper with dressing changes.

Interesting hospital dynamic. McD and I slotted in basically saying we’d
do whatever. Apparently some prior groups came and left because they
were chased off by the hospital director/surgeon.. who some described to
us as a control freak. From my perspective today, he was just fine. I
demoed a splint to him and he then led me to 6 femurs needing splinting.
Maybe he just wanted some free gear, but on this topic our objectives
were completely aligned and we got on great. Some fear of corruption was
expressed by other teams whose gear had walked in the earlier days post
quake. Don’t know. I can see his side too, however. Imagine running a
hospital and then having ivory tower docs descending from everywhere
barking orders. It couldn’t have been easy between language barriers,
varying views on sterility, seniority, “standards of care” and whatnot.

Anyways, today definitely took the edge off. We’re feeling useful. I’m
getting a lot of emails from folks who want to come down and help based
on what they see on the TV. My take now is that much of the acute
medical care is behind. Wound care continues, but even that is wrapping
up too leaving mainly the worst cases behind in the hospitals. Diarrhea,
TB, poverty and psyche trauma will take a lot longer. My rec for anyone
wanting to come down now would be to pack a front end loader… and
soccer balls.

Tomorrow we’ll go back and do the same.. whatever seems needed.

Street Scene from Hinche


830a Hinche wound care round 2..
An ortho team and pediatrician has been here a couple weeks now and early tomorrow morning they head out. So McD and I did another round of wound care while the departing docs did their own rounds to hand off some paperwork to another group headed in tomorrow night. Wheel spinning is tough, but we're getting a swing. The quest for supplies and tools never ends. At least we know our patients now, which is an ER luxury.

I invited my displaced PaP University student friend to spend the day with us to help him practice some English and maybe learn a bit while killing time. I really have a mind to just offer him a room at EPC and get him enrolled somehow at UNM. He stuck around the entire day and read his English-Creole handbook during the down times.

Hasn't taken long at all to make friends with the local Haitian hospital staff. One Cuban/Haitian nurse speaks Spanish but no English, so I'm learning more Spanish than French or Creole now. The challenge to learning French or Creole is that every time I try a word in one language, folks think I'm butchering something in the other language.
The Cuban nurse is a hoot. We've handed her our donated Cliff Bars to distribute since she has a better eye for who's truly hungry vs. not.
Truth is, I think I'm a little glad I don't know Creole. Little slivers of the earthquake stories are plenty. One diabetic lost his whole family and somehow made his way to Hinche. He's screwed. How the amputations are gonna get around is anyone's guess. But at least all the serious patients are on beds now.

We ended the day relatively early since the other team was in pack up mode. So we migrated back to the rectory by way of our translator's unlit block house. She's a 21 year old Haitian girl who has a green card to study in Chicago and has been there 5 years. Her folks are US citizens and she's working on her citizenship as well. She was visiting PaP when the quake hit and killed some of her friends. She had to retreat to her grandmother's house in Hinche. Now she's stuck since she doesn't want to go to PaP without her green card which her father wants to mail her.. but can't since it won't find her. She has to duck out of translations periodically with her own PTSD.. a problem that doesn't make the news like a good amputation.

Story after story. Anyone who says "you can be anything you want to be as long as you put your mind to it" is completely wrong. The ground state of these electrons is nowhere near n=2.

Due to his own family emergency, McD will be headed out tomorrow morning and I'll move to some dorm rooms in the hospital. It might just be me and the surgeon flying solo for a day.

Today's moment of zen.. watching our priest cross himself for dinner while talking on his cell.
But with feeding 200+ folks in his kitchen every day, I reckon St. Peter will cut him some slack.
530a movin' out..
Our cathedral bell snooze alarm made sleeping through unlikely.
McD and I got up locked and loaded for a 630 departure. By 8 we were on our way.. me to the hospital, McD to Port au Prince. New game now.
Charity flights out from PaP are pretty easy we're told.

A week here really gets the neurons spinning. Evolution is on the mind.
If this pattern of rapid life and death in Haiti continues over the next 10000 years, I'm pretty sure Haitian genetics will rise to the top. I don't know anyone who could hold up like these folks, mentally or physically. Maybe they're already Humans 2.0 and we don't even know it.
And as for government structure and national stability, I wonder if it was actually protective that the Haitian government was so ineffective prequake? Perhaps surrounding satellite cities like Hinche are better able to take the added load because they've had to fend for themselves.
Folks in Hinche feel sorry for people in Port au Prince, and stressed about the added population. But there's no sense of.. "now who's running the show?" Generators keep humming, roads remain rubble, medical care remains sparse, rivers keep cleaning the throngs, and folks keep smiling..somehow. What would happen all over the US if a quake hit DC killing 1-200k?

9a luv Ketamine..
Got my gear together with the lofty goal of 3 dressing changes for the 3 worst peds cases.. two burns and a mangled hand. Luckily I also had a bottle of Ketamine at the ready.. the miracle drug. And for an added bonus, my undergraduate student friend appeared to help for the entire day. He's become my translator, tour guide, scrub tech, friend and new reason for being down here. I wanna get this kid back to school.

Went looking for meds we left here yesterday and was told they'd walked off with our local surgeon. He may need my splints more than he knows soon.

The "Project Smiles" team that was supposed to arrive at 3 is delayed to tomorrow. I'm told they're being flown in by Harrison Ford. We'll see. I just hope any media don't gum up the gummed up works. About 3-5 adult femurs still need the OR along with a good number of skin grafts and unclosed amputations.

1p a lull..
Strangely I'm at a loss for the next step. Not many meds to work with.
I've rounded on folks a couple times.. and I'm not about to start treating hypertension.

3p Morphine..
Found the stash. My value just skyrocketed. I'm rounding again with vials of Morphine and any remaining suspicious nurses are suddenly happy to see me and my non-Creole-speaking mug.

5p The gauntlet..
Took a jog through city center and over the bridge. What a place. A continuous roving eye and a stream of "bon swas" seems to be the best security system.

7p MREs (meals ready to eat)..
Not very user friendly. Can't imagine figuring these out in a pinch, let alone in a foreign language.

9p alls really really quiet..
When the sun goes down, that's pretty much it. You can feel your way down the road. But it's lights out everywhere without generators.
Sitting here typing/Skyping alone awaiting Harrison Ford and Project Smiles. Weird.
7a Sim.. Sim..
Woke up to someone yelling a name similar to mine under my window. They needed in and I had the only key. I took the opportunity to have an early crack at the cooler part of the day. Tried to change dressings and photograph all the mid sized wounds for the oncoming team, while leaving the bad amputations to be done later with them.

1p Supplies discovered..
There's an enormous room filled to the gills with supplies. Morphine, Diazepam, Fentanyl in an exposed pile. If I was addicted to these, I'd never leave.

My buddy appeared right after and we were off to the races again with another room of post op femur fractures. Hospital rooms have electricity only at night.. which means that rooms are sweltering without fans in the day. Tape only sticks to cloth which is annoying. And forget about bandaids as they float right off the patient sweat. Some opportunistic flies too. Follow the flies to find the next dressings to change.

430p crap..
Harrison et al. remain in Santo Domingo. Delayed flight. They're scheduled to arrive tomorrow at some point instead. Looking forward to seeing some of these wounds get sorted.

7p amputation rounds..
I'd hoped to change dressings on the amputations with the Project Smiles team tonight. Game change and it was me and Frandy (my student friend) flying solo. But with my newfound Morphine stash, it was no sweat. All the amps are pretty good tonight and Frandy is now gloving up and learning the trade.

I'm thinking EPC donations will go in part toward helping this kid get into school and to create an ongoing relationship between EPC and Hinche.

9p late night analysis..
A psychosocial fractal?.. I found myself in a spot on day one that I forgot to write about. But it's gaining importance in my head. When we landed a group of guys helped us with our supplies. I'm told they were paid to be there. Everyone was pleasant. Thank yous and pleasantries all over the place. Then I was instructed by one of our receivers to hand out a few bucks. I didn't have singles. I pulled out a five which was snapped up like a hawk grabbing a mouse and I stopped there, knowing this was an exceptionally bad move. Immediately everyone turned nutty.
The $5 personal lesson.. I'll never have my wallet out here in public again, nor will I follow such a crazy instruction. The fractal.. I think this scenario plays out on in a larger scale any time a truck appears with water, food, and all the rest. Inevitably there's that last guy and a line of newly pissed behind him.

How to help the really needy is a tough nut to crack. If you've made it to the front of the food line, it's unlikely you're the one starving.
Survival of the fittest is playing out fast everywhere here. Even my own interest in helping Frandy get to back to school is another example. He speaks some English, no medical problems, nice helpful guy.. He makes the cut. No one's "rushing water lines" in Hinche, and folks are generally very well behaved, I think in large part because there are no water trucks. For disaster relief, as with everything, the devil's in the details.

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