Well, Mirlene is going home this weekend to prepare for her wedding so I will have a different interpreter. His name is Stanley and he will be giving me and two other people creole lessons also. Todd & Donna Schmidt are the missionaries here in Oriani. They have been here since July and know some creole already but will be taking the class with me. Lessons start tomorrow. I have studied a bit from a book here but know very little...
    On Saturday it was Christina's birthday and we celebrated by going to the ocean. It is about a 2 1/2 hour drive from here. We left about 11:00 and stopped at a market and got lunch partway down. We went to a part of the beach that has a pier but very few people. After playing in the water a while and walking along the beach Keith found a man who had a boat and would take us for a ride if we wanted. It was not a large boat but the 10 of us easily fit. It had a motor and a very old fashioned looking oar was lying in the front of the boat. We never had to use the oar but the motor worked fine. We rode for a while then explored a small village where it seemed the main livelihood was fishing. There were several men making a net and others attaching fish hooks. One man was stirring something in a big pot over the fire. I don't know what it was, it looked like pretty good sized shellfish of some kind. Then we headed back in the boat. Partway back a couple people bailed over the side of the boat to do some swimming out in the deeper part of the ocean. We turned a big circle in the water then came back and picked them up. They let us off a little ways further down than we were originally at a part of the beach where there are natural springs. The spring water was cold but worked wonderful to wash some of the salt off before heading back home. We had stopped in a town partway down the mountain at a restaurant and told them how many of us there were and what time we would be back and they had a delicious hot meal waiting for us. Fried chicken, fried plantains, rice and beans and a sauce to go over them and macaroni salad.
    Yesterday we got a call about a lady coming in to the clinic with seizures. Turns out it wasn't true seizures but I'm not sure what it was. All of her vital signs were stable but this lady wouldn't talk to us. We sent the family members out of the room and then she did answer some yes and no questions but would never tell us what was really wrong. We gave her some IV fluids then sent her home with some vitamins etc...
    Today we had a baby come into clinic very dehydrated. We couldn't get an IV on him so finally put an NG tube in and gave him some oral hydration and eventually were able to get an IV. By the time the clinic closed he had had close to 2 liters of fluid altogether and was at least able to cry. At first there were two of us trying for an IV at the same time on different extremities and he hadn't made a peep.
   Ok... 'Til next time...

Today I will write about some of the patients we have had lately. The first baby I helped deliver here didn't turn out so well. The baby was born with some facial deformities and was only gasping for breath once every few minutes. We have one suction machine at the clinic thanks to Ken and Laura from St Mary's so I used it and got a lot of stuff out but the baby still wouldn't breathe or cry. The baby had a heart rate of about 60 to start out with but that improved to 100 and then 130. We were giving the baby oxygen and still trying to suction out the airway. We had already turned the suction machine off and were going to give the baby to the mom to hold until she died when she took a breath and gave a weak cry. This was at least 20 minutes after she had been born. She did revive but I don't know how long she lived. The family was from a long ways away and the baby was alive when they left for home but hadn't been able to nurse yet. I'm sure if she lives she will have brain damage though from lack of oxygen because I could feel her heart rate but couldn't ever locate a heartbeat from her fontanel. There wasn't a dad present just some other family members to walk home with the mom.
      Another sad case was a 23 month old little boy who weighed 16 lbs and was so weak from malnourishment he couldn't even sit up anymore. He didn't even want the pedialyte when we tried to give him some and refused to take a lollipop but by the time we sent him home with some food, vitamins, and pedialyte he had perked up a little bit. We told the mom to come back when the food was gone and we would give her some more so we'll see... This mother had come to the clinic with some other women, one had sores on her legs and another one had two malnourished children with her. Between them they had a mule but they also had probably a six hour walk one way.

     I saw a 68 yr old man the other day who had never been to a clinic or doctor in his whole life.
      Then today we had a 9 month old with vomiting and diarrhea. Mom said he couldn't keep anything down. We gave him some pedialyte and in less than two minutes he was throwing it all up. This child is in the beginning stages of malnutrition. I gave him a suppository to help decrease vomiting and twenty minutes later we tried some pedialyte again. This came up just as fast. Then mom said he was having diarrhea. We checked his diaper and found a wiggling worm at least six inches long.... So that was his problem... But we couldn't give him any dewormer yet because he couldn't keep anything down. Before lunch I started an IV on him and Jitan ( our Haitian nurse) kept an eye on him while I ran home for lunch. When I returned he was doing ok just hadn't tried to drink anything yet, so we tried again. It all came up right away again but he was looking a little bit better from the IV fluids. So I tried another medicine for nausea. This one seemed to work so he went home with a bunch of meds after having spent most of the day in the clinic. Hopefully he will be able to keep the de-wormer down by tonight because that's what he really needs.
      Another patient I saw today threatened to kill me, but he is only three years old and had multiple abscesses all over his head so by the time we were finished with him I really didn't blame him. We had to squeeze pus out of at least 10 different places on his head.  We sent him home with an antibiotic and two extra lollipops because we had to do such painful things to him... Hopefully the antibiotic will take care of the abscesses so they don't spread anywhere else.
    Then I had a two month old with scabies and infected places on his legs and feet from the scabies. I  cleaned him all up and wrapped both legs with gauze up to his knees to help keep the antibiotic ointment on him. He also went home with antibiotics and cream to treat the scabies with.

I have received several hints that people want to know what it looks like here so I will try to explain what I can. We are at about 5,000 feet above sea level and it takes three hours to get up here in a vehicle. The road is very bumpy and washed out and there are "motos" honking and passing all the way up. Some places the road is too narrow for two vehicles to pass so the driver will just honk the horn and go. If it is too narrow someone will have to back up until the road is wide enough to pass. There are also a lot of "commu's" (like farm trucks with the high sides) that can be VERY loaded down with everything imaginable. The trucks are usually heaped up with bags of corn, cabbages, rice, potatoes, you name it. Then on top of that and riding on the top of the sides of the truck are the people with all their goods- baskets, bags, bowls, chickens, goats, pigs, children, etc... So the other vehicle is often the one who has to back up and not the commu. The front of the truck will be full of people also, often at least four people. Then there are also people walking on the road, donkeys, mules, horses, and their loads. Also people leading their goats to or from market. The road goes along the edge of the mountains at places with steep drop offs right beside the vehicle and other places it runs along through the riverbed. It is normally a dry riverbed but every time it rains the road in the riverbed gets washed away so a new path has to be chosen. There are several streams that need to be forded also. By the streams there are lots of people washing clothes, taking baths, or hauling buckets of water to their nearby gardens. The people then head back home whether it is up or down the mountain with their baskets of clean clothes or buckets of water on their heads.
   About 30 minutes from where we live is a place called "forest of pines" where there is market every Saturday. Someone from this house will usually go. Today just four of us went so we took the motos. It was just beautiful riding through the forest, although a person tends to be dusty and sometimes a bit shook up from the ride there. Market is just one crazy mass of milling humanity. Just imagine one massive flea market, some of the places have a tarp held up by wood poles for shade. There is a good place to eat there also. Of course there are people selling their few pieces of meat or cooked cowhide or whatever all it is but the place where we eat is in a block building with a roof. The door is a curtain and they wash the dishes right in front of the building. Big pots of food line one corner and another corner has an old freezer that is used for an ice chest to keep some drinks cold. There is usually chicken, rice, and some type of bean sauce served. Today the sauce was made with peas. Very good food! The tables might be ramshackle but they are covered with some type of afghan or tablecloth. There are probably five tables in all and you can sit anywhere.
   

Okay, I will try to answer a few of the questions I got after posting. Yes, I am on call 24/7. The clinic has three rooms that we see patients in. I work in one, a Haitian nurse works in one, and Osias works in one. He is a church member from here that had started a small clinic before this one was even opened. He isn't a nurse but does have some medical knowledge. Each one of us then has an assistant who will fill the medication orders we write. The clinic also has a reception area, a pharmacy where we keep the meds, a room for extra supplies like an IV pole etc..., and a small room with a twin bed in it in case we need it. We also have an ambulance bay. Right now the ambulance isn't working though so that's why we sent the lady down in the suburban. Right now neither of the others who are working with me do wounds except routine dressing changes so they're all mine. I don't mind. I rather enjoyed it.
     Last week combined with Wednesday, Thursday, and Friday I probably saw 40 patients myself.

Well, I left Raleigh at 6 am and got to New York JFK airport about 7:15. My next flight wasn't leaving until about 8:50 but it was on a different airline and I didn't realize how big that airport was. My ticket didn't have a gate number on it so I found a gate where the plane was leaving for Port-au-Prince. This I soon found out was not the right place. I had to go across the street where the taxi's, buses etc... were, then find the tram and take it to a different terminal. At the second terminal I had to go through security again which meant waiting in line a while also. Then after security I had to find the correct gate. It was getting very close to departure time and I wasn't sure if I was going to make this flight or not. I was the last one on the plane but did make it, barely. Apparently the lady at the counter had just tried to call my phone but I hadn't even taken the time to turn it on. The flight was good and I got into Haiti at 12:15. We were scheduled to arrive at 12:55. Going thru customs only took a few minutes then I picked up my luggage and headed out of the airport. Keith had emailed me to not give any redcap more than $5, well that wasn't really a problem because they didn't swarm at me. One guy did walk beside me and tried to talk to me thinking he knew who I was looking for. He wasn't quite correct but at least wasn't pushy. I couldn't see anyone who looked like they were looking for me so I walked down the sidewalk towards the parking lot. Trevor (Keith's oldest son who is engaged to a Haitian girl) met me there. When we left the airport we stopped at a little restaurant for lunch. They had given out turkey sandwiches on the plane so I wasn't really hungry but I got a drink while the other young folks who were along got lunch. Zach ( Keith's second son) was along and Sally, ( their children's school teacher) and Mirlene ( young Haitian girl that Trevor is engaged to). It was quite a nice restaurant, comparable to a Subway but also had burgers, pizza, etc... It was Ina partially closed in building with fans. It was about 95* in Port that day but comfortable under a roof with fans. Then we headed out of town which took probably an hour then 3 hours up a bumpy mountain road to Oriani. They had gotten a wooden door in town so several times on the ride up we had to stop and rearrange boxes to hold the door up so it wouldn't hit our heads. We stopped at Mirlene's  sisters house on the way back for a while. Her sister is a church member and just got married about a month ago. By the time we got up the mountain it was dark. We pulled in through the gate and I had barely opened the door when I hear a little voice " Hello, Angela- is that you?" It was Ketli, Keith's 3yr old Haitian girl that they are trying to adopt. They got her when she was probably 16 months old and was starving. She is adorable!  Keith's also have a 14yr old-Cam, a 12 yr old -Chase, and a 10yr old- Christina.
    I live with Keith's and their school teacher, Sally. We live in a cement house with a cement floor and tin roof. We have electricity from solar panels and batteries. We girls sleep in a separate cement building that has a bedroom for each of us and also the schoolroom. Up here on the mountain the weather is beautiful! Breezy at night and lots of days during the day we will need a sweater. Lots of barefoot weather. Church is a 10 minute walk from our house and that is also a cement building. It has a tin roof also and benches that have one board for a seat and one board for the back. There were about 250 people in church. I think there are about 100 members here. All services and singing was in Creole but the missionary up here, Todd Schmidt, often uses someone to interpret. The message was by someone who was here to visit Todd's so it was in English first then interpreted into Creole so I could understand. All new people are supposed to introduce themselves to the whole congregation before church ends so that was an interesting new twist. Sunday evening church is from 4-5 pm then we went back home and had supper. Monday morning I went to the clinic and spent the day observing. Tuesday also I was at the clinic but in the afternoon worked on getting my phone and email and everything set up. Wednesday morning at the clinic the first question for me was "Are you ready to start seeing patients?" No, I wasn't, so I stocked pharmacy shelves for a while then saw a few patients in the afternoon. A lot of the complaints are for acid reflux, hypertension, and fever. These people don't even have enough money to get Tylenol. Thursday and Friday I also saw a few patients. Mirlene works with me and translates for me. She isn't a nurse but has worked in the clinic quite a while and also worked in the hospital after the hurricane. Friday night while we were eating supper we got a call that someone was at the clinic to have a baby. We stayed at home a little longer so we could eat some banana cake that was just coming out of the oven and when we got to the clinic there was a baby crying. He had been born several minutes before. Probably 45 minutes later the family left for home, dad carrying the baby and mom walking.
    The most interesting thing that happened this week happened this morning, just before we left for market. A lady had gotten her foot caught in the "moto" ( motorcycle) They had brought her quite a ways up here on the moto and left her at the clinic gate and came to the house to let us know they needed help. There was blood on the bike and pieces of flesh on the spokes of the wheel. We went to clinic to help, her leg was broken in several places and her heel was almost cut off. There was a lot of flesh missing from her heel and bone was showing. I washed it out and bandaged it all up then we tried to find some kind of splint. We didn't really have anything long enough so ended up using a cardboard box and some wide clear tape. I will try to post the pictures we took of the whole thing when I figure out how to.

This lady then had to ride 3hours down the bumpy mountain road to the hospital. We put her on the stretcher and put her in the back of the suburban. All we had had for pain for this lady was some hydromorphone pills.......
    Okay, more later.