A day at Wahoo Bay

  This week has been almost as normal of a week as you can get around here. The last of the company that was here for Trevor's wedding left on Tuesday and Ben and Meg and their three girls came. They are from Colorado and adopted a girl about the same age as Christina at about the same time Keith's adopted Christina and have kept in touch. Ben supplied money to finish a house for a family here in Oriani whose house was destroyed during the  hurricane several years ago. This family has 8 children and they have been living in very poor conditions.
     On Monday a 13 year old girl came to clinic with her parents. She had been bitten by a dog a week earlier. Apparently they took her somewhere where she supposedly got two shots but the parents didn't know if they were antibiotic shots or what. The bite was in her thigh and there was one hole maybe made from a tooth? Anyway, it was infected. We are out of tetanus vaccine now so I just cleaned up the wound. While cleaning it I discovered this wound was already tunneling under the skin. I had given her some ibuprofen before starting to clean it out but I hadn't realized then how deep it was or I would have given her something stronger. We don't have very many options for stronger pain medication but we do have a few. This poor girl was crying and screaming in pain. I had to pack the wound then and I probably got about 18 inches of 1/2 inch packing in it. I gave her a shot of Rocephin, some pain meds, and some antibiotics and told her to come back on Wednesday to have it re-packed.  I wasn't sure if she would come because it had been so painful but she came with her dad. I tried a slightly different combo of meds this time but they didn't seem to help either. This time though the wound was worse. Now I could stick a q-tip in over 1 1/2 inches and there was a lot of nasty stuff I had to wash out also. In the United States this child would have been hospitalized and been on IV antibiotics and probably would have went to the operating room every other day to have this wound cleaned out. So I gave her another shot of antibiotics and told her she had to come back the next day. This time I had gotten over 2 feet of packing in the wound. Thursday she came back and  thankfully it looked some better. I tried another cocktail of the meds we have but it still didn't take away the pain. She was still on lots of pain. She also got another antibiotic shot but at least the wound appeared to be getting better instead of worse. Friday Todd did the dressing change for me and he also thought it looked better. We had also talked together and decided to try putting some lidocaine in the wound for a few minutes to see if that wound help. It did! Saturday we let her have a break and today she came back to the clinic and I changed the packing again. It looks a lot better, not necessarily smaller but less infected and the lidocaine worked so much better. I could tell it still hurt but she didn't cry at all today. We will try to change the packing every other day now unless it starts looking worse again then we'll have to go back to daily.
    On Friday at about noon Keith's family, Ben's family, and Sallie and I headed to Wahoo Bay beach for a day. There were 14 of us in the Excursion along with overnight luggage but it was fun. We got there probably about 5:00 so we dropped our luggage off in our rooms and all headed down to the beach. It was wonderful! We swam in the ocean and also some in the pool until the sun set then we had supper. The sunset over the water was beautiful! Saturday morning we slept in a little then headed down to the beach again. A couple of men in a older looking wooden boat wanted to take us out to go snorkeling. Keith offered them a price and they accepted so 8 of us climbed in the boat and off we went. They had enough snorkeling equipment for all of us and a couple of life jackets too. I would have been too freaked to go without a life jacket. The boat did have a small motor so it didn't take us long to get there. We then were free to "snorkel" for probably 45 minutes to an hour. It was so pretty. There weren't really very big fish but very colorful, also coral. Several of us saw jellyfish but nobody got stung. I also saw several eels. Then we headed back because it was time we needed to get our luggage out of the rooms. We still swam for a couple of hours after that and ate lunch then all took showers in the outdoor showers and headed home. Of course we had to stop for some cold cokes and peanut candy. Also got some really good pineapple. We didn't get home until after dark and everybody headed to bed as soon as they could. It was a short but wonderful vacation!

     Today of course was church then this evening we went to Todd and Donna's and had fry bread with all the fixins, fresh pineapple, and jello. Ben's are here until Tuesday.
    Oh yes, there was a baby born one evening while Ben's were here. Just like all of us who come from the U.S. and Canada, they were amazed how not even an hour after the baby was born the family was heading home. They had come on motorcycle and it was rainy off and on so Keith offered to take them half way home which they gladly accepted.

Clinic news

    So now, a little info about the clinic... One day I had a six month old baby come in with an abscess on her butt that needed to be drained. I was pushing around on it to see if it had an opening or if I would have to make an opening when... Pus under very high pressure shot out into my hair and over my head to hit the wall. The baby's mother was rather horrified when she saw this stuff in my hair and just stared. I told the mom she could pick her baby up and I would be back in a few minutes to finish what I had started. I attempted to get the smelly stuff out of my hair and was minimally successful. I really wanted to just wash my hair but we had benches full of patients waiting so I did what I could and went back to the baby and this time did not stand in the line of fire but rather by the baby's head. The abscess hadn't looked very big but had lots and lots of stuff that needed to come out. Then I let the mom put the baby's diaper back on while I got some antibiotics ready. For some strange reason the rest of the day I kept getting wafts of abscess smell and didn't waste much time getting a shower when clinic was finished. 

   Another day a local school teacher brought in a little boy who was probably 4 yrs old and who had stuck a crayon in his nose and it had broken off and was now stuck in there. This little guy was a trooper! He said it hurt but didn't even cry when I stuck a tweezers up in his nose to try and dislodge this green crayon. After a couple of tries I got the crayon loose but was unable to get a hold of it with the tweezers because it was so big and now slippery with snot. So I told the boy to sit up and blow hard out of his nose. He did and the piece of crayon shot out and hit the table. Did he learn a lesson about putting things in places where they don't belong??? I guess time alone will tell.

    This week out cistern ran out of water. Keith had been worried that it would already before the wedding but we had several little showers that helped us out. There are not a lot of options here of where to get water. There are no wells, only cisterns, and the river is a long ways down the mountain. Thankfully the clinic cistern still has plenty of water so several days Keith hired three local boys to haul water. Someone had a 200 gallon tank that they put in the back of a komyon (truck). Then they went to the clinic and had to pull water up out of the cistern with 5 gallon buckets and fill the tank on the truck, then rode on the truck for a short ride to the house, going over the many bumps and splashing water out of the tank, only to get to the house and now had to empty the tank with five gallon buckets also. The sad thing is, we pump the water into tanks on top of the house so we can get some water pressure and those tanks hold about 400 gallons each and we have two of them. We might have to haul water again but at least its getting close to rainy season when our supply will be replenished.

    The other day a lady came into the clinic with something like a cyst on her arm. Apparently she had had it for 3 yrs but it caused her a lot of pain so she wanted us to look at it. I called Todd because I wasn't sure what to do about it. He came to the clinic to look at it and thought we really should remove it. So he put some lidocaine around the spot then he got out a scalpel and made a small incision. After the incision was big enough the cyst or whatever it was popped out. It was about the size and shape of an uncooked bean and was hard. Todd thought maybe it was from a worm but we're not sure. But maybe now her arm can heal and not cause her pain anymore.

A Haitian wedding

It's been over a week since I posted last. The past few days I have thought every day that today I would have time to post an update and as you see it hasn't happened. One of Keith's brothers and his family is still here. Otherwise all the visitors have gone back to the U.S. or Canada. I think there were almost sixty white people here over the time of Trevor's wedding. Before the wedding most of Candace's family was up here and after the wedding Keith's family came up. The wedding took place close to where Mirlene lives in Fonds-Parisien which is a little over half way to Port-au-Prince. It is definitely warmer there than here but still not hot. Saturday night Keith had reserved a bunch of rooms in two hotels there. They were pretty nice places. A lot of the young people stayed in one hotel and the married folks stayed in the other. I didn't see a lot of the other hotel but it appeared to be even more American than where we stayed. In the hotel I stayed in every room had a bathroom with a shower. The water was not hot but that was fine as it was quite warm outside. Every room also had a fan. The building had a flat roof so we could go up there if we wanted to. The bathrooms didn't have doors like most of us are used to but they had mini blinds you could close if you wanted privacy. Sallie and I shared a room and we had no problems, when one of us was in the shower the other one would secretly guard the door. We even had a continental breakfast served to us. It consisted of Haitian spaghetti, (which is a common breakfast food here) boiled eggs, bread, juice and coffee. The spaghetti doesn't have a meat sauce but rather is cooked, seasoned noodles and it was good!
    The congregation at Fonds-Parisien has a large church with a balcony in the back. The benches were full clear to the back doors and there were a bunch of people in the balcony. If I heard right the head count at the wedding was over 500. Trevor's grandpa had the sermon and Mirlene's dad had the vows as they are both ministers. Anthony (Candace's brother) has also been a missionary here in Haiti and he knows the language very well so he translated the service into Creole. Most everyone who spoke at the wedding knew Creole but how awkward would it be to try and translate for yourself. We all had to laugh though when the brother who was having the opening said something in Creole and Anthony translated it into English. There was a large men's group for the choir and also a couple of songs sung by close friends of the bride and groom. Someone local who has a restaurant catered to-go plates of rice and beans etc for all but about 100 people who were close family and friends. We then went to a hotel and had a catered lunch there. This hotel was right by the ocean and we ate outside. There was a long row of tables covered with a grass roof and then a tarp over some of the other tables for shade. The water was so close a wave would periodically splash over the cement wall and give  someone a small shower. There were palm trees all around and it was beautiful.
   I'm sure I will think of more details but that is all for now. I will try to post again soon about clinic life.
  A couple of things I wanted to add: a wedding here is in one way an occasion to dress up and yet is very laid back. For instance, there were many, many suits worn by the men and boys yet  a lot of the ladies just had short sleeves. Also, people would walk in and out of the building as they desired and no one cared.

Oops, I forgot something...

I forgot to tell you all about the pregnant lady who came to the clinic last week with her husband. She was eight months plus some days pregnant with a child. It was not her first, there were several other children but I don't know if they were all hers. This man is 40 yrs old and has already lost one wife. This was his second wife and she was 30 yrs old. Her complaint was that she had been bleeding for eight days and sometimes she would bleed so much she would become unconscious. She was not dilated enough to have the baby so we sent her home with some iron and multivitamins, etc... Keith was planning on going to Port-au-Prince the next day so he would pick her up on his way down and take her to a hospital. Several hours later the man was back at our gate saying that when he was on the way home his wife was riding on their mule when she suddenly fell off unconscious, probably from lack of blood. We told him to get her and bring her back to the clinic and we would see what we could do. Some neighbors who had seen her fall helped him get her back on the mule and to the clinic. We put in an IV and started some fluids then checked out the bleeding. It was pretty severe and she still was not ready to have the baby. We have a Doppler and tried to locate the baby's heartbeat but couldn't. This lady needed a c-section, right away! But we are a three hour drive away from a hospital on very bumpy roads and Mardi Gras was that day so we knew even if we could keep her alive long enough to get her down the mountain we probably would be unable to get her to a hospital because of all the people and traffic. We have pitocin but were afraid to use it because that would probably make this lady bleed out even faster. There was nothing we could do except give her iv fluids. Over the course of several hours she got 5 liters of fluid and was still bleeding badly. She wasn't even having contractions. We don't know for sure what the matter was... Possibly abruption??? She just needed that baby out and somebody to figure out why she was bleeding so badly. By now it was getting late in the evening and we are not set up to keep patients overnight yet so what would be the plan for the night? These people were from a long ways away and this lady probably wouldn't make it through the night. If she was alive in the morning we would definitely take her down but the bleeding wasn't even slowing down that we could tell. We found someone just up the street who would let them have a room for the night so we put the lady on a stretcher and gave them some blankets. In this dark, crude  room lit only by a flashlight Keith asked the man if they were Christians. (The lady was not conscious ) He said they were Catholics but really weren't Christians but his wife had told him earlier that day that they needed to find something more. Keith had a prayer with them and we left them for the night.
    In the morning the lady was no longer alive...

This week has been a busy one. We have several patients that will probably be coming often to see us. One is the man I talked about last week with the burns on his back. He didn't return for a week and we didn't know where he lived so couldn't send anyone to get him. Then one day a neighbor saw him and told him he needed to come back to the clinic. He hadn't wanted to come back because we hurt him too much. We tried to explain that if we didn't get the old skin off his burn it would get infected and would scar very badly and limit his arm and head movement. I'm not sure if we got him convinced or not but he did come back on Friday. We saw him on Thursday evening and his burns no longer had a dressing on them and he had rubbed ashes on them. I'm not sure what the ashes were supposed to do but they didn't help matters any. Of course his back was very dry again so we had to put more cream on it and told him to come back on Friday. We got the wounds partly cleaned up but still the skin wasn't ready to come off and we don't have anything here to scrape it or cut it off with. So once again we put a bunch of cream on and a big dressing and we will try again on Monday. If he doesn't come this time at least we know where he lives now so we could send someone after him. We don't have a lot of  pain medicines that are adequate for a procedure like we need to do on him but we do have a medication that we can give him IM. (Intramuscular) even with that he is in tremendous pain.

     On Thursday we had a patient come with an injury to his arm that was supposedly pretty bad, it was wrapped in several towels that we could see. I took them off and saw a big bloody mess. He had a wound from his wrist almost to his elbow that was very bloody and wrapped in some plastic. We asked what had happened and they said he had fallen from a tree onto some roots. I have never seen roots that could cause a cut that big so I started working on cleaning this thing up to see what was underneath while someone else continued to question the family. Finally they said he had fallen out of a tree onto a machete.... Ok.. Are we going forwards or backwards with this story???? To skip ahead a little we afterwards found out this man was in a fight with his cousin and this wound was from a machete... And it had happened the evening before so now this wound was 18 hours old and it's dressing was some plastic and towels. This cut was deep and needed an operating room but instead we did the best we could. I honestly didn't know if we would be able to get the edges of the wound back together but with numerous people and instruments that we had we got it. We put several dissolvable stitches inside then started to sew it up. We had to use hemostats to pull the edges together and hold them there until we had enough stitches in to hold it together then we would move ahead about one inch and do it again. Thankfully the shot we had given this man worked well. We had him on his stomach on the table because the wound was at such an awkward angle to do anything with otherwise and this man fell asleep for a while. It took us at least two hours to get his arm sewed. up and there were 40 stitches on the outside. We did give him 2 liters of IV fluids while we were stitching because I'm sure he had lost a lot of blood already and then when we cleaned the wound it started bleeding again and even with a tourniquet on his upper arm tightly it was a steady drip, drip of blood. We sent him home with antibiotics and ibuprofen and when he came back the next day his arm looked good so hopefully it will tomorrow also. Back in the states this guy would have had to have at least one surgery if not multiple and I'm sure he would get IV antibiotics for several days for sure. We do not know how much this man will be able to use his arm in the future but we are hoping it won't have to be amputated.

     In Creole class I am trying to get the structure of a sentence figured out. I think the rules are easier than with English but I do not have it figured out yet.
    Today was time change here also. We still had church the old time. Next Sunday is Trevor and Mirlene's wedding so we are hoping everyone gets their time changed before next Sunday. It's just much different when the only clock a person might have is their cell phone. Time has a totally different meaning here than in the U.S. The time doesn't matter that much, you get up when the sun is up and go to bed when it goes down. These people probably have some candles in their houses but very few even have a kerosene lamp.
                 Bon swa! (Good afternoon)

     It has been a quiet Sunday so far, but when you are on call 24/7 you never know what might come up. Here in Haiti Mardi Gras is a big holiday and it starts today. Our church always plans what they call "retreat" during this time. It is about four days of getting together of all the Mennonite churches in Haiti. It started yesterday. About 50 people from around here went. Most of them rode in one of the brothers'  "commio" ( farm truck with tall sides) truck. We might have thought one truck with that many people on it was way overcrowded but according to Haitian standards the truck wasn't even full. It could have held 100 people at least or maybe 150.... The drive in a commio took 13  hours. The last ways was really bad road so took 4 hours. I didn't go as everything would be spoken in creole but am waiting for a report from Sallie. She and another young girl who is also teaching school here went. They were the only whites on the commio.
   The clinic will be closed except for emergencies this Monday and Tuesday. Pretty much everything shuts down here for Mardi Gras. I was supposed to change a dressing on some burns a man has on his back, neck, and shoulder today but he never showed up. We had asked him to come at noon. He got the burns from falling asleep with a candle lit. I guess the candle then fell on him and he was burned pretty bad by the time he woke up. When he came to the clinic the first time the burn was three days old already and had nothing on it so the skin had dried and then cracked on his shoulder when he moved his arm. It really needed cleaning but was way too dry then. I tried putting some wet gauze on it to soften it up and a few minutes later when I checked the gauze it was almost completely dry and the skin hadn't softened much at all. I guess the burn had so much heat in it that it evaporated or absorbed the water. It would have been torture to try and clean it that day so we put a lot of burn cream on it and bandaged it up good and told him to come back the next day. He came and we got most. of it cleaned but not quite all so had put more cream and bandages on and he was supposed to return today. Some places I think it was at least 2nd degree burns. I just hope it doesn't get infected.
         Creole lessons have been rather interesting. It hasn't went quite like we planned because the other couple that is taking the class also have been here 8 months already and know quite a few more basic words than I do so instead of having two hours of class each day we have been going separately for  one hour each. The first day was very frustrating but since then has been better. It's definitely harder work than the clinic work is. Over the weekend it appears somebody threw a rock at the ambulance window so I guess we'll be driving with a shattered windshield for the time being. So far I haven't had to go down the mountain with a patient but I'm sure that is coming.
    Last night it rained off and on for a while and today has been the same. We love to see the water level in the cistern come up. None of us look forward to the day we have to haul water. We will probably have to haul some yet from the clinic before dry season is over but if it can be postponed one week we will be happy.
     Last week one of the patients came to us with the complaint of a large stomach and it felt like it was moving. This lady is a prophetess and is no longer with her husband. She has two children from that relationship. We do have an ultrasound machine here as it seemed highly likely to us that she was pregnant but she said no. We did an ultrasound and according to its measurements her baby is about 30 weeks. I'm still not sure if she believed us but I'm not sure what other evidence to give her. I guess when the baby is born that will be the best evidence. I just hope she doesn't take anything to abort the baby. These people seem to know just what medications and things to combine to make them have an abortion.
  Until next time...