Going to the Dominican

    Sallie Mininger, the children's school teacher, is almost finished with her time here. They will have school yet this week then a short program on Saturday. Keith offered to take the whole family plus Sallie and I and Lacey Toews ( she is teaching school in the Mennonite school here) to the beach in the Dominican Republic before Sallie leaves. There is a small town along the coast there called Los Platos that Keith's have been to several times. It hasn't been very much of a tourist town in the past but now this time they were doing some building along the beach - boardwalks and small kiosks- so it  looks like its on the way to development. The small hotel where we stayed was also getting an addition and some remodeling done. We left right after lunch on Wednesday then were going to go to a missionary's house for Sunday morning church then would come back to Haiti on Sunday afternoon.
    We got to Los Platos after 8 o'clock in the evening and the small restaurant across the street from the hotel didn't have any food right then but after Keith talked with them they agreed to make fish and fried bananas for us. They had to start from scratch so we unloaded the machine at the hotel and still had some extra time before supper was ready. The hotel didn't have air conditioning but had a ceiling fan so with the patio door open it wasn't bad at all. One of the nights there we had hot water, not sure what was up the other nights.
     In the early morning hours the next morning a local man (who apparently remembers Keith's from other times and recognized their machine) decided he could easily wash the machine then get Keith to pay him. Problem was, he used his greasy t-shirt to scrub with. We really realized this the second day when we went to the capital in the Dominican to do some shopping - more on that later.
   This small town also has a fresh water river fed from a cold spring where they have dammed it up and made a very nice place for swimming. It goes from about one and a half feet deep to maybe four feet deep and is cold but feels wonderful on a sunny day. Thursday we just went back and forth from the ocean to the river with no real schedule -except a local woman who is a Haitian but has been
living there about eight years- was going to get some of her friends to make us supper. We did find another little joint to serve us rice, beans, and chicken or beef for lunch. It was delicious. The bean
sauce had cilantro in it so was different from how the Haitians make it but it hit the spot. It was a
wonderfully relaxing day. In the evening we found out the lady had misunderstood or something- there was no food made for us and it was now too late in the day for her friend to cook for us. So we went back across the street to the small restaurant  ( which once again had no food ready) and they agreed to make us chicken and fried bananas. Of course it took a while again so some of us went and showered before supper.
   Friday morning we all piled back into the machine for a ride to the capital and some shopping. We
now found out that the windows on the machine were just covered with grease from the dirty t-shirt. We felt like we had to look through this man to see out. Some water and paper towels helped a little. Supposedly it took four hours to drive there but once we took a unplanned detour and we stopped several places for Keith to look for a water heater and a washing machine motor. After several stops he did find the washing machine motor and it cost $30. In Port-au-Prince that motor would have cost him over $200 so we felt our "vacation" had payed for itself already as Keith got two motors. Somewhere along the way we suddenly had a police man coming out on the road toward us shaking a big stick. We had done nothing that we knew of- then we found out the reason. Some guys on their
motos came flying past us- They were lying down on their moto seats with their feet crossed and no helmets on and were racing. We were their shield from the police! They timed it just right that they passed us right while we were passing the police. I guess the police saw them coming and all he could do was threaten us with a stick because he couldn't get to them. Another place at a police check it was entertaining as the police didn't know creole or English but still wanted to tell Keith something. I guess there were a few numbers left off of the paper that allowed us to drive in the Dominican. The police and border officials here are very corrupt and are constantly thinking up reasons why someone can't  get across the border unless they pay money. Then they take the money and pocket it for themselves. With the detour and the stops it took us a little over five hours to get to the capital. We were all very hungry but knew there was a Pizza Hut somewhere that we wanted to eat at. Of course
none of us had a SIM card from the Dominican for our phones so none of us could use google search or anything to find one. The we had didn't show a Pizza Hut anywhere near and it is such a busy town that you can't just stop beside the road and try to pick up some company's WiFi. By the time we would see there was a network available we would be too far past it to connect. After driving around for almost an hour more we gave up on pizza and stopped at a Burger King. The great thing about that was there was also a Krispy Kreme within walking distance where we got hot doughnuts for dessert. Then we went to Plaza Lama. This is a large shopping center three stories tall and they almost have some of everything.(except canned pumpkin and graham crackers)  Sallie and I have been hungry for pumpkin muffins but we can't find any pumpkin yet. I found one kind of graham crackers but they were advertised all about their fiber content and that scared me off from buying any. Keith had changed some money into pesos but didn't have quite enough left to pay here and had stood in line at the bank for an hour already to get more changed but didn't remember he needed his passport to do that and had left it in the machine. Then somebody said they could pay with American money. That turned out to not be true so most of us had cokes and watched the world go by for a while. Keith did find a water heater in that store though. When we finished there some of us still wanted to find a Pizza Hut for supper. It looked like it would be an early supper after a late lunch but we drove around a long time again and by the time we found a different Pizza Hut it was for real supper time. Supposedly the one we were looking for at lunch time was only one main road over from the Burger King but we never did find it. Let me tell you though, that pizza was awesome! It meant we got back to our hotel pretty late but no one put up too much of a fuss.
    Saturday morning we had more river/ocean time then ate lunch and left to go to the missionaries' house. We got there several hours later after having seen a lot of beautiful scenery. Their house had bathrooms each with a shower with hot water so we were living it up. Our bucket works quite well for a shower up here but if there is a real shower available I sure wasn't gonna turn it down. There are no members at this small outpost yet, just several people in doctrine class. Two brethren from a congregation in San Juan came to help with the service then they served us rice, beans, and chicken. We felt very handicapped the whole time in the Dominican because of not knowing the language but very much enjoyed the vacation. Except those warmer places also have mosquitos... We are blessed it is cool enough up here that we don't have any.  The border crossing took an hour again and cost $200 plus.  We got back here about ten o'clock in the evening. Did it ever feel good to sleep in our own beds again!
   


 

More burns...

On Saturday we went to Port to get Larry and Sharolyn.  Thank you to everyone who sent things with them. We had great fun unpacking everything. Zack had ordered some parts for his moto that he had shipped to Larry and I had requested some chocolate and a few other things. Saturday morning before we went to the airport we stopped in at two hospitals so I could see what they were like. The first one we stopped at was a maternity hospital and a baby had just been born. The second one we stopped at Keith told the guard we needed to get in to see someone and he let us in. I think it probably helped  that he could converse well in creole.  We went up to the second floor to the maternity ward and went in to the room where babies are born, c-section or otherwise.  A baby had just been born here also but the placenta was not yet delivered. We stood around a while and talked then the nurse said since it had been 30 minutes and the placenta hadn't come she would have to do something about it. The patient had no anesthesia and was lying there bleeding quite a bit. The nurse gave the lady a shot of oxytocin but still no progress. Of course there was no air conditioning but the one window where the frame wasn't broken was open. The nurse proceeded to do a manual d & c while we watched. It took a few minutes but the patient didn't make a sound. She did make a few faces and wiggled a little but took it all very well. So now the nurse had a big bloody mess that she had to sort through to see if it was all intact. She took it over to the sink and started sorting through. All at once I started to feel quite warm and rested my arm and head on Sallie's shoulder.  Then things started to get black and I felt like I might throw up. In the background I heard Sallie saying " Keith, I might need some help here." He thought she was joking so didn't really do anything right away. Then he saw my face and knew I was about to faint so got a chair quick for me to sit down.  One of the nurses went to get some water for my face. I personally wanted some cold water and she did the best she could but it was still quite warm. I didn't jump at the chance to bathe my face so she did... I was starting to recover so Sallie and Keith started laughing. It was pretty funny but I wasn't quite to the point where I could laugh yet. I still felt quite a lot like puking! It's only the second time I remember almost fainting. I really don't know what happened, I have heard lots of theories but don't know which one is right. It was probably a combo of a bunch of things. I thought it was a very valuable experience though as who knows, I may have to use that technique myself some time. I still want to go to more hospitals here though because both of these places were not too bad. They had decent equipment and they used gloves etc...
    The man whose foot got cut with an ax has been coming back regularly for dressing changes. A couple of days ago I took the stitches out and there was a place about an inch and a half long that opened up again. When we sewed it up we couldn't get the blood from the artery to stop with pressure so we finally had to just stitch it closed and hope for the best. The first several dressing changes it was still oozing quite a bit. Now I could see several dark old blood clots. The guy was kind of worried, was this really bad? I finally told him it wasn't bad, it didn't look infected right now, I just needed to get those old blood clots out or it would get infected. He seemed to understand and calmed down a little. I really had to squeeze his foot to get it all cleaned out and it hurt him pretty bad. Then I had to get in there with a q-tip yet to make sure I had gotten it all. Now we have been packing the wound every other day and it looks good so far. It doesn't look infected, just needs to heal from the inside out now. This guy lives quite a ways away. They said if you had a donkey that walks fast it would take two hours for him to get home. Now he has been driving moto here so that is better. He just puts a big sock on his foot and off he goes.
    About a week ago a man came to the house with his little boy who is not quite one year old. He had pulled a pot of coffee off of the fire and it spilled on him. He had blisters and peeling skin on his shoulder, the top of his arm, the side of his face, his ear, and the back of his head.

They had brought him right away without putting anything on the burns so that was good. I had to clean the coffee grounds and charcoal off then put cream on and bandage him up. He came back the first several days every day like we asked him to but now we haven't seen him for three days so we're not sure what the deal is. He does live a ways away and the first time his dad hired someone to bring him on moto. Then I think the next two times he walked here. We will probably see more burns in the next little while as sometimes the mothers have to work in the gardens and they don't usually take their children with them. Sometimes they are just left in the house by themselves so...

Seizure epidemic

   Periodically we have patients come to the clinic who are suffering from malnutrition or even starvation.  One little boy about 18 months old was so weak he could no longer sit up. He was just skin and bones, all his ribs showing etc...

Then we had a 3 year old come in a couple of weeks ago. This child had a very swollen belly and his extremities were COLD also. He didn't have good enough circulation. At this stage the children often have very swollen hands, feet, and legs. His feet and legs were so swollen the skin had burst open and he had weeping sores.

He was pretty dirty so we were washing him up and getting him some warmer clothes. We had some fleece pajamas we put on him and it wasn't long and he was telling his mom that now he was warming up.:)  We gave his mom some cans of pediasure and food and told her to bring him back when the food was gone and we would give them more. Just the other day his mom came back with his younger sibling. We asked how the little boy was and she said he had died 8 days after she brought him to the clinic. He had drank all the milk already. She said the last thing he said before he died was "When are you going to take me back to the hospital?" Lots of people around here call our clinic a hospital because it's the closest thing they have to one.
   Last Sunday evening we had a 5 yr old boy come to the clinic with his jaw locked shut. He had no previous medical history and had been fine, playing at 4:00. Now at 6:30 he couldn't talk, couldn't swallow his own spit, couldn't open his mouth, and couldn't even sit up by himself. It was a very strange presentation. All of his vital signs were normal. His blood sugar was 200 so it wasn't hypoglycemia and wasn't high enough to be hyperglycemia. We absolutely didn't know what to do. By now his breathing is making loud snoring noises and his oxygen sats are 60%. We held him in a sitting position and tried to open his airway. That helped but we still couldn't figure out what was wrong. We were thinking maybe tetanus but he had no recent injury we could find and we didn't have the tetanus vaccine so tried to think what else this could be. At one point we honestly thought this little boy is going to die right here in front of our eyes.  Blood sugar is pretty much the only lab we can check except urine dipsticks. This will sound strange to some of you, but we were glad when he started having more symptoms... Things we could recognize. His eyes started twitching and then his  arm started twitching. He was having a seizure! So we quickly put in an IV and gave him some medicine. It took quite a large dose to actually get the seizures to stop. He would stop for about a minute then start again. We had put some EKG leads on his chest and were wondering if maybe his potassium was high. Then we found out that earlier that day he had eaten quite a bit of sugarcane and mangoes. Maybe that's why his sugar was a little elevated. We had also noticed he smelled funny so were trying to figure out if this child had injested something. When we mentioned it to the family they said it was because they were rubbing some leaves on him on the way to the clinic. The leaves were supposed to make him breath easier and one of the family members pulled some out and that is exactly what he smelled like so... We still don't what caused his seizures and probably never will. He was quite sedated when we sent him home so told the family they had to bring him back to the clinic in the morning. What do you know, in the morning he walks in smiling and talking like as if nothing had ever happened.
   Then yesterday I had a 19 year old girl come in, carried in by one of her sisters. Apparently she had had a headache for 22 days and then the last four days she had been unable to walk or talk. She was also having seizures off and on. I gave her a liter of IV fluids and numerous doses of medication to  stop her seizures with absolutely no change. We would think she was falling asleep but it would last  at the most two minutes then she would be jerking again. Her one pupil wouldn't respond to light either. There wasn't anything more we knew to do for her so after numerous phone calls and quite a while waiting the family came up with enough money for us to take her down in our ambulance. We just have to charge a little to cover fuel costs etc... A hospital did accept her but that's all the details I have so far...
  We are also having an outbreak of chicken pox here. We have a few immunizations to give but not the chicken pox vaccine so everyone is susceptable. There have been some pretty miserable looking people come to the clinic. About all we can do is give them some Benadryl and anti-itch cream.
    We had a young guy come a little over a week ago. It was after hours and we just heard it was pretty bad. When we got to the clinic it was about 5 pm and we found out this man had been cut at about 10:00 that morning. All the rest of the day he had spent coming to our "hospital" to be seen. He lives about two hours walk away if you have a horse that walks pretty fast but was working over by the Dominican border. He had been cutting wood and had an accident. The ax had sliced his foot  open from the big toe over half way up his foot.

He had a string tied around his ankle and his foot was in a plastic bag and he had been riding on moto for hours coming for help. When we took the bag off we didn't know what this stuff even was. There was probably at least one and one half cups of blood clotted on the top of his foot. It looked like a big bloody growth. When we got most of the clot off we could see a tendon that was cut clear through and little spurts of blood like as if the artery was nicked. His big toe bone was also broken. We tried to tell him he needed to go down to the hospital but he just wanted us to sew up his foot. He said God would take care of the rest. So we attempted to sew the tendon together and sewed up his foot. Since that day I have seen him twice and am amazed at how good his foot looks so far. Only God knows if it will heal...