Home again...

      Oh, the drama of getting home this time! We left Oriani at a little before 5 am on Monday morning. Got to the Haiti/Dominican border around 8 am. Paperwork there only took a few minutes so we parked and waited for Samuel to come meet us. He got there probably about 30 minutes later so we traded passengers as he had brought several people who were headed back in the direction Jay was going. From the border at Jimani to Santo Domingo takes several hours but the roads in the Dominican Republic are much nicer than they are in Haiti! Samuel is a Haitian who lives in the Dominican Republic with his wife and family. He speaks 4 different languages- Creole, French, English, and Spanish. We drove several hours then he stopped at a little restaurant and got us all some food- chicken, rice, and bean sauce. It was delicious! It seemed to be seasoned mostly like the Haitians cook but maybe with a little different spice- probably some Dominican influence. While we were waiting in the truck for our food we were trying to decide what language was being spoken in the music that was playing. It seemed to be a mixture of Creole and Spanish. Keith had looked up a pharmacy/lab center there in Santo Domingo for us to get our COVID testing done. The rules have just changed for the USA, now you have to have a negative COVID test within 24 hours of flying- until last week the test could be with 72 hours of flying. Both Keith's and I had flights leaving at 3:30 the next afternoon and it was after 3 pm now so we got our testing done. I only needed the antigen test to fly to the USA but they needed the PCR test to enter Canada. Mine was supposed to result in about 30 minutes but theirs would take several hours. They were going to email us the results. If we could not get them printed out at our hotel we would have to go back there in the morning for a hard copy, just in case. (We were able to peint them at the hotel later that night) So we headed to the Old Colonial area of Santo Domingo. That was where we were planning to spend night. The first place we stopped only had one room available, the second place didn't look as nice so we checked out a third. They had rooms and a good price so we unloaded and Samuel went on his way. We were planning to get a taxi to take us to the airport the next morning. It was after 6 pm so we put our luggage in our rooms and walked several blocks to a restaurant for supper. I had a salad with grilled chicken, boiled egg, avocado, etc... Keith had fried shrimp and Candace got some stew with goat meat in it- all delicious. On the way back to the hotel we stopped and got some coffee. The next morning we walked around the shops there in the colonial zone then went to Kahkow- a little chocolate factory. I had been there a month ago when I came and enjoyed it so took Keith's there this time. We did the tour with the videos explaining how chocolate is made etc... and were really wanting some hot chocolate but it was getting late. After the tour we only had time to pick up a few chocolate bars in the gift shop then quickly went back to the hotel and called a taxi to take us to the airport. By the time we had our suitcases in the lobby the taxi was there. It was about a 20 minute ride to the airport. Keith's and I parted ways then as we were flying on different airlines. After checking in and going through security and customs I got some pizza and a coke for lunch. I was messaging back and forth with Keith- they were supposed to leave a few minutes after I  was. When it was close to time to board, there were 11 wheelchairs lined up with people in them to get on the plane I was to fly on. We were a little bit late boarding but not too bad. It seems like Keith's took off on time. It had taken them quite a bit longer to get through security and customs- Keith said they had to show all of their papers. They had asked me if I had a COVID test result but never even looked at it. Wifi was sketchy and that was all I had on my phone. I hadn't purchased a plan to use in the Dominican. Where it worked, it worked well! But at several of the "gate areas" along the terminal there was no service, usually no service at the gate where I was supposed to be boarding. We did get boarded, seat belts fastened, the whole nine yards, but on the final inspection someone noticed something out of place on one of the wings so maintenance had to come check it out before we could take off. That took a bit of time, but then they came on the speaker saying they were taking pictures of the problem to send to a mechanic in Florida.  Okay... then more pictures to send to Florida... then they let us all de-plane to get food, drinks, bathrooms, etc... supposedly whatever the problem was it would take an hour to get it fixed. So we all got off, taking all of our luggage with us. Keep in mind all of the announcements here are in Spanish- with some of it translated into English afterwards. On the airplane they did very well with saying things in both languages,  after we got back in the airport- not so much. Just some of it and then you had to ask exactly what was happening. Soon they announced that the flight was cancelled. We would all need to go to baggage claim and get our bags and get re-booked for the next day. Then suddenly, everyone was lining up in quite an orderly fashion. I thought must be they had gotten the problem fixed and we were boarding again but when we all got to the tip of the incline we rather were sent back downstairs -not back onto the plane. We were just doing an orderly exit. Everyone headed to baggage claim... and there we waited for over an hour on our luggage. Thankfully, Wifi worked well in baggage claim so I could at least send and receive messages. After gathering our bags, we headed back upstairs to the Spirit airlines counter to be re- booked. I had gotten an email saying I was scheduled to fly out the next morning at 9 am- that was fine- but then my layover in Orlando was an 11 hour layover! I thought that was ridiculous! But when I got to the counter the lady (who could speak English well, thank-you Jesus!) said that was the only other flight that day to RDU from Orlando. She said though that our COVID tests would be extended through the next day so we wouldn't have to redo that test. They gave vouchers for a taxi, hotel, dinner, and another taxi in the morning. I wasn't sure how it all was supposed to work but had been told that the taxi that took me to the hotel should be the same one to bring me back to the airport in the morning. So I went down to the line of taxi's. There was someone there who knew some English also so I showed them my vouchers and said I needed a ride to the hotel. There was another older woman right behind me who had been scheduled on that same flight so she had vouchers also. We were herded towards a taxi and had our bags partly loaded but I guess this person couldn't pick us back up the next morning so we moved to the next vehicle. This other lady spoke English also! We verified that we needed to leave the hotel the next morning at 6 am- yes, he could do that, so off we went to a Quality Inn several miles away. There were probably 8 people ahead of us checking in but it was no big deal- it was beautiful weather outside so we waited out there. At check-in, they told us dinner would be served in 10 minutes so I was going to take my bags to my room then come back to eat. They gave me room 430. My key to the room worked, but the room was already occupied. Another gentleman I recognized who had been scheduled on the same flight. Thankfully, he had used the deadbolt on the door, so it only opened about 2 inches then stopped. And it was loud, so, even though it was a surprise that the door wouldn't open, at least I didn't walk in on him! So, after profuse apologies, I  went back down to the desk. The clerk seemed surprised when I told her that room was occupied- she verified that I said room 430- then looked at her papers or computer and said it was supposed to be room 439. That room was right across the hall but she had obviously made a mistake and given me the wrong room number and also activated the key for the wrong room. Back upstairs again, to the room right across the hall. I was a bit nervous I would meet the man from room 430 at dinner, but I didn't see him. Downstairs in the dining room they were serving chicken, fish, rice, bean sauce, muffins, and something else I didn't recognize. By now it was 10 pm. For most of the time, there was only one person serving the meal, so we actually waited quite a while on that also. It was good food though. When I got back to my room I found and purchased a one way ticket from Orlando to Raleigh for the next day- on American Airlines. Spirit really didn't have any other flights going to RDU that day. It only cost about $150 and got me to Raleigh hours before the Spirit Airlines flight was even scheduled to leave Orlando. I thought it was worth it. I would need to get my checked bags in Orlando anyway because of taking them through customs so could re- check them on another airline hopefully without too much difficulty. The taxi we had taken the evening before was at the hotel at a few minutes after 6 am so we got back to the airport in good time. Checked in and went through customs again then headed to the gate. Got something to eat and waited around- recognizing multiple peoe from the night before. Weird thing was, our flight was never posted on the board at the gate where we were supposed to leave from... it got closer and closer to 9 am and there were no Spirit airline employees at the desk and no airplane arriving. Finally a couple ladies came- people were going to talk with them- I suppose wondering where the airplane was- but there were no overhead announcements yet and they were speaking Spanish so I couldn't understand them anyway. How bizarre, I was at a different gate than the night before but still didn't have a Wifi connection in the gate area, I  had to walk down the terminal a ways to connect to send or receive any messages. By now I could tell people were upset but was clueless what was really happening because there were still no overhead announcements. Turns out there isn't an airplane here for this flight. I have no idea why, maybe they never even scheduled this flight with the airline...but they had definitely rebooked us all. People were getting upset now. Then it was mentioned that maybe we could fly on the plane that was supposed to have taken us the evening before- but it was undetermined if the problem had been fixed. So there were a bunch of people upset, the drama was ongoing, etc... I left the area for a few minutes to message Jay or Keith and see what their recommendation was for me but I didn't want to stay away too long and miss an announcement. When I got back I went and talked with a small group of people who knew English. Incidentally,  the gentleman whose room I busted up into at the hotel the night before was in this group. 😄 We both had rebooked for later that afternoon so we hung out together over the next several hours (while getting another COVID test there in the airport, waiting for results then going to check in with American airlines, but I am getting ahead of myself here in this story) Apparently now the airline wanted to rebook everyone again-- this time from another airport! They wanted to put all of us on a bus and send us to the airport in Punta Cana- which is supposedly 2-3 hours away. My question is- if you cannot get an airplane to Santo Domingo- the capital city of the Dominican Republic- how are you going to get an airplane to a smaller airport??? Several of us in the English speaking only group did not relish the thought of a bus ride, another rebooking, etc... some of them had found flights out later that day on different airlines- I had looked also and found several reasonable options - but now I had to go find Wifi once again so I could book one of these tickets. Here I should have just taken a little more time and changed the one way ticket I had purchased several hours earlier feom Orlando to RDU- but I didn't. I didn't want to be way off down the terminal if something new came up with my flight and I was afraid everyone else was probably frantically trying to get booked on other airlines also so I just bought a new ticket- all the way from Santo Domingo to Raleigh. This flight went through Miami. There were 2 options I was looking at- one left at 1 PM that day and the other at 3 PM. I chose the 1 PM flight- that was 3 hours away, surely that was doable... in the end it was- barely! I had to ask to go to the front of the line going through security and through customs because my flight was supposed to board in 10 minutes. But that is getting ahead of myself. Once again we were all led down to baggage claim to get our bags. We waited a while, but not as long as the evening before for our luggage. Then back upatairs and to the line by American airlines. We clarified- yes, we needed a new COVID test to fly on American.  The extension was only good for Spirit airlines. So to the office where we thought the tests were done. No, this was results only. Testing was done upstairs, so we headed upstairs, got tested, then back down to rhe office to wait for our results. They were supposed to be back in 30 minutes and they were. I was getting nervous though, it was 12PM  and my flight was supposed to leave in an hour. After getting a print out of a negative COVID test, back to the line at American airlines. It was long... we slipped in the shorter line for first class passengers or something and didn't get turned down. Now came a passport check, then security and customs. I found an emplyee and asked if they could help me because my flight was leaving soon because the lines here were long also. He got me through pretty quickly then I searched out another employee at customs to help me get through. I had filled out an online form the day before to exit the country but I had to do another one today and the lady only knew a few words of English. Someone else tried to help me, it wasn't working because I wasn't on the correct page so of course when I tried to scan the QR code it didn't work. The customs lady just pointed to the code again and was telling me I had to fill it out. When someone else told me where to go to find the form, it scanned without a problem, now I just had to fill out the rest of the form. I had to keep reminding myself that I was the foreigner in their country- I was the one who didn't know their language- because it was getting frustrating! Early that morning going through customs I had had no problems whatsoever but now I needed an additional form filled out. When I got it completed, they stamped my passport again, for the 3rd time in about 18 hours, and I hurried to the gate. I got there just before they started boarding the flight so got a coke to enjoy on the flight. No problems this time, thank the Lord! I hadn't had a chance though to cancel the one way flight from Orlando to Raleigh-  and now once again, I was on the plane so had no Wifi connection to do it online. I cancelled it when I was in Miami then sent an email requesting a refund or airline credit because of circumstances.  They only allow 200 spaces though to explain your problem so I couldn't give all the details I wanted to. I'm still waiting to hear if they will give airline credit or not. If not, oh well, it wasn't that expensive. I got into Raleigh at a little after 8:30 PM.  Larry and Sharolyn were there to pick me up. I cannot remember the last time I have been that exhausted! Mentally and physically! But I am home...sweet home...

A home visit

Once a month I have been doing a home visit with a lady that is paralyzed. She was in a kamyon accident several years ago and had a spinal cord injury and can no longer walk. This is a very poor family with eight children. Last time I went there was in the afternoon after the clinic was closed for the day. Several of the children were there in the yard so I asked if they were out of school for the day. Most schools around here let out at noon or very shortly after. One of the girls, I am guessing she is about 14 years old, said "Nou pa gen lajan pou lekol"- (we don't have money to go to school). It doesn't seem like it would cost a lot to go to school here but it costs more money than they have. I don't know how old the oldest child is but the youngest one is 4 years old so there would be numerous children to buy school uniforms for. This lady is always sitting on her bed in her dark, little 2 room house. It doesn't seem like she has any bed sores so she must be able to reposition herself fairly well but I have never seen her up out of bed. I don't know where all the children sleep because it is quite a small house. Amberly and I went to see her Tuesday afternoon after clinic. When we had finished our visit we decided to continue walking on down the trail past her house. About a quarter of a mile farther on we found an absolutely beautiful place to sit and enjoy the scenery. From our perch on a relatively new tomb, we could look out over numerous hills and we could actually see the waves of the ocean! It just happened to be a very clear day and we could see a long ways. I wish I knew approximately how far it was to the water but I really have no idea. It was the clearest view of the ocean I have seen from Oriani though. Sometimes on a clear day we can see the ocean from a hill behind our house but I had never been able to actually identify ripples on the water from waves.

Jay went to the border on Tuesday to get Keith's. They got back in time for supper. It was my day to cook. I made tacos, black beans and sopa then peanut butter no bake cookies for desert. 

Wednesday was a shorter day than usual but as I was attempting to lock up another patient showed up. A young lady, probably 18 years old, who had had her first child the day before and had been pretty much unresponsive since shortly before delivering the baby. She was carried in and placed on the exam table in my room. Apparently she had been totally normal until she went into labor. Then someone gave her "ginger tea" to drink. These people belive that ginger tea gives the mother "force". We have not identified any clear way that this tea helps - it just seems to cause intense pain, pain that does not speed up labor. But many people are firm believers in it. Someone also gave her "remed fèy" (herbs, leaves), we have no idea what kind of a combination that was. Then there was some "mistic" (magic) involved and someone "passed oils" over her body. Apparently she had been in this unresponsive state ever since being given all this treatment. The way she was acting, I have no idea how she even birthed a baby. Normally is a person is faking unresponsiveness they will not let their own hand fall onto their face if you lift their arm and drop it right over their face. Her hand dropped right on her face, three times. Her vital signs were stable, except for an elevated heart rate and her glucose was a little high. I'm not sure what that was from because apparently she hadn't eaten or drank anything since the day before sometime. She did not appreciate a sternal rub though! It was a very strange situation. We sent all of the family out of the room and tried to get her to talk but she would not. I truly do not know if she could not or would not. We did not think she would be able to swallow but when we gave her a drink she swallowed without difficulty.  Without knowing what she had taken there really wasn't any treatment we could give. We ended up sending her home with some tylenol and a multivitamin. I have no idea if she will come out of this whenever the things she was given have worn off or if this is her new normal. If it is, I'm afraid she won't live very long. 

Thursday morning they had a little farewell party for me at the clinic. Brianna made Haitian spagetti, boiled eggs, and coffee. It was delicious!

Friday night we packed up food and headed to the forest for a weiner roast. Amberly and I rode on top of the machin with the girls on the way there. We had hot dogs and macaroni salad, then roasted marshmallows and hot chocolate for dessert. It was an enjoyable time. When we got back home there was a patient and numerous of his friends and family waiting at the gate. He had been in a machete fight and had several large gashes to his right arm and a cut on his head. It took several hours to get him stitched up and bandaged. The biggest cut was on the inside of his right wrist. It looked like there were tendons severed but he was able to move his fingers so obviously his tendons were still intact. 

One Saturday Amberly and I walked to market in Forèt des Pins one last time. First though, we had a moto accident to treat. Two people were hurt but one only needed a couple of stitches on his head and bandages for his scrapes and the other needed his scrapes washed and some triple antibiotic ointment and a few band-aids. As usual, the walk to Forèt was beautiful. There is one ravine to climb but after that it is a very easy walk, just follow the path through the pines. It is about 3 1/2 miles. We wanted to do a little more Christmas shopping- and we were very successful! We had mayi kole and Toro for lunch then bought some fruit before taking moto home. 

Today I am going to pack up. We leave early tomorrow morning for the Dominican Republic. We will get to Santo Domingo in the afternoon and can hopefully get our COVID tests done before places close for the day. Keith, Candace and I all fly out on Tuesday afternoon.

As far as the clinic goes, Jay has the names and phone numbers of several Haitian nurses. He has already started contacting them and offering them a job at the clinic. So, no, we do not have a firm plan in place right at this moment as far as workers for the new year, but there are several options being explored. 

 

Treatment completed

 

     This little guy who had the burns to his face, head, neck, chest and arm came back today. They look so good! I gave him another course of antibiotics because he had an ear infection but then I told his mom he didn't have to come back to see us for his burns anymore. His treatment is completed.  His mom had also brought a younger sibling for a consult today. This kid was just chattering away to his little brother as they ate their crackers and I figured out what medications to send home with them...

      It is kind of hard to imagine Christmas is only a few weeks away when these beautiful flowers are blooming beside the road... they are sooo pretty. The bushes are several feet taller than I am. I picked a big bouquet to put on the table on Thanksgiving Day but they don't last more than a few hours after they are cut, so it didn't turn out as planned. 

     School has just let out for the day... so some of the boys are playing a quick game of "football" (what we call soccer) before they go home. The building in the background is the school where these children go. It is a one room building with no desks that I can see, only backless benches and/or cement blocks to sit on. 

     Keith and Candace are coming this weekend to visit for a week. Hopefully some decisions can be made while they are here to determine what to do from here on out. We have been able to get an order of medications delivered. One of the local brethren has a kamyon to haul produce down to Port-au-Prince. Jay got it worked out for the medication order to be delivered somewhere and this man picked it up and brought it up the mountain in his truck. This week we are trying a grocery pick up service to get some groceries for our house. They will also be brought up on the truck. The challenge currently is what to do about nurses to work in the clinic after Christmas. Everyone is in agreement that now is not a good time to bring in a new American or Canadian nurse. So the nurse from Missouri who was planning to come in January is tentatively on hold. Right now we don't know if either of the Haitian nurses will be coming back or not. Roseline is engaged to be married at the end of January. Chancela has worked here for 3 years I think. She hasn't said yet if she will be coming back or not. But the clinic can't operate without nurses... so this is something to add to your prayer list. 

     I have a ticket to fly back home on December 14. I will go back to the Dominican Republic with Keith and Candace on the 13th and we will all fly out on the 14th. 

Stinky feet

      The 18 month old with burns to her hips, thighs, lower abdomen, and diaper area came back today. Her burns look okay. I gave the family more antibiotic ointment and pain medication. The sad thing is, I don't think the story about her falling in the fire is true. Another lady was still in my exam room, waiting to get her medications when the dad brought this little girl in. Of course she asked what had happened and the dad gave a slightly different story. I didn't catch all the details of the story but what I heard fits the pattern of her burns better. It sounds like someone was going to clean her up after she used the bathroom and they submerged her in water that was too hot. That would make sense why the burns are all the way around her thighs, etc... 

     I had another child come in today with burns on her right arm. This one also does not seem to be deep, full tissue injury. It appears like they must have used some kind of cream that probably kept it from getting so dried out. I did not clean it too thoroughly because it didn't look horrible and we don't have strong enough pain meds available here. I put silver cream and a bandage on and gave her a randevou to come back in several days. 

     Several days ago - on Friday I think it was- we had an after hours delivery here at the house. Jay had checked her and she wasn't quite ready but was getting close so he had her up walking. We all thought she would deliver pretty soon, this wasn't her first baby and she was fully dilated but it ended up taking several hours before she delivered. She had a very full bladder so we cathed her to try and help move things along. It didn't seem to help speed things up but I'm  sure she felt better afterwards. Suddenly she said she had to throw up. Of course, we had nothing available but the chux pad she was sitting on. That little bit of drama sent Chancela into the house gagging also but she returned pretty quickly. A lady had been with the laboring woman but finally Chancela asked for the "baby daddy" to come help support the mom through the delivery- to help give her strength. It had rained recently so it was muddy outside. The dad had his black rubber boots on, he stopped at the gallery door to take them off because they were quite muddy. When I saw bare feet emerging from those boots I knew the smell was not going to be pleasant,  at all! It wasn't! I appreciated him trying to keep the mud out of the gallery but this presented a new, smelly, challenge. Thank the Lord that the gallery just has bars across the front so air could circulate. He didn't have socks on and there were several places on his feet where the skin was all white from being exposed to moisture for an extended amount of time so it was a smelly situation... After a while she successfully delivered a screaming little boy... 

     On Saturday Amberly and I walked to the market in Forèt.  It is about 3.5 miles. There is one ravine to go down and back up but for the most part it is a beautiful walk through the forest. We ate lunch there and did a bit of shopping then came home on moto. It was Brianna's birthday so the rest of us worked together to make a delicious supper of grilled chicken sandwiches, macaroni salad, onion rings , and gingerbread cake with butter syrup and whipped cream for dessert.  

     Roseline went down to Port-au-Prince on Friday afternoon after work and is going to be gone through tomorrow. I guess they are working on some things for her upcoming wedding- which is planned for January.  Then today Chancela wasn't feeling well so it ended up being just Jay and I seeing patients today but it went very well! We had one of the medication aids take vital signs on everyone before they came into our exam rooms so we were able to move people through a bit faster. I think I saw 36 patients- several of them were just dressing changes- and Jay saw 31 patients- he also gave 11 Depo (birth control) shots, so that equals about 75 patients. 

    

Joe Biden

      My most interesting patient today was 3 1/2 months old. His name was Joe Biden. I saw it written on the dosye but I didn't know if maybe the pronunciation would be a little different so I asked the mom what the baby's name was. She pronounced it exactly the same as we say it- Joe Biden. He was sick. He had a temperature of 38* celsius and his heart rate was 200. I think his heart rate was that high simply because of his fever because overall he looked quite good. I gave his mom Amoxicillin and Tylenol for him. 

     The second most interesting case was an 18 month old little girl. I guess she fell in the fire on Tuesday evening. This scenario could very easily happen here as fires used for cooking are usually built on the ground or the charcoal is placed in a small metal "stove". She had burns to both hips, both thighs, her lower abdomen, and her diaper area. Thankfully I think the burns are just 1st degree, which is lucky because it would be a challenge to keep any kind of a bandage on in the diaper area. On her hips the blisters have popped but some of the other places the skin is still intact. I gave the family several tubes of triple antibiotic ointment to put on it several times a day and gave them a randevou for Monday. 

     There is a very active church right behind Jay's house. Pastor Jean conducts services at all hours of the day and night- these services include many different types of worship- preaching, singing, speaking in tongues, shouting, praying, music including a keyboard- you name it... at times a song or several phrases of a song can stretch out to last longer than 20 minutes. FYI, the microphone/speaker system at his church works quite well, sometimes to our dismay. Honestly, sometimes they are having a service when we go to bed at night and already at it again the next morning when we get up. Pastor Jean has brought several patients to the clinic in his machin this week. One of them was a 15 year old girl. She was mostly carried in, writhing in pain. Her complaint was that her back hurt, so bad! They said she was pregnant, that actually her baby was "due" a month and a half ago- toward the middle of October actually. The problem was, she did not look pregnant, for sure not 9 months pregnant! They put her on the exam table in my room, but she didn't stay on the table. She got down off the table and was writhing around clutching at her back etc... Her vital signs were stable, heart rate and blood pressure both within normal limits. I was very suspicious that she was not pregnant at all- so we sent her to the outhouse to provide us with a urine specimen so that we could do some "tests". Her urine specimen showed that she was NOT pregnant and she didn't  have any signs/symptoms of a urinary tract infection either. When I told her that her urine specimen showed she was not pregnant, her reply was something to the effect of " take me home!" I asked her then if she had any other complaints or if her back was the only place she was hurting. Yes, it was just her back, and she wanted to go home. So I gave her Ibuprofen and several doses of a muscle relaxant and sent her home. This happened several days ago and she hasn't  been back so I guess she must be feeling better. 

     We had several families over for lunch today to celebrate Thanksgiving. One family are missionaries from Gwo Cheval, another couple are staying at the mission house in Savann Mouton for a couple of months. Then several families from here in Oriani. It was an enjoyable afternoon and evening. Jesse's stayed later than most of the rest and we played several games with them- escape room and forbidden island- they are both games that are played as a team - so either everyone wins or everyone loses. 

     More another day.

Wednesday's after hours clinic

      Wednesday afternoon at about 3:00 a lady came to the gate in labor. It was her first baby and she wasn't quite ready. She had been having pain since the evening before and was now dilated to about 6 cm so I sent her back home, telling her she wasn't quite there yet. She lives not far away and the family that was with asked if they could bring her back when she got closer. I told them that would be fine... so they said they would come back around 6pm. It isn't often someone can estimate an accurate time of when a baby is going to be born but they were pretty much right on. We went to Wednesday evening Bible study from 4-5pm. Jay left a few minutes after the service started to see an "ijans" at the clinic- a lady with abdominal pain. He never came back to church. We came home after the service but were planning on going to Quenton and Chrystelle's house for supper to celebrate their little boy's first birthday. Roseline and Chancela had gone there already in the afternoon to help with the cooking etc... Jay had messaged that he was going to be at the clinic a while,  the lady with abdominal pain was still there and now he had a man there who needed a bunch of stitches in his hand. In a few minutes there was a man at the gate at the house with a child that had something in her nose. We sent them to the clinic and told them I would be there to help out in a few minutes. We didn't know if we would need to give Ketamine to remove whatever was in the child's nose or not and we had better tools available there anyway. When I got there Jay was busy stitching the guy's hand in Chancela's room, the lady with abdominal pain was in my room, and the kid and her dad were waiting on the bench in the entry. I gave the lady with abdominal pain a shot of IM promethazine then took the kid into Roseline's exam room. She had a blue bead lodged in her nose. She was 3 years old. Since I could see the bead very well I wanted to at least attempt to get it out without sedation. One of the youth guys had walked to the clinic with me so I employed his help and the child's dad to help hold her still while I tried to get the bead out. I was able to get it out in just a few minutes. While this all was going on, the lady who was in labor had showed back up at the gate at the house so Brianna sent her to the clinic also and called Roseline and  Chancela to come help us out. Roseline, Chancela, and the lady in labor all arrived at about the same time. I wasn't quite finished with the kid yet, but that was the only exam room with the bed available so the lady in labor came in there also. After the kid and her dad left, I checked her. The baby's head was right there and it was time to push! I happened to glance at the clock... and it was about 10 minutes after 6 pm. Jay had just finished stitching the hand- of a very drunk man- had sent him home, and was mopping all the blood up off of the floor. Then he sent the lady with abdominal pain home also. She wasn't pain free but it was better, and we had given her everything we had available. Meanwhile this first time mom did an amazing job with her first baby! It was a boy and his lungs worked just fine. He was an angry child until we had him dressed and bundled up, then he chilled out. When they were ready to go, one of the ladies who had come to the clinic with the mom tucked the baby under her jacket and they walked home. We went to Quenton's. It was 7 pm. It was a full afternoon/evening but there were no more calls that night so nobody was overworked. 

     The little 3 year old boy with the burns to his face, chest, and arm is healing well. Instead of coming 3 times a week for dressing changes like they had been doing, on Wednesday I gave them a randevou for next Tuesday,  for us to look at his burns and give more antibiotic cream if needed. He no longer needs a dressing on his arm, his face looks really good, and the places on his chest and the side of his head are slowly getting better.                                          

I don't know of a good way to keep a dressing in place to the side of a face so they are taking a bit longer to heal than the others did. 

Burns, malnutrition, and a baby

      The number of patients coming to the clinic each day seems to be down slightly but today was a normal, busy Monday. I saw 30 patients and I'm sure each of the other nurses saw that many or more so my guess is that we saw a little over 100 patients today. My first patient was a little 3 year old boy who got burned on his face, neck, chest, and left arm on Friday  a little over a week ago. His burns didn't look too bad initially so we gave some Ibuprofen and antibiotic ointment. Jay asked the family to bring him back on Monday. For some reason they didn't.  They showed up Thursday afternoon after the clinic was closed for the day. The family had also put ashes on his burns so now he was covered in thick, black ashy stuff that was caked on and dried. They were not real cooperative, did not really want us to clean the burns but finally did agree to let us try to clean them after we gave some Ketamine for sedation. Jay got most of his face and neck cleaned to a certain extent but I didn't get very far with his arm. The ashy stuff was caked on quite thickly and wasn't really getting much softer even after I covered it with wet gauze for a few minutes. We were going to give a second dose of Ketamine but the dad didn't want us to. We had given the first dose IM and he didn't want us to give his child another shot because it would hurt, so we stopped cleaning. He was hurting too badly to continue. We put triple antibiotic ointment on his face and neck then bandaged his arm using silver cream. This was last Thursday. We told them to come back Friday morning so we could change the dressing on his arm but were very doubtful they would return. They did though. His face and neck looked okay and I was able to change the dressing on his arm without having to give him any sedation. We gave them several tubes of antibiotic ointment to use on Saturday and Sunday and told them to follow-up this morning for another dressing change to his arm. They came! I was so glad to see him back. His face looked good, the right side of his head, right ear etc... had quite a bit of dried drainage that I didn't try to remove. His arm looked very good though. Most of the burned skin had come off with the silver cream. I applied another layer of cream and a dressing and gave him some antibiotics for an ear infection and asked them to come back on Wednesday.  Hopefully he will continue to do well. 

     I haven't seen as much malnutrition this time, until today. I saw three children who were malnourished and Chancela saw another one- the one she saw was only 3 months old, so technically too young to qualify for the nutrition program in Forèt. This program has pretty strict criteria but if the children qualify they are given peanut butter and monitored weekly. That program is our best resource for malnutrition in this area. Sometimes we will have some rice or "manna packs" to give out but we can't guarantee it  because our supply also comes from donations. 

     Normally on Saturday I go to the market in Forèt des Pins. Sometimes Jay will go in the machine for supplies but normally we girls go on moto. With the shortage of gas in the country, the price to go on moto has more than doubled. The normal price is 100 goudes, currently the price is 250 goudes, one way. This past Saturday, we were planning to catch a ride with Jay as he needed to get some groceries. We were planning to leave about 9:30, until a lady showed up at the gate at about 9:00. She had come the night before, in labor with her 7th child. Everything seemed normal but she was only dilated to about 6 cm and her water hadn't broken so we sent her home, thinking the baby would be born probably sometime in the night. She came back Saturday morning, the baby still hadn't been born. Everything still seemed to be progressing well, just not as fast as we would expect for her 7th child. She was now fully dilated but her water still hadn't broken. I asked her if she had walked at all. No, she said she couldn't. (Just for interests sake, the evening before she had come on moto, this morning she had been carried to our house on her bed, from quite a ways away.) I had to be the mean nurse and tell her she had to walk for a while and I would check her again in an hour. With support from her family, she did walk for a while. Then she needed to use the bathroom so I told her she could use our outhouse. I was standing nearby and heard a splash, her water had broken there in the outhouse. When she got back in the gallery I checked her again. The baby's head was lower but she still wasn't ready to push so I asked her to walk some more. She did. I had just checked her again and it didn't seem like she was quite ready yet so I went in the house and was talking with Amberly when I heard some commotion in the gallery. She had gotten up to walk again but suddenly was ready to push. Of course they were right in front of the gallery door so they had to maneuver and I did too so I could get through the door to check her again.  The baby's head was coming, right now. Chancela came to help and Jay came in a few minutes also. The baby was stuck for several minutes, with everyone hollering at the mom to "push"! I was afraid we would have some difficulty getting the baby to breathe after it was born because it was taking so long to deliver but I could feel that the cord was not around the baby's neck. That must have been our saving grace. I was able to get a finger in to help move the baby's shoulder just a bit. That little bit of repositioning allowed him to be born soon after. We only had had time to grab one towel so Chancela did the " move the family member away from the door manuever" so she could get another towel, the bulb syringe, and the cord clamp.  The baby did well, breathing on his own and crying before we had even suctioned him very well. Jay took the baby inside to get him dried off and dressed and I stayed with the mom until she delivered the placenta. Soon after that they were ready to go home. We piled into the machin and headed to Forèt, and it was only 11:30! 

Santo Domingo to Oriani

      I wrote just a little bit about Santo Domingo on Sunday evening but will try to give the whole Santo Domingo "experience" today. 

     On Saturday evening I checked in online for my flight to Santo Domingo the next morning. They offered an upgrade to first class for $65. This also included 2 free checked bags. I was planning on checking 2 bags anyway which would have cost almost the same amount so I upgraded and got a better seat also. When I got to the airport on Sunday morning I took my bags to be checked. They asked to see my receipt for an application to enter the Dominican Republic. I didn't know anything about that requirement but was able to fill it out online without too many problems. Once I had that processed I got my bags checked easily. The flight to Miami was pretty uneventful,  a few bumps but not bad. In Miami I had about an hour before my next flight. The Miami airport doesn't have a huge selection of places to eat. The breakfast places had really long lines and the lunch places were just starting to open so I just got a snack before boarding. Obviously the online application I filled out to enter the Dominican Republic sped up the customs process because it didn't take terribly long. Then I had to go find my bags, which wasn't too difficult either. The hotel where I was staying said it had airport shuttle service but I didn't have any service on my phone to call them and thought it would be just as easy to get a taxi. It was. The guy who was "assigning" taxis knew a little bit of English and understood what I needed so he put me in the next taxi and we headed out as soon as the driver had the address in his GPS. It was about a 20 minute ride and cost $40 American. I was glad I had researched it before hand and seen that the hotel shuttle also charged that amount or I would have felt like he was really ripping me off. In truth, he probably was, but at least I had a heads up what it might cost. Like I said earlier, this little hotel only had a few rooms and was actually more like a bed and breakfast. It had a very small pool and also offered free Wifi- that was awesome! As soon as I got checked in I asked the lady at the desk if there was somewhere nearby that I could get some food. Yes, only about 2-3 blocks away there were several places to eat and also some shopping. I had an empanada and some ice cream then roamed the streets exploring what was available.  Then back to the hotel. I could not identify the water as "hot" but it was just a tiny bit warm. The hotel room had air conditioning and was quite comfortable otherwise. The guy at the hotel desk that evening didn't know any English but I was able to get the point across to him that I wanted to put these water bottles in the fridge in the breakfast area and he was okay with that. The hotel served breakfast from 8-10 so I checked it out the next morning. The lady who was cleaning in the office was the cook too I guess. She got out some fruit then scrambled some eggs and made some toast. The eggs and toast were good. I think the fruit was papaya... I am not a fan. Jay had messaged me about a chocolate factory that was a few blocks away that they had been to so that was where I went first. I did the tour of rhe little factory then was able to make my own chocolate bar. While the chocolate was setting up I went to the gift shop and picked out a few things and got a cup of hot chocolate that was A.M.A.Z.I.N.G.! I wandered around the local streets then browsing in a bunch of the shops until lunch time. One rather interesting thing I came across- towards the back of one of the shops- a young lady was lying on the tile floor. Another lady was beside her with an empty 5cc syringe with a needle. I'm not sure exactly what was going on. In just a little bit, the young lady got up without help and they walked towards the front of the shop - they were saying something- but they were speaking Spanish so I have no idea what they said. I wasn't scared, it didn't seem like an unsafe place to be, just very strange. I cannot explain it. 

     Lacey had arrived at the hotel when I went back after lunch. Her room wasn't quite ready but as soon as it was she put Nyanna down for a nap. I read a book for a while then we went walking. It was too late to really see much so we tried to find the empanada place, and I couldn't find it. It obviously closed in the late afternoon so we found something else to eat then went to a little grocery store to get some bread, peanut butter, and jelly to make some sandwiches for the next morning as we planned to leave at 7:00 for the bus stop. We also got a small container of ice cream and had a little ice cream party on the porch of Lacey's room. We had talked with the worker who knew English before she left and worked it out that the night worker would call a taxi for us at 7:00 the next morning. This taxi was a small car with a tank of some kind in the trunk so Lacey had to share the back seat with some of our luggage. The driver didn't know English but got us where we needed to go when we showed him the address of the bus station. Online it said there were multiple buses from Santo Domingo to Jimani throughout the day but we opted to try for the 7:45  departure. At the bus terminal we weren't quite on the right street but there was an opening in the fence so we were able to walk to where we needed to be. Several willing volunteers came to help carry our luggage- hoping for a small tip- Lacey went with the bags and I paid the taxi driver. I could not understand how much money he wanted so I finally got out all of the Dominican money I had left and showed it to him. I know it was less than $30, but don't know the exact amount. The taxi driver just took it all- I knew the taxi ride the day before had been $40 American but this ride hadn't been as far. Another guy had stayed there by me, I guess to escort me across the street - so he talked to the taxi driver and they agreed that he would give me back 200 pesos. I didn't care, I was happy we had gotten to the bus station without problems. There were numerous people there at the bus terminal who knew Creole and Lacey is very fluent in Creole so we were good now as far as that goes. She had found the bus going to Jimani- actually it was going all the way to Port-au-Prince but we would get off at the border in Jimani. We got on the bus and waited for a little over an hour until they were ready to go. Neither Lacey or I had phone service so we paid someone a few dollars to use their phone to call Jay and tell him we were on the bus but not sure when it would be leaving. We had packed some snacks and pb&j sandwiches but there were numerous vendors around so we got some more water and a couple of apples to add to our stash. The bus was nice, air conditioned etc... We pulled out at 9 AM.  Very soon the music was turned up and we were rocking! The roads in the Dominican are very nice so we were cruising along nicely. We made several stops but they weren't long, two stops at bus stations where we got additional passengers. The bus ride was approximately 6 hours but only cost $25 per person. Jay and Lacey's  husband Ilomy were waiting for us at the border. They had been there a couple of hours already and multiple buses had passed, and we weren't on any of them. Apparently our bus was the last one across and they were losing hope that we would get through that day. We didn't have cell service so had been unable to update them on where we were. Actually crossing the border with the bus was fairly easy and did not take long. It took longer for Lacey and I to get our passports stamped on the Haiti side than anything else. Now it was time for Haiti roads, no more cruising! Rather time to start dodging pot holes and washed out places! Envision a freeway in America  (roads in the Dominican Republic) versus continuously traversing for 2 hours the worst area while jeeping in the Grand Canyon (road to Oriani). We arrived safely at about 7:30 in the evening.  There were numerous little girls jumping up and down and screaming on the front porch when they realized we had arrived. 

     That's all for now.

      We arrived in Oriani safely last night at about 7:30 in the evening. I will post more later about the bus ride, etc...

I am on my way back to Haiti...

     I am on my way back to Haiti to help out at the clinic for about 5 weeks. With the current situation near Port-au-Prince with the Christian Aid Ministries missionaries and the kidnapping, it didn't seem wise or safe to fly into Port right now. I flew into Santo Domingo in the Dominican Republic today. Lacey and her little girl are flying in tomorrow and then on Tuesday we will go together via bus to the Haiti border in Jimani and someone will pick us up there. We are spending night in  the "Colonial Zone" area in Santo Domingo. It is a neat little hotel - more like a bed and breakfast- with only a few rooms. A few blocks away there is shopping available and numerous places to eat- all the way from a little empanada restaurant to much more elegant dining experiences further down the street. I wandered around the little shops for a while this afternoon, then got an excellent chicken and cheese empanada and some ice cream for supper. I will probably crash early tonight as it was quite an early morning this morning. We left my house at 2:30 am... more later.

Home

    

      On Friday we closed clinic just a little bit early then we all piled into the land cruiser- Jay's family, Roseline, Chancela, Amberly, Lacey and her almost 2 year old little girl- Nyanna, and I and we headed down to Port-au-Prince. Luggage tied down on top. I thought our rig fit in very nicely with the other assorted loads we passed on the road. All except for the land cruiser with multiple goats on the top... we were no competition for that! Chancela and Roseline were going to be with their families for the weekend. Lacey was flying home for a few weeks to see her family. Jay's, Amberly and I went to Tin Street Friday afternoon then Jay had booked several nights at a Bed and Breakfast there in Port. We were planning to go to the beach on Saturday,  then I flew home on Sunday and Brianna had an appointment on Monday to get her second COVID vaccine. The bed and breakfast was a very nice place- air conditioned bedrooms, swimming pool, etc... Jay ordered some pizza to be delivered and we all got in the pool. 

     Saturday morning we went to a public beach that is close to the Wahoo Bay resort. From there we got on a small boat and headed out to an island. We have hired this same guy to take us there in the past and the boat ride normally takes an hour. Not today... we didn't realize how windy it was until we headed to the island. Amberly and I and the older girls all were sitting in the front of the boat, this lasted about the first 10 minutes. Then the driver, Fransisco,  wanted us to come inside under the shelter. The waves were good size and splashing into the boat on a regular basis. The plan was to go back a ways keeping close to shore then go out towards the islands and let the current help us get there. I'm going to guess we had been on the water about 15 minutes and there was definitely water in the bottom of the boat. It was hard to tell how deep it was because we weren't holding still. Probably somewhere between 1-3 inches, depending where you were in the boat. Fransisco guided the boat closer to shore, into some "shallow water" so he could turn on the pump to get the water out. I guess it worked the first time, at least partly, but it wouldn't empty completely. So we started off again. After a while the water was re-accumulating so Fransisco rummaged around down by the pump and found a container. It probably was supposed to hold a gallon, but the top had been cut off. He hands it to Jay and asks him to "bail water" out of the boat. So Jay fills it with water then hands it to Fransisco to dump over the side. They had a routine going- my guess is getting 1-2 quarts of water out each time. This went on until we nearly got tangled in a lobster net. While trying to avoid that Fransisco lost hold of the container they were using to bail. We turned around and tried to get it but it was too deep already, we couldn't reach it. We headed back toward the island again, but now Fransisco hands Jay a quart size container- the bottom has been cut out AND it is missing the lid, and wants Jay to continue to bail... I am guessing that now each time he is dumping 1-2 cups of water because it is a small container, plus he has to hold it just right so his hand can cover the place where the lid is supposed to be. By this time I wasn't sure the island and another attempt at snorkeling was worth it. Actually, I had already wondered if this trip was worth it several times. It was definitely the most eventful boat ride I have ever taken. I also was wondering exactly how much gas this guy had, I have been on a boat ride in Haiti before where we ran out of gas. But we kept on.  Slowly but surely the island was getting closer and the shoreline was fading from view. The place where we go snorkeling was on the side of the island that shouldn't have high waves with the direction the wind was blowing so we were still hopeful about that. When we arrived, the water was beautiful. No big waves at all. Amberly and I went snorkeling first while Jay's took the girls to the other side of the island where there was a sandy, shallow place for the girls to play in the water. It took me a long time to be able to breathe with the snorkel but I did it! I wore a life jacket and didn't go out as far as the rest did but I saw some pretty fish, coral, and a couple other creatures I couldn't identify. Also some H.U.G.E. sea urchins! My guess is their spikes were 6-8 inches long. After a while Amberly and I went  and played in the water with the younger girls while Jay, Brianna, and Lydia went snorkeling. Lydia caught on to the whole breathing through the snorkel technique and really enjoyed it this time! The boat ride back to the public beach was totally peaceful, no big waves at all. It is amazing how much difference a little bit of wind makes! The beach wasn't crowded at all so we stayed there a while longer. A man who was there on the beach beside us went out in the water just a little ways and was bringing in starfish. He had 18-20 live starfish in a very short amount of time. They were beautiful! He put them on the rocks there on the beach and we watched them a while. After a while they started slowly moving back towards the water. They are almost creepy looking when they move, using all of their many, many suction cups to inch their way back into the ocean. When we left the guy said he was going to sell them. We ordered Chinese food for supper on the way back to the bed and breakfast.

     Sunday morning we went to church in Blanchard then went to Vol for a quick lunch before I needed to be at the airport. I was looking forward to Haitian rice and beans one more time before I came home but was sadly disappointed.  They had rice and beans, but it was the rice that is fermented. So far I am unable to enjoy rice cooked that way. I got my COVID test done there at the airport and left at 4 pm. I had a layover in Miami then got in to RDU at 10:35 pm. Some of my friends picked me up and I got to my house a little after 12:30. 

     Now the question is... should I go back to help out at the clinic for a few more weeks? Currently there is no one there to take my place. There is a girl who can hopefully go in January but until then- the clinic will have to limit the number of patients they see some days. Jay will probably be able to fill in some days but he won't be able to be there every day. I need to work a few shifts, talk to my boss, etc... to see if I can get something worked out- unless there is another volunteer...

Sunday afternoon surgery... and a sixth sense.

      I was on call this past weekend.  Sunday morning a lady came, in labor with her first child. Everything seemed to be normal except she had an elevated blood pressure. I don't know if it was only because she was in pain or if she really needs a controller blood pressure medication so I just gave her a one time dose of Nifedipine. She was dilated to a six and the baby's heart rate was 136 so I sent her back home with some prenatal vitamins and Tylenol for pain. 

     In the afternoon a 17 year old boy came to the gate with a "blese" (cut) - on his left hand. The fourth finger was totally cut off right at the base of his nail and the fifth finger was almost totally cut off between the knuckles. It was attached by a very small amount of tissue and some skin. The bone was completely cut through. We took him to the clinic to clean it and see if it was something we could fix or if he needed to go down to the hospital. Initially there wasn't a family member with him, just some neighbors. We needed someone to make the decision whether they would take him down to a hospital to find a surgeon to re-attach the finger or what they wanted us to do. The boy's dad was at church but he came to the clinic to meet us. We wanted to explain what options were available. The first option was that we would just put a bandage on his hand and they would take him to the hospital in hopes of getting the little finger re-attached. The second option was we would do what we could here- but that would mean partial amputation of his little finger also- we would not be able to re-attach it. The initial decison was to just do what we could here, and cut off that "piece" of his little finger but that decision was made by the neighbor and the boy's dad over the phone. We wanted to give them a little time to think it over so we used some lidocaine to numb his fingers and cleaned them really well then Jay went to talk with his Dad again. After some discussion, it was determined they would take him down to the hospital in hopes of re-attaching his finger so I worked on putting a bandage on his hand while Jay started to call hospitals to try and find one who would accept him as a patient. The first place he tried was a hospital that uses "Doctors without Borders" but they only accept major trauma and two fingers was not considered a major trauma so they would not accept him. The second hospital he called wouldn't accept him because they do not have a surgeon currently. Whether that meant they truly don't have a surgeon on staff or if they didn't have a surgeon because it was the weekend I don't know. So, plans change again. We do not have an accepting hospital and now Dad is saying "God will heal" his son, they don't have to go down. So we determine to do what we can here. We do have a small tool that is used to cut bone... I can't remember what it is called though. Over the course of the next couple of hours, we trim the bone and close the fourth digit at the knuckle- missing only about one inch of finger and the fifth digit at the knuckle also, but this one is missing over half of his finger, he only has about one inch left. He also gets a dose of IV Ancef, Zofran, and Tramadol. We send him home with 2 different antibiotics and motrin for pain. He came back this morning for his first dressing change. It looks pretty good so far but we are going to try to keep a close eye on it and have asked him to come back every morning for us to look at it and change the dressing.

     This afternoon after the clinic was closed for the day, a lady came to the house in labor. First baby, dilated to 8. Everything seems normal except the Mom's blood pressure is elevated. I was doing a house call when this lady arrived so Roseline and Chancela had checked her. Since it was her first baby it might be several hours yet but I think a sixth sense kicked in here. They decided to have her walk a while then they would check her again. When they checked her the second time, she was ready to push. After she had pushed a short time, I broke her water and soon a little girl was born. She was gasping around and had taken a few breaths and we were using the bulb syringe to help clear her airway. After we cut the cord, they took the baby inside the house and Roseline and I stayed on the porch to deliver the placenta. It only took a few minutes to deliver then Roseline went to get a clean pad for the mom to sit on... and she didn't come back so after a few minutes I went inside too. The baby was not breathing, she had taken a few gasping breaths but was totally limp and very pale and her heart rate was maybe 20 when Jay listened to her with the stethoscope. We were trying everything we could think of to try and help this baby breath. We had gotten a lot of mucous from her nose and mouth with the bulb syringe but she still was not coming around. We had held her by her feet and slapped her on the back, etc... S.L.O.W.L.Y... she was coming around. Her heart rate was maybe in the 60's and we were still getting mucous out periodically with the bulb syringe. But she was starting to pink up a little. We decided we really needed to get her to the clinic, now! At the clinic we have a suction machine, oxygen, and a bag valve mask. We did not have these options at the house. So, I take the baby- still wrapped only in two towels, grab the bulb syringe and head for the vehicle.  Jay runs inside to get the keys. Of course the gate is closed and locked and I head toward it but Brianna is already on her way with the keys in her hand so I turn around and get in the machin. The baby is doing better but still not breathing normally. She is trying to cry though. And, guess what... the machine will not start! The battery is dead. This lady came on a moto and it is right outside the gate. The driver is here somewhere. It is decided that the driver will take the baby and I to the clinic because his moto is right here and Jay will bring another moto. May I add here that it has been raining every day for over a week and the road is very muddy, and slick... Thank the Lord this moto driver seemed to know what he was doing. He drove safely but as fast as he could. I was very thankful because I was holding the baby in one arm and could not hold on with my other hand the whole time. I definitely was holding on with my legs though!😅 Monday is market day in Oriani and to get to the clinic we need to go right through the market. The driver laid on his horn and honked the whole way through market. When we got to the clinic I gave the moto driver my keys to unlock the gate then hurried inside with the baby. The "delivery" cart is kept in the pharmacy so I went to get it first thing and hauled it and the baby into my exam room. I plugged in the suction machine and had part of the tubing to perform deep suction but was missing one piece. By now I am not as worried about the baby, she is crying but still has a lot of secretions. Jay gets there then and gets the suction set up and we deep suction her several times, still getting a lot of mucous out. I checked her heart rate after suctioning her. It is 160. Much better! She is pink now too. Jay had brought the mother on his moto so we get her in the room now also. She had been waiting outside. We monitor them both for a short time and try to get the baby to breastfeed. She doesn't do too well with that yet. We sent them home probably 20-30 minutes later- after discussing that in the U.S. the events of the last hour would surely warrant at least an overnight NICU stay. I firmly believe if we had sent that lady home to have her baby the baby would not be alive... Thank-you Jesus!

     

SVT

      Yesterday it looked like we would finish seeing patients at about noon. It was a little before 12:00 and we only had a few patients left. One of my patients was a little baby, about 1 month old. I took her temperature, then put the pulse ox probe on her foot to check her heart rate and oxygen saturation. Her oxygen was good but her heart rate was elevated. The monitor said her heart rate was 266 so I listened with the stethoscope to verify. Yes, her heart rate was greater than 260. We have an old monitor so I verified again, yes, the baby was in SVT. So, how do I treat this here? The first thing we try at home when a baby comes in with SVT is to apply ice to the face. It looks scary because you literally put a bag of ice over the baby's mouth and nose and hold it there for 15- 30 seconds. It is supposed to make them do the vagal maneuver which often makes their heart rate go back to normal. I wasn't sure if we even had ice at the clinic. We do have a small refrigerator/ freezer unit where we keep the vaccines and yes, there was some ice. Someone had filled an empty Tylenol bottle with water and frozen it so there was some ice available, I just had to figure out a way to crush it. Throwing the bottle down on the cement floor only broke the lid, it didn't crush the ice so I went on the hunt for some kind of a tool I could use. I found a wrench out in the depot that I thought would work. It did! It worked very well. The tylenol bottle was made from thick enough plastic that it didn't shatter when I hit it but it did crush the ice. I put the crushed ice in a bag then explained to the family what I was doing to try to help their baby. The first time I applied it to her face I only put it over her mouth and nose and obviously didn't hold it there long enough because nothing happened. So I tried it again, this time covering her whole face and holding it in place a little longer. This time it partially worked. Her heart rate came down to 190- 200. Still high but not as high. She was fussy and I didn't know how much her heart rate was elevated because of that so I gave her to her mom and told her to breastfeed her to see if that would calm her down. She breastfed but it wasn't even 5 minutes later and she was puking it all up. By now her heart rate was back up to 250- 270. I had been in contact with Jay and he wasn't at the clinic yet but was coming. While I was attempting the ice to the face maneuver he had been researching to see if there were other options of things we could try. I tried the ice twice more, keeping it in place 20 seconds each time (by the way, 20 seconds seems like a very long time when you are occluding a baby's airway!) Each time her heart rate would come down when the ice was on her face but as soon as I removed it she jumped right back up to 250. Jay suggested using a rectal thermometer to try to stimulate the baby to bear down. This also is supposed to stimulate the vagal maneuver.  We did not have a rectal thermometer but I  used a q-tip with some lubricating jelly on it. It worked the same way, when I removed the q-tip her heart rate went right back up to 250. By this time Jay had gotten to the clinic and we concluded there wasn't anything else we could do at the clinic for the baby. She needed to go to the hospital for more testing and medications.  We told the family that they needed to take the baby down that evening.  They could not wait until the next day. I think they understood the urgency but said they needed to go home and get some clothes first. So that was the first patient I sent down yesterday.

     The second patient I will write about was on a moto that pulled up to the clinic shortly before the baby and her family left. It was a lady in labor. This was her 8th pregnancy so we thought it should be fairly straight forward. That's what we get for thinking... I checked this lady and it seemed like she was ready to have that baby, whenever she wanted to push. She was having pretty regular contractions but said she did not have to push yet. We waited around a while, I restocked the pharmacy, etc... she still said she did not have to push. Suddenly she was hungry... I thought surely after some food she would have "strength" and be ready to get this over with. No, she still did not have to push. We got her up to walk but that idea turned out to be fairly short lived. We tried to convince her that the baby was right there, couldn't she just push? Yes, she agreed, but did absolutely no pushing, at all. Finally, we decided to put in an IV and start some Pitocin. That takes a while though because it has to be titrated up slowly. It seemed she was having contractions but was trying her hardest not to push, rather she was putting all her efforts into doing some kind of maneuvers with her mouth during each contraction. She definitely was not acting like she had ever done anything like this  before. We kept trying to encourage her, her family kept trying to encourage her, but we were not getting anywhere. I was beginning to wonder if there was a reason she did not want to have this baby. Finally Jay told the family members that were there at the bedside to go get the dad, he was apparently outside. Shortly after he came in the room either the mom decided it was time to push or else she could no longer fight against the contractions. In a few minutes a little boy was born. He was a very cute little guy, weighing in at 2.75 kg. I got him dressed and gave him to a family member while we waited for the placenta to be delivered. Nothing happened...nothing at all. We tried pulling gently but the placenta was very firmly attached and not letting loose. It had been thirty minutes and still no progress. Finally we decided one of us would have to try and manually help with the removal. I gloved up and followed the cord up to... I don't know what. It felt like her cervix was totally closed. I was getting no where and was causing the lady a lot of pain so I stopped. We tried to research what might be causing this problem.  She was continuing to bleed some off and on. Finally we decided that she would need to go down to the hospital also. She needed more care than we were able to provide at the clinic. The patient still had her IV in so we gave her some IVF's and a dose of medication that is supposed to reduce bleeding. Meanwhile Jay was calling hospitals to see if they would accept her and also calling the ambulance driver and getting him and the ambulance on the way to the clinic. He found a hospital that accepted her so when the ambulance arrived we loaded her onto the stretcher and sent them down. Jay got the dad's phone number so he could call and see how everything worked out but so far we haven't heard back from them. So, I put in a long day and sent two patients down to the hospital. We got home a little after 7 in the evening. 

     We start each day at the clinic with a prayer. This is a good time to look over the crowd to see if there is anyone who looks particularly ill and might need to be at the front of the line of patients to be seen. This morning I noticed an older man who was shaking off and on, almost like as if he had chills. He was very thin and looked sickly but not deathly ill and he was in the front row so I didn't call him in early. He came into my exam room about 45 minutes after we started. His blood pressure was okay, no fever, but his oxygen sats were 62% on room air and his heart rate was 130. Practically no lung sounds. I asked Jay to come help me decide how to treat this patient. His complaint was that he had a "fever" and he hadn't been able to eat for about 2 weeks. I did the rapid tests we have for HIV and syphilis and Jay did a rapid COVID test then we put him on 5 liters of oxygen. That only brought his oxygen sats up to the mid to upper 80's. His rapid HIV test was positive and so was his rapid COVID.  Now what? We decided to send him to the "ti kay" for a couple hours while we tried to figure out the best plan for him and while we saw the rest of the patients who were waiting. We finished seeing the clinic patients by lunch time. The sick man in "ti kay" had oxygen sats of 87% on 5 liters. His family had went home to get clothes so they would be ready to go when we found a hospital to accept him as a patient. It was rather odd, the first phone call Jay made they accepted him. Didn't care about his age, etc... just said to bring him. So Jay loaded him up in the ambulance and headed down the mountain. He is still in Port, he has been waiting for hours to get diesel. The are supposed to start pumping soon but who knows? He is first in line though... so to leave now probably wouldn't be the smartest move. 

     Today I saw an 18 month old little girl with a colostomy. It is the first colostomy I have ever seen here in Haiti. The mom said her surgery was 3 months ago. She had run out of colostomy bags, etc... I don't know how long ago, so she had just been putting another diaper on backwards. The skin was red and irritated but I have seen some colostomies with more skin breakdown in the U.S. I remembered seeing a box on the top shelf in the pharmacy that was labeled "colostomy supplies" so I went to check out what we had. There were several bags that would work for someone her size so I put one on and then gave her a couple extra to take home with her. Who knows how long those supplies will last, possibly only a few days if she can't get a good seal but it is better than nothing. The mom said they have a follow-up appointment at the hospital in November. Hopefully the colostomy is only short term and she will be able to have it taken down soon. One kind of cool thing- while I was working with this patient Roseline came into my room to ask a question and said she had studied about colostomies but had never seen one. Now she has...

     Another patient I saw several days ago had an injury on his lower leg. He came hopping up to the clinic using two sticks to help him balance and a lady was walking right in front of him holding his injured leg/ foot up off the ground. I don't know how far they came walking like that. Supposedly he got kicked by a horse three days ago. His leg was swollen and had large areas that looked almost like blisters with serous fluid underneath. I opened a couple of them and let them drain but did not treat his leg. I told him he had to go down and get an x-ray because it was possible that his leg was broken but I couldn't tell without an x-ray. He seemed very willing to go so I just gave him some Ibuprofen and wrapped his leg up so hopefully it wouldn't get more infected. He didn't really want any kind of a dressing on it. We were wondering why- when he said that someone had "tied" his leg and put some kind of herbal dressing on it. Well, that obviously hadn't helped... but I told him it needed a dressing because it was actively draining and the dressing I put on would not be tight, at all. I just used some abd pads and kerlix. They left the same way they had come, him hopping along using two sticks, her walking slightly in front of him holding his leg up off the ground. I hope the had a moto waiting somewhere for them if they had very far to go... 

     We also have a little kid coming in every other day for dressing changes on a burn on his foot. Roseline saw him on Monday and he would'nt let her touch his foot so she gave some Ketamine and then cleaned and dressed it while he was asleep. I decided a long time ago that it is inhumane to really scrub or clean burns here. We just do not have strong enough pain medication. But I have had very good luck numerous times using silver cream on burns here. The cream kind of debrides the burn. The little boy came back today for his first dressing change. I decided to see what I could do without using Ketamine, I did not want him to be in terrible pain. He was scared but did very well, I didn't clean it at all. When I got the dressing off it looked very good so I simply used a couple of 4 x 4 gauze squares to get most of the old cream off then put more silver cream on non stick pads then held those in place with kerlix and then koflex. It worked well and only took a few minutes. 

     The past week or so it has been raining almost every afternoon so clinic days have been shorter than normal. Most days lately we are finished at about lunch time. Yesterday was my turn to cook and I was hungry for mexican food so I made chicken fajitas, refried beans, sopa, chips and salsa and some bars for dessert. It takes a whole lot more time though when you have to make your own tortillas and chips. It was worth it though. Amberly helped me out by frying all of the chips and Jay grilled the chicken.  Group effort...

      Today I had already locked up the clinic and was walking to the gate to leave when a moto pulls up. It was the little baby that was born a week ago! I was so happy to see them! The dad and the aunt who were here when she delivered had brought her back. She had lost a little bit of weight but I don't feel like it is too much. Now she weighs 1.49 kg. They say she is eating well. She has an extra digit on each hand. We had told the family that when she came back we would "tie off" the extra digits so I did that today. I just used some number 4 suture thread. She hated it when I pulled it tight to knot the thread! She looked good and had a strong cry. Seeing her absolutely made my day!

      I have seen numerous sad cases this week. The first one was a 50 year old woman who was carried into my exam room on Tuesday. It appears that she had had a stroke. She could not speak. The right side of her face and mouth was drooping and her right arm seemed to be rather stiff. Her blood pressure was 211/108. I decided to try and get her to take an oral dose of nifedipine for her blood pressure. She did open her mouth for me to put the medication in but she was unable to take a drink so I used a syringe to give her some water to swallow the pill. She couldn't do it, the water just ran out of the side of her mouth. We had quite a few patients still waiting so Jay offered to put in an IV and give her a dose of IV blood pressure medicine so that I could continue to see patients. He gave her a dose of hydralazine then just hung a bag of normal saline to keep the vein open in case we needed to give her more medication later on. Initially when she came in there were multiple family members at her side. We have a policy that only two family members or friends can be at the bedside at a time so hopefully we can still get to the patient, so they had decided to let her sister and her mother stay, the rest of the family was waiting outside. When we re-checked her blood pressure it was slightly lower but she was still out of it, she could not talk and had lost control of her bladder. I proceeded to see other patients. This lady's family had stepped out for a few minutes and my assistant had also. I was sitting at my desk with my back to the exam table doing consults on a lady and a couple of her children when they was a crash behind me.  No verbal noise at all, just a thud... as this lady hit the floor. She must have been trying to roll over or something and fell off of the table. Her IV stayed in but of course the tubing was stretched tight and she was bleeding from her forehead. I quickly slapped my bare hand to her forehead to try and control the bleeding. Roseline is in a room across the hall and she must have heard the racket because she asked what was going on over there in my room. I told her my patient had fallen off of the table and was bleeding from her head, and yes, I needed some help. Jay must have heard the commotion also from the office so he came to help too. Roseline grabbed some gauze and held pressure to the lady's forehead while I went to wash my hands and get some gloves on then we lifted her back onto the exam table. When I removed the gauze from her forehead she had a wound almost in the middle of her forehead from hitting the corner of the shelf on her way to the floor. It stopped bleeding pretty quickly so we just put several steri-strips over it. Then Jay talked to her family- he told them that we suspect she has had a stroke and do not know how much if any of her previous functions she will regain. She is conscious, but does not seem to comprehend anything that is going on, cannot speak, and cannot swallow. It also does not seem like it would be of any use to take her to a hospital at this point. The family seems to comprehend the situation and take her home.  I heard this morning when I got to the clinic that she died last night. Fifty years old- that is life here. Real, every day life. On a positive note, I didn't have to fill out an incident report for the fall...

     Yesterday a woman and her 11 year old daughter came for consultations. The woman looked sickly but not deathly ill like she needed to be in the hospital. I did the daughter's consult first. Rather vague symptoms- stomach ache, head ache, diarrhea for 6 days. I had written for several medications for her then I proceeded with the mom's consult. She too had vague symptoms- head ache, stomach ache, etc... then she said she has had diarrhea for a year. Caution lights go on in my brain- I need to test this lady for HIV.  We have rapid HIV and syphilis tests at the clinic so I test her... she is positive for HIV. My assistant and I talk about it a little and decide to test the 11 year old also.  We are almost out of syphilis tests and the Mom's test was negative so I just do the HIV test. She is positive also! We ask the mom if she has any other children. Yes, she has another daughter (18 yrs old) who is here but they weren't getting a consult for her. The mom goes to get her and I test her also. Her test is negative. Where did they get it from? Did they give it to each other? Did someone else give it to both of them? Surely this wasn't congenital, I don't think the mom would still be alive if she had had it 11 years and wasn't getting treatment. We do not have the medication to treat HIV at our clinic but we take down their names and phone number and will pass that information on to someone who has a clinic in Croix-des-Bouquet. This clinic will then get in contact with the patients and provide medications and follow up. It is sad... I wonder how the child got it...

     Another patient I had yesterday was a man with an enlarged prostate. We have numerous patients with prostate problems who cannot pee and so need a catheter. Some of them come every month for a catheter change, some don't come that often, some only come when the catheter isn't working and they are in intense pain. It has been very difficult getting a catheter in this patient in the past. A little over a month ago when we changed it last I was not happy with how it was draining. It did not flow well at all so I had flushed the catheter several times and gotten multiple clots out but it still was not draining well. I left the catheter in place because it was at least partially working and told him he had to go get this checked out at a hospital. So, yesterday he comes back in a lot of pain and with bloody urine in his catheter. His catheter looked suspiciously like the one I had placed a month ago so I asked him if he went down. No, he hadn't.  He didn't have the money. So I asked him what he wanted me to do, I had done my best last time and he needed more help than I could give. Well, he didn't go down because he didn't have the money, but now he is back at the clinic wanting his catheter changed. I tell him I will try. I tried, several times, several different sizes, with no success. I cannot get it past his enlarged prostate. I give him pain meds, and an antibiotic for a UTI because his urine was bloody. Roseline comes in to help me explain to him that we have done everything we can here at this clinic. He needs more help than we can provide. If he is unable to pee without a catheter he needs to go to the hospital and not come back to us...It makes me feel bad, but I have done everything I can. We give him a little bit of money before he leaves to help with the expenses of more testing etc... 

     Yesterday I also saw a man with a mass on his neck. It appears to be some kind of a cyst and not an infection. It has been there a long time and just slowly gets bigger. They say a nurse from our clinic has drained it before, it was not filled with pus, rather a yellow liquid. It was quite a large lump and was bothering him so I asked him if he wanted me to try to drain it again. Yes, he did. So I got out the lidocaine and numbed a spot on the side of the mass then stuck a needle in it, and aspirated 22 ml of dark yellow liquid. It was a rather satisfying feeling when he left with a normal looking neck that only had a bandaid on it. I don't know what kind of a cyst it is, the fluid may re-accumulate, but hopefully it won't, at least not for a while.

     Casey and Rebecca and their boys were planning on coming today to visit but several of their COVID tests were positive so they can't come. I'm disappointed,  but I'll get over it. 

Medical dilemmas

      A beautiful little girl was born at the clinic last night. The mother thought she was 34 weeks along, by ultrasound measurements the baby was 31 weeks. The mom came to the our house in labor just before 3 pm. She said her water broke at 8 am yesterday morning. When we checked her she was definitely dilated and was having some contractions. This was her 4th pregnancy. Now the question is, do we encourage her to go down to a hospital? Do we take her down in the ambulance? Will we find a hospital that will provide care for a preemie? Will the baby live? Only God knows. We decide to take this lady to the clinic and let her deliver there. The baby's heart rate is good, but we have no idea what will happen after the baby is born. Ethically it would not be right to send this lady home to deliver. At the clinic at least we have suction and oxygen if it is needed.  Jay goes to the clinic with her, while Brianna, Amberly and I go to the afternoon service and the girls stay at home with Chancela. We are glad the girls stayed home when we realize how far we have to walk. It is 3 miles one way. We stop in at the clinic on our way home. The first lady hasn't delivered yet but now there is another lady there who is in labor also. The second lady is quite a bit more dramatic about everything than the first one. It is her first baby. Also she has drank ginger tea, which supposedly is to help a laboring mother, but as far as we can tell it just gives them a whole lot of extra pain. It seems that if they have drank ginger tea they aren't in pain only during a contraction, instead they are in pain all the time. I check the second lady and she is not ready to deliver yet. She is dilated to a 7 and everything appears to be advancing normally so we explain this all to her family. Now it is just a matter of time, and she is not yet ready to push. They are satisfied that everything seems to be progressing as it should so they go home. By now the first lady is fully dilated but does not yet feel the urge to push, so we wait. After a couple of hours we start an IV and some Pitocin to try and help speed things along. The baby's head is right there but she still does not feel like she needs to push. After the IV is in, we go home in shifts for supper. A little before 11PM  I check her again. It seems we are ready to go. I encourage her to push with the next contraction. The dad senses that the time is getting close and he disappears out of the room quite rapidly. When she pushes the membranes are visible so we pull the cart with supplies over closer to the delivery table, glove up, and are ready for this baby.  After only pushing a couple of times, the baby is born. The sac is still totally intact around the baby's whole body and the placenta comes right after. I try to tear the sac open with my hands. I get through one layer but with everything wet and slippery I can't get through the second layer. Jay grabs a scissors from the cart and opens the sac. It isn't even 20 seconds later we hear the wonderful sound of this little baby crying. I suction out her mouth and nose and we place her on her mother's abdomen for a few minutes before we take her to weigh her and get her dressed. She weighs 1.57 kg. The dad comes over to look at the baby while we are doing this. Almost right away he notices that his little girl has an extra digit on each hand just like he does. ( That is a very common sight here. Normally it is on both hands and attached by a small piece of skin. Usually the small extra digit does not have any bones but sometimes has a fingernail. ) The dad requests right away that we cut the extra digit off. Jay and I talk about it and give them a randevous appointment for one week. If the baby is still doing well at that time we will tie suture thread around the extra digits so they will fall off. We get her dressed and give her to the female cousin who has been at Mom's side all afternoon.  We try to get the baby to breastfeed before leaving the clinic but she really is not interested. The family is from a long ways away so they will be spending night tonight with someone they know here in Oriani. They all three plus the newborn baby get on the moto and head off into the darkness. We walk home, very happy the baby is alive. I have no idea if she will continue to do well or if she was just born too early to survive without being in a hospital. 

     On Wednesday I saw a 23 month old with severe injuries. I am unsure exactly what happened to this child. He literally had a hole in his neck where it seems like he must have had a large abscess. His neck was continuing to drain some pus but the hole was a very disturbing site. Whenever he would turn his head you could see tendons and things moving around in his neck. He had another wound on the back of his left shoulder that looks like it also had been an abscess that was mostly drained. These wounds both looked like they needed to be packed but it would have been inhumane to pack that one on his neck without some kind of sedation. Plus, this child needed more help than we could give.  His lower back seemed to be swollen and red, but it also had a huge black blister on it. The skin was peeling around these sites and he was swollen, for sure from his abdomen on down. The swelling looked like he was also suffering from malnutrition but it could have been from his other problems, I don't know.  The story is that 2 weeks ago someone was trying to carry this child on their shoulders when he fell. They think he landed on his head. I think he may have landed on his back. I don't know how the boils/ abscesses got there. Probably all of his injuries were exacerbated by "tying". It is a common remedy for any type of pain. Tying is folklore and is supposed to keep pain from spreading to another part of the body. The problem is, often whatever is used to"tie" the wound is put on too tightly and can cause circulation problems etc... Sometimes also, plants or herbs are made into a paste and put on the wound before it is tied. This can lead to huge infections. I suspect that is what led to the abscesses on this child but I don't know for sure. I couldn't tell if the skin on his back was burned or bruised or what exactly was going on there but I suspect an injury inside also, possibly a fracture or sprain of some kind. This child needed x-rays, IV antibiotics, wound care, etc... I didn't want to start treating him when he needed more than I had available.  For instance, I could have given him antibiotics. I could have given him a shot and oral antibiotics but I didn't.  I was afraid if I gave some medicine the family might not take him to the hospital right away, they might try to give the antibiotics for a few days at home to see if he got better but I wanted him to go to the hospital that day. So I simply gave him a dose of tylenol, plus a second dose of tylenol to take in a couple of hours and put small bandages on his wounds to hopefully keep the dust etc... out of them on the ride down to the hospital. I told the family several times they needed to go down that day, not even to wait until the next day. I'm afraid it was too late for this child already.