Gran Gosier

      On Thursday Jay's went down to Port-au-Prince and picked up Amberly Goertzen. She is from Nebraska and is going to be the school teacher for Lydia and Ellie. 

      We decided to make Saturday a beach day. We left the house at about 8:30 and stopped at the market in Foret des Pins for about an hour. The girls needed school shoes so while Brianna and the girls were shoe shopping I took Amberly on a very brief, short tour around Foret market. I took her to see where they butcher cows then we did a quick circle through some of the booths. We got some pistach and a slushy drink (pistach is the locally grown peanuts that have been roasted over a fire). They are amazing! 

     After a long, bumpy ride (which I really don't mind) we got to Gran Gosier beach at about 1 pm. When we go to this beach we always stop in the town of Thiotte on the way down and place our supper order at a small restaurant there- how many people, what we want to eat and what time we will be back. Jay built a fire there on the beach and we quickly ate some hot dogs before enjoying several hours on the beach. This is not a commercial beach at all. We saw one other man. He had caught some fish and had a small fire going and was washing his clothes in the cold springs there. It is not unusual to see a few people, often when someone is bringing their cows or goats to drink. We spent several enjoyable hours in the sun then washed some of the salt water off in the cold springs before heading back to Thiotte for chicken, goat, rice with black bean sauce, bannann peze (fried plantains) and potato salad. We got home a little after 9 pm, a long day but very enjoyable. 

     Sunday afternoon we saw one emergency- a lady had been in a moto accident and had a broken leg. Both of the bones in her lower leg were broken. We cannot fix that here so we gave her a shot for pain and splinted her leg so hopefully her trip down to the hospital isn't quite so painful. 

     Today we finished seeing patients at about 2 pm so we closed the clinic and came home. There were a couple of calls later this afternoon. One was a young lady who looked like she wasn't feeling well but her complaints were rather vague. She did have a cough but her lungs were clear and her blood pressure was normal. I was contemplating what medication to give her and mentioned that it just really wasn't clear what was wrong with this lady. Brianna wondered if the lady was angry at someone. I hadn't thought to ask so went back out on the porch to question the lady and her husband. Yes, they readily admitted,  she was angry with someone. I told them I could give her a few medications to help with her headache and other complaints but I didn't have any medicine that could help her get over being angry with someone. I asked her if she knew Jesus. Yes, she said she did. I told her Jesus is the only one who can help you with this anger. There is no medication I can give you that will take that away. 

     The second patient I saw after hours today was a kid who had been kicked in the mouth by an animal and he needed a few stitches. I'm sure it hurt a lot to get lidocaine shots in his lip to numb it up so I could stitch it but he did very well. He flinched a couple of times but there were no tears. I put 5 stiches on the outside and 2 on the inside. 

     That is all for now...

"Li pa ka pale"

      I was on call this past weekend. This was the emergency Chancela and I left church to go deal with. There is a moto waiting just outside the church yard to carry the nurse to the "emergency ". I got on the moto for the short ride theough Oriani to the clinic. No one is there. So I ask the moto driver where is the person with the emergency? "They are coming. They are in a machin in Oriani". So I unlock the gate, unlock the clinic, check to make sure my exam room is ready for whatever this emergency might be. Still no patient... Meanwhile Chancela gets to the clinic also,  she opted not to ride on moto. Looks like I should have done the same, but it is too late now. I ask her if anyone told her what the emergency is. No, she doesn't know either. We are both waiting at the clinic when  a kamyon (a big farm truck used to haul produce and everything imaginable to market) pulls up by the gate. They want to bring the kamyon right on the yard so someone opens the gate wider so they can back in. Then someone decides they should really back up as close to the front door of the clinic as possible so more revving of engines and hollered directions are given. The truck comes very close to smashing into the front of the clinic because they didn't  turn as sharply as they wanted to but it comes to a stop with a few inches to spare. The " emergency" that is obviously in the back of the kamyon is still very much of a mystery to us. The "tailgate " of the truck is lowered and several young men hop up in the back to assist those already in the back with getting the patient into the clinic. About 6 people carry a metal bedframe with a lady on it to the back of the truck where several more are waiting to carry the bed to the clinic door. So, surely this patient is deathly ill right? We don't let them attempt to bring the bed in the front door so they stop on the porch and probably 4 people manhandle and carry the lady in to the exam room and put her on the table. She is young with no obvious injuries. She does have a few tears on her cheeks. We ask what the problem is... " li pa ka pale". The literal translation is... she can't talk.  Ok. Wow! There are several ladies there who say the patient fell this morning and now she can't talk.  Chancela asks if the husband is around. Yes, he is outside. So she brings him in and asks him to tell us what happened because the patient is not talking. She just looks at us and will occasionally shake her head. His story is similar, she fell this morning and now she can't talk. We ask if she is angry. No, she isn't angry. There have been times we have had patients who will not talk because they are very angry at someone. There have also been times " pa ka pale" is a severe case of indigestion... at least that is the only thing we have been able to determine is wrong. Two ladies stay in the room with us,  we send everyone else out. Chancela begins asking questions. The lady refuses to talk or even open her mouth at first. We give her some pedialyte with a syringe. At first she just holds it in her mouth but eventually she does swallow it so we give her some more, via syringe. She swallows it, though reluctantly at first. While Chancela is asking questions, I took her vital signs. Completely normal, all of them. I check a blood glucose and since we needed to do a finger prick for that anyway, went ahead and did the rapid test we have for HIV and syphilis. Glucose is 99, the other tests are negative. We give her a Tums to chew and some more pedialyte. By now Chancela has convinced her she can sit up without support. She is starting to talk a little too. Shakes her head that she can't lift her arm to her head but does not resist when we lift it for her. So, what shall we treat her for? Your guess is almost as good as mine. We check her urine for a UTI and do a pregnancy test, all negative. She says she hurts but we really don't get much more information. Something is going on though because a tear will occasionally slip down her cheek. If she is angry or sad she does not tell us why. After we get the urine sample we do not help her back up onto the exam table but rather let her lean against it and give her a small cup of pedialyte to drink by herself. The other two ladies who are in the room are happy when Chancela gives them each a small cup of pedialyte to drink also.  She is talking some now and is leaning against the exam table without support from anyone else. We have not discovered anything else to treat so get some Tylenol, iron,  and some more oral rehydration powder to send home with her. I throw in some vitamin b powder also for good measure.  One of the ladies goes outside to collect the payment from the husband- 500 goudes ( approximately $5) - for an emergency call.  They say "thank-you, thank-you nurse..." The two ladies walk on either side of her supporting her- one of them takes off her own shoes and gives them to the patient because she doesn't have hers along. They support her to the edge of the porch and then a couple guys pick her up and carry her just outside the clinic gate while a couple others carry her bed. We lock the gate and leave them there to figure out is the best way to get this lady and her bed back to their house.  We gave her a Tums and some pedialyte... who knows what the whole story was. But she left the clinic able to walk with assistance,  able to talk, and able to drink. Chancela and I got back to church in time to get in on the last few minutes of the service. 

A little fighter... and an abscess

This little guy came into the clinic today. He weighed 1.9 kg with a diaper and a onesie on. They say he is two months old. I don't know how many weeks he was when he was born but he has to be a fighter to still be alive!

A five year old boy came in today also with an egg sized abscess that I got to drain. Thank the Lord for Ketamine because it had to be very painful! I sent him home with Bactrim and some gauze and tape because I'm sure it is going to continue to drain.

 

An earthquake, and tropical storm Grace

     Friday was my day off. Every Friday Jay works so one of the nurses can have off. Brianna and I walked to "the point" in the morning. It is a little over 2 miles one way. The view from there is just beautiful! I wish I knew how many miles we could see. You can see the coast from several different places along the route we walked. Then at the "point" itself it is an awesome view 360* around. One way is the coast, then around to quite a steep drop off down the mountain where you can see all the fields and gardens on the next mountain over. There were several small children who walked the last little ways with us. Of course they all wanted a "gift" from us. Brianna gave them the drink she had brought with her but I didn't have anything to give them. On our way back the children decided to link arms and try to block the path so we couldn't get through. I started to run toward them to try and break through and they scattered... shrieking with delight! So of course they had to try to block us several more times. Then on Friday afternoons we have worship at someone's house. I was just getting ready to leave to walk to the house where we were having the service when an "ijans" (emergency) showed up at the gate. A lady in labor... we checked her and it didn't seem like anything would happen anytime soon so I got in the machin with Jay's as they were planning to drive to the afternoon service. Chancela was on call for the weekend so she stayed at the house with the lady in labor. When we were almost to the house where the service was going to be we met a moto with several passengers. They were on their way to the clinic with a lady who had a bad headache and just didn't feel well. Jay told them they could go to the clinic on the Catholic compound here in Oriani or we would be back in a little while and could see her then. We had a service in a small two room house- there were probably 15-20 people in those 2 small rooms plus a few more outside that there weren't enough chairs for. A young couple lives there with their 2 small children. After the service they served hot tea and bread. I was rather dubious about the tea but it was quite good! I walked back home. When I got home, Chancela was just sending the pregnant lady home. Everything seemed to be normal and it didn't seem like she would deliver anytime soon. She had just seen another emergency also and the lady we had passed on the road was waiting to be seen so Jay checked her out. Her systolic blood pressure was well over 200 and her complaint was that her right side felt "dead". She had probably had a small stroke. There isn't anything we can do for that up here on the mountain but Jay did give her some blood pressure medication and pain medication and had her lie down for a while. She had to have a second dose of blood pressure medication before her pressure was low enough that we felt comfortable sending her on her way with daily meds.        

     As most of you probably know, on Saturday there was an earthquake here in Haiti. The earthquake epicenter was in  Les Cayes. That is approximately 107 miles away from Oriani. We felt the ground shaking but there was no damage done here. It happened at about 8:30 in the morning. I was sitting on my bed reading something on my phone when it felt like I was shaking. I thought I must be dreaming but when I looked up and looked around my room my dresses were all swaying and a cord for some of the lights in my room was swinging back and forth too. I went to the market in Foret des Pins with Brianna and Ellie. Then on Saturday evening we were invited to Jesse and Kiki's for a weiner roast. They are missionaries from another church who live near Gwo Cheval. 

     Sunday started out as a normal Sunday- breakfast and then church at 9:00. We had a member's meeting after church so lunch was a little later than normal. Evening church is at 4:00. Probably around 3:00 we got a call that there had been a truck accident and we should prepare for a bunch of injured patients. The accident happened near Gwo Cheval so some patients would probably go to the clinic in Foret and some would come to us. So Jay and I headed to the clinic. Roseline was down in Port-au-Prince with her family for the weekend and Chancela was in the middle of cooking supper. There were 2 patients at the clinic when we got there- a lady who possibly had a fractured hip and a man with just a couple of scrapes- nothing that even needed to be sutured. Jay tried to see if he could identify a fracture with our ultrasound machine but was unable to tell for sure. We treated those 2 and waited quite some time, hoping for more patients. There were supposedly about 30 people on the truck but it sounded like it had tipped over while trying to pass another stopped truck on the road so it probably wasn't going very fast. The clinic in Foret had gotten about 10 patients- it sounded like several of them would need some stitches, etc... but nothing very bad. I was disappointed we didn't get any more patients... good for them though. Sunday evening it rained a little bit then the rain from the tropical depression started in for real on Monday mid morning. We had a lot of patients to see on Monday- they had come before the rain started. With the tin roof on the clinic it isn't easy to hear and communicate if it rains very hard but we were able to see all of the patients who had come. The lady whose blood pressure was so high on Friday came back in to have it checked again. Her blood pressure was much better this time, obviously the medication was working. She still had the complaint that her right side feels "dead", but she is able to move it. We gave her a randevou to re-check her blood pressure again in a week. We finished seeing patients at about 3 pm then worked in the pharmacy for a while, hoping the rain would let up briefly so we could walk home. Nope, that wasn't going to happen so about 4 pm Roseline, Chancela, and I dressed up in our makeshift rain gear- white plastic trash bags for rain coats, black trash bags as shoe covers/boots and whatever else we could figure out to attempt to stay at least partially dry then headed home. It was an interesting walk home, we were pretty much soaked by the time we got here. I stuck my head in the house long enough to ask Brianna if she could put some water on the stove so I could have something hot to drink after I showered. She made soup and kolaches for supper then we worked on a puzzle for a while. It rained all evening also and off and on through the night but this morning it was past. We got over 5 inches of rain. Currently the cistern is about 1 inch from overflowing. Today was a slow day at the clinic though, actually there were only a couple of patients there when we started this morning but they slowly trickled in off and on all morning. I saw a few people but mostly worked in the pharmacy. I'm trying to organize it a bit and getting rid of some medications that are expired. We all came home right before lunch today. I did some laundry then worked on supper off and on all afternoon. I made fajitas, black beans, sopa, and a carrot cake for desert. After supper I took a walk while the rest did the dishes. 

A picture is worth a thousand words...

This little guy came into the clinic several days ago, only a couple of days old. He has cleft lip and palate so is not able to eat very well. The family is from right here locally, from Gwo Cheval. This picture was sent to Keith Toews from St Mary's, Ontario. He has been able to get enough donations to get help for this baby. A consult with a pediatrician is 200 goudes (or about $2). The surgery is predicted to cost about $300.00. So the current plan is that Jay will take the baby and family down to the hospital Monday morning - se Dye vle ( if God wills).
 

     A few of the patients I have seen in the last week- a young girl, 18 years old, came in with a large wound on her foot. She looked rather sickly and it was obvious she had had that wound for a while. Both  of her feet and legs were swollen and both feet were peeling.  We have a rapid HIV test and a rapid syphilis test available so we decided to check her for that. We didn't tell her specifically what we were testing for but I think she knew that one of the tests was for HIV because when the man who had brought her stepped out of the room she asked if we would please only share the test results with her. Yes, that is no problem. She was obviously nervous that her test would be positive. Both tests were positive. We can treat the syphilis with IM Penicillin but the HIV positive patients we refer to the clinic in Croix-des-Bouquet. They provide medications and counseling for HIV and TB positive patients. I cleaned her foot as well as I could and then bandaged it. It was very painful for her so I did not get it as clean as I would have liked but it was better than when she came. We asked her to come back to the clinic for dressing changes but I don't know if she will be able to or not. She is from very far away. The IM Penicillin I wanted to give in a big muscle because it is painful so I gave it in her butt. Her whole back side was covered in thick, almost plaque-like skin. I hope we caught her illness soon enough that she has a fighting chance against it. 

     A young man who was in a moto accident and had a very large cut on his foot. He went to the clinic in Foret initially and they stitched it but when he came to us several days later it did not have any kind of a dressing on it at all and was very dirty. I cleaned it as best as I could, I removed some of the stitches as it was looking like it was infected. Todd and Donna are here visiting for a couple of weeks. They were here as missionaries several years ago and he is an RN so I asked for his opinion also on how to dress this foot wound. The wound really needed to be debrided but we do not have strong enough pain medication available to do that so we decided to do a wet to dry dressing for several days and see how it looked. I have changed his dressing about 5 times already. Twice I have needed to trim away some dead tissue. The second time I used lidocaine to help with the pain for that part of the procedure. Today we removed the rest of the stitches as they were no longer doing any good. It really isn't a job for anyone with a queasy stomach... it is rather smelly, but he has done very well with keeping the dressing mostly clean and dry. This one is just going to take time to heal. 

     A lady with a burn to her foot and leg that happened 13 months ago. It is unclear to me if the site has never totally healed or if it has opened back up. She also is from a long ways away so I don't know if she will be able to follow up appropriately. 

     A young lady today who was obviously in a lot of pain. She was in an accident about two weeks ago and had several bad copies of x-rays of her pelvis with her. The doctor had told her she didn't have any broken bones. We were unable to identify from the x-rays if there was a fracture or not, something didn't look quite right, but I don't know how to read x-rays either. For sure not ones as unclear as these were. Palpating along her spine did not cause pain, the pain was more on the side/front in her hip area. She is supposed to follow-up with the other doctor later this week but is in too much pain currently to make the trip down. I gave her some IM Tramadol, then Flexeril and Motrin pills to take and instructed her she needs to get to that follow-up appointment. 

     An elderly lady I saw today... her oxygen saturations were in the 30's initially. I didn't believe it at first, changed the pulse ox from one thickly calloused finger to another, to another. Listened to her lungs, diminished, but she didn't sound horrible. Called Todd and Jay in to look at her. The highest oxygen saturation I ever got on her on room air was 60%. Transferred her to another room where she could lie down and put her on some oxygen. We have a concentrator that allows us to give 5 liters per minute. On 5 liters, she averaged in the 70's, did get into the 80's a time or two for a very brief period. No coughing, just complaining of a headache and shortness of breath. I gave IM Rocephin, an albuterol neb (which did nothing at all- I just thought I might as well try it- it wouldn't hinder) then Levaquin and Prednisone by mouth. She stayed at the clinic all day on oxygen. We were at the clinic until after 4:00 this afternoon, by the time we were ready to leave she still was only maintaining oxygen sats in the 70's, still on 5 liters. So she is is the little house close by the clinic on oxygen overnight and Jay will take her down tomorrow morning when he goes to Port-au-Prince for medications. We do not have an accepting hospital , our best chance is to drop her and a family member off close by the hospital. If they walk up to the hospital hopefully they will be accepted and treated. If not, they will have to try and find a moto or some other transportation to another hospital. 

     And that is only 5 of the patients I have seen over the past week...

     On another note, the nurse who was planning to come here in October has backed out. So, if anyone is in the least bit interested in possibly giving some time here in Haiti please let us know. Or if you know of anyone who might be interested, pass the word around. I can almost promise you, you will never regret coming and giving some time to help others in need. 

      It seems like a small tornado went right through the yard here on Saturday afternoon. It was pretty much out of the blue, one minute blue sky, the next some big raindrops and strong winds progressing to a whirlwind. Jay watched it from the porch of Keith's house. The rest of us were inside so we didn't see the whirlwind, just heard and felt the strong wind blowing things all over because the house windows were open. The trampoline appears to have gone partway over the house. It was on the grass behind the house when this all started and it ended up twisted and upside down right by the front porch. It couldn't have come between the house and the little shop without wrecking the banana trees there and they are fine. We don't think it hit the roof either because none of us heard the kind of noise that surely would have made. The rabbit surely had the scare of his life though. He has a little fence that can be moved around in the yard so he can have fresh grass. Of course it does not have a floor and it isn't closed in on top either. The fence was moved several feet and turned 90 degrees but somehow he was still inside the fenced area. I really would have liked to see what actually happened- both with the trampoline and the rabbit... Within a few minutes it was calm again and the sun was shining. 

     On Saturday Brianna and I went with Todd and Donna to Foret market in their machin- no, I didn't forget the e on machine, in Creole a car or pickup is simply called a machin. We shopped a while then ate lunch together. Brianna and I wanted to look for a few more things after lunch so we came home on moto. 

     Today was another busy Monday at the clinic. I'm not sure exactly how many patients we saw altogether but I saw 42 patients myself. One of those patients was in my room for at least 30 minutes while Jay tried to get a catheter in him. This man has an enlarged prostate so has an indwelling catheter that he gets changed periodically. He came in today in a lot of pain. It seems like the catheter must have gotten clogged sometime yesterday afternoon because he hadn't had to empty the bag since then. I removed the old catheter because it had been in a long time but then was unsure of myself because this man seemed to be in a lot of pain. He actually sounded like a woman in labor with his moaning. So I asked Jay to come look at him with me. We determined he just had a very full bladder, but were unable to get another catheter to pass after multiple attempts. Finally, when we were about to give up, it went in. I had sighed a prayer earlier, now it's my turn to say "thank-you, God". 

     There were only a few people left sitting on the benches when I had a lady with a blood pressure of somewhere around 237/123. We have some immediate release Nifedipine so I gave a dose to this lady and let her sit there in my room while I finished seeing the rest of my patients. After 20 minutes or so, we rechecked a blood pressure. Now she was at 198/100, still very high, but definitely better than it had been. Also, we don't want to bring a blood pressure down too quickly so we gave her blood pressure medication to take every day and sent her home. She also got some Ibuprofen for her headache and a shot of Penicillin for a very red throat with white patches. Hopefully by tomorrow she will be feeling a little better. I felt lucky with this lady, several days ago I had another lady whose blood pressure was very high also.  The Nifedipine by mouth hadn't worked for her so I had to put in and IV and give some IV Labetolol to get her systolic pressure below 200. I know these people have probably been living with a blood pressure like this for an extended amount of time but I feel better personally if I can get the systolic under 200 before sending the patient home. 

     I have spent hours since I have come here studying Creole. Some days I think I'm getting somewhere then other days I wonder if I will ever be able to fully understand a normal conversation in Creole and almost feel like giving up. But surely I am learning, slowly...

     I was just looking back over my last post and I see that it didn't all get published. I don't remember what all else I had written,  I just know that we finished seeing patients that day between 1-2 o'clock so it wasn't bad at all. I was having problems with my internet connection that evening and obviously it just got disconnected before I was totally ready to publish that post.