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.