Well, after getting into bed at 1:30a, I failed at sleeping in today and was awake by 7:30a. I have therefore taken the opportunity to doze on the couch throughout the day. It feels good to be home but I have to say that I am already trying to figure out when I may be able to go back to Haiti. I can see how people end up staying down there for years, there is so much to do and the people are so wonderful.
I have spent the day catching up on my favorite HGTV shows. I am enjoying have the windows open between rain storms and listening to the frogs in the nearby pond.
The pictures from our trip will be available soon. I look forward to sharing my experiences with family members in person in the near future. :)
I will plan to use this blog again during my next trip to Haiti. Until then...
Sunday, May 22, 2011
Saturday, May 21, 2011
Day 8
I forgot to write about another interesting incident yesterday. One of our docs happened to be looking in the waiting area and saw a young lady face down in the mud. The other visitors/patients seemed to be ignoring her. They said she had been screaming and possibly had a seizure. We were about to put her on a cart when someone woke her up and she began thrashing/screaming. Apparently her mother had just died and this was her grief response. Everyone then just dispersed and left her thrashing and crying...it was quite odd. I kept an eye on her and eventually she made it back to a chair.
We all went to one last mass this morning. It began as a funeral but the family had to leave and get the body home. The message for today was sustainability. It felt like it was geared towards us. There is still so much need in Haiti, what can volunteers and Mayo do to keep helping? I don't think the answer is clear yet.
Our flight back to Miami was uneventful. We spent a lot of time going through customs. I just had a $13 bloody mary with my lunch/dinner. I am looking forward to getting away from this 100% humidity. My skin has seen better days, I have an unpleasant body odor and my hair is beyond help at this point. Erma Bombeck said when you start to look like your passport photo, it's time to go home. What does it mean if you look worse than your passport photo?
We will arrive back in Rochester at midnight. I'm looking forward to opening the windows and sleeping in.
I will plan on writing my final blog tomorrow.
We all went to one last mass this morning. It began as a funeral but the family had to leave and get the body home. The message for today was sustainability. It felt like it was geared towards us. There is still so much need in Haiti, what can volunteers and Mayo do to keep helping? I don't think the answer is clear yet.
Our flight back to Miami was uneventful. We spent a lot of time going through customs. I just had a $13 bloody mary with my lunch/dinner. I am looking forward to getting away from this 100% humidity. My skin has seen better days, I have an unpleasant body odor and my hair is beyond help at this point. Erma Bombeck said when you start to look like your passport photo, it's time to go home. What does it mean if you look worse than your passport photo?
We will arrive back in Rochester at midnight. I'm looking forward to opening the windows and sleeping in.
I will plan on writing my final blog tomorrow.
Friday, May 20, 2011
Day 7
Let me start by saying if I ever have to eat another protein bar, it will be too soon. I tried a variety of different flavors...it doesn't matter, I still feel like I'm eating a horse treat.
I started off the day at mass. The music today was particularly beautiful. There was a young woman there who had a gorgeous voice. I ran into her later and was able to tell her so. The homily today was about letting go of hate, grief and anger because it only weighs you down. It reminded me of one of my favorite quotes, which happens to be on my fridge. It's an Emerson quote, "Finish each day and be done with it. You have done what you could; some blunders and absurdities have crept in; forget them as soon as you can. Tomorrow is a new day; you shall begin it serenely and with too high a spirit to be encumbered by your old nonsense."
Today was an interesting day and it was our last day. For the most part it was pretty slow. Betsy and I did an organization project with the sedatives, pain meds, and ACLS meds. At the end of our shift, a woman who had been there a couple of hours coded. It seemed to take a bit for people to react. Although it was apparent there was nothing that they could do for this patient, they were able to do a lot of ACLS teaching. While they were doing this code, another young woman came in who was unresponsive. At first I was freaked out because all the doc were busy with the code and I was unsure how critical her situation was. It turns out her vitals were fairly stable. Reportedly, she had ingested bleach but no one had witnessed this and no one knew how much she drank. At first she did not open her eyes, but eventually she had tears streaming down her cheeks in response to our questions. Here in Haiti she would be described as catatonic but she did not fit the criteria that I'm familiar with. It just about broke my heart. Something obviously happened to make this young lady to make her want to hurt herself and I have no idea if she will ever have the opportunity to talk to someone.
Father Rick and Conan came for dinner this evening. I have to say from a public health standpoint, it's pretty fascinating what they have been able to accomplish. It's hard to keep doctors in Haiti and most of them have no interest in working with the underserved population. It turns out they have hired many young men who have very little education, but they are the x-ray techs and IT people. They went searching for these young men in the toughest neighborhoods, many of them were involved with gangs. The majority of employees at both the pediatric and adult hospitals are Haitians. And in terms of healthcare providers, there is some interest in starting their own PA program to fill the gaps in the system. Right now the ratio is 1 doctor per 15,000 patients.
Well, I best get some rest, tomorrow is going to be a long day. Bonne nuit.
I started off the day at mass. The music today was particularly beautiful. There was a young woman there who had a gorgeous voice. I ran into her later and was able to tell her so. The homily today was about letting go of hate, grief and anger because it only weighs you down. It reminded me of one of my favorite quotes, which happens to be on my fridge. It's an Emerson quote, "Finish each day and be done with it. You have done what you could; some blunders and absurdities have crept in; forget them as soon as you can. Tomorrow is a new day; you shall begin it serenely and with too high a spirit to be encumbered by your old nonsense."
Today was an interesting day and it was our last day. For the most part it was pretty slow. Betsy and I did an organization project with the sedatives, pain meds, and ACLS meds. At the end of our shift, a woman who had been there a couple of hours coded. It seemed to take a bit for people to react. Although it was apparent there was nothing that they could do for this patient, they were able to do a lot of ACLS teaching. While they were doing this code, another young woman came in who was unresponsive. At first I was freaked out because all the doc were busy with the code and I was unsure how critical her situation was. It turns out her vitals were fairly stable. Reportedly, she had ingested bleach but no one had witnessed this and no one knew how much she drank. At first she did not open her eyes, but eventually she had tears streaming down her cheeks in response to our questions. Here in Haiti she would be described as catatonic but she did not fit the criteria that I'm familiar with. It just about broke my heart. Something obviously happened to make this young lady to make her want to hurt herself and I have no idea if she will ever have the opportunity to talk to someone.
Father Rick and Conan came for dinner this evening. I have to say from a public health standpoint, it's pretty fascinating what they have been able to accomplish. It's hard to keep doctors in Haiti and most of them have no interest in working with the underserved population. It turns out they have hired many young men who have very little education, but they are the x-ray techs and IT people. They went searching for these young men in the toughest neighborhoods, many of them were involved with gangs. The majority of employees at both the pediatric and adult hospitals are Haitians. And in terms of healthcare providers, there is some interest in starting their own PA program to fill the gaps in the system. Right now the ratio is 1 doctor per 15,000 patients.
Well, I best get some rest, tomorrow is going to be a long day. Bonne nuit.
Thursday, May 19, 2011
Day 6
So we did a short education session with some nurses today...we did a case-based discussion. We had prepared some ED/ICU cases to review with the nurses but all the nurses that showed up were from St. Lucs (aka the medical floor). It worked out well. I spoke a little bit of French during the discussion but it was quite frustrating since I cannot translate a lot of medical terms. The nurses also gave us some topics that they would like to discuss in the future. They were very quiet at first but they got more animated by the end and we have a great photo to send them!
I went to mass this morning. Don't worry Mom, I'm not becoming Catholic nor am I planning to adopt a Haitian orphan (although the latter is tempting). But I certainly like to listen to the hymns in creole. Father Rick and Conan (the two head honchos of the pediatric and adult hospitals) bury the dead every Thursday. Apparently they bury about 100 bodies per week, by my math that's 400 people per month. Interestingly, the pediatric hospital delivers about 400 babies per month. I find those statistics interesting. It is not uncommon for people to abandon infants that appear deformed in any way since many people cannot afford to take care of these children. I think that is why the orphanage is so well populated with kids.
There was a deluge of rain this evening. It's interesting that Father Rick and Conan show up with an entourage to make sure that the tarps are not going to cave in. Not many patients showed up during the rainstorm. Of course, when we left this evening, we found out why...the streets were completely flooded. Of course all I could think about was cholera...no wonder it's still a problem. However, our driver Masyal drove us safely through the river of poo.
I think I might have to keep this entry kind of brief. I'm sweaty and stinky, it's time for a shower and bed. It's hard to believe that tomorrow is our last day. We will have a chance to do a bit of shopping on our way to the airport on Saturday.
More to come tomorrow....
I went to mass this morning. Don't worry Mom, I'm not becoming Catholic nor am I planning to adopt a Haitian orphan (although the latter is tempting). But I certainly like to listen to the hymns in creole. Father Rick and Conan (the two head honchos of the pediatric and adult hospitals) bury the dead every Thursday. Apparently they bury about 100 bodies per week, by my math that's 400 people per month. Interestingly, the pediatric hospital delivers about 400 babies per month. I find those statistics interesting. It is not uncommon for people to abandon infants that appear deformed in any way since many people cannot afford to take care of these children. I think that is why the orphanage is so well populated with kids.
There was a deluge of rain this evening. It's interesting that Father Rick and Conan show up with an entourage to make sure that the tarps are not going to cave in. Not many patients showed up during the rainstorm. Of course, when we left this evening, we found out why...the streets were completely flooded. Of course all I could think about was cholera...no wonder it's still a problem. However, our driver Masyal drove us safely through the river of poo.
I think I might have to keep this entry kind of brief. I'm sweaty and stinky, it's time for a shower and bed. It's hard to believe that tomorrow is our last day. We will have a chance to do a bit of shopping on our way to the airport on Saturday.
More to come tomorrow....
Wednesday, May 18, 2011
Day 5
Today is La Fete du Drapeau (Flag Day) in Haiti. I did a bit of research on it. The holiday dates back to 1803. The original Haitian flag reflected that of the French. However, once the rebel army won, they tore up the flag such that only the red and blue stripes remained; this was symbolic of the Haitians overthrowing the colonialist, pro-slavery French. The flag was visible everywhere today. They transferred most of the ER/ICU patients to the other part of the hospital in anticipation of a lot of trauma. It was actually a bit slow most of the day. I fear that the evening/night shift will be crazy!
We went to the orphanage this morning. Our first stop was the library where a bunch of kids sang the national anthem for us, it was so cute. They were marching in place and waving little flags. A lot of these kids have special needs and will remain at this house...they will not be adopted. The property that the orphanage is on is huge. Most of the staff lives in tents but they are in the process of building a new dorm for the kids and staff. During this visit, we had a long chat with the pediatrician who works there. His English was a bit rusty so he asked me to translate his French. I was amazed that I was able to understand most of what he was saying; my translation on the other hand was not so great. I definitely could not be an interpreter. Many Haitians faces light up when they realize I speak French. Many Haitians can understand French but not all of them can speak it. I have not used my French in about 10 years so it's nice to be able to fumble through my verb conjugations.
Today was a great day for our 80-something lady with the left sided pneumonia vs. pleural effusion. They almost did a thoracentesis last night but apparently a family member was unsure about the procedure. I have learned that the Haitian people are fine with IVs and blood draws but when it comes to a thoracentesis or paracentesis, it's a little bit more controversial from a cultural/religion standpoint. The family members have to be notified and educated before these kinds of procedures, otherwise there can be a lot of drama. However, after 3+ days of discussing that she needed the procedure, not necessarily for diagnosis, but for palliative reasons, we used the one kit we had to do it. It was great...neither of the Haitian docs had done one before, so they did it together with one of our docs. I was holding this poor frail lady upright and she was not responding to any painful stimuli. About midway through pulling off the almost 1.4 L of fluid, she began to wake up and look around. She looks so much more comfortable and she no longer needs oxygen. Yay! I think it was great for the staff and the patient's family to see that successful outcome.
I am going to mass again tomorrow morning. Thursdays are typically the day they bury the dead so it should be quite a cultural experience. I am going to work the evening shift tomorrow to get a little bit of a different experience.
We went to the orphanage this morning. Our first stop was the library where a bunch of kids sang the national anthem for us, it was so cute. They were marching in place and waving little flags. A lot of these kids have special needs and will remain at this house...they will not be adopted. The property that the orphanage is on is huge. Most of the staff lives in tents but they are in the process of building a new dorm for the kids and staff. During this visit, we had a long chat with the pediatrician who works there. His English was a bit rusty so he asked me to translate his French. I was amazed that I was able to understand most of what he was saying; my translation on the other hand was not so great. I definitely could not be an interpreter. Many Haitians faces light up when they realize I speak French. Many Haitians can understand French but not all of them can speak it. I have not used my French in about 10 years so it's nice to be able to fumble through my verb conjugations.
Today was a great day for our 80-something lady with the left sided pneumonia vs. pleural effusion. They almost did a thoracentesis last night but apparently a family member was unsure about the procedure. I have learned that the Haitian people are fine with IVs and blood draws but when it comes to a thoracentesis or paracentesis, it's a little bit more controversial from a cultural/religion standpoint. The family members have to be notified and educated before these kinds of procedures, otherwise there can be a lot of drama. However, after 3+ days of discussing that she needed the procedure, not necessarily for diagnosis, but for palliative reasons, we used the one kit we had to do it. It was great...neither of the Haitian docs had done one before, so they did it together with one of our docs. I was holding this poor frail lady upright and she was not responding to any painful stimuli. About midway through pulling off the almost 1.4 L of fluid, she began to wake up and look around. She looks so much more comfortable and she no longer needs oxygen. Yay! I think it was great for the staff and the patient's family to see that successful outcome.
I am going to mass again tomorrow morning. Thursdays are typically the day they bury the dead so it should be quite a cultural experience. I am going to work the evening shift tomorrow to get a little bit of a different experience.
Tuesday, May 17, 2011
Mosquitos
I forgot to mention my mosquito paranoia. Since one previous team member returned to Rochester with possible dengue fever, I may be a bit overzealous with my efforts to combat mosquito bites. I treated my entire Haiti wardrobe with permethrin before coming. I douse myself with DEET every morning and night. I'm also pretty sure I'm the only one using my mosquito net. It's actually quite ridiculous...I'm still not exactly sure how to get the net to stay up so I'm using it more as a shroud versus a net. If I'm still struck down by a mosquito-borne illness, I will know I did my best to protect myself.
Day 4
So those of you who know me well are aware that I have sweat glands the size of my home state, so you may be wondering, "How's she doing in that hot/humid climate?" I had not been working for very long on my shift yesterday when Jean, my favorite interpreter, said to me, "You are already sweating." I responded, "Oui, toujours." The heat is pretty intense on the day shift, by 11 am, I'm basically soaked. It's disgusting. Today I went over to round on hospital patients at St. Lucs. The internists on our team were doing teaching rounds with the New Haitian docs that have been hired to cover the hospital and nights in the ER/ICU. I came in late and could only stay for about two patients. The fans were not turned on and no air was moving. The patient we were discussing was interesting: mumps and possible TB. But I was so distracted by my sweating I could not stand it. I kept on staring at these Hatian docs and thinking "Not a drop of sweat, how is that possible? Why did I have to inherit my father's sweat glands?"
I rounded with the docs in the ER/ICU this morning. I found myself repeatedly asking, "so what's the plan for this patient?" I have noticed that many of these patients have been here several days which puzzles me. The ER/ICU in my experience is the place where a patient is stabilized, once that happens they are transferred to the next appropriate setting. As the morning progressed, I noticed that some of our plans were at a standstill. So I started harassing the Haitian doc to write some orders, specifically a CT scan and chest x-ray for two different patients.
The CT scan of the head was for a patient who we knew had a stroke, we just needed to confirm it. During rounds I was asking a lot of questions about the patient. She is an 86-year-old who has hemiplegia and is basically nonresponsive. I was asking about the treatment plans for this patient. Dr. Crevecoeur said in Haiti there is no such thing as DNR/DNI. The expectation is for the docs to do everything to "cure" the patient. And there is really no such thing as palliative care. I asked if there would be a meeting with her family to determine how much intervention they want. He said it would happen at some point and likely this patient will be dying in the ICU or at St. Luc's.
Another patient who is in her 80s was found to have complete white out of her left lung on chest x-ray. We are not sure if it's fluid or infection. She's on good antibiotics for an aspiration pneumonia. For the past two days there has been discussion as to whether or not the fluid should be tapped. I'm thinking let's make a plan and follow the plan. ;)
A psychiatric patient came in the afternoon. She was a young woman about 6 days postpartum. It looked like a postpartum psychosis. She received 4mg of Haldol and 1 mg of Ativan. I could tell the meds were taking effect and she was starting to relax when the nurse arrived with a foley. Apparently they wanted to give her lasix for her lower extremity edema and therefore wanted the foley. Um, really? Do we need to diurese her now when she is floridly psychotic? She needs to sleep. Of course she's puffy, she just had a baby. I let the Haitian doc know my opinion...that the foley would only succeed in agitating her more and I don't think it's necessary right now. I left to check on other patients, but I could hear her screaming from the next room. I don't think they were successful. When I walked by later..she was sleeping with no foley. I wish I could have fought a little harder to prevent her from having to experience that but I don't want to burn any bridges.
Well we need to get working on some education sessions for the nurses. I'm going to the orphanage tomorrow...I'm looking forward to playing with the kiddos.
I rounded with the docs in the ER/ICU this morning. I found myself repeatedly asking, "so what's the plan for this patient?" I have noticed that many of these patients have been here several days which puzzles me. The ER/ICU in my experience is the place where a patient is stabilized, once that happens they are transferred to the next appropriate setting. As the morning progressed, I noticed that some of our plans were at a standstill. So I started harassing the Haitian doc to write some orders, specifically a CT scan and chest x-ray for two different patients.
The CT scan of the head was for a patient who we knew had a stroke, we just needed to confirm it. During rounds I was asking a lot of questions about the patient. She is an 86-year-old who has hemiplegia and is basically nonresponsive. I was asking about the treatment plans for this patient. Dr. Crevecoeur said in Haiti there is no such thing as DNR/DNI. The expectation is for the docs to do everything to "cure" the patient. And there is really no such thing as palliative care. I asked if there would be a meeting with her family to determine how much intervention they want. He said it would happen at some point and likely this patient will be dying in the ICU or at St. Luc's.
Another patient who is in her 80s was found to have complete white out of her left lung on chest x-ray. We are not sure if it's fluid or infection. She's on good antibiotics for an aspiration pneumonia. For the past two days there has been discussion as to whether or not the fluid should be tapped. I'm thinking let's make a plan and follow the plan. ;)
A psychiatric patient came in the afternoon. She was a young woman about 6 days postpartum. It looked like a postpartum psychosis. She received 4mg of Haldol and 1 mg of Ativan. I could tell the meds were taking effect and she was starting to relax when the nurse arrived with a foley. Apparently they wanted to give her lasix for her lower extremity edema and therefore wanted the foley. Um, really? Do we need to diurese her now when she is floridly psychotic? She needs to sleep. Of course she's puffy, she just had a baby. I let the Haitian doc know my opinion...that the foley would only succeed in agitating her more and I don't think it's necessary right now. I left to check on other patients, but I could hear her screaming from the next room. I don't think they were successful. When I walked by later..she was sleeping with no foley. I wish I could have fought a little harder to prevent her from having to experience that but I don't want to burn any bridges.
Well we need to get working on some education sessions for the nurses. I'm going to the orphanage tomorrow...I'm looking forward to playing with the kiddos.
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