Dr. G. Day 5 2013

aiti day 5 April Day 4

Really interesting day. Another morning in the clinic with more nursing students with multiple small complaints. We did get to see a couple of men today which was a welcomed change. One was an Ethiopian gentleman who worked for the UN and is now retired. He has lived in France but has decided to retire in Haiti. I asked him how he liked the country and he had only positive things to say. I think he is probably able to live cheaply in a big house and is apparently used to third world style living. Most of the students packed lots of packages of medications in anticipation of tomorrow. We then left the hospital and walked back to Gladys's house. The sun today was incredibly strong, the dust was not quite as bad due to a really heavy storm the other night. More concrete being poured on the street. We finished packing our suitcases and waited in the mid day humid sun as we watched the interpreters perform the impossible. They loaded about 10 heavy suitcases full of medications plus all of our individual bags in the back of the bus, then on top of our bus, while it was at a pretty sharp angle leaning into the street, then finally making room for 18 of us to then sit. I think we were all a little worried about being a next day news story.

The bus drove us to a local supermarket where we loaded up on local wine and coffee, then off to the mountains! The translators chose to sit in the back and were cracking up the whole time. I think they were laughing at the bus driver who was cantankerous and complaining about the situation the whole time, which admittedly was not easy. We then drove through down town Port Au prince. Oh god, now I realize that we were staying in the nice part of town. We had a trickle of water pressure, no air conditioning and limited bathroom space, our conditions would probably feel like we were slumming it to most people of our Philly local suburbs. Trust me, we were in luxury at the house. It wasn't so much that the people were living in shacks, but in tarp covered boarded up shanty town that looked like they had been there for years. The most disturbing thing is the amount of trash everywhere.Piles and piles of trash. Susan mentions excitedly that there is so much less trash in PAP. What?! 70% unemployment in the country. Everyone seemed to be sitting on the side of the street selling stuff that consisted of either clothes and shoes, water and coke bottles that would become more trash or mangos. I don't think pictures would really explain it, we have all seen the pictures of the streets in third world countries, but driving through it you understand. Haiti is particular frustrating because you can see the potential for something so much better. The land scape is beautiful, the people are lovely, its heartbreaking that its all due to bad politics, much of which has to do with the US that its so impoverished. To go only a few miles took over an hour. The traffic is terrible. We saw UN trucks drive by full of armed, dressed solders. Joel tells us that “they do nothing but add to the traffic”. Many tam tams which are local pick up trucks painted with religious quotes colorfully painted with benches built into the back where about 8 people sit for 25cents per ride. Finally made it through the city and started winding high into the mountains. The road was paved for the first several miles which was new since last year Susan tells us. Then the road is unpaved and winding. The translators again are cracking up perhaps nervously this time at the travails of us, the driver and what could potentially be not very funny. The bus turns a corner and suddenly the mountains open up. The cinderblock shacks are out of view and the ocean appears. Everyone sighs “oh... wow”. More cinderblock, some carefully painted graves, children, adults staring out on the road. More are smiling now, fewer are selling things. Some waves. Then farms! Not a lot, but some. And they are beautiful. Wish I saw more. From what I have read so far most of haiti used to be rural but due to politics and the US selling haiti subsidized cheap food from the US most of the farmers moved from the mountains to the city and the farmer went out of business. We kept going up and up until we were literally at the top of the mountain, and now found Gladys's mountain home. She and her friend were here and a helper was cooking dinner. The bus drivers was totally pissed now after miles of dirt mountain road and a huge heavy bus and now he has to drive the suit bags full of medications to the church. We all took in the view from the house. The back balcony looks over the mountain and to the ocean. Its a bit hazy so the whole this was not fully visible but I cant wait till the morning. Its chilly which is sooo refreshing and we all threw on jackets and climbed to the roof. We are on top of haiti. The unspoiled, naturally at peace haiti. Fantastic. Back to business, Phillip on of the students gave a talk on intestinal worms which was excellent before dinner. We had dinner, some Chilean box wine that Gladys brought out. We are doubling up on beds and cots its really fun, Lynda opened up her Haitian rum and we all took sips from cups. Its excellent. I don’t think anyone drinks in haiti except the tourists. Well more rum for us I guess. Good night!   

 

Dr. G. Day 6 2013

Haiti Day 6

I am now sitting on the back balcony overlooking the mountains full of farm lands, stopped by a short valley then the Caribbean sea. They tell me there is a island directly in front of us which I can faintly see the island and a long mountain on top of that area.

What a day! We went out early in the morning to the church which is a 10 minute walk from Gladys's amazing house. The earth is bright red, the path we took was covered in short grass, the surrounding land was all farm with a single cow, then a goat, then a horse from farm to farm, tied down by a stake and a thick rope. The bright red dirt made the green everywhere else this bright primary color green, its was like out of a movie on that you think”they must have really enhanced this” We passed some family tombs, some sheds, some farmers plowing. The church was already full in every pew of people who wanted to be seen and more were lining up outside. By the time we were set up , which was only about 10-15 minutes, the yard full of all ages from infants to elderly. With Gladys's help we got everyone out of the church and set up our stations with medications appropriate for each station. Hypertension, belly pain, gynecological issues or pregnant, anemia and the sick shack. For the sick frail elderly people we let them sit in the church. The rest were triaged outside. I started taking the elders blood pressure who were sitting patiently on the church pew to get their triage going. First blood pressure 210/120, next 180/100, next 230/104, “do you know that you have high blood pressure?...Oui...are you currently taking medications?...non”...they ran out a long time ago.

I then was assigned to the sick shack which was everyone else who was not clearly belonging to the other shacks and or may be truly sick. All day we treated hypertension, worms, malaria, chest pain, GERD, about 5 kids were treated for malaria, lots of cute kids, more tinea, two children had very loud murmurs and we looked into referrals for echos, but if the next step was surgical I doubted the country has a pediatric cardiologist or cardiovascular surgeon for that matter, they don't even have real adult ICUs for gods sake. Every patient with anemia got iron, each with suspected worms got a onetime oral treatment, every hypertensive patient got a handy pack of Amlodipine, HCTZ, simvistatin, and ASA 81mg, just in varying doses depending on how completely scary their BP was. There was some satisfaction in watching the patients take some of these meds on spot, which I did for the kids with worms and for the angina chest pain patients. We joked at the de-worming communion.

In all we saw over 200 patients. It was an organizational feat beyond belief. Out of a church with little grounds, no running water, no obvious electricity we set up a clinic extraordinaire. People did have some wait but we went through 200 citizens of Mussotte from 830 til 3pm. We ran out of goody bags, a prize for everyone who made it through. The kids got pediatric multivitamins, band-aides and anti-fungal cream, adults got condoms, “kotex” (when appropriate) and some routine stuff that we keep in our own medicine cabinets, such as tylenol, ibuprofen, antacids. We will make up more goody bags tonight, but supplies are already running low and we will likely move to second choice therapies in many cases. I asked if there will be fewer patients tomorrow but the answer is no, probably more. Its hard to imagine that more people live in Mussotte. The town does not exist on google maps, but we are located on the Southern part of the island, in the curve of the bay, facing West. I doubt there is an official count of how many people live here. Many of the kids were waring these bright yellow and navy uniforms for school. I suspect it is for the school that Gladys started, and I doubt there was a school here until she built it.

We marched back to the house on the “back roads” which was actually a hike on a trail. This route overlooked the ocean. It all is so untouched. It looks like what Portaviallta without all the towering hotels. If Haiti ever gets infrastructure and gives way to tourism I will be especially glad I saw it this way now.

We found out the history of the house. Gladys lives most of the time in a Port au Prince house which she states has the same view as this house, but much lower elevation. 30 years ago a friend took her to Mussot and she could not believe that this is still Haiti. She soon bought a house for $700, the asking price was $1000 but her husband talked the seller down. Years later the preacher at the church sold her the land we are resting on now for $7000 and she build this lovely home on top of the mountain. She converted the original home into the local school. The house we are in is not fancy by western standards. No electricity until after dark and they turn on the generator, no need for air conditioning or heat, just open and close the windows.. the front of the house has a large tall fence topped with broken glass for security, then an alcove, then a very functional kitchen with gas stove from magically they are able to feed us really delicious dinners, a dining area, a living room area, a back porch with the view, 2 bedrooms on upper floor, 2 in the lower level and a den, 2 bathrooms. Every room is being used by us for sleeping. Thank god Gladys is flexible and made this situation work. There are 19 of us now staying in this house.

The students went for a hike after dinner and now on the roof, having a 'party” with Colt 45 bought at the supermarket, the “adults” (the attendings and Brian) are hanging out listening to music, drinking more haitian rum and writing, reading chatting. Life is precious. We did good today. We are tired, relaxed and in heaven.   

Dr. G. Day 8 2013

Haiti Day 8 4/7/13

We left Mussotte this morning on the same bus that took us there. I got a better view of the mountain towns this time. So lush, Carla, one of the other attendings, wondered if those who lived there knew how incredibly beautiful it all was where they lived. Before we left Emanuel (our cook) and some other locals were picking carrots right next to the house. Cabbage was one of the more identifiable crops.

Emanuel took me, Sangiita, and TJ (third year students) for a walk and little tour last night. He pointed out a limestone quarry that is dug up for making cement (for cinderblocks?) , he pointed out various crops, horses stood in the sunset, goats with their baby goats close by, we took a picture of one man walking his goats back home. He was pretty pissed and made us delete the pictures. Emanuel explained that the people here are pretty proud and do not want to end up on an American magazine cover as the picture of poverty. Of course that was not our intention, although I must admit the purpose of some of the photos are to express what we are seeing in one of the most impoverished countries in the world.

This morning after we got to the bottom of the mountain, we drove through the slums of Port of Prince again. As I suspected,Susan confirmed, the slums appeared the same before the earth quake as after. An endless road of trash, cinderblock homes, people wandering around aimlessly. Today is sunday so lots of dressed people going or coming from church. More and more trash on the streets and in the canals, water occasionally running through the canals, people washing themselves in this same water, only slightly higher ground were the water is slightly cleaner (I guess). Everywhere you look there is a half constructed cinderblock building with no evidence that there is equipment nearby to or workers to complete if.

We picked up David, Joel's brother and dropped off three of our translators. They were so great. They really worked hard along side us. Really funny too, their constant chatter and giggling in Kreol is now feeling missed from our group. From the bus we bought banana chips from the street vender, still hot and salty, delicious. Joel yelled out to this guy who had a basket of them on his head. The vendor was laughing with joy when we bought 25 bags of the treats. Now at the resort walking into an air conditioned room is very very luxurious, but jumping in the Caribbean ocean is outrageous. Lynda was worried she would feel weird going to a resort after all of our time working as we did, but now it seems the right thing to do. Everyone is exhausted. A shower with water pressure was needed. The red dirt and dust that accumulated in every crease of our clothing and skin feels good running off. Its OK, no one ever expected us to stay in Mussotte forever. The pasture sons are both doctors and will continue to see those patients, as a haitian , not us “blan” should. We left them with any left over medications and some supplies. The goal was to give the students an experience of caring for the underserved, encourage them going into primary care. They got more hands on experience here in a few days than they did their entire third year. I think we made some brief difference in those we served. Maybe prevented a few strokes, prevented heart failure, alleviated pain, treated infections, prevented malnutrition through worm therapy. Anyway, I am justifying my pina colada, and day at the beach.

 

(Blan is the Kreol word for foreigners, from the french word for white blanc)