Monday, September 28, 2009

It all started with...

...the national anthem, a bloody hand, and a bottle of valium.

I went to Jacmel with the task of overseeing the volunteer translators and arranging referrals for surgery and other care that was beyond the scope of the US Army medical team. However, by the end of my very first day on the ground, it was obvious that my job was a little bit more than just a coordinator.

I arrived in Marigot, the small town an hour out of Jacmel where the Army was holding its first 5 days of clinic in an elementary school. When I got there, work was already under way, so I walked through and quickly introduced myself to each room. There was dental, optometry, pediatrics, women's and family health, general medical, and the pharmacy. At each stop, I just stuck my head in and offered my name and my role as volunteer and referral coordinator. I think most of them immediately forgot about me as they went back to work.

Twenty minutes later, all work stopped for the opening ceremony. The soldiers stood at attention as the Haitian flag was raised and the Haitians sang their national anthem. Then the Master of Ceremonies asked for the US flag and anthem. Major Heck, standing near me, whispered, "We don't have anyone who can sing. We're in trouble!" Jokingly, I said, "Well, gosh, I can sing." And of course, next thing you know, I'm standing in front of the podium leading the Army in the Star Spangled Banner.

It didn't stop there. The speeches began and I asked the Master of Ceremonies, who is fluent in English, French and Creole, if she was going to translate so the soldiers could understand. "No," she said, with a wicked grin. "You are!" So I had the joy of translating speeches made by the judge of Marigot, the mayor of Marigot, the representative of the Southeast department of Haiti, and a high ranking official with the Minister of Health. The poor soldiers were standing in 90 degree heat for the entire ceremony, so I tried to keep my English versions short - OK, that's really an excuse for the fact that I simply could not remember everything that each official has said in his 10 minute speech even though I took notes. You can see from the expression on my face how thrilled I was to be translating those speeches!

Needless to say, everyone knew who I was by the end of the opening ceremony.

Later in the day, I was approached by one of the docs asking if there was anywhere in the area to get more powerful pain medications. One of the medics has a back injury and was in excruciating pain. For security reasons, the soldiers were not allowed outside the compound without an armed escort, but I could walk around freely. I went down the street to the local pharmacy and bought valium for the medic. Over the next 4 days, I visited the pharmacy at least once a day for different requests, but usually for valium, both for the soldier and for a seizing patient.

My reputation for being able to make the impossible happen was cemented that afternoon when a man appeared at the gates with his hand wrapped in bloody cloth. He had been in a machete fight. The slice went between his pinky and ring fingers, all the way through his palm and into his wrist. I won't post the photos because they are too graphic, but his pinky finger and palm could be turned almost 180 degrees to his hand. If we sent him to the hospital, most likely, he would not be able to have it surgically repaired and he would lose the hand and maybe die from infection. But we had a plastic surgeon in our unit! If we could only get our hands on the supplies needed to do the surgery, he could do it.

I went to the local clinic and spoke with the director. He allowed us to use the clinic's sterile gloves and sutures, while we borrowed lidocaine from the dentists and sterile water from our pharmacy. It took over an hour, but Dr Pitman and his assistant Andy did a masterful job putting that hand back together.

That was it. In one day, I became the go-to person for all questions and needs out of the ordinary. And I loved it!

MEDRETE - Medical Readiness Training Exercise

For 5 days, we treated patients in Marigot. After that, we treated patients for another 5 days in Cayes-Jacmel, a town 30 minutes outside Jacmel. Sometimes we treated our own men too. It was hot, especially at the second site, and in their ACUs, those men sweated a lot. Even I was drinking 4 or 5 bottles of water every day and only peeing twice during the work day. It was easy to get busy, forget to drink, and suddenly start feeling very woozy.

The soldiers delivered food donations to the Marigot school.

In addition to the work inside our treatment sites, every day, groups would go out on Operation TapTap to deworm and distribute vitamins. Sometimes they went to the market or a busy street; other times they went to schools. On our last day, the team dewormed over 600 children at the local elementary school.

It rained almost every afternoon at 2:30 in Marigot. In seconds the courtyard would be soaked and the rooms would be too dark to work in. We would gather up boxes of meds and go into the tent where the remaining patients were gathered and do simple treatments there. Everyone else was in Army boots; I was in sandals. When the mud and rain got too bad, I would just take them off and work barefoot. The men had already been giving me a hard time about my blue toe nails, but the bare feet were just too much. I will never live that down.

Word spread about the clinic. Each day, the line outside the school in Marigot and the clinic in Cayes-Jacmel got longer and longer. Fortunately, we had an excellent crew of US Force Protection, Haitian police, Haitian coast guard, and Haitian CIMO (like SWAT) who kept the crowd well managed and riot-free.

I got to do a little of everything: translating, treating patients myself, firing 3 translators who could not speak English (why did we let them come in the first place I wonder?), arranging to get new volunteers, and finding a way to get a shipment of surgical materials and additional drugs from Dr Pitman's office in Virginia to Jacmel. I was given a mulitude of surgical referrals every day, mostly cataracts and glaucoma, but also one baby with spina bifida and a teenage girl with a burn contracture. Many patients needed treatment for hypertension but we didn't have the drugs in our pharmacy; I taught the soldiers how to write prescriptions for patients to get the drugs in local pharmacies. The drugs were labeled in Spanish instead of French or Creole; I showed the soldiers the dot system of explaining how to take a medication. A little girl was brought in who had been seizing for 3 hours; I got the drugs we needed to stop the seizure and arranged for transport to the hospital. A family with several children suffering from kwashiokor arrived; I sent a driver out to buy a tray of eggs for them. We started to run out of gloves and scalpel blades; I sent a Force Protection officer and a driver to the hospital in Jacmel to get us more. The docs liked to keep candy on hand for the little children; when they ran out, I went down the street and bought more. A mother was asked to bring her son back in two days for follow-up on his pickaxe wound; the docs brought me in to speak to her and to give her the funds she would need to make sure they could come back. It seemed like every day, I was sticking my hand in Colonel Hershey's wallet and taking out more Haitian cash.

In the late afternoons, we would finish and my volunteers would head back to their hotel while the troops went to theirs. By the second day, I was being invited back with them. So most evenings, I went in their bus, ate TRats with them (not the most delicious food I've ever had, but the company was better than eating alone at my hotel or in a dank restaurant with the volunteers), and helped out with pill party, where we counted and bagged meds for the following day of clinic. On days when we got done early, we would swim in bay below the hotel or in the pool. One of the drivers would take me home around 8 or 9pm and I would instantly fall asleep.


I was very privileged to have the opportunity to lead a small sunrise chapel on our one Sunday in Jacmel. About 20 soldiers, half the company, showed up at 6am on the beach. Colonel Hershey, Sergeant Ross, and Lieutenant Harer did readings, and I shared a brief message and led everyone in singing Amazing Grace. It was one of the most beautiful moments of the 2 weeks - just standing on the beach, surrounded by people who felt like family even though we'd only been together for a short time, singing "When we've been there ten thousand years, bright shining as the sun, we've no less days to sing God's praise than when we first begun."

Americans are weird

Of all the requests that the American soldiers made of me during our time in Jacmel, one of them ranks a step above all the rest in its oddness. On the very first day, before anyone even knew my name, SFC Ross marched up to me and asked, "Can you find me some golf balls?"

The answer is no, I cannot find golf balls. Perhaps in Port-au-Prince, but not in Jacmel and definitely not when there are pressing matters such as seizing children and hanging fingers to be dealt with. What I can find, however, is zamand, an almond-like nut that grows on trees in Haiti. One afternoon, when we had finished work early, Ross arrived on the beach with his clubs, wanting to just practice his swing. There were a few zamand lying about on the beach and he hit them, with some success. So he asked me to recruit the local kids to go find him more zamand. The children, thrilled at the prospect of earning a dollar, took to the trees and returned with shirts brimming with zamand. Ross and LT Harer spent the rest of the afternoon hitting zamand at their fellow soldiers who were swimming peacefully, unaware that they were under attack.

Zamand are not the greatest replacement for golf balls, but we discovered that citron, the little limes that Haitians use in almost all their seasonings, are perfect. On our last day in Cayes-Jacmel, I walked down to the market and bought a whole bag of citron. Harer and Ross were ecstatic. I didn't tell the little old ladies that I bought them from what purpose they were going to serve. I think they would have cried.

My Army family

I was amazed last year by the Navy and their caring attitude towards the Haitians they were serving. This year, I was even more deeply amazed by the compassion and patience displayed by the members of the MEDRETE. On the USNS Comfort, there were so many medical personnel that I rarely worked with any one for more than 2 days. Here, though, I worked with the same 40 people, and very closely with the same 10, every day for 2 weeks. And I was impressed again and again by their kindness and selflessness.

Lt Andy Harer was the first person I pinned as a softy - I mean, a compassionate male nurse. A young man was admitted, weak and very skinny and sickly looking. His blood sugar was over 500 and he was close to a diabetic coma. I explained to Harer and the others that there wasn't much we could do since we didn't have insulin, we couldn't get it locally, and the boy's mother couldn't afford to go to the hospital. Andy immediately pulled me aside, "Kez, if I give you the money for the hospital, can you get him there quickly enough?" He pressed a $100 bill into my hand and 5 minutes later, the boy was in one of our cars and headed for St Michel in Jacmel. Andy asked me for updates on that boy every day until the end of the mission when we visited the hospital and heard that he had survived.

The pharmacist and pharmacy tech became good friends of mine too. On our third day, I made my first trip to the pharmacy in the late afternoon. When I appeared in the doorway, both of them hailed me with enthusiastic hello's and "Oh, now she graces us with her presence! Where have you been all day?" There's nothing like feeling wanted, so I started to visit them more often. And as things got busier and I got more tired, I would retire to the back corner of the pharmacy where I could hide to eat my lunch and reduce the amount of times that I got called away for referrals, translation or other needs.

Ironically enough, the reason that I became close with Harer and with Sergeant Ross was that friendly rivalry between the Boston Red Sox and the New York Yankees. Both Ross and Harer are Yankees fans; I'm a diehard Sox fan. We should have hated each other, but in actuality, the connection gave us something to tease about and teasing later gave way to real friendship. Andy even hung a Sox hat on the door of the room where he was working, just for me.

While I did make rounds every day to check on the volunteers and spend much of my free time in the pharmacy, all my working moments were devoted to the general medical area. After a few days, the company had christened the other doctors The Mayo Clinic, because they were very careful about documenting and about full physicals. Where I worked, though, we went fast and furious, busting through patients as quickly as possible to try to serve as many of the huge crowd outside as we could. The entire team was male, except for me, so Dr Pitman named us the Stud Farm. We never thought it would stick, but soon everyone was calling us Stud Farm or the Ranch. We became the screening point for all the other aspects of the clinic: we would diagnose and treat medical conditions, but we also screened for dental problems and did eye testing on everyone with eye complaints. By the second week, that bag of surgical supplies that I had worked so hard to obtain from the US arrived, and Stud Farm began doing minor surgeries too: cyst and lipoma removals, debriding and stitching of wounds, even a few hernias. We did it all.

Dr Pitman was the king of Stud Farm. He gave us nurses complete freedom to treat within our expertise and experience, but he was always available for advice and direction. He took me under his wing from the first day, always making sure that I was drinking enough, choosing the better MREs (specially conserved Army meals) for me, and giving me the Tootsie Rolls and other treats from his MREs. He was a huge encouragement and has promised to be a resource for me when I start working with the Angel Missions surgery center sometime next year. One day, I got onto the volunteer bus in the afternoon, and one of them asked if I had family in the company. "Isn't Dr Pitman your father?" they asked. He isn't, but for those 2 weeks, he did a pretty nice job of assuming the role.

Pitman gave all of us Stud Farmers nicknames. I became NGO, because that's how I'd introduced myself to him at the beginning.

Lt Ken Dean was Warpspeed. He and Harer, nicknamed I&D (a medical abbreviation for incision and drainage) because he did most of the minor surgeries, were from the same unit in New York and they were partners in crime. I did not see anyone in the entire company work as hard as those two, whether it was at the clinic during the day, or back at pill party in the evenings, during set-up or tear-down, loading and unloading. Wherever there was work to be done, Dean and Harer were there.

Meisemer, aka Impulse Power, was a late addition to Stud Farm. We brought him in because he speaks French very well so he could communicate without a translator most of the time. We were always short on translators. Frequently, I would be treating my own patient, translating for Harer to my left, and telling Dean's patient on my right how to take her meds. But Meisemer used his French and quickly learned the important Creole phrases that I taught him and helped us out immensely.

Sergeant Dan Barnes worked with us, getting meds ready, fetching meds from the pharmacy, and helping with emergency care as needed. He was the medic who suffered from severe back pain at the beginning of the week, so when we realized that he was not present at breakfast one morning, we got worried and sent Dr Pitman to find him. Pitman did indeed find him...sitting in his room, the only air conditioned one in the entire hotel, eating a pop-tart. Yes, Pop-Tart earned his nickname.

I don't have photos of the other members: Washcloth, Proline, and Silent Bob. They were all wonderful and sweated over patients with me day after day. Proline, like Impulse Power, was a late addition, and a welcome one to me because she is female and only a few months older than me. We got along very well and roomed together at the super fancy hotel in Port-au-Prince on our last night.

The nicknames were a blast, but I took even more pleasure in hearing soldiers calling each other by their first name. US Army uniforms have the soldier's last name on the breast, so that was easy for me but I couldn't keep anybody's rank straight at first, so I always called them by just their last name. That felt disrespectful and impersonal, so I started asking for first names. For a while, I was the only person talking about Andy or John or Harold, but by the end of our mission, a lot of them were, especially the 5 who made up my little family: Andy, Ken, Shanna, Harold and myself.

If you're like me, you've seen dozens of movies about the Army and so you have a picture in your mind of what a soldier should be like. In my experience, they are far kinder and far more loving than anything you will ever see on the big screen. I truly felt like part of a large family. The women giggled with me and talked seriously with me. The men looked out for me, acting like my older brothers, espeically when they heard about Haitian men hitting on me. I cannot tell you how many times Harer or Ross would ask me very solemnly if I was going to be safe after they left. Men and women alike treated me to meals at the restaurant, gave me hugs and words of encouragement, promised to stay in touch and send me supplies whenever I need them, and got teary eyed when we said good-bye at the airport. I have been royally spoiled.