Tuesday, October 30, 2012

What a week!

It started as a tiny sore on my leg, barely even visible. The next day it was an irritated spot, the size of a dime. For about 3 days, it stayed small as I put neosporin and a bandaid on it. And then, last Sunday, the sore suddenly grew to quarter-size and around it, was a patch of hot, swollen skin. I'm a diligent nurse - I marked the swelling with a sharpie so I could track it and I had my co-nurse, Grace, give me an antibiotic shot.
On Monday, the swelling had spread an inch beyond Sunday's marks and the sore in the middle had grown too. I was running a fever of 99.9 and my leg killed! Every step, every bump I hit on my bike sent pain shooting up and down my leg. And even when I was just sitting or standing, it would jab me out of nowhere. I ignored it and worked a full day of clinic and nursing assistant class. But I did start myself on bactrim, a strong antibiotic.
On Monday evening, I begged Grace to cut my sore open. I love draining pus out of infected things and I had a hunch that mine had some that needed to come out. So she sliced me and pushed pus out of my abscess. It hurt. A lot. A whole lot. I lay down on my bed, took a hefty dose of Ibuprofen, and thought, "What if this doesn't get better?" I was already suspicious that it was a staph infection, which can get very serious very quickly, and sometimes that kind of knowledge just leads to worrying.
Fortunately, I woke up on Tuesday without much pain and felt able to go about my day as planned.
Bad idea.  
The 5am walk to Jubilee that Grace and I took to put an IV in Brian's dehydrated wife, the 10 miles that I biked that day to go to the Home for the Dying, the 3 pharmacies I visited looking for a med for clinic, and the 2 hour class I taught did not do good things for me. By that evening, the swelling had spread even more, and the deep red bull's eye was the size of a golf ball. My ankle was all swollen too, just from being on my bad leg all day. My fever was 101 and I was exhausted.
My roommate went all-out "Nurse Grace" on me. She put me on strict bedrest all day Wednesday, with the only exception being my nursing class. I was allowed to teach but for the other 22 hours of the day, my leg had to be elevated. That evening, our community also had a little prayer meeting, specifically for those of us in the community who were sick. We also doubled my dose of antibiotics.
Tuesday and Wednesday

Prayer and bedrest and lots of drugs started to work on Thursday. The swelling finally began to go down along with my pain and fever. By Saturday, I was feeling great and packed my backpack to go to Port-au-Prince for youth group with my friends Katie and Kathleen. Wouldn't you know, on a road that I have walked hundreds of time in dark, we got held up at gunpoint by 2 thugs who robbed us, which for me meant losing my phone, keys, little Ipod, about $30, a jump drive, favorite sweatshirt, and the necklace that I've worn daily for the past 9 years.

The thugs walked away and the first thing we did was pray for them. "God please bless them," and then we started laughing. We have continued to laugh about that and about my rather serious leg infection all week.

What can I say? Sometimes things get hard, but when your God is close and you know He's in control, it just doesn't feel that bad. In fact, this week, it's felt rather fun. Weird, I know, but I can't explain why except to tell you that God and I have been spending quality time together and that seems to make all the difference in the world. 

Friday, October 26, 2012

Home for the Dying

Six miles from Jubilee is DePoto, the Sisters of Charity Home for the Dying. I've been there twice this week to visit Jeanita, my burn girl. I'm not allowed to use the camera inside the grounds (I love that rule - the dignity that it maintains for the patients!) but this is what I see when I turn my bike off the main road and approach the gates: a peaceful avenue, trees and farmland surrounded by mountains, flowers on every wall. What a perfect place for a hospice center.

Jeanita is doing well. The nuns tell me that when she arrived 12 days ago, her burns smelled so atrocious that they washed and dressed them outside before bringing her to a bed. But on Tuesday, when I last visited her, her burns were clean and looking very healthy. Edges had begun to heal, especially on her forearm and shin, areas where the burn wasn't as deep. Her palm is starting heal but the rest of her hand and the deep sections on her thigh and knee are going to take a long time. All her fingers are contracted, muscles stiffened permanently, so that even when she heals, she will never regain function of that hand. And her pinkie finger - that was the only finger that she never let me debride and so it infected underneath the dead skin. Now the infection appears to have reached the bone and it looks like she will lose that finger.

She still screams and cries when they do dressings, and sometimes she runs out of the building. But six miles is a long way for a girl to even think about going, so she always returns to her bed. They haven't been giving her the seizure meds that I provided and she isn't on an antibiotic anymore or any pain meds, but at least she has clean bandaged burns and she is smiling. I can't ask for more than that.  

Thursday, October 25, 2012

Autumn at last

It is finally cooling down in Gonaives! I've been sleeping with a sheet and sometimes even a blanket at night, and during the day, I can do simple things like sweep and change a bandage without becoming a sticky, sweaty monster.
This week, tropical storm Sandy has been camping out over Haiti, making it rainy and cloudy and deliciously cool! I've worn a sweatshirt for the first time in months.
Welcome to Haiti, Autumn!

A poopy day...literally

Did I ever mention that I run clinic and teach classes in the public latrine?
I'm not joking. Since most houses in Jubilee don't have plumbing or even an outhouse, everyone comes down to the salt flats behind and beside our school to defecate. In the early morning, you can sit and watch a veritable stream of people walking out to "La Saline" to empty their bowels.
It really doesn't bother me. Sure, when I want to walk through the salt flats to get to the ocean, I'm pretty careful about where I step, but otherwise, I'm not fazed. On Monday though, someone had deposited a particularly smelly gift below my classroom window and the ocean breeze was sending its odor wafting through. For 2 hours I felt like I was teaching inside an unflushed toilet bowl.
I love Haiti.

Tuesday, October 23, 2012

The Safe House

About 6 weeks ago, Grace and I moved out of the house where we lived last year with Julie, April and Tia. We moved across town to a second floor apartment about 3/4 mile from our clinic. It's a fantastic location - just blocks from the big open air market and from the square where we buy delicious street chicken and spaghetti in the evenings, close to the taptap station and 1/2 mile from our Haitian church. It's a poor enough neighborhood that people sit on the stoop, play dominoes and tell jokes, but wealthy enough that people don't pester us for food or money. Everyone has been very welcoming and it makes me smile to hear them all greet us by name when we walk by.
We named our new home The Safe House, mainly because it's our safe haven from the insanity of our life here, but also because of the cemetery. We live 3 houses from the city's big cemetery (above is the view of the cemetery from my bedroom window) and Haitians are terrified of the cemetery. It's full of zombies, evil spirits, ghosts, werewolves...you name it. Our Jubilee teens were scared to visit us at first, simply because of our proximity to the graveyard. So "The Safe House" because it's safe from zombies.
Our apartment is breezy and bright. It's small by American standards, but perfect for us. I love it.
Dining room...
Living room/study...
Balcony with my plants from Port-au-Prince...
My side of our shared bedroom...
Grace's side...
One view of the kitchenette...
We didn't make the move alone. We brought with us Chris Greene, the only one of the 4 guys who lived here last year that is back. I would show you a photo of Chris' room but it refuses to load, so I'll just describe it. We call it the Torture Chamber because it is an unfinished concrete cell, the size of a closet. He literally does nothing more than sleep in it on a pad and spends the rest of his time at his desk in the living room or on the balcony. He's a good roommate, cheerful and talkative, helpful and willing. One morning, I woke up to him cleaning the fridge. It doesn't get much better than that!
And of course there's Tug, our rottweiler puppy. He's 9 months old, weighs around 65 pounds and still thinks he's a lap dog!
 We love wearing costumes. This particular photo is from the day we went to a friend's party dressed as each other..Chris on the left is supposed to be me, Grace is Chris, and I'm Grace. It was a hilarious and utterly confusing night as we pretended to be one another. We're weird; we're the Safe House family!

Saturday, October 20, 2012

My staff

Grace, my nurse co-worker and our clinic director, had to go to the States urgently because a family member was ill. She was gone for nearly a month, so I was responsible for my own work and hers. It was exhausting, but one of things I appreciated about it was the opportunity to spend quality time with our clinic staff.
Valmy is a graduate of Martha's first nursing assistant class. He speaks English fluently and helps run the English school that Chris founded. Valmy is in his late 20s but he is a senior in high school so we employ him on the weekends to do our elderly program with Samuela, another NA. They visit about 15 older residents of Jubilee every weekend, doing BP checks, giving out meds and TLC. Valmy also comes to clinic before school on Monday mornings and gives out cards to 50 general consultation patients. This is a challenging job because people get very aggressive in the battle to receive a card, but Valmy stands his ground and somehow keeps the peace without letting himself get pushed around. He is Chris' best friend and has also become a good friend to me and Grace.
Vesline is our nurse. Like many Haitian nurses, she has a bit of a superiority complex but the longer she has been with us, the more I have seen her smile and try to relate to the patients on their level. I know that it is a stretch for her to work in as rough and traditionally dangerous a neighborhood as Jubilee, but she does it with poise and dignity. Vesline's favorite aspect of the job is prenatal care, to the point where an American nurse midwife is going to sponsor her to a 10 month midwife training program in Hinche. We will be sad to lose Vesline but we're excited about her future.
Samuela (below on the left) was Martha's best student from last year's nursing assistant class. She lives in Jubilee and has a heart to love and serve others. We hired Samuela to work the weekend elderly program and told her that if she wanted, she could come to regular clinic days but we couldn't afford to pay her for them. In the past 9 months, Samuela has only missed 1 clinic day! She has been there faithfully, working as an unpaid volunteer without ever once complaining. What a gem!
And finally there's Oscar. Another graduate from Martha's class, Oscar lives a few blocks from clinic and has become our go-to guy for everything. He works all our regular clinic days and also volunteers his time on the weekends to do dressing changes and emergency care by himself. After watching me suture a dozen times, he asked for a lesson and now, he takes pride in being able to sew people up if accidents happen outside of clinic hours. I am blown away on a daily basis by Oscar's cheerfulness, his compassion for our patients, and his willingness to go the extra mile. He plans to go to medical school next year and I don't know what we will do without him.


Tuesday, October 16, 2012

Heavy on my heart

Our burn victim, Jeanita, came to us consistently for about 5 days. Five days of torturous, excrutiating dressing changes where we scrubbed and she screamed. I didn't feel the physical pain but the emotional weight of doing something like that every day is pretty awful too. And yet, we saw progress, very slowly. Chunks of dead skin coming off, charred flesh peeling away, and tiny patches of healthy pink tissue appearing underneath.
Then one day, Jeanita didn't show up. I figured she needed a break, so we didn't press the matter. But when she didn't appear the following day, I sent Oscar, our nursing assistant, to her house. He found her in bed, running fevers, with a local remedy, a mixture of raw egg and goat poop, smeared all over the burns. He begged, lectured, cajoled, and argued, and eventually came back to clinic alone.
We prayed. And we worried. There was a tangible air of sadness about the clinic.
But the next day, there she was, ready for us to do her dressings! Where the wounds had been clean before, now they were oozing pus, especially in the areas where the skin had burned and hardened but not come off. As we peeled those sections of skin away, we found infection underneath.
To make matters worse, whatever resolve Jeanita had had during the first week was gone. Any time during that second week that we rubbed too hard, she would pull away and grab our hands. Once she jumped up and ran out of clinic. Her boyfriend chased her down, picked her up and carried her bodily back to the exam table. Several times, she threw herself on the floor, open burns pressed against the dirty tile, and wailed, "Just let me die! Just let me die!" Personal dignity is a huge deal for Haitians - they would never sit on the floor like I might or go out in public without wearing nice clothes - but Oscar, good old Oscar, knelt down on the floor beside her, held her and spoke soothingly to her until she got up.
* * * * *
Jeanita was always on my mind. At clinic, at home, in the market, during Creole class. I thought about her constantly - how was she doing, whether I was doing an effective job cleaning her burns, whether she would come back the following day. Many nights I fell asleep thinking about her.
While I'm still caring for someone, I try to keep my emotions at bay. I have to, otherwise I could never have the courage to keep doing what has to be done. I'm sure it looks inhumane and cruel, but if I open that door, I become useless. I'd been able to remain at least outwardly detached until one day when Jeanita grabbed me and with her good hand, began to stroke my hair and plead with me.
"Please stop hurting me, sweetheart. Please don't do this to me anymore, my friend. Please, honey, don't hurt me anymore." She was crying and her tears were falling on me and then I was crying too. Crying and answering, "I don't want to hurt you, but I have to."

The next morning, Jeanita didn't come to clinic. Oscar visited the house on the second day of her absence and no one was home. On the third day, he and I went together. We found her sitting in front of the TV, egg and goat poop all over her body, her burns smelling like rotting flesh. After 15 minutes of arguing and begging and reasoning, it was clear that she was not going to come back to clinic. I asked if we could pray for her.

We walked out of that tiny shack and into the dusty barren yard. I couldn't hold it in and I just started to sob. Oscar wrapped his arms around me and we stood together, crying, for a long time.

I couldn't think about anything but Jeanita all day. The burden that I felt for her health, for her life, was so heavy. I prayed for her. I wanted to cry for her. What if I've put her through this hell, I agonized, only to have her die now from infection? All that suffering for nothing.

* * * * *

In the morning,Oscar called me. Joy of joys, surprise of surprises: Jeanita had returned to clinic! I whooped and started dancing around my apartment. And then I thanked God, over and over.

* * * * *

That was Saturday. On Sunday, Jeanita didn't come. Yesterday, she didn't come. Oscar went to the house and found her covered in goat poop. Again.

I planned to go see her today, to try to convince her again to come back. But before I got the chance I heard the news that Jeanita is at DePoto. DePoto is run by the Sisters of Charity, Mother Theresa's people. It functions primarily as a malnutrition center and a home for the dying. They don't give out medical care; they give out love and comfort. If Jeanita is in DePoto, she is there to die.  

Oscar's face reflected my emotions. "Did you hear?" he asked me. I nodded and we just stood there, silent. What is there to say? It seems that we've poured all our energy and all our heart's capacity for compassion into that one girl. And now, it feels as if we've lost her.

Sadness and surrender are encroaching, but I'm taking a stand for hope. Hope that DePoto will have bandage supplies and use them. Hope that cleanliness and good nutrition will work their magic. Hope that God is merciful enough to not let us lose the battle like this. We can't bear to lose the battle like this.

Trade School Haiti - Nursing assistant class

This is the second year that we have taught a nursing assistant class as part of Trade School Haiti, the aspect of our mission in Gonaives that hopes to prepare people for a job and self-sustaining life. Kathy's artisan guilds make up the bulk of Trade School, but we also have a small fishing net program, a goat start-up program, and a garden project.
Last year the nursing assistant course was taught by Martha Hanna, an amazing nurse who teaches in the US and who has years of hospital and community health experience. She also, however, has a husband and children in the States, so this year, I get to teach so she can stay at home. Lucky me!
I love teaching. Ask any of my classmates from college and they will tell you about the review sessions I used to lead where I literally sat at the professor's seat by the chalkboard and re-taught my peers the material. Teaching in Creole is more of a challenge, simply because the vocabulary is so limited - there is no word for muscle contracture, for example, and there's only one word to describe both tendon and ligament - but I enjoy it regardless.
We work hands-on, learning concepts through lectures and role-playing, and then practicing on each other or on "patients" that we borrow among the children who are always milling about outside the class. When Dr Justin was here, he taught a session on eye diseases and eye protection, and Erin, the physical therapist, taught 3 days of patient positioning, range of motion, and proper body mechanics.

We have covered a week of professional behavior, communication skills, and documentation skills. We've learned about childhood development and the hierarchy of physical and emotional needs. We've practiced making beds, bathing patients, dressing patients, and doing vital signs. This week, we're moving into the musculoskeletal system, tackling common diseases and how to care for a broken bone or a muscle injury. They did a great job putting ACE wraps on each other yesterday!
I have 17 students covering a range of ages and backgrounds. They are all eager to learn and serious about class, though we are struggling to overcome the epidemic of "Haiti time" which has about 1/3 of my students arriving late every day simply because that's how this culture operates. You can meet a few of my students here:
Juslene is in her early twenties. She has a 1 year-old son and she has made it through 11th grade. She works the night shift at a local radio station and apparently sends me a shout-out every night! Perhaps I should buy a radio. She is a bright student who is always first to volunteer and first to answer my questions.

Exantus (in the glasses) is a bit of a show-off, but he lives in Jubilee and wants to be helpful so he has spent several mornings in clinic with us helping do dressing changes and odd jobs. Olguy (on the right) is very quiet but extremely particular about his work. He's the guy who practices something a dozen times until he's satisfied with his own peformance.

Venelia is the oldest member of my class at 47 and she is one of perhaps 8 students who have actually graduated high school. The average education level in my class is ninth grade, but from the way some of them write, you would think it was 4th grade - not that they aren't intelligent, simply that they have been raised in a country that teaches them to read and write in a language that isn't their own (French) and when they are asked to do schooling in Creole, they are hard put to do it well.

Stephania was voted class president by her classmates. She is smart and well-spoken but quiet. She has never come late, never missed a day of class, and never been behind on her class payments. She does her patient care attentively and gently. I would hire her in a heartbeat.

Wysline is my youngest student. She's 19 years old and attends 10th grade in the mornings before class. She lives in Jubilee and was recommended for the class by Oscar and Samuela, the NA's who work in our clinic. Wysline spent 2 days in clinic with me last week helping us do bandages and vital signs and shots. When we were done, I caught her outside, carefully writing down the steps to everything we'd done so that she would remember it.

The goal of the class is technically to provide our students with a marketable skill, but the unfortunate reality is that there are too many trained nursing assistants and nurses in Haiti and not enough jobs for them. But I am content to see my secret goal reached: that these 17 would know basic health care and be the healing hands and teaching hearts in their communities. Maybe they will never have a job in a clinic but when Juslene's son has a fever, she will know how to lower it and when one of Pastor Charles' congregants has a stroke, he will be able to do exercises with her while he prays for her. And that is a beautiful thing.

Thursday, October 4, 2012


 Last week, we hosted a group from Journey Church in South Carolina, including an eye doctor named Justin. This was Justin's second visit to a community where cataracts are rampant, eye infections are quite common, and reading glasses are a virtually unmet need. It is always beautiful to see him taking care of our patients, especially the "frequent flyers" who show up for their appointments now brimming with pride as they flash their brand new glasses.

Justin and his wife Megan saw all the eye patients while we ran regular clinic in the next room. They treated eye diseases, gave out sunglasses and preventative advice, outfitted patients with reading glasses, and got prescriptions for others. On Justin's visit 6 months ago, he went back to America with a list of 20 patients who needed prescription lenses and on this trip, he brought those 20 custom-made glasses. He'll do the same every time he comes, probably twice a year.


Another member of the group was Erin, a physical therapist. Erin spent her first couple days going on home visits with Samuela, one of our nursing assistants. They visited all the elderly people who are in our blood pressure/TLC program and Erin worked on excerise regimens for them, especially the ones who have had strokes. She also saw a number of handicapped children in clinic, working with them and showing the parents how to improve their kids' function.

In the afternoons when clinic was over, Erin and Justin took turns teaching our clinic staff from their expertise. We are now adding a well-baby and chronic pediatric needs afternoon into our schedule for children like MC, a 4 year old with seizures and Evens, a little blind boy. Thanks to Erin, our staff know much better now how to help these children develop physically.
Justin taught the staff how to choose reading glasses for patients and when to make referrals for his bi-annual visits. He is committed to providing the clinic with sunglasses for cataract prevention and reading glasses for our adult patients, so we are adding a monthly eye check-up day on the last Friday of each month. I'm excited about another entire set of needs being met for the community of Jubilee!

Both Erin and Justin also taught classes in the nursing assistant school that I now run...more on that later!

For now, we'll just leave it at this: Thank you, Journey Church!

Tuesday, October 2, 2012

How to have fun in Haiti

One of the FAQs I get from visitors to Haiti is, "What do you do to have fun here?"
The question puzzles me a bit. OK, we don't have movie theatres or malls or amusement parks or lots of restaurants, but my theory from childhood on has always been that you make your own fun. Fun is never dependent on outside factors; it depends entirely on your spirit and creativity.
For example, when you find out that your friends from Coreluv who work with the orphanage nearby are pregnant, you show up to the baby shower wearing diapers, sucking on a bottle and carrying a teddy bear and a blankie!

And that is how I have fun in Haiti :)