February 18th at 11:30 am: Brooke Beck wrote to me, "Yvens is home and it was all a success!!!" These were perhaps the most encouraging, utterly joyful words I have heard from Haiti since leaving on December 15th. It baffles me that while looking back at my blog posts from Haiti, I never mentioned this child. I started to blog about him in October...but wasn't ever able to finish. It's a long story, one that began for Brooke in February of 2010 when a then one year old baby came to HAH following a surgery for a congenital imperforated anus (there was no opening in his bottom for poop to come out when he was born). He had surgery that opened his bottom and a colostomy was placed for him to poop thru until this anus was patent. He would wait several months with his rectum being dilated (from what I understand) until the colostomy is able to be reversed and the child's digestive tract will function normally.
Due to the lack of qualified surgeons in Haiti, Brooke and I followed Yves (he was a twin raised along with a second brother by his mother who has moved to Port-au-Prince leaving her family in the countryside to be close to hospitals that could care for her son). Yves's dad had left the scene shortly after he realized that his son would have medical problems. Colostomy's are stinky, messing things to deal with in the cleanly America. Imagine having one on a baby that doesn't understand why his poop is coming out of his side. Imagine living in a tent with limited access to clean water. Imagine having no properly fitting colostomy bags (to collect the stool coming out). Imagine changing ABD pads 4-6 times a day to keep your child's skin from getting raw from leaking stomach acid. Imagine being completely dependent on two white girls who may leave the country at any time leaving you without a solution to your child's predicament. Imagine the stress of a single, jobless mother raising three boys under four in a city far from home. That's the story behind the story.
Brooke and I (but mostly Brooke) cared for this family for months. We gave them free diapers and ABD pads, cream and sometimes food. Brooke often took them groceries as they were living very close to the hopsital. We searched and searched for a surgeon coming that might be able to reverse the colostomy within the correct time frame.
In September Brooke and I were both out of the country. I was in the Dominican Republic on a break and Yves's mother brought him to the hospital. She was always very persistent and hopeful that someone might "fix" her baby...although Brooke and I assured her that we were looking and would contact her if ever a surgeon came available.
The week I was absent (and Brooke had changed jobs) a General Surgeon was at the hospital. He saw the child (without any history given) and decided that he could probably figure out how to operate on him. Colostomy reversals seem pretty basic to General Surgeons I guess...however, when your specialty is Trauma Surgery on adults you probably shouldn't touch a 2 year old's GI tract. Even in Haiti. (This is a common misconception in Haiti..."It's better to do something than nothing at all." NO. No, it's not, if you don't know what you're doing and you haven't even seen it since Residency!...but alas, that is another soap box).
Yvens was operated on, and it was thought to be a success. Another constant problem in Haiti is good follow up after surgery. This General Surgeon was there for a week, but after his departure we would have no General Surgeon coming for over a month. There would be no one to follow...other than me. An RN of 2.5 years.
I returned from the DR the day before the surgeon left. He explained his patient to me (that I knew quite well) and told me about the surgery. I was overwhelmed. I was so excited that the surgery was done and hopefully a success. But I was scared out of my mind that something would go wrong and I wouldn't have a doctor to fix it. He wasn't confident. He told me that the surgery had been difficult and he thought that the intestines would hold but he wasn't sure. He looked at me and said, "Jessica, it's either going to do fine or the intestines will tear and he will die, fast." The next morning, a Saturday I believe, the surgeon left.
Tuesday morning Yven's mother was there early. Before I even came downstairs. I ran into her in the hallway at about 6:45am and my plans for the day went out the window. She handed me a screaming baby with an open insicion in his side, red and warm, leaking stool. I almost lost it then and there. We had no doctors even qualified to assess such a case at the time. Shit. Literally. Shit everywhere. She saw how scared I was in my eyes. I didn't lie to her. This is really serious I told her. He needs surgery and he needs it now and I don't have a surgeon who can do it. I told her I'd try everything.
I was still pretty new to doing things on my own since Brooke's departure. I didn't have a lot of friends or connections in the city, though by blackberry was full of names I didn't know. I stood in the ER exam room with Yvens, his mother, and a translator and I stared at my phone. I prayed. I sent a massive text message to every medical contact in the blackberry. I didn't know any of the people.
"Does anyone know of a Pediatric Surgeon in Haiti? I need one immediately. I have a baby that will die within days."
I waited.
"Who is asking?" came the only reply.
"My name is Jessica and I'm an RN at the Adventist Hospital in Diquini."
"This is Heidi from MSF Carrefour (Doctors Without Borders not even a mile away from us). I have a Pediatric Surgeon who was assigned here but we can't really use her specialty. She is available and ready to work. She can come right away."
The next five days were a blur. The surgeon, Chandrika, my answer to prayer, came and assessed the child. Wanted to give him another 24hrs to see if the fistula would resolve on its own. When it didn't she came to our hopsital, in an unfamiliar OR with staff she'd never met and performed a difficult (because of the lesions) surgery that saved Yvens life. I stood in the OR and watched. She kept him from getting septic and dying. She was not able to repair the intestinal wall...there was too much damage... Instead she reopened the colostomy. This meant that he would need ANOTHER attempt at colostomy closure in three months, with likely no surgeon in the country to do it. But he was alive and healthy. Colostomy and all.
Since the end of December Brooke and I have been searching high and low for a Pediatric Surgeon that would come to Haiti for this one surgery. Seemed like a lofty aspiration, but we had to try. After all, our hospital almost killed this child and it was our obligation to see him through. We wrote emails to doctors and hospitals all over the country. We mentioned it when we were in the States and all to what seemed like dead ends.
On February 9th I got this gchat from Brooke:
Brooke: waiting to hear more but they (Yvens and family) are in Cange (at the PIH hospital) for the week and its looking good. Thanks for your help and will let you know...
On February 11th I got this email forwarded from Brooke:
Hi Brooke,
So Dr. Mooney and I saw Yvens and we will try to do his case either tomorrow or Friday. We sent for some lab work I will give her a call tomorrow once we get our schedule together.
I will keep you updated,
David
On February 12th this one from Brooke:
Yvens got his operation today. I have only talked with Fevil so I don't know all the details...but wow...a year later it is happening!!
And on February 13th:
Done over a year later...Yvens is home and it was all a success!!! VERY HAPPY...
1 John 5:14-15
Now this is the confidence that we have in Him, that if we ask anything according to His will, He hears us. And if we know that He hears us, whatever we ask, we know that we have the petitions that we have asked of Him.
