a warm shower.

I'm spending the weekend at the hotel nearby. It's my first time away from the hospital for more than 7-8 hours. The first night away in six weeks. The water in the shower was warm tonight, which was amazing. It's very refreshing to take cold showers when it's consistently 97 degrees with no AC, but honestly being covered in goosebumps the whole time makes the cleaning process go much faster. The warm water was an excellent break...and a shower curtain too! Oh the things I miss =)

I've once again decided that I need to be taking formal Creole lessons. I'm slowly getting better at understanding it. But speaking is still difficult and it's so much easier to just use a translator. Maybe Amy and I can set up some scheduled formal lessons. I think it's the only thing that will really work for me.

A brief update on the patient I mentioned before. He made it through his surgery...which was actaully miraculous, because the next morning he looked terrible. His oxygen sat was 81% and only 93% on four liters of oxygen. He also had a distended, tender belly for the first time. I knew his only chance was getting him out of our hospital back to a General Surgeon. Brooke and I decided from his chest xray that he had a pneumothorax (collapsed lung). His chest also looked uneven and it would explain the 02 sat. We didn't have a surgeon that could place a chest tube...and two surgeons and an IM doctor disagreed with our diagnosis anyway.

I called the German Red Cross explaining the situation and basically informing them that they would be taking the patient back. He had his ortho surgeries and we really needed a General Surgeon to evaluate the mess he was quickly becoming. They agreed to take him although their anesthesia was away for the day. The transfer was uneventful and the next day I called a very upset Medical Director to ask what had happened.

"That patient caused a meeting of my entire medical staff to assess what happened" he said. "We put a chest tube in him and it immediately dumped 800cc'c of blood (amazing what and ICU and ER nurse can diagnose together). He had a massive hemopnuemothorax." Things went downhill from there. He needed to be taken to the OR immediately due to his internal bleeding but the lack of anesthisia made that impossible. They had tried to transfer him again without success and he had passed sometime shortly after that. Even if surgery had been an option, in a country without a CT scan and xrays diagnosing internal bleeding...the future is bleak for anyone.

The GRC felt responsible, for clearing him (before they sent him to us the first time). There was no way for them to know that he'd been slowly bleeding to death inside, and probably the same result would have occurred if they had known. But nonetheless they decided to revamp their system. "Sometimes these things just happen." He'd kept assuring himself.

On a brighter note I have a baby kitten. I heard her crying outside my balcony and fed her a couple days before one of the gardeners walked in with a sack holding something. I looked inside and it was my kitten! She's pretty wild and wouldn't let me hold her for a couple days but she's doing well now. I treated her with people medicine for parasites (thanks google) which cleared up her bloated belly in a couple days and she actually looks very healthy now! She still hisses when you approach her but gets over it when you start to pet her. She misses her mommy I guess.

Junior (I've mentioned him, he's the orphan that lives with us) named her Maiyla...I need to ask him how to spell it...but it sounds beautiful in his Haitian voice.

She'll hopefully be moving into the house with us in a few weeks (Amy said is was okay Nathan =) Maybe it's being optimistic but it looks like things are actually moving forward on us MOVING OUT of the hospital.

My little brother David left yesterday. I already miss him dearly! Makes me wish I'd spent even more time with him while I could have. He's a stud, loves Jesus and people so well and is wise beyond his years! Can't wait to visit him someday in CA. Please have a hot brownie and icecream for me. That's what I want right now.

This last week was crazy productive with Dr Scott at the steering wheel. Anxious to see what it will be like after he leaves Tuesday, but I think he's cleared up a lot of chaos and questions I've had. Sometimes I think there is no way I can do this for 6 months. Other times I can't think of doing anything else. The emails and prayers are always welcomed. Thanks for reading.

family.

Everyone pictured has been here or will be here for at least four months. Thus we consider ourselves the long term volunteers.
Luke, David, Jessica, Nathan, Amy, Brooke, Dr Scott.

this is for mom.

My room got a significant upgrade two days ago. Still no AC but I finally managed to steal a dresser and real mattress. It's funny, I slept better on my cot.

BEFORE:






AFTER:

this is for Shelby and nurses in general.

So Sunday evening, amidst the chaos of having a brilliant new team here trying to get organized and do operations on what is supposed to be the slow day, the German Red Cross decided to transfer me a orthopedic trauma patient.

This might have been due to the fact that not 24 hours earlier Brooke and I drove to the German Red Cross’s hospital to get their correct info as they are a General Surgeon resource and it’s nice to see where you are shipping people off to.

We had good conversation with them and told them we’d be happy to take orthopedic transfers. We gave them our contact info.

So Sunday evening, one of the Radiology techs who thinks he runs the hospital walked up to me waiving papers in my already overwhelmed face telling me in Crenglish that there was an ambulance out front.

I read a few words of the report before handing the French words (or maybe they were German…) to a translator and going to see the patient.

He was in his 50’s. He had an open femur fracture. Closed tibia fracture and humorous fracture (these were determined later as the GRC hadn’t done xrays). He was bleeding from the goose egg on his head. He reeked of alcohol. He had been hit by a car. The Germans clearly didn’t want to deal with him.

The patient was taken to the ER where I went and found the one short-term volunteer ER nurse because I was in the middle of about five other jobs at the time and I at least needed a BP on this patient.

The BP was 60/?. The hemoglobin was 6.0 (definitely a surgery candidate with no blood in this country).

I wish I knew how to cuss in German.

We dumped fluid in him. Got his blood pressure up. We drew his labs and sent his wife with the blood samples and script for blood to the Red Cross at General Hospital (this is the system…the family goes, sits in line for hours or days, donates, and maybe gets blood for their loved one). I spoke to the Haitian nurse telling her the situation and asking her to watch over him closely. We weren’t sure he would make it.

He lived through Sunday night.

The next morning I learned that the patient hadn’t gotten pain medicine all night and his blood pressure had been taken maybe one time.

I transferred him to Pre-op where I knew he’d be watched more diligently.

He lived through Monday (hemoglobin 4.8) with a promise of blood at 4pm.

He lived until Tuesday with a promise of blood at 8am.

At about 2pm the family member came back and told me the Red Cross said there was no blood.

We called our other contacts with no results.

I walked past Meghan in the hall. A girl from a clinic way out who’d brought some patients in for Ortho clinic. “Do you have any blood contacts I should know about?”

“Well you can always call Big Paul.”

I’ve heard a lot about Big Paul but hadn’t met him. Apparently he’s some crazy American, been here since 10 days after with no medical background but simply “gets shit done.”

He provided us with the hundreds of cases of Pedialite last week.

I called him. He doesn’t know me from Adam. But told me to give him the patient name and he’d take care of it.

He texted me about 30 minutes later and said to be at General at 7pm. I would have two units.

I walked into General at 6:50pm. Brooke dropped me to go by the TB clinic. I walked past about 20 people waiting in line with their coolers.

Holy crap, I forgot the cooler.

I spoke about 5 words of Creole. He spoke about 5 words of English.

I gave the blood tech the patient’s name. I think she said it was almost ready.

I waited.

I lied and said the cooler was in the car. He believed me. Brooke came in without the cooler. She lied and said the cooler was in the car. He told us to go get it. We lied and said the driver was coming.

He knew we were lying. Brooke left to go see if Big Paul had a cooler.

I waited some more. I noticed a girl with a goiter about twice the size of her neck waiting in line I’m sure for blood that would enable her to have surgery.
I suddenly felt sick that my blood was going to a drunkard who walked in front of a car.

I am white. I had connections. I had walked to the front of the line.

I waited some more. The lab tech brought me a cooler. (Guess I should have told him I forgot it to begin with).

Big Paul walked in with no cooler. It didn’t matter. I had the blood.

I walked past the girl with the goiter and the other patients waiting for hours…or days.

We only got one unit of blood. That’s okay. I hope the girl with the goiter gets the other one.

I gave the blood to our patient’s nurse back at Adventiste. She hadn’t hung it when I came back 30 minutes later. I asked her why and she said the patient had a temperature and she couldn’t hang it when the patient has a temperature. I didn’t understand. I told her the blood would expire in four hours and it had to be hung now. I explained the importance of watching the temperature baseline to make sure he isn’t having a reaction, and that didn’t matter that he had a temperature. She wouldn’t do it. I asked Brooke what to do. She said….yeah, it’s that cultural hot body, cold blood thing. Trying to respect her education Brooke and I explained that the patient was going to die without the blood and that the risk of hanging it while he had a temperature outweighed the fact that not hanging it meant certain death. She wouldn’t do it. Brooke and I asked if we could hang it ourselves. Then decided to compromise.

We gave Tylenol immediately and left for half an hour. We would now have about 2.5 hours until the blood expired.

30 minutes later the plan had worked. Brooke said he was afebrile and the nurse was hanging the blood.

He’s getting it now. Dr. Scott says if his hemoglobin is above six he’ll take him to the OR.

Maybe he’ll go in the morning.

For now we’re just waiting.

healing.

Quito is a patient whose dressing I changed everyday I was here short term in May. It was probably the most extensive one I did. He came into clinic on Monday with a completely healed leg. He had his external fixator removed. Dr Scott said that he was one of those patient's they went back and forth about amputating. So glad they didn't.

First pictures are from May. The other's from Monday. I missed the picture without the exfix. But known that it was incredible.

transport.

Today I rode on a moto. I discovered it’s much like a magic carpet. If you keep your hands and arms inside and your eyes closed you’ll come out alright. There aren’t really taxis in Haiti. There are the infamous taptap’s which look exactly like and function the same way as dala-dala’s in Tanzania. They are brightly colored pickup trucks and vans with open backs. People pile in and hang on for dear life. You bang on the rusty metal top to let the driver know that you want out. I’m sure I’ll ride in one eventually. But today we opted for the moto. My good friend Frantz’s mother runs an orphanage about two miles from the hospital. We had a surplus of diapers and Pedialite delivered this week so Frantz and I went to deliver some.

A moto is basically what Georgians would call a dirt bike. Some are actual motorcycles. But the drivers roam the streets and you simply yell out “moto” to get one to stop. You climb aboard after haggling over the price and distance of your destination.

Brooke has been taking them across the city for a few months and has gotten comfortable with it. I wouldn’t do it by myself quite yet.

I ended up sandwiched between Frantz and the moto driver and decided that as long at my knees were tucked in as close as possible I would survive. I wasn’t really scared, but quite convinced that we were going to take out a few children and even a goat. We never did though. The motos swerve between cars fearlessly and even take uneven terrain with ease. I was pretty surprised.

I am slowly adapting to the Haitian way of life. Having the power out for over eight hours today made me realize that even with little resources we take many blessings for granted.

Andre, who has had a fractured arm for seven months finally had his surgery today. He has come to clinic at least every week that I have been here, sometimes twice a week and between physician preference and just time he was put off until today. I can’t wait to talk to him tomorrow and see how he feels. He is such a sweet man.

This week has been pretty slow for me as I haven’t felt well and have actually managed to take a nap almost everyday. It’s hard for me to not feel like I should be working every hour, but I’m starting too relax.

Some major bridges have been built between the ex-pat staff and the Haitians. The nurses and two of the Haitian MD’s round with us every morning now. It takes a lot of time, but is so beneficial to build those relationships.

We have to empower the Haitians to take charge of their hospital. Especially the nurses in caring for their patients. They don’t take ownership the way American nurses do (or ICU ones at least). It’s a shame. But education and just offering to help them has made so much difference. Baby steps…but all in the right direction.

Guest Blogger!

My voice has been gone for two days now...my typical cold symptoms...so my dear friend David has agreed to post for me. Well actually it was his idea...but here lies my first guest blogger:

BLOG JACKED!!!!! Hello friends and family of Jessica. My name is David Harris and I'm taking over "Therapeutic Connection" tonight! I've been at the hospital doing supply and "logistics" since April and I'm only here through next week! It's bittersweet. You can read my blog at davidinhaiti.blogspot.com.

It's crazy how things often change quickly. If you happened to be on www.nhc.noaa.gov (the hurricane watch site) at around 3pm local time, 1pm west coast and 4 pm east coast, you would have seen a pretty big storm move over Hispaniola. Seemingly out of nowhere, strong winds blew, heavy rain poured down, lightning flashed, thunder crashed, the whole nine yards. People all around ran for shelter as water leaked into patient rooms and there were mini-floods in the hallways. But within twenty minutes the worst had passed, the water dried up, and now the skies are clear.

(Jessica's gonna hate me for this...) It's kinda like how at the end of this month, the long term ex-pat volunteer population here will suddenly drop to three. Brooke and I will be leaving within days of each other. Luke took off last week. Although former "long termer" Dr. Scott Nelson and future "long termers" Terry and Jeannie Dietirch will be around next week, they'll also be gone by September. Next month, will definitely be a transition period at our hospital. New faces will be filling vacated positions, responsibilities will be shifted, there's still a lot of uncertainty, and plenty of potential for chaos. But God is working here, the "storm" will pass, and His work will continue. Please continue to pray for everyone involved down here.

one month.

Well if you ask David he says that it hasn't been a month yet. Since I arrived on the 16th of July. But I've been here for four weeks and I consider that a month.

It's been absolutely insane. But I have no doubt that this is where I am supposed to be. This month has been hard but I have no doubt that it was the easiest of the six. When August ends there will only be three Americans here full time. That makes me kinda nervous. But God has called everyone else to amazing things. Brooke and Luke have both taken jobs in Haiti with different organizations, and David is returning to beautiful CA to finish school.


Last night I sat on the hospital roof with mountains to my right and back, the ocean in front of me and the sunset to my left. It was the first time I think I've had silence in a month. I was able to think clearly and sing and pray. I was able to feel like God was surrounding me.

Everyday is difficult and often disheartening. But I'm learning how to deal and work around obstacles that make our jobs difficult. I'm seeing that God has a small group of us bridging this gap for the hospital...between long term physicians that are really going to turn this place around. We often feel like we're completely strung out and unable to see much good come from our efforts, but I have no doubt that God is smiling and going to reward our work.

I've met some incredibly faithful men and women, Haitians and Americans, Canadians and Brits all here serving, sweating and hoping that this country is going to turn around.






Haitian people are beautiful and frustrating. Persistent and committed. Eager and often selfless. More than anything they are patient. I've had patients wait on cots with one meal a day for five days to have their bones fixed. They rarely ever complain. I freak out when my patient has been told not to eat (for three days in a row) and never made it to the OR. But they usually just say okay, I've been waiting for seven months...what another few days? It amazes me.

I'm not patient. The Haitian people are trying to help me be. I'm a slow learner but they are very committed.

I realized yesterday that I've been here awhile and still speak little if any Creole...it's because I don't make or have time to study. But I really believe I need to make it a priority. How do you show love to people you can't communicate with? It's very difficult.

Pray for that. Pray for wisdom in friendships and strength to get everything done. Pray for patience and peace. I don't miss home yet. I am often tired and frustrated but rarely unhappy. God's grace is enough and He is the sustainer.

Me and Jeanty the great!




This used to be an orphanage, well i guess it still is...tents full of orphans at least.

hope for haiti.

Monday was my worst day in Haiti. The only one I’ve really hated actually. I don’t know if it’s the chaos of orienting new people every Monday or the fact that everyone gets sick or injured on Mondays. And Brooke left me for several hours (it’s okay I still love you).

Somehow the day managed to end. This week has been a very different feel as the Ortho surgeon is a Pediatric specialist, and with few Peds surgical cases we are only doing about one case a day.

Kevelyn was transferred back to us (we transferred her to Miami’s hospital for a general surgeon and they sent her back…also contributing to my Monday). She was in a car accident last week with bilateral femur fractures. We discovered yesterday she also has an ankle fracture. That’s what happens when we try to conserve xrays I guess.

Pray for her. She has a long road ahead of her. She’s already fighting infection as Miami did not give her any antibiotics for three days, and she still really could use a transfusion. But there is no blood in Port-au-Prince. (Although I saw one private pay patient being infused yesterday….amazing how that happens).

Everyone seems to be counting down the days for Dr Scott to return for his brief stay. I think we’re all hoping his medical knowledge and male leadership will help to organize things again.

I finally got a list of all the labs we are capable of doing. Now if I could just memorize the medications we have….which is impossible because they change with each incoming team.

Some things will never get easier, but many are.

I had to put my foot down for the first time yesterday regarding a patient’s discharge. There were about six ex-pats arguing whether or not he should depart. I think some of them are still mad at me. But someone’s got to make decisions.

Jeanty, a Haitian translator/OR tech/transporter/caregiver/amazing person keeps a running list of patients without family members. The number keeps growing. If you are in the hospital in Haiti without family no one feeds you, bathes you, or helps you get to the bathroom. It’s an ongoing struggle. The hospital provides one meal a day. But you’re SOL without family for the others. Many of us chip in so that Jeanty can buy them food, but this is something we’ve got to figure out.

We have a sickle cell patient in the ER right now with a hemoglobin of 2.7 and no way of getting any blood. I asked Brooke what they did back in February…it’s not like the “no blood” situation has gotten worse over time. She simply said that the patient’s died. “You do everything you can and then you pray,” Dr Gray said today. That’s the way of life here.

I struggle with whether I’m supposed to accept it or not. It’s not okay that the #1 hospital in the country doing orthopedic surgeries has no access to blood... especially when billions of dollars were donated to the Red Cross. But what can you do? You can’t stay angry because you wouldn’t get anything done.

So you just keep working and hoping. Hoping that the “hope for Haiti” everyone talked about is still out there somewhere.