house arrest.

We have been on lock-down since Friday night due to the Presidential elections. Apparently it can get pretty violent but has seemed annoyingly quiet and boring to me. Despite about ten people walking down the street singing a song about their favorite candidate and banging on an empty water jug, I haven't seen anything. But then, I guess that's the whole point of being on lockdown.

Quiet streets means a quiet hospital when no one wants to venture out. We were afraid it would mean lots of traumas, but that hasn't been the case, though they are supposed to announce the "winner" or more likely "run-off candidates" tomorrow.

For the first time in over five months I have walked around the entire perimeter of the hospital property. There are pretty banana trees in two corners, although the ground around them is piled with trash they are still pretty. Millions of lizards dance at your feet and I was completely amazed that I did not encounter a single spider.

The grounds of this place seem to be keeping so many secrets. I often wish I had been here right after the earthquake to see what it was like, though I'm not sure I could have handled it. There are spaces in the grass where tents used to be and I wonder how many patients the trees have seen pass. There is rumor of the corner where they used to dump amputated limbs...but there is no evidence of it eleven months later.

There is a garden. It so closely resembles my Grandaddy Mac's yard in Miami that I feel quite at home in it. The air feels the same and swatting mosquitoes keeps you busy. Many plants...almost all in fact...remain in their pots (just like grandaddy's) and there are old pieces of machinery begging to be disposed of scattered about. I didn't spot any boats, but the rusted old school desks and treasures hanging from vines are picture perfect.

Our roped off cholera tent keeps the fourth corner from being explored. But you can smell it. I don't believe I will ever be able to smell bleach again without thinking of cholera. It's just how it smells. Like sour bleach. Thankfully our tent still hasn't been too busy and MSF is now scheduled in their transfer pick-ups.

Tomorrow, I hope, our sentence is lifted and I will be able to go outside the gate again. Although it is kinda nice having the boy at the gate hand-deliver my coca-cola.

We are all resting up anticipating Dr Scott's arrival next week, a repaired C-arm, and a busy schedule.

Seventeen days.

"I'm really just thankful for clean water" ~Azaria

"If nothing else it's good that you were happy to return to Diquini," Ruth said about my trip to the north. And she was right. I would like to say that I have returned with a very different attitude. Maybe it's because I'm going home in just a few weeks or maybe because there is some encouragement in discovering that nowhere else is any better than here.

It's been a constant theme in my time here and though sometimes it's scary, it's nice to know that the country, as a whole, is messy. It's not just my hospital. It was good to return to the support of my friends here as well. There are so many beautiful Haitians that make each day here a delight. Sometimes they are hard to please and their expectations are impossible to fulfill, but all in all they provide consistency and support. Even the patients that I see operated on returning to clinic is rewarding. This morning I was greeted in the hallway by our patient that had his leg amputated due to elephantiasis a few weeks ago. I always worry a great deal about the amputees. In an already difficult country, losing your limp (after managing to keep it through the earthquake) is always depressing. But this man had such a giant smile on his face! He knows that his life is better and he is healthier now.

And there is Jonas. What a story of thanksgiving! He was said to be a "stable" femur fracture sent from a town a couple of hours away. I wasn't here when he rolled in but his hemoglobin in the 3's and a grossly dislocated knee and broken femur (moto wreck) made him everything but stable. He was watched for a week or so, I think as many as three doctors hoping his leg would pull through...but the stench became unbearable even to him, and after many washouts and revisions he ended up with an Above the Knee Amputation for a dead lower leg. We were afraid that wouldn't be enough though, as he looked septic with high fevers and talking out of his head on many occasions.

He went home yesterday. A man with a beautiful wife and two small children stood on the balcony with me yesterday telling me he wouldn't forget me. "I know I lost my leg but I'm glad I have my life. There was awhile when I wasn't sure I would make it out of here," he told me. I told him that we felt the same way. He had been very sick.

For his life I am thankful. For Maffie's too. She's a 18 year old trauma who we all thought would die her first night. Four weeks and about seven units of blood later (in a country where it's hard to get one) she is still on bed rest but she is alive!

Yesterday Partner in Health's MD emailed me saying that they would treat Wilny (see earlier post). The pictures of his cancer lesions are too graphic to post, but I would love to show them so you all would have some understanding of what this means. I'm trying to be patient and not rejoice too much until he is scheduled for treatment, but everything is looking good.

Thanks to the God of messy places. Thanks to all of you who pray and support me in endless ways. Thanks to my family who is steady and unwavering in their love. Thank You for the cross.

cholera.

Last Friday night I got a call from Big Paul late in the evening. We have only met one time face to face, but he and his partner Little Paul call me often trading around supplies and sick patients. They were recently featured in Men's Health magazine and have become known at Port-au-Prince's Cowboy EMT's. When these guys ask for help you know they really need it.

Paul told me that he had recently (as in two days before) returned from St Louis de Nord, a small town in Northern Haiti that was being taken over by the cholera epidemic. He said he was leaving tomorrow, possibly at 7am on a UN chopper to get a medical team up there. We need nurses, he'd said. Can you help?

Having come off of a particularly difficult week and really wanting to get out of the hospital I told him I'd try. A few hours and couple phone calls later Elinor and I were committed and leaving at 3pm the next day. I was excited to do some hands on nursing and not have to be in charge of anything for a week. Although I confess I was extremely nervous, knowing very little about cholera.

Our team of six nurses, three EMT's, two logistics people, and one fresh graduate from med school arrived in the dark to St Louis. It didn't take me long to figure out that no one had any clue what they were doing. We created our own work schedule and some of the team went straight to the clinic. I was on at 4 am.

I can hardly express the anger, frustration, desperation, and sorrow of the five days following. What an unbelivable disease. Everything you read about cholera says it's all in the fluid resusitation...but no one seemed to know how much. For five days we played a guessing game. We won a lot. But always felt like we were losing. I have never seen death come so quickly and so unexpectedly.

Old people and children were obviously the most vulnerable. Although we were all taken aback when an 18 year old boy died rather unexpectedly. Trying to get patients who weren't vomiting to drink was maybe the biggest challenge. Everyone wanted an IV but there were times when we were down to five liters of fluid and it was impossible to give everyone what they needed. A sweet old man I was caring for asked me for soup and a cola with salt in it (craving salt showing his dehydration). I managed to track down and feed him some soup for lunch, only to have him die not five hours later. I left for a bathroom break and a woman I'd more or less admitted who had been talking to me on my way out the door died while I was gone. We lost 19 people in four days/five nights. I can't decide if that's sounds like a lot or not. But when you remember every face it's hard to brush off.

I don't understand where the world is. The Red Cross, WHO, and even MSF are absent in St Louis. There are no protocols or plans. Patients come in on their linen covered in feces and after they die their family takes it back home. Little old ladies were mopping up their husbands waste without gloves on, and children were eating from bowls next to their poop buckets.

There is no education, no pamphlets, no structure. A group of five or so English speaking (educated) teens stopped Melissa in the street and told her they didn't understand. Where is it coming from? I heard one say. How did this start and how do we stop it? They were clueless to the fact that it's in their water.

I was perhaps most angered by the fact that the Northwest Christian Mission where we were staying houses a old people's home and an orphanage. Over eight of the elderly from their home were our patients. At least five of them died. No one has yet to test their water! I won't be surprised if they are all taken by cholera in the next month.

When we left today there were two new paramedics to take our place. TWO people to care for over sixty dying patients for a twelve hour shift. Where is everyone?

Are people just tired of hearing about Haiti's problems? Do they think that since they helped with that whole earthquake thing they've done their good deed for the year? Cholera is wiping out the regions the earthquake didn't touch and it seems that there is a whole lot of talk and no action.

I do not think the clinic we worked in should be functioning. It's completely unsafe and ill run. I have no doubt that it's spreading as much cholera as it's treating. But that being said, those people would be dead if it wasn't there. I don't believe the rumors that the UN started this mess, but regardless of the source they need to be doing something about it. This disease is here to stay and unless drastic measures are taken to educate and treat the Haitian people tales of the earthquake will die out as the stories of cholera flow through the streets.

on a brighter note...

One answered prayer already! David, the HIV baby that I've mentioned a couple of times before was placed in what I believe is the only HIV orphanage in the country! Thanks to our new medical director's connection. He will have all the access he needs to medical care and treatment. His mother is able to visit as she wants. Please continue to pray for somewhere for her to go as her family wants nothing to do with her.

He is the Provider.

plenty of mess without a hurricane.

I think a baby has died everyday this week in Peds. Or at least it feels that way. I haven't been able to sleep two nights because wailing mother's are being consoled outside of my window. Mother's losing babies that have nothing to do with earthquakes, cholera, or hurricanes. It's just life in Haiti.

I haven't been involved. I haven't been involved because both the other hospitals in Carrefour who we have great relationships with and who often save patients we can't closed this week. What a disaster. They were both planning on closing in December, but with the cholera and hurricane one stopped serving orthopedics and now is a cholera treatment center (for one patient that might have cholera). The other was a tent hospital that wanted to disband before the hurricane (that did not hit our area).

They will both be missed. But they were closing in December anyway...I think we are now the only hospital in Carrefour. I wasn't involved with the babies because I think we are the only hospital in Port-au-Prince doing orthopedics...maybe the only one in the country...

I have gotten a phone call everyday this week about a fractured femur transfer. We just don't have the capacity to be seen as a trauma hospital. It's really frustrating because at the end of the day, there is probably nowhere else for a femur fracture to go. We have eight trauma patients in house waiting for major surgeries. They were waiting for blood. Now they are simply waiting for manpower...for a doctor that's staying for more than eight days.

Our patients are still only getting one meal a day. I think that is perhaps the worst thing of all. We're talking about developing a new wing to the hospital and a great rehab center when the reality is if Elenor or I doesn't remember to go feed Paul (a patient here with no family) he will only get rice and beans at 1pm. He won't even get any water. That's a problem.

I believe we are in way over our heads here. We are all trying as hard as we can to make a difference and "improve healthcare in Haiti" and all that mess, but truthfully, the disaster doesn't seem much better than eleven months ago.

Tuesday night we had five trauma patients come in within an hour and a half. It scares me to think that if that had happened just six weeks ago I would have been the only ex-pat nurse here. Fortunately we had a great OR team and three full time nurses to jump into the action and get the patients straightened out. Everybody lived, and for now that seems to be the only goal.

I apologize if this post is a mess of ideas and complaints, but as the end of my time here approaches I wonder what, if anything, I have actually accomplished. A friend told me the other night that she would love to work long term in Haiti as long as she didn't have a job someplace that she felt would completely fall apart when she left. Sometimes I fear that's what we've gotten ourselves into. I pray that it's not true.

seven weeks.

I just returned from a five day break in Miami. It was a bit strange being my first time in the States since July 16th, but all in all it was wonderful. I was able to rest and spend time with my family and friends. I was also able to think about these last seven weeks approaching me. I can hardly believe it. Some days I feel like I've been here forever! Other times it seems so short.
I know that there are four things I need to accomplish in this time. They are four faces, four prayers. Four people who need help in four very different ways.

1) Wilny D'Haiti is 27, he has three children at home. He has lymphoma covering the entire back of his head. He wears a hat to keep away the stares. I'm not one to be disturbed by much, but the lesions and lumps on his head are hard for even me to look at. He is the one I was raising money for. For a long time I was told that there is no chemotherapy in Haiti. Through great connections and friends I've discovered that that isn't necessarily true so Wilny has been undergoing a series of tests so that he might be accepted for treatment. He will hopefully have his CT scan this week, which will give the doctors even clearer insight into what is needed. Please pray that he is accepted and that his treatment plan is set before I leave here.




2) Andre. Many of you know him. He's a eighteen year old boy who has been living here at the hospital since shortly after the earthquake. He needs a home. Andre comes from an abusive family and suffers from JRA so he is unable to do very much for himself. He has to eat a liquid to pureed diet and cannot get around without constant pain. He has nowhere to go. He currently sleeps on a cot in the hallway. Pray that we find somewhere to place him this month.

3) Kensia is a 15 year old girl with a heart murmur so loud you can practically hear it while standing next to her. She is in need of an aortic valve replacement due to severe aortic regurgitation and stenosis. I have managed to get two NGOs interested in her case and she could possibly have heart surgery in the Dominican or Israel depending on the assessments. She has a meeting tomorrow with CURE international who has promised to get her paperwork/passport ready. Please pray that the paperwork is processed quickly and her surgery is scheduled before December 17th.

4) Soline and David. I have mentioned them before. David is an 9 month old HIV positive baby, who is once again in a tent on the hospital grounds because he got sick at the orphanage. Soline, his mom, just turned 18. She is anxious to work but has no family support or resources. She does not have any friends. She had a really rough day today. She's alone in a country that is not kind to unwed mothers with HIV. Pray that we can find somewhere for her to live, pray that she can find work. Pray that David survives.