not swallowed in the sea
9 years ago
cholera.
Friday, November 19, 2010
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.
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...
Sunday, November 7, 2010
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.
He is the Provider.
plenty of mess without a hurricane.
Saturday, November 6, 2010
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.
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.
Tuesday, November 2, 2010
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.
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.
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