About 64 patients were seen yesterday. It was only a half day. Aimee and Mary conducted their PTSD workshops and then Barbie and Kim (actually his name is Brian - I dunno – maybe it’s a Canadian thing) shuttled the groups of 20 from the old tin church where the workshops were held to the Residence building where the clinic stations are set up. With the help of interpreters, they located old paperwork and filled out new. Then the patients lined up against the wall, seated in neat white folding chairs, waiting their turn to see the nurses, who weigh them and check vitals, then on to the docs. Following the doctor, they visited the pharmacy if necessary. I was impressed by the efficiency of the process and in the evening the team gathered to debrief and the observation was the same. They all agreed that it had been the smoothest 1st day of any of the preceding years.
The team gathered at the humid-sticky, plastic covered tables to debrief and assess how to proceed for the remaining days of clinics.
“We could do more procedures,” said Dr. Bob. “Things like dental extractions.” He has a wry sense of humor. They discuss the front end of the exam and ways to expedite the flow. The discussion ranged from the possible distribution of candy for young patients to how feeding symptoms in the PTSD workshop might be complicating assessment of other symptoms for the doctors. Apparently, the patients came to the doctors from the PTSD clinic complaining of pwoblem memwa (trouble with short term memory), pwoblem domi, (difficulty falling to sleep) fatige (exhaustion) etc. They had a litany of symptoms that could easily mean something else but proved to be confusing for the doctors because it seemed that they may have just adopted the PTSD symptoms recently discussed. The medical staff decided with the mental health team that communication at the end of the workshop should emphasize that the original complaint for the visit was brought to the doctors’ attention first but if they had identified symptoms of PTSD that they could return to the workshop after the clinic and receive more counseling and prayer.
Dr. Bob also offered up a scenario that would create stress for a hypothetical patient: she lost her husband, a child died, she is raising her sister’s three children along with her own and her house was destroyed in the quake. Her symptoms are not necessarily typical of post traumatic stress or directly attributable to the earthquake. He asks Aimee and Mary would they have the time and willingness to counsel these individuals. Naturally, the response was yes.
It seems though that there is never enough time or man power to meet the vast needs of this country. In the wake of the earthquake, despite the enormously increased North American presence, the situation i.e., Haiti’s poverty, malnutrition, hygiene, corruption etc. seems to be exacerbated. Part of the problem is a lack of communication between agencies.
For example, no one even knows what sort of medical care one can receive at the “hospital” and that is a very generous term for the building in Grand Gaove. No one here can seem to answer whether or not there is even a facility standing in the neighboring town of Petit Goave.
Today a young woman came to the clinic with a severally distended abdomen, swollen ankles, heart palpitations, weakness, she could barely walk and then only with help. Her hair was matted and infested. She had had a baby in February but the father stole the baby from her and took it to the country, leaving her in Port au Prince. How she made her way here is unclear but the poor woman was not at all well. The doctors examined her and felt that she was experiencing congestive heart failure.
They were certain that they were dealing with Postpartum Cardiomyopathy, which is very rare occurring in about 1 in 2,500 women. In Haiti, apparently it is a much higher incidence. The cause is unknown but contributing factors can be stress and malnutrition. Haiti’s flavors du jour.
Clearly, she needed further testing to be definitively diagnosed and she is ill beyond the clinic’s treatment capabilities. Suddenly there is a faltering in the seamless progression of the day. Where does she go? No one seems to know what to do with Sherlyn. No one seems to know what kind of care is provided where and who is still alive to practice? Eventually we learn that the hospital in Petit Goave is open. The Norwegian Red Cross is running it now. So Brian, the photo journalist from Canada and I jump in the truck with Sherlyn, her aunt, and our two Haitian translators to take yet another careening ride though the Haitian countryside. The looming hillsides plush with vegetation rise and fall from view, lightly held in a veil of cloud. We speed past vendors and tent cities and idle nationals waiting for something, perhaps change, in the oddest places: guardrails, gravel heaps, ditches and gutted car bodies. Suddenly we plunge into the chaos of Petit Goave and weave our way to the hospital. I am in the back seat with Sherlyn. I take her picture once and touch her arm, gesturing for her to look at the picture in playback. “Belle.” I say. She smiles weakly and looks back out the window. Every now and then, she grunts as we hit the areas of road crevassed by the earthquake. Her breathing is erratic and her hair is alive. But she is beautiful. It is heartbreaking.
Once we get to the hospital, she seems to receive quicker attention by the presence of her North American companions. I tell Brian that we have been good for something, even if we seem to be the butt of everyone’s joke. The laughter and Creole moves around us, like taunting children, in the tarped over waiting area. We have been asked, ever so politely, not to take any more pictures so we watch and wait following Sherlyn as she shuffles, escorted by her aunt, from one exam station to another. Finally, they admit her. I quickly ascertain that admittance is not what we understand it to mean in North American terms. She has secured a bed in a tent.
However, I walked though the hospital tents there and they were full of people who were so malnourished and ill that they could barely move. I thought of Sherlyn and wonder how, if at all, her situation was exacerbated by the earthquake. Postpartum Cardiomyopathy sets in one month prior to delivery to five months postpartum. The baby was delivered in Port au Prince shortly after the earthquake. Imagine the stress of those conditions.
The world has largely lost interest in Haiti but Haiti still suffers from the earthquake. The Canadian Nurse in Petit Goave was supposed to stay until December. He does not think he can do so. I could see in his eyes that it was too much here.
When I return to the clinic at Haiti ARISE, I am confronted all over again with my admiration for this Doctor and his team. Every little bit counts. Yesterday an elderly woman came to us with a head injury from when part of her house collapsed. We learn that while she lay there in her shattered home, men came in and took her things. They also kicked her and beat her, breaking several of her teeth. Still here she was, broken and beaming, sweet beyond words. She was so grateful for the little bit that was done for her here. When I came to take her picture, she hugged and kissed me. Dr. Bob will see her again early next week and remove the tooth that is so damaged that she cannot eat. She is slowly starving to death. Yet you would not know it by the smile on her face and the love she gave us.
At the end of the day we walked to the beach and rested in the soft Carribean water. Floating and laughing in cool proximity with each other, sipping sodas and drinking from coconuts. It looks like a vacation for a moment. Barbie, who has worked so hard all day, managing the patient flow from the PTSD workshop to the clinic and helping with intakes, is grinning from ear to ear. She is finding this side of Haiti quite to her liking. We all sample some conch cooked in butter and lime and purchase some items from beach vendors. Then clamber into the bus, a few of us on top, and sway homeward in the breezes cooling before the rain clouds.
beautiful
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