La gran aventura and finally some photos

 the cholera tent, there are 3 sections, this one is where people are under observation with IV fluid, if they have confirmed cholera which is determined by whether their diarrhea looks like rice and water, they move to the next section where they continue the IVs and begin medication )doxycycline if they are not pregnant or children) and then to a third tent where they are kept until they are six hours without diarrhea. Then they can go home with meds.  No deaths since I{ve been here.  Doctors without Borders comes every week to receive reports and do an inspection.  We follow a Red Cross protocol.  It is very clean and totally organized.  I am not working here, I am working iin the clinic next to this

the front of the clinic where I work 

This is labor and delivery.  I haven{t assisted in a birth yet, but I am waiting.....

This is the pristine Bajia de las Aguilas where we went today and can{t wait to return, as you can imagine. 

This is the vista from Hoyo de Pelepote in la reserva de Jaragua, pura naturaleza in every direction, we hiked 6 kilometers in to get there

The poor fellow I mentioned in one of my earlier blogs with Kaposi{s sarcoma, among other ailments )TB, pneumocystic pneumonia, HIV)

My kreyol tutor and translator, Peter, whose english is a few steps better than my kreyol, but he is 27 and bursts into laughter continuously.  This on the shore of Anse-a-Pitres, there is a bustling fishing trade, guys on the shore makiing nets all the time

the little kid{s wound before  I sewed it up, sorry out of focus

same little kid on his feet a few days later, limping and having trouble sitting on his bottom, but better and on his way to get an xray in the DR, the border guards finally let him through and thank God his spine wasn{t injured in the impact

mangled fingers I had to sew

mountain goats that popped onto the screen from when I was in the Pyrenees last fall and I can{t seem to get rid of them.

Wow, what a challenge to get these photos posted, I had to bother the guy in this cyber place over and over and finally a kid of about 14 figured it out for me.  I have been here for about 2 hours so I can{t post everything I wanted but at least its a start.

Just so you dont think that I am working harder than Mama Teresa in the midst a sunami, today Lydia and I took the day off and had an amazing excursion to La Reserva Jaragua, which is a national reserve in the southwestern part of the DR, something like 25,000 square kilometers of protected land that has amazing flora and fauna found no where else in the world.  It was declared a reserve in 1983it had been land used by the giant Alcoa for many years, who were mining bauxite from the land and then sending it by boat to Texas to make into alluminum.  They abandoned this business in the late 70s with the onslaught of plastics, and slowly trickled to a halt, after raping some of the land and then screwing hundreds of people who had come to Pedernales, where I am living on the Dominican side of the border.  After walkiing for an hour and ahalf in the cool shade of white pines and ferns we arrived at this spectacular view you see above.  There are petroglyphs from 2500 BC at the bottom of this ravine, but you can{t get there unless you have a guide and a few days to spare.

From there we went 45 minutes by car with our guide who is the owner of the pension where we are staying, to a lovely spot on the coast and then walked another hour to this totally untouched beach, also on land that had been owned by Alcoa and later acquired by the Dominican govt.  It is pretty well protected ecologically from exploitation and there are aabsolutely no hotels, only one little hut one hour away by foot, closer to Pedernales where you can get something to eat.  Calm gorgeous water and 5 kilometers of white sand to traverse.  Cant wait to return, wanna come!

kreyol lesson

I´ve been away from the clinic for about 36 hours because I went into Santo Domingo to meet Lydia, mybest friend from Maine and who I went to nursing school with there so many years ago.  She is a nurse practitioner at Colby college and is here to help me for a week.  She brought a nebulizer ' for people with asthma and bronchitis, and a hematocrit machine, old style one with pipettes you stop up with clay that I haven´t seen since the 70s, so we can see who is anemic.  I´m going to set her towork as a lab technition, something she was before she went to nuring school, and she will be doing rapid tests for sphyilis, maleria, HIV, glucose, urine screening.  It will really help us out because on a normal day one sees about 3 or 4 pregnant women who have never had such testing.  The lab at this clinic stopped 2 months ago when the lab tech got another job and people have to cross the border to get the basic screenings in the DR which basically means that people don´t go at all....

As of the day before yesterday my 2 surgical victims were doing remarkably well, but time will tell whether abscess or God forbid, gangrene sets in.  I´ll seethem both today, and keep you posted.  I credit everything to the will of Bondye, the big guy or gal upstairs.

That sets the theme for today´s lesson )!!!!!), the kreyol language.  As you probably know, this language came out of the slaves working for the French field bosses who may not have been too cultured and didn´t speak the best french, anyway, the slaves modified its structure a lot.  Now only about 15% of the population speak french, and everyone speaks Kreyol.  By the way, there are three other types of Creole, one from Louisiana and Guyana, one from the Lesser Antilles, and one from the Mascarene Archipelñago in the Indian Ocean.  I am gtetting all this info from the lesson  book and lexicon that I have acquired from Indiana University where there is a department of Creole languages.  It´s a great method and the Haitians get a big kick out of the dialogues and stories in the text because its all about the funny little quirks and expressions of every day rural life.  I thought in this blog I could give you a few samples every day of my favorite expressions.  When you read it written, it cracks me up because it looks like someone is talking with their mouth full of mashed potatoes, but doen´t sound that when when it is pronounced.  For example, Jesus Christ died on the cross is ¨Jezikri mouri sou lakwa´¨  Kreyol was originally written in french style, then adapted in the 40s by some anglophones to match better phonetically, then in 1975 some Hiatians modified it further but it was not recognized by the gov´t until 1975.  Duvalier never spoke to his people in kreyol, only french, even though 85% couldn´t understand what he was saying.  Orthography wasn´t taught in school and the director of my program here, who grew up in Port a Prince studied kreyol orth. at Aristide´s house every week for his teenage years, when Aristide was the ¨little priest,¨before he became president.

So a few words I want to leave you with=  FREKAN )freakin´!)  means arrogant. 
BOURIK  is the word for a donkey, but it also what you use to mean impolite
YING YANG  means a feud
a few important medical terms
KOKO, vagina
Aparey ' penis )apparatus= also known as ti gigit, ti pijon
Fe Bagay ' literally ¨to do that thing¨´  do I need to explain???

more later, hopefully with photos  xxLouise

TEsting my utter limits

Thanks for alll of you for tolerating all the stupid mishaps of getting to this page, its kind of like how things are for me here, nothing is simple!!  First off, I want tothank the generous congregation of St John´s Episcopal in Salisbury for the fantastic donation for supplies here.  Last night, our director Dr Alex, left on an open boat from Anse a Pitres to Jacmel, about a 6 hour journey where he will buy some needed stuff like a baby scale that broke and some rapid HIV and urine pregnancy tests with $200 of the money they gave me.

I´m still trying to conquer the challenges of posting pictures on this blog.  I think you would like the pictures of the colorful boats, fishing nets, clinic sites, and of course the characters I will be talking about.

 I had the most clinically challenging day of my life yesterday.  After a sleepy weekend, withjust a few pts dripping in with common complaints, yesterday morning I was called into the little ER to see this 8 year old kid who had been hit by a motorcycle.  He had a serious deep laceration in his back, just above his buttocks and Alexandre tried to get the border guards let him into the DR to go to the ER inPedernales, but because of the cholera or because someone was a pendejo, they wouldn´t let him in. So I tried my best, cleaned the wound which was about 2 inches deep and 3 iniches wide and spent 2 hours sewing him up.  The kid was really brave, the anesthesia seemedto make it tolerable and now I have to just pray he won´t get an abscess, we will see him every day until we´re sure hes´OK.  That was stressful enough, trying to stumble through kreyol and find all the suture stuff and maintain some semblance of sterility in stifling heat, but then Alex tells me ÿou hve another accident waiting for you¨´  The doctors here, by the way, seem very dedicated and knowledgeable but do not do any surgery...anyway the cholera tent is now full so they and the nurses have been working around the clock, and everyone is exhausted.

Anyway, the next guy had gotten his hand caught inside a car motor and had done a good job of mangling his middle and ring finger, the index was swollen and painful, crushed but not broken. One finger was similar to wounds I have fixed in the past, but the second one was somewhat dangling atthe very tip.  Again the border guards wouldn´ñt let him through, so I did a feeble attempt to sew up what I could, after cleaning the wound and bandaging him up, giving him IV and antibiotics.  I did some heavy praying to all the lwa, La Altagracia, La Virgin de Guatalupe last night and today if he is worse I will sell my soul to get him some proper care.

Then, as I was shutting the door of my consultorio, looking forward to the walk home inthe fading sun and dying for a beer and a cigarette, with Alex hurrying to catch the boat to Jacmel and the other DR, LaMartine, exhausted and asleep in his room, in stumbles this phantom of a person, skinny, coughing blood, bleeding from the nose and lips, covered with kaposi´s sarcoma!!!  I came crying to Alex who was getting dressed )the doctors and a nurse live out behind the clinic compound) to come help me with this person.  It turns out he knows him, he had been in an HIV program at one time but stopped coming or something.  I guess he had just gotten really sick witha fever the night before, so his family, quite nonchalantly, brought him here.  No one protecting themselves from his cough or bloody belongings....Alex too was pretty relaxed about it, but he did wear a mask, as did I and Istarted and IV )something I haven´t done since my nursing days in Maine) and gave him some antibiotics for the kind of pneumonia that people with HIV have. 

So as you can see, it was not a boring day.  Thanks for listening.  Since I am reading ¨Cutting for Stone¨ an amazing book about surgery and practicing medicine in Ethiopia in the 40s,50s,everything seems particularly megadramatic, you know how it does whenñ you are living inside a book, but now I have two fantasy lives, and one is real!

testing the techno

This is my first attempt to write a blog and for you who may be interested, I am writing from Pedernales, the most southwestern town in the DR, 2 miles from the Haitian town Anse a Pitres where I am working at a community health center.  I arrived about 5 days ago to this dusty border town that is actually quite friendly and mellow even though I got sucked into the whirlwind of their annual ¨Patronales¨which was also combined with a celebration of Altagracia, the blessed virgin ofthe Domincan Republic.  However I saw NINGUN cross or image of the virgin here, just a lot of super fria Presidente beer, merenge, slasa and bachata blasting from Marshall stacks and lots of ladies in skin tight spandex!  I regret to say I couldn´t stay awake beyond 11 pm to see some of the great live acts they brought to this little town, artists who I have admired for years, but you have to stay up for hours and tolerate a lot of sensory torture before you are awarded with the ultimate prize.  So far I whimped.

In order toget tothe clinic you either jump on a motorcycle and tear down the 2 mile road at 75 mph for about 75 cents, or you walk to the border where there are some officious, and sometimes inebriated dominican border officials who may or may not let you in.  The first day I came with a duffle full of meds and only a copy of my passport but the official gave me a hard time, despite my having a letter from the organization I am volunteering for.  All the other times I have crossed into Haiti I have never had to show anything, I guess my gringa face has been enough proof of identity up til now.  Anyway, this guy was offensive and even though, Alexandre, the Haitian doctor I work with, was exceedingly polite to him, I complained that he was going to make me go back to ¨´ël maldito hotel,´ to get my passport and at that point he gave me a look that Irealized was not too pretty.   Kind of like, ´¨Icould make your day really suck, lady.¨¨ So I backed off and said I would go get my documents and moreover, I would love to do an EKG for him and any of his companeros´.  So now we are good buddies and I am treating several of the border police for high blood pressure, bronchitis, etc.  I slide through the gate like a phantom.  To get to the Haitian side there is a skinny little bridge over a amazingly clean river where a handful of women are washing clothes, someone else is washing their truck, some kid bathing naked.  Across the bridge, although only 3 feet wide are motorcycles, wheelbarrels full of bags of rice or flour, etc,  you have to watch your limbs so you don´t loose anything. 

The clinic is only 100 yards from the border, in a compound which is shared by the UN peacekeepers, this particular team is from Peru.  The clinic has been there for a long time but was neglected until Batey Relief Alliance, tagged with the unfortunate acronym BRA, signed a contractwith the Haitian Ministry of Health to begin acollaboration about one year ago.  There are two doctors, two nurses, a pharmacist person, an outreach worker who also vaccinates children in the town and its outlying areas, and probably several other workers that I haven´t met.  I am the only foreigner and I think the first one to have volunteered inthe clinic.  The clinic is a square with a nice open courtyard in the center.  I will try to send pictures but this computer is not cooperating at this moment.  There  is a little ER, a pharmacy, 3consultation rooms, a lab, a room for ´¨acouchement¨or labor and delivery, medical records, etx.  I like it alot more than my office in Amenia, even though by mid day you are sweating like a racehorse and the fan in my consultation room squeaks and groans and acts like its going to come off its mount and decapitate me!  Outside and with a separate improvised entrance are the temporary cholera quarters, as of yesterday there were about 12 people admitted, all with Lactated Ringers IVs and lying on camp type beds with a hole inthe middle for their buttocks, with a bucket underneath them so they can relieve themselves ad lib.  Conditions are very clean and organized, other clinic employees and family take complete care of those who are admitted, andpeople are allowed to leave if they have no diarrhea in 6 hours.  No deaths since I have been here.

I am working with the most adorable, intelligent and fun doctor, Alezandre Widner, who is from
Anse a Pitres but was educated in Cuba.  He speaks good english and likes to sharpen up his skills with me.  We speak a mish mash of english, spanish , french and kreyol when we are trying to get a difficult point across.  My kreyol is coming along, in spits and spurts, thanks to some knowledge of french and all the studying over the past 6 months.  I am also working with a translator who likes to call himself Peter, who is helping me say things correctly to my pts in kreyol, the problem is he doesn´t really speak much english and I sometimes catch him improvising what I am trying to say to someone.  Again the melange of english, kreyol, french and spanish.  But we are both learning and enjoying it with plenty of laughs.  I pay him by buying him lunch, he´s pretty damn skinny......and soon I will begin to give him a few $$ a day.