More magic, not the nice kind

This is Grand Gossier as you approach by sea

I wrote a long blog yesterday but it got devoured by the strange forces that inhabit my surroundings before I could send it off, so I am trying again.  I hope by now most of you have restored your lives to its more normal pace, post Sandy. I was traveling this week to pick up meds in the capital which I will be using for my last two weeks while we do some mobile clinics in the remote areas surrounding Ansapit.  We are leaving on Monday by boat down the coast towards Jacmel to Grand Gossier, where we will make headquarters in a clinic that has no meds, doctor or electricity; just one nurse who wings it by candlelight.  I am joined by clown-mime-magician Chris Yerlig, sponsored by Project Troubador, who will help me do our style of "medicine show," where we will travel by foot with a local health promoter and my trusty sidekick, Peter.  Chris, who goes on to Port au Prince next Friday for a few weeks of teaching and performing, will entertain the waiting pts and their families while I do my thing and the health promoter holds information sessions about sanitation, disease prevention, nutrition.  The area is completely cut off from health care access, so this ought to be quite an experience!

When I returned to the clinic from Santo Domingo yesterday morning I was told it was a holiday (Day of the Dead), so no one was around - they were all back in the residence cooking, washing, hanging out.  I looked in our little ER and saw this most distressed pt lying awkwardly on the stretcher, IV long ago finished and tubing disconnected, scraped up and dirty and, mezami!!!! he had ants crawling all over him!!!!  It appears the night before some people had brought him in after he fell from a tree, or the tree fell on him while he was trying to get some avocados.  Rumor had it he was stealing the avocados and the accident was another koute manga, or negative force imposed on him from a zombie that keeps watch over people's gardens.  I know it sounds outlandish, but in addition to these kind of beliefs, it was the Day of the Dead, so people, even those who work with me, did not want to touch him for their superstitious beliefs.  Compounded by the fact that this 27 yo boy was from far away and had no family to advocate for him.  My dear Dr Demo shared this mix of apathy, embarrassment and frustration as he thought he had fractured his pelvis and had him in a holding pattern until he could somehow get him across the border.  I soon realized that his legs were 

beginning to swell, and that he could not move from his chest down, no sensation, nothing.  This was a spinal cord injury for sure!!  I washed him off (dead weight) trying to keep him as immobilized as possible, and shooed off the ants and covered him with the filthy sheet and pillow that someone had provided. I got him some food and water  and sent people to look for someone who knows him to clean him, feed him, advocate for him.   I had to keep hassling  my coworkers back in the residence about what should be done, saying I could pay for someone to get him on a stretcher, over the border, into the back of a truck and to the hospital in Pedernales.  They all looked at me with the most indifferent look, as if this person had a mere stubbed toe.  Because Chris was here and we had a show back in Pedernales, I left later in the afternoon thinking that the nurse on call was going to get the wheels rolling.  I gave her $30 to cover the expenses of getting him to Pedernales, which is hardly a trauma center.

I came back this morning and he was worse, no progress made in getting care for him, still in the same postition but his abdomen was rigid as a floorboard.  I realized he hadn´t peed since the accident and catheterized him. Got lots of urine but the belly was still rock hard.  His skin was burning hot, temp 40.5, which I think is almost 105.  I decided today I would stay with him until he got moved and with a little more $$$ incentive I got 5 of us to carry him across the bridge in a stretcher and onto the back of a pickup in the blazing sun, dust and chaos of the border.  When we got to the hospital I was relieved to see the face of a doctor I already knew who gracefully got the wheels turning.  It happens that along with an acute abdomen (obstruction from lying in the same postition for so long), xrays showed fractures of T9, 11 and L1.After a couple hours I negotiated $170 for a nurse and ambulance to take him to Barahona, 3 hours away where his care will be covered, if he lives long enough to get there.  I am so disturbed and disheartened by the neglect of my coworkers¡¡¡¡ Yet I know this hardened attitude comes from years of working where there are so little resources,  plastered on a backdrop of mistrust and superstition. This painful realization of mine was softened by the compassion and cooperation of the Dominican doctors and nurses, who are often maligned as mega-haitian hater racists.

 Poor Rene´l being transported by truck with fractured vertebrae

 They had to do the xray on the floor because they wanted to keep him immobilized