Sunday, November 25, 2012

Last words for this round

I got home a week ago in time to celebrate Thanksgiving in New England with my family - sweet!  After loosing 10 pounds due to the scarcity of food and food choices, I am cramming myself full of a daunting amount of taste treats.  Yet this pleasant experience could not distract me from my recent experience - I am haunted day and night by dreams and desires to continue meaningful work in Haiti, elevating it to a more intense level as I toy with the possibility of starting a clinic in Majofre.  I stare myself in the face with the hows, whens, whats and whys of making it happen.  A giant Rubik's cube of logistical steps and potential pitfalls.  I have your encouragement and support to thank for this beautiful mess, as well as a team back in Haiti, doing their part to make it become a reality.  A group of us will continue to communicate by email in a variety of languages over the next few months, and God willing, I intend to touch back down with both the Haitians and you, my faithful followers, sometime in March.

to finish, a financial update:

2012 donations to date: $3025

2012 expenses to date: $1668
Meds and supplies: $1049
Patient assistance:  $192 (food, ambulance, tests)
Mobile clinic expenses (transport, food, stipends for assistants) $427

Therefore, I have $1357 to launch the next episode.

deye mon gen mon - beyond mountains there are mountains

Friday, November 16, 2012

Medicine Show continued

     OK, I´m back at it a week or so later, after another 4 days of clinics in the mountains and coast.  Before going any further I have to finish the story of Rene'l, the unfortunate fellow that fell from the avacado tree.  I went to the hospital in Barahona where he was sent last week and was able to locate the nurse who took care of him after he arrived from Pedernales.  He remained conscious until the end, but died at about 5 pm the next day, with her at the bedside.  She felt terribly sorry for him and thought maybe they could have saved him if someone had come with him and helped )$$$$$) transfer him to Santo Domingo.  His fever remained 105 and he had multiple internal injuries.   Eeek, I felt a little guilty hearing that.  Instead of saving his life, I was romping around with a clown.  But the obvious question is how would he have survived afterwards, paralyzed from the chest down?  As of today, no family has appeared in Ansapit to ask his whereabouts. His body is still in the morgue in Barahona.

Rene'l's nurse Ingrid in Barahona; too bad I can´t photoshop me out

     After leaving Grand Gosier last week we walked 8 km up to a place called Majofre to do a little clinic in a place where there is no health care at all for many miles.  Chris did more shows for waiting patients and I saw many people, lots of elderly who complained they couldn´t see.  My classic question is ¨Can you thread a needle¿¨ because the majority of them can not read.  I would lend them my glasses and magically they could see!!!  I have to bring a team of optometrists up here or at least a boatload of reading glasses.  I can´t imagine how lost in the world I would be without my $18 pair. I saw about 100 patients last week, and thanks to your dollars, people were provided with antibiotics, hypertension, pain meds, etc.
Chris ready to boogie in Majofre

This week I returned with Dr Demosthenes (Dr.Demo) from the clinic in Ansapit and the rest of the team, including Susan Koppenhaver, our practice manager from Hudson River Healthcare in Amenia.  I also brought along Patrick Howell, the director of an NGO in Barahona who was curious about Haiti and what I was doing.  We rambled for hours over the hills on motorcycles to return to Majofre, where we did another few days of clinics, this time seeing twice as many pts since we were 2 practitioners.

Susan, Patrick and driver ready to hit the hills

     With the help of local leaders, we have begun to hatch a plan to finish a clinic in Majofre that a Haitian American who grew up in the community has started.  He (Mr. Fritz) came back to his home town after retiring and, responding to a need for healthcare in the region, he began to build a clinic but ran out of money before it could be finished.  We stayed in his compound where he has the only electricity in town (2 hours), a bar, little general store and a bread bakery using a huge wood powered oven.  Dozens of children come over at night and watche TV, sitting on the ground of his dooryard.  We did a few days of clinics while Jean Paulin and Patrick interviewed the residents, met the local leaders and began to outline steps for finishing the clinic construction, brainstorming on how to get the Haitian Ministry of Health and an NGO to partner.  It is an ambitious plan, but if the Gods are on our side.......
View from the road to Majofre

Partially finished clinic

Dr. Demo with a cutie


Waiting room

getting stoked for some hot bread

     Haitians continue to be, at least in this part of the country, the most gentle, surprising, kind hearted people I have ever encountered.  It sounds like ridiculous hyperbole, but I have hundreds of simple examples =  we were taking off from Grand Gosier in a vessel last night resembling a hollowed out 40 foot pirate ship without mast and sails.  This boat had broken loose in Ansapit during hurricaine Sandy and floated 40 miles down the coast  to Grand Gosier, getting severely beat up in the process.  Chris and I saw it being repaired on the beach last week, they were jamming felt in the spaces between the planks that made up the side of the boat and painting the hull with tar bubbling over a little fire in the sand.   I was surprised yesterday when doing one more clinic on a cliff I heard a roar of cheering down on the beach.  They had finally launched Le Souvenir after 2 weeks of repairs!  We embarked last night to return to Ansapit on its maiden voyage.  About 10 minutes into the trip the 40 hp engine sputtered and died.  For 30 minutes the captain kept yanking the cord, sweating, groaning, huff'puffing, but not a swear word was uttered!  This grease stained sailor still kept calling his deck mates mache, ´¨ my dear¨¨ and saying his please and thanks yous even after repeated coughs, chokes, gurgles.  When we finally got going, much to my disbelief, under the stars and above the phosphorescence in the waves, all hands on deck started singing thanks to Agoueh, the god of the sea.  The chanting went on for two hours, along with the captain blowing a conch shell every time we saw some candle or lamplight on the shore.

Le Souvenir is launched

    I must mention that at the same time Haitians can be extremely annoying, ruthlessly pushing you aside on the narrow footbridge with their motorbikes loaded with cargo 6 feet wide, standing in the doorway of the consulting room listening to everything privately said between doctor and pt, despite repeated chiding. You can not eat anything in front of anyone without sharing it, or open your wallet in public without pleading eyes watching you.  It as if we are all a teaming mass of people struggling through life´s tortures and pleasures all together, no such thing as privacy, no being alone.

A few of my dream Haitian houses

secluded bungalow

for immediate occupancy

fixer upper

                                                   Fellow travelers on the road to Majofre

A 9 inch tarantula I found one night in my bedroom watching me undress!

Friday, November 9, 2012

sweet victory

November 9th, Friday

Hello friends, first of all I want to congradulate all of us for the great news of Obama´s second term.  We found out when we woke up on Wednesday at our clinic high on a cliff facing the sea, from a Jacmel radio station.  Jean Paulin and Peter taught me this little song in creole from the last election which we sing and dance to in the attached video segment:

Ann nou rele, vive Obama
Sa sel Obama kap fe la plis e le bon tan (repeat)

Obama  Obama kap fe la plis e le bon tan

We all call out, long live Obama
Only Obama can do the most in good time





loading the boat in Ansapit


We took off for our "medicine show" on a small boat loaded up to the gills with 100 pound blocks of ice to be delivered to the fishermen along the coast to pack their fish to sell in the market in Jacmel.  Our captain, "Blan" (they call him that, "white" because he is lighter skinned and gets sunburned), and his deck hands show incredible strength, their bodies rigid with muscles hauling heavy loads, including us,  on and off the boat, constantly jumping in and out of the water for deliveries.  We putt-putted along the coast with his 15 HP motor, dropping off loads at fishing villages dotted along the coast, until we finally reached Grand Gosier 7 hours later, only slightly sunburned.

loading Chris in Ansapit


Approaching Grand Gosier, our clinic was that yellow building on the right


Ta-Ta who cooked for us and our view from the center where we worked and stayed


Jean Paulin giving a little talk to waiting patients


We set up shop in a center recently built by some NGO for conferences, visitors, town matters, etc.  Although it had no electricity or running water, it did have a big tank of rainwater we could douse ourselves with and flush down the rancid potty.  I saw 70 people (nothing earth shattering to report, no new cases of kout manga) in 2 days while Chris did tricks for people waiting to be seen and some evening shows in the town square.  After 3 days I felt like I lived there, people asking after us and looking out for us.  Eating red snapper, swimming at noontime break, all this and being able to sleep in a tent under a sky jammed with stars was exquisite, even without cold beer!


Nasty breast infection we were fighting hard; double antibiotics, topicals and salt water compresses


Saturday, November 3, 2012

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