A night out in Milot

2/26/2010

We have seen many medical conditions that we never would have seen in the States here.  I have seen two cases of spinal tuberculosis, a sad case of a child with metastatic Ewing’s sarcoma  (a treatable condition in the US but terminal for this boy) and a child with severe, massive hydrocephalus ( again terminal here).  A Georgetown cardiologist here told me in his first day here he has seen more cases of critical rheumatic heart disease than he has seen in all his years practicing back home.  It can be explained by the severe lack of health services in this country.  Patients that need to be seen here often need to walk extreme distances over strenuous terrain and endure very long waits; and this is the premier tertiary care center in the country. “The Mayo of Milot”.   

There are other slight differences.  Before I came people advised me to bring “high test DEET” for the mosquitoes.  I had assumed they meant to bring it for walks and outside activities.  No, they meant to use it in the OR.  I was completely bombarded the other day.  It was frustrating because there were large “no fly zone” placards on the OR doors but people kept leaving them wide open.  On one occasion I saw ten flies come in.  Nonetheless, after an aggressive spraying in the ORs, it seems much better.

Kristen in our PACU

Sam, Med Student extraordinaire in charge of the PACU

This evening a medical student, “Sam” and I walked around downtown Milot.  We were a little apprehensive going out at first but Edeline, an ex-pat Haitian nurse told me  “Relax,  all you need to do is smile and say ‘Bonswa’ and people will smile and reply back.  People here are very friendly, they don’t cause problems”. 

A friend at the hospital entrance

We headed out into the darkness as there are no streetlights here.  The curbs were illuminated by the fires of the “banan” stands.  They are fried plantains with a sour/spicy sauce on top and better than any bar food I have ever had.  We carried our banans, munching heartily into the darkness and sure enough everyone we greeted with a “bonswa” replied with a huge smile.  A group of young men offered me Haitian citizenship in exchange for my US citizenship.  I told him, unfortunately,  that I didn’t have the authority to do that... People were great and quite amused that these two “blans” cared enough to venture out and get to know them on a Friday night.  

Anesthesiologists from Duke/Raleigh showing us the real way to do ultrasound guided nerve blocks

The stereotype in the US seems to be that neighborhoods of the low income and underprivileged tend to be magnets for crime, drugs and lascivious activity. Thus, our fellow volunteers thought we were crazy to walk through this area at night.  What we found was the contrary; a wonderful night-scape of a relaxed, caring people seemingly a world apart from the tragedy that tore them apart a month earlier.  I love the people here. Their smiles and laid-back nature are infectious.

The walk across the street from the OR to the tents

The UN's frequent presence around town

A local banan stand at night

Carefree on a Friday night

Milot town

First week photos and experiences.

Here are a few pics from the first week

We are all looking forward to Coq Au Vin...

the Tap-Tap, the main mode of transport in Haiti

The cases to get done today and Pierre, the hardest working man in Milot.

Our compound backyard.

OR room #2

2/25/2010

It is now my fourth day here and I think I’m starting to acclimate a bit.  I’m sleeping through the dogs fighting and roosters crowing throughout the night much better.  Our compound, however, now has a goat.  He clearly did not appreciate the dogs  and emitted some of the most horrendous noises I’ve heard come from an animal last night.  He did seem to be alright this morning though.

Things continue to be quite busy here.  Phillips Electronic donated a fluoroscopy unit for “real-time” X-rays in the OR.  As a result we are able to see  just how bad some of the patients’ fractures are.  Our days  now filled with revisions of patients’ original emergent repairs.  It has been both a satisfying and frustrating experience.  Satisfying in that we are able to give the people a better chance of functional recovery, but frustrating in that the procedures are taking 3-4 times longer than they would in the US.  As a result there just aren’t enough workable hours to take care of everyone (and remain sane).   Our hospital currently has the most advanced technology in all of Haiti even though it would not be considered remotely adequate in a Western country.  As a result we have seen an influx of Port-Au-Prince residents helicoptered in daily for treatment.

All the patients coming through, it seems, have heart-wrenching stories to tell about the earthquake.  Most have lost at least one, if not all of their family members.  The majority do continue to be, for the most part, upbeat.  Sadly, there is not much I can tell them other than “m’regret” ( “I’m sorry” in Haitian Creole) as my Kreyol is not so good.  A nurse told me of a patient who was being flown back to Port-Au-Prince who started crying.  She asked why and the patient replied she had absolutely nothing to go back to.   

I am a bit apprehensive that once the media finds more interesting stories to move onto, they will cease coverage of the plight here in Haiti.  As a result, the influx of third-party and foreign aid will diminish. This country is highly dependent on foreign aid for its survival and the support of its people.  Without this aid, the continued rehabilitation of its earthquake victims and reconstruction of its largest city may all but disappear.

It is now 10 PM and having just transported our last patient of  the day on an army stretcher, across the dirt road, in the rain, to his current home in Tent #5 where he will spend the night with 50 other patients, I’m going to pass  out on my own cot. zzzzzzzzzzzzz      

My First Day Experience Here

This is a delayed post from my 1st day here.

2/23/10

We arrived yesterday afternoon into Cap Hatien.  Our plane descended into a beautiful green landscape, quite mountainous and filled with sundry plots of farmland.   From there we were taken into town by our Haitian porter,  Delnatice, to try and find some electrical supplies for our hospital engineer.  

While “OKap” was described in travel guides as a “sleepy, little town”, I found it anything but.  People everywhere, on the move, in every direction.  On bikes, scooters and on foot people were scurrying about with an urgency I would more likely associate with  New York than  Haiti.   A volunteer explained it to me.  “They are all living for today.  Tomorrow is so uncertain that every day they do as much as they can everyday.  It has become more pronounced since the earthquake”

We visited several hardware, contracting and electrical stores, but none of them had the  basic supplies we needed.  So up the mountain to Milot.  It was a wild, bumpy ride on a dirt road, dodging potholes the size of Volkswagens.  Finally we arrived at Sacre Coeur Hospital and it was pretty amazing.  

The compound spanned over several blocks.  A volunteer compound that had previously existed  needed to be rapidly expanded to handle the sudden influx of volunteers.  Tents had been constructed and the rooms which formerly held 1-2 volunteers now held four.  Another anesthesiologist described the experience as “the most challenging camping trip I’ve ever been on”.

The hospital itself now spilled over into several military tents known as “tent city”.  The sicker, acute patients stayed in the hospital building.  The bulk of the patients however stayed in the tents.  As we were walking to visit the operating rooms, there was a band playing.  It sounded like a slow New Orleans jazz band.  My colleague commented, 

“ You know what that is, dont you?  That’s a Haitian funeral procession.  You’re gonna hear that a lot here...”

A Very Quick Post

Wednesday 2/24/10

 It has been pretty exhausting so far.  Very hot (low 90s).  The patients and some staff are staying in military style tents.  The OR is working well into the night.  There are so many cases to do.  We have done mainly fracture revisions, debridements of infected wounds, and yesterday we took care of a guy with a chemical explosion in his face.  Burned off his ear and half of his scalp and neck.

Apparently there was a story in the Wall St Journal yesterday about us.  We were taking care of a baby Doe and they found her parents in Port Au Prince!  There was a 4.5 Aftershock in Port Au Prince yesterday.  Nobody will go in buildings because they are so frightened.

There is not time to be sad because it is so busy there is no time to reflect on it all.  The people (Haitians) are so nice and appreciative.  I woke up at midnight and the roosters were already crowing?!?!   I thought they were morning birds?!?!

The Duke Anesthesia folks that are here are really great.  I am learning a ton from them.  One of them wrote the textbook on Regional Anesthesia.  I'm going to miss them when they leave Saturday.

I will write a more detailed account if time allows.

Why Haiti?

One of my main motivations for traveling to Haiti was to better understand the country and its people.  The statistics on Haiti are absolutely mind-boggling for a country in the Western Hemisphere.

     Haiti was "discovered" by Columbus in 1492.  The native Taino tribe reportedly welcomed him initially with open arms, only to be completely annihilated by the Spanish over the next 2 decades.  The western third of Hispanola was ceded to the French in 1697 at which point the country of "Haiti" was born. Haiti became the jewel in the crown of the French colonies.  It was the most lucrative of the colonies thanks to the sugar and wood industries.  Sadly, the French wealth depended upon the exploitation of slaves imported from West Africa.  The conditions were deplorable, which eventually led to a massive slave revolt under the command of Toussaint L'Overture in 1804.  The result was Haiti's independence and the formation of history's first black republic.

     Over the past two centuries the people of Haiti have endured an endless succession of coups, dictatorships and military violence against its people. Reports of political corruption have been much publicized and Haiti has been historically vilified has being one of the most corrupt countries in the world.    In 2006 Haiti finally democratically elected their own president and Parliament although their response to the recent earthquake has been much criticized by Haiti's people.

Haiti is only a few hundred miles from the United States but is truly a world apart.

• Life expectancy in Haiti is 59 years which is among the lowest in the world surpassed only by countries in Sub-Saharan Africa.
• The prevalence of HIV is 2.3% which ranks Haiti as 28th worst in the world.
• nearly 20% of children will die before their 5th birthday
• Its literacy rate is just over 50%
• Its unemployment rate is 80%
• 80% of Haiti's people live in abject poverty
• Haiti is now 97% deforested which severely has affected not only land fertility, but also has created a serious land erosion problem
• Its GDP ranks 203rd out of 228 countries worldwide

     These factors have resulted in a complete lack of infrastructure in Haiti.  Most people live without electricity or plumbing and survive by subsistence farming.  Haiti has also been unfortunate enough to be situated right in the path of 4 major hurricanes since 2006 and also lies on a major fault line.

     Despite this, the Haitian people have been described as very kind, generally happy and as possessing an "optimistic fatalism" by Haitian Creole professor Bryant Freeman.

     Their characteristic response to adversity is "Si Dye Vle!" which roughly translates as "It is God's wish".

     This rugged-stoicism in the face of centuries of severe hardships made me want to assist the Haitians all the more!

Si Dye Vle!!

pictures courtesy of traveljournals.net
facts courtesy of the CIA factbook

All set to head off for Haiti!

This weekend I will set off for the small town of Milot in the Northern mountains of Haiti to assist the organization CRUDEM with the medical support of thousands that have been affected by January's horrible earthquake.  

CRUDEM has been in Milot since 1968  and serves the 225,000 people living in the Milot region of northern Haiti. The village of Milot itself has a population of about 25,000, and an additional 200,000 people live within a 12-mile radius. The area is made up of many small hamlets and rural communities, situated on rough terrain consisting of mountains and plains. 

Sacre Coeur Hospital is one of the few hospitals in Haiti which was not damaged by the earthquake.  As a result, they have grown from a maximum capacity of 73 beds to well over 300!  There have been makeshift wards constructed in the adjacent missions and schools.  The town is literally bursting at the seams with local townsfolk opening up their homes for families of the patients.  I humbly hope there will be enough time and space to help all those in need...


( Images and data from the CRUDEM website. Be sure to visit at www.crudem.org)