Very tired feet and a good chuckle

Wow! Friday is crazy in the ortho clinic. We worked non-stop removing casts, cleaning wounds, suturing, replacing casts etc. I started the day by rounding (seeing all the patients) in the tent with the Ortho team and Sister Judy who translated. That was fortuitous as a group of physical therapists from the Comfort came over to help for a few hours and I knew who they needed to see and what needed to be done. We had given out a wheel chair to a pregnant woman who lost a leg and had weakness in the hand so she could not use crutches. The others were needed to learn to use their walkers after pelvic and leg fractures. One diabetic lady was going to follow up with her endocrinologist but he was killed and her house was gone. Many of the chronically ill lost not just their homes and families but also their medications and their doctors. Sending them home is a bit tricky when there is no home. Fortunataely many NGO's have descended and are busy with that task.
We had a group of nuns in the clinic as one of the sisters needed her leg cast replaced today. I was helping with that when the nun who was translating asked me which order I belonged to. She was surprised that I was not a nun. No one who knows me would have thought that.
Our last cast replacement was on a lady somewhere between 50 and 80. Hard to tell here as it is such a hard life they age early and often have no idea when they were born. Derrick put a cast on her and the last wrap had dinosaurs on it. Very colorful! She smiled broadly but with few teeth.
In the meantime the 2 orthopedists did surgery all day long. They are still going...

Little boys

Paul will tell you that I have a thing for little boys. At work I see lots of baby boys with urinary malformations (anatomy makes this more common in boys) and since I see them often and sometimes for a great many years, I become attached to them I love my girls but there is something about those boys.
Yesterday morning a boy named Jimmy, who is about 11, came to orthopedic clinic for a dressing change. He had lost his right lower leg and when the dressing came off, it was not pretty. I worked with Warren, a volunteer surgeon from Tyler Texas, who removed the stitches all around the stump and then removed some of the dead tissue. It was painful for the stitch removal but it was just so scary for this boy. Warren worked gently and we cleaned it up and dressed it, putting a cream on it that is usually used in burns. Tears came down Jimmy's face and there were a few grimaces but he was so brave. After he had a new dressing he smiled and said "Merci" Although I was afraid to ask, I did and was relieved to hear his family is alive and intact. We will see him again on Monday.
I got restless during a quiet period in the clinic so I went upstairs to the wards to look for lonely children. There was a volunteer in one room who directed me to Morris (8Mos?) who rarely has visitors. He was sitting in a high chair so I went to play with him. That was unsatisfactory so I picked him up and he snuggled right in. We walked the upper deck. For clarification, the hospital is built in a large rectangle, 2 connecting squares which encircle courtyards of grass, trees, plants and religious statues. He was enthralled by the helicopters which circle fly in and out frequently. So we walked, and snuggled and laughed. Morris has a mediocre cleft lip repair and heaven only knows what else. But he is awfully cute with that lopsided grin. Unfortunately I had to return to the clinic so Morris had to be put back in his lonely crib.And of course he cried and I felt terrible. So is it better to snuggle a while and break a heart or to just let them be lonely?

Tents

Everywhere you look there are tents. On the grounds of the hospital their are large tents, personal size tents, huge tents, government tents, US Aid tents. I waked the grounds yesterday after working and it is amazing. All of the adult patients are in tents- long tents that are hot, lined with cots and no privacy. The children are in the hospital proper and there are about 120 of them- that is the capacity. You see them in the cribs all skinny with reddish hair which is a sign of malnutrition. This is not just from the events- it is long standing. I took donated baby clothes to the maternity ward. Those babies are so tiny. Yesterday I held one who was 2 days old and he weighed less than 4 lbs I am sure. Mom was taking him home but in the states we would have beefed him up a bit.  My travel partner was very busy. Pat is a pediatric endocrinologist who specializes in international adoption and has been on many third world trips working with kids with malnutrition and parasites. But yesterday he spent countless hours with an adult diabetic they could not get under control. The tent she is in is crowded and noisy and since she is very ill (in a diabetic coma) there are lots of staff near her. She recovered enough to pull out both IV's so that is progress of sorts.
I realized that I had turned a corner yesterday when I unwrapped a stump of a boy about 6 years old and thought "wow that looks great" It was beautifully healed and no longer need a dressing but I never thought that I would think a stump is beautiful. Fortunately he now goes to St Germaine behind the hospital for rehabilitation and prosthetic fitting. Amputations have become so common that a young man whose knee was severely injured by trampling crowds after the earthquake started crying when he heard he needed surgery. He just assumed he would lose his leg. But fortunately he can be repaired.

A solemn start

It is Ash Wednesday so I went to the chapel service at 7am. NPH is a Catholic organization and the head of this hospital is Father Rick, a Priest who went to medical school. He has a true calling. He opened the service by announcing that the team that goes out to look for bodies every night had brought back 5 last evening. Two were identified as nuns and one of them was the sister of the Archbishop of Cap Haitian. The other 3 were a nurse and her 2 children. All were buried beneath the palm trees next to the chapel on the grounds of the hospital. The archbishop was to come today to say prayers for his sister. Father Rick then led the Mass which was sung in Creole, read in English, Homily in English and Liturgy in Creole. Since these were familiar words it is not exactly like speaking in tongues where no matter the language we understand each other. But perhaps it is as close as I will get. From the Mass he segued into a service for the dead. It was seamless and moving.
At 8 we went to the morning meeting where Dr/Father Rick presided. Most of the discussion centered around how to do continuing care for the orthopedic patients as the number of Orthopedists is dwindling. Part of the tension revolves around how do we keep this a pediatric facility and still care for everyone. These patients will need continuing care for months so plans must be made.

Back to orthopedic clinic for me which is a happening place. I took out sutures, changed dressings and assisted where ever I could. At the end of the day we had an anesthetist who sedated several children to remove the pins from their now healed fractures. The tools would make you handy men green with envy. The last one for me was a child with a fracture that was not set well. He was sedated and then the MD attempted to correct the alignment. One of many reasons I do not do orthopedics.
So my feet are a bit tired. It is hot, but there is food, water and internet so all is well. At least for me.

Free time

Tonight we are out on the porch of the guest house just chatting and enjoying the evening breezes. Work has been completed for the out patient staff and we are waiting for the Italians to cook dinner. There are about 100 of them in a tent city although not the tent city you see on TV- these are nice tents. There are US folks, Germans, Canadians, Slovakian and Bangladeshi. That last one surprised me. People have come from all over to help in the wake of the tragedy and while I am seeing "medical" folks, there are carpenters and engineers and all kinds of other "just want to help" people. Very impressive.
This area of Haiti shows little damage even though it is so close to the epicenter. Some time this weekend we will go out to the surrounding community and I suspect that will be difficult but I would like to see where all these patients came from. And not the one we saw today who has a neck injury from being hit by a military truck. That is a whole different type of "friendly fire" .

On the way in today we did see tent  cities and US AID giving out huge bags of rice. The line was very long but orderly. Those bags had at least 2 people carrying them- I suspect they were 50 lb bags.
The border was quite a mess. All these huge trucks trying to go on a 1 1/2 lane road 2-3 abreast. Our driver left the road to drive parallel on a a dry road (lake bed) like a bat out of hell and then scooted back up to the main road bypassing at least 10 minutes of waiting. If I met my demise in Haiti it will be in a car accident.
It turns out they do cookie distributions at night. I want to go on that just to see. I will let you know if I can work it out.

Tabarre Haiti

Getting here was an adventure. The flights were fine although it took a while for them to clear the broken plane (not ours) off the runway in Santo Domingo. We were met and taken to the orphanage (NPH) to hang out until our van ride across the border at midnight. They go at night as it is cooler and less traffic but that means we were in the van for 10 hours and sleeping on those dreadful roads- well not really.
We had time to change into scrubs and wash our faces (and get some coffee- cold but caffeinated) before Pat went to the pediatric clinic and I went to Ortho clinic. It is one of my weaker ares but believe it or not I can follow directions. Mostly we changed casts and did dressings from earthquake casualties. It is a busy place. By 2:30 I realized I was done so back to rehydrate (sweating like crazy) and sit so that I can be useful tomorrow.
I thought I was going into a tent but with all the folks coming and going, I was able to snag a bed which means a shared bathroom! You have no idea how lucky that makes me. There are tents everywhere, nice tents but tents and no facilities with them. The tents are everywhere on the grounds which are secured with guards. I like that.
I spoke with translators who lost their families, The focus now is on relief for the staff who have been working non-stop. There are a lot of tired people here.
I am not yet able to post pictures- the signal is weak but I will keep trying.

Getting ready for Haiti

Tiny premie raised on loveIt was once paradise Very cute children

Deciding what to take for 10 days when the climate is hot and steamy and you know that bathing is haphazard at best- well it is a dauting task. So I sprayed socks, tee shirts and scrub pants with Premethrin,and have rolled them so they fit in large zip locks and now my back pack is full. What is too disgusting to bring home will stay behind. No makeup, earrings, hair fixins needed so all my personal effects fit in the backpack. Lots of baby wipes for bathing, hand sanitizer and tissues for whatever. My hair has been cut quite short.
This is the first time I have had to bring my own food. Did you know that the dollar store has individual tuna and chicken salad packs with crackers?I have beans and rice, pasta and herbs to donate to the communal cooking efforts. And a giant bag of M&M's.
These Haiti pictures are from 5 years ago. In my big bag are lots of crayons for the hospital(they bear a "pharm" logo so cannot be distributed in the US) which reminded me that these wer e an unknown on the last trip. We had to teach the kids to color and they had never seen coloring books pages. Culture shock!
I am told there is wireless internet at the hospital and my sweet husband has given me a netbook so I will blog and send as I can.