Tuesday, August 16, 2011

Cholera: Up Close and Personal

Our last night at San Therese was peacefully uneventful. We had two live births within a half hour of each other around 2am. The rest of the night Susan and I napped on a yoga mat or chatted, disturbed only once by the keening of a woman across the courtyard. I immediately recognized it as the signal that a loved one had died.
Friday was our last full day in Hinche. My day was crowded with last minute filming of Genette, the bright, young clinical professor at Midwives for Haiti; packing; stopping for one last time at the Ebenezer (the air-conditioned super market); making Grandma’s tomato sauce one more time on the open charcoal fire; going to Magdala’s for dinner at 4pm and figuring out how to carry the still warm sauce with Dina and I on the back of a moto bike; getting back from Magdala’s in time to meet Genette and my other Haitian midwife friend, Esther, at the Crystal Bar for one final farewell.
Within the folds of my busy final day, I was introduced to cholera. When we went up to the hospital to film Genette, we asked if we could observe the UNICEF cholera tents set up in front of the hospital. Twelve large, white tents were set up, each with a UNICEF stamp on the front. They were much more like circus tents than camping tents, having the neatness and formality of a well-heeled NGO. There was a triage tent as well as men’s, women’s and pediatrics. Most of the tents were empty or only partially occupied, which was a relief to the senses. Each tent had 8-10 stretchers lined up in two rows. Each stretcher had a hole in the center with a bucket underneath, carefully containing the vector of a deadly disease.
Most people did not seem in intense suffering. Many had IVs, but most were hovering about, biding their time for the disease to run its course. There was a fascinating container that was the encampment’s water supply, a 12 ft. by 12 ft. giant water balloon, used for bathing and drinking. A naked man on a stretcher was being carried away, perhaps after a needed rinsing off.
To leave the cholera area (the whole encampment is walled off with security at entrance and exit), you need to have your hands rinsed with water treated with bleach and step on a pad soaked with disinfectant to clean off the bottoms of your shoes. We had made our observation. No photos allowed. My obligation to witness the suffering of the Haitian people is fueled by my desire to comprehend the magnitude of the disparity that I wish to amend. I am constantly trying to evaluate whether we are making a difference.

In the afternoon, I had an even closer look at the cholera epidemic. When we arrived at Magdala’s house for dinner, a very special invitation I might add, she said that she had to place an IV in a child up in the tents on her land. Of course, I offered to help and we all trekked over to the small plot of land that she had let the government use as a cholera encampment. There were only 4 tents, each labeled: triage, observation, transition, morgue. A small, dehydrated 3 year-old girl, dressed only in her underwear, was on her mom’s lap. She was sitting up and animated, but the two nurses who monitor the encampment had decided that her condition had gotten worse and that she now needed an IV. We set about to work, looking for the most accessible vein to place an IV. On a healthy three year old, this is always a challenge, tiny veins, a scared patient, few options. Working with Nilove proved to be no easier, her dehydration making it even harder to find a strong, plump vein to work with. We tried multiple times to insert the IV catheter, each time to the wailing and tears of our little patient. Her cries were eerily reminiscent of the laboring women, a uniquely Haitian song of pain and suffering. It was heartbreaking to understand what she was saying in Creole, “Mama, let’s go home, let’s go home.” We tried on her hand; we tried in the antecubital space. None were successful. I found a small toy in my pocket that I had figured could be given away at some point. Here was that point. The toy calmed Nilove for a few moments. We finally got a good stick in her hand but the sigh of relief was only momentary as the little girl jerked her hand away and the catheter pulled out. Both Magdala and I looked at each other in disbelief. Our only good stick was now worthless. We tried in her foot, the other antecubital, and the other hand. After 6 tries and running out of the smallest angiocaths that we needed, we gave in to our own failure.
Nilove would have to continue her oral hydration therapy and hope for the best. She would not die; she simply needed hydration support until the cholera passed, and isolation to help prevent the spread of the disease. The only other patient at Magdala’s encampment at this time was an older woman, in her 70s. She too was ambulating and would not die, simply biding her time. We rinsed our hands and stepped on the disenfectant pad. As I saw the iodine-colored water run up over my flip flops and onto my bare toes, I wondered how effective this ritual was.
It had taken us an hour to finally acquiesce to our lack of success. Magdala is an amazing midwife, giving of herself in areas where she should not be taken to task. She says they have seen over 50 people in her tents. We walked back to her house for an amazing Haitian feast of fried tilapia, beet salad, a green salad with fried goat, avocado, cornmeal cakes, a “lasagna” of sorts (layers of lasagna noodles separated by a ground meat) that went perfectly with Grandma’s tomato sauce, Haitian spicy coleslaw, spicy goat sauce with onions, fried plantains, a few fried potatoes, and black rice with dried mushrooms. It was a feast of appreciation and hope for our future working together. Magdala’s husband is a pastor and deeply religious, he asked me to say the prayer before the meal.
When a pastor asks you to say something, you speak: I prayed for the little girl up in the cholera tent, I prayed for the continued strength of Magdala and her family to offer safe haven for the poor and the sick. I prayed for Magdala’s continued work as a midwife, to reach the pregnant women in the villages and bring them a better birth experience. I prayed for strength for us all and for hope, for our continued working together, each year, to create a better world.

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