Wednesday, August 5, 2015

Three for One!

We are quickly falling into a regular rhythm in Haiti. Volleyball at 6am (Maria and Norrell “off to work”), then a big nap for us, off to the boys’ campus for lunch and Kompa-guitar playing, moto-taxi ride to the Azil (the orphanage run by Mother Theresa’s order), moto-taxi to the Midwives for Haiti house for dinner and intermittent WiFi, then back to the girls’ for partying and cold-bucket showers.
Last night was especially hot, but that didn’t stop us and the girls from Maison Fortune from hanging all over each other for hours.  Sophia has an amazing voice and we prompt her to sing her favorite songs for us (Justin Bieber). At one point she wanted me to translate Bieber lyrics into Kreyol. She would sing the line in what she thought was English, Viola would translate it to me in English and then I would attempt to translate in Kreyol. It was exhausting and hilarious.
Our Kreyol is getting better and better (pi bon!). Last night I was so proud of myself when I figured out that Islande is actually NOT speaking Kreyol but nonsense words. That was until Viola told me, “Oh yeah, she always does that”.
Today was long, exhausting , and fun. I did C/S number one at 11am.  Dr. Celestine gauged my interest in doing the surgery.  I said, “Sure, I’ll do it,” so there I was in the OR, without him.  Luckily the scrub tech and the anesthesiologist were both Cubanos, so we had a good time.  Sponges and sutures seem to be rationed; sponge, suture, and instrument counts were nonexistent.  EVERYTHING is broken in the OR, but rigged just so.  My second C/S was a 28yo HIV+ lady whose first baby died.  She had an ugly vertical keloid scar.  I did her C/S +tubal and an extensive scar revision. C/S number three for the day had “CPD”, basically completely dilated with extensive caput after just one hour of pushing- a soft call, but not my place to lecture them today.  By this case, people were coming into the OR to watch and some were taking pictures of me. 
There was one patient who took a large dose of malaria medicine in an attempt at self-abortion.  She got the D&C, just like she did at her last undesired pregnancy.  This is a mainly Catholic country, where pharmacists don’t usually sell Misoprostol to women, and where many women are denied tubal ligation due to their age (i.e. under 35yo with 3 kids and 3 late miscarriages did not qualify this week, but the HIV+ lady got her desired tubal).

Chajman lou a. The heavy load. I am here because I think I am helping. If I wasn’t able to do even some small part, I think I wouldn’t come. But the load is heavy and many hands make light work. Veronique, the house parent at the girls’ orphanage where we are staying, is in charge of 65 girls from ages 3 to 20. She knows exactly who is who and what their particular needs are. She knows the 3 girls with learning disabilities and she tells me that she gives them extra special time with her. She is dedicated and committed.  Together we brought our little 3-year-old with the burns to the state-of-the-art hospital an hour away.  She was happy to have me along, as she had never been there before.
Thus a question: how would you know how to access a health care system if your whole country has never had one? As Haiti’s healthcare infrastructure grows, so does the need for the people to know how to use it. I was happy to feel useful, certainly knowing how to work the system even if it wasn’t my own. We waited for 4 hours to see an emergency room doctor. On the crowded benches that looked like pews, a man said that he had been waiting for 24 hours.
No way, I’m an advocate if nothing else. I had taken a tour of this hospital when it finished 2 years ago, so I knew there were other areas where we could go. By talking to a doctor at the nurses station on Pediatrics, I was able to gain entrance into the actual emergency room through a back door. I just wanted to talk with someone and try to get our little girl triaged appropriately (and much quicker than 24 hours).
 I found a blond American doctor. (We certainly do stick out here.) She was from New Orleans, and I understood later that she is one of the teaching doctors here for the Haitian medical residents. People deferred to her. She was willing to come out and look at Jenica and let me know if we should stay or not. Movement in the right direction. She looked at the burns and actually thought they were 2nd degree, no admission to the hospital needed, but in order to get meds and bandages, we needed to wait our turn in the waiting room. Pray some more for help soon.
It certainly begged the question: how long do we wait? 3 hours? 10 hours? 24 hours?  It seemed like we were close to being seen, but it was still so hard to tell. The girls (we had brought along a 4 year old with a rash, too) sat quietly, drinking a kool-aid drink and eating a Haitian street sandwich. Darlene takes care of Jenica like an older sister. Mind you, she’s four. More people fill the Emergency Room church of Paul Farmer. Most have home-doctored injuries like our Jenica. Will they all wait 24 hours for care?
One thing that’s different for sure about the Haitian system and ours: we paid $1 for Jenica to be seen.
Three hours into our waiting, a young Haitian doctor appeared by the reception desk. I jumped at the chance to talk to him and simply ask where we were in the queue. A 3-year-old with burns? He didn’t even know about her! But he was friendly and kind, and went looking for her chart.
By an hour and a half later, Jenica had been seen by the doctor, received sedation to do the debridement of her burns, and was all bandaged up, ready to go home. I was truly grateful for the care for our piti (little one). The female Haitian doctor that we saw was competent and compassionate and obviously knew what she was doing.
Am I helping? For one, I know that I am just as committed to our home base-orphanage as I am to the midwifery program. We are here and we help where we can. If it is helping Veronique and a 3-year-old, so be it. If it is resuscitating a newborn in respiratory distress, so be it. If it is helping the midwives to stay committed to their work, so be it.

The load is heavy. I am willing to do some lifting.

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