Rough Roads

Back road to Port

Well it’s been a very busy month here in Haiti. We came back from our little vacation in the Dominican January 6. Kelson Weibe, my wife’s cousin, came to spend a month with us. We were able to cross back into Haiti without difficulty. I noticed from the first week back at the clinic we are seeing an increase in patients. On the first vaccine Wednesday this year, we vaccinated 65 children. This of course uses up our vaccine stock, and getting more is a challenge!

Vaccine Wednesday

I spoke with our agent in Port and he said the road above Petionville through the mountains is now passable by landcruiser. He was able to get 2 large foam coolers full of vaccines, a medication order for us, and one for the clinic in Foret. Kelson, Roosevelt, Jean Fritho, and I headed out early in the morning to meet him in the mountains above Kenscoff. Google maps said it was about 105 kilometers. The road goes along the coast before heading up over Mon Kajac. It is a very beautiful route, but the road is very rough. It took us nearly 8 hours to travel the 105 km. Coming over the top of Mon Kajak is incredible. I am used to steep mountain roads, but this is another level. Since the main roads into Port are blocked, the Haitians have been working to widen and smooth this road. It isn’t too bad now, but very steep. Nearly 10 km of what felt like 20 - 30 degree descent with a cliff on one side and 2,000 foot drop offs on the other. I put the land cruiser in 4 low and eased on down. At one place the road crossed a narrow saddle with 1,000 plus foot drop offs on each side. The views were spectacular with steep mountains covered with gardens dropping off on every side and the ocean in the distance. We met our agent and loaded up the landcruiser. His drive had been even more interesting than ours. Coming through Port they started hearing gunshots, but accelerated and made it through. He says the big stores in Port are mostly still open and he can get whatever we want. He just has to wait for lulls in the shooting. We headed back up over the mountain, the land cruiser handling the grades well. About half way back home we stopped in Belle Anse on the south coast for a meal of fresh fish from the Caribbean. We made it home after 16 hours on the road. A very long day on some very rough roads. Thankfully we can get most of our medications from the Dominican with a much shorter drive, but this is an option too…for now.

Transporting medications and supplies

January 21 Keith and Candace came to visit. They have their Haitian residence so the border was no problem. It was very good to have them here. The locals were very happy to see them and they kept busy visiting people. Keith and Kelson worked with Jenel to put the transmission back into the Ford. It is now able to move under its own power for the first time in about 4 years. It still needs new tires and a thorough going over, but that is something Jenel can work on as he has time. Keith and I discussed the need for another nurse’s house. He was able to find one in town to rent. We might still need to build a house at some point, but this gives us more time to plan. Keith, Kelson, and I went to Fond Parisien to buy medications and visit friends. Keith and Candace weren’t here very long, but I think they accomplished a lot in their time here. Kelson went back with them to Santo Domingo. It’s always good to have people here to help in the clinic and the Haitian staff enjoys it too.

As you can see from the monthly report we are seeing a lot more patients. This trend has continued into February. I am not sure what causes the increases and decreases in numbers. I keep a spreadsheet to track them, but so far have not been able to identify a pattern. One recent trend I have noticed is an increase of patients, often children or teenagers, with swelling under their jaw. They present with fever and sometimes inflammation and white spots on the back of their throat. Our lack of a lab makes it hard to diagnose, but it seems to respond well to a course of amoxicillin or augmentin for older patients. The nurses report this in the “tonsillitis” section of the monthly report. One of the nurses told me yesterday of reports of children dying from this and not being brought to the hospital. So we are working on getting the word out.

Another frequent complaint in the clinic is wounds. We aren’t seeing as many chronic wounds as a year ago. Maybe we made a dent in the number of nonhealing wounds walking around the mountains since the clinic reopened? But it is still a steady number of visits. We had some people come to the gate one night with reports of an injury from a moto accident. I was busy, so Kelson and Heidi went to the clinic to help Mis Vitanie. The primary injury was the woman’s ear was partially torn away. Kelson and Vitanie did a good job reattaching it.

Thank-you for your continued prayers and support. Hopefully this gives you a little idea of what it takes to keep the clinic supplied. Sometimes the news from Haiti can be discouraging, but it is still possible to keep working here. Before Keith and Candace came, they went to a Haiti benefit auction in Florida. There they met other organizations still working in Haiti. It is still possible. God can do miracles if He has willing workers. If anyone is interested in helping, please contact us. Even if you are not a medical person, there is work to be done.

Reflections and Plans

Good morning from Haiti. I hope everyone had a good Christmas and wish you all a Happy New Year! Looking back over the past year it is amazing that for every difficulty we encountered God provided a way through. I have described the difficulties of the road being closed to Port and the problems that has caused to the people here, and here is a little update. They cannot sell the produce from their gardens directly to the markets in Croix de Bouquets and Port au Prince as they have in the past. The local economy relies on this money. Due to the geography of the country there are no side roads to take. They have developed some workarounds such as selling produce through Jacmel. But the market there is too small to handle the supply from this area. Another work around is to load produce onto Dominican trucks at an unofficial border crossing in the mountains above Pedernales. From there the Dominican trucks take it to Elias Pina in the north where it is loaded back onto Haitian trucks and taken into Port from the north. Unfortunately the expenses involved make it so the local farmers barely get anything for their produce. At the clinic we have seen an increase in people asking for food and that aren’t able to pay even the small fee we ask. We still help even if they can’t pay, but it does make a dent in the amount of cash we have on hand.

The road situation has made it so we have to import all our medications and medical supplies from the DR. Fortunately, this continues to be possible even though the border is officially closed. I do not understand the Dominican government’s approach to the situation in Haiti. It seems to be calculated to make life as difficult as possible for the average Haitian. Commerce is allowed but no Haitians are officially allowed into the DR. Bribery and smuggling make this a joke and a shakedown racket at the expense of the Haitians. Plus a lot of the gangs’ weapons and ammunition are still smuggled across the border. The Dominicans say only Haitians or people with Haitian residency are allowed to cross into Haiti. Fortunately for us the immigration officials in Pedernales know us and allow us to cross as if we have our Haitian residency. To get residency would be very difficult and require us to go to Port so we have never pursued it. I do have paperwork from setting up our Dominican bank account that proves we have lived in Haiti since before the border was closed. Some of my wife’s family came to visit us over Christmas and we spent time with them at the beach in Pedernales. Thanks to our better understanding of the border they were able to come up to our house for a week. It is a real boost to morale to have visitors come. We closed the clinic for about 2 weeks over Christmas and New Year. This gave one of our nurses, Yollette, a chance to go to Port to visit family. She was able to find a way in and make it back safely. The other nurse, Vitanie stayed in the area and between her and me, we helped with emergencies. We traveled back to Santo Domingo with our visitors, then spent a week in the DR enjoying American restaurants and visiting friends. On New Years we went to the house of some Haitian friends for their traditional pumpkin soup and coffee.

Looking forward to the new year there is a project that has come up that we will need your help with. The clinic has rented a house in the middle of the village for years. It was the original clinic before this one was built. Since the clinic reopened we have rented it to our nurses. They are from Port so they needed assistance in finding housing. This has worked well, but the contract expires in August. The owner does not want to renew the contract. Currently there is a housing shortage here due to the people seeking refuge in the mountains. Our idea is to build a new house on the land the clinic owns beside the clinic. This will require us, unfortunately, to postpone the project for a cistern beside the clinic and will be an added expense for us this year. Any help that can be sent for this will be greatly appreciated.

I have kept in touch with the man who buys medications for us in Port. We have not been able to buy any there since June of last year. He tells me there is a possibility for us to buy now and bring in up a steep mountain road above Port. I am willing to try it and sent him a list. I asked if he can get out to find things. He says yes he can, he just needs to wait for breaks in the gun battles between the police and the gangs. Imagine if you had to plan your shopping around gun battles! Thank you again for your support over the last year. Even though things are as difficult as ever, we will continue to try to serve the Haitian people as best as we can. Pray for change here, God knows it is needed.

Count Your Blessings

Well in the spirit of Thanksgiving in the US, I will list the many things we have here to be thankful for here in Haiti. In no particular order. First of all, I am thankful for the security we have in this area. Despite the turmoil in the valley around Port au Prince, we still can operate here in relative security. Second, I am thankful for the support of the community. If I have any problems, they are quick to help and they often make sure to let me know how much they value the clinic. Third, I am thankful for the work and dedication of our Haitian staff. They are always here and cheerfully attend to the patients. They work together well. The nurses have really grown into their roles and the community has welcomed them here. Here are before and after pictures of a leg wound caused by an axe while splitting wood that Mis Vitanie sutured.

Fourth, I am thankful for people that have helped so much. Like my Dominican friend who is always available to help with banking, transportation, and any paperwork we need to be able to operate through the DR. The man in Fond Parisien who is able to bring medications across the border for us. Without him we would not be open now with the road to Port blocked. I am thankful for the man in Port who has helped so much with buying medications and supplies in Port. He can’t do much now, but if the road reopens he will help again despite the dangers he faces in traveling around Port to find things for us. Also I am thankful for our friends in the DR who are happy to let us stay at their house and make us feel very welcome. Fifth, I am thankful we can still find some level of hospital care for patients who need it. The little hospital in Fond Parisien continues to operate and is able to do emergency C sections. Everytime I send a patient with OB complications I am tremendously thankful for this. To tell them to go home, or watch them suffer here without being able to help doesn’t bear thinking about. Sixth, I am thankful for our health. When we first came to Haiti it seemed we were getting sick every month or so. This year has been much better. Seventh, I am grateful for the support from North America. Without it the work here simply would not be possible. Thank you for your prayers, messages, and donations. Finally, and most importantly, I am thankful to God for always making a way. Everytime things seem to get worse, we are still able to function. Given the difficulties here, this is a miracle. Several stories from the last month. Fre Enok is a deacon in Fond Parisien. Last February his son had an accident and broke his leg. He was able to go to Port and have it surgically repaired with rods placed in his leg. After the road to Port closed, he was not able to go back to have the rods removed. I checked with Haiti Air but they are out of the country again. So our ambulance brought him to Thoitte and he was able to find a vehicle there to take him to Jacmel. This is probably a 12 hour drive over the worst roads you can imagine, but he was able to get to Jacmel. The hospital there was able to remove the rods and I helped him get back to Fond Parisien. The boy who went to Fond Parisien for emergency abdominal surgery is still in the hospital there. I spoke with the surgeon. He had a perforated bowel and needed 2 surgeries. Without our ambulance promptly taking him to Fond Parisien, he would have died. Due to the infection in his abdomen they aren’t able to close the wound yet. He developed a clot in his leg. The hospital sent the dad to me to see if we had coumadin, a blood thinner, as they didn’t have this. Unfortunately that is not something we carry. But I did have an old vial of heparin. So I went to find the dad. On a muddy trail beside his field I tried to teach him how to do subcutaneous injections and the importance of him walking every day. He said he would send it to the hospital. That is post operative health care in Haiti. One day Mis Yollette called me into her room for a young woman. She was skin and bones, very malnourished. She had a 2 month old baby at home but couldn’t breastfeed due to malnourishment. She was having a hard time finding food and complained of her belly hurting. I gave her medication for parasites and amoebas and multivitamins. I also gave her money for food. She came to church that Sunday so I told her to come to the clinic the next day with her children. We treated them for parasites. I gave her a little more money and had Fre Willy take her up the street to where his wife was making food. They gave them 2 meals to share that I paid for. The first time I saw her she was so weak she could hardly walk. Sunday after church I saw her again and she is looking a lot stronger already. Well, so it goes here in Oriani. We do the little we can and God works with it. Rumor has it the road to Port might open today. I pray that it does, because the farmers here depend on selling their produce down the mountain. And it would be great to buy things from Port again. Thank you again!

Vaccines and Surgical Emergencies

Hello from Haiti. Another month has come and gone and we are still able to operate despite the difficulties of the country. The weather is cooling here too. Often the temperature drops to the 50s during the night and our uninsulated houses can get chilly. But the days warm up into the 70s and are very comfortable. October brought a lot of rain, but the last week has been dry. There is no change to the security situation in this corner of Haiti. The main road to Port au Prince remains blocked because of the gangs. I am able to keep the clinic supplied with medications from the Dominican Republic, but our vaccines need to come from Port. Our supply was running low and our vaccine nurse, Mis Rachel, was not able to keep the vaccine program going. If you compare months you will see our vaccine numbers dropped a lot in September. MSPP (Haitian health department) tried to send them to Jacmel and then up the road for this area, but were not able to. I gave Mis Rachel the suggestion that they coordinate with Haiti Air to fly them here. They were able to fly a load to us for our clinic, Fond Verrettes, and Fond Parisien. This allowed Mis Rachelle to get busy again. She got several people to help her and spent 2 days walking through other zones giving out vaccines and letting people know to bring their children to the clinic. Her report showed about 80 people they vaccinated in the area. These aren’t in my report. So God keeps making ways to keep working.

Our ambulance made 3 transfers this month. 2 were for OB complications. The other one was for a 17 year old boy. He had gone to the little hospital in Thoitte for a fever and not feeling well. 4 days before he came to us he started having abdominal pain. The hospital told him they couldn’t do more for him and sent him home. He lives close to Fre Willy, so he came to the clinic. His abdomen was extended and firm and very painful. He didn’t have any bowel sounds. Ultrasound showed a very enlarged bowel in the right lower quadrant. I had several patients like this last year and they all died before I could get them to help. It was in the evening so a helicopter transport would have had to wait for morning. I notified one of our ambulance drivers and while they were getting it ready we gave him antibiotics, IV fluids, and pain medicine. I messaged the surgeon at the little hospital in Fond Parisien. I am never sure what they can handle, but he said to send him and they would be waiting. The next morning the driver returned with the ambulance and told me they were waiting for him and took him straight into surgery. Fre Willy told me he had another surgery several days later. He is still in the hospital and starting to recover. They left the surgical site open as it is still draining. From what Fre Willy told me the father said they told him the small intestine had entered the large intestine. Hopefully the boy will be able to make a full recovery. If so it is almost a miracle that everything came together and he was able to get to help in time.

Whether to send the ambulance or not is one of the most difficult decisions for me. The road is rough and long and the ambulance is old. Almost every time it comes back with something broken or needs to be towed back. Because of this and the limited help to be found, I have to decide if the risk is worth it. Or if the need justifies risking the ambulance on the road. We had a girl in labor at the clinic. She had been in labor for about a day already. Ultrasound showed everything was normal, but she was not progressing. Vintanie and I decided if the baby wasn’t born overnight we would send her in the morning. In the morning the baby hadn’t come yet, so we sent her in the ambulance. It made it about 3 miles and died. Jenel went to see if he could get it running. After several hours they towed it back to our yard. Now what to do with the patient? She was not in good enough condition to go by moto and they couldn’t find another vehicle. I sent them with Jean Fritho in our land cruiser. This is not something we want to do very much because if it breaks then what? We really would have problems! But she needed to go and it didn’t seem right not to. Another time we had a 8 month pregnant girl come in with some abdominal pain. I was able to find the baby’s heart on ultrasound and it definitely wasn’t beating. She needed to be evaluated in Fond Parisien, but her vitals were stable. They asked about the ambulance. So now what?  The ambulance was working again. It had been an electrical problem a local electrician was able to fix. Do I risk the ambulance breaking down to send a stable patient? Then it might not be available for a real emergency? I told them they should find a moto. They complained that the road was bad. I’m very aware of that. But the girl was in no immediate danger so I stuck by that decision. Was it the right one? God only knows.  A new ambulance would be great! But the cost is very high. And the clinic is facing other needs for money. The clinic batteries are starting to get old and weak. To replace them will be a big expense. Also, I was just informed the house we rent in town for our nurses from Port will not be available for rent after August next year. There is a bit of a housing crisis here now with all the people who came up the mountains for safety. It seems our best option might be to build a house next to the clinic. But that will be another big expense. Finally, our time here is coming to an end next year. We need to find another administrator, but so far no one has volunteered. Will we need to find a way to keep the clinic open with only Haitian staff? That would require hiring a doctor and another expense. And another person to find a house for. Surely God has a plan! Thank you for your support. The needs here are greater than ever. This means that your opportunity to help has never been better. Thank you.