Dry Season

Good morning. It’s been beautiful sunny weather here in Haiti the last few weeks. A few cloudy afternoons, but no rain. Monday was smokey from the fires in the mountains. Wind and trucks leave behind clouds of dust. Cisterns are getting low and the farmers have been hoping their gardens make it to the rainy season. Tuesday we did finally get about half an inch of rain. Rainy season starts about the middle to end of April, so this should give them the boost they need. Good news from Fond Parisien! The road to Port au Prince was opened 2 weeks ago! Hopefully it will stay open! The farmers are counting on it to sell their produce in June. We are counting on it to be able to buy medication  and other supplies from Port. The man that arranges medications is hoping to send us a shipment in the next week.

Mis Rachelle, our vaccine nurse, went to Fond Verrette ( a town halfway down the mountain) Monday for a meeting with MSPP (Haitian health department). She says we are second to Fond Verrette in vaccines given in this part of the mountains. This is due to her hard work and dedication. I also want to give a shout out to our other nurses. There have been a lot of after hour visits, or “emergencies” and they have done a good job of helping out with them. Sometimes it's hard to know if the people actually have a legit reason to come after hours or are just taking advantage of not having to wait. Either way they have done a good job of taking care of them and the locals often seek them out instead of coming to me. This hasn’t always been so…as sometimes people think the American gives better treatment. I am happy to see this as it shows the community trusts them. I still get some emergencies though. The other night I stitched up and bandaged an older woman that had a moto fall on her leg.

A few weeks ago we had a 5 year old girl brought in. She hadn’t been feeling well for a few days and had nothing to eat the day before. She was not responding. A check of her glucose showed 49. I started an IV and gave her dextrose and fluids. After about an hour she was able to sit up and drink some gatorade. Her glucose was over 200, so I told the mother to get her some food. Mis Yollette gave the parents some education on the importance of eating and drinking small amounts even when they aren’t feeling well to give them energy. Haitians do not drink enough even when they feel well. So if they are sick, they often need fluids to help them recover.

April promises to be a busy month. We are working on buying a generator from Port au Prince. I was hoping I could write in this update that we had it, but it is still in transit. Given that the route is “fragile” to use the term of the Haitian businessman that is arranging the purchase and transportation for us, it is a risk that we will lose it. Pray that we don’t and that it can make it here next week. We are looking forward to having Matt Giesbrecht here next week. Hopefully we can get the generator setup and the Ford fully roadworthy while he is here.

Jenel took the ambulance to Thoitte last week to a boss to weld together and reinforce some cracks developing in the body. He also found someone to repair the seats as they were falling apart. This was very necessary but expensive. Funds are running a little low and please consider making a donation if you can. Thanks again for your continued prayers and financial support.

Projects and Funding Needs

Hi to everyone. It is dry season here and the dust has been getting deep and the cisterns empty. However, the last week or so has been cloudy with some rain. This has allowed people to start planting gardens for May and June harvest. This is a faith venture as the road to Port is still closed and there is no promise they will be able to sell to the markets in Croix de Bouquets and Port. The road being closed also makes it so we can’t send patients to Port by ambulance. Thursday the 27th we had a man brought into the clinic. He was a forest ranger and had been checking out a place where someone had cut down a tree. A branch had stayed stuck up in another tree and fell on his head. He was not responding appropriately and clearly needed a head CT and an evaluation by a neurosurgeon. But, there is nowhere I can send him. Haiti Air is still out of the country and even if he could get to Port the hospital there that had neurosurgery was burned by the gangs last year. I could only keep him quiet and watch his BP and hope he would wake up. After a bit a pastor came in to see him and told me if we could help him get to the border, he could get him to the hospital in Jimani, DR. I doubt Jimani has any neurosurgery capabilities, but sending him at least felt like we were doing something. Jean Fritho took him in the ambulance. Unfortunately, he died before being able to cross the border.

The ambulance did manage to make it up the mountain under its own power. But Jean Fritho said he had to go slow because it was shaking so much. Also it is developing some cracks in the body. It is very much showing its age. Jenel took it to a mechanic in Thoitte. He said he needs it for 2 days and isn’t able to weld the body now because he doesn’t have any oxygen. The ambulance will need to be replaced soon. It is one of the biggest services we offer and is very important as too often people can’t afford transport to hospitals down the mountain. The other 2 ambulance transfers were OB emergencies. One was a teacher at a school beside our house. The presentation wasn’t right. The doctors in Fond Parisien weren’t hopeful, but they were able to deliver 2 healthy twins by C section and the babies and mom are doing well.

Other news from the clinic. The surge in patients with swelling to their throats seems to have slowed a little. But we are now seeing more patients with viral respiratory infections. I had a 4 year old girl who died from a severe case. No doubt she would have been intubated and admitted to a Pediatric ICU in the US. We don’t have those here. She had stridor with limited air movement in her lungs. Nothing I did seemed to have much effect. Most of the time they are not too sick and respond well to treatment.

In January we were able to go across the mountain above Port au Prince to get medications and vaccines from our agent. I was hoping to be able to do this again in March or April. But, the gangs came up the mountain and are currently blocking that road and the road to Jacmel. The good news is that we are still able to buy medications from the Dominican Republic.

Ok, so we have several projects we need to work on. We need a new generator for the clinic. During rainy season often our solar panels can’t keep up and we need to use a generator. Especially if we have emergencies over night. Next, as you can tell our ambulance is getting to the end of its life and needs to be replaced soon. Also, we still want to build a cistern at the clinic to be able to provide water during rainy season. And finally, at some point we might need build a house for our nurses that come from out of the area and need a place to live. We did find a rental house for now, but this still might need to happen at some point. All this takes money and our funds are not sufficient at this time. Please consider donating if you can. Know your money is going to help the poor people of the mountains here in southern Haiti. Thank you and God bless you.

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.