Hello again from Oriani. It seems like only a short time since the last update, but already a month has passed. Our numbers are similar to last month at a manageable level. MSPP (the Haitian Health Department) sent a nurse to us for several months to oversee vaccines. It is good to see a little bit of activity from the government, even if it is minimal. She is busy on Wednesdays, our prenatal and vaccine day. One Wednesday she vaccinated 49 children! Other days of the week she doesn’t have much to do. Last week we printed flyers for her. She went to all the churches in the area to let people know to bring their children. There are anti-vaxxers here too, unfortunately. She will talk to parents with children waiting to be seen. Some will come to get their shots, others refuse. I’ve asked but so far haven’t got an explanation of why they refuse. Carmina suggested she go to schools to pass out her flyers, but she says school children are too old. After the child is 3, they refuse to vaccinate them. We told her that there is no medical reason for this, but that is their policy, so that’s what they do.

Vaccination Day! Photo by permission CHC

After several months of trying, our clinic was accepted by Vitamin Angels. They are a non-profit that provides prenatal vitamins for pregnant women. This is huge for us as we see a lot of pregnant women and prenatal vitamins are very expensive. They provided us with enough for a year from a warehouse in Kwa de Bouqet. They also provide Vitamin A for children to prevent complications from malnourishment. They also give Albendazole (a dewormer) for children. We are thankful for their support. Everything helps.

It is rainy season here. That seems to be the respiratory season too, just like at home. If you look at the report you will see we saw a lot of patients for respiratory conditions. Most are just flu-like symptoms. We give Tylenol and cough medicine and encourage them to drink a lot. Most Haitians seem to be chronically dehydrated. Some require supplemental oxygen and we occasionally keep them overnight, if we can’t wean them of oxygen. The 2 year old from last month came back. His father said he started having some difficulty breathing after lunch, so he carried him up the mountain to our house. He got there about 8 pm. Thankfully he wasn’t as bad as in August. So I gave him an inhaler and prednisone to go home with. I gave him a ride home in our landcruiser. It was about a 20 minute drive down the mountain. I made sure to praise him for not waiting to come. Maybe I did too good a job encouraging him, because they came back 2 days later as the boy still had a cough. I reassured the dad and told him to continue the medications.

Nebulizer treatment Photo by permission CHC

The challenge of what to do with sick patients doesn’t get easier. We can tell them they need to go to a hospital, we can even get them to Fond Parisien or sometimes arrange a helicopter. Then what? They are no longer in an area they have contacts. They don’t have money to pay the hospital and we can’t help them. Sometimes they go and we hear they did well. We had one woman who had the end of her thumb partially torn away in an accident. I splinted it as best I could and told her she needed to see a doctor. She went to Port and they were able to fix it in place. She has been coming here for dressing changes until it is time to go to get the pin removed. Other times they simply refuse to go anywhere. We had a man in his 20s with abdominal pain. Ultrasound showed free fluid (sound familiar?). He was still able to walk. We told him he needed to go to Fond Parisien immediately. They assured us they would go right away. The next day we were told they didn’t go and he died overnight. Someone said they trusted the devil (Voodoo?) more than they trusted us. Saturday we had an unconscious patient brought to the clinic. She had had stomach pain starting last night. Her blood pressure was 73/32 (almost dead). I immediately started an IV and fluids under pressure. Further examinations didn’t show anything. Abdomen was fine, no free fluid. She had no other complaints than the stomach pain. I think it may have been a heart attack. There is no way for us to confirm here. Her blood pressure did improve with fluids, but immediately started to drop when they finished. We told the family she had to go to Port immediately. Initially they said yes, so we started trying to arrange a helicopter and find an accepting hospital. Then after they had time to think about it, they changed their minds. Only one person can go with the helicopter. Then they are alone in the most dangerous city in the western hemisphere. We could try to do more, but with nothing we could treat it would only delay the inevitable. She would not have lived long enough to take to Fond Parisien. So we sent her home and she passed away later in the day.

The border closure with the Dominican has had severe consequences for Haiti. A lot of food and other goods come from the Dominican. Many Haitians work in the Dominican. Most humanitarian organizations still working in Haiti rely on bringing in supplies from the Dominican. We do too. Half of our medications come from the Dominican with the other half coming from Port. I have been trying to keep the clinic stocked for 3-6 months because of how uncertain these supply lines are. We were going to the Dominican every month or so to buy supplies and groceries. We will be ok for a month or 2, but if the border doesn’t reopen, then what? Is it even advisable for us to stay with the worsening condition of the country? This area is secure, for now, but that could change too. Please pray for Haiti and for us.

This is an excellent article on how the border shutdown and gang violence are affecting health care in Haiti. The hospitals and clinic in Fond Parisien are currently our only higher level of care we can access.

https://www.miamiherald.com/news/nation-world/world/americas/haiti/article279900234.html