Hello again. The month of July was the first month we were open five days a week. We are still reserving Wednesdays for prenatal class and checkups as well as immunizing children. This is partly why the amount of patients is higher for the month of July. Let me explain more about our monthly report. This was a report the CAM required for the donations they were providing. Since CAM is no longer in the country it might be a little irrelevant. I felt it would be good information to have and have modified it slightly to better reflect what we do. Since last month I changed 2 boxes to show emergencies and ambulance trips. Emergencies are after hours visits usually to our house. If I can treat them at home, I do. Often I have to bring them to the clinic. Sometimes I will have one of the nurses meet them at the clinic. Not included are ones that show up but don’t require medical treatment (despite what they might think). This number keeps going up and can be quite tiring for one person to manage. (We still have space for another nurse). Please note the total number of patients is patient visits. Some are repeat patients. Also, we lack testing and the ability to definitively diagnose patients, so treatment and diagnosis are based on the patient’s presentation.

An interesting thing I have noticed in health care is how often you see similar patients during a day or a week. For example, the first week of July started Sunday with a 23 or so year old woman came to my house on the back of a moto. She was complaining of right lower quadrant abdominal pain. It had started the day before and had significantly worsened during the day. Very concerning for appendicitis. I told them they needed to go to Fond Parisien right away. I took them to the clinic and gave her a shot for pain before they headed down on the moto. She went to the bathroom before they left and had a lot of blood in the toilet. I asked the man with her to please give me an update when they got back but haven’t heard anything since.

A day later we had an older man come into the clinic very weak with lots of diarrhea for 3 days. He was so dehydrated I had to do an ultrasound IV. We gave him 3 liters of fluid. Concerning for cholera but unable to tell here. I contacted the cholera hospital in Fond Parisien and they agreed to take him. Rosemard took him in the ambulance. I heard later they didn’t think it was cholera but took care of him anyway. Two days later, when I got up, I saw some people standing in the road in front of our gate. I hadn’t heard knocking so wasn’t sure that they wanted to see me. The clinic was open that day so I looked for them, but they weren’t there. That evening we were at Rosemard’s for supper and they came to the house. They hadn’t come to the clinic during the day and instead went to a local that does some level of medical care. This man was very sick with significant abdominal pain. An ultrasound exam showed free fluid and air in the abdomen. By this time it was after dark and Haiti Air doesn’t fly in the dark. We started fluids and antibiotics and I sent a message to Haiti Air to get him on their list in the morning. Unfortunately, but not surprisingly, he passed away during the night. The following night I had a young man come also with abdominal pain and feeling very sick with diarrhea for several days. Why didn’t he come earlier when the clinic was open? I couldn’t understand their reply. I took him to the clinic. Ultrasound looked fine to me. I gave him fluids and antibiotics. The next day we left for the Dominican for a shopping trip and to spend a day or two at the beach for some R & R. I heard while we were there that he had passed away. Situations like this always make you wonder, did I do everything I could? Did I miss something? What more could we do? God only knows. All we can do is the best we can with what we have.

We tell some patients they should seek care at a bigger hospital. That’s indicated in the referral to other hospitals. Many times patients can find their own way and often aren’t sick enough to need to go right away. We use the ambulance if they need to go right away, but can’t find their own transportation. Saturday a man propped up on a moto came to our house. He had fallen out of a tree and hit his head. He was not making sense and not following commands. He had blood coming out of his ear and nose. Definitely not good! It was already evening, but I messaged Haiti Air to see if they would fly. They said the clouds were too thick over Pic La Selle, but they could fly in the morning. That often happens in the evening. We spoke with a man who said he was the son and said he needed to go to Port au Prince. They agreed and said they would go right away to Fond Parisien and find a taxi to Port. These taxis pay the gangs not to be harassed and Haitians can get through. Meanwhile the patient started to become combative. Not a good sign in a head injury patient. I told them to stop by the clinic and I would give him a shot to put him to sleep. Having a combative patient on a moto did not seem like a good idea. I gave him a dose of ketamine. They propped him up on a moto between the “son” and the driver. Then they asked about our ambulance. I went to find Rosemard to see if he wanted to go. He came and got the ambulance, then we headed back to the clinic. Now the crowd was a lot bigger and they were crying that the patient had died. I checked for a pulse and breathing and found both. I showed the “son” how to feel a pulse and explained that the patient was only sleeping due to the ketamine. They loaded up in the ambulance and headed out. Several hours later I got a call from Carmina. Apparently when they got to Fond Parisien, they didn’t want to go further. They didn’t have money and they were too scared and wanted to come back to Oriani. Then the “son” said he actually wasn’t family. Rosemard took them to Chris pour Touts, the small hospital in Fond Parisien. They offered to keep the patient until morning when the “son” and companions could find transportation to Port. They refused. So Rosemard brought them back. In Fond Verrette they decided they were hungry and discovered they had money for supper. So they stopped for food. Rosemard dropped them off at the patient’s house. This is a story that just gets worse the more I think about it. Since, we wrote up a small contract to give to future patients and families. It explains that the ambulance can not go past Fond Parisien and will not bring them back. Hopefully that will help in the future.

Sunday I was at the clinic with an old man who couldn’t pee. A simple fix with a catheter. On the way home we were met by yet another person propped up on a moto. She was young, had been fine in the morning, and I smelled alcohol. My ER fake meter was pegged. I asked if she had been drinking. They said no. (Funny how some things are just the same as North America). So I did an exam. She moved to pain, flinched when I flicked at her eye, and made herself comfortable on the exam table. Vital signs and sugar were normal. I told them to take her home and let her sleep. By this time more people showed up including her sister who finally said she had been drinking. The many people showing up every evening gets very tiring. I’ve heard that people with money wait until we are closed because they don’t mind paying our after hours fee so they don’t have to wait. Should it be more? Also, we see patients coming from beyond Fond Verette and Thoitte. They pass the bigger clinics and hospitals because we are cheaper, or they didn’t get help there, or we are white. Truly some tell us that! We try to explain we are just nurses and these clinics have doctors and more resources than we do. Should our prices go up? Should we charge for medications? We are here for the poor people of the mountains and want them to come if they need help. Often Fre Willy in reception hears people say they can’t pay. We trust his judgment and he gives discounts to those who need it. But it's becoming too much for our staff and resources. Thankyou for your prayers and donations. They are very needed and appreciated.

The 2 year old boy we treated for a burn last month has healed well. He has some scarring and loss of pigmentation, but healed without any infection! We gave him juice and protein shakes for the first week, since he wasn’t eating well. His appetite returned after that. His parents were very diligent with follow-up appointments and it’s good to see positive results.