Hello from Oriani. We are still here and still working! Numbers continue to be down from summer, with the exception of after hours calls. Those still come in. I met with the local board to discuss this and see if they had any ideas. They have heard of people not coming to the clinic because they are afraid they cannot pay. Our prices are still very low compared to other clinics and we help people whether they can pay or not. They recommended we have a meeting with local pastors and other leaders to discuss this and encourage people to come to the clinic regardless of their ability to pay. Over the summer we had people coming from long distances past other clinics and hospitals because we are cheap. This was straining us to keep medications in stock. We are here to help the poor people of the mountains, not people with resources that come from Croix de Bouquets, because they don’t want to pay for medications. In November we started charging a small amount for medications patients take home from the clinic. Medications such as prenatal vitamins donated to us are provided free. This doesn’t cover half our costs for medications, but we thought it might encourage people not to drive past other clinics to come here. If patients say they can’t pay, Fre Willy and Fre Roosevelt in the pharmacy can make the decision to give medications free of charge. They are locals and know the needs of the people. It’s hard to know what the proper balance is. I hate asking people to pay, but we felt it was necessary to not take business from other clinics. Pray for us that we can have direction for this.
One afternoon I was catching up on work at the clinic and Kelson was out front. He heard a commotion at the gate and called me outside. I was met by a mother carrying a 7 year old boy covered in dirt with blood running down his face. He had been hit by a moto in the market. We brought him inside and started assessing and cleaning him up. The blood on his face was from a small wound above his eye. His left lower leg was deformed and appeared broken. I closed his wound with a suture. We put a splint on his leg and told them they should go to Fond Parisien for an Xray. They said they would but the next day we heard they had gone to a leaf doctor instead. They live close to the clinic so we went to their house to check on him. The leaf doctor had removed our splint and put on some sticks and some concoction that dries almost as hard as a cast. But it was too tight and only several inches long, so it didn’t provide proper support. We asked if we could put it into a cast. Mom agreed, so we went back to the clinic to get supplies. I gave him a shot of morphine. We tried to align the bone as best we could and put on a cast. We gave him some ibuprofen for pain and encouraged him to try and walk on it. I just checked on him, he is doing well with only 3 weeks to go until we remove it.
Sunday morning a landcruiser came to our house. In the back was a woman unconscious with deep rapid respirations. We met them at the clinic. Oxygen was normal with good air movement in her lungs. Her sugar read hi. So, DKA. I remembered the first patient I had here in Haiti. Very similar presentation. It was before the clinic opened so all we could do was give her some fluids before they took her to Fond Parisien. There the hospital sent her to Port, where she passed away. Remembering that I decided to do what I could for her here. I had tried for months and finally got regular insulin and IV potassium and magnesium. I started 2 IVs and started giving lots of fluids with IV insulin every hour. With DKA and IV insulin low potassium is a big concern. We can’t check potassium levels here. We bought a new monitor last fall so I placed her on telemetry (on our new monitor) and placed a catheter to monitor fluid output. I gave her potassium in the fluids. I know this is a big risk, but what choice is there?
I checked with the helicopter, but they were out of service. I kept giving fluids, insulin, potassium, and magnesium, wishing I knew what her levels really were. She had significant ST depression on telemetry, which can be caused by low potassium. It was interesting to watch the ST depression slowly correct with treatment. I stayed at the clinic all day and all night. This clinic gets COLD at night in the winter. The nurses gave me breaks to go eat. In the morning, she was awake, still breathing a little fast, but able to sit up and talk. I stopped giving IV insulin for a few hours but her sugar started going up again. So we continued with insulin and fluids. Kelson came and watched her for a few hours for me so I could go sleep. I went back to the clinic after lunch. The patient was doing much better. A urine strip had shown a possible urinary infection, so I gave her antibiotics for that. Ideally, she would go home on insulin, but here that is impossible. So I gave her diabetic pills, and hoped for the best. We told her to come back at the end of the week for a follow up. She was brought back to the clinic on Wednesday, unconscious, with a sugar of 444. We started IVs, fluids, and insulin again. I contacted Haiti Air. They were on another flight, but said they would ask the pilot when they got back if they could fly. Meanwhile I started calling hospitals and doctors in Port trying to find a place that would accept her. This is a frustrating process. Finally found one that said he would. Haiti Air got back to me and said they would fly. Their dispatch called the doctor to confirm he would accept the patient. He said he couldn’t anymore, but gave the number of another doctor who eventually said he would take her. So I notified Haiti Air. Eventually they got back to me and said they could no longer come, but we could try in the morning. So I messaged a doctor in the little hospital in Fond Parisien. He said to send her there. So I talked with the family and they agreed. Wozema took them in the ambulance.
The next afternoon, I was told she had died in the hospital in Fond Parisien. So many questions. What could we have done different? Should I have sent her Monday after she was stabilized instead of sending her home? Should I have kept her overnight again? Could I have done a better job of stabilizing her? Why is this country such a mess?
We have had Mis (nurse) Rachelle here from MSPP (Haitian health department) to do vaccines. She has been here for 6 months and has done an excellent job of keeping vaccines on hand, keeping up with childrens’ vaccines, and filing appropriate reports with MSPP. Her contract with MSPP to be here ended at the end of January. I’m happy to say she agreed to continue under contract with the clinic. This is possibly the most important service the clinic offers, and I’m happy to have her continue.
This is a picture of the baby that was resuscitated here in the clinic in November.
Thank you for your prayers and support. I am always happy to hear from anyone, so feel free to reach out. God bless you all!