A New Roof

It is the afternoon of April 19, and the clinic is finally quiet after a busy day. Monday is market day in Oriani, so a lot of people from outside the community pass through the area and many of them time their clinic visit to coincide with their market trip. So Mondays are long, full days here at Confidence Health Center! Today we saw, among many other cases, a three year old girl with partial-thickness (2nd degree) burns to her left arm and neck as a result of hot water spilling on her; an unfortunate young man with a badly deformed right arm due to an accident he suffered back in January and was never able to find a hospital to reset his broken bones; and a very tiny baby that was born 6 days ago weighing only 1.45 kg or 3.2 pounds. She is doing amazingly well, even though her mouth is too small to breastfeed so the mother has to get creative to get milk into her. She is almost too small to believe but otherwise appears healthy. Time alone will tell how resilient she is and what her outcome will be.

March was a busy month for us. We saw a total of 1,744 patients, which included 1,223 adults and 521 children age 14 and under. We delivered 2 babies and performed 388 prenatal consults on pregnant women. Otherwise the patient census was mostly more of our usual: hypertension, diabetes, wound care, cough/cold, and skin infections. We also vaccinated 22 children.

In other news, we are very happy with our new and improved clinic roof! Back in February we were blessed to have a group of volunteers fly into Haiti from the States and help us fix our roof. The original metal was in bad shape, with lots of rust spots and holes here and there. The old skylight material was brittle and broken in places, and patching it was ok in the short-term but was not a long-term fix. Every heavy rain brought rivers of water pouring into the clinic. Our board member Dave inspected the roof during a visit last year and arranged for a crew to come repair it by applying an acrylic coating over the existing metal to seal the leaks and extend the lifespan of the roof. We went with a brand called Duro-Shield, which was shipped in a while ago, along with new heavy-duty skylight material.  

The crew arrived on Saturday, February 20 and we started work the following Monday morning. The first item on the agenda was pressure washing the old tin and treating the rusty spots with a wire brush and a rust inhibitor called Ospho.

Treating the rust spots with a wire brush and Ospho.

After that we removed the old skylight material and replaced it with the new. There was an immediate difference in the amount of lighting inside the clinic; I compare it to old fluorescent lighting versus new LED. It was an incredible improvement!

New skylight material.

While the skylights were being replaced, we sealed up the larger rust holes with a caulk material called Vulkem. The final step was applying the new acrylic coating, which is a thick white paint-like substance and went on with a brush and roller.

The old weathered tin versus the new white acrylic.

We were finished up by Wednesday evening and spent Thursday cleaning up and taking care of a few other odd jobs around the clinic. We were also lucky enough to have time to take the crew to the beach and let them experience the beauty of the Caribbean on Friday! Saturday afternoon they flew home. It was a busy week but worth every bit of effort.

The finished product!

We have tested the new roof this rainy season and are very pleased with the vast improvement over the old. There are a couple of tiny spots we need to touch up, but we do not deal with water pouring in multiple places in a heavy rain anymore. We give a huge shout-out to the crew: Dave, AT, Andy, Ryan, Shandon, David, and Joni! Your time and efforts are much appreciated! It is people like you that make running and maintaining this clinic possible.

Voices of Oriani

An old man comes into the consult room and sits on the chair. As his vital signs are being checked, the nurse asks, “So what health problem do you have today?”

“My pee is sweet.”

“Really? It’s sweet? How do you know?”

“Because I tasted it.”

Oh. Well, that’s not necessarily what we wanted to hear. Turns out his blood glucose is through the roof and he is diagnosed with diabetes.

 —

It is a pitiful scene. They have come from Bodarie, which is about a 3 to 4 hour walk from the clinic, down a deep ravine. Grandmother is small and poorly dressed, her daughter is even worse, and the grandbaby is swaddled in a bundle of blankets. Mom and baby are both here for consults. She is only 19, and she delivered the baby one month ago. Now she is wasted, skin and bones, and covered in a strange rash. We run tests for HIV and syphilis but both are negative. We give her what treatment we can and turn our attention to the baby.

As we unwrap the layers of filthy blankets, our disbelief grows. At the bottom of the bundle is a tiny, wasted boy, covered in dried stool and old vernix left over from his birth. Every skin fold is crusted with dirt. He has obviously lain in stale urine for a long time, and everywhere his skin has been wet is fiery red and peeling. We weigh him: 1.8 kg. That is 3.96 pounds for a child a month old. We fire questions at the family. “Was he born normally? Full term? Does he breastfeed? Why is he so dirty? Does anybody even hold him ever? What is he eating?” The mom and grandmother simply hang their heads and murmur responses. Obviously mom is in no shape to take care of a newborn in her condition so we focus our questioning on grandmother. She insists they bathe him but when we show her the dirt crusted in his hands, she turns away. She says he can’t breastfeed so they feed him sugar water mixed with a little milk in a bottle. She shows us the bottle and we cringe as we dump the brownish liquid down the sink.

We clean up the little guy as best we can. He screams as we try to wipe dried poop off of his macerated back. Finally we get him fairly clean and bundle him up in a clean, dry diaper and outfit. We wrap him in a soft blanket donated from a sewing circle in the States and feed him a bottle. He has one good thing going for him: he still has good strength and takes the bottle well. He calms down and goes to sleep after drinking a couple of ounces.

We give the grandmother formula powder and lots of instructions. We tell her she must keep him clean and dry. She must not let him lay in urine. She must feed him every hour on the hour or when he cries. And she needs to bring him back in a couple of days.

Two days later, right on the dot, she is back. Baby looks much the same but this time weighs 1.93 kg, which is a positive sign. At least he is feeding and gaining weight. We give him more formula and clean diapers and send him on his way.

We lose track of the little guy for quite a while. We told her to bring him back on the following Wednesday, but she doesn’t show up. Our hearts are heavy at the thought that we may have lost him. Where is he? What is she feeding him if she ran out of formula? Is she keeping him dry? Then one day, when the clinic is closed for maintenance, there is a knock at the gate and here is grandmother, holding a bundle of blankets. She had misunderstood the return date and we usher her inside.

Our hearts are in our throats as we unwrap the baby. What will we find? Worse? Or miraculously healed and growing? The truth is somewhere in the middle. The good news is that he weighs 2.19 kg, so he is continuing to gain weight. However, he is weak and his skin is still macerated and peeling. We clean him up again, apply ointment to his broken skin, and feed him tiny amounts of formula. After watching him for several hours, we bundle him up and send him on his way with the plan to see him again soon.

They haven’t been back. What will become of him? What is God’s perfect plan for a baby like this? He appears to have a good chance at life, if only he was in a caring, warm environment. Is there someone that can take care of him? What would happen to him if he was in a home that had all the resources that we Americans are used to? There but for the grace of God go I, and every one of us. Hug your children tonight, and be thankful for your warm dry home.

 —

It is late in the evening. The clinic has been closed for hours and the household is winding down at home. Then there is a knock at the gate. Immediately possibilities flow through your mind. Is it a woman in labor? Is it a stroke? Moto accident? Child with respiratory problems? Who knows. We go to the gate to see.

We see a large crowd assembled outside. They seem to be grouped around a young lady who at first glance looks fine. No obvious injury. Standing on her own. “What is the problem?”

“She got shot.”

“Shot? Where?”

They point to her right upper leg. There is a torn hole in her jeans and a cord tied tightly above and below the hole. There is a little blood but no obvious hemorrhage. We open the gate and usher her into the light on the front porch. She pulls down her jeans and tells her story.

She was not fighting or arguing. Other people were and she was just simply in the middle of it. While she was sitting there minding her own business and watching the fight, someone fired a gun and hit her in the leg. As she’s talking, we examine the wound. There is a jagged hole about 1.5 cm across right at the top of her thigh. There is no obvious bleeding, even after we remove the makeshift tourniquets they had applied. And what is really strange is that only about 2 inches away, right under the skin, we can feel the bullet. She claims the shooter was in the same general vicinity as her, but why the bullet would have traveled only 2 inches in soft tissue at such close range is a mystery. Some things just simply don’t add up here.

We come to the conclusion that the injury is very superficial and we can probably remove the bullet just fine right here. There are no bones or major blood vessels involved. No sense in sending her to a hospital in Port. So we go to work, making a small incision over the area where we can feel the bullet and attempting to extract it.

Foreign bodies are notoriously hard to locate and remove, even when they seem so superficial and easy to find. This bullet is the same way. We have a very hard time locating it, and when we finally are able to make contact with a forceps, it simply squirms away from us. What we finally end up doing is to push the bullet along its track and force it out the entry hole it went in. It eventually pops out, completely whole and undamaged. We bandage her up and send her on her way. Just another day in Oriani…

The Good, the Bad, plus a little Voodou

There are few dull days here in Oriani, and it seemed like January was par for the course – lots of interesting cases! We saw a total of 1,611 patients, delivered 4 babies, vaccinated 35 children, and did 213 prenatal consultations. Here are a few highlights since our last update:

One Sunday during the morning church service, a motorcycle pulled up to the church and the driver asked for some help with his wife, who was in labor. Turns out we knew the guy; he drives truck for a good friend and fellow church member, Ti Pierre. So Carmina, Chancela, and I headed over to the clinic to assess her. Everything seemed to be progressing normally but she was very early in her labor, so we sent her home with a few instructions and told her it would likely take a while, as this was her first baby.

Fast forward to Tuesday, when my phone rang at 2:45am. It was our friend Ti Pierre telling me his driver’s wife had not yet delivered but they felt it wouldn’t be long. I told them to come to the house and we would assess her. While I waited for them to show up, I got around a few supplies we would need in case the baby was to be born quickly. When he pulled up in the driveway and honked, I went out in the cold darkness and unlocked the gate. Here was the same lady we had seen Sunday, accompanied by her husband, along with Ti Pierre and his wife and the usual assorted family members. We ushered her onto the front porch where we had our supplies set out and examined her. It was obvious that the baby was not far from being born, so I woke up Chancela and Roseline to come assist and we gloved up. While we waited on the baby’s arrival, Ti Pierre’s wife played double roles by supporting the laboring woman while at the same time keeping us entertained with stories about how her babies’ deliveries had gone in years past, and how Ti Pierre didn’t like to see her suffer so he always left when she was in labor. We tried to get this lady’s husband to come in and support her, but he told us he “didn’t have the heart” and quickly vanished back into the darkness. Apparently, that’s a cultural thing here. In the States, we put a lot of importance on dad being around for the delivery, but here it is very common for the husband to be unable to support watching their wives in discomfort, and many times they choose to be nowhere around. Anyways, we chatted and coached the laboring mom, and around 4:00am, a beautiful healthy baby girl was born! It is a pleasure to help any and all patients, but it seems especially good to see someone you know personally have a good outcome.

Unfortunately, not all our patients recently have had an outcome that positive. One early morning Carmina and I headed to the clinic to see if we could help another laboring mother who was pregnant with twins. An ultrasound done earlier in the week had shown abnormalities with the pregnancy and we had told her she must go to Port-au-Prince for a hospital delivery, but unfortunately she went into labor before she had time to make the trip. The first baby was born normally at home but the second was not delivering, thus her reaching out to us for assistance. We quickly discovered that the second baby was already dead. We did what we could with the capabilities that we have here, but sadly, she hemorrhaged and passed away in our clinic. It was a blow to us to see a patient die that we were trying to help, especially a new mother with a small baby. The family and locals made it even harder, if possible, by graciously accepting the outcome and thanking us for doing what we could to help.  But it caused us, once again, to remember that we are only tools in God’s hands and sometimes there is nothing we can do with our limited resources and abilities. After she died, some fantastic stories starting floating around town. It is custom here that when a pregnant lady dies, she cannot be buried with the baby still inside. The family of this lady had made some attempts to extract the baby on their own, but were unable to. So the next step was to hire an ounga, or a witch doctor, to cast a spell and make the dead mother deliver the baby. We were left with many questions and we still have no idea what the true process was, but in any case the baby was, indeed, removed from the mother’s body before burial. Some things are better left undiscovered. The dark side definitely has power over those who believe in and practice it, but the Christian need not live in fear.

Down the same line of voudou and dark magic, we had another interesting case recently where a lady brought in her fifteen-year old son for consult. Her story was that he had been sick for several days with a headache, abdominal pain, and some vague psychological symptoms including talking strangely, wandering around, and not responding appropriately. She also reported that he had lost bladder control and was now urinating on himself. I had many questions in my mind as I examined him. He appeared to be a well-developed, normal fifteen year old, but he simply stared blankly at me and refused to answer most of the questions I asked. “How old are you?” Blank stare. “What is wrong today?” Nothing. “Can you tell me your name?” Silence.

His vital signs were normal and I could find nothing obviously wrong with him, but something was clearly not right. He had, in fact, urinated on himself, which is not a good sign. Finally I asked Carmina to come take a look to see if she could figure out anything, and when she came into the room things started falling into place. “Do you know who his mom is?” she asked. “She’s a mambo.” A female witch doctor. Ok, so maybe there is something more than medical going on here? As the story unfolded, we found out that she had already taken him to an ounga, or male witch doctor, quite a distance away in Belle Anse, but he had told her to bring him to us. I felt somewhat helpless, as it seemed there were spirits at work here that we probably could not conquer in our short consult time. We finally gave him a few medications and sent him home. When we told him he was free to leave, he simply rose from the chair and stood in the middle of the room, staring blankly around as if he had no idea what to do next. We pointed out the door, and he took a few slow steps in that direction before stopping again and swaying on the spot. Finally his mambo mother took his hand and led him away. What more should we have done? What will his outcome be? What power does darkness have in such a young person? In those circumstances I feel so helpless and my understanding of the Haitian Creole language seems too rudimentary to try to explain what I’m thinking or feeling.  Since then, I’ve visited with a friend of mine here about this boy and he encouraged me that if he comes back to the clinic, we should let our secretary Frè Willy know what is going on so he can come visit with the family. He is a minister in our church and can help us work through these situations.

February finds Haiti in uncertain times. The president, Jovenel Moise, was supposed to be finishing his term and holding elections this weekend, but he says he is not giving up his seat because it was a full year late that he was able to take up the office because of the political situation at the time. The opposition is demanding that he step down, but the international community including the United States supports his claim to another year in office, so we’ll see what becomes of it all. In any case, here in Oriani we feel safe and quiet, relatively insulated by miles of rugged mountains from the unrest in the capital of Port-au-Prince. Keep us in your prayers and support our work if you feel prompted! We can’t do what we do without you and your donations.

Unto Us a Child is Born

December brings thoughts of Christmas and remembering the birth of Jesus, so it seems only appropriate that we had a rash of babies born here at Confidence Health Center in the past month.

Our first was December 9, when our former nurse Larissa was back from Canada for a short visit. We actually had two laboring women in the clinic at the same time that day, and while some of the nurses were assessing the mom in the back room, Larissa got to catch a healthy baby boy in the front room. Deliveries were always a highlight for her during her time here and she had told us she wanted to catch a baby again during her visit.

The very next day our nurse Carmina was out visiting in the community when she called and told me that we needed to get to the clinic ASAP with a pregnant lady who was having delivery problems. We jumped in the ambulance and drove to the lady’s house, which was just out of town past the clinic. After loading her up, we took her back to the clinic and began assessing the situation. Mom was young and this was her first baby. The baby was already crowning but it appeared that the birth passage was small and the mother was becoming exhausted. We began exploring our options for assisting her but after about 15 minutes she was able to deliver on her own! Unfortunately the little guy came out gray and limp, and only after vigorous stimulation and suctioning did he start to breathe on his own and pink up. He never did have that loud healthy cry that we like to hear, but by the time mom was ready to go home he had stabilized. He had bilateral clubbed feet, something that we hope can be repaired in the future.

December 17 was our staff Christmas lunch at the clinic, and while we were in the back enjoying the rice and beans there was a laboring mom in Chancela’s consult room. As time moved on, the nurses became concerned that there was little progress and started discussing whether this mom would need an ambulance down to Port for a C-section. While most of us were out of the room, Carmina went in to find mom squatting on the floor with the baby’s head already delivered! There were calls for some assistance, and soon we had a perfectly healthy baby boy on our hands. It seemed that once mom got serious about having the baby and started pushing in earnest, it only took a few minutes.

December 22 was our last day of clinic before closing for the holidays. It was also the day that we got visitors! My sister and family from Texas came to spend Christmas with us. We are always glad when family comes and we can show them around this beautiful country we are starting to call home.

Just because the clinic is closed doesn’t mean there aren’t patients to be seen. Throughout the holidays we saw occasional emergencies at the house, and one evening there was a knock in the dark and two men were standing in the cold outside the gate. “We have a lady in labor and she needs help.” These words always bring a certain anxiety, because there are so many things that can and do go wrong with childbirth. Before long we had a place prepared in the front porch and when mom showed up, a quick exam showed us that this baby was very close to being born and there was no time to get to the clinic! So we got supplies around (fortunately we keep a few basics at the house) and a few minutes later a perfect little boy was crying loudly and blinking his dark eyes. He was the picture of health, about 6 pounds or so (we don’t have an infant scale at the house) and very alert. My sister got the privilege of cleaning him up and dressing him while Carmina worked at finishing up with mom. She had a pretty severe vaginal laceration, and it’s moments like these that make us glad we were at the right place at the right time, because without a skilled birth attendant to suture these lacerations there is potential for complications in the future.

So that rounded out the month with four deliveries, all boys. In fact, the last eleven babies we have delivered here at Confidence Health Center have been boys! It seemed like an appropriate way to finish December and head into Christmas, fresh with the memory of what it really was like for Mary to deliver the Savior of the world in a stable, surrounded by animals. The pictures in children’s books depicts the scene so clean and bright, but in reality childbirth is not easy and Jesus came into this world just the same as every other baby, in pain and travail.

So with that, 2020 is history and we wish all of you a very Happy New Year 2021! We move forward trusting God to continue to guide us here and bless our efforts as we work in this community.