Moving On

The month of May was a time of changes for us here at Confidence Health Center. Our nurse Carmina got here in spring of 2020 and was a major asset to the clinic. She learned Creole quickly and was well accustomed to the culture of the clinic work here. All good things must come to an end and in May her commitment here was completed, so she said goodbye to Haiti and returned home to Canada. We wish her the best in her continuing career.

God continues to provide, and we were thankful to be able to find another American nurse to replace Carmina. Kay is a registered nurse from Mississippi who has several years’ experience working in Oriani in the past, as well as a medical mission stint spent in Kenya. She committed to spending another six weeks here this summer. Her former experience here means that she already has a concrete grasp on the language and culture and was able to jump in with both feet. We are very thankful that she was willing to come help us out, filling a short gap before a more long-term nurse is able to come.

Otherwise, the clinic has been functioning well and we are as busy as we want to be every day. We are deep into spring rainy season now, which means that everything is green and the gardens are doing well, but it also means that the hungry season is reaching a peak. The crops are not quite ready to harvest and the markets are very sparsely stocked. We are fortunate to be a recipient of rice from Feed My Starving Children, provided to us through a mission here in Haiti called Love a Child. They donate food boxes periodically and in times like these we are very glad to have a little nutrition we can give to patients at the clinic. It never seems to be enough, and it’s always a challenge to know exactly who could benefit from it the most.

Here are a few notes from our past month at Confidence Health Center:

-        A neighbor came to the house one Saturday with their son, a boy around 10 years old named Mondi. His complaint was that he wasn’t speaking. Indeed, when they brought him to us he was completely unconscious, eyes closed, unable to move or speak. We tried everything we could think of to get him to wake up or to show some reaction, but the result was minimal at best. He would flicker his eyelids and occasionally swallow, and when we pulled him to his feet he was able to stand, albeit unsteadily with his eyes closed. His vital signs were all normal and the family insisted that he had not drunk or eaten anything unusual, was completely normal throughout the day until he just suddenly “became like this.” He was breathing normally and there was really nothing medical we could do for him without further testing and scans. The family said they wanted to take him to their pastor for a prayer service. That sounded like a good idea to me, so I sent them away. The next day I walked past his house and he was running around, grinning and being just as naughty as ever. He claimed he had no memory of what had happened the day before. We still have no idea what the cause was. Was it something neurological? Had he ingested some poison that they weren’t aware of? Was he under the influence of some dark magic? Probably will never know.

-        One evening several people brought in an old man who was weak and not speaking normally. His vital signs were normal but he was very lethargic and minimally responsive. I started thinking down the lines of a stroke but when I bent closer I caught a whiff of alcohol on his breath. Ah ha! Maybe he’s just drunk? I asked the family and they immediately agreed, yes he likes to drink and he gets like this when he drinks too much. Well, well, not much we can do for this! He needs to stay away from the bottle! We sent them home and the next day he came into the clinic slightly improved but still not fully functional. Several liters of IV fluids perked him up and he left later in the afternoon walking with support.

-        A very sad case came in one morning, a 14-year-old boy brought in by a female relative. The first thing we noticed was his extremely labored, heavy breathing. He was also very weak and unable to walk without assistance, but instead moved unsteadily and jerkily like a patient with Parkinson’s. He was awake and oriented but his speech was extremely slurred, he was restless, and could hardly breathe. He denied any medical history. Nothing seemed to add up to a clear diagnosis. Even his story didn’t make sense – he said he had lived in the Dominican Republic with his mother since he was a baby but had just come back to his birth home in Haiti the day before, alone, on motorcycle. He couldn’t really give us a reason for leaving his mother and said he had only become sick like this during the trip back to Haiti. I noticed that his tongue and mucous membranes were ashy gray and checked his hemoglobin – 1.8. Normal for his age would have been in the 12 – 15 range. We immediately realized that he was far too sick for our abilities here and began to discuss going to a hospital. Unfortunately, before we were able to finish making arrangements, he started foaming at the mouth and within a few minutes he had passed away. It’s so frustrating to us as American medical personnel to watch a case end up like that without clear answers. We would love to see an autopsy report, or lab work, or CT scans – something to give us an idea of what was wrong. He had obviously been sick for a while and we are just too far from definitive emergency care up here in the mountains. There was nothing more we could have done here, but the whole situation just leaves us sad and wondering.

-        This past weekend we were kept busy off and on checking up on a woman in labor. She was from the Oriani area and came in several different times within a few days, progressing very slowly. Finally by Monday morning her cervix was fully dilated but the baby was still very high and not advancing anymore, so we decided it was time to move her to higher care. Fortunately we had no trouble finding a hospital to accept her and she made the trip down to Fond Parisien in our ambulance. The doctors there confirmed she had cephalo-pelvic disproportion, a condition where the baby is simply too big and cannot be born naturally. They did a C-section and last we heard mom and baby were both doing fine. We were very thankful we had been able to help her and her outcome was positive. A case like that without medical care would have ended up with the death of the baby and likely the mother as well.

So, life moves on here in Southeast Haiti! For months, the COVID-19 pandemic was hardly mentioned in the country and life went on as normal, but in the past several weeks we have started to see in increase in cases again, mostly in the Port-au-Prince area. So there is once again a curfew and a mask mandate in the capital city, although up here in the mountains we have not seen any confirmed cases and are continuing to operate cautiously. The political instability and gang activity in Port-au-Prince seems to be on the rise again, and we monitor news carefully whenever we have to go to the city for supplies. There are a few areas to avoid, but usually business can be conducted safely and up here in Oriani we do not see any violence.

Keep the work in Haiti in your prayers! We need them.

A Call for Supplies

Our operations here at Confidence Health Center are funded 100% by donations. We charge a minimal fee for patient consultations, around $1.20 US per patient, but the amount brought in is barely a drop in the bucket of our regular expenses. Each of our American staff here on a fully volunteer basis and receive no salary. We are immensely thankful for each donor that makes keeping this clinic open possible, from the individual who donates one time to the foundations and groups that are committed long-term. Every one of you is appreciated. It amazes us many times to see how God has continued to provide for us to be open these past 10 years, even in times when we didn’t see a clear way forward.

Today we would like to highlight one group that gives generously to our clinic: Christian Aid Ministries. CAM is a non-profit international aid group based in Berlin, Ohio. We have been privileged to be on their list of recipients for several years now, and our clinic operations would be much more difficult and expensive without their assistance. Their operations in Haiti were on hold for several months in 2020 due to the instability in the country, and we felt their absence keenly. We are very thankful they were able to return to full capacity a few months ago.

CAM has a base in Titanyen, Haiti, and periodically they send us a shipment of donated supplies. These range from over-the-counter medications like Tylenol and cough syrup, to face masks, IV supplies, newborn layette bundles, soap, and much more. Getting a shipment from CAM is like Christmas and we eagerly open the boxes and watch our stockroom shelves fill up! Thank you, Christian Aid Ministries, for your continued support of Confidence Health Center. May you be blessed for your work here in Haiti and around the world.

We would also like to get the word out that we are very open to receiving recently expired medical supplies from clinics and hospitals in North America. Often items like intravenous catheters, bandages, sutures, and instruments have expiration dates but are still fully functional and safe to use after that date. North American healthcare standards require hospitals to junk all supplies and medications that are expired, but operations like our clinic are happy to receive them and put them to good use, providing they are still in the original sealed packaging and do not involve medications that are unsafe after the expiration date. If any of you work at a hospital or other medical facility, or know of someone who does, you can contact your management and let them know that there is a place they can donate their expired supplies rather than seeing all those resources thrown in an incinerator! We have a normal USPS mailing address in Florida, and a company called Missionary Flights carries cargo from there to Port-au-Prince twice weekly, making shipping items down here as simple as dropping off a box at your local post office.

If you have any questions regarding sending expired supplies, reach out to us on Telegram or WhatsApp at +509-38-37-0605 or email at chc.oriani@gmail.com. We will be happy to talk with you and decide if what you have would be appropriate to send. Thanks for your consideration and may you be blessed for your efforts.

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…