This has been a wild, unforgettable week for the country of Haiti. As many of you are aware, our president was assassinated in his home Monday morning. That event and those that followed brought the country to a virtual standstill for a day or two. Businesses were closed, traffic was almost non-existent, and the majority of the population stayed home to see what was going to happen next. There is still a lot of uncertainty about where everything is going, who will replace Jovenel Moïse as the next president of Haiti, and who was exactly responsible for the assassination, but in general life is returning to normal, whatever normal is for Haiti anymore.
As usual, the events and drama circulating throughout Port-au-Prince and other major population areas hardly affected us here on the mountain. We are blessed to be living in what has proven over and over to be one of the safest, quietest areas in Haiti, and we hope to never take our peaceful lifestyle here for granted. Our neighboring clinic at the Catholic church closed for several days following the assassination, but the Haitian advisory committee for our clinic felt it would be unnecessary for us to close, and would even do more damage than good to leave the sick people stranded without medical care for several days. So we remained open as usual the entire week.
It seemed to be a particularly busy week, maybe partly because the patients that would otherwise go to the Catholic clinic had to come to us instead. We had long, full days in the clinic and then numerous after-hours calls at the house.
Mondays are always busy days for us, and we started out this week with a bang when a very sick baby came in first thing Monday morning. She was about 9 months old and had been staying with her grandma for a time while her mom was down in Port-au-Prince. Unfortunately it appears as though her grandma wasn’t able to take very good care of her, because when she arrived she was in very bad shape. She had watery diarrhea and vomiting and was dehydrated, in addition to being chronically malnourished. We walk a fine line trying to rehydrate a malnourished baby without overloading the weakened cardiac system. She was still able to swallow so we gave her oral rehydration solution by mouth. However, she continued to vomit and we wanted to give her a small amount of IV fluids to supplement her oral intake. We were unable to find a vein so we had to resort to intraosseous access, which is a large needle bored into the bone marrow. This sounds more brutal than it is, and in fact IO access is a very effective way of giving fluids when unable to access a vein.
We kept her in the clinic throughout the day Monday and she stayed about the same or slightly improved. She continued to have diarrhea and intermittent vomiting but she became more alert and able to tolerate oral fluids. Since the mom lived directly across the road from the clinic, we let her take the baby home for the night.
We continued monitoring this baby throughout the week. During the day she would come to the clinic and in the evenings the family would take her home. Normally we would refer a patient this sick to an inpatient malnutrition center in Port-au-Prince, but there was quite a bit of uncertainty about the condition of the city and the family was not very excited about going down.
During the week we got another very sick case, this time an older man having trouble breathing. His symptoms pointed to a respiratory infection of some sort, perhaps pneumonia. His oxygen levels were critically low, in the 30% range while breathing room air, where a normal oxygen level should be above 90%. Even on the maximum amount of oxygen we could give him, his levels never came up to normal. He was really too sick for our limited capacity, but the family was very unwilling to take him to a hospital in Port, partly because of the condition of the country and partly because he was a very old man and they seemed to think his chances of survival were low even with hospital treatment. So we kept him for several days in the clinic, putting him in our ti kay, or little house, for the nights.
After a couple of days treatment, the old man was not getting any better. We called our minister, Frè Ilomy, to come visit with him. They chatted for a long time about heart matters, and in the end Ilomy told us the man felt his way with God was open and he was ready to die, if that was God's will. He continued to repeat his wishes to not be transferred to Port-au-Prince.
On Thursday, after treating the malnourished baby throughout the week and keeping the old respiratory man on oxygen, imagine our surprise when another dehydrated baby came in for consult. This one was not nearly as sick as the first but still required very close monitoring and careful fluid rehydration. We gave small amounts of IV fluids throughout the day while pushing oral fluids as well. Kay’s room got pretty full sometimes with both sick babies and both moms, and sometimes a passing family member or two! Thursday night we gave the second baby's mom the option of staying night in the ti kay, since she was from a long ways away, and she agreed. So we transferred her and the baby to the ti kay after clinic was finished Thursday.
Thursday evening the old man took a significant turn for the worse. Even on oxygen, his levels fell to 55%. He and his family were firm in their decision to stay in Oriani rather than be transported to Port, and they said they would like to spend one last night in the ti kay and go home Friday morning. We were not sure he would make the night, and we explained the situation to the second sick baby's mom and asked if she was still OK being in the same room with him if he passed away during the night? She said she was fine with it.
Friday morning the man was still alive, and we removed his oxygen and watched as his family loaded him into a car and took him home. He was in pretty rough shape and we were not surprised to hear he passed away before noon the same day. Even though any death is sad, we are at peace with his report that he was prepared to meet his Maker and was not afraid of death.
Thankfully, the second baby was doing much better. He was awake and active, playing and sucking on a lollipop. We gave some more oral fluids and monitored him for more vomiting, but when he tolerated the fluids with no problems we discharged him home. The mom was smiling and ready to go. They plan to return to the clinic next week for a check-up.
Our first baby came back to the clinic and we could quickly see she was no better. In fact, she was now unable to swallow and the family said she had slept all night so they had not encouraged any drinking. In addition, her intraosseous access went bad so we had no alternate route to give fluids. I inserted an NG tube, a small tube running from the nose into the stomach, and gave her some fluids that way.
Soon after we started giving fluids through the NG tube, the mother asked if she could take the baby home so they could go to a hospital in Port-au-Prince. We were surprised because this was the first time all week that we had heard her express that wish but we said sure, if she was willing and able to make the trip and the roads were open, she was welcome to do that. I pressed her on the details of her plan, and told her I preferred to keep the baby until she was completely packed up and ready to leave, so we could continue to give fluids as long as possible. She said she was ready to go right now, so we removed the NG tube and she carried the baby out. We felt good about the plan, and felt that if the baby was able to make the trip within a couple of hours, there was a good chance she would be admitted to a children's hospital and given round-the-clock care.
Imagine our disappointment when we heard this morning that the baby had died overnight. Apparently the mother had decided to wait to go to a hospital until Saturday rather than going immediately after leaving the clinic Friday, like she had promised us. The baby was unable to make it that long and had died at home. We were very disappointed and confused why the mother had delayed going down for so long, but maybe God had a hand in all this? Maybe it was for the better? The baby appeared to be poorly cared for, so all in all we have to believe that it’s better for her to sing with the angels than to keep suffering here on earth. We once again are reminded that we are not in control and many things we will never understand.
Keep this country, and our project, in your prayers. These are uncertain times for sure, but Haiti is no stranger to turmoil and we feel safe up here in Oriani. For now, we will keep on keeping on!
