Pa Ka Pale

An American nurse working at Confidence Health Center learns that some things aren’t what they first appear. Or rather, some things aren’t what they first sound like. Like any other language, Haitian Creole has many figures of speech and nuances. It’s only a matter of determining what these are and what the real meaning behind them is. This is a continual learning process, and even after working in the clinic for a year or two, one still has to sometimes sit back and say “Excuse me? You say what?”

Here are a few examples:

L’ap manje mwen. The literal translation of this is “It’s eating me.” As in: “I was chopping grass with a machete and accidentally sliced my foot open. Now it’s eating me.” Ok, exactly how is your foot eating you? Further questioning reveals that the foot is, in fact, hurting. It’s hurting bad. It’s eating me. What I need is some pain medicine and a bandage and maybe it won’t eat me anymore.

Depi anvan ye. This reply comes to the question, “Since when have you had this rash? (or this pain, or this wound, etc.) The patient frowns and thinks. Finally the answer comes: “Depi anvan ye.” Well, directly translated this means since before yesterday, so it is very little help to the nurse conducting the assessment. Yes, I can see that this foot has been infected for a long time. Definitely since before yesterday. But when exactly? A week ago? A month? A year? The patient nods. Yes. All of the above. Sometimes they clarify: “Pou plizye jou.” For many days. Ok, never mind. It’s not that important. We’ll forget about trying to find out exactly how long it’s been. Sigh.

Doule anba kè. We hear this multiple times per day. Almost every patient complains of this, both young and old. It means “under my heart is hurting.” Sometimes under my heart is “burning” specifically. I need Tums and omeprazole. I have heartburn.

Li poko gen laj. This is the occasional response we get to the question, “How old is your baby?” Mom frowns and shakes her head. “He doesn’t yet have age.” Well of course he has age, he’s right there in your arms! What age is he? When pressed for details, mom might be able to remember the date of birth. Calculating off of this, you can deduce that the child is 2 months old. But in the view of the mom, he doesn’t have age yet. He’s just a baby. A newborn. Nothing more and nothing less. Age doesn’t matter.

Pa ka pale. These words seem innocent but they usually carry a story. Translated, this is simply “cannot speak.” As in: “We were in the market and left our sister home alone. When we got back this afternoon, we found her lying in her bed like this. She can’t speak.” You bend to examine the patient, and indeed, she is lying flat on her back with her eyes closed, not speaking. Whether or not she actually can speak is not argued. You can try to coax words out of her, but the family is quick to assure you it won’t work. You’re wasting your time. She simply can’t speak. Her breathing is normal and unlabored. Her vital signs are normal. Her eyelids flicker when her eyelashes are brushed, giving the indication that she is conscious and aware. But nothing you do or say will get her to speak. What is the deal? The first time the American nurse encounters this, many wild possibilities come to mind. Has she had a stroke? Seems unlikely, considering she’s 18 years old and in apparently good health. Did she have a seizure and is now in a post-ictal state? She has no history of seizures. Was she poisoned? Is it tetanus? You question the family, as they are the only ones currently able to contribute to the story. They shrug and maintain their story that nobody was home and therefore they have no idea what happened. However, as you continue questioning and probing the issue, the pieces of the puzzle start falling into place. The details come little by little, but in the end you get the gist of the problem. It seems that the girl was not, in fact, alone all day. She had a visitor, a neighbor girl who does not get along with her. They had problems between them, and the conversation got hot, and words were flung around like rocks. There were a few blows exchanged. And then the girl became like this. She can’t speak. Hmm… is she just angry? Yes, the family nods their heads sagely. She is angry. That is all? She can’t speak because she’s angry? Um-hm. Yep. Looks like it. Ok. Well, not much we can do about this! We can give a little something to calm her down, but this is a personal problem and medicine isn’t going to cure it. Yes, the family agrees. It is a mind thing. A problem with her spirit. She needs to forgive her neighbor. We give a little sedative and some gentle counseling and send them on their way. Sometimes the “pa ka pale” sickness strikes because of grief. I recently went to the house of a neighbor lady that had recently buried her son. She was lying in bed, staring at the wall. She couldn’t speak. I checked her over and eventually gave her a injection of diazepam, a sedative. A few hours later when I passed by, she was sitting up, smiling and able to speak again.

Mwen pa ka monte mòn. This complaint usually comes from an older person. The average age in Haiti is startlingly young, but occasionally we’ll get a patient who has passed the mark and is still with us. They usually don’t know their age exactly, but their hair is gray and their normally smooth face is lined with wrinkles. They peer at you with rheumy eyes and squint when you speak to them, having difficulty understanding your American accent. You ask what is wrong? The answer: “Mwen pa ka monte mòn.” Um, excuse me, you can’t climb mountains? “Exactly. When I’m walking home from work in the evenings, I find that I can’t climb the mountain. I get short of breath.” Well, that certainly is a problem, considering that you would be hard pressed to find 100 feet of level ground within walking distance of here. There is literally nothing but mountains here, so if you find that you suddenly can’t climb mountains, you’re in a hard place. But we patiently educate the patient on the natural process of aging, that maybe when you’re 70 years old and have done hard manual labor every day of your life, it’s normal to feel a little tired when hiking these mountains? I mean, I’m in the prime of life and I still sometimes feel like I’m going to give out, hiking up a particularly steep place. They smile and nod their understanding. We give them vitamins and some oral nutrition solution. Go home, papa. You’ve earned your rest. Maybe you will be able to climb a few more mountains yet.

Life Happening

Surprises in the Night

One evening as it was getting dark we noticed some activity outside our gate at the house. I could see the blue flickering of a phone light and murmuring of voices. I didn’t think much of it because the road past our house is a main route to the next zone, Oplimèt, and people pass at all hours. However, around 10 pm I went out to lock up the gates and noticed that there seemed to be some people milling around in the road, not going anywhere, so I shone my light through the bars of the gate to see what was up. In the dimness I could make out the forms of one or two people shuffling about, wrapped in jackets and scarves against the night chill. But what caught my attention was a large angular shape on the ground at their feet. I squinted through the bars to try to figure out what it was. It seemed to be a large object covered in some sort of a plastic sheet, and parts of it glittered bright gold in the light of my flashlight.

Slowly the thing came into focus and I realized, with no small amount of surprise, that it was a coffin. The shiny gold parts were the decorative molding around the handle. It was just sitting innocently in our driveway as though there was nothing at all strange about a coffin on the ground at 10 pm. I immediately thought of several questions I needed answered, so I caught the attention of one of the ladies standing beside it and asked what was going on? She explained that someone in Oplimèt had died and this was their coffin. It had just been brought up from a coffin shop in Port-au-Prince and our driveway was as far as the delivery vehicle could go. Therefore they had unloaded it and were waiting on someone to come from the house of the dead to pick it up and take it the rest of the way. My next question, of course, was whether or not anything or anyone was inside? She was quick to assure me that no, no! It’s empty! Somewhat placated, I left the ladies and their coffin where they were and made sure everything was closed up for the night.

A while later we heard raucous singing and chanting coming up the road. It sounded like quite a crowd of people had left the house of the dead and were coming to fetch the coffin. Side note: the night before a funeral in the Oriani area involves a veye, or a “watch”, wherein the body of the deceased remains in the presence of the family and assembled friends for the whole night. The only way to keep your sanity and stay awake while sitting around a coffin all night is, apparently, to drink alcohol, so the booze flows freely and by the morning of the funeral there are usually several people fairly soused.

By the sound of the crowd coming up the road in the pitch darkness, there had already been no small amount of alcohol consumed, and it was rather unnerving to hear their boisterous chanting and singing shattering the night stillness as they clustered around our gate, arranging the coffin. Presently they assembled themselves and headed off, their funereal marching song fading away into the night as they disappeared back down into the Oplimèt ravine.

The Vow

Recently we had a lady show up to our gate after hours in labor. She was accompanied, as usual, by a crowd of ministering friends and family, none of whom happened to be her husband. In this culture, the father of the baby is usually not present for the birth, or if he is around, he is skulking in the shadows outside, unable to handle the sight of his wife in discomfort. So the fact that this dad was not around was not surprising.

Our initial assessment of the mom gave us hope that it wouldn’t be long before the baby made his appearance. Therefore we assembled the necessary supplies and got ready to deliver a baby. But then things got a little weird.

Contrary to our initial prognosis, the baby stubbornly refused to be born. After quite some time of letting mom labor on her own, we got her up and encouraged her to walk around for a bit, hoping that would speed things up. Nothing happened. The baby’s head remained in the exact same position as when she had arrived. In addition, mom seemed to not be handling things very well and was in discomfort somewhat greater than normal. We did everything we could but there is not much that can be done to encourage a baby to come down, and finally the mom started to ask if she could just go home and have it at home. Usually with a lady in labor this far advanced, we don’t let them go, but she kept insisting and it was obvious that we weren’t doing much to help her anyways, so we packed her up and sent her out the gate.

And that’s where she stopped. She sat on the ground immediately outside and leaned against our fence, making an undue amount of noise and attracting a huge crowd. Neighbors of all age and size stopped to watch the spectacle of a lady apparently near delivery, sitting on the gravel outside the house of the “doctor” with no nurses helping her. Her family huddled around her and everyone involved gave lots of advice about what to do. Finally the whole scenario was getting a little out of control and it was apparent that they were not going home like they said, so I went out to see what I could do.

When my neighbors saw me coming out, they met me at the fence and wanted to talk. I explained that we had not just thrown this woman out on the street, but she had actually requested to go home. This was apparently news to everyone, and they were all amazed and shocked to hear that she had done such an unwise thing. Quickly the news spread around the crowd: “She ASKED to go home! They didn’t send her away! She WANTED to leave!” Judgement was quick and final: it was unanimously agreed that this woman had lost her mind and in fact, the wise thing to do would be to take her right back inside and deliver the baby appropriately. Meanwhile, everyone continued to encourage her to “Push!” and one man even tore off a tall stalk of grass and commenced to act like he was going to beat her with it, apparently in an effort to encourage her to stop being so dramatic and just get the baby born.

I decided we needed to take this into our hands and cut down on some drama. I explained that we would take her back in and continue to monitor her, but we would only let a select few of her family inside and everyone else needed to go home and not stand around the fence staring. Everyone heartily agreed with this plan, and they helped the lady to her feet and she staggered back inside. Slowly the crowd dispersed and silence reigned outside once more.

However, things didn’t move any faster than before. The baby was stubbornly in the same position. Even though dad had finally shown up and was giving his support, it didn’t seem to make any difference. Finally things started becoming more clear and the pieces of this mystery started falling into place. It seems as though the family was involved with the dark magic world, an all-too-familiar system in this culture given the blanket term “mystic.” They had apparently made a sèman, or a binding vow, that this woman must have the baby at her house, surrounded by her own people. The details were hard for me to grasp, but this vow was made in dark circumstances and it was preventing her from delivering the baby with us. The idea that this power exists and actually has control over someone like this is hard for an American to wrap his mind around. But in this country and with someone who believes in it and puts their faith into that world, things like this are very real. My Haitian nurses accepted it without question. The family has made a sèman and therefore this matter is out of our hands. We will not be able to deliver this baby here. She has to go home, according to the conditions of the vow.

It wasn’t long before the family again made the decision that it was time to go. We again cleaned up our supplies and sent the lady packing. She disappeared down the road, surrounded by her family. We never heard from her again. Just another example of just how sheltered and clean our life is in America, and how many other beliefs and powers there are in this world.

Changes, and an Open Door

Our American nurse Kay went home the middle of July. We would have gladly kept her on, but her new job at Mayo Clinic in Rochester was calling her name and she didn’t seem to want to stay! To replace her here in Oriani, Angela Toews from North Carolina came. She is an RN with years of experience as a pediatric nurse, and also has previous experience with this clinic; she spent a year working here in 2014. A lot has changed since then, but much has stayed the same and she was able to hit the ground running and fill the position well.

However, Ang is only committed to staying through October, and as of now we have nobody to fill her shoes. We are actively searching for a North American nurse, preferably an RN with experience, to come replace her. Surely there is someone out there who is looking for a change of scenery! We can promise you, this job will be unlike any you have ever had before. It is never dull and occasionally terrifying, but always fulfilling. You will stretch your horizons farther than you ever imagined. You will learn to eat new food, talk a new language, and make new lifelong friends. You will see things that make you laugh and things that want to make you cry, sometimes both in the same day. Open your heart and mind, and if you or someone you know is interested in becoming a part of the team here at Confidence Health Center, please get in touch with one of the board of directors. You can find contact information by going to our “Contact” page at:

www.confidencehealthcenter.com/contact

Send this on and spread the word! We would love to hear from you.

Full House

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!

Christmas in July

You ever had those times when you just had to sit back and smile in amazement because things worked out better than you ever expected? We’re doing that right now – just hardly able to believe how fortunate we are. It feels like Christmas came to Oriani early! Let me explain.

A long time ago, we had an ultrasound machine here at the clinic. She was gray and bulky and awkward and we called her Big Bertha. Bertha was a great machine, even though she was quite complicated and learning how to run her was kind of like flying the Space Shuttle. We learned the basics and made good use out of her. Then one day about a year ago, she died. Just quit. Wouldn’t turn on. We tried to contact some technicians in the States about repairing her but didn’t we weren’t able to get anywhere with that. We took her apart and examined her insides but we were unable to diagnose what her problem was. Eventually we had to admit that she was irreparably gone and we took her to the back and disposed of her. It was a sad day.

We continued on without Big Bertha, but often we would mention how nice it would be to have an ultrasound around here to be able to quick scan a patient. Maybe we had a pregnant woman and we were worried about baby positioning or placenta previa. Maybe a patient had a large abscess and we wanted to know if it had a drainable fluid collection. We made a few attempts to locate a replacement for Big Bertha, but new ones like her are far more expensive than our budget can handle. However, we started doing some research into an ultrasound machine called a Butterfly IQ+, and the more we read, the more we decided it would be perfect for our needs.

The Butterfly IQ+ is a small, handheld ultrasound probe that plugs right into a iPad or Android device. It is comparatively affordable and while it doesn’t have all the bells and whistles of Big Bertha, it is perfectly designed for quick, bedside exams like we do here. The pricing of the model we wanted, together with the iPad to run it, is somewhere in the neighborhood of $3,500. Together with our American board of directors, we started looking for someone or some group that would be willing to raise some funds to make this possible.

It is Summer Vacation Bible School season in North America, and we were very fortunate to find several Bible Schools that were interested in sending money from their fundraising to help us buy the Butterfly IQ+. We didn’t know how much to expect, but we were going to be happy with any amount towards the total. Imagine our surprise and amazement when we received $8,700 USD, plenty to buy the ultrasound and iPad and have some left over!

We just have to stand in awe at the response and we wish everyone that helped raise funds could come see what your money is doing for these people!

We purchased the Butterfly IQ+ and it arrived last Friday. We had lots of fun setting it up and learning the basics!

Butterfly IQ+ case.

The ultrasound probe and wireless charger in the case.

The new Butterfly IQ+ with the iPad and case.

The very first few days we were able to use our new ultrasound several times. We had a pregnant woman come to the house on Saturday with some vaginal bleeding, and we were concerned about placenta previa, a serious complication requiring immediate ambulance transfer to a hospital. However, in only a few minutes with the ultrasound, we were able to rule out placenta previa and direct her to go to a hospital on her own, as soon as it was convenient for her.

The second case we had was an older gentleman who had urinary retention due to prostate enlargement. After inserting a urinary catheter and draining his bladder, he was still in significant pain and we were concerned that the catheter was blocked and not draining properly. With the ultrasound, we were able to scan his bladder and confirm that there was no blockage and only a small amount of urine remained. Soon after, his pain resolved and he was able to go home.

The next day, we had a young lady in the clinic with a large area of swelling on her throat. With the ultrasound we were able to identify a cystic mass that definitely needs a biopsy to rule out thyroid cancer.

Scanning the thyroid mass.

Needless to say, we are very excited to have this new ultrasound available and we want to take this opportunity to say a huge thank you to each Bible School that helped us with this purchase:

• Lone Tree and Suncrest, Kansas

• Arcadia, Florida

• Faunsdale, Alabama

• Okolona, Mississippi

• Pinecrest, Georgia

May you be richly blessed!

Obviously, the funds that were sent were more than needed to buy the Butterfly. However, we have an ongoing list of items and equipment that we need here at the clinic, and now with these new funds we will finally be able to purchase a few of these. Some items we have been shopping for include a new adult scale, new infant scales to weigh babies, fingertip oxygen meters for after-hours calls when we’re not in the clinic, and a supply of infant formula for babies needing extra nutrition. Some of these items, like scales, can be found cheaply online but they don’t last long and are soon needing to be replaced. High-quality, medical grade scales can be several hundred dollars each, but fortunately with the funds we have now, we should be able to buy the medical grade versions.

The Seca 334 infant scale we are looking into.

Adult scale we would like.

Again, a huge thanks and a shout-out to the children and Bible School leaders that made this possible! It’s people like you that keep this clinic running. May God bless you.