I sit here in my consult room/office…the sounds of patients gathering on the benches outside, motos driving past, sheep bleating, printer whirring, and a soon-to-be mother learning how to push with contractions all accost my ears in a jumble that means I am at the Confidence in God Health Center, Oriani, Haiti. Is this my happy place? I wouldn’t say that, but I do have a lot of job satisfaction. The smell of morning cooking fires drifts through my window and I see the Pik la Sal mountain range clearly against the Caribbean sky, above the fringe of banana tree leaves and past the avocado trees. It’s another clinic day.
We have seen nearly 350 patients this month already. Among the typical hypertension and diabetes and scabies and tinea capitis diagnoses are some unique ones. The malnourished or neglected babies tug especially at my heart… 4 months old, 3.7kg, pale, weak, apathetic mom. A little girl, 50% red from diaper rash and neglect… and then the handicapped 4-year-old whose mother has taken especially good care of him and obviously loves him, cares for him in spite of having other healthy children.
A mom who delivered her thirteenth baby outside the clinic gate… I snipped the cord, gave the healthy boy to Yolette, and got her inside to deliver the placenta… her teenage/adult children helping her walk. She maintained a flat affect throughout our care, and I tried to convince her to breast feed, or at least skin to skin. She only brightened up a tiny bit when I suggested she name him Mackendy after her son Mackenson who had died in childhood.
Lots of neglected wounds are coming in… the stories are similar… “We went to the clinic in (Forèt, Kay Me, Thiotte, etc.) and they didn’t do much and then we went to the medcin fey (leaf doctor) and that helped some but it hasn’t healed and it has been (weeks, months)...” The smell often lingers for a while but improves after one visit. The one wound that kept on giving though was the huge neck abscess that Jonathan drained, then a few days later removed all the necrotic skin, leaving a gaping hole in the poor man’s neck… we sent them to Fond Parisien but even they said they couldn’t help… he is now coming for dressing changes until they can arrange to go to the DR (the other option was Port au Prince).
And Port au Prince is an option. We sent a neighbor there to consult at a breast cancer clinic, and I believe she went (her house is closed and silent whenever I go by). Our lovely little Butterfly Ultrasound that donations bought before Jay died has helped us make these tentative diagnoses with greater assurance. We saw the honeycomb like lump in her breast, and with other clinical evidence decided we should give her some money to get it checked out further. And there are people that pass the gangs regularly… we have a contact that brings us HIV and syphilis tests and family planning supplies from a very dangerous area in Croix des Bouquets. We still are able to receive supplies that are shipped in through Missionary Flights International and smuggled through gang-controlled areas. Some medications and supplies are still purchased in Port Au Prince with the help of a pastor, who also makes it his mission to help with humanitarian needs. We have a safe and easy (if long and bumpy) route to the Dominican Republic via Anse-à-Pitre. All in all, God has opened many avenues for us to operate.
Infected C-section scars… they thought the sutures were absorbable so left them for 3 months… infected scabies finding relief with simple creams and antibiotics… dewormer to everyone, systolics over 200, stroke rehab, DKA, lacerations galore, BPH, respiratory issues, HIV, syphilis, orchitis, and other things that aren’t so straight forward… why has a man been wasting away for months? All our tests are negative… they claim they have no money for higher level of care. The ‘Confidence in God’ part of our clinic name often comes to mind when I try to diagnose correctly to do good and not harm with treatment. I feel God augments my insufficient training and our scant resources.
Speaking of resources… I had fun yesterday going through the two sacks of donated items we got a while ago. Thank you to you donors; we now have more high-quality IV catheters. Also, the sterile Kerlix has been on my wish list since 2020. The syringes, needles and gauze will be used quickly. Thank you!
The Wednesday Prenatal day has turned into Prenatal and Vaccine day and seems to be working. We are still learning with the vaccination program, so Nurse Lirani comes from Fonds Verrettes to teach and assist the two nurses and the two techs. Nurse Yolette was already familiar with giving vaccines, so that was a relief to me. That left Jonathan and I to do the prenatal consults last Wednesday… there were about 6, with the last one being dehydration, in pain, jaundiced… the ultrasound was used. We suspected gallbladder issues? Again, we helped her get to Fond Parisien for a comprehensive workup.
Prenatal day has been fun for me as I have a PowerPoint I show all the pregnant ladies. The Starlink internet lets me show them videos, and they seem to really get into it. There’s also a pamphlet we give them, and hope to encourage more ladies to go to Fond Parisien for official ultrasounds. We had one girl in, 9 months pregnant, and I didn’t find a heartbeat in the place I thought I would, but Nurse Vitanie found one on the other side… she wasn’t in labor, so she went home. The next day she was back, had delivered the baby but still in pain. With our little ultrasound Jonathan found a? placenta? blood clots? still in her uterus. Encouraged her to go to Fond Parisien for a D&C. Well. Turns out she didn’t go, but later at home started delivering pieces of another baby. Who knows when the twin died in utero? Please go for your ultrasounds!
A big thing has been educating the public that we are strict on what does or does not constitute an emergency, and that we recommend them going to Kay Me or the clinic in Forèt if we are closed and they are open. Wednesday mornings are spent sorting the pregnant from non-pregnant and insisting that we are open for prenatal consults, vaccines, and emergencies only. The word will spread and I hope it will get easier.
And now it is 930… the baby girl has been born with no complications, the gallery is lined with people, the consult rooms are busy, the nurses and techs pop in and out of my room with questions, and the sun is shining bright down on the Oriani Clinic! God bless all of you. -Nurse Carmina
