Changes and another busy week!

HELLO FROM ORIANI!

Two weeks ago we took Quentin and family to the airport in Santo Domingo. He has done a lot for the clinic over the years. His knowledge and contacts here in Haiti will be sorely missed. It would have been very difficult to get started again without him. So a heartfelt thank you for everything he has done! Quentin and his family will be missed, but we are happy things are working out for them.

NOTE FROM MY WIFE JULIE

 Friday morning. When the sun rises on Haiti it finds a white landcruiser, roof piled with suitcases, wobbling along flood damaged “roads” toward the Dominican border. Inside the landcruiser are two families watching intermittently the huge potholes and the blue sky, pink clouds floating, thoughts swirling. Anticipation. Apprehension. Hopes, dreams, and prayers. An American-Haitian family headed towards a new life in a new country. An American family still-new-to-Haiti wondering if they will be able to hold it all together. Nobody wants to read a post long enough to entail all that Quentin and Christelle have done for CHC. After 5 years they will leave a huge hole!

BIRTHS AND BUSINESS AS USUAL

Here in Oriani the clinic continues to operate and patients continue to come. Not sure what happened in Haiti 9 months ago, but we have had numerous mothers in labor come in over the last week. We do not have the staff or resources to deliver all the babies in the area. So we bring them into the clinic for a quick check of mom and baby. We check the mother's vital signs and fetal heart rate. Then we check the baby’s position both by palpation and ultrasound. We also check for placental placement by ultrasound. If everything looks good and the baby is not too far advanced, they can go home. We give them instructions of danger signs for when they should come back. There are local midwives that can assist in births. We have invited them to attend our prenatal classes with some success. We hope to provide a class at some point for these midwives. We delivered 2 babies last week. The first was a boy that was named after me! They usually don’t have a name picked before the baby is born. We give them a birth certificate so they have to come up with a name while they are here. The second took much longer than we expected. Poor Vitanie and Yollette ended up spending the night at the clinic. OB is not my specialty and I’m happy we have an experienced OB nurse in Vitanie. I definitely plan to go back to trauma when I’m home!

TRAUMA AND TROUBLE WITH THE LAW!

Speaking of trauma. We had a young man come in with a large laceration to the forehead after a drunken fight at a wake. Of course he said he hadn’t been drinking. The skull was exposed and the laceration was filled with a large blood clot. After thoroughly irrigating it, we were able to close the wound with sutures. The next day he came back handcuffed to the other party in the fight. The local posse under the authority of the magistrate had arrested them and were taking them to Fond Verrette for judgment. (I’m still not very familiar with the different departments in Haiti, but I think Fond Verrette is similar to a county seat back home). The other man had a deep slash across the fingers of the right hand. It was too late to suture, so we cleaned and dressed them the best we could. We gave an antibiotic injection and sent him on his way with oral antibiotics. We told him and his escort he should go to Fond Parisien to see the surgeon there. They all laughed. Somehow I doubt he will end up there. Having patients in handcuffs made me feel like I was back in the ER at Upstate New York. Even though these “police” (not sure what their official title would be) had machetes instead of pistols.

EMERGENCY AT THE GATE!

Several weeks ago I was eating breakfast before going to the clinic. Someone started knocking on the gate. I went out to find several people and a moto. They said there was an emergency at the clinic. I told them to go to the clinic and I would follow. When I got there I found a man laying on the ground writhing in pain. We brought him into a room. His abdomen was distended and firm. An ominous sign. His vital signs weren’t bad so I got the ultrasound. I don’t have much experience with it so I wasn’t sure if I would see anything to help with the diagnoses. I very quickly realized the problem. His abdomen was full of fluid and air. This made it a true surgical emergency. I went to message Haiti Air to see if they could fly him out. By this time the other nurses had come in. Carmina went to start an IV. The man vomited all over, and was gone. We put him on the monitor and I checked his heart. Nothing. At home we would have started CPR, but here there is no point. If we got a heartbeat back we have no ventilator to put him on, no ICU to admit him to, and no surgeons to correct the problem. We notified Haiti Air to cancel. But now what? They had come from beyond Thoitte by moto. Obviously he couldn’t go back by moto. There happened to be a local pastor in the crowd and he started making phone calls for them. However, they couldn’t find a vehicle. Fre Batelmi offered to drive them in our ambulance. So they loaded up and went. It’s sad that it was our first use of the ambulance since opening the clinic. On a more positive note, we were able to use the ambulance since then to transport a pregnant mother down the mountain. She had 2 other children by C section. Now she was at 9 months with a third. Far too high risk to consider delivering here!

LIFE’S HAZARDS AND HEALING WOUNDS

We had a poor boy about 20 months old come in with a 3rd degree burn to his neck and upper chest. He had 2nd degree burns to his face. Mom said it was from boiling water. We gave him a dose of ketamine for sedation and debrided the burn. Then covered it with burn cream and nonadherent gauze. We gave an injection of antibiotics. His mom has been bringing him in every day for a dressing change. Pray for him. We are doing what we can and his mom seems to be very attentive, but it will take time to heal. This puts quite a dent in our limited supply of bandage supplies. I haven’t found a local source of bandage supplies. So far we have to order them in through MFI. We have some chronic wounds we dress several times a week. So keeping our inventory stocked will be a challenge. We still have a good supply thanks to Jay’s efforts, but please let us know if anyone has adaptic or petroleum gauze dressings to donate. One of the wounds we see is a man in his 20s. He broke his leg in an accident 10 years ago and it has never healed. It is all crooked and deformed. When I first saw the wound, I thought there was a good chance the infection had spread to the bone. We told him he needed to see an orthopedic doctor. But, he has no resources and no contacts outside the area. If he went to a hospital he would be on his own in an area he doesn’t know. And he takes care of his blind dad. So, it’s up to us to do what we can. We put him on antibiotics and have been changing his dressing every 2-3 days. It’s been almost a month and it looks a lot better. With some debridement, I don’t think the infection went to the bone. He told Carmina that he can finally sleep at night as the pain has gone away. He used to smoke a lot of marijuana (possibly for pain control), but now he has stopped. We told him the wound would heal better if he didn’t smoke. And now he can work in the gardens to earn some money. Being able to help in some small way, makes up for the difficulties and stress of learning to operate in not just one but 2 foreign countries with languages I don’t know. Sometimes I don’t know if I’ll be able to make 2 years with so many people needing so much. But God is good and we keep on keeping on.

CALLING NURSES!

We see enough patients that we really need a 3rd nurse for the clinic. We would like to bring in another North American nurse, but volunteers are hard to find. The Church is devoted to follow the commandment of Christ to go into all the world. As healthcare workers, we are in a field called and trained to minister to the physical needs of suffering humanity. The clinic offers a unique opportunity to combine these into a mission of service. To show the love of God in action. By helping with physical needs, we can avoid the trap James describes. James 2:14-17 “What doth it profit, my brethren, though a man say he hath faith, and have not works? Can faith save him? If a brother or sister be naked, and destitute of daily food, And one of you say unto them, Depart in peace, be ye warmed and filled; notwithstanding ye give them not those things which are needful to the body; what doth it profit? Even so faith, if it hath not works, is dead, being alone.” As much as we need money to operate, we need workers to work. All the demands to travel to buy medications and supplies and the demands at the clinic are more than one administrator can do. Having another nurse at the clinic makes a huge difference. Now that role is filled by Carmina, but when she leaves, then what? In many ways giving money is easier than giving time. I know that not everyone is in a place to give time. We weren’t a year ago. But surely among the nurses of the Church, there are some who can be the Hand of God extended to those in need here in Haiti.

Jonathan Kurtz - Clinic Administrator

I Wonder...

I wonder what younger me would have thought of me now… wiping a water drip from the roof off my laptop and sipping fresh passionfruit juice out of my Contigo mug. It’s another day at the clinic, and, since this one doesn’t seem to be as busy as most, I will try to give an update. 

I wonder how the little malnourished girl is doing that we saw yesterday. 14 months, body edematous from lack of protein, 6.5 kilograms, skin peeling leaving angry red patches, weak cry. I wonder if the mom understood when I said we didn’t have a medication to fix this. I gave her some beans, strict instructions, vitamins, cream, and a return appointment. 

I wonder what the hundreds of spectators thought when a helicopter buzzed the town and settled down by the soccer field. Haiti Air Ambulance paid us a visit to establish a landing zone. I think most were entranced by the chopper while I only had eyes for Larissa, who came running to hug me as soon as the blades slowed. We hadn’t seen each other since before we were both married, despite living only 100 kilometers apart (by road; much shorter as the crow helicopter flies). Larissa is a flight nurse for Haiti Air and has seen many places of Haiti inaccessible now to the average white person. 

I wonder if the lady we saw yesterday went down to Fond Parisien for an ultrasound. She came Wednesday evening… bleeding after what we understood to be a spontaneous abortion of one of her twins. She said she was four months along, after the midwife encouraged her not to lie to me. The midwife also told her to let me cut off the protective string she had from the medcin fey (leaf doctor). The amount of blood worried us. Our ultrasound skills were tested. Haiti Air said they’d put us on the pending for tomorrow morning when it wasn’t cloudy. I prayed and had flashbacks to when Jay and I futilely did compressions in that same room on another mom who had delivered one twin and bled out in front of us. Thank God the bleeding slowed now. We kept her overnight and by the morning we had expert advice resulting from sending the ultrasound report to Haiti Air. Her bleeding had stopped, and the pain wasn’t so bad. We encouraged a ‘real’ ultrasound from a bigger hospital. The husband said the road to Fond Parisien was washed out. We told him we heard motos were getting through. Eventually they left, leaving us to wonder. 

I wonder what before and after pictures would look like on the neck wound Jonathan debrided a few weeks ago (see previous post). They got to the DR, found a good hospital, and the brother reported back to us that it has mostly healed. I wonder if the two other large leg wounds we are currently treating will turn out as well. One was healed and then the clinic closed, he says, and it got worse. Another young man has had a leg wound for a decade, since a bad accident. They are both young and keep coming for dressing changes and treatment, so there is hope. (The accident one involves broken bones not healed straight, poverty, and lifestyle factors that do not promote healing). I wonder. 

I wonder, wonder, wonder what I should have done. A mother tried to get a consult for her child on Prenatal and Vaccine Day. (We try to encourage people to use the Catholic clinic or the Forèt clinic those days while we see children and pregnant ladies only.) I sent them to the Kay Mè, about a 3-minute walk away. Sister Rosalia introduced us to her doctor when she visited last time, making us hopeful that the quality of care there would be at a professional level. The mom went and the baby was seen and treated. On her way home she stopped by our clinic to check on her friend. And the baby died here. If I had only triaged better. If only the ‘doctor’ had kept them. If only the mom had come the day before. If only. Others assured me that the baby would have probably died anyway. But a dark shadow covered my day after that. 

I wonder what people think of my halting Creole as I give a prenatal class every Wednesday morning. I roll out my little laptop on the bright blue and pink ultrasound cart (see pic of cart on previous post) and give a 45-minute class for the all the pregnant ladies sitting on benches in the foyer. I heave a sigh when I can put on the video about danger signs in newborns and give my voice a break. And does anyone have a wide screen monitor to donate for this? They squint at the laptop and hang on to every word as the video plays. Seeing new information enlighten their faces and watching them read the (minimal) handouts I have in Creole is rewarding. My translating skills accompanied by Google still find alterations when I get friends to edit. Examples of new information for them is that colostrum is good, not spoiled, even though it is yellow; you should only give milk or breastfeed for 6 months, not sugar water or solid food; ginger tea is bad for the mom and baby in a delivery; alcohol affects the fetus, and more. 

I wonder what will happen to Abigael. Her mom gives her sugar water instead of milk and so her skin is peeling off despite our creams and exhortations. The mom walked off in a huff after I told her that we would see her if she waited for a consult like the other patients. There were 3 or so patients ahead of her. “I have cream at home and it’s not helping” she was heard to mutter as she stalked out. I wonder if I had run down the road after her with an expensive can of formula if that would have made any difference in the outcome. Does anyone want to fund a formula program so we can justify buying more of these life-changing cans?

I wonder how much Clarithromycin costs to make. We have had some patients test positive for H. pylori and this antibiotic is in the recommended treatment regimen. Well. Jonathan priced it out and the cheapest price was 146,875 Haitian goud for 2500 pills (~$1,175USD). The first quote he got was about 50,000 goud more. This is almost 20 times more than similar amounts of any other meds we purchase. After that is the transporter fee, etc. We will try to use an alternative antibiotic. Speaking of money… more and more people are coming and saying they can’t pay the consult fee of 300 gouds, which includes meds. This is less than any other clinic we know of, as most have the patient pay for meds after they pay the consult fee, and I hear complaints that they are losing patients to us. Frè Wili, our receptionist, faces the poverty problem multiple times a day… can they actually not pay? Are they lying? Are they poor enough to warrant a pass? How many times have they not paid? Thank you to all you donors who allow us to serve the community whether they can pay or not.

I wonder what my husband thought of the story I told him when he got back from a few days in Port au Prince. How strange men came to our house in the dark and tried to get me to leave with them on their moto… oh, just another night in the life of a nurse on this mountain top. Jonathan was in Port too. I told them to try Yolette’s house, as I’m not on call as per my contract. They had tried, they said, and no answer (She is smarter than I am, apparently). But then I heard a voice I knew… Frè Bartelomi was with them and had led them to my house. From the sounds of it, a lady had had a serious stroke this in the afternoon and, because of the rain washing out the roads, they only got here in the evening. With Frè Bartelomi’s promise to come with me, I bumped down our rocky road on the back of a strange moto, wrapped in my fluffy dressing gown (which is completely acceptable wear here at that time of night, don’t judge). I realized we couldn’t do much for the patient, although the grown sons insisted. I ran some labetalol and got the pressure down, but it soon climbed back near 200 systolic again. No response from the patient, laboured breathing, oxygen low despite an NPA, vomit crusting her mouth, long past the golden hour of stroke response. I started introducing the sons to the fact that she was going to die… they were in denial, but one soon realized what Frè Bartelomi and I were saying was how it was. One stayed in denial for a while, arguing that God could do anything, telling me what an active woman she was, married to a prophet, etc. I gently told him that maybe his mom’s work here was done, and her soul was being called to be with Jesus. He was still telling us how this was his brother’s fault as they loaded her back into the Land Cruiser. I wonder how that funeral planning went.

I wonder how much the hungry month of May played a role in all the strokes we saw back-to-back-to-back… hunger, stress, no money for meds… any or all of the above.

I wonder why 36 hours of rain and wind caused the animals here to drop like flies… goats especially, also pigs, horses, and cows. No one really has shelter for their animals, and many suffered losses of gardens as well. We were lucky… we had food in the house that day (many didn’t), our gardens seem to be mostly ok, and only one little goat died. 

I wonder how Jonathan and Julie feel now that Quentin and Christelle have left for North America. I am impressed by the advances they have made with the language. Jonathan’s expertise is noted in the clinic and things seem to be running well. 

I wonder if the son of one of our CHF patients still thinks I should have checked his mom’s prostate like he asked me too. 

I wonder if there were still bullets in the infected eye I saw this morning, a result of gunshots from a gang in December.

I wonder what will become of the CHF patient I was just called to consult, edema ++ and O2 of 65%.

I wonder if the mom of the baby we have on oxygen understands enough to give him meds at home.

I wonder if I will ever go on a walk and have in my backpack every pill, syrup, cream, condom, etc. that people ask me for along the way.

I wonder what will happen to Natalie, Fabris, Mafi, Midelove, Sonsonn, Yvna, and many more. So many more.

I wonder…Nurse Carmina

And the people keep coming...!!

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

Note from the Administrator

Hi, this is Jonathan writing. We have been here a month! As you can tell from previous updates, we have been busy. Keith, then Matt were here to help us get settled in and open the clinic. We could not have done it without them. The clinic has been open for 2 weeks now. We are open Tuesday, Thursday, and Friday from 8 - 2. We saw 284 patients during clinic hours and 13 emergencies after hours. We had 2 births at the clinic. As word got out, the second week was much busier than the first week. We averaged 20 more patients a day during the second week. Next Wednesday we are planning on having a prenatal and vaccination day at the clinic. Nurse Carmina is spearheading the prenatal class and the MSPP (think health department) nurse for this area will assist with vaccinations.

One of the ongoing challenges is obtaining medications. Due to gang activity, the road to Port au Prince is extremely dangerous and we are not able to go purchase medications ourselves. God has opened several doors and we are now using agents to purchase meds from Port and also the Dominican Republic. Hopefully we can keep using these resources and expand on them as needed. Not being able to go to Port means we are not able to offer an ambulance at this time. We can recommend patients go to hospitals in Port, but we aren’t able to take them. There is a small hospital and 2 clinics in Fond Parisien, just outside the gang-controlled area.  At some point we hope to be able to take patients that far, but they would still be responsible to go to Port on their own.

My previous experience in health care was at a large University trauma center in upstate New York. To go from having all the resources to the limited resources we have here is a challenge. Friday night we had a patient in respiratory distress secondary to heart failure. We were able to start treatment and stabilize with oxygen and the simple BiPAP we have. But then what? We can’t just admit to the ICU like at home. We got her set up in the little house beside the clinic. After being there all night she was able to go home in the morning. It is a change to have to think, not just as an emergency nurse, but as primary care as well. Having Carmina here to teach me how things have been done is a tremendous benefit. Also, the clinic board has been very helpful with suggestions and advice.

The biggest challenge is the language barrier. It is frustrating to not be able to talk to people. Simple things like figuring out a price in the market or taking a history in the clinic. Also, it can be funny. At least the Haitians think so! We have been taking Creole classes twice a week, but progress seems slow. Outside of the clinic, we are settled into our house and becoming used to living here. Quentin and Christelle have been a huge help with this. Overall, we are doing well and have much to be thankful for. Thank you for your continued support. We couldn’t do without it!