UNCERTAINTY

Every morning when I am standing in front of the clinic during Paste Willy’s devotions, I enjoy the view. On market days there is a steady flow of traffic on foot, on moto, on donkeys, and some vehicles into town. The sky is a bright blue with a view of banana plants and gardens beyond the walls and in the back Pic la Selle. It truly is a beautiful setting. The clinic is busy on market days but our staff manage the patient flow smoothly. Our nurses are very comfortable in their roles and call me less often as they can manage care on their own. Sometimes I almost feel unnecessary because of how well the staff is managing. One big change you will notice on the monthly report is the section marked intestinal parasites. In the past the nurses only checked this box if the patient had noticeable worms. However, due to the high probability of intestinal parasites and the negative effects this has on a population already inclined toward malnutrition, we provide antiparasites to anyone with the slightest possibility of parasites. I decided we should mark for everyone we treat for parasites.

            One of the reasons we can increase the treatment of parasites is due to a generous donation of mebendazole, an anti parasite, among other medications we received 2 weeks ago from L’eua de vie, a clinic in Fond Parisien. They had received a large donation of medications and were not sure they could use them all before they expired. So they loaded up the ambulance when it was in Fond Parisien with an eclamptic patient. I am happy to report the ambulance is finally working again.

It also made another trip Friday night successfully. This time with an older patient who seemed to have had a stroke. She had been fine the day before, but in the evening was not able to talk or react appropriately. Due to the sudden onset of the symptoms, I was quite certain of a stroke. However, the family wanted to take her and since I couldn’t be certain of my diagnosis, I didn’t have a good reason to say no. Here a stroke is not an emergency because we have no way to treat it. Even Port au Prince doesn’t have stroke care. Either way Port is not accessible. The patient was delivered to the hospital in Fond Parisien but they couldn’t do anything for her and she passed away. I was pretty certain of this outcome, but how do you tell a family no?

            The situation in this part of Haiti took a dramatic turn for the worse last week. The gang in Croix de Bouquets attacked Ganthier, the town between them and Fond Parisien. The gang overran Ganthier and destroyed the police station and killed a lot of people. They made violent threats against Fond Parisien and promised a massacre. The police tried but couldn’t push them back. But a group of reinforcements were able to come up the road from Port and the police were able to reestablish a presence on the outskirts of Ganthier. Ganthier, from what I hear, is a ghost town, but for the moment Fond Parisien is safe. I was able to go there and buy medications, food, and fuel. So we are OK on supplies for a while. The reinforcements from Port went back to Port and the gangs blocked the bridge outside Ganthier so they will have a much harder time coming back. Produce from the gardens here in the mountains is carried by trucks to markets in Croix de Bouquets and Port au Prince. To pass through gang territory, they had to pay the gangs. I heard the gangs were collecting as much as $40,000 a day! Not sure how reliable this information is. After the gang attack, Fond Parisien blocked all truck traffic as they didn’t want the gang to collect this money. The gang is furious and blocked all traffic for any reason. So we are truly cut off from Port. We can still get medication from the Dominican and we have a good supply, but if this situation continues it will affect our level of care. Security in this area is still OK as the locals are blocking all the roads and checking all vehicles. When the ambulance last went they had to pass the checkpoint and pay some money. Since the people manning the checkpoints are volunteers, I don’t begrudge them the money.

This blockade could not have come at a worse time for the mountain people. Their gardens were just starting to produce and now they have lost everything. All roads are blocked and their produce they rely on selling is rotting. I don’t know what the future holds or how they will have money to replant. Truly dark times for Haiti. What this all means for the clinic and for us remains to be seen. We are still safe enough, but it is a fragile situation. We help in whatever small way we can, but the amount of people begging for help is increasing. Pray for us and this poor country. They desperately need help, but the rest of the world seems uninterested.

Border Troubles

Hello again from Oriani! The month of June did not go according to plan for us. Heidi, my niece, who has been here for 6 months to teach Sebastian, was to go home for the summer. The plan was for us to go to Santo Domingo to pick up her family and bring them here for a week before they went home. We made it across the border without trouble and enjoyed a couple of days shopping and spending time with friends , before picking them up at the airport. When we got back to the border, the Dominican officials refused to let us across. They said since the American missionary couple was killed in Port au Prince we need a letter of permission from the head of immigrations in Santo Domingo before they would let us enter Haiti. Why this is up to them baffles me. I called the American embassy in Santo Domingo and Port au Prince. Neither had heard of this requirement and assured us that we had the right to enter Haiti. Well, we decided to spend the week in the Dominican with our visitors instead, then after they went home, we would try to get back to Oriani. It was disappointing not to be able to show them Haiti, but we enjoyed our time with them exploring different beaches. Carlos and I went to the immigration office to see about getting the letter of permission. They said we would have to submit a request then would get a reply in 45 days. We submitted the request, but we weren’t going to wait 45 days to see if we might get this letter. So Carlos called his contact at the border and we were able to cross, but they didn’t stamp our passports. I guess we’ll see if this causes us trouble in the future.

In the meantime, the Haitian staff did a fine job of keeping the clinic open in our absence. They even sent a woman with an OB emergency to Fond Parisien with the ambulance. However the ambulance didn’t quite make it back to Oriani. It had to be towed the last few miles. We found a crack in the fuel line and I hope it’s finally operational again. But the woman did get the help she needed. I was very concerned for the older gentleman who I did a thoracentesis on the day before I left. I didn’t know if he would be alive when I came back. Thankfully he was, but I have had to repeat the procedure twice. Every time we drained off 1.5 liters of fluid. Despite our best care he is failing and I fear he may not have long left. I told them we were doing everything we could here, but if they thought they could make it to a hospital in Port or Mirebalias they should consider it. It is very hard to know what to tell these people. I don’t know what the state of other hospitals is or if they can provide the help people need. Considering the expenses, difficulties, and dangers of travel here, I hate the idea of sending them on a wild goose chase looking for something they might not find. But, I felt I needed to let them make that decision.

Friday, June 28 we had a 4 year old girl brought in with 2nd degree burns to her torso. They said her clothes had caught fire. I didn’t understand what they said about how it happened. The burns covered exactly what a T-shirt would have covered. It had happened 5 days before. They said they were from a long way away. I don’t know why it took so long for them to get here. I could tell she needed more than we could give her. I messaged the surgeon in Fond Parisien and he said to send her to the Doctors without border hospital in Port that has a burn center. We covered the burns with a dressing and gave her IM antibiotics. I couldn’t find a spot for a peripheral IV because of the old infected burns. She was awake enough to drink so we gave her oral fluids. I tried to contact Haiti Air but they were out of service. Mom and dad were with her and I told them they needed to go to Port immediately. They didn’t have money and I didn’t want them to spend time looking for some, so I gave them enough to get them to Port plus a little. The dad exchanged phone numbers with Fre Willy and they headed off. Unfortunately, the next day the father messaged Fre Willy that she had died on the road. It was one of those situations that makes me feel like I should have done more, but I don’t know what else we could do.

I have to remember we are not the level 1 trauma and burn center I am used to but a clinic. I feel we do as good a job as we can within that role. Basic primary care such as wound care, prenatal care, antibiotics, and some level of control for hypertension and diabetes. Thursday I sutured a man’s finger that was almost severed at the middle knuckle. I placed a finger splint and told him to go to a bigger hospital that could fix the bone. Then I had a woman come in that had been bit on the leg by a pig. I cleaned it up, gave her a tetanus booster and antibiotics, and sutured the wounds. This is what we can do that is something they don’t have without us and can stop little problems turning into big problems. Thank you again for your support! It allows us to keep helping in whatever way we can.

Births, burns, and bad spirits

Hello, again. I hope God is blessing you wherever you are. We are doing well here. Our numbers in the clinic are trending up. I think the change in price along with word getting out that we will help regardless of ability to pay is making a difference. Speaking of numbers going up, our nurses delivered 7 babies in April. I forgot to mention it in the update for April, but I’ll give them a shout out now. The nurses are doing a great job and have grown into their role here. Sometimes I feel the staff here is doing well enough, they are almost working me out of a job. However, I will claim credit in delivering one of the babies here at the clinic in May. To be fair, the mom did all the hard work!

One of my biggest frustrations here is the difficulty in getting people to keep their appointments. For example, the girl with the burns that I mentioned last month. I told the mom to try to keep her burns covered and come back if the dressing came off. But she did a very poor job of this. On return visits the dressing would have been off for a day or 2. The burn was not healing well, so I told her she needed to come back in 2 days, but she quit coming. I don’t think they live far from the clinic, but we don’t know where, so I can’t go find her. Hopefully she will heal ok. We had a 2 year old come with burns on his left arm from dumping hot porridge on it. They come from much further away. Almost an hour by moto. They have been faithfully keeping their appointments, and he is healing well. I thought Friday might be his last visit, but they didn’t come back. Hopefully that is a good sign. Last week we had a man brought to the clinic for scattered burns on his left arm. He is fou (crazy) and had been trying to get into someone’s house and they threw hot water on him. He had some minor second degree burns, so I did a simple dressing. I talked to the man who came with him and tried to understand the situation. We don’t have much to help, but I gave him some valium pills and told him to give the man one if he needed to calm down. We don’t see many true psych patients here, thankfully. There isn’t much we can do for them. Around the end of February, if I remember correctly, we had another “fou” man brought to the clinic. The story was he had been in sendoming (the DR) and had been fighting with people there so his parents went to get him. He had only been back a day or so, but was causing trouble and they wanted me to give him a shot to calm him down. This seemed a little unnecessary to me as he was sitting quietly watching me. I tried to ask if it was possible he had taken any drugs in the DR. They didn’t seem to understand. I told them to go home and I hoped whatever he might have taken would wear off. Apparently normally he isn’t crazy? Anyway I forgot him until 3 weeks ago when Roosevelt and a couple other youth boys came to our gate. This man lived behind Fre Berlin’s house (Fre Berlin’s wife is one of our nurse aids) and he was causing trouble fighting with people. I got my moto, stopped by the clinic for a syringe and some valium, and followed them over to Berlin’s house. This man was up a path behind the house outside a little building. His hands and feet were tied together and another man was holding a leash. He was hopping around and yelling incoherently. His actions and incoherent speech reminded me of the psych/drug patients we see in the US. I asked if he had taken anything and they were certain he hadn’t. What could have caused this? They all said he was a good boy before. Did he fry his brain on bad drugs in the DR? Or some concoction from a witch doctor? Or an evil spirit? He was hopping around trying to hit people. They held him down while I gave him the valium. That didn’t even slow him down so I had to go back to the clinic for ketamine. After he was asleep, I gave them some valium pills to try to give him in the morning. The next day they said he was up and just as feisty as the night before. They didn’t ask me to come back, so I haven’t. Honestly a very sad situation, but there are no psychiatric hospitals in Haiti that I know of.

The situation in Port is very tense, but the gangs are letting people travel around again. They are hoping to get on the people’s good side before the Kenyan force comes to Haiti. After all their violence and destruction that seems very unlikely. However this does give us the opportunity to buy medicine in Port and for MFI to make a couple of flights and bring some supplies from the US and get our vehicle papers updated. Our agents in Port are working on this and hopefully we will see results in the next week or so. Thank you for your support and prayers. God bless you all!

Count your blessings

Good morning from Oriani, Haiti! It is a beautiful sunny morning here. Yesterday was market day and the village was full. We always see more patients on market days. Today, the village center was a little more quiet without lots of people setting up for market. There were 15 people sitting in the benches this morning. I’ve been noticing that as we stay open from 8 - 2 every day, we don’t have as big of crowds in the morning. Instead of everyone coming early to try to be first, they come throughout the day. The mountains are still peaceful with people going about their lives. There is plenty of food in the markets, but prices are high enough that people struggle to buy food. Our dry season wasn’t as dry as some and we had some rain in February and March. This helped people start their gardens and for weeks we could see groups of men hoeing and planting. We didn’t have people begging for water like last year and the moto wash up the street was going every day, so it seems people weren’t hurting for water. Rainy season started 2 weeks ago, but it hasn’t been extreme either with gentle rain most afternoons. Hopefully this will allow for people to have a good harvest.

It really seems like a different country from the reports of chaos and violence in Port au Prince. That does affect us of course. The “toll” charged by the gangs on trucks bringing garden produce to Port and rice and other items to market here is part of the reason food prices are high. Our agent who buys medications for us in Port was able to find some in March, but April has been too dangerous for him to travel. We are having to rely on our stocks and the limited medications we can get from the Dominican. The Dominicans’ response to the situation here is quite frustrating. While it is understandable they don’t want the chaos to spill over, they don’t seem to make an exception for humanitarian agencies. I spoke with a Dominican immigration lawyer who made some inquiries for us. He said there are no exceptions granted for humanitarian agencies. Instead we have to negotiate with local officials if we need to cross. Another issue is the gangs like to cause havoc by shutting the fuel terminal in Port, making fuel harder to find and more expensive.

The violence in Port has led to most hospitals there shutting down. I saw an article that there are only 2 still open. This makes it very difficult to know where to send patients needing a higher level of care. We had a man with wounds on both his legs that has been coming to the clinic for years for dressing changes. His chart goes back to 2021, but Fre Willy thinks he has been coming longer. He needed a skin graft if the wounds were ever to heal. But he had no money to go anywhere. In January we decided to give him money to go to Port. I told him this money was given to God by christians in the US to help people in Haiti and now that I was giving him some, he was responsible for how it would be used. In the past when I gave money there have been times when I fear the people did not use it to seek help like we wanted. So I tried to impress him with the responsibility. He asked us to pray with him before he left. He went for a consultation at Benard Mevs in Port in January. He came back 2 weeks later and said he had an appointment in February for the operation, but needed more money to pay for it. We generally don’t give money for other hospitals as it equals us funding larger organizations, but since he has been coming for years with no progress, we decided to make an exception. So I gave him more money in February for the skin graft. Fre Willy said he had stopped by in March while we were in the Dominican. They still hadn’t done the graft but he had another appointment and was going back. Now I didn’t see Benard Mevs as one of the hospitals still open. Was that money wasted? Hopefully not, but we will see. This is the question I try to understand, how to help. By helping people go am I sending them into a dangerous situation to look for help that can’t be found? Sometimes the choice is easy when I know they can find help in Fond Parisien, for example. Last week we had a very malnourished 5 year old boy come in. If it was only malnourishment, we could have taken care of him here. But he also had a palpable mass in his belly. The little hospital in Fond Parisien has surgeons that can take a look and decide if it needs surgery. A decision I am not qualified to make. So I offered the ambulance. The mom of course didn’t have money, but when I said she didn’t need to pay for the ambulance, she went to find some money and see to it her other children were taken care of. I gave the ambulance driver some money to give her in Fond Parisien and told her, if the hospital didn’t want to do an operation, to go to Love a Child as they have a malnutrition program. This time the ambulance did make it back under its own power, but barely. There is a problem in the fuel system that hopefully we can find and fix.

Friday night we had some frantic women come to our gate with a 4 year old girl. It had been raining and a large branch fell on her. They weren’t able to say where it had hit her and I couldn’t find any injury. She was not responding normally, drooling with her eyes fixed to the right, right side with reduced strength, and left side contracting spasmodically. I gave her some water and she was able to swallow, so at least her airway was ok. I couldn’t do more for her and there is nowhere to send a patient like that. We told them to go home and pray and we would pray too. The next morning they brought her again. They had found a little bump on her head, but otherwise she was fine, standing up and holding up both arms to her mom. A mild concussion? Or a miracle? Either way, thank God! Sometimes we feel so helpless here. Yesterday we had a 2 year old girl come in with second degree burns on about 20% of her body. Family said she dumped a pot of corn. They said it happened 6 days ago. Why didn't they come then? I wanted to yell at them, but held my tongue as I didn’t think it would help. We sedated her with Ketamine and debrided it, then covered it with burn cream and non adherent pads. The burns really didn’t look that bad considering they have been uncovered for 6 days. I can’t imagine the pain the poor girl was in. We gave her antibiotics and protein and vitamin supplements. She will come back every day for dressing changes. I just finished it today, and I think she will do well. Thank you for your continued support. Despite the less than ideal conditions, God is blessing us that we can continue here.