Bringing Hope!

Good morning from Haiti! Thank you to everyone who donated to the fundraiser last month. The response was impressive! We used some of these funds for a small program to help local farmers replant their gardens. I used our local clinic advisory committee to find 40 people. We gave them vouchers for fertilizer and spray as these are their biggest expenses. The committee was able to quickly find people. They said those they were able to help were very thankful. One morning walking to the clinic I had a man come up to me and shake my hand and say thank you. I have also provided some funds to help others. We can’t help everyone, but those we were able to help say thank you and I want to pass that on. This brought some hope to the community that not all is lost. Pray that these gardens can bring a good harvest and that the roads can be open to bring it to market.

Several weeks ago a man brought a screaming 4 year old girl to our house. She had second degree burns to her chest and stomach. I took them down to the clinic by moto. It really wasn’t a severe burn, so I placed a dressing of petroleum gauze and told them to come to the clinic the next day. Well, they didn’t show up. A local woman told Julie she knew where they live and passed on a message that they needed to come to the clinic. Again they didn’t come. So we went and looked for them and finally found them. After wandering around the countryside we found their house in sight of our gate. They had removed the dressing and replaced it with some concoction that looked like a cross between manure and tar. It had formed a dry crust over the burn. They said when the dad came home he would bring her to me. Of course no one showed up.  Since there was pus draining from under it, I brought her antibiotics and insisted she had to come to the clinic. The next morning on my way to the clinic the dad came up to me in the road. He said he hadn’t brought her because he thought we caused too much pain with dressing changes. Well, she hadn’t had a dressing change and he hadn’t been there when I placed the first dressing. Seems like an excuse because someone wanted to try a local remedy. But he said he would bring her that day. They finally actually showed up. I picked off some of the crust that was loose and slathered the rest with a lot of burn cream. I told them they had to come again the next day. They actually did and the burn cream did a nice job of dissolving the rest of the crust. She came back 3 days later for another dressing change. The burn looks like it is healing nicely and her last dressing will come off Friday.

One day at the clinic we had a man with 2 large cuts to the top of his head from a machete. One was deep enough it went into the skull. This had happened 3 days before. He said his brother in law had done it but he didn’t know why. They came from half way down the mountain, about an hour by moto. They had gone to a local clinic that covered it with gauze. Suturing a wound more than 24 hours after it happened is discouraged due to the risk of infection. In this case I didn’t see a choice because of how deep it was. So I cleaned it and rinsed it the best I could then placed some deep sutures to pull it together and sutured it closed. It came together nicely. The nurses gave him a tetanus booster. I was really worried about infection so we gave him IV ceftriaxone and let them stay in the little house by the clinic for 2 more days of IV antibiotics. We changed the dressing and it looked clean. I gave him oral antibiotics to go home with and told them to come back if it looked infected. Since they haven’t come back I am taking that as good news. Another patient we kept in the TiKay (little house) was a 52 year old man with a severe case of pneumonia. He needed oxygen so we kept him there. He was much better in the morning and able to go home.

Receiving Rice Manna Packs Donated From Love A Child

The mountains are still peaceful. The local markets have less than they used to, but food is still available to those who have money. We brought an ambulance full of donated food from Love a Child last month. That was gone in a week. They didn’t have more to give us as the border by Fond Parisien was closed for a week and they are providing food for a lot of families that fled Ganthier. I bought some rice and oil Saturday to give at the clinic. I am also giving some money every week to our deacon to provide. It’s not a lot compared to the need, but every little bit helps. Fond Parisien has managed to keep out the gangs so far. Love a Child seems to have hired private security from the US and they have a drone to help keep an eye on things. The gangs have attacked unsuccessfully at least once. Keep praying for this country that somehow things can improve. Thank you again for your support!

Special Funding Request

Oriani, Haiti is a village up in the mountains of southern Haiti. The economy of this area relies on produce from their gardens that they sell in the markets in Croix de Bouquets and Port au Prince. They use this money to buy rice, flour, oil, and other items they need and require. The economy here has been increasingly strained over the last several years by gangs imposing high “tolls” on trucks and other vehicles trying to access these markets. This has further depressed the already very poor people in this area. However, they continue to put in the hard manual labor required to grow gardens. Some of the gardens are on the side of very steep hills in very rocky soil. The effort put into farming this land and bringing their produce into the village to sell to merchants who arrange transport down the mountain is very impressive. However, in July, the gangs attacked Ganthier, a town on the road to Port au Prince and the road has been closed since. This was very bad timing as the first large harvest is in July and now they can’t access the markets to sell their produce. As a result, they lost their entire harvest! This area was already extremely poor with many people living on the edge of malnourishment. Now with the road being blocked, this has reduced the supply of food and driven up costs. At the same time, no one has money to buy food! The situation looks very grim. Now is the time to replant gardens in hopes of another harvest in November, but they lack the money for fertilizer and the ability to pay for the labor necessary to replant. At the same time refugees from Ganthier and the other towns affected by the gangs are coming up the mountain. This increases the demand for food and medical assistance. Many of these fled with only the clothes on their backs. The clinic has relied on a small fee for service to help supplement donations to cover the costs of operating. Due to the current crisis, we are often waiving this fee as fewer people are able to pay. We are asking for donations to help cover clinic costs and provide food and clothing for refugees in the area. We would also like to provide assistance to farmers as funds become available. The ability to replant gardens will be key in preventing a complete economic collapse up here on the mountain. Any assistance is greatly appreciated and will go much further here than you might think. Please mark funds as “Special Request” Thank you and God bless you.

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.