It goes with the territory

Hello again from Haiti! It's the rainy season here which means a lot of clouds, especially in the afternoons. So far we haven’t had quite as much rain as I remember from last year, but enough to water the gardens and fill the cisterns. We spent a week in the Dominican in September. We went to do some shopping and enjoy some restaurants. We spent the weekend with missionary friends and enjoyed that very much. The purpose of the trip was to pick up my niece Heidi from the airport. She came back to teach Sebastian first grade. Two of my nephews came with to visit us for a week and to help her with luggage. She had a lot with all school books for the year. Carlos has been working on getting the letter to allow us to cross back into Haiti, but unfortunately it wasn’t ready in time. We had to go back to paying our way across. But we were able to cross without difficulty both ways. We finally do have the letter so future crossings should be easier. It gets a little frustrating to have to negotiate our way across just to go to a grocery store and restaurant. Oh well, it goes with the territory and I am happy that God makes a way for us to cross.

While we were gone the clinic staff did a good job keeping the clinic going. Despite the continued difficulties I am happy the little hospital in Fond Parisien can at least do emergency C sections. I’m not sure what we would do without them. We had 2 ambulance transfers in September, both with obstetric emergencies. The ambulance is definitely showing its age. Everytime it goes down the mountain it requires repairs of some kind to the undercarriage. Fortunately the repair of the fuel system seems to be holding and the engine still runs fine.

Last week I had to piece together a lower lip after a moto accident. The patient had several teeth broken off so the lip was quite cut up with some holes through it. I was able to get it closed up and recommended he find a dentist. There is a “dentist” in Foret de Pin, another village here in the mountains, who specializes in pulling teeth. I don’t know if that is where he went, but I supposed that is better than having broken off stumps of teeth in your mouth. Speaking of getting teeth pulled, we had a patient on Monday with a bad infection after getting some teeth pulled 8 days before. Her neck and jaw were so swollen she could barely open her mouth. I gave her IV antibiotics and had her come back 2 more days for more antibiotics. She seemed to be a little better, although that might just have been the Ibuprofen. Saturday I had a 6 year old boy brought to our house. Somehow he had poked a hole in his scrotum with a stick. I sewed it together on our front porch. Who can say they did that? Or cut an umbilical cord with their office scissors? I guess it goes with the territory.

The situation in the country hasn’t changed. The road to Port is still blocked. The gang wants to open it, but the elders in Fond Parisien refuse because they don’t want the trucks to give the gang money. They say they will open the road if the gang leaves Ganthier. So nobody can go to Port except by a dangerous road of the mountains that is barely passable by moto. Gabe says he thinks we could send medications by that road, but I’m hesitant and hoping the road through Croix de Bouquets will open soon. When our ambulance returned from Fond Parisien late one night they were stopped by a group of men armed with machetes and guns who checked to make sure they weren’t bandits. So we are still safe here. Keep praying. The blocked road leaves the local economy at almost a standstill making life here harder for the locals. Thank you for your support and prayers.

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.