Vaccines and Surgical Emergencies

Hello from Haiti. Another month has come and gone and we are still able to operate despite the difficulties of the country. The weather is cooling here too. Often the temperature drops to the 50s during the night and our uninsulated houses can get chilly. But the days warm up into the 70s and are very comfortable. October brought a lot of rain, but the last week has been dry. There is no change to the security situation in this corner of Haiti. The main road to Port au Prince remains blocked because of the gangs. I am able to keep the clinic supplied with medications from the Dominican Republic, but our vaccines need to come from Port. Our supply was running low and our vaccine nurse, Mis Rachel, was not able to keep the vaccine program going. If you compare months you will see our vaccine numbers dropped a lot in September. MSPP (Haitian health department) tried to send them to Jacmel and then up the road for this area, but were not able to. I gave Mis Rachel the suggestion that they coordinate with Haiti Air to fly them here. They were able to fly a load to us for our clinic, Fond Verrettes, and Fond Parisien. This allowed Mis Rachelle to get busy again. She got several people to help her and spent 2 days walking through other zones giving out vaccines and letting people know to bring their children to the clinic. Her report showed about 80 people they vaccinated in the area. These aren’t in my report. So God keeps making ways to keep working.

Our ambulance made 3 transfers this month. 2 were for OB complications. The other one was for a 17 year old boy. He had gone to the little hospital in Thoitte for a fever and not feeling well. 4 days before he came to us he started having abdominal pain. The hospital told him they couldn’t do more for him and sent him home. He lives close to Fre Willy, so he came to the clinic. His abdomen was extended and firm and very painful. He didn’t have any bowel sounds. Ultrasound showed a very enlarged bowel in the right lower quadrant. I had several patients like this last year and they all died before I could get them to help. It was in the evening so a helicopter transport would have had to wait for morning. I notified one of our ambulance drivers and while they were getting it ready we gave him antibiotics, IV fluids, and pain medicine. I messaged the surgeon at the little hospital in Fond Parisien. I am never sure what they can handle, but he said to send him and they would be waiting. The next morning the driver returned with the ambulance and told me they were waiting for him and took him straight into surgery. Fre Willy told me he had another surgery several days later. He is still in the hospital and starting to recover. They left the surgical site open as it is still draining. From what Fre Willy told me the father said they told him the small intestine had entered the large intestine. Hopefully the boy will be able to make a full recovery. If so it is almost a miracle that everything came together and he was able to get to help in time.

Whether to send the ambulance or not is one of the most difficult decisions for me. The road is rough and long and the ambulance is old. Almost every time it comes back with something broken or needs to be towed back. Because of this and the limited help to be found, I have to decide if the risk is worth it. Or if the need justifies risking the ambulance on the road. We had a girl in labor at the clinic. She had been in labor for about a day already. Ultrasound showed everything was normal, but she was not progressing. Vintanie and I decided if the baby wasn’t born overnight we would send her in the morning. In the morning the baby hadn’t come yet, so we sent her in the ambulance. It made it about 3 miles and died. Jenel went to see if he could get it running. After several hours they towed it back to our yard. Now what to do with the patient? She was not in good enough condition to go by moto and they couldn’t find another vehicle. I sent them with Jean Fritho in our land cruiser. This is not something we want to do very much because if it breaks then what? We really would have problems! But she needed to go and it didn’t seem right not to. Another time we had a 8 month pregnant girl come in with some abdominal pain. I was able to find the baby’s heart on ultrasound and it definitely wasn’t beating. She needed to be evaluated in Fond Parisien, but her vitals were stable. They asked about the ambulance. So now what?  The ambulance was working again. It had been an electrical problem a local electrician was able to fix. Do I risk the ambulance breaking down to send a stable patient? Then it might not be available for a real emergency? I told them they should find a moto. They complained that the road was bad. I’m very aware of that. But the girl was in no immediate danger so I stuck by that decision. Was it the right one? God only knows.  A new ambulance would be great! But the cost is very high. And the clinic is facing other needs for money. The clinic batteries are starting to get old and weak. To replace them will be a big expense. Also, I was just informed the house we rent in town for our nurses from Port will not be available for rent after August next year. There is a bit of a housing crisis here now with all the people who came up the mountains for safety. It seems our best option might be to build a house next to the clinic. But that will be another big expense. Finally, our time here is coming to an end next year. We need to find another administrator, but so far no one has volunteered. Will we need to find a way to keep the clinic open with only Haitian staff? That would require hiring a doctor and another expense. And another person to find a house for. Surely God has a plan! Thank you for your support. The needs here are greater than ever. This means that your opportunity to help has never been better. Thank you.

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.