Monday, July 7, 2008Today was the
most emotionally challenging day in Haiti so far. So many different things, one after another, kept
burdening my heart. Even writing about them causes the
feelings to
well up again.
First of all,
Vicki and
Nadine went back to
Canada after they had been with us for
2 weeks. It has been so much
fun getting to know them through the
clinic and just
hanging out, playing
UNO/dutch blitz, and watching
movies. It was
sad to see them
go, but that
wasn't the hard part. After all, we can still
keep in touch via
facebook/email, and who knows, we may
one day see one another again. They both have a
heart for medical missions, so I will
most likely be in touch with them.
The
really hard stuff started with the very
first patient we saw today. It was a
6-year old boy who had been having
difficulty breathing since
Friday night. When he came in, his
respiratory rate was about
30 breaths per minute (normal is 12-20), and his
heart rate was way up around
160 beats per minute (normal is 60-100). He was
breathing so hard that, his
chest cavity sunk in every time he tried to breath, just like the
baby we saw over two weeks ago. Through
auscultation I could here
loud turbulent noise during
inspiration. Even
without using a
stethoscope, we could hear a
loud noise with each breath. It sounded like his
upper respiratory tract (airway above his lungs) was
blocked. We
could not take a
look down into his
throat because there was a
big risk of further
irritating the airway, causing a
complete blockade.
We took him to our
emergency room (formerly operation room) and put him on
oxygen and
nebulizer with various
medications to open up his airway and gave him several
shots of
epinephrine, but
nothing seemed to work. At some point his respiratory rate was up to
50bpm. I had to
auscultate his heart to
count his
heart rate. I
couldn't distinguish the
pulses on his
wrist because they were
faint and beating so fast, even up to about
170bpm. It was
horrifying to actually
hear a heart
beat that fast.
The boy was
struggling so hard just to get a
descent breath that he would try to take the
nebulizer off of his mouth or
move his arms around. We all had to
work together to hold him
up and
still. It was
especially hard for me to watch him struggle because he
resembled Oliguch, one of the
orphans with whom I spent
4 months in
P-au-P last year. It was
heart-wrenching to think that he could
actually die if he didn't get his
breathing back to normal. We
prayed so many times for him as we
waited for the medicine to
work.
After
3 hours (8:30AM-11:30AM),
despite all our
efforts, he
wasn't getting any better, so we had to take the
risk of
transporting him to
Justinian Hospital, which is over
half an hour away.
Gavin,
Evan,
Amy, and
Dr. Stefan went to the hospital, while
Laura and I
stayed at the clinic.
Dr. Stefan used to work at Justinian Hospital, so Gavin figured he would be a
great help there.
Meanwhile at the
clinic, there was a
woman lying on a mattress just outside the emergency room. She seemed
very sick, and people were
gathered around to see what was going on. Soon after we sent the boy to the hospital, a couple guys
carried the woman away and
left the clinic. Just as they passed by Laura and me,
Ms. Prudence came up to us and
explained what was going on.
The woman had been diagnosed
HIV positive, but she
did not tell anyone in her
family nor her
boyfriend. Now, she was so sick with
AIDS that she
couldn't even walk. The two men that carried her away were from her
family, and they were taking her to a
witch doctor because they
didn't believe in western
medicine. I had heard various things that
witch doctors do to their patients, most of which are rather
harmful if they did
anything at all. It was
dreadful to think what they might do to the woman, and how the family could also suffer the
consequences of
HIV because many of the
rituals involve
mixing blood or
making cuts on people with
razor blades.
Then
Ms. Prudence told us about
two little girls, 4 and 3-year olds, that were brought in by their
grandfather a few minutes ago. Both of their
parents had died of AIDS, and the grandfather brought them to the clinic basically to say that
he doesn't want the kids because he
can't feed nor clothe them.
The
grandfather said the younger one is
HIV positive, so Ms. Prudence had them both
tested for HIV. The kids and the grandfather were
waiting for the
results while she told their
story. Then
Laura remembered that
Gill, one of the long-term missionaries, has a
stash of donated clothes at the office, so we went there and
brought some down for the
girls. I didn't know
what to say to the grandfather, so I just walked up to him and handed him what we had. He said, "
Mèsi," so I said, "
Padekwa," but I still didn't know what else to say, so I just
walked away. I felt
sorry that this was
all we could do for them.
After lunch, the
results came back, and it turns out that
both of the girls are
HIV positive, and the younger one also has
syphilis. They were both put on the
HIV program and the
feeding program, so at least they have access to
palliative care and some
food. Although, HIV program has been affected by
budget cuts from the
government, so I don't know
what will happen to it in the near future.
Later on I
asked the grandfather their
names and
ages, and he told me that
Enya is 4, and
Lovely is 3. They are both
beautiful and
innocent little girls.
Ms. Prudence gave them some
food to eat here before they went home. As I
watched the
three of them
share a little bowl of
rice and
beans, my
heart ached to think that the
girls would have to
suffer the
consequences of their
late parents' misbehavior. And they have
no idea what is happening to them.
While
Laura and I were
still waiting for
Gavin and others to come back from the
hospital, the two of us assisted
Lizette, one of
Haitian nurses who works in the
treatment room, change the
dressing on
Madelene, the girl with the
machete wound.
Augusma, the old man with
broken elbow and
torn hand, had also been waiting to have his
dressing changed since the clinic opened this
morning, but his
case is more
complicated so we waited for Gavin.
Gavin and others
finally came back around 3:30PM. It turns out that the
boy has, of all things,
diphtheria. If you are like me or most people in
developed countries, you know that you get
vaccinated against
diphtheria (usually with
tetanus and
pertussis) as a kid, but have
no idea what diphtheria is. It was quite
shocking to know that what I saw this morning was something I would
never see in the States. Even
Gavin, who has been working at the clinic for
2.5 years, had never seen diphtheria before.
Fortunately, the boy is now
intubated (has a tube down to his trachea for ventilation) and
stable. However, besides
blocking the airway with the formation of
false membrane in the throat,
diphtheria can cause
fatal heart and nerve damage by the
toxin released by the bacteria.
Antitoxin is being administered, but we really don't know what will happen to him, especially because he has already been very ill since
Friday. We'll have to continue
praying for him.
Since diphtheria is
highly contagious, and we had been in
close contact with him for
3 hours in a
confined space with no air-conditioning (plus he was on
nebulizer, which makes
water droplets that helps the bacteria travel through air), we need to be concerned for
ourselves and those who come in contact with us. As a
precaution, all of us went straight home,
rinsed our shirts, and took a
shower. Thank God we're
vaccinated.
At dinner there were just the
three of us:
Laura,
Evan, and me. It was a bit
quiet and
lonely, but I'm glad I still have the two with me. Afterwards we
invaded Amy's house, which we'll probably be doing most of the nights from now on, and watched
Spanglish. I was doing stuff on my computer (writing email, catching up on blog writing/reading) so I didn't pay much attention to the movie, but it seemed like a good movie from what I got out of it.
Today was a very
long and
emotionally draining day, but a kind of day that I would
never want to
forget.
