Haitian Courier #6: Pieces of My Memoirs

[This is a copy of the latest issue of my newsletter Haitian Courier, which was sent on July 26. To subscribe to the newsletter, please visit http://groups.google.com/group/haitian-courier]

Bonjou Mezanmi!

My last newsletter was a brief update just to let you know that I'm alive and well. This time I wanted to give you snippets of what I've been doing in Haiti for the past 6 weeks. Throughout this newsletter, you'll see words with web links, which will take you to corresponding entries on my blog.

First of all, I wanted to let you know that my return flight has changed from August 9 to July 31. The reason is that my older brother Sundo is getting married on August 2. So now I only have a few more days before I go home! Seems like my plans always change on the fly (last year I decided to stay an extra month in P-au-P). I can't believe my time here is almost over!

Secondly, I wanted to put a word out that the clinic here needs an X-ray machine to replace a broken one. Please let me know if you know anyone who needs to get rid of an old machine to replace it with a new digital one or for whatever reason. The one we have here has been broken for a while, and it would help so many people if we had a working X-ray machine.

Baby Jaundice, Gunshot Wound, Diabetic Ulcer, Suture Removal, and Laura's Birthday

Monday, July 14, 2008 - Part 2

We saw a 5-day old baby boy who came in to get his umbilical area cleaned. In Haiti, they use alcohol pads to wipe it, so it looked painful. The baby was quite jaundiced so we advised the mother to let the baby have more sunlight (my classmates should know exactly how that works). It was cool to see in real life something that I had learned in class.

I also got to see a man with a gunshot wound that went through his right thigh. The man works in the Bahamas, so he could speak some English. He explained that a thief had robbed him, hit him on the eye with the butt of the gun, and shot his leg. It was neat to see a gunshot wound for the first time, but only because it didn't seem too serious... Ok, it would be kind of neat even if it was serious, but I wouldn't be saying that.

There was an old woman who had been having chronic skin ulcers on her legs since 1998. They were at least 10 cm (4 in) in diameter. Since she had been coming to the clinic for such a long time, she had a really thick chart. I wanted to figure out why she was having these chronic infections, but the handwritings were illegible. So I talked with the patient to get her history while Amy changed her dressing. I was kind of surprised how well I could understand her, but that's probably because she talked slowly. Hopefully I might be actually getting better at understanding spoken Creole. Anyhow after a longwinded story of how everything happened, she told me that a white doctor who was at the clinic long ago told her that she had high blood sugar. Well, go figure.

Then we saw Ruth, one of our Haitian staff from the OMS office, who lacerated her right shin and got 6 stitches a few days ago. The wound was healing well, and it was time to take out the sutures. Evan showed me how to take one out, and I took out the rest. I guess taking out stitches aren't that big of a deal, but first times always feel kind of special.

Maranatha, Turtles, and Homemade Ice Cream

Sunday, July 13, 2008

Today we went to Maranatha Church, which is a few minute walk down the street from the compound. This is the church that Scott has been going to. Scott is a long-term missionary who's been working at the radio station for many years, and he's going back to Alabama for good on Tuesday. Since this was his last Sunday at the church, he spoke to the congregation and bade them farewell.

Afterwards, Amy, Laura, Evan, and I went to Christoph, took a quick dip in the pool, and ate lunch at the poolside. They have a few turtles at the hotel, so we paid them a visit. Nothing too exciting, and their water needed to be changed, but it was cool to see turtles in Haiti.

Amy joined us again for dinner. The kitchen ladies had prepared sloppy joe and ice cream for us (they don't work on Sundays, so they made them yesterday). Ice cream was a bit too sweet for me, but it was still ice cream, so it was good. Later we hung out at Amy's as usual, and the three of them (Amy, Laura, and Evan) watched another episode of Grey's Anatomy while I chatted with friends online. I love Grey's, but I'm not big on re-watching shows unless they're hilarious.

It was another relaxing weekend.

Cap-Haitien Tour, Bargaining, and the Twelfth

Saturday, July 12, 2008

Today we went on a tour of downtown Cap-Hatien. Amy, Wadner, Laura, Evan, and I drove over to Enoch's house and walked around the city from there. Enoch is a Haitian ergonomist who deals with agriculture and works with an organization called Hope Seed. He plays piano at the English Bible Fellowship on Sundays. He was our tour guide for the day.

First we went to the city square (see it on Google Maps), which is between the Notre Dame Cathedral and the city hall. We went inside the cathedral and looked around for a bit. Then we visited a few private catholic schools. I guess it's no surprise that schools and buildings funded by the richest church in the world are the prettiest attractions in this city.

We also visited the Justinian Hospital (Google Maps), which is the biggest hospital in Cap-Haitien and the one we usually send patients to in case of emergencies. At hospitals in Haiti, patients have to pay for every single equipment that is used for them, even gloves. With the food crisis, less and less people can afford healthcare, and more and more people are becoming sicker. Just when you thought the US healthcare system was bad...

After that, we walked through the Iron Market, which is probably the biggest market in Cap-Haitien. If you look up Cap-Haitien on Google Earth (or Google Maps), you will see a big brown square the size of 4 blocks put together. It was so crowded, smelly, and dirty that we were busy just trying to get through, so we couldn't see much of it when we were inside. Watch out for pickpockets!

Then we went to the Boat Market (Google Maps), where you will find a number of tourists. There is one long row of shops that sell paintings, sculptures, jewelries, dresses, and all sorts of souvenir items. I wanted to buy some paintings, so I went scouting down the entire row, then went back to the shops that had ones that I liked.

As usual, I had to bargain like no other. The first seller offered me three paintings for 3000 gourds ($80), but I bargained it down to 1100grds ($30). I probably could have got them for less, but at least it was quick. The second seller offered three paintings for $300US(!), claiming that one of the pieces was done by a famous painter, which is total bull crap, but I didn't want to offend him by calling him a liar (not good for bargaining) After a long negotiation he offered them for 2000gds ($53), but I only had 1600gds ($42), so he just took that. I probably could have paid less if I had been carrying less money... Bargaining takes so much energy out of you.

Then we walked over to La Kay restaurant (where we ate yesterday) and had lunch. I got chicken spaghetti this time, but it was very salty... I still ate it though. I should have gotten cheeseburger again.

In the afternoon, Amy, Evan, Laura, and I went over to Gavin's house to celebrate the Twelfth of July (an Irish tradition). We tossed around a rugby ball for a while, then ate food prepared by Gavin. For dessert we had caramel ice cream, which was probably the best ice cream I've ever had in Haiti.

Chapel, Blisters, Lightheadedness, and Cheeseburgers

Friday, July 11, 2008

This morning, instead of having a devotion at the clinic, we met at the seminary chapel with people from other OMS ministries. Dr. Rodney lead the devotion, all the different ministries shared their praise and prayer requests, and we all prayed together. We have these meetings once a quarter or so.

In the morning we saw some of our regular patients including Madelene (girl with machete wound) and Augusma (fractured elbow and sutured hand). Madelene's wound still seemed to be healing well. Last time she was here, we put some steristrips across the wound to bring the skin closer and make the wound narrower. The wound was a bit narrower, but there were a couple blisters under the steristrips. It may have been caused by friction from steristrips, or she could be allergic to them, so this time we just bandaged the wound. We'll see if the blisters are any better next time.

Then we saw Augusma, whose hand also seemed to be healing well. So Gavin took out the stitches while I held Augusma's arm so his elbow won't move. After 10 minutes or so I started to feel lightheaded, so I got Laura to cover for me and sat down. Earlier this morning I had some loose stool (probably a side effect from erythromycin). I hadn't had much water since then, and I could feel my heart palpitating (fast and hard), so I was probably dehydrated. Then my stomach started to feel queasy just before I felt lightheaded. Good thing I saw that coming and was able to hold Augusma's arm until someone took over. I sat and put my head between my knees for a while, went to the bathroom, and then I felt much better.

All the missionaries took a half day today and went out to lunch as a farewell for three long-term missionaries: John, Dorothy, and Scott. We went to La Kay restaurant, and most of us got cheeseburgers with fries. We don't get to eat much burgers in Haiti, so it was a treat.

In the afternoon I took a long nap to recuperate from my illness this morning. I feel all better now. After dinner we hung out at Amy's as usual.

Death of a Boy, Booster Shots, and Pubic Sore

Wednesday, July 9, 2008

This morning Ms. Prudence told Laura and me that the boy with diphtheria died last night at the hospital. She didn't tell us how exactly, but perhaps the toxin was too widespread. I don't know. I feel like I lost my first patient. At least he survived Monday. I wonder if his family was with him when he died.

The first thing at the clinic this morning, I helped change the dressing on Madelene, the girl with the machete wound. The wound is healing really well, but it's still very wide. Somehow we'll need to make the skin come closer. We're going to try something next time she comes.

Since today is Wednesday, we had Prenatal Clinic. Laura and I took weights and blood pressures for all the pregnant ladies. Many of them had surprisingly low blood pressures. After all the vital signs were taken, I sat in with Amy and Evan, and measured fundus heights and fetal heart rate.

All the staff who had contact with the boy with diphtheria got a diphtheria/tetanus booster shot and those who were in the emergency room with him for a long time got oral antibiotics (erythromycin) for a week. Everyone was complaining all day that their arm is sore from the shot. Luckily, I didn't have to get a shot since I got a booster in February 2006 to prepare for my trip to Sierra Leone. Good thing I brought my immunization record to prove it.

In the afternoon, I worked in the treatment room (aka injection room) mostly giving IM injections. I learned how to give glute shots in Haiti last year to treat a friend with syphilis, but the only source of info I could find on how to give IM shots was some bodybuilding website. So it was good to have Amy (Canadian nurse) and Lizette (Haitian nurse) teach me and get some proper practice.

The last patient we saw was a 17-year old girl who screamed and cried like a baby as I gave her shots of antibiotics. She had a big sore on the upper pubic area. It looked very painful, and the girl was crying and yelling, "I'm gonna die, the doctors are gonna kill me!" Amy and I tried to calm her down as we cleaned up the wound and bandaged it. Looks like she'll have to frequent the clinic to get treated for a while.

Amy joined us for dinner and shared her testimony/life story. Afterwards we played some UNO and then went over to Amy's house to watch John Q. The content of the movie was pretty good, but the quality was shoddy. My favorite part was when the doctor flicked the rubber heart to restart it after the transplant. The movie was basically a political statement on the US healthcare system.

Respiratory Emergency, Witch Doctor, HIV Orphans, and Diphtheria

Monday, July 7, 2008

Today 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.

Labadee, Kayaking, Snorkeling, Starfish, and Priorities

Saturday, July 5, 2008

Today we got to go to Labadee again! This time we went to Columbus Beach, which is much more secluded than other beaches at Labadee, so it was almost like a private beach for us.

We brought kayaks, so I went kayaking couple times. Neil and I rowed out and met up with Evan and Nadine far from the shore. Nadine dared me to take a dip, so I took a dip in the deep water for the first time ever. I have no idea how deep it was. Kind of scary but exciting!

We also brought some snorkeling gears, so I went snorkeling with Neil and Nadine. We saw lots of little fishes, corals, sea urchins, etc. I had never snorkeled before, so this was another first time for me.

We found a big starfish, so I played with it for a while. I flipped it upside down and watched it flip itself over. It took like five minutes, but it was so cool that I watched it twice. It was a very exciting day at the beach.

During dinner at the Holiday House, the long-term missionaries take turns to join the short-term missionaries and share their testimonies. Today it was Gavin's turn for the first time since I got here, so I got to here how he decided to do medical missions. His testimony had a lot of similarities with mine in terms of wanting to do medical missions, so what he said really resonated in my mind. What especially struck me is when he talked about setting priorities straight. He told us how he had put so much importance in doing medical mission, but one day he realized that he needed to put God and relationship with Him first before missions. I realized that I had been putting so much emphasis and effort into preparing for medical missions that my relationship with God had come to a standstill. I believe that God has called me to do medical missions, but I need to let God prepare me for it and focus more on growing closer to Him.

Before serving dessert, the kitchen ladies called me over to the kitchen and told me that they made a birthday cake but didn't know who it was for. Apparently someone had asked them to make a cake for Vicki today (even though her birthday was Thursday). They weren't quite ready with the candles, so I just stood in the kitchen facing the dining hall, and everyone else just stared at me waiting for me to say something. I didn't know what to say because I didn't want to ruin the "surprise" so I just stood there smiling until the cake was ready. After a little bit of awkward moment, we celebrated Vicki's birthday again.

After dinner we were joined by Amy, and the seven of us played dutch blitz. Since we had an odd number of players, Laura played by herself. She had won every time we played, and somehow, even though she was on her own, she beat us all... How in the world? It must be the way she shuffles her cards... jk. Sorry for giving you such a hard time, Laura. You've proven to us that you're the best dutch blitz player in Haiti. For now anyway.

Afterwards we went over to Amy's house and watched first half of Chaos Theory. Kind of a random movie, but I'm interested to see how it ends.

Sickle Cell Crisis, Cannonball, and English Bible Fellowship

Sunday, July 6, 2008

Gavin was in charge of taking us to church this morning. There were Laura, Evan, Vicki, Nadine, Amy, and Steve, who is here for a week to work on some projects with the radio station.

Gavin had been up very early this morning because he had been called in to the clinic because a 10-year old girl was having a sickle cell crisis. He had relieved her symptoms and she was resting at the clinic when we left for church. A few minutes after, Gavin got a call from the mother of the girl saying she was in pain again, so we turned around to go back to the clinic.

Gavin and Amy rushed into the clinic while the rest of us waited outside. I didn't want to bother them, but I got concerned about what was happening, so I carefully went in. I watched Gavin and Amy as they started an IV and tried to calm her down.

A few minutes later the girl's father came in. While Gavin was out of the room looking for something, the father asked me, "Doc, in your opinion, do you think there's a cure for this?" All of a sudden I felt a huge weight on my shoulders, as if I had to deliver a bad news. I almost choked, but said in broken Creole, "Well, Gavin is the doctor, so he would know better than me, but this is a genetic disorder so..." The father understood what I wanted to say, and he responded, "But we can control the pain, yes?" "Yes, we can," I replied, and he accepted my answer.

It seems that the father had already heard that there is no cure for his daughter's disease, but I felt awful to think that I might be the one to tell him there's no real hope. I had learned about sickle cell anemia many times probably since elementary school, but actually seeing how it affected the girl and her family had a profound impact on me. It made me realize how serious the disease is, and that the people suffering from them are not just numbers in statistics.

Gavin and Amy were able to calm her down after a few minutes, and we let the family stay in the clinic with her while we went to church. Since we were running late for church, Gavin decided to go to the church next to the OMS compound. We used a little portable audio system so Gavin could translate into a mic and we could listen to him through an earphone. He started to translate for a bit, but he left in the middle because he was called by the girl's parents again. I could only catch a few phrases because they talked so fast, so I couldn't translate. I need to practice listening more.

After the service, we went to Christoph Hotel as we usually have lunch there on Sundays. We took a dip in the pool afterwards. We did a few cannonball dives, and Laura and I threw Nadine and Gavin in the air like we did last time when we were at Christoph.

Later in the afternoon, we went to English Bible Fellowship, which is held at the Radio 4VEH station every Sunday at 4:00PM. There were a few short-term mission teams with different mission organizations. It was cool to see them and to be able to worship together in English.

On Sundays we are on our own for dinner, which just means that we don't have a cook to prepare us food or wash dishes, but they make pasta salad or something we can heat up in advance. We also don't have a long-term missionaries scheduled to join us, but Amy joined us for dinner tonight, just because she can.

Afterwards, we hung out in Vicki and Nadine's room as they packed their bags because they are leaving tomorrow. We watched the rest of Chaos Theory, which had a pretty good ending. It's going to be so sad to see the two leave tomorrow morning.

Malnourished Baby, HIV Test, Wadner's House, and Vicki's Birthday

Thursday, July 3, 2008

Today was Well Baby Clinic, so Nadine and Vicki helped out by admiring the little babies taking weights and temperatures, giving vaccines, etc. Amy and Evan consulted patients (mostly babies today) together as they have been doing this week. I shadowed Dr. Rodney this morning, so I got to see sick patients including babies. We saw one 8-month old girl who weighed a mere 5kg, which is way below normal (lower limit is 6.5kg). She was so skinny and small, and it was heartbreaking to see her. Her mother brought her in because the baby was having fever and diarrhea. We gave her medicine for the symptoms, and put her on the nutrition program (part of the World Food Program) to help her gain the much needed weight. I'm so thankful that we have these programs to help little babies like her.

Another patient we saw was a young man who had headaches and some kind of rash on various parts of his skin. I can't remember exactly, but I think he also had a little abscess of some sort on his neck. He reminded me of a Haitian friend from last year who turned out to have syphilis. Just as I was thinking this patient might have some kind of sexually transmitted disease, Dr. Rodney asked the patient if he wanted to get tested for HIV. The patient seemed hesitant and concerned about the cost of the test, but I could tell that he was relieved when Dr. Rodney said the tests are free of charge. Dr. Rodney explained to the patient about the pre-test consultation where they educate patients about STDs and HIV as well as ask risk assessment questions. I didn't get to see the results (I was probably eating lunch when Dr. Rodney saw him again with the results), but it was good to see how cases like this was handled in consultations (and that my instincts weren't far from Dr. Rodney's line of thought).

In the afternoon, Amy, Nadine, Vicki (three Canadians), Laura, Evan (two N. Irish), and I reorganized the operation room into an emergency room. While we were going through stuff around the room, we found some circumcision kits, and had a little laugh while Amy explained how to use it. It's basically a metal clamp that cuts the circulation to the foreskin and act like a stencil to direct the incision. The others almost seemed appalled to see it, but I wasn't surprised at all because I had seen one similar to it at my pediatric preceptorship last quarter. Apparently they had never seem those in Canada or Northern Ireland... but I bet they use them, too.

Vicki and I reorganized the little storage room next door. I was impressed by the variety and quantity of stuff we had, but it was a bit difficult to figure out what should go where. Also the room wasn't well ventilated, so we were kind of sweaty. Overall, I think we got a lot of work done in both rooms.

Afterwards I had a Creole lesson with Wadner for an hour, then the six of us (three Canadians, two N. Irish, and me) took a walk outside the compound walls. We briefly visited Wadner's house. Wadner is 25, and since his father passed away, he's been looking after his mother, his three sisters, and his niece. He's building his own house on the land given to him by his grandfather. Wadner also built a pretty intricate workout machine in his uncle's house next door. I was thoroughly impressed by how he maximizes the little resources that he has.

Today is Vicki's birthday, and we had planned to give her a little gag gift. The plan was to steal some of her clothes, put them in a box, and give it to her as a present. I got this idea from my birthday two years ago in Kenya when some of the missionaries pulled it off on me. The entire time we were reorganizing the operation room (now emergency room), I was looking for a small cardboard box, which we eventually found. Luckily, just as we got back from the walk, a few of the local kids showed up wanting to play some football (soccer), so Vicki enthusiastically went out to play with them. Meanwhile, Nadine (Vicki's roommate) helped me steal some of Vicki's clothes. Actually Nadine ended up stuffing the box with most of Vicki's clothes. We taped it up and hid it up at the Holiday House (that's where we eat our meals). Soon after that, I realized that, since Vicki was playing football, she'll want to come back to her room to change before dinner. So I decided to join her to keep her playing until dinner time and convince her to go straight to dinner instead of changing. It worked out just as I had planned. Oh, the power of suggestion!

After lunch today I had asked the kitchen ladies to put some candles on the dessert tonight. They said that if I had asked them earlier, they would have made a cake, but instead they had already made some jello. So after dinner, we lit up a few candles on a bowl of jello and sang happy birthday for Vicki. Then I brought out the box and gave it to her. She looked excited and nervous because we were all giggling. She opened the box and the first thing she said was, "Oh, my skirt!" She dug further and said, "This is all my clothes!" We had a good laugh.

After dinner, we went over to Amy's house, and Vicki, Nadine, and Laura got a pedicure from one of Amy's Haitian friends while we watched August Rush. I really liked the soundtrack.

Healing Wound, Square One, and Ping Pong

Friday, July 4, 2008

First thing at the clinic today, we saw Madelene, the girl with a big machete wound behind her left leg. We had brought her down from Souffrier (site of mobile clinic) on Sunday. She has been coming here every day to get her dressings changed. I had seen her at the clinic all week, but this was the first time since Sunday that I got to see her wound, which was healing surprisingly fast and well.

Today was Hypertension & Diabetes Clinic, which we have two Fridays a month. Laura and I took weights and blood pressures, lots of them. Some patients had such high blood pressure (around 210/130) that I had to double check to make sure I got it right. It was a good practice taking so many blood pressures.

After we finished taking vitals, I sat in with Ms. Ketlye as she consulted patients. Mostly we just made sure patients were taking their meds regularly, and prescribe them meds for another month. Nothing too exciting, but sometimes it's frustrating when patients don't come for a few months until they get sick because they couldn't afford to come. In that case it's impossible to tell if the medication was working or if we should change the dose. It's as if we're back to square one every time they come in.

As I mentioned before, the clinic has been seeing much less patients since January because of rising food prices. It is sad that fewer patients at the clinic doesn't mean a healthier community but rather a poorer and sicker one.

Vicki and Nadine decided to do some manual labor at the seminary construction site, so they were painting the new library with Gordon and Neil all day today. At lunch there were only three of us: Laura, Evan, and me. It was a bit sad to think that it will be like this everyday from Monday when Vicki and Nadine leave.

In the afternoon, Laura and I sat in with Amy and Evan while they consulted. I got to practice abdominal exam on one of the patients who was having some lower abdominal pain. At school we learned all these physical exam skills, but we haven't got to practice them much, so it was good to refresh my memory.

Welcome Inn, the place Evan and I are staying, has a ping pong table. So after the clinic was over, Evan, Laura, and I played some ping pong. I'm really not good at ping pong (as a matter of fact, I'm not good at any kind of sports involving spherical objects), and I hadn't played in forever. Evan beat me, but somehow I beat Laura.

It was nice to have Vicki and Nadine back for dinner. They seemed pretty exhausted from a full day of manual labor. After dinner, we played some UNO, then watched 3:10 to Yuma in Laura's room. Lights went out near the end because it was after 10:00PM. Good thing we were watching it on my laptop. The movie was pretty awesome.

Oh, did I forget that today is American Independence Day? Yeah, pretty much... I'm surrounded by N. Irish and Canadians, and I'm not even American. And we don't have any fireworks. So no point celebrating, I guess.

Goodbye Julie, Blood Drawing, Car Accident, and Augusma

Wednesday, July 2, 2008

Julie (physio from N. Ireland) left this morning. It's always sad to see people go because we all quickly become like family. She was the first person from Northern Ireland that I had ever met (then I met three more within a week). Now she's the first person from Northern Ireland whom I said goodbye to. It's been really cool getting to know her.

Today was prenatal clinic. Before seeing patients, Ms. Ketlye gave an educational talk to all the pregnant women. Vicki and Nadine helped out with weighing and taking blood pressures, and Laura sat in with Amy and Evan. Meanwhile I shadowed Dr. Rodney until he left to see Julie off at the airport. Then I went to the lab where I drew some blood and did a bunch of finger sticks. I drew three blood, two of them from little boys (about 10-12), and all of them went smoothly, so I think I'm getting better at this. But I still need more practice on patients with veins that are hard to see (Laura, are you still up for being a guinea pig?).

When I came back to the clinic from lunch, there had been a car accident where three people were brought to the clinic. In the treatment room (a.k.a. injection room) we had a 75-year old man named Augusma who fell on his right side and had people pile on top of him in the accident. I heard there were two girls from the accident in some other rooms crying very loud, but they were not in as serious of a condition as the old man.

When I came in, Augusma was lying quietly on the table as Dr. Rodney cleaned his wound. A big flap of skin on the back of his right hand had been teared open, so we could see his muscles and tendons. We could tell that he was in pain, but he was moaning very quietly. Gavin told us that in accidents like this, it is important to look for people who are lying quietly among others who might be screaming for help, because often times those who are silent are the ones in more serious conditions.

Gavin sutured his hand, including an artery that had teared under the flap and a small laceration on his right palm. Laura, Vicki, and I took turns keeping the big overhead lamp in place and holding Augusma's other hand. Meanwhile Nadine and Evan helped out with the prenatal clinic. After Gavin finished suturing and bandaged the wound, Augusma still had pain when moving his right arm, and the elbow was swollen, so we took him to the X-ray clinic, which is 10 minutes down the street from us.

As we waited at the X-ray clinic for the film to develop, Augusma shared how thankful he was that he survived the accident and praised God for sending us to take care of him. He prayed and gave thanks to God, and then started singing "Mwen renmen Jezi, mwen renmen Jezi, pou tout sa li fè pou mwen" (I love Jesus, I love Jesus, for all that he does for me). I was really inspired to see how much faith he had in God.

The X-ray showed that he had fractured the proximal neck of radius (bone of forearm on thumb side) and the olecranon (tip of elbow). So we went back to the clinic and put a cast on his arm. Augusma once again shared how thankful he was, sang the song, and prayed. He has such a bright personality. He'll be frequenting the clinic for further treatment. I'm looking forward to seeing him again.

Today was a very long day.

Tears, Baby Fever, Ankle Sprain, and Canada Day

Tuesday, July 1, 2008

After devotions at clinic this morning, we had a farewell party for Julie (physio from N. Ireland) because she's leaving tomorrow. She has been here for 6 months, and had become an invaluable part of the clinic. Dr. Rodney, who is one of Julie's best friends, gave a little speech and presented a certificate of honor and merit to her. Julie also gave a speech in Creole, then per her request we sang "Ala m kontan wè Jezi renmen m" (How happy I am to see that Jesus loves me) in the upbeat style. Tears were exchanged among many.

The rest of Tim's team (Tim, Mary, Christina, Carly, Anna, Emily, Beth, and Jen) left after lunch. It was really sad to see them go. They had become like family to me. It won't be the same without them. Lots of tears were exchanged here as well.

I shadowed Ms. Ketlye at the clinic today. One of the patients we saw was a little baby boy with a fever. I don't know exactly what was going on, but I assisted Ms. Ketlye by fetching whatever she asked me to bring. We did what we could to reduce his fever and then referred him to a hospital. I was impressed by how well Ms. Ketlye handled the case even with the limited time and resources.

In the afternoon we (those of us still here are Laura, Evan, Nadine, and Vicki) played football (soccer) with some local kids. While playing Evan sprained his ankle, so we didn't play for long.

Soon after that a truck from the World Food Program arrived, so we went over to help unload. Today is Canada Day, and most if not all of the food (rice, beans, soy/corn meal) that we unloaded were from Canada, so we, especially Vicki and Nadine, felt patriotic for Canada. Later on after dinner, Vicki and Nadine sang the Canadian National Anthem. Then we went over to Laura's room and watched Hairspray together. There are only 5 of us left now, but we still manage to have fun.

Manual Labor, Hyperhidrosis, and Broken Bed

Monday, June 30, 2008

Today ws the last day of work for Tim's team. They will be leaving around noon tomorrow. Carly, Anna, and Jen decided to work with Gordon at the new seminary construction site, so I joined them for the day. We transported three truck loads of paint, roofing materials, tiles, and lots of other heavy stuff. During the day, we were joined by Neil, a construction consultant from Washington DC. He just arrived today, and he'll be working here for 2 months working with Gordon.

Gordon is one of the long-term missionaries here, and he works for the construction project. I had always heard that he changes his shirt several times a day because he sweats so much, so it was fun to see him actually go through 5, 6, or 7 t-shirts today. Jen claims to have hyperhidrosis (i.e. she sweats a lot, too), so she went through couple shirts during the day as well. I also sweat a lot today, but I just wore scrubs, and let myself dry on the back of the truck as we went back and forth from the old compound to the construction site. I wish I could just wear scrubs everyday for the rest of my life. It makes life so much simpler. Anyhow it was a good work out.

After dinner we played a few games (hand tapping game, dutch blitz), and hung out in Laura's room. There were 10 of us running around her room posing for pictures (thanks to self-timing multiple shutter), and at one point we all got on her bed and accidentally broke it. Fun times. I'm really going to miss them all tomorrow.