Come join me on my journey to Haiti April 2012, where myself, another doctor and 8 3rd year medical students work in Port-au-Prince and a rural village of Haiti.
Hey there family and friends! Well it's tuesday eve and the sun is setting behind strands of clouds on Port-au-Prince. The students are all gathered playing a game in the living room with fans surrounding them keeping them cool. We got in to Port-au-Prince on Sunday without a hitch. All bags of medicine and supplies were accounted for. We drove through downtown on the way to the guest house. The palace is still collapsed. Tent cities are still present. It looks the same and feels familiar, but it's a good familiarity. Despite the unpaved creviced roads, half built buildings and scores of street dogs; being in Haiti feels familiar...a good familiarity.
We have about 15 bags of meds and supplies, so we went through them all and organized them Sunday eve. We took everything to the hospital the next morning and settled in. We set up our own pharmacy and crowned Robert king of the pharmacy (he's not a medical student...but a boyfriend of one of them). We also set up a lab where we do urinalysis, pregnancy tests, hemaglobins, HIV tests, and HgA1c (diabetes test). It took a while to figure out a system. Carla is upstairs in the ER with 2 students; I'm in the downstairs clinic where we can do paps. Andrea, who speaks French does triage and orders labs in advance, but also ended up seeing the whole nursing staff. Two students are in the pharmacy/lab and 2 students are seeing pts downstairs. One student is a runner. Yesterday I was running all over the place to try to make sure everyone had what they needed. We're seeing our usual vaginal discharge patients where we're treating everyone for gonorrhea, chlamydia and trichamonas. Sexually transmitted diseases are very common in Haiti! Of course, we're handing out condoms, too. Some women have been pregnant, so we're stocking them up on prenatal vitamins. And everyone's anemic! Iron for everyone! I'm getting good at just guessing someone's hemaglobin by looking at them.
Yesterday we saw a little old lady who's been coughing “since the earthquake” and losing weight. We got a chest xray. I didn't see anything in the upper lobes, where one usually sees TB but I did see possibly an infection of the left lower lobe (haziness of the left diaphragm) but she also had either an infiltrate (another infection?) or just scarring of the middle lobe. So, we'll have a radiologist read it and see what they say. Her oxygen level was good. I gave her antibiotics and am having her come back on tuesday. There are a lot of untreated hypertension or they've been on meds before and ran out and they don't know the name of what they were on before and they don't have a chart. So we'll start them on hydrochlorothiazide (we have a ton) and sometimes a second agent and we're bringing them back for bp checks in a few days. We're also giving everyone with really high blood pressure a baby aspirin and cholesterol medicine hoping to decrease their risk of a heart attack or stroke. Normally we would check their electrolytes and cholesterol but some can't afford it. We're trying to teach everyone to return to the clinic before they run out of their meds and to bring their baggies so the docs know what they were taking. The ER has seen a woman with chest pain and a woman with probable malaria. Abdominal pain is pretty common, too, since H. Pylori is so common in impoverished countries (an infection in the stomach that causes gastritis and ulcers). We brought a lot a medication for this. We're also seeing lots of kids with decrease appetite...worms!
Yesterday Carla, Irma, Curtis and Estelle went to Hope Village that houses two orphanages...one just for the severely disabled, all wheelchair bound. There's a Canadian team also staying at the guest house who attend to the these kids. They have a nurse and physical therapists and they attend to their wheelchairs and positioning. The nurse requested for us to go out there to attend to some of the kids. One kid looks like he has a diaphragmatic hernia where his stomach is in his chest, so feeding is difficult. One kid looked like he had pneumonia. Carla was impressed at how well they were cared for! We finished early today, so we all went to the Village to play with the kids after work. We all took an infant and momentarily adopted one or two kids each for the afternoon. I had a 5 month old who had been recovering from malnutrition. He was a little chubster now but clearly delayed. He never smiled. There was one little girl about 1 year old that won Robert's heart. She had a lot of personality and was very cute!
When we came home, Carla, Curtis, Stephanie and myself gave the 3 dogs a bath. Negra and Blackie are still here (looking pretty skinny!) and a new one...Sam, a chow chow. Very sweet! I asked Gladys if we could put a little peanut butter in their food to fatten them up. She just rolled her eyes. She knows I attend to everyone in Haiti! There's even a kitty at the guest house! So cute...accept the first morning he got into our room, peed in Estelle's bed and then meowed for several hours! Oye!
So, we're doing great! The students are having a good time. We'll go to the Village again to see the other kids tomorrow. Friday we're off to the beach and then Sunday to a rural village! Hugs to all! Susan :)
Thursday evening. We just finished our 4 day stint of seeing pts at Hopital Espoire. I'm laying in my bed under my majestic net canopy with two fans pointed toward me. I thought that taking a break after 4 days of work would be a bit whimpy, but it's perfect timing. We've had a busy 4 days! Wednesday, our little old lady came back (the one with cough since the earthquake and weight loss). The radiologist read her XRay as negative! Her lungs sounded better, but she had a score more complaints for us to attend to.
Andrea saw a 4 year old with a temp of 104 and pretty junky lungs. Her heart rate was 140 and she was breathing at a rate of 32 but she looked good. Her pulse ox was ok, so we gave her ceftibuten and have her coming back tues. We have a lot of follow ups for tuesday! Let's see if they come. We did have a couple people come back wed and thurs for bp checks, but they didn't bring their medications with them and we couldn't find their charts. So I gave them a piece of paper with their bp on it and told them to return tuesday with their meds. If I do one thing in Haiti, it will be to teach patients to come to the clinic BEFORE they run out of their meds, take their meds the day they come to the clinic and bring all their medications with them. Just one complying with this will be a total success!
Stephanie saw a 17 year old with abdominal pain and fever for 11 days. No vomiting or diarrhea, or cough or shortness of breath. “Is he from the countryside?” “Let me go ask....Yup!” So we're treating him for typhoid and having him come back tuesday. If he's not better, then we'll treat him for malaria. We wanted to get a malaria test, but Dr. Gousse said it's cheaper to just treat empirically for malaria then to get a test. Of course, I could get Carla (our Board Certified Pathologist) to do a blood smear on him on Tuesday (duh!)
Irma saw “grandma” who had about 20 complaints! She addressed each one...whew! Then she saw “grandpa” with just joint pain. She was just calling them grandma and grandpa and then realized they really were a couple. Family Medicine right here in Haiti!
Estelle was seeing this one woman. Estelle's parents are Haitian, so she speaks Creole! At one point she asks me if someone has a positive HIV test, what do we do? “We refer them to GHESKIO,” which is the free HIV clinic in Port-au-Prince. I had met the director on my first trip to Haiti, the one that had discovered the first HIV patients in Haiti in the 80's. Because of the Global Fund (led by Bill Gates, Bono, Jeffrey Sachs to name a few), Haiti (and much of the world) is now getting adequate treatment for HIV. “Why?” She speaks more to the patient, who was speaking very low and looked very uncomfortable. I was very impressed with how well Estelle was able to talk to her and provide a very caring space for her. “Her boyfriend is HIV positive and they've been together for a long time.” “Is he getting treatment?” “No.” I got pulled away as Estelle was compassionately and warmly persuading her to get tested. Later, Estelle told me that the patient was asking her that if she was positive, did that mean she was going to die. She educated her about the treatment and the ability to live a long life with HIV. The next thing I know, Estelle and the patient were heading toward the bathroom, “she's willing to do it, but in the bathroom.” It was negative! She was smiling ear to ear. “Now give her the rest of our condoms!...and bring the boyfriend tuesday, so we can refer him!”
As we were getting ready to leave on wed afternoon, a young guy limps in saying he has a bad leg. His lower leg (where the achilles meets the heel) had an old wound that was crusty and oozing. The calf had atrophied (shrunk). “How old is this?” “Almost 2 years,” my translator Joel notifies me(the same translator I've had with me since the earthquake...the 3rd time he's been with me...he's a 2nd year medical student in the Dominican Republic.) So we take him to the ER to debride the wound (clean it up). He had had surgery on it but it never really healed. “Why did he wait so long?” “He's from the countryside.” So Curtis and Andrea worked on his leg after I numbed it up. The electricity was out, so I wore my head lamp that I just had bought at REI with the bright light on our field. It was hot, since no fans were on. We were hoping not to drip on his wound. Appeared 3 large blue sutures sticking out of is leg. Hmmmmm. We dressed it and gave him antibiotics and told him to come back on thursday for a dressing change.
I ran the downstairs clinic while Carla ran the ER. I thought it would be best since she does inpatient medicine and delivers babies, but I knew I was running the risk of exposing her to possible super sick people in a system she didn't know, which can often be very overwhelming. At the same time, I knew I was protecting myself from the many previous experiences I've had with dealing with emergencies. But it was a done deal. She likes sick patients and was “tired of vaginas” from her own practice. Where I was eager to man the pap clinic. I love doing paps in Haiti. Most of the women had never had paps (can we talk about the drama of Haitians getting their first paps!) and yet cervical cancer is the number one killing cancer in women in Haiti (and all of the “developing” world). We're doing potentially life saving procedures here! (give it to me, I'm not a surgeon; this is as close as a family doc gets to saving lives). And I love teaching paps to students...how to do it properly and caringly. The students would rotate every half day to do paps, so they would get to do several in a row. By the third ones, they were pros, not needing my help. We also did wet mounts, since there was a microscope in the laboratory. The women in the lab have never greeted me very warmly. I was nervous asking them for slides. After the third time going in there, the head lady asked if we had vitamins. I quickly ran to our stash and gave her some vitamins. We've been best friends since! Speaking of the hospital staff, they also became our patients. We did paps on the nursing students, one turned out to be pregnant, and many were anemic. I guess they don't have access to primary care either.
Carla has been blogging as well. The first couple of days she was wondering if she was making a difference as she treated a lot of migraines, acid reflux and panic attacks (since the earthquake!) And then it was Thursday. A six year old girl came in with a wound on her leg. Eric had seen her at first however, by the time he had presented her to Carla, the girl had become unresponsive. They got a nurse to get an IV in her right away, gave her a tetanus shot and eventually got IV antibiotics in her. Carla didn't know how to admit someone so eventually she summoned for Dr. Gousse, who came to see the kid. She commanded the room to act and immediately the nurses moved and whisked the patient off to a room. They saw another kid (5ish) who was febrile and breathing hard...pneumonia...admitted.
But then in came a pair of newborn twins...they were both dead. They were born at home the day prior and looked bad that day. The father brought both of them by “tap-tap” (a Toyota pick-up turned taxi that carries about 15 people at a time). “There was traffic,” he reported. Carla being a forensic pathologist, knew they were dead. “Maybe an hour,” she later recounted to me. But she felt obliged to try to resuscitate them. So she started mouth to mouth on one. Eric followed in suit with the other twin. No heart beat, no breathing. Joel was with them. He explained to the father that they were gone. He had done this before when I had failed to resuscitate a 4 year old kid when I came to Haiti right after the earthquake. Babies die in Haiti...a lot. This is Haiti. This is poverty.
As Carla and I debriefed about the incident, I tried to explain how often working in such impoverished countries one gets either the multiple “somatcky” complaints (usually as part of some other mental health issue) eg., the headaches, heart palpitations, weakness, total body pain or the severely ill patient. And often, with the severely ill patient, there's a sense of being overwhelmed because we don't know the system we're working in or there might be a lack of resources. The mom probably didn't get prenatal care. Over half of births in haiti are home births (I'm not talking about the new in home births in the states...those women have prenatal care and usually a skilled midwife). Carla actually did her residency in Pathology, however, during residency she developed Hodgkin's Lymphoma. After her experience in battling her cancer, she came to realize that she felt called to work with the most needy (before they die!) So, during her fellowship she started volunteering at skid row's Hippy Kitchen. When I was looking for another doctor to work at the needle exchange in skid row, my boss found Carla. She was working for LA coroner's and moonlighted with us. As I got to know her and her mission...to work with the most needy, I told her, “then you need to do another residency...in family medicine....and at Harbor.” And so she did. She graduated last June, and started working at Loma Linda as an attending where she has started the first street medicine program in San Bernadino Valley. Despite today's painful events...she loves Haiti and already is planning future trips!
Thursday was a half day and yet we probably saw more patients today then any other days! At one point, students were just presenting to me one right after the other. They were all blurring together. I was definitely getting tired (and hungry). After we ate and as we were packing up our bags to get ready to take to Mussotte, our leg guy game in. So we took him to the ER. We took the bandages off. The wound looked pretty good but it smelled gangrenous. He was taking his antibiotics. We taught him how to change his wounds every day and to come back tuesday. We confirmed that Ortho was coming on wed. I hope they can save his foot, but he might need an amputation. It's nice to have specialists available at the hospital. Hopefully, he'll see them. The rest of the day was spent at another orphanage. They had given us a list of kids to see. We checked for anemia on all of them (about half were anemic) and went through with their “mom” what the problem was. Since there was only 2 moms, many of the students just played with the kids after consoling them post finger prick. And that was thursday! Whew!
I'm finishing writing this account on Friday. We drove this morning to Club Indigo, a beach resort and had a great beach day! Right now, I'm outside under a full moon, listening to this great acoustic guitar group while finishing this email. Very relaxing! We're all doing great! Talk to you soon! Susan.
April 9, 2012
Craaaazy day! Let's see, where I last left you, we were at our beach resort. It was so beautiful. I went snorkeling twice...got stung by a jelly fish...gotta cool scar on my shoulder. We all did a lot of lounging, swimming and eating! We got picked up yesterday (Sunday...Easter day) and was whisked off to our next adventure...Mussot. We picked up Dora (works at the orphanage and now speaks Creole fluently) on the outskirts of Port-au-Prince and proceeded west. We eventually began to ascend up the mountain where the air got cooler, the ground became rust colored and patches of farmland quilted their way along the mountainsides. Cows, goats, pigs and chickens had staked their claim of land. It was actually fogged in....and cold! Gladys, her grandchildren Chloe and Kyu and her grand-niece Star greeted us at her house that sits on a precipice where one can see mountains and ocean all around! We ate and then took a little walk. Most of us didn't bring any warm clothes, so we all wore Gladys' sweaters and jackets. We arose at 6:30 this morning to eventually get to the church by 8am. The church has a little building that has 3 partitions making up 4 little rooms. The pastor's kids are doctors, so they use this as their clinic when they visit. So, in the main church we laid out all our meds near the pulpit where Robert and Eric manned the pharmacy. There was one table in the front, so Andrea saw adults there and Jen did all the labs there. Curtis and Joel saw kids in one of the little rooms where both benches were always full of those patiently awaiting their turn. The middle section had an exam table, so we set up the paps there. Steph and Dora were the....gynecologists! They did 25 paps! The next area had a table, so Estelle saw kids there and Irma saw kids in the next room over. Star (all of 14 years old!) translated for Irma. Kyu (6 years old! would help Andrea if her patients didn't speak French. The pastor would also help translate for Andrea as she spoke French to the pastor and he translated in Creole). Carla covered Irma and Estelle's patients and I covered Steph, Curtis and Andrea's patients. Carla and I also were running back and forth getting meds etc...for our students. Whenever someone wanted to check for anemia, they would tear off a piece of paper and write out an order for Jen. Then Jen would give the results to Eric who would dose out the iron elixir for the kids (depending on their weight...which we guessed) in addition to the rest of their “prescription”. Most kids were anemic...a couple in the 6's and 7's. Most in the 8's and 9's (normal for kids is above 10.5). Most kids had symptoms of worms. At one point Curtis just started asking “who's got worms?” and all hands would go up. We ran out of worm medicine within the first hour. We then made a “worm list” for Gladys to follow-up on.
One of Estelle's first patients was a 6 month old that had “ear pain” for a month (not sure how a 6 month old tells you she has ear pain, but I digress) and now she had half of her face swollen. Carla said she saw pus in the ear canal. She had a temp of 101.5 This is a kid I would have hospitalized. We gave her Augmentin and tylenol and told the mom if the swelling didn't go down by tomorrow, she'd have to take her to the hospital (closest one about 45 mins away...by donkey). Irma saw a kid and mom who probably had Malaria...went on the list...didn't bring any malaria medicine(I thought we did, but alas....).
Andrea saw a man who had been short of breath for a month. I saw him from across the room...he was sitting up straight concentrating on his breathing. He was breathing fast, too. Andrea reported “50”. He also had temporal wasting, which means he had lost a lot of weight in a short amount of time. His legs were swollen which is consistent with most likely heart failure (not much liver failure in Haiti). His bp was 100/50...cardiogenic shock? So, this is someone we'd not only admit to the hospital in the states, but he'd be admitted to the ICU! I talked out my thoughts to Andrea, “He needs Lasix, which we didn't bring to Mussott. He would need an ACE-Inhibitor but what if he's in kidney failure? We can't give that to him without labs. He needs a beta blocker, but what if he has cardiomyopathy, his heart will stop. Plus, his bp is too low, he might be in shock....he needs to be hospitalized. We went to Gladys, “see that man over there?” “He must be in heart failure,” Gladys astutely diagnoses! So she gave him and his family the “if-you-don't-go-to-the-hospital,-you-will-die” talk. So they put him on a donkey (I saw this with my own eyes) and promised to get a tap-tap to go to the hospital. Whew!
Gladys started taking the adults' bps sitting in the pews waiting for Dokta Andrea. First one, “220/130”...oye vey! Next 190/110, next 180/120...so almost every adult had extremely high bps (and that's not why they came to see the “doctor”). So, I had Robert make up a 4 pack...90 days of HCTZ 25 mg (bp med) Nifedipine ER 60 mg (bp med), baby aspirin and simvistatin 40 mg (cholesterol)...heart attack and stroke prevention pack! We then wrote their names down on a list...this was the chronic care list where Gladys was told to continue there meds after 3 months.
Number one complaint...Stomach Pain! Everyone has gastritis or reflux or H. Pylori or ulcers or all 4! I knew this from last year and thus brought tons of omeprazole and it's cousins. I even got a ton of Tums donated...all gone! We found a gallon bottle of Donnatol and started giving that out....it's a very old fashioned syrup that is used for stomach cramps...NOT FOR KIDS! By the end of the day, Gladys was doling out Donnatol and Tylenol syrup like candy!
At one point, I tell Gladys that we needed to eat. I passed out spicy peanut butter and jam sandwiches and Pringles.
Gladys brings one woman to me, “This woman his having leg pain and head ache for 8 days. Her friend brought her here on donkey.” I'm not sure why, but for some reason, that made her case seem more severe. “Vomiting, diarrhea, fever?” “No.” I brought her over to Steph to do a complete exam (the only exam table). She hadn't pooped in 3 days, was burping a lot and hadn't eaten in 3 days for lack of appetite. Her belly was soft but tender to palpate. We were thinking of a small bowel obstruction...at least partial since she wasn't vomiting. Typhoid could cause this, though she didn't have a fever. The leg pain ended up being a herpetic ulcer in the groin area. To help with the obstruction, we gave her a home made enema, which Steph, future surgeon, was happy to do...some success! Steph decided to check a urine dip....4+ glucose! Blood Sugar 367! Hmmmm....ileus from diabetes? So....we gave her azithro for Typhoid (ran out of Cipro), acyclovir for herpes and lots of Glucovance for her new diagnosis of diabetes. “To hospital tomorrow if not better!” And we put her on the chronic care list...
At 3 o'clock there didn't seem to be much a lull with patients in the church (Gyn and Pediatrics were done), so we just had to start packing up. Jen was still poking fingers for hemaglobins....”red shirt 7.1,” she continued. At one point, Carla looks at me, “Dude, we could spend a whole week here!” This is Haiti. This is poverty. It never ends. It's never satiated.
After a 3 hour bus ride back to Port-au-Prince, I play with the dogs (Sam and I have this game where he stands on his hinds like a bear and we box...Little Negra tries to get in on it and so I have to box a 50 pound and a 12 pound dog at the same time. Blackie just watches, but lets me pet her when I go up to her.) Carla finds the cat...whom we call “Le chat”...which means...the cat. At dinner I tell the students how proud I was of them. They worked very hard in a very difficult situation. No one complained. We saw about 300 patients.
I'm writing under my canopy...with 2 fans going...tomorrow is our last day at the hospital....lots of follow ups...hope it goes smoothly....
Flying home. It feels good to not sweat. I'm always very present to how organized my environs are when I come back to the US from Haiti (or any 3rd world or 4th world country). Lines are so straight; colors are crisp.
Yesterday was our last day working. It was a slow day (especially compared to Mussott!) The 4 year old girl Andrea saw with pneumonia came back...no more fevers, felt much better! Boy with swollen jaw came back after a week of Amoxacillin...practically back to normal! “Make sure you take him to the dentist to take out that tooth!” Many people came back for their bp checks...with their baggies of medications! Success! Most still had high blood pressures but were much better. We increased their medications and again expressed the importance of taking their meds daily and coming back to the clinic BEFORE they run out. Ankle boy came back. Jen said the wound looked better and didn't smell as bad. Possible Typhoid boy didn't come back. Girlfriend with HIV + boyfriend didn't come back.
I made up a box of all the medications that Gladys will have to continue in Mussott for the chronic care list. I told her that I think we should spend at least 3 days in Mussott next year. She agreed. Carla thought we should give out all the over the counter stuff separately...everyone wanted cough medicine, tyelenol, stomach medicine, pain medicine....just like I have in my own medicine cabinet...but they can't afford. In Haiti, one of the common street vendors is a guy carrying a bongo drum that is outwardly decorated with blister packs of different colored and shaped pills. This is the poor person's pharmacy. Who knows what the hell they're getting'!
I also finally wanted to pay Gladys for our transportation, but as I went to my wallet, my 100 dollar bills that I had brought just for her were gone. I kept my backpack at my side pretty constantly...except at the resort. The cleaning staff had access to our rooms. How could I be so stupid? Why did I even bring my wallet to the resort? Why didn't I put in a secured area? Why didn't I give her the money the very first day? I chose to be bummed about it for the day. Now I know better for next time. I'm not too mad, since I know severe poverty and hardship makes people do extraordinary things...some are admirable and some not so much. I'm done being upset about it. I can make it up by moonlighting a shift. Given it probably was a woman, I'm hoping the money is feeding a family or sending someone to school. I'm not condoning thievery, but a little magical thinking makes it easier to swallow.
At one point, I find Gladys and Dr. Gousse and Gladys tells me that a girl is “having twins and having a heart attack.” I peak in the room; Carla's on it. “Her blood pressure is 170 over 'I don't care'. Her lungs are edematous and her oxygen is 87%. I've given her 2 shots of Mag. They say the Obstetrician is 'on his way'.” She's pre-eclamptic which is potentially deadly to both mom and baby. The cure is Magnesium but ultimately, the baby needs to come out. She was also in heart failure, probably from the fluid retention one gets from the pre-eclampsia. I remember that we had IV Lasix from last year. “Give her IV Lasix and Morphine...gotta save the mom.” She goes back in the room after telling me the kids are dead. Wow, two set of dead twins in one week! I think. We go eat lunch. We had decided to end early that day in order to get some souvenir shopping done and go out to dinner in Petion-Ville. Carla decided to stay until the OB showed up. She delivers babies and knows how to do a C-Section...just for this reason. “I'm crashing her (means emergently doing a C-section) if her pulse ox goes below 90 on 100% O2 (oxygen).” Andrea volunteers to stay behind with her. It had been over an hour since the OB was “on his way.”
We go to Petion-Ville...it's a nicer part of Port-au-Prince. There are many cobblestoned walls and “gingerbread” buildings, giving it a more French colonial look. The street markets have better selection of fruits and vegetables displayed in baskets (instead of towels or plastic bowls). There is a small park in the center of town. After the earthquake, any open space was filled with tents including these small parks. The parks are back to normal and looked a bit cleaned up (the only place in Haiti that I've noticed that has changed since the earthquake...the rest of the tent cities still exist). I tell our driver I need to go to the bank. The first one didn't take credit cards. The next one's ATM wassn't working and the line had like 50 people in it. I asked Nadel to ask the guards if they knew where there was another ATM...”the supermarket”....of course. We go there and I'm able to get some money. Modernization eventually available! I meet the students amidst their shopping. I'm not in the mood plus I don't like being attacked by the vendors (not as bad as India, I remind myself). We go to the hotel that Gladys recommended for us as we order drinks to relax. Hotel Kinam is one of the oldest hotels in Haiti. It's in the typical gingerbread-style. I call Gladys to get her ETA with Carla and Andrea and she was out front. I go out to greet them and Carla is grinning ear to ear, “120/70!” she announces. The OB, Cardiologist and Anaesthesiologist all showed up. They operated on her and she immediately improved and ….one kid alive! Thank goodness! She kept that girl alive. Carla decided that we did make a difference after all. We all ate typical Haitian food and then said our good-byes to Gladys. It rained last night...actually it's been raining almost every night...and it rains hard! It thunders and rains and though causes a mess with the roads, I like the freshness it brings. The guest house has a tin roof and so the rain is extra loud. You can barely hear anything else. It's eerie, yet cool. The cat must have run under my bed. Later he meowed to let him out of my room. In the morning, I realize he peed on my clothes. Such cuteness and mischieveness all in one little package! Daisy will roll all over them trying to get the smell on her. Happy will pee over them proving he's the better species. Molly will just want me to pet her nonstop. (Daisy, Happy and Molly are my dogs at home for those who don't know...quite the mottly crew for those that do know them!) But I digress....
As we were taking off from Port-au-Prince, Carla puts her fist up to mine, “Well done.” I'm not sure if I said it or just thought it, but I know what she was thinking. Irma's flight was early from Miami, so she had to hustle. I texted her “bye”. She texted me back, “I fell in love with it!” I'm not sure if she meant with Haiti, International Medicine, Poverty Medicine, or Family Medicine...any of those will do. Mission Accomplished.
As we were leaving, our house manager left us a letter thanking us for our stay. He drew a picture of a tree. The fluffy part of the tree, he drew a face with hair and labeled it “Suzan” and then he drew little limbs coming off the trunk and labeled it “the team”. My little limbs!
Things I'll miss about Haiti: Gladys, Dr. Gousse, the kids, Joel, the dogs, the cat, the mangoes, the sound of rain of the roof, the fresh, cool air in Mussott, rust-colored soil of Mussott, baby goats, the see-through, warm salt water at the beach, the patients' smiles and sense of humor, the food, Haitian coffee, doing paps, my little limbs.
Things I won't miss: Unpaved roads, mud, potholes, traffic, fuzzy hair (mine!), sweating from moment one, jellyfish, mosquitos, garbage everywhere, street dogs foraging through the garbage, tent cities, the sheer terror I get every time I see multiple people on a motorcycle holding infants or toddlers, smog, dead babies, so much poverty.
I got to thinkin'...a popular complaint amongst Americans these days is that “government is too big”. Some people believe “the smaller the government, the better”. But having a government that provides for infrastructure is what differentiates a “1st world country” from the other countries (I use the the term 1st, 3rd and 4th world...I refuse to be PC about this....impoverished countries are not “developing”). It's our government and our taxes that pay for free schools, roads, road repairs, traffic lights, sewage, potable water, garbage disposal, laws and law keepers, seat belt laws, car seat laws, putting vitamins in our milk and bread, making sure our food is safe, ensuring that every child is educated, animal control (getting better), laws against discrimination, free health care (not the U.S. but other more advanced countries), 911, fire-fighters, police, EMTs, protected parks/nature....It's pretty clear how important these aspects of infrastructure are when all that is lacking. Without that infrastructure, one is at the mercy of luck....good or disastrous. Disasters are part of life. If your foundation is solid, you can handle the changing of winds. But if not, we all are just one disaster away from total rubble.
This trip was a true collaboration! From the students to all our supporters! We had about 40 people donating money, vendors from Abbott Kinney donated auction gifts (Zingara, Coutula, The Bohemian Exchange, G2 Gallery, MS Vintage, Gossamer Girls, Juicy Leaf, Just Tantau, Plantation, Sculpture Garden, Sunya Currie, Ananda, Confection Jewels, Aviation Nation, and The Brick House, ) and contributions from Homeless Health Care, AIDs Health Care Foundation, Pardee Properties, Americares, Heart to Heart International, Pitfire Pizza, 360 Orthodontics, Every single one of you, somehow touched our lives, so that we in turn could touch others'. Thank you from the bottom of my heart!