Some of you may know that my passion has always been rehabilitating people following a spinal cord injury (SCI). I haven't worked in rehab for several years now, but I do miss it. I have had the opportunity and the pleasure of working with Johnny during my stay here in Haiti. He is the only patient that is in this hospital with a SCI. No one else in this hospital has had experience treating someone with a SCI, from a therapy standpoint. Having a SCI is a totally life altering occurence, physically, socially, emotionally, and vocationally. I have learned that to have a SCI is much more challenging in Haiti then in the US.
Johnny was involved in a motor vehicle accident approximately 2 months ago (sidenote: NOT surprising given the chaotic driving conditions), and he was paralyzed from the waist down. The first time I saw Johnny, the expression on his face was of despondence. I am not sure what the situation was prior to Kristen, the occupational therapist, and me arriving at the hospital. We did not get the impression that he received much therapy. It seemed that he had taught himself how to function on his own. Initially, he refused treatment, then we learned that he had a pressure sore on his bottom, which is very common after a spinal cord injury because they are sitting all day and not aware that they need to shift around to relieve pressure because they do not have feeling below the level of their injury. Upon observing it, I found that the wound was being very poorly cared for and improperly dressed by nursing. No one had educated Johnny on pressure relief. Pressure relief is the first thing I would normally instruct a SCI patient about, Johnny had his injury 2 months ago. Wow.
We introduced ourselves to Johnny and became acquainted with him throughout our journey. As he realized we could be helpful and not harmful to him, he warmed up to us. I remember the first day we really treated him. I was assessing him, and I wanted to see what he was able to do for himself. He maneuvered himself out of the bed and into the wheelchair without difficulty. Kristen then asked him how he accessed the bathroom and shower. Trust me, the Haitian hospital bathrooms are not wheelchair accessible. There is even a step to get up into his bathroom that is actually the size of a powder room. We watched somewhat horrified, but yet intrigued as he popped his chair into a wheelie placing the front of the wheelchair on the step and using the door frame and the commode directly in front of him to pull the rest of the chair into the bathroom. He then maneuvered his body from the chair to the commode, and from the commode to the shower. He finaled with turning the water on his fully clothed body. We erupted in cheers and applause. This was a motivated man who was going to do for himself and figure it out. I think just our clapping and cheers alone, made him realize how amazing his accomplishments were and that he could feel proud of himself instead of worthless. The reason I made that last statement is because Johnny told us that when he first came to the hospital, nobody would help him. Nobody would take care of him. Nobody would help him bath or get dressed. He felt they were disgusted by him as if he was some sort of freak. I have never seen anyone come to visit Johnny. He says that his cousin came to visit him once, and his cousin told him he looked terrible. Johnny told him he didn't need such negativity, so he threw him out and told him never to return again. He tells us his father came once and took his money. But he says he has God. God is with him always.
I haven't met a Haitian yet who has had an easy life. Johnny, of course is no exception. He is a very attractive 27 year old man. His mother is Dominican and his father is Haitian. His mother lives in Martinique and his father is here in Haiti. I didn't learn the details, but Johnny has been on his own since he was 10, when it seems his parents left him. He was left to raise is brothers and sisters. You can tell that Johnny was a hard worker. His upper body is very strong, and he is very lean. He was a laborer prior to his accident. He would carry heavy, heavy loads up several flights of stairs. He was a truck driver, too. He talks about how all he wants is to return to work. He needs to work. I am astounded by his focus on working. He doesn't speak once to us about wanting to be able to walk again.
In poverty stricken Haiti it is very, very difficult as an able-bodied person to get a job. I am sure it is exponentially more difficult as a paraplegic to get a job. He says that people will likely look at him as a freak, and he won't be treated well. I can't even imagine how difficult it will be for him to even maneuver the terrain in Haiti. Absolutely nothing is going to be accessible to him. There are no handicap ramps or elevators. There aren't any sidewalks or paved roads. The roads are filled with garbage, rubble, and completely uneven terrain. Transportation will be nearly impossible for him. He won't be able to afford a car, most people don't have money to buy a car. Not one Haitian that I met even had a car. People rely on walking and tap-taps for transport. To review, a "tap-tap" is a significantly overcrowded bus or pick-up truck that will not accomodate his wheelchair. And by overcrowded, I mean people are hanging off the back of the bus.
Johnny tells us that he would like to return to the Dominican Republic. He has no one here in Haiti, but he has some family in the DR. A passport will take months to get. And he does not have the money to get it. We found out this week that there is some sort of vocational rehab facility several hours away that will take Johnny. I don't know much about this facility, but there are alot of other young men there who have had SCI's, and they are training on computers and digital cameras that have been donated. Johnny is not in denial. He knows that he will never do heavy labor again. He wants to do be an artist and make crafts and sculpt for a living. This rehab program is definitely a step in the right direction. But realistically, I am very scared for Johnny. He is a smart man, and I am sure he is quite creative. But there are thousands of Haitians who are very intelligent, creative, strong, and able-bodied who can't find jobs, who can't get out of Haiti, and can barely keep their heads above water.
Kristen and I gave Johnny our e-mail addresses. I don't know if I will ever hear from him. I don't know if I will ever find out what will become of him. I pray that his faith in God will be strong enough for him to overcome his obstacles. He has had an extremely hard life. Unfortunately, I think the road ahead of him is going to be grueling, literally and figuratively.
Friday, August 13, 2010
Wednesday, August 11, 2010
The Wheelchair Fiasco
This is a story about how precious any and all material possessions are to Haitians. I noticed when I was in Madame Dossa's tent one day that she had not one, but two wheelchairs in her tent. She keeps them tied together. When we do therapy she refuses to be out of sight distance from her tent. She does not trust that things will not be taken from her.
We have a 13 year old girl, Kevelyne, in the hospital. She has crush injuries to both her legs. Her right leg is in a long leg cast and she has an external fixator on her right leg. An external fixator is a device used mostly by Europeans to stabilize a fracture. It consists of external screws that go through the bone and they protrode from the skin and are attached to metal halos to maintain the screws positions. It's actually pretty cumbersome and can make mobility difficult. But I am told that they are the quickest way to fixate a serious fracture with decreased risk for infection. Well anyway, Kevelyne, is non-weight bearing on both of her legs and we have started getting her out of bed and into a wheelchair. She has been here in bed for a while and will be here for at least 5 more weeks receiving IV antibiotics. She is unable to bend her knees and when she is in a wheelchair, her legs need to be elevated. Wheelchairs are a high commodity here. The wheelchair she has right now does not have any leg rests, so we are supporting her legs with a crutch under her cushion on one side and a piece of wood under the other. Not very comfortable I would imagine.
I notice that one of the wheelchairs in Mme. Dossa's tent has the components we need for Kevelyne. I tell the team we need to get that chair. I had no idea at the time what kind of drama we were getting into with this situation. We decide to have one of the translators, Burton, ask Mme. Dossa for the chair. Keep in mind, these chairs are not hers, they belong to the hospital and she never even uses this particular chair. Burton explained the situation that this was for a little girl who really needed it. She listens and says, "I cannot make this decision, you need to speak with my daughter." When the daughter arrives, Burton has a very lengthy discussion with her, and she says, "I cannot make this decision, I need to speak with my brother."
Later that afternoon, I arrive at Dossa's tent because we are taking her to the prosthetic clinic to get her new leg. I notice that the wheelchair that we were requesting is no longer in the tent. Initially, I thought that she had decided to relinquish it. Oh, I was wrong. I still don't know exactly what happened to that chair, but we are quite certain her son came and took it home.
We were all upset about this, especially since we were trying to be graceful with her and her family. We devised a plan because we do not want the other wheelchair to disappear from the hospital. Like I said, there are few, and it is not right for her to have two wheelchairs, a walker, and a prosthetic. So when Samuel and I give her physical therapy this morning, we have her put her brand new prosthetic on and we walk her away from the tent. As her back is facing the tent, Burton removes the wheelchair from the tent. When we return from walking, Mme. Dossa is clearly upset that her wheelchair is gone. I do not understand a word that she is ranting, but I know it's not good, and I know that she is not praising God this time. Before we leave her we apologize that the chair is gone and that we will keep our eyes open for it.
We were not anticipating that her daughter would then hospital stalk us, questioning the location of the wheelchair. She would literally stand there for 30 minutes as we treated another patient. We knew we had to address the issue. I thought it would be a good idea if we reminded them that the chairs were not hers to keep and that we would give her one to keep if they would return the other chair. I imagined a peaceful exchange. Again, I was wrong. Samuel and I approached the tent, and the Creole dialogue quickly became heated. Samuel, one of the Haitian rehab techs we are training, is normally very soft spoken and laid back. He became very passionate in this exchange. This was an ordeal that lasted the entire day. In the end, Kevelyne never got the chair she needed, and we were forced to take the chair that was quite frankly nicer and much more appropriate for Mme. Dossa away from her. Kinda sad, nobody won in this situation, and it could have been a happy ending if only Mme. Dossa was willing to give up one of the chairs to someone else in need instead of being deceptive. Franz, another Haitian rehab tech, made a good point, he said the family wants every possession they can even if they can't use it because they will sell it.
I felt so helpless in this situation because I could not contribute in the dialogue, therefore I could not attempt to reason with the patient or family. Don't get me wrong, Dossa is still one of my favorite people in this journey, but I was disappointed in the outcome of this story due to the choices Dossa and her family made. Especially since Dossa seems to be a strong Christian.
Well, I guess we will see if Dossa will participate with therapy tomorrow, or if she's still angry. . .
We have a 13 year old girl, Kevelyne, in the hospital. She has crush injuries to both her legs. Her right leg is in a long leg cast and she has an external fixator on her right leg. An external fixator is a device used mostly by Europeans to stabilize a fracture. It consists of external screws that go through the bone and they protrode from the skin and are attached to metal halos to maintain the screws positions. It's actually pretty cumbersome and can make mobility difficult. But I am told that they are the quickest way to fixate a serious fracture with decreased risk for infection. Well anyway, Kevelyne, is non-weight bearing on both of her legs and we have started getting her out of bed and into a wheelchair. She has been here in bed for a while and will be here for at least 5 more weeks receiving IV antibiotics. She is unable to bend her knees and when she is in a wheelchair, her legs need to be elevated. Wheelchairs are a high commodity here. The wheelchair she has right now does not have any leg rests, so we are supporting her legs with a crutch under her cushion on one side and a piece of wood under the other. Not very comfortable I would imagine.
I notice that one of the wheelchairs in Mme. Dossa's tent has the components we need for Kevelyne. I tell the team we need to get that chair. I had no idea at the time what kind of drama we were getting into with this situation. We decide to have one of the translators, Burton, ask Mme. Dossa for the chair. Keep in mind, these chairs are not hers, they belong to the hospital and she never even uses this particular chair. Burton explained the situation that this was for a little girl who really needed it. She listens and says, "I cannot make this decision, you need to speak with my daughter." When the daughter arrives, Burton has a very lengthy discussion with her, and she says, "I cannot make this decision, I need to speak with my brother."
Later that afternoon, I arrive at Dossa's tent because we are taking her to the prosthetic clinic to get her new leg. I notice that the wheelchair that we were requesting is no longer in the tent. Initially, I thought that she had decided to relinquish it. Oh, I was wrong. I still don't know exactly what happened to that chair, but we are quite certain her son came and took it home.
We were all upset about this, especially since we were trying to be graceful with her and her family. We devised a plan because we do not want the other wheelchair to disappear from the hospital. Like I said, there are few, and it is not right for her to have two wheelchairs, a walker, and a prosthetic. So when Samuel and I give her physical therapy this morning, we have her put her brand new prosthetic on and we walk her away from the tent. As her back is facing the tent, Burton removes the wheelchair from the tent. When we return from walking, Mme. Dossa is clearly upset that her wheelchair is gone. I do not understand a word that she is ranting, but I know it's not good, and I know that she is not praising God this time. Before we leave her we apologize that the chair is gone and that we will keep our eyes open for it.
We were not anticipating that her daughter would then hospital stalk us, questioning the location of the wheelchair. She would literally stand there for 30 minutes as we treated another patient. We knew we had to address the issue. I thought it would be a good idea if we reminded them that the chairs were not hers to keep and that we would give her one to keep if they would return the other chair. I imagined a peaceful exchange. Again, I was wrong. Samuel and I approached the tent, and the Creole dialogue quickly became heated. Samuel, one of the Haitian rehab techs we are training, is normally very soft spoken and laid back. He became very passionate in this exchange. This was an ordeal that lasted the entire day. In the end, Kevelyne never got the chair she needed, and we were forced to take the chair that was quite frankly nicer and much more appropriate for Mme. Dossa away from her. Kinda sad, nobody won in this situation, and it could have been a happy ending if only Mme. Dossa was willing to give up one of the chairs to someone else in need instead of being deceptive. Franz, another Haitian rehab tech, made a good point, he said the family wants every possession they can even if they can't use it because they will sell it.
I felt so helpless in this situation because I could not contribute in the dialogue, therefore I could not attempt to reason with the patient or family. Don't get me wrong, Dossa is still one of my favorite people in this journey, but I was disappointed in the outcome of this story due to the choices Dossa and her family made. Especially since Dossa seems to be a strong Christian.
Well, I guess we will see if Dossa will participate with therapy tomorrow, or if she's still angry. . .
Sunday, August 8, 2010
The Lady in the tent
Let me preface that I am sorry I have not been around all weekend. I did not have access to wireless at all! Believe me, it was killing me!
I had heard about the lady in the tent, but I had not had the opportunity to treat her all week. Friday was the first time I got to experience Dossa. The rehab techs were not there this day so Kristen, the OT and I got to treat everyone in the hospital. I had seen her before. She sits in a blue two person tent in the front parking lot of the hospital. She rarely leave her tent, and she sits on the ground in the tent. She has a perfectly good cot with a perfectly good mattress overlay that is nicely made with clean frilly sheets. Dossa does not even sleep on the cot, she sleeps on the floor. She says that she does not sleep on the cot for fear she will roll off since she moves around alot in her sleep. I offer to remove the cot and put the mattress on the ground and she refuses because where then will her guests sleep, she asks.
I am amazed to discover that Dossa is 85 years old. Her skin makes her looks much younger, and she has this captivating energy and presentation about herself. She also has had her left leg amputated below the knee. She is awaiting a prosthetic. She doesn't hop much with her walker becase she says she fell once, she is fearful. She initially refuses therapy, but we slowly charm her into it. My goal is for this woman to be able to get herself off the hard floor of the tent where I respect her wishes to sleep there and get herself into the wheelchair so that she can maneuver around. This is so she doesn't have to be so alone and dependent on others for everything. I can see that she is a very strong, sturdy woman for 85 (amazing!), and this is a realistic goal. I never thought that one of my goals as a PT would be to help an OLD woman be independent getting off the floor of her tent and into a wheelchair!
So, through the interpretor I tell her I need to see her get from the floor onto her bed. I don't assist, because I want to see what she can do. Well, she definitely does not use the technique I would have recommended, but she gets up there without any help, without half of her left leg AND she's 85 years old! Then I ask her to stand. She is fearful. I crouch down into her tent with her and set up her walker in front of her cot which she is now sitting on. Before she stands she says a prayer and recites a Haitian chant. My translator laughs because she says that they are some old Haitian sayings that she has never even heard before. Then she does it, she stands for me without problem. Great! She sits back down and I tell her I need her to get from the cot to her wheelchair. After more prayers and chants, and some instruction from us, she pivots over to the chair with minimal assist. She is on her way to hopefully being able to get herself out of the tent without 2 people dragging her off the floor and into the chair. Once she got in the chair, with her deep raspy voice she sang another chant that sounded like a fight song to me and we clapped to her rhythm and she smiled her toothless smile and her eyes shined with happiness.
After Madame Dossa was in her wheelchair outside her tent finally, she said something to the effect of "We begin life as babies and end life like babies. Just having fun and a good time." This coming from a woman who has lost part of her leg surviving an earthquake, who doesn't seem to have any family, and who lives on the floor of a small tent in the parking lot in front of the hopital.
I had heard about the lady in the tent, but I had not had the opportunity to treat her all week. Friday was the first time I got to experience Dossa. The rehab techs were not there this day so Kristen, the OT and I got to treat everyone in the hospital. I had seen her before. She sits in a blue two person tent in the front parking lot of the hospital. She rarely leave her tent, and she sits on the ground in the tent. She has a perfectly good cot with a perfectly good mattress overlay that is nicely made with clean frilly sheets. Dossa does not even sleep on the cot, she sleeps on the floor. She says that she does not sleep on the cot for fear she will roll off since she moves around alot in her sleep. I offer to remove the cot and put the mattress on the ground and she refuses because where then will her guests sleep, she asks.
I am amazed to discover that Dossa is 85 years old. Her skin makes her looks much younger, and she has this captivating energy and presentation about herself. She also has had her left leg amputated below the knee. She is awaiting a prosthetic. She doesn't hop much with her walker becase she says she fell once, she is fearful. She initially refuses therapy, but we slowly charm her into it. My goal is for this woman to be able to get herself off the hard floor of the tent where I respect her wishes to sleep there and get herself into the wheelchair so that she can maneuver around. This is so she doesn't have to be so alone and dependent on others for everything. I can see that she is a very strong, sturdy woman for 85 (amazing!), and this is a realistic goal. I never thought that one of my goals as a PT would be to help an OLD woman be independent getting off the floor of her tent and into a wheelchair!
So, through the interpretor I tell her I need to see her get from the floor onto her bed. I don't assist, because I want to see what she can do. Well, she definitely does not use the technique I would have recommended, but she gets up there without any help, without half of her left leg AND she's 85 years old! Then I ask her to stand. She is fearful. I crouch down into her tent with her and set up her walker in front of her cot which she is now sitting on. Before she stands she says a prayer and recites a Haitian chant. My translator laughs because she says that they are some old Haitian sayings that she has never even heard before. Then she does it, she stands for me without problem. Great! She sits back down and I tell her I need her to get from the cot to her wheelchair. After more prayers and chants, and some instruction from us, she pivots over to the chair with minimal assist. She is on her way to hopefully being able to get herself out of the tent without 2 people dragging her off the floor and into the chair. Once she got in the chair, with her deep raspy voice she sang another chant that sounded like a fight song to me and we clapped to her rhythm and she smiled her toothless smile and her eyes shined with happiness.
After Madame Dossa was in her wheelchair outside her tent finally, she said something to the effect of "We begin life as babies and end life like babies. Just having fun and a good time." This coming from a woman who has lost part of her leg surviving an earthquake, who doesn't seem to have any family, and who lives on the floor of a small tent in the parking lot in front of the hopital.
Thursday, August 5, 2010
Frustrations with a language barrier
I have completed my third day at the hospital. I'm starting to feel more comfortable. There are so many interesting dynamics here and it is difficult to determine which ones to discuss. There are so many problems with this system that everyone is trying to fix. It is so difficult when there is so much turnover in help. My group is here for only two weeks. Several other groups are here for only a week. The docs that are here this week are only here for a week. Here is the breakdown of what happens: Suppose you were injured during the earthquake. And you had surgery on your leg. The surgeon who did your surgery is no longer here. He left some notes somewhere, maybe, if someone is able to even find them. He gave you instructions for you to follow up in clinic in a month. You don't have an actual appointment, you are just to show up in a month. When you show up, you take a number and wait like you're at the deli ordering lunch meat. When it's your turn in the office a doctor that does not know you, your history, or your language tries to figure out through a translator why you are in their office. And often, the doctor is not able to resolve your issue because they did not do you your surgery, you did not get the proper therapy you needed, and now your knee is stuck, will not bend due to the chaotic medical system. It's not anyone's fault, though. Healthcare workers are coming here, on their own free will, staying as long as their normal lives allow and doing all that they can with what little resources they have. It breaks my heart when there is nothing we can do to help someone.
I had a small breakdown today. There is no huge, emotional earthquake story to go along with this. I got a referral for a boy for back strengthening because he has scoliosis. He has back pain. It hurts all the time since he was a child. He's 20 and looks like his is 14. He is just as sweet as can be and attentive. He just wants to feel good again. He hangs on our every translated word. I look at his spine. It is so curved that he has a hump on the right. There is really nothing I can do. You don't see scoliosis like this in the US anymore. He needed bracing when he was a child. I instructed him on posture exercises and pain management knowing that it will have limited effectiveness. I just wanted to lay my hands on him and heal him. I became so frustrated because I was having an extremely difficult time keeping a translator around. They would just disappear as I worked with him. Finally, I blew up on a translator after he left the room during my session. I was frustrated because I just wanted to help this kid, and I am here as a volunteer and during this time I can not get a translator who cares enough to help me teach him. It's a challenge and after my meltdown, I have three translators in the room. Guess I need to be more aggressive. . . because the most powerful tool we have here is knowledge. And it is so important to transfer that knowledge to the those who are uneducated about their health.
I had a small breakdown today. There is no huge, emotional earthquake story to go along with this. I got a referral for a boy for back strengthening because he has scoliosis. He has back pain. It hurts all the time since he was a child. He's 20 and looks like his is 14. He is just as sweet as can be and attentive. He just wants to feel good again. He hangs on our every translated word. I look at his spine. It is so curved that he has a hump on the right. There is really nothing I can do. You don't see scoliosis like this in the US anymore. He needed bracing when he was a child. I instructed him on posture exercises and pain management knowing that it will have limited effectiveness. I just wanted to lay my hands on him and heal him. I became so frustrated because I was having an extremely difficult time keeping a translator around. They would just disappear as I worked with him. Finally, I blew up on a translator after he left the room during my session. I was frustrated because I just wanted to help this kid, and I am here as a volunteer and during this time I can not get a translator who cares enough to help me teach him. It's a challenge and after my meltdown, I have three translators in the room. Guess I need to be more aggressive. . . because the most powerful tool we have here is knowledge. And it is so important to transfer that knowledge to the those who are uneducated about their health.
Tuesday, August 3, 2010
My patients. . .
Things here are kind of slow to move initially in the morning. I slept on a cot without a pillow and no a/c. I slept like a baby but woke up sweating my bleep off. I rather enjoy the cold shower, though. We are on our own for breakfast, I realize that someone stole all of my Larabars! I love my Larabars and someone took them. I still have all my cash, but will be begging for breakfast for the next week. Nice. I hope that it was someone who was really hungry and truly benefited from my very yummy Larabars. If you've never had one, you should try 'em, Delicious.
The day begins with a group meeting and then rounds. Rounding is absolute chaos. There are too many chiefs if you know what I mean. There is an entourage of 20 of us, doctors, nurses, PA's, PT's, techs, yada yada going around to each patient and everyone has their 2 cents to add and it's just overwhelming, but it at least gives me a good picture of all the patients until I get bored and wander off to do something else. But I keep in mind this one particular patient. He is post-op Day 1. He has a leg fracture and rib fractures from falling out of a tree. He is laying on a cot with a bright purple cast on his right leg that goes up to his hip. They decide that he is to be discharged today and needs to be trained to use crutches. They don't want to keep people too long because alot of these people learn to work the system because they want to stay here forever because it's cleaner and it's a free meal. When they decided that he was going to go home today, I knew we may have a problem. One of the techs is to treat and instruct this patient, so I go on with my day.
After lunch I ask one of the girls in my group how the guy with the long leg purple cast did with therapy this am. I asked if he was ready to go home. She said he did terrible, it took two people to get him off the cot and he could barely stand on the crutches. I decided to check on him. He is sitting in a wheelchair in his room, waiting to leave. One of the doctors gave him 10 bucks for a ride home. There are no crutches even in the room for him to leave with. I try him out on various crutches then a walker. He is able to maneuver a bit with the walker but is limited due to his back pain from fractured ribs. I decide that I don't feel like he is ready to go home today so I talk to one of the docs and she says he can stay for an extra day. I'm working with another patient when I am told that purple cast is leaving. There is all kinds of commotion going on as there are all these people trying to load purple cast onto a tap-tap. A tap-tap is essentially an old pick-up truck with 2 benches along the inside of the bed of the truck to seat passengers. It's like their taxi, they are everywhere. Purple cast looks clearly uncomfortable sitting on the floor of the bed of the truck. I ask his father, how far away is home. He tells me it may take 2 to 6 hours to get home. I can't imagine having a broken leg and ribs, and riding home 2-6 hours in the bed of the truck through rubble!!! Well, I don't feel good about this so I unload him from the truck and try to keep him from being discharged. More Chaos. Well, I lost this battle because they had no idea if they would ever be able to get him another ride home, and as I helped him back into the truck, it became more apparent to me that he was not in as much pain as he was before. I think he wanted to stay in the hospital as long as he could. But the whole scene was chaos and confusion and the patient almost went home without anything to walk with when he can't even put weight on his right leg. And then he was even expected to make that ridiculous trip back to the hospital on Monday, less than 5 days from now simply for an X-ray. So, even though he did not stay, things were straightened out. I hope. .
I have one more story that I would like to share with you. This story belongs to Joan, the nurse practitioner with my group who gave me permission to publish this. Let me set this up. This is primarily an orthopedic hospital, most of the patients have injuries and surgeries to their bones and muscles. There are some patients that are not orthopedic who just end up here somehow, I guess nowhere else to go. These patients subsequently get overlooked when the doctors do their rounds and such. I noticed one patient whose cot is set up in the hallway, oh yeah, some of the patients sleep on cots as well. She seemed kind of out of it, and I figured she was mentally ill. Well she is and she is also very medically ill, but has not been followed by a doctor for a while and nursing doesn't take vital signs or anything. It's crazy! So apparently this women crashed tonight, she became extremely short of breath. So guess what the nurses did? You will not believe this. They pulled her out on her cot to the balcony area, they stripped off all over her clothes, and proceeded to pour buckets of water on her! Then Haitians stood around her and sang. What?!? Does this really happen in a hospital? Apparently so. This is when someone came to the volunteer break room and asked for help. It was evening so we were all just hanging out. This is when Joan sprang into action to assist. Apparently this woman has cardiomyopathy that is untreated, basically she is having heart failure due to fluid retention. And the initial reaction of the Haitian nursing staff was to throw water on her and stand around her and sing. Think about this next time you want to complain about our healthcare!
The day begins with a group meeting and then rounds. Rounding is absolute chaos. There are too many chiefs if you know what I mean. There is an entourage of 20 of us, doctors, nurses, PA's, PT's, techs, yada yada going around to each patient and everyone has their 2 cents to add and it's just overwhelming, but it at least gives me a good picture of all the patients until I get bored and wander off to do something else. But I keep in mind this one particular patient. He is post-op Day 1. He has a leg fracture and rib fractures from falling out of a tree. He is laying on a cot with a bright purple cast on his right leg that goes up to his hip. They decide that he is to be discharged today and needs to be trained to use crutches. They don't want to keep people too long because alot of these people learn to work the system because they want to stay here forever because it's cleaner and it's a free meal. When they decided that he was going to go home today, I knew we may have a problem. One of the techs is to treat and instruct this patient, so I go on with my day.
After lunch I ask one of the girls in my group how the guy with the long leg purple cast did with therapy this am. I asked if he was ready to go home. She said he did terrible, it took two people to get him off the cot and he could barely stand on the crutches. I decided to check on him. He is sitting in a wheelchair in his room, waiting to leave. One of the doctors gave him 10 bucks for a ride home. There are no crutches even in the room for him to leave with. I try him out on various crutches then a walker. He is able to maneuver a bit with the walker but is limited due to his back pain from fractured ribs. I decide that I don't feel like he is ready to go home today so I talk to one of the docs and she says he can stay for an extra day. I'm working with another patient when I am told that purple cast is leaving. There is all kinds of commotion going on as there are all these people trying to load purple cast onto a tap-tap. A tap-tap is essentially an old pick-up truck with 2 benches along the inside of the bed of the truck to seat passengers. It's like their taxi, they are everywhere. Purple cast looks clearly uncomfortable sitting on the floor of the bed of the truck. I ask his father, how far away is home. He tells me it may take 2 to 6 hours to get home. I can't imagine having a broken leg and ribs, and riding home 2-6 hours in the bed of the truck through rubble!!! Well, I don't feel good about this so I unload him from the truck and try to keep him from being discharged. More Chaos. Well, I lost this battle because they had no idea if they would ever be able to get him another ride home, and as I helped him back into the truck, it became more apparent to me that he was not in as much pain as he was before. I think he wanted to stay in the hospital as long as he could. But the whole scene was chaos and confusion and the patient almost went home without anything to walk with when he can't even put weight on his right leg. And then he was even expected to make that ridiculous trip back to the hospital on Monday, less than 5 days from now simply for an X-ray. So, even though he did not stay, things were straightened out. I hope. .
I have one more story that I would like to share with you. This story belongs to Joan, the nurse practitioner with my group who gave me permission to publish this. Let me set this up. This is primarily an orthopedic hospital, most of the patients have injuries and surgeries to their bones and muscles. There are some patients that are not orthopedic who just end up here somehow, I guess nowhere else to go. These patients subsequently get overlooked when the doctors do their rounds and such. I noticed one patient whose cot is set up in the hallway, oh yeah, some of the patients sleep on cots as well. She seemed kind of out of it, and I figured she was mentally ill. Well she is and she is also very medically ill, but has not been followed by a doctor for a while and nursing doesn't take vital signs or anything. It's crazy! So apparently this women crashed tonight, she became extremely short of breath. So guess what the nurses did? You will not believe this. They pulled her out on her cot to the balcony area, they stripped off all over her clothes, and proceeded to pour buckets of water on her! Then Haitians stood around her and sang. What?!? Does this really happen in a hospital? Apparently so. This is when someone came to the volunteer break room and asked for help. It was evening so we were all just hanging out. This is when Joan sprang into action to assist. Apparently this woman has cardiomyopathy that is untreated, basically she is having heart failure due to fluid retention. And the initial reaction of the Haitian nursing staff was to throw water on her and stand around her and sing. Think about this next time you want to complain about our healthcare!
Monday, August 2, 2010
My first day feels like a months worth of activity. . .
I don't even know where to begin, where did I leave off? I'm just gonna throw words up all over the page and see what happens. So actually having my flight cancelled on Saturday really worked out to my benefit. I got a free night in a very nice hotel and just relaxed which I needed. So the next morning as I was waiting for my shuttle, I hooked up with a church group of college co-eds who were going to Haiti to work in an orphanage. So the airport and flight experience was totally different this time. I no longer felt alone, I was part of a group that would kind of watch out for me. The gate no longer felt alien to me. When I landed in Haiti, I did not have to experience the airport alone which was my only true fear anyway. For good reason, cuz it was crazy!!! Also, since I arrived on a Sunday, the "traffic" was not bad.
I met Natalie, the Haiti Project rep at the airport, our "chauffeur" drove us to the Project Hope compound. Chauffeur may sound fancy, but trust me, you need a very aggressive, fearless, but safe and mindful driver to maneuver the "streets" of Haiti. We pulled up outside the gate and honked the horn. The gate opened by an armed guard. The compound is actually a house that Project Hope rented from former inhabitants following the earthquake. The house is large, likely belongs to an affluent family, but is pretty dilapidated. And there is no such thing as hot water here, but I was expecting that. The other volunteers have already arrived of course since there flights arrived on time. There are only two other volunteers in the same boat as me; Kristen is an occupational therapist and Joan is a nurse practitioner. We spent the evening getting acquainted and comparing notes.
We never really know what's going to happen, when it's going to happen, or what's expected of us. It's a must in this situation to just keep an open mind and go with the flow. We are wisked away the next morning to Diquini which is merely 7 miles from the Compound but takes an hour and a half to get there. That's right, I said an hour and a half to go 7 miles! There were 5 of us in the car and let me tell you that we did not talk very much for several reasons; we were taking it all in. There were Haitians everywhere walking and I just wanted to know what their purposes were, where exactly were they going? I saw a woman carrying 4 boxes on her head, others carrying large baskets filled with food. Perfectly balanced on streets that were nothing but gravel pits and potholes. Absolutely amazing. I saw buildings that used to be 4 stories high that had collapsed and pancaked. I saw sewage along the side of the road, filled with garbage like a landfill. I saw the tent cities. I saw my life flash before my eyes as there are absolutely no traffic laws here. Cars everywhere, any side of the street, anywhere there was empty road space, is where the cars would go. On top of that, there were people on motorcycles weaving between cars when there was barely any room to get by. And these people don't flinch. There really is no road rage, because it just is. It's what they're used to. . .absolute chaos.
I don't know if I have the time or energy to go into the hospital experience right now. It's about 10:00 before we arrive at the hospital. Again, people everywhere. How many people are in this country? There are only 2 stories to this hospital. People are lining the hallways on the first floor. They just take a number and wait to be seen in the clinic. And they wait patiently, and they are very grateful for the attention they receive when they receive it. We are given a haphazard tour. There are some levels of organization, but still very disorganized. And at this point it's very difficult to be organized because you have so many volunteers rotating in and out of the hospital constantly. We were oriented and introduced to the people we would be working with. The goal is to educate the local staff so that they are able to maintain and continue with care as the volunteers leave the country for good. I meet 4 rehab techs. They are Haitian men. One has been a tech for 3 years. The one I got to talk with the most was Samuel. He has been a tech for less than 6 mos. He has no formal education. What happened is that after the earthquake he was a translator for the volunteers coming in. There was a huge need for PT's. He said they put a request out for PT's in Haiti, and there were only 15 in the entire country. He became interested and asked to be trained to do what we do. So, in essence, my primary job is to educate them so they can rehabilitate Haiti. I did see several patients this afternoon, and after only one day, I can see so many differences between Haitian and American cultures. I will get into that tomorrow as I feel I have thrown up enough words for the day, and I know other volunteers are waiting to use the computer. So, see you tomorrow. Oh, and for the record, Creole is an extremely difficult language to understand. It's like a bunch of words slurred together. Good night! Enjoy your airconditioning and bed as I will be sleeping on a cot with the mosquitos and no air.
Hugs!
I met Natalie, the Haiti Project rep at the airport, our "chauffeur" drove us to the Project Hope compound. Chauffeur may sound fancy, but trust me, you need a very aggressive, fearless, but safe and mindful driver to maneuver the "streets" of Haiti. We pulled up outside the gate and honked the horn. The gate opened by an armed guard. The compound is actually a house that Project Hope rented from former inhabitants following the earthquake. The house is large, likely belongs to an affluent family, but is pretty dilapidated. And there is no such thing as hot water here, but I was expecting that. The other volunteers have already arrived of course since there flights arrived on time. There are only two other volunteers in the same boat as me; Kristen is an occupational therapist and Joan is a nurse practitioner. We spent the evening getting acquainted and comparing notes.
We never really know what's going to happen, when it's going to happen, or what's expected of us. It's a must in this situation to just keep an open mind and go with the flow. We are wisked away the next morning to Diquini which is merely 7 miles from the Compound but takes an hour and a half to get there. That's right, I said an hour and a half to go 7 miles! There were 5 of us in the car and let me tell you that we did not talk very much for several reasons; we were taking it all in. There were Haitians everywhere walking and I just wanted to know what their purposes were, where exactly were they going? I saw a woman carrying 4 boxes on her head, others carrying large baskets filled with food. Perfectly balanced on streets that were nothing but gravel pits and potholes. Absolutely amazing. I saw buildings that used to be 4 stories high that had collapsed and pancaked. I saw sewage along the side of the road, filled with garbage like a landfill. I saw the tent cities. I saw my life flash before my eyes as there are absolutely no traffic laws here. Cars everywhere, any side of the street, anywhere there was empty road space, is where the cars would go. On top of that, there were people on motorcycles weaving between cars when there was barely any room to get by. And these people don't flinch. There really is no road rage, because it just is. It's what they're used to. . .absolute chaos.
I don't know if I have the time or energy to go into the hospital experience right now. It's about 10:00 before we arrive at the hospital. Again, people everywhere. How many people are in this country? There are only 2 stories to this hospital. People are lining the hallways on the first floor. They just take a number and wait to be seen in the clinic. And they wait patiently, and they are very grateful for the attention they receive when they receive it. We are given a haphazard tour. There are some levels of organization, but still very disorganized. And at this point it's very difficult to be organized because you have so many volunteers rotating in and out of the hospital constantly. We were oriented and introduced to the people we would be working with. The goal is to educate the local staff so that they are able to maintain and continue with care as the volunteers leave the country for good. I meet 4 rehab techs. They are Haitian men. One has been a tech for 3 years. The one I got to talk with the most was Samuel. He has been a tech for less than 6 mos. He has no formal education. What happened is that after the earthquake he was a translator for the volunteers coming in. There was a huge need for PT's. He said they put a request out for PT's in Haiti, and there were only 15 in the entire country. He became interested and asked to be trained to do what we do. So, in essence, my primary job is to educate them so they can rehabilitate Haiti. I did see several patients this afternoon, and after only one day, I can see so many differences between Haitian and American cultures. I will get into that tomorrow as I feel I have thrown up enough words for the day, and I know other volunteers are waiting to use the computer. So, see you tomorrow. Oh, and for the record, Creole is an extremely difficult language to understand. It's like a bunch of words slurred together. Good night! Enjoy your airconditioning and bed as I will be sleeping on a cot with the mosquitos and no air.
Hugs!
Sunday, August 1, 2010
Still not in Haiti, though I should be.
I knew everything was going to smooth, I knew it!!! I arrived at my gate in Fort Lauderdale, no problem. Everyone at this gate was either a Haitian returning home or a relief worker or group. I am still alone at this point, don't know a soul. We board the plane on time and proceed to sit on the tar mac for an hour and a half due to a maintenance issue. Then they announced the flight was canceled. I was near the back of the plane and when we disembarked, I was in the back of a mile long line at the counter to attempt to re-route. There were two people trying to re-route 200 people. I knew this would take an eternity. So I bought a beer and scanned my environment for other options. I saw a group of people move away and I quickly followed, they had opened another gate counter to re-route people. Yay! I got near the front of that line and I believe I received the last seat left on the flights leaving on Sunday. I believe they then started re-routing people on flights scheduled a full 2 days later! I was very fortunate. They set me up in a very nice Hyatt and gave me free food. I am not complaining, this was fantastic treatment, but I do feel guilty because I should not be sleeping in a/c tonight.
I was one of the first to arrive at my shuttle station to take me to the hotel. I engaged in conversation with the 2 other people who were waiting for the shuttle. They were both Haitians returning home. The one girl was very Americanized and had lived in various parts of the US. She had even lived in PA for a while! Anyone know of Mooresville, PA? Guess it's on the eastern side of the state. I have no idea. We talked about her first experience with winter in the Northeast. The gentleman spoke very broken English and I struggled with his accent. I, of course, do not speak a lick of Haitian Creole, or even French. Madame Holt would not be happy to hear that given I took 3 years of French from her in high school. I should have cared and paid attention to her! This gentleman, named Ricky, had an exuberant personality. He smiled alot and just gave off such a positive vibe. He has three children and had been a musician in Haiti. He lifted his right pant leg for us to see that he had a prosthetic leg. He was a victim of the earthquake. He did not only lose his right leg below the knee that day, he also lost his wife who died on that leg. Ricky is moving on, he is still recovering, I can see he still has difficulty maneuvering with his prosthesis, but he is doing very well! He was featured on CNN, I think you can Google him, I haven't had the chance to yet. His last name is Juste, so see if you can find him. His children are staying somewhere in Florida as well for now until he gets well, I didn't have time to learn more about them. Ricky had such a tremendous spirit, and I know that he will overcome all he has been through. . .
Hopefully, my following stories will actually be from Haiti! Pray that I make it there on Sunday!!!
I was one of the first to arrive at my shuttle station to take me to the hotel. I engaged in conversation with the 2 other people who were waiting for the shuttle. They were both Haitians returning home. The one girl was very Americanized and had lived in various parts of the US. She had even lived in PA for a while! Anyone know of Mooresville, PA? Guess it's on the eastern side of the state. I have no idea. We talked about her first experience with winter in the Northeast. The gentleman spoke very broken English and I struggled with his accent. I, of course, do not speak a lick of Haitian Creole, or even French. Madame Holt would not be happy to hear that given I took 3 years of French from her in high school. I should have cared and paid attention to her! This gentleman, named Ricky, had an exuberant personality. He smiled alot and just gave off such a positive vibe. He has three children and had been a musician in Haiti. He lifted his right pant leg for us to see that he had a prosthetic leg. He was a victim of the earthquake. He did not only lose his right leg below the knee that day, he also lost his wife who died on that leg. Ricky is moving on, he is still recovering, I can see he still has difficulty maneuvering with his prosthesis, but he is doing very well! He was featured on CNN, I think you can Google him, I haven't had the chance to yet. His last name is Juste, so see if you can find him. His children are staying somewhere in Florida as well for now until he gets well, I didn't have time to learn more about them. Ricky had such a tremendous spirit, and I know that he will overcome all he has been through. . .
Hopefully, my following stories will actually be from Haiti! Pray that I make it there on Sunday!!!
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