my boys... Zaryen...

The other day I stopped in at Bernard Mevs (well, the u-joint went out on the truck and that's where we stopped...) and got a chance to hang out with a few of my boys. That's right, MY boys - I might have mentioned that I am the proud "mama" of 34 Haitian amputees... Macena was eager to show me how he makes a prosthetic leg, and to show off his fancy new "sporty" prosthetic leg (metal, curved like a "C".) He told me "With this I can run faster than you." I smiled and told him he could run faster than me without it - I've had my ass handed to me by him and the rest of Zaryen on the field. He gave me that sheepish child-like grin, and told me he remembered me from the hospital, back before I was "mama", when he was sick and I took care of him. I remember a lot of these boys from the tent hospital; even without "Zaryen", they were my boys.

Macena was a welder before the quake. After work on January 12, he ducked behind a wall with a bucket of water, to rinse off the sweat and dirt from the day before going home to his wife. That's when the earthquake happened - and he couldn't get out of the way of the wall fast enough, and it fell on him. As he put it, he couldn't run fast enough. The really tragic part - his was a tib/fib break (tibia/fibia - lower leg, below the knee), but he sat at a hospital with no antibiotics - no treatment for a week - and then came to us. The infection was bad, and he had to have an above the knee amputation. I have to admit, I didn't know that much about amputations, until I came to Haiti. Having your own knee joint makes SUCH a difference. Now he works at the hospital, making "fwapees" (prosthetic legs), and is one of the starting players for the Zaryen amputee team. Now, he runs like the wind.

I hung out with Macena and Cedieu for a few hours while they worked (and while the mechanic fixed the truck), talking about the team's upcoming trip to the United States. I haven't been out to see Zaryen practice as much as I'd like - it's a hard to get a ride down to the soccer field in Cite Soliel at 6am, and public transport isn't safe in that area so early (for a blanc girl.) So tomorrow morning, at the crack of dawn, Macena is going to drive his new (new to him) car over to pick me up and bring me to practice. It seems so simple, but was so touching - Macena lives in a tent with his wife and toddler, and gas is over $5 a gallon here. It will likely cost him more than a days pay to come get me, and he beamed with pride when he told me he would take care of it for me.

One of the other guys in the fwapee lab noticed I wasn't eating with them, and offered to split his lunch with me - not a big deal in the states, but a huge deal here. For many of the employees at Bernard Mevs, the meal they get at work is the only meal they eat all day. I smiled and patted my stomach - told him I had a little extra stored up, and that he needed the food more than I did.

When the truck was road-ready, Cedieu walked me out and said something that brought tears to my eyes - he said that even though Zaryen now has better gear and sponsors, I am still their godmother, because I was the first one to believe in them. He said I bought them their first uniforms, and that made them feel like a real team - made them believe in themselves. (They had had people promise to send gear and uniforms, but no one had come through, and I got pissed off and bought them myself.)

The next morning, we drove by the field on the way to work out at the orphanage in Titayin. We stopped by so everyone could see my boys play. And even though they've got real jerseys, most of them were still wearing the shirts I got them so many months ago. I had to smile when I looked at how faded they've become - I pointed out to one of the goalies that his shirt is almost pink instead of red. I think the meaning was lost in translation - like maybe he was washing it wrong - so I quickly explained that the faded color meant that he has loved and cherished it, which is exactly what I wanted to see.


~PJ

some "light reading" with my rambling commentary...

We have both city power AND internet! Whoo hoo!

So, I've been catching up on articles online, and wanted to pass along a few...

#1

Just to be clear, I'm not going to Joplin (yet...), and while some of
the information on this webpage is specific to Joplin, and to the
group that the author volunteered with, I think a lot of the
information shared is good for anyone considering volunteering in a
disaster area.

For example, ALWAYS take a roll of duct tape, sharpies, and a knife or
good scissors. I would add a few things - like a headlamp - to the
list of absolute musts...

http://sunflowerbusinessconsulting.com/repswordpress/?p=262


#2

Volunteering after a disaster is not without its risks. There are
reports of 9 cases of zygomycosis in the Joplin area. Zygomycosis
(mucormycosis) infections are caused by fungi found in soil and
decaying vegetation. Lots of people are exposed to these fungi on a
regular basis, but having it enter your body (ie. through a puncture
wound from a nail from a flying building, or disaster area clean up,
that has fungus residue on it) is what causes the deadly infection. Of
course, extra caution has to be taken by diabetics and people with
compromised immune systems (for obvious reasons... their immune system
is compromised.) It's not uncommon to see zygomycosis showing up after
natural disasters...

I'm in the middle of an interesting conversation on facebook with a
few people about zygomycosis precautions. My personal recommendations
to avoid zygomycosis are:

(1) don't be in a natural disaster (ha ha ha)

(2) if you are immune compromised, perhaps on-the-ground disaster
relief is not the best line of work for you to go into. There are many
ways to help relief efforts that will not put you in harms way, like
logistics, fundraising, coordination of donations and supplies, etc.
After the quake in Haiti, there were people who were not prepared to
do disaster relief that came to Haiti to "help", and ended up being
more of a burden than a blessing. If you end up sick, you can't help
people, and may end up taking away resources from the people who you
are trying to help.

(2) if you are doing search and rescue, ruble removal, etc, wear GOOD
gloves. Ones that nails and glass won't easily penetrate.

(3) IF YOU ARE CUT/PUNCTURED (either because you were caught in a
natural disaster, or while helping with the relief efforts in the
aftermath):

flush the wound well - clean water, or bust open an IV bag of NS (0.9%
Sodium Chloride) and use that...

clean the wound thoroughly - alcohol, betadine, hydrogen peroxide all
kill "bugs"...

cover the wound - Your skin is an amazing barrier to infection, but
when there's a hole in the barrier, stuff can get through. Bandage it
up to keep all the nastiness out. If you don't have bandaids, even
putting some TP over it and duct tape on top of that is better than
leaving a hole in your skin open to all sorts of germs and bacteria.

even if it's "just a scratch", you should still flush the scratch,
clean it, and cover it.

seek medical attention - have it looked at, and for the love of God,
get a freaking tetanus shot, unless you've had one in the past 5
years. And if you're going as a volunteer, and haven't had one in the
past 5 years, GET ONE! I've watched 5 people die of active tetanus in
Haiti. It is a horrible, miserable, painful way to die.

(4) even if you did seek medical attention, pay attention to anything
out of the ordinary in your health during the disaster/relief efforts
and afterwards. For example, if the wound becomes red and hot to the
touch, you might have an infection. If that's accompanied by a fever,
headache, severe sinus pain, and swelling, it might be zygomycosis. I
REALLY WANT TO MAKE THIS POINT CLEAR: if a provider checked out your
wound the day it happened, and said it looked fine, this does not mean
that you are not going to develop an infection in the days that
follow.

(5) whether you have a wound or not, take care of yourself. A few tips:

Be sure you drink enough CLEAN water. Also, Gatorade/ORS is a great
way to replenish all the electrolytes you're sweating out.

Eat. We used to joke about "the Haiti diet", because so many people
lost weight when they came down here to volunteer. While you may not
be hungry in the midst of the chaos, you need your strength so you can
keep helping those in need. And make sure you're eating good food, as
in NOT ROTTEN food. We saw quite a few cases of people who got sick
from eating meats or dairy that hadn't been stored properly.
Examine/smell things before eating them. And, when in doubt, throw it
out.

Stretch. Especially if you're going to be doing any sort of strenuous
manual labor.

Sleep. Not all the time, and not in the middle of a disaster actually
happening, but you need to rest and recuperate so you can continue to
help those in need. Also, we tend to make bad decisions when we're
sleep deprived... and when we're drunk... so don't booze it up WHILE
doing relief work. If you are going to drink, wait until you're off
shift, and don't go overboard. Nothing like being hung over AND
carrying people who are vomiting and have uncontrollable diarrhea...
Just sayin...

Be conscious of your health. Bowel movements are often affected by
stress, but they're also affected by e. coli, salmonella, etc.. Make
sure you have a good supply of all your personal medications, and
include enough for a week longer than you expect to stay in the
disaster area (travel plans get changed, airports shut down, etc.) Oh,
and if you're uuber white (like me), make sure you have sun block.

Be conscious of those around you, give them some grace, and don't
snap. Disaster work is hard - physically and mentally - and you never
know how you're going to react until you're in the situation.
Especially when it comes to death. There is often a lot of death
associated with a disaster. Even people who "have seen dead bodies
and been ok with it" can have a rough time with being surrounded by
piles of dead bodies, or seeing mangled children.


And above all, go in with your eyes and heart wide open. While a
natural disaster is tragic, the experience of helping your fellow man
is one you will never forget. And it takes a special type of person
to give of themselves and volunteer in such tragedy.


http://news.yahoo.com/s/ac/8612835_deadly_fungus_strikes_joplin_tornado_survivors_volunteers

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001672/



#3

But wait, there's more... more cholera in Haiti...

http://www.post-gazette.com/pg/11162/1153028-82-0.stm




#4

I believe Father's Day (in the US) is coming up soon... I read this
and was laughing so hard, I nearly peed my pants. And we can all use
a good laugh down here in Haiti...

http://www.scribd.com/doc/57840168/Father-s-Day-Story-June-2011


~PJ

But wait, there's more... More cholera...

http://www.post-gazette.com/pg/11162/1153028-82-0.stm

~PJ

A good webpage to read if you're considering volunteering in a disaster zone

Just to be clear, I'm not going to Joplin (yet...), and while some of the information on this webpage is specific to Joplin, and to the group that the author volunteered with, I think a lot of the information shared is good information for anyone considering volunteering in a disaster area.

For example, ALWAYS take a roll of duct tape, sharpies, and a knife or good scissors. I would add a few things like a headlamp to the list of absolute musts...

http://sunflowerbusinessconsulting.com/repswordpress/?p=262


~PJ

There are about 60 kids at the orphanage we work with in Titayin. Before we showed up, they were sharing about 10 toothbrushes that got "rinsed" in the dirty bath water tub.

Sharon and I team-taught a lesson on dental hygiene; why teeth are important, how to take care of them, and what it means to "brush your teeth". Thanks to generous donations from previous volunteers and AmeriCares (http://www.americares.org/), we were able to give each child their own toothbrush.

After the lesson we spent a few hours coloring. Most orphans in Haiti never get the chance to do "arts and crafts". The kids were very excited, and wanted their photos with their drawings.

I'm having trouble loading photos from the slow internet connection here in Haiti. To see more photos, visit the photo gallery on my facebook page.

http://www.facebook.com/media/set/?set=a.228565127170138.78179.114686251891360&l=936c932d3b


~PJ

check out MMRC's page about last night/this morning

http://mmrchaiti.org/mudslide-in-peguy-ville/


~PJ

The morning after (or, rather, the afternoon after)

5:30AM

Took two women (late teens/early 20s) to the hospital with injuries sustained from the landslide - one with a 5-7" laceration approx. 1" deep on her leg and the other was hit pretty badly in the back of the head by falling debris. No survivors pulled out of the slide itself thus far.

I could hear the boys pulling in, and had hot water waiting. A pot full of boiling water into a 5 gallon bucket of tepid water makes for the closest thing you'll find to a hot shower in Haiti. Just what the doctor ordered.

As Paul and Billy rotated through hot bucket showers, Nate and I sat on the porch talking. Last night / this morning he saw his first cadaver. You never know how someone's going to react to coming face to face with death. It can be pretty emotional - especially when it's a mangled mother, clutching her child. The second child was found nearby, also deceased. Last night, he and Paul recovered the bodies of a mother and her two young children from the bottom of the slide.

The kids were old enough to have survived the quake, only to be taken by a mudslide a year and a half later.

The adrenaline started to wear off, and one by one the boys fell asleep. Time for a nap, then we'll reassess.

9 AM

It's cloudy, but the rain has stopped for now.

Last night, the ground was super saturated by rain, rushing water pushing at the foundation of a house at the top of a ravine until it collapsed, taking out 5 or more houses as it slid downwards. The people who live all around the slide were very uneasy - they know it could have just as easily been their house, and their family lost in the slide. Sad thing is, it still could be.

The area we were at was very unstable - a freaking death trap. Areas of mud covered concrete, you take a step, then you're knee deep in quick-sand-mud. The guys had to use climbing gear and repel down the mudslide to dig and recover bodies.

President Martelly made a statement last night: "The president with all of his emergency teams are working all night to come to the aid of the victims of the heavy rains tonight"

The Haitian police showed up where our boys were working, but without training and gear, there wasn't much they could do. I know a lot of search and rescue gear was left here after the quake, but who knows what became of it. The police did do something amazingly helpful - they brought a gigantic spotlight.

Our boys were at a slide in Peguyville - between Petionville and Rue Frere - but there was more than one slide last night.

Noon(-ish)

At this point everyone I've talked to is in body-recovery mode, so I'm letting the boys sleep in... No survivors found, nor sounds from the slides to indicate there might be someone buried alive.

I've been getting emails all morning - people offering to be here in a day or two to help search for survivors. While the help is much appreciated, the reality is that there likely won't be survivors to pull out in a day or two. With all the water, the weight of the concrete, etc, anyone who actually survived the slide likely suffocated.

Of course, we will keep looking - there is always hope (lespwa fwa vive)

1 PM

Walking up to buy some bongu, it's clear that even people in our neighborhood (which didn't have mudslides) were rattled by the storm. I didn't get the normal chorus of "BLAAH" (blanc), instead, everyone asked the same question: "Savat?"

"Savat" I answer back with a sleepy smile. In kreyole, the word "savat" is both a question and answer, depending on the inflection. It means both "are you OK?" and "I'm OK".

I broke into the Starbucks packets for this "morning" and made a big pot of strong coffee, and toasted some bread on a cookie sheet. Billy, who slept in the recliner, was the first one up. "Bonjou Mom" he said to me and poured a cold glass of Coca Cola.

Stephanie - one of the girls who lives in the neighborhood - stopped by to say hello. She told Billy that last night the water was knee high. Inside her house.

Billy's girl called a little later - 2 more bodies found this morning. That puts the total to 6 for just that slide. (The boys found a male cadaver last night as well.)


~PJ

Caught beneath the land slide... For those of you not on fb or twitter, this was my night...

We've been in the middle of a tropical depression for the past few days.
The storm that hit last night was pretty wicked, and caused at least one deadly mudslide (no power so I don't know how many else other than the one we got called about.)

http://www.haitian-truth.org/torrential-rains-cause-bridge-collapse-and-road-closures/


8:45PM

The street outside our house is a raging river, at least a foot deep. The thunder is so loud I can't hear the music in the background, and it's making me jump. City power went out an hour ago. Nights like tonight make me feel grateful for a roof over my head. And grateful to not be living in a tent city.

We made Billy stay here tonight - not safe to travel home in this weather...

9:54PM

Got a call from Billy's girl - houses collapsed in a mudslide from the storm, she hears screams from inside. Our guys are on their way to check it out. Hoping the screaming is from the thunder and lightning, not people trapped.

(Note: 10:30-11PM, LP called - at least 5 houses totally collapsed/buried under a large mudslide. Dark, wet chaos. Hoping to find survivors. I called Howard (trauma medic who lives close by) and woke him up... Gathering gear to provide medical care to those pulled out)

11:50PM

Anyone know of any search and rescue teams presently in PAP?

Midnight(-ish)

Massive mudslide between Petionville and Rou Frere, homes buried with people inside. First corpse found minutes ago. *sighing* it's going to be a LONG night.

12:30AM

Second body found. Baby.

(Discussed situation with LP - likely no need for backboards and c-spine collars... This is going to be more "search" than "rescue"... Still seaking cadaver dog and rope for repelling)

2:45 AM

Recovered 3 bodies, possible 4th. Hand clearing ruble from a steep ravine, no way to get machinery in there. Guys repelling down the mudslide hoping to find survivors (thanks for being to prepared with rope, Howard!)

3:13AM

So far, just body recovery - 4th dead body found - no survivors uncovered yet. Hand clearing ruble and debris. Unstable terrain, still dark, still raining... Unless someone has a cadaver dog, we're good for people on-scene.

(Just spoke with Billy - he sounds exhausted and defeated. I'm sure our guys are all cold, wet, exhausted... They put in a full day of work, and we were settling into bed when we got the call.)

3:40AM

just spoke with Billy - one of our local guys - at the top of the mudslide, assisting with body recovery. I can only imagine the memories that this brings up for those who were in Haiti for the quake. My heart goes out to him.

Just read Jen Halverson's blog from the states... (Quoted below).
http://sleepydoctor.blogspot.com/2011/06/more-suffering.html

"I also received a forwarded e-mail from someone who has lived in Haiti for much of her life, saying these are the heaviest rains she has ever seen.

I have been in Port au Prince during massive rains. It is crazy how fast severe flooding occurs in that city. Port au Prince is almost completely deforested, has essentially no functioning storm sewer system, and has hundreds of thousands of people living right at sea level, with the city rising sharply upwards from the sea (meaning the floods roll downhill). Not to mention the hundreds of thousands still living in tents, many precariously placed on steep hillsides."

4 AM

Just got word that a woman was pulled out of the slide - being transported to the hospital now - first news of a survivor to be pulled from the rubble and debris!

4:30AM

Waiting for news on the condition of our survivor, and waiting to discuss a game plan with the guys. The terrain is so unstable - a few hours will bring daylight and give those of us who've been up almost 24 hours a much needed nap before continuing to search for survivors.

Normally rain washes things away; the air smells clean and fresh when it rains. Not this morning. This morning it smells putrid - like the sludge that forms at the bottom of a pond as living matter is decaying - it's as if the rain and mud slides is dredging up more than just memories of the earthquake.
Sent from my Verizon Wireless BlackBerry

~PJ

All sorts of excitement yesterday...

Yesterday was a good example of what I've been saying for over a year: Haiti is not nearly as dangerous as the media makes it out to be. But things can rapidly escalate into being dangerous, and THAT can be dangerous if you're not prepared.

Sharon, Howard and I left the house about 11am. We took a couple tap taps, walked the streets, all very peaceful. At the gates to the tent city, we saw the cousin of a friend of mine. Hugs were exchanged, then we went on a nice walk through the same tent city that I've been in a hundred times. Hands down the safest (and most well known) tent city in Haiti.

When we saw the UN, Haitian police, some guys cuffed in the back of a truck and a crowd starting to form, we picked up the pace - sometimes stopping to assess a situation can delay you long enough to really put you in harms way. We had passed the crowd, the school, crossed the creek, and had just climbed the sand-bagged-gully to the main road of the IDP camp when the shots started firing.

Pop pop pop, pop! We stuck together, speed-walking to reach the security checkpoint at the top of the camp. There was a different sound - not a shot fired, but something exploding. My lungs started burning - not from the walk, but from the tear gas that had been shot into the crowd below us. Shirt over my face, I was about to tell Sharon to do the same when she turns to say her eyes were burning.

A few more meters to the security station. A friend of mine was working security, his eyes got a little wide when he realized where we came from. We passed the checkpoint and ducked behind some trees to catch our breath. (Note: the UN was firing up in the air to disperse the crowd, not actually at people. Since we were uphill of the chaos, we made sure there were large tree trunks between us and the line of fire.)

Howard was able to fish out a surgical mask from his backpack for Sharon - who gave it to the man carrying his screaming child towards the makeshift tent hospital. The child was screaming - probably partly in fear, partly because of the tear gas. You could see the school from where the tear gas had been used.

Sweat pouring, adrenaline pumping, we made it safely to our intended destination - the pharmacy at the hospital.

Like I said, this is a perfect example of how rapidly things can change here in Haiti. As I'm reading over this journal entry, it sounds way more dangerous than it actually felt. The biggest danger to us was being hit by a stray bullet from the UN since "safety" was on higher ground. Or maybe it's just that I've lived in Haiti too long...

~PJ

~PJ

If there is ever a problem with my eyes, please contact Dr. Charlie Agnone in Ohio. She is an amazingly talented ophthalmologist - eager to teach and to learn - and is very down to earth. Most importantly, she truly listens to her patients, finding the "zebras" that other providers miss.

This is the fourth time I've had the pleasure of working with Charlie, and it always ends up being memorable... She always finds the "starfish"...

She set up an eye clinic for the week, and has had a crowd waiting for her each day. Several days ago, a grandmother brought in her 3 year old grandson (Joseph Carl) to be seen for the photophobia that started three months ago. He buries his head into her - unable to open his eyes in the light without excruciating pain.

Joseph has a rash all over his body, worse on the extremities. It started when he was 6 months old as a black, raised, itchy rash. They tried to treat with calamine - no change - then tried galocur (sodium benzoate), thinking it was scabies. The itching got better but 2 and a half years later the discoloration is still present (but not raised). He's also clearly malnourished - orange-ish, brittle hair, dry skin, skinny and small.

The light was too painful; she had to have him come back the next day to be sedated to do the eye exam.

Charlie and I sat around the dinner table the night before the exam bouncing ideas off each other. Our initial differential diagnoses include: syphilis, leprosy, leptospirosis. My money's on the leptospirosis (caused by rat urine in the water http://www.cdc.gov/ncidod/dbmd/diseaseinfo/leptospirosis_g.htm).



In the exam we could see big white raised patches on his eyeballs. It came on too fast and the sclera was too shiny for vitamin A deficiency. Charlie did some corneal scrapings, and we started him on ceftriaxone IV (treatment for lepto).

No definitive diagnosis yet (lab cultures in Haiti are not easy to come by), but today he opened his eyes to look at me - in the daylight... It's amazing what a few days of the right medication will do. His grandmother smiled and put her hand on my arm. "Mesi anpil" she said, as her eyes welled up.

PS. One of the OR nurses asked to watch me make the antibiotics for Joseph Carl - she didn't know how to make a dose smaller than 1gm from a 1gm vial (very common in Haiti). Teaching moments like this are one of my favorite things about being in a hospital. Of course, the syringe pulled out of the vial in the middle of the "lesson", and I got sprayed with an antibiotic that smells like rancid cat urine... Another teaching moment - how to wash your scrub top in the OR scrub sink while still wearing it...

~PJ

It's so hard to say goodbye... typed on my blackberry, 4/23/2011 on the plane back to Haiti...

I'm on the plane back to Port au Prince.

I hate goodbyes. Anyone who knows me can attest to it. I've spent most of my summers camping with the same group of family, and always try to sneak out without doing the goodbye thing. When I was with Medishare, I'd always make myself scarce on Saturdays after orientation to get out of the "goodbye thing". It always felt like I was breaking up with a middle school boyfriend - not because we wanted to, but because his parents were moving cross-country. You both promise to write, but you don't know if you'll ever see each other again. Today wasn't quite that dramatic, but it brought me to tears to leave the states today, even though I love what I do and my life in Haiti.

A previous volunteer sent me an email a while back thanking me for all that I've done for the people of Haiti, and for all the great sacrifices I've made. At that point, I felt like the biggest sacrifices I'd made had been the six-figure income, sleeping in my lavish princess bed, and the ability to quickly pay off my student loans. But this trip was different - my first long trip back to the states since the quake, other than for surgery. This time, I got to "be domestic"; to cook in my large kitchen using fresh ginger from my garden, do craft projects, visit with friends and family for the first time in 6 months, and live in the same zip code as my significant other and dog for more than a week.

And I won't lie, as I was packing this morning I felt sad to leave all the normalcy behind. And for the first time in a long time, I longed for a normal life... Time with family and friends, a regular job, a routine, stability (political and otherwise)... I laid on the bed and started to cry. Terry gave me a big hug, and told me to hang in there - just be amazing. He knows as well as I do that I can't be satisfied with "normal"; I never have been.

Like I said, I love what I do here, and am excited for all we've got planned in the next few months. But I'm human - and have all the emotional trappings that come with being human. I think Lola and Kat would say it comes from my "monkey brain"...

So it's with mixed emotions that I return to Haiti...

~PJ

a good day to catch up on laundry or emails...

News from Port au Prince:

Manifestations have been brewing all day. Stones are being thrown at passing motorists, there are demonstrations and burning barricades (ie. stacks of tires in flames in the middle of the roads.) One of the local markets was burned down this morning. Our neighborhood (Clercine/Tabarre) is still quiet. Most of the action is up near Petionville, downtown, as well as in the Artibonite Department, between St. Marc & Gonaives, and up north in Cap-Haitien. We suspect that unrest will continue to move this way, but it's still too early to tell.

Tara and I just walked over to the U.N. to use the ATM before the streets "get hot" around us. Cash is always good to have on hand when this sort of thing is going on. Unfortunately, we weren't the only ones with that idea, and both ATMs were empty. Things seem pretty quiet in our neck of the woods, but it's also before noon.

To be honest, even though the unrest is being blamed on the election announcement (Manigat and Micky are the two in the run-off election, scheduled for the end of March), I truly believe it has more to do with Preval than Manigat or Micky. Today was the day Preval was supposed to step down. Now he's saying he's going to stay in office until May. One of my local friends told me that they (Haitians) would burn the country down to the ground rather than let Preval stay in power. Which is what they've started doing today...



~PJ

Miselene

CHART NOTES:

13 year old Haitian female with sickle cell disease, bilateral neck masses, nasopharyngeal carcinoma-progressive, respiratory distress, spinal fractures, dysphagia, chronic pain, headaches, decubitus pressure ulcer, anxiety, and insomnia passed away at 13:30 today.

If I were to write it...

13 year old girl, who loves chocolate milk and dancing to pop music. She loves to have her fingernails painted, and to take "field trips" outside. She has a smile that lights up the room, and is one of the bravest people I've ever met. She experienced what any of us would if we had to look death in the face every day; fear, anxiety, and inability to sleep. For months we've been her family; fed and played with her. We prayed when she went to Duke's that they would be able to debulk the tumors. But they weren't, and they sent her home. Home to us.

I'm not new to hospice care, but this is the first time I've done hospice care for someone who I consider family.

She looks so peaceful; like she's sleeping. I keep expecting her to wake up and grab my hand. But she won't. Miselene, my "Haitian daughter", passed away today.

We're sitting here, trying to plan a funeral through an interpreter. If anyone can contribute, we could sure use the help. My paypal account is pjpitts@yahoo.com

~PJ

I'm safe and sound and nowhere near Baby Doc...

I knew when Big Dave's eyes got wide and he said "get in the car NOW" that something big was happening. As we pulled away from Epidor, he told me the news... After 25 years in exile, Jean Claude Duvalier (Baby Doc) has returned to Haiti. We locked the doors, rolled up the windows and headed back towards EDV.

We couldn't have been more than a block down when the manifestation hit. Sort of like an eerie parade/marching band - with tubas and percussions, and hundreds of people stopping traffic as they marched their way up the street. Even the obligatory naked man shaking his butt in the crowd.

We made it home safely, and enjoyed "Mango Mango curry-q" late into the night.

I'm not sure what Duvalier's true reasons are for returning, but I highly doubt it's to help rebuild Haiti as he claims. I suspect is has more to do with keeping Preval in power.

As it is my day off, I'm going to spend the majority of today laying low, with the kitten, and hopefully finish all the partial journal entries I've started over the past month or so...

Below are a few of the news articles that have come out in the past 24 hours...

http://edition.cnn.com/2011/WORLD/americas/01/16/haiti.duvalier/index.html?hpt=T2

http://news.yahoo.com/s/afp/haitipoliticsduvalier

http://www.bbc.co.uk/news/world-11943820

~PJ

12 January 2011, reflections...

January 12, 2010. At 4:53 PM, local time, a magnitude 7.0 earthquake shook the country of Haiti, killing an estimated 316,000 people, injuring another 300,000 people, and leaving over a million people homeless. A year later, the country of Haiti is still struggling to pull itself out of the rubble and has been hit by tropical storms, all the problems associated with "tent city living", and is in the middle of a cholera epidemic. Beautiful, stoic people are rebuilding their lives despite all the tragedy around them.

February 27, 2010. At 4:00 AM, local time, I showed up "bright eyed and bushy tailed" at the Miami Airport to board a charter flight to Haiti to volunteer with Project Medishare to help with earthquake relief. Almost a year later, I am the Chief Pharmacy Officer for Hopital Bernard Mevs Project Medishare, living in Port au Prince. Today the world is once again focused on us here in Haiti, and while much of the media is focused on what still needs to be done, I'd like a moment to focus on what HAS been done. Sometimes, in the midst of all that is going on, it is easy to forget how far we have come.

In the beginning...

When I first arrived in Haiti, the field hospital pharmacy was several folding tables and shelves with piles of medications. No one had any idea what sort of inventory we had or how to get more medications; there was no “institutional memory” of what medications had a good track record with local strains of bacteria and very few drug references. In the early months, there were countless drug shortages due to factors such as a lack of inventory control and protocols...

We are now in a building, and we have a medication formulary that is continually adjusted based on what medications are readily available and effective for local diseases. We are able to give out a month or more of maintenance medications upon discharge or to patients seen in clinic. We have created “quick reference charts” with critical information such as maximum concentration, diluent compatibility, infusion time, and stability (both time and temperature). Local employees go through training on aseptic technique, serial dilution, deciphering prescriptions, and using references. Employees are actively encouraged to ask questions and learn from volunteering practitioners.

We have learned the true meaning of Alterum Alterius Auxilio Eget (Each Needs the Help of the Other).

-Multiple NGOs came together to form the Combined Response Team to coordinate rapidly available (i.e. “in country”) medical assistance and supplies in case of another natural disaster or disease outbreak. We had medical teams providing care in facilities within 24 hours of the official news of the cholera outbreak, and have continued to coordinate medical personnel and supplies for cholera clinics throughout the country of Haiti.

- Within hours of the microburst from Tropical Storm Matthew destroying the tent hospital for J/P HRO, the emergency hospital kits that I'd built were in their hands so that they were able to continue to triage/treat patients.

- I now run an on-call pharmacy service to assist other NGOs and healthcare providers in the Port au Prince area, that currently serves more than 11 organizations. This has decreased the number of medication errors (and subsequent hospitalizations) and increased the quality of medical attention received by patents.


And, on a personal level, I have "found my calling in life": medical relief and education in developing countries. While I am proud of all that we have accomplished over the past year, what I am most proud of is the lasting difference I have made in the lives of the patients and the local and international practitioners that I have touched. A few weeks ago, I was talking with a pharmacy intern about the difference that I feel I am making for the profession of pharmacy. Not only here in Haiti, but the difference that is being made for providers from the United States. Here we work as a team, and I am often side by side with providers directly assisting in care. Many past volunteers have expressed that being here - working this way - has changed how they view the role of pharmacists in their practice. Being here has touched, moved, and inspired them, and I am grateful to have been part of that.


January 12, 2011. At 4:53 PM, local time, I stood in a circle of friends and family from across the globe. Some, I feel like I've known all my life instead of for one short year. We sang "Amazing Grace", and prayed in Creole. Although my Creole is still fuzzy, the sentiment transcended the language barrier. We prayed for those who we've lost, and for those who have come to help, and for the future.

So a year later, are things better in Haiti? As a friend of mine has come up with a far better answer than I ever could, so I'll use hers (thanks Beth). When people ask if things are better in Haiti, I say:

Is there rubble still in the streets? YES. Are there still condemned buildings, ready to collapse at any minute? YES. Will it be cleared up this year, or in 5 years? NO. BUT... Is there less rubble than there was yesterday? YES. Has progress been made in the past month? YES. Are we working to rebuild what has been lost, to come out of this tragedy and be stronger than before? YES.

Are people dying of conditions easily preventable or curable in the United States? YES. Is there still a great need for care? YES. BUT... Are there people who are alive because of the care we provided who would not otherwise be here today? YES. Did us coming down here make an impact, that will continue to touch lives long after we leave? YES. And, most importantly, Will the people of Haiti succeed, and overcome the adversity that surrounds them? YES."


~PJ