first staff photo at new hospital

Here is our first "staff photo" for the Bernard Mevs Project Medishare Hospital Pharmacy:

Georgia and Michel are missing, but we got most of us in the photo!

~PJ

sherwood gazette article

During one of PJ's stops at home in Sherwood, I contacted the editor of our local newspaper, The Sherwood Gazette, and recommended he do an article on her.  Sherwood is all about "local" and since PJ graduated from Sherwood High School and still has her home base in Sherwood, I knew the residents would love to hear her story.

The article came out in the July edition:

Helping in Haiti



~Cathi

exerpt from an email this morning

I want to send a real "update" - about hiring a new Haitian pharmacist, exploring the J/P HRO tent city, and planning tropical storm evacuation strategies (with J/P HRO, not Medishare... they're still in tents...)... But that may be a few days, and I wanted to share part of an email/friend request I got via facebook this morning that reminded me why I gave up the high paying job in the states and came to Haiti.

The "friend request" said this:

"You dont know me in person but i added you becuase i want to say thank u. Its those of you that help with the project medishare that make inpacts. the team 2 weeks ago changed my life. I am a missionary who was over there and got malaria. One of the doctors saw me and got me out of Haiti in time to save my life. I also saw you where friends with sam (Sam, my medical student) too. he is great he took care of me when i was there for that one night. He is like a big brother."

I never met her in person, but I do remember helping with her care - suggesting treatment options for malaria with one of the doctors for someone that we were talking about shipping to Miami. And it doesn't surprise me that Sam took great care of her - it is my firm belief that he will become the best doctor Haiti has ever seen.

Many of you who read my updates have not been down here to Haiti, and may find it hard to believe, but we are the height of medical technology in Haiti. Even now, when we're technically "closed" to new admits, we accept all of the American relief workers who are sent to us. And even when it means dragging the desk out of the nursing station to make room for an additional bed (and turning our supply area into a makeshift ER), we do the best we can with what we have.


~PJ

article published for Phi Lambda Sigma

Between PJ's first and second tours in Haiti, she was asked to write an article for the Phi Lambda Sigma's newsletter The Laurel.

It has been published in their April 2010 edition.  As of the date I am writing this, it is not yet posted to their website yet.  But I have put it up on my file server and can be downloaded from the link below.  PJ's article is on page 6.

April 2010 The Laurel


~Cathi

a day of rest

I finally did it - I took a whole day off, turned the blackberry off - no email, no antibiotic dosing, no contact with the outside world from 9am until 6pm (other than posting a photo of my feet by the pool to facebook).

It was glorious. About 45 minutes away from the hospital is Wahoo Bay Beach Club and Resort, which felt like a paradise in the middle of the Caribbean. I ate the largest lobster I've ever seen, napped by the pool, and let my brain rest for a while.


~PJ

chemistry lesson

Sam, my medical student, got to have a "learning experience" with me the other night. One of the nurses asked him to grab 10mg of morphine, and all we had was the 50mg/ml uuber concentrated vials. Normally I dilute it to 1mg/ml, but none was made up. When it became clear that there was some confusion with the concept of mg vs. ml - more specifically, with the distinction "volume vs. weight" - I saw a great teaching opportunity.

Since the patient was in acute pain, we took care of the dose, then I sat Sam down for a chemistry lesson. "If I have a pound of feathers, and a pound of lead, which weighs more?" was my first question. Then I remembered, I'm in Haiti - metric system - so rephrased the question with kilogram in place of pound. And, just like all of us, he answered "the kilogram of lead. Metal weighs more than feathers."

A kilogram weighs a kilogram, no matter what the material, but the kilo of feathers takes up more space than the kilo of lead. That "space" is the volume. We discussed it theoretically, but the concept didn't seem to be sticking. So I grabbed a bottle of pills off the shelf, and used each one to represent a milligram of morphine, and a tray as the milliliter. Some of us are more visual learners. Once the idea had sunk in, and he did the math, I let him do the dilution for the 1mg/ml morphine stock solution (under supervision, of course).

Back when I was doing my undergrad, I student taught chemistry, and Jim (Professor Schnieder) would have been proud of me. And I'm so proud of Sam - not only did he master a new concept in chemistry at 3am, he did it in his second language. Because, as I like to remind him, his English is WAY better than my creole.

~PJ

life has a funny way of making sure we're exactly where we need to be

(meant to post yesterday (but I fell asleep typing... gee, imagine that...))

Life has a funny way of making sure we're exactly where we need to be. Tonight, for example, I was supposed to be off, but Shane (one of my assistants) is really sick, so I came in to man the pharmacy overnight. Funny how the compounding pharmacist happens to be here when the nurse comes looking for some concoction to make albendazole taste better (good luck with that!) and alternate dosing forms for a
hospice patient.

The albendazole "taste-testing" can wait for later - when I have more than just myself to do the tasting - plus, hospice care has always been one of my soft spots.

It's about 4am, I'm listening to Tracy Chapman sing about "Fast Cars," and waiting for Lauren to come pick up the "hospice kit" I spent half the night making for Peter. We can't save them all, no matter how hard we try. With Peter (also known as Peterson), we have tried and tried - even flew him to the states for treatment. But sadly, the humongous cancer tumor on his neck (about the size of his head) didn't respond to chemotherapy, and neither did the metastatic tumors that cropped up in his lungs and other areas. When it became clear that he would not get better, the hospital staff at Broward General (the hospital in South Florida that was covering the treatment) asked him and his mother about their wishes. Peter wanted to come back to Haiti, to see his brothers and sisters, and to die at home.

So Lauren brought him back, and tomorrow they will spend about 6 hours driving the 25 miles to take Peter and his mother home. (Did I mention that roads here SUCK?)

I made the usual suspects for the "hospice kit"; morphine in several strengths (both injectable and oral) to help with pain control, injectable lorazepam as well as a liquid lorazepam "with a chaser of haldol" for fear and anxiety, zofran (for the nausea on the bad roads), atropine drops for under the tongue (helps stop  secretions)... And a custom ketamine/baclofen/diclofenac/lidocaine gel...

There is a very good chance that today will be Peter's last day on this planet. Without going into all the gory details, the plan is to keep him alive long enough to return home to see his family one last time. I took Lynden to translate for me - he used to teach kindergarden through 6th grade, so he's good with kids. I had Peter explain where it hurt, and describe the type of pain, and explained what I was going to try to do. The pain Peter is experiencing is excruciating, but not diffuse; it's specific to his neck (under the mass and up the back of it) and the area surrounding his chest tube.

I'd read an article a while back about topical ketamine for hospice patients, and we often compound baclofen/ketoprofen/lidocaine at Broadway (my job back in the states), so I did some research (in 4-point font, on my blackberry), and made a gel to ease his pain.

This was one of the few times in Haiti I've worn gloves... A gel designed to absorb through HIS skin would also absorb through mine. I warned him that the application process might hurt a little - I had to rub the gel into the places that hurt. He was a trooper, not even a tear. When I came back to check on him, he said the pain in his neck was gone. He was a little light headed, but able to carry on a conversation and play with the paints and play dough I brought him. He said he felt more "clear headed" than when he was on all the morphine - goal accomplished.

On my way back to the pharm Sam asked me what I had done. Sam is a Haitian medical student who will be starting his third year this fall. He had never heard of the concept of "hospice" or end of life care - it doesn't really exist in Haiti. Sam doesn't know it yet, but as of this week he will be an employee, not a volunteer. He'll be my "intern," and will have projects and presentations just like an intern in the states... Sounds like I've already found his first project...

~PJ