~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