The Children of HAH

Today, I thought I'd post some pictures of children. I actually had very little time to interact with the people and talk to them, which made me feel somewhat disconnected personally at times. We were so busy with clinic and operating (where patients are generally sleeping) that time to get to know some of the Haitian people was slim. One afternoon, though, I got a reprieve and got to go outside in the front of the hospital steps to the tent city on the hospital grounds. There was a large group of kids playing out front jumping rope and a lot of the adults had gathered around to watch. A group of volunteers who was waiting for their tap tap joined in to play as well. I got to talk to a couple kids that day, learn some names, give away some candy, and get lots of smiles, most of which I didn't capture in pixels. Here they are:

This is an 12 year old girl who had significant contractures of her knees. She underwent a procedure to lengthen the tendons so that she could eventually get her knees straight and be able to walk upright someday. She had casts on both her legs that we changed out one of the first few days I was there and she and her mom got to go home. These pictures were taken the morning she went home. She was a sweet girl and I loved the smiles and interaction between her and her mother.

One of the things you may notice is that children appear much younger than their stated age, often so much that we questioned if their recorded ages were correct! This girl was 12, but she really looked more like 8 or 9 by our US standard.

Here is one of the physical therapists working to help her walk with her walker so she could go home. Picture courtesy of Kaye Whitney, PT.

Kaye was pretty amazing. She rounded with the Ortho team every morning at 6 to keep all the day's therapists (who would arrive later in the morning) up to speed, she worked in the stock room sorting supplies, worked with a team to clean the kichen top to bottom one night after a full day of work, and also volunteered to pass out meals to the entire hospital during her last week, a job she said was so difficult to do because she just didn't have enough for everyone and had to turn away hungry family members.

Here is one of the new lives born during our time at HAH. She was born by emergency C-section and is a beautiful little girl. All the c-section babies I saw were girls. Average birth weights for the babies in Haiti are only about 5 or so pounds, a stark reminder of the malnutrition rampant in the country.

There are some of the kids outside the hospital living in tents on the grounds. This boy was playing with a little guy in a wheelchair and was pretty skeptical of having his picture taken, but sure liked popping the bubbles some of the volunteers were blowing at them.

Fun with bubbles

This little guy, Joseph, was one of our Ortho patients who had some infected wounds on his right leg. I didn't see him but once or twice, but our team took care of his wounds. He was a very sad boy and rarely smiled or interacted much, until the bubbles came out. Fred and Dianne who saw him regularly couldn't believe the smiles and joy he had playing that day.

This is Fred Liss, MD and his wife Dianne who brought bubbles with them to share with the kids. They were a hit! While we were playing, I saw a teenage boy sitting by himself just watching the interactions and the attention all the little kids were getting. You can barely see him sitting behind the lady in the wheelchair in the white dress. He looked pretty lonely to me.

I went over and talked to him through my interpreter friend, Jeanty, who had accompanied me outside. He told me that he had broken his leg when a wall fell on him during the earthquake. He had been showering when the quake hit and was with him mom in the house. He was able to get outside before his leg was injured. We talked a little bit more, and Jeanty told me Elizay asked for me the next day, but unfortunately, I didn't have a break again to go outside before I left HAH. I was very sad that I didn't get to see him again and talk to him one more time.

These are some of the girls jumping rope with some of the volunteers.

This young woman amazed me and demonstrated the resilience of the Haitian people after the quake. If you look carefully, you'll see she has an amputation of her left leg. You can just make out the ACE bandage around the end of her stump. Talk about amazing to see her jumping rope and having a good time with all the kids. I was flabbergasted and so moved by her. It still can bring tears to my eyes to see the pictures and remember her jumping rope.

This boy has an external fixator on his right leg and was outside watching all the activity from his wheelchair. He kept making signs at me, so I took his picture. He seemed upset by that until he got his sisters together with him and some artwork he had made and had me take a picture of them all together. Then he was happy!

She was one of the ones blowing bubbles and just looked so beautiful to me in her white lace dress, braided hair and smile. I dont' know her name.

This girl followed us around a lot. I forget her name right now, but she wrote it for me and I have the paper somewhere. She would join us for morning report on the steps and ask for our pens and notebooks to draw pictures and teach us words in Creole. She was the girl I met at the helipad our first Monday at HAH (see previous post and picture).

This young man was outside during report one morning. He is just one of the many patients living in a tent on the hospital grounds.

More kids at morning report hoping to make friends with volunteers. One day, they all wanted name tags like we wore, so someone took paper medical tape and made them all name tags. They were all really proud to wear them.

The boy closest to me (obscured some by the girl with the pink shirt) is Kervens. We were buddies my last week and would say hi and high five in the hospital halls. He remembered my name because I told him how close it sounded to his name, so we were buddies after that.

This boy has a condition called Arthrogyposis, a rare condition in which multiple joints suffer contractures. He came in for casting each Wednesday with him mother. He was a tough one to get to smile, but we got lucky a few times. He had very limited knee extension as well as clubfeet. With getting him help early in life, he has a chance to walk somewhat normally someday and may be spared the pain we saw in adults who never got the treatment they needed as babies and children. While Arthrogryposis is a rare condition, it is more common in Haiti and the DR as I have seen a number of children and adult patients with it in my few trips to the island.

This is Dayana. She was treated for a deformity of her right leg and had a Taylor Spatial Frame (TSF) on her tibia. A TSF is an amazing device, and Scott is probably one of the most experienced surgeon in the world in this technique. I had the privelege of assisting in a couple of TSF operations with him, which is more than most Orthopedic residents will see in their lifetime. Anyway, it's bascially an Ilazarov type external fixator "on steroids." It is used to correct deformities of long bones over a period of time. It has two rings that go around the leg, and then six adjustable struts that bridge between the two rings. The surgeon applies it very carefully to get the alignment of the rings right, and then takes some Xrays to make measurements on which the correction will be based. These measurements then get put into a computer program on a webpage, and it spits out a program of daily adjustments that the patient makes on their own at home over a number of subsequent weeks or months, depending on how severe the deformity is. This allows the adjustment to be made in very small increments and done slowly so there is less pain involved and the surgery is much less invasive than one where the the bones are cut to be realigned and then soft tissues have to be released and lengthened to correct the deformity.

Dayana was at the hospital almost the entire time we were there, going home on the Tuesday of our last week. Her surgery had been a couple weeks prior to our arrival, but she didn't have family who could help her with her adjustments to her TSF at home (see explanation below). Finally, our therapists were able to train an aunt how to do them so she could go home. Then, the family said they needed a tent, so our nurse coordinator went through the process to get her family a tent so they'd have some place to live. During her entire stay in the hospital, she had a cot in the hallway, never having a room to herself. During the days, I would see her in a wheelchair sitting at the end of the hall upstairs where there were some windows that overlooked the main hall below. From there she could watch the people come and go and have some way to pass the long days at the hospital by herself. I would often pass her sitting in her chair and slip her peppermints or butterscotch candies, and on the special days I had M&M packets in my bag, she was the glad recipient of some chocolate. She seemed pretty lonely, so I made a point to say Bonjour to her, to get her to smile and let her know she wasn't forgotten.

Wow, this little girl has a story!

Her story is told by Terry Dietrich (in quotations):

"She was brought from about 6 hours away by a neighbor. She has the most unbelievable case of bilateral Blount’s Disease I have ever seen.... "

Blount's disease is a condition affecting children where the tibia bows outwards at the knee. Here are her Xrays. Her right leg is pretty bad, but her left is much worse!

Basically, for those non-medical people, these xrays show horrible bowing of her tibia at her knee joint. Here's a normal knee to show the difference:
"....The neighbor speaks perfect English. He is married to a woman from Kansas. They live and work mainly in Kansas but come down periodically to their home here. When I told him that we could do an operation to straighten her legs he got tears in his eyes. The Taylor Spatial Frame will be perfect for her. I want to do her surgery with Scott."

It was amazing to see how all the pieces of her puzzle were put together to get her to HAH where she can have life changing surgery. She was neighbors with an American who cared for her and her family and had the means to get her to a center where the surgery could be performed. Because of the earthquake, Scott brought world class orthopedic care to Port Au Prince and will be able to operate on her legs with TSFs. Her surgeon is one of the most experienced TSF surgeons in the world. It's amazing to witness how God works all the pieces together to change this girl's life.

On a side note: I see Pierre and Stacey have found my blog now! It's great to have you guys in touch. Please say hi to Constantine, Gretchen, Mary, and Freeborn, too! I am not sure where my email addresses for you all are, so please drop me a line so we can exchange pictures and keep in touch.

More pictures: click on the pictures to enlarge

One of our anesthesiologists, Constantine, performing a spinal.

CRNAs Mary and Freeborn

Constantine at work

I&D of an infected wound and application of wound vac on Quito (From L-R Jan, Sharon, and Terry)

VAC placement around a Taylor Spatial Frame, thanks to Jan, our wound care RN specialist who helped us learn some advanced VAC techniques and wound care.

Rebuilding in town

Tough guy-- all the kids want to pose like tough guys and show hand signs. I saw this in the DR as well. It took a bit to get them to smile but showing them their picture on the camera screen usually helps get some smiles from kids and parents a like.

A view of the mountainside from our veranda sleeping quarters

A view of the back grounds of the hospital and laundry facilities. You can see the blue towels from surgery hanging out to dry in the lower right corner.

This was a sweet boy we met in clinic who was ready to learn to walk without his crutches.

One of our physical therapists during week one, Kaye, who worked some miracles.

This was the sterile processing room before reorganization. You can just make out the steel sink along the wall on the right that was used for cleaning the dirty instruments. So, the dirty, pussy, bloody instruments would be brought in and set down to be cleaned right next to the clean instruments waiting to be wrapped for sterilization. This sink was moved to it's own dirty processing room and new shelving set up for better organization.

Supplies to sort

Liz and Sylvia from LLU spending long hours sorting instruments and supplies.

Terry seeing a patient in clinic on our first morning. She had fallen and broken her wrist just that morning and we were able to reduce the fracture and splint her in our "after church" clinic.

Just some pictures today

Since I'm slowly recovering from my Haitian Parasite crash diet (effective though not recommended), I am up for posting some photos today and will probably edit my post with more detailed descriptions tomorrow. Most of the scenes are taken from the bus on the way to the hospital. Clicking on the photo will enlarge it.

Here is the exit from baggage claim at the airport. All the men in gray uniforms are porters ready to help with your bags and will require a tip even for just touching your bag. Cure Intl and HAH arranged all our transportation arranged and took care of our bags and tipping. We just had to keep saying, "No, no!"

Here is the gate to which you exit from the airport. Once beyond the gate, it's "every man for himself" so we were cautioned to remain inside the gates until we met our transportation. Thankfully, he was there waiting for us with the bus.

Packing all the stuff in the bus. Thankfully, no one had to ride on top (just kidding!).

Oncoming traffic on the narrow crowded streets.

Some common sites along the way-- note the spray painted cries for help and good bye messages to loved ones.

The following photos were taken by Hasan Syed, MD of LLU who came down during our time at HAH. He got some better shots from the van he was transported in than I could from the overflowing bus.

Joseph

This is a picture of the man to whom I left my powerbars to upon departure. I got word yesterday that he is turning the corner in his recovery. I was sent this picture by one of the physicians still in Haiti who has been continuing to work with Joseph and his multiple injuries. He was the victim of a car vs. pedestrian accident in early April and underwent less than optimal care by the local hospital there. He was transferred to HAH for more definitive Orthopedic care and, honestly, needed to be in an ICU. We battled a raging infection in his lower left leg and had to consider amputation as a viable option in order to save his life. However, with a lot of hard work on the part of many people, including Joseph and his wife, he is sitting up in a wheelchair and his wounds and fractures are healing. He looks to have lost weight, but he looks healthy and is smiling.


This was our team on morning rounds one on Tuesday the 27th discussing with him and his wife the possibility of having to amputate. We were able to pray over him together for his healing that morning which brought tears to my eyes. His wounds and complications from his injuries were starting to get complicated and we weren't sure we could continue to work to save his leg with the resources we had available for his care. Here is a picture of his leg and the massive tissue deficits from all the debridements we had to do to control the infection.


He lost most of the musculature and tendons of his anterior compartment, which will make ambulating difficult as he won't be able to pick up his foot normally, but he may very well keep his leg and just need a brace to support his foot.

In addition, he began developing multiple pressure sores from being bed bound. We were able to get him into a hospital bed from the cot he'd been on for a couple weeks and our therapists started to work with him and his wife on repositioning to help, but things were progressing from bad to worse. We had to do daily washouts and debridements of his leg to battle the infection and necrotic tissue, and we were battling his hemoglobin which kept falling despite our attempts to get blood for him. If the hospital had had the equipment to process blood, I'm sure a number of us would have donated as my blood type was a match for the major antigens at least. Obtaining blood was another hurdle as was getting accurate hemoglobin counts. He had been hovering in the 6.2-6.4 range for a few days. At one point, Joseph's reported hemoglobin was down to 4.5. Since he was hemodynamically stable, we had to wonder how accurate the result really was, but nonetheless, he was losing blood and we could not get enough packed red blood cells to transfuse him up to a stable number.

I was educated on the process for getting blood. First, a nurse or lab tech will draw a tube of blood for a "type and cross" so his blood can be matched to donated blood. Next, the family takes the tube of blood and the prescription for blood to the Red Cross down town. For every unit of blood, two family members must donate a unit of whole blood. Therefore, if we wanted two units, Joseph's family needed to take four people to donate blood. Then, they would be given a unit of type specific blood and the family's donation would go into the general bank to be matched to someone else. Also, blood can only be obtained during the day, so there was no way to get blood after dusk. Even with the prescription indicating the low blood count and need for more than one unit of RBCs, Joseph's wife returned with one unit of blood and the promise that if she returned again the next day, she'd be given another unit of blood then.

It is just another example of the uphill battle these people face in getting healthcare. Howeve,r had it not been for the earthquake in January, there would not have been any resources to save this man's life. Instead, because of the relief effort, surgeons and skilled medical personnel, the Red Cross, the orthopedic and wound care equipment were all nearby when Joseph suffered a life threatening accident. Thankfully, it appears he is starting to improve and while his life will be forever different because of his injuries, he will live, and it looks like he'll also keep his leg.

This was going to be a quick post of a picture, but I guess the story was waiting for me to tell it. I have actually been fairly sick since my return from Haiti, and so have not been feeling well enough to post pictures and write more, but I am starting to turn the corner myself and get back to processing my pictures and my trip. Look for more posts this week as I have energy.

Aftershocks

There were no aftershocks felt while we were in Haiti, but I will be feeling the aftershocks of this trip for sometime. In my dreams, I see children with amputations selling goods from baskets on their heads, babies with clubfeet needing casting, cases in the HAH ORs and doing battle with the flies to prevent them from landing on our patients' open wounds. When I'm awake, I still hear the cries of the people experiencing PTSD (post traumatic stress disorder) including our little 11 year old girl, Mirlanda, who lost her entire family in the quake; I hear the cries of a mother, Denise, who awoke from anesthesia suffering flashbacks of losing her baby. How do you even begin to comfort someone who has lost so much? I see Joseph battling to keep his leg and prevent an amputation, and Kettely, sick from necrotizing fasciitis, struggling to save what remains of her leg after an infection of the stump of her above knee amputation. There are countless men, women, and children struggling to rebuild their lives and families, with stories of homes destroyed, businesses ruined, lives lost. Last Friday, I lost a friend to cancer. In my grief, I collapsed in gut wrenching tears. Yet at the same time, I thought of the images of people running through the streets in the days after the quake inconsolable from the loss of their children, parents, their entire family. I felt deep pain and anguish from one friend passing and could not even begin to imagine what these people have lived through. Yet there is still a spirit in them of determination and to push ahead and continue. I was amazed when we drove through town and the couple short walks we took beyond the hospital gates to see all the road side stands people had set up trying to sell their wares to passersby. Families have large steel bowls, probably close to 2 feet in diameter, that they place over open flames to cook their meals with the smells of delicious foods wafting through the open car windows. Each morning during our morning report and worship, we saw children in neatly pressed uniforms being led hand in hand by parents taking them to school for the day. We saw bright eyes and big smiles and loving and tender moments between family members caring for their loved ones in the hospital. Kettely's daughter wiping her mother's forehead with a damp cloth to quell the heat from her fever, a mother rushing to put clean sheets on her son's cot after he returned from surgery, families bringing in meals for their loved ones, mothers emptying bedpans for their children. The list goes on.

I left Haiti Thursday morning, a day before scheduled so that I could be at the memorial service on Friday afternoon for my friend, Gail. I returned home to WI Thursday night and got to my house about 10:30, having left the hospital at 6 that morning. It was a long day of travel and full of emotions-- emotions for leaving behind Haiti and the people there, emotions for knowing that Gail is gone and the pain of burying a friend, a mother, a wife, a sister. Our plane from Port Au Prince was full of various relief workers-- I sat next to Carlos, a biomedical technician from Cape Coral volunteering at the Medishare field hospital, and Stan from US AID working to build infrastructure in the country. I knew that most everyone on that plane had seen things like I had and had been there caring for the Haitian people and for the country. Once in Miami, though, we all went our separate ways, and my next flights were back to a random mix of US citizens and visitors returning from vacations or business trips. TVs in the airports showed preview coverage of the Kentucky Derby. Flying into Miami showed subdivision after subdivision with red roofs and blue sparkling pools, well groomed golf courses, green lawns and flourishing trees. Streets in repair and free of free flowing water. When we flew out of Port Au Prince, I saw blue tarps over tent cities and homes and buildings destroyed. From the plane as we were waiting to leave Miami, the tears flowed despite my feeble attempts to keep them at bay so as to not draw attention to myself from those next to me in my row. I had, just that morning, said good-bye to a new friend who sleeps a few hours a night in a tent on the campus of HAH. Last week, a departing aid worker gave him a sleeping bag so now he has a bit of cushion between him and the ground. I gave him some money and some of my remaining snacks so he might eat more than once a day. I left all my meal replacement bars to Joseph, our patient fighting for life and limb as he suffers from malnutrition amongst other battles. I could not keep in the tears of seeing our wealth and comparing it to the world I had just left. I got to leave. I do not know if I will ever see those people again. Yet how can I not return? As hard as the trip was, coming back to the US might be even harder. In Chicago, I had a longer layover, and got to sit down with a large twist cone of TCBY frozen yogurt. After the long hot days and sweaty nights, I missed having cold drinks and ice cream in the evening, and when I saw the TCBY stand in O'Hare, I had to stop. As I sat with my cone in the sunlight, enjoying the warm rays through the window of the terminal, I saw a woman eating a "to-go" meal of out a styrofoam container. I immediately flashed back to the lunchtime meal distributions at HAH which were served in those same divided styrofoam containers, with a large portion of rice and beans, a small serving of a vegetable or salad, and some sort of protein. I think in my two weeks there, I ate those meals twice. A woman from Loma Linda with whom I worked a lot during the two weeks would save me a meal somedays when there were enough for the "Americans" to get meals. Often I wouldn't get to the breakroom anywhere near the time of food delivery. One night, she had left a meal for me with my name on it, but instead of eating it, I heated it back up in the microwave and took it down to Joseph who had not had a meal in two days. He was often "Pa mange, pa bwe" (Creole for no food, no drink or NPO for the medical people amongst my readers) during the mid-day meal distributions while awaiting surgery, so he would not get a meal. His family had little to bring him and he would go days without eating. So we started trying to make sure Joseph got to eat at least one good meal a day. He was the recipient of much of our left over food upon departure. I left my sheets, blanket, and Green Bay Packers towel in the care of Jeannie to have washed and given to a patient or interpreter in need.

As I walked through the terminals of the airports, I saw all the luxury shops in which one could buy expensive soaps, jewelry, sunglasses, etc. I thought of my friend Jeanty, the volunteer interpreter from Cap Haitien who had come to HAH to help when he heard and felt the quake. He told me Thursday morning that he wanted to come to the US someday. What shock he would have had to see the extravagances in the airport! I said good bye to him Thursday morning not far from the tent he sleeps in. He showers in the hospital and gets one meal a day from the hospital cooks. He is very thin and is hoping to make some money to send home to his mom and 5 brothers and sisters to help feed them up in Cap Haitien. The PAP airport is a sharp contrast. There is one entrance and one metal detector and xray machine through which everyone passes. Then, one line to get to the desk to check in and check baggage. While waiting to get through the first metal detector, the line extends outside under a canvas awning where locals come up and down the line saying, "Missus" or "Mister, buy my painting?" "Like my painting?" "want a bracelet?" "jewelry?" One even knew the word "Souvenir" I bought a wooden jar and hoped that it would help his family eat this week. Inside the airport, once we got through emigration, we went through another xray machine and metal detector and then proceeded to the gate. Along the way there was one tiny shop with a few books and Haitian artwork on display with carved wooden boxes, metalwork, jewelry. Before the stairs, there was one stand selling coffee beans. That was it-- two small stands inside and street vendors outside. The control tower was a box of windows high on a truck lift. The baggage claim was a makeshift conveyor belt that sometimes worked in an old airplane hangar with fans and makeshift gates for immigration and customs. It is apparent that the quake has damaged the airport and they are making do.

This weekend, I have not felt well, struggling with a bit of a GI bug and exhaustion. I have spent my weekend on the couch in my living room watching the wind blow through the trees and listening to the birds. I am hardly interested in TV though I did watch the last inning of the Cubs game yesterday. I was glad to see a win, but would I have really cared if they had lost? My friend, Sylvia, from LLU wrote to me Friday night telling me in her email of her travel which summed up my experiences on Thursday as well. She writes,

"When I arrived at customs [in Miami] the officer asked me if I had accomplished my goals in Haiti. I told him "Oh no, I never could have." Then the second officer who checked my passport said, "Welcome Home." and I choked up and couldn't even reply. It just seemed so surreal."

Yes, it just seems so surreal.