3/17-3/24/11

3-17-11

Things are so unbelievable here, if there was any way to really describe it to all of you, it would be a big relief to me. If there was any way to really capture all of the different pieces, as well as the big picture. Things are crazy here, in so many ways. Everything: activity level at the house, with people coming and going, noise levels; coordinating the people who work at the house in order for everything to run smoothly; the street: how do you make peace with the fact that 15 people a day yell something out at you in the street? Something that has to do with the fact that you’re white, and therefore different. The hospital: the level of knowledge and the level of apathy of the people who work there, the almost complete lack of materials to work….
I have been feeling really frustrated with everything here recently. It is really hard to live here. At the house, there is never really a quiet time or a time where someone doesn’t need to engage with you. There has been a volunteer here for 2 months, Lara, who helps tremendously with the volunteers. She talks with them a lot and spells things out for them. I feel like I don’t have the energy to do this, even though it is supposed to be part of my job. I already manage the house, prepare classes, teach, work at the hospital…but the thing is, Lara also does a lot of extra work around here, and I have been comparing myself to her a lot and wondering why I can’t also do all of this extra shit all the time---I can’t and I also don’t want to--I don’t want to put myself through that, always working, always talking with the volunteers, taking all of these other jobs on…is it that some people are just more capable than others?? To step into a situation as overwhelming as this and just take on all of these different responsibilities?? Is it that at this time of my life, I need to be more inward and focused on myself, on my growing relationship with Blada? Is there anything wrong with that? I just don’t see how it would be possible for me to be as engaged with so many different aspects of the work here, when I already live here, and am doing the work that is mine to do. I know this in my mind, I know what I am capable of, and don’t want to put more than that onto myself, but I also can’t help but feel that in the eyes of MWH I am not doing enough.
Sometimes the reality here in Haiti, in the street and in the hospital, is so depressing…I just get depressed, and feel like I can’t enjoy it at all. It has been up and down for the past year. It has never been easy, even though I have learned to love and appreciate many things about the culture and people here. I really do enjoy a lot of things about Haiti…some things here, they are lacking in the US…but sometimes the hard things about being here are just so overpowering…and going back and forth between this place and the US, which are starkly different, it is hard to assimilate. Even months later after traveling, the differences stand out in your head, in your experience.
In the hospital, you see things that are really frustrating. So many little things that you just can’t believe. Such as: I was talking to someone’s mother yesterday, in the hospital. This lady had had 10 babies. Then she told me that one of them was a c-section. I asked her which one: it was the 10th. Why? Because the baby was “too big”. someone’s 10th birth!! She had already birthed vaginally 9 times!! How is it possible that someone would think this is possible? There are so many c-sections done here for “CPD”. So many. It’s the easiest diagnosis to do a c/s for. They take it so lightly. They do a c/s for a reason that’s not real, and then the post-op care is not good. Sometimes people don’t ambulate for 2 days. These people are really at risk for thrombosis. Plus a lot of them already have high B/P. (Thrombosis is when you have a clot that develops in a vein, usually in the leg. If it detaches, it can travel to the lung or heart or brain).
Yesterday, there was a woman who had a dry IV in her arm--that’s almost everyone--so I asked her how long it had been dry, and she waid for 2 days. And I looked in the chart, and it was true. She had the same dry IV in her arm for 2 DAYS. Why?? And each person who checked her, 3 times a day, they just wrote in her chart, the IV that ran out is in place with the IV tubing closed. But no one looked back to see how long it had been dry for? If they needed to give her IV fluids, they would have had to re-stick her anyway.
Today, there was someone with a 4.6 hemoglobin who needed a blood transfusion. We did the requisition for the Red Cross, and one of the students walked over there to deliver it to them. Well, she knocked on all the doors and no one was there. Someone finally came and told her: the Dr isn’t here--go back to the hospital and call the Dr. So she came back, and we found someone who had the Dr’s number in their phone, but then no one had minutes on their phone. Ok, so then we found someone with minutes on their phone, and we called. They said they will send someone over to pick up the blood specimen (so that they can match her blood type). Hopefully that will happen today.
At the hospital, in order to get materials to work on the patients, for example to give someone an IV, you have to write a prescription on a special prescription paper, and then send the family to the in-hospital pharmacy, to get the materials, like IV fluids, IV tubing, etc. When the pharmacy is out, then the family goes to a pharmacy on the street and buys it. (Most of the time). Well, sometimes at the hospital you don’t even have the little prescription papers. Like today, they were using regular paper (which they actually had) and tearing them and putting a Maternite stamp in it, in order to use it for a prescription paper.
The sharps boxes are stuffed full, because people throw the needles and syringes into them. Instead of detaching the needle from the syringe. So I was talking about this to the head of maternity today, and she was like, “well, this is just how we do it.” then she shows me how she does it-- she takes the protective covering OFF of the needle, and then throws the needle and syringe into the sharps box. Seriously? I don’t know if she was doing this just to say like: “I have my own way of doing it“, or what. Does that make sense at all?
Things are just so fucked up at the hospital. Another thing is that working with Haitians, there are major cultural obstacles. Ways we are raised as children, that are so different. I have been feeling discouraged about the new class--I remember feeling this way last year too--I just don’t know if they’ll ever be capable of grasping the real underlying concepts. Will they be good enough? How good is good enough? In a country where 76% of women give birth without a trained birth assistant, and many of these women and babies die??
And these things I am describing are just tiny, tiny slivers of the reality here. It is so big, you just wouldn’t believe it. Some day I will tell some of you more stories in person. If you want to know. When I come to the US, and hang our with people, and they don’t ask me questions about my experience here, I don’t feel compelled to talk about it, because I don’t know who is actually interested in hearing about it.
Oh, and Aristide is returning to the country today or tomorrow, for the 1st to=ime after his exile. Baby Doc is in the country as well, as of atleast a month ago. And, elections are Sunday. The second election--the re-vote--after the vote in November. It is really very strange. Something big is going to happen. The volunteers from this week are evacuating though the DR--not through Port au Prince--tomorrow morning. Hopefully no new volunteers will try to come this weekend. Not a good idea.
There must be a bigger plan for the manipulation of Haiti, which is why both Baby Doc and Aristide are going to be here for the election. There has to be. For some reason, Haiti needs to be kept in darkness and chaos and poverty.

3-19-11

So…I am feeling a lot better than I had been feeling this week. I am really trying to figure out ways to reduce my level of stress here. I have to come to a place of greater acceptance of the reality here. The realities here, the mentalities here, etc. everything that I was writing about a couple of days ago. If I can somehow turn it around and use humor…this has definetly helped over this whole year--like, the rediculousness of some things that happen here…just try to laugh it off, just try to see it as interesting and ridiculous and therefore funny…I don’t mean laughing off the hardship of peoples’ lives here--I mean laughing off the stress of my job here, the fucked up things I see over and over again at the hospital….things like that. The poverty and suffering that you see here is something that gets burned into your heart. You can’t forget it, and you can’t not compare it to other places, where peoples’ basic quality of life is sooo much better. Here, people are denied the right to a basic, normal quality of life. I don’t mean just the fact that they’re poor. It’s so much more than that, and there’s no way I will ever really be able to explain it to someone who hasn’t spent time here or somewhere like here.

I am feeling more at peace and happy here though. Blada is a solid support. So understanding of my difficulties here. So patient. I think if we can make it here we can make it anywhere. And everywhere will have its own particular challenges.

Yesterday at the hospital, there was this woman who had had eclamptic seizures the day before, and they had decided to do a cesarean because she was not in labor at all, her cervix wasn’t ripe at all, she was 41 weeks, plus she had already had seizures. Ok, I agree. The only problem was, the OR team never arrived that night and so she still hadn’t gotten the c/s yet (the next morning). So, we started working on her, making sure she was getting the right meds and stuff. Well, according to her chart, no one had done any rounds on her at all since sometime the night before (they don’t usually write the times in the charts--just AM, PM, and NIGHT). So, then we saw that her IV drip with blood pressure medication was dry. Since who knows when. Then, we also saw that her IV had infiltrated----that means that the little catheter that stays in the vein, it wasn’t in the vein anymore and the fluid was all just going into the interstitial space (basically just into the tissue). So, it was so infiltrated (for so long) that her whole arm was swollen. Not only was her ARM swollen, the swelling spread all the way to the midline of her chest. No kidding. When they took the adhesive off (they keep IV’s in place here with really poor quality adhesive that’s almost impossible to rip and really sticky)--the adhesive tore off patches of skin on her arm. This is the second time I’ve seen this with peoples’ IV’s that were neglected and had infiltrated into their tissue.

So, it’s been quiet--I don’t know if things will blow at any moment or what will happen. The vote is tomorrow. Both ex-presidents are here. It feels like something big could happen. I felt like it was a really horrible idea for any volunteers to arrive in port au prince today and I strongly urged MWH to not let them come. The worst time to come here. I am relieved, no one is coming. We just really don’t know what’s going to happen. I’m going to lay low here in Hinche.

3-24-11
Wow…so we work with the students each wed, thur and fri in the hospital…in just that small window of time each week, you get involved with patients, you see a lot of things. Yesterday, when we started, I was pleased with the students ability to take care of people, talk to people, stay with them, follow through with their care, etc. I was really pleased with them. This was the first time I’ve really felt that way. Because in class, I usually feel so bewildered and frustrated with their level of understanding. So, there have been many cases in these past 2 days, but today was especially interesting and also sad. The main situations are these: there is a woman who had given birth at home and then was admitted to the hospital for a retained placenta--somewhere between 14-24 hours later--it’s not clear in the chart. She said she had lost a lot of blood at home. So, the next day after she was admitted, they did a hemoglobin and hematocrit on her--her hemo was 3. They sent a sample of her blood to the Red Cross close to the hospital, for them to match her blood group, and they said that they didn’t have any O negative blood. They said for her husband to gather 4 family members to come and donate blood for her. They are from a town called Maissade. So, today--the next day--all the 4 people were here, so they went and donated blood. This afternoon, we got the blood for the transfusion. Just one bag. She needs more than that. Anyway, we gave her the blood transfusion. I am still learning about some things like giving blood transfusions--luckily, one of the students in the class, Magaly, is very experienced and already worked at the hospital here for 5 years, in maternity, before starting the program. She ran the blood transfusion and me and the other student helped. At one point, the blood clotted in the IV tubing, because it was flowing too slowly, and she flushed the tubing with a different IV fluid that we had there. She really knows how to solve all the problems you can run into with an IV. Anyway, this woman, with the 3 Hgb, she is really with it. You wouldn’t think she had a 3 hemoglobin. Her pulse is very high--130--but her other vitals are basically normal, and she’s present and responsive. Her conjunctiva are totally white though. And she gets dizzy if she stands up, and she “sees black”. Seeing black is a scary sign. The last person who was severely anemic (hgb 2.3) was seeing black too, and she died. But, this woman, she also doesn’t have any problem breathing. Hopefully tomorrow morning we can do a requisition for blood from a different hospital in Cange. I gave her husband some money this morning to buy inject able iron for her. He doesn’t have any money on him…then, it became apparent today that her baby definetly isn’t getting enough milk at all from her. Of course--that goes along with anemia. We started giving the baby glucose water in a syringe--but the baby needs more than that. At 4pm, I tried going to the Partners in Health storehouse, behind the hospital, to see if they could give me a little formula. They were closed. But, the weirdest thing happened. As I was walking away, this man approached me--the guy who works for ZL (Zanmi Lasante--Partners in Health)--he’s in charge of supplying the hospital--and he showed great concern and gave me money to give the husband to buy formula for the baby. That was like a divine intervention. In only wish this guy would come by maternity once a week and ask us what meds we need, if he was really that concerned. Anyway, that was great luck for today.
As all of this was going on, Genette (a grad from last year--one of our clinical instructors for class 4--) came up to me and brought me into the delivery room, where a 31 year-old woman had just died. She had just arrived about 15 minutes before--a reference from another hospital in another town, for severe anemia. Hemoglobin of 5. Apparantly her vitals were not super abnormal, but her temp was really low (93 degrees)--which can be a sign of infection. Severe anemia and infection can go hand in hand, and Marthonie thinks that she died from septicemia--infection in the blood. Once an infection gets into your blood, you die quickly. The infection circulates to all of your organs and your body shuts down. When I came in, they had already tried CPR and now they gave her adrenaline IV--she was also on oxygen. There was no heartbeat, no breathing, no papillary reaction to light--nothing. 34 weeks pregnant with her first baby. She didn’t look dead, except if you looked into her eyes. How could this be possible? For the veil between life and death to be so thin. It’s hard to understand, even though you know that it’s true, for all of us.
Genette had me go outside with her to deliver the news to the family. She has done this so many times, she asked me to, she didn’t want to this time. So, I did. Her brother started crying. Her mother marched inside to see her, and looked at her, and then said: “I will be calm.” she said some other things I didn’t understand, and talked to her daughter some, and then said: “ I am not going to yell.” (yell/cry. Here, people mourn together and loudly. They cry, yell, fall down on the ground, etc.). “I’m not going to yell/cry now, or next year, or the next year…“she counted all the way up to 2015. When she was saying this, this made me cry. To me, it seemed like she was saying that she wasn’t going to let this destroy her.
I told this story to Blada, who gave me another interpretation of what she was saying. That here, people very often attribute death and sickness to other people putting spells on them/using voudou. So, that what she was saying was that she wasn’t going to take revenge on anyone yet. And, also, that if she doesn’t cry yet and doesn’t take revenge yet, that in a way, that is like saying that her daughter isn’t dead yet.
I wondered if maybe we could take the oxygen she had and put it on the lady with the 3 hgb. I asked Genette, and she said that unfortunately int eh postpartum room, there is no electricity. (It’s an O2 concentrator and requires being plugged in). There are so many layers to the reasons why people don’t obtain the care they need. Such as no electricity in the pp room.
The other lady, with the 3 hgb, her husband took me aside to talk to me. This was before the other woman came in and died. He said: “Do you think my wife is going to make it? Because if not, I would like for you guys to hand her over to me to return home and for me to make arrangements for her funeral. Please tell me if she’s not going to make it. I don’t have any money on me. I can’t afford for her to die here.” This was so sad, that in reality, he doesn’t know at all what is wrong with her. He doesn’t know what anemia is, what hemoglobin is, etc. I mean, even though we have explained it to him. So, basically, he doesn’t know what’s going on, and it’s all in our ‘hands--he doesn’t even have money in his pocket to but inject able iron for her. He is totally powerless to help her. This is so sad. He doesn’t know if she will live or not, and he just needs to know the truth. I assured him that I think she looks pretty good--I’m surprised that she has a 3 hgb--she is handling it really well--and that we are trying to get more blood for her etc. and I assured him that we will tell him the truth about her state.
Some days, the hospital and life here really discourages me and depresses me. Other days, like today, even though all of this happened, a 31 year-old woman dying--I don’t feel as sad. Maybe it will hit me later--sometimes it does. One time this year when I was in the US at my mom’s house, we watched this documentary about Afganistan and maternal health etc. it reminded me so much of Haiti, I just cried and cried as I watched it.
Anyway, so that is a summary of a couple of situations that occurred over the past couple of days at the hospital. There have been others…there always are so many unbelievable situations that are actually peoples’ real lives.