5-14-11

5/14/11

The last 2 weeks….prett busy. Always at the hospital, each week, there is some patient who stays in my mind over the weekend. Each week. There are so many different cases that we see.

The week before this week, there were 10 visitors in the house. I had been really worried about how this would be, and yes, I did lose sleep because some of them got up and made a lot of noise really early every morning. But, overall it was actually a really enjoyable week. I liked the people who were here. Several of them were with MWH, and the rest of them were doing their own thing--burses and doctors doing mobile primary health care clinics. There was this pediatrician who was heartbroken because he couldn’t save this 3 year-old kid’s life--the kid had pneumonia--the family wouldn’t let him treat the kid because they believed the sickness was caused by voudou. They wouldn’t participate. It was out of his hands.

Nadene and Steve, the directors of MWH, were here, and that was good--we talked about a lot of things and made some progress. Plus they are fun to be around. Really relaxed, with a good sense of humor.

There was another person who was here that week, who really touched me. Her name is Dr Alice. She is an OB with the heart of a midwife. Super loving and compassionate towards women. I was really taken aback by this, because that’s not usually what you expect from an OB. We had a situation that I will describe, where we worked together on this lady, and she was just so, so loving and compassionate and patient. It brings tears to my eyes to think about it. I’m just so thankful that there are OB’s like this out there. I met another female OB one time who also seemed super super nice--she actually had her kids with midwives, so that tells you something. But I didn’t ever work with her like this. Steve, he’s an OB, and he’s really great too, but he’s a guy. Anyway, I want to pay tribute to all the really cool doctors out there who are just as loving and gentle as midwives. I really am so ,so touched by what I saw. I will always remember those moments.

The woman I worked on together with Dr Alice was a 5/5, (5 pregnancies, 5 births) who was about 1 ½ months postpartum. She was from far away. She came in with a terrible, terrible breast abscess. She had probably stayed at home for a long time with it, and then she had gone to this other hospital, where she sat for 10 days without them doing anything for her. Then, her family brought her to St Therese. This was the worse breast abscess that either Dr Alice or this other MW had ever seen. The OB here, he incised it with a scalpal blade, and as soon as he did, pus just shot out with such force that it hit the wall. It kept coming out. All over the floor. He had put her to sleep for this--with ketamine. For about 10 min. After the pus stopped shooting out on its own, he dug around inside her breast with his fingers, in order to loosed up and remove any other pockets of pus. The abscess was involving a huge portion of her breast. When he had incised the abscess, the skin over it just burst open, and made a huge hole ( like 4cm) and also another little hole, going to another abscess, which was connected to the main one by a tract. All the skin above and around the abscess was already separated from the tissue beneath.

Dr Alice and I continued caring for this woman after this. We went to the hospital twice a day to clean out her abscess and re-bandage it. It was in one fo these moments when the mom was in a lot of pain, when Alice was cleaning our her wound, when Alice impressed me so much. She was saying to me “she’s working so hard” and just being so loving with the woman. Really compassionate, really feeling for her and validating this woman’s experience.

So, we continued doing this for a few days, and had to debride the inside of the abscess a few times, and do a lot of massage to get her engorgement down and work the pus out. She started improving. Alice left on sat, and by chance, another OB arrived that same day. So, I continued the wound care with her. Well, it started looking like each time we went, we needed to debride it, because there was still more dead tissure each time. Plus, it looked like she may have another abscess higher up in her breast, but we weren’t sureif it was that or engorgement. To add to the problem, for the 1st 2-3 days, the people at the hospital were neglecting her and not administering her IV antbiotices. As much as they overuse antibiotics, this woman really needed them and wasn’t getting them. Well, finally they got their act together and started doing that atleast.

So, the following Monday (this past Monday, 5 days after the woman had come in), we decided to transfer her to Cange, because there is a better hospital there (Paul Farmer’s place). As of right now, St Therese doesn’t have a general surgeon, so there was no one who could do surgery on her. (We thought she needed surgery at this point: more extensive debridement, etc.

So, the only way to get her there was to take her in the MWH jeep. Ronel, the driver, readily agreed and we prepared to TR. Well, this same day, in the morning, another woman had also come in to the hospital and was in grave danger. She had a hernia that had gotten trapped (a part of her intestines were protruding through her abdominal muscles and couldn’t be replaced back)--she was in A LOT of pain, and the danger was that after a number of hours, this part of the intestines wasn’t getting circulation and would die--which would cause other problems and eventually death. So, it ws hard to wrench her out of the hands at the hospital--people were insisting that we wait until one of her family members returned in order to send them with her. Yes, that would be good, but we didn’t know how long that would take, and her life was on the line. She had already been there all day, writhing in pain. Finally we left, and I called Blada and had him give someone money for a tap tap for when the family member showed up.

So we left the hospital, and then had to drive around Hinche and the market, looking for diesel fuel to fill the jeep engine. That took a long time. Finally we left Hinche…made it to Cange eventually--both women got admitted--the urgent one, she got into surgery within an hour. She was also 24 weeks pregnant. The breast abscess lady, Felice, she got surgery the next day. Thankfully, there was an American BREAST SURGEON there who did the surgery. He discovered another tract going to another abscess, probably the one we weren’t sure of. She got the care she needed. I am so thankful. Unfortunately I haven’t heard anything from either ladies, and I have no updates since the day after we TR them. The person I was in contact with, he went back to the US.
Hopefully I will hear from them.

Then, a couple days ago, we had a baby who was born with a defect called a meningocele. Basically a hole in his back overlying the spinal column. A hole, covered by a membrane. I covered it with sterile gauze and saline, and kept if wet, and tried to make arrangements to TR ASAP. It didn’t seem urgent to anyone else, and there really wasn’t a way to TR him anywhere anyway, until Ronel and the Jeep were free. Once again, Ronel readily agreed, and this time, took the bb to Port au Prince. To a hospital where they can do that surgery. I haven’t heard anything and don’t know if we ever will, but I’m just so thankful that atleast we were able to transfer the baby.

So, that has been the last couple of weeks.

I am making plans to return to the US this summer--first to EL Paso, for a final visit (for now) and to gather my stuff, and then drive to NC with it, because that is where we will land when we come on a fiancee visa (hopefully next summer). Then I will be in NC for a while too, and then come back.

We have another MW and her Haitian partner moving in here really soon--in about a week. I’m looking forward to having more continuity at the house and maybe more help with the volunteers.

That’s all for now…