Haiti 2019

Typical street scene on our commute to work

Haiti is a confusing place. Yin and yang not only balance each other but they battle each other. It is a place filled with life (avg age 23, US 38) and a place filled with death, often of the very young (under 5 mortality in Haiti is 47/1000, US 6/1000). under 5 mortality  We have met some of the kindest, most gentle souls despite the petri dish of deep seated corruption that is brutal and pervasive. The conflict infects visitors. At one moment you think of selling it all and moving there to help those in need and a minute later you’re moving up your return flight to escape back to the comforts of home. These are not random thoughts. They grow from realty. Twice I phoned Dr. Mark, a dentist who had literally sold everything, including his practice to move to Haiti and build a hospital. You might think it may not last but that was 27 years ago. The team before ours had flown home a day early due to more planned riots protesting the price of gasoline. The price of gas had increased by order of the President to $4.75/gal, more than twice as much as most Haitian's daily income.  US issues warning about Haiti  I want to come more often and then I want never to return. The conflict is within me. Like many of the rampant tropical diseases, there is no vaccine for this infection.

St. Dominics Orphanage, goats near chicken house

Amplifying the dizziness was our movement between different worlds this visit. Our planned accommodations at the ALOM Clinic were not quite ready for its first visitors so we fell back on plan B, staying at a beachside resort.  Each night we returned to cold beers and a spectacular Caribbean sunset.  We enjoyed a full buffet dinner bathed in onshore sea breezes after a day of sweating at a dusty clinic site and a lunch of peanut butter sandwich washed down with room temperature water.  I did not want to stay at the resort because I thought it wouldn't seem right.  Wouldn't it feel indulgent, especially when so many have so little?  Then when we actually did spend the last night at the clinic, I longed for my cold beer and beautiful setting sun over the Caribbean Sea.   I don't think I'm strong enough to survive in Haiti.  It is a place only for the strongest.

Sunset at Kaliko Bay 

Returning from a mobile clinic site to the fixed clinic we entered into chaos.  A patient had just been brought in bleeding profusely from a knife wound.  He had allegedly been stabbed by his wife.  She was already in police custody and unfortunately for both of them, the good people at ALOM were unable to save him.  I was on the phone with Dr. Mark discussing options when I saw chest compressions begin.  He was too unstable for transport and an ambulance was nowhere in sight.  He had lost too much blood and units of available blood in Haiti are as likely as a snow storm.  Her assault charge was upgraded to murder.  A paper sheet was pulled up over the 25yo victim and the bloody floor was mopped.  The sterile smell of chlorox quickly masked the scent of death.  His parents came to collect his body.  The very next day Dr. Vlad was called to the women's prison to examine the wife.  She had apparently had entered a catatonic state upon learning of her husband's passing.  She refused to respond to Dr. Vlad.  The prison officials felt that she would be better cared for outside of prison so she was transported to the ALOM fixed site.  This is how we came to spend the night with her and her around the clock detail of guards as we inaugurated the conference room on our cots behind locked doors.  She and the guards were in a different room.  The morning of our departure she was once again speaking.  It is a very sad situation where everyone lost.  He lost his life.  She lost her freedom and their two month old baby lost both parents.  This event will not be reported in the paper or on the evening news.  If the AP picks it up it will be from my blog.

Kaliko Bay Resort -purple star  ALOM Clinic - yellow star

Amy saw a baby on Monday that had recently been found in a latrine.  The baby was now with an adoptive family providing care but was failing to gain weight. She prescribed higher caloric formula and recommended another weight on Friday but she didn't see the baby again.  What would the options be if there was no weight gain though? The odds are against that baby but at least it has found a supportive family.  The baby had been found by a 12yo boy.  The hero was rewarded with a year of school and a uniform by Dr. Vlad.  School is never free in Haiti.  The approximate cost for a year of school and the mandatory uniform is $70.  Hopefully the found baby will make it into one of those uniforms one day.

Amy seeing patients at Tapyo mobile clinic

I want our kids to go on these trips because I want them to have perspective.  A visit to Haiti provides perspective, especially inside healthcare delivery.  Abbey probably got more than she was expecting.  She saw a baby left for dead in a latrine.  She watched a man bleed to death.  She not only worked in triage at the mobile clinics, she was triage at one site when nurse Lucy got called back to the fixed site for a government inspection.  Abbey took blood pressures, temperatures and even did finger pricks to obtain blood sugar levels.  She recorded those vitals and passed the cards onto the waiting doctors.  This was all done without an interpreter since triage has no interpreter.  I was very proud of her and very pleased with her experience on this trip.

Abbey checks blood pressure at Arcahaie mobile clinic

One case in which all three of us participated I suspect will haunt us for sometime.  It is a 15yo boy that looks like he was just liberated from a concentration camp.  He is the thinnest person I've ever seen.  By ultrasound I detected a massively dilated stomach and no other abnormality.  What could be the cause of such a finding? Chronic gastric ulcer, post inflammatory stenosis, lymphoma, bezoar, parasite? He had actually been seen a week earlier in the clinic and had appropriately received a dose of worm medicine and a course of antibiotics.  In the US this kid would be admitted to the hospital.  A PICC line would be placed for nutrition.  A gastroenterologist would be consulted and an endoscopy with biopsies would be performed.  A pediatric surgeon would also be consulted.  I suspect a gastric bypass would be performed.  It's not that easy in Haiti though.  There is no free healthcare or free hospital.  This case is the second time that I had called Dr. Mark for advice.  He recommended a few hospitals, including Paul Farmer's in Mirebalais but said we would need to travel with the patient and to bring at least US$2000 to get the boy admitted.  We were leaving the next morning so this was impossible.  Admission often takes paying a series of bribes from guards to doctors over a series of days.  Nurses hoard supplies and then sell them to patients.  Families are required to care for their own family members inside of the hospital.  We heard many stories firsthand from people who had experienced the system from the inside.  One particularly revealing example was the US$1,000 that was needed to retrieve the body of someone's father who had passed after a short admittance to the government hospital in Port Au Prince.  I suspect he will be gone soon as he is weak and already very anemic.

Basile putting the finishing touches on another busy day at ALOM

A parallel system "providing" healthcare in Haiti is the Witchdoctor.  Witchdoctors can be found in every town and village.  If the witchdoctor recommends something, the family does it.  No questions.  These are mysterious men with feared powers.  Many times the treatments involve potions or foul smelling poultices.  Some witchdoctors though are more inventive.  We heard of a family that was dealing with a daughter with severe typhoid.  She needed inpatient care but the hospital wanted $10,000 up front.  They couldn't afford it so they sought the witchdoctor.  He said that he needed $20,000 and they needed to leave her with him for 10 days!  They raised the money.  Sometimes families sell a vehicle or a home to raise these funds.  The witchdoctor then took the woman to the hospital and paid the $10,000 but made certain that the staff knew that they only had ten days for the cure.  When the family returned, they were very pleased to find their daughter cured as promised.

Traffic circle might help this intersection

I am thankful for our wonderful hosts in Haiti, Drs.  Vlad and Merline. We bonded with the thoughtful and kind staff at the Alpha Omega Clinic, especially Junior, Sony, Mackenson, Lucy, Dr. Francise and Jude. We are grateful for the Sisters of Mercy that organize these trips.  In particular, none of this would be possible without Dr. Ellen Lawson.  We are fortunate to know her.  Her example is humbling.  She can best be described by one of our long distance cycling mantras, "relentless forward motion."  Her life experiences could fill a book or two but I expect that she'll never have the time to sit down and write one since she is always "doing." 

I suspect it will take a while to recover from this visit.  Haiti is a state of constant heightened awareness.  It pushes on you and pulls on you.  You never know quite what to expect but you're definitely getting something, a new perspective. 

Naway pita Haiti.