Haiti Reflections: Day 2 - March 16 (part 2)

The number of people we saw with hypertension was staggering. It was in excess of 90% of the adults. And we're not talking about anything even close to normal B/P. In nearly 30 years of EMS, I've seen fewer people with pressures over 200 than I saw in those four days. Most of those EMS patients with B/Ps over 200 were suffering a traumatic brain injury or a stroke (hypertension is a common response to brain swelling); the Haitians were just walking around with it. The highest I measured was 264/130. We talked about it but we're at a loss for why this might be so prevalent and so severe.

Dental patients were in abundance and this was expected. Dental hygiene is non-existent and tooth decay is rampant. Our dentist, Dr. Joy Jordan, was one very busy lady.

Just before noon, two people - one male, one female, both elderly - were dragged (literally) into triage within minutes of each other. Both went down while waiting and were victims of heat, dehydration and probably low blood sugar. The guy had a seriously decreased level of consciousness and was cyanotic around his lips. He gave the distinct impression of a man actively trying to die on us. Both were taken to an area in the middle of the clinic that had a couple of beds, which became known as "The ICU" because that's where we took and treated all the seriously ill people. We started IVs on them to buff them up and worked with Dr. Vania Francois to get them back to their baseline. (Vania is Father Yves' sister.) (His sister as in biological sibling, not his sister as in a nun.)

There was a steady stream of kids headed to see our two pediatricians, Drs. Sarah John and Beau Laguerre. We didn't do triage on them as all aspects of kiddie care was being done by the pedi people.

In all, we saw over 600 people and told 500 to come back tomorrow. This was actually a low number as we got off to a late start due to having to set up.

After triage was finished processing the last patients of the day but they were still waiting to be seen by the physicians, Father Yves took me next door to show me the house his mother is building (his mother as in Mom and maternal progenitor, not mother as in a nun). It's a nice place and Mrs. Francois seems like a very nice lady. To turn out kids like Yves, Vania and Sondi (who was translating and helping out in general), she must be. It's also evident where they get their brilliant, ever-present smiles.

Sondi and Mrs. Francois

Father Yves and I then went back to the school and I got another look around without kids this time. He told me that the school is going to have to be demolished and rebuilt, not because it was damaged or decaying but because it doesn't meet the new Haitian government earthquake codes.

Father Yves also told me about the deal that the government has made for the clinic. If a complete clinic is built (a new, purpose-designed building that is medically equipped), the government will provide two physicians to staff it full time. (Each person whose medical training is paid for by the Haitian government owes two years of service, so that's how it would be staffed.) The cost: $300,000.

When the last of the patients left the clinic, we headed to dinner. The food was, as described in an earlier post, tasty and satisfying. Father Yves also provided us with cold beer (!!!). Prestige beer is Haitian and a very nice beer. We didn't expect it, so it was that much more delightful. It also brought to mind Benjamin Franklin's saying: Beer is proof that God loves us and wants us to be happy.

After dinner, we debriefed, going over what went right and what could be done better. We also learned that the team would be split for the next two days with half going into the mountains to a village called Canon.

Greg and I talked it over and he would be the medic going up on the first day and I would go up on the second.

After the debriefing, I went to the Barracks, wrote my journal entry for the day and fell into a deep and easy sleep.

Haiti Reflections: Day 2 - March 16 (part 1)

Our first clinic day dawned and we grabbed our breakfast then started setting up.

Dawn over the clinic.

We grabbed our baggage and began unloading it all, distributing the supplies we brought to the appropriate areas. These areas were triage, general medical, gynecology, dentistry, pediatrics, lab and pharmacy. There was also a storage area for overflow.

The section with the most setting up was the pharmacy.  Everybody dedicated a sizable portion of their 100 pound luggage allowance to medications.  Alex and Sharon, our pharmacists, had to sort out and organize the meds. They also set up a counting and dispensing system that seemed to work very well.  The amount of work they and their assistants had to do to set up was enormous, and their level of work continued to be prodigious until the last patient left on Saturday.

Alex and Sarah at the pharmacy's counting table.

Before the clinic gates were opened, we went next door to the church, Ste. Jeanne de Chantal. The church was opened up so that the people coming to the clinic would have a place to sit that was out of the sun and off the street. This was a to avoid a huge problem during the last mission - people were crowding the streets and then dropping like flies in the midday sun.

We entered to find the pews packed:

The picture above shows most, but not nearly all, the people waiting in the church. I'd guess that about 30% of the church's capacity is in additional pews on either side of the altar. There were also people waiting outside and more coming into town. As Father Yves introduced us as a group to those who were waiting patiently, I said a quick and quiet prayer for strength at the realization that this was just the tip of the iceberg.

After that, we went to the other side of the clinic to the school. The kids there were like kids the world over: happy, friendly and adorable. We were there as they assembled for their daily prayers.

The school rooms are spare but functional with desks and chalkboards. Annual tuition is $50. A pittance for us, a king's ransom for many of them. Each day they get a good education and lunch...for a lot of them it is the only meal they will eat.

We went back to the clinic to finalize our set up. I was in triage where we would determine the reason each person came to the clinic (their chief complaint) and take their vital signs. We also placed ourselves in the role of traffic cops. Diana, one of the nurses, placed a desk at a strategic point at the entrance to the building. This allowed us to control the flow into the waiting area, keeping it from getting out of hand (this was another problem encountered on the last mission: a waiting area so crowded nobody could move and so loud the physicians had difficulty hearing their patients).

We were also introduced to our translators. These were locals, mostly men but a couple of women, who had varying degrees of fluency but all were eventually situated where their abilities were matched to their task.

It was during these introductions that I saw it. I couldn't believe it. I stopped and looked a second time. I blinked. I checked my glasses. I wasn't seeing things. It was real.

Here I am in Haiti, some 1,500 miles from home physically. Culturally, I am on another planet. And yet there he was, a Buckeye fan:

Only hydrogen is more universal than the Buckeye Nation.

Adzi (no idea how it's spelled but that's how his name is pronounced) has actually been to Columbus and has been on campus. He aspires to attend OSU. Having worked with him directly over the course of several days I can say he's probably bright enough, and certainly has enough fluency.

The walls of the compound were important to maintaining order. People were desperate for medical attention. The gate between the clinic and the church was another important "choke point" where the flow of people could be controlled. The local guys who manned the gates did a pretty good job of keeping things regulated and not allowing us to get overwhelmed. Here's a picture I took over the wall of what they were dealing with on the outside of the wall:

All of those people are crowded against the gate. Unfortunately, these are the ones who are younger, stronger and healthier than many of those waiting patiently in the church. If you've ever read Dale Carnegie, you'll recognize the idea that each person thinks of their own problem as being more important than yours. For these folks, their need for medical attention drove them straight to the gates, bypassing those who had been waiting. They were also driven by sense of urgency created by the brevity of our visit. They walked for hours in the heat to get there and knew that if they didn't get seen while we were there, it would be months before anyone would be back, if there's a return visit.

Then the gates opened.

Each person entering was sent to the initial triage area where they were given their "medical record." This was half a sheet of paper with spaces for their name, age, chief complaint, vital signs, physical exam, physician notes and treatment record. These records were collected from each patient before they left the clinic so that the nuns would have the ability to follow-up with those who might need it and so that there was some basic record of what we were seeing.

The initial triage area was outside the clinic, with benches set in the shade. The patients then went to the next "choke point" (Diana's strategically placed table) to get their name entered into a log. Bill was instrumental in crowd control at this point and wrote a LOT of names into the book. While some vital signs were being taken in the initial triage area, most were being taken in the area just behind the registration table. This was my main task (along with assisting Bill and Connie in controlling the occasional crowd surge).

After triage, patients were sent to the waiting area where they were then sent to the appropriate physician.

Looking from triage into the waiting area

Looking from the waiting area out to triage

To be continued...