Hope

Piti-piti zwazo fe nich.

This was a Haitian proverb that patients said to encourage each other as they practiced walking on their new limbs, and I heard it many times over the past two weeks.  It means, "little by little, the bird makes it's nest."  I love this because of the emphasis on patience and a hope for a positive result of hard work.  On a broader scale, there is an overwhelming amount of work to be done in Haiti on fundamental levels in order for things to change.  Individual efforts by the government, the UN and NGOs are generally disconnected and loosely organized at this point, and I think it's easy to resort to feeling despair.  I'm hopeful that change will happen through the cumulative efforts, little by little, and I am anxious to see good happen for Haiti.      

Goodbye, Deschapelles!

Today is my last full day in Haiti.  Yesterday, the community celebrated the 51st anniversary of the hospital, which also happens to be the 100th birthday of Larimer Mellon, the late founder of the hospital.  The whole day was filled with festivities, including a ceremony, live music, and soccer matches with the neighboring town.  The patients at the clinic were the guests of honor, and one of them, a very talented young guy named Leon performed a rap song that he wrote and produced.  His hope is to promote awareness and understanding on behalf of people that have disabilities.  Leon lost his left leg to cancer two years ago.  The performance was awesome.

This morning, I went to the local Baptist church with our clinic translator that is also a believer.  He is actually studying to be a pastor.  Although the sermon and songs were in Kreyol, it was good to pray and worship together.  "Great is thy Faithfulness" was one of the songs, and I sang along in English.  I loved how everyone sang full-force.  It brought to my mind a moment in the clinic this past week.  It was late afternoon, and most of the patients had already departed.  A sad, bluesy song came on the radio, and all activity stopped as everyone joined in to sing.  Some people closed their eyes.  The only word I could recognize was "alleluia," but I could feel that they were singing from the depths of their souls.  I felt like my heart was breaking as I reflected on how much pain these people have gone through--they lost their mothers, fathers, sisters, brothers, friends, homes, jobs, and limbs.  In spite of horrible tragedy, there's incredible faith.

Alumni house

We have a pretty sweet deal at Alumni House, the hospital’s dorm for volunteers and hospital staff.  We have (cold) running water for showers twice a day for one hour, three quite tasty meals prepared (today we had stewed goat and okra over rice), shared rooms, laundry, and an awesome pool.  We have 3 PTs, 1 PTA, a midwife, a general surgeon, an epidemiologist, and an RN sharing the house, and it’s interesting to work with people from different backgrounds and parts of the country.  We teach each other phrases in Kreyol, discuss patients, and share funny stories about our days during meal times. 

Random creatures wander around the front porch and yard.  There’s Sally, a sweet dog with some kind of hernia, an orange tabby that eats spaghetti, baby goats, various types of lizards, roosters that climb trees, hens and chicks, and small horses.  We all wear ear plugs at night because the roosters crow at all hours.  In spite of mosquito nets over our beds and spraying bug repellant three times a day, I have a multitude of bites covering my arms and legs.  I saw a fat tarantula in the hospital, which is another motivation for me to use the mosquito net. 

Last day at Hanger clinic

As another one of the therapist so aptly stated, two weeks was a short time to be in Haiti but a long time to be away from home.  I feel so privileged to have been part of the work here for this short time.  It's hard to adequately sum up this journey, so here are some pictures.

Above: the concrete walls of the clinic are painted with beautiful murals by local artists.

Above: Anna at work in the Hanger lab, shaping a plaster mold for a prosthesis.

Above: These prostheses are ready to be fit.

Above: Graduation day. When people are ready to be discharged to go home, we give a parting speech with info regarding prosthetics fit, remind them to come in for follow-up visits, and give them a certificate and a medal to celebrate that they completed the program. His prosthesis is covered, and he's ready to go!

Above: So inspiring to walk with this guy.  He was born without legs and walks very well with prostheses and forearm crutches. 

Above: This is how hard it rains here! 

Sunrise hike

Few things would compel me to voluntarily get out of bed at 4:30 am.  I was told that I shouldn’t miss the hike up the mountainside for the sunrise.  We scrambled up the rocky path along side barefoot boys and herds of goats.  Glad I did.

Back to PAP

Wednesday: Went back to New Life Orphanage in Port-au-Prince.  The 2.5 hour drive wound down the mountain side, past fields of corn and sweet potatoes, and through small towns.  Tent cities lined the road in Port-au-Prince. I can't imagine living in a tent for 5 months--no electricity, running water, or privacy.

 

When we arrived at the orphanage, a crowd of about 20 people was already there waiting for us.  People just kept coming and coming.  There were probably around 50 people in the chapel at one point.  I did some education regarding phantom limb dysethesias and desensitization, checked on fit of existing prostheses and checked for pressure wounds, and exchanged crutches in bad shape for new ones.  Some people came in with some really cool home-made crutches.  

We barely had time to eat our rice and sauce for lunch.  Returned back to Deschapelles around 8 for dinner, a quick swim (too late for shower), and right to bed.

L'Escale

New patients arrive to the clinic on Monday and Thursdays.  The patients travel from up to 3 hours away to get their prostheses and therapy.  If they are not from the local area, the hospital provides temporary housing and food while they are here. The place is called L’Escale, a former TB sanitarium.  The shelters are simple cement block structures grouped together, and accommodations are very basic—mattresses on the floor and a few chairs make up the furniture. 

I was amazed to see how rough the terrain was—the patients have to navigate these uneven surfaces with crutches and one sound limb.  Patients usually stay for 1-2 weeks before they are discharged, and family members are welcome to accompany them.  It was nice to meet some of the family members, and see the patients in a more relaxed setting. 

We brought Nahomie’s limb to her after some adjustments.  She had the brightest, sweetest smile when she received her prosthesis.  It was great to see her practicing her walking.  We hoped that some of the older ladies would take Nahomie under their wings.

Hanger Klinik

As I already mentioned, the Hanger group built a clinic in partnership with Hopital Albert Schweitzer shortly after the quake.  Hanger has been steadily sending prosthetists to cast, fabricate, and fit limbs on site.  There are currently four prosthetists--three from the US, and one from Switzerland, a few prosthetic techs, and four therapists.  Two of the therapists, Karen and Maureen, were a welcome surprise—they originally had planned to volunteer at a hospital in Port-au-Prince, but plans fell through and they came to work here.  We are so happy to have them, as there are about 30 patients to evaluate and treat on a daily basis.  It’s a huge advantage to work side by side with the prosthetists, because we can collaborate to quickly identify fit issues and fine-tune alignment. 

The patients constantly amaze me with their hard-work, patience, and determination to walk.  They often go from initial fitting to walking with one crutch or a cane in a matter of days.  We have two sets of parallel bars for gait training, a ramp, and a set of stairs. Most patients with transtibial amputations achieve safe and independent ambulation over even and uneven surfaces in one week.  Some patients with transfemoral amputations or more elderly patients stay for up to two weeks.  Remember Nahomie?  She received her limb and took her first steps with one axillary crutch today.  She’s progressing well over the limb and weightshifting with more ease.  There were a few fit issues, so we decided to keep the limb for adjustments and bring it to her later on in the afternoon. 

Sunday

Today was a fun day: took a "tap-tap" to a neighboring town of Veret, hiked to a waterfall, went swimming, and had a long relaxing afternoon to read, nap, and listen to the rain and thunderstorm.  Tap-taps are the equivalent of busses: you stand by the side of the road and put your hand out, a pick-up truck stops, you jump in the back, and tap the window when you want to get off.  Veret was interesting and lively.  We passed by a market with fruits and clothing for sale, walked by women carrying impossibly large baskets and bags perfectly balanced on top of their heads, and churches alive with singing.  Children would stare and scream "HELLO!" as we walked by.  One very cute girl ran up, grabbed my hand, and ran away, giggling.  There were some nicer houses, but most homes and shops were little more than cinder block, rusty tin, and sticks.  This area was not affected by the earthquake, so these communities are much better off than many people in Haiti.  Many men approached us, telling us about how they don't have work, have children to feed, and need our help.  Poverty at this level is something that I have never witnessed before, and it's been difficult for me to process.  I know that I can't help everyone--this is something that will take many years and much effort to change.  Helping the people at the clinic is a small contribution but one that I hope will make a big difference in a few individual lives.    

Rounds

Bonswa!  Didn't get a chance to write yesterday--it was a very full and productive day.  Time seems to flow differently here--every day feels like a week!  We went to grand rounds at the hospital, worked a full day at Hanger clinic, ate lunch, walked to L'Escale (the place where patients live 1-2 weeks while getting their new limbs fitted and doing therapy, more on that later), quick swim, and then dinner with Sean, the PT coordinator.

We joined in on surgical grand rounds.  Most of the communication is in French or Kreyol, so we were fortunate to have a general surgeon from Boston and a PT that is fluent in English translate for us.  I saw some stuff that was really fascinating, and some stuff that I NEVER want to see again.  Some of the injuries were related to the earthquake, and some were not.  One guy went to a local healer, was doused with flammable liquid, and lit on fire.  He sustained burns to 40% of his body and will need extensive debridement and grafts.  Another lady sustained a small laceration during the quake, but because she was diabetic and the wound had poor healing, it became infected.  She underwent extensive debridement, but it was found that the gangrene was down to the bone so she will need an amputation.  I was shocked to know that many of the surgical procedures occur without anesthesia, or with mild pain medications, such as Tylenol and Motrin.  In spite of the incredible pain that I have no doubt that people were enduring, patients were mostly stoic or smiling and chatting.  More about my day to come.

First day at Hanger clinic

Had a really good night's sleep.  We have confused and very boisterous roosters that crow outside our windows at all hours of the night, but I was so tired that I fell back to sleep immediately after waking up.  Today was my first day at the Hanger clinic on the Hopital Albert Schweitzer.  Patients are bussed in as a group from the hospital housing--they stay 1-2 weeks for prosthetic fitting and rehab, and then they return home.  It was a very busy morning.  I was amazed at how fast some of our patients progressed--they would put on their prosthetics, get up with crutches, and just go.  They also worked extremely hard in the 95 degree weather. 

The boxes of supplies I brought were received with open arms.  Jill, the case manager who has been working here long-term, was so amazed and happy as she unpacked the toiletries, socks, bedsheets, hand sanitizer, duoderm and more.   She explained that many people that come to the clinic literally have nothing, and have been sleeping on plastic sheets.   

I evaled and treated one little girl today, Nahomie.  She broke my heart--she is only 12, has a transfemoral amputation, and lost both of her parents in the earthquake.  She has been living with her elderly aunt.  Apparently, someone spotted her walking on the street with crutches in Port-au-Prince and referred her to the clinic.  She rode the 3 hour bus ride by herself, and came with nothing except some clothes.  We gave her toiletries, bedsheets, and a stuffed animal.  She thanked us with a big, shy smile.  It was a really good first day!
   

I'm here!

After a 6 hour red-eye from SFO to MIA, 2 hour layover, and 2 hour flight from MIA to PAP I am finally here!!  After immigration, I found my boxes quickly, but waited around for about 30 minutes for the walker to arrive.  Immediately after I exited the airport, I was engulfed in a mad sweaty mob of porters grabbing my cart to assist me, drivers vying for my business, and other passengers trying to exit.  I tried repeatedly to refuse help but eventually gave in and was happy I did--he literally pushed people out of the way with the cart to clear a path, found the driver assigned to pick me up, and navigated the 125+ lbs of my luggage over dirt roads and rocks to the van.  He earned a generous tip!

The drive through the city was striking.  Masses of tent and tarp shelters lined the road.  Rubble and garbage was everywhere.  Rough roads, clogged with "tap-taps", motorcycles and vans made for slow-going.  It's hot, humid, and dusty.
 
The driver took me straight to an orphanage (I think called "New Life") in Port-au-Prince, where I joined two Hanger prosthetists, Josh from Louisiana and Jeff from Pennsylvania, and one PT from Chicago, Derek.  We were set up in a chapel, which consisted of cement brick walls, rough timber frame, corrugated tin roofing, and long wooden benches.  We had one translator to help organize the ~20 people that were waiting since 8 am to be seen.  Some patients were there because they were ready for casting, and some were there for adjustments to their existing prostheses.  Our role as PTs was to partner with the prosthetists to assess for fit and make the necessary adjustments, and do some gait training.  Most of the patients were adults, but two kids were from the orphanage: one sleepy 6 year old boy with a high transfemoral amputation, and a shy and sweet 15 year old girl with a transtibial amputation.  Both were there for adjustments.  Many very cute kids ran in and out of the chapel throughout the afternoon, teasing each other and playing with baby powder.  We were finally done around 4, and then started the 3 hour drive up to the hospital.

In the hospital library now after a quick shower and delicious meal, prepared by our dorm mom.  Derek gave me a tour of the hospital and a run down of what to expect tomorrow.  Fighting to keep my eyes open now . . . so tired!  I'm sure I will have a deep sleep tonight and will be ready to work at the hospital clinic tomorrow.  Bonswa!

  

Supplies

Stuff that I'm bringing:

• Wound dressing supplies (Duoderm, tape, scissors, gauze)
• Biofreeze
  
• TENS electrodes
  
• Athletic socks
• Athletic shoes
• Athletic shorts
  
• Hand sanitizer
• Dental hygiene supplies
• Soap, shampoo, conditioner
• Office supplies
• Blood pressure cuff
• Bed sheets
• Crutch tips
• Theraband
• Kinesiotape
• Pediatric walker
• Knee brace
  

Thank you, everyone for being ridiculously generous in such a short period of time! Now time for last-minute packing . . .

On a happier note

It was great to connect with Dave, another PT from Santa Cruz that will be volunteering at HAS at the same time. His wife was one of the first PT volunteers at the clinic, and they shared some invaluable tips, such as:

• Baggage does not come out in neat little lines on a coverer belt--it is stacked up like a mountain. Give luggage tags to a porter to find them, as they may even be in another building.
• There is no hot water, and the shower is more like a trickle. Consequently, I will be bringing wet wipes.
• Mary Ann sent over some useful phrases in Kreyol, which is somewhat like French but a local dialect. "Bonjou, mwen rele Robyn, mwen fizysien terapi!"

Also, thanks to my generous friends and co-workers, donated supplies are pouring in! It's really uplifting to know that our donations will impact many lives.

bleh

Feeling sick and exhausted today. Perhaps it's the typhoid vaccination or the anti-malaria pills?

Behind the starting line

Just one week before I depart for Haiti! For what seemed like a very long time after I applied to volunteer with Physicians for Peace, I waited for more details on how I could be involved.

PFP is an organization that not only sends volunteer healthcare professionals, including physicians, dentists, nurses, physical therapists, physician assistants and others, overseas to provide care, but is dedicated to the ideal that health care in the developing world can best be improved by providing training and education to health care professionals in those countries. The focus is to create long-term and sustainable medical education and training programs to places in need. including to places in need. PFP has made hundreds of trips to Africa, Asia, the Caribbean, Central America, Eastern Europe, and the Middle East.

A few weeks ago, I was contacted by Shaun Cleaver, a PT based long-term in Haiti. For the past two years, he has been involved in creating the Rehabilitation Tech Training Program at Hopital Albert Schweitzer, a community based hospital north of Port-au-Prince. Just weeks after the earthquake, the hospital opened a Prosthetics and Rehab clinic in partnership with Hanger. Now, Shaun coordinates prosthetists and physical therapist volunteers to meet the overwhelming need for artificial limbs and rehabilitation. Because of the dire need, after our first conversation he asked, "Can you come next week?"

I'm feeling confident in the mission that this organization strives towards and privileged to join this team. I'm also feeling stressed-out, adrenaline pumping and out of breath, like I'm racing just to get to the starting line. I have so much to do in terms of finishing my paperwork at CCS, preparing for the student that I will take on when I return, organizing and packing supplies to bring, getting my travel immunizations and medications, frantically reviewing articles on amputations and prosthetics, cramming basic French into my brain . . . a huge comfort is that I have my Father watching over me, friends and family praying for me and cheering me on. I'm going by myself, but I am definitely not going to Haiti alone. I am so humbled by how God is making everything possible in such a short time, and grateful for the support that I've received!