31 January 2011
It’s been over a week since my flurry of updates. The field trip to Belle Anse and Thiotte was highly productive, good for my psyche and allowed me to gain some perspective on my work with Save the Children. Plus, we didn't roll the car, hit any chickens or blow out a tire. All good.
Before I tell you about the field visits, I want to let you know that I am back in Boulder watching it snow and hoping the temperature might possibly hit freezing today. It’s a bit of a long story, so let me know if you want more detail. Suffice it to say, I did what I could for the medical evaluation and recommendations for Save the Children’s Cholera Treatment Units in the South East Department of Haiti. My time there gave the Jacmel office time to clarify its cholera strategy. That involved creating a Cholera Response Coordinator position (filled with an in-country STC person who will be PERFECT for the position) and hiring Haitian doctors to supervise each CTU. I participated in briefing the doctors, as well as making recommendations to the new Coordinator in regards to the CTU clinical and operational deficits. With the new structure, we all agreed that I would return home. Sad for me, but it’s the best.
Serendipity – the trip from Jacmel to PaP involved stopping in the Leogane STC office. As I arrived, the Jacmel director pulled me into her office and pummeled me with questions about cholera management – they had opened a CTU the week before and were opening a 2nd one in a few days. She had just hired a CTU Coordinator, who didn’t know cholera and, it turned out, didn’t know anything about human physiology, either (“oh, cholera affects the veins, too?). So she and I spent 4 hours visiting their sites, me attempting to download everything I know about cholera management, assessing the CTU, making rec’s for changes, and doing a “physiology 101”. I was so thirsty at the end of those hours, but felt satisfied to have had a chance to help them at such an important point.
I spent the night at the STC director’s home, debriefing with him, feeling so sad about leaving. Yet somewhat resigned to the appropriateness of the decision. I am hearing from the new Jacmel Coordinator that things are moving ahead. My dreams are still full of people, procedures, faces, regrets and gratitude. Time will ease all.
But how about a bit more about Belle Anse and Thiotte?
I finally left for Thiotte and Belle Anse on the morning of Thursday the 20th. Travelling with me were Thomas (my interpreter), Florian [Thiotte’s Water, Sanitation and Hygiene (WASH)] Supervisor and Nelson, the most incredible 4-wheel driver in the world. The first 30 minutes a paved road followed the coast, in and out of small market centers. Turning north, we climbed into increasingly rougher volcanic mountains. Even driving over mounds of old basalt, banging along sometimes as fast as 20 mph! The grade both up and down took all my self-restraint to keep me from begging to walk. At least I got to ride in the front, so I didn’t get car sick!
Belle Anse at 11:30 – we ordered lunch at a sea side “restaurant”. It would take an hour to prepare so we went on to the CTU. They had about 8 patients. The entrance/exit “sprayers”, chlorinators and nurses were in place. One of the clothes washing women was lying on the entrance to the latrines in the shade. The public hygiene promoters (PHPs) were sitting on a bench, complaining to me that they couldn’t do anything without a motorcycle, that the communities were too remote to reach by foot or car. I noticed that the medicines and IV supplies are strewn about the floor of the pharmacy tent, along with empty fuel cans. They need tables or shelves. The patient care area is missing a hand washing station, a sharps container (for used needles) and a trash can. I made a note of these things and we returned to our lunch (fresh fish, fried bananas and fresh grapefruit – my request!). The closest I got to the Caribbean was that lunch, waves beating against a rocky beach 15 feet away.
Leaving for Thiotte, Nelson assured us that the worst of the road was behind us, but I’m not so sure I agree with him. Two hours later we arrived at the Thiotte CTU, probably 30 degrees cooler than BA. We were greeted by the staff and only two patients. After a time of answering questions (Will cholera ever go away? How do I protect myself?), I toured the compound, made some notes and traveled another 15 minutes to the Esperanta Hotel.
Thiotte’s staff, as in the other CTUs, are divided into 3 teams – one on days, one on nights and the third is off. 3 - 4 people shared a room. There are only 2 bathrooms in the hotel, so disgusting that one night I actually deferred showering, not wanting to step into the 2 inches of cloudy standing water oozing out from under the door. At 3,000 feet elevation, it was so cool that I used a blanket at night. I have to confess, I had a little “medicinal” rum every night there – I HAD to sleep!
Time there was intensely focused on establishing an inventory control system for the pharmacy and other supplies. Supplying Thiotte is no small challenge. The Administrative manager didn’t have a clue that he needed to request supplies well ahead of running out of something. Or requesting petty cash reimbursement. With a 6 ½ hour drive each way, planning ahead for resupply was a concept that I felt imperative to help them all understand. One of the nurses on each shift is the “pharmacy nurse”. The one I worked with was so unresponsive to my questions and suggestions that I wondered if she was getting anything that I showed her. I am quite concerned about integrity of the Administration manager. (I later learned that gangs regularly infiltrate non-profits and if anyone tries to report, they do so at risk of being killed for “ratting”.)
I held two staff meetings that included letting them know that eventually STC would no longer provide their food. You can imagine that was a big hit. I also had to negotiate a new contract with the hotel for our staff’s lodging (and I added meals, just to see what I could get!) We had been paying about $20,000/month. I got them to agree to $15,000 for 60 days, including food and to only put 2-3 people in each room. I actually couldn’t believe it when they agreed. I will be really interested to hear what the written contract sorts out to be. I was pleased to at least move the negotiations in the right direction. It was so difficult to leave, as I had little time to actually sit with the nurses – of course their charting is in French, so reviewing it was a bit of a challenge for me.
I had an interaction that was a little humorous. Outside the exit (where you step onto a footbath that has a chlorine-soaked rug and the “Sprayer” sprays the bottoms of your shoes with chlorinated solution) there was just rough dirt. Bad enough when dry, but not a pretty picture at all when the rains start. Just about 10 feet away was a big pile of gravel. I asked the engineer if any of her workers (who weren’t busy) could spread a small amount outside the exit. She said no, it’s not their job. So, I walked over, picked up a shovel and started spreading rocks. Two of the younger guys jumped up, brought over another shovel and a wheel barrow and took my shovel from me, laughing heartily. So, the little mud-hole is covered!
Leaving Thiotte Tuesday morning, we arrived back in BA to a bit of a panic. Eleven patients, no fuel for the vehicles, they had received calls from 4 patients to be picked up out in the remote communities – and we had heard that one had already died, waiting for help. The family was in a panic about how to handle the body. Oh, and this CTU’s Administration manager told me there was no petty cash to buy fuel locally (they are supposed to request fuel from the Jacmel office – it’s $5.50/gallon in the field!!) So, you can guess who started shelling out money.
And still the PHPs whined to me about not having motorcycles, all the while sitting on their comfy bench. I was not pleased. The medical director is at least aware of community issues – he organized the mayor and a policeman to accompany him, a chlorinator and one of the PHPs to drive out to the family of the deceased patient. Hours later they returned and Thomas and I were eager to find our hotel and some dinner. Another oops. We only got the hotel owner to give us rooms with the doctor vouching for us as STC employees (yup, we did have badges). After driving around town, finding no food available, we BEGGED the hotel to make us a meal (as well as the 2 guys who had been out on the trip with the doctor). And how did we pay? I had exactly the equivalent of $25 and that’s what she charged. Dinner was ordered around 7 pm. We ate around 9:30. I was so tired I could hardly sit upright to eat! It was exquisitely beautiful, though. Orion was directly overhead, and I even saw Scorpio rising. I could hear the waves crashing on the beach. Eventually I fell asleep, planning to leave at 5:30 am and knowing the ride back to Jacmel would be tough, physically and emotionally.
Back in Jacmel, I met with the new Cholera Response Coordinator as he briefed the 3 new CTU Supervisors – all MDs. I yearned to spend a day with each one, but had to leave it at about 30 minutes with the group. I prepared several reports for the new manager and said good bye to the few people in the office with whom I had connected. My ride to Port au Prince was scheduled for the next morning. Leaving that place was so bitter sweet, it was almost unbearable.
The lists of what yet needs to be done still cycle through my brain and I hope that I did enough, that somehow my recommendations will be integrated in ways that made sense for those left to care for the patients. In PaP, my angst was somewhat relieved by meeting with STC’s Country Director, debriefing both the process of my hire, as well as the status of cholera care in the South East Department. Even in my disappointment about leaving Haiti, I know that my time was well spent and trust that, somehow, I was able to help ease the cholera burden.
Thank you all for hearing me out…for your support, for your willingness to hold the people of Haiti in your hearts and prayers.
Much love,
Beverly
PS I know my email lists are not so perfect (thank goodness I’m a better nurse than computer geek), so I’ll put my emails on my blog: LyneGlobalHealth.blogspot.com.
Monday, January 31, 2011
#5 - Haiti - STC - Cholera
20 January 2011
Quick update addendum
As I ready for bed, way later than I’d like it to be, wanted to let you know that reports are now that there are 40 cases and 10 deaths. Still really high, but not as bad as 50 deaths.
New digs are awesome. Someday I’ll take a minute and post some pics.
Many people have asked how to contribute – to Haiti, to cholera, to me. If you want to make a donation to Haiti in general, I recommend the Colorado Haiti Project. They are who got me to Haiti in the first place and have over 20 years of consistent LOW overhead partnership with a really remote, needy community. If you want to contribute to me, here’s a proposal: plan to help me celebrate my 60th birthday this year. My BD is the end of May, but I’m open to suggestions! And Save the Children is a great organization, so you have many choices.
For now, good night!
Beverly
Quick update addendum
As I ready for bed, way later than I’d like it to be, wanted to let you know that reports are now that there are 40 cases and 10 deaths. Still really high, but not as bad as 50 deaths.
New digs are awesome. Someday I’ll take a minute and post some pics.
Many people have asked how to contribute – to Haiti, to cholera, to me. If you want to make a donation to Haiti in general, I recommend the Colorado Haiti Project. They are who got me to Haiti in the first place and have over 20 years of consistent LOW overhead partnership with a really remote, needy community. If you want to contribute to me, here’s a proposal: plan to help me celebrate my 60th birthday this year. My BD is the end of May, but I’m open to suggestions! And Save the Children is a great organization, so you have many choices.
For now, good night!
Beverly
#4 - Haiti - STC - cholera
18 January 2011 (2nd email today)
This is going to be really quick – we have just gotten word that there have been 50 cholera deaths in Gran Grassier (not sure of the spelling). Thiotte is the closest Cholera Treatment Unit to them, so I’m so grateful that I already have plans to be out there. Am somewhat concerned about the staff’s capacity to handle a big patient influx. They only started operations a few days ago.
I’m sweaty and tired from the trip to Bainet. Thought the bottom was surely going to fall out of the car, the way the driver was BLASTING along the mountain roads.
Also – just got a new modem that supposedly will work in the hinterland. We’ll see!
Thanks to all of you for your notes. It really buoys me up to hear from you.
With love and determination,
Beverly
This is going to be really quick – we have just gotten word that there have been 50 cholera deaths in Gran Grassier (not sure of the spelling). Thiotte is the closest Cholera Treatment Unit to them, so I’m so grateful that I already have plans to be out there. Am somewhat concerned about the staff’s capacity to handle a big patient influx. They only started operations a few days ago.
I’m sweaty and tired from the trip to Bainet. Thought the bottom was surely going to fall out of the car, the way the driver was BLASTING along the mountain roads.
Also – just got a new modem that supposedly will work in the hinterland. We’ll see!
Thanks to all of you for your notes. It really buoys me up to hear from you.
With love and determination,
Beverly
#3 - Haiti - STC - cholera
18 January
Dear All,
New developments: as of 2 weeks from yesterday (Monday) I will be the Medical Coordinator for Jacmel Save the Children Cholera Treatment Units. We will have a new (but current employee) to be the overall manager – including dealing with staff lodging, meals, etc. I’ll oversee the clinical aspects, inventory control of the pharmacy and preparing mountains of reports. I’m psyced! As I said, never a dull moment in Haiti.
I’ll be going to Bainet today, just for the day, spend the night in my new “digs” – I’ll actually have a room/bathroom to myself in one of the lovely staff houses, close enough to the office that I can walk! And will be able to hear the waves, if not see them on the beach.
Then I leave for Thiotte (rigorous 6 ½ hour drive to the east) Wed morning WITH an interpreter. Thiotte is reporting that the staff is afraid to touch patients, so will need to review and renew their cholera understanding. Probably to Belle Anse (about 2 hrs to the west of Thiotte) on Sunday. Back to Jacmel Thursday night. Also probably no internet access, either!
That’s all I know for now! All take care,
Beverly
Dear All,
New developments: as of 2 weeks from yesterday (Monday) I will be the Medical Coordinator for Jacmel Save the Children Cholera Treatment Units. We will have a new (but current employee) to be the overall manager – including dealing with staff lodging, meals, etc. I’ll oversee the clinical aspects, inventory control of the pharmacy and preparing mountains of reports. I’m psyced! As I said, never a dull moment in Haiti.
I’ll be going to Bainet today, just for the day, spend the night in my new “digs” – I’ll actually have a room/bathroom to myself in one of the lovely staff houses, close enough to the office that I can walk! And will be able to hear the waves, if not see them on the beach.
Then I leave for Thiotte (rigorous 6 ½ hour drive to the east) Wed morning WITH an interpreter. Thiotte is reporting that the staff is afraid to touch patients, so will need to review and renew their cholera understanding. Probably to Belle Anse (about 2 hrs to the west of Thiotte) on Sunday. Back to Jacmel Thursday night. Also probably no internet access, either!
That’s all I know for now! All take care,
Beverly
#2 Haiti-STC-Cholera
13 January 2011 and 16 January 2011
Greetings from Bainet, Haiti. A little town on the southern coast of Haiti, situated on a tiny bay, waves breaking so closely I can hear them from the patio where I am sitting. This is my 4th night here, but let me tell you, I can’t even remember what my own bedroom looks like!
Save the Children set up their first Cholera Treatment Unit in mid-December. With 16 beds for extremely dehydrated patients, 3 beds for moderately sick patients and 4 beds for patients who are being observed before they are actually discharged, they are extremely well laid out. There are 3 doctors, 3 nurses, 9 auxiliary nurses (like nurses aids, but a little more training), guards (to make sure people wash their hands with chlorinated water and who spray the bottoms of your shoes upon leaving), cleaning people, clothes washing people, chlorinators (those who add the appropriate amount of chlorine to the water for hands, for equipment, and for cleansing corpses), public hygiene promoters (PHP). I think there might be another category of workers, but it eludes me now!
Yesterday, I received 3 more employees, unbeknownst to me – they came needing lodging and food, but we had almost no place to put them and no budget to add food. Then, today, we were happy to receive 2 more vehicles and 2 drivers. Again, it was a surprise to me and I also didn’t have lodging or food budget for them.
I’m hearing from the staff that they have not been getting 3 meals/day, their residence is crowded and the toilet doesn’t work, they have to pay a young man to bring buckets of water for cooking and bathing (he has a hand-made wooden cart and pushes the 50+ gallons by hand), and other complaints. It all seems to be due to the head doctor never filing reports about how he spent the original petty cash – he won’t get reimbursed until he accounts for what he has spent. DUH! We have an appointment to prepare the report tomorrow – for some unknown reason, one of the nurses left with half of the receipts and just got back tonight. Hopefully, we will receive funding by Monday.
Because the complaints were so consistent, I decided to provide funds (and will be reimbursed) for a really good meal for the Jan 12 anniversary of the earthquake. All our clinical staff are here, away from their homes and families. Most of Haiti had the 12th as a holiday, but they, of course had to work. I wanted them to know that their being here is neither unnoticed nor unappreciated. Silly me, this morning, the head doctor told me there was no money for food – that means meat. We talked – the budget was about $25 to feed 18 people. I gave it to him, again I will be reimbursed. BUT tonight, there was not enough food for 6 of the staff who are working 9am to 9pm. They came to me (as I was finishing dinner at the place I am staying…boy did I feel guilty!) and I gave them the last 750 goudes that I had – I think they should be able to get a meal for 150 gds, but I gave them an additional $5. The doctor kept telling me it wasn’t enough, and I kept telling him that was all I had. He is really upset. I commiserated with him and told him to go eat! Wow, enough – what else can I do? I don’t have my kitchen – can’t cook for them.
But tomorrow I will be in their kitchen watching the cook and watching all the hands that help and take little samples. I will also supervise dishing out the amounts. Good grief…and we will have a discussion with as many of the group as can be present. I do hope that the lead doctor hasn’t been pocketing any of this…
Meanwhile, today we received a very sick child, about 4 years old. I left as the doctor was trying to get an IV in him…Mom at his side. Eek. We’ve had about 6 pretty sick patients and had to restart an IV on a 6 year old yesterday as he couldn’t hold anything down. The nurses and docs all seem to work together really well. They do full sets of vital signs and round on the patients together. Unlike the cholera care delivery I was part of in October in Haiti. Here, the doctors actually listen to the lung and belly sounds and do a physical assessment. All 3 doctors trained in Cuba, which also helps me, as they speak Spanish.
And to another topic – I find myself speaking Spanish with smatterings of Creole. A few people here speak a little English. But sometimes I launch into Spanish with them and wonder why they are looking at me so funny. Haven’t had much time to study Creole. And I don’t know what I was thinking, bringing FOUR books with me! Maybe things will move into a more even keel and I will find time to read. So far, not since I left Jacmel.
In case you noticed, I have not had email access since I left Jacmel on Monday. They gave me a portable modem, but I have not had success in connecting. Today I spoke with the IT guy in Jacmel and the answer is: Save the Children had not paid the bill, so access was cut off! And they are irritated with a remotely based Haitian doctor who has not submitted a form – someone who has not been an administrator before, and who has his hands full with a staff of about 30, doing around the clock rotations! I had to laugh when I heard the bill will be paid “today or tomorrow.” And the woman who is my direct Supervisor lost her phone, so has not answered any of my calls. Finally, I started calling other people in the office and asking them to ask her to call me! Good grief.
The place I am staying is the second floor of a family’s home. They have a couple of lovely balconies and 2 rooms and a bathroom. It turns out that there are 2 women from Save the Children in the 2nd room. Too bad about the door not closing between our rooms, eh? And there are no locks on the doors. This morning one of the gals started talking on the phone at 5:15 and finally stopped around 6. She even kept talking in the BATHROOM! The woman of the house, Madam Nicola takes my stainless steel percolator every morning and puts in on her non-electric burner (gas??) and then brings the pot up to me. Oh, my gosh, is that a delight! She made me lunch and dinner today – including a piece of cake that her friend made. Wow. I feel bad about what the staff is going through, but I decided to take my meals here to give myself a tiny break from the language challenge. Of course, Mdm. Nicola sat and watched me eat every bite tonight. She is terribly sweet, so mostly I very much appreciated her company.
OK for now, writing on my computer battery, so better stop for now…
Much love, Beverly
16 January 2011
Brief update from Jacmel. After a visit to the Bainet CTU from a team from the World Health Organization, I returned to Jacmel Saturday afternoon. I was tired, hungry and feeling pretty alone; it was a really hard evening for me. This morning brought some great changes, though. Good conversation with my dear friend, Gretchen Berggren helped me get my head on straight. She promised that she would take my situation to prayers at her church and do you know what? It seems that I will most likely be having a woman interpreter this coming week! WOW!
Many of you may have heard that Baby Doc Duvalier returned to Haiti tonight after 25+ years of exile. We, here, in the Southeast Department are most likely not going to see any riots or problems. But it is fairly likely that some outbreaks will happen in Port au Prince and elsewhere. I just hope it doesn’t get violet. Even though they are saying he wants to give 5 million pounds to help Haiti, there is great skepticism about this return and what it is really about. Let’s see: power and money are my bets. Anyhow, if you are so inclined toward prayer, this would be a really good time to let it rip. These people could use some serious healing time.
Again, I so appreciate your good wishes and little notes. Thanks to all! Mesi Anpil!
Love,
Beverly
Greetings from Bainet, Haiti. A little town on the southern coast of Haiti, situated on a tiny bay, waves breaking so closely I can hear them from the patio where I am sitting. This is my 4th night here, but let me tell you, I can’t even remember what my own bedroom looks like!
Save the Children set up their first Cholera Treatment Unit in mid-December. With 16 beds for extremely dehydrated patients, 3 beds for moderately sick patients and 4 beds for patients who are being observed before they are actually discharged, they are extremely well laid out. There are 3 doctors, 3 nurses, 9 auxiliary nurses (like nurses aids, but a little more training), guards (to make sure people wash their hands with chlorinated water and who spray the bottoms of your shoes upon leaving), cleaning people, clothes washing people, chlorinators (those who add the appropriate amount of chlorine to the water for hands, for equipment, and for cleansing corpses), public hygiene promoters (PHP). I think there might be another category of workers, but it eludes me now!
Yesterday, I received 3 more employees, unbeknownst to me – they came needing lodging and food, but we had almost no place to put them and no budget to add food. Then, today, we were happy to receive 2 more vehicles and 2 drivers. Again, it was a surprise to me and I also didn’t have lodging or food budget for them.
I’m hearing from the staff that they have not been getting 3 meals/day, their residence is crowded and the toilet doesn’t work, they have to pay a young man to bring buckets of water for cooking and bathing (he has a hand-made wooden cart and pushes the 50+ gallons by hand), and other complaints. It all seems to be due to the head doctor never filing reports about how he spent the original petty cash – he won’t get reimbursed until he accounts for what he has spent. DUH! We have an appointment to prepare the report tomorrow – for some unknown reason, one of the nurses left with half of the receipts and just got back tonight. Hopefully, we will receive funding by Monday.
Because the complaints were so consistent, I decided to provide funds (and will be reimbursed) for a really good meal for the Jan 12 anniversary of the earthquake. All our clinical staff are here, away from their homes and families. Most of Haiti had the 12th as a holiday, but they, of course had to work. I wanted them to know that their being here is neither unnoticed nor unappreciated. Silly me, this morning, the head doctor told me there was no money for food – that means meat. We talked – the budget was about $25 to feed 18 people. I gave it to him, again I will be reimbursed. BUT tonight, there was not enough food for 6 of the staff who are working 9am to 9pm. They came to me (as I was finishing dinner at the place I am staying…boy did I feel guilty!) and I gave them the last 750 goudes that I had – I think they should be able to get a meal for 150 gds, but I gave them an additional $5. The doctor kept telling me it wasn’t enough, and I kept telling him that was all I had. He is really upset. I commiserated with him and told him to go eat! Wow, enough – what else can I do? I don’t have my kitchen – can’t cook for them.
But tomorrow I will be in their kitchen watching the cook and watching all the hands that help and take little samples. I will also supervise dishing out the amounts. Good grief…and we will have a discussion with as many of the group as can be present. I do hope that the lead doctor hasn’t been pocketing any of this…
Meanwhile, today we received a very sick child, about 4 years old. I left as the doctor was trying to get an IV in him…Mom at his side. Eek. We’ve had about 6 pretty sick patients and had to restart an IV on a 6 year old yesterday as he couldn’t hold anything down. The nurses and docs all seem to work together really well. They do full sets of vital signs and round on the patients together. Unlike the cholera care delivery I was part of in October in Haiti. Here, the doctors actually listen to the lung and belly sounds and do a physical assessment. All 3 doctors trained in Cuba, which also helps me, as they speak Spanish.
And to another topic – I find myself speaking Spanish with smatterings of Creole. A few people here speak a little English. But sometimes I launch into Spanish with them and wonder why they are looking at me so funny. Haven’t had much time to study Creole. And I don’t know what I was thinking, bringing FOUR books with me! Maybe things will move into a more even keel and I will find time to read. So far, not since I left Jacmel.
In case you noticed, I have not had email access since I left Jacmel on Monday. They gave me a portable modem, but I have not had success in connecting. Today I spoke with the IT guy in Jacmel and the answer is: Save the Children had not paid the bill, so access was cut off! And they are irritated with a remotely based Haitian doctor who has not submitted a form – someone who has not been an administrator before, and who has his hands full with a staff of about 30, doing around the clock rotations! I had to laugh when I heard the bill will be paid “today or tomorrow.” And the woman who is my direct Supervisor lost her phone, so has not answered any of my calls. Finally, I started calling other people in the office and asking them to ask her to call me! Good grief.
The place I am staying is the second floor of a family’s home. They have a couple of lovely balconies and 2 rooms and a bathroom. It turns out that there are 2 women from Save the Children in the 2nd room. Too bad about the door not closing between our rooms, eh? And there are no locks on the doors. This morning one of the gals started talking on the phone at 5:15 and finally stopped around 6. She even kept talking in the BATHROOM! The woman of the house, Madam Nicola takes my stainless steel percolator every morning and puts in on her non-electric burner (gas??) and then brings the pot up to me. Oh, my gosh, is that a delight! She made me lunch and dinner today – including a piece of cake that her friend made. Wow. I feel bad about what the staff is going through, but I decided to take my meals here to give myself a tiny break from the language challenge. Of course, Mdm. Nicola sat and watched me eat every bite tonight. She is terribly sweet, so mostly I very much appreciated her company.
OK for now, writing on my computer battery, so better stop for now…
Much love, Beverly
16 January 2011
Brief update from Jacmel. After a visit to the Bainet CTU from a team from the World Health Organization, I returned to Jacmel Saturday afternoon. I was tired, hungry and feeling pretty alone; it was a really hard evening for me. This morning brought some great changes, though. Good conversation with my dear friend, Gretchen Berggren helped me get my head on straight. She promised that she would take my situation to prayers at her church and do you know what? It seems that I will most likely be having a woman interpreter this coming week! WOW!
Many of you may have heard that Baby Doc Duvalier returned to Haiti tonight after 25+ years of exile. We, here, in the Southeast Department are most likely not going to see any riots or problems. But it is fairly likely that some outbreaks will happen in Port au Prince and elsewhere. I just hope it doesn’t get violet. Even though they are saying he wants to give 5 million pounds to help Haiti, there is great skepticism about this return and what it is really about. Let’s see: power and money are my bets. Anyhow, if you are so inclined toward prayer, this would be a really good time to let it rip. These people could use some serious healing time.
Again, I so appreciate your good wishes and little notes. Thanks to all! Mesi Anpil!
Love,
Beverly
#1 Haiti-STC-Cholera
9 January 2011
Dear family and friends,
Greetings from Jacmel, Haiti! I am so excited - Save the Children has hired me to supervise their cholera Treatment Units in the Southeast Department of Haiti for 3 months. It’s been a whirlwind the last few weeks – interviewing 13 Dec., invited to the position 18 Dec., flurry of employment paperwork and background check and departure on 5 Jan, arriving in Port au Prince (PaP) 6 Jan., oriented to Save in PaP same day, including grocery store (how much coffee and oatmeal do I need for 3 months?), visit a Cholera n over at 3:30 pm – met at least 35 of the 150 staff here. Found out that that my new supervisor was not informed that I don’t speak French!! Oh, boy. But most of the doctors here speak Spanish, so we will somehow make do. I THINK I might have an interpreter for my first week…never any guarantees.
A really cool thing happened in Miami. A guy who was in line where I was also getting coffee had a darling 14 month old son with him. We looked at each other and he said “I know you!” He is a flute player in the Haiti Philharmonic and I had played with them last July in PaP! What total fun that was! Then, in my one day in PaP, I did get to have lunch with my friends at the St. Trinity Music School – Bernadette, Pere David, Guerlyn, Thara – wonderful. ALSO, the composer, Dicksons, was there. I had the great joy of playing his piece “After the Earthquake” with the phil last summer. And there he was, in person! He told me he had a vision about the quake and had written the piece months before it happened. Quite moving. Keep in mind that the anniversary of the quake is approaching (12th Jan) and people are quite anxious. Also keep in mind that Sunday, the official results of the presidential election will be announced. If they do not keep all 3 top candidates in the run-off election (17 Jan), everyone expects riots even worse than in December.
Back to Jacmel…There are 3 Cholera Treatment Units (CUs) in the Southeast – Beinet, Belle Anse and Thiotte (now being constructed). Until I arrived, the Jacmel Save director has been overseeing all of the cholera efforts on top of everything else that Save does. I am the first of 4 supervisors to arrive. I will visit all 3 sites, do an initial assessment and “just in time” teaching where appropriate and then we will further strategize. Until the other supervisors arrive, I may also try to visit each of the CTUs on a regular basis to reinforce proper protocols and help with problem solving. My personal goal is to make sure that we have a strong allocation to education and outreach so that cholera does not get a strong foothold in this department. So far, their numbers have been quite small, but are starting to rise. I don’t think I’ll be allowed to go to the mountainous communities to help with the education because most are only accessible by foot, burrow or motorcycle. But I will work with the Public Health Promoters to make sure they get psyched about their importance and try to assure that they are getting out to the most remote communities. We shall see, eh?
We just heard that World Food Program delivered medicines and supplies to our Belle Anse unit. It seems that the organizations that have the infrastructure to mount the Cholera Treatment Units (Save the Children, MSF) do receive support from those that are here and active, but can’t do the massive intervention required for a CTU. We have at least 25 employees at each CTU and I’m guessing I’ll be pushing to hire more PHPs – public health promoters.
For now, I will be in Jacmel for 1 more night, to Beinet on Monday/Tuesday and back to Jacmel Tuesday. Then I hope to go to the eastern CTUs – Belle Anse (3 ½ hrs from Jacmel) and Thiotte (another couple of hours from BA) for several days. I’ve been staying at the director’s house – 2 other full time employees are here and there are several extra rooms for transients such as myself. Too bad that the swimming pool is undergoing cleaning. Guess there are great beaches, but I don’t think I’ll get there very soon.
Theoretically I will have a modem that will give me internet connection, but that remains to be seen! In the mean time, know that I am happy, people here are so great and they are grateful to have me arrive, even without French or Creole. My Creole keeps improving piti, piti (little bits) and I hope to be fluent in the next couple of hours! Why not ask for the miracle, eh?
Much love,
Beverly
Dear family and friends,
Greetings from Jacmel, Haiti! I am so excited - Save the Children has hired me to supervise their cholera Treatment Units in the Southeast Department of Haiti for 3 months. It’s been a whirlwind the last few weeks – interviewing 13 Dec., invited to the position 18 Dec., flurry of employment paperwork and background check and departure on 5 Jan, arriving in Port au Prince (PaP) 6 Jan., oriented to Save in PaP same day, including grocery store (how much coffee and oatmeal do I need for 3 months?), visit a Cholera n over at 3:30 pm – met at least 35 of the 150 staff here. Found out that that my new supervisor was not informed that I don’t speak French!! Oh, boy. But most of the doctors here speak Spanish, so we will somehow make do. I THINK I might have an interpreter for my first week…never any guarantees.
A really cool thing happened in Miami. A guy who was in line where I was also getting coffee had a darling 14 month old son with him. We looked at each other and he said “I know you!” He is a flute player in the Haiti Philharmonic and I had played with them last July in PaP! What total fun that was! Then, in my one day in PaP, I did get to have lunch with my friends at the St. Trinity Music School – Bernadette, Pere David, Guerlyn, Thara – wonderful. ALSO, the composer, Dicksons, was there. I had the great joy of playing his piece “After the Earthquake” with the phil last summer. And there he was, in person! He told me he had a vision about the quake and had written the piece months before it happened. Quite moving. Keep in mind that the anniversary of the quake is approaching (12th Jan) and people are quite anxious. Also keep in mind that Sunday, the official results of the presidential election will be announced. If they do not keep all 3 top candidates in the run-off election (17 Jan), everyone expects riots even worse than in December.
Back to Jacmel…There are 3 Cholera Treatment Units (CUs) in the Southeast – Beinet, Belle Anse and Thiotte (now being constructed). Until I arrived, the Jacmel Save director has been overseeing all of the cholera efforts on top of everything else that Save does. I am the first of 4 supervisors to arrive. I will visit all 3 sites, do an initial assessment and “just in time” teaching where appropriate and then we will further strategize. Until the other supervisors arrive, I may also try to visit each of the CTUs on a regular basis to reinforce proper protocols and help with problem solving. My personal goal is to make sure that we have a strong allocation to education and outreach so that cholera does not get a strong foothold in this department. So far, their numbers have been quite small, but are starting to rise. I don’t think I’ll be allowed to go to the mountainous communities to help with the education because most are only accessible by foot, burrow or motorcycle. But I will work with the Public Health Promoters to make sure they get psyched about their importance and try to assure that they are getting out to the most remote communities. We shall see, eh?
We just heard that World Food Program delivered medicines and supplies to our Belle Anse unit. It seems that the organizations that have the infrastructure to mount the Cholera Treatment Units (Save the Children, MSF) do receive support from those that are here and active, but can’t do the massive intervention required for a CTU. We have at least 25 employees at each CTU and I’m guessing I’ll be pushing to hire more PHPs – public health promoters.
For now, I will be in Jacmel for 1 more night, to Beinet on Monday/Tuesday and back to Jacmel Tuesday. Then I hope to go to the eastern CTUs – Belle Anse (3 ½ hrs from Jacmel) and Thiotte (another couple of hours from BA) for several days. I’ve been staying at the director’s house – 2 other full time employees are here and there are several extra rooms for transients such as myself. Too bad that the swimming pool is undergoing cleaning. Guess there are great beaches, but I don’t think I’ll get there very soon.
Theoretically I will have a modem that will give me internet connection, but that remains to be seen! In the mean time, know that I am happy, people here are so great and they are grateful to have me arrive, even without French or Creole. My Creole keeps improving piti, piti (little bits) and I hope to be fluent in the next couple of hours! Why not ask for the miracle, eh?
Much love,
Beverly
Tuesday, November 30, 2010
Caring in the Midst of Cholera
The chilly Boulder night helps me to realize that I’m home from Haiti. My three weeks (28 Oct - 18 Nov) in Deshapelles at Hôpital Albert Schweitzer (HAS) in the Artibonite River Valley linger; I find this “re-entry” challenging. Trying to relax, my dreams are pummeled with Haiti and cholera.
As you have surely noticed by now, I was really lame about communicating during this trip. My computer was a TOTAL brat, so I couldn't compose emails at the guest house. And my only access to email was in the hospital library and quite limited. I was usually so exhausted by the time I could get on-line, I could barely read through my emails before I trudged home to get a blessed “bucket bath,” beer and dinner. I have posted more pictures on Facebook.
I’m here to tell you that the Haitian roosters started their cock-a-doodling at 2:30 AM - not even my ear plugs helped me sleep through them. True confessions: I actually got up and threw ROCKS at them, perched up in the tree ri Jason has twin boys. What kind of coincidence is that??
Dr. Ian Rawson, director of the hospital oriented us to the layout and sent us by car to nearby Petit Trou de Artibonite, where the Doctors without Borders Cholera Treatment Center was receiving more than 100 patients per day. I was thrilled, also, to meet the CDC team, who worked so hard to scope out how this horrible bacteria had come back to haunt Haiti. Now this is a good way for my tax dollars to be at work!
Cholera is a bacteria that essentially sucks all the body’s fluids and eliminates them first, through diarrhea and then through vomiting. If the fluids are not replaced immediately, death will happen – and can happen in hours to days. Treatment is simple: oral rehydration solution. We triaged patients: If they were “only” having diarrhea, we assigned them to an area where we encouraged them to “bwe bwe bwe!” that is, drink! If they had already started vomiting, we started at least one IV line of Lactated Ringers and put them in a bed where we could keep tabs on them. The protocol is to get 6 liters into a person in a couple of hours, so it takes incredible diligence. And when there are half a dozen patients like that, it is almost impossible to keep up.
The extreme need, the intensity of caring for patients who are beyond oral rehydration, the frustration of not being able to communicate with my Haitian co-nurses when we needed to move quickly, the satisfaction of seeing someone on the brink of death come back to life…I am yet again humbled and grateful for being a nurse, for being able to help, for all the teachers I have had, for the support from friends and family to allow me to do this work.
Almost all patients arrived with family member (who provided sheets, food, personal assistance, etc.). But the ones who didn’t were on their own. Haitian nurses don’t touch patients or provide any direct physical care. I carried hundreds of bedpans to the toilets and did my best to clean patients who were alone. One young fellow had been lying in 4 inches of diarrhea on a cot for hours. The Nursing Director got him into a real bed, we stripped him and got paper sheets over and under him. He couldn’t get out of bed for a day – it was heartbreaking. BUT, he got better and I was thrilled to see him, dressed and smiling as he left 4 days after he was all but dead. This is the joy of cholera – people get better quickly.
A team of 4 nurses from Project Hope had arrived 2 days prior to my arrival, during a time when there were only about 5-10 admissions per day. They didn’t speak any Creole or French and were frustrated by the Haitian way of delivering care. I think they were a bit disappointed. So, by the luck of the draw, their 2 weeks ended 2 days before we got slammed with triple that number of patients in one day and I was the only non-Haitian nurse available. But it was fine.
I found great connection with many of the people with whom I worked. The medical director is an energetic Swiss doctor, Silvia, who quietly works to improve the delivery of health care in a situation beyond our imagination. Of course, the nurses and I bonded in ways that transcend the language barrier; sharing the struggle to save a life, seeing the bright outcome of a patient waking up and then walking out of the hospital when he had been so close to death...I felt so grateful for being part of that effort. The guys who kept our unit free from body fluids - they were heroes in my book! And the patients, of course. I don't even know their names or how far they had to walk or be carried to the hospital. When a patient reached the point where we could remove his IVs, I would say "Bon travay! Orevwa cholera!" "Good work! Good-by, cholera!" And we would all beam in gratitude.
A new group of 6 Project Hope nurses arrived 2 days before my departure. The medical director asked me to orient them. I feel really good aThey didn’t speak any Creole or French and were frustrated by the Haitian way of delivering care. I think they were a bit disappointed. So, by the luck of the draw, their 2 weeks ended 2 days before we got slammed with triple that number of patients in one day and I was the only non-Haitian nurse available. But it was fine.
I found great connection with many of the people with whom I worked. The medical director is an energetic Swiss doctor, Silvia, who quietly works to improve the delivery of health care in a situation beyond our imagination. Of course, the nurses and I bonded in ways that transcend the language barrier; sharing the struggle to save a life, seeing the bright outcome of a patient waking up and then walking out of the hospital when he had been so close to death...I felt so grateful for being part of that effort. The guys who kept our unit free from body fluids - they were heroes in my book! And the patients, of course. I don't even know their names or how far they had to walk or be carried to the hospital. When a patient reached the point where we could remove his IVs, I would say "Bon travay! Orevwa cholera!" "Good work! Good-by, cholera!" And we would all beam in gratitude.
A new group of 6 Project Hope nurses arrived 2 days before my departure. The medical director asked me to orient them. I feel really good about their willingness to work hard for the cholera patients and to ease the load on the Haitian nurses. I specifically counselled them about this not being their turf and to be respectful of the nursing culture here. Not to compromise their professionalism, but to respect the Haitian nurses for where they are professionally. And I reminded them that "we" will leave; the Haitian staff will remain with the fullness of challenges on a daily basis.
If I could have a magic wand, my wish for Haiti would be instant healing of all the suffering; and for me - instant fluency in Creole…oh! And finding work that would allow me to be in Haiti full time.
Thanks for making it all the way to the end of this tome!
As you have surely noticed by now, I was really lame about communicating during this trip. My computer was a TOTAL brat, so I couldn't compose emails at the guest house. And my only access to email was in the hospital library and quite limited. I was usually so exhausted by the time I could get on-line, I could barely read through my emails before I trudged home to get a blessed “bucket bath,” beer and dinner. I have posted more pictures on Facebook.
I’m here to tell you that the Haitian roosters started their cock-a-doodling at 2:30 AM - not even my ear plugs helped me sleep through them. True confessions: I actually got up and threw ROCKS at them, perched up in the tree ri Jason has twin boys. What kind of coincidence is that??
Dr. Ian Rawson, director of the hospital oriented us to the layout and sent us by car to nearby Petit Trou de Artibonite, where the Doctors without Borders Cholera Treatment Center was receiving more than 100 patients per day. I was thrilled, also, to meet the CDC team, who worked so hard to scope out how this horrible bacteria had come back to haunt Haiti. Now this is a good way for my tax dollars to be at work!
Cholera is a bacteria that essentially sucks all the body’s fluids and eliminates them first, through diarrhea and then through vomiting. If the fluids are not replaced immediately, death will happen – and can happen in hours to days. Treatment is simple: oral rehydration solution. We triaged patients: If they were “only” having diarrhea, we assigned them to an area where we encouraged them to “bwe bwe bwe!” that is, drink! If they had already started vomiting, we started at least one IV line of Lactated Ringers and put them in a bed where we could keep tabs on them. The protocol is to get 6 liters into a person in a couple of hours, so it takes incredible diligence. And when there are half a dozen patients like that, it is almost impossible to keep up.
The extreme need, the intensity of caring for patients who are beyond oral rehydration, the frustration of not being able to communicate with my Haitian co-nurses when we needed to move quickly, the satisfaction of seeing someone on the brink of death come back to life…I am yet again humbled and grateful for being a nurse, for being able to help, for all the teachers I have had, for the support from friends and family to allow me to do this work.
Almost all patients arrived with family member (who provided sheets, food, personal assistance, etc.). But the ones who didn’t were on their own. Haitian nurses don’t touch patients or provide any direct physical care. I carried hundreds of bedpans to the toilets and did my best to clean patients who were alone. One young fellow had been lying in 4 inches of diarrhea on a cot for hours. The Nursing Director got him into a real bed, we stripped him and got paper sheets over and under him. He couldn’t get out of bed for a day – it was heartbreaking. BUT, he got better and I was thrilled to see him, dressed and smiling as he left 4 days after he was all but dead. This is the joy of cholera – people get better quickly.
A team of 4 nurses from Project Hope had arrived 2 days prior to my arrival, during a time when there were only about 5-10 admissions per day. They didn’t speak any Creole or French and were frustrated by the Haitian way of delivering care. I think they were a bit disappointed. So, by the luck of the draw, their 2 weeks ended 2 days before we got slammed with triple that number of patients in one day and I was the only non-Haitian nurse available. But it was fine.
I found great connection with many of the people with whom I worked. The medical director is an energetic Swiss doctor, Silvia, who quietly works to improve the delivery of health care in a situation beyond our imagination. Of course, the nurses and I bonded in ways that transcend the language barrier; sharing the struggle to save a life, seeing the bright outcome of a patient waking up and then walking out of the hospital when he had been so close to death...I felt so grateful for being part of that effort. The guys who kept our unit free from body fluids - they were heroes in my book! And the patients, of course. I don't even know their names or how far they had to walk or be carried to the hospital. When a patient reached the point where we could remove his IVs, I would say "Bon travay! Orevwa cholera!" "Good work! Good-by, cholera!" And we would all beam in gratitude.
A new group of 6 Project Hope nurses arrived 2 days before my departure. The medical director asked me to orient them. I feel really good aThey didn’t speak any Creole or French and were frustrated by the Haitian way of delivering care. I think they were a bit disappointed. So, by the luck of the draw, their 2 weeks ended 2 days before we got slammed with triple that number of patients in one day and I was the only non-Haitian nurse available. But it was fine.
I found great connection with many of the people with whom I worked. The medical director is an energetic Swiss doctor, Silvia, who quietly works to improve the delivery of health care in a situation beyond our imagination. Of course, the nurses and I bonded in ways that transcend the language barrier; sharing the struggle to save a life, seeing the bright outcome of a patient waking up and then walking out of the hospital when he had been so close to death...I felt so grateful for being part of that effort. The guys who kept our unit free from body fluids - they were heroes in my book! And the patients, of course. I don't even know their names or how far they had to walk or be carried to the hospital. When a patient reached the point where we could remove his IVs, I would say "Bon travay! Orevwa cholera!" "Good work! Good-by, cholera!" And we would all beam in gratitude.
A new group of 6 Project Hope nurses arrived 2 days before my departure. The medical director asked me to orient them. I feel really good about their willingness to work hard for the cholera patients and to ease the load on the Haitian nurses. I specifically counselled them about this not being their turf and to be respectful of the nursing culture here. Not to compromise their professionalism, but to respect the Haitian nurses for where they are professionally. And I reminded them that "we" will leave; the Haitian staff will remain with the fullness of challenges on a daily basis.
If I could have a magic wand, my wish for Haiti would be instant healing of all the suffering; and for me - instant fluency in Creole…oh! And finding work that would allow me to be in Haiti full time.
Thanks for making it all the way to the end of this tome!
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