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!
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