Coming Down

I had a good cry last night. It's one thing to hear the word "poverty" as an American, and quite another to be there, to see it, to smell it, to touch dirty people who have flies crawling over their crusty scabs. To see children who are hungry -- and not just hungry, starving -- to say it's heartbreaking is not the right word. It's wrong. It is horribly, terribly wrong to have children starving in our world. And yet it's not just Haiti but so many other poor countries where this is happening. My brain is starting to see a small corner of the problem of world poverty, and my soul hurts.

And yet -- sitting down across from a dirty, poor, underfed Haitian, I looked in her eyes and all I saw was the humanity. That other than having been born in a different place, this person was human like me, was just like me. They could BE me. So I didn't have any reservations whatsoever about reaching out and touching them like I would anyone else, dirty or not. Their humanity was utterly compelling.

The experience really made me realize that we as Americans do so much categorizing people. "Muslims are..." or "Black people are..." or "People in poor countries do this..." and that when you sit across from a human being and touch them, you realize that categorizing people at all is fundamentally flawed. And when you take away the boxes that you have people in in your mind, you have to address each person in the world as an individual. That is hard to imagine, and yet so freeing.

- Megan

Tune into the the last episode of General Hospital

So rumor has it that another team is coming into General Hospital Friday and we don't need to come...well as Danielle said..that just won't do...see I had promised those kids in the tent that I would come back and seeing as they have had enough heartbreak of their mothers and fathers being killed in the earthquake and not coming back...I was not going to continue that streakIn Ohio if a physical therapist abandons their patients they can lose their license and even though I had brought my license to prove I was a bona fide therapist-no one checked it...heck I was on General Hospital so I could have even played a real doctor and they would not have checked it...but we all stayed in our scope of practice minus ordering xrays and triaging the emergency room....enough of words from our sponsor lets get back to regular programming......

So on my last day I was lucky to start my day working with the kids in the orphan tent. The two kids did not get their external fixators removed from their arms or legs, but were told it would be Friday instead. I worked with all of them and found that they all had worked on their homework diligently and from even the last few days were able to now walk without crutches, dance with their grandfather and family while singing Beyonce, Rihanna and Alicia Keyes...it was classical Me belting out "I am Superwoman" by Alicia Keyes and have the kids answer back in English "Yes I am....Yes I am!" we danced and sang to songs all the while they did not notice that they had managed to dance or walk for 5 to 10 minutes without using crutches and without pain.

One girl I was working with had a leg length discrepancy of close to 2 inches so that one leg was significantly shorter then the other. I had remembered to bring heel lifts that would help balance out the difference between her two legs...but her beat up flip flops and super glue was not going to work....so I asked Claude our wonderful translator if he was willing to find me sandals in the marketplace...which he did find a great pair of Haitian sandals for 8 dollars...so I gave her my tennis shoes and it made a big difference with her walking. ....as we were taking video we had the camera crew come in from Amsterdam to finish the follow up story of the little girl Julia who had been an international story of surviving for days under her dead mother. These film journalist had managed to get a Canadian plastic surgeon that had flown in to see if he could do surgery on her wounds so that she could return to "normal" whatever that is in Haiti. Unfortunately, they kept running into people that were roadblocks for the proper documentation to take her to the surgeon and to Canada for the surgery. Having spent my entire time at General Hospital, I realized the people that they needed to talk to in order to get the proper documentation and by 2 pm they had it in hand and the little girl was cleared for surgery in Canada....yeah!!!!

I had also promised Jonas that I would come back and wrap his amputation wound and teach his family how to wrap his stump so that it forms optimally and properly for best outcomes. I checked on Jonas and found unsurprisingly that no one had redid his dressing or given him pain medicine at all since yesterday at 9 pm......it was 2 pm at this point...can you imagine having your leg amputated on Tuesday and after 9 pm Thursday not getting any pain medication, or tylenol, or advil or anything at all...yikes! Well I had to take off a bandage that had been caked on a wound for 4 days on a kid that had not had any pain medication since Thursday. I needed to make sure that he had pain medication before I started this...so they search began........................see there are no nurses in the tent that the Haitian staff is running...I mean nooooooo nurses after asking the family that the last time they saw someone come through was at 8 that morning. I asked one of our doctors if he could get me pain medication, but although he could write the prescription -he could not administer it as it had to be the Haitian staff that put it into the I.V. ...ALLLLLLLright enough of this...we headed out to find the right person to solve it. We tripped across the leading orthopedic surgeon for Haiti in the Orthopedic tent. I used my P.R. schtick to have the translator tell the surgeon we desperately needed his help because his patient had not had the bandages removed because the American Doctors had not thought to remove them stupid American Doctors...I need you help great Haitian Doctor (okay orthopedic surgeons are impressed with them selves and the best way to get what you want is to appeal to their egos-it works-whatever it takes!) He immediately left all the people talking at him to help me (see I told you it works! :> ) He visited with the little boy and then demanded that the Haitian nurses get the pain medication and he even changed the saline solution himself. Once medicated and comfortable, I and wonderful Frances ( another volunteer from our camp) who was first mate in us doing our wound care on Jonas. We did the dressing change and taught his family to do it as well. We taught them how to rewrap the stump twice a day and confirmed that I had emailed the gentleman to get his prothestic device after 2 weeks...we left the supplies and wished them well knowing that they would be heading in the right direction in getting the help they need....and hopefully they will have their boy doing everything someone their age should do within a few months.

So this is the last episode of General Hospital...we had drama, hope and happy endings...a great way to end a show

kimberly

I am grateful for........

Sitting in an Air France plane after a week of living without real showers, air conditioners, ice, consistent electricity, beds, running water is something to be grateful for – and I was very grateful when I sank into 9B. We had done it. Made it to Haiti and performed our mission and safely made it back onto the plane in one piece. In fact, in the end we were not scared of the country or the people. We had gotten to know them individually, deeply individually as we watched their deaths, struggles, hunger, dehydration, grief and against all odds – happiness despite a minute on January 13^th that changed all of their lives forever.

As the air conditioning came on and cooled the temperature on the plane, I thought about the family that had their son Jonas in a tent that was sweltering at 80 degrees and above all day long. As we ate the food handed to us, I thought about the 80 year old woman who asked for food from her hospital bed because they expect family to give them food and her 7 children had moved to the U.S. and had not visited her since the earthquake. I sipped the red wine thinking about the countless people who came into the emergency department and clinics from dehydration. I rested my head on my chair and thought of the countless people in the tent cities that did not have a chair or a bed in their makeshift tent and thus slept on the dirt…unless it rained and they had to stand up until it was over.

We landed and headed to customs. Waiting in line I looked around at the smooth marble floors, the building that was cool and well light, and at the surrounding buildings outside the window that all were neatly in order with shiny cars and free of debris and trash. A video was playing welcoming you to the United States – showing the many splendors of our country as the song goes from the mountains to the prairies…and Danielle and I discussed how emotional it made us feel to come home.

So I looked around slowly and took it all in and thought to myself I am grateful for all this…..and as I began to walk through the airport I started to think if you take the time to be in your surroundings enough to listen to life around you – you catch things you would have missed if you weren’t truly in the moment. Now people that know me….know how I whirl through life and my husband Michael laughs at how my idea of relaxing is doing something productive on my free time….but I stopped…..and thought about how the Haitian people were happy and grateful despite everything that was handed to them….and I decided to try to identify every little thing through my day that I should be grateful for in my life. I was aware now to be grateful for the shower and warm bed in the hotel in Miami-something I took for granted for before. Simple moments, simple pleasures.

I am grateful for husband Michael who is breathtaking to me. I am grateful for Luke who is an amazing soul, Ella who is magical and Jack who is a breath of fresh air. I am grateful for my family and friends and health. Grateful to spend an amazing week with four women who are dedicated to their profession, families and friends-what a great journey.

Kimberly

Living the Dream

Working day 5, Megan and I got split up. It wasn't intentional, some general SNAFU stuff happened at General Hospital, which caused more people to be shunted to our team going to the camps. We ended up with a team of 9, including 5 paramedic/EMT guys from Portland. Now, in Haiti, 9 people is almost enough to staff an entire hospital, so it seemed too much to send to one tent city – even though, really, the need at Delmas 31 was so great we probably all could have worked around the clock and still not seen the end of it.

For medical professionals, we had Megan, Myself, Cortney (just barely finished med school and not in her internship yet), and the Portland guys. We also still had Carson, the amazing woman with no medical training who somehow organized and facilitated every organization she was attached to. Cortney didn't feel comfortable being being the lone medial director of a group, and Megan had promised patients at Delmas that she would be back for follow up. So I teamed up with 2 paramedics and an EMT. Unfortunately, no one knew about the split before we got there, so we had to unpack, sort, split, and repack everything to stock 2 clinics.

So off I went with 3 kinda cute emergency med guys (Jason, Chris and Gordon) up through the very crowded, winding streets of Petionville. We passed through a huge street market, selling everything from knock-off purses to live chickens. On the trip, we worked out that we would have 3 clinic stations and one person as float / runner / triage / pharmacy. We initially thought we would switch out, but Jason turned out to be fantastic as the float so we stayed in our roles the whole day. I was the medical director, and the guys came to me with any complex patient questions. It was a little dream come true – me getting to boss around 3 action/adventure guys on a tropical island.

We entered a small camp, all enclosed in a fence with a gate, which had an open area covered in chairs and benches (and luckily some tarps for shade) in front of a still-standing house. It looked like an open-air church, filled with people nodding cordially and wearing their best clothes. I wondered what the event was – but it was us. We were the first medical team to visit the camp since the earthquake and just about everyone who lived there and the surrounding neighborhood at least stopped by to see the show. The people at this camp weren't as poor as Delmas 31. The neighborhood had been wealthier and more people spoke French or even a little English. There was still desperate need, though. The kids were still skinny, the adults exhausted and traumatized, and we saw several patients who would have been turfed immediately to the ED if I saw them in clinic at home. Still not much of an option here. Highlights included a child with a bad asthmatic bronchitis which we cleared pretty well with steroids and inhalers (we made the family stay for a few hours so we could keep an eye on him). I saw an older guy who probably had a DVT – luckily he knew someone with a car and could get to a hospital. The team saw 3 different adults with systolic blood pressure > 220. (We kept a close eye on them, too, and saw there BP's go down with meds). We still saw the majority of “since the earthquake, I've got a headache, I've got a stomach ache, I don't sleep, I get exhausted easily”. The kids had thin limbs, scabies and worms. I began to perfect my PTSD speech “We are seeing so many people here with your same symptoms and it is very normal. After a trauma, most people feel very stressed in their bodies and their minds. These symptoms are not life threatening. They will pass as life becomes more normal, but I know you are uncomfortable and I would like to help you with that”. Most people seemed reassured, and then we gave them the “Haiti Gift Bag” (named by the paramedics) of Tylenol, Zantac and Vitamins (plus anything else acutely we needed to treat). I was again blessed with a terrific translator named Alex, who is hoping to get back to university soon.

That day my team saw > 100 people in 5 hours. We also accomplished 2 great things. When we got back to Quisqueya, we told Miquette and the staff about the camp, and they assured me that they would send another team there in 1-2 weeks with more cardiovascular and asthma meds. So hopefully, these people will not be abandoned and they will feel more secure and cared-for. With less worry about basic health and survival, they may be able to move forward, start working, start repairing, start buying, start rebuilding (is re- the right term for a place that was such a mess to begin with?).

The second great thing we did, was with a little boy named Peter Lee. Peter Lee is 9 years old. 2 years ago, he started complaining of pain in his right hip. There was no preceding injury. He started limping, developed pain to his back and knee. He is in constant pain, and could barely walk without support. Chris saw him and called me in to consult. I'm pretty sure Peter Lee has something called avascular necrosis at his hip joint – this can be repaired with surgery / therapy, but definitely needed more than some Ibuprofen. We got his mother's contact information (strangely, everyone in Haiti, even very poor people have cell phones – Digitel, the cell phone company is the most profitable business in Haiti), and Miquette called her that night to arrange for Peter Lee to be transferred to a hospital for X-rays and a orthopedic referral. I saw Peter Lee the next morning before transport and was able to give his mother a bag including a blanket, towel, and some extra food. I'm looking forward to contacting some people still at Quisqueya to find out about him. Miquette told me the mother was crying on the phone, so grateful that we had kept our promise.

I think the experience I had with this family was a microcosm of what the world needs to do with Haiti. WE NEED TO KEEP OUR PROMISES. If the world offers aid, then we need to go, triage the major issues, choose problems that we CAN help with, be honest about WHAT we can do to help, give realistic timelines, educate people scrupulously on how to sustain any improvements, train local leaders and staff to manage ongoing progress, and allow constant local feedback so Haitians know that they can and must ultimately take care of themselves. This process can work with health care, infrastructure, education, government, you name it. I hope that whoever is in charge – Preval, the UN, the Clinton Foundation, the Red Cross, the World Bank have this kind of framework in mind when they think about aid. I also hope that they get off their butts and start applying aid soon, while the country is in such a teachable moment.

Jamie said something to me that I love – she wants to get her emergency medical training, so someday she can be part of a delegation where Haiti sends aid to some other country in need. She and most other educated Haitians I met feel strongly that Haiti needs more than aid, it needs to become self sufficient and develop national pride. If there is enough people who think like she does, and the right help is applied at the right times, it might just happen.

Thanks again, everyone for your attention and support. Love, Rachel.

Last Day.

Today was a strange one. We got up early, packed all of our things, then Rachel went to help another team with all of our medical supplies that we gave while Kimberly wandered off down the street with an interpreter to try to find a needy Haitian family to give her small camping air mattresses to. By the time Kimberly returned, my blood sugar was so low from missing breakfast that I had already dragged Lisa off down the street to Epi D'or, a European style coffee shop complete with a crepe stand inside.

After a delicious breakfast (in which Rachel, Danielle, and Kimberly did show up to join us) we went back to Quisqueya to pick up our taptap. We had agreed to pay the drivers $100 to take us wherever we wanted to go. We were excited to go up to a lookout point and see the city, but instead our drivers took us way past the lookout point to a Baptist Mission where there was a museum, a zoo, and a bunch of shopkeepers desperate for some American money.

We did a little shopping but got kind of annoyed at not being taken where we had wanted to go, and then on the (very long) way back down, the car was overheating and we wound up begging the driver to take us back to Quisqueya. When we arrived, we enlisted the help of a Quisqueya employee named Theo to explain to the drivers that 1) they didn't take us where we wanted to go and 2) our trip was cut short because of the car trouble, and so 3) we didn't think $100 was a fair price for that. So we agreed to pay them $70 -- there is a severe gas shortage until 4/24 when some more gas will arrive, so prices are steep right now.




Then we lazed around for a little while. About 10 minutes before our scheduled departure time for the airport, Miquette came running into the compound yelling for a doctor because there had been a "big accident" right outside. Rachel and I grabbed gloves and a BP cuff and hauled ass in the heat, where we found a Haitian man having been hit by a car while walking, being tended to by an American military medic. He was injured pretty badly, lots of cuts and scrapes and likely a big nasty ankle fracture. We kicked it into high gear, assessed his vitals, made a splint with the material in the medic's bag and wrapped his ankle, then Hans the German ER doc from Humedica jumped in and took over, started an I.V., had one of his staff bring a canvas stretcher, onto which we gently placed the man and carried him to the bed of a truck in the Quisqueya compound.

I couldn't help but think, dude, if you're gonna get hit by a car in Port au Prince, you really couldn't have picked a better place than the one where there was a small military unit and a compound full of American doctors. Really.

Anyway, it really helped me feel better about my last medical act in Haiti. Not abandoning a child in a dark empty hospital, but putting my hands to work helping a man who was in serious pain.

When I looked up after loading the man into the truck, I noticed Rachel was gone. I went up to our room and found it empty. My friends had finished grabbing all of my stuff and we were packed and ready to leave for the airport (at this point a little bit late.) We got to the airport at 2:30pm for a 5:45pm flight.



In the waiting area we met Faustian Desir, a Haitian-born American Army Staff Sergeant. He and 50 other young Haitian men took off in a boat headed for Cuba in 1990 when he was 18 years old. At the time, young men in Haiti were being murdered by the thousands by troops during the transition of government that led to Jean Bertrand Aristide's "presidency." An American Coast Guard ship picked them up, took them to Guantanamo, and after 2 weeks they let him go to the US along with 15 other Haitians. When the US invaded Iraq in 2003, Faustian volunteered for the US Army and he is now a recruiter but is also being used as an interpreter during this time of need. Today, he and his mother were on our flight -- he has arranged for her to live here permanently. Truly a fantastic story.

As our wheels lifted off the ground, my eyes welled with tears. I'm just not sure I'll ever see this place again, and to leave these poor people in the state they're in is so hard. The sun was setting and there were no street lights, no electricity anywhere other than the airport. The only light we saw was from fires on the ground -- likely people burning trash. Flying over Miami was a stark contrast. Everything is clean here, and the lights work, and the traffic flows, and there is a working infrastructure.

If the government officials in Haiti took the tax money they receive and hired Haitians to rebuild their country (instead of lining their own pockets), those Haitians would have money to spend, which would create demand, which would create business, which would create jobs. Not that these issues are so simple, really, but government corruption is the first place to start to fix things there. I believe that.

But for now, I am looking forward to seeing my family tomorrow. And I will remember to feel grateful for the blessings we have in our own country.

Signing off from Haiti,

- Megan

A Major Apology

Hey everyone.

In my very upset state last night I accidentally inserted the word "military" in the sentence I was writing about the poor American response here. That was not intended and is indeed not true. The military are here, have been here. I've seen them everywhere. They were here in the beginning, building piers and offloading supplies and helping to rescue people and dig up bodies and help ensure that thousands didn't starve or die of thirst or a major epidemic of disease.

The American military were here setting up huge tents on the Quisqueya compound within days of the earthquake. I saw photos of them last night -- you can even see them on Google Earth because the latest satellite images of Quisqueya were taken while they were here.

I apologize deeply to my military friends who have worked hard all over the world in crises such as this. It was unintended.

My problem is with the Red Cross and the $400 million donated American dollars, much of which hasn't found its way here on the ground.

- Megan

Danielle's signing off from Haiti

Day 5 at University of Miami Hospital was really great. Basically this is 180 degrees from my last hospital. Again it all boils down to MONEY. I don't have every detail, but this is what I understand. After the earthquake the University of Miami set up a massive effort which included this hospital, which is modeled after the hospital in Miami. Several large circus tents all strung together represent an operating room, ICU, NICU, ER, Recovery for adults, Recovery for kids, lab, and supply area. On arrival we checked in and had a brief orientation from PT staff. Well the guy who had been there the longest (5 days). I marveled at the organization. Hillary Clinton's aide was there Tuesday as they are asking for 40 million to help continue this hospital long-term. Based on my 8 hour experience, making me the expert I'd be in favor.

Even with all these kudos I do want to mention that each patient is assigned a bed sheet on arrival. It belongs to them for the duration of their stay, be it 3 days or 3 months. Maybe they will be lucky enough to have a family member wash it by hand. From what I could tell they were not being washed. We are donating everything we have left to various groups on our departure. Kimberly even bought a pair of sandals on the street so she could give her shoes to a patient today. I am sending mine with my Arubian friends tomorrow.

I treated all my patients for about an hour. Luxury really. My favorite patient of the day was a 34 year old woman who has a T4 Spastic Hemiplegic. Basically she will never walk again functionally, will require assist for transfers into her wheelchair and she has legs that spasm into flexion. My interpreter said that she cries at night because her boyfriend said he did not want a crippled woman. She is all alone with the exception of a sister who lives far away and sounds like she has not yet visited since the earthquake. She had a bright smile 5 minutes into our treatment time together. We worked for about 45 minutes and she smiled and said she liked to work hard. Always makes a PTs day. I spoke to the MD about anti-spasmatic medication and she said there was not any. They have her on Flexeril which is a muscle relaxer which will only make her drowsy and not touch the neurological spasticity. The patient indicated she had an injection at her last hospital that relaxed her legs. The MD said they could give her some anti-anxiety drug, which could have a placebo effect. Unbelievable. On my second visit with her in the afternoon I gave her an hour massage. Why not, who cares that Medicare won't pay for a massage. I work for free. I am quite certain that she had not felt any such physical touch in all her life. She was so relaxed and peaceful. She smiled several times as to say thank you. No need for interpreters. Tomorrow my friends will deliver her my shiny white satin sleeping bag (Dreamy) that I have been sleeping with all week. I hope she feels pampered.

I also worked/played with 2 children that seemed to be in a PTSD daze. I took them outside and tried to play with my homemade balloons made from my gloves with them. It was really hard to get them to smile and they were both so floppy. One of them was recently hit by a car, as the cars drive fast/quickly/wildly with little regard for any other cars/people in the road. Even worse than me. I gave one of the girls a lollipop and was concerned there would be a riot. Apparently when you give a candy or blanket or any clothes to a child all the other Mom's mob you to get some for their child. Keeping up with the Jones in Haiti.

I spent an hour feeding/holding a premature baby which was such a highlight. She was a good little eater and the RNs are working to death and often don't have any time to just sit long enough to hold the babies. At night American soldiers can be found taking sweet turns holding these little ones.

My friend Ann wears a necklace that says Kindness Matters. I thought of this phrase often throughout our time in Haiti. That was my major contribution - treating others with respect, love, compassion and letting the Haitians I met know the are valued as human beings. I think about how crushed Megan felt from feeling defeated when trying to help the young mother get her daughter more medical attention. That mother had probably never had someone work so hard to help her. That is a gift that will last a lifetime. Rachel met a little boy who had terrible pain in his hip for 2 years. She organized a transfer so that the boy could get more medical attention today. The time she took to follow through on a promise she made to the mother is the act of kindness the mother and son will feel for a lifetime.

Will I return to Haiti? I am not sure if I will, but I will return to a third world country with my children when they are old enough to value the many lessons there. I want them to know that people all over the world live differently but all share the common need for love and compassion.

I feel very blessed to be an American. Megan spoke of the Haitian born American soldier we met in the airport. He is so proud to be an American. He seemed to glow with pride. His story brought me to tears followed by chills to see the honor he felt and the responsibility he felt to serve our country.

It was all inspiring to see our American soldiers at work in Haiti. Just their presence made me feel safe. As we run through our days in Colorado Springs we live amongst our military men and women and probably do not realize what their days are like. I can tell you the days are hot and long in Haiti. I can tell you they jump into action at a moments notice with great intensity and you feel honored to have them on your side representing your country.

So how did 5 very strong women with 5 very strong personalities do?? I estimate if we had been on a vacation to France in one small room and bathroom we would have killed each other. Five strong women in Haiti works. It is amazing what happens when you share a common goal to just give give give all day. The end result was 5 women who all had very different stories to tell but all feel our time in Haiti was of value.

We have all spoken at length about what to do to help Haiti. How to solve the problems that seem so vast and so endless. Education is the key. Haitian's have to pay for school for their children which translates to lots of uneducated people when the unemployment rate is staggering. The young men that served as our interpreters give me hope that change can come to Haiti. As I have mentioned in prior blogs they are very ambitious, smart, respectful and kind. Many American's during our week in Haiti have pledged to send a few to Medical school (15K over 5 years) and are working on foundations to build a nursing school in Haiti. These are the steps that can spark change.

Thanks to all who listened as we all journaled our thoughts as they unfolded during our Journey. I am the last one awake in our cozy hotel in Miami. The hotel with warm showers, safe water, soft beds and most importantly no ROOSTERS.

Danielle

Pictures may be added in days to come. First things first - sleep - fly - hug our families!!! Can't wait!!!!!