Haiti Day 5, December 30, 2013

Hello again everyone, 

Made it to day 5!  Time is moving right along down here....and it's still hot if you're wondering.  I'm probably going to freeze entirely when I return to Chicago as it's going to be like a 90 degree drop....though it might feel nice too, never really a chance to cool down here (though the showers are ice cold.....).  The beginning of the day was pretty slow for me.  I went down to the hospital and as they said, it was jam-packed.  All the people who didn't come over the weekend for various reasons all showed up Monday morning.  It was literally overflowing with people.  In this case I wasn't able to do much as the doctor who I normally work with was off visiting her family for the day and the remainder of the doctors don't speak much English.  In general, when the patients come in for their well checks, follow up visits, etc. the system is very tightly run and I can't exactly just go all cowboy on them (in the ER a little....).  They document everything and really only provide the level of care that the patients can afford to pay, so it's limiting and doesn't allow me to do much in these cases.  Considering I was feeling pretty sick anyway, I returned to my room and slept for a good portion of the morning.  I would periodically go down to check if there was anything going on in the ER, and if there wasn't, I would return back upstairs and rest a bit more.  My cough has turned into this lingering nagging cough that just is always there and is super annoying, but not really doing anything....other than annoying me and everyone else.  I really miss those cough drops about now haha.  But this morning as well I was a little light headed and just felt like crap overall, so the nap did me some good.  When I checked in downstairs around 4ish I saw a couple of patients with the medical director.  One 27 yr old woman post-partum day 5 who had some pretty severe swelling in her legs....her bp was elevated and we gave her a prescription to get an ECG done and decided we would go from there tomorrow.  We discussed all the possible things that could be going wrong, but are limited again to providing the tests that she can pay for.  I guess it's not like in America where if someone can't pay you just do it and the costs get eaten up by something else (really expensive orange juice for instance).....here, there's no one and nothing to eat up those costs, so if they can't pay for it they simply don't get it done.  So, we'll see what the ECG shows tomorrow and if she can afford more lab tests we can order them.  If not, I guess we send her on her way and hope for the best.  Couple other patients had come into the ER....a small child with burn wounds over the lower back, buttocks, and upper thighs -- they said something about the weather burning him, but it looked more like hot liquid was spilled....so not sure.  I let the nurses take care of him as I attended to a guy with a nice 3-4 inch laceration on the bottom of his foot.  After yesterday I'm confident in repairing these wounds and the medical director was thrilled that he could leave me to it.  The nurse prepped the "sterile" field for me and I started to try and numb this guy up.  Now sure, I'm jabbing a nice inch long needle into your open wound, but after yesterday and fixing up all those motor bike accidents, I guess I got used to the tough guy patients.  Maybe cause yesterday they were all in the room together and no one wanted to show any pain to their friends, but they all just sat there quietly as I jabbed them with lidocaine and then stitched them up.  This guy was howling and screaming like crazy and I could barely numb him up.  I guess the bottom of the foot is sensitive.....either way, it made it rather difficult.  At one point I injected into the wound to give him some more lidocaine and he jerked his foot away right as I started to push -- resulting in a nice face-full of lidocaine and whatever else squirting out of his wound.  Luckily I closed my eyes pretty quick and didn't get any into them, but needless to say as soon as I was finished stitching the guy up I went upstairs, wiped my face down with anti-bacterial wipes, and flushed my eyes out with saline.  Now, stitching the bottom of a foot is a lot tougher than a knee, arm, face, or even head.  Especially around here where everyone is barefoot most of the time, the bottoms of their feet are like leather.  I had a nice big needle but the thing was nearly bending in half as I was trying to push it through each side of the laceration.  I'm sure this contributed to his pain, as I was extremely forceful.....and after the first stitch he was yelling at me so loudly the medical director came back into the room.  He smiled and told the guy "it's okay to cry," smiled at me and walked out.  I proceeded with the next two stitches, and yeah, he was crying by this point.  The nurses were all saying something to him, I think making jokes about he was over-reacting.  I had one more stitch to put in and he was insisting that I just stop and he would leave as is.  I tried to put more lidocaine in but again, he kept pulling away.  So, I handed the stuff to the nurse, latched onto his leg, and held him down as she injected and did the final stitch for me.  In the end it looked pretty nice and I think it will heal well anyway.  The lady that I wrote about yesterday, with the really low blood sugar, she came back in today and I guess the doctors think she might have appendicitis....and I have no clue what they are thinking about doing.  From what I saw they gave her IV fluids and were just waiting -- not like we really can do much here at this hospital, so she may be transferred out if she can afford it.  

At this point Dr. Josef returned and we went and admitted a pregnant lady at 39 or so weeks...she looked ready to give birth at that moment.  But she hasn't yet, she's still down there screaming a lot, so we'll see if sometime tonight she delivers.  Hopefully they remember to let me know if she does cause that would be interesting to see how they do it here.  Obviously no epidural or any other kind of pain med.  I took a picture of the OB/GYN room to send to you later....it literally looks like a dungeon torture chamber.  I tried to listen to the fetal heart tones, and the doc swore she could hear them with the metal cone thingy....but I couldn't hear anything.  It's also very noisy in there in general, but even if it wasn't, I think I would need superman's hearing.....she said with practice I would learn to hear it.  We'll see.  We also went and saw a guy who had tetanus and we discussed what the treatment should be.  I guess her and the medical director were having a disagreement on it.  Luckily, some of the medical apps still work on my phone even without internet or service, so I was able to pull up some data that had clinical studies cited with the best treatment options.  We'll see if it helps.  I think they were trying to get the anti-tetanus immunoglobulin to give him but they don't have it here or something....it was a little confusing.  Either way, the guy is writhing in pain in an isolation room (basically a very small room, enough for just the bed) as his body is twisted and contorted by the toxin.  I read that tetanus causes hyper-reflexia, and I kinda wanted to go in and check, but since they already knew he had it (I guess it was immediately obvious), it didn't seem like a great idea to go and torture the guy more, so I resisted my temptation.  

So, at this point I'm just waiting to see if a baby comes out at any point tonight and if anyone comes into the ER for any other reason I'll help em out.  But otherwise, should be a rather quiet, very muggy hot night.  

Prayer:

- My health still....it would be nice if this cough would clear up for sure, but at this point just that I can push through it and make it to the end of the week without coughing up my lung....or my spleen for that matter.  I think with the little rest I had today that overall I'm feeling better....I'm no longer light headed or anything.  Excedrin is helping the headaches along with the Amlodipine I take daily now to knock them out.  Haven't needed to use the Imitrex injections yet, so that's been nice cause that really incapacitates you.  

- Amazingly I haven't gotten sick in any other way.  No diarrhea or nausea or vomiting -- I attribute this largely to the fact that they cook the food here so well and make sure that it's extra safe for me to eat.  Also, the water is all bottled so no risk there.  Even if I use the faucet water to wash my hands, I still usually use hand sanitizer afterwards just to be safe.  

- 2 more days of working in the hospital, so just pray that I continue to be effective in that matter and that I'm a blessing to the staff and doctors here.  The nurses and staff all keep trying to talk to me and laugh a lot about my responses -- I still know very few words as their accents are hard to hear so even when they try to tell me a word it's hard to really grasp what it is.  I keep wishing that my iphone worked so I could google it, read it, and connect it better.  If I had just a basic understanding of the language it would help a lot -- something to put on my list to work on in the future.  I know I suck at languages, and that hasn't changed yet.  When talking with Dr. Josef it's helped that she speaks Spanish too, cause sometimes if we can't communicate it in English we just speak Spanish.  Now my Spanish is pretty terrible as well, but I realize how much I actually do know, especially in comparison to Creole, so Spanglish is really working with her anyway.  Some of the staff think they know a little English, so they'll try to talk to me, but they are still speaking Creole and not realizing they aren't actually speaking English....then they laugh as they realize it and throw me a word or two in English.  Everyone wants to know how many brothers and sisters I have, if my parents are alive, if I'm married, where I'm from in the US, stuff like that.  So one or two words in English and we can usually get some stuff across.  Anyway, I'm not going to magically learn Creole, but I've been effective enough as is and we've had some fun at my expense, so pray that the last two days here at the hospital are just as good.  

- As I mentioned, Thursday I will plan to go to the children's home, so just be praying for the kids and that I'll be able to help them

- Prayer that everything works out with me getting home on time wouldn't hurt.....my return is going to be tight as I'm traveling back leaving here Saturday 11am and returning to Chicago 11pm -- gives me one day to rest up and start my surgery rotation at 4:30am on Monday.  So, not much room for error like a missed flight or anything.  Coming here, everything was great -- arrived on time, all my bags came (what!?), so going back it'd be great if it was the same.

- I'm hoping that this experience really helps kick start global health at Rush and my future organization and everything.  In the immediate future, sometime in January, I'm going to meeting with the community service director at Rush and the Salvation Army contact I initially spoke to about what possibilities will exist for other students to travel to various countries and have a similar experience as I have had.  Now that I've spent some time here I'm kind of making a list of what will need to be known in advance and how things would need to be set up and scheduled so that other students learn and don't feel as lost as I initially did.  But I really think that this opportunity is at least one of the keys to solving the global health problem at Rush as far as lack of opportunity for interested students and it will really open up the door for me and others to return here in Haiti and to other countries in the future.  I've had such a great welcome from everyone here and I realize a little bit more of how their system works that I think it will help launch other mission trips, some with maybe more of a focus than this one where I just hopped a plane and flew down here.....but it's the start to something much grander for sure.  I've always figured that if I just jumped in with both feet and hoped for the best that things might line up in a good way....so far so good haha, granted it makes for some crazy experiences and bizarre adventures for me (and lengthy e-mails), but in the end I trust that the ideas in my head will be put into action.....hopefully, if nothing else, that my these small things I'm doing others will be inspired and they can be the ones to really make the impact.  I'll update you all much more in the future with all that is happening back in America as far as the non-profit stuff, funding, participants, etc. as there is a lot starting to unfold and once it does, I anticipate amazing things.  But I'll save that for another lengthy e-mail.  In short, please just continue to pray that God uses this adventure to be the spark that really ignites the passions of others to join with in making what I believe to be His dreams, a reality. 

For the moment, that's all I have for you.  Thanks again for reading.  I am terrible at journaling, and every time I attempt it, I usually fail to do so the next time.  However, writing these e-mails to you all is a sort of way for me to journal out the day and will help me to remember what is happening here in the future.  I hope that the experiences I am having here are at least some sort of inspiration for you, as without your support I would not be here doing what I am.  So thank you again, and I know the people of Haiti are thankful as well. 

Orevwa (good bye) for now,

Aaron Tabor