Haiti Day 3, December 28, 2013

Bonswa (or good afternoon/evening.....the near extent of my Creole haha),

Saturday at the hospital has been pretty chill....not many people came in to the clinic and most of the hospitalized patients are well stabilized and taken care of by their families.  We had one woman come in who was 39 weeks pregnant and the doctor showed me how they assess the position of the baby and listen to the fetal heart tones -- assessment is done entirely by feeling the woman's stomach, which I could do only after she showed me where the back, hands, and head of the baby was....maybe with some practice.....and listening to the fetal tones was with this metal cone essentially, but I'm not sure we actually got that to work.....def not as high tech as Rush's OB equipment :)  

Last night was a rough night in the hospital, I was unaware but apparently there was a huge accident and the badly injured were brought here to attempt stabilization before bringing them to the bigger hospital in Port-au-Prince.  From the look on the doctor's face this morning, she got little sleep and things did not go well.  I'm not entirely sure, but sounds like they were able to do very little and I don't know if the patient's survived their trip to Port-au-Prince.  She was telling me this morning how she doesn't like practicing medicine in Haiti and cannot wait to leave because the medicine is so limited and what she can do for her patients is so minimal compared even to what she could do in Cuba, let alone in America.  I'm realizing that even with the skills necessary to help the people here in Haiti, a lot of it comes down to the resources available, or lack thereof.  When we were working with the pregnant woman, who came in because she was having vaginal pain, in America we def would have done an ultrasound before sticking our hands in there to make sure there wasn't a placenta previa or anything else that could potentially kill the baby....here, there is no such option.  I can't imagine how many times the babies do not survive due to the limited technology, which from what I've been told is actually fairly common sadly.  For me, it just reinforces the need for me to continue to learn to practice in areas of limited resources and gain experience as I am now.....my American training will definitely serve me well for knowing how I could work to improve the availability of care around the world, but I need to understand rare diseases and "old school" techniques just as well.  They will make sure to let me know from now on if there are accidents in the middle of the night.  She said she wanted to come and wake me, but didn't know if she had permission, which of course I said that it was totally ok. 

The hardest part of being here alone is really just having no one to talk to....so I've been doing a lot of reading in the spare time and at nights, which has been good as I haven't had much opportunity to simply read non-medical books during med school.  On my previous mission trips I have been accompanied by many other friends and am used to being able to sit around and talk about the opportunity, recap the day, speak English lol, anything....so that's a bit difficult at the moment, especially on a day like today where there isn't much going on in the hospital, don't even know where the doctors are, and actually I think they're in their rooms sleeping in case some accidents come in later.  That's the thing too that's very different, there is one doctor here who works all day and is on call at night -- she basically works 24/7, so that's brutal for her.  The medical director is here everyday and potentially would come in at night for a major emergency, but he doesn't live as close by.  Minel, the director of the whole hospital, he speaks English as I've mentioned, and we eat each meal together and we can chat about things during that time....lately his wife has been joining us as well and they like to ask a lot about my training and life in the US and I ask them a lot about the culture, cities, lifestyle, etc. here in Haiti.  So, I shouldn't say there is no one to talk to, but maybe no one that I can talk to with ease haha, so it's a daily challenge, and I don't have the constant access to wifi I'm used to so learning Creole is challenging.  If I could see the words, connect a spelling to them, they would stick better....didn't have time to get a creole-english dictionary, though I'm really wishing I did.  Next time....I will definitely do my best to learn for the future. 

Tomorrow is supposed to be a pretty quiet day as well, as on Sunday not many people come into the clinic and most of them will be in their churches.  Lots of Catholic influence here, but a good amount of Protestant as well, and everyone believes in Voodoo, at least to some extent.  Doesn't seem like that influences the medical culture too much though, at least not that I've seen thus far.  Not sure though as the medicine is very primitive....they would possibly object to the more American way of doing things though, not sure really.  I will be joining Minel in the morning for church and he has offered to give me a tour of the area afterwards.  The goal will be to go back into the hospital after that and make our daily rounds, which usually just consists of checking in on the HIV patients, our one stroke patient, checking if the fevers have broken for the children, etc.    

Just went back down to the hospital this evening around 8pm and spent a couple hours checking in on patients with the doctor.  We had a boy come in that we diagnosed with cholera, so that was good to see.....we obviously don't see that in the US, so I made sure the doctor explained everything to me that she was seeing in the patient....mostly the white, very watery diarrhea with obvious signs of major dehydration -- hard to miss, but I suppose if I had never seen it before on initial presentation I might miss it in the future....so happy that I'm learning.  We also spent a good amount of time this evening comparing notes on different presentations of pregnant women and finding out how they would diagnose a placenta previa, which is basically just wait for them to present with bleeding after 20 weeks.  We potentially had a patient with TB today as well....he came in coughing and vomiting up lots of blood, and along with his obvious malnutrition and weight loss, it made it likely.  They ordered some sputum cultures and we will check for the acid-fast bacilli to confirm......it's hard with these patients because if he does have TB, it's not like he was isolated or I even had a chance to grab a mask....but I guess this isn't terribly different from the free clinics we work at in the city.  Granted, he wasn't coughing really at all when I saw him, so should be okay, and if he has TB he'll be transferred over to their TB center for treatment, but realizing that lots of people around me could potentially have it.....overall though I hear it's hard to catch in passing, so let's hope :)

My e-mails are getting longer I think, so thanks again for reading.  This one I have added to throughout the day whenever I had a chance, so if it's a little spastic, it's not just one smooth thought, and that's why.  

Prayer requests:

- I'm still feeling a bit under the weather and my cough has slightly worsened....basically a re-start of my cough from a few weeks ago, and of course I somehow left my cough drops back home, so still hoping the antibiotics knock it out

- The ongoing heat is also starting to re-trigger my migraines, even with the medications, so I had to come up and take a small nap today to help knock it out.  Luckily there really wasn't anything going on with patients so I could afford to spend the time and do that, but on any other day it could be tough.  So, please pray that I can push through the migraines -- heat always triggers them and it's like up to 90 degrees hotter than it was in Chicago haha

- Pray for the staff that I'm working with.  It's very evident how taxing it is on them to be treating these people with limited resources and often they feel like they aren't doing enough.  Honestly, it's amazing what they do pull off with what they have and I respect them immensely.  I am beyond privileged to be learning from them right now and am really getting a great experience first hand of third world medicine and how doctors treat within that system.  Dr. Josef is now introducing me as "her student," with immense pride -- everyone laughs a bit when she does, and I just smile and have no clue if they are making any other jokes as I can't understand them.  Most other people refer to me as Dr. Aaron, and if I even tried to explain to them where in the process of medical school I was, it would probably just confuse them.  

- These people here are so communal and thankful it's astounding.  They spend most days trying to sell just enough of whatever to buy food for that day, and then they go to the next day.  It's interesting, watching people live day to day, people who should be filled with worry on American standards, but who are not.  They are remarkably....content.....which baffles me as I struggle on with my quest to understand what being content means and requires, so these people have something to teach me for sure.  Regardless, they have great needs, and the needs are beyond what I can provide for them in this moment, but I trust that he has his hand on them.  

Thanks again for reading and for your support.  God bless.

-Aaron Tabor

Haiti Day 2, December 27, 2013

Greetings everyone!  

Day 2 in Haiti was a smashing success.  The medical director here, Dr. Eduorado, is a really amazing guy (who thankfully speaks really great English) and all of the staff love and respect him.  The other doctor I've been working with, Dr. Josef, says that she learned to love medicine from working under him.  She trained in Cuba and is in the process of doing her residency, part of her training here in Haiti.  She says she doesn't speak any English, but we've carried on conversations and I've been able to understand the diagnosis, pathology, and treatment for every patient....so I tell her she's doing just fine.  She speaks French, Creole and Spanish fluently, so every once in a while my broken Spanish serves me well enough to fill in her English gaps.  She has been an amazing teacher as well.  When I first spoke with everyone via e-mail before the trip it was very unclear what I would be doing in the hospital; thankfully, I had been communicating with the director of the hospital, who's a lawyer....the medical director has a better understanding of things :)  I told Dr. Josef when I met with her today that I really wanted to learn how they do medicine here in Haiti....for one, we see diseases that either don't exist in the states (like cholera, typhoid, malaria) or to an extent that we usually would not see them (like draining tuberculosis infected pus from an abdomen), but even the diseases that we commonly see, we treat them very differently.  They do have an impressive set up here -- their lab can run CBCs with differentials, HIV tests (funny story in a minute), as well as some other basic labs, you get the point -- and it enables us to do more obviously than if the clinic was just set up in the villages as we've done in the past.  But they don't have the luxury of checking what types of bacteria are infecting every single person, and if they have a fever and show other signs of infection, they pump them full of whatever combo of antibiotics they can that will cover everything.  They are very receptive to teaching me how they do medicine here and are grateful (and expressed it) that I want to learn a "different" way of medicine -- obviously in the states we have unlimited resources essentially, and we can do pretty much anything.  Here, they obviously don't have it, so their medicine sometimes doesn't even seem evidence based, and I'm sure many American doctors would scoff or cringe, but they do what they can and the people thank them for it.  The medical director today asked if I would like to work with Dr. Josef to "exchange our medical knowledge," to which I replied, "of course, though I'm sure she will be able to exchange more valuable information than I will."  Knowing that I want to do this kind of work in my future, it's amazing to learn from people who are effectively doing it and see how to manage diseases with limited resources.  Also, have to say, the Salvation Army has a very amazing and well respected set up here, with overall a great nursing and doctoral staff.  Sure, the OB/GYN room looks like something out of the Sheriff of Nottingham's dungeon and it's not the cleanest hospital room I've ever been in, but they are doing amazing work and the community gathers to support them.  It's amazing how the families of the sick cook, clean, change bandages, etc. for all of the patients here, and they are so willing to pay for their medications.  To them, if it's free it's clearly not of value, so they want to pay something.  Today we treated a girl with a UTI with IV fluids, some antibiotics, and a few other things for malnutrition, and I think the total was around $3.00 -- but they are so willing to pay and so appreciative of the services.  Okay, that funny story (funny to me anyway) -- Dr. Josef was trying to tell me about this disease that is extremely common around the world called SIDA.....to which I replied, I have no clue.  She insisted that I knew it and that it has become increasingly more common.  Then she said that they run the VIH test for it and surely I knew what that was.....to which, again, I was like, um no clue.  Then she wrote it down VIH/SIDA -- and was "really? we treat with anti-retrovirals?"  ahhhhh, light bulb.  "You mean HIV/AIDS?"  And she tells me that in French they write the letters in a different order......yeah, that took about 5 minutes of me staring at her and her thinking that her English truly was bad.  

All in all I worked about 12 hours today, and if any emergencies happen overnight I'll run down to help them.  The bus drivers are so crazy that people get hit fairly often.  I may see a baby delivered in the next few days too, which I'm sure will be ever so different than at Rush.  And oh yeah, the food again is just insane.  I swear that all Minel's wife Denise does is cook all day for us.  I woke up and she started cooking breakfast, which we ate around 8:30, then she started making lunch which we ate at 1:30ish, then she started on dinner which we ate late around 8:00.....I'm sure she's not in there all day but it sure seems like it!  The food is just simply amazing and I'm actually eating better here in Haiti than I do at home....probably cause I cook for myself so PBJs sound easy enough most days.  

If you've actually read through this, congrats.  I'll keep sending updates each day and if you're annoyed, just delete them :)

Prayer: 

- That I continue to learn and effectively treat our patients, and that maybe God can help me find ways to help add to their practice and not come across as "american snobbery"

- I head to the Children's home tomorrow for a bit to check it out.  Plan is to do wellness checks for the 40 kids next week sometime before I leave, so tomorrow will just be a taste of that

- Everyone here is so crazy sick, even the doctors are hacking away.....I had been dealing with some chronic bronchitis before I left, which I thought had cleared up, with the 80-something degree weather increase and lots of sick people I'm starting to cough a bit.  I started a course of Cipro when I got here for prophylaxis against travelers diarrhea and so hopefully it will help prevent any crazy infection, but there's lots of viral stuff floating around here, so pray I stay relatively healthy

- Language barrier is super tough overall -- today some of the maintenance crew sat me down and gave me a Creole lesson....basics like hi, how are you, my name is, what's your name - which was awesome.  They really want to help me learn, but I suck at learning languages, so pray that maybe God rewires my brain or something and I can start to learn these.  If I'm gonna work in Haiti and the DR I really should become somewhat proficient in Spanish, French, and Creole

Thanks everyone.  I'll update you more tomorrow!

-Aaron Tabor

Arrived in Haiti! December 27, 2013

Hello everyone,

I made it to Haiti! Got in yesterday morning and met up with Bob and Rae, the American Salvation Army couple who work in Port-au-Prince, and they drove me down to Fond-des-Negres (pronounced Fond-de-Neg for those of you who don't speak French like me), which was about a 2-3 hour drive.  The place I'm staying is far nicer than I expected, like beyond anything I would have thought.  The overall complex is very nice here, though the hospital is small and mostly what I expected, the living quarters above it are pretty much any normal apartment building.  I have my own room with a bed, desk, and private bathroom.  The electricity does come and go, but for the most part we always have it because the hospital has a back up generator.  Still have the mosquito net hung around the bed, though everything is screened in and my host thoroughly soaked the room with mosquito spray just in case.  They seem to always be cooking, so I definitely will not starve.  Yesterday they cooked "lunch" which consisted of chicken legs, spinach and carrots, potato casserole, rice and beans, and then for dinner they made a type of porridge that was pretty amazing.  Aside from touring the complex yesterday and going through all my luggage and supplies (yes, everything made it!), the day was pretty chill.  I will start working in the hospital today, which I'm still not sure what that will consist of, but we shall soon find out.  They do have a fully functioning pharmacy that seems to have a good variety of medications, and the TB ward is off in a separate part of the hospital where the patients stay for 2-6 months receiving treatment.  The rest of the hospital is separated into men, women, and children, though it's pretty much mixed whenever there is overflow.  There are small "kitchens" around the outside where the families wash the clothes and cook on small stoves, essentially charcoal grills -- if you stay in the hospital your family has to provide everything for you while you're here, there isn't a hospital staff like that or nursing care that even changes bandages and such, so the families are very involved.  They do sell the drugs to the patients as well, and that's the main source of income for the hospital.  If patients cannot afford it, there is some way they work around that, usually asking other patients to help pay it seems......everyone here is very communal, if anyone needs help they just help you and keep walking.  If a child is trying to cross the street you'll see someone grab their hand, get them across and then keep going (which I tell you, the streets are like....well Bob says it's like driving in a video game, and I agree....people are just crazy).  The computer I'm typing on is in the main living room and I have access to it whenever, so I will be easily able to send e-mail updates to you all and let you know how things are going.  It's not WiFi that I've figured out at the moment, so no pictures will be coming your way for now.

I'll let you know how the day goes!  Pray that I stay healthy and that I can be effective in treating our patients today.  Thanks so much.

-Aaron Tabor

Leaving for Haiti: December 25, 2013

Hello and Merry Christmas,

Thank you again to all of you who have supported me and helped make it possible for me to go on this trip to Haiti.  I will fly to Ft. Lauderdale tonight at 7pm, and after a 7 hour layover, head to Haiti and arrive in Port-au-Prince at about 8:30am tomorrow on the 26th.  I will be picked up by a Major in the Salvation Army who will drive me 2.5 hours to Fond-des-Negres where I will stay and work at the Bethel Clinic for the next 10 days.  I believe I will have some e-mail access while I am down there, so I will do my best to send e-mail updates letting you know what's going on and some prayer requests.  

Main prayer request is that I can be effective in providing medical care to the Haitian people.  I will be working alongside the Haitian doctors and nurses at the Bethel clinic, and I am excited to see what I can learn from them and what I can teach them as we use the limited resources to provide medical care.  Obviously I hope that I don't get terribly sick.....I've taken the necessary precautions with updating my Typhoid vaccine, taking Mefloquine for Malaria prophylaxis, antibiotics for traveler's diarrhea, etc.  They have told me they will be providing me with bottled water, and most of the food should be cooked for me by someone who will make sure that it's fully cooked and as clean as it can be.  Obviously there is still some risk in me picking something up, so prayer that I stay healthy so that I am effective would be appreciated.  

Other than that, pray in any way he leads you.....I don't know much about what I'm doing and where I'm staying yet.  The hardest thing is going to be the huge language barrier, though there should be a few people there who speak English and will help me translate and teach me some Creole.  

Thanks again for the support and your prayers.  I look forward to sharing with you all that happens down in Haiti.  I'm also looking forward to the 90 degree weather and leaving the snow!  

-Aaron Tabor