Friday, July 19, 2013

The Packing List

Fanny pack 
No longer stylish, but useful nonetheless.  When you quickly need bandages, a light, or gloves. Supplies are not as readily available as in a US hospital. For work in the triage tent or the ER.  We bought two fanny packs at REI, an outdoor store, before the trip.  One was way too big, so I’ll take it back after, unused.  My EMT niece and I shared the other one, trading off when the other came on shift.  Beth is my niece’s name; she wants to go to medical school.  I told her she needed Emergency Medical Technician (EMT) training if she wanted to go to Haiti with me.  So she did the class last summer.  Her nurse aunt and I guided her through IV practice on the relatives after family dinners.  Now she is pretty good.

Bandages and Chucks
Donated by Caroline from church.  Her husband was supposed to live longer, to need more home health.  But he left this world and the medical supplies were still fresh.   “Chucks?” the translator in Haiti said.  Like “Chuck Norris?”  “Yes, same Chuck” I laughed.  Refers to a large absorbent sheet with plastic on one side.  So useful when blood is dripping down.  To catch the life before it hits the floor.  Less messy.  Less dangerous than the splashing red.  For us, not for the patient.  For him it is less dangerous if he keeps his blood inside his veins where it belongs.

Cliff Bars
From Costco.  Very useful when hunger hits and rice and beans won’t come for several hours.  My wife bought two boxes for us before the trip.  I can’t stand going into Costco after a trip to Haiti.  Gives me nausea, even more than usual.  I take it out on the oversized cart--kicking it in the parking lot.  Why can’t someone even put it where it says “put carts here?”  How many suction machines could be purchased with one cart-load of junk food from Costco anyway?  Could have used another suction machine in the triage tent.  That patient, someone’s mother, hanging on by a thread.  Maybe if I had had another suction machine she would have lived.  Instead I rolled her over as the brown liquid no longer was vomited but ran out of her lifeless form, onto the floor, scattering the EMT’s like ants.  How much of that was from internal bleeding?  I will never know.  Autopsy is an unavailable luxury.  Need to move on to the next patient. 

From Walgreens.  $12 on my visa.  Should have gotten two.  Or three.  So useful for guiding the needle while suturing lacerations.  Hard to see the needle sometimes at night, or during the day, when the curtains are closed to keep it cool.  I use the headlamp to crown a Haitian medical student so she can learn suturing.  Then for the trauma surgeon since I couldn’t stop a hand from bleeding.  Into a bucket this time.  Too much blood for even Chuck Norris.  A deep bleeder, since the knife had gone all the way through. “Tendons OK, though,” said the orthopedics doc.  Maybe he should have bought a headlamp, too.  On another case, he lost track of the needle long enough to poke his finger.  Wasn’t a big hole, but he looked down and there was a bit of his life oozing out in little red bump.  Only one drop, but enough to tell him the risk, bring the fear.  The patient with HIV, not on meds.  One in 300 chance of getting the disease himself.  He wandered a bit after the surgery.  What should he do?  What of his wife and kids back home?  He mentioned it to me and I whisked him off for “PEP.”  No, not a talk, but a month-long mound of HIV pills called “Post Exposure Prophylaxis.”  Reduces your risk of getting HIV from your needle stick. They have five days for you here, and you can pick up the rest when you get home.  Take some nausea meds, you’ll need them.  It’s the same approach we take in the U.S. with HIV needle sticks. 

Baby wipes
I don’t use them, but my niece does.  Some days when she can’t bear the cold grungy shower.  I am not afraid of the cold shower.  I find it refreshing actually, though painful.  You feel new after, not just clean.  But the violence of that cold water is not enough; more than just sweat gathers on me in Haiti.  And it seems I don’t deserve a hot shower.  How could I be pampered when down the hallway death approaches due to lack of adequate washing?  Where the water itself has brought death by cholera instead of the life and cleansing it is supposed to bring.

I don’t really need them most of the time.  I can see 20/20 with one eye, at least after Lasik surgery, complements of the government, before I got out the Navy a few years ago.  But they help to read the x-rays, and God knows there’s no radiologist looking at them.  Except now there are some volunteers out of Duke helping out reading the CT scans.  That helps, except when I disagree with the read.  Hard to get a hold of them after.  Will have to leave that to the next team.  There is a European girl with several months of belly pains who comes for an ultrasound.  I talk her into a CT scan.  She can afford it and she needs it.  The radiologist from Duke says her adrenal gland has a tumor.  Let’s get her a copy of the CT; she will need that when she has a follow up in Canada.  They can compare.  See if it grows like a cancer or stays quiet, an unseen blemish of no consequence.  We hope.  I see fear in her eyes, and I do my best to speak to it.  Speak to God of it.  She has worked hard for the people of Haiti.

I always bring a whole box.  As a doctor, the last thing I need to worry about is whether I have a pen in my pocket or not.  So I don’t care if I leave them here and there around the hospital, even in the States.  If someone needs one, I hand it over.  Though at the same time I always bug the med student if he is unprepared.  They need to grow their anxiety a little sometimes.  Can’t be a good doc without some anxiety.  Didn’t know the pens would be so busy this time on a certain form:  the Haitian death certificate.  We write in English, trying to understand the form in French.  Getting the name right is easier this time, due to the printed intake form from the hospital’s new computer system.  In the Sates, I get the forms back months later:  what sort of cancer was it?  What stage?  Was it treated?  Usually I can figure out the answers to these questions by looking back through the chart.  But in Haiti the cause of death is more often a guess.  And the box of pens does nothing to make it clearer.  Nor can it hold off the power of death.  The trauma surgeon tried to take it in stride with a joke:  just fill out the death certificates when they arrive, he said, and save our time later.  The black humor of his trade; shared with soldiers, morgue workers, and the like.  I try that kind of humor some, but that shield for me is incomplete.   What gets through gathers in the pit of my gut somewhere and gnaws.

Sun block
My white skin is an extra chore, but something I can afford.  Trying to prevent a painful burn and slow the lines that are forming from various adventures.  Skin cancer risk doesn’t bother me.  I can’t fathom having it, though I have treated enough of it on others.  I bring for a week more than I can use in a month.  The excess margin our culture carries around.  Too much sun block above the eyes and it runs down in the mid-day heat and burns my eyes.  

I never have much time to read during my week of work at the hospital in Haiti.  When I am off shift, there are interesting people to talk to, quite the adventurers that volunteer their time.  Some quite wacky, maybe they can’t function in America.  Unfortunately the third world gives them default leader-status, at least at first.  But most are admirable, self-giving, and illustrations of a Covey Highly-Effective book.  The airplane ride, though, gives me reading time.  It is a long way from Seattle to Miami, and layovers to make the flight cheaper are also prime reading spots.  I bring a devotional to read in the early hours before I start work.  Crucial to forming spiritual energy that rapidly depletes during the long, draining days.  My book Authentic Faith by Gary Thomas says  “Our attitude toward God is defined by our actions toward the less fortunate.”  I share a passage with one of the nurses as she feels compassion fatigue:  “As you begin to reach out to the hurting, it’s important to check your sentimentality at the door.  In reality, it’s something we need to do with our eyes fully open.”  On the plane I read a less encouraging book: When Healthcare Hurts, by Greg Seager.  After that, one realizes that there is even more hard work to be done here:  Balancing helping and giving with critical and scientific analysis.

Didn’t need to use them.  The new headlamp lasted the whole week.  And I hardly used my otoscope this time: between the pediatrician helping me in the ER and just randomness I think, there were not too many ears to look at.  Probably should have left the C batteries in Haiti for the laryngoscopes.  It is difficult to keep the laryngoscopes ready for the next emergency.  This kind of code needs an Intensive Care Unit (ICU).  This hospital has one, an ICU that works.  The ICU is a major step up in complexity and cost in the third world.  It takes many batteries, along with working ventilators, trained ICU nurses, loads of equipment with a working supply chain, and many, many other things.  Though it doesn’t have all of the bells and whistles (and extra redundancy) of a high acuity hospital in the U.S., this oddly partnered hospital in Haiti has walked up this difficult step and is sustaining.  Probably has taken much more investment in time and money and training than anyone would have anticipated.  Someone should write a paper about it, I ponder.  Not me I hope; musing is more my line.  I put the batteries back in the garage when I get home.  A room that holds 2 cars and the boxes and bikes and lawn care stuff of an American family.  Seems wrong, like the Costco cart.  If this room were carried to Haiti, it could be another ward full of patients.   I could have accepted another person to the hospital.  Could have saved a life.  Lives for toys it seems.  Lord, have mercy on me. 

Seems rather pointless to put it on only once in the morning.  Like using a teaspoon to drain the ocean when I am on duty in Haiti.  Maybe it helps more when I am out of clothing and what has aired out on the bunk bed is going into service for another round.  Smelling good is another luxury.  When my wife and another niece pick us up from the airport, they are not shy to encourage us to visit the shower when we get home.  Walking around Miami in veteran Haiti underwear and then flying just did not produce an appealing fragrance for them.  Perhaps we should have sprayed on some perfume from the duty-free shops.  

Shoes with no holes
It feels like my feet are cooking in these shoes.  But flip-flops just will not do, with blood and needles and cholera.  The first time I wore these shoes here, I thought I would throw them away after.  With the bleach from the cholera tent and the ubiquitous dust from the earthquake rubble, they were not pretty.  But a shoe shine later in the Chicago airport and they were good as new.  Had them back three times since.  The first couple of times in Haiti I wondered why my legs were so swollen.  But my doctor buddy in the Navy explained heat edema to me, having had the same puzzle in Iraq.  A transient problem as the blood vessels dilate in the heat, probably worse with the salty Caribbean food and long days walking around the hospital grounds.  Beth added to her discomforts this edema and a significant reaction to the mosquito bites with quite a bit of pain.  I had to reassure her that, no she was not going to die or be disabled.  She got it.  Tears she had, but she kept them away from the patients.  During the work day, she kept a smile on her face.  That and management of chaos, skills of value ingrained in her over high school years of part time work by the McDonald’s corporation.  Who knew that Ronald would be so helpful in Haiti?

My Traveling Hat
I am very particular about my traveling hat.  This is my third over the years.  Brim bigger than the current fashionable Fedora.  Soft and wool made, so that unlike a cowboy hat, it can be crushed and bounces back to its original shape.  Helps protect my over-white facade, and makes me feel a little like Indiana Jones.  No whip though, and women don’t chase me.  I do enjoy the adventure part of these trips.  It is exciting to be there in the midst of the action.  Some are quite addicted to it, signing up for long stents with Doctors Without Borders or moving to places like Haiti full time.  I am taking it in doses.  Need to be careful not to overstep my bounds.  To avoid doing medically overseas what I cannot do well.

Small bills, they said.  For tips, for food, for souvenirs.  Needing more and more each trip.  As Haiti rebuilds, there are more things to do, more ways to spend your money.  The massive fields of post-earthquake tents are gone.  There are parks again, stores.  Back to urban sprawl.  When does post-earthquake camp change back to urban slum?  Perhaps in part defined by whose hands the money passes to and through.  The shop owner now, not the developer so much.  And still there is hunger.  Still orphans and knives and no margin.  An odd, odd thing, money.  Can cause so much damage and so much good.  A thing of faith and a thing of filth.


I always carry it on my person.  I don’t know really if that is safer than leaving it in the room.  Nothing seems to get stolen out of there.  And if someone came in with a knife and wanted my passport, I am sure I would part with it rather than part with an organ.  But I doubt that would happen, with our fenced area and our guards.  Our bunks are in the back hallway of the small hospital.  Formerly private rooms for patients back before the earthquake put things on top that were on the bottom and vice versa.  Many third world hospitals are like that:  a large open ward for the poor, and private rooms for those who can afford the rent.  It helps the hospital stay afloat.  Now they are just starting to reintroduce billing, a transition back to having the patients pay.  But it is only the open bay patients now; the private rooms are still filled with volunteers.  Hard to say what is better for the health care system and the patients: not paying or paying.  But those decisions are, appropriately, in the hands of those who don’t need a passport to live here.  Of course the passport for me is the final thing on my list.  Gets me on the plane out, back to the U.S.  Don’t even need a ticket any more really:  it is an idea rather than a piece of paper, accessed by the passport.  Who you are, or who the government and the bank define you to be.  Another book of faith.  Not as solid eternally, but it helps for now.  Means to an end I hope.  The many stamps in my passport reflecting a love: for the world, for cultures, for people, for life. 

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