The Harsh Realities of Haiti: Patients Who've Tugged At My Heart Strings

I've had many questions about the types of patients we are seeing in Haiti, so I thought I'd write a blog about some of the ones who have really tugged at my heart strings.

My first week working as a licensed doctor was spent in Haiti and on my very first day a group of volunteers from MamaBaby Haiti (including a group of midwives) were volunteering at the nearby Hopital St. Francois, a catholic hospital run by our friend Father Geordani.  I felt completely unprepared for what I saw that day without my safety net that I got used to in school of a whole group of students a a doctor working on each case.  One of my first patients that day was a young pregnant mother who resembled a skeleton.  She was brought in because she was having contractions at 34 weeks.  Her eyes were sunken into her head and she didn't have an extra ounce of flesh anywhere on her body.  After questioning her, we discovered that she had been starving herself since she found out she was pregnant because she didn't have a way to feed yet another mouth.  It was finally determined that this woman was not in true labor but was likely contracting due to dehydration.  The nurses gave her an IV and we spoke to her about the possibility of putting her baby up for adoption when the time came.  Eventually the contractions stopped but we have no way of knowing what ended up happening to this suffering mama and her poor baby.

The next little patient is a sweet little baby girl named Sabina Mae. Before she was born her mother had come to see me for a couple of prenatal appointments since we didn't yet have a midwife on staff.  I taught myself how to use a doppler and learned what information I needed to get from these women by looking back at my notes from Obstetrics class and making frantic calls to the midwives on our board.  The day Sabina Mae was to come into this world, was the first anniversary of the earthquake, January 12, 2011.  Her parents showed up at our gate in the morning asking if she could be born at our clinic.  We had a midwife coming in just two days but since neither Sean nor I had ever delivered a baby, we told her we would drive them to the hospital.  Her mother looked so frightened, with blood staining the back of her nightgown, holding onto her husband's arm with each contraction and they were worried about the cost of going to the hospital.  We assured them that we would be able to assist them and that all they had to worry about was getting the baby out safely.  We got them to the hospital and I was planning to stay with them but the staff at the hospital didn't want us to be in the delivery room. So we asked Sabina's parents to call us when they were finished for a ride back to our clinic so she could recover.  After just a few hours we got the call that a new baby had been born safely and that both mom and baby were doing well!  It was a wonderful surprise to me to find out later that her parents wanted me to be her godmother!  This not only meant that I got to choose her name, but would also  be responsible for Sabina if anything was to happen to her parents.  I felt so honored that I started to cry.  I chose Sabina which means "peace" to honor the day she was born and Mae to honor my Great-Aunt Della Mae who had recently passed away.

Marc was about 1.5 years when his mother brought him in to us.  She complained that he was irritable, not walking, had a poor appetite and was losing his hair.  At first glance I would have guessed he was about 8-9 months of age but was shocked to find out he was actually as old as he was.  It turned out he had marasmus which is a condition of gross malnutrition.  He had not been breastfed and had instead been given a mixture of flour and water along with Gerber baby food from 3-4 months of age until the day of his visit.  I had to excuse myself and go have a little cry when his mother told me all of this wondering why someone couldn't have intervened sooner?  Why is it that in Haiti mothers don't have access to good lactation consultants and education about what to feed their children?  After a few minutes of feeling upset and frustrated, I realized that this is exactly why we are in Haiti.  It is still often hard to know that no matter when we arrived here we would have been too late for some but I try to focus on those for whom we've made and will make a difference.  After pulling myself together I went back into the exam room and tried my best to educate his mom about what was going on and how she needed to slowly change his diet to one more appropriate for a 1.5 year old.  We have not see this little guy since this visit but I think of him almost every day and hope he's gaining weight and getting some more balanced nutrition.

Rosenaka on her first visit.

Rosenaka is a 2 year old female who was brought to us by her mother.  At first glance I thought she had been the victim of a burn accident but upon further questioning, we realized that she was suffering from a serious case of Impetigo.  Her mother said they had been to several doctors and she had not had any improvement.  This staph infection covered the majority of her head and face as well as her genitals and it was obvious this child was seriously suffering and had been suffering for a few months.  We prescribed an antibiotic and after 5 visits now, she looks completely normal.  Our next goal with her is to help her to gain some weight and to eat a more balanced diet.

Rosenaka at her most recent visit last week with her mother and Dr. Sean.

Another patient I saw while volunteering at the Hopital Saint Francois was a 12-year old boy was brought in with severe watery, tan-colored diarrhea with mucous, vomiting, leg pain, and lethargy. His eyes were sunken and rolling into the back of his head and all he could do was to lie on the bed.  All of these symptoms pointed to a diagnosis of cholera and we knew we had to act fast.  It's become commonplace to simply diagnose cholera clinically because of the serious lack of access to stool testing, not to mention the lack of time.  It's not unheard of for a patient with cholera to pass away within just 12 hours of the onset of symptoms so if it looks like cholera we treat it like cholera and ask questions later.  For this little guy, he was so dehydrated that we were unable to get an IV into his veins so we decided to rehydrate him rectally and orally.  After watching him for a while we also decided to give him homeopathic aconite because of his shock-like presentation.  The aconite really perked him up and he seemed to get that spark back into his eyes after just a few minutes.  This gave us a lot of comfort but we decided to try to get an IV into his arm again because we knew we weren't out of the woods yet.  Unfortunately it was late in the day and the hospital said we had to send him home (seriously????) so we asked if they would transport him to the cholera ward in Cap in their ambulance.  The response was that the ambulance is not for patients with communicable diseases and he would need to take a taptap. Again seriously???  We knew that we were unable to bring him home with us because at that time we didn't have any resources so we decided to drive him to the cholera ward in our own car where he would receive overnight observation.  I was unable to ride along due to lack of space but I'm told the ward was really a gymnasium with lines strung across the length of the building on which IV lines were hanging.  Connected to the IV lines were 200+ patients, mostly lying on the floor receiving treatment from a completely overwhelmed medical team.  Some of the patients had clearly passed away but the medical staff did not apparently have time to deal with them, they just had to move on and try to help as many people as they could.  I don't know what happened to this little guy but I have hope that he made it.  Cholera in Haiti has been a seriously scary situation, but I'm happy to report that we saw this patient in early November when cholera was relatively new and still on the rise and fortunately the situation has gotten much better in Haiti: daily infections and deaths are considerably lower and many more medical professionals, especially Medecines Sans Frontieres (MSF, better known in the US as Doctors Without Borders) have since arrived to focus primarily on combating this disease.

These are just a few of the several hundred cases we've seen since starting our work in Haiti.  Those several hundred are just several hundred in the pool of millions of Haitians of whom only 1 in 10,000 has access to a doctor.  Please take some time to reflect on this and consider what you can do to change these lives and this country.

Mesi,
Dokte Sarah

Trip to Cap

We spend the majority of our time at the birth center, especially since we are without a car right now so yesterday all of the girls living here decided to make a getaway.  Originally Sean was invited but he decided to stay home and fix his computer.  The mission was to acquire junk food and fabric to make skirts and maybe have lunch in Cap-Haitien.  It would have been a day JUST for the girls except we decided to bring Santo to help us translate and for some protection from the guaranteed cat calls you will get if a group of ladies are out on their own in Haiti.  We walked across the street to the tap-tap station and miraculously were able to fit all seven of us (Edie, Ashlin, Zeenia, Charles Marie, Rida, Santo & me) in the same tap-tap.  For those of you who don't know, a tap-tap is the main form of transportation in Haiti.  This picture gives you an idea of what it's like to drive around Cap and a tap-tap is pictured to the right.

A tap-tap is made from a small pickup truck with a cover on the back, some benches are installed for people to sit down and usually very loud and chaotic music is blaring.  Standing on the back of the tap-tap (as in this picture) is the manager who is responsible for tapping on the side of the vehicle to tell the driver when to stop and start. He also collects 10 goudes (about 25 cents) each way from each person who wants a ride.  Since this is usually the only source of income for both the driver and the manager, they try to cram as many people into the tap-tap as possible.  For example yesterday our tap-tap had 24 people at one time riding along (4 in the front seat, 4 standing on the back bumper and 16 in the bed of the truck).  Once the benches are crammed to the max with 7-8 people on each one, people stand in the middle sort of bent in half resting their hands on people's knees or they will just sit on the laps of those seated on the bench.  It's quite an experience especially with the loud music and the lack of deodorant that's a noticeable scent in the air.  After about 45 minutes we finally arrived at our destination in Cap and decided to head for the market.  After about a 20 minute walk and a couple of close calls with a motorcycle and a car (the rule in Haiti is the bigger your vehicle the more right-of-way you have with pedestrians being at the absolute bottom of the barrel) we arrived at the Americanized market where I bought a few munchies for Sean, myself and our Haitian staff to enjoy with some birthday money I had been given.  I felt like a 12 year old spending my birthday money on treats but this is the first time we've really indulged since being in Haiti and it felt good to know I didn't have to feel guilty since I eat a pretty clean diet here.  Edie one of our midwives was thrilled to get her two-liter of diet coke even though we keep trying to convince her that she will do much better on water.

After filling our backpacks and arms with as many treats as we could hold, we headed for the restaurant (one of 3 or 4 in Cap that's safe for American tummies) for lunch.  I was SO excited to find that this restaurant sells "Bon" ice cream which is a treat we enjoyed when we were in the Dominican Republic!  This is the first time we've seen ice cream in Haiti so we'll have to remember it for future reference.  The sign outside said one of their specials was a lobster salad and being right across from the ocean, Zeenia and I knew we had to give it a try.  We were also craving hamburgers and french fries so we decided to split both with pineapple juice to top it off.  At one point our waitress even brought out french baguettes with REAL butter, not the margarine we have to use at the birth center due to no available refrigeration.  This restaurant is a nice little diamond-in-the-rough from the absolutely insanity that is Cap-Haitien.  It's an outdoor restaurant owned by a French woman, the food is delicious, the service is great and at night they have live music and dancing.  We often see other aid workers from MSF and the UN there.  If all is quiet you can hear parrots and other creatures in the trees and like yesterday, there are often white caps out on the ocean to watch.  I think this will be one of our getaway spots when we need to have some time away.

After lunch it looked like it might rain so we decided to put the fabric shopping off for another day and to find a taxi home.  We found two for a decent price and piled in.  Ours was a relatively calm ride, but Edie reported that she had to close her eyes and pray because apparently their driver took great pleasure in freaking her out with near-collisions.  We had such a great time and now feel recharged to continue our work.

Power Struggle

As in most developing countries, and Haiti is no exception, electricity is almost never a consistent thing.  In the 3.5 months we’ve been here, we’ve had maybe two days where we had power for an entire 24 hour period.  We’ve had several days with NO power in a 24 hour period or power at completely erroneous times such as from 11PM to 3AM.  Sean and I have theories that the power is controlled by a little hamster on a wheel and when it gets tired the lights go off.  It’s always funny to me to watch the transition people make during their stay in Haiti.  On their first day they say things like: “wow, there isn’t any power how do you survive?” or “I’d love to have a shower but there’s no power…” or “How can I check my email with no power” or “Am I really supposed to deliver a baby in the dark?”  By the end of their stay most people will cheer when the power runs on, stop whatever it is they’re doing to plug their electronics in and after taking a shower will check their email and update their Facebook status; even if it’s 3AM and they’ve been asleep since 9PM.  Martin for example, one of our current volunteers who has spent his month in Haiti making us laugh and tirelessly working on fixer-upper projects has been trying to build gates for us for the better part of a week now.  Whenever the power is on he runs down to the garage and welds furiously, coming back inside frustrated saying “I was 15 minutes away from finishing before the power went out”.  So he decided to adapt to his circumstances.  The night before last when the power came on well after midnight, he rigged up a work light and spent a few hours working on the gates.  I think he’s almost finished so let’s hope the power cooperates today.  We’ve noticed a really interesting phenomenon about foreigners coming to live in Haiti: Everyone gets really sleepy right after dinner and will usually go to bed within a few hours of the meal.  We eat around 5:30 or 6PM and it’s not uncommon for most to be fast asleep by 8 or 9PM.  Everyone also naturally gets up around the time the sun rises which is usually about 6 or 6:30AM.  It’s amazing how your body will adjust to be in rhythm with the sun when give then chance.  Sean and I are really loving sleeping this way and as any good naturopath knows, good sleep is the key to good success so we must be well on our way. J

Introduction and Krapos

My name is Sarah Preston Hesler and I am a Naturopathic Physician (ND) who recently located to work in northern Haiti along with my husband Sean Hesler, who is also a naturopath.  Why Haiti you ask?  Why not?  Haiti is the poorest nation in the Western Hemisphere and that was before the terrible earthquake in 2010.  Add on top of that the cholera epidemic and political unrest that have been plaguing Haiti as it tries to recover.  Then consider the rising food prices and the fact that 1 in 10,000 Haitians has access to a doctor and you can see why we are here.  Haiti needs help so badly and as time goes by I will be sharing much much more on that later, I'm sure.  More on what we are doing here: Sean and I are employed by the organization, MamaBaby Haiti (www.mamababyhaiti.org) a 501c3 who's mission is to reduce the maternal, fetal and neonatal death rates in Haiti and we are the medical directors for the birth center/clinic.  Our center is located in Morne Rouge just west of Cap-Haitien.  On staff we also have a lovely Haitian nurse midwife, Charles Marie who is extremely competent and very sweet with the women who come to our facility to have their babies.  We also have frequent volunteers from doctors, to midwives, to students to community volunteers who just want to help Haiti.  It's a pretty great life but it's just amazing how different things are here.  Yes we're all just people trying to survive in this world and some of us are having an easier time of it than others but honestly sometimes it's so shocking how different things are here.  

Take the Krapo ("frog") Incident for example:  Before I can tell you this story I have to give you some background: On our property we have a swimming pool.  This pool is not filled and is ridiculously big and deep.  We as an organization don’t know what should be done with it.  We could fill it but when you consider that most of our patients don’t have access to clean water, how can we justify swimming around in it for fun?  We've considered the idea of filling it with dirt for extra garden space, filling it with fish to provide more sources of protein for our patients or just leaving it as is.  The matter has yet to be resolved so for now, it collects rain water and as of today has a fence around it to prevent any small children from falling in.  Many creatures have taken advantage of the collecting rain water including mosquitoes, dragon flies and krapos.  We have tadpoles and krapos who like to make a LOT of noise at night.  As the tadpoles were growing, we realized that most Haitians are TERRIFIED of krapos and claim they will “pee in your eye and you will go blind!!”  This of course makes all the Americans laugh hysterically.  The Haitians however, don't seem to have a fear of the same things we Americans fear like spiders, snakes, or mice.  When we are shreaking and running away from a mouse or a spider they are laughing at us so I guess it all works out.  

Anyway, back to the story: One day someone brought a full-grown frog into the pool as a joke and Sean, our friend Zeenia and I decided it would be a good idea to catch it.  Santo, our translator who lives and works with us started throwing pebbles at the poor thing and was yelling emphatically for us to leave it alone and that we would surely lose our vision if we picked it up.  Sean eventually caught the poor thing and started chasing Santo around the yard with it.  Santo ran out of the gate and down the road and one of us decided it would be hilarious if the frog was in his bedroom when he came back.  Yes this is what we do for entertainment with slow, spotty internet and no TV.  We went about our business as usual until Santo came upstairs saying “You put the frog in my room!”   We took the frog out of his room and then started getting threats from Santo that he would put a snake or a spider or a mouse in our rooms.  He would walk by us and say “I have three mice for the three of you…”  We hope this will be the first of many practical jokes that are played in Haiti.  Alright the power's off and the battery backup may die very soon so I better sign off for today.  Thanks for reading!

-Dr. Sarah