Ambulance Roulette

"The ambulance here is used for everything", Fr. Geordani explained to me today. 

This morning I possibly would have gone in the ambulance to the Dominican Republic to fill small oxygen tanks, but was informed that today would not be a good day to go.  Presidential elections were yesterday and conditions might not be entirely predictable. In fact Fr. Geordani used the ambulance just last night to take two people who were shot in Cap to the Domincan Republic for safety and care. Thus, I went to the clinic and started triaging. 

TANKS SANS OXYGEN

One patient came in grasping her relative's waist as she walked in. She was clearly in respiratory distress, with trach tug, flaring, grunting and RR in the 40's. The nurses didn't seem fazed in the least.  Next door to the doc we went. He ordered an H&H, stool exam for parasites and a test for typhoid. Lungs seemed clear, that is in this loud clinic. I suggested an IV and a neb. He ordered Ibuprofen for her fever and IV fluids. IV started, 2 atrovent neb treatments and 4 puffs of albuterol later, she was still retracting but less severely and lungs were clear and open. St. Francois de Sales has no oxygen except for in the operating room. That tank is gargantuan, hooked up to the anesthesia machine and I could find no way to administer it to her. In my mind I thought, "She should be transferred to Justinian Hospital in Cap.", and so I tried to convince the doctors she could brochospasm more severely in the near future and that we should consider transferring.


A few minutes later, a woman who had drank battery acid was brought in with screams of pain. Soon thereafter, we were on our way to Justinian. A couple minutes into the ride, the patient ceased to breathe and was pulseless. I started CPR while thankfully the doctor drove on the pothole laden, bumpy road, swerving around motorbikes and trucks to Justinian. No oxygen to give her, I was it. I was unable to open her jaw, so I opened her airway the best I could and breathed into her nostrils, her eyes blank and body flaccid. I thought she was gone for good as we were jostled about. I have never given CPR in an ambulance before and it was a jerky transition between compressions to administering breaths.  At about 4-5 minutes into the ride she blinked, no respirations, but a sign of hope. I shouted to my valued translator, tell her to breathe! She barely nodded no. After the quick ride, about 10 minutes, she was blinking but not breathing. I gave two last rescue breaths then she was lugged from the ambulance, into the hospital. After that, I didn't lay eyes on her.  Later today, I thought to call the American nurses that I'll be working with tomorrow in Cap-Haitien. They happened to be @ Justinian hospital and will try to check on her. 

HOPITAL ST. FRANCOIS DE SALES, VAUDREUIL

I know God's love is with us. I couldn't have known that today, of all days, we REALLY needed the ambulance here! I could have been in the DR getting oxygen or could have chosen to bring the respiratory pt to Cap. and not returned in time for the patient who really needed it. There would have been no way we could have transported the poisoned woman to Justinian Hospital quickly without the ambulance! If you pray, please do so for her and her family!  Thanks for everyone's thoughts and prayers for the Haitian people and for me individually!

Clinic and Lab Life... Anyone have any lab equipment to spare?

Patients waiting in the morning for consultation

Open Air Waiting @ St. Francois de Sales

I wanted to post these pictures earlier, but alas, 

the internet was down. Things are very different here. Nurses order lab results and possibly order medication. I'm learning about what medications they have to offer, however simple dietary changes could really benefit this community. Tampico (sugar water with juice added), kola (the name for all soda), energy drinks and coffee seem to be preferred over filtered water.  It is not uncommon for 3 year olds to be drinking coffee. So far for carbs, I can only find white bread, white rice and, THANKS BE TO GOD...at least I found bulgar wheat.  According to the nurse I'm working with, all of the following complaints warrants a stool exam: vant femal (bellyache), tet femal (headache), granfe (rash), dyare (diarrhea), or lafyèv (fever). Anyone with a fever is tested for Malaria and anyone with a fever > one week for Typhoid as well. I see a lot of UTIs, yeast infections and rashes. 

Part of the Pharmacy

Part of the current lab.

Centrifuge with it's broken buddy

New lab being built on second floor.

Spectophotometer

Lonely Microscope

The lab doesn't have the ability to run chemistries. It has one microscope, one centrifuge, one spectophotometer and no autoclave. All other equipment needs to go to the lab equipment mechanic...and there isn't one here.  The clinic has an open air waiting area which is fine on most days, except when bad weather shows it's face. Thankfully there is an x-ray machine just down the street. The nearest EKG is in Cap-Haitian. I have yet to see an otoscope/opthalmascope. Just a couple days ago I asked why there was no oxygen in the ambulance. Saturday, I'll be picking some up. Thankfully the doctors and nurses are kind and patient as I learn kreol and read up on tropical diseases.

Parish balcony, Church Door and Dogs

As promised, here are more pictures of St. Francois de Sales. I'll be posting pictures of the clinic next. Pleasant quiet breezes are found on the balcony. Goats, pigs and cows roam on the adjacent lot which serves as a dumping ground for some. However, there is also a little plot where corn is grown. The shed-like structure is where the guard dogs hang out during the day.

The parish. I live upstairs.

View off balcony.

Metal birds and flowers as entrance of church.

Vaudreuil (pronounced VO-DRAE)

One week and one day into my life in Haiti, I've collected photos on my camera, but am having difficulty uploading them. Here's a few, with more to come...

Sign for St. Francois de Sales Hospital

Gate to St. Francois de Sales Church and Parish

St. François de Sales Catholic Church

This past week I worked in the clinic here, with my translator and another nurse at my side showing me the ropes.
The clinic and hospital are very small with little assessment equipment.  I wish I would've invested in an otoscope and pulse-ox monitor. There is a laboratory on site with very limited options.  Sometimes nurses examine patients and order labs, something I'm not accustomed to deciding. On Wednesday, I spent time with Mama Baby Haiti, at a rural clinic they hold weekly at an open air school. The Docs and Midwives were great to grab assessment tips from.

I've visited Cap-Haïtian 3-4X's now since it's not far, about 8 kilometers according to Fr. Geordani.
Last night I accompanied a patient in the ambulance to St. Justinian, the main hospital in Cap. The patient's head was hit with a cement block and he was unconscious for about 1/2 hour prior to transfer.  It was a challenge to keep him talking with my limited kreyol and no interpreter at my side. Making him name everything in site drained my vocabulary but thankfully I knew most of the right answers.  Potholes and nutty drivers crowd the road that leads both to Cap and Port-au-Prince. I hear it takes about 4 hours to get to Port-au-Prince.

Here in Haiti

     04:00 yesterday my alarm rang to prep for my IBC Airways flight to Cap-Haitien. It was the only airlines that I could find that would fly directly into Cap and the only one of the day. I stayed the night before at the Miami International Airport Hotel, and I'm so glad I didn't have to get up any earlier. At the airport, a cluster of college kids and a Haitian pastor kept me company before and during the flight. As the plane approached Haiti, it was clear why this land was named Ayiti which means mountainous land in the Taino language. The Tainos were the naives on Hispanola when Columbus arrived in 1492. The mountains are glorious, the land green, that is compared to the high desert of New Mexico, and the lovely breeze is crisp.

When I arrived @ the small Cap-Haitian Airport, I was greeted by my kind host, Father Geordani. He has gone out of his way to connect me with Americans, taking me to Cap last night to have dinner with Hannah, who works with the Cap-Haitien Health Network, and today introducing me to volunteers with Mama Baby Haiti, a fairly new nonprofit that is introducing prenatal care and natural birthing to the community of Vaudreuil. I’ll be working with both of these organizations while I learn Haitien Creole. 

The living quarters are adjacent to the hospital, school and church. The buildings are behind a 24 hour guarded high concrete fence and metal gate. A locked metal gate at the bottom of the stairs and the lock on my room door further ensures my safety. 

St. Francois de Sales Hospital and Clinic in Vaudreuil, Haiti