One baby's omphalocele and yesterday's story of trauma.

What a cutie pie!
The nurses here will be changing the gauze on this little one's omphalocele daily.

A few weeks ago, this baby was born and we brought him to the main hospital in Cap-Haitien thinking he would receive surgery. We placed a sterile saline dressing on this baby's abdomen with plastic wrap over it to keep it moist. I was surprised yesterday to see this baby in the clinic and decided to take these pictures. This condition is called an omphalocele.

According to PubMed, "an omphalocele is a birth defect in which the infant's intestine or other abdominal organs stick out of the belly button (navel). In babies with an omphalocele, the intestines are covered only by a thin layer of tissue and can be easily seen." It is not uncommon for this condition to be accompanied by other birth defects, so I hope to see this baby often in the clinic so I can check on him.

Wish I had the "man-made" cover for this baby omphalocele, as mentioned in the PubMed article.

You might ask, "How is this dealt with?" The following is an excerpt from PubMed: 

Omphaloceles are repaired with surgery, although not always immediately. A sac protects the abdominal contents and allows time for other more serious problems (such as heart defects) to be dealt with first, if necessary.

To fix an omphalocele, the sac is covered with a special man-made material, which is then stitched in place. Slowly, over time, the abdominal contents are pushed into the abdomen.

When the omphalocele can comfortably fit within the abdominal cavity, the man-made material is removed and the abdomen is closed.

Sometimes the omphalocele is so large that it cannot be placed back inside the infant's abdomen. The skin around the omphalocele grows and eventually covers the omphalocele. The abdominal muscles and skin can be repaired when the child is older to achieve a better cosmetic outcome.

This baby is breastfeeding and producing diapers with both pee and poo. That's a good sign!

Here's an example of a tap-tap which is the mode of transport for many Haïtians here. Many people use motorcyles and I have even seen a mom carrying her baby while she sat on the back. There are no traffic signals and the roads are in horrible condition with many potholes. Thus, we see a lot of motorcycle accident victims. Yesterday evening, I was asked to bring the ambulance to the hospital and  we quickly rushed a little girl, about 8 years old to Justinian hospital in Cap-Haitien. She was bleeding from her ears and nose. I was very concerned she might stop breathing on the way. It was dark in the ambulance and I could barely see to adjust her IVF's.  My attempt to feel her chest rise was frequently interrupted by my inability to keep myself seated.  I'm thankful to say she was still breathing when we arrived, but I don't know if she made it. She was unresponsive and her pupils were fixed. Please pray!

Mama Baby Haiti

I've realized that the 1st month's time in Haiti, I was unable to keep up on posting, so now it's catch-up time. Within the first week, I met Mama Baby Haiti, the non-profit that's located just down the road from me. The mission of these midwives and naturopathic docs is to lower the maternal, fetal and neonatal mortality rate in Haiti. They graciously agreed to let me come with them to one of their weekly rural clinics. We walked up a dirt road, past a creek, to a remote location in Morne Rouge, where people have set up a school and where a local congregation also meets on Sundays. The congregation has been trying to build a church for years, but lacks funds. The school is in bad shape, it has a roof, partial walls, broken chairs and is decorated with faux flowers that hang from the ceilings. Plastic flowers usually upset me, but these preciously positioned ornamentations sweetly hung in the breeze. I was touched by the care people have for this space.

At the school/church in rural Haiti's Morne Rouge.

The clinic quickly filled with kids and breastfeeding moms, and I assisted with assessments, taking vitals and listening to heart, lung and bowels. 
I was shocked to see how many rashes and skin infections the kids had and initially wished we had a dermatologist with us, but the 3 docs with Mama Baby Haiti confidently treated these infections. 
I learned a great deal from these doctors that day.

This little girl, about 6 years old, has a terrible infection that was treated during Mama Baby Haiti's rural clinic.

Two out of the three Mama Baby Haiti naturopathic doctors, Sarah and Sean, standing in front of this Grandmother's house. She cares for at least 8 kids and reports she struggles to provide meals.

These doctors truly care about the community in which they serve and are hard at work. I just spoke to Dr. Sean Hesler this evening, he told me they're swamped with patients and normally have to turn many away. 2 days a week they see children, 1 day adults, and 2 days are reserved for prenatal care. They have a wonderful birthing space for delivering, equipped with the essentials, in case of complications. As they treat patients, they focus on supporting the immune system.  Please visit their amazing website and blogs!

Mama Baby Haiti Website:
http://www.mamababyhaiti.org

Mama Baby Haiti Blogs:
http://www.doktesarah.com/
http://drseanx.com/

I am inspired by their hearts, physical work and their vegetable garden to boot!

Here I am my 1st week in Haiti, with Mama Baby Haiti staff and my excellent interpreter Joseph. 

Shada A.K.A. Slums of Cap-Haitien

Two weeks ago, I spent time with some dentists in Shada, the slums of Cap. Since then, I've been able to visit 3 times. Food for the Poor distributed furniture for the lone clinic there, along with 10 bags of rice and soy! I was blessed to participate in these distributions and learn about this community. Coming here is like walking into an infomericial for Feed the Children or another non-profit, except with the added sensory experience of smell. The stench is strong but the children's curiosity and beauty quickly help you ignore your olfactory system.

The people of Shada.

Shada, at the edge of the ocean.

People waiting for the dental clinic in Shada.
I went 2 weeks ago to help American dentists and to learn a technique used for cavities when little to no supplies can be found.

Timoun ak mwen (Children and me). This was my 1st day in Shada. 

Myself and Madame Bwa. Madame is a lay healthcare worker who lives and runs a clinic in Shada. 

This little girl is obviously malnourished. Her hair is red. This meal was provided by Food for the Poor and Madame Bwa. 

Food for the Poor provided rice and soy for these kids, while  the community added bean sauce, okra, oil , time and love. Madame Bwa said she had to spend her own money to provide the extra ingredients.

Beautiful children!

This little twin is not a newborn. According to her mom, she's 3 months old.

Aww! No scraps for these guys...no crumbs to give.

I spend most mornings at St. Francois de Sales clinic with some runs to Justinian Hospital in the afternoon or evenings to transfer patients. Since my last post I transported a baby born with gastroschisis, a woman in hypertensive crisis, a dehydrated boy who has a heart murmur and a woman hit by a motorcycle. The roads are in despicable shape and I'm so grateful that I'm not the driver. Since my last post, I've come to learn that the woman who drank battery acid survived and is at home! 

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.