4th Medical Mission to Bod me Limbe

Team Members
Tiffany Keenan, MD
Karen Cimer, RN
Daniel Robichaud, EMT
Monette Caissie, support
Anne McKinnon, RN
Jocelyn Daye, RN
Adrien Despres, support
Eunie Mcelwaine, RN
Magda Lisztwan, MD

Sunday, January 27, 2008

Our day started at 3 a.m.! Out to the airport to go on Lynx Air, a 20-seater with no bathroom for a 2.5 hour flight…We were met at the airport in Cap Haitien by Jo and whisked off by tap-tap on the goat path to Labadie. Not before stopping at the bakery for some chocolate croissants. It would have fit in nicely in Paris, with beautiful clean counters, many sweets and cakes, and an armed guard. The contrast between this little cookie haven and the outside was remarkable. At Labadie it was time to put all our luggage and ourselves into a couple of boats for the ride in the waves to Bod me Limbe with Tiffany and her raincoat covering her computer. When we reached the shore and the village, we were greeted with the running and giggling of a lot of village children as we disembarked. Then it was time to set up our beds with mosquito nets and plastic covers for the mattresses to keep the bugs at bay. We spent the afternoon unpacking the clinic supplies that were brought down from Canada and restocking the pharmacy shelves. All was ready for the clinic to start the next day. After a delicious meal provided by Jo and the village women who help him, we had a staff meeting to assign roles for Monday. We were all glad to hit the hay early after a long adventurous day.
Anne


Monday January 28th 2008

I think the roosters started crowing @ 4:30 this am and the mosquitoes are in ample supply. My rear-end is still a bit tender from the ride on the tap tap yesterday. Breakfast was ready to eat @ 7:00. The gruel topped with cinnamon went down very easily and the Haitian coffee was truly a treat. It looked really strong but was quite mellow. Jo and Tiffany were off to Labadie on the Jet Ski to pick up medication from the doctors on one of the cruise ships. Apparently, they had an interesting day, and ended having to stay over as the sea was too rough. Some of the Team were off to the village to distribute vitamins to the women, Anne and Eunie with Alex and Thermitus and Karen and Magda with Santo and Rivelino. Morel and I stayed back @ the clinic to receive women who were interested in Family Planning. Having never done this before, it was truly a learning experience, but by the end of the day had developed a learning curve for pregnancy tests and Depo injections. Monette and Robert worked in Registration and were efficient in pulling the needed charts. Dan was charge of giving a First Aid course. Instead of having two separate sessions, everybody arrived in the am. Old and young were together, but apparently went well. Apparently though’, Adrien’s day was the most fun. He’s been working on a play / singing group with the village children. The Haitians are such a talented, musical people. Just to make the day a little more interesting, we had many rain showers, too numerous to count. By supper, everybody was more than ready to eat. Goat was served and was delicious and surprisingly more tender than the beef we had last evening. Hopefully, Jo and Tiffany will get safely back in the am. To end the evening on a positive note, Rivelino announced the toilet was flushing – it’s amazing what a bit of duct tape will do … he would make Red Green proud.
Jocelyn

Tuesday, January 29th, 2008

Breakfast started a little late this am, not the usual 7 am. Guess things work a little smoother when Jo is around. Tiffany and Jo arrived before 8 o’clock from Labadie and we were all grateful to see them as their presence is absolutely necessary. After Tiffany answered some of our questions, we were at our stations by about 8:15am. By the end of the day, we had seen 152 patients. Some interesting things we saw were a woman who said every week she vomited a worm as big as a snake and as long as her arm. Tiffany treated her for worms and gave her a second dose for next week. We hope it works and who knows what the problem really was! Another person had spinal cord infection from syphilis. Thank goodness we don’t see this too often! Considering this was our first day in clinic, things worked rather smoothly. We saw the last patient at 6:15 pm. Jo’s delicious chicken dish went down very well. Most of us had another early night. For those who have been here before, we noted we have never felt such cool weather. People were asking for blankets and that is very unusual for Haiti. We all agree: it’s great to be here.

Wednesday, January 30th, 2008

After a cool breeze overnight and much gratitude for the quilt Joe gave me, the sun arose and the routine sounds of the morning began. Sweeping and calling of the women in the courtyard of the school, the slapping of sandals on the concrete, and my reluctance to leave my mosquito net cocoon. The sky was clear blue, the shower a rather refreshing trickle, and breakfast was once again fabulous. Egg “crepes”, banana/grapefruit salad, and freshly squeezed grapefruit juice. Delicious! Already at 7 am the people were gathering, and so the registration crew left the table around 7:30 am to start the process. The morning was much slower than the hectic pace of the first day, with people waiting a few at a time on the benches outside. Once again, I was faced with multiple complaints from each patient, all feeling the lack of regular medical care and hoping to leave with something in their hand. It reminded me of home! The babies were gorgeous, the children shy but shushed and propelled by their mothers to be examined by the “dokte”, and it seemed every women had some form of vaginal discharge. So many times when asked what they had to eat today, it was “nothing yet”. And you could not give money to everyone who asked for it to buy food. But there was satisfaction in giving vitamins, helping with acid reflux. My most interesting and sad patient was a 29 year old woman with a beautiful 6-week old baby. She had a right breast lump for a year, and this time it felt ominous. Firm, tender, definitely not normal. My prayer is she can use the money and referral to find a good surgeon for her.
The day ended early at 3 so there was time for a swim, including an entourage of variously clothed children. The soccer was a 1-0 victory for translators vs. Bod Me Limbe players. And after delicious shrimp curry in our 5-star Chez Jo restaurant, the night ended with music
uniting us. E.g. You are my sunshine. A good day. Happy in Haiti.

Thursday, January 31st, 2008

The rats were more subdued last night. We slept well. But the extreme palm-husk sweepers started again in the schoolyard at their usual 6am, shouting all the while slapping the ground. And my roommate, Magda, awakened in the same state in which she fell asleep – one of being chronically pleasant. So much to learn from her.
At 6:15 the roar of the crowd gathered outside the school started, gradually crescendoing until Tiffany made her appearance, in her pajamas, to organized the registration process. Mothers, children, the elderly and the seemingly well all pushed forward for the rare chance for better health and comfort. Meanwhile, behind a wall of concrete and guilt, we ate a breakfast of cornmeal bread, cheese, grapefruit, bananas, coffee and hot chocolate.
The clinic chaos operated as usual. My job, being Karen of Famasi, is to feign being the clinic pharmacist. With the essential help of my translator, Rivelino, medications are dispensed and explained: how to open bottles, plunge a syringe, breathe in through an inhaler, apply cream, insert suppositories, instill ear and eye drops, use a cane. Pictorial medication labels are used to designate when to take medications. Explanations are given, reviewed and regiven to patients who leave happy, dissatisfied, grateful, or oblivious. Dressings are applied here also, some to fresh wounds but most to chronic ulcers and infected lacerations and burns. Many are asked to return for daily treatment. They all comply. Any opportunity for obtaining more “stuff” is never turned down. The need is too great.

Today’s tally: 69 authorized visits and 157 patients seen in total.

We end the day as it cools. I have a Haitian beer on Jo’s roof while watching the local soccer match: shirts and skins and pants and no pants. The ball is coveted.

Tonight our rice is accompanied by chicken in sauce, black bean sauce, deep fried plantains and a spicy cabbage salad. The translators entertain us with an evening of dance and cross-cultural mocking. Team building at its finest.
Nine thirty. A late night to bed. The old cliché of the bed bugs rings true here.
But we have nothing to complain about. Nothing.

Friday, February 1st, 2008

An early morning for me as always. 6 am and I can hear the roosters crowing outside. It’s been a busy week to date but the weather has been just right with little rain and everyone is in good health which is wonderful.
So after another lovely breakfast at Jo’s we’re off to start clinic. Today an early start at 7:30. We’re doing well in the morning and actually see 97 people. But, on the way in there is a huge lineup so I spread the word that we’ll see children and pregnant women in the afternoon. We agree at 1:00 for kids and 2:00 for women. Little did I know that the word would not only spread through Bod me Limbe but the surrounding villages as well. Thirteen women showed up for the prenatal session which Eunie had outside under the large tree. It wasn’t an ideal situation but at least the women were seen, given maternal vitamins and advised to come back for a follow-up visit in May.

The children….well we saw 10 briefly just before lunch. Mothers held their children on their laps and exposed the affected part of skin. It was more like a pediatric dermatology session. So much impetigo…small scabs and sores on the skin caused by abrasions and contaminated soil. One little boy was very sick with several lesions on his penis so I started him on injectable antibiotics. The other 9 children were all treated with antibiotics. I told the parents the importance of wearing clothes or at least underwear on their children. One mother asked what she could do if the kids just didn’t like wearing clothes…a good response I thought. A little polysporin would go a long way in this group.

So then the Peds Blitz began. 84 kids in 2 ½ hours!!!! What an afternoon!! It was very interesting. A pediatrician (Angela that’s you) probably wouldn’t be impressed that we didn’t do proper developmental assessment with a complete physical exam, but we felt it important that we see as many children as possible. So…skin infections, pneumonia, ear infections, and meningitis. I’d say over 75% of those children received antibiotics plus one with injectable antibiotics for meningitis. All kids were also given albendazole to cover for worms.

It truly was amazing to be able to see so many children. I wonder what would have happened to them with the antibiotics. Some, I’m sure would have the immune response to fight them, but for others it probably would be just another hit to their malnourished bodies. We’ve decided to make these Peds Blitz’s days an ongoing part of our mission. (Though hopefully next time in a more organized manner).

So our work day finished just after 4:00 and was followed by an Italian dinner of Spicy Meatballs the Haitian way.

After our group meeting the evening turned toward a more Western influence and Jo’s small gazebo became a disco for all to enjoy. Time to let loose after a hard day of 210 patients.

Tiffany

Saturday, February 2nd, 2008

Today we all went out with the translators to the women of Guioten, Mongoio and Bouchi. It was a hot day but the walk wasn’t to bad, but it was a lot of fun. Its interesting to see how the people live in these villages and how they make you feel so welcome, its really heart warming. Throughout our little journey we saw really interesting things, like rice, pistachio, peanuts and cotton plantations, also we saw man making coal but best of all we got to eat fresh coconuts, very yummy. To get from village to village we had to take these little boats that really didn’t feel to safe, at one point some of us just skipped the boat and walked through a very mucky water, it was faster but much more disgusting. After coming back from this very interesting excursion, a few of us got into a boat with Mwele and cross over to caramel island for a swim, it was a lot of fun and very refreshing. Tonight we have our voodoo night, amazingly this turned out to be a lot of fun, music and dancing and a very big fire. I guess this is one of these things that you have to see to understand. To make this evening even more interesting and exiting we had some of Jo’s coconut daiquiri’s and peanut butter daiquiri’s very tasty. Over all this turned out to be a very exiting day.

Monette

Sunday, February 3rd, 2008

Woohoo! Our first official first day off. Its one well deserved. Early in the morning some of us toke a small boat for a beach day at Caramel Island with Mwele as our captain, the others decided to go to a Baptist Church in the village from 9-12 and took a boat later to come to Caramel Island to join us.

The full Barbosa family was there ( Jo, Jumanie, Marianna ) it was a really hot day and the water was really nice. We had some coconut water still in the shell, eat some rice and tofu, fried fish and lobster and with some drinks.

During this time at the beach, we had a unofficial Olympic Canada vs. Haiti, we had 50 M sprints, some kickboxing demonstrations, arm wrestling, cart-wheels, and I do believe Canada won. HEHEHEHE.

Later this evening we had a great supper then we headed to the school, where there was a theater set up, we opened the night with the Haitian National Anthem , then we went up and sang the Canadian Anthem. The Baptist church sang a few songs, then the Catholique church, then the kids from BML sang and played tambour which Adrien had worked with them prior. Then it turned out to be a rap contest from the teenagers of the village.

Off to bed we went, was a fun day, and back to work tomorrow.

Daniel

Monday, February 4th , 2008

I woke up from a deep sleep at around 3am. There was already lots of activity outside as people were already lining up to see the doctor and were talking quite loudly. Everyone from the team was up and around at 6:30am, our usual time, except Saint Armand Nelson who was standing outside our room at 5:30 anxious to start registration.
We had our porridge and warm bread breakfast and at 7:30 got registration under way. People were pushing against the fence wanting to get in.
We stopped registration at 11:20 after having registered 76 people. Lunch was as usual very good thanks to Jo, (marinade and kibi). At 12:40 we started registration again. It was my first day at the registration desk and the morning had gone by quite fast because Robert, my Trawdi for the day, were always busy.
I had trouble with names or should I say the spelling of names but felt really good at the end of the day. The final number was 121 patients.
One lady came to the clinic, registered and was sent to the lab. When she got there she did not know why she had come. She said well I heard we could get free medications here so I came. Daniel told her she needed to have a reason to be there and then she started telling about all her pains.
As well, Eunie had 6 pregnant ladies come to the clinic to teach them about pre-natal care. We sent them directly to the lab for urine tests. One by one Daniel gave the cups and asked them to go to the toilet next door for urine samples. Three of the ladies did exactly as Daniel had told them. They knocked on the door next to the lab which was clearly marked library, and after waiting there for about five minutes They came back to see the technician with empty cups. Alix , Daniel’s Trawdi for the day had to redirect them. Everybody had a good laugh, even the ladies.
Eunie was very pleased with her results after her teaching and the ladies seemed to have had a very pleasant experience.
We also had a patient who was brought in on a bed carried by four people. His forehead was wet with sweat and he was yelling with pain. We registered him and I watched Dr. Tiffany administer a medication by injection which calmed him right down . This lady had worked very hard and seemed so calm after a full day that not even a frown was showing on her forehead.
Adrien

Tuesday February 5th 2008

It is the last day of clinic. Selfishly, I am happy to not have to hiss at rats at night anymore and maybe be able to sleep through the night again. Another cold shower, this time with a bucket and cup of water as the tank was empty. Breakfast…more oatmeal, delicious bananas, and the “hint o’cinnamon” peanut butter.

We started the day by seeing the staff who had helped us. The translators were each seen individually and given some treatment or another for various ailments. I found it hard as the “Dokte” to maintain professionalism after getting to know these guys over the week. Treating friends is definitely different. Then the clinic began. Many adults were seen for the “60 +20” cards that were distributed. Sometimes there was a sense that the parents took the cards that had been given to their children. There was more “Gaz”, back pain, and vaginal discharge, and of course scabies. It was encouraging to see the young boy with ?meningitis (always a question, as a spinal tap was not possible) who had been getting injections steadily improving and graduate to oral antibiotics. Another little one who looked so sad the week before had more life in him after a few antibiotics. I hope he continues to improve. The little I had (next time so much more could be prepared!) I gave to the kids, and they smiled when they saw the shiny gold Werther’s candy.

I had my first challenge. Earlier I had done an excision of an upper lip mucosal lesion: no problem. Then the gentleman with multiple lipomas appeared. I decided to resect the large 5 x 4 cm mass behind his left ear. There was no consent form. No documentation of my qualifications for this. But the job was done. My operating theatre involved an open window for light, a head lamp, a nurse, several other onlookers in the window and likely sterile equipment. But after much suturing he left with a smile on his face and I hope I made his life just a little bit better.

After a bite to eat everyone fell to packing up the clinic, which was not too bad, apart from the ever demanding job of the Famasi. There was some Frisbee playing, relaxing on the roof with a beer, and then the absolutely spectacular dinner that Jo had prepared. Squid, grilled fish, and curried shrimp. Divine!!! The meeting after ended on a note of triumph and satisfaction at a job well done, and all our wonderful Haitian teammates received their salaries and gifts. The night ended with a lesson in Haitian dancing, some star gazing, and my last sleep under a mosquito net for a little while.

Wednesday, February 6, 2008

Tear down morning started just before 6 am. The mosquito nets were unstrung, mattresses put to rest in a classroom and all personal packs loaded up. A sentiment frequently heard this morning is that we would be quite pleased to stay longer.

We bid farewell to our Bod me Limbe friends after breakfast, followed by genuinely warm wishes between our translators and ourselves. We have lived and worked together for 10 days and developed some important friendships.

Our boat left for Cormier Plage, the small resort we were to stay at before our flight the next morning. By necessity, we must stay within driving distance of the airport, as the seas are not reliable. Today, for example, the swells had half of the boat’s passengers bailing while a few others battled the natural desire of their stomachs.

Cormier Plage is lovely, although well past its prime and largely neglected by most standards. But we played today. And we reminisced, laughed, and wondered at our experience.

During dinner, Tiffany thanked us all, especially Jo, for work well done. A second toast was made right back to her for her tireless work and strong leadership.

And now I will make a final toast to the fine people of Bod me Limbe who have allowed us the privilege of working in their community, living with them, and enhancing our lives.
And, hopefully, theirs.

Thursday February 7th, 2008

It was lovely to wake up this morning in a comfy bed to here the sound of the waves on the shore. After breakfast at the hotel we drove in our stretch limo to the airport!! Not!! We loaded up the tap taps as usual and were on our way.

As we entered the airport I saw a van with canes and wheelchairs on the roof. I was thinking it looked like Healing Hands material and it was. Gail Buck and her team from Portland were just getting to Cap Haitien and loading their van for a trip just outside of cap.
Our airport departure was uncomplicated and the flight passed by quickly. Then the complications….

I’m finishing off this blog from the Fort Lauderdale. It’s 5 pm and we all thought we’d be half way home by now. Anne, Eunie and Magda have gone on home via Toronto but the rest of us will be overnighting in Montreal. We’ve heard that the snowstorms in the past 24 hours in Montreal and Toronto have put things behind so here were are waiting….you know after coming from Haiti we’ve all learned a certain degree of patience. I remember the night Jo and I came from Cap and waited over an hour for a boat to take us to Labadie. The people didn’t seem to be bothered by the fact that they weren’t getting home before dark. They knew a boat would come. How often in Canada do we complain when our bus is 10 minutes late or even now when our plane is 5 hours late. You just need to make the best use of time, wherever you are. Or take a moment to reflect on life…listen to the sound of the waves, the goats, the children playing.

It was different in Haiti – a slow pace. Here, we’re all overwhelmed once again by the noise of people, television and the speed at which everyone and everything moves.

So next week we’ll be home once again to our comfortable surroundings. There truly is no place like home. I know that people have been changed by their time in Haiti. This experience, however, is not for everyone as we all do not have the opportunity to travel such great distances. But, I think we all can take a few minutes to help someone in our day. It may be with your local youth group, food kitchen, helping a shut in neighbour or simply just greeting people with a simple hello and sincerely asking how they’re doing.

We are here to help one another. I am grateful that I have been given the talents and opportunities to become a physician. I encourage you all to share your talents with others and give when you can.

Tiffany