New Guy

Hi everybody! I am Hans Hertzler and I'm the newest member of the Gospel to Haiti clinic team. I believe I am here to fill the role of clinic director/ patient transport guy and all around help-out-where-needed person. My primary medical background is working as an EMT for a busy ambulance service in Oklahoma for the past year and other EMS/Rescue operations with my local fire dept for the past several years. Understandably, I don't feel overly well equipped for the position that I am attempting to fill, but I have been experiencing a hands on crash course in Haitian Healthcare for the past three weeks since I arrived and have learned an incredible amount already. I also am working with one of the world's best teams of nurses who have been very understanding and patient with me as I try to learn the many interesting and un-american aspects of this clinic's operations.
  Here's a little news from this last week. We've had the normal regime of runny noses and pregnancies and digestive issues as well as a few more interesting cases. On Wednesday an older lady arrived at the clinic with severe difficulty breathing and edema in her legs. She was also experiencing some chest pain. We decided that she probably had congestive heart failure along with some pneumonia. Her blood pressure and heart rate were also way above normal. We put her on some oxygen and administered a diuretic via IV. It is hard to always get a very precise diagnosis with the limited diagnostic equipment available here, but it seems the staff here has adapted very well and does an amazing job with minimal equipment.

Me trying to find a suitable vein for a difficult IV start

The cut, before it started bleeding bad again.

Holding the knife victim down while Rhoda closed up the cut

  Last Thursday I was working here on the mission compound when Rhoda radioed from the clinic and asked me to come down and check out a lady who thought she was having heart issues. Apparently the rest of the nurses were busy with another case. There was complete chaos outside the door of the operating room when I arrived. A woman was throwing herself violently around on the floor and several men were trying to take her outside. The witch doctor came walking out past me when I arrived, leaving her dog behind in the clinic. I finally figured out that the nurses were trying to stitch up an approximately 2 inch laceration on the forehead of a 20 year old girl who had been cut with a knife in school while trying to protect her younger sister. The girl's mother was the one that had lost control of herself when she saw the cut. We finally managed to get the dog, who bit me when I tried
to reach for it, and the rest of the bystanders out the door. I went and checked on the sick woman that had just arrived. She was complaining of pain and weakness all over which had started in her stomach. Her close relative had died from a major heart attack the previous Saturday and she was worried the same thing was happening to her. Her vitals were all within normal limits and there was nothing going on that looked very cardiac related. I tried to reassure her with my extremely limited creole that she probably was not having a heart attack and went to see what was going on in the operating room. The  stitch job had been aborted due to excess bleeding from a small blood vessel that had been severed by the knife resulting in a large hematoma. After some discussion and attempts to find the vein the nurses decided to go ahead and put some stitches back in and control the bleeding with direct pressure and ice packs. Our patient did not seem to be able to keep from thrashing around and fighting when anything was done to the cut so we had to physically restrain her while Rhoda stitched the cut shut. We finally finished and put her on a hospital bed with an ice pack on the wound. She had completely worn herself out by this time. All in all, it was a traumatic experience for most of those involved.   

  Saturday morning a lady came in with severe dehydration, vomiting, and diarrhea. Mali started running IV fluids and several hours later it was discovered that she had cholera, a disease highly feared by the locals ever since the 2012 cholera epidemic. The nurses moved her to a separate room from the other patients and continued to work on rehydrating her. as of this morning her blood pressure has improved and she seems to be doing much better. Thanks for reading! We welcome any prayers or input that you may have!

                                                                                -Hans

Hold That Knife!

     Yesterday someone asked me what my dream day would be like. It seemed so funny. So out of context. It had been a busy Sunday, as usual, I might say. This person needing that medicine, that person wanting a few minutes to talk. Another person wanting something for a tooth ache. And then, a bandage or two at the clinic.

    Then the big cot came. A pale faced lady is found lying at the front door with a sheet knotted around her middle. The crowds are pressing in all around us, waiting for a glimpse of what is up. We try to get the woman to talk. She is weak, and her blood pressure is low. It seems that her husband cut her stomach. Or did she do it herself?! And why?

    As we unwrap the soggy rags, the contents  of what's inside of people began to show. We tried to hide our surprise at our first close up of intestines. They were pink, what did you think?

    So, some of us got a Ringers flowing into her veins while others of our wonderful staff hurried around finding sterile gauze, fluids, and bandaging supplies. We washed up the exposed inward parts, wrapped them in wet packing, and sent the lady out to get operated on. 

    Thank the Lord, Donny was able to get a place in the hospital in Laogone late in the evening, and the woman was safely put through surgery today. So that is the happy story. And if I was to talk about my dream day,anyway, it would probably include someone getting healed or saved.

    So much has happened in the month that you haven't heard from our team. It's probably been the busiest month in the whole two years since I was here. So many stories. A couple more trips to Mirebalais. Deaths, and births. And always one more mystery patient to keep us scratching our heads and praying. 

    Like Monet. He is the fistula boy who has been on our hands for a long time. Or the girl who we sent to TiGoave for tests, and she returned in basically the same condition we left her in. A swollen leg-warm to the touch. And supposedly it appeared overnight.

    We welcomed Hans Hertzler to our staff, so look for him on our blogs. He is our new clinic trauma director/emergency transport chief. We thank the Lord for what he has done for us already. 

                           -for all of us, Rhoda

   

Mirebalais Madness...........

     Mirebalais.....here we come. Our good ole ambulance chugs up Goat mountain and then thru the countless switchbacks. Some of the patients are starting to feel nauseous and we hear the lids being ripped of the marmites. Soon we are rolling down the windows and Whit and I are fighting for a breathe of fresh air. One lady starts laughing and then soon we all join in. Haitians are great to accept the situations they find themselves in!!
   After 1 hour we pull in thru the gates of Mirebalais . Everyone jumps out and we try to make ourselves look half decent.
 "Alright everybody... here we are, follow us." Whit and I lead 5 of them off towards the archives. Julian stays with Jean Louis and our little hernia  in the surgery waiting room.  Lines of people waiting, nurses flying around, security milling through the crowd,  important looking doctors, surgeons, lab techs walking with a sure purposeful step... Whit and I look at each other. Where do we begin?? This place is huge. We get to archives and get things sorted out. Whit heads off towards the place where they get CT scans with some of the people. I head off towards to get an x ray done. Beginning of a looooonnngg crazy day. Running from one place to the next.  
  " Sorry, we cant help you today, our x-ray machine isn't working. Go get a signature from a doctor. This is the wrong place sorry,ect..."
       My phone is ringing in my purse, "Alo." "Mis Mali, I need you, I don't know what to do anymore, I am lost, where are you." " I will come, stay right where you are." I meet Whit in the one of the long halls. She is marching off with 3 other patients. We grin and exchange stories.
        At about 2 in the afternoon one lady whisks the little girl off (that was patiently waiting since 9 for a CT scan,) and bathes her. Whit suddenly realizes the girl  is gone when she hears the doctor finally calling out her name. Here goes our chance. We now need to wait till tomorrow morning to get her in again.
    All day we run and then we sit waiting for tests, scans, results, doctors.... By 6 both our patients that had operations pending  are in pre-op . As much as could be accomplished  has been done. Tired and hungry we jump in the ambulance and head back to P.A.P for the night. Thanks to Blue Ridge we had a relaxing evening.
  Next morning we find ourselves once again in Mirebalais.  It doesn't seem as huge and strange anymore. We quickly find our patients. Its touching to see how happy they are to see us. One lady threw her arms around us and cried. "Oh Mis, you didn't leave us alone,you came back."We laugh and try to make them forget the operations that are ahead of them. 
    The old man grabs my hands and tells me with a very  decided air. "Mis, I will be going home with you because I have 7 marmites of peanuts to plant and I need to get it done." I laugh...."Well,if the doctor says you are doing well enough to leave, but if not you are going to have to wait." I hear him mutter as I leave. "I will go back, those peanuts need to be planted." I smile at Whit... I love every one of them. They colour our lives up so much!!!
    At 12:30 pm the little Hernia girl is wheeled off into the operating room. Her mom hugs me and cries. She is worried she will wont come back out. After 3 hours of waiting they wheel her back into post-op. She is doing fine and still sleeping.

  A half hour later the old man is wheeled in. At 6:30 pm  he is wheeled into post op. We walk in to see him and he is already sitting up,asking for his normal clothes.  I am sure he wanted to prove that he COULD plant those peanuts!! Even the other nurses smile and laugh as they see his very decided look.

     We had some minor complications so we ended having to go back to P.A.P for the night instead of heading homeward. Wednesday morning.....doctor signs their discharge papers and we all pile back in the ambulance....
    SO ready to head home, home to our Aylegue family and hospital. We are so thankful for our 2 first successful operations and the joy its brings to our patients.
    The verse in Mathew that takes about "when I was sick and you visited me" kept running through my mind and giving me courage to keep going. If I can see Jesus in my patients sad ,hopeful eyes....that's enough to keep my going!!!
-Mis Mali

   
      

Don't Untie That Knot!

It is Friday. Ninety or more people are thinking that they should be seen sooner rather than later. The beds are full. One lady is in labor. And then, this boy shows up.
    He looks not too bad from the start. But he has these rags around his stomach. And they are oozing intestinal stuff. And we need a hospital bed.

    By afternoon we had a bed for the white-faced boy. We started to unwrap him, and then the doctor said, "Just leave it go. Don't untie that knot. He needs a surgery."
    The big problem is that they are having demonstrations on the Streets by the hospital, and we don't know if it is possible to arrive safely in the hospital.
    And then, to heighten the dilemma, the dad leaves, and walks off with the mule he came on. Now what? This man could be dying! Should we put in an IV or not? One doctor says do, the other one says don't....What if he dies on our hands?
     Donovan and Mali jumped on the one machine and tried to go find the father of the 20 year old boy so that we could get help for him.
     Finally, the dad was found walking down the road. We were so glad he was showing up. But not for long, soon he walked out the gate again, just as we were loading the ambulance to go to town! A helpful neighbor went and made him return.
      Finally, at about seven o'clock in the night, we had a ride ready to go to Port-au-Prince, to see if we could find someone who would receive a man with intestinal fluids running out of his umbilicus. The ride was as crazy as usual. Bounce. Bump. IV pulls loose. Machine stops. IV is repaired. Bounce. Bump.
    Nearing midnight, we arrive at our first prospective hospital. The doctor says they don't have the machines to operate on the man, and that we need to go to the general hospital. We go.
   We find one helpful man who gets in to see the doctor. The doctor says we can stay. But then a crime scene is brought into the hospital, and among all the yelling and noise, the doctors are all obligated to leave for security reasons.  The young doctor apologizes, tells us that he can't help us, and the patients who are sprawled here and there in the emergency room get ready to leave, without having been helped. We find someone to show us out the back door, to avoid walking by the yelling, blood, and danger zone.
    We sit in our machine with our angry, hungry patient, who is hungry, full of IV fluids, and in pain. A rat walks by.
     We sigh, pray, and wonder how we got here. Hours away from home, turned out of the second hospital.
    God gives us one hopeful thought at this moment, as the stench of our patient washes over us. How about Bernard Bevves hospital? It is expensive, but what are we going to do to save this man's life?
     We go out on the road, drive through the dangerous streets, and honk our horn as we arrive at the third hospital for the night.
    "We can't help you," they say. I got out of the machine, and walked by a man with a gun.
    "Where can I give some information?" I asked.
     They showed me to an office, and opened the gate for Donovan to pull in the machine. By a miracle from God, there was a team from Canada on campus, and they seemed very helpful.
     We were able to get a CAT scan, a surgery lined up, and leave that spot by about 2:30 am. But the story was not over that easy. The next day, after the Canadian team was gone, and we were on our way, trying to get home, the phone rang.
    "We don't have a place for your patient," the voice rambled.
    I couldn't believe it. He was supposed to be in surgery! Will I ever understand this country????
    By the mercy of the Lord, our patient was able to stay the week-end. We made a lot of phone calls, prayed a lot, and waited. This is Tuesday, and our patient was finally able to see a doctor today, I believe.
    We are hoping to bring our patient home sometime this week to continue recovery.

     Just for fun, I am throwing a picture of our present team in here. We ran away from the compound Saturday evening about sunset, tired of emergencies, bandages, IV's and blood. Those who were here at home had quite a time as well, and we couldn't wait to feel fresh air in our hair.
     Today, being Tuesday, Mali, Whitney, and Julian are in Mirebalais again, helping two other patients realize some long awaited surgeries. Their trip is turning into a three day experience. Hopefully when they get back, you will get an update from one of them!
    Good-night! Rhoda for the team
   

      Hello! My name is Janette. I am an RN from Pennsylvania and I came down to help out in the clinic for a month. It is my turn to blog so I will tell you a little about what I am doing while here.  First thing in the morning  I do several dressing changes on wound patients. The main thing I'm doing though is the prenatal program. We call all the pregnant ladies that have arrived by that point (some keep coming throughout the morning) and have them sit in a room all together. We do vital signs and then have a little  teaching session. We use a book on fetal development that shows pictures of the different months and we talk to them about drinking enough water, eating healthy foods, etc. Then Whitney and I each take patients and do consultations. A consultation starts by measuring fundal height and finding a fetal heart beat. Then we do a focused assessment and write up a list of medications for them based on that. Each lady is given an 'appointment' to come back to the clinic. Healthy patients usually come every month; others come more often.
           Here's a little taste of the medical system down here:  Last night Donavon took a patient out whose life depended on an operation. The first hospital wouldn't take him, the second was going to but then the doctors all had to leave for an emergency, finally the third hospital did accept him and was going to do the operation this morning. However, they called this morning and said they didn't have a bed so who knows if he got the surgery or not. This is Haiti! The mission will follow up with him and do what they can to make sure he gets the care he needs.     

 

Whitney and I

The clinic staff

The Big "C" Word

CHOLERA. 

I was looking forward to being on call at the clinic for the weekend.   I assumed that with all the rain that we've been getting, it wouldn't be too busy and I could get some other little things done.  I got started about 8:30 Saturday morning bandaging several return patients and seeing a couple others.  Marcile came down to restock the pharmacy.  "Maybe today I can actually help her!", I thought.  She asked if I was having a busy morning.  "Oh, no, not really!  Just a few people, nothing serious." was my reply.    Minutes later, Mali walked in to get some meds from the pharmacy, and informed me that a cot had just been carried in with a very sick-looking boy on it.     I quickly stuffed my hands into some gloves and stepped outside to find just what she said; a very sick boy.  The crowd that carried him told me that he had had watery diarrhea since the evening before, but that there was too much rain to bring him sooner.   His altered level of consciousness and deeply sunken eyes showed how extremely dehydrated he already was!  I'd never personally had a patient with cholera before, but I remembered hearing about the certain smell it has, and I was sure that what I was smelling had to be that certain smell!  We usually send cholera patients to another small clinic about 10 minutes away that has a cholera center, but they've been closed recently, so we made a quick decision to put him on a cot in the shack in front of the clinic.  I ran to get everything for an IV.   Meanwhile Fre Daniel got on the ball spraying everything and everyone down with Clorox water.   In the process of getting the boy carried up to the shack, Fre Noas came into the shack where I was setting up and grabbed my arm saying, "Mis Whitney, come quickly! I think maybe he died, I don't know!"   I ran out where they'd set him down just outside, and heard his gurgling respirations.  "He's still alive!  Now carry him in fast!" I told them.   As soon as we got him propped on the cot, Mali and I started the desperate search for a vein that looked good enough for an IV.  

He seemed to drift in and out of consciousness as we tried and tried again for a good vein.  "Mali, do you feel like you can do this better right now?  My hands are shaking too much, and I think I could've gotten one in by now if they weren't."  But she encouraged me on, and again we prayed as I hopefully tried another vein, only to have it blow again.   We radioed Rho down at that point, and she came and calmly donned gloves to try her IV skills on the other arm while I kept searching for a good vein on his first arm.  Mali spotted a better looking vein further up his arm and offered to try it, which I thankfully agreed to.  My hands were still shaking.   We all thanked God when we heard her say, "I'm in!" and saw the IV fluid dripping into his body as fast as it could go!   Then Rho got one running in the other arm.   It didn't take long before he visibly began improving, and I started to relax.  I had felt such a sense of responsibility to help him that it almost made me panic, and I was very grateful for the teamwork of the other girls pitching in!  I think Marcile must have felt like she'd ran a mile by the time she got done fetching everything we needed from the clinic to the shack! :)  Anyway, now over a dozen liters of fluid and four gallons of diarrhea later, sixteen year old Onel should get to go home tomorrow!   This morning I took his IV out and left him with a liter of pedialyte to drink.   When I came back to find he hadn't drank much, I told him that if he didn't force himself to drink, I'd have to come put another IV in.  "I'll drink later, after awhile." he'd say, and put his arm over his mouth.  I hovered over his face with a capful of fluid, telling him he'd better open his mouth or I would dump it on his face.    He told me, with a stubborn smirk, to dump it on his face.  :)   This evening when I checked on him, again I told him that if he didn't force himself to drink more, than I'd have to force him to, and again he covered his mouth and turned his head away.   I told him that if he doesn't drink enough, he could get seriously sick again.   He told me he's not sick anymore, so I said, "Ok, then you can go home now."   Well, he didn't think he was quite that well!  And when I inquired, he affirmed that he did still have a lot of diarrhea, but still he insisted he would drink more later.   When I again held the capful of fluid to his mouth and told him to open up, he mumbled that he couldn't cause his mouth had a problem.   

I asked, "What problem does it have?"  

"I can't open it." was his reason.  "Oh but look, you can open it to talk!" I pointed out, at which he shut his mouth tightly and started talking like that.   Hiding my own smirking smile, I offered one more solution; "I'll help you open your mouth then!"  That didn't sound like help to him.  Finally I just laughed and told him if he's well enough to be that naughty, he's well enough to go home.  :)

I waited to post this til this morning so I could get this photo of him...looking much better! :)   We're in a bit of a difficult position with the Bases hospital being closed, cause we aren't really set up to open a cholera center here should there be a bunch more coming, so please pray that there won't be!  Have a blessed day!

Sunday-On Call!

( Hello, everyone! You guessed it. A lot of visitors using our Internet, and now you won't get to hear from our world very often, until things are back to normal.)
    I will try to give you a quick peak,and hopefully, the internet will be nice for a few minutes, here.
    We have had some interesting road trips. By foot, or by vehicle...either works.
     One Sunday a friend asked us to pick up their cousin with the machine. We decided that Christ would have us do that, even though it was a Sunday- our theoretical Day of Rest.
    "It's not far," our friend assured us.
     Our machine drove and drove, until we hit too many rocks to continue. Then we stopped our machine, got out, and walked. I think we walked for at least 45 minutes down a very steep, curvy, hot trail. ?
    "So it's not far?"
    "We are going to need a helicopter to get this person back out," we joked, as the sweat ran down our bodies. Hans Hertzler, our newest prospective team member was comparing his medical run to a normal medical call in his practice in the States. "It's not the same," he chuckled.
    As we arrived at our patient's house, we realized that the family was still trying to concoct a cot to carry the patient on. Now that was fun.

    "Bring me a hammer."
     "OH, where are the nails? Get me a rope."
     "Hurry. Hey, that's crooked."
     Meanwhile, the patient was looking fearfully on. Her breath was coming a bit labored, which seemed to have something to do with diminished activity in her left lower lung. We were thankful that her stats were holding fairly normal, because it didn't look like we were going anywhere quickly, that much we knew.
     After the contraption of a cot/chair was successfully finished and inspected by the group, we headed up the mountain, where we left the lady in the hands of her cousin overnight.
    The next day we did more follow-up work, testing, and just waiting to see how her meds would work if she took them like they were supposed to be taken. Her family requested that we could help her to town where she could get more extensive testing and health care.

     Today some of our troops are out on a medical follow-up run in Terre Rouge. This patient fell and broke his back, after which he was transported to TiGoave. After a very painful ride to town on an improvised "road cot" bed, we were able to load him into an ambulance for transport to Port. He returned to his home in the mountains without a cast on his broken back.
     This led us to go to his house, create an improvised cast, and try to keep his digestive system working, even though his body is not responsive below his waist. You can pray for this young husband and father as he faces his stark future without the hope of ever walking again.
    Have a good week. I just want to rejoice in what God can do. The battle is His....which makes me almost tell another story about a 7 year old girl who God delivered from a spiritual-based sickness last night. But there are a million more stories, too. And most of them make more sense if you are here to meet the main characters. God bless your week. Rhoda for the Ahlege Team