Monday, May 7, 2012

The Day Haiti Broke Me

Wednesday, April 25th, 2012

I can't believe how long ago this morning was. It feels likes eons ago. I am mentally and physically exhausted. I hope I can do this blog justice because today was monumental for me and I just don't know if I can convey the day properly.

We decided to get up before sunrise this morning to see the sun come through the clouds and over the mountains. We had an alarm set, but didn't need it thanks to all the barking dogs outside our hut. The sunrise was breathtaking and a beautiful way to start out a clinic day, always the hardest of the trip. Looking back, I'm glad we started our day off with such a beautiful prayer. I needed it.

The church today was a fraction of the size of yesterday's church. Except for the small door in the back and the front of the building, it was also void of natural light. When we factored in the overcast skies, we knew that we were going to rely heavily on our headlamps for the day. We quickly set up our clinic in our dimly lit, dirt floor church and got set to work. We knew that we had to get to work quickly. If we had any hope of making it home tonight, we had to leave before the afternoon rain came and turned the roads into mush.

Again, our morning started off with a bang. My first patient had yet another cyst. This one was on the side of her head. It was difficult to get the full story, as so much seems to get lost in translation. It seemed that she was in an accident 10 years ago and it had gotten bigger in the last 3 years. Or something like that. Initially she stated that she could feel it move when I pressed on it. I have heard from previous teams of similar stories where they lanced it to find a family of worms living underneath the skin.

Again, I called Katya and Tony over to look at it. The story then evolved a bit to where she couldn't feel anything move and she may or may not have had an operation or something. I really need to learn Creole since I can't seem to stay away from this land. It would make me so much more effective. It's the least I could do for all these people who would move mountains for me.

Anyways, I regress. Katya thought for a minute about how to proceed. She decided because we weren't sure what we were going to find and it wasn't affecting her life that it wasn't worth the risk. Also, yesterday we were comfortable knowing the patient would be able to have her stitches removed. We did not feel as comfortable that would happen in this quaint village.

So we decided the best option was that of no intervention. We encouraged her to go to the hospital, as we didn't want to do more harm than good. It was hard to not be able to do anything, but I'm sure we made the right decision.

My next patient complained of a bump in her stomach. I felt around her belly button and felt what a nice rounded lump, similar to someone who is in the 2nd trimester of pregnancy. But this woman was adamant that she wasn't pregnant. I called Katya (who I am highly dependant on if you couldn't tell...) for her opinion. We grabbed a couple of benches to help her lay down. Of course, the benches weren't the same height.

Ok, I think I need to clarify my use of the word "bench". When I say bench, I mean 3 pieces of wood haphazardly nailed together. The pieces of wood may or may not fit together to make a bench. And there is a high likelihood that there is at least one nail sticking out in a random spot. 

Alright, back to my scenario. When Katya laid her down, we discovered that it was a mass, not a uterus. And not a small mass, but one the size of a small watermelon. Again, we could do nothing for her, but advise her to go to a hospital to have it removed. I was off to a swell start.

Then my heart broke. Matt signaled to us that there was a little boy who needed to be seen because he was really sick. I looked over to see a very small child, Consonal, struggling to stand. I put my hand on his arm to guide him to our bench. My stomach fell the minute my hand felt his bone. Absolutely no muscle or fat, just bone.

I then heard the scariest whimper. I have never heard such a frightening sound. I initially thought he was wheezing, but I was wrong. It sounded like a child in great pain, but not strong enough to tell us. The child was frail, hunched over and in immense pain. I was terrified.

I reached down to pick him up and put him on my lap. It felt like I could easily break a rib. I looked at Katya and told her I was afraid the child was going to die in my arms. We lifted up his shirt to see a very distended belly and the child wither in pain when we tried to touch it.

Naturally, the first instinct is to offer IV fluids. But when a child is so severely malnourished, providing IV fluids can cause much harm. Because electrolytes are usually highly compromised by this point, you can easily fluid overload or cause other imbalances if not monitored carefully.

So Katya mixed up a little electrolyte solution while I cradled Cousonal in my arms. He was able to sip a few ounces slowly without vomiting and we allowed ourselves to be slightly encouraged. Especially since mom had said that he never ate without vomiting.

I held this boy with as much love as I could physically muster without causing more pain. He cuddled up right next to me and laid his head down on my chest. We prayed over him and the tears couldn't stop. He was 7 years old and smaller than my 4 year old, maybe 30 pounds at the most. Here in my arms, was a dying child close to my son's age. Even now, I have no words, just tears. I felt so helpless as I held this child on what could easily be one of the last days of his life.

I gave him re hydration fluid little by little and just held him in between. We alerted Pastor Ron to the direness of the situation and asked if there was a hospital we could take him to. He said that this is exactly the type of child for Mother Teresa's and maybe we could arrange something.

So we loaded him up with antibiotics (he had a fever as well) and hope that he will be accepted at Mother Teresa's. I hope he can handled the car ride down if it all works out. Those bumps, rocks and mud flung us grown woman around like rag dolls. I can't imagine weighing 30 pounds and already being in severe pain. I don't know what is going to happen and am trying to be at peace and let God do his work. It's not easy.

We were lucky enough to find a little area of thigh with enough muscle to give him a shot of Rocephin. As I braced Cousonal for it, I tried to not break any bones. Tony braced me bracing the boy on the unsteady bench, and I was falling apart quickly. I was trying to not cry in front of his mother, as I didn't want to alarm her.

I still struggle with that part of it all. I don't know if these parents understood how sick their child was.  I didn't want to scare them, but I did want them to know how serious this situation was.  I still don't know if they realized he was dying in front of their eyes.   Should I cry openly to convey how worried I was, or do I act strong?

This mother and father were also very frail looking, so I'm not sure I believe her story of the child being ill and vomiting every time he ate. I don't think they could afford food for their family. Part of me wanted to shake this woman and yell, "Feed your child!" I wanted to yell at the rest of the well-fed community to rally around this family like they rallied around us and ensure that this child got food.  Every ounce of me yearned to carry this child on my back over to the Domincan Republic and nurse him to health.

As a NICU Nurse for almost 5 years, I have had more than my fair share of dying children. Not just children, but babies who have parents that have spent months dreaming of their child's arrival, only for that child to be taken days or hours after birth. Truth is, my job can be devastating and maybe more than most could mentally handle. And as heartbreaking as my work is, Cousonal rocked me to my core.

I think it's because usually there is a genetic defect- something that went awfully wrong during fetal development. Something that is devastating, but unpreventable. As hard as it is to believe, I can accept this. I have to be able to accept it or I wouldn't be able to work in the Denver Health NICU. But I couldn't accept this. It's not like malnourishment was a common sight here. While the diets may not have been the healthiest or contain the biggest variety, it looked like the vast majority were getting their most basic nutritional needs met. But not Cousonal, this boy who instantly and instinctively curled up on my lap. He had been failed and I could not accept it. I don't know if I ever will.

After the painful injection, Cousonal became inconsolable and reached for his mom. This broke my heart further. I had lovingly held this child for an hour and could feel his trust. Then I betrayed that trust by holding him while we caused such pain. I handed the frail, crying child to his mom and sat them away from everyone so we could keep on eye on him and ran out of the clinic.

Dan followed me out, as I leaned against the cinder block and sobbed. Dan held me tight and I let my emotions flow out of me. The weird thing is, it wasn't just Cousonal I was crying for. I was crying for all the babies at work that I never let myself grieve for; the triplet I had last week, the child born with a major brain defect, the 24 weeker born in the screening room, for Edison, for them all. It all came and there was no stopping it. I thank God for Dan and his intuition to just hold me tight. As I type and relive this painful moment, I could use another hug...

But the day had to keep moving. Villagers were coming over the hills faster than we could see them. We handed out more med kits, baby kits, medicine and glasses and tried to be patient as the workload piled up on us.

We handed out all but one pair of our eyeglasses as we were wrapping up the clinic. This little elderly man walked up to Russanna, complaining of his eyesight. She handed him our one remaining pair, a pair with big thick lenses meant for someone that can't see their hand in front of their face. The man gingerly slipped on the glasses and his eyes lit up! He nodded eagerly with wide open eyes and couldn't believe his good fortune. Neither could we! One strong pair of eyeglasses left and one needy villager- what are the chances!

Throughout the day, we listened to the rain hit the tin roof of our clinic. While I love the tinging sound of the drops hitting the metal, I know we were all worried about the drive home while we worked. We knew that it was very possible that we could end up staying in this village for another night. And strangely enough, we were ok with that.

But we decided to press our luck and forge forward.  We made mental preparations that we may not make it all the way out of the mountains and could spend the night camping. The villagers appeared to take our remaining supplies to the truck (which was only a speck from where we were standing). As we slipped, fell and plodded down the muddy, steep hillside, a barefoot elderly lady with a Culligan water jug booked it past us. We continued to get passed by children carrying our supplies. And once again, in the rain.

Heading back to our vehicles

We made it (in one soggy, wet piece) to our vehicles and climbed in for the four wheeling adventure of a lifetime. I'm not sure how many times we climbed in and out of our Land Cruiser so it could make it up a hill. I don't know how many times we hit a bump that sent me into the air and onto Tina's lap.  I lost count of how many people pushed our vehicle out of a sticky place. I was covered in fire ants and mud by the end of it.  I do know that somehow, someway, we made it back to the orphanage safely.

One of the highlights of my day involved a hitch hiker we picked up on the way home, Gaston. Phinton, our beloved translator, was given a chicken by the first village we stayed at. Phinton was so excited for his chicken who he first named, "First Chicken". He gently slid him under his seat and acted like a child with a new puppy. He was excited because he was given a rooster, which are valued higher. It would be easier for him to get a hen so he could start a sustainable source of food for his young family. Somehow, the group decided that a more appropriate name would be "Gaston" and Phinton easily complied.

Phinton is a funny, lovable, hard working Haitian who the whole team adores. On top of that, he has an amazing voice and is working on a Christian music album. He has been with the orphanage for a while and was a translator for my first trip, 18 months ago. Since then, he has met a beautiful young lady, gotten married and now has a 3 month old healthy baby boy, Phindy. Similar to many young couples in America, he is conquering the struggles of starting a family and it was a joy to see how appreciative he was over a rooster that cost $6 to buy in Haiti.

I know that I didn't do our drive home justice. I know it was a joyride and we saw things you only get the pleasure of seeing in the mountains.
Not another stuck truck!

But I can't recall it. My mind is on Cousonal, the child that will keep a piece of my heart in Haiti forever.

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