Tasting Autumn

9-11-10

It is 9/11. I remember that day. So so sad.

We had our Hearts Helping Haiti benefit and it was one of the most beautiful days of my life. The setting was pristine on the hillside lawn under the old oak trees looking out over the Nelson's vineyard and valley (see the picture of "Breath" singing for us). People came and set up their chairs. The music was beautiful and we made $15,000! That will pay the rent for our orphanage for 1 year and help us get food and medicine to them. Thank you to all of the loving souls who are helping us.

Lucie is the president of the Reveil Matinal Orphanage Foundation, she came from New York with her son Jason. It was a love fest. Soul Mates united to help our 20 daughters in Haiti. Lucie brought home made Haitian African outfits for the auction, above is a picture of us winners with our friends. (Kirsten, Tifanny, Lynn, Lucie, Christina, Serena)

Breathing and relaxing. I have sworn to several important people that I am going to truly slow down now. We have our yearly "Taste of Autumn" benefit coming up on October 3, then I leave for Mexico for 3 weeks where I officially turn over a new leaf. Having 20 new daughters has taken my stress level to a height that is unsurpassed from past experience. This is my biggest challenge, to save the world and not freak out from stress.

I tried to attach the poster from our "Taste of Autumn" event but failed, you can go to our website hearthstone-tuhogar.org and check it out, please come if you can, it is a wonderful fall day with the family. Apple Pressing, hay rides, lots of food and music. We are auctioning off a mansion in our Baja paradise, El Cardonal for 12 people for a week it includes a fishing excursion (see the poster above). I am going to Olivino on Monday to get an official training in my new passion "Olive Oil Tasting". Come to the event to see what I learn.

I taught a Versant class this week at the hospital. These are 16 new nurses that are joining our team at UVMC. I read them the following story that I wrote one year ago. I share it here with you, it is a glimpse into my work as a PA hospitalist at UVMC.

8-31-09

Fall is coming, thank you God. The chickens are clucking, other birds are calling all around me. No wind. Perfect cool temperature. The ground is holding water longer. The plants have almost stopped growing. Eggs, tomatoes, Asian pears, yesterday. Beans, basil, apples, cucumbers, summer squash for the family outing to Leonard Lake.

I keep remembering the light on the clean white sheets. Natural light coming in through the window. Praying, breathing, resting, letting go. He was a thin homeless man. With long kinky gray hair and beard. He was seen on our streets for years. They moved him from ICU, on high flow oxygen, his lungs were done. Marvin assigned him to me.

He was struggling to breath, very hard work, and not getting him anywhere. Letting go was the order of the day. There are wonderful medications to help with air hunger. It was a pleasure to help him relax.

The staff had him perfectly clean. Hair combed and flowing. The bed was immaculate. We called for spiritual care, the pastor sat and prayed with him. May you be pain free, at peace and know you are loved. He was breathing away.

We wandered in and out, checked him often. When the time came we stayed by his side. I called for Marvin. He was surrounded by love as he faded peacefully away. So clean, and comfortable in the light, on those clean white sheets.

So proud and moved I was that he died with such perfect dignity. In my thoughts I thanked the housekeepers and nurses for their labor of love, honored to have a place on this team.

I woke up the next few mornings with tears of grief for this man. I knew that I was the only person crying for him, his wailing woman. Thankful that I cared, it would be even more sad if no one cried.

Hearts Helping Haiti

8-10-10

The planet is spinning and some times I have to hang on for dear life.

In May we went to Haiti as a team of medical volunteers with an additional mission to find our orphanage. Before we left a committee of community members set the date of August 21, 2010 for a fund raiser for these unknown children. Chris from the Nelson Family Vineyards gave his beautiful venue. “Hearts Helping Haiti” was born, an outdoor music festival to feed hungry children in Haiti.

In Port au Prince our interpreter Gregory recommended the Reveil Matinal Orphanage. One month after he watched one of his children die he gave his two daughters to this Adventist orphanage of 20 girls. These are now "our 20 girls".

Lucie is the president who runs the orphanage. She is Haitian and lives in New York. She is deeply thankful that we found them and are organizing our community as a sponsor.

Haiti is corrupt, I am sorry to say this but it is true. To be honest there is a lot of stress at our orphanage. Our task right now is to insure the over all well being of the girls by moving them to a safer place, hiring qualified staff, and supporting their nutrition.

Patti has been making trips Haiti to adopt Gregory’s girls. In July she took Leanna’s sewing machine, sewing notions and fabric to our orphanage. She taught the four oldest girls to sew.

It is going to take a village to support these girls into adulthood. Please join me at our fabulous Outdoor Music Festival on August 21, buy an auction item, make a donation, or just let us know that you support us with your love. This is a chance for your money to go straight to help a hungry child in Haiti.

If you want to join a team to Haiti we are looking for people who love children and want to help feed, teach, play, garden, build, and hug them. Lucie is coming to the benefit, so you can meet her if you are interested. I hope to see you on Aug 21.

Reveil Matinal Orphanage Foundation (rmof.org)
Benefit information: heartshelpinghaiti.org

Love and Thank you Lynn Meadows

PS Trust the Trauma Queen I will return to sending out regular posts, when I have time to breath. Next week a German documentary team is coming to my house to make a film about our famous fire of 2008. Stay tuned for more trauma stories, they never stop.

Pictures: Our girls having their daily meal of white rice and beans. Sewing class with Patti.

The Trauma Queen is Traumatized

PA Midwife is one of my hats. You have not heard from me in a while for good reason: THE 2 CAESARS WERE BORN!

Here is my blog entry from 6-25-10

Otto meets Amazon Woman

A woman could lift a car off her baby if she had too. Faith proved it yesterday.

Who is to know what is really in there when you are pregnant for the first time? Intellectually you think there is a baby in there, but until you see it it is not real. Faith labored at home for 2 days, she stuck with it, believing that she must sacrifice for her unknown child. Taking walks in the starlight, breathing, relaxing. There came a time at the end of the second day when we knew that her baby was not moving down, so we made our way off our ranch to the hospital (they live on our land). Warmest of receptions and Pablo our OB/GYN tried his incredible tricks and through it all Faith stayed true, through her exhaustion, she gave it more than you think is humanly possible. Then a cesarean, to the joy of our 9 pound Otto taking his first breathes. Faith never once complained. I am in awe of this woman. Thank you Thank you for allowing me to witness your beauty, love and strength. Oh yes and Otto has our gentle loving soul Orion for his dad.


Back to 7-17-10

Okay so I was up for 2 days with Faith and trying to juggle my full time job which I ended up flaking out of on Otto’s Birthday. The process that we shared for Otto’s birth was beautiful and traumatic. There was much to process, the processing is very hard work. I was wasted.

Just when I was getting my feet on the ground my beloved daughter Robyn went into labor with her first child, 3 days before her due date. When it rains it pours. Robyn planned a natural birth in the hospital, so she came to me since I happened to be working. Things were going great until they discovered that the baby had changed position during the night to head up, and she stuck her foot through the cervix! 6-28-10 my fabulous squeaky little 7 lb. grand daughter was born by cesarean. Her parents are George and Robyn so therefore her name is Geordyn. We love her so much, but wonder, “What was she thinking?”

Of course we are so in love with our 2 Caesars. My life has been full to overflowing with helping Robyn and her new family, maintaining my job, garden, marriage, organizing our huge August 21 Music Festival for the orphanage and planning my return to Haiti. I confess, my life is insane!

I am proud to say that today I laid on my bed and read parts of a book called Sabbath, it is about “finding rest, renewal and delight in our busy lives”. Seeking quietness, slowing to rest, giving thanks, praying, lighting candles, making love.

Pictures: Faith hanging in there with a contraction, Otto and Pablo before the first breath, Geordyn

Trauma Queen Comes Out.

We had some weddings at the Ranch House. Tanya and Tristan started it, and worked their behinds off to make it wonderful. The Ranch House is the community center of, "The Ranch", where Bob and I have lived since 1972.

Tanya and Tristan invited their wedding guests to be creative, wear their wedding gowns, renew vows etc.

So I get out my wedding dress from 40 years ago, luckily I figured out a way to fold the top down and I was able to get it on. My original veil was this giant white net that went down to the floor, with a hideous headdress with fake silk daisies. Several years ago I took a scissors to the veil and made it short for dress ups. The thing has gotten a lot of mileage.

Bob's and my 40th wedding anniversary just happened to be the next day (June 20). Bob put on the coat of his original 1970’s brown courderoy suit with bell bottoms. It still fits him!!! We got up front and declared what a miracle that he has put up with me for 40 years.

Erin and Jeramiah have a beautiful baby girl. The morning of the wedding I was picking flowers and found out that Erin bought a wedding dress and rings. She was having a wedding within a wedding.

I volunteered to make her a brides bouquet. We happened to have our three girls with identical flower girl dresses from a family wedding three weeks ago. I had a spice cake from our Haiti Slide show bake sale, so I picked some edible flowers to decorate it. The whole wedding took 5 minutes to plan. Worlds lowest stress wedding. Thank you Tristan and Tanya for a wonderful celebration of love, a great contribution to our community life. Deborah thinks we should do group weddings once a year.

Pictures: Lynn and Bob, Lynn and Bob, Tristan and Tanya, Erin and Jeramiah with girls

Haiti Update: We are still working night and day to put on our Music Festival on August 21. Next post will lay it out for you.

I have not felt so alive in years

Ukiah Team 5 is in Haiti. She is our RN Alice, the last straggler on our first round of volunteer medical teams to the Hopital Adventiste d'Haiti. Every person is changed and wants to go back. As Leanna said, "I have not felt so alive in years".

I heard from Jean my interpreter. He has started his language school in a church. He checked on my baby Sara and says her family is OK and she is doing well. Patti our RN from Team 1 is back in Haiti to pick up her two new girls from the orphanage. She is coming back with Gregory their father to complete the adoption paper work in the United States. Kathy from materials management at our hospital is organizing a "shower" for them.

Words From Skip Ukiah Team 4

We are home, it has been four days and all I can think of is Haiti.
The beautiful people that we encountered, their warmth, their appreciation.
Like everyone else I will never take for granted our supply chain, or the length of lab turnaround.

From the moment we arrived with the group from Children’s Hospital Oakland (CHO) we worked well together and got done whatever was necessary. A wonderful group of people that I hope to keep in touch with.

On my third busy day in Haiti, I am on my way to start an IV on a baby when this very large man comes bursting in the ER saying, "Let me in I have an emergency". As if that did not get our attention, the two armed men bringing in a young, well-dressed woman in a wheelchair did indeed. I took one look at Tammy from CHO and said, "I got this".

It turned out the woman was being treated for malaria and typhoid and had been found down in her home. She presented to the ER with completely altered mental status. Several members of out team, Bryon, Tammy and one of the Haitian nurses helped gather supplies, while I started an IV, labs etc. It became apparent that this woman was suffering from a serious form of malaria and was not doing well. The Miami field hospital was contacted, they have a portable CT scanner along with a neurosurgeon and they accepted the transfer.

I will never forget that ride across town; lights and sirens over some of the roughest roads you could imagine, UN troops with their machine guns, the intense rain, flooding, total devastation all around us and all I could think was please do not start seizing now. I cannot express the relief we all felt upon arrival. The team at the Miami field hospital were awesome and we felt that she was in the best place possible considering her serious condition. I remember the look her husband gave me and mouthed, "thank you". That day was his 39th birthday. I wonder if she made it?

At the Hopital we began relationships with wonderful people that will stay with me the rest of my life. When asked if I would go back all I can say is "when do we leave"?

Pictures: Patti's new daughter, Skip with translators, Poster for our slide shows

Saving Haiti 20 Girls at a Time

Charlucie Jaboin and I talked on the phone yesterday. She is a Haitian woman who lives in New York and is the president of the the Reveil Matinal Orphanage in Port au Prince. The 20 girls are hers. She and her group are thanking God that we found them. The orphanage was formed 4 years ago, sometimes they do not have enough food, right now they have not paid their staff in months. She is my new best friend and we are making plans. Here is an excerpt from my email to her.

We are so busy here with the benefit for the orphanage, it is making me a little crazy. We have 2 slide shows next week to inform the public about our work in Haiti and promote the music festival. We have teams going to the Sierra Nevada Music Festival at the same time to person a table to promote the event and sell tickets. I have never put on an event this big and I might explode in the process. If you are Adventist then you know about the Sabbath (I am not Adventist). I am on the Sacred Work Council at our hospital (an Adventist hospital). We have talked about the meaning of the Sabbath and I have been thinking about it a lot lately. I want to rest, reflect, rejuvenate, for 24 hours each week. I see the point.

PS. I am holding everyone of your girls in my heart and prayers, I love them and want to be part of helping them grow up to be beautiful women who have a good life.

Today I went to the website rmof.org and made a donation with pay pal.

Words from Becky

I wanted to share this email I got from Junior, one of the translators. It is so sweet. I thought you'd want to share it as words from a Haitian. I can't believe HE is thanking ME so much.

----- Message transféré ----
De : Variant Augustin Junior

Hey Becky, how are you ? This is Variant Augustin Junior. It's a pleasure to me to write you in this time, for being able to know how are you doing and to say how much I was happy by reason of your help that you gave in Haiti. The main thing cause me to write you is because I wanted to say to you hello, to know how was your trip? How your family is doing, and to thank you the big thing that you did in Haiti. I didn't find any chance to thank you when you're in Haiti. You are very kind-full and a co-worker with the Haitian patients. I don't have any treasures to offer you to reimburse you but you're an angel. I believe that God knows anything that I wanted to give to you so that is gonna push me to pray for you.  That God protects you in anything that your doing most of all when you're walking in the street and keep on blessing you with your family completely.  Keep straight you in his way. This is Junior your loving translator which never forget you.
   God bless you.     

Words from Briana Ukiah Team 4

Things are going fine. A large group of volunteers 25 arrived last Friday. Most of them are from Children’s Hospital Oakland. We have a pediatric anesthesiologist, pediatric plastic surgeon, two pediatric intensivists, two adult orthopedic residents, a general surgeon, two family practice MDs, an ER doc, and two midwives. In addition to about 12 plus nurses, 2 PTs, and 1 OT. The hospital is well covered. So much so many people find themselves looking for something to do. I have moved from urgent care, to the lab, to surgery over the course of my stay.

I had the opportunity to steal a translator and spend some time in the lab. They have a tremendous amount of work on their hands. They do not have a hematology analyzer so everything is completed manually. In addition their chemistry analyzer is from the 60's and has a very limited capability. So much so that the lab techs manually separate a patient's sample into multiple test tubes, add a specific reagent (na, k, cl, etc) and wait for the reaction to complete. Then each tube is loaded on the analyzer one by one to be read. They are definitely held back by their lack of tools. They can’t do gram stains as requested because they don’t have grams iodine?? Seems to me that they need some attention, a point of care hematology and chemistry analyzer would help them tremendously and grams iodine shouldn’t be to hard to get. I am sure the practitioners would appreciate it as well. I enjoyed my time in the lab, they were a great group of people. I think they were happy to have someone take interest in what they were doing and hopefully they will benefit from it.

Its been raining a bunch. Makes the air extra humid but it tends to be a bit cooler, although not too much. The rain is worrisome though, more rain will bring more disease and less viable shelter. The streets have rushing water already, and its just the beginning.

The hospital is starting to charge for surgeries, urgent care visits, lab, xray, and a daily volunteer fee. I have heard from several translators that they aren’t being paid which is unfortunate. Seems like without translators most of this work would be impossible. Good thing they have gracious translators who
continue to help without pay out of the kindness of their hearts and deep dedication to help their people.

Pictures: Hands, Translators, Michelle the Pediatrician, Briana on the job.

Sean Penn Sighting in Haiti

John Azzaro and I were crying at the same time yesterday. We were listening to KZYX and heard the voices of our 20 new daughters singing from Haiti.

When the Ukiah Team first visited the Reveil Matinal Orphanage in Port au Prince, the girls were running and playing happily in their secure compound. We sat together and made our way carefully through the group meeting each child one at a time. We repeated their unusual French names, and made eye contact. My personal goal was to show each child that I loved and respected her as a unique individual.

We have chosen to sponsor this orphanage, and our hearts are opening.

Words From Linda Ukiah Team 3

Today a group of us decided to go to the Reveil Matinal (Adventist) orphanage on the other side of Port au Prince. Emily had heard of this home for girls through Lynn and knew we had chosen to become sponsors. One of the nurses from the med/surg team is adopting two little girls from there, so we had to go and pick up paperwork. The orphanage was only 12.5 km away, but it ended up taking us 2 hours to get there due to rush hour traffic. The ride was a bit scary: we got lost a few times, were involved in some near accidents, and got stopped by the UN soldiers. We finally made it and quickly realized that the trouble getting there was worth it. The girls were adorable. They immediately attached themselves to us like glue. I had a hard time going up stairs because there were 5 of them that wanted to hold onto my arm, hand or leg. The orphanage was well kept and clean. We gave them presents, it was difficult to keep things fair. Each one got a coloring book, a handful of crayons, a stuffed animal and a toy. Melanie and Crystal led a few songs and then we asked the girls to sing. Their voices sounded so pure and innocent that it made tears well up in my eyes - I didn’t know what they were singing about as they sing in French. Maybe it was the voices or the tempo, but it evoked a strong emotion of sadness and helplessness as I imagined what it would be like to grow up without parents and the stories that led them to become orphans. At the end the translator told me they were singing about the hardships that they have endured, the resiliency of their people and how God will always be with them. Afterward we all sang a song together. They knew one English song and luckily we knew it too. The stay was short but the moments we spent with those little girls is something I will not forget.

Outside the sun had just set and it was dusk. The night life began in Port-au-prince. We passed many brightly colored Tap Taps blaring Haitian music, people out in the market selling their goods by candlelight, other street vendors packing up to go home. People on the move, others lingering about. It felt like everyone was out in the streets. The liveliness contrasted greatly to the images of rubble that we passed. There were fires burning endless piles of trash, and the palace which was somewhat of an eerie image as it sat there toppled over, abandoned and dark.

The trip home was shorter, thank goodness. We were hungry, tired, sweaty and covered in dust from the drive. We pulled up to the hospital to find kids and translators gathered to say good-bye. We took pictures gave hugs and exchanged emails. A few of us headed down the street to grab a bite to eat. We didn’t take a translator which made it difficult to order vegetarian food. The restaurant was owned by a family. They were in the room with us watching the TV and chatting. They introduced their grandmother to us, a tiny lady around 70 years old. She came and gave us all kisses and hugs. It is rare in Haiti to see someone as old as her. After our meal we said our goodbyes to the family like they were old friends.

Words from Brian RN Ukiah Team 4

Haiti is all you guys said it was. There is the destruction that is vast and all encompassing, the abject poverty that I have not dealt with before, the frustration of things not getting done in anything like a timely manner (ER labs that take 24 hrs to get back), and not being able to find routine things we are so used to working with. Even in all of this the Haitian people are so warm, welcoming, friendly and loving. It is just amazing! I was standing in the ER watching people walk through and it struck me how proud they carried themselves, back straight and chin up. It is very cool. We shared the plane with Sean Penn who has been here several times lending himself to Haiti. I didn't have the nerve to talk with him but it was nice to see someone of his stature doing his part. We are here right now with a large contingent from Children’s Hospital Oakland who are pediatric nurses and doctors. A good group to share our time with. Some of the people who are here long term are amazing. 19 yr old David who is handling all the supplies, 22 yr old Luke who seems to be the general administrator, etc. These guys are wonderful and have set the bar pretty high for the rest of us. The hospital has instituted a policy that people have to pay (a minimal amount) for the clinics and this has cut down on some of the patient flow. See you all in a few days. Love Brian

Pictures: Top, Don,t sit here by Michael Turner, Team 3 with the girls of Reveil Matinal Orphanage, Little ER patient, Coloring books from Ukiah to our Girls

The Poorest of the Poor Have Song

Dear Friends

I do not have TV at my house. When the earthquake hit Haiti I only heard stories and my imagination made the pictures for me. I heard of incredible destruction and death, of a lost child finding his way to an orphanage and being turned away. The orphanage had fallen and they could not take care of the children they had. The image of a parent less child wandering the streets alone, that is when I decided I was going to Haiti. The rest is history. Laura and I joined together, she took on organizing the medical mission and I took on the children, we decided to find an orphanage to sponsor while working at the Hopital. Before we left for Haiti we began planning a benefit music festival for the children. We found our orphanage and chose it because it is a safe and loving home. Today I called Charlucie (Lucie) Jaboin the president of the Reveil Matinal Orphanage Foundation, she is Haitian and lives in New York City. This is the girls orphanage in Port au Prince we wrote about in a previous blog. It is the home of 20 girls age 3 to 12. Their dream is to move to a larger place that will be able to have boys, and will be located within walking distance of the Hopital Adventiste d'Haiti. Today I told Lucie that we want to help her realize this dream. Charlie MD and I are going to be interviewed on our local public radio station KZYX/KZYZ 91.5 and 90.7 on Wednesday June 2 from 9 to 10 am. For people out of Mendocino County you can stream the show on the web at kzyx.org. We are going to call the orphanage and the girls are going to sing for us.

While working at the Hopital I came to realize a deeper value of song. Groups of people would break out in song throughout the day. A person may have lost everything and they still sing. The singing is beautiful, healing and full of love. The music gave us a sense of peace and true beauty.

Please Save the date for our benefit: Hearts Helping Haiti, Saturday, August 21, 12 to 7 pm, family fun, music festival, at the Nelson Ranch, south of Ukiah. Please volunteer to help we will need 100 people that day. We are having 2 slide shows/receptions on June 17 and 18 as a kick off for the benefit.

The following story is about Adnise, the 22 year old woman who walked with David and Melanie for the first time in her life.

Pictures: The Girls of Reveil Matinal Orphanage, Ukaih Team at work in the ER at UVMC Skip in the middle is in Haiti now and our wonderful supportive Hospital President Terry Burns toward the right, David and the shoes for Adnise.

Words by David our Physical Therapist

I am not going to be so arrogant as to say that Adnise has never owned any shoes. While likely she hasn’t it is always possible. I can assure you that none of them have been adequate to actually fit her bilaterally clubbed feet. This is a project that we have been working on for the last week. Once I saw how good she was doing walking I enlisted the help of one of our great handymen. After I introduced him to this young woman, he wanted to make some good shoes for her as badly as I did. He took wooden reinforced shoes and cut them down to her size and rounded the edges. We then spent a good chunk of the afternoon sewing straps on. Once we had them all fixed up we took them down and gave them to her. She was experiencing some muscle cramps when we arrived which definitely dissipated some of the excitement of the moment. After a little soft tissue work on her feet she was smiling and ready to be up and trying out her new shoes. She was able to walk much better without the pressure of the hard tile floor on her little feet. She continues to complain of the weight of her braces which are actually very light, but when you haven’t walked in your entire life, everything seems heavy.

Everyday we try to make as much of a difference as we can, sometimes it is the little things that mean the most. Building relationships is as important as anything else that we are doing here. It is an opportunity for us to step back and realize that we
don’t have a list of things to accomplish, we are here to reach out to people in whatever way we can.

LOVE MORE, RISK MORE, DREAM MORE

Words by Emily

Dr Nelson's morning talk included excerpts form a memoir of someone who worked with Mother Theresa, and he ended with the above quote.

Becky and I decided to go across town to visit Toby Salz, our UVMC ED physician who was volunteering at the General Hospital in Port au Prince for 5 weeks. We took Jimmy, our interpreter who had been raised in the US and speaks American English. Due to some unfortunate circumstances involving our legal system, he'd been deported back to Haiti after 26 years in the US. We took care of him when he showed up in the ER at the Hopital writhing in pain from a kidney stone. He was so happy to be around Americans again that he is volunteering and hoping to work his way to a hired position. We took a Tap Tap (small trucks with seats in the back, colorfully painted). The General Hospital is considerably larger then our Hopital Adventiste d’Haiti but similar, as both hospitals are under equipped, understaffed, and caring for seriously ill patients. Toby has been the acting medical director of the ER there, as he has been there the longest, and is coordinating the withdrawal of the international volunteers. The plan is resumption of exclusively Haitian staff, a process which was not going smoothly.

We drove by the palace, still a crumbled ruin, slated for rebuilding at some point, to be paid for by another country - Belgium?. We pushed our way onto a crowded Tap Tap to ride home after walking through the degraded and trash-lined streets. The people were friendly, I never felt frightened or threatened in any way, but was still relieved to see the white gates of the hospital grounds.

Our last day was a flurry of working in the urgent care clinic and helping the new family practice doctors get oriented. They hit the ground running. I went to the pediatric nursery one last time to say goodbye to the babies and spent some time trimming Sara's fingernails. We spent an hour on the steps of the hospital waiting for our driver, the interpreters couldn't get their fill of the beautiful nurses of the Ukiah team. I know for all of us, the Haiti experience will remain some of our most moving memories and hopefully will result in some long lasting friendships.

Words of Becky

Brianna and Oscar from our lab arrived. Their Thursday arrival was helpful as it allowed us to show them the ropes and share whatever knowledge we'd been able to scrape together.

Our last day at the Hopital was bittersweet. David, Melanie, Mike, Dale, and Brad left early in the day, we all got up early for a group photo. Talk about a great team building experience that our hospital will surely benefit from. Linda, Gurpreet, Becky, and Emily put in a few more hours of work as help was needed. We had a wonderful send-off from the remaining staff and the translators. What a great group of people. I will be forever changed by this trip to Haiti. A week is not enough time, I fear that I may have gotten more than I gave.

Last 2 photos:
Emily and Becky find Toby in Haiti
The Morrisons in their luxury digs

Everyone Here Has Chest Pain

Words by Mike

Day two in the urgent care tent. I counted 97 patients seen by myself, Emily and Rick, our uber pediatrician from Los Angeles. A smaller crowd than yesterday. We have tried to apply some simple order to the tent, everything in place before the doors open to the throng waiting patiently outside at 7:30, a triage person taking vitals and simple history, a numbering system for the patients, etc. But the forces of disorder and disorganization are relentless. It began with no "papier" on which to write notes and minutes lost trying to make copies, then endless lack of various this and thats, people jumping the queue while dozens resignedly wait on the benches. Periodically something dramatic presents itself, an asthma attack or a head wound which is ushered through to the ER. Medicine is something of a spectator sport here, the bench people listen avidly to the clinical details related by the patient at the doctors "desk", a crooked tray table cum folding chair. I don't inquire about the comments and jests coming from the gallery.

Some of the patients problems are straightforward, but management never is. Doctors may have been seen before, but there is never a diagnosis by history. Medicines may have been given, but they are unknown. Patients always run out of medicines. But they have no money, and to get a medicine refilled for free requires a long trip to the hospital and a half days wait. Everyone over forty seems to have uncontrolled hypertension. Some tests may be ordered but generally require another visit for "results". Many simple tests are unavailable, even simple things like thyroid function. You can write prescriptions but the pharmacy may not have the medicine or you might have written "incorrectly" so virtually every RX generally requires me to walk down to the pharmacy to see what is there. Many problems result in consultations for nonexistent consultants. For example I've seen several large hernias. Supposedly a general surgeon is coming in two months, so all we can do is take the patient's phone number (or the number of the neighbor lady) and promise that they are being placed on a list to be seen. There are no urologists on the horizon. No ophthalmogist for my lady with the cloudy cornea and eye pain.

Everyone here has chest pain. They also have stomach pain, back pain, headache, palpitations, dizziness, and weakness. But they are worried about the chest pain. The EKG machine does not work. This had been the only available technology for assessing acute chest pain. If ischemia is likely we skip down to the end of the algorhythm and treat with the few medicines we have. But the majority of our chest pain patients have obvious and profound post traumatic stress disorder. You don't have to scratch too deep to encounter sadness, uncertainty, pain and deep anxiety. I think: what can be done for these people? So I walk down to the pharmacy and ask to see if there are any available psychiatric meds. There is a big bottle of diazepam. What else? A ha - I find a bottle of zoloft. Not much, but certainly enough to treat the unemployed school teacher aware enough to frankly write "depression" as his chief complaint. "Oh no no" said the pharmacist, "this (zoloft) is a very very strong and dangerous medicine and you should not give it to anyone."

Another universal complaint is epigastric pain. Haitians are an abstemious lot: few smoke or drink. Few can afford to buy NSAIDS (Ibuprofen). As they live in crowded conditions I suspect H. Pylori to be quite prevalent. But still, why so much epigastric pain? But today the pattern finally emerged. Most people describe a gnawing epigastric pain relieved by meals. Well then, I ask "how many meals a day do you eat?" The answer, in general, seems to be one. Some people eat two. I've yet to find a patient who eats three. And for some, the answer is "Sometimes one - sometimes none". Haiti is hungry. Very hungry.

Pictures: The super cute baby, Becky and Brad hard at work, the uber pediatrician Rich and the preemie.

Miracles in Chaos

Words from Linda

“It’s about 12:30 am here and I am having a hard time winding down. Gurpreet, Becky, Shan and I just returned from playing "Santa" to the kids in the hospital. We created little goodie bags with coloring books, crayons, pixie sticks and toys and then placed them by each sleeping child so that they could have a surprise when they woke up. We were very stealth about it and no one woke them up!

This morning we were up early to do rounds with the orthopedic surgeon. Afterwards we had planned to begin doing wound care on the patients but the triage tent was so busy that Gurpreet and I were asked to help down there. Dr. Turner and Emily had a long line of people waiting to be seen. I was told to take vitals and triage but after an hour and a half I was drenched in sweat and began to feel overwhelmed as I realized there was no end in sight. Not to mention I still had a lot of dressings to change! I decided to ditch the triage tent and do wound care with Brad. One wound patient takes an an hour + no matter how much we prepare, for the most part we have a good work flow. I am proficient enough in my creole that I don’t need my translator during the dressing changes. David and Melanie the PTs have become experts on wounds and wound vacs - they have been here the longest and provide continuity for the patients.

There is plenty to do helping the ED - lab draws, giving meds, starting IVs on dehydrated people, there is always someone who cant find a supply and they need a "gofer" There is a lack of organization here with the supplies. It is frustrating. Gurpreet was involved with some complex cases today as well as being stuck with entertaining 4 nursing students. Becky is just doing great things in the ED and is the go-to girl in that department.

We went out to eat tonight at a local restaurant. We had a few beers and shared our "war" stories of the day as we munched on fried plantains and piccoleas (sp?). It was nice to get away after a long crazy day. The young 24 year old mother with the skull fracture was a very sad case. She was transferred from Doctors without Borders, and after more than 6 hours spent trying to save this girl which included inserting our only central line in the hospital, intubating her, giving her IV meds and IV fluid etc., after a consult call was made to a neuro surgeon and the MD director advised letting her go. The whole situation is just extremely unfortunate and sad.
OK well I have to get at least a few hours of shut eye before tomorrow. “

Words from Becky

“Being here is hard, great, wonderful and awful. The inflexible and unadaptable need not apply. Doing things that are simple at home are very difficult here. Starting IV's kneeling on the hard floor in low light, with any variety of strange IV piggy tails or IV tubing, making our own saline flushes. Trying to find a small drinking cup to bring a patient some water so they can take a pill. Finding a good working thermometer and then run out of probe covers and resorting to doing axillary temps without probe covers, until that thermometer stops working and you have to search high and low for another one that works. Weighing the moms holding the babies and then the moms alone to get the weight of the baby. Wanting to explain something to a patient and scanning desperately for a translator. Wanting to give Septra/Bactrim to a patient but finding out that this antibiotic is currently not available here. Helping the patient connected to the large oxygen tank use the bathroom; the tubing is not long enough to reach the bathroom, they do not have a portable tank available, and they don't have a bedside commode or even curtains separating patient rooms. What do you do? Luckily the Haitian people are not very modest. They can't afford to be.

Dale and I had a sad case yesterday. A 12 year old boy came for a cardiology consult. He was very polite and wore dress shoes and grey trousers with a button up shirt. His oxygen saturation would drop below normal, and when I listened to his heart I heard a very pronounced murmur. Dale discovered the boy had a strong thrill (vibration) on his chest that was the source of the strange heart sound. He also pointed out his clubbed fingers. With the help of the translator it turned out the boy has a congenital heart defect. His mother said he needs surgery to try to repair it, but they cannot afford it. Dale is compiling a list of cases to refer to charitable organizations when we get back to California in hopes of finding someone who would do the surgery.

Apart from getting to feel good that I am helping people in need I am becoming a better nurse. I am getting comfortable doing things they taught me in nursing school but wasn't very confident in doing before; EKGs, nebulizer treatments, manual blood pressures. With so many really sick people, my triage skills are being put to the test.

Rich the pediatrician had a great case today. He saw a 3 month old baby that came to the hospital in with a cleft lip. Reg the ENT repaired it in surgery this afternoon. A success story to keep us going. (Miracle in Chaos)

Linda and Gurpreet are turning into little ED nurses, and Brad has been fantastically helpful in a number of tough situations. The Ukiah team is a very significant presence here (all of the teams). "Oh, you're from Ukiah, too!" We were the ED today. It is amazing to me what a huge impact our little hospital from our little town is making here and I'm very proud of us and thankful for the UVMC family for allowing it to happen, including those left behind to run the show short-staffed."

Pictures: Baby with the mom in the yellow shirt is one of the dehydrated babies, Becky with some new friends.,Ukiah team down time.

PAS GEN PROBLEME (No problem...)

Words from Emily
"Our interpreter, P. Roosevelt, taught me some Creole last evening at dinner:
Ki kote ugan dule? Where does it hurt? I used it a few times today. Mostly we rely on our trusty interpreters, but I have resorted to sign language, a bizarre mixture of Spanish, English and even some French which I am recalling from some faint recesses in my mind, learned in high school. Today started out with a flurry of activity as we had a toddler in status asthmaticus, a temp of 105 and seizing. The two pediatricians, Michelle, and Rich, were tied up in the newly cleared trauma room, which is also the storage room for the ED. We have already used it several times in the 2 days it has been set up. We couldn't get an IV started, so they finally started an IO line in his leg, then shipped him out to Miami Field Hospital, with another ambulance ride for Michelle. Meanwhile the Urgent Care tent was filling up with two long waiting lines full of people - lots of kids, babies...Mike waded in and saw most of the adults, while I helped when I could and also ran interference in the ED. I took care of some of the waiting babies - did we mention that they are CUTE? Rich finally got out to the tent and steadily worked his way through them, he and Michelle ended up admitting several. The nursery is now overflowing. There is a tiny six week old who was born several weeks premature, weighing 1.25 kilograms at birth. He still looks like a tiny newborn, and is being treated for diarrhea. He was taking a bottle but not very well, so they may start tube feedings.

Last night we went to dinner at L'Hotel Olaffson, antiquated and historic. Many famous people have visited over the years. The restaurant and lobby are full of wonderful Haitian art, some of it featured Voodoo symbolism. It took a while to get our dinner, it was pleasant to relax with our team as well as three of our interpreters.

A sad case in the ED this afternoon - a young woman who had a skull fracture from an assault. The ED team including Becky, Linda and Brad worked on her with Mark the ER doc, cooling her down to try to get brain swelling reduced, and preserve function, but the CT scan showed severe brain injury and they finally extubated her and let her go. She had no family except a baby daughter who had been left with friends, she worked as a maid, her employer accompanied her to our hospital. Her last experiences were of kind touch and concern.."

Trauma Queen speaks from Ukiah: Today Laura, Kristy, Dale, Tami, Leanna, and myself (Lynn) were all back from Haiti and working at UVMC (Ukiah Valley Medical Center). Leanna is wearing this gigantic Cheshire cat smile every time I look at her, like we are sharing some fabulous secret. I was floating around, trying to get grounded. When I close my eyes I see our Haitian babies and external fixators. I kept thinking there was a door in our hospital like the magic wardrobe that we could walk through and be back at the Hopital Adventiste d'Haiti. I am so glad our team 3 is there, carrying on the work, we all feel the link. I sat with Terry Burns our hospital president today. He is proud of our special little hospital that is sending 10% of our employees to volunteer at the Hopital. He sent a challenge out to the other Adventist Hospitals to beat us and send a higher percentage of their employees! We have another team of nurses and lab techs arriving in Port au Prince on Friday. I am putting the word out on the radio and everywhere to donate sheets, towels, and chux to send down. Dale has some more Bactrim suspension to send so Emily please pass the word to the Pediatricians.

Jean was my fabulous personal interpreter. He chose to work in pediatrics because he loves children. He is a mature, articulate professional. I am happy to say that we decided to give him a micro loan to start a language school. He went to linguistics school for 4 years and was a language teacher when the earthquake hit. His school and job are gone and he has been volunteering at the Hopital since the disaster. We are giving him a large tent and school supplies to start out. I have a sense of peace that our support of Jean will be a sustainable benefit of our volunteer work in Haiti.

Pictures: 2 brothers, Linda arriving with supplies, Lynn and Jean

THIRD WAVE HITS THE SHORES OF HAITI

First picture is of Melanie helping a 22 year old woman walk. She has a rare bone and connective tissue disorder causing her knees to be frozen backward and her feet malformed. She has been at the Hopital for treatment, they slowly brought her knees to straight, and the picture shows her talking the first walk of her life with Malanie at her side.

May 21. Headed to the airport early this am we are Ukiah Team 2 passing Ukiah Team 3 in the sky as they arrive. On our way home, none too soon. I was having trouble keeping my vital organs healthy. It will be a relief to be in a climate where it doesn't take constant vigilance to maintain my electrolytes in balance. As we passed through the city of Port au Prince, there was hustle and bustle everywhere. People were crowding the streets moving purposely along, to school, to market, to work. This sounds like a typical city morning, but these people were moving along with the streets piled with rubble, broken cracked buildings everywhere, piles of garbage, open sewers and dirty water to slosh through. Pigs were out in numbers eating garbage. At one place near the market there was a tanker truck accident and there was an oil spill covering 2 city blocks where people were slipping through this thick gooey substance that consisted of oil, dirt, water and garbage, it covered everything that touched it.

10 of us were crammed in a hired van to get to the airport, the traffic was insane and we got is a car accident in a turnabout (fender bender). The place was crawling with UN peacekeepers in military uniforms from around the world. They witnessed the accident and pulled us over. It was a bit unnerving, at the same time fascinating. The officer who spoke to us was from Senegal. The UN forces are the government in Haiti now, the police force. They were appropriate, our driver was a professional and had all his papers in order, we were set on our way in time to catch our flight out of Haiti.

The ride was hard for me with profound questions on what good we had done, what is the best way to bring aid, what is sustainable? What is the answer to the extreme poverty, pollution, disease? I met a volunteer in the airport who was an agronomist. She had come to teach people to raise rabbits sustainably.

THIRD WAVE HITS THE SHORES OF HAITI - Words of Gurpreet, Emily and Becky on their arrival at the Hopital

“The ride from the airport was filled with experiences that assaulted our senses; the mob outside the red gates, the miles of rubble and trash-lined streets, the crowds of beautiful Haitian people, many children and no fat people. Emily PA, Becky RN, Gurpreet RN and Linda RN, Brad RN, Dale MD (cardiology) and Mike MD (internal medicine) the new Ukiah Team joined with Rick the pediatrician and Reginald the ENT doc.

Luke, pre-med student and administrator oriented us to the hospital, we changed into scrubs and got to work. Dale was immediately enlisted to help with Laura’s cardiac patient. We were happy to find David and Melanie from the Ukiah team, the only ones who knew about the med/surg patients. Dr. Nelson welcomed us warmly but seemed disappointed that our team did not include any OR nurses. Gurpreet, Linda, and Brad jumped into doing wound care, of which they are rapidly becoming experts, especially dealing with all those external fixators from the orthopedic surgeries. Becky and Emily headed to the ER where we met Mark who after one week was running the place. George, also ER physician, was busy seeing patients. Shan is the other pre-med student who is incredibly helpful. In the background is the hard-working Haitian team of doctors, nurses and, most helpful, the translators (they even know where the dressing supplies are!)

We went to the nursery and met Lynn and Leanna's baby, Sara, who is continuing to be more responsive and interactive all the time. Michelle the pediatrician is great to work with and will not be shocked if she sees another dehydrated baby or two tomorrow.
Today we took care of an asthmatic woman in severe respiratory distress. She got all the treatments and medications we would have given at UVMC but still remained hypoxic with extremely labored breathing. We arranged a transport to the Miami Field Hospital. Mike accompanied her in the ambulance and later said they almost had to intubate her en route. They were relieved to arrive at the well-equipped ICU at Miami.

After Mark, Emily and Becky ran in circles all afternoon trying to find medicines and supplies, it was wonderful to see Reginald organizing the ER supply room. He even cleared space in the middle of the room as Mark had envisioned to be better prepared in the event of another code (after running two codes on the floor last week). Becky is very proud of her first dehydrated Haitian baby IV (DHBIV) and also wishes there was an RT volunteer in this group as Becky and Emily have been figuring out how to do the EKGs. We helped suture the last open wound on the face of the young girl who had facial trauma from a brick that fell off a wall. Sadly she remains blind in that eye, presumably from optic nerve damage as the eye appears normal. She was discharged home today.

The cutest ones in Haiti are the children. They have big beautiful eyes and smiles on their faces. Today Linda, Melanie, David, Brad, and I spent all day doing dressing changes. Most wounds are complex, especially the ones with external fixators. If we were in USA, we would medicate the patient for the wound care process. Here we had to change dressings without medications which made the process longer. I had the opportunity to get to know some the patients and translators. I almost felt like I shouldn't have questioned them because their stories are heart breaking and make me want to cry. How can I cry in front of these patients who are so happy to have us here to help them? (I know what you are thinking Candace but I'm holding on). So many patients here don't have any place to go on discharge. One of the patients asked me if I can help get her a tent, there are so many like her. We did take some time to eat lunch and by the end of the day, my feet were hurting so bad. When I finally sat down, I couldn't get out of the chair and today was supposed to be an easy day. I better go. Take care.”

Picture of Emily at new resusitation station in the ER, Bus load of Ukaih Team 3 arriving from the airport

Near Riot Caused by Lynn and Laura

Laura wants me to tell the story about our work today at the "Canada" tent. We are doing the Hopital a big favor and have taken on the complicated task of discharging some patients from the tents around the hospital. Last week we organized a survey and determined that there are 46 patients in a total of about 20 tents. The patients need their families here also, as they feed and care for them, that swells the residents to 200 or more. The biggest nicest tent was donated by Canada. The first time I saw it I had this emotional reaction of love for Canada. This tent is beautiful, has room for 15 patients and was put up by the Canadian response team right after the quake. It is full of patients who were injured with amputations, and multiple fractures who are getting physical therapy from Handicap International/Christian Blind Mission (CBM).

Some of these patients are ready to be discharged. Discharged to where? Rubble, starvation?? It is no surprise that they do not want to leave. It is complicated but since I represent the Hopital, I can say that we need the beds for patients that are in the hospital that require only physical therapy. Due to the Grace of God there is an organization called the International Organization for Migration (IOM), which is part of the UN. They have social workers who help find placement for patients who have been effected by the quake. They give each person a tent, a tarp and provide transportation to their home, if it is rubble they help them find a place to pitch their tent. They help the patients get to medical appointments.

The IOM came to the Hopital to take 4 patients today. I had patients to move into their spaces so I went out to the Canada tent to determine where the new patients would be placed. I noticed that 4 of the cots had been folded up and placed with the departing patients belongings. This is a problem. Places to lie down are at a premium. We do not have enough beds in the hospital, in the ER yesterday my patient was getting her IV hydration lying on the floor.

I called Luke our sweet young administrator on the walky talky and informed him that the patients were leaving with their cots unless he came down here and did something. Next thing I know a determined looking Haitian woman with big hair comes striding through the crowd with a nice Haitian man following behind. A loud conversation begins in Creole and voices get heated, people start moving in and Sherie from CBM and I start slowly backing out of the tent. We back way out of the crowd and listen for many minutes. Pretty soon the man and woman come out and carry the cots into the hospital. There were angry people looking at us and saying all kinds of things, but I had no clue so didn't take it personally. My interpreter said at one point that a lady said "I have no bed". I looked her in the eyes and said, "I am sorry". At the same time I thought of the little boy with the multiple operations on his leg that needed that cot, the elderly woman who was crushed in the earthquake and has not walked since, who was supposed to move onto that cot. I love these people all of them.
With time things settled down, the 4 people left and we moved the new patients into the Canada tent.

Kudos to Tami W. for sticking with the urgent care tent for the whole 2 weeks. Day in and day out she dedicated herself to serving the endless flow of out patients presenting for care. It is a hot, humid tent, filled with patients waiting to be evaluated. I am sure she is tired and has learned more that she ever dreamed possible.

We are saying our goodbyes all over the hospital. I only cried when I said goodbye to my baby Sara and her Mom. I hope to organize another team in January. Let me know if you want to join us. We have a great team coming in tomorrow so this blog will continue to bring you the story of the Ukiah Team at the Hopital Adventist d'Haiti.

Pictures: Painting of the Earthquake, Michelle our pediatrician with Sara and her Mom, The Canada tent in front of the Hopital, The Second Ukiah Team at 6:30 am, Tami in the urgent care tent, Cindy with her baby in the ER.