Tuesday, November 1, 2011

Haiti Perspective

Perspective: a way of regarding situations, facts, etc, and judging their relative importance.

Just when you think you have your life figured out...when you feel your life is in dispair...when you can't see any goodness in anything you do...PERSPECTIVE can kick you in your ass and put you back into reality.

I consider myself a person who is very aware of PERSPECTIVE. Not all the time, but I would say a lot of the time. Even so, I have recently been knocked out of my PERSPECTIVE bubble.

With the permission of my sweet friend, Nora Applebaum, I am going to share some things with you.

Nora is a mom, a sister, a daugther, a friend, a nurse practitioner, a wife...but even moreso, she is a completly selfless, giving person. Every year, she pays her way to go on a trip to Haiti, to work in a mobile clinic, helping countless sick people.

Sick beyond anything we Americans could fathom. She treats children who are literally on deaths bed, but the parents or grandparents are so grateful for her help.

Here in America, there are countless times parents throw big hissy fits because their child has ear pain and they can't get the appointment time they want....in order for them to go to all the other things that must be more important, like baseball, hockey, soccer, fill-in-the-blank.

I would love for all who are here reading my blog, to read these notes from Nora from her latest trip to Haiti. .....and then, I implore you to consider donating ANYTHING to the great causes she supports...which I will include in the next blog post.

Thank you for reading. It's important....and it will hopefully put things in PERSPECTIVE for you, as it has for me.

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RE: Haiti Trip

Hi All. We have arrived in Ft Lauderdale!!!. It is mid 70's and clear. Beautiful. Just finished the team meeting over dinner. What a wonderful group of people to share the work with. We meet in the lobby at 3.45am (ok, REALY?) to catch our plane to Cap Haitian. Ugh!So off to bed! Hope to have some internet in Haiti to hear the update on the Cards!!! Wearing my Cards shirt on the plane tomorrow!!love nora


RE: Sunday

Hi All. Really had trouble getting the internet. No skype so far. I am trying to type fast to get this out. We went to a town called Don Don yesterday, south and west of Cap Haitian. About a 2hr drive up a skinny rocky road, with lush jungle along the side, banana trees, water falls, with the mountain falling off about a mile below. Out my window I could see through a beautiful valley and in the distance the Citadel, the castle on the mountain. We set up clinic in a tiny school room...saw about 400 kids and few hundred teeny tiny old men and women. The adults seem like elfs, grizzled, smiling, and barely 80lbs soaking wet. These kids were really not used to seeing "Blancs" so a bit of a barrier to cross doing an exam. Had a few impressive cases of pertussis, mumps, pneumonia, scabies, cellulitis, bony TB (ribs), and of course everyone has intestinal worms. Always impresses me to feel them move away from me when examine the abdomen (of the child, not the worm) ha! Had several cases of malaria, but no cholera yesterday. So much malnutrition. Had a 30lb 8yr old. Just dont even know what to say about that. Our team is great, as fun as always. Not sure I could do this without them to make me laugh. Off to day to the clinic in Tovar. Ray said they saw 2300 people last week (team one). So, as Ray say, we will be up to our behinds in alligators...well he is a little more colorful. You get the idea. wish me luck love you, no


RE: Monday
Hi All. Today we went to Tovar, the mission clinic. Piled into 3 vans, generator, water, and all the supplies. Cap Haitian in the morning is a chaotic mess of mopeds with Dad, 4 kids, and then a mom swerving between open air buses with 20 uniformed little girls. No stop lights, no street signs, complete me first driving. Not for the faint of heart. Along the roadside you see piles of trash, huge pigs and goats rooting around, and little kids in clean pressed uniforms holding hands and walking in a directed manner. Apartments in varying degrees of completion, rebar sticking up, and trees growing in the depressions. Clothing is strewn over the edges drying in the sun. As we leave the city gates, we enter a lush paradox, black soil, and pitiful cows tied up, their ribs clearly visible. Banana trees, avacados, mangoes...abound. Most people walk, with huge buckets of water on their heads, smile and wave. The kids scream, "blanc" and wave frantically. Most dont have anything on the lower half, and run barefoot, fullspeed down gravel roads. The van jumps incessently as it descends into the pot holes, and I regret not having done more core strength exercises. (Sorry Ben). Kind of hard to complain about musculoskeletal pain from a van ride, when they walk overnight to be seen at clinic. We arrived at the clinic to have about 100 people waiting. The day was crazy. I saw 62 kids. Can you believe that??? Many with malaria and so profoundly sick. I thought I knew illness until I have treated patients suffering from malaria and dengue. Such misery. Tons of scabies with secondary skin infection, whopping pneumonia, perforated bilateral otitis (ear infections), cellulitis/abcess (we have a DVM on the team so he does our I&D and sutures), a couple with presumptive typhoid, UTI's, zinc deficiency rash, normal kid traumas (falls from trees and bikes), 5-6 mumps, many pertussis cases, a few burns (cooking on open fires) and of course the scourge....malnutrition. Had a 24 lb almost 8yr old and a 12 lb 3 yr old today. Lots of orphans, grandmas caring for 5 or 9 grandchildren. Tested them all for HIV, no positive today, thank god. Had an 8 day old whose mom died in childbirth, and grandma had fed her tea, nothing else to give her. So much grace in the face of ridiculous odds. (gave her the formula, vitamins, and bottles from the office) They dont complain, and always say thank you to me. A connection of mom to mom, human to human. They just want the best for their baby. No different than me. Finished and piled in the van to return to the Mon Joli. We all listen carefully to each others triumphs and disappointments. I tear up hearing to the heart wrenching stories. I try not to talk with the lump in my throat. Just nod my head. So much to learn. So much to admire. We arrive at the hotel, exhausted. Team dinner of goat and fish and squash. I marvel at our team. So many different people, from many geographic areas, all here to provide some relief or make a little difference . I am I lucky or what???I hope to get to the orphanage tomorrow to see my little charge. She will be one year older. Love to all nora



RE: Tuesday and Wednesday
Hi All. Internet has been very uncooperative. Had a couple big storms just to confuse the satellite. So I will try to type fast. Wednesday is market day in Grison Gaurde, the town just past the Tovar clinic. The road is busy with people walking pigs, goats, and calves to sell. Many carry bushels of avacadoes, or mangoes, coffee beans, cassava, woven chairs, ...whatever they can sell. The small horses are loaded down with baskets hanging off the sides, bursting with wares. It is a bustling morning, many folks stopping to chat along the way, or buy fried bananas as they walk miles to reach GG. It seems an idyllic picture. Then we pull in to the clinic, and so many wait outside. Mothers carrying sick children, elderly men and women sitting in a daze on the porch. Time to work. Saw 68 kids yesterday and 74 today. About a third are well, just have worms. Their moms just want someone to examine them and tell them they are ok. The kids stare at me curiously, and if brave enough, reach out to touch pale skin. They try to feel my hair and are just not completely sure what I am going to do. They clearly want to know more about me, giggle and talk amongst themselves about me, but are hesitant to do much more. So cute.Some patients are so very memorable, and I wake at night thinking about them. Had an 8 day old baby, brought in by grandma. Mom was "too sick to breastfeed", they had spooned him tea. The baby looked amazingly good on exam. Fed him some formula and I laughed at his expression of joy. Gave the grandma "taptap" (taxi) money to come in so Liz could evaluate her. Turns out she had an enormous HPV tumor, 16x12cm, over the perineum and was HIV positive. She is a young girl, now destined for misery. The baby also tested positive for HIV, but not sure if that is reliable, probably not an accurate test at this age. Either way, both were referred to the HIV clinic. Had a three year old that fell into the cooking fire, severe burn all the way up the inside of his R arm. Stood perfectly still while we cleaned and dressed the wound. What american kid would do that? He did start crying, just silent tears rolling down his cheeks. I gave him his dose of antibiotic, some tylenol, and wiped his little face. He looked up at me and said in a tiny voice, "Mesi, madam" (thank you maam). I was stifling the big ugly gulp cry and just gave him a hug. Many kids are severely injured over fires here, and often the secondary infection is worse than the thermal injury. And of course the threat of tetanus. A serious concern of big open wounds. Thankfully he had received his vaccines.Saw 4 wk old that had fever and was seriously dehydrated. He had impressive rigidity, difficult to flex his neck or hips. Likely meningitis. Rehydrated him, gave him 100mg/kg of Rocephin, and hope to see him back tomorrow. Not sure if he will make if through the night. Mom is also at home, "sick". Auntie brought him in and sat stone faced as I explained my concern. I rarely meet a mother that has not experienced the death of a child. They seem to accept that and just emit pain and sadness. So many more, I cant begin to write about them all. Two more days of clinic. I begin to feel a panic for the kids that will fall ill next week. If you are "lucky" you get sick while the team is here. I have to push the thoughts away and just plow through. Maybe one of these children we see will grow up to be the next president, or invent the cure to cancer. All I know is that to honor my children back home, I have to help the ones I can here. We did hear about the battle shaping up at Busch....crossing my fingers. LoveNora


RE: Thursday
Hi all. An overwhelming day today! Saw 84 kids. I am exhausted. Really hot and humid today. But probably one of my best days EVER......My meningitis baby made it through the night!!!! He had his eyes open and looked at me like a little scared bird. He still had a fever, and impressive nuchal rigidity, but an improved status. Dad feed him overnight with a syringe, he was too weak to suck, the formula I sent home with him. I was so excited to see him I jumped up from my rickety table on the clinic front porch and ungracefully tripped as I hurried to meet him. I saw the baby's face, looked in the Dad's eyes, and just hugged them both. He was trying to be so stoic, but was just overcome with emotion. It was a little embarrassing, having such a raw moment in front of all the waiting patients, but what the hell. It made the whole trip worthwhile. I think he just might have saved me more than I helped him. So many memorable other kids.....Saw a 7yr old that was hit by a motorcycle right outside the clinic. Had an 8 yr old with severe hydrocephalus (fluid on the brain) that can now crawl and say a few words (as if life in rural Haiti wasnt hard enough).... Saw a 4 yr old with a huge cyst on his arm, benign, but reassuring to mom that the voodoo wasnt taking him over. Many cases of malaria which always impresses me. Two kids with cutaneous anthrax, presumably from hugging/playing with goats. Indescribable scabies infections, over all of the body, with secondary pustules from scratching so hard. A darling 7 yr old ran to me with her arms outstretched, when Daphne called her name. Her mom said she remembered me from last year and that Edeline wanted to see the lady with the 'water eyes" (blue color). She was only 18lbs!!!. Think of that. Her arms were not much bigger than the size of my thumbs. I asked what brought her to clinic today, and she said she just wanted to say hello. They were in threadbare, tattered clothes, so very thin, covered in scabies, but smiling as they talked to me. Asked about MY kids. Amazing. I talked to her about the Mamba (medically enriched peanut butter) program and mom nodded and said that would be fine. Treated her infections, enrolled her in Mamba, loaded them up with AK Meal (protein and grain mix) and hugged goodbye. They had about an hour and half walk back home. Dang.
Tomorrow is our last clinic day. Such emotions. I am so grateful for our team, and will be sad to say goodbye...for now. Am I lucky or what??love nora


Actually Nora....those of us who know you, are the lucky ones....



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