Cruising the Oregon Trail

Be nice to me, I gave blood today

2011-08-12T13:40:00.001-07:00

After noticing that a rather large number of patients have been getting blood transfusions lately, I wandered down to the lab and asked the manager, Salah, if there was a need for blood here. He replyed in the affirmative, citing a need for type-O in particular. (I am O+.) I was working at the time, but promised to come back after my shift to donate.

During my shift, I tried to encourage my collegues to donate as well. Unfortunatly, Palestinians seem to be as lame as Americans when faced with the idea of voluntarily going under the needle, and I didn't get any takers. However, at least the excuses where different. Rather then citing a colorful recent sexual history, most stated that they could not donate during Ramadan, that married people couldn't donate, or that women couldn't donate.

I actually didn't think that I would be able to donate myself, as my hemoglobin is generally through the floor and I have been joining the rest of the hospital in the Ramadan fast. But I guess that a diet of yellow rice and chicken is high in iron, because I was actually in the double-unit bracket (although I only gave one.)

I did warn them about recent travel to Haiti (which is a rule-out for America because of the risk of malaria) but that was not a problem. As an ex-screener for tissue donations, I was pretty shocked that I didn't have to fill out a 10 page survey of my medical and social problems, but things here are pretty different.

"Gas The Arabs"... seriously?

2011-08-05T16:24:00.000-07:00

Jessica

I have been in touch with a young lady named Jessica who has spent the last few weeks in Gaza, and I was happy when she gave me a call, saying that she and another volunteer, Emmett, were in town and were hoping for a visit. They were involved in an Art Exchange in Gaza, where they worked with art projects with the kids there, and exchanged the art with other kids in the states.

Unfortunatly, I had to work that night. I did manage to sneak away-- I wanted to smoke shesha with them, and smoking during the day on Ramadan was not allowed. I had suggested to then that they visit the night market, but we found out that was closed. I was shocked-- 2AM shopping was half the fun of Ramadan while I was in Yemen. However, the Israelis did not allow shops to be open at such a later hour. So with only about 8 hours that one can eat, Palestinians can still only shop during less then half of those. (Another blow to the economy.)

Jessica had actually been in Palestine about a year ago and knew more about Hebron then I did. Emmett had not been, so the next morning we had breakfast in my room and then headed out. (As it was Ramadan, I had snagged some food during my overnight shift to store in my room, where we ate away from the eyes of fasting Muslims.) We walked to the old city, where we were approached by what I call an "impromtu tour guide". Seeing that we were on the way to the Cave of Ibraham, he told us that it was closed, but that he would show us around.

People come to Hebron for two reasons-- to see the Cave of Ibraham, and to see the occupation. As most visitors to the Cave are Jewish and therefore stay in the settlements, any westerners that can be found in the old city can generally safely be assumed to be examining the effects of the occupatiuon, as we were. Our tour guide, Ibrahim, was well aware of this and basically started to give us the tour without asking. It's hard to say "no" to someone whose schpeal basically starts with "come and see what terrible things have happened to our city." To say "no" sounds like "I don't care".

Ibraham was a great guide. His "specialty" seemed to center around the different art and graffitti that can be found around the settlements, as can be seen here. The most shocking, of course, was a door that proclaimed "Gas The Arabs JDL" (JDL stands for "Jewish Defence League".) which made me both angry and highly confused.

Shada Street
Palestinains on the left, Isrealis on the right

The roads that are around and in the settlements are often segrgated,with some roads allowed for Palestinians to walk on, and others restricted. (There are also areas where Israelis are not allowed to go.) There is even one street, Shada street, where a divider through the center of the road seperates the area that Palestinians are allowed to walk from the areas where Israelis are allowed to walk. (Only the Israeli side allows cars, in general Palestinians are not allowed to drive in the Israeli-controlled areas of "H2".)
Our tour ended with a walk through a beautiful Arab Graveyard and a stop at a subterrian lake which Abraham and Sarah supposidly washed at at one time. Washing in it yourself was supposed to be good luck, so I headed down. The stagnent water was rancid, smelly, and buggy so I quickly dabbed myself with the green water while Jessica snapped a quick picture. Afterwards, I felt much dirtier then before.

In retrospect, ew.

Ibrahim concluded his tour at this point, and Jessica talked us into heading to the "Synagogue part" of the Cave of Ibrahim. After the shooting in 1994, the cave was seperated into two parts. My tour book informed me that I was not allowed into the Jewish half, but Jessica told me that would be assumed to be Jewish and allowed in. Turns out that she was right. We walked right in to an area that was crowded and stuffed with people and books. Jewish tourists mingled amoung the people praying as we examined the Cenotaphs from the Jewish side. It was too busy for me, so after seeing everything we decided to check Ibrahim's claim that the mosque was closed. (It wasn't, the little twerp.)

The mosque side has a totally different feel. The first thing that we noticed was the hostility of the soldiers as we endered, which contrasted strongly with the welcoming smiles that we got walking into the other side. One of the soliders asked Jessica if she had "anything sharp, like a knife". (I did not point out that had she been carring a knife for the purposes of harming someone she was not likely to verbally own up to it.)

Damn it, this doesn't look like Mt. Doom

When it is not Ramdan, many people will come simply to sit in the cool shade and drink water (as often the mosque is the only place where drinking water can be found.) The only think that I don't like about it is that women are forced to cover in incredibly hot denim capes that Jessica said made us look like hobbits from Lord of the Rings. We took a seat by a fan and were approached by a kid asking for money. I offered to take a picture of him instead. He counted by asking if he could take my picture, and I handed over my camera. As a result of this action, my camera was returned about a half hour later with about 5 lovely pictures (and 45 blurry ones) documenting the mosque and it's visitors from every concievable angle. Palestinian children are easily amused. He did take some good pictures, especially pictures that I would have never taken, such as the following pictures of people praying:

There is nothing that bridges a language gap like a phrase book.

Jessica and Emmett left that day for a small area outside of Bethlaham. They were going to be staying with a woman who is dealing with an entroaching settlement that is slowly taking over Palestinian farmland. At night, fences will appear that grab farmland and are protected by the IDF. My hat is off to her, I can barely stomach the "Gas The Arabs" sign.

Night Shift

2011-08-04T16:01:00.001-07:00

If you have money to blow, we could use
a few new incubators

I have been working in the NICU, and during Ramadan most of my shifts have been night shift. This is because people prefer to be home during "Iftar", the meal where the fast is broken.

For me, one of the best parts is getting fed at 3AM. Normally, I would either have to wake up to get food at this time, squirrel some food away, or just go hungry.

This little one is hoping that her
next leap will be the leap home.
Seriously, it's a 360-degree ultaviolet device
for jaundice.

At one point, a sleepy staff member came out and told me a bit about himself. It turns out that he had two jobs-- one here, and one in Ramallah. Ramallah is about a 3 hour round trip. I asked, surprised, how many hours he worked in a week. He told me 40. I nodded, thinking that this was normal, until he told me that he had an additional 35 hours at the hospital that we were at. Turns out that he is working two full time jobs.
I found out the reason for this when I asked if he had kids. It turns out that he and his wife are not able to have kids, so the extra money that he is raising has gone to two unsuccessful in-vitro fertilization attempts. They are trying for a third. Having kids is vital to family life here in Palestine. (As there are no retirement homes here, it is also vital for a comfortable old age.)

"You Come To My House And You Will Be Better"

2011-07-28T12:36:00.000-07:00

I've been sick again (this time tonsilitis, which I am prone too) and my illness has been causing a few cultural snafus. Just like the local belief that a stomachache apparently needs to be treated with food, a sore throat (and other respirtory illnesses) need to be treated with a journey out of the city and into the country.
So, when news hit the hospital that I was sick, a "rash" of invitations came rushing in, each to a villiage more distant then the last. Although it's rude to refuse an invitation to another's home in this culture, I tend to put my foot down when I am not feeling well and just want to rest. Unfortunatly, the invitations do not appear to be voluntary, and I have taken to hiding in my room to avoid them. The first one I thought that I would be able to perry with an excuse, but the lady said that if I came to her house I would be better. I laughed at her joke, then realized that she was serious. At that time I had a slight fever and I was an hour from the end of my shift and an hour from bed. Unlike milky food which can be hidden in the trash, I have had a harder time trying to convince people that I just don't want to travel or meet a ton of people when I have a fever.

For me, it seems unreasonable to make any type of demands on someone that doesn't feel well, and I am trying not to feel frustrated that people will not just accept my "no thank you, I don't feel well, perhaps another time" and drop it. I am trying to imagine my own reaction if I found out that someone was continuing to smoke during a nasty chest infection-- I would not take a "no thank you" to my advice to stop smoking if I really cared about the person, no matter how polite. I think that people here feel the same way about getting me some fresh air. But, after working for eight hours, I really just want to rest and spending another four hours trying to stumble through a conversation with my weak Arabic is just not an option.

I have been transferred to the NICU, where I have been for the last few days. The plus sides is that I don't have to try to talk to scared parents that don't understand my English. The con side is is that I am working with men who don't really know how to react to a woman like me, but I think that we will all learn. People of opposite genders are not friends here, unless they are also family.

Water Water, nowhere?

2011-07-26T12:36:00.005-07:00

I was talking to some NGO workers the other day, and I learned about the problem in Hebron that involves water.
You have probably heard at one point or another that the water is not divided equally amoung the groups here. There are basically two governments, the Israeli government and the Palestinian Authority (PA), which is below the Israeli government. The Israeli government decides who gets the water and how it is devided up amoung the people, and the PA who rations out the water that the Israeli government decides that they get.

Needless to say, there isn't a water problem that I know of in the settlements. The area of the city outside the settlements is another matter, however. Most of the Palestinians have water tanks that are on their roof. The PA gives each house 2, and richer families will buy more. The water is rationed to different areas during the month. When it is your month, you fill up your tanks and that is all the water that you get for a few weeks. This means that water usage that it not considered "vital" will have to wait. Some couples will even have to forgo sexual activity as they are unable to properly wash afterwards to pray. (I also heard that during the Intifada, bored Israeli soldiers guarding the settlements would shoot at the water tanks to rupture them, and leave the families without water.)

This is obviously not an issue here at the hospital, where we are able to have all the water that we need. But after learning this, I have taken steps to conserve.

A Sad Day

2011-07-18T10:52:00.004-07:00

Beleive it or not, the hospital isn't all
dying children and crazy staff.
There are good days, too.

The day before I got sick, we admitted a little guy with Down's Syndrome who was having respiratory problems. I had not been able to determine what exactly was wrong with him, but he had obvious cardiac surgery, acidosis (probably respiratory), and was gray. I guessed that he was about less then a year-- age was hard to judge because of developmental delays. We did the same respiratory resuscitation efforts that we had done on Farah the day before and he was admitted to our pediatric ICU.

He wasn't doing very well when I came into today, with bruises on his body from what looked like DIC. I found out that he had been coded during the night. He was on a respirator and a heart monitor that was showing periods of apnea. I think that the heart monitor may have also been a defibrillator that was keeping him alive, but I wasn't able to find out. I worked in another area for about an hour, then when I went in to see how he was doing I saw that he had died. He was wrapped in a sheet that was taped closed, and someone had written something (probably a prayer) in green. I am not sure why the child died, or if he would have died had he been in the States. Down Syndrome kids tend to have pretty significant cardiac problems, so it was probably related to that and may or may not have been fixable.

About an hour later, the family started to congregate. I didn't take much notice of the men, but a young woman came in and sat in a different set of chairs and started to cry. Everyone was busy with rounds at this time. Now, the problem with working with families that have lost someone is that death rituals differ greatly, including among different areas and classes. So although my first instinct was to take this women in to see her son, I wasn't sure if that was appropriate.

I did know that, regardless of culture, it wasn't appropriate in any situation for this women to have to quietly sob while people were laughing at the nursing station five feet from her. I tried to get someone to take her someplace private (I didn't want to lead her away without telling her where she was going, and I didn't have the words to explain) and they started to take her into Farah's room (the young baby I've been caring for). Knowing that the last thing that women needed to see was another women holding a living baby, I intercepted the her and took the bewildered women into the nursing break room. I gave her some tissues and a glass of water and then demanded that she be allowed to see her son.

Finally, two nurses took her into the PICU and unwrapped her son for her to see and touch. She cried,touched his face, and asked that he be covered up. The family wrapped up the youngster in a blanket and took him away.

Code Bleah

2011-07-17T06:51:00.001-07:00

Been sick for the last 24 hours with some sort of stomach virus that has been going around. I think that I am finally over the worst of it. The staff here have been really great about taking care of me, although mostly they come into my room to try to talk me into eating food that I can not digest. I am going to head out in a bit and try to find a store that sells ramen. Instant ramen is a pretty universal food, I am hoping. I keep trying to explain to the housekeepers that I would rather be punched repeatedly in the stomach then try to digest the oil-laden hummus, flatbread, and yogurt that they keep bringing me.

My one (and only) patient, Farah, went down a few days ago to have a gasto tube placed as tube feedings unfortunatly seem to be a part of her permenent future. While she was down there, I got to wondering what would happen if a patient coded while on the unit. I had not been shown a crash cart, paddles, or anything like that. And I came pretty close to finding out. About an hour later, one of the nurses got a call to pick her up. I was behind the nursing station when the doors opened and Nabila called out that we needed O2. I wasn't able to figure out what happened exactly, but Farah was grey as stone and her mother was in tears. We took her into the room and I used a nasal cannula that was there to give her O2 until someone brought a vent. We got an O2 monitor at her and she was running at 76% O2 (normal is 95-100). We manged to get to O2 stats up, but she kept on stopping breathing on me and I had to shake her awake. It took 20 minutes to get her color back, and I insisted that the doctor be called when the poor little girl wouldn't stop gasping for breath. Normally, I would have called a rapid responce the second that she had gotten off the elevator, and reamed surgery for sending what obviously was an unstable patient on an elevator without supplimental O2. On that note, I don't think that I have seen any portable O2 anywhere in the hospital. We do the best that we can with the little amount of equiptment that we have.
Anyway, she is doing a lot better now.

Salami Legroom

2011-07-14T11:21:00.004-07:00

Nabila, my preceptor, hasn't been paid in
three months, yet here she is diligently
showing how we get a flush

As Friday is a Muslim holiday, Thursdays are basically Fridays here in Hebron. As a result, there is a fireworks show going on at some big place about 200 yards outside my window. They shoot off about 20 or so every hour. It was cool at first, nows it's starting to get annoying.

Life at the hospital goes on. I found out today that no one here has been paid for a month. One of the nurses told me that since there is no money for the Ramadan feast (Ramadan is in August) she is planning on eating her children for the Iftar, or breaking of the fast. I think that the joke might have lost something in the translation. (There go the damn fireworks again.)

My patient, Salah, whose name is actually Farah (Salah is the mother) is still here. The doctors said a week ago that Farah could go home as soon as her parents buy a home suction machine. I am starting to wonder if the parents know that. I have tried to get the other girls to ask the mother if she has questions about this request, but the baby is still here. Not that I mind, I enjoy taking care of her. (That is us in the picture.)

Me and Farah

But I am really worried about her. I think that I mentioned that her mother and father are older, which is probably why she has so many congenital defects. She was also an IVF baby. With the baby being likely developmentally delayed (I suspect Down's Syndrome), deaf, and mute from the trach, she will need much more stimulation then most babies to help her mind grow. She will cry, but it is completely silent, so she can't even ask for attention.

Farah and her mother, Salah

And there go the fireworks again...

Hebron

2011-07-12T11:14:00.000-07:00

Unrelated note, what is up
with this picutre?

For my first day off, I took a walk into the old city of Hebron. Hebron is unique in that it is the only area in Israel and the occupied territories to have a settlement in a major city. Hebron is divided into two areas, H1 (under Palestinian control) and H2 (the Israeli settlement.)

Guard tower at the separation
between H1 and H2

As a Red Cross/Red Cresent volunteer, I have made it a goal not to become involved in the politics of the situation. Although I have my own beliefs, I am not here as a protestor to to serve some agenda, at least I am trying not to. It is hard when everyone wants to talk to me about politics, or you walk around in Hebron.

I am willing to consider arguements about Israel's right to be here and it's founding, etc etc, but do firmly beleve that the settlements are wrong. Supported and populated mostly by the most extremist populations, it is generally believed that they serve simply to increase the land holdings of areas that are not under Palestinian control. They are akin to people moving into the “Green Zone” of Iraq, and are not only agaist international law, they are against Israeli law as well. They are tolerated in this country for the same reason that the US tolerates things like Abu Ghraib and Gitmo-- it is thought that they are necessary.

Hebron old city market, with the covered to catch garbage.
Can you imagine living here?

A lock to a shop soldered shut

In the case of the settlements in Hebron, they have causes the old city and it's holy site – Ibrahimi Mosque-- to become heavily fortified by Israeli solders. Lonely Planet states that there are 4000 soldiers to protect the 500 settlers (no, that isn't a typo, in fact I just looked itup again to be sure.) After eeing the rooftop lookout points and walking through three checkpoints to get to the mosque, I did not find this hard to believe. The settlement houses are across a small alley from the Palestinian houses, and the Palestinians have had to put webbing over the roads as the settlers will throw trash out the window. In one house that I visited, my host said that he had to keep his windows closed and locked lest his neighbors from across the way toss rocks and Maltov cocktails into his home. (I did not believe him about the Maltov cocktail part until he showed me a area that had been bombed by such a concoction.) He also showed me that many shops were forcefully closed and their doors welded shut to prevent the re-opening of the shops. The shops were too close to the settlements (often, they were in the first floor of the building) and so they were taken away. Resisters were arrested.

The old city

Hebron's recent history includes a massacure in the Ibrahimi Mosque, were a settler (who happened to be a doctor) walked in and killed 29 men and boys while they prayed, injuring another 200. This is most of the reason for the security to get into the Mosque. After walking through two remote controlled locked doors and being searched by two guards, I could start to feel the irritation. My irritation reached its peak at the last Israeli solder who searched me. She was blonde with an American accent, and when she asked me: “Where are you from?” I couldn't help but answer “America. And you?” She gave me a dirty look and let me pass. So much for not getting involved politically.

Praying at the tomb of Abraham

Heartbreaking

2011-07-06T08:16:00.001-07:00

I am continuing to work with Salah, the little girl that I spoke about yesterday with the congenital defects. She is still needed almost constant suctioning. Today the doctor ordered that we try and perform feedings with the bottle, but she will almost immediatly start to choke, and she doesn't try top suck (probably because she has never successfully fed from the bottle or nipple.)

Her mother is an older lady (40+) who is having a very hard time dealing with her daughter's medical needs. I noticed that she has had no visitors, which is rare in Palestinian culture. I learned today that she is actually from Bethlaham, so she is a long way from home. She also doesn't have any other kids. She is trying to be positive about her daughter, but when little Salah vomitted everything that ws given her, the mother broke down and stated to cry. If the child survives, then this women's next few years is going to be spent caring for a child that can not even eat. The mother has been very good about doing the suctioning and feedings herself, but today I had to take over when she was threatening a nervous breakdown. Even if I could speak English, there would be no words of comfort that I would be able to give her.

She must have been looking forward to having a child very much. Of course, there is no guarentee that any child will be born healthy, but I am sure that she was not expecting to suddently take care of a child that is so ill. I tried to get her to leave this afternoon, even for a few hours. She left overnight a few days ago, and returned in much better spirits, but the mother didn't want to leave. The child will be discharged soon, and hopefully will some day be able to have surgery to correct some of her defects. But I worry that the baby will die much before that.

We also got a terrible case of meningococcal meningitis. I was horrified to see that he was not put on droplet isolation, but they did have contact isolation (of sorts). He was covered with sores due to a very high PTT that was probably caused by DIC.

Days 2 and 3

2011-07-05T08:35:00.004-07:00

Nursing Station

Well, I have completed day 2 and 3 of my hospital work. Today was very slow, we didn't have any admissions. I am starting to remember what I found most frustrating about working overseas, and that is the slow pace of life. Honestly, the workload of the entire unit could be done by one nurse from the hospital that I used to work at. The parents do most of the care, leaving the nurses to just administer medications. There were four nurses today, including myself. That means that there is about only one patient per nurse. Much of the day is spent talking and eating. There is a special concern over my eating habits to the staff, and the kitchen will often call the floor to tell me to come eat.

Intake/med room/1 of 2 sinks

I did get my own patient today. Little Salah is a little girl who was born with severe congenital defects. You can see in the picture that she has a trach, 6 fingers on her right hand, and deformed ear canals. I have not been able to find out more about her condition, but I think that even in America there would be little that could be done for her. She requires almost constant suction, feeding through her NG tube, and is on an antiepeleptic drug phenobarbitol. She is going to stay until her mother "psychologically accepts her condition" and has learned to care for her. I think that this will happen soon. The mother would not allow me to touch her or play with her two nights ago, but today the mother picked her up and cooed to her and was able to perform feeding and suction. At the end of shift, I was told to give report. Sif, the head nurse, was there for report and I assumed that he would translate. I said that the infant was stable, was not needing suction as often, but that the mother needed to understand the importance of checking residue prior to feeding.

An empty patient room

I am learning a lot. I inserted my first NG tube, although I wish that it had not been on a baby of a month old. All patients get an IV, and scalp IV's are not inserted by the doctor, so I am terrified when I will first do this. There are only two sinks on the floor with liquid soap and paper towels, so I carry a bottle of Purel which I share with the other nurses.

What I wouldn't give for my maternal and child textbook!

Day One

2011-07-03T07:23:00.001-07:00

No pictures, I am afraid, I forgot to bring my camera. I should have some tomarrow.
I am hoping that this is just first day jitters, but I am actually not sure if this is going to work, but I am certainly going to try. The language barrier is a real problem. All the people that work are Palestinians and have only a very basic skill of English. I think that they thought that my Arabic was better, but if they are willing to give it a go, so am I.
I am working on the Pediatric ward, and my preceptor probably has the best English there. The kids that were there involved a few babies with hyperbilirubin, a baby with terrible congenital defects, and a few older kids with chronic health problems (respiratory).
The worst part was that I couldn't answer the questions of the parents or even explain what I was doing when I went in to take vitals. At one point, a mother went to the door and motioned to me. I told my preceptor, who was charting, that help was needed and she told me to go in myself. I did, but obviously couldn't understand what she needed. I mean, how awful is it to have a sick kid, and a nurse who can't talk to you to boot? Communication and teaching is such a vital part of nursing, and this is why I am not sure if I will be successful here. Even asking a simple question like "do you want some tea?" is rewarded with a barrage of Arabic rather then a yes or a no. I am not very good at learning languages in the first place, and I don't think that I can raise to a level where I can be a helpful worker. But, as I said, I will try.
There was rounds in the morning, and for some reason they would switch to English when the doctors would announce what his plans were for the child. At one point he pointed at a premature (29 week) newborn and asked everyone what we should be concerned with regarding the eyes. No one there knew, and he was very pleased when I finally said that we should watch for retinopathy of prematurity, so maybe I will be able to help after all.

We will see tomorrow, maybe it will go better.

Hebron

2011-07-02T20:00:00.001-07:00

Well, I finally made it to the hospital. I am in my new room listening to call to prayer. My room faces west and I am able to watch the stunning sunsets over the city of Hebron. The strangest thing is that it feels like I never really left.

Yesterday, after a very brief argument over the day of the week in a Tel Aviv bus station, I discovered that it was actually Friday, not Thursday. This meant that the offices of the Red Crescent would be closed, and I would not be able to travel that day. This was actually pretty good news, as it meant that I would have a day in Jerusalem, although I was eager to start my work. At the bus station, I met a guy from Holland, Jaap, who was coming in to volunteer as well. It turned out that he was not only going to Damascus Gate, but he was also planning on staying at the Palm, which was the same place that I was last time.

We actually met due to the extreme rudeness of the Israeli citizenry that I have encountered here. We had been waiting for about 30 minutes in the searing heat for a bus to come. When it finally did, Japp helped me to load our luggage onto the bus while the rest of the people got on. When he started to get on the bus, the driver told us that there was no more room. We had to grab our bags from the bus, which drove away almost the second that our bags hit the pavement. Although this behavior was what I may have expected in America, I was used to the hospitality of the countries that I had been in and was pretty shocked. But it did give me a traveling companion, and we spent the day in Jerusalem together, visiting the tomb of Jesus and watching Shabbat at the Western Wall.

Ack, I am so tired. Will write more later. But here is a picture of the Seperation Wall for your viewing pleasure.

They're not buying it, Chewie

2011-07-01T00:45:00.003-07:00

Made it in!!!
I didn't think that I would. I got into the airport having made a few friends on the plane and was chatting with them in an attempt to look casual as I approached the passport station. I had read somewhere that whistling people appear to be less worrisome, so I whistled a silent toon and tried to look tired but excited.
When I approached the customs person, I think that my first mistake was answering a little too pat. On the plane, I talked to a few Israelis who all expressed a good deal of shock when finding out that I was planning on asking for a three month visa. I was told by all of them that there really wasn't enough here to have a three day stay. I also found out that there really isn't an age limit for working on a Kabutz. So when they asked what I would do here, I said that I wanted to start in Jerusalem and move outward to see everything, and maybe volunteer in a Kabutz if there was time. She nodded, hit a few more keys, then asked me to go to the office "for security reasons".

When I went to the office, there were a few people of obvious Arab decent there (the women where wearing scarves) and no other white people. I waited patiently, trying very hard to stay calm. I felt a little better when another white woman was shown in. She was irate, swearing under her breath. I folded my hands and tried to look polite, feeling a little better. I felt a lot worse when she was was told a few minutes later that she was free to go.

All the people I was waiting with (and a few new people) were cleared and I started to feel screwed. An hour later, I finally noticed that one of the security men were looking at my passport. My stomach sank when he started to key my name into a computer. I basically gave up hope when he picked up the phone and told the listener my name.

I was called in a few minutes later, and the minute I stepped in a second man who looked like a policeman walked in behind me. Great, I thought, they are going to arrest and deport me on the spot. The computer guy asked me if this was my first time in Israel. Knowing that he knew the answer anyway, I said that it wasn't. He asked what I had done during my last trip, and before I could answer the two men started talking. I wished that I knew Hebrew. Mr. Computer then asked me about money, and asked to see my credit cards. I handed them over, with a glimmer of hope. He dashed that when he then asked me if there were any "problems" during my last trip.

In a move that probably allowed my entrance, I told him flatly that yes, there were problems, I was arrested and deported during that last trip. Hegding my bets that his computer didn't have any details about my arrest, I said (very somewhat truthfully) that I was following "a guy I met" from Denmark. I said that I stayed with a group of international women, and that I was arrested "for being in the wrong place". I said that it was stupid. I also told him that I was planning on volunteering during my stay. I told him that I was in contact with the Red Crescent and was also hoping to work with the Israeli version of the Red Cross, and perhaps a Kabutz. I said that I was a nurse.

He then asked me many times if I knew anyone here. He asked if I was still in contact with the women or the man that I was "following". I laughed a little and said no, I didn't even remember their names, I think it was Gustov or something. I talked with a few others later who had been held, and questions about people that we knew in the area were a common theme. Finally, I was asked to wait somewhere else. I assumed that they were holding me so that they could get the right people to escort me out of the country.

My hopes dashed was actually a bit of a relief, as was the coke machine that was in the new place I was waiting. I got a coke and watched some football on TV while I waited my fate. After about another hour, a women said my name, handed me my passport, and said that I could go.

"Uh, where?" She pointed to customs. I opened my passport and saw a three month stamp. It was a beautiful moment.

Palestine iPreperations: How to get in (hopefully)

2011-06-21T13:06:00.001-07:00

Well, the preparations are going slowly, and it turns out that the electronic preperations are much more of a big deal. As I heard from a friend today who is going to Gaza:

On my way out of Tel Aviv, they went through every scrap of paper I had, including a notebook for directions to various places. They also scoured my bag for residues, found teargas (I was at a [protest, details deleted] and the IDF [Israeli Defense Force] teargassed us), and had me escorted onto the plane by a heavily-armed, uniformed soldier. The airport security (IDF) have been highly trained to evaluate people and how nervous they are. They rank you on your way out of Ben Gurion based on your security threat level and I was a 5 (out of 6). I'm afraid of ever trying to fly back in.

I had a friend who arrived last summer and had her laptop searched. They demanded a password to her email and found that she emailed all of her pro-Palestine information to another email address, then demanded the password to that. She got in after a seven hour interrogation and strip search.

NEEDLESS TO SAY, a lot of the horror stories are true. BUT there are a lot of ways to save yourself some grief:

- Carry NOTHING about your work, or anything political AT ALL.
- Have Jewish Israeli contacts who know you are coming and will be able to confirm you will be seeing them if called.
- Have a clear itinerary. Make a couple hostel reservations or have your contacts be ready to reaffirm the same itinerary details.
- They will be suspicious of a one-way ticket. Have an explanation for your trip. Maybe you plan to fly home through Egypt?
- Clean your laptop. Remove every Arab-sounding name from your phone and email contacts. Disable Facebook. Try to erase any kind of political past you may have online.
- Dress nicely on the plane. My travel companion was pulled off of the plane immediately for questioning because she couldn't be bothered to look decent, and they automatically assumed she was an activist (dingdingding).
- Make a friend on the flight. Chat with them as you leave the plane. It makes a big difference to be shooting the breeze with a nice Jewish lady. :)

So, part of my preperations include removing myself from the internet. You may be thinking "well then, dumbass, maybe you should not be writing about them in your blog!" Don't worry, this blog, Facebook, and everything else is going to be going away in a few days.

Anyone who wants to help can let me know if they find me on the internet, and where they found me. (Don't worry about FB or this blog, because they will be gone.)

Also, please don't email me anything pertaining to my trip for a few days. The last thing I need is an email stating "How's Palestine?" for the IDF to find when I get off the plane.

I am going to be bringing everything back up a few days after I get in. See you then!

Make Memorial Day Happy

2011-05-30T16:39:00.000-07:00

It’s Memorial Day, and I have been seeing a lot of the following drivel on Facebook:

A normal person has 1,000 wishes. A Soldier only has one, to come home safe. I know 97% of you won't post this as your status, but the 3% that do are my friends. In honor of someone that died, a wounded warrior, or who is fighting (or has fought) for your freedom, please re-post in their honor. Memorial day Weekend! God Bless all those serving now..!!!!

Well, uh, no, I am not going to repost, of course, and that might mean that I am not one of those lucky 3% that get to be your friend for a few keystrokes. (Kind of slutty, don’t you think?) But I am one of the 0.09% that actually DID something to help make the lives of vets a little more bearable. You can join me, and here's how:

1. Call your local VA to volunteer or donate, even just stopping by to chat with a vet. As part of my job, I have to call hospitals all over the place. When you call a VA, the first thing that the recording says is “Thank you for calling the VA. If you are having thoughts of harming yourself, please call the Suicide Prevention Hotline at …” followed by the local number. (FYI, the national number is 1-800-273-TALK (8255) and they have a special page for vets.) That’s right, enough vets are calling the VA because of suicidal thoughts that they had to stick a message on their recording. That’s f’ed, people, and a FB status isn’t going to make these people feel better.

2. Call or write your congressman and ask them to vote against activities that cause violence in the region of your choice. No, I am not just talking about Iraq, I am pretty much talking everywhere. I suggest that you ask for the School of the Americas to be closed, which is a training camp for Latin American dictators and basically teaches one how to throw a coup and then trash the country afterwards. One such graduate was Michel Francois, who threw the coup in Haiti that removed Jean-Bertrand Aristide and caused the death and torture of more than 5,000. How will writing your congressman help? Well, the School of the Americas in in Georgia. That’s Georgia, USA.

3. Give money. Pick a charity of your choice and sned 'em $$. Too busy for that? Then send a text message "DAV" to 90999 and you will donate $5 to disabled vets. Or give a dollar or your lunch to a homeless guy, who is probably a vet. (If I was a vet standing on a street corner, I would personally want to deck every idiot who thinks that some FB status is going to get me fed that day.)

“Be the change you want to see in the world.” I am sure that when Mahatma Gandhi said that, he was hoping that it would be more then the FB status of a bunch of spoiled westerners.

You can make it so.

You have a pal in Palestine

2011-05-29T16:34:00.000-07:00

Well, my next move has been decided, and that move is Palestine. It was between that and Haiti, actually. Funny story. You see, one fine day I woke up and found the following in my email inbox:

Thank you for contacting the Palestine Red crescent Society. Being a nurse, we would like to have you volunteering at the Hebron branch Hospital. I have already contacted them, they need you for at least 8 months. Is that suitable for you? They will provide you with accommodation and meals.

This was sort of a shock since I barely remembered applying. I sort of took a rapid-fire approach when I got back to Haiti and realized how much I wanted to work overseas. My preferences where Haiti, Palestine, and Nepal. Most of the places that I applied to wanted me to basically write a disertation before they would even consdier rejecting my application. So to be accepted outright was sort of a rush and terrifing at the same time. Give a girl some warning, will ya?

You might also have noticed the definite lack of information that the email gives. I actually really had to beg to wean more information out, but it looks like I would be staying at a hospital in Hebron. In fact, I think that I am going to be doing something like this: http://www.ms.dk/sw187323.asp

So, my next question was how to get there. Like a moron, I assumed that I would get a working visa, etc. What I found out was:

We prefer that you get one way ticket or an open ticket that you may change later according to the situation over here. You will get the ticket to the Airport, that you are coming for Tourism to Jerus'm and so. After 3 months here, volunteers actually go to Jordan, stay there for a couple days and then come back through the same bridge an get visa on borders for new 3 months.. so we may only have for 6 months instead of 8, unless we figure out a way for you to stay here more.

As Lando said, "This deal is getting worse all the time." Uh, you want me to lie at the airport and you can't guarantee eight months? Of course, I felt like an idiot to think that the Red Crescent was going to get me a visa. The Palestinian Red Crescent (PRC) has about as much authority to hand out visas as I do (perhaps even slightly less!) So I figured, well, this is the International Committee of the Red Cross (ICRC), right? Perhaps I can appeal to the Israeli version of the Red Cross (MDA), to let me in, citing the impartiality that the Red Cross inflicts on it's members. (They aren't called that, but I am using that name so that this post doesn't pop up on too many search engines.)

Now this is interesting. Turns out that there was a huge debate and the ICRC wouldn't let them in. While I was researching this debate, I figured that the ICRC did this because the MDA was stopping PRC ambulances and accusing them of hiding terrorists. I found out that in fact, the dely of letting Israel in was actually due to a squabble over what symbol they would use. MDA wanted to use a Red Star, the ICRC demanded that they use one of the three designs that they already had. I mean, what the hell?

It was around this time that I heard back from an organization in Haiti. This post is getting long, so I will wrap it up to say that I did not get the Haiti job, and I have since chalked it up to God or fate or whatever telling me that I need to go to oPT, where I am probably more needed. I felt like a bit of an ass anyway for choosing Haiti over them simply because Haiti was more convenient.

Third Goal

2011-05-10T13:25:00.000-07:00

Third goal: this kid is counting on me

Well, it's been about a week since I have been back, and I have found although it's nice to be able to take showers with running water (although I am still feelign guilty over the waste) I miss being overseas a lot more then I thought that I would.

I did a presentation at work (which was really more of a slide show) to show them the type of work that I have done, and unlike the other countries I have been to, I would really like to try and fufil what Peace Corps calls "The Third Goal". Peace Corps has three goals: to help the people that you visit, to teach the people that you visit about America, and then to bring whatever you have learned about this country back to America.

I think that Haiti has learned all they really want to know about our grand country, thank you very much, so the second goal wasn't really a priority to me, but the third goal is. It's also probably the most challenging, as it's nearly impossible to not learn about a country and teach them about yourself when you are in the borders (well, maybe for some Americans) but when you get back it's really easy to forget what happened and just concentrate on enjoying different types of foods again.

On second thought, maybe Haiti's better off without me.

Speaking of which, I could really go for some Eithopean. I had sushi the other night. Yum. (See how easy it is to get distracted?)

Anywhoo, my PP presentation was a step in that direction. I mean, aside from the fact that it's one of the poorest countries in the world, has been overrun by coups and recent natural disasters, what do people really know about Haiti? What do they really know about US policy there? Or even about voodoo? Why should be care about Haiti when there are so many other places that also deserve attention? And what the hell is up with the School of the Americas that is still running for some very odd reason?

Yes, all good questions. I'll leave it to Paul Farmer to answer them, most of which he does in his great book, The Uses of Haiti.

Meanwhile, I am looking for more work down there. Or in Palestine. Or maybe Nepal. Or Burma. OK, so I suck at Third Goal. I know I don't want to go back to Samoa is all.

Goodbye Haiti :(

2011-05-02T17:03:00.000-07:00

Goodbye Haiti, I will miss you!

What I have learned:

1. ALWAYS study the language. Learn “it won't hurt” “sit here” at the very least.

2. You never have enough clean clothes

3. You always have more electronics then you need

Things I will look forward to at home:
1. Secularity

2. A REAL shower

3. Flat surfaces

Things I will miss:

Everything.

Another satisfied customer

This is my last blog entry from Haiti, but there is still so much to say. We had the last day of clinic, and we mostly had schoolchildren and older people. Mary Kay, when signing the contract for the iStat, agreed that all 300 cartriges needed to be used to show that the machine was really needed in Haiti. The problem was that we had to struggle to get that number, especially since the tests would take about three minutes to read. Since we had about 75 tests still to run today, I was really running with those stupid tests.

So to run a test, I had to pierce the patient's skin with a lancet and squeeze the hand to get the blood. I needed a ton of blood as the cartridges needed quite a lot. As a result, I had to squeeze the hell out of those Haitian hands (many of which were badly callused, and my hand is very achy from 5 days of squeezing, or as I liked to put it: “My hand is as sore as a NYC hooker!” (Take a sec, you'll get it.)

Andrew, Amanda, Mary Kay, Kristen, Judi, Norma, Glenn, Chelsea
Maia, Kimberly, Naomi, Linda, Lynn, Margie, Kelly, me, Suzette, Julia, Julie, Sherry

I think that another thing that this trip has done is really recharge my desire to get out and join a medical team. I am going to really work harder towards this goal. I loved the people that I worked with, they were such a great mixture of people with varing talents and humor. As well as Haiti, I will miss them terribly. I hope that we are able to keep in touch, perhaps even have a party later.

I have learned so much from the people of Haiti and my teammates, and I hope to come back soon. I hope that I have helped to make Haiti a better place in even a small way, helped to make someone's life a little brighter, and helped give Haiti a butterfly's breeze push to a better future.

Thank you Haiti, I will miss you.

It's a Hard Knock Life

2011-05-02T15:04:00.001-07:00

Mary Kay had promised had promised Rachel, who ran a local orphanage associated with MTM, that we would test all the kids for anemia. This news was not well received my me as I hate testing kids for anemia, as they scream and fight and don't bleed well. Plus you have to stick them in the heel, rather then the finger, and often they are able to give a well-aimed kick to the face.

Mimose seeing Suzette at the airport in Haiti

In Haiti, you are considered an orphan if you have lost one parent. Many single parent households will put their kids up for adoption if they can't take care of them. One girl in my group, Suzette, was actually adopted by her mother Kelly (also in the group) when she was nine, she went to live with Kelly at 12. Her birth mother met us at the airport and stayed with us for a few days. We have often wondered what Suzette is thinking as we see her with her biological mother. Kelly, her adoptive mother, is obviously who she thinks of as her real mother. Suzette does not seem to hold any anger towards any party for her situation, but seems like a well adjusted young lady with two mothers. She was adopted when she was nine, but didn't get to live with her current other until three years later.

Suzette and Mimose

Rachel told us a bit about adoption while we were driving up, stating that the mothers can come and visit thier kids while the kids were in the orphanage, and many often do. This can be very hard for thier kids, and sometimes the mothers will change their minds. Single fathers generally balk at the idea of a closed adoption (which all are by default) while mothers tend to view adoption as an act of compassion towards kids and feel that they would have a better life. Rachel's kids are generally gone in about 18 months, which is a very short time here.

Attacked on the couch (Judi, Kristen, and myself)

We pulled up to the house and saw a kid, standing in the driveway staring at us. I got my supplies out of the car adn started to walk towards the house when two more kids came running out. The first kid ran to me and threw his arms around my legs and squuezed for a second, looking up at me with angelic eyes before moving on to Kristen. The next few kids did the same, and soon we were surrounded by enegetic and outgoing todlers who had obviously never heard of stranger anxiety. After we got into house, Krisin sat on the couch and three kids hopped into her lap. I saw next to her and was similarly tackled. I wondered if Rachel had trained the kids to act this way to help encourage perspective parents to take them home. Whatever she was doing, it was working as almost all the kids already had homes.

Me comforting a munchkin

Work time. I got out the kits and started on the kids and almost immediatly became very unpopular. The caretakers would hold the kids while I poked them. One of things that I noticed was that the caretakers, like the translators, were very disengaged. (You can sort of see what I mean in the picture.) I wondered if this was because it was the end of the day. The kids were pretty interested, however. They gathered around and watched with interest as I poked thier compatriots then screamed like banshees when it was thier turn. I needed to scream myself (for help) periodically as they started to crawl onto me as they fought for attention.

Drawing blood

Many of the kids, sadly, were anemic. Rachel feeds the kids well, lots of greens, meat, and milk, but almost half had low hemoglobins. We left them with some children's vitamins and instructions to give iron with juice, and not give milk within an hour of getting the vitamins (milk prevents the absorption of iron, while vitamin C enhances it.) This isn't easy when you have 15 kids that you are caring for (most meds are given with meals) but I know that Rachel will try. With so many kids, she was able to keep them very straight. She knew the background and active illnesses of every kid.

Orphanages like Rachel's, that focus on adopting out kids, are only one type. There are others that focus on keeping kids in Haiti and trying to help them become productive members of society. What Haiti doesn't want is for mothers to receive funds from overseas to support their kids, since this would encourage parents not to work. But there are a lot of kids that need homes and food, and no real solution.

The damage doesn't look as bad from out here

2011-05-02T05:49:00.002-07:00

My roommates made me buy chocolate
(Julie, me, Mary Kay, Lynn in back,
Kristen and Norma in front)

It turns out that that I didn't have to walk all the way over to church, it came to me as the music flowed over the valley into the guesthouse.

Although I had been worried that Sunday would be a fairly dull day (the clinic is closed that day) it turned out to be a pretty interesting one. During our morning prayers, Beth (who runs the guesthouse) announced that she would be heading to grocery store in a little bit. I immediately volunteered to accompany her on this normally mundane task. We bundled into her four-wheel drive and headed out. The grocery story brought back memories of Samoa, where I saw packets of cookies and other foods that I had not seen since I left there, leaving me to wonder if all developing counties shop at the same store. The people in the group that could not fit in the car asked me to pick up some chocolate, after much debate Judi and I found some Peperidge farm cookies that appeared to be the best bang for the buck. We exchanged some money and added them to our possessions. We made another stop for ice, driving past the mansion of the former president Rene Preval. Beth told us that since she doesn't have a freezer, she buys ice every day when she takes the kids to school. Judi and I also examined the meat, which was grey and suspicious looking. One pack was labeled “dog meat” and Judi wondered out loud if dogs where the intended recipient or the contents of the package. (It turns out that dogs are not eaten here, however cats are!)

There were rumours in the guesthouse that Willham was going to take us someplace after church. Perhaps Port-au-Prince! He was at a religious conference, and his return was perpetually imminent. Shrotly after returning from the store, Beth asked me to come with her, and bring my iStat! mary Kay (the pediatrician) and Norma (a NP) were also summoned. As I gathered up my supplies (it takes an amazing amount of crap to check a few drops of blood) I learned that a pastors wife had been found fainted in a diabetic coma, and we were need to come check her out.

What we found when we got there, however, was a very different story. She didn't have diabetes (the person who lived in the house just thought that she had) and had not actually fainted. she was, however, pretty sick with a fever. Her blood levels were fine, so we advised acetaminophen and rest.

Willham had returned by the time that we got back, so we, as they say here, had to “hurry up and wait”. We gathered up water and food and other supplies, wondering where we were heading to. By the time that we got in the car, we were told that we were heading to a place called “lookout point”. So desperate were some of the people in the group that they didn't out where we were going until after we got into the car and were on our way.

You can barely see the waterfront at Port-au-Prince

The trip up was quite lovely. Most of it was on a “real road” (such a road in the states would have caused worldwide riots) and we enjoyed the breeze and the change of scenery. “Lookout point” was exactly what it sounded, what we didn't realize that was it was looking out on Port-au-Prince. I really wish that we could have gotten decent pictures of the awesome view that we witnessed. We saw the presidential palace, the airport, the ports. I couldn't help but think of the line from Star Wars: “That's funny, the damage doesn't look as bad from out here!” We also noticed that for such a big city, there should be a lot of hi-rises and major buildings, but there were only two builds that rose above the others. Most were only two or three stories.

It's easier to see PoP in the painting!

After we had our fill of the view, we went to try to barter for some of the stuff that they were selling. There were a few other trucks of white people, they were all with NGO's or churches. As far as I can tell, Haiti has no tourists right now, so the souvenirs sellers were a touch desperate. I had already bough a few things, so I wasn't very interested until I saw a painting that I really liked. The guy wanted $40 for it, I told him that I only had $20. All part of the game, apparently. Beth had told us to pick a price that was half to a third of that offered. The sellers were very good at looking offended at our bids, but I was told that it was all part of the game. However, when I pulled out my money, I found that I only had $15 left. He took the money and demanded $5 more. I told him that it wasn't a matter of me holding out, but that I really didn't have any more. He demanded $4, then $3, then $2. I put down the painting and tried to get my money back, but he refused to both surrender the cash or stop asking for more. Finally, I took the paining and walked away. He pocketed the money, but followed us to the truck loudly proclaiming that I was ripping him off. All part of the game.

People sold art at the viewpoint

Stuff on sale

But the most interesting part of the evening was when we got back and I was told, once again, to grab my iStat. I actually have to run, so I will write about this later.

So Many Patients, So Little Time

2011-05-01T08:38:00.004-07:00

The front of the line waiting to get into the clinic

With church today, it's hard to believe that we only have one more day of clinic here. I could easily stay for at least another week before I start to wish to come home, and it feels like we could stay for a month before we actually start to help the population of 2000 here. (The population in Haiti is 9 million. With about 20 people in hour group, it's easy to see how Haiti's resources have been completely overwealmed for health care alone.)

Back of the line. Willham is walking up.

When we open, the line for people puts the Star Wars episode 1 lines to shame. Often, the people will start waiting the night before to get into the clinic. Siblings bring siblings, mothers nurse in line, they wait in the sun. All to see a health care provider for five minutes and get a few pills. Some people have aches, stomach problems (gastroreflux from worms, generally) and others have things that are much more serious. We ask people to come back the next day to wait in line, some can, some can't. We see as many people as we can and still turn away people at the end of the day. It makes me never want to leave.

Julie giving stiches

(Sidenote: I have decided not to go to church. I have already sat through many church services in other languages and I really did not want to go to this one. When we found out that the truck was not available, and would have to walk there and back in dresses and nice shoes, That did me in. Sorry.)

I was back in the lab today, but I did see a few people that came in for pretty serious stuff. We had one kid that was seen who needed stitches in his scalp. Julie, the pathologist, sewed him up and gave him some antibiotics. He had fallen while traveling up some stairs. (In the picture you can see that the boys have a school uniform with a plaid design on the shirt, the girls wear blue skirts and suspenders, looking sort of like "The Wiz" version of Dorothy. I hate school uniforms It is a plot to confuses the hell out of exapts. Anyone who has been overseas and had to deal with them knows what I mean.)

Linda's holding a little one with an extra finger removed

We also had a little one who had an "extra finger". I don't have a picture of the before picture, but here are the after ones. Although mary Kay (the pediatritian) said that it was indeed an extra finger, it looked more like a skin tag. She just got some sterile scissors and cut the thing off.

After the surgery

The waiting room. Linda, the trip leader, is in the back

Once the people get into the clinic, they are "triaged" with their weight, pulse and blood pressure taken. If they are pregnant, have hypertension, or are a kid they are triaged to the lab. Otherwise, they see a doctor. It's kind of crazy trying to explain to people where and how they should sit and we try really hard to not have any confused patients wander out after they have gotten their lab work and see that they are done. We are also able to give them eye exams and have a full pharmacy. For such a small clinic and a smaller number of workers, we do a good job. There are 23 of us. Four are providers, four are nurses, and the rest are non-medical personnel. (Some of them have medical backgrounds, such as working in a medical office.)

Pharmacy

The eye examination room

Yes, even speech therepy!!

One of the volunteers, Glen, is a speech pathologist with a specialty in stuttering. It turns out that one of the interpreters, JM, has as stutter. It's hard to tell, as the pauses when he is speaking English and generally attributed to his grasp of the language. Glen has been working with him during lunch breaks, teaching him a few techniques that he can use to treat this. It really is a miracle that of all the people in Haiti, there happened to be a person with a stutter and a speech pathologist in the same place. So Glen feels like he also has a special place here in Haiti.

Who is happier, Kristin or the baby?

On the way home, we ran into one of the familes that we helped, and we were able to get them a ride home. Kristen had started to walk and decided to stop one of our trucks when the rain started, and that truck stopped to pick up the family. They handed over the baby for her to hold, and as she said, she was in heaven.

Hopefully today we will go to Port-au-Price to look around, then we will have one more day at the clinic.

Seeing Patients

2011-04-30T06:00:00.004-07:00

Opening the clinic

Rather then going on and on about the perils of travelling to and fro from the clinic, I thought that I would spend a moment discussing the real reason that I came to Haiti-- to provide health care for the Haitians.

A lot of people (myself included) assumed that I came to Haiti to provide earthquake relief, but in truth most of the most effective programs have been working in Haiti for years before the earthquake hit, Mountain Top Ministries included. The village that I work in, Granmothe, was actually not directly affected by the earthquake. There was an influx of people coming out of Port-au-Prince after the majority of the city was devastated which has overwhelmed what little resources that there are here.

This little one had a burn on her lip

Most of my time was spent in the lab area, which is a tiny little space, separated by a cubicle wall that houses the scabies treatment area and a shelf that blocks view into one of the treatment rooms where patients are seen by one of the providers. This assembly-line setup has meant that I don't really come into contact with the individual stories or illnesses. But I got pulled from the lab for a few hours and was able to help one of the nurse practitioners, Kristen, as she helped patients.

My job with Kristin was to keep track of the patients she saw, write out prescriptions on a pad, mark the diagnosis on a list, and gather the supplies that she needed. This was the first time that I was actually being a nurse, and I loved it!

The first patient that we saw had complaints of stomach problems and gas. Kristen laid the patient down and felt her tummy, then asked me to do the same. In the books, a patient with worms had what was described as “a doughy stomach” and I had been worried that I would not be able to recognise this. I shouldn't have worried, the woman's stomach felt exactly like a huge bowl of bread dough. This was incredibly common in Haiti. Fortunately, it was easily treated with a dose of Albendazole. Worms would also cause gas, as they would bloat the host. We have nearly every patient Albendazole, as nearly every patient.

Glaucoma (right eye)

The next patient that we saw was a little 10 year old with a terrible looking eye. We called for a consult with Mary Kay, the pediatrician. We quickly diagnosed him as having glaucoma. This exciting moment of seeing this rare ocular disease was quickly tempered when we realized that we had no treatment. Without the correct eyedrops, the young boy would one day go blind.

Cataracts, conjunctitis

The next two people that we saw also had eye issues. One lady had nasty cataracts and conjunctivitis (pink eye). She was easily treated with amoxicilian eye drops. In looking for these eyedrops, we also found some eardrops for another patient that we had seen with a nasty ear infection. Antibiotics are really a wonderful thing, and they are perfect for our purposes, as we would not see the patient again. However, I was worried about compliance. The people who worked in the pharmacy hardly had time to count off the pills and tell them how to take them, much less provide teaching on the importance of taking all the pills and not sharing them. Paul Farmer has done a lot of work with TB (which requires 6-12 months of treatment with a nasty antibiotic) to prevent resistance. With every pill that we handed out, I worried about what would happen if that particular bug became resistant, but other then not handing out the pill there was no other solution.

I helped Kristen to a pap smear (to pictures of that!) She needed me to hold up an otoscope so that she had a little light to see what she was doing. She and I had to lean over between the woman's legs, as I shined the pathetic flashlight into the speculum so that she could visualize the cervix.

elephantiasis

Near lunch we saw a woman whose leg was swollen with elephantiasis. I was back in the lab by the time that I met her, and didn't even notice that her right leg was double the size of her left until I got her on the table. She was also hypertensive. The clinic was closing, but I snuck her in to see Norma, the other nurse practitioner after getting her labs. In addition to the massive swelling of her legs, she also had a pulsing right carotid artery that could be felt easily on palpitation. Her right leg was swollen as well with pitting edema, but that was easy to miss with has massive other leg. Her right leg was probably edemous as well, but the elephantiasis hid that. She saddest bit, like the boy, was that the condition with treatable and preventable, but because she hadn't sought medical attention prior, her leg will always be terribly deformed.

Scabies

In addition to these, we saw a few people and kids with scabies. For the adults, we treated with a pill, ivermectin, which is not approved in the US but works well nonetheless. For very young kids, We had to use the scabies cream. This involved taking them to the “scabies treatment area”, taking off their clothes, rubbing them with permethrin cream, then redressing them with new clothes. I worry about the effectiveness of this treatment, as they should really be re-treated a week later when the scabies eggs that are under their skin hatch, but we have no way of seeing them again. This makes the babies scream

Kristen and JM with the glaucoma eyedrops

The Glaucoma boy had a happy story. While sitting on the floor to breastfeed, our trip leader, Linda, noticed a bunch of eye drops that were under a shelf. She got them out and saw that they were glaucoma drops. We asked around and managed to find out the address of the boy that had Glaucoma and were able to send a 4x4 with the drops to him. We passed along several bottles. Although this will probably only postpone the inevitable (blindness) it was still good that we could get him some treatment. Even if blindness is only postponed for a week, I tried to think of all the things that he would see during that week that he would have otherwise missed. As Kristen said, we can only do what we can do.

Haitian Rollercoaster

2011-04-29T06:00:00.015-07:00

A few little munchkins we met on the way

After the harrowing experience of riding home in the pickup during a thunderstorm, I decided to join the walkers and trek back. Unfortunately, it was not raining this afternoon, and the sun was doing all it could to try and convince me that a walk was a bad idea. the only positive thing about walking was that Haiti is on "island time" and walking in the sun seemed a better idea that waiting around in the van for Willem. (There is a third option, which would be waiting in the shade in view of the truck, but that option seems only to have come to native Haitians.

My little 12.5 megapixal camera can NOT do justice to the landscape of this place, and I doupt that I have the poetry that would also be needed to describe it. Mountain Top Ministries is located in a section of massive hill-like mountains. I say "hill like" because they are rounded and covered with vegetation, but have the height and slope that is normally associated with a mountain. The villagers will plant their crops on the side, with the plants growing at acute angles to the land. Sadly, this is one of the reasons that the county has such a poor growth rate per acre, as this method of planting causes massive erosion. In addition, much of the trees were cleared for plantations and for charcoal, so thier supportive roots also are not present to help keep the soil in place.

The road heading out of the clinic.

So my commute to work is three parts. First, we travel almost at a 45 degree angle downhill with the riders in teh back holding white-knuckled to the truck. Then, there is a light respite as we travel over a massive dray river bed covered in large white rocks. Finally, we travel uphill again at a hear 45 degree angle (the Haitians are not one for switchbacks.) It's not a trip for the lighthearted or the weak-stomached. In addition, the "road" is actually mostly mud and rocks. Oh yes, and there is often a massive drop to one side. And the road is one lane with tons of blind spots. Good times. Some of the people in my group cross themselves before they leave, and trust me, they are not just being cute.

The little bracelet girl

So I walked. We met up with a few kids who joined our group. One was a little school girl who enjoyed tossing her bracelet down the path. It would bound, bound, bounce until it hit a curb and she would run and grab it and start again. she listed to our chattering in English with great interest, saying "oui" and "no" when she felt it was appropriate. This part of the road was fairly well maintained, with the middle pretty much cracked out but the sides still more or less intact. There were huge ruts in the side so that there was something to grab onto, the road is that steep!

We came across a few other travelers
Unlike myself, most people are not able
to choose if they walk or not!

Chicken wire "bricks" with rocks inside make up a wall

Eventually, the road gave way to a rocky path near the bottom near the dry river bed. The "road" was washed away when the waters came, and no one was been able to rebuilt them. One of the groups that came with MTM actually rebuilt the road, which was hard to believe since the rock path was barely transverseable-- made me wonder what it looked like before!! In addition, the group build a wall by making boxes of chicken wire, then loading them full of rocks and making large "bricks" that they would use to keep the waters back. These were still intact.

Other volunteers chose to ride instead

A pathetic Haitian excuse for a road

The dry river bed

After making it down the mountain that the clinic is on, we trek along a wide dry river bed. I guess during the rainy season, the river will fill up. The rainy season is from May and goes on through the summer. It's good that the season is in the summer, because if the river bed is transformed into an actual river, the children that go to school at the ministry can not cross it to get to school and back. There is no bridge. When the water comes in, people are stuck. As an American, it is nearly impossible for me to understand how life can be so ruled by the weather, when of course in most of the world the weather is a way of life!

She loves shoes, boys and chocolate

All in all, the trip is about three miles although it feels like more, especially the last mile heading up hill in those slippery paths. There are not many houses on the ministry side of the "river", but on the guesthouse side we start to see a lot more houses. Some of them are nice houses, others are not so nice. A lot of them are just concrete bricks that make up a room, with no electricity or running water. Many times, the water is brought from a public well on the heads of female children of the household, and all the laundry and bathing is done from this.

Mountain Top Ministries at dusk,
as seen from the guest house
(although it should be called
"Halfway up the Mountain Ministries")

Finally, we get to the guesthouse! Time for a soda, a cold bucket shower, and a rest. While resting, I realized that the ministry could be seen from the back of the guest house while sipping cold Sprite on the porch. I noticed that you could see the ministry from the porch. I suggested that it might be easier to install a skybridge, like the one at OHSU, where we can just ump in a little carriage (preferably air-conditioned) and travel over in comfortable seats over a wire. Beth, who runs MTM with her husband, said that this was a good idea and she would be happy to have it built as soon as I raised the funds needed.

The Haitian Experience

2011-04-28T18:12:00.005-07:00

While driving in the back of a pickup under a metal cage going uphill along a cliff on a mud path in a thunderstorm:

Sherry: It's all part of the Haitian experience!

Me: What, dying?

Another long day in the clinic. We saw about 500 patients today, I did blood sticks on about a quarter of them. I have been so busy that I haven't even seen the rest of the clinic (a large room, divided by curtains, that is about the size of a very small gas station convenience store) and I didn't notice that the weather outside was turning bad. Anyone that has been in the tropics knows that the weather can be very bipolar.

This little guy didn't cry once

I am lucky as my station is right by the window with the breeze blowing in, but I was so busy that I couldn't spare a glance outside. I had to do sticks on all pregnant women, kids between 6 months and 3 years, and people who have hypertension that are on meds. A lot of people, but I would see more if it meant that I didn't have to see any babies. These little guys are the worse because they are just too small to really give the amounts of blood that the machine needs to be able to do a proper reading. They are also pretty dehydrated. They also start screaming the second that the little needle pierces their skin, and that's the real problem. I try to get the people that are standing around watching the spectacle to help out by holding them down, but they generally don't hold hard enough, and they also get bored and wander off or start to play with the baby. Meanwhile, the baby will smear what little blood has come out all over the place with their screaming. I have been trying to get the moms to breastfeed in order to keep them quiet, but that only helps a little.

Me and Judi drawing blood from a 87 year old

Anyway, while working on baby #5 the head of Mountaintop Ministries, Wilhem came running into the clinic and said that we had to get done and leave now. I looked out the window as he was telling us that a thunderstorm was coming, and saw that he was right. I finished up the draw that I was working on and started to clean up. One of the nurse practitioners, Norma, stopped by and said that she absolutely needed am H&H and one last baby. Wilhem was yelling that if we were going to leave, we had to leave now. By this time, the clinic was empty except for me, my lab assistant Janet, the family and Norma. I guess that the family had been waiting for several hours to be seen, and Norma needed an H&H to make a crucial decision in her treatment. Fortunately, I was able to get blood on the kid (a one year old) pretty quickly and we threw it into the machine. We cleaned up the lab, watching the storm blow in from the neighboring valley and threaten ours as the machine ran through it's agonizingly slow three minute cycle. The test came back, negative, and we grabbed the iStat and ran out of the clinic to the waiting pickup.

My side job, treating scabies with Kim 2

We jumped in, watching as the clouds invaded our valley and everything turned to gray. I asked Lynda, the trip leader, if maybe we shouldn't stay at the clinic and wait the storm out. I told her that this would give us a chance to clean the place up, maybe come up with a few new protocols, but she wanted to head home. Since her infant baby was riding in the front, I felt that she wouldn't have said that we should head out.

I had never seen anything like that fog coming in. It was a black thunderstorm, and we were right in the middle of it. It wasn't the rain that worried me, however. It was the journey home. You see, both the guesthouse where I am staying and the church are on the near tops of large hill-like mountains. The roads go almost straight up the mountain, with few switchbacks that we are used to int he states. As a result, it often feels like we are travelling at a 45 degree angle, and it's harder to say whether it is more terrifying to go uphill or downhill. Plus, there is often a step drop on one side of the road. So the reason that I was offering to sleep on the concrete floor of the clinic rather then brave the drive home was that the roads were of that really slick mud and rock that sends even the most sure-footed person on their ass. Oh, and did I mention that the driver had to stick his head out the window just to see the outline of the road?

Obviously this story has a happy ending. We got home okay and I was soaking wet from the rain.

Tomorrow I am going to switch stations and work with one of the NP. This is going to be great as I will see patients and learn about their conditions and assist in their care. I am sad to be giving up the lab, but I am also very excited to know that I am going to learn about their health problems and learn more about patient care in a developing country, as this is really what I want to learn long term.

Finally, a touching story. When I was trying to get blood from a Haitian, I commented that "Haitians don't bleed." My translator smiled at me and said "That's because they've bled enough."