The Palace at San Souci

A short walk from the compound is the Palace at San Souci which stands in ruins, a mere shadow of its previous glory.  Henri Christophe built San Souci in the 17th century to mirror Versailles, but an earthquake in 1842 left the palace in ruins.  After centuries, children play soccer on the vast fields and high school students litter the steps as though the invisible walls form a library.


I ventured up to the ruins with a friend after work one day and we were bombarded with locals wanting us "blancs" to buy their goods at one of the few tourist attractions in Haiti.  We ignored them and walked toward the palace gates, but somehow my friend was a few paces behind me and a local closed the iron gate behind me, trapping her on the outside.  I turned and realized what had happened.  They wanted to exploit whatever money they could from the blancs.  After the last couple of days I had been through at the hospital, I was emotionally fatigued from our work and this gesture enraged me.



As a side note, I "speak" French.  The quotations indicate that I'm coherent and can compose an intelligible thought, but I'm always aware of my grammar mistakes and vocabulary deficits.


I calmly walked back to the gate where my friend was standing and in perfect French had a dialogue with a tradesman:
What's going on?
You have to pay $5 each to see the palace.
I know you don't have to pay to see the palace.  And we don't have any money.  We work at the hospital in Milot for the sick children.  Please let her pass, sir... (He frowns and the gate opens).  Thank you.


My friend's jaw dropped open once we passed.  What did you say?!  I wasn't even sure I knew what I had said.  But the adrenaline of being indignant at our exploitation when we were working so hard was enough to inspire fluent French.  We stayed at the palace until the sun got close to the mountains and headed back for the town.

The neighborhood boys

Top row: Maria, me, Sara, Sol, Toofie, Eddie, Samuel, Jamesly
Bottom row: Beverly, Luvin

These boys are awesome.  They were waiting for us at the gates of the compound every day asking, "Le ballon?!"  Our daily soccer game took place at 5 pm sharp.  The score never really mattered and we ended each game with a Coke.

They were joyful, child-like, and innocent.  In a country where childhood is not a right of passage, it was important for us to embrace these neighborhood boys while also letting loose the stressors of our own day.  I nearly died when they greeted us on our last day wearing fairy wings from a dress up box we brought.

Most of these boys are orphans or are living with extended family.  Some of them go to school.  Several of them would quietly pull us aside and ask if we had any food.  I emptied my bag full of Cliff bars into their hands on our last day.  They have inspired us.

Stay tuned for future plans to get these boys to school for $120/year while also celebrating the Haitian sensation in the US!

Broken Hearts

It was a new day.  Wednesday morning.  A good night's sleep and hearty breakfast behind me, I was ready to start clinic again after a rough day on Tuesday.

My first patient walks in.  A 12 year old boy with his father.

Chief complain: chest pain.

Once he sat down I could see his thrill through his t-shirt.  

My heart sank.

In the United States, the complaint of chest pain is fairly common in pediatrics.  It is rarely related to cardiac etiology.  More commonly it is costochondritis, pleuritic, anxiety, etc.  But I was in a third world county and knew within a minute of being in the room that he had rheumatic heart disease.  

I swallowed the lump in the back of my throat and blinked through my tears.

The diagnosis confirmation came later that afternoon when his CXR, EKG, and ECHO returned.  His cardiac function is at about 60% so we placed him on some medications to help him maximize what function he has left.  Inevitably he will need surgery.

There is a group from the United States that replaces heart valves.  They do about 100 surgeries every year.

He's #126 on the list.

A hard day In Haiti

We had two children die today.

It's a lot to process because these children were fairly stable and would not have been in the ICU in the United States. The most recent death was after a 45 minute resuscitation. But I can say that our team worked like a well- oiled machine. I always have a pit in my stomach afterwards like I could have done better. I suppose that's not a bad thing. The cross cultural differences really impact the care as much as the lack of resources and it's not easy to get used to.

This morning's clinic had a dichotomous group of patients. They were either really sick or totally fine. Some kids would come in complaining of cough for 3 days and when I told the parents they were fine, it's a cold, and this would go away in a few days, they didn't believe me and wanted medicine. Really? It felt like the US where I write a prescription for saline drops.  The other half was a baby with a moderate congenital heart defect and a 10 month microcephalic baby with hypotonia. There is no in between.

Tomorrow is a new day. I will get rest and start the morning with rejuvenated energy.

Byenvini à Haiti

I thought I was in Tanzania until I heard the beautiful Haitian Creole. There are so many similarities between Haiti and East Africa that I feel right at home here. The smell of burning wood and trash is actually a comforting, sweet smell bursting with lots of memories. The locals live similarly with street side vendors, carrying 20 gallon buckets of water on their head, and aweing at the "blancs" (white people) as we walk by. The most welcome difference is that I can speak with the people! Finally my 7 years of French is coming in handy! I even made a care plan for my patient with the nurse tonight en français.

The houses are made of cinder block and tin roofs. It's easy to imagine how devastating an earthquake could be when four simple walls are constructed right on a flat piece of dirt. I'm told by my colleagues that life is actually improving from their earlier trips as the roads are paved, there are lots of baby goats, and power lines line the main roads. 

Life is simpler here and being out of my "comfort zone" makes my heart happy. I put quotations around "comfort zone" because it implies that it's uncomfortable for me to rough it in a third world country. Quite the contrary. Those who know some of my crunchier tendencies or have traveled abroad with me can vouch for the laid back nature of my life. What really makes my heart well with tingly bubbles is realizing how blessed I am, getting both feet back on the ground with my fellow humans, and embracing a completely different way of life. 

Life at L'Hopital Sacre Coeur (HSC) has been pretty easy thus far. We have been rounding on the patients with the Haitian doctor and we admitted a little girl to the OR with a tib/fib fracture tonight. We even took the afternoon to enjoy a local beach. Tomorrow we start clinic and I'm afraid I will eat my words about how Island Time has made our stay so pleasant. 

Remind me to talk about:

-the children, particularly nutrition and kwashiorkor. 

-resource limited medicine with the world's greatest resource

-the team

-the food

Packing List

Headed out the door.  But real quick, here's what I'm bringing for 10 days in Haiti:

- 4 shirts (scrubs are provided by the hospital)

- 2 shorts

- 1 dress

- lots o' undergarments (I have learned my sweaty lesson)

- giant bag of Skittles

- a dozen granola bars

- 2 pairs of shoes: chacos and Saucony's

- IV start supplies

- liquid multivitamins

- gloves

- alcohol

- needles for meds/syringes

- 1000 stickers

- Harriet Lane

I was surprised to find all of my belongings packed quite easily into my suitcase and backpack.  I knew I was low maintenance, but this impressed even me.  

Off for the airport!  Check back in or follow me on Instagram.

Haiti

It's been a while...  Since I traveled to a country where I didn't speak the language.  Since I've ridden in the back of a truck and had pit stops that included bushes.  Since I ate fresh tropical fruit straight from the farm.  Since I cared for a child born into an impoverished life without the means of caring for themselves.

I need this...  The adventure of diving into a new culture.  The ruggedness of a third world country.  The sacrifice of my gifts and service.  The humanity of caring for a stranger's child.  It's been a rough winter and I really need this to get my feet back on the ground and remind myself of my driving passions.

As I prepare to depart for a medical mission trip to Haiti, I decided to bring back Local Townie because it was one of the most redeeming experiences of my time in Tanzania.  Live blogging the daily routines, struggles, and experiences helped my memory remain sharp, yet realistic.

I'll be spending about 9 days working at CRUDEM'S L'Hôpital Sacré Coeur in Milot, Haiti (a short drive south of Cap Hatien) with a group of colleagues through Children's National and various other children's hospitals in the US.  I'm the only pediatric nurse practitioner from our group and I'll be running the outpatient clinic as well as taking call on the wards at night.  Despite my experience with international medicine in East Africa, the stakes are so much higher in this game, and I feel the burden of being the sole provider with immense responsibility.  Being a student in an exotic setting carries far easier responsibilities than managing resource-limited medicine independently.  The opportunity alone is humbling yet exciting.

Finally, my 7 years of French will pay off, although discussing infectious diseases and antibiotics was not something that we practiced.  I'm hoping to pick up the Haitian Creole pleasantries to give myself some street cred.

Bonjou! M rele Becky.  Mwen se enfimye amerikenn.

My hope is that I can be somewhat connected and can document the experience through shoddy wireless internet, so I invite you to check back for updates.

Na we pita!