Some Useful[ness]

She was one of hundreds who came to the clinic for burning, stinging, watering eyes, with decreased vision. But hers were the worst I had seen. Her eyes were glassy, red, teared, with the look a pterygium forming. A pterygium is a non-cancerous growth of clear, thin tissue that lays over the white part of the eye. Risk factors are exposure to sunny, dusty, sandy, or windblown areas. The air in Haiti is thick with contaminates: concrete dust, diesel, burning trash of all kinds, burning charcoal for cooking. Everyday we drove in and out of the city, we wore sunglasses and respirator masks (the kind you use to keep tuberculosis, and other infectious irritants out of the body). But she she had access to neither of these. She lived in the tent city next to the ruins of the National Cathedral.

I told her I would give her eye drops to take home, and cautioned her against sitting close to smoke. I also told her I needed to flush her eyes. I tucked a drape under her shirt collar, and had her carefully lean her head outside the taptap window. She stayed perfectly still as as a stream of flushing solution cleaned each eye. When the flush was finished, I used a sterile gauze to wipe away the water streaming down her cheeks. It felt like I was wiping away her tears.

On our last day of mobile clinic, the taptap pulled away from the curb after we had sent the septic two-month-old baby to the hospital. Over a dozen people were still waiting to be seen. I knew they would be seen by my colleagues the following day. But still, I couldn't keep from having to wipe away my own tears, as these beautiful people became smaller in the distance.

Since I've been home, the tears still come easily when I read the news of Haiti, or see commercials on TV for the many aid agencies working in Haiti.

Yesterday I watched a short clip from the Dalai Lama's recent visit to Nova Southeastern. We first saw news of his trip to NSE on the front page of the newspaper while awaiting our connecting flight in the Miami airport. I am always inspired by the Dalai Lama's words. But those that struck me from this talk were this: "The nature of compassion is taking care of others, of their well-being.....My only interest, so long that I have life, is that my life be meaningful, [have] some useful[ness]".

When colleagues at work ask me how my trip to Haiti was, my response has been: "It was beautiful and devastating, and truly the most meaningful thing I've done".

Thank you again for your part in all this. Thank you for your support, your prayers, and for following our blog, so we can tell our story, and the story of the Haitian people.

~Maryclaire

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We will continue to post blogs and stories. We have updated more photos to previous blogs. If you go to "little hands" you'll see many pictures of the beautiful children.

Mesi (Thank you)

A father brought his four month old baby boy to the clinic for persistent diarrhea. The next day as we were loading up the taptap to go home this father found me and grabbed the interpreter. His baby was better, he wanted to say "Mesi" ("Thank you" in Creole).

A young woman who had given birth to a baby girl just days after the earthquake, came in for some of the "usual" post-earthquake complaints. Among other things, she was anemic. Her one month-old baby girl was beautiful, but did have thrush, like so many of the children here. As I sent the mother away to pick up multivitamins to strengthen her and her baby through 'fortified' breast milk, she flashed me a big smile and said "Mesi, Mesi".

We sat in the taptap mobile clinic as Aaron patiently explained the next steps (which hospital to go to, how to administer antibiotics) to the family with the septic two-month-old baby, as I dressed the wound with antibiotic ointment. The father, who had been turned away at the national hospital looked to us both and said "Mesi, Mesi, Mesi".

A 39 year-old carpenter came in with complaint of back and sciatic pain. He had palpable muscle tightness in his lower back and hip muscles. I told him I'd prescribe ibuprofen, but I let him know the true solution for this problem was stretching out those tight muscles. I taught him modified yoga stretches. As he demonstrated the chair twist, a big smile broke out on his face. He could feel how this stretch was working on his aching back muscles.  "Mesi!" he exclaimed as he left.

While 'touring' the devastated cathedral grounds, two young girls living in the nearby tent city asked us if we had anything to eat. We split the only remaining food we had on us at day's end, a lone granola bar. "Mesi" they said in unison, with a big smile on their faces.

As we gathered supplies out of the storeroom on our last day, we gave bouncy balls and jelly bracelets to the children living on the Nazarene grounds. As I placed a purple jelly bracelet on the small wrist of a five year-old girl she said to me, in English, "Thank you, Thank you", and blew me kisses saying "mwah, mwah".

These stories are just a few of the many expressing our patients' gratitude. All of this thanks, I pass along to you--our family and friends, friends of family and friends. Your generous support of us and the Haitians has changed lives. Mesi, Merci, Thank you.

~ Maryclaire

......

We returned from Haiti late Wednesday night. We are well, though exhausted. We have both joy and sadness in our hearts. It was simultaneously wonderful and devastating to work with the Haitian people, and hard to leave with so much work left to do. My dreams are filled with the people of Haiti, and the need that we left behind.

We will continue to post remaining blogs and photos. Please see our previous blog posts that have now been updated with photos.

The Things That Remain

We're home now. Safe in the US and with some degree of culture shock.

I know for me it's hard to talk about this whole story, as we're still kind of there, in Haiti. It's hard to go from despair and hope and death and all of it to TV's and water you can drink straight out of the sink and people's day to day conversations.

We have some stories for all of you to finish out. There are more things to say, more things to pass on. We have other people's stories to tell, as well as our own.

We'll finish out the remaining posts, and hit on those other topics. We have some multimedia slide shows we have to create, that will narrate some of the story.

Stay tuned over the next few weeks for the end of our adventure.



-Aaron

P.S. We are still in need of donations. Anyone you can pass this information on to who may want to donate, please do so. We borrowed all of the money to head on our mission, and still need to pay down those debts. We were actually doing well until Pay Pal discontinued our ability to receive donations.

Any donations in surplus of our debts will be directly donated to Heart to Heart International, and will go to mission critical meds like we brought, that we will send directly with future team members heading into the field- vs. those sitting in port with all of the other aid agencies. Thank you for your continued support!

Emergency Medicine

We worked very hard to get heatstroke on Monday, our final day of clinical work in Haiti.

The taptap needed a repair, so we were unable to start out right away with mobile clinic. Instead we made a housecall that was needed. At the start of the earthquake, the medical aid response was huge. Doctors, nurses, surgeons, paramedics- rushed into Haiti providing life-saving care. Many operations were performed. A popular procedure was reduction of fractures and stablization with external fixators- large medical devices that keep the bone straight and in place on the outside of the body. The problem is that all of the surgeons left. Nobody is here to take out the external fixators. Now there are thousands in Haiti with devices in their bodies unable to move or walk, and getting secondary infections because of the permanent wounds. We are working hard with agencies right now to address this. The pediatric hospital, St. Damiens (which was a regular hospital comandeered by international pediatricians and neonatologists) has agreed to even see adult patients on a limited basis, and will remove the fixators when appropriate. We are responsible for maintaining care until then.

A lovely woman who has been kindly taken in to an actual house (one room) up the street from our clinic receives regular house calls from us for wound care on her external fixator. Things had been fine until Monday. On our visit on Monday, we found the wounds to be pussing, hot to the touch, and with other signs of infection. We immediately prepared the woman for transport. We could not find our only doses of our first choice of antibiotics, so were forced to compromise with an injection of an appropriate med, and oral follow up with a very less than ideal med. We wish we could tell you this was the first time we did this, but it is what it is in Haiti. We sent her immediately to the children's hospital.

While we were out, a large aftershock hit the church, and many ran out from the building. There was no damage, but many were scared. Eventually we were able to load up to the taptap. On our way down to the street we ran into many who had been scared out of the building- mostly amputees- who would go no further. They were unable to be seen by the others upstairs in the clinic, so we set up there and saw them all. Eventually we were able to finally hit the street, and again we set up in front of the Cathedral.

We saw many that day, and Bel Aire most certainly set us out in clinical style. These were the sickest patients we had seen during our entire stay in Haiti, and we were more like an emergency room than a clinic. We admitted or referred 6 in the last hour alone.

I saw a baby in the gutter that was being rocked by a teenager with a foot. He stated the baby was fine but we demanded he be brought into the truck. The baby was a double-orphan because of the quake, and had non-stop diarrhea for one month now. Not uncommon, the people drink any water they can find, and boiling is almost never an option.

Maryclaire saw a pregnant woman who has had vaginal bleeding since the earthquake. She would pass a handful of clots nearly every day.

I was called out of the taptap urgently because there was an older man, who could barely breathe, and could not stand or walk. When I found him in the filthy room, he was working hard to breathe and was in obvious pulmonary edema and heart failure. We did not have the medicine of choice, but a similar medicine was available to start to take the fluid out of his lungs. I brought it back but it is a blood-pressure lowering medicine and we had to check his pressure first. Of course it was extremely low. With my penlight I could now see the signs of extreme dehydration. He was dehydrated, yet his lungs and legs were filled with fluid. I rehydrated this man right there so I could take the fluid right out of his body again. I admitted him urgently to the General Hospital.

On the way to the taptap, I was expecting to tell the driver we were leaving immediately. A man ran up to me with a baby wrapped in a towel. I looked at a light bandage over the neck, and found a gaping wound. We examined the baby on the taptap. Two month old with signs of extreme sepsis. We aadmitted the baby to MSF (Doctors Without Borders) as the child had already been turned away elsewhere.

The afternoon continued to be a challenge. It was hot. We were dehydrated and could barely stand by the middle of the day. It would take all night to put the fluids back into us, and earlier both Maryclaire and I had to be rehydrated in the clinic (image to the right is crusted salt on my shirt at the end of the day. The streets of Bel Aire certainly did not hold back on our last day of work.

-Aaron

Bearing witness

We no longer have clinic on Sunday afternoons. Initially the medical need was so critical that clinics, ours and those run by other relief organizations, ran seven days a week from dusk to dawn.  Though our staff attends church service with our translators and our patients Sunday mornings, the clinic is now closed on Sunday afternoon. The founder of the Heart to Heart International (the humanitarian organization we are working with), Dr. Gary Morsch, joked with our clinic director,

"Who decided we weren't working on Sundays anymore?".

"God",  Dr. Spaulding responded. "He wanted all of us to have a day of rest".

We are fortunate to have the founder of Heart to Heart back in Haiti for a few days during our time here. Dr. Morsch was initially to Haiti three days after the earthquake assessing need and planning operations to meet that need. Sunday after church, he offered to take us around Port-au-Prince, to share with us what he knew of Haitian culture, and to allow us to witness the full magnitude of the earthquake's destruction. While we could see the ruins of the National Cathedral outside our clinic windows, Sunday was the first time we saw the devestation of the Palace, the courts, the nursing school, the national hospital and pharmacy, and countless other cultural landmarks.

We walked the two blocks from the clinic to the Cathedral. Our first stop was at the ruins of a building next to the clinic. Scattered amongst the rubble were clothes, plastic flowers, and human bones. It was jarring. All streets are lined with fallen debris that has been pushed into seemingly monotonous piles of concrete. But if you look closely, you see personal affects, the materials of everyday living, and the remains of those who perished.

We walked on in near silence to the National Cathedral*, which was a notable and beautiful landmark. (About 80% of Haitians practice Catholism.) Dr. Morsch, who is a retired marine, took us perhaps a little farther into the rubble than common sense might allow, but this site drew us in. As I dusted underneath my feet, a beautiful marble floor emerged. To my left, a baptismal basin sat askew. Priest's vestments, one in black, one in white, laid amongst the twisted metal, chunks of concrete, and shattered stained glass. The archbishop was killed in the cathedral the day of the quake.

From this sobering site, we took the Tap-tap (so named bc you "tap" it when you want it to go or stop) downtown to the Palace and National Hospital. On our way there, we stopped at the nursing school. The quake happened during class session. Many, many died. It was chilling to see medical supplies, notebooks, shoes, and other affects. Though like before, most chilling was to see the scattered bones of those who died just six weeks ago. The devastation is so great, with 90% of structures in rubble, that there is not the man power to remove rubble and retrieve remains in a timely fashion. Approximately 240,000 of those who perished are already in mass graves. The death count from the quake is surely double, triple this, when you consider the many whose bones remain amidst the debris. The downed school across from our clinic holds the bodies of 200 children. We said a prayer for the nurses, and all of Haiti's people, and moved on.

We finished up the day at a missionary school that was having debris cleared by 120 college students, mostly from the University of Miami, who came in for a weekend to help clean up. The man who coordinated the students' efforts, was a friend to Dr. Morsch's brother, Paul Till. While there we spoke with a woman from Vermont who has been teaching at the school for 11 years. Her apartment was on the upper floor, towards the back of the building. It came down in the earthquake. We asked her about the quake, what she had experienced. So many talk about how loud it was. The first thing you heard was the noise, they all say. But this woman added another dimension to our understanding of the quake. While the noise of the earth rumbled for 35 seconds, the wailing of the people lasted for hours:  There was an incessant loud wail of unimaginable human anguish throughout the streets for two to three hours after the earthquake struck.

From this conversation, I now know that the memory of this wailing, the participation in this wailing, is part of what my patients bear. Part of what spurs their headaches, their stomachaches, their inability to sleep at night.

~Maryclaire

p.s.  More to come tomorrow from Aaron on our second day of Mobile Clinic.

*p.s.s.  To see pictures of the Cathedral, the palace and other landmarks pre and post earthquake, please go here.

The thousand words a picture is worth

I bought a painting today. On the way home from clinic we drove through the downtown, just past the destroyed Palace (Haitian White House) and sprawling tent city in front of it, is a small market place with a dozen vendors.  It is surely a fraction of the tourist trade that used to line the capitol city streets. These few vendors vied for the attention of American doctors. My attention was drawn to a stylistic and nearly monochromatic painting of Haitian women dressed in white, gathering bags of  rice into baskets headed for the marketplace.

Many of our patients arrive to clinic in clean white clothes. All arrive well-dressed, the men in pants and button-down shirts, the women in dresses, skirts. The children, too, are dressed well. This despite the fact that they are living in the street. Just outside the clinic a shoe shine has set up 'shop' along the dusty streets that are lined with fallen debris. Men are lined up throughout the day having shoes, even tennis shoes, cleaned and shined. The people here have a quiet, reserved dignity that is at once startling and humbling.

There are signs throughout the city that say: "Revive, live life. Haiti has not perished". There are t-shirts with this same message seen on the backs of paraders walking through the streets, with music and singing. The music is starting to come back in parades, in church, in the streets. The streets were eerily silent of music for weeks after the earthquake. Partly from lack of electricity and music makers, and I imagine, from overwhelming sorrow.

Sunday morning we attended service at the church that is home to our clinic on it's top floor. This was the second Sunday service held after the earthquake. People were too afraid to enter buildings before that. This Sunday, however, several hundred people filled the pews. Again, all impeccably dressed, even though they have been living on the streets for 5 weeks.  Men and boys in ties, and suit pants, women and girls in beautiful dresses, with hats and bows in their hair. I sat next to a woman dressed in a white linen dress and held her six-month old baby for part of the service, so she could fully participate without being distracted by a squirmy, cute-as-a button, big-eyed, baby boy. (Yes, of course, there was also my selfish motivation of receiving rejuvenation from this little spirit).

The service was over two hours long and filled with praise, singing, dancing. It was powerful and humbling (I am continually humbled by the Haitians) to see these people who have lost so much,  able to offer such joyful praise. This culture knows what it is to live in gratitude...and dignity. I witnessed this at the church service, and every day I work at the clinic. 

And so now I have this painting of women in white to remind me...of the Haitian people, of my experiences here, of the calling we all have to live in gratitude and dignity.

~Maryclaire

House Calls

She spoke no English, no French, and we speak incomprehensible Creole. Her message was clear though through her eyes, her face, and her gesture- "I'm not going up there- I've tried, but there is no way".

Our mobile street clinic was an incredible success. On the street we have found so many people who as expected were too afraid of entering buildings- much less going to the fourth floor of one- to enter the church that is the home of our clinic. Maryclaire and I took our Taptap and driver, our best translator Calixt, and drove to the massive ruins of the National Cathedral which lies in front of a massive tent city.

We weren't sure exactly what was going to happen but it pretty much solved itself. We brought a case of meds and supplies, and between Maryclaire and I, we acted as physician, nurse, and pharmacist. Calixt would bring one person at a time into the Taptap and we conducted ourselves as we would in the clinic. Later we brought Anita back to the site so we could have an RN with us to help out.

We saw 50 patients in a short time, and transported 34 to the clinic in between. When we left we had a crowd of 30-40 begging us not to leave, but so happy when they heard we would be coming back on Monday. We saw a lot of the general complaints we've been caring for (eye irritation, gastritis, muscle pains, parasitic infestations), but also sicker issues that we were able to refer or transport not only to our clinic but to the outlying field hospitals we have relationships with. We were able to ask what we had planned: 'do you know where someone is who is very sick, and unable to reach medical care?" We'll continue the mobile street clinic today, moving into other areas of downtown.

In the afternoon we took the long route home to take a translator home, around areas of downtown we haven't yet seen- including the Palace, the national nursing school (with 500+ nursing students and teachers lost), and other devastated areas. We stopped by the stadium so our departing paramedic Jim, who was finishing a 3 week tour and had been here early in the disaster, could say goodbye to the place he had seen so much pain and chaos. The stadium was transformed, and a palpable feeling of peace and calm was the dominating feeling, over the

smells of human aggragation, filth, and the obvious disrepair of a tent city within the structure. It was moving to see the look on his face, to see the results of his work. Maryclaire and I walked along separate from our group, talking to the children and families. We were asked to urgently come see a woman, and we made a house call to her. She was 8 months pregnant, and was dehydrated, and having abdominal pain. This was her first pregnancy. We assessed her, Maryclaire calmed her and her family, and they asked if we could come back and see her one day. We said we would.

The Palace looks like a scene from the movie Independence Day or Armageddon. The entire roof of all sections is slid down, the pillars crushed, the front caved in. Imagine the white house crushed and sloped, with a multi-thousand person tent camp in front of it. It was shocking. In sharp contrast there was a parade of the people in front, led by a truck blaring songs of praise. The people were singing and dancing, all wearing some bit of yellow. Their song was of joy, not of grief.

At the end of the parade near the end of the tent city, we dropped off one of our interpretors. This was the first time one of our new nurses had realized the fate or our translators- our colleagues. They were just as homeless as all of our patients. She didn't realize this because like our patients, they are always dressed in the best clothes they can find, and well groomed. With nothing, they make sure they always look their very best. We passed a graffiti sign after leaving the palace that said 'Haiti has not perished!'. With so much emotion in the air, and with such respect for the peoples imaginable loss, deep tragedy, and persistent love and defiance it was impossible for us all not to cry.

We were all so grateful to the people of Haiti for giving us so much in that hour, and in this experience.

-Aaron

little hands

A small hand slipped into mine at the end of the day, while we were walking a path on the Nazarene grounds. It belonged to one of the parishioner's children. Many of the Nazarene parishoners, like so many Haitians, lost everything. They are living in tents on the five acres of the church grounds (our base camp). Every evening we come home, and every morning as we load up the truck, children flock to us. They have bright eyes, beautiful smiles, and eager helping hands. They are happy to be made busy boxing up the day's medicines from the store room.

We are surrounded by vibrant children everywhere. And it is wonderful. As we load up clinic supplies outside the Bel Aire clinic at the end of the day, the street is filled with children. Playing ball, flying kites made out of plastic bags and sticks, giggling and laughing. As we load up, they make their way to us, saying "bon soir, ca va" (good afternoon, how's it going), and asking us to take their picture. They love having their pictures taken, and laugh with delight when we show them the image. Adults have asked to have their pictures taken too.

On our drive home today, we stopped by the stadium. "The stadium" is the soccer field that was made into tent city grounds immediately after the earthquake, where much of the initial medical aid in Port-au-Prince was stationed. You likely saw footage from this at the beginning of the news coverage. It was a chaotic place. Today, there was a sense of palpable calm. The medical clinics have left the grounds, and relocated as ours has, but the stadium grounds provide a safe space for hundreds of tents, and food and water is distributed.

As we walked around the stadium grounds, a little two year old asked me to take his picture. His mother then asked me to take hers. She is not the only adult to ask. In my mind, I think of this request as asking me to 'bear witness'...to who they are, to what they have been through.

At the end of each clinic visit, I ask my patients if they have any questions. The other day I had a woman say "No, but I want to tell you about my sister". She then told me about how she had lost her sister in the earthquake. I feel empty handed as I hear these stories of grief. "How can I even begin to offer a "cure" for this hurt? For this woman, I simply placed my hand on her knee, looked into her eyes, and said "I am so sorry". She then went to our pharmacy station to pick up her medicines for trouble sleeping, headaches, stomachaches.

My last patient of today was a 19 year-old man. He had one complaint: "I wake up in the night, and I am screaming, and I don't know why." My heart breaks again, and through the interpretor, I talk about post traumatic stress in layman's terms and offer him breathing exercises and benadryl to help him get back to sleep after he wakes from these night terrors.

After hearing these stories throughout the day, my heart is rejuvenated by the smiles and unending joy of the children. I held tight onto that little hand that slipped into mine at day's end.

~Maryclaire

Taking It To The Streets

A complete success.

We could not believe the traffic to the clinic today, and our ability to handle it. We were down one doc, three nurses, and one medic- yet we saw 25 more patients today than any previous day.

We are completely in tune as a team- from paramedic to nurse, to docs, to translators. It was absolutely incredible, and all of us were proud.

We were haunted as a young woman sang her prayers in the church below us as we prepared the clinic this morning.

Sicker patients arrive. I sent a 79 year old woman for immediate surgery for a gangrenous finger. She burned it on a fire 5 days ago, and today pus and air was oozing out of it without any pressure on the wound or finger. It just hissed on its own. There is a large Carribean market we pass every day to and from the clinic. The entire market was crushed and hundreds perished within. Every day back and forth from Belle-Aire we smell the decay of those bodies. This was the smell emminating from my patient's wound. I evaluated her finger and immediately gave her an injection of antibiotics, and transported her by our Tap Tap to the newly reopened General Hospital with a letter in English, and a letter in Creole. She will certainly have the finger amputated, and I hope we have saved her arm and her life.

A baby and her mother both were turning yellow. The baby started throwing up yesterday and her belly is distended. Her eyes are yellow. Yes, her mother had hepatitis before she was born, and yes they both used to take medicine for the infection but not any more. I sent them both urgently to the MSF (Doctor's Without Borders) hospital up the street.

Maryclaire had a young woman return in follow up with her HIV test results after I saw her yesterday in the clinic. HIV-negative. Syphillis- positive. She may be two months pregnant. We don't have any penecillin today, but we will tomorrow. She'll come back tomorrow.

We are overjoyed by our work in the clinic, and the people who bless us by coming to see us. All of them are in great need. We feel as though our efforts are bearing fruit, and look towards more infrastructure coming into place. We have come to find out our clinic is now going to become a permanent clinic, in this location. The director of Heart to Heart will arrive this weekend, and we will have the rooms finished properly in the future, with glass and frames in the windows. Some day there will be power, and water. We cannot believe we are part of this. We cannot believe that in the coming years when we are back again to work we will be in this clinic and say "we did this".

While we were gone, three new doctors- OB-GYN, Internal Medicine, and Med-Peds arrived, along with a new RN.

In the morning, Maryclaire and I are going to try something very different. In the early morning, we will orient the new docs to the clinic. Afterwards, we are taking a translator, a driver, and a truck, and we are going to run a walking clinic.

We will go through the neighborhood with our backpacks, supplies, and support- making house calls in the streets, in the tents, and yes even in some standing homes. We will be seeking out the patients who will not come to our clinic because they are either too terrified to enter a building (especially the top floor of a building), or are too sick to come see us. We will use the truck as a dispensary, an examining surface, and even an ambulance if need be. We're not sure how it's going to go, but anything is worth a try.

This is definitely worth a try.

Wish us luck.

-Aaron

Pay Pal

All,

We are very grateful to Ethan Stern for his incredible perseverance and working so hard to coordinate our donations- and for all of you who have attempted to contribute to our work. All of our expenses for this expedition have been borrowed as we live on very tight budgets given our limited salaries, but the urgency to leave and the demand for our skills was too great.

Today Pay Pal demanded we stop using any form of button on our site, despite continued compliance with all of their demands. This evening they ordered us to refund ALL contributions.

We have taken down the button, and are sickened by their behavior.

We are both very sorry for the inconvenience this has caused everyone, and thank you for your intended generosity.

Anybody interested (and with the patience of a saint!) may contribute through the old-fashioned methods listed to the right.

Again, sorry, and thank you.

{Except for Pay Pal- no thanks to you at all.)

-Aaron & Maryclaire

Safe

We are working very hard.

We've built a full clinic in two rooms above a church in a downtown neighborhood of PaP over the past 2 days. We now have formal exam rooms, exam tables, a dispensary, oral rehydration station, and wound care center. We have seen hundreds of patients during the process, quickly building before and after clinic hours. We are seeing sicker patients every day.

Our team split in two today, with Lincoln and two nurses- Sherry and Sue, picking up a remote clinic closer to the coast at Legone- the epicenter of the earthquake. Maryclaire and I have stayed back to run the clinic and tend to the Belle Aire neighborhood with Dr. Spalding, a nurse, and a paramedic. We are seeing more complicated cases now later in the week as people hear about the quality of care we provide above "the church that withstood the earthquake". During the weekend of mourning, 1,000+ church members gathered in the church for worship for the first time since the earthquake. The praise was said to be deafening. We are so awed that those who could be faced with so much horror, so much destruction- after so many years of poverty, disasters, and despair- could praise God with such energy, and such joy.

A lot of our base team is heading out today- home for the US and elsewhere and we had a big send-off after dinner. Many tears and memories shared from people in various stages of deployment from various points of expertise. Our Field Director is leaving as well.

Lots of dust and smoke. We are always congested when we come back to the seminary. We ride the 'Tap Tap' taxis- modified pickup trucks that drive customers around quickly, efficiently, and dangerously. People ask me to explain what a Tap Tap is. I say a Tap Tap is a dare that you know you are going to survive. Even when you get into a Tap Tap accident like we did today. Drivers allow inches between cars- driving directly up the middle of the road, jumping curbs, and apparently trying to kill people and animals, as well as their passengers. We're used to it by now, and our entire state of being is surreal these days.

Tremors last night, and we literally had another small earthquake moments ago but the seminary is on very stout foundations.

We are surrounded by destruction, and very hungry, thirsty people- who are kind, and patient, and grateful. We are grateful.

Goodnight.

-Aaron

Room with a view...

A donation of wooden clinic tables, a twin sheet set, and large wooden cabinet for storing medicines transformed our clinic today. We now have three clinic 'rooms' separated by sheets and dividers. Each with a table (or chair functioning as a table) for basic medical equipment (gloves, alcohol wipes, hand sanitizer, blood pressure cuff, stethoscope, otoscope for ears, opthalmoscope for eyes), a clinic table, and a chair each for doc, patient, and translator.  My clinic 'room' has a window (open space in a concrete wall) that overlooks the streets below that lead to the port. The streets today were filled with people making their way to the port---food drops came in today. (When we return I will post the views out my window...unfortunately we have no way to upload photos here).

Patients line up for the clinic at 8 am in the morning. Doors open when we get there, usually around 9 am, but it depends on how long it takes our 'tap-tap' truck to navigate the 10 km through congested traffic. It usually takes an hour. A tap-tap truck is a Toyota pick-up truck with a metal cage over the bed, and thin metal seats from each side. This is a common mode of transportation here with trucks adorned in multicolored paintings and religious affirmations, accommodating 20 Haitians. Our tap-tap is grey, and transports 8 'larger' Americans.

Once at the clinic, we quickly stock the medicines brought from the large storeroom on the Nazarene ground, the mission area that is our base of operations. We have a large supply of medicines, but our wish list is still long. We are using medicines creatively, taking advantage of side effects and other lesser-used properties. Please know we used your donations to purchase antibiotics, pain medications, benadryl, multivitamins to bring with us. These are some of our most commonly prescribed treatments.

My first patient of the day was a 52 year old man in a wheel-chair. He had lost both his legs. His complaint today was shortness of breath. This is a common complaint here. Aside from the thick smog of burning trash, there is much dust in the air from all the smashed concrete. Concrete is the foundation for most buildings here. It is mined from the hills and makes a very brittle concrete, which is a large part of why multi-storied buildings just collapsed straight down in the 35 seconds that devastated the landscape. For shortness of breath and asthma I prescribe a mask to block soot and benadryl to relax the airways. We have a group of docs coming down next week who are bringing actual asthma medications.

Later in the day I saw a 14 year old boy in a left arm sling. His arm had been crushed during the earthquake, over 30 days ago. He  brought x-rays with him. I'm not sure where they were done, or how long ago, however, they showed a communated fracture at the humeral head. This means that his upper arm bone was in two pieces that are now overlapping by at least 3 inches. If he is ever going to regain use of his arm, he needs surgery. I referred him to the children's hospital. They will likely need to re-break the arm to re-set it.

I saw dozens of other patients throughout the day, each with their own story. I continue to feel honored to be part of their recovery, and thank you once again for your part in making all of this possible.

~ Maryclaire

Food As Medicine

A busy day in 'clinic' today.

We have moved all operations out of the soccer stadium in downtown because of worsening crowd management and sanitary conditions.

We have taken over the top floor of a church in towntown Port-au-Prince and set up an emergency room.  Slowly this itis taking full shape.  We have 3 examining 'rooms' which are sectioned off by basic curtained dividers, a dispensary for medications, and an oral rehydration station.  We had 3 docs seeing patients today, and the RN's and paramedics covering wound care, dispensing meds, and running rehydration.  Today we received two examing tables.  Our workflow is taking shape and we are providing quick, efficient, quality care.

I am astounded that there is still no food here.  We are treating the entire range of conditions, but I become angry when I see that food still has not arrived to my patients.  Of course they accept this with quiet dignity.  I ask all of my patients:  'how is your family', 'where are you sleeping', 'do you have access to food or water'.  Everyone has a heartbraking story.  Nearly all of them sleep outside on the concrete, some with towels, some with nothing.  Many people present with headaches and body aches.  They have these pains from sleeping on the street- literally- not on grass, not on a bench, on the concrete street.  Only one patient I saw today had any access to food. 

Water is the one that strikes me the hardest.  I have to prescribe diuretics for patients with symptomatic heart failure, who are on the brink of dehydration already.  In the US I would casually tell someone who is extremely constipated to drink more water- impossible.  I saw several babies today that in Wichita we would have admitted for dehydration without hesitation.  Today there is nobody who can take these babies- we have tried to refer them over the past days with no success.  We rehydrate them there above the church.

I have to be specific with my questions on water- not only do you have access to it, but can you drink it?  After pressing a patient today on how she was getting her water, she admitting she was drinking the stagnant, filthy water in the gutter of the street near collapsed buildings, sewage, and decaying bodies- and drinking straight from the curb.

It is distressing that water and food are being released, yet not finding there way to people in need.  We can see multiple ships in the harbor from our vantage point above the church- including the USS Comfort (the Navy's hospital ship).  We are unable to directly release food and water to our patients or we will be swarmed upon by these hungry, frustrated people.  We are set up for medical aid only, yet the most important medicine the earthquake victims are in need of is water, food.  I prescribe a multivitamin for 10 days to anybody without any food at home- a double dose if they are pregnant.

We are thrilled that our clinic has taken shape.  We are setting up referral bases in the area as possible since our situation has changed since the stadium move.  We have a somewhat congenial with a Cuban Clinic up the street, but now a tent hospital in the middle of the city with full OR and delivery suites (with potential Tap Tap ambulance service), direct Medicins Sans Frontiers (Doctors Without Borders) rehydration stations, and other referals are in the works.

We will continue to work, much more to catch you all up on in time.

-Aaron

Fat Tuesday

We arrived into Haiti yesterday, on Fat Tuesday, but Carnival has been canceled this year. 

Today, we heard shouting and music coming from a parade of people marching through the streets below our make-shift clinic in a downtown church. I initially thought this was homage to carnival, though I soon found out this gathering was part of a demonstration crowd who had paraded in front of a government buildings, asking for food, water, shelter...and all things lost in the earthquake.

Our clinic is located in the Bel Aire district in a Church that is one of few standing structures bordered by rubble all around. To the left is a three story school building, leveled to the ground with over 200 children killed, to the right a five story apartment building, similarly leveled. A body was pulled from that rubble yesterday. Despite all this, the people have a resilient spirit.

An easy smile came from most clinic patients today whose ages ranged from 4 months to 87 years. A colleague who has been here for the past week tells us he saw a patient who was 103 years old the other day. Despite age, the complaints are common: itcy rash (scabies), stomach ache and heartburn (acid from stress and not eating for weeks), insomnia (hard to sleep on the ground), heart palpitations and headaches (anxiety and post traumatic stress), yeast infection and thrush (malnutrition for weeks with little immune reserve). We have also treated dysentary in infants, STI's, wound abcesses, dehydration.

Though we have been here for just over 24 hours, we feel more ingrained into it, as if we have been here much longer...in a good way. We're looking forward to going back to 'our clinic' tomorrow.

As they say in Haiti, Bon Soir (good night).

~Mc

Haiti

We have safely arrived to base camp at the Nazarene seminary outside Port-au-Prince. We were transported by the US Embassy with members from the State Department. The ride from Santo Domingo to Port-au-Prince was about 7 hours long. In all of my rush to get to Haiti I never considered the marvel that is the Dominican Republic. The country has a tremendous amount to offer, including it's people and it's beauty- and is facing a huge influx of refugees, despite years of bad blood between the two halves of Hispanola. We were escorted by the Haitian Diplomatic Police when we arrived to the border and were waved through customs and checkpoint with sirens on. The scene at the border can only be described as beautiful chaos- a mountainous desert area with dusty leafless tress,bordered by a blue-green crystal clear lake- surrounded by the culture, vehicles, smells, and sounds of Haiti. In 1 hour we would be to Port-au-Prince. We have abruptly gone from speaking English, to Spanish for the past 18 hours, and now to French and Haitian Creole.

The devastation and squalor is humbling and I've been told that I've seen nothing really. We were delivered to the US embassy and quickly transported to our base camp at the Nazarene seminary just outside of downtown- a true oasis amongst the chaos.

We were introduced to the team- our old friend Lincoln among them. Everyone is cheerful, and the work has been going well. Besides Maryclaire and myself, 2 RN's- Sue and Sherry are new to the operation. There are 4 docs here at our site now that the two of us have arrived, 3 RN s and 2 paramedics, and our Field Director, Barry. Our current medical director is an internist from Colorado Springs, Duane Spalding. Logistics change daily and even hourly.

The public health aspects are becoming an increasingly important aspect of our operations in and around Port-au-Prince. We are now doing biosurveilance for the UN in addition to our clinical duties and participating in direct logistics with them at the Cluster Meetings that occur every day at 4pm.

We have a limited and creative formulary to say the least. We are treating wounds, malaria, pneumonia, gastritis, and everything else- while maintaining vigilance for cholera, typhoid, and rabies which are expected to be emerging now . I am grateful for my training as a full-scope family doc, and humbled by what I do not know.

We are continuously reminded of what has happened- from the silence and darkness over the metro area from the terraced view of the seminary, to our house mother sleeping in a tent in the driveway with her daughter because she is afraid of sleeping under a roof.

Everyone is changed by this.

A day of travel

We have arrived in the Dominican Republic safely.

After 10 hours on and off of planes all day, little sleep last night, and several days of running around for supplies it feels wonderful to be so close to our destination.

The sensation of arrival was surreal.  On exiting the airport, there were hundreds of people waiting for aid workers with signs for all of the major groups- World Vision, Doctors Without Borders (MSF), Red Cross, and many others.  There in the crowd was our own support personnel for Heart to Heart International.

Nancy and Doc were warm and wonderful people to meet after an exhausting couple of days.  They transported us to the hotel (safely despite an entirely new culture of driving) and arranged our stay for the night.  They will take us to the US Embassy in the morning where we will meet for transport over the border.

Here at the hotel we would say that approximately 2/3 of the people in the lobby are with some relief organization.  It is quite heartwarming to see such an outstanding response from the world community to this tragedy.  We are glad we can be a part of it, and that you could all be a part of it as well through your overwhelming support..

More to come tomorrow- from Haiti!

-Aaron & Maryclaire

News Coverage in Wichita

Yesterday we were fortunate to have the local NBC affiliate take an interest in our trip to Haiti.  The producer and cameraman came by my loft at 2pm and did about 30 minutes of interview and filming to learn about our trip and why we were called to serve in Haiti.  Imagine our surprise to find out it was the leading story after the opening ceremony of the Winter Olympics!  The piece represented our mission well, and also included an interview with Rich Moberly, M.D.,  an international fellow at Via Christi Family Medicine who returned from Haiti several weeks ago.

Our friend Lincoln Westfall, D.O. is now on the ground in Port-au-Prince, however because of the continued period of mourning, the team has not been able to be active in the area as of yesterday and all operations are being held until the president declares the period of mourning over.

Please follow Lincoln at:

http://lincolnwestfallinhaiti.blogspot.com/

We are looking forward to working with our friend and classmate in a short period of time.

Today we spent more time gathering supplies, and we are nearly prepared to leave.  We have very few stops left to make tomorrow.  I flew into Albuquerque today with the supplies gathered in Wichita and my personal gear.  We will need to pack (and repack) tomorrow.  Our goal is to travel fast and light.

We look forward to tomorrow as a day of rest before our departure on Monday morning.  We are excited, anxious, and hopeful.

We are overwhelmed and grateful for all of your support.

-Aaron

Day of Mourning

Today is the one month anniversary of the earthquake...a day of mourning in Haiti and abroad. Aaron and I have spent this day collecting supplies: suture, multivitamins, iron pills, baby diapers, baby formula, etc.

Two days ago, Aaron had the good fortune to speak with a doctor recently returned from Haiti. As part of a cultural primer she told him what the Haitians expect from personal encounters, including the medical visit: direct eye-contact, a smile, and human touch. I have to admit, prior to the quake my knowledge of Haitian culture was sparse, but learning of this cultural value for human interaction both humbles and inspires me.

~ Maryclaire

If you are at this blog spot you are family and friend to us, or family and friend to those close to us.

All of you are aware of the devastation that has been wrought upon one of the poorest nations on our planet. The earthquake that struck Haiti mid-January took over two hundred thirty thousand lives, with many more wounded, and millions displaced. The death count rises daily as many with chronic wounds, infections, and untreated medical conditions go unaided, despite the incredible surge of relief that has come from all over the world.

In response to the disaster, we will be traveling to Haiti this Monday, February 15th and will be on the ground for one week plus time for travel, working with a humanitarian group in and around Port-au-Prince. It is a relatively short period of time, however for every day on the ground we work, we will each provide medical and surgical care for at least 100 people.

Together, in seven days time we will provide care for at least 1400 people. The people's need for care is great, ranging from rampant worm infestations, to infants with skull fractures, and women so anemic their tongues are stark white.

The costs involved in getting to and from Haiti, travel within the country, and supplies are considerable, but the call to go is greater. And we are confident these costs can be overcome through the goodness and generosity of others.

If you have wanted to contribute to relieving the suffering of the Haitian people, your dollars could go no further than helping directly place a doctor within reach of the victims of the earthquake.

Any financial donation you or others can provide on this mission of mercy makes a considerable difference, and absolutely no contribution is too small. Please know, all money donated to us goes directly to putting us in the field. It literally brings our hands, filled with supplies and human touch, to the people. There are no overhead or administrative costs.
All monies received above travel costs will be donated towards medical supplies and bringing more healthcare professionals in. The need for medical care will continue for many months to come.

Please distribute this message widely to any who may be able to help.

We invite you to follow our work in Haiti on this blog. We will try to update daily, though we have been told internet access in Haiti is spotty at best.

We ask that you keep us in your prayers and well-wishes. Thank you.