Alright –on the first plane heading home. Final thoughts...

When traveling internationally – particularly from an airport such as the one in Haiti – if it is only $80 more for business class on the way home, you take it. Seriously best 80 bucks I've ever spent, and I’m still on the ground in Port-Au-Prince. I also imagine this will feel nice come tomorrow morning, as I land in Seattle just after midnight, and have class at 8:30 in the morning. Nothing quite like hitting the ground running, right?  I would also like to take this time to thank whoever it was who invented the air vent on airplanes.

In other news, I think we figured out what that strange “rooster” noise was… My new guess is a screech owl. I wasn't able to completely confirm, but a quick Google search at the hospital yesterday showed that screech owls do in fact reside (or have at some point) in Haiti. In my half asleep state the other night, I almost made a recording of whatever noises were occurring at some point in the night, and now I wish that I had. Oh well, something to come back for.

Our last class was Monday. In general I feel they went well. There was a definite “education gap” between the students, with some being incredibly well trained and still sharp when it came to EMT-level knowledge of diseases and disease processes, while others struggled to recall some pretty basic stuff. I think the gap stems from initial training. It turns out EMPACT is not the only organization that offered EMT training after 2010, but education wise it was by far the best. The other gap was between those EMT’s who worked in hospital or pre-hospital setting and those who weren't currently using their certifications, but this is a more normal delineation. Again, I stress that they went well for everybody involved, although I again found myself wishing I spoke the language. Claudel and Saul, our translators, were incredible (EMPACT EMT’s themselves), but it meant that all information had to funnel through them, which always alters my natural flow.

---Break in the action: Just spotted a whale as we were climbing from the airport! The water looked funny, and when the plane tilted a bit the light changed just enough to see the shadowy outline. ---

Triage!

Yesterday, our last day at Bernard Mevs/Project Medishare (the hospital), was a full day spent in triage. I didn't really explain how the hospital works before, so here goes. When a patient comes to the hospital, they simply come and knock on the front gate, right off the street – imagine going to visit your rich uncle Mr. Burns – same style of gate, just pink, and with the hospital name on it. They are greeted by two big security guards, one holding a loaded 12-gauge shotgun (good fun). Depending on the nature of the person’s request, they are allowed to pass (routine appointments, visiting another patient, etc), or, if the person is requesting to be seen by the emergency department, the security guard gruffly shouts “EMT!” in the general direction of anyone standing in the triage area, which happens to be the closest section of the hospital to the gate. One of the Creole speaking EMT’s will then go and quickly interview the patient, or in cases of more obvious emergencies (GSW’s, stabbings, severe respiratory distress, etc.) the EMT will just wave the person in, or in some cases, wave in the vehicle transporting the patient (car, Tap-Tap, Land Rover, motorcycle, or other) to the triage area.

Looking toward the gate/street. On the left is where the
patients sit, the ramp on the right is triage.

Now, let’s be clear – HBMPM has one entrance and one entrance only. This means that not only are all patients, both coming and going, walking/wheelchaired/or vehicled, are passing through this gate, but also all cargo, all administration vehicles, and the occasional ambulance transferring a patient from an outside hospital to use the CT scanner (that is, when there is power. Electricity is typically lost sometime around three or four in the 

afternoon, and while the majority of the hospital is on a generator, the big portable CT scanner is not). It is a very, very busy gate, and all traffic goes right through the middle of the triage area. Think about it like this (adding pictures for help clarify): all patients sit on one side of the thoroughfare, and the one bed, one bench, on chair triage area is on the other side. Patients come from the gate, sit on the wooden bench under the shade flowers on one side, and wait to be checked in/triaged. We typically come over from the triage area itself, interview them, determine the nature of their complaint, and advise accordingly. It is absolutely up to the EMT’s to determine who needs to be seen now and who can wait, which was really fun. The role we played was absolutely critical to the proper functioning of the organized chaos that was hospital triage. Side note - why shouldn't the patients cross the “road?” Because they may not make it to the other side. It wasn't as if cars were moving quickly through there – probably only 3 to 5 miles per hour, but it seriously felt like the world’s  slowest game of Frogger at times.

Nicole and a paramedic whose name I cant remember outside triage - if you look at the curtains and then find them in the picture above of the inside of triage, it will give you a good idea of size...

Once a patient was evaluated by an EMT, they were registered, and waited for the doctor. Few patient’s would go directly to the ED, as it only had in the neighborhood of 8 beds, and the ICU 3 or 4. Doesn't allow for much leeway or patient surges (for example, a triple shooting). Anyway, back to the bench. The patient’s sit on the wooden bench, when the doctor has a chance to finally evaluate them, he/she writes some quick notes, orders either an IV of normal saline (most people are dehydrated as it is, can’t go wrong with a little fluid), labs, an x-ray, pain meds, or a small sampling of other preliminary treatments/tests. The patient, or more commonly a family member, must then go and pay for these treatments and pick them up from the pharmacy, then bring them back to triage where they have the medication administered. This is the general process.

Highlights from yesterday included a neat-o distal femur fracture, some routine trauma (girl hit in the head with a rock, a girl thrown from back of Tap-Tap who ended up having a small subdural, and a broken arm), routine medical (I don’t feel well, on again off again toe infection for the last three years, abdominal pain that’s probably food poisoning), and a 25 minute span that wasn’t so routine. It started out with an “ambulance” coming through the gate and parking directly in front of triage, effectively blocking off all traffic from going anywhere. This naturally led all the available EMT’s, nurses, and a couple of docs to investigate, to find a gentleman prone on the gurney (on his stomach), with a very clean stab injury to his lower lumbar region, almost DIRECTLY over his spine. Imagine a spinal tap gone terribly, terribly wrong. The patient was quite stable – great vitals, full range of motion in all extremities, no bleeding. Nonetheless, one of the docs climbed in to the ambulance to figure all this out while we all watched and waited. About 15 minutes in to this, a very angry/emotionally upset young male started shouting at security/anyone who would listen, very near the back of the still parked ambulance. After a few minutes of shouting, he was led down toward the administration building, reasons unknown.

Picture Break! (get it?)

Distal femoral shaft fracture. Elderly female, non ambulatory for the last several years, fell out of her chair the day before. Totally stoic - not even a grimace (femur fractures are notoriously painful). 

Another one of our favorites - patient being discharged with a recently cast leg. This is how I recommend how people should travel with a cast.

Returning to our story.... We all continue watching the doctor evaluate the stab wound. Given that the patient was stable, compounded by the lack of beds in the ED, the patient was granted the sole triage bed, until further notice. Easy peasy, get him out of the ambulance, transfer him over, get vitals, start a new bag of fluids running.

Enter Kate, RN, head of hospital logistics (She’s super cool, from Seattle – I recognized her from the Seattle Children’s ED actually – her and her significant other Scott have been at the hospital for over a year now), very calmly attempting to collect details on the patient who coded (died) outside the hospital gates.

Patient who coded? Say what now?

The four EMT’s, two nurses, and doctor all in triage at the time sort of look around at one another, hoping someone knew more. After several minutes of confusion, a story finally emerged. While everyone was gathered around the stab injury in the ambulance, which was of course blocking the gate, another car with a patient either in, or about to enter cardiac arrest (still unclear why, possibly another stab injury) pulled up. The security guards, hollering “EMT,” managed to get one of the Haitian EMT’s to break away and come check what was up. The EMT found a patient in cardiac arrest, with what we like to call “injuries not compatible with life.” Or so the story goes. At any rate, sounds like the guy wouldn't have been long for this world, even if he had made it through the gates.  But, as Kate calmly explained (I mean this literally – I was really impressed with how she managed the situation) to the EMT, if you find a patient who needs immediate resuscitation - even if it is clear they aren't going to make it - right outside the gates, you don’t turn them away, or tell them as such. Her words were something along the lines of, “that gentleman,” (the aforementioned angry one) “will forever remember that his friend died outside the gate. He got all the way here, only to die while he waited to get in the hospital. At the front gates." Which, when you think about it, would feel brutal. Personally I relate it to what they teach EMT's regarding SIDS. Should you find a lifeless newborn, you never ever "call it" inside the house, even if it's obvious. At that point you are treating the family. Morbid, but it makes good sense if you think about it logically. 

At any rate, the rest of the day seemed to past rather quickly, and aside from riding home in the back of an all metal Tap-Tap during a thunder storm, passed without incident. I am now sitting in Miami International Airport, I just ate fresh fruit (a catch up post needs to be dedicated to the dietary trials and tribulations of the past nine days), and this post is incredibly long. I DID manage to capture some decent footage of the mean streets of Port-Au-Prince, so I'll see about uploading those when I get home. 

That's all for now - thanks to all who have kept up, and especially to those of you who managed to make it to the end of this post! 

Cheers,

Nick

Quick Update

I don't have much time before class, but figured I'd attempt a quick post.

I learned a bit more about Richenord (pronounced nothing like it is spelled - you may know him as Little Brother...) yesterday when went to the beach. Turns out hey may not actually be an orphan - at least not in the typical sense. He does live permanently at the EMPACT house, but I got the impression that his mother is still alive. I think his domestic situation may be of a different sort.


Sunday was our "day off" from classes, and we had been scheduled for a beach day. Nicole and I were both a little bit on the fence about this, as it involved a two hour Tap-Tap ride in each direction, and our backsides were already quite sore (and still are). We decided to undertake the challenge, largely so we could see another part of Haiti. The beach was strange - a beach resort of sorts for super rich Haitians and foreigners. Of course, the entire drive TO the beach is nothing but slums and poverty. I'm glad we took the drive, but I'm not sure I would want to pay for the $15 dollar day pass again. For reference, here is the back of the Tap-Tap. Hard wooden benches over bumpy roads with bad suspension.

One of the more interesting things we passed was a new "village" being established by Haiti's President to "house" the homeless. Decent looking concrete structures - much like the rest of the housing in the city - but located smack in the middle of nowhere. As nice as it looked, I couldn't help but think we were watching the genesis of "a project," or simply the next slum.

Gotta run, but here is a picture showing a two dollar bag of mangoes. Be jealous!

That's all for now - back to the U.S. on Wednesday.

Cheers,
Nick

The cow in the meadow goes moo. The rooster at 2am goes CHHHHEEAASAAAARRRRRRRRCCCGGGHHHGGH

As I mentioned before, the house we are staying in is up a dirt road, out of the city a bit. This means a farm like feeling at times, but it also means cleaner air, a generally serene atmosphere, and lots of very restful (albeit sweaty) sleep.

Except for last night, when an animal(?) Of some sort, probably a rooster, decided to simulate a banshee getting strangled by a shrieking monkey at what I think was around two in the morning, which was odd - the roosters usually don't wake up until around 3:45 we've found. This of course in turn made every stray dog in the neighborhood howl and bark. Not sure what exactly was going on there...

But I digress. Meet little brother!

His name is not actually little brother, but I'm still not entirely sure how to spell his actual name (Creole, much like french, has lots of swallowed letters/sounds), so we'll stick with little brother. He lives at the EMPACT house permanently with Saul and Francois (I'll introduce them later, but Saul along with another person, Claudel, have been our main translators and guides - as well as both being Haitian EMT's themselves), and we see him every morning and in the evening when we get home. I'm only mentioning him because in conversation with Saul yesterday I realized he isn't actually Saul's "little brother." He's a 14 year old orphan, whom Saul (23, an orphan himself, I believe) Claudel (26), Francois (not sure how old she is, probably very early 20's) and Madame Jackie (The house cook, she's older, probably in her 40's) watch out for.

I guess it just struck me when I thought about it more how many Haitians are orphans, or how upended life still is in many ways for many many people down here, even if on the surface the city/country roars full steam ahead.

Didn't mean to get too philosophical on you. Insert sappy music and a cheap play for money here.

Anyway, Little Brother is awesome - spending his summer break playing soccer. His English is coming along, probably in large part to the number of Americans who stream through the house, and he's planning on becoming and EMT when they let him.

In other news, the latest adventure with breakfast - Sloppy Joe's. I had a picture, the internet decided that wasn't happening.

Tomorrow I'll try and write a little bit about some of the other people we've been interacting with on a regular basis. Class today went well, although explaining cardiac tamponade through a translator really doesn't work very well, I've discovered.

Cheers,
Nick

Some Pictures

Because that last post went up so well, going to try some pictures...

Breakfast! Plantains, onions, chicken, potatoes, unk. root veggies all in a spicy tomato sauce. 

Nicole relaxing at the table on the front porch.

Our trusty Tap-Tap. 

Our first class from yesterday. 

I'm going to attempt and capture some video/pictures of driving (you all know how much I love the driving), but after Nicole had her phone stolen right out of her hands yesterday while in the Tap-Tap, I'm a little leery of bringing mine out while we drive. 

Cheers,

Nick

Hello From Haiti

Hi All –

Sorry for the delay in posting; I had intended to post at least once every other day, and I’ve failed thus far. Unfortunately for whatever reason there isn’t internet at the house currently, so I’ve only been able to get online briefly while at the hospital, and there isn’t a good place (or more important – time) for me to sit and compose my thoughts into a proper post. Instead, I decided to type it out at home and then post when we go in tomorrow morning.

First and foremost, this city is pretty much China, but with Haitians. I literally saw a truck with Chinese characters on it yesterday and had some serious déjà vu. The unmistakable essence of coal dust in the air/on clothes/everything, the trash lining the streets, the buildings, and of course, the utter ridiculousness that is “driving” are all eerily similar, and I’ve loved every minute of it thus far. The adventurous part of my soul –apparently powered by third world coal dust – has been watching quietly from the sidelines for some time now, and finally gets to play.

My flights were uneventful, aside from the woman who wore all four of her new derby hats (her husband wore the other two), as she did not have a hat box to transport them with. The airport in Port Au Prince was also pretty uneventful – although after exiting the newly air-conditioned immigration hall, you get a real dose of humidity. Also known as insta-sticky. I was met outside the airport by the other American I’m here with – Nicole – and our Haitian guide Saul. We quickly hopped in the back of the trusty Tap-Tap (basically, an old rickety truck with some wooden benches in the back) and off we went on our hour long (should be twenty minutes) traffic ridden death defying drive to the EMPACT House, up in the hills above the city proper. The house itself is fantastic – an extremely pleasant villa/compound-esque building with bunk rooms upstairs, a cold water shower (incredible), several balconies, and a great front porch. I’ll try and put some pictures up, internet connection willing.

Wednesday was our first full day, and we were scheduled to volunteer at Hospital Bernard Mevs/Project Medishare for the day shift – 6 am to 6 pm. We were absolutely warned before coming that time may not be of the same importance culturally, and, as predicted, we ended up leaving the house just after 8 in the morning. Throw in the hour drive, and suffice it to say we didn’t quite make our shift start time. The good news, however, is that it really didn’t matter a whole bunch. The triage area where Nicole and I were working already had two full-time Haitian EMT’s staffing it, and they ran the show. Nicole and I mostly just got in the way.  She volunteered for Project Medishare a few months ago, so she knew her way around a bit more than I did, but given that neither of us speak Créole, there was only so much we could do. Still, it was a good experience, as it gave me a much better idea of where the hospitals are at, what sort of patient is common, and most important what our students would see on a normal day, and what they were expected to treat.

In the span of several hours I saw more than one baby with hydrocephalus, an extremely septic woman who was having her infection largely ignored in lieu of other less important yet easier to identify treatments, a 16 month old responsive only to painful stimuli after falling and striking her head on the stairs, several broken arms, and an elderly gentleman with a history of diabetes who had been constipated for over four days, and now had extreme abdominal pain.  What was most interesting to me was the way in which these patients were prioritized. Altered baby and abdo-pain guy, the two patients who to me seemed both at higher risk of severe complications compared to the others, ironically took a back seat to the broken arms and sliced open finger.

Yesterday (Thursday) was our first day teaching, and by in large the class went really well. Only had 6 students, which was the perfect size to test the waters with. Today we are expecting a group of around 15-20 students, as well as an observer from an organization called “Global Giving,” which helps organizations raise money. Should be interesting to see, definitely ups the ante a bit. UPDATE: The global giving lady was quite the firecracker. She just moved to Haiti permanently from DC, and her job is basically going around vetting different organizations, making sure they are doing what they say the are doing. I actually think that's a good thing, but she definitely was grilling Nicole and I for a few minutes. Good fun. 

Anyway, for the sake of brevity, some interesting observations:

Spaghetti is a breakfast food – eaten with ketchup and mayo.

Spaghetti can also be turned in to a juice. Obviously.

Our house is up the gnarliest, pitted, steep, bumpy dirt and rock road one can think of. Big fun in the back of a rusted out 1980’s era Datsun.

Internet is still an issue, but I’ll try and get some pictures up as soon as I can.

Alright that’s all for now – I’m currently sitting on the roof of the hospital, which, at four in the afternoon is not pleasant.

Cheers,

Nick

Ready, Set, Haiti

At the request of many, and in an attempt to ensure I am able to record in some way my upcoming trip, I've revived my old blog from my days living in China. Fear not - those fantastic diagrams and pictures aren't going anywhere - I just thought it'd be fun to continue the same blog rather than build a whole new one (read: I'm lazy).

I'm currently t-minus around three hours from lift off. To summarize for those who aren't clear, I'll be spending the next nine days (June 18th through the 26th) in Port Au Prince, Haiti volunteering for the organization EMPACT Northwest/EMPACT Haiti. While I will spend a few days volunteering in a hospital run by another NGO - Project Medishare - the majority of my time will be spent teaching. Myself and the other volunteer Nicole will be administering a modified "continuing education" class for Haitian EMT's, very similar to the continuing education all EMT's in the United States receive regularly.

I'm still learning more about the genesis of the program myself, but as it was explained to me, following the earthquake in 2010, bilingual university students who were lucky enough to survive the devastation began acting as translators for foreign aid workers traveling to Haiti. Over time, the students picked up much of the medical knowledge needed to perform an initial patient assessment, until someone had the bright idea to continue the training formally. As time has passed, EMPACT's mission in Haiti itself has began to focus on maintaining, supporting, and growing this program.

So, in an effort to do something a little bit different and maybe a little bit more important than the normal, I'm jumping ship. I managed to avoid checking a bag (American Airlines, with two transfers on the way down AND it's an international trip = high probability of bag loss), so here's hoping I don't get questioned too much about the slightly larger than normal bottles of liquid...

This is roughly what I managed to squeeze into my trusty Deuter. I did ultimately need a "personal item" about the size of a gym bag to carry my computer and some clothes that didn't fit. A general overview of what went in:

1 mosquito bed net
1 air mattress
1 VERY light weight fleece sleeping bag thingy
2 empty water bottles
2 large bottles of de-worming medication for children
1 box of gloves
1 headlamp
Flip flops, crocs, and lightweight athletic shoes
A super awesome teal fanny pack
A wad of $1 dollar bills (for making it rain)
Assorted synthetic shirts, pants
Snack food
wet wipes
Ibuprofen
Antimalarial medication
...And some other random stuff.

At any rate, as this is such a short trip, I'll do my best to get a post in every day or two, hopefully highlighting how the trip is going and helping highlight the current state of things in Haiti.

Hey Hey, You You, I Don't Like Your... Donkey Meat?

So this is going to be a short post, because unfortunately, China has decided that Blogger is evil and has blocked access to the site. I am able to get around it using a proxy, but unfortunately uploading pictures isn't an option currently, and this post requires pictures for maximum effectiveness.

At any rate, yesterday I finally made the obligatory trip to Taishan (Mt. Tai), considered to be the most important of the five famous mountains in China. Taishan is conveniently located about an hour and a half north of Qufu, so getting there wasn't a problem. I was invited by Peter, and made the trip with him, his girlfriend, another friend of ours named Hawk, and his girlfriend.

Now, Taishan, standing at 1525 meters, is a decently sized mountain. Because of this we decided to give ourselves plenty of time, and headed out at around 7:30 in the morning. Peter and I had agreed on the phone the night before that we should get breakfast before heading out, to make sure we were all ready and rarin' to go hiking. So, at 7:30 when we all piled into the car, I casually asked Peter where we would be having breakfast. He lightheartedly replied what I thought sounded like "Dunkin Meat," and everybody in the car laughed. I took this to mean he was jokingly attempting to say "Dunkin Doughnuts," which didn't seem that strange because there is a Chinese breakfast food called Yu Tiao which is a very delicious, light pastry which you can dunk in warm soy milk. This is also how Peter usually works in words/phrases he has recently heard to try and figure out how exactly to use them day to day. So of course I half jokingly said, "Oh you mean Dunkin Doughnuts?? Sure!" And everybody in the car chuckled. Insert Mr. T saying, "I PITY THE FOOL!" here please.

What Peter had actually said, and had said it in a lighthearted way to insinuate that it was okay for me to decline, was DONKEY meat. I, of course, had warmly accepted this invitation to sup on a magnificent bounty of donkey meat soup, with a donkey meat pita on the side. Imagine a Reuben from a New York deli - meat and bread. Now imagine it containing donkey meat. This was my very unexpected breakfast, and the start of a very interesting day. The good news, is that donkey happens to be quite delicious, as I learned. Noah, you would have liked it - it's cooked extremely well done, but maintains a very flaky texture, and tastes kind of like beef. Also very lean. Maybe that's why all the signs in the restaurant proclaimed happily, "In heaven, dragon meat. On earth, donkey meat."

After breakfast we headed to Taishan straight away. Now, at this time it's important for me to bring up an odd phenomenon concerning Chinese music appreciation in general. Being that, by in large, they LOVE Avril Lavigne. Not only do they love her, but they are absolutely convinced that most westerners (and thus, me) love her. Just one of those things. At any rate, either Peter's girlfriend or Peter himself had very recently purchased the complete Avril Lavigne three CD box set, conveniently timed for our awesome trek to Taishan. After listening to "With You" and several soul-invigorating rounds of "Sk8ter Boi," I finally caved and furthered their stereotypical understanding of western music by loudly singing along to "Girlfriend." See title for opening lines, but substitute "girlfriend" for "donkey meat" (I think I might ACTUALLY like Avril if the lyrics were really "Hey hey, you you, I don't like your donkey meat...").

When we finally arrived at Taishan, we prepared ourselves, and made our way to the starting path - a big stone staircase, which conveniently extends the entirety of the mountain...

This is where pictures would be nice, but immagine a wide stone staircase steeply climbing four or so miles to the top of a mountain. Our group wasn't the strongest, so unfortunately we only made it half way and then decided it would be best to finish our journey by riding the cable car up the second half. In retrospect, our lunch at the middle was so leisurely that I would have just skipped it, hiked up, and met the rest of the group at the top. Oh well.

At any rate, I made it up Mt. Tai and back down, and it was really quite nice. We couldn't have asked for nicer weather - I haven't seen a clear day like the one we had yesterday in China as far back as I can remember... It had rained the day before which cleared out the air just in time for us to have a beautiful, cloudless day.

When/if I am able to access Blogger again under normal conditions, I'll upload some pictures so you can see what exactly a stairway to heaven looks like (at the top of the mountain is a gate called the "southern heavenly gate.").

Oh, in other news, on Friday when it was cold and rainy, I was walking home from class in the morning and happened upon a cold, shivering, wet puppy pathetically trying to warm itself by wedging between a stone wall and a pair of shoes. We gave him a bath and fed him, and he's become a totally new dog, full of energy and curiosity. He's really, really little - just old enough to eat solid food really. We named him Sneakers, given the unlikely place in which I found him. In conclusion, we now have a puppy. At least until one of our students takes him home next week.

That is all.