:: Yeesh in Haiti ::

my 5 week trip to Tabarre, Haiti

La fin — May 13, 2018

La fin

This will be my last post. To say I was sad to leave Haiti is a severe understatement. I have met so many people who have left such a big imprint on my life. I learned about myself, about love, about patience, about kindness, and about persistence. I saw things I never would’ve imagined in a million years I would see and I am so thankful I was given this opportunity.

On my last day, I met with Dr. Gautier, she runs St. Damien Hospital and is a pediatrician. She is so lovely. We had a debrief prior to me leaving so she could hear about my experience there. We spoke for an hour and she took a page of notes. She was completely engaged with my thoughts and St. Damien is lucky to have her. She even gave me a bracelet as a gift. She assured me I am always welcome at St. Damien and even offered me a job when I finish fellowship (haha we will see). I am sure I will see her again.

Afterwards, I went to archives to say bye to the people I have sat with for countless hours every day for 5 weeks. I handed out pens, plume,  because they never have any!!!!We laughed and hugged and I promised I would return. BECAUSE I WILL.

Lastly, I went up to maternity to say goodbye. I saw Dr. Volmont, Dr. Pierre, Michoutas, and the other nurses and midwives. I will greatly miss them all.

To my new family that I gained- Madame and Monsieur Franklin, Madeline, Rose, Esaie, Mackensy, Whitney, Dina, Thomas, and Tania. Thank you for your love. Thank you for always protecting me and taking care of me. Thank you for welcoming me. Thank you for helping me hand wash my kilot (underwear apparently I am not very good at it). Thank you for taking me around Tabarre, for feeding me an infinite number of mangoes and Haitian food, for always being up to fete (party) with me and always open to trying all the crazy American things I am talking about. I love each and every one of you and you always have a place to stay if you ever get the chance to get on a plane and come to America. I wish that and so much more for each of you.

Being home is strange. Looking around, seeing all the infrastructure, driving my car, being in my air-conditioned apartment with electricity and water. I can brush my teeth from the sink! While it is nice to come back to, it is hard not to think of all the people left in Haiti with nothing. I mean, how different your life could be just by the country you were born in. If my mother didn’t immigrate from Haiti, that would’ve been my life.

This was the greatest experience of my life and I am eternally grateful to Stony Brook OBGYN Global Health for giving me this opportunity. Stay tuned for part II of Yeesh in Haiti because you can definitely expect sequels. I will return to Haiti.

Grossesse Abdominale — May 9, 2018

Grossesse Abdominale

Sorry team, I know there has been a pretty long dry spell here. I’ve had a lot of difficulties with internet connection. Anywho, I’M ALIVE. I survived a roach in my bed in the middle of the night and all! In any case, this week has been business as usual. Pounding charts in the archives while trying to balance being involved on the maternity ward. I have completed about 5 months of research and gone through 450 charts! I’m am very satisfied with what I have accomplished, especially since the charts were in French and I had little to no help.

Since this is my last week, I came up to say goodbye to some of the staff on the maternity ward as they don’t all come in on a daily basis. While saying bye to Madame phillipau, she alerted me to the fact that a case was about to start for an abdominal pregnancy, Grossesse abdominale. THIS IS RARE. 1 in 10,000 births (I looked it up when she told me they have had 4 this year). I had to scrub in! So I changed into scrubs and scrubbed in on a laparotomy to remove the infant. She was 31 weeks pregnant and this pregnancy has been growing in the peritoneal cavity of her abdomen (I.e not inside of her uterus). Like most Haitian women, she did not get prenatal care and she originally presented with abdominal pain and spotting and was found to have an extrauterine pregnancy at 31 weeks. The management for this is immediate delivery as this is life threatening condition. Since the fetus was viable she was given a course of dexamethasone (steroids) for fetal lung maturity and arrangements were made for delivery.

Given the rarity of this case and the fact that they have 4 in a year (hospitals accumulate cases over decades) the researcher in me jumped at the opportunity to write a case series. Madame phillapau was all over it too, I think she saw my excitement and couldn’t resist but to entertain me. She started looking through the registries of all the deliveries but unfortunately it’s about impossible to find the 3 other cases without going through chart by chart. There are no ICD 10 codes and no IT department to pull the charts you want. The archives are also a mess and half the time they can’t find the chart when you do have the name and MRN. Sigh. Unfortunately it’s unlikely I can do a case series but I will definitely do a case report. Research here is very frustrating but I’m hoping that will soon change and that Stony Brook can help them more effectively collect data.

In terms of exploration, I now consider myself a pro at getting myself around Tabarre. I have walked the streets countless times and even went to get some Haitian food in the street last night, NOM. Griot, bananne peze, accra, and patate. I was in Haiti Heaven NOMMMM. I threw a party for Cinco De Mayo and everyone got sou! (That’s drunk in creole) apparently my drinks are very strong compared to Haitian standards. Oh well! Everyone ate chips and queso and drank margaritas. It’s crazy, they had never heard of a margarita or a taco. I enjoy exposing my Haitian friends to things they have never seen or heard of !

Unfortunately, tomorrow is my last day and I’m so sad to leave the patients, the staff I’ve gotten so close to, and my friends at the house.

Tet Chaje — April 27, 2018

Tet Chaje

So couple of updates. For one, WE HAVE WATER AGAIN! I took a 45 minute ice-cold shower last night, and loved every minute of it. I washed my hair and all my lady bits 3 times through. D’leau, I never would’ve thought how much I would appreciate this. Here, my day revolves around d’leau (water). Is the pump on, can I shower? can I flush the toilet? Filling up bottles with clean drinking water at the hospital or at home so I never run out. Scarce. Clean water is scarce. Yesterday during our lunch break, I went to the supermarket with one of the ladies in archives just to fill two jugs of water. Jeez. In any case, I am happy and clean again and love water so so much, I will never take you for granted again!!

In research update news, I am 250 charts in!!! WOOO. 2 weeks exactly left, I am not going to be able to get through a years worth of charts they have over 2,000 deliveries in 2017 but I will aim for 6 months. It is crazy the pathology they see here. In one month I have come across 5 ecclamptics (women who develop grand mal seizures and need to be delivered immediately). It is an obstetrical emergency and in 3 years of residency I have not seen a single one. They saw 5 in March of 2017. In any case, going through the dossiers has giving me a broader creole vocabulary and I can better understand rounds. Even if I miss something because they are speaking to fast. I can glance through the chart and grasp the big picture because of all the time I spend reading through charts.

Yesterday we had a maternal death. A 31-year-old who presented at approximately 30 weeks  gestation (unclear the exact gestational age but definitely 3rd trimester on appearance) with her mother. She had been complaining of abdominal pain and first shared she was pregnant with her family the day prior to presentation. In medical school, I had a resident on internal medicine who used to tell me, “I know this isn’t relative to you and you plan on doing OB/GYN, but if you get nothing else from this rotation, I want you to be able to tell ‘sick vs. not sick’.” I didn’t understand what she meant until I went to round on my patient with congestive heart failure and he looked different from the day before. He looked ‘sick.’ I called my resident to tell her. He died that day. This woman looked sick sitting in the triage waiting area. Her eyes were closed and she could barely hold herself up. She was rushed to the salle d’accouchement (delivery room) and everyone sprung into action. It reminded me of home. Pulse ox on, BP cuff on, someone attempting to get history from the patient, someone speaking to mom, someone assessing the fetus. All at once in perfect synchrony. Unfortunately she was DOA (dead on arrival). Then the focus switched to the fetus. You have 5 minutes to get the baby out after mom has died, that’s how long it can survive without blood and oxygen from mom. Unfortunately the baby had already died too. There is some concern this may have been an abruption (placental detachment prematurely) that may have led to DIC but no one has any idea. Another death. It’s all around me. Yesterday as I stood at the front door of the hospital 4 men carried out a dead body on a gurney covered in plastic wrapping. They placed it in the middle of the street. I felt so sick. This is someones mother, brother, child, and they are sitting in the middle of the street for everyone to see. Gut wrenching. TET CHAJE!!

The Black Jacobins — April 26, 2018

The Black Jacobins

Alright guys, time for a history lesson. This is important. I truly believe the only way to truly appreciate Haiti and see it for all it’s glorious beauty is to understand it’s intricate history. Prior to leaving the US, at the recommendation of my brilliant cousin Brian, I purchased a book called, The Black Jacobins. It is a book written by C.L.R James that examines the Haitian Revolution of 1791-1803. Unfortunately, it is difficult to find accurate dipictions on the events that took place and there aren’t history books lying around on the Haitian Revolution. So this book is as good as it gets. It is exceptional. On January 1st 1804, Jean-Jacques Dessalines, an African-born ex-slave declared Haiti independent making Haiti the first black republic in the world and the first country in the Western hemisphere to abolish slavery completely. THIS IS HUGE. The tiny country of Haiti largely inhabited by illiterate and dehumanized slaves accomplished so much in just 12 years. Throughout the book, the author  approaches the revolution by analyzing revolutionary potential and progress according to economic and class lines, rather than racial distinctions. It speaks of the conditions the slaves endured and how economic and class lines could allow one barely literate slave to lead a revolution. There were times the book had me in tears, it paints a vivid picture to the lives the slaves lived.

The Black Jacobins also focuses on Toussaint L’Ouverture as the revolutionary leader. He kind of reminds me of Obama. He is thought to have united the revolutionary forces and lead the slaves in numerous battles. His influence, as well as that of the French Revolution, is the main focus of the book. He spearheads the revolution nearly to the end when he is captured and imprisoned in France (where he would eventually die), and then some of his most powerful generals, Moise and Dessalines, complete the revolution.

So sure when you see Haiti, if you so choose, you can just see poverty and need everywhere you look. But if you look closely through the lens of history you can also see strength, resilience, and empowerment.

AYITI!

Meningite — April 24, 2018

Meningite

Bon soir zamis! Today rounds were cancelled as there have been 2 neonatal deaths this week from meningitis and the unit has been racking their brain as to what the common factors were. One of the babies was born with some signs of compromise and went straight to NICU. The other baby was vigorous and thought to be in good health until he began seizing the day of discharge. I don’t know if there is a common etiology between these two babies or not– I mean they were low risk and both born to primips (women who are giving their first baby) with no known medical problems. In any case, one thing we do in the US is GBS prolphylaxis. All pregnant women get tested at 34-36 weeks for GBS (a common bacteria that if colonizing the genital tract could cause neonatal infection) and if positive they are treated with penicillin (or an equivalent) in labor. This is impossible here. Many of these women never have a single prenatal visit and present for delivery and are “presumed to be term”. I can’t even count how many times I’ve come across that reading through my dossiers. Michoutas and I were discussing our frustrations of the recent occurrences and throwing some ideas around. One thing she said was being considered was a clinic at St. Damien for pregnant women in the 3rd trimester so they can regularly screened for hypertensive disorders which are so prevalent here and GBS. Also, screening for domestic violence is crucial here. The overwhelming majority of the 150 charts I have gone through thus far have screen positive for IPV, which we know can escalate during pregnancy. The problem is that many of these women do not want to seek care. There is a lot of myths and passed down legends on pregnancy and childbirth that are impossible to debunk. These women would prefer to deliver at home with the old woman who lives down the street and delivered all the other children on the block. I don’t know if any of the above would have changed the outcomes but I think they are good ideas.

I’ve heard many myths from the maternity team regarding deliveries and postpartum. For one, elders in the family beat new mothers with palm fronds after delivery to help with milk let down. OUCH! (I know some of my aunts were subjected to the same beat down after their deliveries). Also, there is the belief that they need to stay insulated and cannot cool off postpartum to preserve their pelvic organs. Moms cover themselves from head to toes with blankets and sit on a warm bucket. The warmer the better. Mind you it is 95 degrees out and humid as heck. I swear I can see the equator from my bedroom window. Also no sex for 3 months. I’m cool with that since none of the women here leave with contraception. They receive counseling but they have to wait until outpatient. I wonder how many of these women follow up? The cultural differences are incredible.

Remember Dina (other favorite 11 year old)? Her father has become very ill. He cannot walk and is having fevers and headaches. I’m concerned he may also have meningitis but there is a serious issue with access to healthcare here. Even if there is a nearby hospital, the cost is horrendous and you will wish you died when all is said and done if you don’t have the means to afford it. So he has been laying sick for 3 days now. I even offered my services (trying to expand my scope of practice to men, ya know?) but he needs antibiotics and an LP which I cannot do. It is very hard, Dina has been crying and I wish there was some way to help. Unfortunately the healthcare system in Haiti is severely underdeveloped, there is no insurance, rules, or regulations to protect the patient. So incredibly frustrating.

Side note, I am feeling much better from my illness yesterday. I got home from work with honey tea waiting for me and concerned friends and family. Still not 100% but definitely functional!

Montezuma’s revenge — April 23, 2018

Montezuma’s revenge

Sorry, Yeesh in Haiti team, I know I’ve been MIA for the last few days, I have been a little distracted, will possibly discuss more at a later date. In any case, I had a fantastic weekend and came back to work this morning. Yesterday, I hung around the house with my favorite 11 year olds who for the billionth time brought me some mangoes they picked for me off the mango tree in the yard. For the last week or so the water pump at the house has been broken, from what I understand, the water pump is an apparatus to pump water throughout the house for bathing, toileting, etc I have therefore been bathing from a bucket of water that gets brought up to my room every night. This is all fine and well, I can deal with only washing the essentials but it gets tough when the toilets cannot flush and you cannot wash your hands! I have gone through 3 bottles of hand sanitizer already. In any case, I pride myself on being very easy going and have just been doing as the romans. I have been being very careful with what I eat and drink so as to not get sick but I slipped up. Thomas brought me FIVE MANGOES that he picked for me yesterday and brought it for me to indulge in a big bowl of water. I did not even think to ask where he found this scarce resource and instead pigged out on my mangos inadvertenty drinking some of the water. Well now as one would expect I have gotten some sort of GI bug (hence the title of this post). Nausea, abdominal pain, vomiting, and diarrhea. GREAT, I got travelers diarrhea aka Montezuma’s revenge as I recall from 2nd year of medical school! Thankfully I have some prophylactic azithromycin that I took on the onset but I am still very uncomfortable. I know this may be TMI, but hey, most of you are health care professionals, you get it!

Yesterday I rode a tap tap (an open taxi where multiple people pile in to get around) to the supermarket and bought some groceries. Lugging all of it back up the hill with Madleine was no fun but still a great experience! Last night, I threw a party for Lolo’s (the driver) 62nd birthday! He was not present but hey is that a requirement? I taught my new friends how to make microwave popcorn (THEY HAD NEVER DONE IT BEFORE!) and we ate haitian creme (ice cream), drank wine and prestige all night, all in the name of Lolo! (haha all I need is a reason to have a celebration). At the supermarket, I bought him a cake and insisted we sing and eat it for breakfast this morning before he dropped me off to work! I don’t think they can handle me here!

This morning since I am so ill and running to the bathroom q 20 mins, I am going to go home a little early. ( I don’t know that that is a much better option since the toilets dont really work but I will figure it out). To my pleasant suprise, I had a visit from a friend from back home today, Miss Cooper, one of the postpartum nurses from back home! She’s been reading the blog and is here visiting family for a few days and stopped by the hospital this morning to give me some chocolates and say hello! Wish I wasn’t feeling so crappy so we could’ve grabbed lunch and chatted more. Thank you Miss Cooper, I’ll see next month at home. SBUH ❤

IMG_0292
Miss Cooper, postpartum nurse from SBUH who is in Haiti for a few days and came to visit! Thank you for the chocolate and the support Miss Cooper.
Death, dying, dead — April 19, 2018

Death, dying, dead

I feel like this has been a recurring theme since I arrived here. Today I found out that my consult from last week, the 11 year old with vaginitis passed away this morning. She had a brain mass and hemiparalysis and suffered from a brain herniation this morning before being able to be transferred out for neurosurgical intervention. My heart is so broken for her mother who continues to walk around the hospital in the dress her daughter last wore. Everywhere I look I feel like there is death. A patient we’ve been following with pre-eclampsia with severe features had an IOL at 34 weeks and also suffered from a neonatal death. Chart after chart, I read of neonatal deaths during my research. I’m drained.

Thankfully, amongst all the despair, my dearest friends back home gave birth to their new healthy baby girl!! Congratulations Tom and Jenny. My heart is filled with happiness for you both and I cannot wait to meet her.

Nineteen — April 18, 2018

Nineteen

The number of mosquito bites I have right now, but lets get down to business. Today was a day dedicated to research. More dossiers. I have gotten through 100 charts which is great! I am getting so much faster and having a lot fewer questions. I went through about 30 charts today and only had 2 questions for Madame Phillippo.

I spent the day with the ladies down in archives, they are so distracting they invited me out to Jacmel on May 1, apparently a national holiday in Haiti where no one goes to work. I asked if I could get the key to the archives so I can come in and read charts instead! In any case, I told them I would think about it. Then there is the constant plume struggle. I think my pen gets “borrowed” about 50 times a day!! Sheesh, you would think if you worked in medical records you’d bring a pen to work!

Afterwards I went to newborn nursery to visit a baby we delivered. The mom left the infant on the bed and eloped. He is the cutest, sweetest, little boy. I went down there to talk to him and hold him. Thankfully there is a long list of people interested in adopting him so he should find a home. I hope it is a good one.

Next I ate lunch in the restaurant in the cafeteria. I had bannane peze, poulet frites, pickliz, and couronne. All this and tip cost me 200 gourdes. That is a little more than 3 US dollars. It is insane. I also dined with a little chicken (see photo).

Bonjour~ — April 17, 2018

Bonjour~

I feel like I’m in a scene from Beauty and the Beast walking into the hospital every morning…Bonjour, Bonjour, Bonjour, Bonjour, Bonjour, Bonjour! It is raining Bonjours~ I really like it. Everyone is so friendly and nice and as you walk by each staff member, patient, or office, you hear a cheerful, “Bonjour!” or “Ou te byen domi?” (did you sleep well). People in Haiti are very much interested in your sleep patterns. I do not think they would approve of the sleep schedule of a resident physician in the US (or the majority of our population for that matter). The Haitian people are very simplistic, for the most part, it is easy living here. The stresses and tribulations we perseverate on the US are irrelevant here.

Today, I went to rounds with the team, or as they call it in creole, tournee. There was a patient who came in overnight in labor and ended up with a cesarean hysterectomy and an infant mortality (she had a uterine rupture- RARE!!). That was the hot topic this morning during rounds. It was like a mini, M & M, however I think some reflection after such a morbid event is warranted. The mother was stoic, not a single tear or word. There are huge cultural differences here when it comes to obstetrics and infant morbidity and mortality.

Today during rounds, I again tried to keep up and follow best I could, when the Doctor presenting turned and asked me, “What do you do when you have a 28 weeker with abnormal dopplers?” I perked up, and mustered all the words I could in creole to explain our management of premature infants with abnormal fetal dopplers. Everyone nodded and it sparked a discussion on the contrast between Haiti and us. This is what it is all about, a mutual learning and respect for each other and our different practices. I find that everyone here is very open to hearing and learning about my western ways and I am more than intrigued to learn and see how they manage patients.

I got an update on my GYN consult on the ER from last week. Looks like she has a brain mass and that is what is causing her right sided paralysis. She needs a CT scan prior to seeing neurosurgery but they cannot afford it. Ugh, so frustrating. In our ER everyone gets panscanned for no reason at all! I hope it works out.

After rounds I went back to my Dungeon down in the archives. So archives is down on the first floor near the pediatric ER. The walk to archives every morning is brutal. Seeing the dozens of children lined up in the scorching sun, crying, screaming in pain, malnourished, and some without even pants or diapers completely breaks my heart. I smile and say Bonjour to each of them every day as I walk by.

“Today, give a stranger one of your smiles. It may be the only sunshine he sees all day.”

Image.png
My pile of dossiers (charts) to go through. Love the people in the archives department, they take good care of me! (even help in translation when I’m struggle busing)
Cabrit — April 16, 2018

Cabrit

Today was a great day. I powered through a lot of charts and finally got to ask them to pull some more for me because I finished what I started with!

This afternoon, Madame phillippo greatly wanted to begin the in service for the new electronic fetal monitoring machine. We went through all the accessories and I taught her how the use it. She was blown away by the fact that you can have both maternal and fetal heart rates show up on the strip at the same time. She was also blown away that you can get the pulse, FHR, Toco, Spo2, and BP all at the same time- things we take for granted. We have dozens of these machines at home. Now they have one. I’m happy I was able to see the looks on everyone’s face during the explanation though. It was priceless.

After the in service I went to lunch with Sasha where she and other residents who rotate at St. Damien stay- Villa Francesca. While there I got some great news, I got my first fellowship interview invitation :D!!! YEYYY. All the ladies in the archives department were very excited for me, one gave me a mango :). Accepting this invite was mission impossible from Haiti but it all worked out!

When I came home the Franklins were equally as excited about my “bonne nouvelle,” but all I could hear was “BAAAAAAAA” coming from the back of the house. It was a goat! (cabrit in creole). I named him Baaa. Madame Franklin says he’s for dinner tomorrow 😭.

Sigh, a girls gotta eat.

%d bloggers like this: