Wednesday, December 4, 2013
Dr. Ann Lemire is an internist-pediatrician specializing in HIV medicine who works for the city of Portland's Public Health Division. As volunteer chair of Konbit Sante's pediatric collaboration, she works with her colleagues in Haiti to improve care for the littlest patients.
Konbit Sante is a Portland-based nonprofit that has been working for about a decade in Cap Haitien to improve the health care system there.
From Jan. 31 to Feb. 10, Lemire worked in Cap, helping triage patients arriving from Port-au-Prince after the Jan. 12 earthquake there. She treated children in the pediatric unit at Justinian University Hospital, Konbit Sante's partner and the second-largest public hospital in the country.
These are Lemire's notes from her latest trip, used with permission, about "some of the people that came into my life and their proud stance in the face of incredible adversity. I shall not forget this experience of being in the presence of angels."
A different task – quake victims
Nineteen days after the cataclysmic 7.0 earthquake in Port-au-Prince, I arrived in Cap Haitien, the second-largest city of Haiti, 85 miles NE of Port-au-Prince. I was in the company of five other Konbit Sante volunteers and two U.S. staff members. All but one of us had been to Haiti multiple times, but this visit was different. During the next week we worked as a team, attempting in some small way to assuage the sufferings of the refugees from Port-au-Prince and the people of Cap Haitien.
La Marche d'Honneur
On Jan. 31, after a quick debriefing, we made our way to the Justinian Hospital. Partway there we could see the streets ahead filled with people singing and praying, all dressed in white. They were accompanied by U.N. tanks manned with Nepalese and Chilean soldiers who were very respectful of the crowd. I spoke to one of the women, who said this march was to honor the many who had died in l'evenement (the event) and to thank God for sparing Cap Haitien. She handed me a prayer leaflet and asked me to pray as well.
After completing our hospital rounds, and as the sultry, dusty air was giving way to a gentle breeze as daylight drew to a close, we took a walk along the boulevard in hopes of finding some ice cream. Upon approaching the boulevard we again became caught up in this group of people dressed in white -- now numbering in the thousands.
They walked behind cross-bearers and other religious ministers and had small pickup trucks with amps interspersed among them. They prayed and sang with one voice as they held up photos of the dead. Arms swayed and rosaries were held up as they cried out, "Benissez le Seigneur! Grace a Dieu! Seigneur prend pitie!" ("Blessed be the Lord! Glory to God! Lord have mercy!")
We were mesmerized by these beautiful people so peacefully, gracefully displaying their faith, thanking God for safety and praying for their dead loved ones who could not receive a proper burial. As far as the eye could see along the boulevard, the white, swaying procession marched on.
We were all filled with emotion at what we had just witnessed, and this Haitian proverb came to mind: Our nights are long in Haiti, but our dreams are longer still.
Timoun (the children)
During my regular volunteer trips with Konbit Sante, I work with the pediatric section of the hospital. My Haitian colleagues, Dr. Charles, Dr. Toussaint and Dr. St. Fleur, and the dozen or so pediatric medical residents are exceptional in their clinical abilities and their devotion to the timoun (children). During this trip I helped them with seeing children, which once again gave me a greater awareness of what monumental obstacles my colleagues face in their daily work.
Care for hungry, bleeding child
One day, after seeing children in the outpatient clinic, Dr. Janvier, pediatric chief resident, called me to see this tiny baby who had just been brought in by his similarly tiny maman et papa. Colstan was 1 month old and was bleeding profusely from the rectum.
Weighing in at 3 pounds, he had been crying constantly because his mother's milk supply had diminished greatly and he was hungry -- as were both his parents. So his maman had made some tea to soothe him. We do not know what she used to make the tea, but now the palms of his little hands were startlingly white in contrast to his glistening black skin.
Colstan needed blood immediately -- no small task in Cap Haitien. The parents were instructed to take their baby's blood sample to the Red Cross down the street, where they would both have to give blood so their child could receive blood. But they were sent back because there was no technician to type the blood.
Four hours passed and still no blood. I finally went to find them and begged the Red Cross director to please find someone to come in. The director continued to call and was finally successful. Eight hours after the baby's arrival, he received his 10 mls (2 teaspoons) of blood, which was all he needed.
His bleeding ultimately stopped and, after stabilization, he was admitted to the malnourished children's section, where he and his parents would receive nourishment. This inpatient program is sponsored by Konbit Sante in partnership with another program, Medika Manba (peanut butter), to help malnourished children and their families.
Formula for starving baby
Two days in a row, I saw a grandmother with her 3-week-old granddaughter. The baby's father was killed, and the mother is now hospitalized because of shock and her milk supply is gone. It is bad news that this older woman will have to depend on formula. It took me more than an hour to organize formula powder, water and a 2-oz. bottle that I cleaned with water, Fab and a drop of Clorox. I then showed the grandma how to use it, and she happily fed the starving baby, who ate vigorously. The baby rewarded me with peeing and pooping right through her thin cloth diaper right into my lap! She gave me the biggest smile!
Four stretchers at the airport
One afternoon, our director, Nate Nickerson, received a call from the airport saying that four patients had been dropped off by a military plane with no information as to where these patients had come from nor where they were to be delivered. Arriving at the airport with two pickup trucks, we saw that there were now six patients -- four on the tarmac and two in an ambulance.
Of the four patients on the tarmac, one young woman had a severely broken pelvis. She made no sound and never winced in pain, although I'm quite certain she was not medicated for pain. Another woman had lost the ability to move her legs. A very emaciated man had his right leg amputated above the knee, and an older man had a bad fracture of his right thigh (femur).
In the ambulance were two injured women -- a young woman with pelvic and hip fractures, and an elderly woman sitting up with a hip fracture. They all wore a piece of tape on their shirts stating "TRANSPORT" and had X-rays with them, but nothing more.
There was a reporter there from I know not where who kept placing his camera in the patients' faces, and it saddened me to see how these poor Haitians, while maintaining their dignity and suffering silently, were not even afforded privacy.
Wrinkled face hard to forget
While seeing patients at a medical station that consisted of only two chairs facing each other, I met an elderly man, Jean, who complained of grangou (hunger). He moved his sweet, wrinkled face with teary eyes right close to mine as he told me about losing his daughter, who had been his caregiver, and now he had nowhere to stay.
He had traveled north in the hopes of finding something. I directed him to a line for a food ticket, but I'm not sure he ever got there.
For the remainder of the week I saw him occupying a bench in the emergency room waiting area. I sat briefly with him one day and asked how he was doing. He merely shrugged his shoulders. I could not tell if he had gotten something to eat, so I gave him a nutrition bar, which he pocketed. His face is with me still, and I wonder what has become of him and the thousands like him.
Gratitude for providing help
Beautiful Emilienne sat in front of me with her wriggling, smiling 2-month-old daughter, Judie. On Jan. 12, she had just returned home from picking up her daughter when the earthquake struck. Fortunately, she was able to run out before her house collapsed.
She was very distressed, as she had not been able to find her husband, and after three weeks she decided to make her way to Cap to be with her family. She worried about not being able to sleep and felt her breast milk had diminished greatly. I examined little Judie, and it was obvious she was in fine form and I was happy to reassure her maman.
The baby was receiving very good nourishment, but Emilienne needed to care for herself so that her baby would continue to thrive. I pointed to the area where she could meet with one of the Haitian counselors. As she left she thanked me as if I had given her the greatest gift, and it left me in awe on how rich human interaction can be.
A country that steals your heart
Six years ago, Michael Taylor, founder of Konbit Sante, asked me to work in pediatrics with Konbit Sante. He told me that Haiti would steal my heart. With every visit, that reality takes hold ever deeper and deeper. With this visit, the people of Haiti have taken over my dreams and my hopes that our little organization will persevere in being a steadfast partner in creating a better life for the people of Cap Haitien.
One last proverb, often the mantra of Konbit Sante: "Piti, piti, zwazo fe nich li" ("Little by little, the bird makes his nest").