We woke up early on our second day in Haiti. It was the first day of training and we would be busy from start to finish. We walked the mile to St. Luke’s Hospital; we were covered in dust by the time we got there. We saw all the school children walking in their uniforms; they would periodically dust off their shoes with a tissue and continue walking. We walked against the traffic so we could see the cars that we would need to avoid. The driver definitely has the right of way on a road with no rules.
We arrived at St. Luke’s and entered through the gate, smiling and saying “Bonjour.” We found the doctor in charge and introduced our new team members. We rounded with the doctors for a couple of hours and they graciously filled us in on the patients in the ED. No patients are being admitted to St. Luke’s right now – the funding is short, so only ED and ICU patients are accepted. The clinic has been cut down to three days a week instead of five, and there is a sense of frustration.
We recognized many people from previous trips and brought them presents as a thank you for all their hard work and hospitality. We met with the Nursing Director and head nurse and prepared the weekly training schedule. “We gave a list to the last group,” they said. “I know. We will do EKG, Lab Values and ACLS cases, chest tubes… That’s what you wanted right?” I thought for a second that I might be losing something in the translation, but they were pointing to the bag of items that I brought with me. “Are those the classes you wanted? We can do anything you want,” I said. They pointed to the bag. I caught on and started to empty the bag of supplies we put together. They had been waiting for the glucometer and Lactate meter strips; they were actually using them and had run out. I emptied random items onto the table. A blood pressure cuff, something so simple and yet really appreciated. A box of constricting bands and other items, “Thank you so much” they said in their accent. “Pa’d Kwa,” I said. (I have been studying my Creole.)
We saw an ambulance with a couple of people unloading a patient. The ambulance was from Doctors without Borders, but it was written in French on the side of the truck. I stopped the supervisor and asked who was with the patient in the back of this ambulance. After about 30 minutes and a great amount of translation, we discovered that the driver is a contracted position, but the ambulance for St. Luke’s has a Technician level person inside. We taught this level the past few trips – patient movement and CPR – but this is the same group that mops the floors and gathers the trash. They do whatever needs to be done at St. Luke’s. We gathered a group of them in the suture area and had an impromptu class on vital signs, as it was evident that they are responsible for the patient but have no medical training. The class was a hit and although it was planned for 45 minutes, the group was still asking questions after 75 minutes! It was clear they wanted to learn as much as they could. A few of the previous team members brought down some paramedic text books; the technicians carry the books around and read them whenever they can. They are practicing both English and “paramedicine” according to them. The supervisor approached us at the end and asked if we could run the class again so the group that couldn’t go could learn; he then whispered that he wanted to be involved, too.
After the class, we had to run out to the bank to get some cash, as the lines were down the night before when we visited the market. Our driver, Blese, picked up two of us. We arrived at the only bank in the area and found a 40-car drive-through line that extended into the street. Two trips back and forth to get passports and other items later, we arranged for a woman to use my debit card at the bank and bring me American dollars. She handed me a slip and told me to go wait in line which I agreed to do. The driver then muttered something in Creole and I was brought to the front of the line. I reluctantly cut in front of 80 people. No one spoke. All was eerily quiet. They are not allowed to speak in the bank. I was embarrassed, and exited as quickly as possible.
We returned to assist the two PA’s in teaching a class on chest tube placement. We had a lecture and a practical session for all the physicians. This topic was requested by the Medical Director as the staff was unable to perform the procedure and it was likely to be needed at some time. The class was successful and we worked clinically the remainder of the day.
At the end of the day, we were all exhausted, hot, and sweaty. We made our way out to eat, and it began to rain. Torrential rains. The kind you only see in a movie or hear about. The sort of rain you’d expect to happen when you are stranded on a island after a plane crash and have only a volleyball as a friend. You could close your eyes and tell the Americans from the Haitians, based on the gasps and the silence. The Haitians were silent, then laughed at all of us. The rain got worse. We took cover but the water was so heavy that it broke the cover, and it crashed loudly, abruptly, and in a very scary way.
t was at that moment that it occurred to most of us that we were not near home, we could hear thunder now, and we could guess what was about to happen. Lightning struck and the lights went out. This was the kind of storm that causes the generators to go out, the kind that causes a power outage in an entire country.
Wow, that puts it into perspective! The patients are sick, they wait for supplies, there is only cold water, and there is power only sometimes. In the black of night, in a rain storm that has held back for nearly four months in the driest of times, we all had the realization that another disaster could happen. We need to work fast and have as much impact as possible.