Friday, February 26, 2010

Hey Yoooouuu

This week I have been assigned to be in charge of the health care on "the truck". Our truck is a white flatbed with a roof and benches, enclosed by a cage -- not unlike an open air circus car. The roof is accessible by ladder off the back, and up on top, the best views of the city are to be be had.

Our truck goes deep into the slums of Port au Prince Monday, Wednesday and Friday. We are seeking out patients who would otherwise not have healthcare. The abject poverty here is beyond one's imagination. If you have seen Slumdog Millionaire, your mind might have a vague idea of what I am seeing. And most of the astoundingly squalid living conditions predated the earthquake of January 12th. The neighborhood, Citi Soleil, translated "City of the Sun", is broken into districts, including, ironically for an east coast native, areas called Brooklyn and Boston. As a child growing up in New England, Boston was the emerald city of my imagination, where we would journey for amazing adventures, like the aquarium and the Museum of Science. Now, when we say, "Let's head to Boston," my brain jolts; Boston don't look nothin' like this.

Shanty town. Cinder block walls and corrugated roofing interconnect into an exotic human beehive. A "river" runs through the neighborhood, perhaps 20 feet wide and filled 8 feet deep with plastic bottles, broken glass, garbage, human waste. Pigs wander over the floating garbage heaps in the river, rooting beneath bottles with their noses to find tasty morsels, like discarded chicken heads. A small girl walks with a white plastic bucket, presses it down into the garbage, and pulls out a blackened sloshing potion. She drags the bucket towards a cinder block enclosure. What is she doing with this water? Perhaps mixing it with formula to feed a new born baby sister, whose mother has learned through the miracle of billboard marketing that instant formula will make her baby plump and healthy...and so she discards the breast? Why doesn't the billboard mention that mixed with blackened riverwater, with pigs grazing on top of floating plastic bottles, this formula may cause infant death?

City of the Sun was once ranked the most dangerous city in the world, controlled by a network of violent gangs. In the past decade, it has become less dangerous, but is definitely still a place to enter with respect and vigilance. Today we drove to our first stop and climbed out of the cage of our truck and began to walk down a cement walk, trash river on our right, tent city on our left. Our small medical team is escorted by our Haitian guard. He is a pleasant, authoritative man, who speaks some English. He has told me he is from this neighborhood. He walks with authority along the cement footpath. He is given respect by the people, many of whom sit on the steps of their oven like homes in the blazing February sun. We have been told if we walk with him, we will be safe here. And we are. I don't know who he is, but I do know, to these people, he is someone. And I walk with him.

Adults stare with flat eyes as we pass by, but when I say a soft, "Bon jour" their eyes alighten and smiles meet their faces. The children, fearless, walk up and grab my hands and walk with me.

"Hey you, hey you" they call out in English.

"Hey, you!" I say back and point at them. They giggle. Some follow us on our journey.

Little boys run up to me with fists clenched in a greeting; I clench my fist and strike mine to theirs. They then strike their chest. So, I do the same. They find this very amusing, and look at each other and laugh. So do I. Little girls run past and touch me with their hands. I turn and make eye contact and they smile. One small child touches his hand then points to me.

"Blanc..." he says, pointing at his skin. "Blanc..." Translation: "Who's the white girl walking down our alley?"

We are greeted with nothing but respect. I am so grateful for this experience of Haiti. An experience of kind smiles and respect and gratitude, even in the depths of this slum. We are on a hunt for patients with casts and metal external fixators that hold shattered bones together. So many of these residents in this cinderblock shantytown experienced crush injuries. How many times have I read as their chief complaint in their medical notes, "A house fell on me...." or, "A wall fell on me." The evidence is here in this neighborhood. Today, two small cinderblock houses have been flattened, lying strewn across the garbage river and onto the walking path. On Monday they had stood erect. They were flattened by the aftershocks that had awoken me from sleep 2 nights ago. Tarps have been erected, emblazoned with painted words, like USAID and Red Cross. Families sleep inside -- elderly and newborn. Some shelters are mere cotton sheets, which will disintegrate in the oncoming monsoons. But the decision to sleep outdoors is, for some, the right decision, with teetering buildings and walls surrounding them.

We find a boy in a cast extending down both legs and up his torso -- treatment for lumbar fracture and lower extremity fracture. It is a bright green happy color, now grimy from the dirt. We find a young woman walking on a painfully deformed ankle -- having never received care, six weeks after her injury. Another with a cast.

"Who put this cast on," I ask.

"I don't know," said the young man.

"What did you break?" I ask.

"I don't know," said the young man.

I inspect the cast and imagine the fracture it contains. And here is the epidemic we seek. People treated in the days after the earthquake by goodwill filled international surgeons and released to the streets. We find one discharge summary which reads, in Spanish, "Follow up with your orthopedist in two weeks." Yes, follow-up with your orthopedist. If you are literate and can read this note. And can speak Spanish (which you don't, because you speak Haitian Creole). And can afford to see an orthopedist. And can afford to take a taxi to his office. And his office is not now 5 feet high because it collapsed in the earthquake.

In other words, we are now seeking out the patients who now are 6 weeks into healing, trapped potentially indefinitely in fiberglass casts and surgically placed metal fixators that protrude from their skin and track bacteria back into their bones. Orthopedic surgical cases who have no follow-up, and who are therefore destined for infection and possibly even death in these squalid conditions. In each neighborhood we gather these patients, clean their wounds and skin graft sites, take care of their jutting orthopedic hardware surgically implanted into their bones through their skin. We find these patients by walking through the neighborhoods, asking if anyone in the neighborhood has a cast, or crutches. We sit on top of the truck and drive through the neighborhoods, hunting for bright colored fiberglass casts.

On this day, in our hunt for a woman rumored with a leg fracture, a man calls out that there is a woman down the alley who gave birth last night, and that she is having severe pain. So, with our guard to guide us, we wander down the concrete path, take a footbridge over a garbage river, and wind our way through the labyrinth of cinder block lined narrow footpaths which is the slums. We pass a woman chopping the head off a chicken, and come to a small darkened door. Inside the oven-like one room home, a woman lays supine on a bed, holding her belly. Her new infant child lays sleeping by her side. Through a translator, I ask how she feels.

"Fe mal," she moans, rubbing her abdomen. "It hurts."

She is feverish. Likely uterine infection. Her baby is sleeping.

"Have you breast fed your baby?" I ask.

"No," she says. "I cannot make milk." Images of formula made with black river water flash in my head.

My nurse colleague checks the baby. Slightly tachycardic -- from mild dehydration, or early life-threatening sepsis? We take mother and child, and backtrack through the slum. If the man had not alerted us to this woman's presence, it is very possible both mother and child would have succumed to infection, and possibly, ultimately, death. We walked her to our truck -- as she, with dignity, refused to be carried -- and drove her to our courtyard tarp hospital. Two lives, possibly, saved.

We head out again to the slums. This time, we ride on top of the truck in the open air. We need to be careful for the occasional low-lying power cord and errant tree branch which could knock us off our stoop, but from here, we again see another Haiti. We can see over the concrete walls from this vantage, into tent villages behind. From Monday to Friday, the tent cities have grown. Probably due to the frightening aftershocks. We pass bustling streets, with many street vendors -- some of whom have set their sidewalk shops just in front of teetering buildings. One more unpredictable rumble and more "A house fell on me" notations will appear in the medical charts.

"Hey you, heyyoou, heyyyyoooooo" children call out in English and point. I decide my new name is Hey You.

We stop in four more neighborhoods. Our truck is recognized. We are "the doctors". Children and adults and elders limp towards us, some with crutches, some carried. We perform their every other day wound care on healing legs with horrific wounds. Dark Haitian skin reveals the white scarred extent of injuries already partially healed. So many, many scars.

We are called to a medical tent run by a young Italian pediatrician. She speaks to me in Italian, and then when that fails, Spanish. Spanish! My lips open, and I am communicating with an Italian physician in Haiti in Spanish. Fabulous. She points to an elderly woman -- skin and bones -- slumped against a pole. Her son sits at her side.

"She is very ill, and I have no way to take care of her," tells the Italian woman. "I can only care for children."

I tell her we will take this woman, and that we will be back every 2 days, and will take anyone she finds needing adult or orthopedic care. We shake hands and each nod a respectful, "Adios." How did she get here, I wonder. I wonder if she wonders the same about me.

We lay the elderly woman in a stretcher and lift her into our truck. She is too weak to lift her arms. She is starving. She is dehydrated. She is feverish. She appears to be dying. She opens her eyes and stares at me. I have a plastic bag of emergency relief water. I cut off the end and pour trickles into her mouth. She drinks thirstily, her dark hand over my pale one. I take her other hand and hold it as we work our way through the streets back to our hospital.

From the squalor of her slum, we carry this woman into our courtyard. In fear that she has tuberculosis, we make her a small tarped area of her own on the distant part of the yard. We choose a spot next to a cluster of palm trees. A wondrous campsite, in my experienced camper's eye. By now, it is nighttime. The patients have begun to sing their evening prayers, a mixture of song and energetic rhythmic spiritual clapping. By the light of headlamps, my nurse colleague Deb and I draw blood, start an IV, and do basic lab tests. A swab of her inner lips and a two minute test reveal this woman has HIV. Likely AIDS. Likely TB. And is on the verge of death. We get her a warm blanket for her nocturnal chills. Nourishing fluid enters her parched body. She rests comfortably in our clean, warm courtyard, palmtree swaying above her, beautiful Haitian song wafting gently about her, warm tropical breeze wafting past. If she dies tonight, I am glad that we could give her this night in this peaceful world of our beautiful makeshift hospital.

Through a translator, I speak to the weak old woman and her son. "I don't want you to feel bad because we've placed you away from the others. You have an infection, and we don't want to possibly spread it to others. It's not that we don't like you..." I said, holding her hand.

"No," said the son. "No. We know. We understand. You have already demonstrated your love."

1 comment:

  1. thank you for the dignity you are providing for as many people as you can reach. i am moved deeply.