Last week here...

I began the last week here working closely with a good friend of mine from the states who came to visit and spend some time in the clinic. We saw tons of patients, he assisted on a few births and even caught his first baby! It was so awesome to have someone from home here, it made for an amazing start to what will probably be a very busy and very sad week..though I am beyond excited to see my family and friends at home who I have not seen in over 8 months! I have been taking full advantage of the fact that we got our car back and we have made a trip to the beach the last two weekends-talk about relaxation! The beach is one of the most beautiful I have seen and the fresh seafood 'caught to order' has me wondering what I need to do to make living on the beach a reality :)

Dr. Yves and Sarah with his first "catch".

 Santo our head translator and all around helpful guy graduated from the Community Health Worker program last weekend. He was the class valedictorian and I am so proud of the work he did and will continue to do for Mama Baby Haiti. He gave a great speech and we were happy to be able to support him as the staff here is definitely our family!

Congrats Santo! At the Community Health Worker Graduation.

All smiles at the beach!

It has also been very sad for me to have to tell my patients I will not be here any longer as the responses have been overwhelmingly positive...only the best wishes for my future plans, thankfulness for the treatments I have given and the results they have achieved, and gifts I never imagined would make me feel so overjoyed at this opportunity I have had here. Last week, Jacques brought me some more plantains, I got some homemade 'dulce' (Haitian sweet peanut goodness), a hat, a bag of oranges, and the best compliment ever, "after God, comes you doctor". Now, I certainly don't think that I deserve these kind words and generous gifts but there is really nothing like feeling truly appreciated along with knowing that you have been able to do something you love while making a real difference in the lives of others. Words cannot describe the feeling.

I have learned so much here, not only about being a doctor but about the Haitian culture, people and language. I know I will be back very soon and hopefully I can reconnect with many of my patients even if it is just to say hello and tell them how much they have affected my life as well.

I spent many visits pleading with this mama to stop feeding her baby sugary drinks as she is malnourished and failed to gain weight, at the last visit she met her goal weight and mama said, "I remembered what you said about the juice and I stopped giving it to her and look how big she got!" 

A sweet grandma and baby Biendie who graduated from the Medika Mamba program last week!

Beach time!

I was lucky enough to spend last Saturday at one of the most beautiful beaches I have ever seen with a group of amazing new friends I have the pleasure of spending time with in Haiti. Only about an hour (if the road was paved it would probably take half the time if that) outside of Cap Haitian is the town of Labadie which is where the Royal Carribean cruise ships docks. As a PSA, I want to show my frustration with RC for the shear fact that when they dock in Haiti, they FAIL TO TELL PASSENGERS THEY ARE IN HAITI! They say, you are on the exclusive island of Hispanola or call it Paradise Island. Passengers get off the boat, walk onto  a beautiful beach with blow up toys, chairs, bars, trampoline, roller coaster, zip line and other fun activities without ever recognizing they are docked at the poorest country in the western hemisphere. At least RC helps the city of Labadie by sending the children born there to an American run school and employ many Haitians…I guess this is a consolation to not even disclosing where people actually are. Anyway, past Labadie, you have to take a, “water tap tap” (think wooden boat with a motor) about 15 minutes around part of the island (the island that houses the country of HAITI) and you end up in a small secluded bay that is called Paradise Beach (still part of HAITI). The water is indescribable; the pictures only minimally do it justice. The clarity is beyond amazing, you can see any and everything that is in the water. I will let the photos do the talking but I felt privileged to be able to see this amazing beach Haiti has to offer.

grilled lobster, conch, octopus an plantains for less than $5 per person-YES PLEASE!

crystal clear waters...ahhhh

Yes, the water is actually this blue!

view from the water tap tap on the way to the beach

I could get used to this...

gorgeous!

Mini Update

Jacques my close to 80 year old patient brought some plantains and pineapples to the house just because he  was 'at a garden and thought of me'...I couldn't help but kiss his sweet wrinkly face.

A girl could get used to this! More goodies from a patient. I love my job :)

This last week has brought with it our new staff midwife, Sarah Taylor; three babies; 60 patients; 5 days without electricity; Youtair (one of our translators) heading to PAP to try and beg for our car back; Marie leaving for Hinche for 2 weeks and Sarah working with a TBA/matron here at the clinic. TBA's are traditional birth attendants who are trained from a young age but not formally. They usually follow other matrons and learn their skills that way. We heard all sorts of horror stories about how they practice but I had never witnessed it on my own. Sarah needed a helper for a few weeks and one of our staff suggested his family member who is a matron. She is very sweet, very religious and very much a traditional birth attendant. Sarah is working hard to teach her how we do things here and to make sure she is practicing gentle birth...it has been a learning experience that is for sure!

Dieula's son, Womanoff. She keeps asking is I can marry him but I think he is a bit young.

One of my other favorite things about living here is that the kids in the community come by and hang out, in particular the kiddos of our staff members. Womanoff is the spitting image of Dieula our cook and is one of my favorites. He helps me in the garden, plays soccer with me and of course, like all kids, asks me for, "kado" or gifts.

Carrying bamboo on a hand cart trying to turn a corner...your day is not that bad now is it?

 I rarely get to take pictures when we are in Cap as it is hard to do so without feeling like an invasive tourist. Luckily I got a chance to ride in the back of Sharon's pickup and snap shots out the side window on our way back from Shada after a clinic.

It's sugar cane season!

Only 4 more weeks! Eek!!

An update on Wideline is that she has gained another 0.2kg weighing in at 1.9kg and is doing great! They spend 4 days with us this week and it was really nice to be able to see how they are bonding and just what an amazing mother Widline is becoming.

It is really beginning to hit home that I will be leaving Haiti in 4 weeks. Exactly. I have been telling patients who have been coming to see me repeatedly that I will only have one or two more visits with them and their responses have me feeling pretty sad. One woman on Wed asked, “but who will take care of me now?” I have no answers for them as there are no new prospects for doctors to come and replace me here at the clinic. I hate the feeling of being one of those people who drops in here, works for awhile and then leaves. Where is the sustainability? Where is the continuity of care? What will become of these people now that the only free clinic in the area is no longer available to them? I have to admit I have not been sleeping that well the last few weeks as I have been consumed by the worry that perhaps I should find a way to stay longer to continue taking care of my patients here, I mean, how can I just leave!?! Deep breath Zeenia, deep breath. I know it is out of my control, I understand MBH is looking for docs and they have so far been unable to find someone, I feel certain that with the loads of education and teaching I have done with my patients leave them with more knowledge about how to stay healthy and when to seek medical care therefore empowering them immensely…but I still cannot shake all of the guilt. However I know I will be back here in Haiti and hopefully I will be able to reconnect with my patients and continue to the work I have begun here. I also recognize what elements need to be in place to create real change and I hope to be able to use this as a learning experience for future endeavors.

A proper latch can make a world of difference! Rachel and Nina talk breastfeeding in Shada.

Zaboka from one of my favorite patients, Rose!

If you all don’t know, Naturopaths Without Borders (www.ndwb.org) has become official and we will soon be coming to a resource poor country near you J In all seriousness, I am very excited that I can be a part of the groundbreaking work we will continue to do as an organization dedicated to providing quality Naturopathic health care to communities in the US and abroad who have minimal access to care. After seeing what a huge difference Naturopathic medicine has made here in Haiti I am sure that people and communities all over the world we become stronger and healthier with the education and medical care we can provide! When you give people the tools to be able to take their health into their own hands, to use local foods and plants as medicine as well as to educate them on appropriate use of pharmaceuticals (a big problem here is that you can walk into a pharmacy and purchase about anything which leads to many people buy antibiotics for everything from lack of appetite to cough to rash etc. If antibiotic resistance becomes rampant we as health care practitioners are in for some serious trouble, not to mention the inappropriate use of other more serious medications) you are giving them back the power that has been taken from them as they have to rely on others for everything from work, to medicine, to food…all the aspects of life. I hope to be able to work more on the community garden projects, educational workshops and community discussions about sexual education, nutrition, domestic violence and overall health and wellness. I would like to work on getting materials such as posters, books and teaching materials here for use as there is simply nothing here, and much less anything in Creole (this is tough though as a huge percentage of people, especially those who see me at the clinic, that cannot read or write so essentially pictures are the way to go). Sharon and I have been developing some classes for the community which I think can really be expanded into a whole series of lectures with powerpoint presentations, posters, props etc. We have such great responses from the community when we present to them and I know that it is only a matter of time before they start telling others what they have learned and others tell others and BAM! We have the makings of a revolution JDown with Tampico, I say! Access to birth control, a must! Stop feeding your infants under 6mo. water, it’s imperative! Get STI testing and treatment for all, it could mean saving a life! Ok ok, I will stop now...you get the point.

Sharon working with her translator Joseph in Shada.

This is what you look like after working all day in Shada with 50+ people in a  10x20" room with not enough water.

A special someone

It has been far too long since I have blogged but following up an amazing blog like the last one is hard work J Not to say that the last few weeks have not been great, as they always are, however sometimes it just takes a certain *something* to spark the flame that becomes a new and powerful blog. 

This week I wanted to introduce you to a young girl named Widline who came to us at 8mo ready to deliver her first child. She is a young teenage mother with no family to support her as we found out after the delivery. She stayed a few days to nurse her 1.4kg baby who we hoped would survive as we understand the chances of this are not great given the odds a baby of this size has to face. 10 days after giving birth she arrived here to inquire about why her baby was sleeping so much and not feeding, in fact the last time the baby fed well was right after birth. Marie and the other volunteers worked hard with her to get the baby breast feeding and introducing new ways to get a baby that small to get the milk in. It was very inspirational to watch all the love and energy that poured out from all the midwives and volunteers. We also had a group from Hands up for Haiti come and a wonderful OB/GYN named Dr. Malley who happened to be here when Widline came for an appt. She worked all afternoon with her on getting the baby to breastfeed and was exactly what Widline needed at that moment, a mentor or simply someone to care about her. At this time the baby had not even been named yet and so Dr. Malley and Marie helped her to think of names of people she loved or those who cared about her. She came up with Wideline as she said she had no family and no one who cared about her. This was one of the saddest things I have experienced here. Subsequently the story of her pregnancy came out and she stated the conception of Wideline had not been mutual or intended which made sense as to why she seemed so indifferent towards the baby…not to mention it is hard to bond with a baby who is saving all of it’s energy to survive so she was not very receptive or awake to outside stimulation. 

Dr. Malley formed quite a bond with Widline and offered her the Saint Christopher necklace she was given before this trip with the instructions that she should use it as protection for herself and her baby. Again, this energy and love shown to this young mother was truly amazing…Dr. Malley was asked to me the godmother which she accepted graciously and since then I have been sending her pictures and stories of Widline who comes by every 3-4 days. She was here two nights ago for a check up and also asked Marie if there was any way she could stay the night as she has no access to food elsewhere and she feels safe here. We told her she could come and stay a few nights anytime she needs, this young mother and her baby have defied all odds and though the baby is not out of the woods yet, she continues to grow stronger and healthier and yesterday appeared to finally get her suckling reflex to work properly and she breastfed like a champ! No more dribbling bits of milk into her mouth, no more hoping we can get enough nutrition into her, this baby is going to make it-I feel more certain of this every time she comes! I am so happy to have the chance to meet such an amazing young mother and her child and I am sure her story has impacted the lives of all who had a chance to meet her. We work towards making sure she has enough food to eat as it is scarce and possibly a new pair of shoes as her old ones are about 3 sizes too small. She is an inspiration and I am glad I have a few more months to get to know her.

Food for the soul

Today has been one of the best days I have had here in Haiti which is making it very hard to purchase my tickets home (I swear I am just waiting for a better price…)

I hope I was able to make her day as awesome as she made mine!

I have a few patients who I absolutely LOVE to treat. Oddly enough they are at the opposite end of the spectrum from the kiddos who capture my heart under normal circumstances. Today one women who I treat weekly for her back and leg pain came early this morning and Jason our guard came to get me to let me know she was waiting for me out on the patio. I light up when I see this woman as she is such a kind gentle soul. She is in her 70’s and always comes to appointments alone. Her children have died and her grandchildren are less than helpful. She walks with a cane, slowly and purposefully as she has intense low back pain that radiates down her leg making ambulation difficult. This morning she was her ever smiling self when I showed up dressed in my pj’s. She pointed at the bag I had lent her last week to carry her medications home in. I opened the bag and inside was 4 gorgeous coconuts and about 10 lbs of oranges and limes. She paid for a moto taxi to come this morning as she couldn’t carry everything but wanted me to have this beautiful gift. My eyes water just writing about it. There was nothing she wanted in return and there was no special occasion, she simply said, “as long as God allows me to walk I will bring you gifts.” Wow, talk about a way to start the morning! I accepted the fruit and gave her my breakfast in return.

My gifts that were made into the most delicious juice ever today!

sugar cane

I merrily went about my day (seriously it was the best adult day I have had here, as you all know I am not a fan of treating the adults but I have worked it out to basically see only the returning patients one week and I love to see how well they are doing so it makes it manageable) thinking how thoughtful it was for her to come and bring me those heavy fruits. At the end of the day a women who we see often, not as a patient but as a grandmother of a baby we treat, was waiting for me on the porch. Last week I helped facilitate an arrangement for her grandchild to stay in an infant care center called Children of the Promise as her mother is unable to care for her due to some cognitive issues. Grandma wanted to let me know how she was feeling about the situation and how she felt about the process and then took me out front to show me the four large sugar canes she brought me. Say what!?! Two sets of gifts in one day?? I really AM the luckiest girl alive J We chatted for a bit with Marie, Leonise (our translator) and Monise which was really fun, it was like girl talk mixed with match making as they were all plotting ways to get me to stay in Haiti. I had joked with Marie the night prior that if I met someone and got married I would have to stay. This pleased everyone as Marie relayed the story and they all discussed qualities I need in a man and how they were going to throw me a party and bring all of the eligible Haitian men for me to meet. I, in turn did my best, in Creole, to stay with the conversation while I pantomimed how Haitian men can dance and American men cannot…it was pure hilarity. They were laughing so hard and yelling “m’zanmi” with their hands in the air, I really wish I could have gotten a photo. Oh well, I have a mental snapshot that should last at least another 50 years.

I have been so blessed with such an amazing experience here which has transformed the way I not only practice as a doctor but how I see others and their daily struggles. There is so much love and beauty here in Haiti, how could I not come back for another round. This is like food for the soul and I am eating it up!

Patient yesterday who received a doll made by hand in the US because she was too cute not to, guess what goes around comes around.

Work hard, play hard

On Sunday night Sharon, Santo and I went out to the apartments where another friend of ours, Eyleen, lives. It was her birthday and coincidently there was a group of Haitian dancers that were coming to show off their skills that night at a small outdoor restaurant within the compound. The group was called a ‘traditional dance group’ but Santo told us that they were actually more of a specific form of dance group, one associated with the vodou culture which I have now come to realize that is very different than portrayed by the media. It is also different from the vodou religion which is a distinction that is not always made. The dancers were great and their costumes were amazing, especially the sequined red vests for the men…the drumming was awesome and we had a really great time. I am so thankful Sharon has been driving us around since we have no car, it is so very necessary to get out of this compound and I am grateful that she is so sweet.

I have been trying to get out and about more which has been good for the homesickness as well as the stress caused by running this clinic and being the only doctor here. I love my work and this job has afforded me many opportunities that I would never have been able to have otherwise but it is very demanding and stressful which I think is infinitely compounded by being here alone. On the other hand I am realizing that I will be home sooner than I think and it is freaking me out a bit. I miss the US and my friends and family terribly but I also worry about everything here…who will take care of the patients, who will make sure Dieula and Monise have a special piece of cake just because; who will buy Santo cheddar cheese Pringles and share Prestiges with Jason and le boss; who will get Marie treats from Croissant D’or? They keep telling me it will be ok because I will be back soon. I hope they are right.

On the job training

In other news, I watched Shannon, a certified nurse midwifery student and 6 year OB/GYN nurse veteran show Marie how to insert a feeding tube into a pretty listless little girl who was delivered here 10 days ago. Mom came in today for a check in and said she had not been feeding the baby, “because she sleeps all the time” and that the last time she fed well was when she was born-yikes! We were concerned about the care the baby would get at the local hospital as the most likely would have given some fluids and sent mom home, it is clear what the baby needed was to be fed and the mom needed to understand the severity of the situation. We chose to keep the baby here and work on getting her to feed while Marie talked to mom about feeding in general. Baby was unable to muster the strength to suck from the breast so Marie and Shannon helped mom pump and tried via a bottle which was not effective either. We luckily found a NG tube and Shannon gave us a little one on one tutorial! The baby by this time had her eyes open and was becoming feistier which was a huge relief. Mom is going to hang here for a few hours form some ‘inpatient care’ while they continue to educate her and get the baby some more breast milk. This just goes to show how easily education goes over the heads of patients. Marie is phenomenal about educating moms before the leave, making sure to watch for breast feeding difficulties, talking extensively about solely breastfeeding and making sure the baby feeds frequently. We also make sure we are here for the moms if they need anything and ask that they come back in 3 days for the first consult after birth. This mom failed to come back. This is one of the main pushes for a community health worker to be involved with car. Thankfully Santo will be done with his class at the end of August and we can send him out on his motorcycle to check on moms and other patients! We know that the most crucial time for the babies is the first week or two after birth and this is one great example of what happens when there is follow up on the mothers’ part. With a community health worker we will be able to track the family down and make sure things are going well…I can’t wait, it will step up our ability to care for the women immensely.