Another Day Another Dollar

Sunday night has passed, and everything has quieted down for a time.
I am tired but feel good.
Teams come in on Saturday and they get oriented and ussually Sunday is the day that they realize they are practicing medicine in a disaster zone and Haiti. Some react in different ways, "we are not prepared for this, this was not in the job description. I know what needs to be fixed in order to run this hospital. I can save Haiti in a week, just give me the right tools" I listen and slowly my eyes glaze over, or I find myself repeating myself week to week. Mostly though I apologise and say sorry we cannot meet your expectations. This ussually causes some moment of reflection.
Moments of Reflection, this week I have noticed Leogane is slowly waking up from its slumbering depression. Haitians on the street are no longer greeting me with friendly "Hey You" now it is, "Blan, give me one dollar" or "I am hungry, give me something to eat" the refugee camps have stopped distributing daily rations, and Haitians are starving again, it is not fair. It is also time for me to be leaving I think. I do not know how to answer these questions, and there is no amount of money or time I can spend here to fix it.

Today is Wednesday night and I am finally back to my blog. We have a little newborn back with us. This newborn was delivered to a hospital in Port au Prince that had a ventalator. She arrived in a dump truck with a nurse and tech keeping her breathing and from cardiac arrest. After that they picked me up from the airport. 6 weeks ago now. She is back here. She was abandoned at birth so we are finding a family to adopt her in the states. We are bringing her back here to get a birth certificate and start the adoption process.

Life is good here. I cannot complain. Somedays are worse then other but overall it is tolerable.

The Grind...

I was walking through the broken streets of Leogane Haiti, looking at the collapsed houses. The second stories just collapsed on the first stories. Houses folded in on themselves. People, long dead were in some of them. My first thoughts were Superman could have lifted that up and gotten trapped people out. I kept walking but I began to dwell on the absurdity of how my mind works. Of course Superman would not be here in Leogane. He lives in Metropolis, Batman in Gotham City, Will Smith's Hancock in Miami or in California, Spiderman in New York, Luke Skywalker in a Galaxy far far away, no one lives in Haiti. Why? The place that needs super human hope, love, and strength. I need to stop watching comic book movies. Its convient to help out a trapped citizen of some developed city get out of one scrape. can comic book characters help an entire nation get out of several scrapes? Say, a lack of infrastructure. How would super human strength work that one out... I realize I sound jaded and cynical but the disaster area is starting to stablize and things are reminding me of what it was like living here 7 years ago. Somethings have changed but an undeveloped infrastructure has not.
I wonder what will happen after I leave in May. Did I make any difference? Yes our hospital has been successful through this crisis but is it going to sustain the lack of resources, Haitian management that may or may not be fully committed to keeping this hospital going. My favorite poem comes to mind right now. Rudyard Kipling, "If", "If you can make one heap of all your winnings and risk it on one turn of pitch-and-toss, and lose, and start again at your beginnings And never breath a word about your loss;" I feel like this is not my life's work but I have put in so much energy and effort.
I have met with plenty of well meaning people telling me how to run a hospital. My fellow medical students, yes professional medical students, and I work to keep patients alive, keep a count of our donations of drugs, supplies, and keep teams semi organized. Yes there are things I do not like about our hospital. I cannot keep an accurate inventory no matter how many hours volunteers and I spend counting, we do not have enough money to finish building our clinics, and other unfinished things. Yes things do not get done... you are not doing anyone any favors by telling us how to run a third world hospital during a disaster zone.
I like my job, but it is coming to an end. I am watching as the refugee camps slowly stop handing out daily rations to the dwellers of the camp. They have returned to pre earthquake state of being, starvation. What will happen when we leave? the hospital will close down? We face this, it is a real possibility. No one can help the Haitian except the Haitians themselves. I have been refocusing my energy these last few weeks with the simple goal: What will happen when I am gone? Will this get done by anyone else? If the answer is no, then I set it aside and let it be. It may be important to me but it is not to the Haitians. Therefore it is really not important. there is a certain freedom in that decision. It lets me do things that are important well.

April Fools Day!

Today I am struggling and it is only 7am here. It is April Fools Day so I am hoping this is all a joke.
Two days ago a one year old coded at the hospital because she had been struggling to breath for 24 hours with an Oxygen tank. We do not have any ICU capabilities. I found a transport to Port Au Prince. The hospital I found in PAP has a ventilator, if the it was not already occupied would have the capability of taking her. I basically jumped on a person who was nice enough to drop some of our arriving team members to Leogane. He lived in Port Au Prince and was returning that night. I grabbed him and said, "can you take a 1 year old baby with you. I will get someone to explain to you where to go. I am sending a Haitian Nurse with you, and the mom." I took him over to the hospital. He of course had no choice but to say yes. We got there in time to help with the code. We worked on her for 20 to 30 minutes. That was a hard one for our team. She just needed a break from breathing and we have medical technology out there in the world to help her, it just was not here. The day I arrived to Haiti I was picked up in a dump truck. This same truck was used as an ambulance that morning to transport a nurse, a tech and a newborn in respiratory distress to a hospital able to take her. I know this situation well.We are a hospital working with the kindness of several other people and their cars to get our patients to any other hospital that is better equipped for patients we just do not have the capacity or ability to treat, on top of providing care we do have here.

I am facing the same problem today. I have a 17 year old girl that has Cardiomyopathy and we had to amputate her leg. Her Kidneys are now failing. There is dialysis in Port au prince again. The hospital is ready to accept her. I just do not have a car. I was also contacting Haiti Hearts, for her needed heart surgery. I do not know the line here between futile measures and reasonable measures. Can she survive here with all these problems? I am working so hard to give her that chance. Do I risk burn out myself?

It is now almost 8am, I found a truck that we can fit her into and get her to Port au prince. I am sending an American Nurse and a driver. it is not an ambulance but it is a vehicle. It is so close to working I am not sure if I am working too hard to get her somewhere else to die, or if I am giving her hope. I know that is not a question for me to answer. But I ask it anyway.

this field hospital is symbol of hope to everyone in this area. We work with Doctors without Borders hospital as well. Our field hospital is what is left of the haitian hospital and it represents a symbol to the haitians and the people of Leogane. All the organizations are collaborating to build this hospital, sometimes there is friction, sometimes frustration, but ultimately we are all trying to improve Leogane Haiti in our own way.

She is off. I put her in a double door cabin, a nurse, with an ambo bag, some medications, and a trusty driver. I called the ER in Port au Prince. They can expect her in an hour and half.
I said goodbye to her sisters, the only family she has now. I told them to be strong and now I am back to the regular day of finding funding, convincing people to buy a car/ambulance, paying salaries, the normal Hospital adminastration things that never seem to end.

Just a few thoughts from my part of the world, on this beautiful april fools day!