Wrapping Up

Well, as you can tell, it has been a while since I have been able to write.  And even now, I am not sure I will have time to remember everything that I have been thinking about lately.  

In some ways things here feel very hopeless because there are so many needs and it is hard to even know where to start.  But in other ways, I see signs of hope.  Lorraine works and lives in the guest house I am staying in.  She is a believer and an orphan.  She simply asked for prayer that she would be able to make it alone in the world.  She has no family and is trying to pay her own way through school.  Unlike many other people in Haiti, she never asked for money.  She has only 2 years left of high school.  Wilkins, my translator, another believer, gave up the opportunity to go to school for nursing in Venezuela.  He had a visa and college there is free.  He came back though because he had a group of Christian friends here that he really liked and they were encouraging one another to learn how to live in peace and simplicity in Haiti.  Currently he is working for Family Health Ministries for a modest salary and trying to finish college in Haiti.  He has already saved up the cost of the last two years of his university.  He just needs to get in.  Miss Nicole is a nurse who works in a clinic about 2 hours from here by the time you take a tap tap into the mountains and then a 30 minute motorcycle ride.  She goes every day, most times at her own expense, to work with the community out of a little dispensary.  She has not been paid for 2 years.  She hopes she will get paid eventually but she seems to find it hard to leave that community with no health care.

I think these people are the answers, if there are any answers, and I am asking myself how I can best support them.  Well, more time for that.  

Leaving tomorrow....back to the grind.

Unbelievably, I was able to finish 6 focus groups and they are all translated and transcribed into English as of 1 hour ago.  Praise God.  This has truly been his labor from the beginning.

photos

Children playing in the Caribbean 

Jackie, Michelle and I with a friend visiting Port au Prince
Market with typical accumulation of trash in Port au Prince
My view from the balcony in Leogane, the first house I lived in


It has been almost a week since I last posted.  I have done another focus group of which the main sentiment is exactly the same: we need a hospital.  (Big surprise)  They really do need a hospital.  Anyway, maybe it is appropriate also that after hearing about all their sicknesses, I find myself recovering from being pretty sick.  I don't know exactly what I had, probably some combination of allergies, cold, flu, GI....but I am getting better.  I just found myself wanting the comforts of home so much this weekend so I cannot imagine what it would be like to not ever have those comforts especially when you are sick.

One of the girls who takes care of the guest house I am staying in is pregnant at 16 years old.  The father of the baby is not involved and she had to drop out of school because of it.  It seems there is still a good bit of shame involved in getting pregnant early and out of wedlock here.  She does not even feel comfortable walking on the streets.  We can communicated pretty well since she speaks really good french.  She has not gotten any prenatal care as of yet.  I keep trying to ask her questions to be sure everything is ok, but still, I worry.  She is tiny to have a baby and a set up for pre-eclampsia on top of it.  I want to pay for her to get prenatal care but when you are surrounded by so many needs, it is hard to figure out what is the best thing to do.  I think I will pay for her to have at least one visit before I leave.

unpredictable

One thing I always forget though I never should is how unpredictable things can be in a place like Haiti.  I write this at 11:15pm as I am waiting in the clinic in Leogane with a few medical students for a woman to deliver a baby.  She should deliver by morning...but we all know that is completely unpredictable.

Delson is next door in his house.  I guess that he can get some naps since I will watch the baby's heart rate.  I hope that it stays good since it would be really hard to do a cesarean section now in the middle of the night.

I did my first focus group yesterday.  I learned some really interesting things, but the most important thing was that they need a hospital.  They have no where to go.  I already knew this, but it was really powerful to hear it.  Thank you, Doctor Rachel, thank you, thank you.  We know that this is not going to happen right away but we are so happy you care for us.  Our politicians do not care for us and now you come from a different country and you care.  I hope that this hospital gets finished soon and that it works for them.  I really do.

Complicated Haiti

Well, the good news is that I am taking lots of pictures in Haiti...more than in Tanzania so I am going to try and upload some as soon as I have a better connection.  

Since I last wrote a great deal has happened.  On a clinical side, I have done HPV screening (equivalent with a pap smear) for about 150 women.  This has been interesting but so fast that I do not get a great chance to interact with them.  I do try and keep an eye out for other problems that I can refer to Delson if they need.  I was not supposed to be doing all this....but since I am here...

On the research front, I have identified my team of helpers.  They are all young college age students from different areas in and around Leogane.  Wilkins is my translator and more of a perfectionist than me which is very good for the study and much more than I expected.  He has been a great help already with getting my documents ready.  Two girls, Lillian and Enid are helping me actually run the groups.  I am anxious to see how this will turn out but we will see tomorrow as that will be my first group.

On the fun side, I have continued to eat really good salty and slightly hot Haitian food of all types including goat and conch and all kinds of fried things.  I got to make friends with GiGi Delson's 18 month old son who is adorable and now no longer cries when he sees me.  Friday I went to Port au Prince for the weekend which I was unsure about at first given that all I have seen of that city is not enjoyable.  But, we stayed in a very ritzy suburb called Petionville which actually seemed like a different country all together.  I felt like we were in the south of France or something.  It is on the top of a hill and as you go up the hill from the ocean, you also go up in class, the houses get more and more expensive and the cars more beautiful.  It was a nice little break.  

Yesterday, I moved to the guest house I will be staying at.  It is very nice and this week busy with Haitian Americans and Americans who are visiting.  At some point, I will be the only guest and after a few days dad will join me.  This morning, my hostess in the home (from New York now) took me to her ancestor's village about 25 minutes from here which was beautiful.  It was a totally not commercialized fishing village which had only ever had 3 doctors visit it (me being the third).  In any case, the children were beautiful playing in the ocean and with the hand made canoes.  They brought us fresh, fleshy coconuts and I got to go for a swim in the Caribbean.  It was a pleasure to just be with them.

I have learned that Leogane is the African center of Haiti and as such it is a center for voodoo and other related culture.  This weekend, there are brass bands with African rhythms walking the streets followed by crowds of people dancing.  This Ra Ra music is supposedly left over from Africa and somehow related to voodoo....it sounds kind of like the circus....at 4 in the morning.  Voodoo is interesting. I am still learning about it but it is very different than what you think of in the Hollywood version.  In general, it is an African native religion where all things in nature have spirits that are to be prayed to and with and to be appeased in order for good things to happen.  Good voodoo priests actually see it as their calling to care for their community by conversing with the gods.  "Good" voodoo cannot be bought or learned but it is a "gift".  "Bad" voodoo exists and those people that buy their powers can only be bad.  They are the ones responsible for placing curses on people and families.  Voodoo is mixed up in every religion in Haiti in many ways.  All I can keep thinking is that I believe in spirits too but I am glad that I know the God of Gods...and there is nothing to fear.

arriving in haiti

Well, I have arrived in Haiti after a whirlwind week of traveling, seeing friends and family, the Blue Jean Ball, etc.  Just heard the BJB raised about 77,000 dollars for women in Tanzania.  That is amazing.  It made me teary a bit seeing people spend so much money, still knowing what a little it was for them compared to the women it was going to.

Anyway, Haiti, as you might be noticing is actually (surprisingly) so far more technology friendly than Tanzania.  Still, it was sobering, as expected, to fly in yesterday.  Just from the aircraft, I could see areas of flimsy homes that were flooded from rain over the last few days and areas of homes built on top of homes for as far as I could see.  Delson Meriser is the OB Gyn who works here.  He met me at the airport and I got a colorful tour of Port au Prince.  There are people everywhere, mostly trying to sell something small in the street to make a bit of money since there are not that many jobs.  We drove past the presidential palace which looks a bit like the White House and down a street which Delson said was extremely dangerous 4 or 5 years ago with hijacking a frequent occurrence.  The lack of sanitation struck me yet again with sewers packed with garbage running into the ocean which is at level with some of the homes.  Anyway, he brought me to a great restaurant called 5 coins where I ate roasted and then fried pork and goat along with some hot sauce and onions, green beans, fried plantains and some sort of hush puppy type of thing that was the best I have ever had.  Anyway, it was delicious: mildly spicy, vinegary, greasy.  What more could you ask for....Except three hours later Delson's wife cooked fried fish and black rice....also very good.   I went to bed at 7pm very stuffed.

Delson invited me to stay with his family for a few days while I am waiting for the rest of the team to come join me in the other guest house.  I have a beautiful room, balcony and wireless internet!!!.  Anyway, I also got to go for a run with another OB Gyn resident who is here for a few more days so that was nice.

Today, I am hoping to meet up with my translator for the month.  Also, I am hoping to get 1-2 women who can help lead my focus groups and figure out the final translations for my questions and consent forms...I hope this all works out.  In the mean-time, I am going to be seeing the clinic and the cervical cancer screening that is going on for the next two weeks.

Here are a few pictures from Moshi.....I will try to get more in Haiti

Picture of a labor bed with a laboring patient....

Giraffe on safari

A beautiful waterfall....on its side...cant figure out how to rotate it...got to get wet under it too.  Very cold and refreshing.

Mt Kilimanjaro on the way to the hospital in the morning

A woman walking down the street with a long slab of bananas on her head.

more moshi

Well, since my last post, lots of new experiences and no internet so here's a brief update:

1. Rounded on the pediatric ward (neonatal intensive care) and saw some really good care of some sick babies, many of the sickest born to moms with HIV.  One baby was abandoned by her mother for a reasons that the medical team was unsure about, though likely due to the financial and social stress of caring for a needy child.  They will try to find a family member and if this is unsuccessful, she will likely be given into custody of social services.  Adoption is possible though infrequent.  On a better note, all of the babies we delivered earlier in the week for a variety of complications were doing well.

2. Spent the day at a local district hospital.  When they heard I was a doctor, I got the grand tour, met every medical person here.  "Please come back Doktari" was the common request.  Most of the hospital (busier than Duke and KCMC) is staffed by mid-level providers (like PAs) who do cesarean sections and run the wards.   Patients must come here to be evaluated before being transferred to a referral center like KCMC.  Anyway, I spent the day with some volunteers from a local NGO who accompanies patients from a certain rural village from the bus stop, to the hospital, to their appointments, to ordered tests, to pharmacy.  They also pay the minimal fees for any medications and the consultation (about 1.50) as well as transportation to and from the city.  Four of the patients were waiting to see the general surgeon who I had met in the ward earlier in my tour.  He had about 40 patients in line when he finally arrived at his office at 10:30 or 11 (first come, first serve).  Since the volunteer who was with me was busy with some other patients, I went in to see him with the last two.  The volunteer arrived in the middle and he said it was amazing to see the difference in attention to these patients when a doctor was there.  He actually made a big deal about explaining things to them and discussing follow-up with me.  He went so far as to give the volunteer his cell phone number....frustrating that everyone does not get careful care.  This happens at home too (for VIPs v. poor patients).

3. Did a walking safari.  Yes, we walked around a local national park with an armed park ranger.  It was exciting at times (approaching the male buffalos who had been kicked out of the herd temporarily).  Most times, it was just beautiful--mountains, green, watery fields.  We saw many buffalo and warthogs but also saw some beautiful giraffes, zebras and a few monkeys.  I got to "swim" a bit under a beautiful waterfall as well.  Finally, we ended the day with perhaps the most dangerous part--riding home in a minibus squeezed in with 40 or so passengers traveling down one of the most accident prone highways in the world....scary, when you have no hold on anything and the bus is passing the care in front with oncoming traffic.  Well, obviously I survived.

4. Today I rounded on gyn with the residents and it was fun to interact with one of the very good residents here in a way that was beneficial to us both.  I had a bit more confidence about treatment than him (since I am a year ahead and this is his first gyn rotation) and he knew more about resources available to patients.  Also, like me he did not speak Kiswahili so we muddled through together with two really good interns helping out.

community

Luckily for my brain and my body, there is not much for me to do here.  I never remember how much I like being busy until I am not.  It is strange to be right next door to labor and delivery and not be able to do anything to help out.  This is actually a good thing for me....a rest.

As far as traveling goes, I spent Monday morning visiting some women in the villages around Moshi.  A friend here is doing a research project that involves asking women about their birth experiences whether in the hospital or at home.  We spoke with a really sweet, laughing woman who could not say anything bad about her experience.  She laughed at everything--especially at herself when she could not sign her name.  She had never been to school.  I could not decide if she was ashamed and the laughter was a cover-up or whether she truly was happy and able to see the good in life.  It is certainly a gift to be able to do that.  Of course, her daughter (1 year old ) was fat and healthy.  Then, we went to another village and tried to find the woman we were to interview but this proved more difficult because people in that village were fairly suspicious of us two white people (mazungu) even though we were with a Tanzanian grandmother.  We did not really get anywhere.  I was sorry because I thought maybe it was made worse because I was there.  In any case, it makes me realize that to really get to know a community and to gain their trust, takes time and persistence.  

Yesterday, we visited a beautiful little district hospital about 90 minutes from Moshi.  The pediatricians gave a lecture there to the staff and then we did some consults.  The labor ward was not busy and seemed uncomplicated but we saw 2 sick children that we brought back to KCMC with us for treatment.  One was 5 days old and likely suffered from asphyxia during a difficult delivery.  This can happen in the States too, but usually he would have gotten more intensive care earlier....and in this case, would have had a cesarean section.  His mom cried when she realized we were concerned....and we have no idea about the prognosis.  The other child was suffering (at 6 years old) from a complication of HIV.  He was so weak, he had to be carried by his mother.  It hurts to see children hurting.  

the weekend

Moshi is truly beautiful.   With Mt Kilimanjaro in the background every day, how could it not be.  I think the population here is pretty well-off as well.  Life here is actually pretty nice.  It feels like a vacation to me before going to Haiti.

It was a huge contrast to go to church today and see all these well-dressed people walking into the chapel when outside there were poor people waiting for health care or visiting their family members in the hospital.  It was also interesting to go from an African service directly to an English service (alot quieter).  There are so many humanitarian workers from all over the world here, including Tanzania and other African countries and everyone is asking themselves the same questions: how can we really help tanzania (or insert other developing country), how much should we give, how guilty should we feel for our lifestyle, how will change happen?

I think there is probably only one messy but true answer to all of these questions and I think it is Jesus Christ and his church.  What a privilege to know him---and to have a long time to learn his answers!!!

Tomorrow, I will get to spend time at the District Hospital and also in the village talking to a woman about health care.  I am looking forward to seeing that part of Moshi.

arriving in tanzania

I am here in Moshi. The weather is beautiful.  It is hot, but not so hot that I can't go running.  There is a great breeze.  Kilimanjaro is beautiful.  You can't always see it because of the clouds.  

So far, there have been many crazy things to hear about.  I can't do much because I don't have a license.  Actually, this is probably a good thing because I am enjoying having minimal responsibility.  Anyway, here at Kilimanjaro Christian Medical Center, we actually do have decent care for patients, BUT most patients who come here have to be referred from the local government hospital.  So, alot of the emergencies that transfer in are true emergencies and probably should have come here alot sooner.  

We have had several near misses for babies in the last few days but somehow they have all made it....so far.  We'll see what the weekend brings.  I have gotten to help out alot with resuscitating babies, which has been great since I barely get to touch them in the States.

This coming week, I am hoping to spend some time meeting some people in the village since I still am not sure what is going on with Tanzanians.  I spend all of my time so far with Americans and unfortunately I cannot speak Swahili.  Everyone I have talked to has been very interested in Obama however....

It is such a short visit!!!!

Beginning thoughts

After a busy year, I am finally ready to spend my little bit of free time during residency in Tanzania and Haiti. It is exciting and surreal. I am looking forward to time for reflection, being outside (even if it will be HOT!), and being reminded, I hope, of why I became a doctor.

Dad said in church today that he remembers me saying at 8 years old that I wanted to be a doctor in Africa. It's crazy to think that we never know what is really possible. We rarely believe that dreams or visions we have will actually happen. But, here I am, a doctor, for the first time going back to Africa....so, I guess, with God all things are possible.

I don't know if I feel like a great missionary at this point in my life. In fact, I feel like I need a missionary. I don't think this trip is so much about being able to do great things for people as it is about allowing me time for discernment about the future.