The first day we arrived in Haiti we traveled to the top of the Citadel with Dr. Pearlmutter. If you recall from the earlier blog post it was pouring rain so we decided to visit again. Typically a truck drives about 4-6 miles to a parking lot then drops you off for a 1 mile hike. We decided to get some exercise and walk the 5-7 miles uphill to the Citadel at 5am. When we arrived at 7:30, the front door of the Citadel was locked so we took some pictures and continued on our journey back down. The round trip hike took about 5 hours. Andrew has posted some pictures below.

There were about 35 new volunteers that came to stay the week. Most of them came with a plastic surgeon from the DC area, but there was also a team of pediatricians from Tufts that were here to lead a conference. The plastic surgeon brought along a few anesthesiologists, a few ER docs, a pediatrician, a general surgeon, and a dermatologist to name a few. With all of these new doctors around it was the perfect week to get sick.

That is exactly what happened. Yesterday, just before lunch I didn’t feel so great. Originally I didn’t think twice about it due to all of the stomach issues nearly all of us have suffered at least once. But I soon realized that I probably had some virus that hit another family who came to visit last week. I was given Zofran (anti nausea medication) and an IV that hung from a lamp post. I went through 6 L of fluids over the course of about 7 hours. I can’t say Haiti is the most ideal place to get sick, but I don’t think I will ever have this many doctors checking in on me again.

Hike to the Citadel

Maggie and Spencer holding the Citadel in their fingers

How the mighty have fallen

Mid-term update

I thought I could get by with just posting pictures, but my fellow bloggers aren’t letting me off the hook so here's an update on my life at the mid point of our stay in Haiti. First, to give some update on my water project, I’ve sampled about 40 wells around Milot, Thbieau, and Carrefour des pairs so far. Unfortunately, only 4 wells have turned out to be “clean” (negative for coliform bacteria and ecoli). Of those 4, 3 were wells built or rehabilitated by an NGO called Living Water International. Professor Hyde and I were both impressed by this group’s work so we were planning on sending them a letter and report of what we’ve found. It turns out, however, that an American couple living in Milot is working for this organization. I got to meet one of them last week and I am planning to go out to the field and learn more about their work next week.

I’ve also had some memorable moments aside from my project. When we were in Thibeau the first time, all of us were swarmed by a sea of blue uniforms (and a crazy lady).

As I was taking pictures of the kids, I heard kids behind me shouting, “Jackie Chan! Jackie Chan!” Since I am the only one who even remotely resembles Jackie Chan, I turned around and saw kids trying to grab my attention so they could have their pictures taken. I made the unfortunate mistake of sharing this story to others, and since then some people have been calling me Jackie. When I visited Thibeau the next week, I walked at least 2 or 3 miles away from that school to get water samples. I was surprised to hear some people there (not the same little kids in uniform but some teenagers) greet me as Jackie Chan as well. To make matters worse, when we visited a church on the way to Thibeau for our weekly blood pressure clinic last Sunday, Maggie and co taught 2 Haitian women to say “I Love You Jackie Chan!” while I was trying to retrieve my back pack from church after getting locked out.

On a more positive note, I’ve also become famous for my “stomach of steel.” So far, I’ve eaten every single thing they serve at the compound and a whole variety of seafood while we were in Cormier beach, and yet I have not had a single episode of diarrhea/vomiting. I just really hope my stomach can hold up for at least 3.5 more weeks.

In any case, it’s still only Wednesday and this whole week has been pretty darn hectic. A team of about 30 volunteers arrived this past weekend and somehow they’ve brought a whole lot of interesting medical cases with them. Just to name a few cases I’ve seen or heard about, a man with a soft ball sized squamous cell carcinoma on the side of his head, a child with diabetic keto acidosis, and a guy with a huge neurofirboma on his head (Eric who saw it personally saw it said that it looked like someone had pooped on his head).

Ok, I think I’ve written enough to make this count as a “real” blog post, so I’ll let the other guys describe the craziness that’s been going around us in more detail. Now I am just going to go back to my old job and start posting more pictures.

MacGyver Medicine

Somehow I seem to always end up talking about gastrointestinal distress but this story is too good to pass up. We recently had to say goodbye to Jim and Dean Sackey (who were replaced by Dr. Green and Steve Cohen) and we were joined by the Egan family clan of Jacksonville, Florida. Dr. Egan who came down to work in the pediatric clinic was accompanied by her husband, her grandmother and her two sets of teen age twins (apparently twins run in the family). Tim Traynor, a chain cigar smoking, motorcycle riding, gruff around the edges force of nature and semi-boss of CRUDEM immediately put them to work power washing and repainting the hospital walls, digging ditches and any other hard manual labor he could think of. They took on the tasks with an admirable stoicism, but unfortunately for the twins Grace and Neely the Haitian food did not agree with their constitution. Both spent an unfortunate day throwing up everything they had eaten for the past month. As the night progressed Grace’s nausea showed no signs of improving and she was becoming dehydrated.

Chris, an ICU nurse that is staying down here until September, offered to grab a bag of saline and an IV line and find some Zofran from the hospital. The moment she got back it began to rain in the biblical get-your-ass-on-the-ark sort of way. This impressive downpour was accompanied by thunder and lightning that was almost strobe-like in in its frequency. At the time Eric, Spencer, Sophia and I were trapped at the hospital with our computers and had no way to get back. We ended up searching through the OR and found 4 trash bags which we punched holes into to make ponchos. We all started running once we got out of the hospital but all of a sudden Eric was 100 feet ahead of us; I’ve never seen someone in flip-flops run that fast. Spencer commented to me as we ran back that he felt like we were in Vietnam in the middle of a firefight. Running along the dirt road with jungle on either side it really did remind me of Apocalypse Now.

We arrived at the porch, soaked, out of breath and looking like four ninja turtles (I was obviously Leonardo). We arrived to a very strange scene: Dr. Annie had found an empty water bubbler tank and stuck a long handled paint roller in it for a make shift rack on which the saline bag had been hung. Grace lay on a plastic lounger with the IV needle in her arm as rain pounded the gravel around the porch and periodic lightening split the dark. There will be a video forthcoming.

I was very impressed with the Egan kids. Had I been put in their place at my age, spending an entire vomiting after working hard labor I would have been bitching and moaning but all weak I didn’t hear a single complaint from any of them. Grandma Neely spent hours cleaning up the compound, pruning hedges and planting flowers. Papa Egan directed the washing, painting and digging. While I didn’t get a chance to spend a day shadowing Dr. Egan in the clinic, everyone who did really enjoyed the experience. We all appreciated Dr. Egan taking the time to talk about sickle cell disease and treatment. At the end of the week the Egans gave us the best gift I’ve ever received: two blocks of cheese, two packages of Oreos and various other supplies to help us get through the next four weeks. Thanks so much guys!

Sunday morning Eric, Spencer, Andrew, Maggie, Dr. Green and I ran our first hypertension clinic at the Baptist church across the street from us. We got there around 8:30 AM and soon had a line snaking around the small patio we had set up on. We had to shoo people into the church and promise to come back after the service. By the end of the day we had taken about 100 blood pressures. The next day we were shipped off to Carrefour de Pere in cramped back of Monsieur Tattoo’s ambulance where we held another BP clinic bringing our grand total to around 140. Dr. Bryant, an ER doc from Lahey joined us that day as well.

Tuesday, for those of you who don’t know, was the most important day of the year because it was the day I was born. I started out the day by following Dr. Green in clinic. Haitian patients are very unique in many ways. Haitians seem to have a major problem with chronicity; they find answering the question “how long have you had this symptom for” extraordinarily hard. I think the reasons for this are manifold; Dr. Pearlmutter remarked that because access to health care is so rare, when Haitians do make it to the clinic they tend to dump years of built up illness on the exam room desk making it hard to separate individual symptoms, timelines and diseases. Dr. Kernisan, a Haitian-American anesthesiologist that came down with the CT team, made the interesting observation that Haitians do not see disease as a cause (of symptoms) but as an event, another challenge from God. Thus the linear timeline of cause and effect is less important to them. Finally, Haitian creole lacks tenses which complicates questions having to do with the past.

If you were to ask the entire Haitian population if they smoke or drink you would find maybe five or six who said yes to either of those questions. There seems to be a social taboo against these two activities because they will often laugh and say “Of course not, I’m a Christian!” With Dr. Pearlmutter, Dr. Sackey and finally with Dr. Green I’ve noticed a pattern of patients who present with a benign chief complaint but are really there for something completely different. One patient, a young woman, complained of shoulder pain. After running through an unremarkable physical exam she mentioned that she was also having pain with urination and discharge. Another young man came in complaining of folliculitis after shaving; Dean Sackey gave me a look that conveyed “really?” and told him not to shave so close the next time. Right before he was about to leave he decided to mention that he was also having pain with urination. Inevitably when you ask these patients whether they are sexually active they will laugh awkwardly and try to avoid the question. Apparently they are so embarrassed by even a benign yeast infection that they will lie to the triage nurse to avoid telling anyone until the last minute. In any event, Dr. Green and I saw our share of pain with urination and epigastric pain (probably the two most common symptoms).

After lunch we relaxed some and Spencer went into Cap Haitian with Chris and Delnatus ostensibly to get Diet Coke. It began to pour and they were still gone when we sat down for dinner. I was halfway through a heaping plate of spaghetti bolognaise when Spencer sneaked up behind me and slammed down a Mango Smirnoff Ice on my plate which he then made me chug, kneeling, on a full stomach. The surprises weren’t over yet. As I was getting up to go Delnatus and co brought in two HUGE cakes (a pineapple cake and a vanilla cake) and led a chorus of Happy Birthday. Sufficiently embarrassed and red in the face they made me cut the cake to pass around. We finished off the night with some Haitian rum (Barbacourt three star “Rhum”) which was actually pretty decent.

We had originally planned to run a teaching session with the community health agents of Carrefour a Pere on Thursday but we learned the day before that Thursday was actually a national holiday known (at least in English) as God’s Day. No one goes to work on God’s Day thus we ended up staying at the compound (which gave me time to finish my John Grisham novel). Unfortunately, God’s Day is also celebrated with a street parade and loud music that starts in the evening and lasted through the night. We did not sleep well.

Today we trained the Milot community health agents (CHAs) in spinal stabilization, splinting and bandaging. Things went really well and the CHAs asked us to continue to conduct our trainings on a weekly basis which we will be happy to oblige them with. This evening we made our farewells to the Egan family as well as a Carlene and Sarah, ER nurses from Canada, and Tom, a Crudem board member who had been working with the facility personnel. Tomorrow we will be getting a group of 30 coming in so we will have plenty of company. Our group is also planning to hike to the top of the citadel de la ferierre at 5 tomorrow morning which means I should probably end this already rambling blog post here. Good night everyone!

The time I went to Cormier beach and slept the whole time I was there...

At least I got some cool pictures of Cap Haitien and Cormier Beach!

A Much Needed Day Off=Seeing a New Side of Haiti…

After a busy week with the general surgery team from Hartford CT, Harry, and Dean Sackey in clinic (more on that later) we planned a trip to a hotel at Courmier Beach, about an hour away from Milot (or what is now called home). We left after breakfast and headed out, packed tightly into our favorite ambulance, with our favorite driver- Monsieur Tattoo. The ride from Milot to Cap Haitian is paved- which is a rarity in Haiti. Because it is paved, every car, motorcycle, and trucks takes it as an opportunity to go as fast as they can, avoid speed bumps by swerving around them, and pass as many cars as possible (don’t worry Mom, it sounds worse than it is). The ride through Cap Haitian was eye-opening. Streets are lined with trash, houses are half-finished, and cars pack the little alleys. In the middle of this appeared a pristine building that really came out of nowhere- Harry thinks it might be city hall. (Pictures of Cap Haitian are included)

Leaving Cap we drove up and down a mountain side on a bumpy dirt road, we probably would have been complaining more about the bumps if we weren’t distracted by the beautiful views of the beach that we are heading to. We arrived at the hotel and immediately upon entering, you felt like you were in a completely different country. We quickly set up on the beach for a full day of reading, eating, swimming and most importantly, napping. It was great to get away for a day to clear our heads from a very busy first two weeks and of course be entertained by the plethora of French men in tiny speedos (picture provided) and a wedding with a variety of musical performances (best song definitely went to a "singing" of Whitney Houston's "I Will Always Love You")


Before heading out on our beach adventure we said goodbye to the CT surgery team and Jim. It was sad to see them go and we can’t thank them enough for everything they did for us. The surgery team was so willing to teach us and invite us into all of the surgeries they performed all week. Harry is also a surgeon so in total there were 3 surgeons performing operations throughout the entire day. The memorable surgeries that we saw included: hernia repairs, a double mastectomy, duodenal web repair, skin grafts, an appendix removal that ended up actually being GI Tb, breast mass resection, an ectopic pregnancy removal, and the removal of an ovarian cyst that was the size of a melon (wow, typing that out made me realize how lucky we truly were to have the opportunity to observe all of them!). Thank you again to Harry and the CT team for providing us with that opportunity and for sharing your knowledge and guidance throughout the entire week.

We were also sad to say goodbye to Dean Sackey on Friday and Jim on Saturday morning. We had a great time shadowing Dean Sackey in the adult clinic and have many memories from the week. She was a great mentor and helped to advance our projects further. Jim was with us from the first day so it definitely will be weird without him around. He set up two trips out to different communities, networked with many of the doctors in the hospital to set up shadowing experiences, and was always there to guide our projects in the right direction. Thank you so much for everything. We welcomed two new faculty to Haiti this week and are excited to work with both of them in the upcoming weeks. Steve Cohen- Sophia and I’s PI- is our public health professor who has been so nice to take a break from work and come help set up our project with us. Dr. Don Green is a family medicine physician who we are excited to shadow in the adult clinic. There are going to be three different sets of volunteer groups in the next week (one is over 30 people) so things will be busy. Eric is currently abiding strictly to rule #5 knowing that with the larger numbers, there is less food and thus a new rule was made. Rule #6- Always be the first one to dinner.