The journey started on Monday, February 1st. There was a meeting scheduled at the hospital were we would be briefed about our trip, and would meet everybody on the team. All the paperwork that needed to be done, including a waver for the hospital (because unfortunately they did not want to be involved in this in the first place…), copies of our passports, emergency contacts etc. The plan was to leave early the next morning around 8 AM.

Unfortunately, the weather did not cooperate. Now I live in the South…usually not too cold in the winter, but this winter was a real one. So there was concern about de-icing the plane. So at 6:15AM we were told that the flight had to be postponed until noon, and then we would get a new update. Luckily, we were able to leave and finally took off around 2PM. The flight was smooth and we got to the Bahamas about 3 hours later. We stayed in Nassau in a very luxurious hotel, and the next morning we took of to the airport for the last leg of our trip.

From the airport in Les Cayes, Haiti it was about an hour or so ride on a mostly unpaved road to Hospital Lumiere in Bonnefin, up the mountain. We arrived around 2:30 PM and were shown the guesthouse. Since we had to leave our luggage behind in the Bahamas, due to weight limitation on the plane, we didn’t have a lot to unpack. We changed into scrubs and straight to work. I was going to take over from a nurse that would be leaving the next day. She gave me the quick tour and report on the most critical patients.

The ward that now was my responsibility had about 28 patients. Almost half of the patients had an amputated limb. Lots of people with external fixation to heal their broken and crushed bones. Two of my patients were still critical. One patient, Sherlee, had crush injuries to both her lower legs and heading to amputation of both legs. She would run high fevers even though she was on a lot of antibiotics. My other worry-child was Linda, who’s left leg was amputated almost at her hip, she also would run very high fevers and appear to be very sick. Now you don’t have all the nice equipment that we have here. So everything you are used to to rely on is not there. You have to go back to the basics and trust your gut even more. There were enough antibiotics and pain medicine, but not enough small bags of fluids to dilute the antibiotics in, so everything was in syringes. However, there were also not enough syringes, so we had to reuse and reuse and reuse…. All the things you were told not to do. But you have to choose between two evils. All the antibiotics had to be pushed in by hand, and a lot of the antibiotics should be run over 30 minutes or more. So very time consuming. The Haitian nurse and I came up with a schedule. Since I would be in charge of the medicine cabinet, because these were all donated and didn’t belong to the hospital, I would be in charge of the oral medications and she and another Haitian nurse would prepare all the intravenous medications. We worked great together this way and every patient received their medication on time.
Unfortunately, you can not get around politics and power struggles….  The church group that had taken charge over the hospital after the earthquake had some interesting members. Apparently, this hospital was due to be closed the end of January. The doctors and nurses that were still working there had not been paid since March of last year. They do have housing, but basically have been working for free. Also, if patients needed medication, or an Xray, or lab work, they would have to pay in advance. Otherwise it would not be done. Imagine that…

Anyway, one of the missionaries had a little power surge going on. She would lecture me that I was not here to ‘just do my job’ but also that I had to teach. That the Haitians were all criminals and stole whatever they could. On my ward there was a room that was assigned as supply/medication room. No good lock so every night all the meds and supplies would be moved to the front of the hospital, were all the supplies were stocked and locked. One of the EMT’s that was there when I started, spend his morning putting a new lock in the door on my ward. Another volunteer made sure the lock could not be jimmied and he and his wife and sister in law then put all the meds and supplies in the cabinet. This all without me knowing about it (or caring for that matter) but much to the annoyance of the woman in charge. So she reamed me another one. In front of other people. About something I had nothing to do with or wanted to have anything to do with. Now this woman had not been very nice to me from the day we walked in but I figured it was because I did not have a penis (you know these bitter women…) Anyway, this whole thing kind of pissed me off a little bit. I had worked non stop since that morning, it was now 13 hours later and I was tired, hungry and emotional shot. So when she walked into my little supply room and asked me if there was a problem I let it rip as politely and calmly as I could. I told her again it was inappropriate to talk to me like that, especially in front of other people. That I did not come to Haiti for her, her church, her politics and her rudeness but that I came her to help the people that were laying in the beds in the wards, to help the nurses that worked and lived here that had been working nonstop without pay from tow days after the earthquake until now, and still will be working for a long, long time. I am not a religious person but will respect others beliefs, however, I do also expect people to respect my beliefs. And the words ‘I am a good Christian, he/she is a good Christian etc., I was getting a little tired of it. So I told her that if she was such a good Christian as she had stated many times, maybe she should reread the Bible because she was sure not acting like it. I was a little shocked that I actually said this, I usually do not discuss my beliefs or other peoples religious view, but as I said, I was tired and emotionally overwhelmed. But it worked. Not only did she become more civilized to me but also to other women.

So with this little incident behind me, I could focus on what I came to do. And enjoyed every minute of it. You will never meet braver people than the people that I met there. Every face had a story that made you want to cry. People lost everything, not only were they injured but they also lost their family, jobs, schools, houses, their whole life. And still, there would be laughter behind the tears. Grateful to me for taking time out of my life to come to help. Grateful to me for giving pain medications. The whole ward would clap and cheer when someone would get out of bed for the first time and walk around with a walker and the help of two amazing physical therapists, Ulrike, a German who has been living in Haiti for the past 12 years, and June, a physical therapist who is also a wound care specialist. I met Marie-Rose, who cut off her own arm to escape from underneath the rubble. A little girl in the pediatric ward who lost her mom and three siblings. Christopher, who lost his twin. Ralph, who lost his leg and had a knee injury on his other leg. He was in his second year at the university in Port au Prince, but the university is no longer there. A nurse midwife that lost her leg and understood that I was too busy to brush her hair for her. Of all the things, I would have loved to sit next to her and do this little thing for her that would mean so much, but one of my other patients crashed and I had to take care of her. The 15 year old boy who’s leg we couldn’t save. All this pain.

The Haitian nurses I worked with were so very nice. Of course, the first day they have to figure you out. Imagine this would be you. Suddenly, these people from another country come in and start telling you what to do and how to do it. Not the best way but unfortunately a mistake that I encountered when in Tanzania and the nurse who was with me was quite arrogant and the worst example of an American…

When we figured out with the help of a translator how to work as a team, we ended up having a great time. The girls actually spoke English but hid it from me for a couple of days…because they didn’t think they spoke it well enough…. So after the fun we had about that, life became easier and I was able to learn a couple of Creole words and my new friends would be able to practice their English.

The days flew by. Working from 8 in the morning until about 10:30-11 at night. I don’t think I have been this tired in my whole life! Then back to the guesthouse and hoping there would be water. And if there was water it was very very cold…. Sleeping on a cot or bunk bed. Up again around 6 since there were a lot of people living here and the walls were not very thick. And the roosters having a conversation didn’t help either. But you do it. Also because I was so very lucky with my team. Lee and Dave, the orthopedic surgeons, and Chris, the nurse anesthetist. All of them great people and now my friends for life! Susan, who I knew from when I was a pediatric flight nurse and she worked in the PICU, and then working together in the peds ER. Here we are, meeting again in Haiti. She had been there a week before us and decided to stay another week. We had so much fun at night after the long day.

My relief team came on Saturday but did not start working until late Sunday afternoon because they had to go to church first….

Luckily I had two nurses taking over from me so on Monday they started to get to figure out their routine and I had time to hang out with my patients and spend most of the day in the OR. Where I think I found my new thing…medical photography. Never like the OR but looks much better through a lens. Or maybe it was the team that was there, who knows.

The next day we were going back. However, the plane that was supposed to take us had a cracked propellor so we stayed a day in Les Cayes at the compound there. For us the Hilton! Luke warm water, what a luxury! Fresh fruit for breakfast and pancakes!! WOW!!! After a very long day we finally made it back to Charleston around 2 in the morning, to my house around 3 and in bed at 3:15….

So here I am. After my regular three dayshifts in the ER the past three days. Laying on my couch exhausted still. Looking at pictures and wanting to go back tomorrow to check on all my patients.

Hopefully the people of Haiti will survive all this and become more acceptant of handicapped fellow Haitians. Because there will be a lot of them.

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Today I went back to work to find a bunch of emails.. Leaving Tuesday at first, but now maybe Monday. Which gives some practical problems, like my house is a mess, I am working my three weekend shifts…and if the days are all going to be like today….not good.

But oh well, what do I really need? I finally have a use for my old crappy scrubs that are just taking up closet space (better try them on to see if they fit) have plenty of old tank tops and t-shirts, shorts and other clothes. Someone at work told me to get men’s boxers, apparently they are very comfortable (although I wonder about the hole in the front..)  But what would be my size???  I have plenty of sunscreen lotion, Kathie is making me homemade granola because I really can not stand those protein/power bars….. I have a bunch of antibiotics already filled, sunglasses, a hat so I think I’ll be okay. And I can do anything for a week!

We are going to a hospital in Les Cayes, on the west coast and outside of the quake zone. Still very very busy, with lots of patients to see.

But for all of you that have expressed their worries, not close to Port au Prince and very safe!!!

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Then yesterday, when I came back to work, and checked my email, I found an email send by one of our orthopedic surgeons. He was trying to get a team together to go to Haiti to render care to the victims of the earthquake. So I emailed him back. Told him my experience, and I guess it is quite a list. So I got an email back from him… “When can you go????” one of the biggest compliments for me. So I told him whenever they needed me to go, but I also needed to get permission from my nurse manager to take the days off. Now it is not as long as Tanzania. Only 7 to 10 days. Only one weekend of work that I will not be there. So not too difficult I would think… Silly me. Even though I had emailed my boss fairly early I still had not heard anything back at the end of the shift. Now I know I am not the only one that wants her attention on an issue.. but jeez, this is Haiti and an earthquake and people dying and in desperate need of basic care.

So this morning, after I send my patient home after waking him up with a cheerful sternum rub (frequent visitor of our department with a narcotic dependance) and also requesting from him to please not play with himself while I was in the room, I wrote another email to please let me know as soon as possible so I could let the team know if and when I would be able to go.

Got an email back…

Have to run it by the next boss up…

And he probably has to run it by his boss…..

So we will see. They are trying to go this coming Monday or Tuesday, which would be a little quick practically, but not undoable (is this a word?). The next team would go on February 1, a week from monday.

Keep your fingers crossed. Think good thoughts! Because I really want to go. I think my future may be in this kind of work.

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Then I am yelled at by family members on the phone because I did not want to take down each family member’s phone number to call them back individually. When I explained that I did have one phone number and would update that person, I was told that this was ridiculous and this person could not understand why I could not do this. Even after explaining the unit was busy and we were short staffed. I then invited the family member to come and work with me for a day and then maybe she would understand… Maybe not the best thing to say, but I just do not like being yelled at…. Although now I was yelled at even more…..And I have to admit that my compassion for little complaints is not at a high level right now. So maybe it is time for another job.. However, this past weekend I did discovered that when my patients are really ill, my compassion comes back very quickly. So at least I have not become nurse Ratchett just yet. So there is hope.

But I do miss the simple smiling as a thank you. The friendly faces, the laughing out loud when trying to speak my few Swahili words, the simple things. And yes, I know it is not ideal and it is easy to idolize when you sit on your couch at home. Food and good coffee readily available, a washer that does your laundry. A shower you turn on and water at a nice temperature actually comes out. Grocery stores around the corner with more stuff that you will ever need. So I know that this is not really a good comparison. But I do feel I did make a difference when I was in Haydom. More that I do here.

So I will go back. Not really sure when and for how long, but this is not the end of my story….

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First let me go back a couple of days. Everything for the trip back home was taken care of. A couple of my friends, Ellen, Riki and Thea were driving to Arusha on Tuesday to go climb Mount Meru, slightly lower than Kilimanjaro. So I could ride with them, and we would go shopping and eat and have a good time before I had to go to the airport. Unfortunately the car died. Completely. And being in the middle of nowhere, AAA or the Dutch equal ‘Wegenwacht’ do not really have a little post out there. Try to get a tow truck arranged… Poor Ellen. (that is the car owner and my Dutch friend who would cook for me and provide me with a hot shower every couple of days since I did not have a working shower the last week) So now other plans had to be made. The thought of having to sit in a Landcruiser for 7 hours with 20 or so other people was not too appealing for me but I had to be at the airport Tuesday evening, because I was really not going to miss that plane home!

So after everybody had given me advice on how to get to the airport, I ended up being able to get on a Flying Medical Services flight out of Haydom to Arusha Airport. Together with Ellen, Riki and Thea, who by now should have reached the top of Mount Meru. So after hanging out in the orphanage with my little skinny preemie that now had moved from the NICU to the orphanage, I was ready to fly on Tuesday afternoon. Until I saw the plane. Now I used to be a flight nurse… so should not have to think twice to go on a plane that looked about the same size as my my car. But I guess there is a reason I don’t do that anymore. About halfway through the flight I started to feel that unpleasant familiar feeling of AIRSICKNESS…. Yikes. Now what?? No windows to open like on the helicopter, no partner that was looking at my color changing from normal to grey-green and would ask the pilot for more air in the back. and 30 or more minutes to go before we would reach Arusha.. But I remembered to focus on the horizon, gave myself a mental lecture and stared at the mountains laying ahead of us. So I didn’t puke! Phew, what a relief since this was just the beginning of another 17 hours or so having to fly on a plane.

We landed at the foot of Mount Meru and did see the beautiful, snow covered Mount Kilimanjaro in the distance. I got a cab for the hour drive from airport to airport. Funny, that ride was about twice the cost of flying from Haydom to Arusha…

And let me tell you about traffic in Arusha. A two lane road is made into at least a 6-lane road. Dala-dalas, the public transportation buses are everywhere, frequently almost stopping to leave people jump off or to have people jump into the bus. And here also, the more the merrier. It is amazing to see how many people fit into these buses. The police trying to direct traffic on an intersection, but only to accomplish a larger traffic jam. Carbon footprints? What in the world is that? I think my lungs probably have changed colors inside from all the diesel fumes….. Bicyclist and pedestrians everywhere on an unlit road. Very, very interesting and the best thing to do is just sit back and try to enjoy the ride..

We left Kilimanjaro Airport around 10:30 PM for a short flight to Dar-es-Salaam to return to Amsterdam from there. And man, was I lucky with the person sitting next to me..a sighing, moaning and complaining older American woman. She was very upset she had to sit in the middle seat and made that perfectly clear in an unpleasant way to the flight crew, that actually has nothing to do with seat assignments, but she wouldn’t listen. Then, apparently, I coughed, so she asked for a face mask. I guess I look very sickly and the coughing sounded like I had the H1N1 flu written all over me. Or maybe even TB. Anyway, the next thing I know when I looked at her, she is sitting there with a eye mask (you know, those dark colored, thick eye masks) over her nose and mouth. Makes it hard to breathe I guess, because that didn’t last very long.

Now I am bi-langual. Dutch and English. And I was flying on a Dutch airline. So after unable to sleep since the sighing and moaning and groaning went on, with the reading light on that was sort of shining in my face, I finally went to the back of the plane to get a cup of coffee. And was able to chat in my native language to the flight attendants. I can not have but admiration for them since they were nothing but nice to this very obnoxious lady. And the coffee and cookies they gave me were great.

We made it to Amsterdam, the lady next to me found out I spoke English about an hour before we landed, I guess the book in English did not give her a hint the 8 hours prior to that. And here I was, in the homeland for two and a half hours. I went through immigration and then shopping! I had been told there were some grocery stores at the airport, so there I went. Secretly hoping my best friend would stand outside so we could have a cup of coffee…. But she wasn’t there, so I just did the shopping. Black, salty licorice, cheese and stroopwafels..

On my way back through immigration, the whole Amsterdam soccer team Ajax was ushered through first. Now I thought there would be 11 players, maybe a couple of reserves and a coach or two. But this was the never-ending line of people with Ajax-suits on. So here I stood, with everybody else gawking at them, but me just thinking, why can I not go first since it is just one of me. Anyway, I ended up inviting them to Charleston. Somehow I don’t think they will show up.

The second flight from Amsterdam to Atlanta went fine. I had nobody next to me, a little more legroom and slept on and off. The flight attendants on this flight would come by occasionally screaming if we wanted coffee, tea or water. So I would wake up startled, but luckily by this time I was so tired that I would doze off quickly.

The first thing I did after I arrived in Atlanta was to get a good dup of coffee. Man, that must have been the best cup I’ve had in a long time. Tanzania exports a great deal of coffee, but they must send out the best because the past four weeks I have been drinking the worst instant coffee ever. Even the coffee I drank through nursing school, this tar-looking mix diluted with hot water, tasted better in my memory.

I was picked up from the airport, taken to Five Guys Burgers and then home, a long, long shower, a cold beer and my own bed…. Slept for 12 hours straight only to be woken up once in a while by one of the cats that would put her paws on my face. Now I am doing laundry. Don’t know if I can get the red dust out of my clothes but we’ll see.

I’m going to catch up with my friends, and think about my trip in the comfort of my own home. Because I don’t know if I can do this again. But who knows, maybe I will. For now, I’m just glad to be back after this experience.

And the Yankees won the World series!

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Anyway, after a nice, quiet morning, all hell broke loose. First, one of the babies that was not supposed to survive due to birthweight but has been hanging on for 5 days now, developed severe sepsis. So here I was, again, after all this time, starting another IV on a baby less than a kilo… Antibiotics were started and maybe he will survive the night..

Then one after the other baby came in that needed resuscitation. One too small and too early. One of my students sat with him in her lap until he died. The mother did not want to see him, she was told last week the baby in her womb had died. So she already had started her mourning process and imagine having heard this and then your baby is born alive, and the died about an hour later. But he did die peacefully, no prodding or sticking, by a nursing student that held him and talked to him.

Another newbron came in, no respiration, low heart rate. And then you have to make decisions you never though you would: from which baby can I take the oxygen away to use it on this one? Because these are the options: either two babies on nasal cannula oxygen, or one baby is ventilated with a mask and bag. So this is what you do… The other two are on their own for now. If their saturations drop, we’ll switch. Because the baby that needed to be helped with her breathing also needed chest compression. Since I had no oxygen to start with.

So today I am going back. I feel I can handle it much better than the first week, I am adjusting to the environment and equipment (or lack there of) Who knows, maybe I am able to do this….

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We left on Friday afternoon, 5 people and guide in a very, very old Landrover. Our first stop was in Mbulu, about an hour and a half from Haydom. To check and fasten one of the tires…. This event would repeat itself numerous times during our trip, but if you have ever been on one of the roads here, you know that if a tire would be loose, you would not get very far….

We arrived at Katuro, a town at the foot of the Ngorongoro Crater National Park. We spend the night at our guides parents house. The next morning we packed ourselves in the Landrover and entered the park.

It is the strangest thing. You have seen stuff like this on the discovery channel, animals like this in the zoo. But now, here you are, in the middle of it. The roof was taken off the Landrover so we could stand up and look around. Now it still is the dry season here so imagine the red dust every time someone else would pass us…. But then we were starting to see the animals. Some far away, some close up, like the lionesses having lunch.

After the first day we had dinner at a restaurant owned by a guy from South Africa. Hamburger and fries…. So very western but so very delicious!

On Sunday we drove to Lake Manyara. A totally different eco system, greener and more trees. Warmer and more humid. So more bugs. Again, lots of beautiful views, animals and things to see.

I can go on and on about how beautiful it is. But the best thing is to look at the pictures….Hopefully I will be able to put them on the site, the internet has not been cooperative lately so check back if they are not there!

And after the two days in a Landrover that has seen better days… Paris-Dakkar is for wimps.

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Monday we went to the nursing school. The curriculum is set by the Tanzanian Ministry of Health. The length of the training has been cut by a year. And here also, a shortage of teachers and more students than spots. After three years they graduate and then can specialize as a midwife or psychiatric nurse. Next Monday we are going back to help with teaching how to obtain vital signs, so the groups can be made smaller and hopefully everybody will be able to get enough out of it.

Yesterday and today I spent the morning in the preemie ward. Not too bad, lots of preemies. Quite interesting to find a baby with no identification, just laying there with some blow-by oxygen. Still wrapped in just a sheet from the delivery, unknown how long it has been laying there. So then your task is to locate the mother. It’s like a puzzle…. And no worries about mislabeling specimens or identifying with two identifications, there isn’t any. Man, I hope I can still do this when I come back, reading ID bands and asking patients for their name. If you are lucky, the baby will either have a piece of tape around the wrist with the name of the mother on it, or a piece of tape on the sheet it is wrapped in with the name of the mother on it.

When I arrived at the preemie ward, there was somewhat of a chaos. The two preemies that have been there for a long time and need to go to the orphanage were both screaming because they wanted to eat. Three mothers of the other preemies were there too, to feed. So imagine this room being as small as my kitchen, two benches, 40 degrees Celsius or so and a couple of adult bodies radiating off heat…. Then the personal hygiene here is not what we are used to, so you probably have guessed by now.

Today I had excellent help. I was wondering around on hospital grounds looking for linen, I am finding my way but not quite sure where certain things are. And there they were, two Norwegian student nurses, walking there. I asked them if they were bored and guess what, they were! The ward they were assigned to, had nothing for them to do. The Haydom nursing students are in class on Wednesdays so I was by myself. So they were more than willing to come and help me out. Weighing, changing and feeding and in no time everybody was clean and fed and sleeping.

Then Ellen, the doctor in the maternity ward, also needed help. And since now my work was being done, I was able to help her round. So the other nurses could do what they needed to do. And in the end everybody was happy.

Friday afternoon I am leaving for a safari. We are going to the Ngorongoro Crater and Lake Manyara, both located in Northern Tanzania. Now where am I located, you may ask. If you go to one of my earlier blogs, there should be a picture of a map. I am near Mount Hanang, this is the mountain I see from my window. So look it up if you feel like it… So hopefully I will see elephants and zebra’s and maybe even a lion. I am very much looking forward to this!

Until next time!

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The market is quite large. You can buy a lot of stuff. Lots and lots of shoes. Lots of used clothing, from Europe and the US. Masaai blankets, fabric, knives, medicine, jewelery and food. We ordered barbeque first before we started to walk around so we could have some food and drinks after the shopping spree. Ofcourse people were staring at us, this group of 7 white people with our guide Clement. We were suddenly the main attraction. Forget about the snakes, forget about the chicken and cows and bulls. Seven white people walking around in the red dust. And with money. You really start feeling guilty  that you are this rich westerner and really do not want to bargain the price they ask. But then it is the culture to do so.

After our ’shopping spree’ we had lunch. The barbeque meat was placed on sticks in front of us and with a knife you were supposed to cut it off. Now I could easily be a vegetarian if it was not for the fact that I really like a hamburger from FiveGuys once in a while. To see the meat here kind of gave me the willies but you don’t want to be a partypooper so you just join in. Plus having a Kilimanjaro beer helped somewhat since the bottles are twice the size of what I am used to. And I am still a cheap drunk…Until the guy that prepared the meat blew his nose in his hands…..not so good. So maybe I will become a vegetarian after all….

So enjoy the pictures I took. It was quite an experience. It’s a shame you cannot put sounds and smells on the pictures because that is something I really do not know how to describe If the pictures are not showing up have patience, the internet is not as fast and reliable as you are used to there in Europe or the US.

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So I am doing somewhat better now. I had a long talk with one of the Norwegian researchers who is an anesthesiologist in an ICU in Norway. She told me that all these emotions are normal, that you walk into a situation where you do not know what the rules are and what the tradition is. And also, all by myself. She told me that I did the best I could do under these circumstances and that this situation (Tanzania, Africa, third world countries in general) is not my fault. That I did what I could with the equipment I had. I think sometimes we think we do good by donating equipment but not realizing that this may make it more difficult in the end. Because if we would not have had one of those anesthesia bags to give this baby CPAP he would not have survived the delivery. Now he lived for 24 hours, but not the best life you would wish for a newborn. So it makes you think a lot about what would benefit the hospital and the people it takes care of.

I still feel that we did too much for this baby and that we prolonged his suffering. And that goes against everything I believe in.

So meet Lucy…..

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