Sun, Feb 28, 2010

How can it be Friday already?? Where did the week go? It's kind of amazing how the week can seem to fly by! People come and go, and things change at Delma 33, yet the basic workings stay the same.
   It's been a good and interesting week... particularly today. But let's start with earlier in the week. I don't remember what days some of these things happened on....
   I worked in our "ER" one day and packed and changed the dressing on three abscesses. It seems like we see a pretty good share of abscesses. It seems like people don't take care of injuries that they get, and then they get abscessed.
   The other day we had some US army guys (82nd Airborne) come to Delma 33 wanting in to see what we're doing. I think they were going around and looking at medical places and taking notes on what they were doing. Well, the Merlin group at Delma 33 has a no guns policy, and these guys were, of course, toting guns. So one of the in charge Merlin people told them that they were welcome to come and see but they weren't allowed to bring their guns. That didn't work; they weren't giving up their guns, so they weren't allowed to come in, so they didn't. I found out about that at the end of the day on the truck ride home.
   Maybe I know, in a very small degree, what Toni's (the charge nurse where I work at home) job is like. We have two relatively new (to Delma 33) nurses. So today it seemed like I did a fair amount of question answering and order reading, but I enjoyed it. God is definitely helping me! Maybe I'll be better at reading the famous doctor scrawl when I get home. They're not all bad.
   After the earthquake, some of the Haitians were taken to the Dominican Replublic to hospitals over there to be treated. IFM has a van converted into an "ambulance". They've been using that to bring Haitians back from the Dominican from the hospital. Haitians and Dominicans don't like each other, and it seems like the Dominicans are getting tired of the Haitians and want them to go back to Haiti where they came from. It's so sad, some of the Haitians are still in bad shape from the earthquake, but here they are at this hospital, and they keep telling them tomorrow they'll operate- tomorrow, tomorrow, tomorrow. 
   Last night, Ezekiel, one of the Haitian guys that helps out at IFM, brought some more patients back from the hospital. They were both women, and they both had x-rays with them. Jordon, one of the German Baptist docs, looked at the x-rays. Some of us others looked at them too. The one lady had a broken pelvis, and the other had a broken arm and leg. The pelvis looked like it was healing at least somewhat, the arm had a rod in it, Jordon said, and the leg had an external fixator on it. It's pins that go into the bone on both sides of the break, and the pins come out through the skin and are attached by a bar. We took the pelvis x-rays to Delma 33 today, but sent the lady on home last night. Jordon thought that they probably wouldn't do anything more about the pelvis at Delma 33, and he was right. The lady with the broken arm and leg slept here at IFM in the main house on the couch in the living room/kitchen. The plan was to take her with us to Delma 33 in the morning. She hadn't had any pain medication for four days because the hospital was out. We gave her Ibuprofen and Tylenol PM, and then during the night one of the nurses that's staying in the main house got up and checked on her and gave her more Ibuprofen. 
   So this morning she was going to go to Delma 33 in the ambulance, but we would still go in the truck. Lori, an RN from Indiana, and I rode with her in the ambulance and Ezekiel drove. We have her a shot for the pain before we left, which it ended up being longer before we left than we thought. I guess I was getting used to things being done in American time rather than Haitian time. It seems that time to Haitians isn't a very big deal. Anyway, we were finally on the way. Sometime during the trip, we decided to give her some Ibuprofen and hopefully take some of the edge off of her pain. Ibuprofen seems rather insignificant for that, but you have to work with what you have at the time. 
   The guy that was with her knew some English. He told us that she had chest pain. A lot of Haitians, it seems, have heartburn, so when he told us that, I figured that's probably what it was. We had given her Ibuprofen, and she was laying down. So between my little bit of Creol and his little bit of English, we discovered that yes, she had acid. That's what they call it. Lori had some peanut butter crackers in her bag, so we dug them out and gave her one. She didn't seem to like the peanut butter (Haitian peanut butter is spicy), so Lori scraped the peanut butter off of the crackers and we gave her the crackers. It seemed to help.
   Ezekiel had the siren on in town, but it didn't seem to do much of anything. It's kind of a funny siren. It seemed to help some, but NOT like it does with ambulances at home, although we did have two UN vehicles wave us around to pass them. Traffic was bad, so we went to take a different route... that road was BAD. It wasn't paved, and it was rocky. Sigh! I went to the foot of the stretcher and help her foot still so her leg wouldn't move so much. And Lori and I sang some songs. We sang a couple of short songs, and before I knew it, she was resting. She even had her eyes closed!
   I braced her foot for the rest of the way to Delma 33 (even though we did turn around and got off the awful road). And when we got to Delma 33 things were kind of caotic in the "ER". They had been short two nurses for a little. Lori and I didn't think we'd get there that late. And I was the one that was designated for the "ER" today, but they managed without me. Cheryl, another one of the nurses that has been in and out for a while, was working in the "ER", so she just stayed back there and I went up to the clinic part. The two "new" nurses were working up there, but right in the morning it's usually slower; they were handling it fine then; it was later that the questions came.
   So our lady that we brought to Delma 33 was admitted. She's to have surgery I think maybe tomorrow. She has infection in the arm that was broken. They're going to have to do skin graft, they're thinking. The leg is doing well, which is a blessing. 
   And now I really must get to bed and finish this later, because I'm not done, but it's LATE. At least tomorrow is Saturday, and Sunday, Lord willing, is our day off! I'll try to get this off tomorrow... good night!

   Ok, so now it's Sunday. I couldn't get on the internet yesterday... it wasn't behaving.

Where to start? I guess I'll tell you some of what we did on our day off on Friday. We went to the IFM clinic, IFM orphanage, and then to a tent city to assess the needs there. We've delivered food to them at least once now, and we have more to deliver I think tomorrow. 

   My role has seemed to have taken on a new aspect. It doesn't take long to have seniority when the staff turnover is so often. So now I'm one of the go to people. "Juanita, where is so and so?" And PTL, often I can locate it in a short time. So being somewhat in charge is a different experience for me. But it's fun if you know what you're doing.

   I helped one of the docs lance a dog bite, I think it was on Monday. Poor little boy, he had one swollen infected leg!(I'm hearing Doc play his, I think accordian, out in the courtyard. He's playing "When The Roll Is Called Up Yonder".)

   We've seen a total of about 300 (I think more) patients so far this week. Still lots of malaria cases, and it seems like we're seeing more typhoid too. Oh, and scabies. We've gone through pretty much scabies lotion treatment, but it takes 2 oz. per person, and we like to treat the whole family. It's not worth treating only one member of a family exactly.

   Some random tidbits... today one of the docs and I were doing something, and one of the nurses came over to us and said, "What are you mad scientists doing?".... our emergency the other day was- a dead man... I've spent roughly 72 hrs. on the road in a truck since I've been here... laying on a pile of rice sacks on the back of the truck on the way home from Delma 33... sitting on a bench to eat my lunch, and being told that a girl had had an accident there- no, it wasn't wet, they had wiped it up, but I don't know if anyone had disinfected it....

   I don't really have a whole lot to say. My time here is coming to an end; I'm leaving March 4th, Lord willing- two more weeks. Lord willing, I'm going to Puerto Rico to visit my brother and his family for a couple of days before I get to the states. I'm  It'll be sad to leave; I've found a home here. I could (maybe, not for sure) find my way from the mission to Delma 33, and still there are new things to see... big airplanes, US army, UN stuff, destroyed buildings that I didn't notice before....

   Please keep praying for us. One specific request- there has been some personality conflict between two people, pray that it would cease and that God would use me as He wants in the situation.

   And now it's time to get to bed. Hope you all have wonderful week and weekend serving our Lord!    ~Juanita

Thu, Feb 11, 2010

It's nearly 8:00 PM... somewhere someone is playing the keyboard... there's voices and thumps outside my bedroom door in the kitchen/living room. I just turned the ceiling fan on because I was getting warm. The horn honking outside has stopped, but I can still hear vehicles on the road. I'm sitting on my mattress on the floor and emailing. Another day done.

   The past two days I've sort of been "training" one of the "new" nurses in. Two LPN's came on Tuesday. Wednesday was their first day of work. They're both older Mennonite ladies. Yesterday I was in post op and today I was out in the outpatient clinic. We just found out a little before we left that the clinic isn't open tomorrow. God is so faithful! We could all use a break except maybe the two nurses that just got here on Tuesday. And we didn't have many, if any, docs to work in the outpatient clinic. One of the RN's who's had lots of experience here in Haiti was working as a doc today, and it was our Irish doc's last day. I don't think they're doing surgeries either. Tomorrow marks a month since the earthquake... wow! How time goes! And we're still seeing and treating earthquake injuries. They're more minor injuries.

   One of the things that we've been running into is patient's having no where to go when they're discharged. How do you send someone home when they don't have a home?? And yet we don't have tents to give to everyone; not a fun situation.

   Yesterday one of our fighters was getting a blood transfusion when I got there in the morning. He's a young man named Emmanuel, and he was in a house with 15 people, and he's one of the 4 that survived. The docs were trying to save his leg for him, but after multiple times in the theatre (operating room for those of you that forgot ), it was decided that the leg had to come off. I got to see some pictures of the surgery and a video clip from it. 

   Claudine is 14 or so, and she was in school when the earthquake struck. The bones in her right forearm where badly crushed and she had a piece missing from her wrist, so the plastic surgeon had to do a procedure where her arm is sewn to a flap from her stomach for two weeks. After two weeks I think they separate it. Yesterday she went to the theatre to have it looked at. She was still pretty sedated when she came out of surgery, so the nurse that I was "training" and I stayed with her for a little while to make sure that she would breathe. I would gently smack her cheek every now and then or call her name. It was fun to see her gradually coming out of the sedation and responding to me quicker and quicker.

   Today I heard a sort of funny conversation. One of the Irish docs was talking to one of the other Irish docs. He had been told to go to the surgical tent about something. Then he asked the other doc what the surgical tent was... he guesses it's the theatre. The one that was asking the question is one of the newer members of Delma 33, so maybe he hadn't heard that before. So not only do we have limited supplies and resources, but sometimes we don't understand the other culture's medical terms, like the vocabulary I gave you in the last email. It makes it interesting. Oh yes, and the speech accents!

   Throughout the day I think of things that I want to put in my email, but I forget some of them when the time comes. One of them is our hand washing stations. The first week or two (I'm not sure, maybe more), we had hand sanitzer. But as we kept getting organized and growing, we got hand washing stations with real soap!! You could actually work up a lather!

   Yesterday I got a little treat. One of the girls working with IFM came and asked me if I wanted to go with her and another girl to have lunch at a Haitian restraunt. So the three of us left the clinic and walked up the road a bit to the restraunt. It was nice. We had beans, rice, chicken, a boiled plantain, and tampico (a fruit flavored drink).

   This past Sunday was our first Sunday to close the clinic and everyone at IFM had the day off. That's the plan now for every Sunday. So on my day off, I got to learn to stitch a cut! I'm so glad I got to learn and do that; I've wanted to for a long time. So that was and is a highlight of my time here. The person came to the mission, and we stitched her up here. It was a machette cut... ON HER HEAD. I don't know the details behind it... I don't know if it was an accident or not. She got seven stitches put in. RN's don't normally stitch in the US, so me and one of the other RN's that never stitched before sewed her up.

   So tomorrow, I'm not sure what's happening for us medical people that are here to help with earthquake relief. The thing I do know is nothing early! That didn't seem hard to decide. We might go and see the IFM clinic and maybe go to one of the tent villages not far down the road from the mission. 

   Thanks for your prayers and continue to pray! I know that God is with me... it's evident that He is! We've been treating LOTS of malaria. I don't think I have even one mosquito bite! PTL! And we've been staying pretty healthy considering. May God be praised!    Have a great God filled weekend, juanita

 Ok, so here's some vocabulary...

ward- the tents where the overnight(s) patients stay

are you happy to do that?- are you okay with doing that?

trolly- stretcher bed or exam table

theatre- operating room

latrine- toilet

parecetamol- tylenol

   A glimpse of one day that has been similar to the past couple of days (today was different)....

Venita (an RN my age from Indiana here with IFM) and I made our way back to the ward and found Marlene(a nurse from Holland). That day only, the regular nurse, Janos (from the United Kingdom) was sick. After Venita went to visit the latrine, we made our way through the tents that were in our charge for the day and she gave us the run-down on who was going to theatre that day. You need to understand, though, that just because they're on the schedule to go, doesn't mean that they have time to get them done that day. Marlene ultimately was the one that we would go to with any questions that we had. Three of our patients were scheduled to go to theatre that day. Two of them were already gone (if I remember right), and two of them were waiting to go home (wherever that was, maybe just a tent somewhere). The ones that were going home were both young girls. 

   We had two Haitian nurses in our charge, and they were supposed to do most of the care, and we would supervise. We would like to teach the Haitians to be able to at least somewhat be able to care for the patients. What are they to do when we leave if we don't teach them?

So once we had given them time to get their work done, Venita and I went through the tents and checked charts. We checked to see that blood pressure, pulse, and temperature had been taken and within normal limits on each patient, and that the meds had been given. The meds mostly consist of Parecetamol (or sometimes it says Tylenol... same thing), Ibuprofen, and an antibiotic. They don't have that many meds. 

   Diana, an 8 yr. old, had gone to theatre, I think, to have her dressing changed or something done with her hand that she had surgery on. Diana wasn't around when I got there, but later in the day, she was in her bed. I could tell she wasn't feeling the greatest because she was in her bed and not bouncing around and following us around. She's such a spitfire and bright spot. She was up later in the day though.

   Venita discovered about five Haitian nurses around one of the patients with an IV. The patient's IV had gone bad. She was to go to theatre later that day, and she didn't need any IV anitbiotics, so Marlene was okay with us leaving it out and they would start one when she went to theatre. 

   Sometime during the afternoon Venita and I handed out cookies to the patients that were allowed to eat (the ones not going to surgery). Diana was bouncing around and wanted some cookies. I told her, in my limited Creole, to go lay down, so she slowly went and sat on her bed so that when we came by she was there and could get cookies. I didn't mean that she had to go and lay in bed all day, but she had to go and wait her turn for us to come around to her bed. So after she got her cookies, she bounced back out the door of the tent. 

   One of our patients that came back from surgery had to finish the IV fluids that she was getting and then get an antibiotic that was to run over four hours. So we had to figure up the drops per minute and then set the clamp on the tubing at the right place so that we had the correct drops per minute. That means timing and counting drops and playing with the roller clamp until it's right.

   One of our other patients that had surgery was a young girl that needed a skin graft. Not only a skin graft, but they had to take some muscle from elsewhere to fill in the gash in her wrist. So now her wrist is sown to her stomach and there's a skin flap. I just saw the drawing of what they did. She wasn't allowed to sit up more than 45 degrees. Poor girl, she'll have to have her wrist sown to her stomach for two weeks, I think is what they said.

   At one o'clock there were more meds to pass, so that meant another check around two or so. I've never been a nursing instructor, but I have been in nursing school, and I feel kind of like a nursing instructor back in the ward. But that's okay; that day we "checked off" one of the Haitian nurses to give IV antibiotics. It's not like here in the states. Most of the antibiotics are given IV push.

   At three o'clock they're supposed to take blood pressure, pulse, and temperature on everyone again. So around four we can do our final rounds, checking to see that they got it all done and checking the meds that need to be given that evening after we leave and address any issues.

   One this particular day, we started a little later. Venita and I had gotten into a discussion with one of the British nurses about Creation, and some other stuff. One of the guys (he's in nursing school and almost finished) that's working with IFM, came by and joined the conversation. I let him take over, he's good at debating and knows his stuff. He's not afraid to challenge someone and show them inconsistencies or weak points in their argument. He's a German Baptist from California. His name is Chris. I joined in on the conversation then after Venita and I got our rounds done. Please pray for our foreign coworkers. This particular guy's name is Rob. The day before that, Chris and Romona (one of the nurses her with IFM and my roommate) had been talking to one of the anesthesiologists, who is an agnostic. I love how God had given us opportunities to talk to our coworkers about Him. 

   We left late because there were so many patients to see. Poor Chris had driven that morning, and he is not experienced at driving in Haiti, but hey, we had to get there somehow, right? The ride in probably wasn't as stressful as the ride home. Chris did a great job though. One the way home, we passed about five or six UN tanks going in the other direction. Chris had to drive in the dark too, and traffic was terrible coming out of Port. He was stressed about hitting someone- a pedestrian- because supposedly Haitians don't take kindly to that. I mean, hitting someone is a big deal, but I guess you don't know if you'll lose you're life over it till it happens. At least that's what they say. We make it home fine.

   Today I was working in the clinic area where the docs see the patients. We're not really seeing earthquake victims in that part anymore. It's more like a doctor's office. You know, this ache or pain or problem. Ok, so take these pills or antibiotics for this amount of time.

   Something interesting though: Ramona and I got to do some digging around on one of the guys from the mission. He got a splinter in his hand. So I shot some lidocaine around the area and numbed it up so that we could dig. We didn't get the splinter out, but we felt it. We didn't have all the time in the world to work on him because we were really there to take care of the Haitian patients, not one of the American staff. At least we opened it up so that hopefully it can work it's way out somewhat.

   We left Delma 33 early today because we were done seeing patients in the clinic area. We went on another tour in Port. This time we went out toward the water more. On our way out there, we passed a body on the side of the road! I don't know, but we wonder if maybe it wasn't just recently dug out from rubble. And about 10 yards from the body was a guy going on with life washing a truck. But what are they supposed to do? What can they do? Stand around and gape at the destruction and feel sorry for themselves? That's one thing that kind of stands out- they're going on with life, it seems so at least. 

   And now I need to sign off. I have off tomorrow- we all do. We're supposed to have off every Sunday now. The last time I was in church was Jan. 10, and that was a Haitian church. It will be good to one day, Lord willing, go to church again with people I know who speak a language that I can understand. But meanwhile, God's children are in Haiti too, and even though I don't understand most all Creole, sometimes I know what song they're singing because I recognize the tune. Besides that, we had a singing, sharing, and praying time tonight here at the mission. We did it outside. It was nice.

   Here's wishing all a blessed week with Jesus! Thanks for your prayers. Oh a praise report- I haven't been dreaming about earthquakes and I think it's the prayers of you all- the way it just suddenly stopped and I haven't had one since!    ~juanita

Sun, Jan 31, 2010 06:58 PM

You know that you're dirty when... you wipe your face with a cloth and it comes away with blackness on it... the creases in the palms of your hands and the backs of your knuckles are black... you leave black marks on the floor with your bare feet because they got wet... it's pretty much hopeless, admit it, you're dirty from head to toe!

I pushed my feet into my flip-flops and pushed myself up off my mattress on the floor. It was still dark outside, but another day was going to be soon dawning and there were people that needed my attention. After a record breaking time of only an hour (it took us three once) to get to Delma 33 (the clinic/hospital), it was time to get to work. There weren't that many patients sitting out in the patient area waiting to be seen, but we only had one doc to see them, instead of two. We got more docs noonish or so. They were all Irish docs. One of our patients had lost her mom and dad in the earthquake, and she too would have died (although God of course could have spared her), but she was on an errand at the time of the quake. She did cry a little when she told us about her mom and dad. One gentlemen needed his stitches taken out. One of our Irish docs had sewed him up- three stitches on his nose- so I took them out.