Saturday, December 12, 2009

Do You Want Spaghetti or Bananas for Lunch?...or, Freaky Friday, again.

On my first trip to Haiti, the final day of the trip, Friday, was a crazy adventure in understanding Haiti healthcare, by delivering a baby in a Haitian hospital (‘A Haitian Birthday” post). Well, it must be something about the Friday thing, as this Friday Dec 11 offered Stephen and me yet another Grand Finale of the trip experience.
One of my main tasks for the week was to go out with the CARITAS mobile clinic team, with our 2 newly graduated midwives who will be adding prenatal care to the services this charity provides on a monthly basis in several remote rural villages. We learned only 2 days in advance that it was a “go” to do this, but I got the message to Magdala and Thelamaque, and they showed up at the orphanage at 5 am Friday…our last full day in Haiti. Soon thereafter, the midwives, Stephen and I, with a big bag of supplies and prenatal charts, and piled into the Toyota Land Cruiser, with the CARITAS team, 2 Haitian nurses and a driver. Being a driver in Haiti is a REAL job, really a profession. The roads are so terrible- rutted, with blind curves, and the traffic on them so heavy and diversified that driving is more like a rally road race than a “ride in the country”. We were a little behind schedule after waiting for our tardy interpreter, so the driver put on the gas whenever he could. Random donkeys, other trucks, chickens, goats, and deep potholes of course interfered, but he was valiant. We rumbled along in our Land Cruiser as the sun came up and the road got rougher after we left the paved part in Los Cohobas. We stopped to pick up, or drop off items or messages on the way, and the journey lengthened into a 3 hour adventure that included both Magdala and me getting carsick from the crazy turbulence, dust, and heat.
THEN we arrived at our destination; the itsy bitsy village of Rosec, with its tiny church and parish house compound. As we parked in the dusty courtyard and folks began to bring pieces of broken furniture, benches, and tarps which would build our “clinic”, the driver asked us “Do you want bananas or spaghetti for lunch?”..It was 9am, 90 degrees, and I’d been vomiting. Gee Whiz….decisions, decisions! Neither Stephen nor I had any clue how to reply to such a random question, and not much interest in lunch at that point, though we did find it intriguing that it was going to be obtained from a “restaurant”…one of which I really hadn’t seen yet that day…but anyway. Based on the status of the village, I didn’t want to expect more than anybody else would be eating that day, and if the menu was bananas or spaghetti, I’d eat it and be grateful. I said whatever they wanted to get was fine and passed over some cash.
We set to work, opening our bags on an ancient table that once had 3 planks, but now had 2, the middle one missing. We also had a small table for our desk, a couple chairs, and they got a bench from the church for our patients to recline upon for exams. Tarps were stretched to define our space, and one for shade, as the sun was getting higher. Meanwhile our patients were filling the “waiting room”—a bunch of other benches out in the middle of the courtyard. I am proud of our new midwives. Magdala and Thelamque are new at midwifery, and I am pretty new to practicing in Haiti, but we made a good team. I provided an organizing element, monitoring and assisting the giving of meds, physical assessments and plans of care, using faithful Manno as interpreter. The Haitian midwives had good ideas about practical Haiti things, like putting the bench so that the head was “uphill”, and discarding the urine samples in a gravel pile nearby. They were diligent and competent, recording each pregnant woman’s history and not shocked at the standard answers, which often involved 6-10 pregnancies, histories of prematurity, hemorrhage, and infants who died of unknown causes. Most women had no idea what their diagnoses or problems had been—there is very little discussion, education, or explanation given during Haitian health care, when the people to receive it. The women we saw had no previous prenatal care, and ranged from 16-35 weeks gestation. This also involved a lot of guesswork, as most women also had no idea how far along they were. Hopefully the “new Haitian midwives” we’re training will be communicators and educators with Haiti’s women.
Stephen took great photos and film of all of this, and reported to me several times that ”they just keep waddling in!”, lining up on the benches. Well, sun got higher, the day got hotter, and lunch came from the restaurant in styro boxes. We paused to eat. It was fried chicken, a couple very scrawny but tasty wings, actually, and boiled plaintains—aha! that was the “bananas” part of the lunch order!! Apparently it was a “choose your starch” question; we could have had “spaghetti”!! Darn it. This was the Haitian equivalent of “fries or baked potato?” Oh well. It was something to eat, and it was brief, as we had a message from the CARITAS nurse, who was working across the courtyard, asking us to “move it along, the ladies are complaining about waiting." In Haiti?? Tired of waiting? It seems all these folks have to do is wait! Some of their friends even came to wait with them, for entertainment! Do they have other appointments? We’re doing our best, lady! But we tried to speed up.
In my USA practice, a “New OB” appointment is the longest one. Even with nurses to help, it takes a good 30 minutes to start a woman’s pregnancy care and have a handle on her situation. Our Midwives for Haiti mobile clinic was new to Rosec, and the women had never seen anybody for care, so we had nothing but “new OB”s” all day. But we saw 18 women, provided Prenatal vitamins, iron, and administered worm medicine to everyone. Some we treated for other problems, including a terrible case of pneumonia that I would have sent directly to the hospital if we had been in the States. As it was, I put her on oral Amoxicillin and Zithromax, with the advice to GO to the hospital if she felt worse or not better in 1 or 2 days. I hope she gets well—it’s a long, hard journey from there to “the hospital”, and not much reliable help even when she gets to one.
After lunch, Stephen had shot most of his film and battery. He disappeared for a while… Then he came around the tarp while I was working on my lab desk/broken table,…looking a little… disoriented?...astonished? and said “Mom, I just attended a Haitian funeral.” This stopped me in my tracks, just for a minute, as I was seeing the pneumonia lady and was also running out of vitamins…I looked at him, and said;”Yeah? I bet that was different?!”…Oh, you will never believe it, he said—and gave me some details, only a few, until later—but it included a procession singing and dancing,
Drumming on buckets and drums
Banging machetes
Drinking alcohol and spitting it on the coffin…
But then, the coffin did not fit in the mausoleum,
So they hacked it up with machetes until it fit.
The widow seemed to like Stephen’s presence, and stood with him a minute, then basically signaled that he should leave. Which he did….so he came back to the compound with that funny look, and a wild story to tell later.
By then I had run out of vitamins and iron, but the CARITAS nurse said I could send the ladies over to her nurse who would give them some, but I had to “write a prescription”. I asked Manno: how in the world I do that, in Creole? On what form? But we just punted…I pulled out my little notepad, and he helped me spell out “Name” (Nom), “date” (Dat) etc., and we wrote a Rx template in Creole. I had a dog wandering under my half a table as I wrote these, and I have no idea where these “documents’ will go… but I wrote Creole prescriptions and the ladies got vitamins. And iron. Oh, what a day. It only took 2 and a half hours back, and no one lost their lunch—the lunch of “bananas” and chicken. It was the Freaky Friday, final-day-in-Haiti, all over again.

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