Sunday, January 31, 2010

Arrived in PAP

After many developing country delays we arrived in PAP at almost dusk. We are in a safe secure house with evangelical Christians and running water. Senses for today

SOUND:the extraordinary and truly awesome sound of the Blackhawks as they thumped and
Swooped in for the patients. Some show of force.

TASTE:the surprising hotness in tonight.s dinner. And getting used to eating like a squirrel. Lots of nuts and trail mix to keep going.

SMELL: while waiting at the US embassy for our ride, when the wind changed we caught the unmistakable stench from the collapsed building across the street only to be rescued by Vicks rubbed in our nostrils to mask it.

SIGHT:the parade of 24 gurneys ferried by 6_8 workers from all countries followed by Haitian fam members under the violent wind of the helicpter into its jaws.

TOUCH:the sweet softness of the newborn toes of the twins born at the camp this morning!

Into Haiti and back

Sitting in a large airy building surrounded by doctors and nurses of all stripes from all countries-Korea, Spain, some in spiffy uniforms, others in scrubs.

Yesterday the team I have bonded with(described before I think) went two hours away to a small village inside Haiti. People on the team who have worked in Africa said it felt like one of the remotest places they had visited there. Our flatbed truck, loaded with workers(ie us guys) and supplies arrived and was swarmed with bare children, wizened (?AIDS) old ladies, diseased limbs, and snotty nosed babies.

We set up a clinic in the church and examined about 150 people for all manner of fairly mild acute illnesses. The most striking thing was the remarkable malnutrition, including the characteristic reddish hair on jet black children. My Haitian translator said it was the worst poverty he had ever seen. We handed out mediciines even though we were missing the most basic things: food, vitamins, soap and immunizations. Huge problem of ditribution here and everywhere related to this catastrophe.

We had a great time doing this, felt like we made some small difference even if it was to pass out pain medication and make a few diagnoses of pregnancy. Had we had birth control pills, I think they might have accepted; women had 6-10 children.

waiting arrival of a blackhawk helicopter to evacuate some twenty patients to other facilities so more can come up from Port Au Prince.

Highlight of the day was my conversation in the cab of the flatbed with the Pastor who accompanied us to this village where he is a sometime preacher. He belongs to a group of 1600 pastors across Haiti who want to "reconstruct Haiti" including education, health, participatory democracy and reforestation. We were able to connect him and his organization to two on our team who have worked for the Clinton Foundation and who now work for wealthy foundations including Sarlo Foundation.

Planning to go into PAP as soon as we have permission and security from our leader (Real Medicine Foundation). Word from people there say it is beyond imagination. That food, water and shelter have still not been delivered in anywhere near adequate numbers. stay tuned.

Friday, January 29, 2010

Leaving for the border


Leaving for the border--Jimani--in ten minutes:


large hospital there understaffed for next three days til team arrives from Knoxville
will be part of plan to develop outreach clinics into "sheet camps"(people sleeping on sheets out int he open, tens of thousands of them by scouts' reports.)

New team arrived at our hospital to take over our 11 bed unit. Surgeons picking up where others left off. Good tranisiton but too many people there so glad to leave where I can be more useful.

Already bonded with DR nurses and staff: intense what happens so quickly under these circumstances.

My team going to Jimani consists of:
husband and wife in their 60's from NH, he is general surgeon, she is hippie who is community organizer and nurse.
an ER nurse from NH. a riot, nothing fazes her, good teacher, great nurse, fun to be around
a public health person from US...all I know so far who dropped her 2 yo in Texas with MOm to be here.
Kevin, 28, who reminds me of my son Nick and is workign for Real Medicine Foundation, the organization I am sponsored by. Thank good ness someone knows how to do the technology. He and I watched the state of the union the other night on his computer live.

And so I go. They want worm medicine, antifungals, dressing changes adn pain medication.

Hope to be in touch but it will be brief. Stay tuned.

Overall impression is of a vast amount of good will, way too many supplies and organization actually happenign from the ground up instead of top down. Unicef sent a young man to our clinid yesterday;he is going door to door to track Haitian refugee kids. A good start but really small. So much need, so vast, so deep. Many speak of their "pais perdu", lost country.

Wednesday, January 27, 2010

Hitting the deck running

After a roughly four hour drive from Santo Domingo to Barahona, we pulled up to the cheerful iron gates of the Children of the Nations International compound. Inside it looks like a low end hotel complex with several two story buildings, some drained water fountains, a questionable swimming pool, concrete paths leading the way through the dust. Large piles of water bottle flats are everywhere.

And emerging from buildings are trim, thin worn and sweaty doctors and nurses--but you can't tell who is who since most wear scrubs-- who have just returned after their long days to clean up for dinner. I am quickly brought up to speed on the fact that almost all of these people have been working 14 hour days for a week and are leaving within the next 48 hours.

We make rounds twice at the clinic about a mile away that was a COTN sponsored community clinic but has been re-fitted as a small hospital, with three tiny operating rooms, a ward with 8 recovering amputees and another with 4 including two brothers. All but one of the kids are up, some with both legs casted, some still in diapers, and the older boys wheeling around with their rusty chairs or oversized crutches.

Day One:
Up at four with the roosters, after a nightmare of dying in a plane crash, there was no time towaste before getting to the clinic to relieve the two night nurses.

I felt like an intern on the first day in the pediatric ICU. It's been a long time since
Striking Senses today:
Touch: the rough skin of the bare, thickened, scarred feet of all but the youngest children
Smell: the distinct scent of a urine soaked cast (soon to be changed under anesthesia in the operating room).
Taste: the wonderful comfort of chocolate after a 14 hour day.
Sound: the sound of the preacher praying with the parents of the patients early this morning. Asking God to protect Haiti, and to give wisdom to the doctors healing their children.
Vision:where to begin: with the over-stocked shelves ajumble with unusable, sophisticated supplies?; with the faces of maimed children smiling and calling out to play?; with the flies hovering over the operating table in the OR?

Actually, hands down, the most memorable vision of the day was a reunion like no other. When the team went to Jimani (the Dominican town just over the Haitian border), they picked up twelve children, including Migalena who is 12 and was accompanied by her gorgeous 18 year old sister. Although Her sister escaped unscathed herself, she had to pull Migalena from the rubble and in the process her arm was injured enough to require amputation and an enormous and deep gouge in her thigh. Their mother was in the DR when the earthquake struck and they had been separated since. Today, the girls' mother walked into the clinic and cries of "Mammy, Mammy" reverberated around the clinic. The reunion was of course bittersweet as mom processed the sight of her daugher without her left arm and coping with so much pain, but by days' end, she was braiding her daughters' hair and eating chocolate with them

I have nothing but respect for the surgeons and anesthetists who have treated these survivors for the past week. They are careful, gentle, detail-oriented and wonderful communicators. They leave tomorrow. This week's challenge will be to transition to a new team and to plan for the recovery of these children.

Tuesday, January 26, 2010

From the Santo Domingo Airport

I sit in a thoroughly modern, bright, somewhat humid airport food court pretty much like any other but for the occasional group of burly men in t-shirts with RESCUE printed on their backs. Israeli is my guess.

I wait the arrival of my companion to Barahona who will also provide the rental car. It's a few hours wait but I am thrilled to have access to my computer and the blog. And to people watch.

All my concerns about going through customs were allayed;rescue workers--or white people who might be construed as such--seem to be waved right on through. Thanks DR!

This is a venture to challenge the senses:

the touch this morning of my sweet soft bed
the taste of the first pot of Duncan Donut's coffee at JFK
the smell of the flight attendant's after shave
the sound of the planes engines, lulling me back to sleep at 6am
the sight of the beautiful earth below, holding its mysteries and making me wonder how it can actually shift and move, wreaking destruction, only a tiny bit of which awaits me.

Monday, January 25, 2010

Thinking of Job

One of the organizations I found out that I will be travelling to the Dominican Republic with tomorrow is called Children of the Nations which provides "holistic, Christ-centered care for orphaned and destitute children." Being Jewish but with lots of exposure to Christian traditions I thought nothing of it when I first realized I would be under their auspices. Later in the day I received a priority packing list from them. This includes the desperately needed medical supplies (from "general anesthesia machines" to bedpans). But it also includes a short list called "Personal Protection" which goes as follows:

"gloves, goggles, masks, scrubs, hand sanitizer, bug spray, sun screen, headlamp, Bible"

This got me to thinking about all the ways the Bible could be part of my personal protection and of course I began to think of the story of Job. And all the other tales of suffering in the scriptures. Phrases like "theology of suffering" and "the meek shall inherit the earth" and "but for the grace of G-d go I" are flooding my thoughts.

Six am flight tomorrow morning. I am packing my Harriet Lane Handbook of pediatric care, the "bible" we all depended on as residents.

Sunday, January 24, 2010

Going to Help Haiti

Dear Friends, Family, Colleagues, and Blog Followers,

On Tuesday morning I will be leaving to work for two weeks in the Dominican Republic in a hospital being set up today in Barahona, DR, about midway between Port au Prince, Haiti and Santo Domingo.(map)
Among others, they will be receiving 14 injured children sometime today. I will be under the auspices of Real Medicine Foundation and Children of the Nations that are working closely with Partners in Health and others organizing help on the ground.

Since I first heard about the earthquake, I, like many of you, have felt called to help. I hope that my language and medical skills will help make my contribution a meaningful one for those who suffer. As you know by now, money is still what they need most. So I encourage you to continue to find ways to raise awareness about and funds to help with the complexities facing Haiti moving forward.

My practice and my other work and family will be covered for me by a host of competent and caring people. If the technology gods are on my side you will be able to follow my work on my blog.

"Bon chans!" (Kreyol for good luck!)

Wednesday, January 20, 2010

Partners in Health Working in Haiti

As a followup to my last post, I want to share photos from Haiti and the work being done by Partners in Health on the ground there.

Friday, January 15, 2010

Oh Haiti!

I have to avert my gaze from the television. I cannot watch another professional CNN reporter cry on screen. The photos and stories from Haiti overwhelm. The urge to be there is pressing. I have added my name to three volunteer lists, but alas, I do not know how to amputate or operate or even stitch anymore. Comfort, diagnose, and nurture. I can do that. If you call I will go.

In the mean time, I urge everyone to contribute money to the relief effort. Most of us have our favorite, perennial recipients of our goodwill. Let me introduce you to one that is particularly relevant and effective in the Haitian tragedy-- Partners in Health.

A few years ago I read Mountains Beyond Mountains by Tracy Kidder and was swept away by the eloquent non-fiction account and the temerity of Dr Paul Farmer who has worked in Haiti for over twenty years, building an effective and simple health care system now largely staffed by Haitians who have been trained by Farmer and his team. This organization probably stands the best chance of helping the most people because it has outlying clinics and over 1200 well trained community workers, 500 nurses and 120 doctors throughout Haiti. Here is a statement by Kidder about the success of Partners in Health given just yesterday. They need basic supplies: bandaids, casting materials, iv fluids, etc etc etc.

Please consider a donation.

Wednesday, January 13, 2010

Keeping Your High School Junior on Track

Entering the second half of junior year with my twin daughters is like replaying a song. I had forgotten the tune after traversing this age with my five older kids, but it's coming back to me. Real fast.

Junior year of US high school can be treacherous. There are so many passages before these kids:thinking about college, planning college visits, figuring out oneself, learning to drive, keeping up with school, SAT preparation and exams, figuring out meaningful summer plans, staying fit, contributing to school life, and managing complex social lives. Students at this age are really stretching and reaching, trying to go it alone, working to maintain their privacy while they experiment with new friends, ideas, and lifestyles. As parents it can be daunting to know when to step in, how to be supportive, how and when to give them space, and how to empower them without ditching them.

Let's just take a few of the challenges before us and how we adults can help:

Driving: OK, so I try not to grab the passenger side dashboard when we stop within inches of the car ahead of us. She is learning to gauge these things. When driver's ed became just too stressful and the only advantage it really afforded our family was the ability to eventually drive themselves to school, I said dropping out was ok. I don't mind chauffeuring; it's a fine time to catch up on their news, or vocab words or in their case, sleep.

Fatigue: It's our job to say no when the bags under the eyes and the pallor are more telling than the wish to go out on the weekend. In my office kids tell me all the time that they are not allowed to do something "because my parents won't let me." They understand that we are supposed to put limits on their exuberance. Sometimes they actually welcome it.

Illness: Keeping kids healthy is a matter of food, sleep, exercise, stress management and good health care. With respect to the latter--two simple rules:Wash your hands and Get your shots! All teens should have had a booster on their Pertussis (whooping cough) vaccine (tag-teamed with the Tetanus booster);flu vaccine (both seasonal and H1N1);and meningitis booster (if they received Menomune more than five years ago).

NEXT ENTRY: Stress management for your Junior

Sunday, January 3, 2010

Eating to Save Your Family and the Planet

As we flip to 2010 our thoughts might turn to healthier lifestyles for ourselves and our families. Traditionally this could mean joining a gym, signing up with Weight Watchers, taking dance lessons, buying organic more often, or making other simple changes to improve our eating habits. Just in time comes Michael Pollan’s book, Food Rules, released recently in paperback, to serve us up some easy guidelines.

Pollan is the nation’s guru, educator, advocate, and activist about our country’s food and our relationship to it. He appears in the hit film Food, Inc. about the American food supply, is a journalism professor at UC Berkley, and writes prolifically.

Below are comments on five of my favorite rules that Pollan exhorts us to keep in mind when shopping for groceries:

RULE NUMBER ONE: Don’t buy anything that lists sugar in its first three ingredients. This might seem obvious until we actually look at labels, when it can be shocking to see how much sugar is in food. Remember to teach young kids (and teens) that ingredients are listed in order of concentration by weight on a product’s package.

RULE NUMBER TWO: Avoid products with ingredients that cannot be found in an ordinary pantry. This is a tricky rule since many kids and adults from typical American homes may not actually know what an “ordinary pantry” consists of. Suffice it to say that if the name on the list has hyphens, bi/tri/hexa-anything, the suffix “-ate”, or an alphabet soup of capital letters (eg MSG) we should try to do without.

RULE NUMBER THREE: Shop the peripheries of the supermarket and stay away from the middle. I checked out this rule by scanning the products at my favorite local store, Trader Joe’s, to see if the outside circuit made me a better shopper. Indeed, even at a place committed to healthy and environmentally friendlier practices, TJ’s has the junk food in the middle aisles. It also has the essential frozen pizza, the chocolate (dark and full of anti-oxidants to be sure), and the dog food in this location.

RULE NUMBER FOUR: Avoid food that is pretending to be something it is not. This includes bacon bits, soy made to look like meat, and cheese food. Choose instead real bacon (every now and then), tofu or real meat, and natural, unprocessed cheese. Pretend foods usually contain ersatz flavors made in an organic chemistry lab and then massaged (literally) to make them the right shape, texture, or consistency to masquerade as something else.

RULE NUMBER FIVE: Foods making health claims on the package are not foods you want to buy. For starters, health claims change with time and whim. Think about all the wonderful foods-whole grain bread, fresh lemons, fish on ice, bunches of kale—that literally cannot speak for themselves. To have a claim on them requires handling, packaging, shipping, and often artificial additives, coloring and preservatives.

With a few simple guidelines, we can easily be healthier and save money at the same time. Cheers to the New Year!