February: A Week from Hell Part 2

In a previous post, I wrote about a team of pediatric medical students that came to Haiti from Johns Hopkins and that there were two young boys that were going to make a reappearance.  Well, here they come.  Just to recap - one of the boys was about 6 years old and had Osteomyelitis, commonly known as a bone infection that had pushed through the skin of his shin and was now weeping pus.  The second little boy had broken his elbow and never received any care and could no longer use it.

The Dr./Sr. (Karen Schneider, RSM) who was the leader of the team that found them had worked with an orthopedic doctor that was coming to a hospital outside of Cap Haitian for a few days with a team of other doctors, orthopedic doctors and orthopedic surgeons.  She was able to work out a deal with the team that that if the boys could get to the hospital, the team would be able to see them and they would not have to wait.

Enter Beth and I.  We were charged with first of all, hunting down these two boys based on pictures since we had no real information on them.  After finding them, we were to bring them and their mothers via public transportation from Gros Morne to the hospital near Cap-Hatian.  Dr. Sr. Karen would cover all medical, travel and lodging expenses.  There was also another young man who had his hip crushed between two cars who was going to come as well.  When the accident first happened, the local hospital managed his internal issues, but did not do anything about his hip and essentially he needed a new hip at age 20ish.

Osteomyelitis.  Photo courtesy of Dr. Sr. Karen. 

So, we all piled in the back of a truck and headed toward Cap-Haitian.  Public transportation in Haiti is usually quite the adventure, but despite a minor accident in our first tap-tap, we experienced no other travel difficulties.  We had no idea what to expect when we got to the hospital in Milot, but as soon as we stepped foot inside the gate, I knew that it was going to be a crazy few days.  We had no idea where the visiting orthopedic doctor was, what he looked like (other than that he was white), or where we should even begin looking.  We asked a few people and walked in circles for a while before we finally found Dr. Lovejoy.  He saw our kids, told us that his team could not do anything about the hip because they did not really have the expertise or the materials to really fix the hip, but that they would look into the other two boys.  I'm not going to go into detail about what happened to each boy because it would take forever and this is already going to be a long post.  The boy with the un-set broken elbow had surgery the day after we arrived and only had to spend one night in recovery.  It turned out that his joint was completely destroyed and the bone out of place, so there was only so much the doctors could do.  They scraped around a little bit to try and restore some range of motion, but they said that it was unlikely he would ever regain full usage.  Since then, he’s been coming to the our house for physical therapy every few days and has gained back a little range of motion and is working on regaining strength in his arm.

The boy with the leg infection was too sick to have surgery right away.  He had a high fever the day after we arrived.  At the time I wrote this way back when, he was actually still in the hospital.  Before the team left, they were able to do the initial debridement, but it took another month and a half for him to receive a second surgery.  He and his mom were at the hospital for long time - almost three months I think.  We were unable to go see them again while they were still in the north, but we were able to talk with the mom on the phone every so often.  What she told us was extremely sad.  She said that the doctors don't help her son and don't give him medicine.  She said that other moms in the pediatrics unit said that they aren't doing anything for her because white people are helping her and paying for everything.  Whether this is true or not, we will never know.  But the important part is that he eventually received the attention he needed, returned home and is walking normally on this leg and hasn’t experienced any other difficulties.  He’s going to school, running around, playing soccer and is as cute as ever!

It was an incredibly interested and frustrating trip learning about and experiencing the Haitian medical system first hand.  In order to organize this post, because I could literally write for days about everything that happened, I created a list of areas within the hospital that we experienced difficulties or challenges, just to give you all a better idea of what the system is like here.

1.  Payment

One of the first things I noticed about the hospital is the method of payment.  You have to pay for everything.  Now, this is true in the States too, but here you have to pay before anything will happen.  You have to pay whatever the fee is to see the doctor.  If you need an x-ray, you have to pay for it first, otherwise, you just sit and wait.  If the doctor needs medicine, you have to go to the pharmacy and pick it up before the doctor will administer it.  In order to get your IV removed to be discharged, you first had to pay your bill.  The boy with the broken elbow sat in his bed for a while with an empty IV bag attached to his hand, waiting for us to figure out the payment.  Because of this, it seemed like half of what we were doing was running back and forth between pediatrics and the “caisse” (cash register) and waiting in a long line of people trying to get medicine or pay the necessary fees for the people they were with.

The pediatric unit.  The hospital itself was beautiful.
It had pretty good facilities and seemed pretty clean.

It was also amazing to see just how expensive being sick it.  I know that this is the case in the States too, but I have never really experienced the actual monetary side of health care.  Costs added up so quickly between medicine, tests, x-rays, supplies like needles or syringes, food and so many other things.  Every time I was standing in line to pay for something, I couldn’t help but think about all of the sick people that I had seen in the street, at school and in the clinics that were unable to afford health care.  There was no way that the families we were working with could have afforded the care that their children needed if Dr. Sr. Karen hadn’t covered the costs.  It’s a sad reality in Haiti to see people sick with treatable illnesses that go untreated and get even worse.  It made me incredibly thankful for the medical insurance that I am so lucky to have.

2.  Speed

Haiti, in general, moves slowly and everything just takes time.  While in most aspects of life, it's nice to slow the pace down and have time to stop and smell the roses, but in my mind a hospital is not one of those slow-paced places.  I had assumed that because it was a hospital, things would be quicker, but this it seemed like everything took forever.  Not only did you have to wait in long lines for payment and the pharmacy, but after you returned with the medicine, there was another wait for the nurse to come and administer it.  “Haitian time” is one of the adjustments that you have made when living in Haiti, and while it was frustrating to have to wait, it was just another thing to get used to.

The boy with the broken elbow.  A few days post surgery.

3.  Nurses

One of my best friends at home is a nurse and I can't imagine the amount of work that she does.  I understand nursing is hard and demanding work and there are typically not a lot of nurses on duty at once.  Though I respect the work of nurses, it was frustrating to see the quality of nursing care our kids received.  The nurses seemed very burdened and downcast.  In my experience with nurses, they make you feel comfortable with whatever procedure they have to do, they spend time with you and treat you with compassion.  These nurses appeared to not have the time or energy to do any of that.  

This was another one of those things that Beth and I had to get used to.  We came in with expectations based on our experiences with hospitals and medical professionals in a completely different country and it took us a while to get used to how hospitals were run in Haiti and realize that just because we were used to certain things being done in a certain way, they were not necessarily going to happen here.

Inside the peds unit.  Privacy, not really a thing
in hospitals here.  Most units are complete open
and a privacy screen may be used if something is
being done.  Other wise everything gets done in front
of everyone.  When I was at the hospital, I receive a
shot of some kind of pain medicine and they did it
in the "waiting room/entry way" with like 5 other people
waiting and half the nursing staff because the white
girl was getting a shot.

4.  Dr - Patient Relationship

Another interesting aspect of the hospital was how patients were treated.  It wasn't that they were mis-treated, it was just different.  In the States, I feel like everything is explained to you.  "This medicine is for _______” or “I'm going to do _______ because it will do ________” or “you have ______ and this is how we're going to treat it.” or “we did ______, _______ and ______ during your surgery.  It went _______.  Here's what you should be doing to help recover.”

To our understanding, this is not really happen.  Doctors didn’t seem to tell the patient what they're doing, they just did it.  They didn’t really explain why they are going to do something, the potential outcomes, risks or anything else.  Beth and I asked questions about everything because we wanted to know that information that we were used to knowing.  Looking back, I realized that we were the only ones doing this.  For example, after the boy had surgery on his elbow, we went into the recovery room with him and his mom and when we asked her how the surgery went, she didn’t know.  It took us a while to figure out that his elbow was destroyed and that he likely wasn't going to be that much better than before the surgery.  It was a different experience for us to watch things just happen and not really knowing what or why it was happening.

Leg boy.  He was such a trooper and still is considering how
long he was in the hospital.

5.  Administration

Because we only had just enough money to cover transportation, food, lodging and some medical expenses, we ended up having to deal with administration to figure out a system as to how the kids could get the care they needed without having to pay directly and how Dr. Sr. Karen could wire money.  Having never had to deal with hospital administration before and the fact that it all had to be done in Creole, it was a little nerve-wracking.  It was difficult to find the people, the papers and other information that we needed in order to make sure everything was all set for the little boy and his mom after we left.  After extending the trip by three days and right at the last minute before really did have to go were we able to find someone that helped us figure everything out.  The head of the hospital knew what was happening, the doctors in the pediatric unit knew that the mom was going to put everything on credit and then when they were done, the receipts would go to the head of hospital.  But, not long after we had returned to Gros Morne, the mom called saying that the boy hadn't had medicine in days and they wouldn't give her credit any more.  We had no idea what we were going to do, but luckily Dr. Sr. Karen had a friend in Cap Haitian that was able to lend the mom money and make sure that she had everything she needed.

Beth and I taking a moto from our hotel to the tap-
tap station for Milot.  It was crazy!  There were
tons of people, cars, motos, animals, you name it,
on the road.  It was pretty scary and we were
almost in several accidents.  (Don't tell my mother!)
This pretty much represents how we were feeling
driving around Cap-Haïtien.  

When we first got back to Gros Morne, the trip itself seemed like an absolute nightmare.  It was frustrating, hard, sad and interesting all at the same time.  Nothing seemed to go smoothly.  Coming from a completely different hospital system meant that Beth and I had expectations on what we thought was going to happen and it took us a while to understand and remember that we were somewhere totally different and we needed to roll with the punches.  The experience did, however, shed a little light on why when we ask sick people or the parents of sick kids if they went to the hospital, they often say no.  Because many people have to travel long distances in order to get to a hospital or one with the specific facilities they may need in addition to all of the medical expenses, the hospital costs, food, lodging, and everything else, health care is often physically and financially inaccessible.  It’s sad to see in Haiti and everywhere else in the world including the States, people suffering from treatable diseases with no possibility of receiving the care they need and deserve.  

But the important part is that these two children, especially the little boy with the bone infection was able to see the doctors and get the care that they needed.  We are so thankful for Dr. Lovejoy’s team.  They were so wonderful and helped Beth and I navigate through a heath care system that we were unfamiliar wit.  They helped us so much and took time out of their schedules to check on our kids and work with the Haitian doctors to make sure they knew what they needed.  They were fantastic and saw so many people with all kinds of problems from people with broken bones, elephantiasis, osteomyelitis to the point where the bone was just no longer there and the leg needed to be amputated and who knows what else.

This little baby was in the crib next to our boy with the leg infection.  The baby was there the entire time that we were there, but we never saw anyone who looked like a mother feeding him, helping him or holding him when he was crying.  Beth finally asked a nurse about him and she said that the mother brought him to the hospital for some reason or another and then left him there.  That was a few months ago.  Apparently, this happens pretty frequently.

This young man was one of the other patients in the pediatric unit.  He was such a character!  He came right up to us, and started talking to us.  I can't blame him.  Life must have been so boring having to sit in his bed all day, unable to do anything.  They did have a DVD player and showed a movie one day when were were there, but beyond that, kids kind of just laid there.  We never really understood what exactly happened to his face, something to do with his teeth, but when we left, his mother was trying to find the money so that he could be discharged.  Otherwise, he was stuck there raking up even more hospital bills that couldn't be paid.

Thanks to Dr. Sr. Karen's generosity, Beth and I did get a mini vacation.  She paid for us to stay at the best hotel in Cap-Haïtien.  It had hot water, a pool, wi-fi and American TV.  Essentially, the Ritz!  It was a little strange to leave everything that was going on back in the hospital and come back to such luxury, but a hot shower and just laying in bed felt so good and helped us have the energy to help our boys and their moms back at the hospital.

Just hangin'!

Cap-Haïtien.

Taken in September!!  
The little boy that had the bone infection - rockin' his new school uniform!!
It was wonderful to see him walking normally and looking forward to school!
(Beth's photo)