Haitian Courier #6: Pieces of My Memoirs

[This is a copy of the latest issue of my newsletter Haitian Courier, which was sent on July 26. To subscribe to the newsletter, please visit http://groups.google.com/group/haitian-courier]

Bonjou Mezanmi!

My last newsletter was a brief update just to let you know that I'm alive and well. This time I wanted to give you snippets of what I've been doing in Haiti for the past 6 weeks. Throughout this newsletter, you'll see words with web links, which will take you to corresponding entries on my blog.

First of all, I wanted to let you know that my return flight has changed from August 9 to July 31. The reason is that my older brother Sundo is getting married on August 2. So now I only have a few more days before I go home! Seems like my plans always change on the fly (last year I decided to stay an extra month in P-au-P). I can't believe my time here is almost over!

Secondly, I wanted to put a word out that the clinic here needs an X-ray machine to replace a broken one. Please let me know if you know anyone who needs to get rid of an old machine to replace it with a new digital one or for whatever reason. The one we have here has been broken for a while, and it would help so many people if we had a working X-ray machine.

Anyway, here are some of the things that I've seen and done so far. During the first week at the clinic, I learned how to do a breast exam, observed a vaginal exam, saw a patient with trigger finger and a very sick and hyperventilating baby. The fist weekend I went to the beach in Labadee with a bunch of people from different mission teams.

Second week, I saw several HIV patients including an old lady with an acute onset of dementia, practiced drawing blood, saw a fetus using an ultrasound, gave babies vaccine shots, and heard all sorts of lung sounds at the tuberculosis clinic. That weekend we went on a mobile clinic up in the mountains, where I got to draw lots of blood, and we brought down a girl with a machete wound to take care at the clinic.

Third week, I did some manual labor at the new seminary construction site, helped reduce a fever on a baby, saw tendons on a torn hand from a car accident, pulled a birthday prank on Vicki (another short-term missionary), and took lots of blood pressures for the hypertension/diabetes clinic. That weekend we went to Labadee again, and I went kayaking and snorkeling (for the first time). On Sunday, we saw a girl who had sickle cell crisis.

Fourth week started with the most emotionally draining day, where I saw a 6-year old boy with respiratory emergency, who turned out to have diphtheria, and two little orphaned girls who were tested positive for HIV. The boy ended up dying at a hospital, so I lost my first patient. We had saved the boy's life by bringing him to the hospital and having him intubated and put on antitoxin, but next day during the night he woke up and took out the tube on his own, and died. It was such a tragedy. Also that week, I dealt with many impatient (and non-patient) parents at the well baby clinic, got to eat a cheeseburger, and took a tour of downtown Cap-Haitien.

During the fifth week I saw a Haitian nurse open a closed hymen on a 7-month old girl, helped treat a delirious patient with fever caused by tuberculosis, learned how to take out stitches, sent Laura (another short-term missionary) on a birthday treasure hunt, rode a motorcycle, tried to resuscitate a 6-month old boy who ended up dying, learned how to start an IV, and learned how to properly clean wounds and change dressings from a Canadian nurse. On Saturday I went to see the Citadel, which was quite amazing.

This past week, I learned how to do vaginal smears, saw a lesion on a cervix through a speculum, helped take a boy with a broken femur to a hospital, distributed some food for tuberculosis patients, and attended a funeral of one of the Haitian doctor's mother-in-law. On Wednesday, there was a violent and insane woman, so we had to drag her out of the clinic.

I haven't written about the last couple weeks yet, but you can see some pictures on my web album. I will continue to write about my experiences after I come back home to the States.

Since all the other short-term medical missionaries have left as of last Saturday, it's been pretty quiet (and a bit lonely especially during breakfast and lunch), but I'm still enjoying my time here. Of all the mission trips that I've been on, I've seen and learned the most through my trip to Haiti this summer. I want to thank all the short-term and long-term missionaries that I've met here for making this such an enjoyable experience, all my friends and family for sponsoring me and for praying for me, and God for allowing all this to happen and for making this undoubtedly the best journey and the best summer ever.

Thanks for reading and for all the responses and comments on the blog!

Bondye beni w,

SunMin Kim

Blog: http://zanmihaiti.blogspot.com

Photos: http://picasaweb.google.com/doxadeo/Haiti2008

PS. Thanks to Laura, I now have a number you can call or send text messages to: +509-3727-7275 (but it's only good until July 31)

Tragedy, Repentance, Baby Hymen, and Paranoid Fever

Monday, July 14, 2008 - Part 1

This morning I found out from Gavin how the boy with diphtheria really died. On Tuesday night, he woke up when he was still intubated, and while no one was watching, he took out the tube himself, which caused his airway to shut completely. By the time someone came, it was too late. What a tragedy, and such a waste after all our efforts to save his life. How sad that the boy unwittingly killed himself, and that he died without his family around. It's one thing if he had died of the toxin, but he still had a very good chance of survival. If only he had been monitored or sedated...

We also heard a good news today. Ms. Prudence told us that the man who injured Madelene with a machete had come out from hiding, apologized to everyone at the church, and became a Christian! While he was hiding, Ms. Prudence's husband, who is the pastor of a church up in Souffrier, told him that Madelene is healing well, and that he should repent. It was really cool to hear that something good came out of what seemed to be an unfortunate event.

Most of our regular patients come on Mondays, Wednesdays, and Fridays, so we got to see many of them today. And by regular patients, I mean Madelene (machete wound), Augusma (torn hand and broken elbow), Kettelie (pubic sore), and Acephise (facial abscess). The more I work at the treatment room, the more I become familiar with these patients. It was great to see how each patient was getting better, except Acephise's abscess still seemed pretty bad. She had lots of green discharge which smelled awful as usual. Because the abscess is right on her cheek, she could hardly talk. We're still not sure if she's taking the antibiotics. I think she'll be coming to the clinic everyday now.

We also had couple of interesting cases today. Ms. Prudence brought into the treatment room a 7-month old girl whose hymen was completely closed. She wanted to show Amy how to open it. Basically she gently rubbed a tip of a cotton swab against the hymen until it opened up. It was hard to watch the little baby girl helplessly cry with her weak little voice. Ms. Prudence put some draining strip into the newly formed orifice so that it won't close up again. It looked like such a traumatic event for the little girl, but I suppose the earlier it's done the better. At least she won't remember that she had to get her hymen open. Still, it looked really painful.

Another interesting case today was an 18-year old boy named Eddie with a really high fever (105ºF) who was carried into the clinic by his relatives because he was so delirious and paranoid about everything. Whenever he saw gloves he'd say we're going to operate on him and kill him. He was scared of the thermometer and would try to dodge it. We tied him down on a bed so he wouldn't run away. We had to get three or four guys to hold him down while Gavin gave him shots of lorazepam (my class should know what this is and how it works) to calm his anxiety and sedate him.

We figured that Eddie might not be cooperative enough to take pills, so I ran to the pharmacy (within the clinic) to get some acetaminophen (Tylenol) in syrup form (which comes out to be quite a lot to match his dose). He wouldn't drink it claiming that it's poisonous. So we gave some to his cousin who had brought him in. Even after she took a sip, he wouldn't drink it saying that she didn't sip it. Then after a while of trying to convince him he finally took it and put the whole thing in his mouth. We all stepped back thinking that he's going to spit it out, but he gulped it all down. We had to repeat the exact same thing when we gave him chloroquine syrup (except the syrup was twice as much as the Tylenol) because we thought he might have malaria.

We had to get his fever down quick, so we used cold wet towels to wipe down his whole body. We kept telling Eddie to lie down and rest, but he refused saying that he would die if he lay down. We left him with his cousin while we went to lunch, and when we came back he was much calmer and was even laying down. Eventually his fever went down, so we let him go with an instruction to get sputum samples to test for tuberculosis.

Death of a Boy, Booster Shots, and Pubic Sore

Wednesday, July 9, 2008

This morning Ms. Prudence told Laura and me that the boy with diphtheria died last night at the hospital. She didn't tell us how exactly, but perhaps the toxin was too widespread. I don't know. I feel like I lost my first patient. At least he survived Monday. I wonder if his family was with him when he died.

The first thing at the clinic this morning, I helped change the dressing on Madelene, the girl with the machete wound. The wound is healing really well, but it's still very wide. Somehow we'll need to make the skin come closer. We're going to try something next time she comes.

Since today is Wednesday, we had Prenatal Clinic. Laura and I took weights and blood pressures for all the pregnant ladies. Many of them had surprisingly low blood pressures. After all the vital signs were taken, I sat in with Amy and Evan, and measured fundus heights and fetal heart rate.

All the staff who had contact with the boy with diphtheria got a diphtheria/tetanus booster shot and those who were in the emergency room with him for a long time got oral antibiotics (erythromycin) for a week. Everyone was complaining all day that their arm is sore from the shot. Luckily, I didn't have to get a shot since I got a booster in February 2006 to prepare for my trip to Sierra Leone. Good thing I brought my immunization record to prove it.

In the afternoon, I worked in the treatment room (aka injection room) mostly giving IM injections. I learned how to give glute shots in Haiti last year to treat a friend with syphilis, but the only source of info I could find on how to give IM shots was some bodybuilding website. So it was good to have Amy (Canadian nurse) and Lizette (Haitian nurse) teach me and get some proper practice.

The last patient we saw was a 17-year old girl who screamed and cried like a baby as I gave her shots of antibiotics. She had a big sore on the upper pubic area. It looked very painful, and the girl was crying and yelling, "I'm gonna die, the doctors are gonna kill me!" Amy and I tried to calm her down as we cleaned up the wound and bandaged it. Looks like she'll have to frequent the clinic to get treated for a while.

Amy joined us for dinner and shared her testimony/life story. Afterwards we played some UNO and then went over to Amy's house to watch John Q. The content of the movie was pretty good, but the quality was shoddy. My favorite part was when the doctor flicked the rubber heart to restart it after the transplant. The movie was basically a political statement on the US healthcare system.

Diphtheria Discussion, HIV Support Group, and Flight Change

Tuesday, July 8, 2008

A huge contrast from yesterday, today was a pretty slow day.

After the morning devotions, about once a week we have a meeting to discuss interesting cases and to educate the staff, and diphtheria was the obvious topic for today. It was a miracle that the boy made it to the hospital, and thanks to Dr. Stefan, they were able to speed things up. Gavin talked about different diseases that could present with similar symptoms, and others that we should be able to distinguish.

For the first couple hours at the clinic, Laura and I sat in with the HIV support group. First, the HIV counselor checked in with each patient to see how they were doing, and I tried to translate for Laura. It wasn't so difficult to understand when the conversation was mostly one-on-one between the counselor and a patient, but then I could hardly understand anything when everybody began to talk.

What I caught were something about eating well to stay healthy, coming to the clinic right way if you're sick, and using a condom every time even if both you and partner are HIV positive. At one point they were talking about food and beverages, so I wonder if they were talking about back when they used to get something to eat and drink at support group meetings. Since the government has been cutting the budget for the program we haven't been able to give them food during the meetings for a while now. But honestly, I don't really know exactly what they were talking about.

Near the end, one of the ladies stood up and sang a song about having hope in Jesus Christ. I wish I could understand more of what she was singing. In any case it was good to see the patients having a lively discussion about living with HIV. At the end the counselor asked us if we wanted to say anything, so we just thanked them for letting us sit and listen to the discussion.

About two weeks ago, my older brother Sundo emailed me saying that he and Rachel got engaged and that they are getting married on August 2. Exciting, yes. But the problem with that was that my flight back to the States was on August 9! My brother explained to me that it was the only date that could work for both of them and the families, and that he really wanted me to be there. I was bummed because I was really enjoying my time here in Haiti and also didn't want to miss my brother's wedding.

At first I thought that God wanted me to stay in Haiti, but what changed my mind was when my mother said we are to serve God for His glory all our lives, so coming back a few days early would be acceptable. Also, she wanted me to spend a little more time with the family before I went back to med school in the fall. So I agreed to come back early to be able to attend the wedding.

So today I spent some time on the phone (Skype) with American Airline to change my flight. I ended up paying $170, but I think it's worth going to my brother's wedding. My new flight is on July 31.

I had a Creole lesson with Wadner this afternoon. I hope I'm getting better at listening.

Respiratory Emergency, Witch Doctor, HIV Orphans, and Diphtheria

Monday, July 7, 2008

Today was the most emotionally challenging day in Haiti so far. So many different things, one after another, kept burdening my heart. Even writing about them causes the feelings to well up again.

First of all, Vicki and Nadine went back to Canada after they had been with us for 2 weeks. It has been so much fun getting to know them through the clinic and just hanging out, playing UNO/dutch blitz, and watching movies. It was sad to see them go, but that wasn't the hard part. After all, we can still keep in touch via facebook/email, and who knows, we may one day see one another again. They both have a heart for medical missions, so I will most likely be in touch with them.

The really hard stuff started with the very first patient we saw today. It was a 6-year old boy who had been having difficulty breathing since Friday night. When he came in, his respiratory rate was about 30 breaths per minute (normal is 12-20), and his heart rate was way up around 160 beats per minute (normal is 60-100). He was breathing so hard that, his chest cavity sunk in every time he tried to breath, just like the baby we saw over two weeks ago. Through auscultation I could here loud turbulent noise during inspiration. Even without using a stethoscope, we could hear a loud noise with each breath. It sounded like his upper respiratory tract (airway above his lungs) was blocked. We could not take a look down into his throat because there was a big risk of further irritating the airway, causing a complete blockade.

We took him to our emergency room (formerly operation room) and put him on oxygen and nebulizer with various medications to open up his airway and gave him several shots of epinephrine, but nothing seemed to work. At some point his respiratory rate was up to 50bpm. I had to auscultate his heart to count his heart rate. I couldn't distinguish the pulses on his wrist because they were faint and beating so fast, even up to about 170bpm. It was horrifying to actually hear a heart beat that fast.

The boy was struggling so hard just to get a descent breath that he would try to take the nebulizer off of his mouth or move his arms around. We all had to work together to hold him up and still. It was especially hard for me to watch him struggle because he resembled Oliguch, one of the orphans with whom I spent 4 months in P-au-P last year. It was heart-wrenching to think that he could actually die if he didn't get his breathing back to normal. We prayed so many times for him as we waited for the medicine to work.

After 3 hours (8:30AM-11:30AM), despite all our efforts, he wasn't getting any better, so we had to take the risk of transporting him to Justinian Hospital, which is over half an hour away. Gavin, Evan, Amy, and Dr. Stefan went to the hospital, while Laura and I stayed at the clinic. Dr. Stefan used to work at Justinian Hospital, so Gavin figured he would be a great help there.

Meanwhile at the clinic, there was a woman lying on a mattress just outside the emergency room. She seemed very sick, and people were gathered around to see what was going on. Soon after we sent the boy to the hospital, a couple guys carried the woman away and left the clinic. Just as they passed by Laura and me, Ms. Prudence came up to us and explained what was going on.

The woman had been diagnosed HIV positive, but she did not tell anyone in her family nor her boyfriend. Now, she was so sick with AIDS that she couldn't even walk. The two men that carried her away were from her family, and they were taking her to a witch doctor because they didn't believe in western medicine. I had heard various things that witch doctors do to their patients, most of which are rather harmful if they did anything at all. It was dreadful to think what they might do to the woman, and how the family could also suffer the consequences of HIV because many of the rituals involve mixing blood or making cuts on people with razor blades.

Then Ms. Prudence told us about two little girls, 4 and 3-year olds, that were brought in by their grandfather a few minutes ago. Both of their parents had died of AIDS, and the grandfather brought them to the clinic basically to say that he doesn't want the kids because he can't feed nor clothe them.

The grandfather said the younger one is HIV positive, so Ms. Prudence had them both tested for HIV. The kids and the grandfather were waiting for the results while she told their story. Then Laura remembered that Gill, one of the long-term missionaries, has a stash of donated clothes at the office, so we went there and brought some down for the girls. I didn't know what to say to the grandfather, so I just walked up to him and handed him what we had. He said, "Mèsi," so I said, "Padekwa," but I still didn't know what else to say, so I just walked away. I felt sorry that this was all we could do for them.

After lunch, the results came back, and it turns out that both of the girls are HIV positive, and the younger one also has syphilis. They were both put on the HIV program and the feeding program, so at least they have access to palliative care and some food. Although, HIV program has been affected by budget cuts from the government, so I don't know what will happen to it in the near future.

Later on I asked the grandfather their names and ages, and he told me that Enya is 4, and Lovely is 3. They are both beautiful and innocent little girls. Ms. Prudence gave them some food to eat here before they went home. As I watched the three of them share a little bowl of rice and beans, my heart ached to think that the girls would have to suffer the consequences of their late parents' misbehavior. And they have no idea what is happening to them.

While Laura and I were still waiting for Gavin and others to come back from the hospital, the two of us assisted Lizette, one of Haitian nurses who works in the treatment room, change the dressing on Madelene, the girl with the machete wound. Augusma, the old man with broken elbow and torn hand, had also been waiting to have his dressing changed since the clinic opened this morning, but his case is more complicated so we waited for Gavin.

Gavin and others finally came back around 3:30PM. It turns out that the boy has, of all things, diphtheria. If you are like me or most people in developed countries, you know that you get vaccinated against diphtheria (usually with tetanus and pertussis) as a kid, but have no idea what diphtheria is. It was quite shocking to know that what I saw this morning was something I would never see in the States. Even Gavin, who has been working at the clinic for 2.5 years, had never seen diphtheria before.

Fortunately, the boy is now intubated (has a tube down to his trachea for ventilation) and stable. However, besides blocking the airway with the formation of false membrane in the throat, diphtheria can cause fatal heart and nerve damage by the toxin released by the bacteria. Antitoxin is being administered, but we really don't know what will happen to him, especially because he has already been very ill since Friday. We'll have to continue praying for him.

Since diphtheria is highly contagious, and we had been in close contact with him for 3 hours in a confined space with no air-conditioning (plus he was on nebulizer, which makes water droplets that helps the bacteria travel through air), we need to be concerned for ourselves and those who come in contact with us. As a precaution, all of us went straight home, rinsed our shirts, and took a shower. Thank God we're vaccinated.

At dinner there were just the three of us: Laura, Evan, and me. It was a bit quiet and lonely, but I'm glad I still have the two with me. Afterwards we invaded Amy's house, which we'll probably be doing most of the nights from now on, and watched Spanglish. I was doing stuff on my computer (writing email, catching up on blog writing/reading) so I didn't pay much attention to the movie, but it seemed like a good movie from what I got out of it.

Today was a very long and emotionally draining day, but a kind of day that I would never want to forget.