Haiti, round 5:
Love in the Time of Cholera
Cholera is new to Haiti, but I treated quite a bit of it in Bangla Desh-
in 1982 of course, but how much can things change? It’s biblical in
its dimensions. Probably from that psychotic book of Revelations,
where the beast comes out of the ground, kills so many, and they
lie dead in the streets for three and a half days, the populace
stepping over them, afraid to touch them even to bury them. I went
down in the 22 again last Monday, came back Sunday night.
Cameron King from Bahamas Habitat was my handler. At 23,
she’s a seasoned pro at this- she has enough contacts to
seamlessly change course and plans midflight. So I stuffed the
plane to the gills with supplies from Jim Tucker at MedMission,
got through lousy weather out of BHM, and left Ft Pierce the next AM
as soon as I could get the eAPIS crap settled. It’s easier than it was.
Saw great views along the Exuma chain.
2 minute customs in Inagua, and gassed up at 7 bucks a gallon, cash- bidnez is bidnez, right? The plan was to fly to Cap Haitien, the epidemic having started in St Marc, nearer the North peninsula. But Haitian politics is pumped up. Elections are due next week, and (justified) anger over the Nepalese UN causing the outbreak in the first place led to riots, and Cap Haitien was closed. Cameron arranged for Sam Bloch from GrassrootsUnited to offload the plane and pick me up in Port. I diverted to Port au Prince, getting later now.
The gathering gloom and mountain/cloud intersection dictated a descent to 1000 ft over the Bay of Gonave to stay VMC, finally got through to approach, and I got in line- filed in behind and a little below a 727 on an ILS glide path. Wake turbulence lasts this long- burble, burble, say “what is…” and flip. …And I thank Greg Koontz- stick forward! No harm, no foul. It didn’t hurt as bad as clearing customs- $200 for nothing. Sam Bloch, founder of Grassroots,
met me with a schoolbus, and we loaded the stuff-
100 lbs of sugar, 20 lbs of salt, and 5 lbs baking soda, and salt substitute
(potassium), to make oral rehydration solution (ORS), IV fluids, and
catheters and setups, water purification systems, and many urinary
catheters I wish I didn’t bring. They don’t pee.
We went to Sam’s place, and I met a large number of young dedicated aid
workers of various stripes- builders and plumbers, organic farmers- hard
working polyglots whose main commonality seemed to be a reverence for and
history of attendance at the Burning Man festival. I need to go to that
one day.
Met Brenda, my handler, who gave me a cup of fantastic coffee.
She came back in a few minutes- as luck would have it, the doctors
without borders folks just pulled out of the slum clinic in Cite Soliel
because of security concerns, and a clinic full of cholera patients was
unattended- wanna go? We have a marine can ride in with you.
So I met a whole new Sully. Robert Sullivan, a strapping Boston Irish kid
with a Dundee sized knife, down on his own nickel and on his free time,
with Global DIRT- a strange but useful disaster response team, and we
loaded the NG tubes etc. onto a tap tap, and went down for the night
shift.
Met sister Marcella, an Italian Fransiscan nun and nurse, 25 years in
this slum, runs a 45 bed clinic now filled solely with cholera patients ,
and her assistant, sister Lisa, from Scranton. They looked beat, and
Leah, the clinic coordinator, was there, speaking great Kreyol, so we
sent the nuns home and took over.
It was a long night.
They came in droves early and again late, the neighborhood not safe in
the wee hours. It was hard to find a place to put them, and I couldn’t
discharge the recovering patients into the dark night, either- lumped
them on hard chairs near the door. A dead patient, wrapped in
garbage bags and masking tape, graced the break room floor –initially so
shocking I couldn’t go in.
But later I got so tired I napped adjacent…mosquitoes were active, couldn’t sleep
much, but to my shame, I never gave another thought to the stiff.
Brendan, another Global DIRT guy, has got serious IV skills- makes him
an all star in this circuit. He says the Haitians don’t seem to love
their kids- they don’t smile much- and points to an 8 year old boy
sitting guard over the dying 3 year old Taicha Inocent in bed 8. Where
are the parents? After daylight the parents arrive and spell the
brother- 5 other kids at home. Brendan hits most every vein, but he
misses that point. A dedicated caretaker got Taicha through the night,
the parents grateful. And he may not have seen this 18 year old boy,
carried 5 miles on his father’s back.
Cholera runs the gamut- from asymptomatic to a little diarrhea, to
important dehydration to life threatening fluid losses of 25 liters a day
(really).
These admissions are slanted toward the dying, toted in by brave family,
puking, slimed all over with shit, clammy and shocky, ghastly eyes.
Clean ‘em up and get them on a cot, then clean them up another 10 times
during the night. Look for an IV site, and try to get them started, keep
your gloves on and don’t pick your nose. Pick a number- 3 sticks, and if
you fail, put in an NG tube, and push the ORS down it with syringes. Of
course they vomit, but not all of it. When you get ahead a little, you
can start an IV line.
The mainstay is ORS, the sugar and salt solution that bypasses the
paralyzed Chloride pump in the gut, and just like in Dakkha, the clear
fluid they must drink looks so much like their clear stools they claim
it’s causing the diarrhea. Not bothering to examine that logic too
closely, I came prepared with orange food coloring- now the ORS looks
like medicine!
And there were 5 or so who were nearly dead…hearts pushing nothing at
160/min, no pulse palpable, belly skin tented up- they were dying… but
they didn’t, and as the sun purpled, then oranged the mountain crest,
their eyes were coming back out, a couple of them made some urine.
There is nothing better than that.
Home at 10, too late for breakfast, and slept through lunch. But Brenda
gave me some oatmeal- a tender mercy. It was hard to eat in Haiti this
time.
Word gets out about the NG tubes, could I go to St Damien’s tonight- a
referral clinic for Sr Marcella and others?
Apparently now an owl shift man, I leave before dinner, and arrive to
relieve Dr Roberto, a nice pediatrician from the Univ of Verona, and I
talk to him about the NG tubes, and he shows me how to put in intraosseous
lines- sort of a big thumb tack of an IV drilled directly into the bone,
and capable of running large volumes of fluid…like Wagner’s operas, not
as bad as it sounds. It was very impressive, and with shocky babies, a
great benefit compared to my atrophic IV skills. I immediately became a
big fan.
St Damien’s- a first world 120 bed hospital, where is the funding from?
The cholera area is 300 yards out back- 9 UNICEF tents, 5 full, glowing in
the night.
My new home. And we round, tents 1,2,3,4,5, and start again,
find the nurses have shut all the IVs back to low flow, so they don’t have
to get up and change them so often. Lecture them, repeat the rounds, and
find the flows cut back again. Sheesh!
Gladys and Eva, sweet French women who run an orphanage, bring in
Kinsley, 2 years old, with clear cut cholera.
He’s in a tent with 14 other kids, the orphanage crushed in the quake.
They have 4 tents with 60 kids total. We’ll fix him up, and we send them home
with bleach and instructions, but before the week is done, we see 6 of her kids
from 2 tents, and Gladys looks exhausted.
This is the shape of things to come as the disease gets established
in the tent cities.
Maybe not all of them have cholera, and we stress over this- there are
other forms of secretory diarrhea, and if we keep them here, they soon
will get it. I start a few on antibiotics, not many, reasoning they’ll
shed shorter, be less infectious if we do have to move them to the
general hospital.
It goes on for days, patients walking a few miles to a truck, riding
roughshod in the back 3 hours down for admission, in by stretcher, out on
their feet in a couple or three days.
Some I think have HIV, and they don’t recover too well.
Thursdays, St Damien’s picks up 25 unclaimed bodies from the morgue, and
pays for the privelege, trucks them out to a nice spot, Tetanyan
(kreyol=”less than nothing”), and buries them in individual, marked
graves. A very Catholic idea, imparting some dignity to the close of
these unmarked lives. So of course the leader of the band is a nice young
Jewish guy from LA, Bryn Mooser. For him a mitzvah, I suppose, and he
asked me to join him. Sure, I said.
The crew is mostly Haitian, and they smoke cigars and drink rum
ceremoniously before slipping on the overalls to get started. Haitian rum
drinking ceremony is hilarious, the bottle a baton, a fair amount of
spewing like a flame swallower, various incantations I missed, but very
funny, a bit off color, I think.
The morgue is a reeking disgrace, a dead man bloating in the entrance,
bodies stacked like cordwood, babies stuffed into crannies. Untended foul
sluff makes for uncertain footing.
The workers begin Haitian chants and bang a drumbeat on the massive
fridge, Bryn plays a tenor sax- closing time jazz, and a spooky dignity
descends. I handle the body bags- involved, but at a safe
distance, clean. At the end, I carry a few.
Load the truck, traipse through the town, and ride up to Tetanyan, passing
the huge mounds of the mass earthquake graves.
The diggers rest in the
shade, and a band pours out of a tap tap, plays hymns and jazz tunes while
we toss the bags in.
An old preacher, one of the funnier rum drinkers,
says a few prayers, all together now, and it’s done, the grave diggers
amble back up the incline.
A bit of old New Orleans, really, with music and paid criers, but there’s
a sweetness about it. Less Revelations, more Isaiah-
“In your mother’s womb I have named you, and you are mine.”
Then home through the Exumas, a balm to any heart.
Haiti’s not going anywhere, and cholera is going to be around awhile.
Suppose I’ll go back here.
Happy Thanksgiving.
