Friday, May 20, 2011

Last Day of THIS Journey

Today was the last day at the clinic. We are flying out tomorrow. Highlights of today were 1) the snacks and juice that Janet so graciously suggested that we buy and share with patients, families, translators, nurses and children who come to the clinic, and 2) the lapboard I found for Mr. Delille, who finally came back to see me. It was my last time to the supply closet. I thought that maybe, this time, I might not find what I needed. I kept looking and looking and a divine voice inside my head told me to get down on the floor, look under the shelf, behind a box and there I would find the very thing I was looking for—a plexiglass board that fits on a wheelchair to support his right arm. With some adjustments, Andrew (one of the translators and someone who would make a great physical therapist one day) and I attached the lapboard.

He had such significant subluxation that a shoulder sling was just not enough. To make such a wonderful find for Mr. Delille was a fitting way to end the journey at the clinic.

I extend my gratitude to Global Therapy Group for the opportunity to volunteer. I have left a piece of my heart in Haiti and look forward to the day I can come back to feel my heart become whole again.

Thursday, May 19, 2011

Feeling Anxious

From my journal: “Can’t sleep tonight. I am anxious about leaving. I am anxious about the patients we need to see tomorrow.” I especially was worried about Mr. Rousseau at the Pavillion Nursing Home because he was getting skin breakdown and needed a new seating system and schedule for pressure reliefs.

Friday, May 13, 2011

Raymond's Eyes

Today, I cried for Haiti.

I cried alone.

I cried with Janet.

I was overwhelmed with sadness. Raymond, my patient with watery, sparkly blue eyes—he did it. We just connect. And I want to do so much for him and the others that I see. The patients and family members tend to be happy, resolved, welcoming and appreciative of the help that we give. They certainly do not exude sadness. I think my feelings come from a sense that there seems like there is so much to be done, not just with Raymond, but with so many people I have met.

Haiti may need a school to teach physical therapy. There is only training for rehabilitation technicians. My patients following stroke needed occupational therapy and speech therapy, too. I felt deficient in these therapies and longed for consultation with these other health care providers.

A friend from my church told me to keep a journal when I went to Haiti.
So, I did.
My friend told me to make sure I wrote down any of the times that I saw God.
So, I did.
Today, God was in Raymond’s eyes, in Janet’s hug and in all the stories.

Monday, May 9, 2011

Offering Hope

It was on this day, that I felt compelled to write a quote from the Haitian-English Medical Phraseology text in my personal journal. The packet was left on the dresser by my bed to help us translate words like kanpe (“stand up”) and chita (“sit down”). These are the words, that after a few days of working at the Global Therapy Group clinic, I felt like I was beginning to comprehend: “You are here to offer hope to a people that has only too often resigned itself to death. The role of health care is to avoid or relieve suffering; there is more suffering here than in most places. “

Today was my first full day at the clinic. I loved seeing the patients—all of them. Their smiles were bigger, brighter and more numerous than I can remember seeing in one day…ever. My first patient of the day was a young girl with a club-foot deformity who needed a lift for her shoe, to help her compensate for a leg length discrepancy. I wondered if we would have anything in the supply closet that would give her the extra couple of inches that she needed. So, I went searching and found a cast shoe that was almost just the right height, one that she could use with different shoes and made her feel much better!

Trail Magic

About 10 years ago, I went backpacking on the Appalachian Trail, which traverses the mountains from Georgia to Maine, for about 5 months. On rare, surprising occasions, I was able to find exactly what I needed (or maybe just wanted)–such as a cooler full of sodas after hiking 15 miles or the tip for my walking stick to replace the one I wore out completely. This serendipity was coined “Trail Magic”. This is the feeling I had EVERY time I went up to the supply closet. Although the supplies were very loosely organized in some parts of the closet, my trips there always seemed divinely orchestrated and allowed me to provide AFOs, wheelchairs, cushions, canes, arm slings, air casts, splints, and elastic bands to my patients. At times, I might not have found exactly what I thought I needed, but was able to fabricate it, like an arm and wrist splint to fit my patient whose custom splint no longer fit his arm that was weakened by non-use following a stroke.

It seemed that so many of my patients following stroke had exceedingly weaker upper extremities than lower extremities. Not sure why that is. I think education on the concepts of learned non-use and the potential for neuroplasticity and recovery of function are ones that would benefit the patients and families, and possibly nurses and doctors.

The families have so much responsibility for their family member, from the moment he or she is admitted into the hospital and especially after the patient goes home. I had the pleasure of seeing one patient, Madame Marie Martha, from the day following her stroke in the hospital, and later in the clinic after she was discharged home. She was fortunate to have many family members helping her while she was in the hospital…3-4 different, genuinely caring, and concerned people in the room every day. The challenge for me was making sure everyone involved had the same education in order to provide the very best care for her. Everyone needed to know the precautions for protecting her arm during transfers, how to use the gait belt, and the importance of trying to encourage her to do as much for herself as possible during activities of daily living. Hope for recovery increasingly became a focal point of the family and patient education when I worked with patients following stroke. This made patients smile. I felt an increasing obligation to make sure I gave the best care possible so my patients had the best shot at regaining their lives.

Saturday, May 7, 2011

Arriving in Haiti and beginning work at the clinic

We arrived in the morning at the airport and our driver came to pick us up…he had stayed at the airport until late in the evening the night before waiting for us, so was glad that we had finally arrived safely. We had our first experience of being on the roads, scooting in and out and around the crowded streets of Port-au-Prince. Our trip was slowed by a funeral progression in the streets, with loud singing and dancing in front of and behind the casket being carried. It was a bumpy, exhilarating ride and I tried to soak it all in as I began the journey.

We dropped off our bags at Caroline and Henri’s house. They and all of their lovely children would be our hosts, companions and guides…each at different times, sometimes all at once…throughout the next two weeks. I was anxious to get to work at the clinic, since that is what we came to do and we were already late. Saturdays are a shorter day, but there was still time to see one patient, Ruth. She was the first of many patients whose sweet smile and gentleness made for an instant connection. Even though I did not know hardly any Creole, the translators helped me determine that she had some weakness and pain from a previous fracture in her leg. Being 14 years old, her main problem was that she could not run and play with her friends without hurting. So I gave her some exercises and Janet, my friend and fellow PT did some drawings for her home exercise program. I made Ruth laugh when I asked her if she was REALLY going to do the exercises. As she assured me that she would, I thought…I CAN do this (because I was worried about not being confident and not speaking the language well enough) and I that I might really be able to help the patients at the clinic.

Cynthia, a Canadian PT and seasoned volunteer at the clinic, then asked if I wanted to go with her on a home visit with a patient following stroke. Without hesitation, I joined her in the car with the patient’s son and their driver. I was slightly unnerved and concerned by the sight of the driver blessing himself before starting the trip, as well as by him making certain all the doors were locked in the backseat where Cynthia and I were sitting. But, of course, we made it safely, as I did many more times during by two weeks, as Alix became my patient. Before I volunteered, I was worried that I might not be able to help as much as a PT with more experience with patients with amputations, since that seemed to be the injury I heard most about happening after the earthquake. In the United States, I treat mostly patients with neurological problems and was surprised when Donna told me the clinic was seeing a lot of patients following stroke.

In Alix’s home, the porch rail became the parallel bar, the length of the porch became the gym and his very low bed became the mat table for exercises. Although he spoke Creole, French and English, his dysarthria and expressive aphasia led me to use more tactile and visual instructions than words, making spoken language less necessary for treatment. His son, Alex and friend Sonya were exceedingly helpful with physical and communication assistance. And when Sonya turned up the music a bit on the stereo one day, I danced a bit and shared a smile and a laugh, and later hugs. As my friend Janet noticed within hours of being in Haiti, smiles, laughs and hugs have no language barrier.

Friday, May 6, 2011

Charlotte and Janet's Journey Begins

This was the day Janet and I were supposed to arrive in Haiti to begin our volunteer time at the Global Therapy Group clinic. But instead, the generous pilot and owner of the private plane we were in, Jerry Smith, decided not to land in Port-au-Prince at night. Seemed like a prudent thing to do. So, our next option was to land on the island of Exuma in the Bahamas…of course! This was not part of the adventure I expected, but I rolled with it and enjoyed an amazing sunrise before we left for Haiti…again. Highlights of the first day of my journey were seeing a beautiful rainbow with absolutely brilliant greens and purples from the plane—so close we could almost touch it…and later, listening to ABBA on XM channel 70’s on 7 while flying through clouds that looked like the glaciers of Alaska.

Monday, February 28, 2011

Ann in Haiti---Week Two

It is the beginning of our second week in Haiti. Time is going so fast! I can’t believe that we will be headed home in just three more days! Friday was a special day. One of the patients who I worked with last year came for a visit. Anese was 6 months pregnant with her first child when the earthquake hit last January. Although she lost her L leg below the knee, she did not lose her baby. Isaac was born last April 14th. When I met Anese she was 8 months pregnant. She had had her leg amputated and had just been fitted for her first prosthesis by a prosthetic team visiting from the US. She was very determined and was never too tired to work with me. She asked me if she would be able to climb mountains with her new leg. I assured her that she would be able to do most anything if she was willing to work hard. In no time at all she had mastered walking with two crutches on level surfaces, then the stairs. By the time I left she was able to walk on level surfaces and stairs with only one crutch. Despite her determination, there were many obstacles for Anese. It was not just that she had lost her leg. It was that she had lost her leg, was 8 months pregnant, had no shoes, and had no home. When I met her, her entire family was staying in her hospital room because they had no tent and no place else to go. I managed to find her a pair of shoes to wear so we could walk outside. When we left Haiti, we managed to find a 2-person tent to give to her. One day when we were practicing walking, I asked Anese what she was going to name her baby. I was very flattered when she told me that her baby would be named “Ann” after me. I asked her what she would name the baby if it was a boy. She assured me that, “It will be a girl”.
When it was time for me to go home last year, it was hard to say goodbye. I felt a connection with her and this baby! I last spoke with Anese last April when one of the translators I had worked with called me from Haitian Community Hospital. He had gone there to work and found that Anese had had a baby boy! She asked him to call me so that I could name the baby since he could not be named “Ann”. I told Anese through the translator that she had been through so much with this baby and that I thought she should choose his name. She insisted that I was to name him. I was not sure what to do, so I told her “Ann means grace. Choose a name that means grace”. The baby was named Isaac. When Cholera hit Haiti, another of the translators tracked Anese down and was able to give me the news that she and baby Isaac were OK and had not gotten ill.
Friday, Anese and Isaac came to the clinic to visit. Anese had a new socket for her prosthesis and was walking with one crutch. We gave her some new socks to help her prosthesis to fit better as her leg had shrunk more. I showed her an exercise to do to help her not to limp. Then we spent time visiting and took turns holding baby Isaac. Anese told me that I was his godmother and that my daughter Maria who is here in Haiti with me was his sister. She asked me when I would be able to come back for his baptism. I told her that I thought that she would need to baptize him and that I would be there in spirit. Isaac and Anese looked wonderfully healthy! He is beginning to walk when someone holds onto his hands. Anese was very happy when I gave him some shoes that I had brought and two little outfits. (What is a godmother to do but bring gifts for her godchild?).
I asked Anese where she was living. She told me that she and her husband and baby Isaac were still living in a tent city in the tent that we had given her. She told me that neither she nor her husband were working. I asked how they were managing to eat with no money. She told me that friends, family and her church helped them. She asked me for money to buy formula and diapers. I gave her the 10 dollars that I had brought to the clinic with me that day.
I don’t know if I will ever see Anese or Isaac again. They don’t have a mailing address. I have a phone # for her, but since I don’t speak Creole, talking on the phone is not a really viable way to keep in touch. Clearly, the biggest mountain that Anese and so many of the people here still need to climb is the huge mountain of poverty, lack of work, and lack of resources. It can seem so discouraging. Even though I have been here twice, supported by lots of good people at home who have donated to pay for the cost of coming, and bringing equipment with me each time I come, it does not seem to be enough. I have so many resources in this life. Coming to Haiti makes me realize that even more and gives me even greater gratitude for those gifts. It also makes me want to do more for Anese and all of the people who I have worked with here. Despite at times feeling overwhelmed by all there is to do in Haiti and being unsure of the best ways to help. I am so grateful to have had the opportunity to use my skills to benefit people here. I am also grateful for the opportunity that my daughter Maria has had to be here with me, to appreciate all of the gifts that she has been given, and to experience the joy of sharing the gifts that she brings to the world in being herself and in caring about others.

Thursday, February 24, 2011

Ann in Haiti--- Day Three

It was our third day in the clinic today. Bridgitte walked with her walker with a platform attachment 20 feet with only contact guard! She also put her brakes and footrests on and off by herself. Her daughter said that she needed minimal help to transfer. Bridget was very excited that we gave her the walker to take home! Progress!
Doing PT here can be a bit frustrating at times. Yesterday I worked with a man who had had a proximal Tib/fib fracture stabilized with an external fixate. He had -20 degrees of ankle DF, a lot of soft tissue scarring, and edema. After some edema massage, joint mobilization, passive stretching, wrapping with an ace wrap, giving him a night splint and gait training to try to keep his heel down as long as possible during stance, he went to see the orthopedic surgeon. He came back afterwards saying that the doctor said that he needed a different type of ace wrap. Since we did not have any other ace wraps, we decided to walk into the hospital and talk with the doctor, and see what he had in mind. The doctor wanted a wrap that went around the patient’s ankle to keep him from externally rotating. I explained to the Dr. that I felt he was turning his foot out due to his lack of DF Range of motion, which we are working on, and that I was not sure that wrapping the ace differently would help much. The Dr. was very pleasant, but insisted that wrapping would help. So the pt and I walked back to the clinic, and I wrapped the ankle again…. Clearly, the surgeon did not have much exposure to PT and was not used to working with another professional who might have expertise that was different from his. But, he welcomed me to come and see some patients with him on Friday. Maybe we can educate him about what a PT has to offer just by the exposure!
There is a definite need for PT here, but the patients and Dr.’s do not always realize what we have to offer because they have had little exposure. There was no history of rehab in Haiti until the earthquake when professionals from around the world came to help. Since then, however many of the patients hurt in the earthquake seem to have disappeared. The host at the guesthouse where we are staying says that many are just coping as best they cannot realizing that PT could help them more and that it is available. The more that we are here helping people to get better and helping surgeons to have better outcomes, the more the word will spread. Ultimately, there is a need to train rehab professionals in Haiti.
Tomorrow is another day! I am planning to show up and see patients with the orthopedic surgeon being very diplomatic in my suggestions!--- Ann

Tuesday, February 22, 2011

Return to Haiti ---Ann, PT

After eleven months, I am back in Haiti. It is so wonderful to be here. Despite all of the chaos of getting around every day, there is something about this place that calls one back. I find things much improved in some ways and much the same in others. There are noticeable improvements in the airport. It was much less chaotic getting in, getting luggage, and meeting our ride. We had one bag that did not arrive. We were pleased to find that there actually was a procedure for tracking where it was and getting it back (which hopefully will happen tomorrow!). It did take me almost an hour to stand in line and fill out the paperwork; but still, our hosts tell us that we can actually expect to get our bag! There is much less rubble everywhere than a year ago. The hospital where we are working is now almost empty of patients. There have been repairs to the roof, and there are few foreigners to be seen.
What has not changed is that there continue to be people in need of basic healthcare. This morning we worked with a patient whose blood pressure was 200/105 at rest. She had BP medication but had not taken it in three days. It is not clear if this was due to lack of money to buy the medication or lack of understanding of its importance. Another patient who had diabetes complained about feeling dizzy. I asked her when she had last taken her blood sugar. She told me that she had done it the day before and that it was 250. She had insulin in her bag, but clearly did not understand the basics of monitoring her blood sugar and adjusting her insulin based on what it was.
I spent a fair amount of time this morning working with a patient, “Bridget”, who had had a stroke. Her daughter was also there for physical therapy because of back pain caused by transferring her mother. It became clear quickly that Bridget was capable of a more active role in caring for herself than she was currently performing. By the end of the morning, she was able to put her wheelchair brakes and footrests on and off by herself and had begun to propel her wheelchair with her unaffected arm and leg. We then spent time teaching her daughter how to transfer Bridget without compromising her back, and to encourage her mother to do as much as possible for herself. Hopefully some of this teaching will “stick”. I know, from my time here a year ago, that the culture of illness/injury here is that the ill person is passive and to be cared for. Changing such attitudes in both patients and families is not an easy or quick process. Never the less I have hope for Bridget as she seemed eager to do more for herself and quite proud of her ability to begin to walk with a walker and platform attachment.
There is much to be done in Haiti and it can seem overwhelming at times. When I am working with patients like Bridget and her daughter, I take solace in knowing that for these two people there is something that I can do to help to make their lives a bit better. Tomorrow is another day! There are many “Bridgets” here in Haiti who can benefit from the work of Global Therapy Group and the skills that I have to share. ---- Ann