Lizandra--- Tu as un boun-boun?

It's hard to believe I’ve been here for 9 days already.   The first week here I enjoyed a  good digital break. The wifi wasn’t consistent so I took advantage and hardly used the computer at all.  This week I've reconnected and am ready to share the trip with you.

So much and so little has happened.

Everyday is an adventure and everyday is mundane. It feels like many of the stories can get lost in translation.  How do you share a country and a people with words on a computer screen?

I guess through stories, so here is one:

The other day we were on our way home in a tap-tap, a pick-up truck converted into colorful and packed public transportation, and one of the volunteers decided to give her Creole a try.

She asked a little boy who was eating candy: "Tu as un boun-boun?" The little boy didn't answer.  She immediately looked at me and said, "I think I just used the wrong word for candy."

She took out her Creole dictionary and pointed to the definition boun-boun = vagina.  She just asked the little boy. "Do you have a vagina?"  Luckily he didn't understand anyway- but oh my did we have a good laugh.

The days are filled with funny culture-gone-awry and experiences such as that.  But they are also filled with the reality of the tough life in Haiti. 


Today, Louise the PT from Sweden, worked with a little boy named Andy who was stuck under a building for hours in the 2010 earthquake. He suffered brain damage and damage to his left arm and leg.  He smiles and plays and is an amazing testament to the strength and will of the Haitian people.  He had been in last week and Madge made him a brace to help his arm, and today Louise confirmed that it is helping and created clever games to help him improve his strength and coordination.

This is the Haiti I am experiencing. A gorgeous vibrant country filled with amazing and resilient people. And little girls who are close to dying of a totally preventable disease and little boys who are doing the best they can.


 

Two days ago at the Global Therapy Clinic we saw a little girl named Evaline who had just had her first birthday. She was in very bad shape, incoherent, no grasp reflex, no eye contact and real sense of awareness of her surroundings. The PT's did an assessment of function, she was clearly disabled. But we were trying to understand to what extent and what we might be able to do to help.  As they did their assessment and asked more questions it became clear there was something more going on with the little girl. She was sick, very sick.  We told the father he needed to take her to a hospital right away. One of the PT's wrote a referral form to the free hospital nearby. They left and we hoped with all of our hearts they would take her.  We called the next day and they had gone to the hospital and Evaline had Cholera.  Please send her your prayers and love.

Kate---How Haiti Touched my Heart and Changed me Forever

During my two weeks in Haiti, there were so many patients who touched my heart, but two who have found a permanent space in it. My first day in the clinic I met a beautiful woman named Madame Bleck. She had suffered a recent stroke and was very affected on her right side. I am an OT who specializes in Pediatric acute care so to assess, treat and communicate

directions to an adult post stroke took some grad school recall and some trial and error. I’m so grateful to Pascal and Andrew who sat patiently as I thought out loud waiting to translate my instructions. Madame Bleck also sat patiently with a smile and always carried out everything with 100% effort, wanting to do more than what was asked of her. She never showed frustration and had a great sense of humor. I was moved by the two things she really wanted to be able to do. First, to safely transition in and out of kneeling to pray and second, to return to her position as a greeter at church. She was so determined and sharp that many times I’d tell her what I wanted to try and before the translation was complete she would be showing me a very similar task she had come up with at home. I can say with certainty that she is the hardest working patient I have ever worked with and under all her strength was an even more impressive humility and softness. I will not soon forget all that made her beautiful especially her laugh. At the end of 2 weeks Pascal, Madame Bleck and I would be laughing as if I spoke Creole and she spoke English. Her happiness was contagious and

I will miss her.

The second was a young boy named Woodly. Not only did he get into my heart, his story broke it. When we arrived at the clinic Monday morning, there was a line of patients all

familiar, with the exception of a father holding a school aged boy like a baby with so much sadness on his face it broke my heart. I soon learned that Woodly was 8 yrs old

with a newly diagnosed seizure disorder. He had a seizure that lasted 4 hours Friday and he hadn’t walked, talked or performed any functional tasks since. This was very

different than the seizures he had experienced before. My head was spinning and I couldn't believe that a child who had a catastrophic seizure 2 days ago was not in a hospital. I

did a very gentle, basic evaluation and with the help of Pascal and talked with Woodly’s father about what I was seeing that was hopeful and the things that were concerning. I got

a splint for his hand and sent them away with a very simple plan for the evening and told them to come back tomorrow. I cried my eyes out that afternoon. I have seen how

devastating and difficult seizure disorders can be when you have all the resources in the world. I felt so inadequate. Woodly came back, and over the next two days was showing a lot of Improvements. He was sitting with minimal help and walking with help from his father. I knew that there was still a mountain to climb because he had very poor motor control

and no safety awareness. He also showed obvious visual deficits, but he had a smile on his face and a new energy in him and everyone, even the other patients that had seen

him change in a week felt like smiling. But it was a short celebration. During therapy that last day Woodly had another seizure. It didn’t last long but he quickly returned to the

quiet state that we first saw a week earlier. It was at this point that his father expressed his despair. This is his last living child and he can't do anything to save him.

He asked me to take him home with me so he could have a better chance. I saw so much love and pain coming from him and it took everything I had not to break down right there.

I promised that I would look into the available local resources and that’s when I saw how important this kind of

clinic is in Haiti.

Seven days later, I was sitting in a restaurant in St. Louis as Jo Ann, the executive director and co-founder of Global Therapy Group took down Woodly’s name and said there is help available and that she will get the process started. Alone in the clinic that day I felt inadequate because I was thinking I wish "I" could do more. That night at dinner Jo Ann said, "It takes a village"  and she is right. As if working at the clinic was not enough of a gift, it is impossible to talk about this life changing trip without including the Hudicourt/Theodore family and the amazing experience of being a guest in their home for two weeks. From the moment I first spotted Anel my driver at the airport, until he hugged me and dropped me off two weeks later, I was surrounded by smiles, laughter , warmth and care from Henri, Caroline, Pascal, Vincent, Anais and Jessica. It’s amazing how well you can get to know people in a short time when you turn off the distractions and tune in to each other. We told jokes, played games I hadn’t played in years, and some that were new to me. I laughed harder on my trip to Haiti than I had in a long time. I feel blessed to know them all and look

forward to seeing them again. I wasn’t ready to leave Haiti. My heart was so full and I was

just getting really comfortable in the clinic and wanted more time. Haiti is a special place. There is so much need and so much work still to be done, but it is a reality that

co-exists equally with a sense of hope and great love for country. And more importantly, for family and each other. It is a magic I have not felt in any other place. I will miss

it all, but I can take the lessons I have learned back home

and start creating some joy where I wasn't finding or creating any before. It wasn’t goodbye for me. It was “See you real soon and until then I say thank you!” to Haiti and the amazing friends I have made there. You sent me home a better version of myself and I am so very grateful.

                            
                             Woodly

Madame Bleck

                           

Kate---My Dream of Haiti

My trip to Haiti felt like an old dream realized and the

beginning of a beautiful new journey...... It was through art and music that I developed a curiosity and connection to Haiti as a young girl and when I was 16 I begged my father to let me go to there for a school service project. I was the only girl of 5 kids, he shook his head

no and said he just wasn’t ready to let me go so far away on my own. I went off to college, life happened, my responsibilities increased and Haiti became a distant dream. This year I woke up and realized I was stuck, I was living my life with my head and I was not going for what

was in my heart. I made a list of my hearts desires and going to Haiti was #2. I sat at the computer and googled “Occupational Therapy in Haiti”. The first hit was Global Therapy Group. I watched Donna’s video, emailed her the next day and on July 14 I landed in Port au Prince.

I knew very soon that I had landed right where I was meant to be. From the amazing welcome by Caroline at the guest house to Andrew’s big smile first thing Monday morning, I felt the fear of the unknown fade away, being replaced by the warmth of the smiles coming from the people waiting patiently for therapy in the morning sun. I sat on the patio that first Monday night and was overwhelmed with gratitude that I was there and I was so excited to go back to the clinic in the morning.

The first thing that became obvious in the clinic was my dependence on equipment and resources. I would look at the child I was working with and my head would go,"I wish I

had a ...” Or, “I really need a ...." The limited amount of equipment available in the clinic forced me to clear my head and just think. I problem solved and talked to Andrew or Pascal about what I wanted the child to do so they could translate and direct them, and I soon realized the clinic didn’t have what I was used to but it had enough. This process was anxiety producing the first few days not because I needed things I didn’t have, but because I was

used to having so much 'stuff'. I had stopped using one of my greatest tools as a therapist...my mind! This realization made me mad and I was all of the sudden motivated by the challenges, humored by some of the less than stellar ideas I had, and inspired by the gratification that comes with successful problem solving. I am a natural communicator. It has been a strength I have relied on clinically and I was curious how the language barrier would impact my connection to the patients. It took a little getting used to, I struggled with knowing, who do I look at. How much do i say at one time? And things of that nature, but I also realized that the process creates this beautiful moment of complete silence. I would sit and listen as Andrew or Pascal relayed information to a patient and as the patient was responding, I wasn’t already thinking about my own response or asking a question that may change or interrupt their thoughts. Because I didn’t understand the words they were saying, I was just sitting and listening, watching the faces and body language of the patients waiting for the translation. I learned again that my eyes & ears are also very powerful pieces of equipment that I may be under utilizing at home. I am not suggesting that the equipment & resources we have in the US are not beneficial and often needed for success,

and I wish the clinic had more of them, but it was important for me to be reminded that tools like watching, listening, problem solving and creativity combined with motivation, determination and laughter, can not only bring hope and healing to patients, but can remind a therapist why they chose and love what they do.

Rosaline's Stairs Eimear 5/16/12

Rosaline lived close to the clinic at the bottom of the grand new stairs that President Martelly built to connect a densely populated area of housing and Petionville. She dropped into the clinic from time to time to check her blood pressure, always accompanied by her great big smile and friendly chatter. On Thursday, much to Andrew's dismay, Donna and I decided to go exploring the new stairs and their surrounds. We bumbed into Rosaline who escorted us on the stairs. She took my hand to guide me. She showed us her home and her children. The stairs was Rosaline's pride and joy. Back at the clinic Rosaline's blood pressure was sky high. We informed her of the dangers and inquired about her blood pressure medications. These were all gone so we informed her of a clinic that would provide free medications. Donna gave her a bracelet to remind her to get some hypertensives and to take them regularly. Rosaline sang with us before returning home.




Efforts continued to complete the stairs and to decorate the street for the Presidents official opening on Monday. All of the walls were painted in pink, the president's colour and a mural was painted in his honor.

On Monday, as we were waiting for the president to come and inaugurate the stairs, one of Rosaline's daughters came up to the clinic screaming. We ran down to find Rosaline collapsed in a dirty brick alley which connects her house to the stairs. On instinct, I promptly go about my ABCs, she was breathing, barely responsive, massively tachycardic and had a blood pressure of 220/180.

I momentarily took control of the situation and asked Andrew to find out who had called the ambulance or doctor and when would they be here. I got really frustrated because I couldn't get a straight answer from anyone. Apparantly they didn't want a doctor or ambulance, they didn't want to move her. They wanted to let her get up by herself, they shooed me away and started pouring water over her and placing leaves on her feet and around her body.

I was so confused. It appeared that nobody was making any effort to get her any help, or to bring her to hospital. At first I thought it was because they couldn't afford help. But soon I realised that they believed that if you touch someone when they are down that you'll make them paralysed on one side. I did my best to convince them that she is probably already paralysed on one side and is desperately in need of urgent medical attention.

I had both Caroline and Andrew translate my opinion to the family and what the best course of action was. My efforts to get her help were futile.

I had to respect the wishes of the family and walk away leaving a poor soul lying in a dirty puddle on the ground. I unknowingly had disrespecting their culture. I left with on old lady scorning me (I was a bit worried when I missed my flight in Miami!). If she survives, and is hemiplegic, they will think that I caused it. 

I knew that it was a big bad world down in Haiti, this just drilled it home. If only primary health care was more accessible. Perhaps it is better that she didn't get help.

It is unlikely that Rosaline will ever climb her stairs again. 

Eimear Working with Donna 5/13/12

Sunday, May 13, 2012

Donna and I have had a great week working at the clinic. It has been awesome working with Donna. Sometimes we are lucky enough to meet such amazingly positive and inspirational characters. People like Donna tend to bring out the best in us. It's been a pleasure Donna, thank you!

It was our mission this week to try and communicate with Michel Martelly, the Haitian President. He is a former musician known as "Sweet Micky". Martelly was sworn in as president on 14 May 2011 following the Haitian general election. The following day, the incumbent Prime Minister, Jean-Max Bellerive resigned to allow Martelly to choose his own Prime Minister. Martelly was quick to pledge reforms the post-earthquake reconstruction process.

In August 2011, Martelly announced a plan to reinstate the nation's military. This plan was met with controversy as many human rights activists were concerned about bringing back a military which had been responsible for many atrocities in the past.

In September 2011, Martelly formed an advisory board that included business executives, bankers, and politicians such as Bill Clinton, that he hopes will improve business and economy in Haiti.

Martelly underwent bilateral shoulder surgery in Miami last month. He developed a pulmonary embolus post surgery. This left disaster struck Haiti without a president or prime minister for some time. He is back now and we figured that he must need some good shoulder rehabilitation. Unfortunately, after some research through the small circles of elite Haitian society, we found that he already had a therapist, perhaps he had flown somebody in from the US. We had hoped to personally convince him to support our organisation by giving us some desperately needed funding or a new premises to open a more permanent clinic. It was a long shot, but worth a try!!

On Monday, Martelly will be officially opening a great big set of stairs that connects two levels of Petionville. It happens that it is right beside our clinic. I have an elevator speech prepared just incase! Here's hoping, fingers crossed! Although, I'm a bit skeptical that I'll get past the security gaurds...let's see how far Irish charm can actually get you....!

We met lots of patients at the clinic this week. I have really enjoyed working with the wide range of disability and injury that we see here. We tend to get up to 3 new patients a day with the remainder attending for ongoing rehab. We see about 10-12 patients per day. One of our new clients is 6 year old Dayens who presented with Cerebral Palsy. We sent him home with a sketch of a standing frame, in the hope that his family may be able to build him one. Haitians do seem to have particularly good ingenuity. The following are pictures of a young lady who suffered multiple orthopaedic injuries to her arm in the earthquake. She was fitted with an external fixator by palpation with no xray. She finally received an xray in April this year. We had her bring it to us. Unfortunately, there is very little callus formation around the distal radius and ulnar fractures. Her wrist range of movement is very impaired, with little hope of improvement. Despite her injuries she has returned to work and appears to be managing well.

I don't have long left in Haiti. I'm excited to escape the mosquitos, hectic roads and humidity. I really look forward to climbing a mountain, or having a surf, or ripping up a trail on a mountain bike. However, I will be sad to say goodbye to Andrew, Frantzo, the clinic and the Hudicourt family. I do regret leaving when there is so much work for me to do here.

Eimear May 7, 2012

Roosters and Lobsters!

Friday was another great day at the clinic. A lovely lady gifted me with two pretty paper-maché roosters, nice! How I will get them safely home on 3 different flights, I do not know!!

I had an awesome weekend with Donna Hutchinson (one of the founders of Global Therapy) and the fabulous Hudicourt family. We spent today on a beach, a couple of hours drive from Port-au-Prince. We swam in the most beautiful turquoise ocean, ate lobster and lambi straight from the sea and enjoyed the beautiful country scenery. It has so much scope for mountain biking, hiking and watersports here, I was in awe!

It appears that Haiti has some incredible resources but lacks the organization to benefit from them. Haiti produces amazing fruit, great coffee and lots of rum, however, not much of it reaches the global market.


On the drive out of the city, I was fascinated to see mile after mile of transitional shelters set up for the many thousands who's  homes were devastated in the earthquake. At its peak, one and a half million people were living in camps. Tremendous efforts have been made to re-home hundreds of thousands, however, there are still some 300-400 thousand people living in tent slums. 

At the clinic, I made the mistake of asking one gentleman patient to practice his hip flexion/knee extension on a step at home, he was a bit reluctant, then I realised that he lives in a tent, I felt a bit insensitive, oops! I later met the same gentleman desperately begging on the street.

Eimear May 3, 2012

Lost in Translation

It occurred to me today, as my patient stood up instead of lying down, then took off his shirt, instead of his shoes, that I will never take communication in the same language for granted again.

Although my Creole is improving (by about one sentence a day!), I find it particularly difficult to piece together a fully comprehensive history of a presenting problem.

As a physio, I rely heavily on my ability to communicate verbally, and non-verbally. Listening, reading body language and interpreting the presentation of a problem enables me to come up with a good idea of the probable diagnosis, before I even touch a patient.

Subjective assessment is probably the most important aspect of a physios work because without a good questioning and answering session, there is almost no way for you to get a handle on what is actually happening with your patient.

Taking this tool away from a physio is like taking a spanner off a mechanic, or a ladder off a builder. 

Although my translator is excellent at relaying all the relevant information, we seem to lose the fluidity of questioning and answering. I lose my train of thought (especially when the occasion turns into a group discussion with all the random waiting punters) and presumably miss out on vital pieces of information. 

Despite my best efforts at learning Creole, I get the distinct impression that much is lost in translation. I feel a bit guilty about this and I hope it doesn't effect my standard of care too much.

I just wonder how many people I've treated for stroke when they've  actually sprained their ankle, or for a sprained ankle when they've actually had a stroke...whoops! Let's just hope that my objective examinations are up to scratch!

However, they do seem to be coming back for more....it was another fun and busy day at the clinic:

On a lighter note, I learned today, that in some Haitian cultures, if a woman marries a younger man, then she becomes the age of the husband, and he becomes her age....sweet! An easy solution to the aging problem. Way to go Haiti!

Signing out...off for some frizz control and mango eating...

Eimear May 1, 2012

Expectations are Everything

I have had an awesome week at work, it is such a pleasure to go to work each day to be greeted by these two beautiful smiles: 

However, I have been a bit perplexed about how my Haitian patients have been receiving my treatments.

I have fleeting moments of immense job satisfaction when I feel like the best physio in the world EVER!! 

Another patient delighted and excited about the outcome of their treatment.  My ego swells (albeit momentarily!) and I love my work more than anything in the world!

But I get to thinking about the outcome of applying the same treatment technique to a patient with the same pain or disability at home. The positive outcomes here are so much more positive! It doesn't quite equate. Somewhat a paradox.

I interrogate my translator Andrew, assuming that I am being told what I want to hear in order not to disrespect or disappoint me. I can see the objective improvements, and Andrew assures me that all subjective reports of improvement are genuine!

Maybe Andrew is also too nice to tell me otherwise?!!

Why is it that basic physiotherapy management works better here?

It got me to thinking about assumptions and expectations of intervention.

Perhaps if you expect less, or don't know what to expect, you get a more positive outcome.

Perhaps the awareness and belief in physiotherapy is yet underdeveloped so that the "magic wand" phenomenon doesn't yet exist. 

Perhaps people are so unaccustomed to professional help that any little difference creates a much more pronounced physical and psychological benefit.

Has anybody got any thoughts on this?

As Jo Ann Roberts (one of the founders of the Global Therapy Group) informed me when I raised this perplexing  matter: "they listen to us, do what we ask and actually get better". What a delightful way to work! 

Eimear

The first 3 days 

I arrived safe and sound at Port-au-Prince. The view from the plane gave me a great appreciation of the size and population density of the city. The city sprawl appears to be limited on the west by the sea and to the east by the mountains. There is a wonderful chaotic Caribbean vibe with endless street sellers carrying their produce on their heads.

My host family sent a lovely tap tap driver named Anel to pick me up. He spoke no English, I spoke no Creole. Despite this, Anel felt obliged to give me a comprehensive language lesson. I smiled, nodded and repeated some random sounds!

It took two hours of proper four wheel driving on worse than country type roads through the city to get home (it's probably about 20km). There is no apparent use of any road rules. The nature of the roads reminded me of driving up the McCauley riverbed to access the Godley valley in New Zealand, just throw in a few million Haitians for effect. There appears to be no observance of any road rules. I have to admire the spatial awareness of Haitians. Trucks, tap taps, cars and people all miss each other by fractions of a millimeter!

Despite my exhaustion after a sleepless night at Fort Lauderdale airport (where the airport sheriff told me to “expect the worst down there” thanks mister, that added nicely to my nerves!), I went straight to the clinic.

Global Therapy have done a great job at getting an indoor clinic up and running. The clinic itself resembles a shed in the backyard of a house. It is small but functional. There is no toilet for patient use and to wash your hands, you have to go outside to the store room.

I'm working with two very enthusiastic Haitian guys called Andrew and Frantzo, they have made me feel very welcome and are very eager to learn. Andrew is the clinic manager and my translator. He has done such a good job that he will be funded this year to attend university in Minnesota to study a Physiotherapy Assistant program. Frantzo had recently graduated from a 9 month rehabilitation technician program in Haiti.

To date, the majority of patients I have treated have suffered CVAs. This is due to a large incidence of uncontrolled blood pressure as a result of a lack of primary healthcare. We also see a number of traumatic orthopaedic injuries and I have ordered a prosthetic lower limb for a lady who sustained a below knee amputation.

Eimear

Today my heart broke

A six year old boy presented with the classic symptoms of Duchenne Muscular Dystrophy. This is a rapidly progressive neuromuscular condition with a life expectancy of 13 years (in developed countries). His signs included a positive Gowers sign, a trendelenberg gait, frequent falls and an inability to hop or run. 

I turned to my Physical Manual for Neurological Conditions text to read “informing patients that their child has DMD causes extreme distress and should only be undertaken by the most senior member of the team, in an appropriate environment, with a support worker present who can maintain contact with the family”.

I felt so ill-equipped without the back-up of a whole multidisciplinary team. This really hit home the lack of basic services available to the Haitian population. The Neurology service is particularly limited.

The mother has approached various doctors but has no appreciation or understanding of the disorder. Perhaps she has seen a western style Doctor and has an acceptance issue, or a lack of understanding due to a cultural or language barrier, I am unsure. It worries me that empathy is lost in translation. I shed a tear of frustration on my way home from work. How do you give hope to someone, third party, when there really is very little hope to give? I can't imagine the desperation and pain of the family.

I went home to my mango tree with very intense feelings of loneliness and isolation, faced with a whole weekend of nothing to do and nobody to do it with. However, to my rescue came the adorable Jessica. She is a teenage daughter of the family I am staying with. She entertained me all evening with her bubbly personality and chatter. She even taught me how to count to 100 in Creole!

My light of life - the Mango Tree!

Eimear

There is a rooster who greets me each morning and calls my next patient. I think I'll call him “The Secretary”!

The Clinic "Secretary"!

Inside The Clinic!

The following are some images from outside the clinic:

The kids from the house next door! They couldn't afford to continue school after the earthquake  so some kind Global Therpay volunteers are funding them.

Overcrowding due to a large population density.

Poor living conditions.

Hanging out the washing before the rains come.