Amputee Physical Therapist Packed Her Bags and Flew to Haiti without Hesitation
Mary Anne - Physical Therapist
3/19/2010
When Mary Anne Kramer-Urner first heard the accounts of the destruction caused by the January 12 earthquake in Haiti, she was profoundly saddened. She’d had a similar reaction in the aftermath of Hurricane Katrina, and felt a strong desire to join the relief efforts, but did not know how she could contribute. Within days of the earthquake, reports of thousands of victims losing limbs that had been crushed or infected came pouring in, and Mary Anne realized that the situation in Haiti was different. Her skills as a physical therapist with experience working with amputee veterans in the US would be critical to the recovery process in Haiti.
Immediately, Mary Anne turned to the Internet to search for volunteer opportunities in Haiti and found Physicians for Peace and our Walking Free program. She learned that Hanger Orhopedics Group, in partnership with a select few organizations including Physicians for Peace, had established a long-term prosthetic and rehabilitation center on-site at Hôpital Albert Schweitzer (HAS) in Deschapelles, Haiti. Physicians for Peace was looking for physical therapists with exactly Mary Anne’s qualifications. She completed the online application and clicked 'submit'. Not long after, Mary Anne received a phone call from Mary Kwasniewski, Senior Director of Global Medical Programs at Physicians for Peace, to see if she would be interested in going to the April Haiti mission.
Meanwhile, we had already been working with a physical therapy volunteer, Shannon Kidd, who had been on previous missions with Physicians for Peace to Guatemala and other countries. Shannon was confident that her previous experience and understanding of the Walking Free program would make the learning curve to working in Haiti relatively easy. Days before her planned departure, Shannon injured herself and was unable to travel to Haiti.
We called Mary Anne and asked whether she could move up her travel plans and leave 2 weeks earlier than planned. Prosthetic production had already begun in Deschapelles and physical therapy was needed. Mary Anne would be the first Physicians for Peace physical therapist to arrive at the Deschapelles clinic. She was excited, but a bit apprehensive. She had never worked outside the country before, she did not speak Creole, and she was not sure what conditions she would find. After conferring with her husband and daughter and making sure that the hospital where she worked would give her the time off, Mary Anne agreed to leave on March 19.
The few days before she left, it was a whirlwind of activity, packing, obtaining medical supplies she thought she would need, making sure that her daughter would be ok. Mary Anne was exhausted by March 19th, and the journey was just beginning! Mary Anne kept a journal during her two weeks in Haiti, and we are reproducing it here. We are touched by the warmth and emotion she put into her work and her writings. Everyone with whom Mary Anne had contact in Haiti (hospital administrators, Hanger Orthopedics Group prosthetic experts, Haitian prosthetic trainees, and most importantly, the patients) was impressed with Mary Anne’s professional skills, her work ethic, her enthusiasm, her energy and her love for others. We thank Mary Anne for her selfless contribution. Like so many of our medical volunteers, Mary Anne is driven to make the world a better and healthier place, one mission at a time.
First Step in Leaving for Haiti:
3/19/2010
San Jose Airport 5:57pm (flight departs at 7:55pm)
Dave just dropped me off out front. It finally hit me as I took my bag handles and prepared to go. I felt scared for a moment, a little shaky at the knees, but his smile and loving eyes held me and it let me calm a little. The baggage handler asked if I wanted to check my bags outside. I was still teary and a little flustered, and told him that I wasn’t sure if I should or if I needed to go inside. “As long as you aren’t flying international, you can do it here.” “I’m flying to Haiti through LAX.” He beamed and asked, “Are you going on a mission to help those people down there?” I nodded. “Bless you.” He was thrilled to be a small part of the caravan of many helping souls that I’m carrying in my heart to Haiti.
That’s been my overall experience around this. Everyone is happy to hear about my trip, offering prayers (even one of my fellow non-religious friends, who said she was sending me with her own kind of prayers). “I have some luggage you can borrow.” “How can I support you?” Wherever I put out feelers, someone has something positive to offer. I was disappointed that my workplace couldn’t subsidize my salary, but Dave explained that they would have to do that for everyone doing any kind of volunteer work anywhere. Makes sense. At least our marketing department reimbursed me for the Theraband I’d purchased to take with me; every little bit helps.
I was interviewed this morning by Linda Fridy at the Mid-County Post newspaper about the details around my decision to go and how it all came to be. In the middle of that, I received a call from Ron Sconyers of Physicians for Peace, who wanted to update me on details of my trip and what I might expect. It was all very surreal—incoming calls in the middle of interviews—felt like a celebrity of sorts. I’ve been on an emotional high all day, but slowly came down to a crash and took a nap for about an hour before leaving. I’m not used to having such emotional swings.
Carroll (my sister) saved me from my “packing insanity” today. I’ve had so many plates twirling in the air for about a week now getting ready, that I just couldn’t concentrate on the actual physical task of packing for the trip. I was going over check lists, picking things up and moving/losing them, and generally being pretty ineffectual. She offered to go over my list and help me put things in order. She helped me get grounded, and finally we got the packing done. She read off item after item, watched where I put each one, monitoring the “not taking” pile to make sure that I didn’t mix it in with things that I was taking. I don’t think I could have done that without her. So glad that she came along when she did. As I said, she saved me!
I’m missing Sage’s Spring Concert tonight. It’s going to be starting in 15 minutes. Her singing has really blossomed into something big. And, she’s passionate about her voice teacher, Ms. Urquart. She (Ms. U) received a pink slip on Friday, and Sage was outraged. She asked for some feedback on a letter to the Santa Cruz School Board to say how upset she was. Then she asked for help submitting the letter to the Santa Cruz Sentinel newspaper editor. Wow—such true passion from a young girl! Makes me so proud. The letter to the editor was published yesterday, and Sage got lots of kudos from the community. Her friend, Itsia, even made a “plaque” from the article, decorating it and covering it with cellophane. Sage was tickled to have achieved something so big for her principled ideals. Also, she and some other kids will be going to the School Board meeting on Wednesday where they’ll speak and sing. Lots going on!
The bar at the airport is a hopping place. There is a guy with a laptop and ear bud, speaking far too loudly for this place, completely oblivious that he’s not alone. Food and beers consumed by everyone but at different speeds is the common denominator. That, and the fact that everyone is waiting to go somewhere. I have another hour until my plane leaves.
When coming through Security, I was buzzed to a special place for inspection. I was “one of the quota people” I was told. The woman from TSA said “hold out your hands, please”, and then she wiped my palms with a little white disk which she then placed into some kind of reader device. After about 5 seconds, “Okay, you’re done.” I’ve never seen that before, and I have no idea what the hell she just did, but, I’m glad to have passed the test.
Leaving San Jose (finally)
8:17 p.m.
The plane is leaving about ½ hour late. Everyone it seems is making a connecting flight in LAX, so people are edgy. I had to check my little carry-on as did most others, but at least they took care of that right at the door to the plane. I’m already really tired—a mixture of physical drive and emotional strain has brought me to a cranky, tired place in my body. And, this is merely the first leg of my journey to Haiti. I wonder about a lot of things. Will I be enough for the task? Will I meet the expectations of the team already on the ground? How will my ‘typical day’ look? Can I stay healthy? Can I impart what I need to—to both the patients and those working there? Can I pick up some Kreyol—enough to get the basics across? How to morph what I know into real service and skill? Two weeks seems hardly enough. I’m not used to such insecurity in my PT skills, but I just don’t know what to expect. All things will be revealed in time!
Nearly missed my connecting flight to JFK. That would have been disastrous! Another passenger and I had to run to the gate; we took off 6 minutes after we got on the place. Whew!
Waiting for flight from JFK to Haiti
3/20/2010 (8:37 EST)
Met a woman named Maria while waiting for my flight. She’s a pediatrician from Los Angeles, and she works at USC/County Hospital. Her husband Daniel is a dentist. He’s of Haitian descent, but is culturally American (speaks fluent Kreyol, lucky guy!). They are going to the region of Marmala, Haiti (or something like that) to do emergency dentistry for a week. They are travelling with a large group of dentists from LA; one woman grew up in Haiti but moved to California to go to dentistry school. She’s an oral surgeon now and is travelling with her own pharmacy of analgesics. She said that she can imagine having someone lay their head on her knee while she works on their mouth, pain-free. They are a great group of people. Everyone is going with the will to help.
Flight AA837 (JFK to PAP) Business Class seat 2B.
Sat next to Pierre, a Haitian man, who lives in Long Island, NY, working as a truck driver. Going to Haiti to see his sister-in-law who has a ‘broken hand’ and a below-knee amputation from the earthquake. He had left Haiti on 1/11/2010—the earthquake happened the following day. He’s very sad; partly due to survivor guilt, I think. I drew some exercises for him to do with his sister-in-law, and described desensitization and scar mobility techniques. (Most people haven’t yet touched their remaining limb, and hypersensitivity is a big problem among the earthquake amputees.) I gave him the name of the hospital where I’ll be and told him that I wasn’t sure how people made their way there, but I thought that if he could find a way to get her there, we could help her. He tucked the paper with the hospital information into his pocket and tears ran silently for a moment. He also told me that he’d just been given a diagnosis of Lyme disease, but he thinks his symptoms are something else. He describes severe sleepiness while he’s driving his truck. He also has insomnia. I recommended that he try writing in a journal to help him with his thoughts in the middle of the night. He thought that sounded like a good idea. He’s laden with grief, tears up frequently, but tries to smile through it all. He said “Haiti used to be so good. Now it’s a bad place to be.”
Just got out of the airport. What an experience! My luggage was nowhere to be found, but there were dozens of bags everywhere and no real order to things. Feeling completely baffled, I searched for about a half hour and still came up with nothing. I finally just stood back and watched to see if something would come to me. After a few minutes, I noticed that a man showed his luggage tags to one of the workers milling about; a minute later, the worker appeared with the man’s two bags. He paid him $2 and was on his way. I did the same, and a few minutes later I also had my bags (that were actually in a different part of the building because they’d arrived ahead of me—I would have never found them on my own!)
Was met outside by Mike, a PT from Toronto Rehab Institute, who has been working at HAS for the last two weeks. He had to come to Port-au-Prince for some work-related things and offered to meet my plane. Also on the ride were the van driver, Gaspar, and his friend, Obnes Civil. To my relief, Mike was right inside of the red fenced area, holding up the sign that read “HAS”. I was never so happy to see anyone in my life! We picked up my bags, looked ahead at no one, walked stiffly to the truck. “Stay close and don’t talk to anyone” he said. Two men and a boy swarmed around us for handouts. Once in the van, hands banged on the outside as more people peered in through the windows. My stomach tightened and my throat was tight.
Backing out onto the street, I realize that I’m shaking, and I’m a little sick to my stomach. It’s very hot and sticky. We traveled just a few minutes and then pull into the enormous tent medical complex in Port-au-Prince. Mike tells me that it was put up hastily in a basin, and now that the rains are starting, it’s clear that it has to be moved to higher ground. I can’t imagine how that will happen. Mike gets out of the truck; I remain with Gaspar and Obnes. I speak no Kreyol and they speak no English. I wait for Mike’s return for what seems like a very long time (probably only a few minutes in reality). He’s talking to the CEO of the Miami Project before we head out of town. Listening to Haitian radio, watching as men with guns standing outside the compound seem to be watching me. It’s all surreal. I feel stunned, tired and wired from the magnitude of the journey so far.
Made it to Deschapelles
3/20/2010 (7:26 p.m. Haitian Time, which is only 2 hours later than home on the West Coast because they don’t do Daylight Savings Time)
No road rules, horns honking at every turn to scare kids, goats and chickens off the road. Passing other cars, blindly. Moving too fast; I have no seat belt, so I grip the headrest next to me with one arm and brace myself with the other. After 3 or so hours, we drive down a dirt road and am told that this is the entrance to the hospital; a road known as The Corridor. It has little shops either side, but at first glance, it just looks like tattered shacks. The van pulled up through a gate, the guard waved us through, and we stopped in front of Alumni House, my new home for the next 2 weeks.
Tried to call home shortly after I arrived. I desperately wanted to talk with Sage and Dave, but no answer. Left a voicemail; felt like I was calling out to a void. I’m homesick and exhausted and overwhelmed. It looks like I’ll be treating patients on my own on Tuesday with or without a translator (yet to be determined). My roommate in Alumni House is a college senior, Ruth, here with the Haitian Reforestation Project. She came last summer for two months, and has returned for two weeks to help collect data on the progress of the trees they planted. She’s very nice and helpful. I took a dip in the pool when I got here, which just seemed wrong, but appropriate none the less. Met Mandy and Angie at the pool; they are two PTs who are also from Toronto. They and Mike leave Tuesday morning. Everyone is going out tonight, but I’m too fried.
3/21/2010 (6:30 a.m.) Trying to learn some Kreyol before I head out:
Bon jour—Good morning/hello, spoken up until noon
Bon soir –greeting/“hello” spoken after the noon hour Komon ou yay? (or, kejan ou yay?—How are you?)
Pa Pi Mal—not bad (in response to ‘how are you?’)
Mwen rele—my name
Piti piti—little by little, or a little bit
Mwen grangou—I’m hungry (I heard this many times every day)
Mesi—thank you
A chante—nice to meet you
Eskezem—excuse me
Anpil—a lot
A damen—until tomorrow
Eske ou pale Engle?—do you speak English?
Eske ou compran Engle?—do you understand English?
Mwen pa compran Kreyol—I don’t understand
Kreyol Mwen regret sa—I’m sorry
Hôpital Albert Schweitzer
3/21/2010 (2:12 p.m.)
Toured Hôpital Albert Schweitzer with Ian Rawson today, accompanying the MSNBC crew that is here documenting the Hanger Prosthetic clinic this week. A little boy with a suprapubic catheter was crying and holding himself, desperate to find help because the catheter was clogged. He didn’t appear to be with anyone. Ian went to see if someone could help; we thought that was that, but several hours later, when I went to find the library to try to email home, he was still there crying and trying to get help. It was Sunday, and he’d have to wait a little longer. I wondered how he’ll live his life. He’s only maybe 7 or 8 years old. How will he survive, and why can’t he pee on his own? He looked fine other than that.
Saw a woman in the medical ward who is struggling to heal an above-knee amputation wound that got infected. We saw lots of other sick people and some newborn premies. It’s quite a place. Family members bunk underneath the patients’ cots. They stay to help the sick person, feed them, bathe them. Very different from home.
Toured L’Escale with Ian and the crew. This is where the amputee patients are living while they are receiving training for their new limbs. It used to be a TB village once upon a time, but was closed a few years ago. Now it’s serving a new purpose since the earthquake. So much along the way to observe. Being Sunday, most people are going to church. We walk through the very hectic market. Ian explained that one woman was selling little clay discs. They help calm hunger pangs and provide salt and iron. Years ago, a film crew came through and videotaped kids eating these, and then broadcasted that the people of Haiti were eating dirt. Even talking about this upset Ian. It showed the ignorance that can be spread by a misdirected or unconscious media. While at L’Escale, I worked with a few people; namely a woman with a spinal cord injury and one with a stroke. These two women (and three others with femur fractures) had somehow found their way to L’Escale the week after the earthquake and were admitted there in error amid the chaos. (L’Escale was supposed to have only amputees there.) We’ll have to figure out how to treat them while they’re here, and also where they should go once they leave. There is such a need for everything, but no easy way to distribute anything. These people are survivors. Most crawled out of rubble, many were under it for several days before being freed or freeing themselves. This is not a life for the faint of heart. Everyone needs something, and everyone has so little.
There is another camera crew here this week. They are here making an HAS/Mellon fundraising video. This entire hospital runs on donations brought through the Mellon family trust (or something like that). It’s quite an undertaking, and must feel like a huge responsibility to serve the healthcare needs for 330,000 very poor people.
Tomorrow is my first day on the job. I’m excited and nervous all at the same time. Will I be able to do enough? Can I keep up with the day’s flow? I wish I could speak the Kreyol language.
Work Day #1
3/22/2010
Whirlwind seems to be the word of the day around here. I got a taste of the heat and pace today, and even though it was hot, chaotic, I spoke no Kreyol, and the day went on forever, the rewards were many. I was able to get several people to a better place. Most of the women were embarrassed to use crutches, and wanted to ambulate without one immediately. I can imagine what might be going through their minds—how am I going to do my daily life while holding onto 2 sticks? Can’t carry water, do laundry, cook, etc., with my hands full. That, and just the way it looks. It’s as though, if they can get moving on with it, some of the fear and grief of “Le Tremble” will fade away. I’m sure that most of these people who’ve survived being trapped for days under rubble have quite a bit of PTSD going on. I wonder what kind of counseling help might be available… I’m glad that Joy (nurse from Project Hope) is here to help put together a flow process; to figure out how to best have patients come through L’Escale rather than getting stuck there indefinitely without a discharge plan.
I developed a painful heat rash between by legs from the heat, friction from the seam of my scrubs, and just plain sweat today. Thankfully I found some Baby Powder. I’ll try Tegaderm bandages tomorrow. Not one of the dangers I came prepared for!
I spoke to Dave and Sage last night—what a treat. They sounded great. They’re really proud of me. There was an article in the Santa Cruz Sentinel on Sunday about me and an Occupational Therapist from our Hand Therapy Dept (Cheryl Bancala) coming to Haiti. I’ll try to email them tomorrow—or call. It’s hot and I’m tired. I’ll tuck my mosquito netting in around the edges of my mattress, climb in with my camera and flashlight, and take a look at the photos I’ve taken so far. I also have some pictures on my camera of home. It’ll be a nice way to wind down my day.
One more thing—we need a better charting system.
Work Day #3
3/24/2010
Entirely missed writing yesterday. Just no time until late at night, and then no energy left. The Toronto Rehab Institute PTs left yesterday, so I was on my own. In some ways it seems like I’ve been here for a very long time. Days are full, fuller than the busiest days at home. Part of it is that there are so many people, and there is no tracking system to keep track of who has shown up and who needs what. I’m learning the patients’ names, but most of the names are not common to my ears, and I struggle with the pronunciation and spelling, so it’s taking me longer than usual. We’re going to try something new today. I want to sign people in when they come in so that we can pull their notes from yesterday and see what we need to do. This has been only hit and miss so far—sort of like chaos is the only constant around here. I want to have a short educational introduction for the morning group, and then repeat it again for those coming in the afternoon. I’ll go over such things as why it’s important for people to use two crutches at first to get stronger and let their skin get used to the new prosthesis; then, once they’ve done that for a few days, they can progress to using just one, and then none—over a few weeks time. The women are typically more self-conscious about using crutches than are the men, I’ve found. (Is it something like the women in the US being more self-conscious about their weight? Who knows?)
Spoke to Dave last night. He sounded great, and said he’d seen the MSNBC story about Schnelly. I think I’ll be in the video story that goes online today. He and Sage can see me! What a trip that is!! The MSNBC group (JoNel, John and Carrissa) have been great. They are trying to be culturally sensitive—keeping in the background mostly—and so has the HAS film crew. But there was another film group that descended upon us today at the clinic (not sure who they were with). They were horrifying. Snap, snap went their cameras. “Smile” she cheerfully demanded; who wants to smile when trying on a prosthesis for the first time?—it might be painful, or it might make it more real that their old leg is gone. Whatever the emotional situation, having someone telling you to smile, especially when they’ve never even asked your permission to photograph, seems plain rude. I was ashamed that they were American—too loud, flashy and way over the top. One of the young women I was working with said quietly through the interpreter, with a worn out expression, “I’m so tired of having my picture taken.”
I worry about how these beautiful people will learn to integrate these new legs into their lives. What if the prosthetic limb starts to hurt a month down the line, and the person is back in Port-au-Prince in a tent? It’s a 3-hour car trip, and the cost to travel here is likely out of most peoples’ reach. How to keep the skin clean and healthy with no access to running water or regular, healthy food? What if the prosthetic limb breaks, a bolt snaps, or the socket cracks? What if they run out of stump socks and the limb doesn’t fit anymore? What if they fall on the hard rocky terrain? What if? What if? What if? I feel like a mama bird, feeding my babies, and then after two weeks of nurturing them, they fly off to parts unknown—most are likely moving into a tent somewhere in Port-au-Prince. I read recently that Haitians have never had experience with tents before—they don’t camp for leisure like we do—so having thousands of people living in this way right now is totally new and strange. I just keep wondering about water and sewage—not a pretty thought, but a much more terrible reality.
I have to find a way to help them learn to rely more on their prostheses while they are here in L’Escale. We’ll have to have a bigger PT presence there so that we can start to monitor how much people are actually wearing their legs after they leave our clinic. How to help, and how to honor?
“Little by little, the bird builds its nest”. “It’s a lucky horse that dies without a sore on its back”. Life is full and hard here.
“Little by Little, the Bird Builds Its Nest”
3/25/2010 (Work day #4)
My heart is getting fuller and in that way, softer and more vulnerable. Shaun told me this little bird proverb when I was talking to him yesterday. I’d been talking about how overwhelming the need is around here. It helped to put things into a clearer perspective. The problems that I see and feel here are not new. They are not all as a result of the earthquake. Many of the problems stem at least partially from decades, if not centuries, of neglect of an entire people by those in power. It seems that Haiti’s overwhelming debt to other nations is largely to blame. And, much of that debt was incurred because they won their freedom and were no longer slaves; apparently, they had to pay France millions for lost slave revenues. Crazy! So, it was comforting to have a longer view with this bird’s nest adage.
Jennith and I saw 26 patients between the two of us today. The days are full and seem to fly by, sort of in a blur. I was interviewed today by John (MSNBC photographer) regarding 4 year-old Schnelly and his progress, as well as his expected potential. It’s part of their wrap-up story, and it will air tonight. Dave and Sage have been keeping track of me by watching the MSNBC online show. The film crew will be leaving tomorrow. John said he’d send some photos directly to my email; I look forward to seeing those when I get home. I’ll miss them—they’ve been fun to visit with at the dinner table as well as have around the clinic.
My patients are amazing. All courageous survivors—some lost their limbs because of the earthquake, others lost them years earlier, or were born with them. All of them are welcomed here at the Hanger Clinic (Klinik Hanger, in Kreyol). Hanger has vowed to make limbs for anyone who comes asking, regardless of the cause of the amputation. That’s an incredible thing and such a gift to the people of Haiti. I’m proud to be a part of this effort. For those who had prior amputations, this opportunity to get a prosthesis is simply a miracle. Many people have travelled hours and hours to get here, and now anxiously await their new limb. Some have nowhere to go once they get their prosthesis. So much wasted potential and talent. Everyone needs work (something like 5 out of 100 people have a job right now). Always hungry, thirsty, just trying to survive. Every day. “Grangou, Mary Anne, grangou”—Hungry, hungry, Mary Anne—patting their tummies with their hands. What is the best way to help? I’m still struggling with that. And, in the meantime, I do the best that I can every minute of every day in giving the gift of my service and knowledge.
Work day #5
3/26/2010
Most helpful phrases:
Mwen rele Mary Anne (my name is Mary Anne)
Eske ou rele? (what is your name?)
Aw chante (nice to meet you)
Bon jour, komon ou yay? (good morning, how are you?)
Pa pi mal (not bad—in reply to ‘how are you?’)
E ou mem? (and, how are you?)
Li fe cho—pronounced lee-fay-show—(it is hot)
Map tune konya (I’ll be right back)
Fe mal (feels bad, hurts)
I have a group of young women who come daily for PT from L’Escale. They feel like daughters to me. Every one of them has some special spark of life, most of them have no family left and are planning to move to the tent cities springing up in Port-au-Prince after leaving here. Some dug themselves out of rubble after hours or days being pinned; crush injuries followed by infections all led them here to me.
One of the girls (19 years old) found out that her only living relative is an aunt who wants her to move in with her to work at her booth in the market. This girl had been attending college before the quake, and was hoping to finish—she is now very depressed to be relegated to a life of selling vegetables. Her eyes glazed over more and more with each passing day. Another, a 23 year-old woman, was eagerly awaiting the arrival of her father who was coming from Miami to see her. She was excited and apprehensive all at once, since she hadn’t seen him in a long time, and now she was an amputee—very mixed emotions. And, yet another, 20 years old, who is here with her mother. They have nowhere to go once she’s ready to leave. HAS was given a few tents to give out; she and her mother will be issued one to take back to Port-au-Prince where they’ll set it up and call it home. There are several other women, all younger than 30, who have lost husbands, children, parents.
The stories are all so similar, and yet so individual. I don’t understand the nuances of each person’s situation given the limited language shared, but my heart breaks open a little more each day. The young men are equally resilient. They have come here in a variety of ways, all hearing about the Hanger clinic by word of mouth. Most awaiting a new leg, but a couple have come needing an arm. The arms have to be fabricated in the US because of their complexities. Their residual arms are casted, and then the cast is shipped to Hanger in the US, and then some weeks from now the arms will arrive. Could be a long time given the hold-up at port. I’m sorry that I’ll be gone when the upper extremity physical therapy begins.
Went to Cange with Jay and Gil from Hanger
3/28/2010 (Sunday)
Claude, PT with Project Hope, joined Jay, Gil, and I to Cange. Cange is a small remote village in the Central Plateau, on the edge of Lake Peligre, about 3 hours drive from HAS. It has a hospital there that was founded in the late 1980’s by Dr. Paul Farmer of Partners in Health. They don’t have a prosthetics clinic, so Hanger has offered to come up and work with the amputees that are there in a ‘mobile unit’ sort of way. J
ay and crew come up about once a week to cast and fit patients. The Hanger guys are talented and are more like artists than prosthetists. It was a great trip, both up and back, and the overall experience there was as wonderful. We brought four prosthetic legs for initial fittings with three adults and a little boy (2 above-knee, 2 below-knee). We had intended to cast two upper extremity amputees as well, but their arms were too swollen, so they were measured and fit with shrinkers until next week when the casting could occur.
I was able to work with Claude for the first time. He asked me what I look for at first and what the stages of progression were when working with amputees—first it’s the comfort and fit, then, from there I look for equal weight bearing, symmetrical pelvis, pylon alignment, base of support, hip extension at terminal stance, heel strike, equal step lengths, upright posture, equal weight shift - once that’s in place, I add increased speed and decreased hand support for additional challenge. Describing this for him made me really stop and think about what I know. I realized that I need to write it down to pass on to the next team.
While we were working with the patients, the local people were preparing for a celebration that will take place tomorrow. It’s called “Thanks to God” (in Kreyol, it’s Mesi …), and it takes place a week before Easter. It’s when the community comes together to celebrate, even in the midst of this huge post-earthquake crisis, and gives thanks for the great bounty given by God. Young girls were practicing their dance performances, and we heard a very loud squealing pig that suddenly became silent. I looked inquisitively at Allie Lutz, a woman from Partners in Health who was helping to translate for us, and she whispered “that’s tomorrow’s dinner”. It made me realize that we really never know our food at home and that this is so much more honoring of the animal. I was pleasantly surprised by that thought.
We finished fitting and training everyone, ate lunch with the other people working there, and then headed home. We were supposed to bring two women back to L’Escale for prosthetic training, but Jay got a call right when we were ready to leave saying that there wasn’t room there for them yet. We had to leave one woman there at Cange, and would drop the other one off at home in Mirabalais (halfway between Cange and HAS). Jay felt horrible, but they seemed to take it in stride.
On the ride home, I sat next to the woman’s nephew. He was about 14 years old and spoke only Kreyol. We started to point at objects, or pantomime an animal, and then say it in our respective languages. I wrote the words down showing the English and then the Kreyol spelling: Bef=cow, coulev=snake, lapli=rain, cabrit=goat, cheval=horse, chien=dog, chat=cat, naje=swim, neve=nephew. He pointed to me and said “beautiful”. When he got out of the car, I handed him the paper with the words in our languages, and gave him the extra paper and pen to take with him. He held it to his chest, and with a big smile, said “love”.
Taking the Next Step
3/30/2010 (7 p.m.)
Today was definitely better and less crazy-busy, although it had its moments. For example, Annuelle, Acelia, Emmanuelle, Christella, Gaelle, Wilifred, Genjeve, Soule, Valentine, and others I can’t specifically recall were all a-buzz pending their return to Port-au-Prince. Some will leave today, and others will leave tomorrow. These are the first people from L’Escale to leave. It’s a very big deal because now there will be room to bring in more people for prosthetic training. It’s been sort of a log jam up until now.
The mood has definitely shifted from a “wait and wait some more attitude” to a “hurry up, I’m leaving” attitude. Everyone wanted to have their leg covered, and everyone wanted a cane (because everyone else had one). It was hectic trying to give everyone whatever they needed for their departure, and it was with mixed feelings and a little trepidation thinking about them heading off to faraway places—most to tents in Port-au-Prince—with these new limbs.
The prostheses are hot, hot, hot—and not in a fashion sense. Hot, sweaty, cumbersome and complex to manage. And, my friends must go out into a very dangerous and unpredictable world with them. Scary. I just wonder how they’ll do. There are tiny kids, the youngest is 4—and older folks, I think the oldest is in his late-70’s, which around here is ancient, given the malaria, anemia, TB, HIV, and the myriad other deadly diseases running rampant. Life is cheap here. Everyone is hungry. There is little access to potable water—people bath, drink and urinate in the same places, not far from their sad crumbled little cinderblock houses. Most people eat once a day, or every other day, as a rule. “Grangou” is the word on everyone’s lips—Hungry.
I’m helpless to help. It only adds to the problem to give outright handouts. Teaches people to beg and isn’t sustainable, and degrades and dishonors—but ignoring feels horrible and mean. It frustrates everyone to be without work, without food, without shelter. Especially now since the earthquake.
I found out why Port-au-Prince was hit so hard. There were many multilevel buildings built with cinderblocks and the very occasional rebar, with cement laid on top of each story to act as the ceiling for the ground unit and the floor for the next. When the 40 seconds of shaking was done, it had moved and cracked apart the block walls, which brought the cement floors crashing down story upon story, crushing everyone who had stood under or next to them just moments earlier. Those who survived were maimed with crush injuries that festered and infected while they waited to be rescued, or until they could dig their own way out from under the cement rubble. Hence, the huge increase in amputees in Haiti. HAS hospital went from an 80 bed capacity to having close to 800 people to treat. People were lined up with legs tied to bars for traction in attempts to set their fractures. Chaos for days. They ran out of most pain meds after a week. And, more surgeries were needed, more fractures to set with external fixators. A sea of pain. It was amazing that they were able to do it all with so few resources. These are survivors in the most visceral way. I am in awe every day here. Sunday is church day here and people dress in their one fine outfit, clean and perfectly pressed, and sing praises to a missing God. I leave on Friday. I can’t believe my time is almost up.
Went to St. Marc on Sunday
3/31/2010 (5:30 a.m.)
It’s a town about 1 hour away, where Shaun and others go to buy staples that are hard to come by in the Deschapelles market which is outdoors and consists mostly of fruits, vegetables, rice and scary raw meats. The trip consisted of me, Jennith, Gil, Don, Jay, Shaun, Dr & Mrs Maibach, and our driver. The drive was actually sane, and the scenery beautiful except for the poverty scenes along the way and in the town itself. Went to two markets, passing the begging children and mothers (and some old men.) Breaks my heart that this is all they can do to survive. Walked to the beach while waiting for others to finish shopping; the Caribbean was gorgeous, the trash horrible. Plastic trash everywhere, strewn and blown about, trying unsuccessfully to decay. A pig rooting through it all, middle aged boys (11-15 years old, or so) “playing” an abandoned, stripped truck with their hands, banging out a Calypso-Rap beat. I had to turn away, and couldn’t look them in the face—the faces of this land of abject poverty. Every one of them a jewel of potential that will likely never be realized.
I thought of a title for the book I’ll never write about my trip here: “My Year in Haiti—that lasted only two weeks”. That’s how it feels—the heaviness weighs on me and makes me feel impotent, makes time drag. It’s hard to take a deep breath. I love it here. I hate it here.
It’s taken 12 days to sort of get used to having several Black maids at Alumni House. They cook, clean, and generally keep the house going all day, every day. I put my dirty clothes in the blue plastic hamper on the other side of the house and they appear clean, a day or two later, sitting on the ironing board to be claimed. Meals are served starting at 6:30 a.m., 12:30 pm and 6:30 pm. The table is full of all of the residents of this and the house next door. Maude (pronounced “Mode”) is basically the house mother, and the others seem to, at least laterally, report to her. This is one of the prized jobs around here. I heard from one of the residents here that Haiti is at something like 95% unemployment right now. That’s 5 out of 100 people who has a job, who can earn a living, who can have hope. Many people volunteer at jobs all day every day in hopes of getting hired on.
Doing a job on a voluntary basis also allows a person to have a purpose to their day. Otherwise, it’s a bleak, long, hot day without meaning, without hope. But, really, with all that needs doing to help this country heal, there should be enough jobs for everyone! Deschapelles reminds me of a little mining town. It sprung up in 1956 when the hospital was built. It’s been the major employer of the local people. Plus, HAS shares its water well with the people so that they don’t have to trek hours a day to get water. HAS is a haven in a country where the government seems mostly missing. As far as I can see, Haiti has no municipal services whatsoever, and I think that this is largely as it’s been even before the earthquake. No trash pick-up, no water or sewage treatment system, no road maintenance, an so on. The hospitals are all privately-funded. People have to struggle to survive.
Went to See the Patients in L’Escale Who Don’t Have Amputations
3/31/2010 (9 p.m.)
Madame Joseph had a stroke on Jan 12th. Her son had rigged up a head piece to which he attached a travois; he put him mother on it and he and a friend shared the task of dragging the travois down from the mountains. It took them 15 hours to reach HAS. I brought some compression stockings for her to reduce the swelling in her legs, some Theraband and an ace wrap to support her left leg and brought a compression/sling to support her left arm. I showed her son how to put everything on (and it was complex!) and he got it right away. By the end of the treatment, he was able to walk with her from the bed to the door and back, safely. I explained that I wouldn’t be returning since I was leaving in a day. He told me through the interpreter “thank you for showing me how to help my mother. She’s too young to sit and stare at nothing all day.” He also asked if I thought she would get better. I told him frankly that I thought she would eventually be able to walk around in her home with a quad cane by herself. I told him that I didn’t think that she would regain the use of her left arm, but that anything was possible. He said that he was grateful, and that the arm problem didn’t matter. It broke my heart; in the states, she would have likely had a nearly complete recovery. The day I’d met her (almost two weeks ago) she’d had some active movement in her arm, but without intensive rehabilitation, her brain gave up and quit trying to move it. But, this is Haiti, and she made it down from the mountains by the grace and the will and the love of her son. I wonder how they’ll get back home.
Tomorrow is my last day here. It’s the day before Good Friday, and most people are already planning for the big weekend. I’ll wrap up loose ends at the clinic and at L’Escale, and then will get packed. I will meet my ride at 3:45 a.m. for the trip into the airport. For once, I’ll already be up when the rooster outside my window, roosting in the mango tree, crows his first song of the day.
This blog entry was contributed by Dr. Nabeel Qureshi, a recent medical school graduate who served as an intern for Physicians for Peace in his last year at Eastern Virginia Medical School. Nabeel's contribution to the Resource Mothers Program was significant. As a student of psychiatry, he was able to provide training on two very important and difficult aspects of women's health - depression and domestic abuse. He had this to say about his experience: 
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