Some things I don’t quite understand here….

Posted August 28, 2010 by oaxacadoc
Categories: Uncategorized

Some thoughts and observations – good, bad, and maybe thought provoking – from my time so far here in Haiti.

How does the person who burns garbage know to do it just when I hang out my wash to dry and the wind shifts this way?  (And why did it start pouring rain just before I went to take it off the line?  Rain rinse might be good, but not when respinning it isn’t really an option — see electric grid below.)

Has my hair been totally dry since arriving in Haiti 2 weeks ago?  Or any other part of my body for that matter?  And will my passport ever dry out and no longer be warped after I return to the US?

Why are roosters crowing associated with heralding the dawn when in actuality they crow all day long, and often at night too?

What’s with women and hats here?  I have seen more hats, many fancy or elaborate, here, even on staff wearing scrubs in the clinic. My ball cap and Tilley hat just don’t make quite the same fashion statement! (more photos hopefully to follow.)

What’s with the electric system here?  The public power grid is not sufficient for the house and appliances, so it’s supplemented by a diesel generator that charges car batteries, that then need an inverter (I’m lost at this point…) but that somehow is faulty and so throughout the night there are sudden bright flashes from light bulbs, usually right overhead where one is sleeping.  Is this one of the CIA techniques?

 

Shouldn’t there be a way to take all the rubble and garbage throughout Haiti and employ people to clean it up, and convert it into something useful?  This could be a way to financial independence and funding of other projects.

 

 

What makes people think that things that cannot be repaired and reused in the US can be in Haiti, where there are fewer resources and less know-how?  Wheelchairs missing foot rests or without tires, biomedical equipment in need of repair, and items totally worn out are sent here.  This causes a problem of storage (it is hard to find storage and a place that won’t get wet) of things that very well might never be able to be used, not to mention the cost of shipping things here.  Shouldn’t we consider giving good things rather than cast offs?

Have we created a culture of dependence here (yes, I realize the irony in the juxtaposition with the last item)?  Yesterday a young child walked up to me and without saying anything else demanded (in perfect English) “Give me something!”  How can we start helping Haitians to do problem solving in areas such as jobs, health care/medical system, economy, etc… rather than to expect us to come with our solutions and supplies?

When will we see biomed techs and electrical engineers and such realizing the great resource they could be in mission in developing countries?  The equipment that comes and does work needs to be maintained and repaired at times, but there is no one here with that capability.

How do Haitian women ride side saddle on the back of a motorcycle, with their legs crossed, not holding onto anything, and not fall off?  Do they have a special gyroscopic system I’m missing that allows that as well as the ability to balance huge unwieldy loads on their heads and walk without tripping or dropping things?

And finally, why am I so blessed?

 

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pediatric ponderings…

Posted August 27, 2010 by oaxacadoc
Categories: Uncategorized

Some random things from seeing kids in the clinic today…

It is really hard to put on powderless gloves when your hands are hot and sweaty. After laughing at my attempts, the nurse finally showed me the trick of shaking it out, holding wide the wrist and blowing into it, and squeezing air down into the fingers (don’t try this if the gloves need to be sterile ). It was still a bit of a challenge, but at least my fingers were starting to get in the right slots…

Much of pediatrics is the same wherever you are – kids get colds and ear infections and mothers worry about kids. The main difference here is that the moms aren’t all asking for the most expensive newest antibiotic and amoxicillin still seems to work.

Some things aren’t the same though.  I have been surprised to find that most of the mothers don’t know the birth weight of their babies (even when born in the hospital) and that the clinic workers also aren’t very tuned in to what babies weigh.  They had one 2 month old weighing 28 pounds.  Most weights are rounded to the nearest kg (2.2 pounds)!

Power outages, while inconvenient to me while seeing patients must really be annoying to the US surgeon here this week. There is no back up generator at the hospital.

Unneeded suffering is disturbing wherever it happens. I saw what was probably the saddest case of my career in pediatrics today. A totally cachectic 2 year old girl was brought in by mom, who has one other at home and one on the way. The child was normal till 6 months ago according to mom, when she started to waste away. She was just a skeleton with pale flesh (really noticeable in a Haitian child) and horrible scaling rashes and a pitiful pleading look in her eyes. In taking the history, I was asking mom about HIV history. She handed me a paper to show that she was HIV negative, but somehow she had never noticed and no one had ever told her that also on that slip was that she was RPR positive – indicating syphilis. This child requires more lab work and more care than could be provided here, but very likely has congenital syphilis and protein calorie malnutrition. This could have been prevented! The positive is that there still is time for mom to be treated and hopefully her current pregnancy will have a better outcome. I thought of taking a photo of Julie, to include, but then decided that she is indelibly etched in my mind, and a photo here would not be respectful and caring of her dignity. Do please pray for little Julie though.

It was a tiring day – after mainly seeing the children of the staff at the hospital, the word has gotten out that there is a pediatrician here, and many are coming who have been in need of care for a while, some in need of more care than I can provide here, and sadly at times, more care than is to be found in all of Haiti at this point. Some valuable programs disappeared with the earthquake and so a country with poor health care coverage to begin with now has even more access issues and holes in vital areas of care. Pray that the various organizations working here can start to coordinate efforts and work together to provide the needed services and care and that aid goes to those who should be receiving it. Pray also that both Haitian and expatriate professionals who see the various areas where their expertise could make a difference will be willing to view this as an opportunity for ministry and for giving back indirectly to all who have made their current situation possible.

Thanks for continuing on this journey with me.

first week musings

Posted August 23, 2010 by oaxacadoc
Categories: Uncategorized

(The above photo has nothing to do directly with this post, I just like it.) 

I’ve been here a week now – time passes differently here, going from very busy, to inactive, to having lots to do but not the resources to do them, to time consuming activities that we don’t even think about in the US.  But things are going well.

First, though, a few photos to illustrate what I said about garbage in the previous post.  The following photos are from outside the market, showing huge piles of trash and rotting vegetables.  In one photo, you can see a pile of clothes being sold right next to the start of this garbage heap.  Even the beach in Les Cayes is grossly “trashed” – I could hardly believe that it was possible to have such a beautiful scene with such a horrible foreground.

But back to this post….

My clinic time will really get going on Monday, and so far I’ve mainly been doing consults on rehab or PT patients.  Dr. June Hanks runs Advantage Haiti, which works with physically challenged patients.  The earthquake has obviously created a much larger base of people with physical challenges, and now there are a lot more of the upper class and educated parts of society with significant disabilities and the need for access.  While Les Cayes is not that close to the epicenter and did not suffer much damage, many people from the Port au Prince area came here after the quake to seek treatment and to be away from the danger of aftershocks, etc…  So many of the stories are heartbreaking…I saw a 6 year old girl with an above the knee amputation and a poorly healed ankle fracture on the other foot who was there with her father, having lost her mother and 2 sisters in the quake.  Unfortunately the ankle was not adequately repaired, and she will need surgery, not readily available, to have a functional foot.  Others come with injury/loss to 3 or 4 limbs.  They are working hard and are amazingly resilient.

There are also people in the rehab center who aren’t victims of the earthquake, but who have disabilities that can be helped with prostheses and/or therapy.  The women are connected into a training project (started by German missionaries, but with Haitian teachers) that helps them learn to sew or do needlework.  They then can submit their crafts for quality control, and if they are deemed acceptable, are sold, creating a source of income for the women.  One of the women is totally crippled and deformed with what I suspect is osteogenesis imperfecta, leaving her with misshapen bones and contractures of her joints, so that she is essentially always in a sitting position.  None the less, she crochets things so that she can earn money to help support herself and is smiling and encouraging others when I see her. 

Mobility issues are huge here, given the state of the “roads”, the number of hills and steps, and the lack of a concept of “accessibility”.  Marvin and Carmen, from Nicaragua, make prostheses and orthotics, giving amputees the ability to walk, and the patients I have seen are amazing in their determination and success.  In fact, I learned the danger of believing a woman with an above the knee amputation who has yet to get her prosthesis who told us of a good short cut from the rehab center up to the clinic!  Another program gives “PET” cars…I don’t know what PET stands for, but it is a small tricycle powered with arm pedals.  Using these is hard upper body work, but makes some patients able to be mobile where they otherwise wouldn’t be.  This woman, a high double amputee, is learning to use a PET car.

More than the physical recovery I have seen, what amazes me is the emotional resilience of the people receiving care through Advantage Haiti.  They aren’t moping because they have lost limbs, lost family, or lost function from other health situations.  They are embracing life and working hard to be involved.

Of course, work isn’t the only thing going on.  We all went to a beach about an hour away from here Friday afternoon/evening.  The sand is nice, the water is warm, and the area is nearly deserted!  We enjoyed a nice swim and a dinner of spiny lobster.  I will admit, however, that seeing at least 6 cows being walked up and down the tide line did cause me a bit of concern about the actual cleanness of the beach.

Tomorrow is Sunday and I’ll get to experience church in Creole and in Haitian style – should be interesting.

first impressions

Posted August 20, 2010 by oaxacadoc
Categories: Uncategorized

 

This photo represents a lot of how I’m feeling about Haiti – this was on the wall just outside the MTI guesthouse in Port au Prince (PAP).  Beauty and danger/horror existing together.  The positive way to look at this, I guess, is to say that the horror couldn’t eradicate the beauty.  But it’s also possible to say that the pretty hides the danger beneath…Hmmm…..

I flew into PAP without trouble on Sunday.  The trip from the airport to the MTI guest house was my introduction to a way of driving that makes Mexican drivers appear calm and reasonable!  Forming your own lane, passing in the oncoming traffic lane, motorcycles playing chicken with other vehicles, pedestrians maintaining their place on the street with barely inches from traffic, but resolute in not giving an inch… And the tap taps are amazing – extremely colorfully decorated vehicles about the size of an extended van, but with more people packed in than one would think possible, and with many also hanging off the back.  How the population isn’t decimated from traffic incidents alone is a wonder to me, as is the fact that there aren’t more people who have lost feet or legs to close passing vehicles.

 
   

After passing a pleasant evening at the guesthouse (where there was actually AC – a false hope of what accommodations would be like in Les Cayes) and getting to know Dr. June Hanks, a professor of Physical Therapy at the U. of Tennessee, Chattanooga, we flew on a UN helicopter to Les Cayes on Monday.  The UN airport is busy with small cargo planes and large helicopters doing “humanitarian flights”.  I was glad for being on a helicopter as it was a smoother ride and afforded photo ops that would have been more difficult on a small plane.  This chopper was large – not like the small transport choppers I’ve ridden before – and had everything written in Russian with later added English inside.  A Red Cross nurse was also on the flight with us, and there were supplies that were dropped at another location before we got to Les Cayes.

At first glance, this area looks much like some villages/small towns I saw in Tanzania with ramshackle shops of corrugated metal and other cast off materials close to the road, and the road alternately paved but with monster potholes, or dirt and difficult.  Again the traffic is a contest with multiple players, though I’m not sure who’s the winner other than you win if you make it to your destination without you or anyone else being maimed in the process <G>. 

In city of Les Cayes (the clinic/hospital is in a small area outside of Les Cayes called St. Simon), there are people milling about everywhere with little that they’re doing – unemployment is 80% here.  It would seem that there could be some work, if there was money to pay for it, as there is a hill of rotting garbage on the street outside the market.  The “super market” pales in comparison to a small convenience store at a gas station in the US.  Meat is scarce, even chicken.  Goat is common.  Figuring out costs in a store is complicated as sometimes it is in “gourdes” and sometimes in “Haitian dollars” which is actually just a concept/construct as there is no such bill or coin as a Haitian dollar.  It’s equivalent to about 5 gourdes if I’m understanding correctly.  Since I don’t really know how to ask how much something costs in Creole nor would I understand the answer, this is only a problem in wondering what the numbers on items mean.

Creole is relatively speaking, an easy language, but for me, I keep ending up speaking Spanish when I get into situations where people are speaking Creole.  But interestingly, who would have thought that my ability to speak Spanish would be a good thing for while I’m here?  Marvin and Carmen are a prostatist/orthotist  and a PT from Nicaragua.  Marvin speaks English and some Creole, but Carmen only speaks Spanish and rudimentary Creole, and is feeling lonely and apart from things.  It’s been fun chatting and joking in Spanish in the evenings, and this has been a blessing to Carmen.

Now to work – things are starting slowly as the doctor who speaks English decided to go on vacation right now.  I have seen a few people in the hospital in consultation, and one woman from the Bernice Johnson Home which is a place for rehabilitation and occupational training of women with physical disabilities.  There is a young woman there with a strange history of generalized weakness with onset 4 years ago – she has never seen a doctor for this but is now confined to a wheel chair!  I’m trying to set up a cyber-consult with a neurologist friend to try to figure out what’s going on with her and if there’s anything to do. 

There’s also a young girl in the hospital, Esperanza (Spanish for Hope – don’t know why her name is in Spanish) who was abandoned at the hospital by her family several years ago.  She has massive hydrocephalus (water on the brain) with a hugely enlarged head that she cannot move, and  overwhelmingly delayed development of the rest of her, so that she is essentially an infant.  It’s too late for a shunt to change her outcome and to reverse her developmental losses/delays.  But even worse than that is that no one holds her or plays with her or provides real human contact except when changing diapers and feeding.  She lies in a bed under mosquito netting looking out at nothing all day long.

The hospital would never pass accreditation in the US.  There are 8 rows of beds, about 50 beds in all, men, women, children all mixed together.  I’ve never really seen anything done by the nurses, and I have yet to see a doctor in the hospital.  I examined a young child with a question of a febrile seizure, and had a huge crowd of family watching (and translation by the man in the next bed as he’s lived in the US – HIPPA violation for sure <G>), but not a nurse other than a visiting US nurse to be seen.  Treatments seem to consist of IV fluids and medications.  I’m told there’s an OR there, but the GPs are the only ones there, and they do amputations and pins in fractures…Seeing the ward, I’m not sure I want to see the OR.

This has been a long post, but I wanted to set up the scene of where I am and my first impressions so that as I continue to write during this month, you have some idea of the context.  Thanks for reading along this far.  Please continue to keep me and this work in your prayers. 

Thanks for participating in this journey to this point.

Cindy

Haiti

Posted August 13, 2010 by oaxacadoc
Categories: Uncategorized

It’s been 7 months since the earthquake in Haiti.  Much has been done, much remains to do.  By now the “romance” of the situation is waning –  those who want to do something with quick results and great photos have gone on to something new, and the slow hard work of building infrastructure and systems while still attending to urgent needs is the day to day reality.  So why should I go to Haiti now?  Well, for those very reasons.  In many ways, this is the “exciting” time for one trained not just in acute care/curative medicine (I’m a pediatrician) but also in public health/community health development.  Lives needed to be saved, rubble needed to be cleared.  There’s no doubt there was a huge need for immediate relief after the earthquake.  But now is the time that a huge difference that can impact years and decades to come can result from evaluating the situation, the resources (both Haitian and of donor organizations), and the will of the people, and facilitating the building of a new and hopefully better system.  This is the opportunity to come alongside people who could easily feel abandoned by God and help them relearn that they are loved by God and that they have talents and abilities to build their communities.  And, oh by the way, I’ll still get a chance to help take care of children since the health care system is still horribly overtaxed and the presence of a US trained pediatrician usually brings out families from all around.

I’ll be working with Medical Teams International (MTI), an organization that Covenant World Relief has partnered with in disaster relief in Haiti.  A look at their work can be found at http://www.medicalteams.org/sf/about_us/media_center/articles/10-07-12/6_Months_After_Haiti_Earthquake_Medical_Teams_International_Remains_Committed.aspx.

Do I really know exactly what I’ll be doing?  No, not a clue really <G>!  Be Flexible has always been the operative principle in mission work, and this experience will be no different.   I’ll be flying to Port au Prince on Sunday, August 15 and stay overnight at the MTIguest house and then fly to Les Cayes on a UN flight on Monday.  Les Cayes is on the south coast of the island (I’m told there’s a beach there) and is the location of a rehabilitation hospital where MTI has been working to provide prosthetics and help in the reintegration of those with physical disabilities into the community.  Below is a map of Haiti.

I don’t know yet if I’ll be doing medical care of patients at the hospital, training of health professionals, or community health work at Les Cayes, but I’m sure whatever I end up doing, it will be challenging and rewarding on many levels.  Three of my four weeks will probably be at Les Cayes, with the fourth week being in Port au Prince and helping at a church where the pastor has taken in something like 70 orphans, all of whom need pediatric care.  All the while I’ll be also looking at public health issues as well as seeing if there are any partnerships that might be pursued, etc…  As I said, I haven’t a clue what exactly I’ll be doing, and when I look back at what I’ve written here, it will probably be vastly different.  What I do know is that God will have a way to use my various skills and background and the circumstances to transform all the lives involved, including mine.

So could I ask for you all to be partners with me?  I definitely want and need your prayers: 

  • For health and safety — ’nuff said!
  • Ability to communicate well — both with translators and with my few phrases of French/Creole (and to not fall in Spanish as soon as no one is speaking English <G>).
  • Wisdom and knowledge in unknown medical/pediatric and public health situations.
  • Humility to come alongside rather than dictate to Haitian health providers and community leaders.
  • Good working relationships with US and Haitian colleagues.
  • Resilience during times of intense work, long days, and often horrible tragedy.
  • Dependence on God.
  • Peace of mind about the well being of my family in the US (and peace of mind for them about my welfare).
  • Stamina.
  • Did I mention health and safety?

I’m told I will have some internet access, so I hope to blog as I can about the situation and what I’m experiencing.  I’ll only have a small point and shoot camera with me, and I don’t want to appear to be a tourist nor to be capitalizing on their sadness, so I hope to post photos, but we’ll see.  I will also try to post to Facebook, which I hopefully will be able to do from my phone if all else fails.  Finally, if you need/want to contact me while I’m in Haiti, you can email me (cindy.hoover@covchurch.org) or text me (954-682-4683) — at least I think this t-mobile number is going to work there.  I can’t promise responses (except for Mom and a few others <G>) until after I return (and then it will be to a mountain of email, etc…). 

Oaxacadoc is wandering a bit out of familiar territory — thanks for coming along on this journey none the less.

Adieu.

I’ve Finally Returned!

Posted August 13, 2010 by oaxacadoc
Categories: Uncategorized

Most of you probably think I totally abandoned my blog.  This hiatus was caused by rather overwhelming family situations that have occupied the greatest proportion of my time over the past year+. 

My Mom, while visiting me in Oaxaca, suffered a stroke.  I learned a lot first hand about emergency care in a foreign country, and the difference money makes.  Just a couple weeks prior to Mom’s hospital stay in the premier hospital in Mexico City (where she probably received better care than she would have at the local hospital in Florida and for a ridiculously low price by US standards), a Mexican pastor colleague had had neurosurgery under quite different financial circumstances.  Makes me wonder why we are so lucky/blessed, but I am nonethless happy that Mom could receive excellent care.  Over the course of this year she has worked very hard in therapy, suffered a setback after falling and breaking her good arm, but now has bounced back and is preparing to move to an independent adult living facility on the ocean where she’ll be able to enjoy life with a few less worries (and where I’ll rest easy knowing she’s safe).

In the midst of this, my great aunt also suffered a horrendous accident.  At 95 years old, she was still living by herself in her condo.  She unfortunately slipped in the shower, and while she didn’t break anything or hit her head, she couldn’t get back up and so had the water running on her face for 22 hours till I went to investigate after she consistently was not answering her phone.  She had a 2 week stay in the hospital with subsequent skilled nursing care and now has made a full recovery!  Amazing (and I hope indicative of my genetic makeup<G>)!  Next week she will move into the same adult independent living community Mom will be going to — they’ll be just 2 floors apart, each with lovely apartments with both ocean and intracoastal canal views.

I have also traveled to supporting churches, conferences, and Covenant camps this year — and enjoyed seeing many old friends and meeting new ones.  It was fun sharing what God is doing in Mexico and helping others catch a vision of how we all can participate in one way or another in the mission of the Kingdom.

Now it’s almost time to return to Oaxaca (and to finish telling you all the story of Semillas de Salud and the School Health Project), but first, I’ll be spending a month in Haiti with Medical Teams International, the partner organization that Covenant World Relief has been working with since the earthquake.  I’ll be writing another post shortly to tell about this trip.

Oh, and obviously no Oaxaca photos to post, but I’m including a couple of the “wild life” around my Mom’s condo here in southern Florida.

School Health Screening Project Part 1 –

Posted May 27, 2009 by oaxacadoc
Categories: Uncategorized

9road2smallOtra vez, saludos desde Oaxaca.

I’ve been a poor blogger the past couple of weeks — I’ve had a very disrupted schedule with the quarantine that lasted about 2 weeks and which necessitated many changes in planned travels.  But being home doesn’t mean being idle!  It just means a bit less exciting activities to write about.  That said, I’ll start trying to catch everyone up on what’s been going on with Semillas de Salud and the School Health Screening Project (named Juntos Por Salud in spanish — Together for Health).

This school health screening project was the designated offering project for the Vacation Bible Schools of Covenant Churches.  children-holding-hands-smThrough the generous sharing of the children in these VBS programs, we received approximately $35,000 to use in screening school children between the ages of 3 and 12 for anemia, lazy eye, vision difficulties, hearing difficulties, height, and weight.  A physical exam by a trained professional is also hoped to be included for each child.

 

 

First why these tests?  Anemia, “weak blood” or “tired blood”, is usually due to a lack of sufficient iron in the diet, and can adversely impact the cognitive development of children.  anemiaIn fact studies have shown that iron deficiency alone without yet being of a level to cause anemia, impacts cognitive development negatively.  Much of this is a vicious cycle, since the mothers are often iron deficient, the babies are born with lower iron stores, the breast milk provides less iron, and the subsequentdiet is deficient in iron.  All children hit a low point in iron stores and hemoglobin level (what is measured to determine anemia) around 9 – 12 months of age.  The American Academy of Pediatrics recommends that breast fed babies receive iron supplementation beginning at 6 months of age to avoid anemia.  Here in Mexico many babies start with a lower store of iron and do not receive supplementation.  The subsequent solid food diet also often is iron deficient (though the very poorest often have a bit less problem with anemia because they eat a lot more beans and lentils, things that are replaced with poorer iron sources such as chicken and pork when a little money is available).  With the anemia can come this poorer cognitive development and subsequent problems with learning.  The earlier we can detect this and correct this, the better the long term prognosis on a community and individual level for school success. 

In each community, we look for patterns of the anemia — who has anemia?  at what ages?  do they “outgrow” it?  is there a discernible difference in diet or such in the children with anemia? anemia2 With this we can work with the community to develop a program to hopefully not only correct the current anemia in individual children, but also to change habits so as to prevent anemia on a community wide level.  While I am hoping to eventually be able to compile enough data to encourage the government health system to provide iron supplementation to all infants starting at 6 months of age, we are also hoping to work with groups of parents and health providers in each community to help find affordable iron resources — whether in returning to more of a traditional diet with more beans, lentils, or such, to encouraging the use of amaranth, an ancient grain that was used by the Aztecs and has a high protein and iron content. This is a slow process, but one that hopefully takes root deep enough to persist and to change things on the community level while bettering the lives of the individual children.

Anemia illustrates well the “micro” concern of the physician for the individual with a problem as well as the “macro” concern of the public health worker seeking patterns that can help lead to effective interventions.  I want each individual child to be healthy, and I want the community to be a place where it is easy for families to do what will bring maximum health to the children.  This also reflects the combination of “God loving the whole world”, a macro concern, with the care and healing of individuals throughout Jesus’ ministry.    We are striving to bring a touch of God’s love to each individual child who is seen, but also a proclamation to the community that God is here and loves them and wants them to know his love.  Sometimes we focus more on macro, sometimes on micro.  In the end, though, we must do both, whether in health or in mission/evangelism.

I hope to get back to this blog by the end of the week to continue talking about why we’re testing what we’re testing, and how we’re doing it.  And we do have some results to report.  This will take several posts….it’s a long road, but an exciting one.  Thanks for journeying along with me.  Please pray for this project, for Semillas de Salud, and for me as we slowly enter communities with health and God’s love.  Prayer support is vital for what is going on here, for encouragement and wisdom and perseverance at times.  Financial support is also welcome.  If you as an individual, or your church would like to participate financial with supporting me or my ministry of holistic health, checks or inquiries can be sent to:

  • Dept. of World Mission
  • Evangelical Covenant Church
  • 5101 North Francisco Ave.
  • Chicago, IL  60625

              Hasta la proxima.  Be Well.

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