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Port Simpson, second time around!
As I fumbled around at home trying to pack for my second trip into the community ("40 lbs. limit or you pay, pay, pay"!), I had a few calls from the folks there to be sure I was in possession of my ID and a solid plan to keep it that way. Everyone loves a good joke- ha, ha! I assured them the ID was strapped with duct tape to my person!
When I got to Prince Rupert, I couldn't find my comb so I just ran my fingers quickly through my hair and tried to stay on schedule. I stayed in Prince Rupert overnight and in the morning, when I realized that the comb (and any other type of hair management device) really wasn't in my luggage, I figured out what had probably happened. It seems that the airline had thrown away the only comb I brought with me (it had 4 prongs on one end specifically for styling my type of hair) and not said a word to me. "Did they think I would rush the cockpit and style the pilot's hair against his will?!" I wondered.
I was not very happy at all and, when I arrived at the float plane terminal that morning, the only thing I could think of was that my hair probably looked pretty rough. I felt somehow unkempt. After I answered all their questions and concerns about the location of my ID (!!), I asked if there were any combs there or nearby I could buy. But, it was not to be. I tried not to be too obvious in t he waiting area as I attempted to untangle the flat mess of hair on the back of my head where I had ground my head into the pillow all night – likely worrying about how I would do my hair in the morning!
As I was checking in for the flight (still fussing about my hair), I noticed a distinct change in the facial color of the slim trainee standing behind the counter. She was listening so very intently as the details of the program were explained to her and, as I watched, she began to slump over. I asked one of the other staff members to grab her as I rushed around the desk. We settled her to the floor and her color began to return. We got a cloth for her face and a sip of water but, suddenly, she became unconscious again. This happened 3 times. The ambulance was called, to my relief, and I gave my report to them, watched as they began their assessment and, then, went to wait for my flight. As I left, I said to the gals "well, I guess my hair is really a mess now, eh?" and we all had a good laugh.
The flight in was fabulous (again, I am wondering about the weather concerns people have!). The next day, to the health centre, came a package from the airline with a large variety of new combs, brushes and hair picks plus luggage tags and a key holder! When I called, the gal said they thought I would need these because my hair would have been in very bad shape by then, since I had no comb. She was right! I had begged and pleaded for a comb or brush but there was not a spare one in the community so I had just washed my stupid, sproing-y hair and hoped the curls hid the knots! Guess how many and what type of hair taming devices I carry with me now?!
The only other entertaining thing about my trip was the fact that I almost didn't get out of the community on the day I was to leave because the float planes were not flying. Another nurse on-site had to leave as well so we shared a cab to the dock and took a water taxi back to Prince Rupert. Sunny day, blue sky and calm water took us all the way there! I had to leave the community about 5 hours ahead of my intended departure time but it was the most sensible thing to do.
It was a lovely time in the community and a fabulous trip home – can't wait for next month!
Submitted by: Colleen C. - RN, BSN
I Asked For An Adventure – a true story!
"What a lark!" I thought. I was going to a remote community on the West Coast of BC to do a 1-week Nursing job for them. I wasn't exactly sure where the community was when I applied but I knew the job well and I was up for the adventure. As it turned out, the trip was "all that and a bag of chips" in the adventure department! I call some of the circumstances described as "things that make you go hmmm..." because they just seem like such a series of unusual circumstances.
I have not travelled much for a few years because I have been too busy with local activities so I was not familiar with all the rules and regulations of the travelling game. I was told there was a luggage restriction on the float plane I was to ride in so I found my lightest suitcase and tried to make everything I needed for a week weigh in at 40 lbs. I did it! (even though, in past travel experiences, that would have been the weight of shoes alone!) But, I had packed all the wrong things and put everything in all the wrong places ("a pox on me", I had actually put liquids and gels "unsecured" in my carry-on bag!). The scanners found every one of the "secreted" items immediately, threw out with great disdain the water in my water bottle and made sure that I had learned my lesson thoroughly. I was given pamphlets and special bags to take with me for future use and reminded several times of the rules. I sat dutifully as I waited for the plane to leave and was fairly meek throughout my trip to Vancouver. (OK, maybe not such an auspicious start!)
I had a lay-over of about 5 hours in Vancouver before the flight to Prince Rupert and just zoned into the wonders of that airport – it is always changing. I wandered all over and finally found myself sitting directly in front of the gate I was to leave from, in front of a man who remained there for the entire time I was there. Except for a brief few minutes to go and relieve myself, I remained in that spot as several flights left through that gate, past that man. Finally, as the time came perilously close for my plane to leave and I noticed that no one else remained in the seating area, I stood up and, as if he had never seen me before, the man gasped out my name and ran to hold the plane so I could get on!! Not once had I heard any announcement about the flight or even my name mentioned! I dutifully scurried out and onto the plane, past all the comfy people and into the very last row. (By now, I was wondering if the Universe was sending me some kind of a "message"! But, now we were on track, I said to myself)
When I got to Prince Rupert, I was starting to get a bit nervous about my first-ever float plane ride – I had heard some nasty stories about flying around in the North. In fact, one agency had implemented a policy that required all of the managers who had to fly over water of any sort (that's the entire Province, I think!) to take a special escape-from-an-upturned-and-submerged-plane training in case their plane ever goes down- yikes! I guess it was fairly easy to see my angst as I chattered away to the airport personnel like we were old friends! I asked to meet the pilot – they all looked 14 to me! The pilot for my flight was quite a bit older than that, though, and looked experienced so I felt better. He was quietly professional completely uninterested in my adventure, so far – I am positive he has heard all kinds of strange things so my stories were pretty tame, I think!
The ride into Port Simpson was fabulous! All those people who warned me about the flight were "crazy", I thought to myself, and completely ignored those who told me how very lucky I had been. Apparently, the flight is not usually that smooth. (I was sure they were exaggerating.)
When I got to Port Simpson, I immediately saw that the tide was out. I knew that because the ramp up from the dock was almost vertical! That equated to about 30' of slippery, shoulder-dislocating dragging for me – 40 lbs. with no wheels up a steep incline is an accomplishment! No one had told me that the overweight charges for a wheeled suitcase are well-worth the expense. All my careful packing to be in accordance with the weight restriction equaled a very painful and most embarrassing experience. I arrived at the top of the ramp, gasping, and was greeted by a calm member of the health team who had watched my ridiculous struggle and now waited patiently as I wheezed, sniffed and shuffled my way to the van and off to the Health Centre. ("Nice first impression" I kept thinking, "but, things are really ramping up, now!")
I was taken to the Health Centre where I was to meet a plethora of really great people. I was absolutely amazed with the beauty of the community and the warmth of everyone I met. I learned that everyone in the community has CB radios in their vehicles and homes – I thought that was interesting. I was soon to know just how interesting!
The unit I was given to stay in was a brand new and very nicely-appointed townhouse (one of 4 at the end of a graveled, fairly isolated road in a new area being developed for housing. The 2 duplexes were the only buildings there and, when I arrived, there was someone living in one of the other units. The nurse that was in the community before me let me know there was no phone in the unit but that she had managed to get high speed internet set up. I didn't really think about having no phone while I had a neighbor in the unit beside me. However, the next night was very "dark and stormy" with wind blowing and the dark even darker. Suddenly, I had some other thoughts about having no phone. It was very quiet and there were only distant lights from the nearest house for comfort. I was sure that a phone would have been more effective than an email to someone, in an emergency. I remember the other nurse telling me that there was also no fire extinguisher in the unit and, to demonstrate the concerns about that, she presented an interesting scenario. She said "if you have a flaming steak and the place starts on fire, you have no extinguisher and no phone so you will have no choice but to run outside, flail your arms and yell for help. But, you might choke on the steak and then the wolves will get you anyway so, really, none of this matters much, anyway"! (I watched out the windows all night, the first night I was there!)
I loved my work, made a positive impact in the health team (I think) and got to know the community quickly. I was really loving this new type of nursing – travel nursing! What fun!
I made a point, as I try to do whenever I go into a new community, to learn a few words in the local language, especially a greeting of some sort. I researched, practiced and refined what I learned over and over, using the words as much as I could in the community (and being corrected, always politely, whenever I did). When finally I was able to use my greeting with an Elder, who I hoped would recognize my gesture of respect for their culture, I was doing a home visits and met with a very lovely woman, the oldest community member, in fact. Once we settled down to talk, I asked gently "how are you?" in the language and the way I had been taught. She paused, looked up at me and said "Isn't that lovely, dear, but... (she smiled sweetly)... I don't speak the language"! (I smiled sweetly back to her and recalled a saying I heard once – something about never getting a chance to make a first impression! She still smiles when she sees me.)
While in the community, I was frequently taking pictures of the many fabulous sights. On my third day in town, I stopped across from the Band office to take some quick shots of the sun on the water and a totem pole I saw there. I stepped out of the van to take the pictures and bumped the door shut. Problem: the van was running and the door had locked behind me! It took me only a few minutes to realize I could not get out of this alone! I finally went over to the Band office, quite embarrassed, to ask what I could do about the situation. The receptionist said she would call one of the firemen. Sounded OK... but, remember those CB radios in every home and vehicle? The Band office also has such a radio and – guess what? – the news of my plight was quickly broadcast all over the community AND it was announced that it was the nurse! (I was pretty much developing my profile right then and there! And, there was more to come...)
(These are "things that make you go hmmmm", if you recall) I learned that there is a "Ben (my son's name) Mountain" and a "Nelson (my previous last name, before I got married) Street" in the vicinity. Almost seemed like the place I was supposed to be, alright.
It was a great week in the community but too short. The day I was to leave dawned clear, sunny and crisp – a beautiful day. I finished up at the office and threw everything in the van. I was driven to the float plane dock where, again, I dragged my suitcase down the vertical ramp. (I assure you, it was only a small bit easier going down!) The flight was wonderful again so I now had the firm belief that everyone was just kidding about the horrible flights.
I arrived in Prince Rupert again and called a taxi to take me to the departure point for the shuttle to the airport. I was going home! The taxi arrived and the driver found me completely buried in my carry-on bag and suitcase, searching frantically for my wallet. It was not in my possessions and I had no ID for the plane and no money or credit cards for anything I might need over the next travel day! The company I was working for was contacted and we tried to think of ways to find and get the wallet back to me and still make the flight on time. Remember those CB radios? Well, you can guess the message that was broadcast around the community this time. It was the nurse, again. (My reputation was firmly in place!)
They found the wallet in the van I had been using, of course, but not before the whole community set about hunting for it, communicating with each other constantly by... you guessed it... the CB's. It had to be couriered to me at home so I was to be without it until then. The company arranged for me to get on the planes I needed (that, in itself, was tricky)and authorized some meals to be charged to my room in Vancouver. So, off I went. A man offered to share his taxi to the airport with me when he heard my "sad" tale at the counter (more nice people). He entertained me in the cab by telling me he was a frequent flyer in the area but had just had the "absolutely worst flight" he had ever had into Prince Rupert! (I tried not to listen!) Air Canada took me aboard in Prince Rupert without a worry about my ID. No problem. I was on the way home, now.
On the 2-hour flight to Vancouver, I rode beside a very interesting physiotherapist who also travels around the North providing services. We had a great conversation and some good laughs as I told her my stories, including my missing ID and money. We had to wait for ½ hour when we got to Vancouver so that a spot for the plane to dock could be found (what?! – weren't they expecting us?!)and, by the time we finally picked up our luggage, I joked with my new friend that it would certainly be too late to get room service now but it was OK because "I could likely live on my fat until morning", I told her. Another laugh between us and she introduced me to her husband, who was waiting for the luggage with her. As the bags began to drop onto the belt, she came over and slipped a $50 bill into my hand. Amidst my attempts to give it back, she told me her husband had told her to do it and not to worry about it at all! They wouldn't take it back nor would they substitute a smaller bill. I had to chase after her to get her business card so I could at least contact her when I got home. She gave me the information but, again, insisted that I not worry about it. (People are pretty cool!) I went from the airport to a hotel in Vancouver and checked in without incident - amazing!
Behind me, at check-in, were an Asian woman and her daughter whose flight had been delayed so much that all her connecting flights were now disrupted, she told us. Somehow, I didn't feel quite so bad, after hearing that.
In the morning, I was late getting up and couldn't get breakfast before I left for the airport. I went to the hotel restaurant with my trusty breakfast voucher in hand and asked only for a big to-go cup of coffee. Although everyone in the place looked feverishly, there were no to-go cups to be found. I must have looked a bit crestfallen because the waitress was so very apologetic. I told her about the ID, money, credit card thing and... are you ready?... she immediately pulled 2 American dollar bills from her pocket and told me to "take them", she would "never use them" and I could "get a coffee, at least, at the airport"! I was flabbergasted and fell all over my words thanking her for the gesture. (MORE good people!)
When I got to the airport, I hurried to stand in line for ½ hour at the Air Canada queue. When I got up to the desk, I was told I was at the wrong place and the airline I wanted was at the end of the airport. When I got there, I saw no Coastal Pacific counter. I was informed that it was at a completely different terminal! My plane was to leave at 11:15 and it was 10:30 when I sat down to wait for the shuttle to take me to the right terminal. The shuttle was supposed to come at 10:30 but it did not. At 10:40, a young man stood up and said he was going to take a taxi instead of waiting. He asked me if I wanted to share one and told me he had experienced many times the shuttle just not arriving at all as scheduled. I was forced to recount the saga of my impoverished state again and he said to come along with him in the cab. The time was 10:45. The taxi driver made 2 wrong turns before he finally figured out how to get to the terminal! The time was now 10:55 and I was getting really rattled but, while we rode together, the young man asked me if I needed any money! (It was almost unbelievable!)
I ran to the check-in desk and gave the attendant my name and a short version of the no-ID story. I assured her that the company I worked for had called to flag my name so the airline would know. However, there was no flag or banner or note or fireworks of any kind on my reservation to explain the situation. And, there was no way the woman was going to let me on the plane! It was 11:00 when I called the company – the fellow agreed to FAX my ID immediately to the airline but, he said, he was on the road and it would take 15 minutes to get to the office (the time was 11:02 now and anxiety had risen to push a few small tears out of the corners of my eyes to go with my sense of resignation). The airline agreed to hold the plane for 5 minutes in order to get the FAX and, at 11:14, the FAX arrived (a completely indecipherable document with a smudged image from my drivers' license!). I think the airline staff were keen to get me away from their immediate vicinity so, suddenly, I was in the security line and out just as fast – I was, of course, much wiser about my packing this time and I had already discarded my water!
I mean it when I say that, if not for the amazing problem-solving skills of Jamie and Jeff (now known as "The J Team") of Solutions Staffing, I think I would still be standing at the bottom of that damn ramp but, this time, with a tin cup and a forlorn look! I can't thank them enough.
By the way, on the way home, I rode beside a very pale and quiet woman, about 40-ish, who had, not 5 days prior, had open heart surgery, a double bypass! Know what? I have no problems at all. Next time I ask for an adventure... c'mon, you know I will!
Submitted by: Colleen C. - RN, BSN (a "newbie" travelling nurse)
So, when you return from a trip like the one I just took, everyone asks “how was it?" A simple question, or so you think... until you really start to ponder the answer.
I have become accustomed to answering “good” in a nutshell, the word ‘good’ encompassing other adjectives such as: emotionally draining, exhausting, rewarding, hot, humid, dirty, devastated, amazing, inspiring, eye-opening, challenging, scary, peaceful and life changing. How do you elaborate on a description like that? How do you share the details of a journey like this one? I’m not sure, but I’m going to try.
February 26th 2010 I board a Cathay Pacific flight leaving YVR, destination JFK airport in New York. Upon arrival there I wander through the airport taking in the last of organized surroundings for a while. As I sit in the departure gate, surrounded by many Haitian faces looking at me wondering what my ‘mission’ is, CNN breaks the news of an 8.8 earthquake in Chile. I can’t help but think... I wonder if they need help there right now? Everyone is glued to the TV and I can hear mutterings in Creole, French and English about how scary all these worldwide earthquakes are. I board my next flight, a VERY full American Airlines flight (they are currently the only commercial airline flying to Haiti) and strangely end up seated next to the two other guys with New Reality International flying out of New York. Enter Dennis and Erick. These two crazies from upstate New York were a pleasant break to the monologue of possibilities that is running through my head. Erick is an emergency Doctor and Dennis a Physician’s Assistant in the emergency department. A position that doesn’t exist in Canada, but should! Together we laughed, joked and nervously (our flight did not have a smooth landing, I believe I may have gripped the chair ahead and screamed at one point) awaited our arrival in Haiti.
Landing in Haiti is kind of surreal, much like this whole trip. From the air it looks like any developing nation that lives simply in brick structures with lots of farmland and very little infrastructure. As we get closer to the tarmac the devastation becomes visible. Crumpled buildings, makeshift tent cities, a constant stream of smoke from the Port where fires still burn and an airport that looks more like a military base. Rows and rows of army green tents; large tanks and armoured vehicles rumble about, each one carrying a handful of helmeted, armed soldiers wearing all the flags of the world. There are crates and crates of relief supplies tied up tight on shipping palettes, destinations unknown. There is nothing usable about the original Port au Prince (PAP) airport, though still standing, it is cracked and partially collapsed in some places. A company from the US is working with American Airlines to rebuild the airport quickly, but so far there is one new hallway and a makeshift arrivals area. It is humorous, but also kind of inspiring to see how much the Haitian people are trying to return to some semblance of normalcy. Upon disembarking from the plane we walk down a shiny new outdoor hallway – air-conditioned – to the sounds of Haitian music being played by a live band. We are then slowly ushered back outside onto a bus and taken to Immigration. The heat is overwhelming. Having arrived from 8 degrees and rain, into 35 degrees and humid – I’m finding it hard to breathe. Our luggage and supplies are lumped into a heap outside immigration along with the belongings of every other passenger on board our flight. It is mass chaos as we crawl all over one another to try and find our bags, drag them to our meeting spot and organize getting out of the airport! Meet Rick, Howard and Laila. They had come in on an earlier flight with the rest of the team (who are waiting on our schoolbus down the road.) After much stacking of crazy heavy bags and exiting the airport, we push our way through the crowd of yelling people outside the airport and down the broken cobblestones about three blocks to our bus. Large army vehicles, local buses, cars and people stream all around us. The air is thick with our anxiety and the sense of a people teetering on the edge of chaos.
We bump and jostle slowly down the road towards our destination, Haitian Christian Mission, approximately 40 minutes north of PAP. The going is VERY slow, other vehicles, large (okay car-sized) potholes, cows, goats, kids and people clog up the narrow streets. Jacob, James, Mary, Lara, Rick, Dan, Howard, Justine and George have now entered the picture. The bus ride goes in and out of conversation. We are all exhausted from traveling, the first half waiting for the second half, and are trying to take in the scene outside the bus windows. At first glance it looks like a developing nation, and by that I mean, living in relative simplicity; children running around with very little clothing and no shoes, worldly possessions being carried in colourful baskets atop people’s heads, garbage and refuse in ditches, 80 year old women doubling on motor bikes, little shops selling everything from cell phone minutes to motor oil. Of course there are also the road side food stalls, women busy slicing and frying plantains and chicken parts. At second glance I notice the buildings; most of them are one story now instead of two, with the bottom floor crushed beyond recognition. Stairways are falling off the sides of houses; carefully constructed tents have now replaced houses and shelter. Piles of “usable” bricks are being salvaged by a people that know the international relief effort and rebuild operation will be a long and bureaucratic process that will likely not begin before rainy season comes. Occasionally one can catch a glimpse of a makeshift memorial, and more than occasionally you will see signs (written in English) that say “we need help now, food and water please!”. These are painted or written on old boards, the sides of building and on the road with arrows pointing down alleyways and into backyards where refugees are living by the dozens. We are jolted out of our thoughts by our arrival at Haitian Christian Mission (HCM), rusty heavy gates roll open and our bus bumps through the opening into the courtyard. A sea of dark eyes and inquisitive faces stare back at us through the bus windows; wondering who this next set of transient white people is. What will they bring? How long will they stay? Will they remember me next week? Will they take me with them when they leave?
Betty the Boss greets us and shows us where we will stay. There are rooms inside with dorm style beds and a couple of simple bathrooms. It is stiflingly hot and humid inside, so we opt for mats on the deck where there is at least the hope of a breeze! Mosquito nets hung from the rafters are our shelter. Around every corner there are kids and people peering in, trying to catch the eye on the newcomer. We look around the mission and see the setting in which we will be providing care. HCM recently opened a new clinic for its midwives, which also has a recovery ward/medical ward consisting of nine beds. There is also an operating room with basic supplies…and rats. Rats are a BIG problem here, likely due to garbage, human waste and human bodies. We meet another team from Missouri who are doing surgeries and recovering patients in the sweaty medical ward. There is a HUGE pile of supplies on a table in the corner and not a chart in sight. I decide here and now that I will make that pile of junk my mission to organize by the end of the week. Despite the messes in every corner and the trains of sugar ants going up and down the walls, the clinic is clean and functional. HCM is working with local people to train nurses and doctors to provide safe care year round at this clinic, but currently still relies on the support of foreigners on a regular basis. When in Rome is the saying right? So I get to work. Helping the nurses from Missouri recover their post operative patients in the searing heat of the “ward” while pathetic fans attempt in vain to cool us off from above. While getting to know these nurses and getting used to the constant staring eyes of patients families, I become aware of other sounds, sounds that will be “normal” like everything else, very very quickly. These are the sounds outside the clinic; like most buildings in the developing world, there are no actual windows. This is mostly to help attempt to keep ventilation going and also to reduce costs of construction and upkeep. The confused rooster that crows all day and night (apparently this happens when the birds are stressed), a chorus of clucking, squabbling hens and the occasional chime in of a goat or dog. These are the noises we all quickly become accustomed to hearing.
So after many long hours of traveling and taking in all my new surroundings, meeting the fabulous team that will change my life forever, and working in the clinic with new nurse friends until 1130 pm – I collapse under my mosquito net and attempt to tune out the sounds of my first Haitian night and get some sleep. Unfortunately being one of two people experiencing a four hour time change, sleep doesn’t arrive until about 3am... and morning starts at 6am... wait I mean 5am, especially when alarm clocks “pre-set” themselves for daylight savings time and go off early. No pointing of fingers though... really.
If I was to describe every little detail, smell sounds and experience of my seven days in Haiti this story would be 15 pages long. I would happily write it all down, but I know human nature and I want to keep people interested. So now that I’ve set the stage, and you have a sense of what our environment was like, I will float this story over the remainder of my days down there and hopefully give you a sense of why I was more exhausted after these 10 days than I have been to date in my life.
Our days started with a bumpy, hot bus trip to a local temporary hospital that has been set up on the grounds of a local orphanage. The orphanage has been nice enough to allow the US medical team to set up their HUGE tent city (called “Love a Child”) in conjunction with the Red Cross on their property for one year. The majority of the patients that live here with their families are amputees. The Red Cross estimates that there are close to 5000 new amputees in Haiti since the earthquake. This hospital is for rehabbing and treating wounds, very few emergencies are seen here. Though at the time of our visit the Dominican Republic was closing down the clinics it has opened since the earthquake and sending all the Haitian patients home... so Love a Child was getting inundated with new patients, their families and ALL their belongings. Our time here was spent doing daily rounds and treatments on various in patients in their various tents. I was amazed at how fast people were healing from new amputations. There was very little signs of infection despite the average temperature inside the tents being upwards of 45 degrees C. As I absorbed this scene, I couldn’t help but think wow – so many smiles and so much laughter amidst all that these people have been through. We truly have something to learn about happiness from this situation. Church singing underneath the trees continues in the background while we move on the help relocate the two operating room tents. 40 degree sunshine beating down, 25 people, one person yelling 1,2,3 LIFT and presto – two OR’s get lifted, moved and set down on new platforms. This process making room for another massive army tent to provide shelter during the coming rainy season, in the process displacing many mice and rats that had taken up residence UNDER the operating theatres. While working with people from all the world for this one day, and trying to avoid missing anything that my senses becomes aware of, I take note of a little girl making the most of her situation. While her entire family is gone, she has no home and now finds herself with a more uncertain future than ever before, she makes a job for herself; a job that takes care of other people. She is spreading cups of water along the dirt corridors that line the rows and rows of tents. She spends several hours a day doing this in an attempt to keep the dust and dirt down when the afternoon winds kick up. A local translator helps me understand her story and her intense sense of purpose. She simply states “dirt will make the physical wounds that people have much, much worse; at least I can help prevent that pain from happening.” Well said.
Evening activities vary from working until the moon is high in the sky, to relaxing with local refugees and eating a modest dinner while laughing and venting about our days. Most meals at HCM are modest. Two meals a day for sure, simple and usually involving lots of white flour and starch; and sometimes, if time or situation permitted, a bite of peanut butter and bread or crackers for lunch. Thank goodness for granola bars!!
Our days of providing care to the Haitian people vary from running clinics at HCM and taking our “show on the road”, setting up mobile clinics at various locations. These include churches in downtown PAP and also local temporary tent cities. Many people have asked me what I mean my ‘providing care’, lots of people assumed we would be dealing with emergencies 24/7. But seeing at we arrived almost eight weeks after the earthquake, the intense triage and outright emergencies had been dealt with. Now the population of PAP, Haiti is dealing with the aftermath and a severe lack of supplies, medications and primary care. Enter... Church clinic!
Our lovely translators, always happy smiling and laughing, arrive on the balcony where we are finishing up a morning cereal and ant avoidance session (right Erick) and state “are you ready to work now?” Are we ever; five of us head over the church on the ground of HCM and are greeted with close to 500 people whom have been waiting to be seen by the doctor since 4am. Hearing this, it makes you want to get up earlier every day, work longer and later, and not stop until they have all been seen. But the reality is they will just keep coming, as long as you are seeing patients they will continue to line up. Our translators double as triage nurses, taking names and complaints on a piece of paper. When the stack runs out... the clinic closes for the day. The Haitian people seem to understand this and will simply camp in the courtyard and try again tomorrow if they don’t get seen today. The rest of the day is a blur, seeing patient after patient, essentially functioning as a family physician who also needs to pay particular attention to watch out for critically ill people that have traveled for hours to see the doctor. The heat rises with every hour, and we are thankful for the arrival of a giant fan to help circulate the air that is thick with sweat, tears and the cries of impatient children and babies. Common complaints are belly pain, vaginal infections, trouble peeing, scabies, lice, fleas, hernias, birth defects, congenital problems, viral illness, dental problems, trouble sleeping, symptoms that likely indicate severe post traumatic stress, chronic headaches, dehydration, asthma, respiratory illness, malaria exacerbations (due to a lack of malaria medications since the earthquake), pregnancy issues, menstrual issues, acid reflux, diarrhea, vomiting... okay you get the picture – if you can think of it, it is a problem in Haiti!
After an exhausting day of providing care and dipping urine samples on an altar (still not sure if that is a bad thing) we welcome home the rest of our team. They have been in PAP all day providing primary care through a mobile clinic, their pharmacy and supplies being set up in the bed of a pickup truck. They look weary, dirty and beyond exhausted. But all they can say is, we have to go back and do that again there is just so much need.
One of the cases we saw and provided urgent care for included a woman in severe congestive heart failure/pneumonia who had walked (yup that’s right) 3-4 hours from the mountains with her daughter to be seen by us. Needless to say I walked her right over to the hospital ward, started an IV with some antibiotics while trying to ignore the incessant beeping of our one cardiac monitor as it tried to alert me to her oxygen saturation of 78%. Her daughter immediately settled in next to her mom, on the floor, and pulled out a little burner to begin cooking her lunch and also provide some food for the other people living in the hospital. There are about four permanent residents in the hospital. One is a very sweet 82 year old women with dementia... and a HUGE open wound on her foot (you may remember the photo of this) she spent three days stuck under a building, and the surgical team from Missouri had attempted to save her foot through a rather large debridement, exposing her tendons and hoping to encourage granulation tissue and new growth. As I mentioned before HCM is trying hard to train local people to work as physicians and nurses, but there is definitely a gap in knowledge base that needs covering. I had one experience, with the patient mentioned above, where the Haitian doctor wanted to treat her CHF with a drug that would lower her heart rate and blood pressure while compromising her cardiac output. This is for a women gasping for breath with a blood pressure of 75/40. The trend also seemed to be, see the patient once... then hope for the best! One patient being looked after solely by the Haitian medical staff had the same empty IV bag for two days... before I finally couldn’t take it anymore and dealt with the situation. Anyhow, they are trying so hard to deal with everything that has happened and also to look competent in the eyes of the world that I give them credit for every second they are trying, and for every minute bit of difference they are making.
Something that really stood out for me while caring for people down there, was how amazingly tolerant they are of pain, bad smells and bad situations. They share everything with each other in close quarters (as if they have a choice) and accept that they have to provide their own family with food while they are being treated in the hospital. Everyone helps to reorient “foot lady” and to get the little girl with burns down the entire right side of her body, and no family, to the bathroom. It really highlights the intense sense of community these people share and in a weird way, how the earthquake has bonded them and brought them together even more.
Arriving in a tent city and setting up a mobile clinic is an entirely new experience for our team. The poverty and living conditions of the majority of new refugees is right in your face. The smells, sounds and sights that go along with it are right there too. Big eyes on little faces, situated above hugely swollen bellies and bare feet greet us as we set up our modest pharmacy, tables to examine people at and a tent for shelter from the blazing sun. Soon after arrival, almost the entire tent city is lined up waiting for a chance to sit in front of the “doctor”. Mary, our nurse anesthetist from LA, has a list of common ailments, solutions and prescription suggestions in her pocket, and is now ready to try her hand as a primary care provider. What struck me was how the community came together to round up the sickest infants and children (mostly orphans being looked after by the community as a whole) and put them at the front of the line. Hour after hot sweaty, dizzying hour we made out way through the line-up of people and the dwindling pharmacy supply on our table, rationing everything from Pedialyte to Tylenol. To give you an idea of cost of medications for Haitians, six Tylenol costs the equivalent of three months wages…if you have a job or any income at all. So vitamins, gravol, ibuprofen and especially simple antibiotics are out of the question.
While we continued our daily missions of roving clinics, wound care and dressing changes at the HCM clinic, and dealing with midwifery emergencies we had another team of people working feverishly all day everyday. Doing what you ask? Bringing eye exams, simple eye surgeries and GLASSES to about 400 people per day! James, Howard our beloved Rick and Jacob saw patient after patient suffering from Itchy watery eye syndrome. Many people suffer from cataracts in Haiti, and present to the doctor with “black vision” and “lots of falling”. So sad... such a simple solution there just isn’t the technology there yet. So our always humourous team of ophthalmologists fearlessly plowed their way through the sea of eyes and glasses, making a HUGE impact on the quality of life for many many Haitians. They even trained half of our team to do eye exams and glasses fitting for them! Well done Lara, Laila, George, Justine and whoever else I failed to mention.
So suddenly six days has gone by, I can’t remember the last time I looked in a mirror or cared what the reflection looked like anyhow. The good news is at this point my body has stopped sweating all the time! A nice break, to have my daily cold shower and not be sweating again before my sarong is wrapped around me! My mind, body emotions and soul are more than exhausted and I will be forever bonded to the people I have come here with, and the ones I have met while in Haiti. Just when I begin to contemplate what is next for me, as I’m cleaning up more piles of stuff and relocating piles of ants in the hospital ward... Erick and Dennis bring a little girl in from Church clinic that isn’t responsive. She is 3 years old. She has been waiting 40 minutes to see us. Sometimes triage requires more than a name. Her parents (through the translator) say that she was like this when they tried to wake her up this morning. Her heart rate is 40 and irregular; she is having seizures every few minutes, her respiration rate in slow and erratic and her temperature is sky high. Things aren’t looking good. Erick gives me the “eye” of I need you and I need you NOW. So what’s wrong with her? No idea... no one has any idea. Her parents claim she was well yesterday, no cough no fever... normal. Many things start to go through our minds; is she septic... from what? Does she have meningitis? If YES then that means a whole bunch of other things for us. Does she have pneumonia? Is she severely dehydrated and febrile? No one knows. So we go into emergency mode, and start to treat her. IV access through the feet, not possible. Finally gain access through an elbow vein. Fluids, IV antibiotics and transfer her to our “trauma room” otherwise known as the operating room, sleeping quarters on some nights, and occasionally rat home. Her oxygen level is not life sustaining and her lungs are full of fluid. Her blood pressure keeps getting lower and lower, she is still seizing. I don’t know how long we worked on her, intubating her with whatever sized pediatric breathing tube we could find, gave her sedation based on what we had not what we wanted or needed and based our drug doses on “educated guesses” including approximate weight and what Dennis’ iPhone application said. All the while Laila is working feverishly on the phone trying to find a hospital in PAP that will accept this child as a patient. No one is willing to. With a breathing tube they claim they can’t support her needs. Finally, we find one willing to accept her as a patient. So we package her up, wheel her down the hall and load her into the back of a jeep. Continuing to breathe for her, and give her medicines and take care of her in the back of a sweltering hot, bumpy jeep for two hours into PAP, and to three hospitals before someone actually let the team in the door. A doctor (North American) is looking at her and noticing that she has finally peed (a great sign) and is now breathing on her own... breathing tube is now out, kind of by accident. At this point Mary says quietly to the driver “we need to back away very slowly, get in the car, and drive like you robbed a bank” so we did. Leaving her behind and accepting that we will never know how that little girl faired, or what happened in the end; in the same breath focusing on the fact that we did as much as we could for her, and tried our best. We really did exhaust ourselves trying. I then make myself busy for the rest of the day, absorbing everything that happened in the morning, and find the tears are starting to flow and I didn’t even notice them start. Could be I am numb? Could be they are the same temperature as my skin.
It’s time to go home now, lots of goodbyes and sad hugs. Load onto the big yellow rickety school bus with no door and head out through those big rusty gates that look so familiar now. Our bags are light, and our hearts are heavy and exhausted. Not much conversation on the way to the airport in PAP as we stare blankly out the window and take in the landscape that has become normal so quickly. One quick stop to buy cell minutes for DP and to check the gas level with a stick from the ditch and we’re on our way. Bump, bump thump all the way through six lanes of crazy traffic going whatever direction it pleases to the departures lineup. The flag above the gate says “air franc”, really it means “all flights” as there is still only one commercial airline flying. We buy jewellery and souvenirs from street vendors and are intrigued to note that as you enter the terminal a guard looks at your passport, and crosses your name of a big long list. Yup, every person that comes in is accounted for and they ensure that every person leaves when they are supposed to. Interesting indeed. Once inside we are taken aback by how new and clean this terminal feels; crammed full of people waiting for flights from one of two gates. We all leave at different times. Some people are sleeping, some writing, some reading and some madly texting their loved ones at home. I decide it’s time to call home, for the first time this week. I call my parents house, when my dad answers the conversation goes like this... “Hi dad it’s me!” to which he pauses and replies “Hello? I think you have the wrong number...” I then say "No dad don’t hang up! It’s me!” Recognition and a conversation ensue. This is comical for many reasons, but mostly because I’m an only child. I’m not sure who else calls him Dad!
Now enroute back to North America. The tiny country of Haiti is slowly disappearing below our 737. Dennis and I get seats together right at the back of the plane, the ride sure is turbulent back there. Fitting I suppose given the nature of our week. We chat, reminisce and fall asleep listening to music and watching some bad movie. Mmmm a bad movie, that is kind of a fitting descriptor for the lives of some of the people we have encountered this week. Haiti was the poorest nation in the western hemisphere before that fateful day in January of 2010. Now it is not only the poorest, but the most determined and resilient, at least from my perspective. Another interesting word; perspective, something I gained a new understanding of during the last week of my life.
I went to Haiti on a whim, knowing that as a nurse I’ve always wanted to do disaster relief and aid work as part of my career. I made an internet connection with a random organization and embarked solo to meet up the most amazing group of people for the most amazing week of my life. I didn’t know what I would be doing in Haiti, or how I would feel at the end of my stay there. Now I do. Did we change their lives? No, but we used everything humanly possible within ourselves to put a bright spot in their days/weeks/months and gave them hope that the world hasn’t forgotten them. Will they forget us? Probably... will we forget them? I think you already know the answer to that. So until the next group of white aid workers on a mission arrives, the people of Haiti will continue to thrive, heal, live, die and move forward towards their future one day at a time. I will return to Haiti.
To view photos from Christina's Haiti experience, please click here.
In the afternoon of August 2, 2009, a patient I was seeing at the Alexis Creek Outpost Hospital casually remarked, “I wonder how serious that fire is that’s coming over the ridge.” I glanced out the door and was stunned into silence (not a common state for me) to see billows of smoke coming over the hill above the Outpost. Apparently the lightning earlier in the day had done some damage. Four hours later, the smoke was getting thick and black, the fire looked close enough to touch, and the evacuation notice was posted on the door of the Outpost. After making a plan with the RCMP in case they needed my services, I loaded the back of my Xterra with everything I could think of that I might need, and that I needed to save – emergency response “jump bag”, LP-12 monitor/defibrillator, portable nebuliser and lots of respiratory meds, med kit, controlled drugs and record book, suture kits, random antibiotics… I discovered how hard it is to decide what to take and what to leave! I also packed up belongings for myself and Mucho, my 150 pound dog/best friend who accompanies me wherever I go. Driving away from the 100 year old log cabin that is the Outpost and my home when I’m in Alexis Creek, wondering if it would still be standing when we came back, I’ll admit I had to swallow hard to hold back tears.
Mucho and I drove 10 km east on Highway 20 to the Tl'etinqoxt'in (Anaham band) office where the Incident Command Center was set up. I reported in to the Incident Commander and someone kindly made me a sign that said “Mobile Medical HQ” to hang on my truck. The kids all crowded around my big fluffy friendly dog while I checked in by pay phone with Jeff Shannon from Solutions and the employer’s admin-on-call and then got to work. The first night was a busy one with many people stopping by my truck, predominantly with respiratory issues from the smoke. I had to suture one laceration and discovered some creative ways to maintain a sterile field in unconventional circumstances. I slept on the back seat of my truck between seeing patients, with my trusty giant dog standing guard.
The following day was a blur of activity. The Tl’etingoxt’in band manager invited me to set up my clinic inside where I could plug in my nebuliser machine instead of running a power cord out to my truck and having the patient sit on a plastic case by the bumper, with me trying to hear their lung sounds over the helicopters and big machinery… a little like working at the Airfield Hospital in Kandahar, Afghanistan. I must say, it was sheer luxury to again have a private place where I could see patients properly. I was also invited to sleep on the couch in the office and join in the meals where the band members who were involved in the fire suppression were being fed. I can’t begin to describe how much I appreciated and enjoyed their companionship and generosity. Fresh warm bannock is irresistible.
In the three days that the town of Alexis Creek was evacuated, I did several “house calls”, taking my Xterra mobile medical unit (and my furry assistant) along with me, some to people’s homes and some inside the fire zone to evaluate fire fighters who were injured in the line of duty. In those three days, I also saw many patients – some formally and some not so formally, some at the bumper of my truck and some inside the office. While I was doing what needed to be done, helping people who needed to be helped, finding fun and warmth in the midst of stress and uncertainty, I was aware of the people who had homes in town or had ranches and livestock threatened by the forest fires. It was a tense and agonizing time for so many people.
When the evacuation notice was lifted and Mucho and I were driving back to the Outpost, my heart was warmed to see, through the smoke, the big golden sunflowers blooming alongside the white-washed log building. Hauling the equipment and supplies back inside, I thought how lucky we are, all of us, as mobile nurses, as “travelers”, to have the opportunity to see so many cool places, to have so many great adventures, and to be an intimate part of these amazingly wonderful communities.
As I write this, it’s four months later and my dog and I are back in Alexis Creek to spend Christmas working at the Outpost. It was -36C this morning, the sun was shining, and I feel so incredibly privileged to be here.