Happy Thanksgiving Everyone! I hope you’re all enjoying the gathering of family and friends on this special day set aside to give thanks for God’s blessings on our lives throughout the year. I hope our thanksgiving is not limited to just one day of the year, but rather a daily, and moment by moment outpouring of praise as we recognize God’s hand in each moment of our lives!
As you gather with your families this Thanksgiving, I ask that you keep the country of Haiti in your prayers. They are continuing to face great adversity since the earthquake in January. Thousands are still homeless, living in tent shelters. Sanitation is poor and the threat of cholera continues to grow. Over 900 deaths have been reported.
I’m thankful today for the opportunity the Lord has given me to serve the people of Haiti once again, and to work under the leadership of Samaritan’s Purse. This morning at breakfast (0600) we were served eggs, oatmeal, and a heaping dose of encouragement from God’s Word from Roger, one of the pastoral team members from Britain. I greatly appreciate SP’s strict attention to feeding us Spiritual food. The pastoral team has made themselves available 24/7 for our counsel, and they seek to pray for and minister to or patients as well. They round the clinic beds all day long, praying for and with patients and sharing with them the hope of Christ. I feel this to be a luxury I wish was available while working in the U.S., as I often feel too “pressed for time” to address the spiritual needs of my patients. And it has made all the difference starting our day off as a team in prayer!
I worked for 4 hours this morning at the cholera clinic in Cabaret, a few miles east of the SP base. The tent-clinic is rather organized, with a triage, pharmacy, and nourishment/hydration depot. We are using bleach water to decontaminate surroundings in the clinic, hand-washing stations, and shoe decontamination stations where persons entering and exiting the clinic are to step onto carpet padding, soaked in bleach water. Each patient’s low-lying cot is a simple wood frame with padding and a blue tarp stretched over-top, having a triangular hole cut-out of the middle for patients to pass emesis and stool. Underneath the triangular hole lies a “bleach-water-filled” bowl, providing instant decontamination of body fluids. The family members are trained on how to dispose of the fluids and soiled diapers in the “latrine” area. When family members choose to stay and care for patients, they are a huge asset to our staff.
Working at the Bercy clinic has been the most “intuitive” form of nursing I have practiced. We have no blood pressure cuffs and are using thermometers for suspected extreme temperatures (only one or two available). We are essentially gauging patient’s hydration status by checking their heart rates and examining their symptoms and we are seeing good results)!
Patients are hydrated intravenously with Lactated Ringers solution first with boluses followed by continuous drips (and maybe more boluses to follow). We often face challenges in IV insertion as the patients are coming in severely dehydrated. In some, very limited cases, we have had to obtain intra-osseous access as the risk of osteomeylitis in an outdoor field hospital in Haiti is quite high to say the least. . Thankfully, I haven’t had to care for a patient needing such access. When patients are able to tolerate hydration by mouth (they usually need at least 12 hrs to recover), they are given Oral Rehydration Solution (ORS), a mixture of electrolytes and sugar water. We are treating the cholera with either oral doxycycline or azythromycin (erythromycin suspension for small children).
When I walked into the clinic camp this morning, the first news I heard was that a mother delivered a baby… that was stillborn. “She was a beautiful full-term girl,” said Amy, one of our NP’s. I’m sure the angels of heaven enjoyed escorting her to Heaven’s gates this morning. Praying for that mother who is mourning now…
I and Becky, an RN from Ottowa, and two Haitian nurses (Bernard and Ariel) cared for patients in tents 9 & 10, under the direction of one of our Haitian doctors, Dr. Jacob. Becky and I tried to get used to the routine and how to work with and communicate with the Haitian nurses. Nearly every patient had a family member with them to help bathe and clean-up their emesis and diarrhea, which looks like rice water in the initial phases of cholera. As the illness progresses, the diarrhea begins to look green/brown/yellow in color, as bilious fluid reaches the lower bowels. (Sorry, that tid-bit was for all you medical folks out there who are interested in such details).
One 18 yr old woman (we’ll call her Danya) I cared for was so severely dehydrated, her eyes were sunken-in, her skin so dry, and yet she continued to vomit violently. Danya’s father was there to help her. The poor woman’s tattered clothes were barely covering her thin frame, and Danya attempted to keep herself warm with one of our tin-foil looking emergency blankets. She was on liter number 13 of lactated ringer’s fluid, and certainly would need much more as her condition had not yet improved. Danya is just one example of the many desperate cholera cases flooding our clinic.
There is no segregation of the tents. Men, women and children are in cots, side-by side, having no privacy. All dignity is lost when they are left to vomit, stool and urinate in front of neighboring patients, family members, and staff. Despite these conditions, I have heard not one complaint from the Haitians or their family members. They are patient, thankful for the care we give, and suffer in silence. I rarely hear a whimper from the mouths of the precious children who are already so bare thin, they literally look like skeletons with this awful illness that has made them severely dehydrated. When I look at the, I thank God their parents were able to bring them to our clinic, for it’s certain they could not have lived through this vicious cholera.
Decontamination
When I returned to our base at 11 AM, I began our ritual decontamination process. Everyone’s first stop before entering the base, whether they came from the cholera clinic or not, is to was their hands. Clinic workers are then sent straight to the “decon” (decontamination) station where we scrub our shoes with hard brushes and a water/bleach solution. We also spray-down any equipment (pens, stethoscopes, and watches) with a milder bleach solution. We even take off our socks to let them soak in bleach solution before entering the bath house. We are not allowed to enter the dorms with our used scrubs, so someone who is “clean” must hand us our showering bags from inside. Then it’s straight to the showers to wash head to toe, followed by changing into new scrubs. Soiled scrubs are collected in a special bin and bleach-washed. It’s nice to have running water for our showers, and a bit of a wake-up call as the water is not heated!
The vehicles we use are also decontaminated via power-washing the exterior (not sure that they use bleach) a wiping-down the interior. This is the washing routine we are to go through each time we return from the clinic. I feel it reminiscent of the ritual cleansing the Israelites had to go through before reentering the camp after becoming “unclean.” It is a laborious process, but a full-proof plan as we have had no incidents of cholera on base!
I work night shift tonight, so I’m heading to bed!
