Saturday, March 3, 2012

Check that off my list

The day after my last post, also the day after the anniversary of the earthquake, I was thrust into a rare experience brought to you by the life and times of a privileged foreigner living in Haiti.
Indeed the story I am about to tell is one that I still can’t fathom happened. It’s pretty crazy. It was both the longest 36 hours of my life, and the shortest. In fact, I am pretty sure we entered the Twilight Zone, adrenaline kicked in, and just in the knick of time the stair still unbuilt appeared to save us from tumbling down into an abyss of unknown and potentially fatal decisions. [I apologize in advance if this post is unwieldy and long. I don’t have much time to dedicate to editing what I write] 

Friday, January 13, 2012 (doomed from the beginning?)
I had spent the night at the Oloffson Hotel with Winter and Rick, and as I was getting ready for work just after dawn broke, I received a desperate phone call from my coworker Stephanie. “I need help and I don’t know what to do. I’m in so much pain and I can’t lie down. Something is really wrong.”  Despite being an excitable person, I am also rational and calm in high stress situations. I asked for a more detailed description of her symptoms and realized quickly that she needed to go to a hospital.

You see, Stephanie had left work early the Tuesday before, complaining of stomach pain and nausea. She did the same Wednesday, and Thursday our coworker Meaghan checked on her and said she looked really ill. It had been 4 days since she had been able to hold any food or drink down, so I knew she would be weak and very dehydrated. To me it was obvious from the beginning that she needed more than just a doctor’s visit. I told her directly that I thought a hospital would be best because I was sure she’d need intravenous fluids.

On my way to her house, the realities of Haiti set in and I was running through all the possibilities I could think of. Best-case scenario, it’s just a “little” parasite or amoeba. A couple pills and some serious re-hydration and she’ll be back to it in a day. Or was it cholera? That’s an epidemic here. Shit. God knows what the worst-case scenario could have been—tropical maladies are scary and numerous. Upon reaching her, my suspicions were confirmed. She was a pallid-green and barely mobile due to both pain and feebleness. Comfort wasn’t even an imaginable concept. She was SICK.   

I had no car, no knowledge of an emergency room in Haiti, no personal doctor’s number…essentially, we had nothing. And Garry, our country director and all around go-to guy, was out of the country. I called a few people for advice, which turned out to be good for support and concern, but not too useful for information. Winter, however, helped me check for the address of the one and only recommended hospital by the US Embassy.  

Our acting #1 administrator came to get us in his car. He took us to Hôpital Canapé Vert, the supposed best hospital in Port-au-Prince, only to find out that they don’t take emergencies. Well, now what? I had no idea. We drove down the road a bit to Hôpital St. Louis, a small, private Haitian hospital. Reputations and recommendations aside, we just needed to get Stephanie somewhere. She was moaning from pain, and vomiting because she said it was the only thing that gave her any relief. That right there was proof enough that things were messed up. 

The doctor asked her some questions and did a quick examination. I translated because she was in no state to think or speak in a foreign language. Almost immediately, they hooked her up to an IV and added antibiotics. The doctor disappeared, as did our Haitian coworker/administrator. We were alone in this hospital, with no clear prognosis, and no plan of action. I ask the nurse what was up. She told me that they think it’s just a bad intestinal infection—something she ate. Riiight. Okay. But how do we know? 

Stephanie’s pain became more acute, so when the doctor showed up again, I asked him to give her more medicine and he asked us to go get a sonogram and x-ray to check for appendicitis. Okay, at least now we were doing something to find out what might have been wrong. Proactive. Still nerve wracking.
HELP’s driver and office assistant came to get us from the hospital to go do these tests, but the hospital wouldn’t let us go without paying. “But we’re probably coming back, and we are an organization. We’re not just going to skip on the bill.” Nope. You gotta pay, or leave someone behind. So I forked out my money, because there was no way I was leaving Stephanie alone.  

Into the bustling streets of PAP we went: Stephanie walking in the fetal position holding onto one of my arms, while my other was holding up her IV bag. The car ride was tough. Traffic and potholes can make driving in PAP unpleasant without pain. Poor Stephanie endured all of this, only to arrive at a lab without a doctor to interpret her lab results and about 50 people in line before her. Welcome to medical care in Haiti. [It’s worrisome on many levels]  

We went to a different lab, but they could only do one of the tests there. In other words, we were obligated to go to multiple labs in order to complete these tests. On top of that, neither Stephanie nor I had enough money to pay for these exams, so while Stephanie was waiting for her sonogram I ran home to get all the money I had. Met them back at the lab just as they were finishing up, paid, and talked to the doctor who told us that the sonogram showed no burst appendix. She surmised: a bad intestinal infection it was. Back to the hospital for more antibiotics and observation.  

It was about 2 or 3 in the afternoon. Stephanie, for the first time all day, seemed to be a bit better. The little hospital admitted her for the night. I said I would stay with her. Our office assistant told me she would pay for it and leave us there for the night. 

There we were: two white women in a small room with walls that were once an uplifting sky-blue now gray with dirt and dust, with an old creaky, hand-crank hospital bed. It was a room without windows or a light in the bathroom, and the television only played one channel and had no sound. Stephanie managed to get comfortable enough to take a nap. I made more phone calls, canceled classes, gathered more belongings from our houses and came back, prepared to stay with her over night. 

Shortly after I got back, Stephanie woke up screaming in pain. The HELP office was closed by then and because it was Friday, everyone had already gone home to be with his or her family. Luckily, Stephanie’s father works for the State Department. Stephanie had resisted using this connection because everyone was telling us it was just a little bug and conditions seemed livable, but this was the tipping point. We agreed that she needed to make a phone call and within 30 minutes a US Embassy duty officer was at the hospital with an armored suburban ready to move us to a new medical facility called Bernard Mevs/Medishare Hospital. Hope. The owner called us right away, and speaking English, said that they were ready and waiting for our arrival, reassuring us that she'd be taken care of. 

Not so fast. While we thought the bill was paid, it in fact was not, and we weren’t notified of this small and insignificant detail. There we were again, fighting for the hospital to let us leave. I communicated our plans to the nurses—they seemed to be in agreement with me—yet still could not let us go without paying. But we didn’t have enough money for the overnight bill. I negotiated with them, arguing that we weren’t spending the night, therefore did not need to pay the entire bill. I finally made them an offer they couldn’t refuse; we got it on paper, signed by the present parties, and our release was granted.
The armored suburban pulled out of the hospital gate. It was awesome—inch-thick windows and doors so heavy you had to put a shoulder into it to close them—although, I didn’t have enough time to fully admire it because I was busy making phone calls to our people in the US and Haiti, Stephanie’s parents, and the new hospital’s administrators. I imagine that riding in a tank is comparable. 

When we arrived at Bernard Mevs/Medishre Hospital a doctor greeted us before Stephanie could get out of our private tank. He was part of a visiting team of doctors from University of Cincinnati, American, and serious about getting Stephanie the right care. I finally felt like I could breathe for a minute. Relief. They set Stephanie up with a new IV drip, more antibiotics, and morphine for the pain. Even these doctors initially diagnosed her with a bad intestinal infection, but were insistent on monitoring her pain and vitals over night. In the case that it grew worse, though, they had me make more phone calls, one of which was to our insurance company to notify them that we may need a medical evacuation. Conor, our executive director who was on vacation at the time, and Kim, our operations manager were very helpful.  

Drugged up, Stephanie fell asleep for the night. I was pumped up with adrenaline and made friends around the hospital quickly, ate some food for the first time that day, helped with some translation, and was permitted to watch a few operations and treatments I never would have seen if we weren’t in Haiti. I loved it. Felt like maybe going into the medical field would be a good move for me.  

They took in one little boy who had just been hit by a car. His lower leg was torn up. You could see his bones and chunks of muscle were missing. He hardly had any clothes on, and they wouldn’t let his family back in the OR area. An excellent team of doctors and nurses surrounded the poor thing, but they were all scary white people and didn’t speak his language. They were trying to ask him about his pain levels, but he didn’t understand. I held his hand, and asked him how he was doing. He said he was cold and afraid. I asked them to get him a blanket, then he was able to talk about his pain, but he was clearly in shock. They pumped him up with drugs, and soon he wasn’t feeling much at all. Doctors cleaned his wound—picking out morsels of gravel from his tendons, squirting some sort of sterile solution over his bone—and finished by wrapping him up with some loose gauze.  I asked how his leg would recover, and the prognosis was grim. If he could avoid infection (difficult in Haiti) his leg would heal and just look a little deformed where he lost the muscle mass. Otherwise, he’d probably become an amputee. Damn.   

I eventually grew tired and they set me up in a hospital bed right next to Stephanie’s. That's the royal, white privilege treatment.  

Saturday, January 14, 2012
I woke up early. Wandered outside to find some Haitian hospital staff so that I could ask where to get some good kafe griye (Haitian coffee). They got some and brought it back to me at Stephanie’s bedside. She woke up soon after and said that the pain had gotten worse and far more concentrated on her right side. 

I called the doctor in.  

5 minutes later I was back on the phone. “Hi, Kim. Sorry to wake you up at 4 am your time, but the doctors say we need to med-evac Stephanie. They think she has appendicitis and they can’t test for it here because the only CT Scan in the country is at this hospital and it’s broken.” As it turns out, a sonogram will only show a burst appendix. So that was good. Her appendix hadn’t burst…yet. 

After countless phone calls and 3 pages of notes later, it seemed like we had arranged for Stephanie to fly to Fort Lauderdale, Florida. One person got to go with her. We decided that I was the best candidate because I had been with her through everything, could recite her medications, and had spoken with all the doctors. One problem: I didn’t have my passport. 

HELP’s driver came to get me at the hospital. We rushed to my house to get my passport and pack a bag for Stephanie and myself, and then sped back. We made it in just enough time to check Stephanie out of Bernard Mevs/Medishare, get her into the car, and make it to the airport.  

A small private jet with an EMT and RN on board would be escorting us to Florida. We entered the PAP airport through the elite, private entrance. Customs was completely different. It was one little guy in a tent checking passports and “official lists.” 

Once our plane landed and our names were cleared, we drove right onto the middle of the tarmac. Our med-evac team checked Stephanie’s vitals and the Bernard Mevs/Medishare representative, Howard, made sure the transition went smoothly. They strapped Stephanie into the stretcher on the plane; I crawled in to sit in the back. I had never been on a private jet before! It was only a 2-hour flight, Stephanie slept for most of it, and I got a nice nap in, too. 

We arrived at the Fort Lauderdale Executive Airport, where all the crazy rich people have their aviation clubs. Row after row of private jets, all lined up like little models. The yacht club of the air. After clearing customs in the US, Stephanie was transferred to an ambulance-van and I followed in a regular car. We went straight to the best “trauma” ER in Del Ray, Florida. 

It was about 4 in the afternoon by now. The med-evac crew helped check Stephanie into the hospital, while I stayed with her to chat with nurses and doctors again. The story became pretty standard and boring at that point because we’d repeated it so many times. A few hours and a CT Scan later, the hospital confirmed that Stephanie was suffering from acute appendicitis. Amazed that her appendix hadn’t already burst, we wheeled her into the surgery ward and prepped her for the operation. 
I felt like a nervous mother finally getting relief after a long 36 hours of uncertainty and witness to suffering. It was a standard procedure. Soon Stephanie would be feeling better, and the whole experience could be filed under the “Adventures of Life in Haiti” category. I stayed with her until her real mother arrived that night at 11:30 pm. Then my dear friend, Rick, took me out for a late dinner and a good night’s rest.  

I spent the next day at the hospital with Stephanie and her mom. Got to talk to some loved ones, but arranged to fly back to PAP the next day. My work was done, and it was time for me to go home. Still, how many people get to say that they were medical-evacuated out of Haiti? Not many. What a story this will be for the rest of my life.

Now that it's over, I'm experiencing a mix of emotions. I've never felt so alone in a place in Haiti requires sufficient self-reliance and gumption. There's no doubt I have both of those, but this made me realize that I'm here as an individual. Simple as that. If I get shot, I hope for my sake, that I am cognizant enough and prepared to get myself care. It's also horrible to think of how many Haitians die of appendicitis. A condition that is easily treatable, but because of a lack of access to medical care must leave many hopeless. Doesn't matter for a foreigner though. Most come here with evacuation insurance. And off we flew. To our country where we could get "proper" care.

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