2013 medical volunteer trips to Panama

After taking last year off from my medical mission trips, I'm back!  This time...Panama! 

April 26-May 3 I will be in western Panama in Ngabe-Bugléto provide physical therapy services as part of an interprofessional medical team from Samuel Merritt University. I am so excited that we were able to coordinate dates across the University to allow FNP, PA, DPT, and nursing faculty and students to provide much needed medical services in under served rural areas in Panama. Best part (aside from the fact that I've never been to Panama or even Central American) is that we have 1 DPT student and 2 DPT alumni from SMU also coming along!

As always, if you have cash burning a hole in your pocket and you would like to be a part of my trip through financial support, you can donate to offset my costs (or as a birthday gift!) by visiting my donation site:  http://gogetfunding.com/project/medical-volunteer-trips-to-panama-2013. $5 minimum, all donations handle securely via PayPal. Any amount is very much appreciated.

I am probably going to return to Panama on our August medical trip (dates still not firmed up), again with some DPT students and alums and again as part of an interprofessional group from SMU.  I'll keep you posted on that.

I've already had the joy of my visit to the travel doctor. Had to find a new one this year, the guy I usually see had retired. But the new place is great, and now I'm all boostered up on my typhoid vaccine and have my prescriptions filled for anti-malarial meds and antibiotics. And because I only needed a week at a time for these trips, insurance was not an issue like I had the last time I went to Haiti.

I'm really starting to get excited about this trip. Especially since our first and our last day in Panama will be at a beach resort near Panama City. I think that's a great way to both start and end a busy 5 days of medical clinics from dawn to dusk, don't you?

Typical day:
7 am--morning meeting. Updates from hospital departments (internal medicine, surgery, pediatrics, observation which is like an emergency department, and cholera unit) and overnight activity like admissions and discharges and census. Other hospital-wide announcements. Then a brief presentation. We've had UTI presentation / treatment in infants and children, DVT prevention, and radiology cases from ortho and internal medicine. This lasts from 30 mins to 45 min and is conducted in both French and English.
After meeting: rounds. I've been going on surgery rounds which is awesome since PT can chime in and clarify orders (esp. post op) and get to see wounds and radiographs.
9 am: PT meeting to assign inpatients. In theory outpatients have appointments for what day to return, but usually just show up and wait until someone can see them.
9:15-11:45 am: treat patients, or for me supervise students.
12 - 1:30 pm: lunch. We walk 5 min to our house for lunch and some down time during the heat. Sitting in front of a fan is awesome.
1:30 - 4:00 pm: see the rest of the patients, sign student notes, follow up on stuff from the morning. All while sweating a lot.
4 pm: we've heard a rumor this is when peds rounds are, but after 2 days sweating in the hallway until almost 4:30 with no luck, we may give up on this.
After work: go to the house and change so we can walk 5 min to the pool. It is so nice when you are sweaty and tired just to swim around a bit.
Try to get back to the house before 6 pm so we don't miss the evening water!
Evening: have dinner, chat, fill out our daily logs about the students and cases, plan for tomorrow. Also time to email, read, chat, and watch a movie on the computer. I'm usually in bed before 10, sometimes 9, but often read or watch something on the computer for a bit. The power goes out for a few minutes at 10 pm and 3:30 am, so best to not be up and about because its super dark and I don't want to run into any bugs!

Sorry for the lack of updates, it's been busy! Plus, the Internet isn't so good here which make updating difficult.

I'm one of 2 PTs supervising the 6 rehab tech students. They've been on clinical for 4 weeks, and will get a week off after our 2 weeks with them. They are seeing adult and peds inpatients and peds outpatients.

We have a special cholera unit here, as this is the original cholera region, and the rainy season has brought it back. They are cordoned off, have a triage tent, an area for the very ill, and then a few tens for those getting better. There is a shower/bathroom tent and an education table. When you leave the area you have to wash your hands with soap and water (not normal here) and have the bottom of your shoes sprayed with disinfectant.

Big news today is Hurricane Emily is supposed to hit tonight. However, not a lot of details about how bad they think it might be or any precautions we should take.

Dino

Deschappelles is great so far. I'm in a great house, am getting familiar with it's quirks. Big difference is we only have running water for 3 hours a day (3 one hour periods; 6 am, noon, and 6 pm). Did venture over to the pool on campus. Also plotting to go to the beach (1 to 1.5 hour drive in a taptap) next weekend, either for the day vs overnight. We've decided to acclimate today after the long traveling day yesterday, and save getting organized and oriented until tomorrow.

Thunderstorm I coming--big looming black clouds and audible thunder. Seems to be an afternoon occurrence here.

I know I'll fit in since someone in the house is playing Love Shack!

Safely in back in Port au Prince

Five hours to get from Cayes to PaP--pretty much the same as last time, but with a bit more drama.  It probably didn't help that I was more awake this trip (still sleep deprived, but not going on 36 hours of being awake like the trip out to Cayes).  Interesting traffic-related drama I can remember includes:

1. Donkey running away from owner right in front of our Land Cruiser when we were going about 60 mph.  
2. Road shared with the following: people and children walking, motorbikes with up to 4 or 5 people on them sometimes with no helmets, cars, trucks, mac trucks, tap taps (mini vans or trucks that act like buses STUFFED with people and sometimes with stuff stacked on top), vendors selling stuff, rocks, debris, donkeys, and we even saw a guy in a wheelchair.
3. My neck is handling all the driving sitting in the back of the Land Cruiser facing sideways remarkable well.  Better than my backside, in fact.
4. Swerving around while honking is how you pass here.  The road is only two lanes (if that).  Read #2 again and imagine that.
5. Ate half a 'sandwiche fromage' at the truck stop.  Reminded me of pannini at the train station in Europe, since it was toasted and melty. Hasn't made me sick yet, and highly recommended.

We had super big thunderstorm lasting all night last night, so sorry for no update.  I did add some photos over on FB (open account, anyone can view): http://www.facebook.com/media/set/?set=a.2215388714051.2130245.1527584939&l=aea6c348d4&type=1

If I get motivated tonight, I may put the ones I took at Bonne Fin and the ride out here to PaP up tonight.  Turns out I leave tomorrow for Deschappelles (thank goodness for international phone service so I could get that phone call while we were on the road) and on to Hopital Albert Schweitzer.  Cannot wait!

PaP (Port au Prince) is depressing and hopeful.  There were signs of rebuilding, but also a lot of trash and rubble and poverty.  And that's just what I saw from the road.  Also, lots of UN and UNICEF trucks.  The MTI Team House here is amazing--very nice, swanky by Haiti standards.  I don't know about the armed guard at the gate, I suppose it's necessary but it's a reminder of how safe I felt in Cayes and how potentially unsafe PaP can be.

Well, looks like rain is coming and sounds like there may be distant thunder.  The breeze is certainly nice, and the humidity here doesn't seem as bad.  Looking forward to being TIRED tonight and sleeping in an air conditioned room.  The adventure begins again tomorrow.  I don't know how able I will be to update from Deschappelles, so these may be short (via text).  

One of my patients with his Papa.
It's the small luxuries--a quick shower before bed, fans blowing on you, fresh grenadia (passion fruit juice)--that make up for the living conditions and sad stories. I will admit I am thankful for my electric toothbrush, and while it seems extravagant, it makes a nice end to a grueling day.

Tomorrow it's up into the mountains to Bonne Fin to see the large hospital there and consult on some patients. I can't believe it's almost time to leave Cayes ad head back to the crazy "civilization" of Port au Prince before heading to Deschappelles!

I almost forgot the craziest thing that happened today--I was sitting on this small stool to work wit a gentleman's ankle, stood up and picked up the stool to find  a tarantula under it! A live, hairy, big brown tarantula! I didn't scream, but gasped and pointed and then put the stool back over it to keep it from walking anywhere near me. I then made Berto (one of our translators) take it outside. Carmen found it's friend later in the back room. Crazy!

Photos live! part deux

More photos:  http://www.facebook.com/media/set/?set=a.2215388714051.2130245.1527584939&l=aea6c348d4&type=1

[Should be an open Facebook album, so anyone can take a look.  And no bug photos!  Or at least not yet!]

Sunday

I'm glad we decided in the beach yesterday, since we had a bit of a downpour this morning. Thankfully now the sun is out, and we are hoping for a cooler day today--96 F with maybe 95% humidity.

Yesterday at Port Salut was another gorgeous day, helped by a few cold Prestige beers, some fried fish, and a plate of frites. A few bites of avocado and spicy slaw, and it was another fantastic meal. I remembered to out in sunscreen so I am also not burned.

Did some laundry last night when the generator was running, so at least I will have fresh clothes for this week.

It's my last week here in Cayes, and should go fast. Ulrike, the German pedi PT I worked with some stopped by the clinic in Friday and kindly worked an invitation for us to see the hospital in Bonne Fin where she's been volunteering lately. We are scheduled to go on Tuesday afternoon. Wednesday morning a local artisan is bringing his trinkets for some front door shopping, along with Mde Max who will have coffee for sale. We are going to work Thursday morning at the clinic, but will be driving back to Port au Prince that afternoon. I'm staying in PaP until Saturday afternoon when I catch a ride to Deschapplles. I'm hoping to visit the MTI clinic in PaP on Friday, but could also happily spend the day doing my laundry and catching up on sleep.

Well, I hear banging from the prosthetic shop, so I think I'll go see if Marvin and Carmen need a hand.

I'll try to upload a few more photos (Internet seems to be good today), especially the ones of the cow on the beach. No that isn't a typo. (And Joy, I won't post any photos of bugs, so you're safe!)

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Photos live!

I finally got the photos I took (mostly of Port Salut) to load!  Check them out http://www.facebook.com/media/set/?set=a.2215388714051.2130245.1527584939&l=aea6c348d4&type=1

Exciting night last night--bathroom fail with water all over the floor and hallway with a visit by the plumber, huge thunder storm with downpour, and then power outage at 4:30 am with the need to start the generator!

My bites match my sheets!

Dinner

Beans & rice with sauce, roast chicken, beet & potato salad, spicy slaw, and avocado.  With citron!

Helping make prosthesis

Ed & Taryn removing plaster from inside of a prosthetic leg.  We hung out with Marvin and watched him make a leg and adjust the foot on it this afternoon.

Let me try to explain how hot it is here...

Sorry about no update yesterday.  The internet was super slow and the wifi was acting up at the house.  Seems to have fixed itself (even our attempts at resetting the router had no effect) by this morning, so here I am.

Clinic and the inpatients are going well.  There's a lot a pediatric patients with developmental delay and/or what seems to be CP (hey, cut me a little slack, I'm a GERIATRIC clinical specialist).  I am glad they are coming, but feel very inadequate.  Then I remember if I wasn't here they would be getting nothing.  No PT at all.  So it's a bit easier to at least try what I can.  Taryn and Ed even think my one girl that is coming every day (so tomorrow will be 5 days) seems to be doing a bit better.  At least now this little one will talk to me and doesn't seem so scared.  She's a bit easier to work with, just seems to have physical problems and is so smart.  She names colors and counts and tries to get away with stuff with me, she's so sharp!  At least for some of the more challenging kids (one who has really low tone and is very floppy, and another who has a lot of tone and is very stiff) we've decided to treat with at least 2 if not all 3 of us.  More heads are better than one when you're trying to do a bunch of stuff!

The inpatients are pretty interesting.  We've got 2 patients with burns, one pretty severe on both his arms and his legs.  They are healing up, only one open area, and yesterday and today marked the first time since his burn (at least a month ago) that he's been up walking.  He's a champ, and his daughter was so happy.  They think he might be able to go home in a few weeks and we are hoping he can be walking by himself with a cane by then. Another inpatient is pseudo-famous.  He had cholera in January and developed a very rare reaction to the saline solution used to treat the cholera that gave him paralysis.  For those medical types, they thought he developed Guillian-Barre, but it turned out it was this rare reaction.  He's the only person in Haiti know to have survived this reaction, and he's walking now with some bracing and a platform walker.  Today he went up and down a long steep ramp we have at the clinic, as well as up and down the stairs. 

The heat is oppressive.  I don't know how to explain it, and I don't know if I'm not tolerating it as well as last year or if I just blocked out how awful it is.  Nonetheless, it's hot.  Damn hot.  Hella hot. So hot that after the 2 block walk to the house after clinic this afternoon at about 3 pm I'm all tired and completely sweated through.  Mind you, at the clinic and in the hospital I'm hot.  But at least there are a few fans and I'm indoors in the shade and I'm occupied doing things while I'm being so hot.  In the afternoon, after clinic, without much to distract me....hot.  Too hot.  Damn hot. Hella hot.  So hot that your sweaty, sweaty clothes aren't really all that smelly because you are constantly sweating and there is no time for the bacteria that cause the smelliness to grow.  That hot.

The food continues to amaze me, and the cooks here are so sweet.  It's been nearly a week since Taryn, Ed, and I arrived and they have figured out what we like.  So they keep making those things.  Or they do little things.  Taryn loves hot sauce, now they've figured that out they keep getting the Tabasco out of the fridge and handing it to her when she's making up her plate.  Or that Ed likes tea in the morning, so they have a small bowl of water for him either already heated or all ready for the microwave.  So adorable, and so very, very kind!

I promise to try to upload some more photos, if the internet holds, later tonight.  For now I'm off to reply to some email and take a nap.  I hope it rains tonight, since that helps a bit with the heat and certainly helps me sleep a bit more. 

Lunch! Polenta, beans, spicy slaw, goat with carrots and onions, and pineapple! With fresh citron juice!

Port Salut and serious chillin'

Back from a gorgeous day over in Port Salut.  The ride was nice, through the countryside and over the mountain to the southern coast of Haiti, a bit farther west than Les Cayes.  We went to the same beach I celebrated my 40th birthday at last year. It's a beautiful beach, very shallow with great blues and greens and white sand.  Had the lobster with frites again (because you don't mess with a good thing), and some of the local Prestige beer.  Gotta love Haiti time--we ordered right when we got there at about 10:45 am and were told it would take 35 minutes.  A little of 2.5 hours later, voila lunch!

What I learned today...part of the reason Port Salut is so pretty and developed (it even has a bit of a tourist trade with 3 hotels on the beach) is because this is where Aristide was from.  He had a private airstrip so he could fly here for weekends when he was dictator.  The UN now uses the airstrip for helicopters. 

I swam a bunch, read a bit (thank you Kindle, for handling the sun so wonderfully), had some more beer, practiced my French with Harold (our driver), practiced my Spanish with Carmen, and otherwise had a great day.  Also got to listen to the Women's World Cup final match in the car on the way home.  I loved how the announcer was speaking French but when anything exciting would happen he would slip into Kreyol.  Hee.  From what I caught, it was exciting to the end.  Too bad for the US, but at least it was a great game.  I also loved driving past small, cinder block houses to see people all crowded at the doors and windows watching the game on the few TVs that people have hear, as well as hearing all the radios turned up with the game. 

I'm a bit uncomfortable right now.  I've got a bunch of bites from something (I don't think mosquitoes) and have added a bit of a sunburn on my shoulders and upper back.  Whatever.  It was a great day.  I did take photos, so I will try to upload those later tonight!

As Cholera Surges In Haiti, Aid Withers Away

I found the following story on the NPR iPhone App:
http://www.npr.org/blogs/health/2011/07/15/138161193/as-cholera-surges-in-haiti-aid-withers-away?sc=17&f=1001

As Cholera Surges In Haiti, Aid Withers Away
by Richard Knox

- July 15, 2011

Cholera is back in Haiti.

Well, in truth, cholera hasn't gone away since it was introduced last October, possibly by infected U.N. peacekeepers from South Asia. And undoubtedly cholera will plague Haiti for many years to come because it's nearly impossible to eradicate from the environment.

But new numbers show an upsurge in cholera since the rainy season arrived this spring. Between April and June, the Haitian health ministry reports more than 86,000 new cholera cases – one-quarter of all the cholera reported since the beginning of the epidemic.

In 11 largely rural communities, Shots has learned, cases nearly quadrupled between April and June, from 3,932 to 14,425. Cholera hospitalizations in these areas went up nearly six-fold.

Meanwhile, health workers say the international support that came to Haiti's aid during the peak of the cholera epidemic last fall and winter has withered.

"We have a smaller pool of people responding and similar caseloads to what we were seeing the later part of last year," Cate Oswald of the medical aid group Partners in Health told Shots. "So we're working double- and triple-time with very limited resources. We're quickly going through dedicated cholera funds."

Speaking from Mirebalais, a town 40 miles northeast of Port-au-Prince, Oswald says the latest surge in cholera cases has been relatively invisible in the most remote towns and villages, sometimes inaccessible to cars or trucks.

"In areas where there are zero latrines and no effort to improve water hygiene, we're seeing caseloads as high as the early days," Oswald says. "When the rains come, as people defecate in the fields out of necessity, all this is running into rivers. So it's just this ongoing cycle."

Recently, Oswald says, she got a call from a health worker in Petite Montagne, a hamlet five hours by foot on a rutted mountainous road from the nearest clinic in the Boucan Carre region. The health worker reported 14 people who needed to get to a cholera treatment center immediately.

Untreated, cholera can kill within eight hours from overwhelming fluid loss. Timely treatment with rehydration is cheap and life-saving.

The Partners in Health clinic in Boucan Carre had been aware of a cholera outbreak in Petite Montagne because dehydrated patients had been arriving by stretcher, carried for hours by family members over the rutted road. In the past two weeks, the group realized it had to get more help to the mountain town.

"Petite Montagne has needed help for months," Oswald says. "But when we realized how many people are being infected in this new wave, we said there's no way we can't do this."

It took a day and a half to mobilize supplies and workers and walk them to Petite Montagne.

In responding to cholera, time equals lives saved. So Partners in Health recently purchased 120 cell phones for about $10,000 and is distributing them to its far-flung community health workers.

The phones have been programmed (in Creole) to allow easy input of cholera cases and deaths, how much oral rehydration and intravenous fluid packs are on hand, where trucks are needed to take the most severely ill to treatment centers, and how much water-purifying tablets and bars of soap are available.

"As the rains have come, it's been incredibly hard to get this data," Oswald says. The cellphones will help speed the response and give the Haitian ministry of health a better picture of what's happening in rural areas.

Meanwhile, debate is still grinding on about whether to deploy cholera vaccine to reduce the accumulating numbers of cases and deaths. So far Haiti has counted nearly 380,000 cases and more than 5,500 deaths since mid-October.

Earlier this month, a meeting of vaccine advisers to the Pan American Health Organization in Buenos Aires recommended small-scale projects in Haiti to vaccinate against cholera in "underserved urban and rural areas."

Last December, a high-level meeting of the Pan American Health Organization in Washington concluded that large-scale cholera vaccination should be considered in Haiti.

But the Haitian government, worried about civil unrest among people who couldn't get vaccine, turned down one manufacturer's offer to donate tens of thousands of its vaccine. And this month, PAHO's expert advisers worried about competition between vaccination against cholera and other diseases.

Meanwhile, health workers are trying to cope, anticipating that cholera caseloads will continue to increase.

"August and September are the peak hurricane months, and we notoriously have very heavy rains in that time," Oswald says. "So we're preparing ourselves. We're putting cholera treatment centers under tin roofs with plywood walls and concrete floors instead of tarps and tents. We know cholera is not going away." [Copyright 2011 National Public Radio]

To learn more about the NPR iPhone app, go to http://iphone.npr.org/recommendnprnews

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Rewarding Saturday

Last night was crazy!  It rained so hard for hours and hours and hours, complete with thunder and lightening!  I thought at first that the sound of the rain was being magnified by the tin roof, then remembered there's a whole other floor above the one I'm staying on.  And then I looked outside...I've never seen rain like this.  I can't imagine what a terror a hurricane must be here!  It had stopped by this morning, and the sun is out and by now nearly everything (including the dirt roads) is dry.

Today we all decided to donate some of our time to the Sisters of Charity orphanage in Les Cayes.  Marvin and Carmen casted a bunch of kids for braces and orthotics they will have their 2 apprentices work on this week, while Taryn, Ed, and I treated some of the kids with disabilities and showed the regular caregivers some techniques they could use with these kids.  I don't even know how many kids I saw in the 2 hours we were there (5 maybe), but it was great.  I've done zero pediatric PT outside of my course in school and the more post-op ortho stuff we would get at the hospital every now and again (scoliosis surgery, fractures), but found I remember more than I thought and put my neuro skills, NDT in particular, to good use.  Two of the kids I saw were also blind, which was extra difficult because playing games is very much complicated by the language barrier, their development problems, and no vision.  I did get smiles from everyone of them, even the last little girl who was so complex I nearly gave up.

We also got a tour from Sister Guadalupe.  The center has health care and hospice for adults with HIV/AIDS and advanced Tb.  The whole second floor is for pediatrics, which 4 classrooms, 2 activity rooms, a quiet dark room, a sensory integration room, a treatment room, dorms for boys and girls, and a mini-hospital room for the sickest children.  It was a bit overwhelming, many of these children were abandoned because of their problems or are orphans because of the earthquake.  They do have some normally developing orphans who are up for adoption.  Five of these kids were having a French lesson and sang us a welcome song and practiced their English.  Four of them are awaiting adoption in the US, so practicing the little bit of English was important to Sister so they can at least understand something when they go with their new parents.  She said the earthquake has made adoption by US families much easier, and for that she is grateful. [PS Kristin--no, I didn't ask about taking any of them home with me, but it was a great temptation!]

This is the same order of nuns as Mother Teresa, and I can see the similarities.  The three sisters we met were all sharply intelligent, spoke multiple languages (Kreyol, French, English, Spanish), and clearly loved their work.  They admitted to being overwhelmed and challenged by having to make decisions about which child might get what (braces, therapy, more schooling), but clearly had the best interests of all the children in mind.  It was both heartbreaking and inspiring, all at the same time.  I think we may go back next Saturday to deliver the braces and work with the kids a bit more, and I really hope we do.

We decided that since tomorrow the cooks are off, we would delay our trip to the beach until then.  That way we can have a great fish and/or lobster lunch.  We plan on leaving early (before 9 am) for Port Salut, which is about a 45 minute drive.  If the weather's anything like today, it should be great...high 90s with about 90% humidity and a few high clouds.

We made a quick stop by the Les Cayes wharf, which sadly is covered in garbage.  There's what could be a cute little beach that is about 10 feet (yes, 10 FEET) deep with washed up garbage of all kinds.  Then, before coming back home for lunch we stopped by the market to get a few local beers to go with dinner.  The gentleman at the market was hilarious.  He kept wanting to practice his Spanish with Marvin and Carmen (they are from Nicaragua), even carefully announcing the total in Spanish.  

If you'd like to support my trip here, please click the link to the right.  I can still take donations, and would love your support!

First day on a Friday is good!

First working day in Haiti went really well. The other two PTs here, who just got married 3 weeks ago, are awesome! Just that right attitude to jump in there and go for it, tempered with a healthy dose of respect for another culture. I am looking forward to what could be a great 2 weeks!

Saw some familiar faces today, mostly staff at the clinic. There were 2 patients from last year. One was here today for a prosthetic adjustment with the prothetists, but recognized me right off and gave me a big hug. The other was one of my favorite patients who was unfortunately back with an amputation to his remaining foot that hasn't been healing well. He was the older gentleman who made me practice my French who had a poorly healing tibial amputation last year. Diabetes is terrible at home, but here with the less than hygienic living arrangements and dust or mud everywhere outside, it is even worse.

Growth area for me today-- treated a sweet girl with what I presume was CP. Even got her to count and name colors for me by the end of the session, which was great as she was a bit afraid of the 'blanc' when we started.

I am also pleased (probably way too pleased) to announce that I seem to have remembered a bunch of my PT Kreyol/French from last year! We've got translators, but I do like being able to ask simple questions and give simple directions on my own.

Marvin and Carmen, the two prothetists here, took us for a short hike around the village, out to the river, and by the local market this afternoon. I had forgotten how miserable the heat and humidity are, but think I'm almost used to sweating constantly again. Hiking in it was awful, but the great views of the mountains and the interested stares of the locals help take my mind off the heat.

It's been a wonderful 41st birthday here in Haiti!

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