April-June 2011

7^th April 2011 (0720)

How wonderful and awesome are God's ways and plans. I don't know why we give so much praise to mens plans that don't nearly match up. You always know the who-what-when-where-why. We don't always need to know. We had a good-bye party for Sharrie. She's called back to a job in the U.S. I know it will be hard for her and Randy to be apart for 8 months.

8^th April 2011 (0716)

How often I fail to just rely on God for my strength and courage. When things seem out of control, I need to stop to pray & let God's words come to mind. Everyday there is something frustrating about this job whether it's dealing with people not doing their job; having to remind admissions of the same thing over & over; the cleaning staff getting annoyed anytime I ask her to clean a bed (she'll clean all the beds we don't need before she'll clean the ones I ask for) or giving me a hard time about giving me sheets; administration deciding to implement a fee for our patients without telling us. Basically, our orthopedic service is stuck in an odd position because it's being run in a private hospital that has decided to up to this keep it free. But I do believe the workers know they are not paying, so they don't feel like they need to give them the same care. And then trying to balance the clashes between our doctor and administration. Sometimes I just feel overwhelmed and don't know how to handle these situations. After this, I'm not sure what is more frustrating. This or floor nursing. I think floor nursing was definitely crazier...but it was only 3 times a week. This I'm constantly here so I don't get a good break.

But regardless of these frustrations, I do love Haiti and the Haitian people. I love speaking Kreyol and I'm glad to help with whatever is needed.

11^th April 2011 (0830)

How often we work and try to plan out every detail or our lives. How we try to please men to win their approval. Lord, how fruitless is all of this. Help me to show faith in, character like, and trust in You. I can trust that God will work out the problems in the hospital; He will help me to learn and memorize the songs for Gospel Kreyol; You will show me the right time to marry. So I don't need to worry or do things on my own. I pray for the hospital for to being seeking Your help when making decisions. I pray for collaboration and teamwork. I pray for the upcoming vacation to give us the rest & rejuvenation we need.

Lord, how often we take things for granted, even here in this hospital. The generators are going bad (and Haiti power is not reliable) so we are losing electricity a couple hours a day (which means no running water). Can you imagine a hospital that didn't have electricity 24/7 on a regular in the states? It is what it is here. We make do with what we have. (As I'm writing right now...28^th April....the generators are going crazy....it's flashy in & out...and only some parts of the hospital have electricity).

12^th April 2011 (1805)

I am a people person (well, maybe not as much as I used to be) but I love talking to people and sharing frustrations & joys. But, sometimes God (well all the time) I need to come before God first. Because other wards I am only getting mere man's opinion & judgment. At times, You will speak to us through others, but I really have to work on coming to You first before man. This is difficult for me!! Not saying I can't go to friends at all, just need to start with God. I am still need of refining from God.

Many people from back home ask me what it's like on a regular basis to work here. Of course there are many comforts I've given up- 24 hour reliable electricity; a variety in food, easy (and comfortable) transportation; all the supplies needed to do my job; family & friends; a well-paying job; etc. But truly, I don't have it bad at all. I'm getting a stipend to pay my bills & pay for all that I need; free room & board (even if it is dry rice & beans everyday); and a job. There are joys & frustrations like every job- such as a I love speaking Kreyol with the patients & nurses. I'm learning a lot of random skills & ways to make do and character building. It's the usual as a nurse job- super busy in the morning & have to deal with the same issues of people not doing their job. We start with rounds- then I'm balancing admitting patients & discharging patients; writing orders for the doctors; dressing changes & other patient issues (I act more like a Physicians Assistant than a nurse, but do some floor nursing work too). As of now, I don't have a translator. Most of the time I can get my point across by myself. Trying to keep things smooth between the ortho team and administration. I guess they've deemed my title as orthopedic coordinator. Some weeks I'm so busy I don't think I can handle it and others are a normal pace. ZJ (the social service year doctor) is working on improving policy & procedure to get things running smoother.

Work hours vary, but tend to be 40-60 hours a week. Occasionally, I get woken up in the middle of the night. In the evenings, we try to exercise & cook. I try to fit in talking to Wilshaw (not enough, I'll admit). Now, that I'm in Gospel Kreyol Choir, I also try to practice my songs every night (I have to memorize about 30 songs in French & Kreyol). Wednesday we are trying to make bible study. And then, at night now I'm trying to read a couple verses in the Kreyol Bible and look things up in the dictionary. Practice praying in Kreyol (because I want to be able to pray with people and talk about my faith).

On Sabbaths, after service, we usually eat together. Then rest or reading. Now I have choir practice or programs at 3pm. Sunday is a light work day, chore day, or visiting friends. Friday afternoon is my food shopping day. There are days I go to bed to late and days I don't want to get up for work. But I do love my co-workers so that helps.

So, do I think I'm a "better person" for working in Haiti? NOT AT ALL!! Lol, it's just a passion God gave me. Living in Haiti actually feels like home now. We all have our own callings & places to live & work. For now, mine just happens to be here. I'm not scared walking down the street & I go shopping by myself (well always with another person...but they don't have to be Haitian b/c I can purchase things on my own). I think I might at times be a little hardened to all the suffering and hardship. I will admit, in a lot of places in America, we are sheltered to extreme poverty. Here, it's in your face more and sometimes you just want to take a break from it. But of course, these people never take a break...they have to learn to make the best of it. The hard part is the people who have enough but lie to try to get more. It makes you hardened a little at times, because sometimes it's hard to tell who is faking it and who is really in need.

There are many things you see here (in terms of medical), that you rarely see in the states. We had a 28-year old motorcycle accident from 2 months ago come in. He was in another hospital (being seen by an American doctor) in Cap Haitien. He had a femur, hip & tibia fx. He had ex-fixs to hold the broken bones in place, but the tibia fx was still an open wound for the last 2 months. I went to take down the dressing over the tibia fx (didn't know it was an open wound), and saw his tibia bone broken in half still sticking out of his skin. I don't know what the plan was at the other hospital, but it wasn't working so I guess that's why they sent him here. And unfortunately I've seen lots of complications that I never saw in the states (or not often)- compartment syndrome 2 times, 2 people die from pulmonary embolism, and a probable death from anesthesia.We ran out of all our meds for DVT/PE prophylaxis currently (which really isn't the best for big fx).

When I sing with the choir, it feels like the choir back home except a different language and less personal space (the car rides are always nice & personal, lol). So, anyway, that's the normal as of now. We're off to get some donated supplies now!

15^th April 2011 (0830)

I am so glad for this week of vacation. You know our needs God, however I do pray for those who do not get paid vacation either by choice or necessity. I'm glad to be here, but I will miss speaking Kreyol for a week. Yesterday we went to pick up supplies at J/P HRO, and while we were waiting for Richard to reutrn I was surrounded by a group of young Haitian men. I called my friend, Yonie, who speaks no english, and after one of them told the group "She speaks Kreyol", I guess as a warning to not say anything that don't want me to hear. I love that!

I think Beatrice, our 14 year old patient who had surgery to correct her blouts disease on March 13^th (but developed compartment syndrome), was sad to see me leave. I spent 29 minutes listening to gospel kreyol music with her last night. I reminded her to call on Jesus in prayer for anything. 14 is still an age where they look up to people my age. I hope she chooses God as first in her life.

16^th April 2011 (1950)

As the sun sets and another Sabbath day end, I have nothing but thanksgiving and praise to You, O God. As I read in Your word, it is so mighty and worthy of life. It refreshes and restores me. It helps me confess and repent to move towards doing what is better. I'm reading a fiction book about 5 women in the bible (well it is based off their stories, but expands it in a historical context) and a book about marriage. Marriage is hard, and I want to be as prepared as I can (I know it's a life long learning experience). Marriages are falling apart and it really affects the family so I want to be serious about it. I want my marriage to bring us closer and others to know Christ.

I am so thankful for wonderful friends that week after Your way and word. We can pray, study, laugh, implement God's word, and have fun together. I am thankful for quietness and peace as well as not all the dust and dirt in the air. The ease of transportation. A warm, comfy bed and no mosquitoes overnight. A warm shower. A break from living and working in the same spot.

I was just thinking about Spendie telling us when she was on the tap-tap about an illegal prescription drug seller selling lisinopril (a blood pressure medicine) as a vitamin. Oh my...lol, that's a disaster!! He didn't know what it was, but as a doctor she knew what it was. Oh, I do love Haiti...even the quirks. I've been told most Haitians would prefer to live in Haiti, but come to America because of better jobs in order to support family in Haiti. I do miss things in America. I guess you're naturally going to miss things you grew up around.

20^th April 2011 (0835)

We got to go to Animal Kingdom for free. That was fun! I enjoyed Disney when I went at age 14. It's expensive, so I am very thankful for my dad spending his hard earned money to provide us a memorable trip together as a family.

I've been enjoying the hot tub and talking to Wilshaw on the phone and being able to understand everything clearly. And I've been getting lots of practice on our songs.

25^th April 2011 (2219)

We have arrived back to what I call home sweet home. Thank You, Jesus, for providing a week away to get some sleep, an opportunity to read, visit Orlando, shop for things we can't get in Haiti, water park, enjoy the Sabbaths in a new environment, and talk to lot sof friends and family. But mostly, it was a time to not have to stress about the daily routine of work and be away from living in the hospital.

At first, I was cringing about going back to the stresses again, but when you get back here and greeted with excitement, it feels good to be back. The one nurse told me she could sense that my presence was not there. How sweet- never had anyone say that at my other job. Beatrice discovered I arrived back today and called me to come visit.

I pray for Elisabath as it appears she is going into labor.

27^th April 2011 (0703)

How glad and joyous I am be up today. I have many joys & praises- they decided orthopedic surgeries would still be free; a fan to keep me cool overnight; a mind to choose (free will); filling food; ability to sing, work, do my laundry by hand; a beautiful view of your nature in the middle of the city to study Your word; Elisabeth giving birth to a healthy daughter!

I'm getting back to the swing of things here. Enjoying speaking Kreyol again- it comes back easily and my goal is 5 new words each day. And now I'm working with Amy to organize the outside storage supply room. It's got so many random boxes everywhere. But if we can go at it, a couple times a week for 2-3 hours, it will get there. I mean there is an overabundance of some things we rarely use, but the things we use often are running out. We got about a garage full of hydrogen peroxide!! The hospital is starting to buy IV fluids and medicine.

29^th April 2011 (0722)

The faith of others inspires me. My one patient that I was trying to get an IV in (unsuccessfully) would just tell me to try this spot after I missed one. And then he said "God is blessing You." Haha- how many people would say that when you've just stuck them 2 or 3 times and missed, lol! And the other evening (after sunset), the electricity went out for a couple moments (but you never know how long it will be off), and it was pitch black trying to provide nursing care. I was holding a flashlight for the nurse when the light came back on and she said "Thank You Jesus." Such pure and simple faith.

1^st May 2011 (0751)

I am thankful for genuine for fellow sisters & brothers in Christ. I appreciate the gentle way Ossee & Coran approached me about my earring yesterday. They weren't judgmental but just respectfully asked me to remove it because in Haiti, they said people in the Adventist Church make it a big deal and they will talk about you (and then hence talk about the choir). Ossee said he's been in the states so he knows it's not a big deal and he has no problem with it. Coran asked about how it was seen in the states (tried to understand instead of judge). I appreciated their approach. And I'm very willing to respect cultural things.

I took my 2 female patients to divine service yesterday. I love girls around the age 11-14. There is a 18-month old girl that is slowly getting used to me. She used to always cry and hide in her mom's lap when I entered the room. Everyone else said she likes you, she's just afraid. She's adorable! Slowly, she's letting me come closer (especially singing songs with Beatrice, she's getting used to me). And then there's Maxi, the 28 year old guy I described before with all the leg fractures that were never properly dealt with and sent to us 2 months later. His bone is still sticking out, but the wound is shrinking in size! It hurt him a lot to change the wound, so I helped just to keep him calm. The whole time he was yelling my name (even though I wasn't changing it) so I told him to call on the name of Jesus. He had told me earlier I was patient and never got mad (well I guess I don't show it when I do). I told him I try because that's what God asks of us. That was a powerful example to how our attitude and interactions really will be noticed by others and can be used as witness tool. I truly pray for my attitude, interactions, and reactions to be refined to be like Jesus (no matter what comes on my plate). The best way to do that is staying in God's word and praying.

I was so happy I knew the songs at Gospel Kreyol practice. Although I had a cough and running nose, so it made it difficult to sing at times. I am so thankful for some friends I've made in the choir. I pray for each individual walk with You so that we are truly glorifying You and preaching to lost souls.

I'm happy my family gave my mom a special birthday yesterday! I pray that we continue to serve one another, be kind, and have patience. Let love (God's type) guide our interactions!

3th May 2011 (0712)

How sweet it is to get a good nights rest and then have lots of time for devotional in the morning. I rested very well last night, I need to cut out what is not necessary every night so I can go to bed earlie

I got to see Elisabeth's baby girl Donna. How precious is life! It could never have happened by chance or continue happening without an active involved God. I enjoyed being around Elisabeth's mom as well. I slept in the room with all 3 though, so I didn't sleep well that night. But I was glad to share the day with them. I am going to try to visit them more often. I want to cook for her. It was fun watching Elisabeth's mom teach her things of motherhood and it made giggle when they disagreed on the cloth diapers.

6^th May 2011 (0716)

How lovely is God's name in all the earth. No matter what is going on here, that doesn't change the fact that You are an amazing and never changing God. How beautiful it is to sing songs of praise to You with my patients. I'm thankful for the choir to learn words of faith and then share singing with my patients because that is a huge part of their culture. And even the 18-month old baby allowed me to give her a kiss on the cheek! We have come a far way from when she used to cry everytime I entered the room.

I thank you for providing safety on the road! Amy went out to St. Marc today and ran into 2 issues on the road. They ran into a demonstration that was monitored by armed U.N. Soliders...they found a back road around it. Then, later, they were driving through Cite Soliel (the most dangerous part in Haiti), which we've driven through many times, but this time the car in front of them got robbed at gunpoint. It was a nice looking car apparently (filled with Haitians)- they don't particarly target Americans here...just people showing off their wealth. It's better to be in a ratty car.

Lord, life is uncertain here, so let us be prepared at anytime to die or that You may come back. And this applies to everyone- no matter if you live in the "safest" area of have lots of money. No one is immune to death. But we all have been the wonderful gift of salvation and eternal life (a place void of evil) through Jesus Christ.

8^th May 2011 (0925)

I'm having a "uh-huh" moment for what marriage is about. While yes they are meant to be our lover and friend, ultimately marriage is supposed to be a metaphor of our relationship with Jesus Christ as to the church. Love and respect and honoring who has authority. So whether our spouse is doing the right things or not, we are asked to not to change, get even, or get them to try to treat us better but to please God in our reactions. So whether you choose a believer or not, we need to, as professing believers, obey God. I am glad for this time to prepare my heart for marriage. You know we needed more time to prepare us to be husband and wife. In the meantime, we have callings that have called us apart for awhile.

12^th May 2011 (1300)

I'm so glad for another year of life. While God has prepared a better life ahead for us, there are still many joys and blessings in this life. 25 years, that's a pretty good age. It's funny how make every new stage of your life into the best. How time flies! This is my first birthday ever away from home. I miss spending it with my close family and friends, as well as my mom's TLC (Tender Loving Care). I had to make my own breakfast.

No, but a couple people knew it was birthday and have been telling others so lots of people gave me a birthday wish and kiss. It was also nurses day, so after the program today they sang happy birthday to me. So I did some work, but relaxing and reading in the cool now. Napping, practicing some Kreyol.

This week has been busy with surgeries, but thankfully a lot have been same day surgery. Only 1 generator works right now....just need to have a bucket of water for the morning in case. Electricity is supposed to go off early morning (5-7:30 am) so then surgeries can happen all day.

I've been trying to fight off the feelings of depression. I think it hit me in all my business, that I've made lots of amazing friends but haven't made a close girlfriend. I struggle without that, but I want to find my refuge in God's wings. I can make it and take it with Jesus. My life is in God's hands. Sometimes I get frustrated that I'm not better at Kreyol than I am, but I just have to keep it keep at it and keeping a learning a couple new words every day.

Yesterday it was nice to finish at a decent time (5:30pm) so I could sit on the roof to watch the sunset and practice my songs. It's so peaceful. If it wasn't so hot, I would sit up there now.

It's such a reality check when you hear of others stories- it gets your mind out of your own bubble. It's hard not to be hardened to things here sometimes because there are times when people truly have nothing, but other times people can afford it but think they can get things out of you. It's hard because all in all, I know that a lot of people I interact with have significantly less than me (even if they have enough to make it by each day). I guess this is called getting out of your "comfort" zone. It's going to be uncomfortable...but I guess it's better to be deal with uncomfort than live a whole life of comfort but never reached anyone else's need. Sometimes it's hard to be compassionate when you're tired and you have to deal with lots of people who can't pay for things in the hospital. I've never had to get involved with those aspects as a nurse in the U.S., but here I do.

Surgeries and beds are still free, but clinic, labs, & meds are costing now. So a lot of times, people can actually pay for those things. I have had to buy some things though. We put 2 of our patients in a building outside because they need daily rehab only. Apparently it was built for that reason (long term rehab needed for those who live too far to come everyday) by Project Hope, but now they're not sure if they want it for that. But Jamo decided it's just sitting there so we put our 2 pre-teen girls in there. It's always fun seeing post-op patient's back in clinic. Although they all think I can get them in sooner to be seen by the doctor. Everyone gets a number and has to wait in line (up to 8 hours...it's a full day even to go to the doctors in Haiti).

17^th May 2011 (0720)

How sweet and wonderful it is to sit in a quiet spot overlooking the mountains and ocean, hear the birds and silence, and get away from the business of life. What a beautiful spot to do devotions in the morning. Saturday morning, the recognized all the nurses of the hospital for nurses week. I have to appreciate the measures the medical director and doctors went to to make the nurses feel appreciated. Because apparently the nurses were getting tired of getting told all they are doing wrong and not getting appreciation every once in awhile. They mentioned good nursing attributes about all the nurses. They even included me. They said I work a lot and I can speak with the patients. Then, they prepared a wonderful meal.

Saturday evening, we sang at a program in one of the biggest churches I've seen so far. It was across from the palace. There were hundreds of people inside, and about another 100 outside because there was no room inside. Just standing there there to hear. Never seen people do that in the states. If there's not a comfy seat, forget it!

Sunday, the medical director paid for us all (about 15 people) to go to a beach resort. I think the tickets were about 40 USD. That's extreme generosity and wanting to show that she cares and appreciates the nurses. It was a nice time to relax, play, and speak Kreyol. I realized I think I learn the most Kreyol with Beatrice and her family. When a returned, a 41-year old male with a 2-week old pelvis fracture threw a suspected pulmonary embolism (clot in the lung) after they finished manipulating his hip to put in traction. His oxygen sats were ranging 70-85%. They started him on a heparin drip and the sats came up. But, since the Haitian nurses don't know how heparin drips work (or maybe they do, but I couldn't guarantee he would get watched well enough overnight) and we weren't sure how stable he was, ZJ & I split the night staying up watching him. He is still doing fine, and with all that heparin his PTT Level is normal. Which mean he normally probably clotted very fast (heparin was given before the PTT was checked) which means he was probably very high risk for clots. Especially not being on DVT prophylaxis for 2 weeks after a pelvis fracture. Unfortunately, the PTT solution ran out, so I have to figure out what to do because it's really important to check it every 6 hours until therapeutic and then every day to prevent it being too high or too low. We still do have to do the actual internal surgery to fix the fracture. Now, as Amy said, we need to make sure he knows Jesus.

20^th of May 2011 (0715)

So glad it is Friday! This week has been somewhat mentally exhausting. I've been busy, but half of the time I'm not sure what I was doing. But, I'm here to serve no matter what it is. I can truly say I enjoy serving my patients here. The hard part comes when you don't have everything you need. For example, this guy with the pulmonary embolism has never been therapeutic on heparin after the first day.We haven't been able to get him therapeutic again.  Now ZJ and Terry are gone, so I'm left here trying to figure out what to do. I'll just have to ask Dr. Spendie, but I always feel bad because she works for free all the time for our patients. And I know this patient can't afford it.

And having professionals do their job poorly because they wanted to leave (and I don't think it's because they didn't know, but that they didn't care). Hanging ice cold blood after 30 minutes when it's not an emergency. I found him with elevated blood pressure and shivering. I got him warmed up and apparently he doesn't have any major heart problems. That was basically a stress test on the heart. He is fine, but I didn't appreciate the unprofessionalism from the Haitian anesthesiologist.

But, I really enjoy hanging out with Beatrice and any other long term patient with her at the time. They brought me new fruits last night, but I worked too late so I didn't see them. I'm exhausted from waking up in the middle of the night and working long hours. I guess it's hard when you feel responsible for the patient's overall care. In the states, I have to stress about it when their, but then I go home and rest assured someone else is taking care of them.

22 May 2011 (1135)

Medishare CMO (chief medical officer) got my telephone number and has starting calling about transfers almost every week now. I'm accepting the fact that I truly never get one day off that I don't have to do something medical. That's why they give us vacation every 3 months, and let me tell you I need it. I worked 2 years with only 2 weeks of vacation a year, but I don't think I could survive 6 months without a vacation here.

To me, my biggest ministry is connecting to the patients. Especially kids between the ages of 11-16. Divegline (a 13-year old girl with a femur fracture) said she didn't want to come to church again, but she decided to come. The message was given from a genuine follower of Christ and the speaker spoke to both my girls afterwards. The one guy even helped me bring them back down to the long term house and spoke to the girls. Then, Brittany and I went back later to sing with them and read a bible passage. They both believe in God, but they're at an age when it can be tempting to see what the world has to offer.

We sang at a tiny little tin-roof church on the top of a mountain yesterday evening. So beautiful, but hot until sunset. I ended up in front of the microphone again, but instead of making me move Roseandy and Tammi pulled me in closer. I did fine. I made one noticable word mistake, but got right back on track. It's so wonderful the experiences I have. I wish I could share the experiences I have better in words and pictures, but I can't. Some of the best experiences have no pictures attached. I'm not a very good writer, but I try to share the best I can.

I'm going to cook with Beatrice's mom today. She's so generous. She wanted me to know more fruits, so she bought me a couple fruits.

I started to get frustrated a little this week over little things. We have 2 IV pumps for the entire hospital. We used the one for the heparin drip, but realized it wasn't calibrated so it wasn't giving the dose put in the machine. So we had to figure out the difference based on what it gave and what it should have gave, and then titer the dosage to that. And then without Brittany here, the labs needed every 6 hours wouldn't have happened or they would have been wrong (because the first time they did it, it was very wrong). Overnight, even though it's a 24/7 hospital, the hospital really doesn't function. Most of the workers sleep. There are so many items, skills, and people not readily available working as a nurse here (and it's not as bad here as most of the hospitals in Haiti), that you really do have to be flexible. But there are lawyers here, so it's hard too because you do what you can for what you have here, but at times you know it's not all can compared to the states.

But there are many pluses as a nurse in terms of rewarding work. Connecting better to patients. Most patients are nicer, more grateful, and patient. Learning to communicate in another language. Interacting and working alongside the Haitians. Learning very random skills. Put in position where you are the one of the nurses with the most experience to take care of critical patients, but yet I've never had ICU or ER experience. I'm very thankful for Marc and ZJ to help me learn. ETC!

Well, I think that's all for now. Time for laundry. We made pizza last night, which is just a wonderful change from rice and beans. The hospital food has the same flavor, dry. I hate to admit it, but I probably would have been one of the people complaining about having to eat the manna for 40 years. I like variety in food, but I guess it really is a luxury and comfort.

24^th May 2011 (0720)

I have been feeling joyful, content in the Lord, no matter the circumstances recently. And for God never allowing me to get pushed past what I can handle. I'm thankful for the people placed in my life, family in Christ to study The Word, and for keeping me even though I don't get enough sleep. I've been trying to quiet myself to hear God speaking to me. I noticied a couple times this week, that in a frustrating situation or when I'm busy, a bible verse came to mind and helped me handle the situation better than I was about to handle it on my own.

31st May 2011 (0410)

Any time of the morning before starting on our day is a good morning. The nurse woke me up to ask what pain medications she could give, so I showed her morphine was on the chart and showed her the vial (even explained how to give it). I decided to check down 30 minutes later, and it turned out she never gave the patient the medicine but went to sleep. The child was screaming. So I gave the medication and stayed up to monitor them. So I'd thought I'd take the quiet time for bible study. Everyone's sleeping, including the workers! The roosters and mosquitoes are up!

The group of 18 people arrived that we were prepping for. But, we all met together with them on Sunday and got most things set straight. Terry actually brought up most issues. I think he is handling issues better and being more understanding. Makes my job much easier and not so stressful. Especially last night when Medishare sent a young male pelvis fracture that they said was hemodynmically stable. He arrived in the E.R., so we put him in a bed. The nurse checked his vital signs, and came to get me because his SBP was 60. Needless to say he was not hemodynimically stable, he was in shock. I got Terry and the anesthesiologist and we got him out of shock but something was terribly wrong. By the grace of God, there happened to be a general surgeon on call who doesn't normally works here. He suspected abd internal bleeding (because the guy was struck in the abd by a car). His abd was getting bigger and harder and his blood count was dropping. He took xrays and discovered it was that, but the pelvis fracture was stable. After much reluctance from the American run hospital who sent him unstable, we took him back because they have a general surgeon and ICU. He didn't have much more time before he would internally bleed to death (probably 3 hours). It was 2 am in the morning. I don't think the patient realized how serious he was. Even his family didn't want to come search for blood. I had to break it down to them that he doesn't have until the morning. We got to bed at 3:30 am, and had to get up Monday morning to start a full day's work. And of course, I'm woken up again in the middle of the night. It's going to be a long, tiring week. Ugh, this is why I have to get away on my days off.

But, the group has been good to work with in terms of rules, working with the Haitian staff, and flexibility so I can't complain. There are a couple Haitian Americans with the group, and they'll speak some Kreyol with me. A lot of them think I'm learning Kreyol fast, but I don't think I'm learning that fast. One of my favorite parts of the day is visiting Beatrice and her mom. We laugh, talk and they love teaching me new words. I hope to visit them in July. Maxi is leaving tomorrow morning and Divegline left already. As well as another good part of my week, is speaking with Gospel Kreyol. Sometimes it's hard in the large group to understand because it's fast and lots of people are speaking loudly at once. So I tend to be quieter, but I enjoy listening. I do better with one one one conversations. I'm running into this problem, that there are too many people who speak English or want to learn English with me. Number one, I don't have time to teach English. Number 2, if I spoke English with everyone who wanted to speak English, I wouldn't advance as fast in Kreyol. I'm torn what is the right thing to do. If someone came to the U.S., I'd have no problem speaking English with them. But since I'm here, I want to speak the native language and advance. It's hard because I don't think they realize I speak too much English already because I'm around lots of Americans.

6^th of June 2011 (0715)

Last week was so busy and long days, so I am really glad to get a slower week. Jeff and Francel are 2 calm and nice pediatric specialty orthopedic doctors to work alongside. We got 2 calls from Medishare for a pelvis and hip fracture, as well as Louison (previous spinal cord injury surgery we did) who fell and it loosened the previous plates & screws we put in. But they will all have to wait until Terry returns.

We actually only ended up with 3 inpatient and 2 outpatient by the end of this week, which isn't bad considering they did about 28 surgeries this week. It was a self-sufficient, cooperative, and pleasant group. They pre-oped all the patients (everyone got a H&P), handled the scheduling, and had nurses to work the recovery room. They set up the PACU nicely and brought lots of useful items. We had a dinner at the oberge. The main doctor, Dr. Jon Hezenberg is Jewish, so no arguments about no surgeries on Saturday. Plus the group wanted to get out. Dr. John was really nice and taught me a fair amount about TSF's on Saturday.

Sunday was a catch-up on sleep (well afternoon nap), laundry, and that was about it. We went to the delimart. On our way out, we tried to ask the guard a question but he told us to hurry up and get out. When we returned to enter the hospital gates, we found out why. Police showed up as we did. Apparently a visitor punched the chief security guard when he told them visiting hours were over. The guy called these police who arrived at the gates, but Francois (the security guard) left to get trusted police. So he told the guys at the gates not to let any police in. And the police did not appreciate being told they could not come in. Then people starting jumping through the hole in the fence. Of course, they couldn't let us in because then everyone would want to come in. So we found a back way through forests and a hole through the barbed wire fence. We made it back in safely, but dirty. It finally resolved, and they arrested the troublemaker. Nathan say it really only escalated to that point because security wasn't doing their job well. He said first thing today, that will change.

10^th June 2011 (0648)

How grateful I am for a sunny day and life. We had lots of rain the last week, and a dozen or two people died in mudslides. This week has been wonderful working with Dr. Jeff Young and Dr. Francel Alexis. They're both calm, nice, and flexible. But, yesterday, we had someone go bad coming out of surgery. They're not sure what happened (clot, stroke, abd bleed, aspiration, etc) but he was fine throughout the surgery. Completely cleared for surgery, blood sugar & HTN controlled. He had a spinal, but started losing conscience when they when closing him up. We checked his blood sugar which was fine, but his blood pressure & sats started dropping. He ended up going into cardiac arrest. We tried to revive him for 1.5 hours but he didn't make it. It's hard to say why he died, but he was 5 days post a hip fracture, and was not on any DVT prophylaxis before coming to us. And unfortunately the Haitian anesthesiologist was not the best. She wasn't able to intubate him and didn't help with the code. But, we had enough qualified other medical staff to run the code.

I'm learning codes. I never had anyone code in the states here, but this is the 6^th I've seen. And I don't even help with the NICU baby codes. It's just crazy, and I need to sit in some practice codes to get more efficient.

12^th June 2011 (1252)

What a wonderful opportunity to get away from the hospital. It's just a needed day away for all of us long term volunteers to enjoy nature and relax. Haiti is actually beautiful once you get outside of PaP. We had to get up early, but it was worth it. My stomach was been upset the last 2 days, but I think it's mostly stress. I just worry about our patients sometimes. After having 2 unstable people in 2 weeks, I constantly feel uneasy about some patient going bad. So Nathan, the head boss, decided we all needed to get away because we have no group here this week.

I realized my ministery is children between the ages of 12-15. Sondy and Beatrice and both staying in the long term house. It's a joy to me to have both of them there at the same time. I went last night to talk, read the bible, pray, and sing. I want to do that every night this week because this opportunity won't come that often. Time just goes so fast! I never get to do all that I want to do. I haven't even seen Elisabeth and baby Donna in like 6 weeks.

I visited Roseandy's apartment on Saturday evening, for a small 1 bedroom and sharing a kitchen and bathroom, she pays 3,000 HD per year ($375 USD per year)...which isn't a lot compared to what we pay. But, imagine lots of Haitians only make 125 USD or less a month. It was a study house overlooking a corn field. It was back from the main road, so a little more peaceful. There is a mountain across the street and she said it's cheaper to rent there (about 1,000 HD per year...125 USD per year), but everything is crammed together and you have to trek up the mountain. But she said those living on the mountains, did not feel the earthquake on January 12^th. Although mudslides are probably a danger.

I'm excited for this week to be calmer because we only have Dr. Francel (the Haitian orthopedist who will be doing 6 months of fellowship here). I can get more Kreyol practice, especially in rounds because we don't have to translate to any American doctors. He tends to revert to English with me because he worked with mostly Americans in the Dominican, so he's used to speaking English to his co-workers. But lunch on Wednesday, I ate Mac and him so that was good Kreyol practice.

We took off the cast on Beatrice foot because she said it smelt bad and hurt. It ended up having a infection, so today we had to clean it out in the O.R. I feel like a clutz in the O.R. I need to spend a couple days so I can help with Jeannie is not there.

I really enjoy just having choir practice on Saturdays instead of a program sometimes because we do devotionals and then just sing. Then we end the Sabbath together.

21^st June 2011 (0717)

I feel like a lot of Haitians go to bed early and rise early, so I need to adopt that practice. I guess if I had no electricity or internet that would help. I just have been feeling exhausted all the time. I was going to be done at a normal time yesterday, but then I had to write a medical report on a 19-year old male patient who has a bone tumor growing on his shoulder and down to his bones. They started arranging care with another hospital, which was fine with me. Apparently this place might be able to get him to the states, which would be better. Apparently it's a massive surgery they have to do to remove his arm, part of his shoulder, etc. There are lots of big vessels there and nerves. They have everything easily accessible in the states (including an ICU), so I'd prefer them to do it their if they can.

So, I try to fit everything in. Talking to Wilshaw, exercise, and Kreyol practice. Excited it's less than 4 weeks until Wilshaw comes down. Robenson bailed on us because he's not setting up the ride, but it might actually be nicer that way. I'm still going to try to find my way to the orphanage without him

Terry's back, and we have 2 doctors, as well as 1 resident & medical student staying for 5 weeks. And we have an anesthesiologist, praise the Lord! We got 1 of 4 of the hip surgeries done. There was a MSF hospital shutting down that sent us 4 hip fracture ladies between the ages of 66 and 87.

26^th June 2011 (0900)

I always love mornings to wake up slowly and not have to rush into anything. I'm thankful for the opportunity to visit other church homes as a choir to worship God with them. I'm thankful for the group to laugh with, even though I'm always squished in the car and can't understand all of it. I somehow ended up sitting in between the 2 joksters of the group, so they would go back and forth standing up & sitting down telling jokes. I am slowly starting to get more of the jokes. Haitians love jokes, story telling, and singing. Glad I can join that part of the culture. Then, I spent about 2 hours with Beatrice and Chademere last night. It's time well spent. Chadmere is a 14 year old girl with bad rickets, they placed a device on her leg to make it straight. She's staying longer term for therapy. There's many people I want to spent time with, so sometimes I need God's guidance on how to spend my time the best.

This week was pretty busy- they did surgery all 5 days, but a lot of them went home. I worked in the recovery room. I'm learning because I have not had formal Pediatrics or recovery room training or experience. They have a thing called an oral airway, just to keep the tongue down so it doesn't obstruct the throat. Well, the guy starting gagging on it, so I thought it was time to take it out. Then his sats dropped to the 80's. I ran and got the anesthesiologist who put oxygen on him and taught me a technique to keep the airway open. He did fine, and we got him up and coughing. But it sure did give me a fright. I"m not used to taking care of patients with things in their mouths yet. I'm learning, and thankfully there are people to teach me- Marc, Summer, and Tim.

Other than that, slowly trying to get better at Kreyol everyday. I'm trying to make my night devotions reading the bible in Kreyol. That is really helping my Kreyol. I wish I could learn faster, but I'm getting there little by little. Mostly for work, I don't use a translator. I actually translate now for the doctors. I praise God we successfully performed all 4 of the hip surgeries. They're all doing well. 2 left, and 2 more will leave tomorrow. I still pray for them because the mortality rate is 50% a year after surgery. Mostly, for their souls to know You.

I feel so joyful in my soul. I am thankful for God to give me this joy and peace. I'm thankful for God refining my character (and I guess the trials & tribulations to do that). Even though it can be hard on the sleep habitat, I'm thankful for this opportunity to live with a body of believers to help me learn what it means to live as God calls us to live.

10th of March- 5th of May 2011

10 March 2011 (0640)

There is something extra special about waking up early in the morning. My prayer today is that God will give me the right words to say to my patients, especially to my newly paralyzed 25 year old man, Francois Louis. He came here for spinal stabilization surgery, but has already completely severed his spine at L1. I guess no one told him he would never walk again, even after the surgery. So when they broke the news to him yesterday, it was heartbreaking to watch him and his mom cry. But, towards the afternoon he started asking me questions as to what he will be able to do so I think he has accepted it. I want to get the process going so he can go on to rehab.

This week we've had mostly outpatient surgeries, which is good because they plan on doing a lot of surgeries this weekend with the 2 hot shot doctors coming in. I pray for respect and teamwork.

I enjoy so much going to Orphee's house. She asked me if I could get there by myself next time, and I probably could but not sure if my boss would like that. I'd have to walk though because it's too hard to see out of the tap-taps to know where I am. I just love talking with her sisters and playing with her sister's 5 month old baby Sebestian. He's so adorable and playful. They are very generous with hospitality.

I think I forgot to mention that administrator Madam Clotaire never used to speak to me in Kreyol (only English), but last week she said "ou pale Kreyol net kouyne" (you speak kreyol well now) so now she only speaks Kreyol to me. It makes me laugh, but I enjoy it.

They finally put up dividers in the patients room. We were trying to keep men/women separate, but there's always more females than males. Plus visitors are often of the opposite sex. I guess they were worried about promiscuity, but I don't think that's really going to be a problem because it's still an open room.

11 March 2011 (0707)

I was so glad to hear yesterday that our paralyzed patient & his mom are believers in Christ. I gave him a bible study guide in French and then we all prayed with them last night before his surgery today. Marc asked if they wanted to sing first, which they did and then prayed a touching and beautiful prayer from the heart. They were so thankful for all of us workers, the beautiful clean bed, and God teaching them everything because without God they could do nothing. I hope as a team we can continue to pray with patients from time to time. I would like to minister to spiritual needs more. Especially to the patient's that stay longer because I get to know them. I'm glad we started up a bible study again and prayer time as a group. It will help us stay in unity and refocus us if we get off track.

12 March 2011 (2315)

What another blessed Sabbath day to honor You and grow closer. It's always a blessing to get a good nights rest, worship, fellowship, and bible study. I am really enjoying this book by Francine Rivers on 5 females of the bible (right now it's Tamar). I couldn't put the book down. She just expands on the details of the lives of these women, so it helps me understand the story better & relate it to my life somehow.

I watched the spinal surgery on Friday. That was interesting! He's doing fine now. Unfortunately they couldn't reduce him because his bones had already started fusing together, so they placed screws and pins. Other than that, I'm going to be joining the gospel Kreyol choir! I'm so excited. They sing mostly kreyol & french, but they sing a couple songs in English. It will be neat to be around the group and really practice my Kreyol. The director is an eye doctor who speaks english, but I want to ask him not to translate everything for me. I've been going to the french/kreyol service at the chapel, but the last 2 weeks the pastor asked if I needed a translator. It was kind of embarrassing today because it was in the middle of the sermon. But I know he was just trying to be thoughtful and make sure I understood.

15 March 2011 ( 0030)

Lord, I cry out for mercy. Things happen that just don't make sense or seem fair, but I guess that has happened since sin entered the world. We had a busy start to the day with about 50 clinic patients, 9 scheduled surgeries, and already 10 patients on the floor. So it was a stressful start of the day discharging patients and finding pre-op beds for everyone. I finally got all of that organized, so I went upstairs to have a meeting with the CEO (basically, I forget his official title) of the hospital. Just trying to figure out volunteer and orthopedic plans for the hospital.

Well, I went downstairs to check on everything. The nurses came running over to show me a patient, a 13-year old girl who had surgery earlier that morning that was unresponsive and not breathing. I yelled for all the doctors & grabbed the crash cart. The came within seconds got her intubated & doing CPR, and all other ACLS protocol. Unfortunately they could not revive her. I was just frustrated because there was nothing medically wrong with this child and she didn't have a big surgery. The doctors said everything went fine in the OR. They check a chest xray after and it showed nothing, just cardiomegaly (enlarged heart). But the anesthesia doctor said that will happen after every death (and she had been dead about an hour before they took the xray).

As much as we were trying to say we're not sure what happened (and of course you can never be 100% without an autopsy, which apparently there is no doctor in Haiti currently to do that), the most logical cause of her death was not coming out of anesthesia. She probably wasn't getting enough oxygen, went into respiratory acidosis & eventually her breathing & heart stopped. She didn't have a pulse when we found her, and afterwards the doctors guessed she had probably been dead about 20 minutes before we even started CPR. Lord...it was a breakdown of a system and quality nursing care. We had no recovery room, so my guess is she was brought out of the OR still too early and the nurses didn't keep a close eye on her. Usually the family is good at watching them, but I guess we've just been taking the risk everytime. Although usually anesthesia doctors are aware we have no recovery room so they keep them back there longer.

Lord, in the last 2 months I've helped with 3 cardiac arrests and all 3 of them were basically dead already when we were called and started CPR. I can take one quick look at the patient & tell that they've passed already, but we still try to resuscitate then. Lord, it's hard to accept these types of deaths that I feel shouldn't have happened. Well, the biggest change it made was deciding to make a recovery room that they will be starting tomorrow. Lord, help us improve the nursing care and quality of this hospital.

17 March 2011 (0045)

Heavenly Father, You are perfect. If only we all could exemplify that then things would run better and smoother. But, Lord, I can't beat around the bush now. It's been a stressful and frustrating week. Realizing some major flaws that had to be taken care of; Doctors that are only here for a couple days so they're overworking the system and not taking into account the hospital wishes and capacity. The recovery room was set up the next day and today there were Haitian nurses to work in it. The only thing is we will have to train them what to watch for. But, there's been a lot of in-patients and new surgeries, so it's just been a lot to keep up with. And just trying to deal with a system that is developing but even parts that are developed are not always done right. Even we are not doing everything that the hospital has established. While granted some things medically are excessive in my opinion in the U.S., it's not good to not have basic order & protocol for things. But, I know it's not all the nurses fault. That's administration's job. It's interesting to hear the nurses perspectives on how things were before the earthquake in the hospital.

We had a debriefing M&M (morbidity and mortality) on the girl that died. I believe it sparked some change. But at first the 2 doctors wanted to put all the blame on the nurses, which I don't feel it was all their fault and it wasn't getting us anywhere. Help us God to improve and make things run smoother. Then the medical director had a meeting with the family. The family is still confused why she died, but they only asked for the hospital to help pay for the funeral (apparently it's over 1,000 USD for a funeral). I realized I have a picture of the girl who passed because she had come to clinic a couple times & always came up to me. It saddened me to look at it.

We visited the general hospital today while waiting for blood at the blood bank. It wasn't as dirty as people have made it ought to be. Just one big room with lots of patients and not many nurses & doctors. The smell was similar to any hospital (hospital's never smell good). The worst smell is on the sidewalks were men pee in the still water. A couple patient's with oxygen & NG tubes. Families were doing a lot of the care. We even saw a NICU (neonatal ICU). But, I will say after seeing that that our hospital has potential and we can be thankful. The nurses get paid more than 2 times more at the General than at Adventist hospital, but I'm sure it's stressful there too (they get about $400 USD per month at the general & $125 USD per month at the Adventist hospital)

We rounded up lots of us to donate blood at the General Red Cross so we could get 2 units of blood, but apparently the donation place was closed. We pleaded to get blood in exchange for people donating tomorrow. So we waited and just chatted. I guess the anesthesiologist went back to ask about how long it will take and they told him to get out, they won't answer any questions. (He only went back there because there is never anyone sitting at the receptionist area to ask questions). Well, the doctor is 6 feet and 9 inches and told them he's not going anywhere until they give an answer. Lol, so I think intimidation worked although they were mad and came out yelling that everyone had to sit out here. He even said "and I remember you" lol OK- I said "Sir, we are sitting out here so you don't need to yell at all of us." The anesthesiologist said they were not processing anyone's blood even though about 10 people had been waiting hours for blood. Apparently they didn't feel like it, so they were making everyone just wait. They told our doctor when he asked what if this is an emergency that "We don't care. We've seen lots of people die already so what does one more death matter." So unfortunately that really is the Haitian (or maybe more Port Au Prince) mentality sometimes and it's very unfortunate. But, if it would be there family it would be different.

After all that, we got our blood in 10 minutes. But of course, all the Haitians who had been waiting anywhere from 4-12 hours were upset the "blan" got their blood before them. We apologized to them about the unfairness. I hope they all got their blood. I don't want it to give blans a bad rep (altough it's cultural to show favortisim). Well, time for bed because 12-in patient & 12 surgeries scheduled. Give me strength, Lord.

19 March 2011 (1320)

How excellent it is to have a day away from my job & secular worries. Lord, while caring for Your sick children is not secular, I cannot work 7 days a week. It's been a very busy, stressful, and frustrating week. I could go on and on about how workers & systems are not functioning well and need to change, but today is my day away from worrying about these things. And there is no use complaining, just have to push through it and change what I can. Today is my day to occupy my mind with Christ because I have the rest of the days to occupy myself with the work You have placed in my life. Days off are the reason I can keep going, once I renew my mind and have a rest. Then, I am ready to handle the next week and it's problems.

I hope I can get out in nature again soon. I think getting away from the city really does something for our spiritual and physical health. Our only get away in the hospital is on the roof because you are surrounded by mountains and the ocean. It's a breath of fresh air (except when the generator gas is blowing towards you) and time to quiet my mind. The message today was about taking that quiet time with God. We can't be so busy that we don't have oil in our lamps. Oil represents the things needed to sustain us, the word of God and meditating on it. And the burning of our oil is our prayers.

I'm happy to be a part of Gospel Kreyol. I'll try not to be so shy and make friends. It's just a joyful part of the week to bring music to our Creator's earers. I am thankful for God allowing me to each day understand and speak Kreyol a little better.

20 March 2011 (1115)

I thank you for another day, Lord. Gospel Kreyol sang at Herob SDA church. They sang beautifully. Man, I can't go many places without sticking out. I was the only blan amount hundreds of people and when they were talking they were saying there's 1 person in this room who doesn't understand. You can imagine their shock when I told them I do understand them. And I think I'll certainly improve my Kreyol spending time with this group.

25 March 2011 (0700)

How different are my days when I spend enjoy quality time with You. Forgive me Lord for the days I wake up late and don't have enough time for quality devotion. The work week has been better though. I'm just catching up on sleep because last week I had 2 nights of only 3 hours of sleep so feel exhausted from that. We've changed to only doing clinic Monday, Wednesday, & Friday now. And surgeries Tuesday and Thursday so that helps to have a more normal schedule.

I transferred Francois Louison, the spinal cord patient, to St. Bonface. Glad I could go and get him settled. It was a breath of fresh air to get in the country. There were miles of just green!! And I love watching how the country people live and work. I think it is a better environment for people. It made me miss being out of the city. I got to see Mamie, one of our other spinal cord patients from November that got transferred to rehab at St. Boniface. Hopefully I'll get to go back and see them both again. You connect to these patients, so it was hard saying goodbye but I know this place will be much better in getting him progressing to normalcy. His mom didn't want me to leave, but they will be fine once he makes friends and learns how to do everything by himself. He won't feel so helpless then.

26 March 2011 (1400)

Gracious Father, I thank You for getting us safely here to Gonaives. Forgive my complaining. I guess all in all I am used to more comfort so to be in a 2-seater with 3 people & all of our belonings when it's 95 degree and you're tired it's testing. We stuffed at least 60 people in the bus plus all of our bags and musical & sound equipment. But, we made it and I'm sharing a room with 3 other females. 2 of the females have really welcomed me so I was glad to bunk with them, Rose and Yonie. They make me feel so comfortable and help me out.

So, embarrassing story. We stopped on the side of the road to use the restroom. I was going to hold it, but decided I shouldn't stop the bus later on so I better go then. I got up and asked where they we were going to the bathroom (I guess which bush we were going behind) and they said against the side of the bus. I was mortified, but every other girl did the same thing. So with a bus full of 60 men and women, I squatted beside the bus to pee! It took awhile to get started because I was trying to keep myself covered up and then it seemed like eternity. And then, when I got back on the bus the guys had to joke about the blan peeing on the side of the bus; a sight they clearly don't see often. Oh dear, there are some things I don't know if I'll ever get used too. I'm cool with squatting in a private area, but never in public.

But anyway, we arrived & took a shower which felt amazing because we were all sticky and sweaty. Now, we're just relaxing until it's time to go. It's definitely good for me being around all Kreyol. I am quiet in a large group, but in smaller groups I speak up more.

So, I performed 2 times yesterday with Gospel Kreyol. The first time was at the big university church with 4 other choirs so I could blend in better (if you want to call it that. I was standing in the back so no one could see me). I also saw a lot of the nursing students. I pushed Sondy in a wheelchair up the big hill to church in my heels, but it was a joy to see his excitement to be in church with us. I enjoy him being around so much. I know it won't be long until he leaves again. It's hard because I don't always make enough time for him, but I need to. Oh how dear he is to us and to You. I pray that he stays strong in his faith.

The 2^nd time was in another church in the evening. So, apparently the director's way of deciding songs is the moment we get on stage he decides one song at a time. You learn what song you will sing next by him either making reference in his talk to the church or the music will just start playing and you have to figure out the song. So I got up there and had no idea what were singing and I hadn't practiced many of the songs with the choir. I only had the songs for 5 days to practice. But I prayed about it and there was no reason to stress. I was able to sing 7 of the 10 songs. It was fun and the girls beside me helped me out a lot. For once, I didn't get pointed out as the blan (ZJ did mention I probably wouldn't after I start singing with the group).

On the way home, we saw a motorcycle accident where the driver turned to fast and they fell off. The drive drove off and the left the passenger's body on the ground. He wasn't moving, so I wanted out to check on him. They wouldn't let me out at first, so by the time I got over there was a large crowd trying to pick him up. I was just trying to figure out how to get him to the hospital when the police showed up. They seemed to just watch these unmedical people try to care for the guy. So I just let the police do their routine because I don't know how it works around here. You wonder if there are more complete paraplegics because of uneducated people moving the bodies are an accident without spinal precautions. I guess there's nothing you can do to stop that. Then today, Ginel in the choir told me not to get out of the car again. I guess I just don't know the culture well enough. It's hard not to do what we do for emergencies in America because that's all I know. But, I guess they can try to pull you into a legal mess here, so I don't want that. I don't think there's any Samaritan's protection here.

3 April 2011 (1000)

How fast the time passes! Lord, help me to manage my time better so I'm finishing work at a decent time as well as what I do in my time off so I'm getting enough sleep. I don't want to be the sister that was busy with so many preparations, but not choosing what is better (sitting down at the feet of Christ). We are so much more vulnerable to temptation and our interactions may not be as glorying to Your name as they could be when we don't spend enough time in Gods word and prayer. I want my work, gsopel Kreyol participation, friendships, interactions, etc to not be selfish and self-seeking but to be focused on You and loving others. No wonder Jesus said to us "seek ye first the kingdom of God and all these things shall be added unto you."

I finally am caught up on sleep. I slept through my alarm clock (which almost never happens for me unless I'm totally exhausted) and had an off work week in terms of my productivity. But, I was glad to be able to go to Gonaives and getting to know the people of the choir better. Random stories- I forgot a towel so all 3 of us shared a towel (and no one makes a fuss of that here even though they didn't know me that well). I sang all but 2 songs Sunday. It was neat when the electricity shut off in the middle of the song. It was a church the seemed financially better off than most in Haiti. They had nicer pews, lights & fans that worked well most of the time. Afterwards, everyone was being silly playing games. I choose to talk to this one 18 year old female in the choir but everyone kept calling my name so eventually I went over. I'm still slightly timid, especially not being 100% fluent in Kreyol, but it's fun. But being around them will help me pick up Kreyol fast. Even the piano player, Wilmyr, wouldn't translate for me because I think he wanted me to try to figure it out on my own and see how much I understood. He lived in the U.S. for 5 years and played with the Broooklyn Tabernacle Choir so his completely fluent in English. He's an amazing piano player.

Afterwards, we stayed up until midnight talking and the one guy Johnson was cracking jokes. It was a smaller group so I felt more comfortable speaking up. Then all 4 of us girls slept on the mattress until 4am. I was exhausted and thought everyone else would be on the way home, but nope, the jokes kept going from 4am until we got home at 7am. I get intimated in a large group to speak, plus I could barely keep my eyes open so I slept the whole way home. They stopped to use the restroom again, but I refused to go, even though they asked.

We ran into a strike on the way home. Apparently gas went up 40 gourdes (about 1 USD) so now it's about $4.08 USD/gallon. So the public tap-taps were not allowed to run and if they did people were throwing rocks at them. So, until they figured out we were a private tap-tap, we got stopped and people were yelling to the driver to turn around. After awhile, we were allowed to keep going. Apparently they were throwing rocks at public tap-taps who weren't following the strike. Clinic was slow that day because of lack of transportation.

I have really enjoyed this group, the Lovejoy's, because they have been respectful of hospital wishes and willing to help with whatever. And they asked before scheduling cases on Sunday. And they didn't expect me to work on Sunday. There were the usual joys and frustrations of working here this week, but I can say that I'm enjoying having all the pediatrics babies. Dr. Lovejoy is a pediatric orthopedic surgeon. Plus the babies leave that day or the next so the bed situation has been easier. We only ended up with 3 patients this weekend so we quickly did rounds together. I placed a wound vac on the BID dressing change order so now we don't have to worry about that.

We learned 2 new songs with Gospel Kreyol. It was nice to learn new songs with them instead of me catching up on ones they know already. And, then I guess the first sabbath of every month Dr. Greger does a program for the youth. The praise team sang and Dr. Greger did a presentation on the nervous system and the eye. He then talked about the negative effects of television because of how our brains analyzes, integrates, and stores everything we see. It was good and I'm glad God is using him to educate the youth and provide them what God has to offer instead of the world.

Well, it's hard to remember all the stories. But I did hear the hospital has been trying to move everyone off the grounds (all the families still in tents). And there has been a family living in a building on the grounds for 10 plus years because a previous administrator allowed them. But, now the hospital wants them to leave so the hospital can use the building. I guess the family is refusing and this week someone poisoned their 3 dogs to death as a threat. I was disgusted when I heard that story because that should not been happening in a Christian hospital. But Marc warned me that not everyone who works at the hospital is Christian so they may try to poison you if they don't like changes you're trying to make. Well, it's not worth dying over as Marc said, so I just need to be careful who I take food from.

5 April 2011 (0716)

Even if I wake up tired, I always feel refreshed & joyful after spending time with God. You are a good God, lord. We just have to put our trust in You. I enjoyed going to Orphee's house as usual to spend time with her family. I brought banana bread and they they wanted to know if they could sell it in the market. That would be hilarious if they started selling my family's banana bread recipe in Haiti. As always, they are generous in providing food, clean sheets, and their company.

9 February- 6 March 2011

10 February 2011 (0710)

Sunday was a wonderful day! I went to nurse Ophree's house. It was a nicer house with running water and a loving family. Her 2 sisters, brother, cousin, and brother-in-law lived there. Her sister has an adorable 4-month old baby boy. We cooked, played with the baby, Orphee did her laundry (and I watched how they do it by hand), and talked. I just bring my dictionary to help facilitate any words I don't know. What is so amazing is how hospitable and giving people are who have less than me versus Americans who have way more. Granted all of her family seemed to have well-off jobs, I know the nurses make equivalent to about $125 USD per month at this hospital. Orphee refused to let me pay for anything (the tap-tap ride, food, etc) even though I'm the one who asked to visit her. When I got there she gave me a different outfit and shoes to cook in. All of her siblings spoke a little English. And her house had a beautiful view of the ocean.

And then when I got home, everyone was heading out to watch the superbowel. So we stuffed 8 people into a 5-seater car to drive up to Penionville (where all the rich people live). It was a 1-hour crazy drive with Sam. But, we got there and back. I mostly was just updating my blog, especially since they couldn't get the superbowel until the very end. They had blocked in over the satellite, but finally they figured out they could get in on the local TV, go figure haha! Some carnival things were going on that night, so the streets were packed at 10pm.

This work week has been a nice relaxed pace because there has been no anesthesia. Dr. Terry left yesterday for 2.5 weeks and the next ortho doctor comes tonight. We have only 2 patients here- one car accident with femur fracture and another women who had her femur rod replaced. She needs blood today, but that's about it. It will be a good day to catch up on random things.

I've been staying over at one of our younger female Haitian doctors house, Spendie. Her younger brother and sister live there too. Their mom lives in the states, so she keeps an eye on them (one is 18, the other 22). I have to say, the way people have respect for their parents & older siblings is nice. It just keeps things functioning better. We have lost that in many American  families. Spendie said she knows it's harder on her young siblings to not have their mom, but she's trying her best to get them through school and find a decent job. Again, the hospitality she provided me you would have thought I was someone important lol. She gave me a scarf she bought for herself, food to eat and to take home, and a pillow to sit on the chair. It's fun to get away from the hospital and get to know her. Their house also has running water and electricity (when the government puts it on). It's got a quaint courtyard. I've been enjoying doing bible study, prayers, and hymns together with them every morning and night. They all have bed frames with huge pieces of foam for the mattress that are comfy. She can now afford to pay a lady to come clean and cook in the morning she told me, which helps her out working full time as a doctor. They all still do their own morning and evening chores though. It's just a simpler life here, but I think that's good sometimes. Spendie has lived in the US for a little, and her 1 ½ year old lives in the US with her mom, but she says she prefers to live in Haiti. She knows there is more comfort in the U.S., but she feels more at home in her mother country and knows there are more needs for doctors.

15 February 2011 (2200)

How often we ache for Christ's return when we see tragedy and pain. There was a 28 year old female medical patient that cardiac arrested in the middle of the day. I was eating lunch when they came to get me. Angela, the CRNA was bagging her and the Haitian doctor on call was doing chest compressions. No one knew the patient at all, but it appeared she had been having seizures because there was foam coming out of her mouth. The crash cart was messy so you couldn't find anything and they were doing compressions without a back board, so we had to run to find epi (the med to try to start the heart again) & a back board. We tried, but were not able to save her life. I didn't know this patient at all, but it's hard to see so much death. I've seen 4-5 deaths in the last 4 months (that isn't including the 2-5 deaths in the neonatal ICU they seem to have every month). Back home, I only saw 2 years in 2 years (granted I also didn't work in an ICU). I can't imagine dealing with the amount of death they did after the earthquake and even with this cholera outbreak. It's nothing you can truly prepare for. There are not that many ICU beds for PaP (maybe 1 or 2 hospitals have ICU beds). This was a pretty tragic death that could have probably been prevented. The doctor on call wrote death from a seizure secondary to severe dehydration. But 2 problems: She had been in the hospital 4 days so how can someone be that dehydrated in a hospital after 4 days and also apparently the family kept telling the nurse something's wrong but the nurse didn't do anything about it. If they would have fixed her seizures right away, she would never have gone into cardiac arrest. So basically, it was most likely a preventable death. So that's a hard fact I learned today, even though we have most of the supplies, we don't have all the training here. I have experienced more codes here than ever before and I'm learning. It's hard for us to accept these things from our American perspective. But you can only do what you can with supplies and training available. We are here to try to improve training though because a case like this should not have happened in a hospital that was equipped to deal with it.

Saturday, we climbed up a mountain with Jean Kelly. It was beautiful and a nice get away from the city. There was even a small cave. Saturday night we spent reorganizing and cleaning the kitchen. So needless to say, I was tired sunday morning. But, it was worth it to have a clean and organized kitchen. Sunday I rode with Mac's family to his graduation. The service was all in french, so I only understand a couple words. For some reason, I had been craving a coca-cola all week and his mom bought me one! I had fun talking to his sister.

Afterwards, I met up with my friend Stella. Her brother graduated law school with Mac and they're best friends. It's a small world! I went their house and met all of her family. 3 of her sisters are doctors. I think most of the doctors in Haiti have a parent in America to afford medical school. Their mom lives in the US, so they are slightly better off than most. Then, we had a celebration party for Mac back at the hospital.

So, other than that, work has been busy as usual. Still trying to fit in exercise every night. I bought buckets to wash my clothes in, but I haven't found the time. Instead, I heated up warm water on the stove to take a warm bath. Boy, has that been feeling really good. Oh, I forgot to mention Saturday evening, a 27-week old baby was born (basically born 2 months to early)  and they came to get me because Marc (the nurse with NICU experience) was not there and there was no doctor available. I was like well, haha, not sure what they wanted me to do without NICU experience. So ZJ came and helped me. When we got there, the OB doctor said OK good, thanks, and left. We called the pediatrician and she told us what medications to put the baby on. The baby was soo little. He was a fighter and breathing on his own. It's just a crazy system that there was no pediatrician available to see a brand new premature baby. I have to balance my thinking between well they're doing what they can here, but also this isn't really acceptable. So far, the baby is still alive. I pray for the system to be able to be changed.

18 February 2011 (1317)

I'm excited to see my family and Klair. I'm waiting at the airport for 4 hours. There was bad traffic because of some flooded roads, so we left early. Elinor, the nurse who was here for 6 weeks before, came back Thursday and she'll be covering me while I am gone. She has a good way with the patients, so I'm glad she'll be here to cover me. I'll miss speaking Kreyol for 1 week. I still have a lot ot learn, but I'm getting there. I;m probably learning slower than I want to because I'm around so much English.

Last night, Marc and I were heading to Spendie's house, but we got stopped in the ER because a motorcycle accident patient was brought in and only the OB doctor was on call. Lol, the doctors really have to know a little of everything around here. I had the OB doctor exam my pregnant friend because she contracted HPV. I ask for prayers for her and the baby; as well as her husband (I pray he's not being unfaithful).

I love the welcomes and farewells I receive at the hospital. I like the warm goodbyes. Hugs and kisses. I forgot a long sleeve and it's cold in the airport! I've never been in this part, because last February the airport was very different and when I left in December I went on a small airplane. For some reason, there are 3 places instead of 1 that they examine your bags.

20 February 2011 (0100)

I should have been in bed way before now! I do not enjoy staying up late anymore, but I've been enjoying my time with Klair. We went on a boat ride, ate lunch with her son Aaron, relaxed, and went to her Haitian friend Lucette's house, so it was fun being around Kreyol. She held a party for those who volunteered in Haiti, and most of them were Haitian. I could understand a good amount, but I felt intimated to speak it. It's funny because even though they were all well-educated and have well-off jobs, they all spoke Kreyol together, not french. That's why it's tough for me to put much effort into French. It would only help me at church. They definitely had aspects of the Haitian culture, but it was interesting to see how the American culture has influenced them, especially the women.

21 February 2011 (0615)

I didn't get too much sleep the last 2 nights, but it was fun being around Klair and her family. How time flies. We went to the swap shop yesterday. There were so many Haitians, I loved it!! It really gives me more motivation to get better at Kreyol.

22 February 2011 (0830)

As much as I love what I'm doing, there's just something so wonderful about coming home to see family and friends. I pray that this week I can balance being productive, but also spend quality time with my family. I am so excited about the possibility of my parents, Emmy, and Wilshaw visiting me in Haiti. I would love to show them all around.

25 February 2011 (2230)

I'm back to Haiti! I had a wonderful time with my family. I enjoyed meeting all the people at my Grandma's bible study; going out to eat with Gma, Mary, and Aunt Nancy; Mary's graduation went well. And just spending the evenings with my family. Time always goes too fast!

27 February 2011 (0920)

How wonderful and grateful I am for this day. It's a beautiful day outside. It's sunny, cool, and breezy. I'm ready to start the day. I'm so happy to see everyone. I love the welcome you get here. Everyone is genuinely happy to see you. Such a contrast from my last job. I'm glad for this week's study on jealousy. It's something that can easily creep in and can lead us to do things we never thought we'd say or do.

We went to an instrumental jazz concert today and it was really good!! They had a piano, bass, sax, flute, & drums. Let me tell you, I can't play like that flutist did. It was motivation to practice and improve. I miss singing in a choir and being part of a musical group. ZJ is joining a kreyol choir, so maybe I can see if they want another soprano singer. That would be fun to sing in Kreyol :)

28 February 2011 (2240)

While we should praise God in everything & trust that he works all things for His good, it has been a hard one today because Orphee was denied a visitors visa. I know there are a lot of problems with people staying illegally, but I don't it's fair that she waited 6 hours & paid lots of money and then all the consular did was quickly glance at her papers (including my letter) and then ask her if she was married or had kids. After she said no, he gave her no chance to explain or find out any other details. My problem with this it was very subjective and basked on his or her mood. 

I just felt bad because she spent what she makes in 1 month for this and was basically given no chance (I saw her papers with how much she makes between two jobs each month...let's say it's how much I made in 17 hours of work at my other job). I slept over at her house and went with her in hopes of going in and explaining, but they wouldn't let me because she's an adult. So I sat and spoke with the driver for 6 hours. Well, we probably slept and listened to music for most of it). Boy was it warm in the car. And eventually I had to use the restroom, so they found me a corner in an open field with people all around. Oh boy, I just went and didn't look to see if anyone was watching. I'm sure it was a sight, a blan in a dress and high heels. The driver was like, I'm sorry, this is Haiti.

I really enjoy Orphee's family. I want to spend time there every week. And it's good for improving my Kreyol. I felt like I could speak better after spending time with them. I notice when I'm only around Kreyol like last night and today, that I improve so much faster. I translated for the anesthesiologist and talked to another hospital in Kreyol about a transport of a paralyzed patient on my own on the phone. Not that I'm fluent at all, but able to do OK. There are a lot of words I don't know, but many times I can make my way around words I don't know. "this" (Sa) is a good word to know haha!

I attempted hand washing some laundry yesterday. It was a good experience, but boy did it take a long time. It would have been a little more enjoyable if I would have had a group of friends to chat while doing it. I forget what else I wanted to share. I just have to trust that there was a reason the visa didn't work out. But I lift it up in prayer, because we're thinking of applying again but finding out what needs to be done to help her get the visa.

6 March 2011 (1400)

So, it's been a busy work week as you can see by my lack of writing. I worked 12-14 hours Tuesday-Thursday and 8 hours Friday, so I was ready to be off. I love and have connected to my patients, but I was exhausted. And this week I felt a lot more comfortable with my Kreyol. A lot of times, I don't need a translator. I asked all the translators to speak only Kreyol with me and for the most part they have been doing that. It'll help me to learn it a lot faster. We have a lot of medically sick patients who have diabetic foots or pressure sores, so they have lots of things that need paid attention to. And we had a BKA surgery that lost between 700-900 cc of blood (that's 3-4 cups of blood) and his blood count started as a 9 but dropped to a 4.5 and 15. He was pretty symptomatic, but it took 3 days to find 2 units of blood. Praise God he made it through and looks much better. I was really worried about him. Then we were dealing with getting all of our pressure sores uninfected and putting wound vacs on them. The only problem with wound vacs is the nurses don't know how to use them, so I'm constantly hearing the beeps and having to go fix then. Sandra, the 28 year old lady with multiple washouts of her femur rod, is still here. It almost stopped draining now, but they don't want her to go home until it's completely stops. I love her and her Kreyol is very easy to understand. I told her to come visit me again after she's discharged.

We got a 25-year old paralyzed male who fell out of a coconut tree. After they were almost here from 5 hours away, Dr. Terry told me the C-arm wasn't working. So, now he'll just be here for 2 weeks until they can get the parts & fix it. He can't do the surgery without the C-arm (it's an xray used in the OR). The patient is nice and I truly felt like him and his mom had nothing. Granted, I don't normally give people money because I can't give everyone money and I want it to be used right. I think God whispered to me to give him money though when he whispered to me that his mom hasn't eaten all day because they have no money. He came from Albert Switzer Hsopital. Which they told me was just stacked with patients. He came in impacted with stool, a terrible urinary tract infection, and a open infected wound on his forehead because it was never sutured. His accident was 14 January. I can see now why Dr. Simeon doesn't want this hospital stacked with patients, because the patients are not taken well of then. So we took care of all of that. I spent 1 ½ hours on Thursday and 45 minutes Friday disimpacting him. You tend to connect to these patients and families because you spend so much time with them. This is a hard country to be paralyzed, especially at the age of 25 with a child to feed.

I had 2 "Haitian female" experiences this week with 2 of the male translators (well all the translators are males) expecting me to make their easy mac and wipe their father since I was a female and most males don't do that if a female is around. I don't mind doing these things, but something about it is bothersome when it's expected and forced. I guess growing up in America, I have a hard time accepting that mindset. Women here don't know anything else. If I'm a stay at home mom, I'll do more, but if we're both working then we can share the work.

This weekend through Tuesday is the carnival so things are extra loud and it seems people don't want to work those days. CBM (our physical therapy group) said they had off, but I asked at least 1-2 to come in every day because I can't do their work and mine. I love to hear the sound of children playing or singing. I enjoy community living. And I enjoy being able to translate for myself. There were 2 nights this week we heard gunshots; it startled all the patients. I still get amazed at how people take care of each other without complaining (and they will help me with their family member or someone else's in the room if you ask). But, they can be very impatient. There also isn't much of a concept of organization and long term planning in this culture. So there are things I love about this culture, but also equally frustrating things.

Well, I just glad for these last 2 days to rest, study, fellowship, and relax. Cook for fun!

9 January- 5 February 2011

11 Jan 11 (0045)

 

What a day! I'm so ready to fall asleep after a long day. Except for maybe 2 hours scattered here and there, we were busy from 8am to 9:30pm with a transfer (a badly controlled diabetic patient with a gangrene foot & pressure sores) & 3 trauma's (bad motorcycle accident). I can say there is good teamwork among everyone. After showering & just going to bed, I got a call that one of our trauma patients blood pressure was dropping & heart rate increasing. Hemoglobin dropped from 13.9 to 8.8, but Dr. Terri said no blood unless less than 8.0 so we wrapped a new compression dressing and elevated the leg more. The nurse seems really attentive so I think he'll be watched well. And then, I helped Marc & Orphee with a 20-month old baby who died of anemia. Somehow Marc & I are functioning more like PA's or NP's.

15 Jan 11 (2115)

I went to the January 12^th services on Wednesday. There were hundreds of people at the memorial service our hospital put on, but no outward signs of morning. I worked 12-14 hours Monday and Tuesday so I was exhausted Wednesday so I didn't work much. I'm going to have to learn how to write dressing change orders in French to incorporate the nurses doing it because it gets to be a lot. We're doing lots of much needed surgery, but it can get crazy when we have lots of patients. I have to set my boundaries because I cannot work five 12-hour shifts. I start to become ineffective because I am so mentally and physically exhausted.

But I had a wonderful nights rest, went to service, and then came to visit Elisabeth and Servilus. Servilus bought his motorcycle so we rode that for over an hour all over PaP to reach their house. Let me tell you, the motorcycle was OK in the countryside but downright scary at times in the city because other people drive crazy swerving in and out. I wanted to close my eyes because of the dust, but I wanted to keep an eye on traffic so I forced them open.

Elisabeth is looking beautiful as usual, even in her pregnancy. She taught me how to cook rice, bean sauce, and fish. We cooked outside on the ground with a charcoal grill. I just love spending time with her. I wish she lived closer so I could come more often. We watched a theater production in Kreyol that was made in the U.S. With Elisabeth help, I got the main jist, but they spoke really fast so I couldn't understand everything. The mosquitoes are really bad at their house!! So after a bath, talk with Wilshaw, I'm ready for another goodnights rest.

Side note: I wrote a letter to Orphee to help her get approved for a visitors visa. I would love to show her around Lancaster, MD, Philly, Miami, & New York. I pray that if it's Your will, she would get approved and be able to visit me. She would come back & go around with me visiting friends. And I finally visited the little Haitian boy medical patient who had told the nurse earlier in the week that he liked me. I told him I would come back and visit, but I got busy all week. His name is Reme Leonidas. It's been fun seeing a lot of patients I know come back. Especially the kids, but I haven't seen Sondy or Denise. We haven't had any long term pediatric patients, which is probably a good thing, but I miss the kids!

The results got leaked- it's the lady and Micky who won 1^st and 2^nd place. Apparently there was a lot of ballot stuffing for Jude Celestin. I guess now it's up to the Haitian government to decide if to accept these results. There were some small riots thursday, but nothing today when we drove to Servilus's place. I like how I'm starting to recognize where I am at. I still couldn't get around on my own nor would I ever want to drive here.

Brian, Marc & I have been having fun with the P90X abd workout & cooking. I'm getting used to the rice & beans, cold showers, and mosquitoes. I feel like I'm home.

16 Jan 11 (2154)

It's an interesting experience learning to cook from the basics. The food is delicious. I feel that my Kreyol is slowly but surely improving. The one Haitian American volunteer asked me this week if my boyfriend is Haitian because he said I speak it well for not being Haitian. That's a great compliment for me :) I tend to pick up on whatever accent I'm around. Robenson had to fix the motorcycle so I'm staying overnight and leaving at 5am. I pray that my devotional thought tomorrow will reach or touch at least one person.

17 Jan 11 (2300)

How wonderful it is to be safe, well fed, have a shower, and warm bed. But God is more than just my provider. He's love, righteousness, Holy, merciful, omega & alpha. I like the quote Marc said, "Seek God's face, not just His hands." Today was busy, but not too stressful. And I got to fit in talking with co-workers, exercise, making dinner, and talking to Wilshaw. The one nurse was telling me about a patient, but I didn't know the word I wanted to say back, so I got Mac to translate and the nurse said, "Li pale Kreyol (she speaks kreyol)". I have had a couple nurses say that if I bring a translator. But I still do have a fair amount to learn. I feel it helps me connect better to the co-workers and patients.

18 Jan 11 (2340)

Today was a testing day on my patience- a drama queen patient that was refusing to do what we ask and then refusing to leave. I had to get security involved, and guess what? They didn't leave, but stayed overnight in a cot in the hallway. I told the nurse she wasn't a patient and didn't need any nursing care. And a lot of strong emotions today. Only God knows what is best and the outcome, so I have to put it all in His hands.

20 Jan 11 (2341)

As tired as I may be, I still need to be thankful for everyday. It was a calmer work day. Even though I may not be fulfilling a floor nurse positions, I'm learning a lot of other random skills to help me as a nurse and life in general. Like coordinating care, finding beds, teaching in another language, and learning what is normal. Like tonight, we had two big surgeries that can bleed a lot, especially if not elevated, so they weren't elevated. Back in the states, I would have worried more, but I know the normal now and just compress it and elevate it.

I lift up our meeting tomorrow with Dr. Terri & Dr. Simeon to set our goals, concerns, & protocols. All in all, we can't operate in earthquake mode anymore. I pray for respect to the hospital medical director's wishes now. We have 4 ortho surgeons coming next week so it'll be busy.

21 Jan 11 (2327)

You provided me a miracle and blessings already on this sabbath. I had the nurse change the C4-C5 Quadraplegic's catheter because he had the current one in for 1 month (one not made for long term use) and he was starting to have fevers. Well, I decided to check on it (I just had a gut feeling about it not being in right), and I came in 4 hours later & noticed there was no urine in it. So I got the supplies to put in another one. I deflated the current balloon & pulled the catheter out & it started bleeding profusely. I put pressure on it, but it wouldn't stop. (The balloon had apparently been blown up in his urethra instead of bladder so it broke the lining...and he has no sensation so he couldn't feel it). I was getting nervous because it was late at night & would be hard to get urology service. Thankfully Sophie (the ER MD from England) was walking so I had her come in and try to stop it. She placed a new 18-gauge catheter and the bleeding stopped! Praise God because if it didn't, he would have needed urology surgery. I have to appreciate families here, because instead of panicking they helped as we asked. And then they got the patient (their father), all cleaned up after the mess.

I saw Sondy today and I was so glad! He didn't act like his playful self though. I gave him the picture frame and colored pencils. It seems he will be back again for a couple more cast changes. He told me our little girl patient Denise is supposed to come back March 14^th. Besides her, I've seen all the patients I've printed pictures out for. I love seeing patients again! I realized I haven't been sharing patien stories recently. I've been working long days & my brain is tired by the end. But, I shall try to start doing that again.

It's been a brand new year & way of doing things. We're not taking large short term teams & it's been better just having 1-2 ortho MD & 1-2 anesthesiologist. I've been basically functioning as his PA, bed monitor, and coordinating things. I am trying to work with the Haitians nurses & nursing directors. I definitly feel my role now and it's sure busy. Apparently, Marc brought it up to Nathan to see if I can get a stipend. I am praying about it, but I could be more effective being here for 1 year.

25 Jan 11 (2300)

I have spent way too many days without quality time with God. Sunday became a challenging & busy day. I woke up feeling sick and when we rounded on a patient she looked very sick. I had a Haitian MD look at her & he said septic shock. So he ordered some things & then we had a meeting with Dr. Simeon. The meeting went OK- still have more to compromise & collaborate.

Then, I went to look at the patient again & she was no better. So we got Dr. Simeon involved. The patient ended up being in septic shock (Tempt was 106 degrees Fahrenheit, BP= 45/35, HR 130); she had dry blood in her mouth so the guess was she was bleeding in her GI tract because her H&H= 3.3, 10%; and she was in diabetic ketoacidosis (Glucose was somewhere between 500 and 1000). She had came in with a diabetic foot ulcer that went gangrene. I believe her husband took good care of her but had no money so he couldn't take her to see the doctor. A foreign run clinic was the one who found her and brought her to our clinic. They amputated that foot, but later also had to amputate the other leg because of another sore under the knee that went down to the hamstring. She also had multiple other sores from being bed-ridden on top of other medical problems that we probably didn't even know about. So she should have been followed medically & just consulted ortho, but the family couldn't afford to be followed medically. She didn't have too many signs of problems (or they nurse never told us when she started spiking temps) so it seemed to come on quickly. So needless to say, we were running around trying to save this woman's life. I was up most of the night watching her and then worked 9 hours the next day. Marc watched her Monday morning. Her hemoglobin came up to 5.5, BP up to 75/40, but she never woke up. Her family asked us to cease treatment so they could take her home to die, but she passed away before that happened. The husband said she has been suffering for so long and maybe this was God's way of ending her suffering. I'm glad he saw it that way, but it was hard on me because I felt like she shouldn't have gotten that far advanced in a hospital. She eventually would have died of sepsis or something else in the next month or two at home if she didn't come in, but the surgery exacerbated all her medical problems.

It's a hard thing here because if patient's can't afford it, they can't get treatment. Dr. Spendie said she will see them, even if they can no pay, but that's out of her pocket & I don't want to do that often. The CBM (physical therapy techs) explained that a lot of times in Haiti people don't come to the hospital or they come too late to save them because they don't have the money (or they try voo-doo first). It's hard to understand & swallow, but there is no insurance so this private hospital can only do so much free service without going bankrupt. It's just a different challenge I face here that I don't face at home.

The new team here, 4 ortho surgeons, seem nice & cooperative. They did a lot of surgeries, but made sure we had enough beds for everyone. I got really frustrated mid-morning because we got 2 more diabetic foot ulcer patients that couldn't afford to be followed medically. I didn't want anything to happen like had happened to that other lady who died. Now that I running into this problem more frequently, do we accept these patients without a medical doctor following them. We take a risk every time in doing so. They both need amputations too. So, Marc helped me realize there are no policies yet for this situation so I can't stress myself too much but help to try to make a policy. So that's something new I will never do back home as a floor nurse. Marc said I was the "hospital wife" lol well, I'm learning. Policies & procedures when not taken to extreme are a good thing.

We have a C4-C5 quadraplegic patient here for 1 week (the one I described above with the foley issue), but he's spiking high temps too, so we changed him over to be a medical service patient. We don't want to mess around with time with him because he's so vulnerable. I loved the one patient's daughter today. She was so amused that I speak some Kreyol and wanted to play with my hair. I got her a bible study in French because she wanted a book. I forgot to mention that a lot of patient pronouce my name, "Linz", but I don't mind because I can't pronouce all of their names either.

We went out to eat the Oberge, the local hotel restaurant, the last 2 nights. It just feels good to be somewhere else but the hospital.

27 Jan 11 (0021)

I thank You so much for a calmer work day today. And for the doctors willingness to help with anything. They really helped me with writing orders, dressing changes, and whatever else. So I'm learning how to handle the day, how things work around here, and what things I can work on changing for the better. With teamwork, this hospital really is going to function well. Hopefully it will provide as much spiritual care as physical care. As challenging as it will be to be away from Wilshaw for a year, this is a wonderful opportunity for me to spend 9 more months here. The hopefully be conversational in Kreyol; to understand the system and work with everyone to change things little by little; to have time to develop better friendships; and to hopefully grow closer to God. There are very exhausting, frustrating, and challenging days but those are times I need to remember that will help build my character to be more like Christ.

But, all in all, things I'm learning and doing, wouldn't happen in the U.S. as a one person role: Working more alongside the doctors; knowing all the staff including the medical director, working so closely together towards a change; learning how to make things work when you don't have everything you normally are used to using; learning how to deal with patient's who literally have nothing;  learning time management; bed placement; PA skills; having group exercises & meals; meetings lots of amazing people; etc! So I praise God for this opportunity. Granted we are living fairly decently here (running water & electricity). It wouldn't be safe for us to live somewhere random in PaP in tents. I wouldn't mind living in a tent, but not in PaP. It would probably be OK in the countryside.

It was interesting learning the water filter system & process to fill the water bottles. Too much clorox was put in the water, so Brian fixed it and taught us how to check the water to fill the bottles. Quite the process to get clean water- but nothing compared to what others in this world have to do to get water. The water here comes from the stream & some city water.

Our quad patient was told by me today that he wasn't going to need the surgery for the fracture to heal. I guess he thought he would have normal function again after a surgery, so I had to break the news to him. I've connected with his family and they are taking as best as care as they know. I know it will be a challenge though. He was having unknown high fevers, so they took him to the OR to debride the pressure sore. They said it was badly infected under the eschar and that if it wasn't debrided soon it would have killed him.

We have 2 new long term additions to our team. Brittany is a lab tech & Z.J. Is a social service year MD that is from America (parents are Carribean), but studied medical school in Mexico. So it's fun to have them :) I feel that we have the right combination of long term (1 year) foreign staff here and with the Haitian staff, we'll get this hospital working. We have Marc working on nurse education; Randy is an electrician & his wife is helping wherever is needed; Nathan is the assistant adminstrator & Amy is helping with whatever too (very needed!); Brian is the architect; Terry is the ortho MD & his wife Jeannie is functioning as an OR nurse; and Jamenson is working in prosthetika (where they make limbs for amputees). I don't think I missed anyone.

29 Jan 11 (1609)

It was a great week and wonderful team to work with, but I'm glad for the sabbath. The team took us out to eat. It was a good time to talk and laugh together. Today, we are heading to the beach. I was so happy for the 2 couples that never seem to get away, to get away. They all work long hours & don't have much time for themselves. We all need to work on balancing our time. Life is full of balances- work & rest; exercise & relaxing; time alone & time with others, etc. I pray that God can grant us the wisdom to know boundaries to set. The hard part is there are lots of people who need surgery (even surgeries from earthquake injuries that never resolved or the rods are malunion, etc) and not as many places that offer orthopedic service. So we're serving a large percentage population of the PaP area. Most MSF & other NGO that had orthopedic services are shutting down now.

Driving outside of PaP makes me really miss the countryside. Fresh air, less congestion & traffic, people are nicer & not so much in a rush. I think cities sometimes make people more rude, liable to sin, & puts them in over drive (constant stimulation). It would be nice to be more out of PaP/Carrefour area, but that is where God has me for now. I can live through most things for a year. We had to take an alternative route because there is some unrest & turmoil in Cite Soliel. So now we went the long way past Robenson's house, but I'll take over any disturbances.

30 Jan 11 (2350)

I am so grateful to come before You this evening. It's been a fast day! I was teaching some nursing students how to dilute the morphine 10 mg/mL into 1 mg/mL and how to give it. It took awhile to explain, but I think she understood mostly. The next day she & all the nursing students wanted a picture with me so I guess they were OK with me. Their white uniforms & hats make me giggle. So glad I never had to wear that!

31 Jan 11 (2220)

Lord, life is so short & our lives can be taken away at any moment. This past week has taught me that. We had another patient die today. He was the 55 year old quadriplegic patient I explained earlier. He was in a motorcycle accident on December 25^th. He was seen by a hospital, but sent home. They brought him here January 19^th in hopes of doing surgery on his neck. They decided he didn't need surgically stabilized; that it would just heal by a brace. In the meantime, he came in with a huge pressure sore (bed sore) on his coccyx (it was all covered with eschar). We were just doing a wet-to-dry dressing, but then he started spiking temps that they couldn't find infection anywhere else & it started draining foul smelling green drainage. So they debrided it 2 times in the OR and it was fine. Today, around noon, we changed the wound vac at the bedside and the wound looked good (no signs of infection. It was deep stage IV down to the bone). But his vital signs were good that morning and for the last 3 days. I reemphasized that the patient will never walk again because his nerve had been damaged and that can't be fixed. I told him & his family no matter how the bone is fixed (by surgery or by brace), that won't make him walk again. Because they were thinking of taking him to another country to get the bone surgery, so I think this was the first time they actually understood why he could never walk again. No more than 30 minutes later, his family found me downstairs to tell me he's not breathing. I got the doctor up there & gave him an ampu bag while I ran to look for other supplies. I ran around for 10 minutes (because nothing is organized here) but the minute I got back up, the anesthesiologist pronounced him dead. They had all the intubation supplies there but it was too late. Everything just happened so fast, I didn't know what to think. I had never seen anything like that. Someone who was stable, just stop breathing. They think he either died of a pulmonary embolism (a blood clot stuck in his lung) or his neck got turned the wrong way & the nerve that controls the diaphragm was injured. I think it hit me so hard because I had just interacted with him and changed his dressing.

Some of the translators were saying that this patient had told them he couldn't live like this anymore. It was a lesson to me, when I give really bad news, that I should offer to pray with the patient after wards. We can't wait because we don't know, they could die anytime after. It was a hard lesson for me and we did pray with the family after he passed, but we never can bring back the chance to do it beforehand. When I was taking out his foley & wound vac, I had the son help me turn the body, but his son asked to leave because he didn't want to see the wound again. All I could do was give his sons a hug because I had spent time with his family & gotten to know them. After the family left with his body (it's the families responsibility in Haiti to take the body in whatever transportation they can find, including the tap-taps), I found a letter under the head of his bed. I asked Orphee to tell me what it said. She said it was a prayer, but not to God. She made me throw it away right away because I think it was some type of voo-doo saying. The patient's pastor did come & pray with them, but I've heard a lot of people practice Voo-doo while claiming to follow Christ. So, all I can do is lift up with family in prayer to God, our rock & redeemer. 

 

3 February 2011 (0630)

Yesterday, the medical team had a shorter day (in that, I mean a normal 8 hour day lol) so we cooked for them. It's nice to have a group here 2 weeks because they adjust to how we do things and it makes it easier for me. At first, we were worried because it was a big group and we weren't sure if they would try to cooperate with how we do things now. But they have been very respectful and helpful. And I've learned many things from them.

I stayed up later because a dislocated shoulder came in while I was downstairs trying to finish the census. So I got Terri & I assisted him put the shoulder back in place. The electricity went out when we were trying to insert the IV. That always makes me giggle. I also had to be the translator. I can get by if I need to. Well, time to start the day!

4 February 2011 (2200)

Starting the sabbath off right has been a blessing- finishing cooking by sunset; a vespers bible study gathering; and enjoying our meal together. I'm glad for this group of young believers! It's college roommates, only an added bonus of spiritual accountability and growing together. There is something so peaceful about spending a quiet evening with God. Tonight, I was thinking about how powerful words are. How, 30 minutes after I explained to the paralyzed man and his family that he would never walk again, he died. While he probably died of a PE, I think he also gave up on life. I told the guy I was sorry after I told him the bad news, but the better would have been to pray. I need to be in more constant talk with God throughout the day- no matter how emotionally, mentally, & physically exhausted I am. Help me to be patient even when I'm tired and frustrated. God, open my eyes to others need and not just to focus on the busy work. Help me & all of us to reach people in the truth.