Are you ready for a Multiple Choice Quiz?

62 would be the correct answer to which one of the following:
   a. The number of patients seen in wound care clinic today.
   b. The number of times you can't find what you need when you're trying to accomplish some important task.
   c. The total count of mosquito bites just below the knees between Susanne and Jennifer
   d. The number of Haitian nurses sleeping on the job.
Correct answer: c

The reason I mention this is that while we have both been taking our malarial medicine (thank you Noah Weiss for teaching about malaria Monday) on a regular basis, we are now seeing an outbreak of something we have nicknamed "chimichanga disease" – the real name is Chikungunya Fever. This is a new problem which only recently made its way to Haiti (great timing for us). It's been here for about 3 weeks and is moving rapidly across the country.

Originally from Africa, Chikungunya presents with very high fevers, headaches, joint and muscle pain. It is carried by mosquitos (remind me what purpose these insects provide? Seems like we could do without them just fine). Anyway, one of the head MD's with Medishare along with a staff member came down with it and today alone, 4 patients have presented in triage. I guess on the bright side we can say that we have not seen any acute Cholera this year!

Today was the day when we both hit the wall. Although we haven't been flooded with a volume of patients which is unmanageable, there are a few who are tugging at our heart strings. On the bright side, our sickle cell friend continues to make progress. She is beautiful, bright, likes to cheat at the memory match card game and is always willing to try something new. There is a new boy next to her with a dislocated ankle on one side and a fractured pelvis on the other side. He is in a lot of pain and spends much of the time sleeping. (However Susanne just informed me he has been discharged).

We are not having success getting a smile out of Mackensy. This is the boy who has the large abscess on his abdomen and a failed colostomy. He is very underweight, continues to have low energy and is in a lot of pain. It is unclear what the plan is for him. It doesn't sound like they are planning on doing another surgery anytime soon. So here he is with a very large wound trying to heal and fecal matter coming out of it at the same time. Today, he was unable to contain his discomfort and was crying out but with a weak voice which immediately got under my skin… Susanne was next door in the Peds ICU and I came to get her because I could not be in the Peds ward and listen to this alone. There is not much we can do but be present with him and help support his Mom who attends to him with the love and kindness you would wish for every patient in need. She (like all the moms in the Peds ward) spends all day and all night at the bedside and doses off in a chair for 10 minutes at time. She sings very softly to him when she changes his dressing. To be honest, she looks exhausted and really needs a night off but it is doubtful she will take one. We each position ourselves in a way where we can gently massage him and he allows us to be present with him, which is a sign of him gaining trust in us. This goes on for at least a half hour and while gradually his eyes stop shedding tears, they have been replaced by Susanne's and my tears. Each time our eyes catch each other, we are both tearing up, faces getting watered and I realize this is just what happens by day 5. It gets harder to contain our own reactions to what we see.

Mackensy

Mac's mom is very touched by our concern and eventually she feels safe enough to leave the ward and take a break. We will keep our fingers crossed he will feel a little better tomorrow.

We were asked to see a 13 year-old girl in Peds ICU. The best we can make out is that she has a brain abscess. I say this because the medical charts are in Creole and since neither of us are fluent in Creole and there are not many translators around this year, we make lots of interpretations, some of which are actually correct! It's unclear how long she has been in bed and immobile. She appears to have a lot of weakness throughout her body, no head control and at the same time is able to do some of the transitional movements of supine to sit. We were getting ready to do a stand pivot transfer in to a wheelchair (Susanne spent another 10 minutes searching down a wheelchair – missing one side panel again!), when we realized the dilemma. On the positive side, she is in an "electric bed" which has all the bells and whistles. On the not so bright side, the bed no longer operates (probably donated that way from the states) and unfortunately died in the highest possible position so much so that when standing facing the bed, the mattress is at my chest level. Easy going down – not so easy getting up. So we needed a game plan. In addition to searching for the wheelchair, now we needed to search for a "transfer sheet" (remember there are no linens here). OK, we locate the sheet and get all ready to do the transfer and then rethink this. Should things go down, Susanne and I are going to have to physically lift her up 3-4 feet back to bed. So we decide to get one of our EMT's that easily bench presses this girls weight every day (except here) and proceed with our newest plan. She does well in the chair but fatigues quickly. So while Susanne and I are acting like PT's through-and-through, i.e., how do we get the patient to participate in some part of the transfer back to bed, and we go about rearranging the wheelchair several times, this guy Jason is standing by trying to look patient, and when I finally say "I think he thinks we are crazy for spending so much time thinking this through when given the opportunity he would just pick her entire body up and place her back in bed". So I finally say, "Ok, just do it your way."

Each day does have its highlights and todays revolved around two special men who work here. The first is Kenard who is a Haitian-trained PT from the Loma Linda University program down here. He shows us pictures of his daughter and then in scrolling through his camera roll there are pictures of his wife sitting with all of these women. He said that after the earthquake he and his wife took in four women who lost their husbands and children in the earthquake essentially rendering them homeless. They have been caring for these ladies and currently are trying to find some kind of a trade school to send them to so that they can learn how to support themselves for the future. Imagine, just taking on four adult grownups indefinitely and then being willing to work extra hard to pay for them to attend a school? So that s one good guy, yes?

But it doesn't end there. The other Haitian-trained PT, Seduio, along with Kenard became close with one of the spinal cord patients who was originally with Project Stitch. For reasons which seem more complicated than I care to get into (and you know how curious I am), this guy no longer works for Medishare's Project Stitch. So these two PT's have set him up in his own business where he does custom stitching of logos (Haitirehabproject.org)

Haiti Rehab Project

In addition, they fund an amputee basketball and soccer league. So, between paying this man's rent and car fare to get to his studio and funding this sports program, I would say we have met two more very special people.

Rehab team. The guys are Seduio and Kenard

You may wonder why we like it down here with the daily challenges we face and the top reason I would give is because of the amazing people we meet. Between the family members who take such good care of their loved ones to these 2 guys and Nicolle (from the orphanage) and so on... it really does change how you feel.

So we are now through the midweek hump and ready to face Thursday!

— With love Susanne and Jennifer

On to Day 6...