Haiti Journey Improv

This blog post has been re-posted to HCPLive with permission from Dr. Jan Gurley. You can visit her blog, Doc Gurley at: http://www.docgurley.com.

10 days and counting to Haiti. My mind is whizzing and my days are packed with to-do lists that overflow into the next day. I keep trying to project myself into that moment when I return, and stare at my desk and try to figure out where I was and what I was doing before I left. It seems impossible to emotionally transport myself from these moments now, to there, and, then back.

My kids — as kids are wont to do – vibrate like tuning forks to the emotional environment around them, even when they’re not aware of it. The home front has evolved from teens who lean into me more than usual, to teens who blow like landmines along a disputed border.

My clinic has been lovely beyond belief. In retrospect, it should be no surprise that people who work, by choice, in a clinic for the homeless, are likely to possess levels of compassion that, if scored on Iowa standardized tests, would put them into the “gifted” category. We had an all-staff meeting, where I was asked to stand — so that I could hear the gratitude from those who feel that I am representing them personally on this trip.

I got superb tips from a skilled rehab nurse as we worked together, comments and instructions about what to do in Haiti, between seeing patients here — she pointed out that I should bring ACE bandages for wrapping stumps for all those amputees who got life-saving surgery, but minimal-to-no aftercare, the ones who now have wide-spread infections. “They can wash and re-use ACE bandages, and it’ll help season the stump and control lymphedema. Oh, and felt for padding, and you’ll need to teach them to cut off the arms of long-sleeve t-shirts, and knot the end to use as a stump-sock. God, I wish you could take a few straight-caths. I’m betting there will be some spinal-injury patients. What would they do without a cath?” She walked off, shaking her head in disbelief at the horror of that prospect: dying in agony because you could not pee.

But I could not help, walking through the Civic Center BART station, but notice the huddles humps of two homeless men lying against the wall. They lay on cardboard strips, bunched blankets iglooed around them. In their own form of hell.

Our first team meeting was last Sunday. It was a lovely group of people, men, women, some in their twenties, most in their forties, a couple of women maybe early sixties, all sitting around a living room, while Dr. Enoch Choi updated everyone on the outstanding issues in his calm, soothing voice. He began by saying that he knows many of us are in-charge when we’re in our own environments — but that the point of going as a team is to work together, to accomplish more than any of us could do alone. That we will each be asked to step outside our pre-defined roles, to be more flexible, to work cooperatively. And he reminded us that any of us, who didn’t feel comfortable with that situation, could always head to Haiti on our own – there are no barriers to doing that. At all. You or I or anyone else could get a flight over there and walk right in.

In a way, it was chilling reminder of the breakdown of government and regulation there. And we are still definitely going the weekend of February 14 — the only questions are around the flight destination. If the security situation deteriorates further, we’ll fly into the Dominican Republic and travel by truck overland (6 hours to the border, then another 1 hour to PAP), and stay at the border, driving in to PAP each day. An apartment and driver, plus guards, have been arranged at the border. Not one single hotel room is available (otherwise all 15 of us would be sleeping in that one room).

However, in order to serve more people (and not waste time going back and forth to PAP), we may still, if security allows, fly directly into PAP and work on the grounds of a large, indigenous church/orphanage two blocks from the American Embassy, giving care from that home base and sleeping in tents or on the ground.

Which means we have, so far, two flight options — one is to fly commercial to Miami, then take military cargo from Miami to PAP (the military cargo plane space is arranged, the commercial flight to Miami not so much – that decision is awaiting security developments). If we go by way of Dominican Republic, we have been generously donated 1 million miles by Alaska Air for our team’s flights.

I looked around the room and realized that, for people who would soon be sleeping packed like sardines head-to-toe (even in an apartment bedroom), without bathing for 8 or so days, no one felt comfortable asking the gritty questions. Is there functional sewer systems in Port au Prince? I’ve been to part of Africa where la toilette is a pair of concrete footprints shaped like Dr. Scholl’s inserts (and not large, sixe 6 men’s max) positioned beside an ominous hole in the ground. That might seem like an upgrade from the prospects in Haiti. We’re bringing our own lunch for each day, but what about the infection risk of other meals?

Tent city without toilets or tents

On the personal front, I started my malaria medicine last weekend. I got the weird dreams, the ones I remembered and I dreaded — it’s something about how my brain is wired (I once tried a tiny dose of Ambien for jet-lag and spent the evening seeing writhing nightmarish ulcers sprout on people who were talking mutely, pleading with me soundlessly). This time I awoke with the distinct memory of my daughters’ bass teacher swelling and swelling, elephant-man-like, his seeping split-skin explosion inevitable. Luckily I only get dreams on the once-a-week night I take chloroquine.

My Mama called (yes, I’m Southern, and, hence, she will always stay my Mama). She reminded me that I’m “not as young as you think,” as well as several other choice, sweet, and incisive reminders that I should perhaps re-think this whole idea. I do have two children, after all.

I feel my stomach knot and I get quiet and after I hang up, I take the time to think about it. My Mama is not the kind whose advice a wise person ignores easily. But I think back to those sleeping homeless men, and how dangerous Civic Center can be where I work. And how careful Dr. Choi is being when making plans for the group. And while the situation (and stories) in Haiti are horrific, all the outpouring of compassion and support (a lot of which I’ve personally seen or heard) has been a testament to the vast goodness of humanity. And then my uber-efficient friend, Pam, calls to say the Wells Fargo trust fund for the trip “Share the Wellth” is up and working, and that, more importantly, she has something she thinks I might be interested in taking with me, from her Eagle Scout son’s camping supplies — super-compact, teensy tiny rolls of toilet paper. Yes! Yes! I have my portable shower ready (a packet of Handy Wipes) and I splurge on a tiny battery-powered SpongeBob toothbrush. Doc Gurley motto: Hey, if your teeth feel good, you can even do without coffee.

I downloaded the free Gideon 321 page e-textbook, Infectious Diseases of Haiti, as well as both the free Haitian Creole Byki app (rushed to market with a specially-created medical section — two stethoscopes up to these folks!), as well as the Pimsleur free course of Haitian Creole lessons (two stethoscopes up AGAIN – you rock, Simon & Shuster). I spent the day speaking Creole out loud to myself in my home, narrating my life and interviewing myself about imaginary health problems – an out-of-body experience if there ever was one.

My dining table is an Everest of supplies. I read an article forwarded by Medscape, a reminder that women now are particularly vulnerable, in Haiti, to reproductive neglect and violence. I’m thinking I may pack a giant pile of condoms. Surely they’ll fit too. Ah, but one crucial element remains to sort out — how to get connected while I’m there, so I can bring along all of you who are going with me. There has to be an affordable solution somewhere. So I’m heading out with my iPhone to the AT&T store tomorrow. Which may be the most confusing part of this whole trip – wish me luck!