Highschool Basketball

Caleb coached his first game of the season last Friday. It was a blast. The CCSC Cougars lost in the last 20 seconds even though they outplayed the MATCH school from the beginning. It was a joy to watch Caleb coach, the players run, and the fans scream and dance.

A highlight for me was the little sister, named Pootie, of one of the star players. She sat behind me with her parents and screamed in her high pitched 2 year old voice "Geo! Put da basket baaalll in da hooooo...."

I felt like a proud mom.

For a glimpse into the game from the coaches perspective, check out his blog entry: http://ccschoops.blogspot.com/2006/12/opening-loss-that-wasnt.html

This is my home.

This week has been tough.

Monday was my first day flying solo as a nurse. The past three days have kept my feet running, my brain spinning, and my adrenaline pumping. The busier the floor (and I) get during the day - the more changing of orders for medications, procedures, tests, monitoring, and diets there are - the less I think about the individual experiences and beauty of each of my patients. I hate that. It is so easy to get caught up in the details and the correct protocol (indeed, one could argue that I'm not getting caught up at all, but only paying attention to what's important) that I forget to look at the person behind the layer of blankets, tubes, and hospital gowns.

One patient, a 71 year old Gambian gentleman, reminded me of why I do this job yesterday, and why I can't get lost in the protocol. Known to a few nurses on the floor as "my boyfriend" (indeed, we all call him our own boyfriends, and one nurse threatened to "meet me outside in the parking lot after work to see who gets him"). He is adorable - and has the face of both a wise man and a playful child, wrinkled, proud, thoughtful and genuine. I swear his eyes are blue- although he insisted, that since he comes from the Africa, that this is impossible.

He has been admitted to our floor twice since my start date. The first time, he had his right leg amputated above the knee from a loss of circulation and degenerative vascular disease. He is practically bed-bound, able to hop with his walker when he isn't connected to the myriad drains and tubes and IV antibiotics. He has been in that bed, in room 12a, with the bedside table to his right and the armchair to his left,and his two automatic drain machines positioned on the floor so that he can see the glowing displays for almost two weeks.

Yesterday his TV broke - causing some confusion and anxiety on his part. We gave him the choice to move to the other side of the room (12b) where the TV worked and the view was similar. He was confused and angry and after some thought decided that he didn't want to go... but called for me because he had some questions.

I walked into the room and found him looking worried. I kneeled down by the bed so that we were eye level. "I heard you had some questions for me, what are they? I can give you some answers." With his lilting, magical West-African accent, and his arms opening to display the space around him- he said to me -- trying to explain his dilemma -- "This is my home. Where am I going?"

"You're just moving right over there if you'd like," I said, pointing to the empty side of the room. "It has the same lovely view, and a working TV. I think you'll like it just as much." He pointed to all the equipment around him. "Will this come with me?" "Of course it will, I said." "Alright," he agreed. "If you'll help."

Together the nurses aid and I unlocked and spun his bed to the other side. We lifted and pulled his equipment the 15 feet to the opposite side of the room. I made sure to position his machines so that he could clearly see the on-off buttons. He grinned and laid back in the bed, relaxed. "Thank you." He said. "You are a very good driver."

There are some details that I love to get lost in.

With a bang

This birthday taught me about the power of community and friendship and staying put and working hard and making roots and making wishes.

Thanks to all of my friends and my family who give me confidence and love and wisdom and put up with my moods, and any drama, and make me one of the luckiest eeking-towards thirty-year olds I know.

convenience

A pet-peeve:

The way hospitals, slowly but surely, train those who work in them to think less about the people it was built to serve, and more about their own convenience for the evening. We all enter with the intent of helping people. But slowly, men and women, boys and girls, are all turned to patients. As street clothes are removed and gowns are dawned, the people that we want to help transform into people that we work for - and who we expect to work for us.

Last night I was told to ask two separate supportive families (wives, daughters, sons, friends) to leave two sad, hurt, scared patients when it was HS (the hour of sleep). One man wanted desperately to have his wife stay... "but who will help me go to the bathroom?" he asked, worring, when it was suggested that she leave. We have no explicate rules on our floor regarding guests, or visiting hours. However, it was argued that the women were not allowed to be in a room whose beds were filled with men, and that the rooms were too small for the nurses to reach the equipment if there were other family members sleeping in the room. Since I was the nurse who would need to navigate to the IV poles and monitors, and was more than willing to do so, I thought I should make the decision regarding my patients. "No," came the answers from above. "They need to leave." No reason. Just fear of being bothered. Desire to keep the floor quiet and controlled. In exchange, more worrying, perhaps more pain, and less comfort for our patients.

It is this attitude that bothers me.

1:11am and counting

I am working my first night at el hospital. 6 hours down. 6 to go.

It is super quite on the floor tonight - although every bed is packed with people.

Today's floor is a diverse group - a 26 year old psychotic female who has been gently swaying for the past hour, holding a cup of water, stating that "it gives me balance" when I dare try to remove it - a dying man, with his family, finally sleeping tonight - a 31 year olf Brazilian man, readmitted for a surgery that shouldn't land him in the hospital another time, unable to sleep, perhaps thinking about his adorable baby that visited this evening - an Ethiopian father of three recovering from surgery after a bad break of his wrist, scared to be alone, shrouded by blankets to block out the light he refuses to let me turn off - and many more, slumbering, staring at the ceiling - medicated to fight their pain - wanting sleep - wanting to go home.

Tonight each story intrigues me. Each person brings with them to the hospital such a different perspective and reason. Why is my 26 year old friend in such a state? Some suspect a recent trauma, some suspect a tissue disorder, no one knows, and her words, seemingly plucked from her brain in random order, barely suggest a story and are anything but trustworthy.

In some way tonight, however, her words start making sense, and remind me of how often I too am simply pulling thoughts out of my spinning brain to verbalize. She, a grad student, my age, reminds me of how close we all are to such a line between sense and nonsense. How we only see the world through our own unique eyes, and no one sees it in quite the same way we do.

Week 4 of ornientation. Almost a real nurse.

My first day on the job. I went with the brown.

Witnessing the suffering of others is a challenge each health care provider, friend or family member of the sick or infirmed faces each day. On my floor, we are blessed with perhaps the happiest of the sad cases. My floor is predominantly post-operative. People come, wheeled in on stretcher or by hospital bed, draped in blankets and clutching their patient controlled anesthesia button. They usually look sleepy and out of it and move gingerly.

Through out their time with us, I watch and help them struggle to perform activities that before said surgery were thoughtless- going to the bathroom, rolling over in bed, sitting up and eating. In general, whether communicating via interpreter in Portuguese, Hindi, Creole or Spanish, or though bad jokes about bad television, days are spent working to improve the patients and get them well enough to be on their way….

In general we wave goodbye a few days after we wheel them to their selected room. I get to watch them go from sick to better, from hobbling to walking confidently with a walker, from gingerly rolling over to voluntarily getting out of bed to ask a question. From averting their eyes when the gown is up and exposing incisions and staples on a once smooth abdomen, to looking and asking questions and partaking it their own care. That is the norm.

And then there are the exceptions. The people for whom I know are facing a long road ahead; people for whom this is not their last stop in a hospital for the near future, who are starting down a path of tough time. Holding hands with her doting partner through a drugged half-sleep, one woman laughed about the new words her three year old was learning, struggling with sad news of a recent diagnosis of pancreatic cancer.

Then there are those for whom the hospital is enjoyable – almost like a vacation. Perhaps those make me the saddest of all. A long and matted-haired, wiry man with a visible protrusion from his neck from a tumor comes out of his room. In one hand he is holding his gown closed so as not to expose himself to the nurses charting behind the desk. In the other, he clutches a dollar bill. “Excuse me,” he asks. “Can you tell me where to get some ice cream?” “Vanilla or chocolate?” I ask. “Both, he answers with a smile. I pick up the phone and call the kitchen. “Can you bring the patient in room 11 some chocolate and vanilla ice cream?” It was as simple as that. He grins with a wide smile and almost skips back to his room to his blasting television.

It’s the little things that get to me.

How bout them apples?

You know what they say about an apple a day....

My close friend from college spent the weekend with me and gave the perfect excuse to explore the joys and foliage of new england this time of year. We did some climbing, tons of eating, and enough lauging to last 'till the winter.

To my fan club

After being scolded twice this weekend by my loyal fans, I have kicked myself in front of this computer to update the annals.

After many Mondays spent claiming "I think I will start work NEXT" Monday, and weeks of follow up phone calls, faxes, and getting all my various licensure papers in order, I have finally started, and finished my first week of orientation as a nurse at a real hospital.

Due to self-advocacy and incessant follow up, I have finally landed a job at a community sized hospital about 15 minutes away from my house. The most inspiring fact about this job isn't the union, which will certainly be an interesting component, but the staunch mission of this hospital to create a healthier community. Indeed, it is as close as I have come to the clinic in Haiti mixed with my old Community Health center job. The floor has hired 24 hour interpreters in the 3 most commonly needed languages (Spanish, Haitian Creole, and Portuguese). I have yet to work a shift (that will be Thursday), but am excited for the potential. Perhaps, to all my fellow breastfeeding devotees, the most exciting piece of news is that this hospital has applied for Baby-Friendly status – of which there are only upwards of 50 others in the whole country. Yes, I am proud of this little place and excited to join the team.

Acting as a perfect compliment, I have also started to volunteer for my favorite non-profit, Partners in Health, as a research assistant. I feel when I go to work, as if I am meeting my favorite movie stars. Yesterday, surrounded by good company and co-workers, I attended the most eloquent, opinionated, passionate talk by Steven Lewis, the UN special Envoy for AIDS in Africa. He champions the feminist cause and highlights the severe toll that this disease is taking on the women of Africa. He sited insane and infuriating statistics such as "9% of pregnant women with HIV in Eastern and Southern Africa receive prophylaxis that has been proven to decrease transmission to their unborn baby."

He also stated the crazy fact that the US and England combined spends about 10 billion each MONTH on the War in Iraq (killing people) and less than 8.5billion on AIDS in Africa, a disease that is killing 900 people every hour. His book, a Race against Time, is well-written and passionate and sheds more eloquent light on this topic than I can. I recommend it.

So now, my task is to combine the exciting energy of an international non-profit and with the important work of nursing. Every patient, wherever they are living, deserves the best and most caring care possible. My own mission for the year is to provide this to each patient I have with the same energy that I feel while shrouded by the energy of my personal International-Health stars. Let's see, after 11 hours on my feet, while drowning in IV bags if I can manage this.

I think so.

Here's to good health - for those who really need it right now, those who have it, and those who dedicate their lives to working towards it for others.

Can't focus? Try Concerta

Last week I began and completed my first job as a real nurse. Save the fact that medications and a small dusty clinic were involved; the experience could not have been much more different than my time in Haiti.

The job was posted on my school's list serve "RN needed for 1 week camp. Salary negotiable" on Monday. By Tuesday at 8am, I had rented a car, printed out Google-map directions, and was heading down the Mass Pike towards the Pocono Mountains. I had brought my bathing suit, a bunch of knitting, two good books and an attitude of adventure.

The week turned out to be less than a week of vacation and adventure. I played both nurse and pharmacist - bagging up hundreds of kids medicines a day (Zoloft, Zyrtec, Abilify, Allegra, Ritalin, Concerta, Singulair, etc.) and distributing the little coin-envelopes at breakfast, lunch, dinner and bed time.

In the time between the busy meals I saw tummy aches, scraped knees, fingers with splinters, unidentified back pain, black and swollen eyes, some stomach bugs and a whole handful of headaches. I pretended that I knew what I was doing sometimes, and knew others, and always gave a confident smile, checking the med recs for possible allergies before I distributed Advil. Amidst it all, there was little time for reading and knitting and the rain rendered my bathing suit all but useless.

The phenomena of medications at camp are a strange statement about our society. Perhaps only when we separate kids from their families, and put them in a group, do we see how truly medicated our children are. Here is a list of stats, printed by the NY Times this summer that puts some hard facts to the overwhelming numbers of pill bottles I encountered. What these numbers don't show are the amount of kids that take 4, 5, 6, or 10 prescription medications a day.

Total

One or more Daily prescription medications: 40%
Asthma/Allergy: 20%
Most prescribed medications:
Zyrtec (allergy)
Allegra (allergy)
Singulair (allergy and asthma)

Attention-deficit disorder/Attention-deficit hyperactivity disorder: 8%
Most prescribed medications:
Concerta
Strattera
Adderall

Depression/Anxiety: 3% (yes. I handed an 11 year old Zoloft each morning, not to mention the 15, 16, 17 and 18 year olds. I thought that adolescents’ and teenage years were supposed to be difficult....)
Most prescribed medicines:
Zoloft
Paxil
Prozac
Wellbutrin

Antipsychotic/Mood disorder: 2% (We had a slightly higher percentage. I think about 3-4% of our kids had 'mood disorders.' I made the mistake of giving one young woman on abilify her pills a few hours late. By that time she had already had a break down. Some are teetering on a scary edge of normalcy)

Most prescribed medicines:

Most prescribed medicines:
Clonidine
Lexapro
Risperdal
Depakote

Add the next category - in my camp - anti anxiety drugs. Trazadone, Clonopin, Xanax. Yikes! They're only 11 years old....

Bed-wetting: 1% (We had only one kid who used a pharmaceutical for this problem. I assume it didn't work like it was supposed to - as this kid showed up to use the washer dryer one morning - an embarrassed look spread across his face as he clutched a plastic bag of wet bedclothes.)

So that was the week - in a nut shell. It illustrated a pharmaceutical crisis that is overwhelming children. When I tried to confirm the appropriateness of doses with my Palm, many of the medications stated that they had not been tested on children. I can not help but repeat my new mantra of 'we don't know what it's doing to kids. We have no idea of the long term effects.' Weight gain, increasingly unstable moods, a rise in autism, and (perhaps worst of all) the concept that "whatever the problem, I will just swallow a little white pill and it will all be better."

Scary thoughts. But, now that the envelopes have been thrown away, and pill bottles have been sent home with kids, a good and challenging week over all.

Delayed cord clamping

A zen concept. Perhaps slower is better.

http://www.slate.com/id/2146483

This just in:

I passed the NCLEX.

Whew.

A cup of coffee

I've been spending most hours of each day this past week at various book stores and coffee shops around Cambridge, studying for the boards that I will take tomorrow. As much as I joke, I am nervous. Not passing renders me job-less for the next three months.

Here's today's best (i.e.: worst) question of the day. For the record, there are certainly some difficult questions, but just enough of a sprinkling of funny ones to make me plug on.

A nurse is performing peritoneal hemodialysis on a client. A second nurse observes her sitting by the client, drinking coffee and eating a donut and discussing the events of the client’s week. The first nurse should

a. Appreciate what a wonderful therapeutic relationship the nurse and client have
b. Grab a cup of coffee and join in on the conversation
c. Ask the client if he would like a cup of coffee as well (how rude of the first nurse!)
d. Ask the second nurse to refrain from eating and drinking near the client.

I'll grab a cup of coffee, thanks for asking….

You go to bed, I'll guard the door.

With a title like "annals of nursing" it is my duty to share the less glamorous parts of the beginnings of the profession: NCLEX preparation and multiple choice exams.

I will dedicate the next week of my life to studying for - and hopefully to passing - the nursing licensing boards.

I have been, however, less than impressed with the practice questions and study guides, especially regarding cultural competencies. Here is an example question:

A European American (comment: what? a French-American? A Caucasian? An Italian-American?) has just been admitted to your floor and needs a dinner tray ordered. The physician has ordered a "regular diet." Which menu will you chose?

a. raw fish and rice (comment: when was the last time you saw raw fish on the menu in a hospital? perhaps 1918, when oysters were the item of choice)
b. maize and beans (comment: by maize, you mean corn?)
c. steak and potatoes
d. salad, diet cola, low-cal dressing

Yes my friends, the answer they were looking for was, sadly, "c." Leaving out all of us "European Americans" who prefer sushi, salad and even maize, to steak and potatoes.

This question is rivaled by one I encountered while in my “Psychiatric Nursing Practice” class at Columbia. The question was something to the effect of:

You find your client cowering in the corner of his room in an in-patient psych ward. He states that “you’d better be careful. Alien invaders are marching through that door. They want to plant computer chips in our brains. I need to stay here to make sure this floor is safe.” The appropriate response is.

1. You are hallucinating. There are no aliens
2. You go back to bed and rest. I’ll guard the door for a while to protect us.
3. No wonder you’re on a psych floor…
4. Tell me more about what you’re seeing.
   
   Way to go NCLEX.

Home, again

I am home. Done with my far-flung adventures full of sea lions, blue-footed boobies, runs through cactus filled hills with smiling kids, clinical work, rickshaws, fabric shopping and delicious new flavors.

It is raining in Cambridge now, suitably, matching my mood.

I wasn't able to write while in India - internet cafes were sterile and air-conditioned and I had no desire to sit inside and miss all of the colorful world outside them. The trip was wonderful on many levels and for many reasons.

I flew to Delhi accompanying, or accompanied by, 34 Indian exchange students returning home after a year in the States. They quickly became my brood, and I missed them immediately after putting them on trains and planes to return to their families.

The trip was almost smooth - save one lost passport on the plane while flying from Frankfurt to Delhi. After having each kid check their bags to make sure they didn't have it (accidentally, of course), and turning the plane upside down with flashlights and the help of the cleaning crew upon landing, we considered it gone. After 3 hours of patient negotiations with 4 or 5 Indian officials, each of whom needed to write in a book, stamp the book, and look her up on the computer, she was able to leave. We reached the hotel by 3am and I was in bed by 4. At about 5am, I sat up, awoken by a knock at the door. "Is Rosha-mam there? We need to talk to her, alone." Rushing outside in my pajamas, quickly analyzing their appropriate modesty, I met three of the students who all appeared, wide eyed, to have seen a ghost. "What's wrong?" I asked. "We found the passport...." They didn't know how or why, but it had turned up in one boy's bag who was neither friends with her, nor sitting anywhere in her vicinity. Some mysteries are better left unsolved.

The rest of my time in India felt more like a home coming than an exotic adventure.

This feeling still strikes me as strange: I am not Indian, I have spent more time in many other countries than India, I have no Indian family members and don't speak more than 10 phrases of Hindi. Why then, does this country, bustling with beggars, rickshaws, incense, diversity and food crackling in hot pots of oil, feel so comfortable?

Perhaps this feeling can be attributed to my family's long-lasting love affair with India: our eating meals on Indian stainless steel plates, our making of chai each Sunday morning, the use of "pani" for water and "tik-hey" for OK. My parents and extended family have incorporated bits and pieces of Indian culture into our rituals and routines and this trip reminded me of the striking power of the every-day and of family tradition.

My aesthetic sense also feels alive and inspired in India - the black and white Hindi text written on the buildings, the bright, bold and beautiful colors of the salwar camises and the stark white of the courta pajamas worn by the Muslim men. India provides stimulation for all senses - horns honking, the breeze of ceiling fans mixed with the pounding heat of the 45 C degree temperatures, the scent of incense and curries, the colors of the clothes and buildings and light of the sun. My mind was never bored.

Or perhaps it is the countries impeccable use of trains and bicycles (in the form of stately black heavy bicycles for one, two or three people, or converted to the ever colorful bicycle rickshaws), my two most favorite means of transportation.

Last, but not least, my company made me feel at home. I stayed with Katherine, an old and dear friend who is conducting research for her PhD in India. She speaks fluent Hindi and now Urdu, can bargain with the best of them, and looks as if she is floating as she walks, her lovely dupattas flowing behind her.

Yes, I fell somewhat in love, and miss India already, but I can't complain.

I have an exciting year ahead - exploring the realities of nursing, taking some classes in Public Health, and learning the ropes of a domestic romantic partnership. I will continue to make chai in the morning, to add garam masala to my veggies, to prance around the house wearing colorful fabrics draped around my shoulders, and I will continue to keep the feelings inspired by India, alive.

Vent fait mal

(Above: The twins, Asna and Asli. After collecting water at night from the pump)

Alas, the last day here rendered doctor Patti and me the patients. We got hit by some bug - which has hopefully worked it's way out. Thank goodness for Gatorade.

Amidst the not feeling well and spending some hours in bed, I was able to tie up lose ends. The nurses at the clinic gave us thanks and told us that the week was certainly satisfying. I took pictures of the kids playing in the school yard and conversed with some friends about Hatian politics. I napped. I read a bit. Almost like a vacation.

I will post photos on each entry when I get home. Keep checking back.

Aurevoir de Haiti. Na we plu tot...

Not for the weak-of-stomach

I left the clinic at 5pm today - dirtier than I care to admit. While showering (after a run (cous!) through the thorny mountains with our entourage of faithful supporters), I realized that the white wash cloth I was using was turning grey. How gross.

Things are just plain dirty here in general. Getting totally clean is hard amidst the loose dirt, the dust, the lack of roads and plethora of mud after a rain. Working in a clinic adds a new dimension: snotty noses cut up feet, reports of gross internal bugs and multiple diagnoses of the external ones (they will remain nameless for the weak of stomach). Showering today felt good - but while rinsing my grey cloth, I thought about Asna - the gorgeous young woman, one of the twins, whom I had just seen carrying her huge plastic bucket of water on her head with sweat dripping down her temples and face. Will she shower in that water? Or is that bucket, pumped from a well, the drinking, bathing, and cooking water for her entire family? Getting clean here for me is easy within the confines of these mission walls, but to most rural Haitians, this task is next to impossible. It is no wonder that worms and scabies (oops, I said it, I itch already...) are present in almost everyone we see at the clinic.

Worms: the theme of the day. Suprisingly, however, people do not present here with a chief compliant of worms, as I certainly would if I knew I had them. They present with "cough (tous), cold (gripe), stomach ache (vent fait mal), head ache (tet fait mal), fevers (fievrela) and chills (tremble). However, it only takes the question "do you (or your child) have worms?" to make an easy diagnosis with the answer "yes." Having worms must just be a way of life. Today, each child whose mother said she had worms, received a dose of medicine for the child, one for each of her numerous siblings, her mother, and father. We then gave them a bar of soap and a lesson on the importance of hand washing and the dangers of playing in the dirt. Hopefully this tactic will rid the family of a worm burden for a few months. Having worms is not just gross - but perpetuates a cycle of malnutrition. The worms eat the precious food and use the scarce nutrients from the food the kid eats. This makes them more malnourished, have a weaker immune system, and more likely to eat dirt (the food which often gives them worms). Yuck.

On a more positive and less gross note - things have gone very well at the clinic thus far. I have been working with one American partner and two Haitian nurses in our exam room. Today I felt that we truly collaborated with our ideas and skills. We took turns listening to lungs, peering into ears, pressing on pregnant bellies and shining lights on itchy skin. We talked about why we did and did not think that the patients before us had malaria, typhoid, a bacterial or a viral infection, and talked about what to do. The conversations were in French, mixed with my newly acquired Creole and their newly acquired English. At the end of the day I had no usual reservations about sustainability or importance of what happened today. I think that Narlane and Rita, the two wonderful nurses who I collaborated with learned (if they are lucky) as much as I did today. They gained a new perspective on the people they see every day - and I learned about how people look with illnesses I see only once a year.

On an even MORE positive note - I need to mention the World Cup. Folks here, like everyone around the world I suppose, are into it - and huge fans of Brazil. Yellow and green shirts (not dirty at all) pop up all over the place. I had one patient today who refused to wait for a Malaria test because "Brazil and Japan are playing in a half hour..." I jokingly smacked him on his head with the anti-acids I handed him and sent him on his way. Perhaps a radio version of a good match and a last minute goal from Rinhaldo is as good of a medicine as chloroquine.

SIDA

AIDS is a taboo subject here. I found out yesterday that people who are dying of AIDS or infected with the HIV virus are not told that they have AIDS – only family members are privy to that information. As an explanation, I was told “people die faster if they know what they are sick from, so they are not told so that they do not give up.”

This logic is so flawed that needn’t be discussed here – but the concept is no less disturbing. In an English lesson yesterday with two aspiring interpreters, we went over the chapter on health related terminology (I figured I could pick up some Creole at the same time). When we got to the word AIDS (sida, in Creole), I asked them. “Is there much AIDS in Haiti?” Jean-Willy responded, “Well, people say that the tests come up positive, but how can we believe them because no body here is dying from it.” That is disturbing.

One non-profit estimate that there are 190,000 people living with HIV in Haiti – 3.8% of the adult population - and 16,000 deaths a year from it. However, I am not sure that I trust these statistics. Tests for HIV are hard to come by and people are even more reluctant to go for testing because after a positive outcome – many services are rendered impossible, not to mention the social ostracism that must ensue. The EMT who is traveling with us explained to me that at the hospital in Gonieve where he had previously done some work, the surgeons did not perform surgery on HIV positive people out of fear. In this small village of LaCroix, I know of one woman who is dying (although she does not know it is from AIDS) and two who just died, orphaning a two year old who visited our clinic (he looked healthy, which is a good sign).

There is no public campaign here, from what I can see. There are no signs like “SIDA kills”, or a drawing of a scary monster chasing a healthy white blood cell present on the streets. I have not seen one condom at the clinic or on the street as trash. None of my patients report using condoms – if they are honest about having sex to begin with. In a conversation with Pastor Pierre, who is the resident expert on many topics, he said, “all the cases of HIV in Haiti come from people who travel to the Dominican Republic.” While there truth to the transmition via Dominican prostitutes and Haitian truck drivers, it is not good that the most educated man in town believes that if someone hasn’t been to, or isn’t sleeping with someone who has been to the DR, that there chances are nil. 190,000 people suggests that it is more wide spread.
I worry that it will become a public campaign when it is at crisis proportions. Dating publicly before marriage here is not ok – but people are certainly having sex. Haitian thoughts about the disease are mixed with ideas of voodoo causing sickness, of fear, of social taboos around sex, and most importantly, of a gaping lack of sexual and basic education. This is not the trip to tackle it – but it is on my mind and repeated fungal infections and thrush in young adults makes me wonder…

The blind leading the blind

Today's running mantra was 'do no harm,' and it is with that thought that I made most treatment and diagnostic decisions at the clinic today. Treating Haitian patients is fraught with problems and left me feeling unsure at the end of the day if what I did was right and if it helped at all.

One of the problems is that it's hard to get what the medical community calls a 'review of systems' because the answer is always 'yes.'

For example: a woman walks into the clinic and sits down in a chair (to sit: chite). "Sa ou gane?" (what do you have? or what ails you?) "Fievre." And then it begins.... 'do you have a cough?' 'yes' "do you have any nausea or vomiting?" "yes" "do you have trouble breathing?" "yes" and so on and so on until every differential diagnosis that has run through my head (Typhoid, Malaria, regular viral infection, etc) has been cancelled out and I am left with only the word "sick."

To make matters more complicated, the Haitian sense of time seems to be a bit different and many people explained, when asked "how long have you been feeling like this", "22 days." I do not know what is special about the amount 22 , but many people seem to have been sick since around May 28. Decisions about diagnosis and treatment were thus made around a physical exam (did they look sick? did they have a fever? were they losing weight?) and my mantra "do no harm". If medications for the potential illness could hurt, I did not give them. Thus, I treated many cases of malaria today, suppressed a lot of coughs, rehydrated those who may need it, reduced fevers, gave out vitamins, and treated some pretty bad looking fungal infections on little boy's heads.

When discussing this with Pastor Pierre, the leader of this project, his thought was that if they answer 'yes' to every question, we will give more medications and those can be used to treat other people in the family - or saved for the future. They pay a flat fee ($30 Haitian dollars, about $4USD) to use the clinic, and all medications are included. This sounds like a good reason to say "yes" to me.

All in all, the 33 people we saw today - and perhaps their family members - may sleep easier, breathe easier, and hopefully will feel well cared for tonight - as the Haitian heat pulses, the crickets chirp, and the heat lighting flashes...

Sunday in LaCoix

Haiti, Day 2

Outside the air is thick and heavy and while it is visibly clear, there is no breeze. I can see more stars than I new existed because without my mega-light (thanks dad), there is none. It is hot and if I was not trying to separate my self from the mosquito's and other flying insects, the best outfit would be a bathing suit.

Today, while the official day of rest, was full. It began with a two hour church service in which we (the seven Americans here) were treated as esteemed guests although we looked more awkward and sweaty than anyone, clutching water bottles and holding cameras. Upon entering the church, each member of the community shook our hands, and the old ladies kissed us wetly on our sweaty cheeks. Each person said welcome in their own way: my favorite? Baby Jeffrey that I was lucky to be holding peed in my arms. The church service, accompanied throughout by 17 year old Woodsie on the Guitar, two young drum players, and an aspiring keyboard artist, was full of music, of clapping, of lace on heads, and of joy. Truly incredible smiles and thanks in the midst of striking poverty.

After PB and J offered to us on white bread for lunch, we left for the clinic. I grinned to see that the pharmacy that Patti (the physician with whom I am traveling) spent many hours organizing and labeling last year was still organized. The clinic showed a striking improvement from last year when the pharmacy was cluttered and full of mouse-chewed bottles of expired meds. As we sorted our brought meds and placed them in their proper place on the shelves, I chatted with Judette, the the new nurse who works as a provider in the clinic. She impressed me with her knowledge of medication uses. She, a new grad like myself, works as a full provider in the clinic each day except for the two days a week when Cuban doctors visit. We shared blow-pops and laughed at funny uses for medications. Nurse humor, I suppose.

We then walked around the small village of LaCroix, flanked on either side by kids who ran to hold our hands and play games as we walked. Jason, a 19 year old, wanted to hold mine. I told him he was too big and chose to hold the hand of an adorable 7 year old with braids who spoke no French. After 'quel age ou' (how old are you) and 'what is your name?' we ran out of things to say, but we squeezed each others hands and enjoyed the scenery of the overflowing busses zooming past us. On the walk we past a coconut tree and all sampled warm coconut water released by machete. Some of the prepared kids whipped out spoons and began eating the soft meat. Note to self: always bring a spoon.

I am nervous about what tomorrow will hold. The plan is for an EMT from Vermont and me to run one exam room and Patti and a medical assistant from my old clinic in Vermont to run the other. As much as I learned this year, we did not learn diagnostic skills, and certainly did not specialize in tropical medicine. I hope that my knowledge of medications, my ability to give a darn good bed bath, and prior experience here will see us through.

In the words of my Haitian friend Mezier who is taking his national exam tomorrow - "Pray for me."

Nous sommes arrivee!

Haiti, Day 1

Or day 0.5, rather. I arrived, through billowing clouds, from New York to a place so totally different that it is hard to believe it is only 3.5 hrs by plane and in the same time zone.

It feels great to be in Haiti again. Greeted by live music as we walked off the plane, with the strong sun shining, I waltzed into this week smiling. The four hour, ninety mile bus ride only made me want to shoot photos and stop and explore.

Perhaps it is my bias, because I want to see improvement, but I have noticed changes since I made the same bus ride over a year ago. 1. The airport was more organized. We did not bribe the customs officials with Viagra and children's chewable vitamins to let us in, tax free. Instead, women and men in uniform inspected the bags and did not even ask for the lollipops on the surface (I, however, had no self control and took two for the bumpy bus ride). We were not mobbed by kids or taxi drivers, but instead found our new white four by four only needing to wave off one man who called 'maman!' through the gate. 2. There was more concrete on Route one, and therefore less huge pot holes. 3. There were no road blocks at all, whereas last year there were at least two. 3. There were no UN officials standing with loaded guns on the roof of their building. Instead, they were sitting in the shade and waved. Over dinner I asked Pastor Pierre, the boss of this complex, if it was too late to talk politics and if not, what changes he noticed since the election of Rene Preval. He said that it is calmer and there have been improvements, if only slight. I concur.

But some things are still the same, and for this, albeit selfishly, I am glad. The rooster still crows the announcement of sunset. The kids I met and played with last year still remember me and want to run ('Cous!!!'), stupidly through the thorny hills to accompany the silly Americans while we stretch our legs. The two twin girls whom I photographed last year still look like models, if only more beautiful.

Tomorrow we will set up our two exam rooms in the clinic with our brought medications and vitamins and prepare to open on Monday. If I can just sort out the French from the Spanish that are currently making word-salad in my brain, I will be all set. I am excited for what the week may hold and hope that I can leave as many smiles as received me.

Thank you to all who helped support this trip - both fiscally and emotionally. Keep checking back if you want updates. I will try to write daily if the power stayes on long enough.

Today marked the transition between yesterday and tomorrow. Today, I graduated from nursing school. Our nursing school does not call it a graduation, but rather a 'White Coat Ceremony.' We did not march down the aisle, but instead walked up on stage, flanked on either side by our colleagues, and turned while one of our professors helped us to put on our long white coat.

It was an odd day - certainly not filled with the elation of the end of my first bacholers degree - but filled with some sort of pride and satisfaction upon having completed this year. The dean of the school fed us such cliches as "you are the future of nursing" and "the world is your oyster" and most of us spat it back at her with a cynical smile. She also told us, in the words of a famous nurse theororist, that "you are the sight of the newly blind, the leg of the amputee, and the confidence of a new mother." But as I looked around at my fellow nursing students, I would be lying to say that I did not feel a small bit of the cliche somewhere beneath my light blue school of nursing logo that was embroidered onto my white coat. As the rain rattled on the plastic tent roof and the thunder clanked and clashed somewhere in the distance, I did feel some sort of electricity and culmination. Perhaps the joy of chosing a career path that puts patients and people and families first. Perhaps the joy of doing something practical, not theoretical, of gaining a skill set. Perhaps just the joy of completing a task that I had set out too do more than a year ago.

yes, I am proud to enter the field of nursing. It is a mixed up, confused field - unsure of whether it is a profession, an academic dicipline, a focus of research, or just a plain old j-o-b. But somehow it suits me and I am excited to play the role. Even if I never again put on my white coat with the light blue crown.

Because why would I wear the only article of clothing known to raise a person's blood pressure without even moving? No, I am in this profession for the people I will work to heal - and I do not need a white coat to dawn the cloak of nurse.