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'All we need are some trained Haitian nurses'

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Nursing Times’ resident Haiti-based nurse Fi Stephenson on how the survivors of the Haiti earthquake are rebuilding thier lives.

It is spooky how things seem to work out….

I went to Port Au Prince for a combination of reasons (escorting a patient home, visiting already discharged patients, Disability Working Group meetings, looking for land) when we were contacted by Handicap International  about a new rehab mobile clinic that they were going to initiate in in the city. 

Could this be the answer to our prayers?! May be just ‘right time, right place’? Really exciting news is that we are now working in collaboration with Handicap International and the International Organisation for Migrants (IOM) and are putting together a really good package of care in the community. Handicap International will provide community rehab input to check on physiotherapy and occupational therapy for ongoing mobility and activities of daily living issues, and the IOM will provide assessment of living conditions and need for housing on discharge, their transport home to PAP as well as transportation to clinics. I cannot quite believe it! This had been weighing heavily on my mind. Now all we need is the community nursing care input. Hmm, another problem; no trained Haitian nurses at the moment, and who is going to fund them?

I met up with John who had been one of my patients on the unit for three months. He had been transferred to us post operatively with a spinal fixation wound that had broken down. We looked after him until he could walk again and his wound had healed. He was a young  4th year Economics student. It was a very special occasion when I met up with him and his family in PAP. He is living with his mother and younger brother a little way away from his original home at the moment after his father and grandparents died in the earthquake. To describe his living conditions would, in comparison to the tent people, be palatial, but in essence it is still meager. He is the only member of the family with a bed and mattress. The kitchen is half in and half outside, in a room partly destroyed by the earthquake. The tent we gave them is pitched next to the building and houses the other members of the family. To say they make the best of things is an understatement; surrounded by rubble, this proud family continue to try to educate their children. We, in comparison, are so lucky.

The day of the earthquake John was at home in his bedroom. Suddenly he felt a massive noise and shuddering. He said it was such a shock – it came from nowhere – so loud. He saw the front of the house disappear down the hill. He did not know which way to turn. All he could see was a massive hole where the wall used to be. If he had been in bed, he would have been crushed by the wall. The earth and walls continued to shake and he thought it was safer to jump forward than to go backwards through more rooms and debris. What would you have done? He jumped. And jumped again. He broke his back during his fall. But, who knows what would have happened if he had not done this? Would he have been here to tell his tale?

I am so happy to say that he has now returned to university with a smile on his face! Yes, he walks with a stick, but he walks tall. Yes, he has bladder problems, but he manages with intermittent catheters. No, I do not know how he will be, in the sexual context, procreating as a “man”. I only hope that his spinal cord injury will be kind to him and give him the ability to function in that sense sometime in the future. Statistics state otherwise though unfortunately. When it comes to having a family, thank goodness there are other ways and means now – let’s hope Haitian medicine can help people like him.

As you may remember I am living in the Maison de Benediction Children’s home just down the pot-holed track a few hundred yards from the hospital. The walk to work is never a dull one; passing pigs and piglets, roaming chickens with their chicks, tethered goats and their kids, grazing cattle, plus the odd slithering snake. The home is full of music and singing from Monday to Friday and then filled with quietness over the weekend as the children all go home to their families. The children here have special needs – mostly birth related injuries. It is not surprising as, in Haiti, over 75% of births are at home with no one professionally trained in attendance.

The other day I was asked to have a look at one of the children by the staff there; The Pastor had gone in search of Wendy as she had not come back to the Children’s home after the weekend with her family. It was now Wednesday. He had found her alone, eating wood, covered in her own excrement. She had visibly lost weight and was very dehydrated. Like many children here, her story was a desperate one. Her mother had died in childbirth, her father was handicapped, her grandmother went out and begged on the streets and her fourteen year old cousin was her main carer – and had been since Wendy’s birth, four years previously. We gave her electrolytes to drink and regular small meals, bathed her and cuddled her. The pastor and I came up with a plan to provide extra family support, as well as food over the weekend, which was clearly required. Her family home was a small shack with a swept mud floor, no table, no chairs, no cutlery or crockery. Wendy’s bed was a red piece of cloth on the ground. Where do you start? I guess the immediate reaction is to scoop up these children and try and take them away from this desperate poverty. But you can’t. There are so many. And anyway, does this really address the problem? At least the Children’s home provides respite care, the opportunity for her cousin to go to school and her grandmother to go onto the street. Many of the children are here to give parents the opportunity to work. Haitians fear others with special needs and would rather go to a stall with able bodied people that one with a mother and disabled child. With regards to Wendy; I managed to find her a child’s mattress on which to sleep, in one of the UK containers that had arrived, plus some clothes and shoes, thank you whoever donated these things!. At least she was with her family and had a roof over her head at the weekends. During the week she is looked after by the wonderful Haitian Maison de Benediction staff, hand-picked and taught by Reninca who bath her, and play with her, sing to her, feed her and give her physiotherapy for her poor hyper flexed limbs. She also has a proper bed to sleep in at night and netting to keep the mosquitoes away.

Ok, so ending on a little bit about me: I spent a very happy birthday on the unit here! The patients sang happy birthday in a mixture of Creole, French and even English, which was followed by lots of birthday hugs and kisses! I was presented with a bright pink birthday cake and a gorgeous handmade card that they had all signed! A week later, I went over to Florida for a quick 4 days of (in)sanity – thank you lovely friends, I needed it! And brought back some clothes and sundries that I had kept in storage. Tonight I have unpacked everything and sorted them into ‘stuff to keep’ and ‘stuff to give away’. The sheets that I had packed two years previously are now (selfishly?) on my bed and smell FABULOUS. I cannot believe it!!! They have retained their perfume and I cannot stop smelling them! My other treat was to wear a pair of stud earrings – the first time since January! How crazy is that?! Whilst there, I stayed with a variety of lovely friends who took me as they found me and give me my space to adjust ….. One day, Kirsten and I had hopped into the car to go and buy some groceries and protein bars to take back to Haiti (amongst other supplies I am not able to get out there). On the way, I spotted a pair of sandals that had been discarded in the middle of the road. Kirsten swung the car around and we stopped in the middle of the road to pick them up! I had been searching for a pair of shoes for one of our patients…. Were these Cinderella’s shoes? Yes! Whoo hoo! Back in Haiti, Elisabeth was thrilled with her first pair of shoes that fitted since the earthquake! A good job done – Thank you Kirsten!

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