DUMMERSTON — The baby was 12 months old. His caretaker told us that the reason they were here was for his diaper rash. Lori the nurse looked it over, and suddenly it was clear the diaper rash was the least of this kid's worries.
I offered to clean his diaper area and put some cream on it to help while she did an exam. When his diaper was removed, we got a better look at this poor child's body. He was emaciated. This 12-month-old boy was the size of a four-month-old. He weighed only 15 to 18 pounds. His ribs stuck out, his arms and legs were tiny and thin. He was dirty.
Most imporatantly, his diaper was dry and it was likely it had been dry for some time. This boy was no longer producing urine, yet another sign of serious dehydration among the many we had already noted.
Nobody should ever experience the cry of a child who is so sick he can't lift his head. It is heartbreaking. This little boy was so dehydrated that not only did he not have tears left to cry, he had no energy to give a good hearty wail of distress. The noises that we heard from him were gutteral, primal, a tiny wail of life, a person barely holding on to the thread of existence.
We rushed him over to an area between two trees where a tarp is over the cement and a bathroom shower curtain has been hung to give the tiniest bit of privacy to the most critically ill of patients. We laid him down on an adult table and he looked even smaller against that backdrop.
He continued his wail, which also let us know he was so tired, he couldn't fight all our poking and prying fingers and wouldn't object to anything we needed to do. This frightened me.
Children can be difficult to treat. I remembered from my days on the Rescue, Inc., ambulance that children can cruise along a continuum without getting worse, and they can suddenly crash. Conversely, they can also be at death's door and bounce back. It was not at all clear which way this baby was going to go, but it wasn't looking good.
Our pediatric intensive care nurse had gone for a walk, and this little man was going to be a difficult candidate for the I.V. fluids he so desperately needed. His veins had collapsed due to a lack of water in his system. We tried sticking the needle in his arms, his legs, his neck. There simply were no veins available that we could reach.
A wonderful pediatric nurse named Rachel kept trying anyway. What bothered me the most was that our small and critically ill patient couldn't even object to the tourniquet or the needle, or these five adult faces in front of him. He simply continued his tired, tiny wail of discontent.
When we couldn't get an I.V. into him after several attempts, my heart was breaking to simply comfort him. That's all we had. Human touch is a powerful tool, and I wanted him to know that he wasn't simply a body lying on a gurney, but a human being for whom we were trying to care.
I asked the group to get me two chux towels, plastic sheets we use under dressing changes or when giving I.V.'s to absorb any fluids that arrive unexpectedly.
This little boy was stone cold. His extremities felt like they had been so cold for so long he likely felt like he couldn't get warm. As a body struggles for life, it shuts down anything it can do without right away. The blood pulls away from fingers and toes, from tiny hands and feet, and protects the circulation system and the heart.
I wrapped him in one chux and wrapped the other one over him with the absorbent side out in case he vomited. We were told that he had diarrhea and vomiting a few days back, but that nothing had changed since then.
My sense of things was that the people taking care of him considered that a good sign. They said that he had been sick for the last seven weeks and that prior to the earthquake he had been eating bananas and rice. They thought perhaps he was about half the size that he had been.
As I cuddled him, rocked him, and sang to him, he began to stop the sad vocalizing that sounded like a wounded animal. Our medical student, Nick, thought about some Pedialyte that he had seen in the pharmacy earlier in the day. Since we couldn't get I.V. fluids into the baby, perhaps we could find a way to get some of this Pedialyte into him. But with what?
He was not being breast fed, he couldn't drink from a cup, and we didn't have any bottles. All we had were syringes.
Nick took a tiny needle and placed it on the end of the syringe. He sucked up a few cc's of liquid, then capped the needle off, leaving about a quarter inch that could let a few simple drops of fluid into his mouth.
Nick tried once, then I tried once. The boy didn't seem to remember how to swallow at first, and the Pedialyte dribbled out his mouth. On the third try, he got it.
He continued to watch my face as I sang to him and we kept eye contact. He wanted our help so badly, it felt like he would endure anything to get it. His eyes at this point almost never left my face. He was hanging on tight and he was trusting we wouldn't let him down.
The next sip of Pedialyte gave us a tiny miracle. He smiled. He smiled!
The comfort provided by being warm and being held and being able to receive love, and a few tiny drops of liquid had allowed him to relax such that he could swallow, and that made him happy. Talk about resilience.
He took another 2 cc's of liquid, and that smile mobilized us all. He was a fighter. I continued to sit on the steps behind the gurney, holding him, singing to him, smiling at him while Rachel and our other nurse practitioner checked his head for any viable veins. They found one.
As they worked to place the tiny needle on the top of the baby's head, he gave another primal wail. It was rather halfhearted, but it made me think he still had a little fight in him.
He was finally able to be hooked up to an I.V. |We gave him the tiniest bit more of the Pedialyte, but he spit it all back up. Stomachs and bodies are very sensitive when they suddenly receive fluid. It's important to give it slowly and carefully.
With our tiny patient, warm, safe, with his I.V. intact and a little bit of fluid in his belly, exhaustion overcame him, and he drifted off to sleep to the strains of a lullaby. As time went by, every now and again, he began a juicy cough. My guess what that he was so dry, he hadn't even been able to clear his lungs.
* * *
As he relaxed and enjoyed his well deserved rest, we began making plans about what was to come next. The patients do not have nurses during the evening. We lock them in, make sure they have water, and leave them for the night.
I know. This sounds unbelievable, and from our perspective it is indeed. But that is the thing about working in a Third World nation. You do the best you can, and you must stop worrying or wishing for what isn't possible.
I can imagine the Haitian patients have a different point of few. Some of them had housing before the earthquake, but you can be sure it wasn't what you and I would term “housing.” Others had no home and were living on the streets.
At the hospital, they have a cot and a mattress, something many of them have not experienced their entire lives. They always receive one hot meal at day and clean water to drink. They have bathroom facilities, and they have medical care.
At night, when all the medical personnel are gone, they are locked in this facility so that they are safe. My guess is that they are safer and more well taken care of now than they have ever been in their lives.
They also seem to be a little unsure of what to do with themselves. These are not people who are used to leisure time, even when they are sick or hurt. Theirs is a hardscrabble life every single day, seeking food and water, finding something in which to cook that food, as fuel is also scarce.
So there we were. This child could not spend the night at the hospital without staff who could stay with him. We called several other hospitals to see if they could take him, but only one could, one clear across town, 45 minutes away.
It was unlikely any family member could get him transported over there, as they have no money. Several times this week we've taken up collections to get a very sick person into a taxi to get him or her where needed, but this was Sunday. It was going to be hard enough to find a taxi, let alone shake down the staff again for money.
The other issue was that time was running out. It was getting close to 6 p.m. now and our truck would be coming to pick us up.
I separated myself from all of those discussions, except to offer a suggestion now and again. For the most part, my little patient just sat in my arms for an hour or more, snuggly warm, relaxed, exhausted, and getting vital liquids into his system.
* * *
Somewhere along the line, his father came to the hospital, and the family friend left. I asked the interpreter to tell him that he was more than welcome to come back and see his son. I'd be happy to give him over to him to hold, as that would be far superior for the patient than to give me the honor and the pleasure of doing so.
I am imagining that working with foreigners who speak another language was difficult for him, even with a translator present, and he chose not to accept my invitation.
Time went by, and our ride arrived. We were out of options. I woke up our little patient and we tried giving him some more Pedialyte. When he was able to keep a little of it down, we invited Dad in to see his son.
We told him what was happening, and he agreed to continue to try to feed him the electrolytes throughout the evening and to bring the baby back to the hospital in the morning. Of course, we have no idea at all if he will be able to manage that. Perhaps he has a job and won't be able to take the time off from work. I feel sure if the team doesn't see the baby Monday morning, it will only be because it was an expensive impossibility his family simply could not afford.
I will never know what happened to our young man. I had fantasies of packaging him up, bringing him home, and making him well enough to return to his father. I am often heard saying that “fantasies are free, dream big and often,” but clearly my thoughts were not based, and should not be based, in reality.
We can't save every child, as much as we want to, as much as we are pulled to. We simply can't.
And so on Sunday, I fell in love with a hurting child. I tended to him, I held him, I crooned to him and fed him and kept him safe from the hurts of the world for a few hours. I gave him a pitstop. I can only hope and pray that this little person, this baby of such strength that he managed to smile at me in the midst of his suffering, is strong enough to endure.
Before his father left, as the folks on the bus waited patiently for us to finish our work so that they could go home and enjoy their cold shower, we gave the father extra diapers and supplies. The hopeful message was not lost on the father who thanked us kindly and asked that God bless us all.
* * *
Having made it safely over the border, I have taken several days to digest all that has happened in Haiti over my previous two weeks.
I did not plan very well, and so at the all-inclusive place that I am staying, 45 minutes outside of Santo Domingo in the Dominican Republic, I have my Vermont Haiti T shirt to wear, one pair of shorts, and a scrub top and pants. Clearly no one notices me in their resort wear and fancy skirts and dresses. (Right!)
Because of my exotic beach wear, several people have sought me out to ask me questions about Haiti.
One man, from the U.S. asked where all the money that people send is going? All that I can report is what I've seen that is obviously donated.
There is an entire tent city made out of Coleman tents covered with tarps that say “Save the Children.” Actually, I have seen three of those. I have seen rows and rows of portable toilets in the center of the city. I have seen boxes and boxes of donated food, cleaners, chemicals, clothing, and medical supplies.
At a meeting, one of the logistics people from Germany reported that he had to move a planeload of lactated ringers, a kind of I.V. fluid, within a day so that he could pick up a food drop. That's a lot of ringers, and if the people around Port-au-Prince had medical personnel that could actually hook the fluid-deficient people to the ringers, they would likely use them all.
That's a great analogy to some of the help that has arrived here. There are lots of surgical kits, but will there be enough surgeons to use them all?
There are some mental health drugs available, but will there be enough therapists and mental health professionals who can speak Creole to use them all? Mental health is a field that is barely covered in Haiti, and I'm thinking that it has the greatest need in the entire world at this point.
There lies the problem. Lots of heartfelt ideas about what the people need, and perhaps too many circumstances where what is mailed actually needs a human being to manage its use.
That is not to say that the millions and millions of dollars spent haven't helped. That is not the case at all. If we didn't have the donated medical supplies, there is no way that we could have done our work at the hospital and at so many other locations across Haiti.
If you are inclined to help, I'm told, and I continue to believe, that money is the best way to do that.
If you send goods, there is an enormous tax on those goods for the non-government organization (NGO) to pick them up from the airport. Needs change week by week. It's hard to know at this point exactly what to send unless someone can give you that information from the ground in Haiti.
Money also helps this local economy. If the NGO, mission, or school group has cash in hand, they can purchase what they need from local merchants, thereby jump-starting this very slow economy. That's why I purchased some local art. It was a joy for me, helpful for the artist who sells from the street, and the money stays local.
* * *
I also met a man from the U.K. who is an engineer. He had some very specific questions about why the Haitian people are “so dirty” and “so needy.”
“Why is it that they don't just pull themselves up from their poverty like the Americans did when they first got to America?” he asked.
I'm serious here. He likely asks questions that many of us want to know about, so let's try to take a small stab at answering him.
It is not my experience that Haitian people like to be “dirty.” I did not meet any Haitian people who didn't have a healthy desire to take care of themselves, their appearance, and their “home” - be that a tent, a sheet with holes in it, or a more traditional dwelling.
In fact, I've met precious few people in the world who would choose to live in a dirty state of affairs. I also believe that to be true of animals as well. Pigs, for example, can be the cleanest of mammals, if we give them half a chance to do so.
That means that we have to look further back into what is actually happening in a home of poverty in Haiti.
First, there is the question of water. There isn't clean water available to the majority of the Haitian people. Water needs to be purchased in bottles, an expense everyone has to bear, and those who have no money will choose to drink water that is not clean rather than purchase what they can't afford.
This circumstance alone continues to keep people ill. Many of the world's health issues begin and grow worse over time because of a lack of clean water.
Let's go back a little further. If you have no water to drink, where do you get water at all?
I've seen people drink from obviously polluted rivers, streams, and sewer overflow. I've seen people attempt to wash their clothing in dirty water from the street. I've seen people who have to carry pails of water back to their shelters. I've seen others who have to borrow a pail from someone else because they don't have one.
Many of those shelters have dirt floors, and no beds; people sleep on the floor and use very crude cooking fires. So how does one get “clean” to the satisfaction of the man from the U.K.?
Question two: What would make the Haitian people so “needy” that they need the world's constant assistance? Let's try to take that one apart as well.
The obvious answer is that they have just suffered a major earthquake. That is, at the very least, the first thing that comes to mind. The majority of people that I met had lost everything, from loved ones to clothing, to household goods, to furnishings. Everything.
If one loses everything in the United States, neighbors often arrive to be helpful. Living in New England, I have seen the aftermath of house fires. Suddenly there are fund-raisers, donations, clothing, and other resources to provide for this family.
But back to Haiti, where one family didn't lose everything - millions of families lost everything. Who is left to help? I have met only a handful of fortunate souls in the country on any economic level who didn't suffer some kind of loss, be it family, friends, or belongings.
On my trip through the city of Port-au-Prince, I was taken way up on top of the mountains, the best views of the city. Who lived there? Who lost every single piece of their home and furnishings? The drug dealers. When even the most wealthy people in a city lose it all, who is left to be generous to others?
I also saw one beautiful high school. The Haitian man who owned it bought only the best. There were several buildings around a big city block, which included his own home. He was a wealthy man who created this beautiful school for the students of Port-au-Prince who earned their way into the school by being intelligent and maintaining a sincere desire to learn.
In the six minutes it took to shake the earth in Haiti, this man lost every single building that he built. What's more, he was not at home at the time of the quake. He is the only surviver in his entire family. I'm told that he left town that very day, far too overcome with grief to stick around to see what would happen to his life next. He left the country. Who came blame him?
That makes for another interesting question. How can this one man claim the fame of having risen up out of the poverty that captures an entire nation? He was lucky enough to have an education. Statistics vary, but preciously small percentages of Haitians are able to attend school until they are 18 years old.
That leaves a nation full of people who are not only stuck in the generations of poverty that has racked this nation for centuries, but also illiterate. How many people in this world have made it big financially on this earth, yet also lacked these skills?
A majority of the schools now lie on the street in slabs of rubble. Where will the money come to rebuild them? Do you know any investors who want to spend billions of dollars to benefit the Haitian kids?
I think our English gentleman is likely struck by the bigwigs of the great industrial times of the early 19th century. Oil barons, investors, and technology entrepreneurs come to mind when we go back in time and think of people who rose up from poverty.
But what resources does Haiti have? This part of the island that is shared with the Dominican Republic is almost entirely treeless. I know of no natural resources of value that are here. Anything of value long ago was taken by the French. Then, 100 years ago when the Haitian people were given independence, they were required to pay millions to the French over that last century to keep their independence. When that bill was paid, the Americans got involved. We did them no favors either.
Just as Haiti was perched to have a chance economically, when former President Clinton was ready to assist the government in taking on the challenge to make something of this country, the earthquake hit.
I'm not sure “boot straps” are made big enough to pull up any of the Haitians left living on this island country. Those who can leave do so. Those who can't, suffer.