4/21/11 “I have dirty blood…” Working In The North Of Haiti

Cap Haitian, Labadee, Shadda, Milot, Coco (east of Bayeux)

Norwegian Crusted Scabies

Today is the 1 year anniversary of when we first set sail from Florida to Petit-Goave.  Returning to Petit-Goave after a year and seeing our old friends and patients (and meeting new ones) was an incredible experience, but after a week working in Petit-Goave we weighed anchor and headed north to Cap Haitian.  After the Windward Passage, it was great to ride across the smooth glass of the Bay of Haiti, but as we approached Cap-du-Mol on the western tip of Haiti’s northern peninsula we entered the edge of the Windward Passage and had a few rough miles before turning east along Haiti’s north coast, arriving shortly after daylight and pulling onto the commercial docks in the port of Cap Haitian.

We were met by Hannah from the Cap Haitian Health Network, and after several days of

trash river in cap haitian

 paperwork and meetings we unloaded our medical cargo onto the docks, onto a truck and got it into the CHHN warehouse, where it will be available for distribution to the clinics that are members of the network.  While we were waiting to unload at the dock so we could move to our mobile locations, we took the opportunity to visit a couple of other health centers, meet the minister of health for the north, do a mobile clinic in Shadda—Cap Haitian’s worst slum—and see a steady stream of patients at the dock the entire time we were there. 

holly hefting an instrument of war...

It took us almost 4 days to get our material cleared in, which gave us time to visit Milot hospital, the primary center for major or specialist surgery (staffed year round by local and visiting teams) and get a schedule for the next few months of that doctors and specialist teams will be visiting there; that way when I am further afield I can write referral letters and give the dates and doctor’s names to patients I encounter who need specialist care.  Above Milot is the Citadel…the largest and most impressive castle I have ever seen, perched on a mountaintop above Cap Haitian.  Built after independence, it was made to hold 12,000 troops and be able to fight a devastating guerrilla war from the mountains should Cap Haitian have been re-taken by the French.  I liked the raincatchers built into all the roofs, but mostly I was shocked by the size and scale of it.  “My name is Ozymandias, King of Kings…Look On My Works, Ye Mighty, And Despair…”   The castle was never really used or completed but it has been well preserved as a UNESCO site and SHOULD be a huge tourist draw for anyone visiting Haiti…just plan to bring $10 for a horse if you don’t want to walk all the way up (3,000 feet in 3 miles…I made it but I wanted to have a coronary at the top).

Cap Haitian was not too badly damaged in the earthquake and is quite prosperous in

infected and necrotic burn from hot oil

 comparison to other places I’ve been in Haiti, but Shadda, its central slum, was awful.  We saw a ton of scabies, which always tells me an area is really poor, and some half-done operations (like a colostomy that has not been reversed though it was supposed to be).   A toxic river draining sewage, agricultural and industrial runoff and storm drains from all of Cap Haitian flows between two dykes made of garbage, medical waste and sewage…Donna was saddened to see three children:  one standing in a huge pile of garbage, another simultaneously defecating on the pile, and another simultaneously picking a can out of the pile and checking it for scraps of food.  The general health of the population in Shadda reflects the surroundings.

a river of sewage, garbage, agricultural and industrial runoff flowing through shadda in cap haitian

By contrast Labaddee, where we moved and dropped anchor to work from this protected fjord, is one of the more prosperous-looking little villes I’ve seen in Haiti—pretty much 100% because of the jobs and income that come with Royal Carribbean Cruise Line’s destination here.  RCCL run a school, help support the small clinic in Labaddee, and have extended themselves to us by providing fuel at cost and allowing us to get water from their dock (thank you Peter and Dave!! Lifesavers!!) and do laundry (16 continuous hours of laundry when we first went over there).  I

It is important to remember that Labaddee’s prosperity is relative to places likes Shadda,

meeting his first white person, and unafraid

 so we still saw loads of bad injuries, poorly healed wounds, a LOT of major operations with little or no follow up (we asked Hannah from CHHN to come do a day of physiotherapy and she is planning to try and come regularly), and some unusual cases also—I treated a little boy with a knee wound all septic with ripped apart stitches (almost all healed now), we ultrasounded nearly every pregnant woman in the village of 6,000, and after only two days people started coming out to the boat, night or day, for emergency care.

You never know what will arrive paddling up in a canoe at 10:00 at night—a guy came by

wound care for the skarkbite victim

 the other night and I saw the blood-soaked rag wrapped around his left hand.  We pulled him aboard and unwrapped the hand to find he had been bitten by an 8 foot hammerhead shark (HE says 8 feet…but I’m a fisherman too, so I say read ‘5-6 foot;’plus 5-6 feet is about right for the bite radius).  We patched it up and he has come every day for dressing changes.  I understand he was offshore, tried to pull the hammerhead into his small boat, and it got the best of him before it escaped.  Two worlds collide…Shark one, fisherman zero (for a change).

Me and Jean Claude, one of Cousteau's original divers and one of my heroes

Speaking of worlds colliding, I am fortunate here to have met one of my childhood heroes, Jean-Claude (one of Jacques Cousteau’s original divers), who has built and run the Cormier Plage hotel near Labadie for the last 23 years.  He is 79 years old, dives every single day, swims a couple of miles in the ocean every couple of days, and showed me the artifacts he has collected off wrecks he has discovered over 23 years of diving this dangerous lee shore (I nearly keeled over in shock at the collection of priceless artifacts he has recovered for a museum display when it is complete).  

I think that so far one of my favorite days here in the North so far has been setting off

The only way to pass a physically uncomfortable journey

 from our ship on an 11 mile trip in a leaky handmade wooden boat with no floor or seats, run by one of our new friends here, through a treacherous series of shallow reefs (on a lee shore, too…bet there’s lots of ships’ bones down there), landing not far from columbus’s landing in the new world.  I’ll always have a memory of Sky sitting on the bow trying to keep her back from being destroyed, scanning the mile-long, desolate beach for our contact and a safe passage through the surf.  We located our contact and another boat rowed out through the surf, we transferred our gear and under oars we backed through the surf. 

Donna’s shorts were soaked in the landing and she abandoned them, so partially clothed

sky clerking in a kid 8 years old going on 47...

 we put our gear on our backs and heads and followed our guide off the beach into the trees, stopping at a small school in a village supported by Dr. Anne, an HIV specialist who helped make this mission possible.  We did health checks on all the kids in the school, treating a LOT of scabies and skin fungus, respiratory tract infections, some severe malnutrition from parasite infestation, anemia, and a pre-teen patient who told us they ‘had dirty blood’ from birth.  This patient travels 2 days once a month to visit a doctor providing their meds.  And, as per our SOP, we gave vitamins and albendazole (for worms) to every kid (and quite a few adults, too). 

I love the mobile clinics…each one is its own adventure, at the end of it I have a wealth of valuable firsthand information about the location, and I’ve never done one that did not have at least one patient that I was very, very glad to have come to see. 

And to be honest, it also felt good to ply the same waters as Columbus for a short time.  I

landing our clinic through the surf a short distance from where columbus first made landfall in the new world...

 hope the legacy we leave behind has a kinder footprint than his, but I loved rowing through the surf to land in a new place, with mystery and unknown patients waiting somewhere beyond the tree line in the Haiti’s own heart of darkness.  Humans aren’t meant to look at cubicle walls…we are hardwired with the desire to stand on new worlds and look to the next.  All of us have the explorer soul written into our DNA, and the expression of this most uniquely human characteristic is always a beautiful thing—I think it is when we are being the most true to who we are as human beings.

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