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Building a wheelchair bridge for a girl with CP
When I last posted in June, a couple of months in, we had just started to really connect with the various subcultures in the Bocas Province, and some situations we quickly identified for interventional projects were as yet beyond our reach. Now we have many more friends and contacts in the community, and we can tackle much more ambitious projects for far less cost.
We have:
• Partnered with local group Operation Safe Water to help transport and install raincatcher systems at local schools when we run clinics
• Arranged CPR certification for the fire department
• Worked with the Ministry of Education to train local high school students as trainers for health education in the community and give them medical work experience by participating in our mobile clinics
• Created pictorial and written information sheets on health issues we have identified and that we make available at our clinics
• Gathered and data-entered over 600 patient health data sets and begun doing surveillance of our own interventions and identifying health issues from the data to help guide our mission activities
• Microfinanced patient transports to care on the mainland and chaperoned them in the hospital system (many Ngobe don’t speak Spanish, and are VERY shy, so they easily fall through cracks in systems)
• Connected with an indigenous Curandero to identify and investigate the plants he uses medicinally and are helping him develop his small botanical laboratory always keeping a lookout for.
• Arranged and executed a CPR and First Aid Seminar for the cruising community in Bocas
• Partnered with the Mayor’s Office to run mobile clinics in conjunction with the government visits to the community
• Partnered with the local Lion’s Club to work in a community they support and help supply the neonatal support unit they built with Direct Relief International suppliesAnd, as always, sometimes we find situations that are just not right. Por ejemplo…
Unacceptable for a 14 year old in a wheelchair
While I was in California, Dr. Barney found out about a 14-year-old girl with what turned out to be undiagnosed cerebral palsy in a small squatter’s community called La Solucion. I have been told it used to be where the airport is now (right next to a mangrove swamp), and when they built the airport the community moved out onto shacks built on stilts over the mangrove mud.
She comes to land at most twice a year…land is about 100 feet away over the sewage-contaminated swamp (all the homes
She has rarely, in many years, been to shore
have outhouses and sink drains that drain directly into the water below). She has never gone to school…she has a wheelchair, but rarely uses it because she has nowhere to go; she has to be carried over the dangerous footbridge by her grandfather, and she is too big now for him to carry (Noah noticed he has drop-foot also…potentially a serious falling hazard, especially if you are carrying your 14-y.o granddaughter over a wet slippery footbridge). She is COVERED in bug bites…she can’t really swat bugs away or keep moving to keep them off her, and she lives in an open unscreened house on stilts over mangroves.
Her grandparents have always thought they were at fault for her CP because she fell out of bed at 6 months (though she had never crawled, which makes me think it probably was CP at birth)…they have carried that burden and they always worried they would get in trouble if the hospital found out, so they have indicated that she has never seen a doctor.
If I were a Hollywood writer writing for some medical drama, my editor would probably throw me out of the building for it being so unbelievably challenging emotionally and physically…but this is real life…this is somebody’s actual life. Sometimes people ask if I miss ‘the real world’…let me tell you, it looks pretty real from where I’m standing.
Driving pilings into the sewage muck of La Solucion
We said we would build her a walkway, and now—6 months into our time in the community—we called on the community to help and EVERY level of Bocas society came together to make it happen. Mangrove posts from an indigenous community, lumber and funds and food from local Panamanians and expats, help from boat owners, crew on other boats, locals from La Solucion, local taxi drivers, local restaraunts…at the last minute we even had no trouble rounding up 2 sledgehammers (one from the fire department and one from the fish market, which I sometimes haunt in the afternoons when the fishing canoes come in).
Everyone gave a little (some more than a little), and in 5 hours we sank thirty 10-foot mangrove tree trunks 7 feet into the mud, from the shore all the way to her grandparents’ house. The walkway went on in the next few days, and then this little girl went to shore (we still have some work to do to finish the walkway and make it safer for a wheelchair). I asked if there was anything in particular she wanted to do on shore (which she can see, 100 feet away) and she said ‘Quiero pasier’—‘I just want to go.’
planking the wheelchair walkway
This is my favorite, favorite kind of project…one where the whole community comes together when it learns about a situation like this. When the walkway is done, it will have been done right, with the right material (always seek expert advice) to make it last for many years. No matter what, this girl’s life is going to be changed forever—and here’s the best part: total cost for all the lumber, food for the volunteers actually building the walkway, gas to go pick up the posts from another island, hardware, etc: less than $1000.
There’s opportunities for helping, constantly around us…when we are alone we can help in small ways…but mira aqui, look what we can do when we all come together! Poco a poco para cambiar el mundo.
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I need an opthamologist
The last time I wrote a blog, an unconscionable number of months ago, we had recently arrived here to Bocas del Toro and I ended the blog excited by what might be possible over the coming months…now those coming months have passed, and it is time to catch everyone up and take stock of what we have accomplished here in.
6 months ago feels like a million years ago…with more long-term volunteers, we’ve been able
I love my sister
to really expand some parts of our project, including self-surveillance. I looked at what we had done—how many mobile clinics, how many volunteers, how many projects, how many patients…it is overwhelming to try and describe. I should either write bullet points, or a 3-volume novel to describe everything since my last update.
Canadian medical student doing kids health checks
Over most of our time here, for example, for every 3 days we were here, we ran one day of mobile clinic work—even counting rained-out days (and it rains 150 inches a year here) and days we were involved in any other kind of activity, whether it was working on boat projects, escorting patients to the mainland to get treatment, holding office hours in our consultorio, working in the asilo, eating, sleeping, or doing anything else. We’ve seen over 3,000 patients in more than 17 communities that we visit on a roughly 2-month rotation across the entire province of Bocas (an area of over 4,500 square kilometers), in addition to all our other activities.
No matter what other projects we get involved in, the core of Floating Doctors is our mobility—even the permanent clinics we are now working to establish are to serve as bases from which to continually run mobile clinics by panga, as we have done everywhere we go. I’m incredibly proud of all my volunteers and my crew for maintaining that level of dedication to work one day of mobile clinic for every 3 days we were here.
We’ve seen a lot of different communities, and noticed that there are enormous clusterings of health issues in different small communities that at a glance may seem similar. Why does one community have an incredibly high rate of obesity and diabetes, while the neighboring community has no obesity or diabetes but has lots of parasites? We have gathered detailed demographic and health data on over 550 patients so far, community assessments on a dozen different communities, and are beginning focused projects based on issues we have prioritized based on the data so far. Results of our first survey project coming in the new year…
ultrasounding in a chair in the jungle
We’ve started doing overnight and multi-day mobile clinics—getting two or more clinic days for the price of one day’s travel, since our accommodations have almost always been in the homes of local members of the community, or expats who notify the community that we are coming, house and feed our team, and often allow us to use their facilities to hold our clinic and arrange our transport to work in communities near their homes. I have been overwhelmed by the generosity of the expat and local community here…I have never worked anywhere—in the developing or the developed world—where the community at every level will actually deliver on its promises of support like here. From the Mayor sending trucks to help us cart garbage out of the nursing home, and letting us use his old consulting room to open for patient consults two days a week to the local marina workers who are giving their Sunday to help drive 36 10-foot posts into stinking mud to build a wheel-chair walkway, this is a wonderful community, with many eccentric people (after all, we are here too) and many people with good hearts who have shown us enormous kindness and support for our work here. Thank you to everyone—this is what makes Floating Doctors possible. A thousand hands holding us afloat…
We’ve also joined forces with the Peace Corps volunteers scattered throughout the province;
Harold, Peace Corps worker in Shark Hole; we did a clinic there on his very last day on site...a giant amongst his Ngobe friends; thank you Harold for your fantastic work
Peace corps Volunteers have thus far been 100% reliable—individual peace corps volunteers live (very often alone) in a community and work on a project. We got in contact with one, on the mainland, and ran a mobile clinic at his village…it is so awesome to arrive with everyone notified, a place to work, directions, someone to help interpret and to give us the inside scoop on patients we are meeting for the first time, someone to pre-arrange accommodation in the community, and best of all, the Peace Corps volunteers can and do follow up with patients that we have identified as needing more advanced care. This has been our experience with the Peace Corps every time we have worked with them, and we look forward to our upcoming multiday clinics to some new communities we are visiting through Peace Corps, including a Ngobe community way up in the mountains that I have heard a Peace Corps volunteer visited but that he thinks has NEVER been visited by a medical team. Looking forward to that later this week…
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My little sister Sky...at the helm...she is so awesome
Bocas del Toro, Panama
As always, leaving Haiti was difficult. There is always a sense of leaving things unfinished, no matter how many patients you see or projects you complete. I always tell people, we are not going to go help Haiti. That is beyond our power…but we went to help HAITIANS, and helped many. Leaving is hard…but I comfort myself when I remember that our anchor will drop in Haiti again.
Moonrise 200 miles off Nicaragua
We had an amazingly calm and uneventful passage from Haiti to Jamaica (our 4th time crossing the Windward Passage…it was tolerable this time, I’ll give it that). We ghosted through mirror glass seas 200 miles off the coast on our way south to Panama, a full moon reflected among the stars on a sea so smooth that the horizon was not visible. We caught some fish, slept well, had a whale shark partially breach in our wake, saw pilot whales and dolphins…Jamaica to Bocas del Toro has been by far our easiest and most pleasant transit.
this looks like a scene from an italian opera
Our arrival in Bocas was marked by the immediate generosity of the expat and local community here. Dylan and Darien on S/V Jackaroo, the owners of the Calypso Cantina at Bocas Marina, helped arrange Bocas Marina hosting us while we are here, welcomed us with a fire dance at the cantina, and have just organized a big fashion show fundraiser to support our time here (blog with THAT story coming soon!). Chuck, Courtney and Rosemary and Dana from Bocas Marina have gone way out of their way to support our mission here, and everyone in the local community has reached out to help us here.
This place is almost purpose-designed for a team like ours: a large population spread out over a large area, mostly accessible only by boat, with little or no access to health care…nearest surgery is an hour and half by fast boat ride…a mammogram is 2 hours away…a very, very, very underserved population (lots of indigenous people who have had a long history of poor interactions with foreigners).
We immediately became involved in several initial activities:
Mobile Clinics:
Shark Hole community (mobile clinic with the Mayor)
By car (thank you Rosemary!) and by panga (thank you Alcaldia!) we have so far been running mobile clinics for the communities in San Cristobal, Drago, and Shark Hole and have returns for follow up and visits to other communities on the calendar for the next few weeks, with help from expats in the area, peace corps volunteers in the communities, and with the help of the local mayor (the Alcaldia).
- Sarah doing health checks in Drago (about 1 in 6 had something needing attention)
Dr. Joe, previously the town’s only doctor before entering politics, visits the outlying communities once a week with a government team (health inspector, education directors, building inspector, etc) and we go with to do a mobile clinic. We have some bigger multi-day mobile clinics coming up; on one we will be carrying five 750 gallon water tanks to a remote series of coastal communities for Operation Safe Water.
Nursing Home (The Asilo):
Felicity and I doing ulcer care in Asilo
3 staff (cook, cleaner, nurse) on each day shift to cook for, feed, clean, wash, change, dress, and otherwise care for 25 long-term care residents who are wards of the state, most with few (usually none) family members and no means of support. The fact that the floors are clean and the patients are fed is a huge achievement, but otherwise it is heart-wrenching. There is a 3-inch concrete sill in each door…to go outside, I watched an old man with no legs roll himself up to the sill, climb down out of his wheelchair, lift the chair over the sill, lift himself over the sill, and then climb back into his chair.
The first truckload of garbage taken from the Asilo
Piles of rusting metal and trash and junk fill the backyard, and vultures walk amongst the patients in the fall-hazard garden. There are no handrails anywhere, including the bathrooms. A doctor has not come from the hospital to look at the patients for months, and they have no meds at all. And the patients have no charts at all. SO…we created charts, did full histories and physicals on everyone. Now we can write and document progress notes and exams and studies.
Please come to the Asilo and help us take the residents for walks!
The mayor sent a municipal truck and we filled it three times with garbage and junk, CJ has gathered many cuttings and plants given by other members of the community and begun systematically landscaping the demilitarized zone that was the backyard, we’ve been doing wound care, skin care, walking and exercising the patients, repairing leaking water pipes, changing inappropriate shower heads, providing eyeglasses, and generally trying to improve conditions everywhere we turn. If you are in Bocas and reading this, come by and give us a hand!
Bocas Emergency Network:
Grit from a sanding disc injury lodged deep in abcess...
We arrived here to find that the BEN (Bocas Emergency Network) was already in existence here—a network of about 50 expats scattered across the area who remain in radio contact to alert and assist each other in emergencies. The name seemed a fit made by fate, so our call sign in the BEN is ‘BEN911’. We have taken a couple of calls through the network, but fortunately none which were serious enough to necessitate an emergency callout. We are working on getting our own panga and programming known safe routes through this maze of mangroves to all the different BEN member homes (which are all located near local villages) into our GPS so with a searchlight we can make high-speed response to emergencies or do fast transit to Changinola (closest place with surgical facilities)
One of the cruisers here helping us landscape at Asilo
So far here we have had medical students from Israel and Saskatchewan, Canada, an RN and her cameraman fiancé from Australia, pre-medical and nursing students from Duke and Berkeley, an Optometrist living locally who is going to come do monthly prescription clinics (we have glasses), a nurse from Florida who just moved here with her husband, and we have a tropical medicine specialist coming from the UK, a nurse from California, and other volunteers coming throughout the summer, and some of our old volunteers returning too (awesome). It is amazing watching them go through the experience. It changes us daily, and it is fascinating and rewarding to watch people rise to challenges, encounter people and situations which push them past their boundaries, and seek out and develop opportunities to help.
Felicity helping Asilo residents pick out new glasses
I read about a playwright/director, terrified after an awful dress rehearsal before the debut of his one chance at success, who fell asleep and dreamed that he was scaling a immense mountain peak…vertical walls…no ropes…he, who had always been scared of heights, in the dream is climbing like a man born to the rock and the sky, and as he nears the summit, he loses his grip and slips, hanging just below the summit by his fingertips.
- Eve and Sarah changing decubitous ulcer dressings in Asilo
A man on the summit looks down and asks him if he is afraid of failing…and says ‘it is sometimes a mistake to climb; it is always a mistake never even to make the attempt. Sometimes, when you climb, you succeed, and sometimes, yes, you fall…but there is a third option…’ And then the playwright falls. And as he is falling, he realizes what the third option is: sometimes, when you fall, you find out you can fly.
This I believe.
Dylan orbited by flames
And in this community there are already many hands under us. What do we have in the works? Of course we want to bring in a container from Direct Relief International with equipment and material for the hospital and dispensarias here; we will soon be doing training with the firemen (who do water rescue here also) in Bocas, working with Operation Safe Water to deliver more tanks and equipment for water projects, doing consults using the mayor’s old consulting room, putting a raised vegetable garden in at the asilo, getting some specialists down here, doing more multiday mobile clinics and continuing to return for follow-up…who knows what else? I feel like this is a community in which we can accomplish a lot…it’s an exciting feeling after 1 month; wondering what we will have done here in another few months…
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All pictures of patients used with patient’s or guardians’ consent.
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Nec Aspera Terrent: “Difficulties be Damned”–the Family Motto of Perry Fawcett, Amazonian Explorer
Labadie, Camp Louise, Caracol; Haiti
Our clinic landed in Camp Louise
It has been a very, very busy few weeks…a lot accomplished; we recently treated our 750th patient for this month. That’s an average of 30 patients a day, including minor surgeries, ultrasounds and acting as 24/7 floating urgent care center. In that time, we have also done mobile clinics in Shadda, Coco, Camp Louise and pre-natal vitamin distribution in Caracol and have visited Milot Hospital, Justinian Hospital, and the HHH physiotherapy center and have helped many patients connect with needed specialist care (I got the schedule of all the visiting American specialist teams for the next few months at Milot so I know when and to whom to refer patients).
Pietre, Dave and everyone at Royal Caribbean have been awesome—we are wrapping up
Striking Day to Watch the Royal Carribbean Ships Come In
our time here and getting ready to make our way to Panama to work south of the hurricane zone as the season advances, but I am very grateful to RCCL for making us welcome in Labadie and we will miss everyone when we go.
Scabies scratched and secondarily infected
There’s a saying in medicine: “Common things are common,” and at a certain level of poverty some things become VERY common. Scabies, parasites, respiratory infections and fungal infections are common among my patients, but I hate when several such conditions are found simultaneously in all the members of only one family. A mother, daughter and young son came in with terrible scabies, secondary skin infections from scratching, bad worm infestations, anemia, and chest infections…we medically treated all the ailments, but I spent most of the consult working to make the mom understand the importance of washing, cutting the dirty fingernails of itchy children, washing, not drinking coffee at age 5, washing…and washing. Properly used, a single bar of soap can prevent an awful lot of disease, but poor home conditions and poor health awareness are two regular factors in the illnesses of my patients.
We are barricaded in a single schoolroom to keep from being overrun
We did a mobile clinic by small boat in Camp Louise, a diffuse farming community of a few thousand people living a few miles west of Labadie. We visited the health center there but did our clinic in one of the local schools, treating the school kids and a lot of other children in the neighborhood. We were joined by a nurse from the Camp Louise Clinic, a Doctor, Physio and two teachers and Hannah from the Cap Haitian Health Network. This clinic was a tough one…a crowd of several hundred gathered within minutes; people were trying to literally pull themselves into the room we were working in (we all worked in one room, hot and crowded but impossible to maintain security otherwise). Hannah and the teachers had their hands full trying to keep us from being overrun, but we got through it—as usual in schools, lots and lots of scabies and parasites, and this location had lot of urinary tract infections and bacterial vaginosis in the young kids. Camp Louise is somewhere I would like to spend some time doing health education in the charitable schools there, as the high prevalence and poorer hygiene of the kids with UTIs suggests there might be a special need there.
Aside from the common stuff, the last couple of weeks have also brought us some very
Our Medicine Lifted The Voodoo Arm Pain curse...
unusual cases, and some unfortunate ones. The one that caught me the most off-guard was when I was consulting with a 96-year old woman (she’s in awesome shape, totally ambulatory) presenting with shoulder pain radiating to the arm. As I was writing “?mild strain?arthritis” on her notes, she told me that she had accidentally picked up some cursed money (people don’t like picking up money on the ground in Haiti, because JuJu men will curse the coins and scatter them around) and essentially been voodoo’d, so I gave her an anti-inflammatory and Noah showed her gentle stretches and exercises for improving shoulder stability. A few days later she came in and thanked us because she hadn’t had to go to a voodoo man to pay to remove the curse; our medicine had beaten the voodoo.
Hammerhead Sharkbite
Let’s see…my shark bite victim is all healed up…the kid who came in with his stitched knee all torn open and infected is all healed up, but he’ll have a big scar on that knee for the rest of his life (but gets to keep his leg; it was pretty horrible looking when he came in and we first unwrapped the dirty bandage covering the torn-open, homemade stitches). The other night, just before dinner, we heard a familiar sound…a small wooden boat making its way towards Southern Wind, with a man, a woman, and a young kid with a dark-stained rag wrapped around his leg. He had been cut with broken glass, and a deep, 5-inch laceration on the back of his calf. It was pretty deep, with a lot of fat and connective tissue exposed and swollen with fluid; at first I wasn’t sure if the edges could actually be
Cut With A Broken Bottle ...
closed, but skin is always a lot stretchier than you might think—I washed the wound and sutured it back up, and a few days later the edges had pretty well opposed. Incredibly, the sutures were ready to come out after about 4 days (really—they were already starting to be grown over); I love healthy kids—they heal so fast and bounce back.
This is how I usually spend the journey to a clinic...conserving strength
While walking on the beach, we met a guy whose upper arm bone was completely fractured 2 years ago—I mean completely fractured, and it was never treated at all. It hurt badly for a year…and then the next year, without healing, it somehow stopped hurting and he retained use of the arm. It’s some kind of one in a million medical anomaly; absolutely incredible. His arm essentially has another hinge in it…if you bend the arm, the broken bone tents up under the skin and the arm bends right at the middle of the upper arm—Noah and I were absolutely shocked; this guy needs surgery to screw the 2 broken bones back together, so we are going to see if we can get the surgery arranged with someone before we leave.
got it to hospital that day over mountains...too weak...died 5 days later
And lastly…some bad news…a small baby came in about 5 days ago, age 1 month. It looked premature; it had been born weighing 6 pounds but had lost half its body weight, tipping the scales at a skeletal 3.3 pounds. It had no fever, no diarrhea, no vomiting, no cough, but hadn’t eaten much at all since birth.
The baby was listless and weak; it looked pretty thin at first glance but when Donna unwrapped it, we were shocked and dismayed at its emaciated body. I will always remember the apathy of the mother, the frustration of her sister…but especially the moment when we were examining the baby for its sucking reflex—young babies, if you stroke their cheeks with the tip of your finger, will reflexively turn toward the stimuli (as when the nipple brushes their face when they are being put to breast). This baby repeatedly turned its head away, almost as if it were deliberately giving up…unsettling to watch.
We contacted the Cap Haitian Health Network and got the mom and baby transported over the mountains to a hospital in Cap Haitian where they tried to feed the baby through a nasogastric tube, but last night, after 5 days of deteriorating steadily, the baby died (and it was only fed for 1 or 2 days through the NG because the mom couldn’t afford more…I found out too late or I would have found the funds somewhere!).
Things like this almost always penetrate my Zen, I’m afraid…it takes a lot of determination to let it go when things
1 month old...born 6 pounds...now 3.3 lbs
that shouldn’t happen just keep happening, like that poor guy’s untreated broken arm, or the 10 kids with urinary tract infections I saw in Camp Louise, or that woman’s baby, or the hundreds of other things like that that drop in my lap every month. If you have a 1 month old premature baby that has lost half its body weight you damn well get it care right away, not after it has been deteriorating for a month…but that is easy to say, since to get checked or get prompt neonatal care, care has to actually be available and affordable, and this baby and mother didn’t have that luxury.
So when I sent that baby to the hospital, I knew that it was so fragile it could slip away at any moment, but I knew that its life or death was not mine to decide, only to do everything in my power right then to give it a chance, and the universe would decide. The universe chose to take it back. I’d be lying if I said this time I really, really, really am working hard to not be upset that the result I wanted wasn’t what happened. I wanted the baby to have a future, not just a chance, but I can’t give futures…only chances.
I need more doctors and clinicians out here. Come where your training is REALLY needed!
I love our boat!
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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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Petit-Goave, Haiti–Almost a Year To The Day We First Arrived Here In 2010
This is the overdue final chapter of our voyage from Honduras to Haiti, bringing supplies for the cholera relief and personnel for a string of clinics and villages along the north coast.
Sky clerking in our first patients
After our repairs in Kingston were complete, all that remained was to chomp on the bit while only 40 miles away on the north side of Jamaica’s Blue Mountains a series of storms swept down the Windward Passage and collided with a SE swell across our path. At the first day when the swells and wind subsided, we left Kingston at first light and made all speed for the Windward Passage. Once we got out of the shadow of Jamaica, we encountered the most disorganized sea I’ve ever seen—in the space of five minutes we would encounter NE, SE, W, and N swell…thank god the wind had died or it would have been a horrible bathtub; as it was it was merely uncomfortable until we ghosted into the protection of the Bay of Haiti and at last dropped anchor in Petit-Goave, the first place we ever went for a mission…almost a year to the day that we first arrived in Haiti.
An hour after we dropped anchor, in the dead of night, our first friend from Petit-Goave,
Carrying our clinic bags back to the shore from our Fort Liberte clinic
Aniel, came out in a canoe…the next day, we saw dozens of people we knew; we went back to the DesGranges clinic and saw Meomene and ‘Cheeks’ and the kids who were there when we left. The two schools we built are now surrounded by larger concrete structures in mid construction; a larger future school sponsored by Korea, I think…but when we walked up to our little schools, each one was packed with kids and classes were in session as they have been since we built them. That was a great feeling…the pharmacy we cleaned and reorganized, and the day patient treatment room and the minor ops room were all organized and cleaned as when we left, and more rebuilding and expansion was still going on. We left a box of supplies for Dr. Cutler, an MD from L.A. who we arranged to go out ahead of us last year and who is returning to Petit-Goave to volunteer again this year—I think he actually arrived yesterday, as a matter of fact.
A scene from the past...on our way to our first shore clinic 18 hours after arriving in Petit-Goave
It was so different arriving here this time…amazingly, most of the rubble had been cleared, and most of the tents crowding every street were nowhere in sight. Some houses had been rebuilt (in concrete block without much rebar and suspect cement), but we saw hundreds of wood frame and tin roof one-room structures, on new poured concrete foundations from (apparently) a Swiss-led European consortium. More commerce was happening, some small businesses had reopened, and the central park was clear of tents and refugees.
I admit, when we left Petit-Goave after witnessing both the massive problems the
The only catch we made trolling in Haitian waters...a bag of used maxi pads
Haitians wake up to every morning and the effects of much of the relief efforts after the earthquake, I was not expecting the level of improvement that we saw. My journey to Port-Au-Prince to drop a volunteer off at the airport, however, was much more depressing…a city imploding on itself, with little visible progress over the past year of funds and relief being poured into it. Petit-Goave’s determination to pull itself out of its downward spiral it gave me a renewed hope for Haiti, a hope that I could see in the faces of all of our friends and the new people we saw.
Ultrasound revealed cholecystitis (gall bladder); antibiotics and analgesia given
The best moments for me came during the mobile clinics we ran, on the beach at Fort Liberte and in the ruins of an old French fort back from the coast a mile or so. I saw babies that I had ultrasounded 8 months ago and were born while we were away, patients showed me their thin scars where large machete wounds used to be…when I pulled onto the beach in the first load (two trips in the skiff from the boat to our clinic), the kids in the village saw us coming and ran down the beach yelling ‘Sky?! Rachel?!’ and we were surrounded by everyone we knew and treated in the mobile clinics last year. We wormed everyone again, handed out thousands of vitamins, and saw the usual litany of problems great and small—but we saw one patient in our first mobile clinic–less than 18 hors after we arrived–that made the whole 38 days of struggle and travel to get to Haiti worthwhile.
In the little enclave of cactus on the shore west of Petit-Goave, sitting in the same spot
There are worse waiting rooms
that we did our very first ever mobile clinic as Floating Doctors, we saw a 6-day old baby with an eye infection from Chlamydia or gonorrhea (or both) acquired during birth. This is a very serious, time sensitive problem–a few more days untreated and scarring develops, blinding the child forever (and cross infection and blinding in the originally uninfected eye are very common). We treated the mom and dad and used several days of rigorous cleaning and washing, and antibiotic eye ointment, and the greatest moment of our return for me was watching the pus-filled swollen eye lose its swelling and turn clear—just a few more days and the baby would probably have been blind forever.
Crew shot at the dock in Kingston 3/17/11
It’s not about saving the day, or being a hero…it’s about timing. It’s about being there, and being available as a resource to people who have no other options. A single patient treated at just the right place and just the right time to prevent a lifetime’s worth of suffering for a baby already born into a hard existence. If we had not been delayed by bad weather and bad fuel on the way from Honduras to Haiti, we would have arrived and departed Petit-Goave for Cap Haitian weeks before the baby was born…and when we finished working around Cap Haitian and returned to Petit-Goave, we would have found a blind 1 month old baby.
Life tends to unfold on schedule…not always the schedule I want, and most of the time I never get to know why things happen just the way they do. But sometimes we get a glimpse of a purpose…sometimes what we endure in life makes sense after the fact, and every moment of struggle and frustration and discomfort and fear during the voyage here suddenly became a price I would pay a hundred times over if it meant being able to be there at that exact moment with everything necessary so that baby will get the chance to grow up with both its eyes working.
Dr. Holly saw the baby and when I wandered over to investigate and the problem became
We strip excess packaging from what we bring aboard; this is the total trash generated from a clinic with 80 patients (including ultrasound and two small surgeries)
clear, I though “Ahhhhh….so THAT was why we had to go through that crossing.” If we saw not a single other patient there are people who would say the journey was wasted…the old numbers game; people always want to know how many patients seen (over 5,000 so far), how many vitamins (over a million given away so far), etc…and those numbers are important in making sure the investment of resources is not ‘wasted’…but when I get a patient like that baby, the numbers become meaningless and that one patient becomes, for a moment, your whole reason for existing at all.
To that baby and her parents and to me, it seemed pretty worthwhile that we were there and equipped to help…and we see hundreds of people like this, whose paths cross ours at crucial moments when only a small intervention is necessary to change a life forever.
And with each such patient, our lives are also changed forever and a memory is created that I know I will playback to myself many years from now when my adventuring days have ended and smile and wonder how that little intervention in time played out on the world’s stage ove the years. I’ll likely never know–the years-later effects of what we do aren’t ultimately up to me, but I’ll always remember that we were able to help give people a chance at better lives and futures, and no one will ever be able to take that away from us.
Sunset behind us as we ghost east in the bay of Haiti on our final leg to Petit-Goave
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Part 3 of Our Transit: Cayman to Jamaica
Trouble ahead...out of nowhere
We departed Grand Cayman on a beautiful sunny morning, anxiously clearing past
Left: Polished Fuel; Right: Same Fuel as It Came Out Of The Hose In Roatan
the eastern end of the island and waiting to see if an unexpected northeast swell would devastate us, but all seemed tranquil with gentle 1-2 foot seas and clear skies. With the calm water, our fuel (having already been filtered through 10 of our filter cartridges) wasn’t sloshing badly, and our port engine was running smoothly. When it did require a filter change it was comfortable to drift forward for ten minutes while we changed filters.
The next day, as we bore further south, we started to take the wind just forward of
Holly Steering In Rough Seas
the beam. We shook out the sails, gaining another 2.5 knots to the port engine, but as we came within sight of the western tip of Jamaica, waves wrapping around the north AND south of Jamaica were building and converging on our position at 45-90 degrees to each other, and building fast. As night fell, we were well east along Jamaica but still 50 miles offshore, having worn south to use the wind longer. We turned east and pulled the sails down, securing the ship in anticipation of yet another nasty sea coming…and we were not disappointed.
Sky trying to keep her back together...
The seas came round close to the starboard beam, and the period shortened as we drove dead into the wind. Fuel started sloshing, and we soon found ourselves dead in the water as the port engine sucked up the sludge that was our fuel. Frantic filter changes continued, with increased urgency each time as we bore closer to the lee shore. We downloaded a weather report through our satphone (tough to hold the antennae southwest in that sea state) and realized that, once again, unexpected bad weather (11-12 foot seas and 35 mph winds) were coming to the windward passage, and we knew that we would be very, very lucky to make it around Jamaica’a eastern tip and pull into Port Antonio on the north side.
As day broke, Sky and I made the decision to divert to Kingston, which we might be able to reach before dark.
Getting stability and 2.5 knots extra from the sails...
As we approached, we were not able to raise any of the Jamaican officials. It was a public holiday. We raised a local boater on VHF who connected us with a retired Evinrude dealer, who lived up the mountains and monitored all marine radio traffic. We rendezvoused with the first boater at a small cay off Kingston. He lent me a chart and pointed out the unmarked location of the
Making An Electrical Repair When He Should Be Asleep...But Has No Choice
customs area, a small unmarked anchorage, and the Royal Jamaican Yacht Club anchorage, also unmarked and uncharted. Then, our new friend Tony Tame up on the mountain contacted the customs, immigration, health, and port officials, and we made our final, hair raising approach past Wreck Reef’s dangerous lee shore into Kingston’s main channel and the protection of its harbor…what a relief.
Talking To Ensley, Carib Maritime's Master Mechanic About Where To Find Parts
Within 2 hours we were cleared in and allowed to proceed to the yacht club, where we dropped anchor and collapsed asleep. We then spent 24 hours on reconnaissance; getting a Jamaican sim card and number for the blackberry, finding and calling stores that might carry the parts we needed, finding and arranging transport into town to search for what we need at stores we had already
Ed, source the fuel filters, assembly and additional parts...
contacted. The kind master mechanic and master engineer from the neighboring Carribbean Maritime Training Institute drove us all over town and helped us figure out where to find what we needed. Within 72 hours, we had obtained and installed all the parts that we needed to repair our engine systems (and incidentally, our alternator) and had polished the 400 gallons of diesel in our tanks…opening each of the three tanks’ access hatches, pumping out and filtering all the fuel, scrubbing and vacuuming the sludge from the bottom and then re-sealing the tanks. We finished at midnight, took on fuel the next day and then were invited by the yacht club to wait for weather at their dock.
Borrowing Luther's Fuel Polisher
What a relief! Tied to the dock, everything is easier, and anchor watches don’t need to be set. It will be hard enough in Haiti; it is great that everyone might get a chance to rest now. The weather is driving us crazy…there is a huge high pressure system over the east, sending howling winds down the Windward Passage, and a SE swell meeting it…it is nasty there, and we are heavily loaded with IV fluids.
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Note: This is Part 2 of the story of our voyage from Honduras to Haiti
Awesome!!
First, I will say that the first 48 hours of this crossing from Guanaja to Jamaica will remain with me forever as two of the greatest days I have ever spent on the water…so good that even at the end of the second day, we said to each other that we would surely pay dearly for the day we had. And pay we did…I wish we had pictures of the madness that ensued when things turned from paradise to misery, but by then we were working too hard to remedy our situation, and too sick, to pick up a camera.
Those first 2 days, however, we cruised at 7 knots over a glassy Caribbean sea, with clouds reflected in it, catching fish after fish—dorado, tuna, wahoo, longbill spearfish, blue marlin at sunset, barracuda, grouper (when we passed over the reefs of Swan Island on the morning of the second day) and Jacks. One of the most epic and beautiful days on the water ever—but it meant that when I was off-watch (I had the con from 12-4 AM/PM), dawn was just coming so two full days of catching fish almost hourly kept me awake all day, catching only an hour or two in the evening after dinner.
Sky Directing The Reef Passage
On the morning of the 3rd day, I went to bed around 4:30 AM after my watch, but since my bunk is in the forepeak I feel the seas pretty badly when we are pitching, and I woke to hell…a wild sea, and a cross sea with the wind out of the northeast and the swell from the southeast. We strapped everything down and bore down dead ahead, climbing up the faces of the swells and coming down hard; Southern Wind handles seas on the bow pretty well, but this Caribbean sea is like a bathtub! Every sailor I’ve talked to says it is choppy, unpredictable, subject to sudden changes in weather, and watching the 3rd day of this supposed 7-day weather window dawn to whitecaps and a short cross-swell makes me long for the long rolling groundswell of the Pacific.
Our journey probably would have been merely miserable but uneventful, but 60 miles south of Grand Cayman
Ed Calmy Maneuvering Through The Narrow Slots
and only a day and a half from Jamaica, bad fuel we took on in Honduras (the worst I have ever seen…might as well have put gutter water in our tanks) started sloshing in our tanks and our fuel filters soon became clogged…Ed and Larson spent hour after hour in the engine room shutting down one engine at a time, changing filter cartridges (good thing we stocked up in Roatan with enough to last—we thought—6 months), until one of the canister cartridges grew so hot the metal fatigued and broke, disabling the starboard engine (to run it unfiltered, as we then rigged it in case of emergency, would have seized all our injectors and the engine would have been much more damaged).
Noah Changing A Light Bulb
When the port engine fuel filter clogged again, as we struggled to change it in the heaving engine room and reprime the fuel system, we turned beam onto the seas and started to roll. I threw lawn chairs tied to heavy lines off our bow to act as a sea anchor and hold our bow to the weather, and Noah, Dr. Holly and Randy worked to bring the sails up as we turned north to try and make it to Cayman. Sky raised a nearby freighter on the VHF, whose radio operator relayed our position and situation to Cayman port authorities and USCG Miami, and the Jamaican Coast Guard. The freighter stood ready to divert and take us off if necessary, and Sky contacted USCG directly on Satphone to update them with our position and situation in case a major rescue should become necessary. It meant a great deal to us that the freighter was willing to divert and rescue us if our ship had been lost; when we were in Roatan we saw a captain on another ship be told by the owner NOT to divert to help a sailboat that had gone up on the rocks on a channel entrance; the captain was very shaken up by this as he felt it was very, very bad karma. The law of the sea is the ethos of Floating Doctors…always stop and help, since you never know when it might be you on the receiving end of assistance
However, because I have a ship that refuses to give up fighting and a crew that can tackle any challenge and
A Fresh Steel Pin Goes Into Place...
function even under horrible conditions (even if afterwards we all have a series of quiet heart attacks and have lost weight from vomiting), we refused to give up the battle and with the wind sustained at 25 knots on the beam, the sails stabilized us (I immediately felt it in the engine room) and for a while we made 4.5 knots under sail alone (so much for the skeptics! We may not have all the sail Southern Wind had before her mast was shortened, and she’ll never be a racer, but she was a champion that day).
Repairing A Broken Bolt On Our Spreaders From Being Shaken So Hard
One the sails were up and I saw that we were making headway safely (if slowly) toward Cayman, I don’t remember much more for the next few hours as I think someone made me go lie down. One of the last things I remember is that the port engine had just been restarted (had to be re-primed with fuel every time the filter clogged) I think, and I put my head down on it in the engine room to fall asleep. It was awesome to make the transit with other captains onboard…otherwise I would have had no choice but to remain awake and functional (the most dangerous scenario faced by solo long-distance sailors). I was pretty dehydrated (had had no water for almost 24 hours, had been vomiting, had not eaten for 2 days, and had been awake for almost 4 days…Ed and Larson (and all of us, really) had a similar experience, and we were crazed when we finally pulled in sight of Cayman.
Holly and I brought the boat the last leg to Cayman and Holly (what a trooper) took the helm and let me sleep a little as we stood offshore, waiting for daylight to make our final approach to dock and clear in at Grand Cayman. We knew a mooring was available free, but first we had to visit the customs dock to clear in before we could move to the mooring and finally relax and sleep. I must have looked wild-eyed in the Port Captain’s office but they must be used to it as we cleared in with no difficulty and got onto the mooring asap.
Nick With Bags Of Sludge-Soaked Diesel Filters and Rags
We spent two days in Cayman waiting for the weather to open (or so we and various government and commercial weather prediction services believed it was going to), made a few repairs and tried to recover from the mess and shock of our previous crossing. We didn’t see much of Cayman (saw a lot of the inside of our engine room!) but the water there was beautiful, and it was a shock to be somewhere with good services available. Our next departure, we thought, would see us arriving in Port Antonio, Jamaica to take on some fuel and fix our broken fuel filter and tie up to a dock one last time for a night before crossing the Windward Passage and beginning our mission in Haiti (where we will likely be anchored in poor holding ground of uncertain depth, and it is impossible to completely relax).
The starboard engine could be used in an emergency (though it would surely soon seize if it had to be run), and
Sunset In The Caymans
the port engine was functioning adequately to make it to Jamaica in good weather. Repairs were more practical in Jamaica, so at the next weather window we sailed for Jamaica on a calm, flat day…that was not destined to remain so for long.
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Holly and I finally face the task of completely clearing out, organizing, and restocking our medical go-bags
This week saw the first heavy, 3 day long pouring rain for several weeks (of course, while we are trying to load the boat and finish our preparations for departure) and the tying off of many threads we have been following for months…we closed up our clinic in Oakridge, packing everything up and saying hasta luego a mi pacientes. Un momento muy difficile. Thank goodness we plan to return to open the clinic permanently as a satellite clinic, open every day with a doctor and staff on site even when Southern Wind is working elsewhere. Knowing we are coming back after this voyage, and knowing that with what we learned and the relationships we forged on Roatan, we can and will open that clinic, makes it much easier to say farewell. Instead, we say (we are going to Haiti, after all) aur revoir.
We finished off a lot of rainy day projects inside the boat (there are always, always more
Capt. Ed cutting a new gasket for our 671 GM engine pan...doin' it old school
projects), and got down to the business of prepping to load—that means taking every item out of its storage onboard, condensing everything, repacking all our medical go-bags (thank you Dr. Holly!), and most important: we took delivery of our 5 pallets of material left over in Miami from our last mission to Haiti (thank you Gary, Donna, and everyone at Roatan Rotary!), and our 40-foot container from Direct Relief International, packed with medicine and equipment for the clinics in the island and distributed the material to 5 clinics and the public hospital on the island.
And the unloading begins...
This is a crowning moment for Sky. To get this container in, it required over 1,000 emails between Sky, the shipping company, Direct Relief International, Joseph Natale from Fundacion Heart Ventures, the customs office, the customs broker, Roatan Rotary, a cross-country trucking company and a local trucking company in Miami and another in Roatan, the warehouse in Miami with our 5 leftover pallets, the Ministry of Health in Honduras, 6 different clinics on Roatan, and Cepudo (a Honduran NGO on the mainland).
Roatan Public Hospital emergency room with the floor up to fix the backed up sewer
The difficulty is not in sending down material—anyone can order a container and have it
Gary and Sky picking up the pallets Rotary helped us bring in
shipped down here…but not without enormous import fees. It is sending down material and getting it cleared through customs as donated material without $30,000 worth of customs duties applied that is difficult, not to mention that we wanted to create a conduit so that we could send containers on a regular basis. One time is easy…to set it up to be sustainable is way, way more difficult. It took more than anyone else will ever know to get it set up by Sky, but I will always know and always be impressed how much the people you already love and admire can still amaze you.
Holly checking the pile earmarked for the Pandytown Centro de Salud
In a few months I will begin contacting the clinics again, finding out their needs and getting another request for DRI and container number 2…
Our staging area for the distribution to the clinics--thank you Gary and Donna for letting us use the tents!!!! Lifesavers!
Our aid station at the triathlon finish line
In the midst of all this, we still see patients, provided the medical service for the Bay Islands Triathalon (including the kayaks monitoring the swimmers during the first leg), and Dr. Holly—whose training
heading out...some swimmers were really struggling, and a few got lost and started to swim to Guatemala, but thankfully no one went under and didn't come back up
includes major scene accident management—provided 2 days of training for the Fire Department, following up the training provided by our volunteer Sirin last year.
Maintaining head control as Johel comes out
Dr. Holly showed the firemen a particular extrication trick—when you have a patient with suspected spinal injury from a car accident, you can extract the patient through the back window by lowering the front seat, sliding the board in through the back window and taking the patient straight out. Since we have the use of Gary and Donna’s open jeep, we could simulate the extraction without having to smash a car’s back window. We are nothing if not adaptable.
The weather is looking good for this weekend (pouring rain now)…high pressure pushing down, maybe keeping the low centers at bay over our projected route. Loading the IV fluids tomorrow and the next day…Finish securing the boat for sea…provisioning….and a last good night’s sleep.
Then give me that horizon.
Photos of patients used with patients’ express permission.
Photos of unloading and interior boat construction (pretty much most of the nice-looking photos) courtesy of Dan Chomistek
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BE WARNED: THIS BLOG CONTAINS A REAL PATIENT HISTORY OFFERED FOR ADVICE AND SUGGESTIONS, WITH THE EXPRESS CONSENT OF THE PATIENT. THE DETAILS AND PICTURES OF THIS CASE, A PARASITE CASE, MAY BE GRUESOME.
How Does Sky Feel About Getting Our Stuff?
Today during a scorching sunny afternoon, Christmas came the Southern Wind–here’s how:
When we first left Miami for Haiti, we left behind 5 pallets of additional medication and supplies that we could not fit onboard. We planned to return to Miami and pick them up after finishing in Haiti, and then continuing on to Central America.
From Haiti, we connected with Clinica Esperanza and Barefoot Cay Marina in Roatan, so
Holly learning to work with composites during a hull repair
we came directly here instead of going back to Miami. We saved a lot of fuel and time but it meant we had to ship our pallets here to Roatan. Fortunately, Gary and Donna Evans arranged for Roatan Rotary Club to sponsor the shipping by providing part of Rotary’s yearly donated shipping allotment from Hyde Shipping here on the island. We also had to coordinate someone willing to drive a truck from the warehouse in Miami that was kind enough to hold our supplies to the Hyde Shipping warehouse in Miami…all the while seeing patients, planning our Haiti mission, fueling, securing the boat for sea, coordinating our 40-foot container from Direct Relief International for the island clinics and for Haiti. It has been BUSY.
Cots For The Moms In The Pediatric Ward Of The Hospital...They Sleep On The Tile Floor Next To Their Child's Crib
However, health care is always our primary mandate, and when we are in danger of being overwhelmed by everything we have to do, we ask for help. Especially any clinicians reading this, this patient has suffered significant symptoms for months and has given permission to post his case for review by any of our medical followers.
Please post comments or questions for more details about the case directly on this page where we can all see them and brainstorm together. All posts are visible only after review and approval by Floating Doctors to protect patient dignity and confidentiality.
Patient: 27 year-old Caucasian male; 6’2”, 180lbs
*No prior medical history of note, no medications, no allergies
*Basic Exam:
- Cardio : BP: 125/85, HR 74 (regular)
- Respiratory: Lungs clear, good air entry across both fields, no creps/wheezes
- GIT: Abdo soft and non-tender, non-distended
The patient had spent 7 months in Honduras working as a volunteer co-pilot on a non-profit emergency helicopter service, with frequent trips to the mainland while transporting patients.
If This Is A Worm, What Is It?
3 months ago, a few weeks before his return to the US, he had complained of occasional vague stomach cramps (sometimes acute) and diarrhea. The night before returning to the US, he took a single dose of albendazole and subsequently had what he referred to as an episode of extreme cramping and “explosive worm diarrhea.” The worms he described were 6-8 inches long and very mucous-like. He continued taking a daily dose of 400mg of albendazole for the next few days, but continued to pass similar worms. He went on a strict fruit diet, eliminated fats and although the symptoms seemed to lessen he still passed stringy worm-like strands, some longer than 12” (in the initial days of treatment). After several days, he went to his local doctor and subsequently sent this email:
“I went to the doc yesterday and got a scrip for Flagyl. I never saw the doctor but the nurse
One of the Worm-Like Strands The Patient Hsas Been Passing
talked to the doc and he prescribed it. I’ve been on it for, now, two days. I’m coughing up some terrible stuff. One time (within the last week), while in the shower I blew my nose in my hands. In the mucus there appeared to be a worm about 1/2 inch long. It was either a worm or the most congealed mucus I’ve ever seen. Figuring I was exhibiting symptoms of hypochondria, I chalked it up as my mind playing tricks on me. Today, about a week later, after taking the Flagyl for two days, I’m coughing up some horrible stuff, which looks similar, but not exactly the same, as the worms in my stool. It’s stringy, if stretched out about 6-8 inches long. From what I’ve ever seen, mucus isn’t generally this stringy with elastic properties. When running the sink full of water, swirling one around rinsing it off, and then picking it out of the water with my finger, it’ll run over my finger like a spaghetti noodle would. It doesn’t look like a spaghetti noodle, (much smaller in diameter) but acts in a similar fashion when running one over your finger.”
He augmented his treatment with Pyrantel Pamoate equine anthelmintic, taking the same dose as for a 250-lb pony (900mg) daily for three days off 4 days, then repeating, and was also prescribed mebendazole 100mg twice daily for three days, then 4 days off, then repeating the regimen for a month along with the flagyl (metronidazole). He also ate enormous amounts of fruit and had a colonic irrigation (though he saw no worms come out during the evacuation, only the next day), and is taking 15,000mg of garlic daily.
He has not had blood work or an ova and parasites study (stool sample). He has been advised to collect one of the worms and bring it to his hospital or GP for parasitology, and to have a full blood count with differential to look for raised eosinophils. Results will be posted as soon as available.
Dead And Partially Necrosed Worm? Mucous Strand? What?
The ‘worms’ pictured do not look at all typical. Could they be some kind of mucous shedding of the intestine post infection or from the treatments he has given himself…even the garlic? If so, what about the episodes of coughing and similar, smaller mucous strings from his nose? He has tried most of the heavy-hitters for parasites…even horse worming medication (not on my advice!).
Does anyone recognize these as worms or other pathology, or have suggestions for further treatment or investigations? The patient has no medical insurance so cost will be a factor in patient ability to comply with investigations. Taking the worm to a doctor so it can be sent to a specialist and analyzed if necessary is definitely the next step, but any advice or ideas would be appreciated.
Our 40-foot container from Direct Relief is supposed to be cleared through customs Thursday!
Waiting At The Customs House Desk
Then we can distribute everything, load the boat and depart at the first weather window to Jamaica for fuel and back to Haiti!
All Photos (Except The 3 Worm Pics) Courtesy of Dan Chomistek
