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.
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,
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.
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
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.
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
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.
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
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.
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Part 3 of Our Transit: Cayman to Jamaica
We departed Grand Cayman on a beautiful sunny morning, anxiously clearing past
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
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.
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.
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
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.
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
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.
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
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.
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
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).
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
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).
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.
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
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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Note: A month ago we departed from Roatan for a ten-day transit to Haiti, with a stop in Isla Guanaja to clear out of Honduras and a stop in Port Antonio, Jamaica, for fuel and a night’s sleep before the final 36 hours to Petit-Goave, our first destination In Haiti.
That was the plan, anyway.
The next couple of updates, written here in Kingston, will tell the saga of what happened and catch us up from Roatan to here in Jamaica…I have written them all in one go, and will post one a day till we are caught up.
March 1, 2010–Isla Roatan to Isla Guanaja, Honduras
We knew it would be an up-wind, up-current battle the whole way to Haiti, so we made the 40-mile run from Roatan to Isla Guanaja to clear out, and wait for a weather window long enough to reach the protection of Jamaica. When we got to Guanaja through 6 foot, choppy seas coming from the east, there was no room in the only protected anchorage and we anchored outside in the channel, where it
proceeded to blow hard from the E and SE for 9 days. We dragged anchor several times before finally putting out a second bow anchor, which seemed to hold, but we spent many hours at night watching our chartplotter and peering out at Dunbar Rock to see if it loomed any closer in the darkness than it had 5 minutes before as we bucked and swung on our anchors.
Our generator was not putting out full power; its regulator control board had finally failed (it had done well to survive the lightning strike at all) but Ed managed to coax it to produce some power by using an old cell phone charger, wired directly to the circuit board, plugged into a small dashboard inverter which he wired directly to our battery bank. Thus, we were able to excite the part of the generator circuitry that allowed the generator to produce power, but it would frequently get hot and fail and need to be reset.
It turned out that I had to fly back to Roatan on a puddlejumper with all of our passports to clear out of Honduras, and we also had several cases of vitamins, IV fluids, gauze, syringes, antibiotics, heart monitors, and other supplies to deliver to the health center on Guanaja. I went back to Roatan and got everybody cleared out of Honduras, and when I got back we connected with the director there and we arranged for me and Dr. Holly to help out in the clinic. Holly saw patients for general consults, and I did ultrasounds on some pregnant women and women with abdominal masses.
We also managed to revisit a patient we saw when we were there in October—the patient that we suspected had
elephantaiasis. With a tropical medicine specialist onboard, and armed with the opinions and advice of many clinicians (form as far away as Fiji!) who wrote to offer suggestions, we re-examined him and decided on a course of treatment that might at least stop forward progression of the symptoms by killing any active filarial worms, and Noah taught him a series of exercises and techniques to try and increase lymphatic drainage. The next time we visit Guanaja, I hope he will show improvement…at least no progression!
We endured the wind and anxiety of anchor dragging for 8 days, finally moving to the backside of the island and negotiating a narrow, twisting reef passage to an anchorage with some protection. We still dragged, but only a little, so we managed to have a semi-restful last night and in the morning the sea and wind died down to nothing and we nosed out through the reef passage and headed NE towards Jamaica. Little did we know that the calm glassy waters of our departure would not last for long…
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“The wind was a torrent of darkness among the gusty trees,
The moon was a ghostly galleon tossed upon cloudy seas,
The road was a ribbon of moonlight over the purple moor,
And the highwayman came riding,
The highwayman came riding, up to the old inn-door.”
All Stanzas from The Highwayman by Alfred Noyes
Alone out in the middle of the ocean this stanza repeated itself over and over in my mind. I was scared for this crossing—what I was leaving behind was not just the town of Petit Goave, but the me of before. The me before I was witness to a country brought to its knees, before I had to leave a boy that I knew was being abused by his care takers, before I gave my heart to an orphan I called ‘Cheeks’, before 3 teenagers worked their way onto our boat and forever into our souls, and before we had to leave them sitting in their small canoe watching as our boat grew smaller and smaller in the distance. I felt alone in the ocean- the vast expanse of open water echoed the void that all of those I left had filled. The last thing that I said in Haiti was “ Moi Matrin es Tris”—meaning, my heart is sad.
How I will reconcile all of these experiences is still unknown to me. I find my heart and head wandering around the streets of Petit Goave late at night now restless in the unknown. I miss Haiti terribly.
Our time in Honduras has already been so productive- we are spread out between three clinics on the Island while also working as the doctor and medics on Aeromedical a helicopter that flies emergency victims to the main land. I have already found my little boy love- his name is Oscar and he is a gorgeous 3 year old that suffers from Down Syndrome. He is the most incredible and rambunctious little soul- unable to speak but communicates in a way that speaks directly to the heart. It’s hard for me at times, I
feel his little body in my arms and can feel the same warmth and heart beat that was once my Cheeks. And I know that one day I will be holding another little one and think of my time spent with Oscar– each of them holding onto a piece of my heart long after they forget the details of our time spent together.
“Look for me by moonlight;
Watch for me by moonlight;
I’ll come for thee by moonlight,t hough hell should bar the way”
I wish that I could take each of them by moonlight- take them to a place where no pain or stigma exists- I wish that the my love would ease any burden- but I am honored to be the one that holds these little wonders, still so happy and full of joy no matter of the obstacles that lay in their way. My heart, I hope in some ways, will always beat in time with theirs.
There are no safety nets in what we are doing- not for us, for our minds, and most of all for our hearts. Each of the crew will carry the joys and scars of our experiences, we will carry those that are left behind with us until our hearts stop and our bodies are freed from the confines of this life. I am lucky to have heard the laughter of children playing in the rubble piles of Haiti, to have felt the hands of a Honduran boy unable to speak grasp my fingers while fighting his way up a flight of stairs, to have seen the ocean glow green on a moonless night in the middle of the Caribbean Sea, and to have done all of it with the finest group of people I have ever know.
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
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.
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).
The difficulty is not in sending down material—anyone can order a container and have it
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.
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…
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
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.
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
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.
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
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.
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
- 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.
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
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.
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!
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
Last week we had an awesome experience—in the midst of our last weeks of preparation for our mission to Haiti, we are continuing to open our Oakridge clinic. Pretty hectic—clinic by day, boat work by afternoon and evening, and computer work late into the night…but totally worth opening the clinic not only because we had a full patient list right away, but also because we had some very welcome visitors to the Oakridge clinic on Wednesday.
Optometrists from Manteca Rotary Club in California’s Central Valley came to our clinic
and provided prescriptions and eyeglasses to 40 or more people in one morning’s work. They were cool—came in, knew exactly what to do, had obviously done it before and saw as many people as humanly possible in the time allowed. Exactly the kind of group I love to work with; the maximum effect with the minimum fuss.
One thing that made their work really efficient was the little device they had with them—it was a Welch-Allyn device for scanning and identifying patients’ eye prescriptions. When I heard optometrists were coming, we pulled out and dusted off the traditional optometrist machine sitting in the clinic building we use, but the device they had with them made it
look like a piece of obsolete medieval torture equipment. Fred, the optometrist scanned patients, gave them their prescriptions, and Renee (the former club president) gave them their glasses—both reading and distance.
If one of those were on station somewhere for a month, I think it could do about 2,000-3,000 patients. That is an INSTANT, huge increase in someone’s quality of life. Apparently the units are affordable, easy to learn to use, and of course small and portable. We have GOT to try and get one of those.
It was great being back in clinic—plus, we have Dr. Holly with us as well. We picked her
up at the airport in San Pedro Sula on our way back from Copan. She is an Accident and Emergency Room doctor and Tropical Medicine specialist from the UK, and will be working with us for 3 months before joining the Flying Doctors in Africa. It was wonderful to have so much help in clinic; Donna from Roatan Rotary was with us, Sky was running the front desk, Noah was doing his Thursday physio sessions. I love it when the clinic is humming; ultrasounds and minor ops, consults…love it.
Our container from Direct Relief comes soon…can’t wait to distribute it among the clinics (and pack the 350 cases of IV fluids onboard to take to Haiti for the cholera relief). So much to do in these last
weeks…just like the first time, we went, except this time we have already done it and have substantially continued to rebuild our ship ever since we set sail. We are better equipped and more experienced than our first trip, and that was a success.
I am confident, a little scared (if you aren’t scared of the ocean then you have no business going out on it), and excited to return to Haiti. It’ll be an 800-mile, uphill (upwind and up current) trip but with the right weather window we can do it. Still have a lot to do first, but it is getting done every day…and probably will be right up to the day we leave!
Yesterday we returned from our first vacation in almost two years…the first time we have been truly out of contact (although we did have Sky’s blackberry) and doing something that was just for us.
Sky, Noah, me, and Dan from ‘Satisfaction Plus’ (our neighbor and erstwhile Floating Doctors cameraman), took the ferry from Roatan to La Ceiba on the mainland. We planned to go to Copan, about 400km inland up in the mountains and site of the famous Mayan ruins.
Oh, man…I don’t even know what to say. If you grew up watching Indiana Jones, and ever fantasized about
exotic ruins from ancient civilizations hidden in the dense jungle, then Copan is exactly as advertised. Skulls, grinning jaws, imposing birds and leering faces carved everywhere…tunnels dug by archeologists showing the temples buried beneath the pyramids…dead kings looking down onto the stone altar where human sacrifice was carried out, and the court where slaves played deadly ball games in which the losers were sacrificed at the end. We sat in the king’s seat at the top of the pyramid and strolled through the ‘Mayan Discotheque’ where the royal family and nobles of the court celebrated.
It was everything you ever imagined…totally and completely AWESOME.
The town of Copan was a beautiful little mountain town set in the geologically tortured hills along the Honduran/Guatemalan border…cobbled streets, red tile roofs. It was cool, without mosquitoes, and REALLY inexpensive. We were only there for two full days, but I could’ve stayed for a couple of weeks. Everywhere you walk in the jungle, mounds of collapsed jungle-covered rubble betray the site of yet another Mayan ruin not yet investigated (they have only found 5 of the tombs of the 16 Mayan kings of Copan).
On our second day, we drove 30 km down a really bad road (torn to pieces after the rainy season, took us an
hour and a half in a big pickup truck) through the narrow valleys of the mountains. We stopped at the Luna Jaguar thermal hot springs…I don’t know if I’ll ever be able to go in another hot spring without sneering in contempt…the most amazing hot springs ever.
A dozen or so rock pools on a steep, jungle covered hillside along a narrow fault through the mountains…boiling, sulfurous water at 176 degrees pouring from the rocks and into the rock pools and sending clouds of steam up through the jungle canopy. We lingered among the pools for hours, until after nightfall when candles were set out, then finally we tore ourselves away and drove back through the jungle night to Copan; leaving in the morning for San Pedro Sula to pick up Holly at the airport.
Holly is our new volunteer and is a Tropical Medicine and Emergency Room Medicine specialist from Liverpool. Holly will be onboard three months, and her timing could not be better since we are headed to Haiti. We got back last night and worked on the boat all day today; Ed is coming back tomorrow, Captain Randy is just back, and we have TONS of preparations to make before leaving.
The cholera epidemic in Haiti continues to kill…we have several other doctors and nurses meeting us in Haiti, and others continue to contact us
to see about coming. This is turning into a big collaboration between us, Partners in Health, the Cap Haitian Health Network, SIFAT (water purification systems), Direct Relief International—I’m excited to go back.
When we left for Haiti the first time, the essential systems on the boat were done but we have continued to modify and rebuild ‘Southern Wind’ a little at a time ever since we first left the dock, and this time we will be even more well-equipped than our first trip. We will be working along an area of over thirty miles of coastline, so we will have to be mobile and adaptable…and that’s what we designed our project to do. This time we may well have our team split up and working in several locations at once, so this is going to be a real challenge.
Plus, we also have a lot of patients still to see here on Roatan while we prepare for Haiti…going to be a CRAZY couple of weeks, but the countdown to Haiti starts today!
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All Pics For This Blog Courtesy Of Dan Chomistek
Medicine in developing nations is, most people would probably agree, substantially different from medicine in developed countries. Still, there are many aspects of the health care experience that seem to be universal, shared by ‘have’s and ‘have-nots’ alike. For example, the prospect of surgery under general anesthesia is daunting whether you are having it at the world’s most advanced hospital or in a temporary medical mission surgical tent.
And of course, men, women and children of all ages all hate getting injections (except for little old ladies, who—in every country I have ever worked in—take injections and other potentially uncomfortable procedures pretty much in stride). This week marks the end of our management of one particular patient whose experience made me think about the parallels in health care experience that are shared by patients worldwide.
One day a few weeks ago we had returned to the boat after a long day in clinic, and a 43 year-old
guy walked up to the boat asking if we were the medical doctors and could he consult with us. We invited him aboard, and I immediately noticed he was taking small, tentative, shuffling steps and was bent forward slightly from the waist, pressing his right hand over his bladder. He told us that 9 months ago, after several months of severe pain, blood in his urine, and repeated urinary tract infections, he had saved up for an ultrasound and they had found a great big 3 cm stone in his bladder.
At this stone’s size, open surgical removal is the indicated treatment, but he could not afford the 60,000 Limpira (about $3,300) charged by the private surgeon he saw, but the surgeon said he would make him a deal—he would do the surgery for 45,000 Lempira if the patient arranged for the surgeon to do it at the public hospital, thereby not using any of his own equipment and resources.
The patient DID arrange permission from the hospital to have the private surgeon operate there, but fortunately the patient came to see us (he had no choice, as 45,000 Lempira might as well have been 450,000; he had not worked for weeks and weeks because of his crippling pain).
I visited the public hospital to speak to the chief of surgery there, Dr. Indira Sanchez. She is a fabulous surgeon; the first night I dropped in to help in the hospital I assisted her doing an open abdominal surgery on a gunshot victim, closing perforations in the colon and removing and directly re-attaching a perforated piece of small intestine (total number of personnel involved in the entire surgery, including me? Only five people; patient did fine). She has great hands for surgery—sure, experienced, and capable. I presented the patient’s case to her, she consulted with him, and booked him for surgery only a few days later.
She gave him the orders for his pre-op blood work and chest x-ray (which he had to get at the private hospital because the public
hospital x-ray was not working), and he went straight out and got the tests all done, which we microfinanced. Then he came back to present his test results to one of Dr. Indira’s team, the doctor sent the patient back to Dr. Indira with his endorsement that he was ready for surgery (which we also financed), and two days later the patient had the stone removed in about 30 minutes under general anesthesia.
He recovered well, and is no longer in agonizing pain all day every day. In a few more days he can go back to work, after over 9 months of debilitating pain.
Pre-op blood tests and x-ray: $80
Open surgery for bladder stone removal: $20
Price for living without pain? Pretty hard to quantify, but it seemed pretty important to the patient!
The whole thing got me thinking about the complexity of health care, and how daunting it can be for a patient to try and navigate
their way through the system—DEFINITELY an experience shared by patients in the developing and developed world. Almost anyone who has ever had to use their health service, especially for something major, can appreciate the confusing nature of going from specialist to specialist, office to office, exam to exam, wondering when the whole process will finally be over.
This case was a classic example of one of the main roles now played by General Practice and Family Practice physicians—that of a guide to navigating the maze of specialists and tests and procedures available in an ever-increasingly complex health care system. As Medicine gets more and more specialized, it will become more bewildering for patients—especially for patients who do not have a wide base of health knowledge—to find their own way through it.
The patient gave us permission to document his whole experience; soon we will put out another short video focusing on his experience with a health care system. I think that people in any nation at any socioeconomic level will resonate some part of his experience with their own history of interactions with health care. Some aspects of being a patient appear to be universal…watch and decide.
In this case, the patient was unaware of how to try and arrange a public hospital surgery and our representation (based on the good working relationships we have developed with many clinicians here on Roatan) was key to the surgery being performed.. Although we assisted the surgery and post-op care, our main role here was simply to take a patient and help guide him through the whole process, making an overwhelming prospect (especially for someone acutely sick!) a smooth series of events resulting in the patient regaining his health.
The other primary role of the GP or Family doctor is to try and help keep their patients well enough that they never have to go to the hospital!
A real highlight of the whole experience for me is that it all happened when my mom and
Grandmother and cousin Ishan and his wife Maria were here visiting us in Roatan. These were the people who have been there from the very, very, very beginning, when Floating Doctors was a wild dream keeping me sane during months of freezing, dreary weather in Ireland, to the year of frantic planning and fund raising, to the year of rebuilding the boat, to Haiti and thence to the shores of Honduras.
Our families have been so supportive…without them this never would have been possible. I was very proud to finally be able to show them what all their encouragement and support made possible; it meant the world to me that they came all the way to Honduras to see us. Love to all of you–fair winds and a fast return.
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