Wednesday, December 12, 2018

Ice Cream and Superheroes


It was so wonderful this year on my birthday, that the staff of Hôpital L’Eglise de Dieu Réformée not only took the time to repeatedly wish me “happy birthday”, but were so kind to bring me my favorite foods, complete with a whole quart of ice cream.  I am so spoiled!  They presented their wonderful gifts and left me to enjoy my meal in the relative quiet of our office.  It was a great time of reflection.

Earlier in the day, as I was in my office, a group of 3 ladies came to my office door with referral sheets from another missionary medical group who refers patients to us.  I pointed them in the right direction and explained to them how to check in and see the doctor.  The other missionary group had kindly paid for their visit so they were making sure that all was in order.  As they scurried off to their appointments, one of the ladies held back and seemed to be a bit befuddled by the instructions.  She was very diminutive, quiet and demure.  Her clothes were dirty and tattered, and her teeth were black with decay.  I asked her if she understood and she incorrectly described the directions. 

As the story unfolded, she had only shared a ride with the other ladies but really didn’t know them as she had come from farther up in the mountains than her comrades.  She showed me her referral sheet and said it was for her son who was in her arms.  As I glanced at the sheet, the name, age, height, and weight of the little guy was listed along with a simple note that said “malnourished.  See Dr. Mark”.  I took my first good look at her son and noticed his mismatched sandals, too large brown shorts and his too small “Incredible Hulk” flannel pajama top.  The sleeves were long enough to cover his elbows but didn’t come close to his wrists.  The area around his middle was too small to be buttoned due to his swollen belly.  His hair was non-existent and his size was way below average for his 2 ½ years of life.  Mom and he stared at me as if to ask “what’s next?” so I thought I might give them a bit of personal help to navigate our confusing maze of check-ins. 

One of the staff members helped them to check-in and they were placed in the queue to be seen by one of the pediatricians.  After the usual long wait (we are “first come, first serve” for outpatient services), Mom and “Hulk” again found me in the ER and without speaking, gently handed me the prescriptions for blood work, a chest film, and some meds.  Mom was unable to read them, and once again very politely asked me for some help.  After navigating them through x-ray and the lab, they went back to see the pediatrician for a more definitive diagnosis and a plan. 

Staff seeing a child in the malnutrition program
After another time lapse, Hulk’s mom found me in the pharmacy.  The pediatrician had suggested that Hulk be admitted, but mom said she needed to get back to the rest of her family.  I told her that it would certainly be in his best interest to stay and be cared for by us, and that without the help he might be in danger of getting worse and even succumbing to his physical problems.  She paused and said that the pediatrician wanted Hulk to be part of the malnutrition program, which monitors at risk children twice monthly, and provides some basic nourishment and necessities for them.  The next time the program occurred would be the following week, so she and Hulk would return at that time.  I argued against the delay as Hulk really needed to stay.  Unemotionally mom stated that he would be ok, even though he was too weak to stand for long by himself, and that he had been that way for awhile.  She would not be able to leave him behind or stay with him.  The group had provided a little money for her to get back home, so she left, with a very polite “mèsi” and said that she would see me next week.

So as I sat in my office with a big plate of my favorite foods, waiting to devour a whole bunch of ice cream, while the memory of my birthday with Hulk and his mom were haunting my office. Knowing that this little guy was just one of many I have seen with similar stories made the meal a little more difficult to swallow and generated a time of reflection, a time of gratitude, a time of prayer.  I don’t understand the inequality that life presents sometimes, nor why I have been given what I have been given.  The irony of such a little guy having an Incredible Hulk shirt didn’t escape me on my birthday and that produced a grin on my face.  As another chorus of “Happy Birthday” was presented by a staff member, I was overwhelmed by the blessings of my birthday, including a visit from a tiny “superhero”.  I pray that someday, on his birthday, Hulk will have all of his favorite foods in front of him, be surrounded by friends and his loving mother, and know that there is an eternity ahead when all of this inequality will be made “right”.

I sure hope I get to see you again next week, Hulk!  I’ll be waiting!
This was written on October 31st, Dr. Mark’s birthday, and since then the little Hulk did return, but in worse condition.  After some exams and blood work, they found that again it would be in the boy’s best interest to be admitted.  The mother agreed but was unable to provide any money for his stay.  Because of our generous donors, we were able to cover the cost for Hulk’s testing and time at our facility.  He is still at the hospital and we pray he continues to improve each day.

Friday, November 2, 2018

Such a Simple Thing: Water


“We don’t have any water!!!”
For the last few months, this statement has been uttered many times at the Hôpital L’Eglise de Dieu Réformée.  From bathing patients to mopping floors to flushing toilets to doing laundry, hundreds of gallons of water are being used each day.  One day, as I (Mark) entered the hospital, one of our OB/Gyns met me at the door, and announced:  “I have just finished my second C-Section, and have been using alcohol, bleach, and hand sanitizer to clean myself up.  If we are to continue, we need water!!!”
I could not and cannot argue that point.

Since the days of opening as a small clinic in 2005, the Hôpital L’Eglise de Dieu Réformée has been blessed by Missionary Phyllis Newby’s generous spirit and her sharing of the water provided by the one well on the property.  As the demands for water increased with the growth of the hospital, it has become necessary to regulate the water from that well to the hospital so that Miss Phyllis will have an adequate supply for the more than 60 people living under her auspices.

First Attempt to Drill a Well
There was no question that a new well needed to be dug, and we could tie it in with the other well on the property so that it could serve as a back-up for the water needed for Miss Phyllis’ needs should a problem arise. So the search for water began.  It seemed like such a simple request.  In early August, a fellow missionary, Nicky Runk, came to the Church of God property where the hospital is located and began to dig for our much needed liquid “manna”.  With the rocky, sandy terrain, the drilling was difficult and after a few hours of digging and the breaking of parts of his rig, Nicky was forced to abandon the project until at least November of this year. After reiterating that the area of Saintard is a difficult area to dig, Nicky’s advice was simple:  “Pray for water!” 

..but again, the battle cry at the hospital became louder “We are out of water and we need water to work!!”

Second Attempt to Drill a Well
After several weeks of prayerful searching for a qualified well driller, one was identified, a contract was signed, and drilling began again in mid-September.  After a few weeks of digging, and multiple broken parts, the Haitian well drilling team stated that they were not sure that water was available where they were digging and they felt that abandoning the site would be better.  Within a few days, they and their equipment were gone, and we were unsure of if and when they might return.  Hearing of this, I contacted Nicky Runk again and with his God-given determination and prayer, he agreed to return to try to find water again in November. 

So, again we waited, and again heard the frustrated statement:  “We are out of water!”
After a long two weeks, the Haitian company returned with another well drilling rig, borrowed from another company.  The man in charge said they would try one more time.  They began again.  Finally passing through the so-called impenetrable shelf of rock and surpassing 200’ deep, the group still had doubts of finding water.  Prayers were lifted in the Saintard community, in the US, and by friends in so many places, but water was still not found.

Last Sunday, at around noon, I received a phone call from the hospital.

“They found water!”

I never thought those words would be so exciting! 

“Not only did they find water, but the flow rate is about 16 gallons per minute.  They said it was like a river.”
The Water Tower Being Built
I wish I could say “I never had a doubt” but that would be lying.  I wish I could say that I never had a moment of discouragement about this:  False.  I wish I had more faith.  I can only say that I trust my Father in heaven and I never stopped praying for His will.  I am thankful that His will included some water for our little hospital.

He provided water.

As we begin construction of a water tower, within a few weeks, we should have a good supply of water at the hospital.  Until then, when I arrive at the hospital and I hear:

“We are out of water!”
I know that it is temporary….and I smile.

The whole Israelite community set out from the Desert of Sin, traveling from place to place as the Lord commanded. They camped at Rephidim, but there was no water for the people to drink. So they quarreled with Moses and said, “Give us water to drink.”

Moses replied, “Why do you quarrel with me? Why do you put the Lord to the test?”

But the people were thirsty for water there, and they grumbled against Moses. They said, “Why did you bring us up out of Egypt to make us and our children and livestock die of thirst?”

Then Moses cried out to the Lord, “What am I to do with these people? They are almost ready to stone me.”

The Lord answered Moses, “Go out in front of the people. Take with you some of the elders of Israel and take in your hand the staff with which you struck the Nile,and go. I will stand there before you by the rock at Horeb. Strike the rock, and water will come out of it for the people to drink.” So Moses did this in the sight of the elders of Israel.

Exodus 17:1-6

Saturday, September 1, 2018

Today I Cried


Today I cried.

I am generally a pretty stoic person.  I actually have been described as “Spock-like” because in the battle of emotions versus logic/facts in decision-making, logic/facts wins every time.  It is not because I don’t feel things. I do.  But when it comes to making decisions, I was raised to believe that feeling should be taken out of the equation.  Weigh the facts.  Dwell on what can be logically accomplished and push forward.  That is how it is done.

…but today, I cried.

Our journey given to us in Haiti is filled with terrible heartbreak nearly daily as we work in healthcare and see some horrific situations.  To share a part of the journey with you, a couple of weeks ago, a bad accident occurred about 200 yards from the road which enters the driveway to the hospital.  Fifteen people were killed instantly as a small passenger-carrying truck went underneath a bus.  Several of the victims were beheaded.  Our ambulance transported 3 others from the accident to the hospital: one had severe injuries which led to her death soon after arrival, one was stabilized and transferred to another facility, and one had minor injuries as he jumped off the truck as it was crashing.  The day after this accident, a 3 month-old baby who was awaiting a surgeon to come from the US to get a heart defect repaired didn’t survive the wait.  Her dad works at our hospital and we had journeyed with the proud dad as he and his wife celebrated their new arrival.  Once the defect was found and the baby was transferred to another larger facility in Port au Prince, they said they had a surgeon coming in a few months to fix the defect.  Feeling that may be too long, a few phone calls made it possible for a pediatric cardiologist to visit in just three weeks to do the surgery.  We were all thrilled.  She passed away about 10 days prior to his arrival.  These things broke my heart.

…but today I cried.

Situations continued to occur: telling a caregiver that her hydrocephalic child really must wait for the surgical team to come and there was not much we could do until then, and then hearing that the child passed within the hour; a continuous stream of motorcycle accidents with severe injuries; special needs kids with nowhere to receive help; malnourished kids who passed away in spite of everyone’s efforts; and yet another child who arrived unconscious while awaiting surgery in Port au Prince and we transported her.  All of those situations tore my heart and made me sad. 

…but today I cried.

Today started normally and really the events of the day were no better or worse than any other day.  When I arrived at the hospital and looked in the ER, there lay a 64 year old lady, who had suffered a heart attack.  She was struggling for breath and even with a strong flow of oxygen her levels were not great.  She had been given the appropriate meds for her condition but she continued to struggle.  We felt she needed to be transported and made the appropriate arrangements, got the O2 tank ready to go, and prepared to load her in the transport vehicle.  At that point, the family decided that they really could not afford to pay at another hospital.  We said we would waive all fees from us, and just get her there.  The family stated that they would care for her at home and as she passed they would be there.  After all, they said, she was elderly.  The view of her being loading into the back of a pick up truck with sheets wrapped around her, as we unplugged her oxygen was not one I wanted to have.  She struggled for breath, and fell semiconscious on her make-shift mat as they drove off. I stood with my staff as they drove off, praying for her and her family and shaking our heads at the choice.  That was terrible, and made me heartbroken, but not tearful.

I walked into the inpatient area and talked to a first-time new mom, cradling her newborn who had entered this world eventfully with an emergency C-section the night before.  Our OB had done a great job.  The cute little guy was blessed to have such a loving parent cradling him.  I walked away sensing her joy, went into my office.

Then, I cried.

I am not sure why that was the moment after all of the rest of the events that caused the tear ducts to produce.  I don’t know why this moment was the one. Maybe the “circle of life” had been seen.  Maybe there was a cumulative effect.  Maybe I am getting soft in my old age.  I don’t know, but,

Today, I cried.

It somehow felt cathartic and somehow after pulling myself together, I re-entered the healthcare playing field.  After all, Jesus wept, so I guess it was ok.  I went downstairs in time to see a little boy with a high fever having some (presumably) febrile convulsions.  I watched the staff do the right things and readied myself for the next challenge.   Maybe today was the day that for that one moment, feelings trumped logic.  I am not sure of all of the details, or the “Why”s, and “How”s but God jumped in and gave me a little alone time and break.  It may not happen again, or it may, all I know, is that ,

Today I cried.

Thursday, July 19, 2018

Disturbing Dilemmas


The man in his mid-thirties hobbled up the ramp at the hospital in Saintard, and asked the security guard if “Dr. Mark” was available.  When summoned, I met the gentleman who was sitting on a bench beside his friend, with a pair of crutches resting across both of their laps.  After he introduced himself, this kind man who lived several hours from our hospital said that he had been referred to us by a mutual friend to determine if we might offer him some advice and/or help. 

His story unfolded that a motorcycle accident six months prior in Port au Prince had left him in another hospital for a couple of weeks.  Afterwards, his fractured leg had not healed correctly.  “Is this something your hospital might be able to help with?”  he asked.  “Maybe”, I sheepishly responded, knowing that I was not an orthopedic surgeon, nor was I an expert in long bone fractures.

After a quick exam and x-ray the problem was obvious.  Both bones in the lower leg (tibia and fibula) were fractured and the fractured segments were about 3 cm (about an inch) apart.  His leg dangled when not supported, but somehow, his pedal pulse was still strong.  I sent a copy  of the x-ray electronically to our orthopedic surgeon on staff who said he could help.  I was thankful. 

BUT THEN came the statement that we hear multiple times every day: “Unfortunately, I have very little ability to pay!”  I understand this statement, especially in Haiti.  Of the thousands of patients who we see each year at the hospital, usually fewer than 10  (not 10% but 10 patients) have any type of healthcare insurance.  (Could you imagine if you needed to pay for your healthcare without any insurance?)  Part of our ministry here in Haiti is to help subsidize healthcare so that those who cannot afford it may be able to access it. Our organization helps with staff salaries, supplies and facilities, thus making healthcare not free, but more affordable.  We are so blessed and thankful for those thousands of patients who have been helped.  A surgery for the man with the broken leg (above) will have many costs.  The metal alone to fix the leg may be about $400 US, the anesthesia, the medicine, supplies, a modest salary for the surgeon and the staff to care for the patient, and the facility will cost somewhere around $2000.  Thankfully we can subsidize that to a large degree, so that the patient may be able to afford the surgery.  But what about the emergency C-section that came in later that day?  What about the lady who came the next day from the mountains with a fractured thumb that needed pins? What about the child with pneumonia who needs to stay at the hospital several days to recover? The demand is always greater than the supply, but whom do we treat and whom do we send away, knowing that we cannot help everyone?

So it is with these types of questions that we struggle daily at our little hospital.  I have been through many years of sitting in classes of various levels, but not one of them has provided an answer to questions such as these.  Mark Twain once said “I have never let schooling interfere with my education.”  I must say that my “education” here in Haiti is huge as we have some of the most stretching and growing experiences I can imagine.  Some things that I am learning:

1) God is in charge. 
There is no way that many issues in our lives can be logically, economically, or educationally reasoned away.  The only solution is to seek guidance Spiritually from the One who created it all.

2) Don’t expect it to make sense.
Things make sense only if we try to rationalize it from our level of understanding, not a higher level.

3) Keep trying.
While our treatment modalities and facilities are far from what we would like them to be eventually, we continue to strive to improve lives.  If we can do so in the name of Christ, then we can not only garner some relief in the moment, but the sense of hope for eternity in Him.

I constantly struggle with slowing down and keeping these “lessons I am learning” in the forefront.  I hope to do better... but right now, I am being summoned to consult with another patient who fractured his leg.  My education continues!