Everyone Smiles In The Same Language...

Each trip I seem to have one patient who really touches my heart in a special way.  This time it was a little boy named Scheider.  On Sunday he showed up in triage at Medishare.  He had a low grade fever and a mild cough.  I examined him and he looked great at that point.  He was well hydrated, his lungs were clear, and he acted like a typical toddler as he fought against me when I looked into his ears.  I gave his dad a bottle of tylenol and told them to come back to the outpatient Pediatric clinic to follow up in a few days, but to come back sooner if he got worse.

Early the next morning somebody came to wake me up from my bunk because they needed me in the ED to see a toddler that had had a seizure.  I had seen so many kids the previous day that although I recognized Scheider and his dad right away, it took me a moment to recall exactly what I had seen him for.  I remembered the strong willed little boy who had fought against me when I tried to examine him the previous day.  Now he was a lethargic toddler who sat weakly in his dad's lap, with little response as we poked and prodded him.  He now had a high fever, over 104, and as we got a bed ready for him in the Pediatric ward he started to seize again in the ED.  It took several doses of different medications to get his seizures to stop.  So when Scheider didn't really wake up that afternoon it was easy to initially blame it on the medicine.

I spent the next several days trying to figure out what had caused Schedier's high fever and seizures.  I did a CT scan of his head and it was normal.  I did a lumbar puncture and his spinal fluid was normal.  Every test I performed came back normal.  He didn't have malaria, he didn't have HIV, and he still wasn't wasn't waking up.  Almost three days after he had come into the hospital Scheider was still unresponsive.  I had stopped all of the medications that should have been making him sleepy, so I didn't have a good answer to why he still wasn't responding to us.  I was really worried about him. 

Then, around Thursday he slowly began to wake up.  He was extremely irritable and lethargic at first.  He had no muscle tone, couldn't support his head, and was barely able to move his arms and legs.  But he started to make baby steps of progress-staying awake for longer periods of time and making more purposeful movements with his extremities.  Through an interpreter I told his mom that I just wanted to see him smile before I went home.

On Friday Scheider was still a grumpy little man and not feeling well.  He wasn't thrilled when we made him do physical therapy to work on his tone.  He was still so weak, but everyone was excited to see him making baby steps of improvement.  After he finished with PT we put him back in his bed and I was making silly faces at him.  He looked up at me and smiled!  That moment made the entire trip for me.  Here was a little boy who was barely responsive to a sternal rub for three days, now looking up at me and smiling.  The trip was totally worth it just to see that smile.  In that moment I knew in my heart that he was going to be ok.

After I left Medishare I got several updates on Scheider's progress from a friend who was down there volunteering the following week.  He continued to improve and was discharged home towards the end of the week!

Schedier and his mom, she never left his bedside

I examined him several times a day looking for any changes

Tracy helping Gina with Scheider's physical therapy

The smile that melted my heart! Best part of the whole trip!

Haiti's only NICU

Providing healthcare in Haiti is nothing like in the United States.  Resources are limited.  I frequently didn't have the medications, diagnostic tests, or supplies that I wished I had, things it's easy to take for granted at home.  Project Medishare has the only NICU and PICU in all of Haiti.  One day in 30 minutes we literally had three premature babies just show up in our already over capacity Pediatric ward.  All of them were struggling and in respiratory distress.  There is literally nowhere else to send these babies, so turning them away would have been a death sentence.  We shuffled around the patients that we could and squeezed in our newest little patients.  It's times like this where we would have to decide how to use the few monitors we had to best serve our patients.  I decided it was better to take one of our few pulse ox monitors off the baby with the congenital heart defect and to put it on our new 30 weeker.  We knew that the cardiac baby had problems that we ultimately wouldn't be able to fix in Haiti.  But if the preemie had an apnea/bradycardia episode that we could fix.  With our resources limited, we put the monitor on that baby instead and left a baby with a cardiac defect in her crib with no monitoring.  The simplest things, that we just take for granted here...

Michele, one of our preemies, with her mom

Haiti's only PICU/NICU

Baby Christopher-we had to move him out of his incubator to make room for a smaller preemie

My heart is still in Haiti

I am home, back from another whirlwind week in Haiti.  How was the trip?  It was challenging, frustrating, and exhausting.  But it was also rewarding, eye-opening, humbling, and amazing in a way that you could only understand if you've been there yourself.  It stretched me and challenged me as a nurse practitioner and I am so glad that I went.  I saw kids come to Medishare and receive the best medical care in all of Haiti.  I saw others at death's door that were turned away at the gate because the hospital couldn't accept any more children.  This week I delivered a newborn baby and held another baby as he died.  These are experiences that I'll never forget and I'm still processing everything that happened last week.  Thank you for supporting my trip and sending me back to Haiti.  I wasn't ready to come home and a piece of my heart is definitely still at that hospital down in Port Au Prince.  I am counting the days until I can get back down there...

Day 3

Maybe I'm not cut out for blogging, it's just been so crazy the past couple of days it's hard to find the time to update.  Things have been busy as usual but so far it's going better than I anticipated.  The only pediatric volunteers that are here this week are me and a pediatric nurse from Ohio. Thank goodness she has PICU experience.  The acuity in the pediatric ward is pretty high.  We have a lot of really sick babies in there.  Fortunately there is more Haitian staff so there is a lot of coverage by Haitian doctors at different points during the day.  But there are usually several hours in the morning and evening when I'm by myself.  During those times it's usually so chaotic I feel like all I can do is damage control.  This morning they woke me up from bed with a newborn in triage and a seizing toddler in the emergency room.  Considering how the day started, it turned out alright.  More later...

Day 1

It's been a LONG day, so today's entry will be short and sweet.  I arrived safely at Medishare.  The kids in the Peds ward right now are very sick, two on ventilators and pressors, and another one that should be.  It is definitely going to be another crazy week!

The Day Has Come!

After several months of planning and preparation, it's finally time to go!  I'll be heading down to Miami tomorrow evening and catching my flight to Port Au Prince first thing Saturday morning.  Right now I'm just excited to get back to Haiti.  Although this is my fourth trip with Project Medishare, it's also my first time going by myself without any other volunteers from my hospital.  It will also be the first time that I'll be the only pediatric provider there for the week.  As a nurse practitioner who's been in practice for less than a year...that's kind of scary!  I've been doing my best to get prepared but it's still pretty overwhelming thinking that I'll be in charge of managing the care of all of those kids.  Luckily I'll have backup from the awesome ER team that is coming from Minnesota.  I honestly don't think I'd be going on this trip if it weren't for the MN crew, they're awesome!  Thanks again to all my family and friends for making this trip possible.  I'll definitely appreciate all of your prayers next week! I certainly can't do this on my own!  I'll do my best to keep the blog updated while I'm gone, next update will be coming at you from Port Au Prince :)