Religion is Important in Haiti

A few nights ago, the mother of one of the NICU babies had some questions about her son. The Haitian physician was busy with a new premature infant and could not talk with Mom. He asked me to explain the situation with an interpreter. This baby is the sole survivor of the original four premature infants who were in the NICU when I arrived and he is just hanging on, stable over the day, but still precarious. I found an interpreter at the triage station and he explained word-for-word what I wanted to say to Mom. I described the clinical situation as I saw it. The baby has meningitis and a serious intestinal infection. The baby stopped breathing at least twice during the day while I was around. There are a variety of bad case scenarios for the baby. I mentioned perforation of the intestine, a new blood infection, increasing lung disease, and hemorrhage in the brain, any one of which could cause deterioration and death. Mom accepted this with sadness. I asked her if she had any questions and she replied, “God knows what will happen.” I hear a variation of this occasionally in Canada (God only knows), but more as a hackneyed statement about life. For this Mom, the words were literal. 

Haitian pastors have visited the unit three times while I have been in the unit. The same two men have visited on two occasions and three women on one occasion. They stand in front of a bed and pray for the child. The older man shouted loudly, with an almost angry tone, as if to make sure that God heard his call for the child to improve. The other man looked up to the sky, swayed his hips, moved his arms around like a choir director, and sang prayers. The women who visited staged a variation on this theme. The senior woman asked for the help of God and the other two sang prayers. The pastors prayed only for a specific child. I presume this means the family is a member of the same church. Two Catholic Nuns visited the unit yesterday. They were dressed in a traditional white habit. Both were older women, likely about my age. 

Umberto is the “Go to” person on the unit. He is a young Haitian with good English skills and he has worked for the hospital for several years. He does not have any formal medical training, but he performs a variety of tasks. He knows where everything is in the unit. His official job is to serve as a translator, but he certainly performs well above this pay grade.

Umberto is a devout Christian and his passion is music. He sings in the church choir and over the next week he will perform in two church events.

I asked Umberto why the recent democratically elected leaders have not helped the poor, and he responded that the rich people prevent the leaders from doing their job. “The rich get richer and the poor get poorer. That’s in the bible,” he reported with finality. Faith is clearly at the center of Umberto’s personal world.

The actual biblical reference for Umberto’s quote is Matthew 13:12, which reads, “For whosoever hath, to him shall be given, and he shall have more abundance: but whosoever hath not, from him shall be taken away even that he hath.” 

I have always interpreted this phrase to be a description of what is common but not as a description of what should be. My sense is that Umberto thinks differently. For him, God (the Bible) is the official explanation for the poverty of the Haitian people. Haitians are poor, and since God permits the poor to get poorer, Umberto accepts this. I didn't ask Umberto, but to me this implies that Umberto might believe that God allows this suffering for a reason, presumably a good reason by God's account. This is the Problem with Pain, that CS Lewis wrote about. According to Umberto, although Haitians are doomed to be poor, God offers them heaven so long as they live a good life.

Religion is a strong force in Haiti, whereas in Canada many churches struggle to maintain membership in their congregations. The people in Haiti are poor and they suffer. Canadians, by comparison, are fabulously rich, and Canadians live the good life. Religion thrives in the midst of suffering because faith offers the poor some hope for deliverance, perhaps only after death, but deliverance from their suffering all the same.

Abandoned Babies

So far there have been three abandoned babies in the unit. Two were in the unit when I arrived and one was admitted a few days ago. One, Theodore, the Success Story of an earlier blog, was discharged home. Two remain in the unit.

Jean Francois has been here the longest. He is about 20 months old and he has been in the hospital for over a month.  He has hydrocephalus (hydro = water, cephalus = head). In this condition, the fluid in the brain does not circulate properly and the fluid builds up in the brain. This puts pressure on the brain tissue, which does not develop in a normal fashion. Jean Francois’ head is the size of a basketball. He has pressure sores on his scalp because before arrival he was left to lie on one or the other side and he was never moved. The pressure sores are healing very slowly. In Canada the hydrocephalus would have been treated at birth with a shunt to take the pressure off the brain. In January a team of US neurosurgeons will spend a week at the hospital and they will shunt a lot of children, including, hopefully, Jean Francois. There is an orphanage that might accept his care with the shunt.

Baby Boy Iconnu, which means “unknown” in French, was dropped off a few days ago by a man. The baby is healthy, full term and his exam is normal. He was brought to the hospital within an hour of delivery. The man who brought the baby changed his story several times. First, he was given the child by some street children. Then, he reported that the mother could not care for the baby. Finally, he implied that perhaps the mother might want the baby back if things go ok. My take is that the man is the father, he didn’t want the baby, and he is very conflicted about his complicated emotional decision. All the nurses take turns carrying this baby around.

There are apparently hundreds of orphanages to take care of the children who survived but who lost parents in the earthquake. The orphanages are run by a variety of NGOs and there is a procedure for Haitian families to adopt the children. 

More Random Observations

On my way to the pharmacy to drop off an urgent prescription request, I found a motorcycle at the bottom of the two concrete steps up to the pharmacy area. The owner was washing his bike. I asked him to move the bike to an area ten meters away that was not obstructing the path and stairs. He understood this and made movements as if to move. I went ahead to the pharmacy. Of course he was still there a minute later. I stood there and waited while he moved. He chose the spot because at that time of day, the path and the steps were in the shade of a tree. The spot I suggested was in the sun. His total disregard for the convenience of staff and patients is pretty incredible.

An EMT asked me to assess a child after dark. The patients who wait in the triage area sit on chairs. I needed some light and there were chairs twenty meters away under some light bulbs. A middle-aged woman was lying asleep on three chairs and three healthy men were sitting talking on another three chairs. These people were all family members of patients admitted to the hospital. There was one chair in the middle. I needed at least two chairs for the child to lie down. The male Haitian EMT started to ask the sleeping woman to move! I stopped him and asked the men to move, which they did without fuss. Unbelievable chauvinism! 

All the furniture and equipment was cleaned out of the NICU, so that the unit could be sterilized. Once empty I saw three ant colonies erupting  from the walls. One was from a corner and two were from cracks where the floor meets the wall. 

There were gas fumes in the unit for about 45 minutes this morning. Very strong, headache-triggering gas fumes. Not a healthy situation for children or staff. I asked one of the interpreters to try and figure this out. He looked around, as I already had, and then reported, “The gas seems to be worse in the unit.”  “Thank you,” I replied for his help.  “Brilliant,” I thought for what was self-evident to everyone in the unit. A mother finally solved the riddle. Someone had left a gallon of gas in an open container in the hot sun, just under a window outside the unit. They carry gas for motorcycles in small containers. 

The noise in the unit is a big problem. The walls are concrete and do not absorb sound. About a quarter of the children are not attended by a parent because they were abandoned and the few nurses on duty are obliged to care for multiple children. The abandoned children often cry for prolonged periods. Sometimes they are hungry but often they cry for attention. The unit is crowded and there is one family member allowed for every child. Even without crying children, the staff, family, and children talking in the unit is noisy. There is a TV continuously on in one area and a radio with Haitian music in another. A road is on the other side of one of the walls of the unit and the traffic noise is continuous. This morning one of the children, a six year-old boy was screaming with very typical "attention-seeking" behaviour. After about ten continuous minutes I asked the interpreter to ask the mother to take the child outside the unit for a walk. The smiles on the staff and the other mothers looked like applause for this request.  

Today the NICU children were in the regular unit and each child has at least one monitor to follow blood pressure, heart rate, respiratory rate, or oxygen saturation. The incubators have temperature alarms. The ventilator for one of the infants has alarms. Each child has an intravenous pump with an alarm. Each alarm has a different noise. The monitor alarms need to be set with correct limits so that the alarm does not go off for normal events but the monitors are not set with the correct limits and they commonly go off for normal events. Batteries run out in pumps and this generates alarms. The sum total of all the alarms and the background noises in the unit is that the REAL ALARMS are often missed! For most of the day I set myself up in a place where I could see the values on the monitors of the three sickest children.

There was no filtered water in the hospital last night or for half of today. The tap water is not safe. In the absence of filtered water there is no water, but keeping up with hydration is important for staff. I gave one of the guards $5 and he sent out for five 16 oz bottles of Coke and this was the hydration for several of us in the middle of the day. Filtered water arrived at about 3 PM.     

Observations

The mothers are mostly quiet, often sitting in a chair asleep beside their child, like passengers on an overnight flight, trying to find some comfortable position to pass the hours. There is not a single happy expression on their face, as if life is difficult even in their dreams.

By day the mothers have a variety of looks - concern, fear, apathy. Life carries on for the parents with feeding, changing, cuddling, and playing. There are a lot new toys courtesy of Santa and this keeps the older toddlers and younger children occupied. Of course some desire the toy the other child has and this makes the unit a microcosm of community life. For the infants, there are times when they are carried by a parent, nurse or volunteer, so they know their life is more than a bed with crib bars, intravenous lines, nasal cannulae, nasogastric tubes, and dressings. 

There are bathrooms for the volunteers and staff and separate latrines for the families. The latrines are lined up at the back of the compound and a terrible odor announces their location before they are visible.

Family members eat home-prepared food from metal pots. They sit outside on the ground, a bench or a concrete ledge. Rice and beans is very common, perhaps the staple.  Don’t see vegetables or meat as often. There are sparrows that covet any rice or other morsel of food that escapes their lips.

The unit is very dirty. Only the floors are cleaned and this is done several times a day with a wet mop, but the surfaces of tables, carts, sills, and equipment is always covered in dust, which over time becomes a sticky sort of dirt. No one tidies up and charts, equipment, and papers are often buried. At lot of time is wasted looking for things.

The hospital charts are set up similar to back home and the charting by the nurses is very good. Charting by the doctors is neither legible nor good.  Perfunctory notes. Even so, their decisions are good, which is more important than perfect charting.

Anything metal is rusted. The air conditioners leak on the floor. The freezer for the meds has not been defrosted for a very long time. The electrical outlets spark when you plug something in.

The grounds are covered with rubble in one corner of the compound. Small geckos race between the rocks. When the sun goes down the insects come out.   

The tap water is clear but not recommended for consumption.  I will not brush my teeth in the tap water. I use the filtered water and I use the UV SteriPEN on this as an extra precaution.

The security guards at the gate carry automatic weapons or shotguns. A little gun has no intimidation value. I heard small caliber gunshots just around dusk. Gunshot wounds are common in the adults. 

Killer Incubators

Over the last 24 hours, three infants in the neonatal unit died. They were all premature, all were stable for several days, and each one deteriorated and died over about 6 to 10 hours, all notwithstanding modern and timely interventions.

The sequence of events was the same in every infant. I learned today that about ten days ago another infant died in the same fashion.

Each child developed signs of sepsis (poor feeding or difficult breathing) and within hours the heart rate and blood pressure started to fall and the child stopped peeing. The lab tests confirmed Disseminated Intravascular Coagulation (DIC) a clotting problem in the blood that develops with severe sepsis. Notwithstanding intubation and ventilation with a machine, multiple medications to support heart function, and changes in antibiotic coverage, these children progressed relentlessly and rapidly downhill to death.

Three children dying in a very similar fashion in 24 hours is not a coincidence. This was almost certainly the result of a very aggressive bacteria or fungus. The similar sequence of events leading to rapid death was the signature of one deadly organism. We will never know the name of this organism. There are no culture facilities for this sort of test at the hospital.

One possibility is that the child who died ten days ago was the source of the infection. Once this organism became established in the unit, it was only a matter of time before the germ affected other children. Who knows how the transfer occurred. Perhaps the germ was on a piece of equipment shared by the children. Regardless of how this happened, the end result is that the unit and especially the incubators that were home to the babies who died, are contaminated with a deadly germ. Today the remaining child will be moved out of the unit and the entire unit will be cleaned from top to bottom, as best as this can happen in Haiti. Once this is accomplished we can start to admit other children to the neonatal unit. Then we hold our breath.