Friday, January 20, 2017

Cholera Day 1: 10 babies and 11 days In Port Au Prince

Day 1: Sunday, January 20, 2013
If you missed Day 0, go back and read it first for context. 

The alarm rang at 4:30, starting my day off early. I checked my email. One of the other missionary guys was sick with major diarrhea now. Uh oh. What in the would were we in for?

At 5:00, no one was there, so I went back to bed and got another delicious hour of sleep before anyone knocked on my door.

In that hour, I had a dream in which I was about to do something risky (like jump off a cliff or something), and I woke up with the very clear thought that it was okay to do any dangerous, scary thing in the world during a dream, because the fact was, you were really lying peacefully in your bed the whole time, safe and indestructible from cliff jumps and such like. Following on the heels of that thought was the realization that even in the real world, my life is hid with Christ in God, and no matter what risky venture I could die from, my real self, my spirit, is reposing safe and sound in the Father’s hand, where no one can ever touch it or hurt it, and where I will stay, even if my earthly body dies. So I might as well enjoy the experience. I had no idea how relevant this concept was to be in the experience I was about to walk through.

Nurse Pierreline and Hope
Ryan F came a little after 6, and we left in a tap-tap for the creche. He and the Wesmin (the creche director) worked to dismantle cribs, while Nurse Pierreline (the creche's head nurse) and Jasmine (Wesmin's sister) got the kids ready.

As they were collecting the kids, I asked Nurse Pierreline and Jasmine to tell me their names. Even though I had spent 3 months in Haiti (from September to December), I still didn’t know the babies. At all. I never have been a baby person. I knew my school children, but I had not gotten to know the babies. The two ladies told me the names of the children, and I carefully wrote down the list of names next to a description of their outfits. Katheryn, Nadiya, Pranel (Jet), Sephora, Jackson, Malachi, David. Ugnel, Hope, and one more child whose parents have requested me to withhold her name, so I'll call her "Violet." I said to myself, “I have until these children change their clothes to learn their names, so I’d better get started.”
Mismanagement #3: Sending an unqualified person
Lesson #3: While it is a legitimate need on the mission field to fill a variety of roles, it's also important to keep in mind what people's strengths and weaknesses are. 

We left when the cribs were dismantled and loaded into the tap-tap. I rode in the back of Wesmin's car with a baby on my lap and two toddlers (Nadiya and Violet) on the seats beside me. Jasmine had two babies on her lap. Five more children rode in the tap-tap, totaling 10. Little Katheryn, who sat on my lap, seemed so healthy and normal. I loved on her and snuggled her, fed her some rice cereal, and just enjoyed her lovely little self.

However, before we got there, Katheryn pooped all over me, a light greenish-brown, runny diarrhea. “Here we go,” I thought. “it’s starting already.” But I was only thinking of the whole “it's yucky that babies get wet stuff all over you” thing. Not any farther than that. And God had given me peace about the whole caring-for-babies-despite-disliking-them thing. I asked Him for love, and He gave it to me. And what better kind of love than the unselfish, unconditional kind, which loves even a baby, who can give back the least return for your love?

One of the things I was worried about was having enough diapers. They gave me one pack of 18 diapers. With 10 babies, that’s less than 2 diapers per child. That wouldn’t even last us through the night. I asked for more and they said they didn’t have any.

Mismanagement #4: Inadequate supplies
Lesson #4: Outfit your trip with the sufficient amount of supplies for a successful outcome
Mismanagement #5: Internal feuds. The claim that they "didn't have any" diapers went back to a long-standing feud between the Haitian staff at the creche and the American missionaries. We Americans arrived in September and were told by Heather that the creche was providing all the diapers for the kids, and that there were plenty of diapers in the storeroom for everyone. However, these diapers never appeared. They were regularly hidden or locked up by the Haitian staff where we couldn't get them. Looking back, I'm guessing that they were being told precisely the opposite of what we were being told ("Those Americans are supposed to buy their own diapers! If they take the creche's diapers, they're stealing"). At the time, though, we could never figure it out. Why such a fuss about the diapers? But on this particular occasion, when I asked for more diapers, I knew I wasn't going to be able to get any farther than that. 
Lesson #5: As a manager, you must not have warring factions if you're going to get anything productive done. Warring factions that come from the manager intentionally setting people at animosity with each other is a completely avoidable scenario.   

We arrived in Port-au-Prince after a very silent drive. Joanne and her husband Doug greeted us warmly and welcomed us into their home. We got Katheryn changed right away, and I got to change my clothes into something not poopy.

I went downstairs and greeted all the kids that Joanne and Doug already had, most of whom I knew, because they had been in our creche when I left the country in December. (For context: I had just gotten back to Haiti January 16 after being in the US for about a month, recovering from malaria.)

Ryan worked for a while putting cribs together after Wesmin and Jasmine and Nurse Pierreline left. Joanne and her son helped me feed the babies, and while we were doing this, Joanne found out why the children had been sent to her. She had had no idea that they had been exposed to cholera. "What about all our children?" she said. "Now they're going to be exposed to it." I felt really bad for her and her husband, and I told her I would understand completely if she sent us all back. She and her husband had a consultation and determined that they would not allow these babies to mingle with all the children in general, but would keep them in a separate room.

After all the babies were fed, for which I was grateful for the help, Joanne showed me their setup for how to bathe them, and I took them one by one to give them a bath. That took a long time, and in the meantime, all nine of the other babies were sitting in their separate room on an incredibly dusty floor, with no toys, nothing to do, and no supervision. I felt bad for them, and I felt like they would have had better care at the creche, where someone would at least be there to oversee them while they played.

While I bathed each child, I realized his or her clothes were coming off, so as I gave the bath, I scrutinized each child’s face and purposely repeated his or her name aloud during the duration of the bath. For instance, “Hi, Hope. How are you, Hope? Let’s get in the bath, Hope. Hope, Hope, Hopieee… You are Hope.” In this way, I successfully learned all the children’s names by their faces and not their clothes.

Baths took way longer than I expected, because each bath involved going outside to the patio where they had a shallow 10-gallon tub set up, lowering a 2-gallon bucket down into the cistern, filling it with water, dumping it into the 10-gallon tub, repeating this a couple of times until the 10-gallon tub was sufficiently filled with water, and using soap and a washcloth to wash the children down. Many of them peed (or worse) in the water, causing me to have to dump it out and start over with pulling bucketfuls out of the cistern. All of them shared the same soap, washcloth, and towel. This, I believe, was very detrimental to their health, and I didn't like it, but I didn't have any other supplies.

Mismanagement #6: Not following practices of hygiene and sanitation
Lesson #6: If I didn't like something, I should not have continued doing it. If I felt that this was unhygienic, I shouldn't have just crossed my fingers and hoped for the best. At the time, I had no idea that the consequences of poor hygiene would be so drastic, but in hindsight, I need to let this lesson teach me not to proceed with a thing that feels "off." I had other choices. I could have not bathed the children. I could have taken additional measures to sanitize the washcloth. I could have asked for additional towels. I didn't do any of these things because I was (a) already stretched too thin and (b) in an unfamiliar place where I wasn't sure what supplies were and were not available. But looking back, I think that bath was probably one of two factors that were instrumental in ALL the children getting cholera. (The second factor was that eight of the children were left to play on a floor that had not been sanitized after Sephora's cholera vomit, below.) Neither of these factors would have happened if the children had been kept in the creche, where they were given baths in much cleaner circumstances. 
After the baths were over, I went into the room with the babies, glad that I could finally get to mopping this extremely dirty floor. Some of the kids were able to walk, but the youngest ones were crawling around in this thick layer of dust, and I was desperate to get it cleaned up. Doing this required getting a mop and bucket, more trips to the cistern, and strategically keeping the children to one side of the room while I mopped the other, and then moving them back to the clean side while I got the second side.

When I was finally finished with that, I thought it would be a chance to sit down and just be with them for a little while, get to know them, talk to them, and comfort them in their new environment. I had just sat down with Violet, who looked lost and disoriented, to snuggle her and get her comfortable, when the diarrhea and the vomit started. Sephora threw up twice and Pranel had a huge blowout of diarrhea, so between wiping up one thing and another, I was kept hopping. Every time I had to wipe something up, it meant jumping up, going around to the back of the house, drawing water, rinsing out the one rag that I had, and coming back. All that time, the babies were left totally unattended, and I would come back to find that one was bullying the other or there was a new puddle of spit-up that Sephora was mopping up with her dress.

At this point, Joanne came downstairs and appeared just as I was wiping up vomit.

“Do you need any help?” she asked.

“Well…” I hesitated. What did I know about these things? But I told her about the diarrhea and vomit. Who knows if it’s cholera? I thought. But Joanne thought it sounded like it was—clear diarrhea and white/clear vomit. So we rushed out for the hospital with Pranel and Sephora, leaving the other 8 babies to fend for themselves. I still don't know what exactly happened to them in the interval, but at least I know that Doug and his son fed them.

We tried 3 hospitals and they wouldn’t take us. After the first sent us on, I said, “Oh! I forgot to get diapers or food. Do you want to stop back by the house and grab some?” Rookie mistake. Any mom would have known to grab the diaper bag and some snacks.

“No, we just urgently need to get to the hospital,” Joanne said, so we skipped it. The babies had eaten at about 11:00, and it was now 3:00, high time for a feeding, but we figured that since babies can die within hours from cholera, it would be better to just get to the hospital sooner. Truly it was alarming how suddenly and rapidly they went downhill. Limp bodies, eyes rolling back in heads--and me in the back seat with them, praying for them to hold on.

Finally, the fourth hospital took us in. It was in a bad part of town that Joanne wouldn’t even drive into without a trusted Haitian guy in the car with us. Fredly was very accommodating and helpful and helped us find the places we wanted to go and translated a bit for us. This hospital was the main cholera ward for the whole of Port au Prince. There was a chlorox bath for your shoes when you went in or out, and there were a number of shelves with purses and backpacks on them. Apparently you were not allowed to have a bag inside.

I had my backpack with me, because right before we left the house, I had said to Joanne, “Oh, grab my backpack so I can have my water bottle.” At that time I wasn’t thinking of the fact that it wouldn’t be safe to leave it in the car. Now I had to carry it up to the hospital. Then I had to leave it on one of those shelves and take a number from a lady who said she would watch it. As Joanne and I were setting our bags down, the people nearby said, “If you have phones, money, or other valuables in there, you should take them with you inside.” Well, I had my computer, my purse with wallet, (American) cash, credit cards, and checkbooks, and my kindle, besides some books and a water bottle. Considering that a year's wages in Haiti might be $500, my backpack represented a jackpot, so there was no way I was going to open the entire contents of my backpack and carry them inside when I had a baby in my arms. I shrugged my shoulders and stuck it up on the shelf as if it was the most inconsequential thing in the world. “Lord, protect my backpack,” I silently breathed.

We went in and the medical staff checked the babies. They tested positive for cholera and the hospital admitted them to stay overnight.

The hospital was a long warehouse-like building with 3 sections. The first section was where they did the initial exam, the second section was where the babies stayed, and the third section was where older children and adult cholera patients lay on cots. In our section (the 2nd section), about 30 feet square, there were 15 cribs lined up in rows. There was just enough space between each crib for a chair to sit, and parents were tending to their babies at the cribs where they were placed.

The hospital provided rehydration fluid, but that was it. Each family had to provide food, diapers, clothes, and crib sheets for their child. We had none of these things, so Joanne left to go get them, while I stayed with the babies. (She took my backpack with her, and nothing was missing from it.) Pranel and Sephora allowed themselves to be comforted for a time, but soon they were so hungry they were inconsolable. Also, their diapers had suffered so many bouts of diarrhea that they were bulging with a wetness unlike I had seen any diaper hold.

Finally, Sephora’s diaper could hold no more. I turned around from laying Pranel down, who had fallen asleep on my lap, and I saw a little brown river cascading down Sephora’s bed and landing on the floor in a puddle already the size of a dinner plate.

I had no wipes, no diapers, and no supplies of any kind except a towel. I used the towel to wipe off the bed and soak up the floor. Then I left it there. Later a nurse came by and picked it up and said, “Is this yours?” “Yes, but I used it to wipe up poop,” I said. “It’s full of poop.” She dropped it like a hot cake onto the rack at the end of the crib. (Note that unless otherwise specified, the conversations that I had with nurses were all in Creole. My 3-month-old Creole had to suffice for all my communication for the entirety of my stay in this hospital, except for the interactions with one doctor, who spoke English. So just understanding what was being spoken around me was another incredibly difficult part of the ordeal.)

Later, another nurse came and had mercy on me. She cut one of the disposable plastic pads in half, the kind that you can put under a baby and it has one plastic side and one cotton side, to soak up leaks. She cut it into two big triangles, and we tied the 3 points around the babies’ legs. That bought me some time, though Pranel immediately filled up this makeshift diaper.

Overall, all the nurses at the hospital were extremely caring and thoughtful. For some reason, they took a liking to me and had mercy on me in my distress, going far above and beyond the call of duty, and doing things that were not in their job description and not what they would offer to do for anyone else in the hospital. They were so great! I wished I could treat them all to a nice dinner and write them all a thank-you note.

Pranel woke up and simply would not be comforted. I didn’t have anything to give him. I knew he was just hungry. I tried patting him, bouncing him, picking him up, putting him down, fanning him, sitting him up, and everything else I could think of. He just screamed. Everyone else in the hospital was commenting in Creole over the fact that this crazy white person hadn’t brought any clothes, diapers, food, or sheets for this child. But what did I know?

In my defense, I had never taken a child to the hospital before, much less a Haitian hospital, so I didn’t know what it involved, and I did suggest food and diapers, at least before we got too far away from the house. I will certainly never make that mistake again!

Another nurse had mercy on me and went and bought a can of juice to feed the babies. I gave them a few sips, but they didn’t like it.

Where, oh where was Joanne?

At 9:00 PM, she came. She brought food, diapers, clothes, and sheets for the babies, and a gorgeous big sub sandwich for me. She gave me a Sprite, too, but I gave it to the nurse who had given me the juice.

We fed the babies and Sephora immediately started vomiting it all up, and ended up vomiting up more than she ate.

Joanne said she had even brought my suitcase in the car, so if there was anything I wanted to grab, I could go out and get it.

I went out with our interpreter, he unlocked the car, I opened the back, and my suitcase was not there.

“Okay…” I thought. But after all, I figured I could still get by, even if I just had the clothes on my back for the next two weeks.

Joanne had also asked me to look for the bug spray, because there were swarms of mosquitoes everywhere inside the hospital, but I couldn’t find it. (This was another trying aspect of being there, since I had just gotten over malaria. It only takes one bite…)

I went back inside and reported to Joanne that I couldn’t find the bug spray. Then I just talked about the babies and other things for a few minutes. Then I figured the time had probably come to tell her.

“I don’t want you to freak out,” I said, “but my suitcase was not in the car.”

Huh??” she gasped. “Of course I’m going to freak out. I have to call Doug!”

“No, I’m not even sure if it’s lost, and anyway, it’s a small loss,” I said.

She called Doug and he said he had never put the suitcase in the back. Whew!

Joanne left at 11:00 PM. I stayed up watching the babies sleep until 12:30. Then I went to sleep myself for a few hours.

Read the next post: Cholera Day 2.

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