NJ Medical Director Travels To Haiti’s Bush Country

http://www.prweb.com/releases/2010/04/prweb3829614.htm

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Rob and Danny's Trip to Haiti Blog

1:35 p.m.: Waiting for bags, hot, crowded

3:04 p.m.: Port- au- Prince is a complete mess with utter chaos. There are soldiers with machine guns. Haitians fighting over us to carry our bags.

3:05 p.m.: Exiting the airport was like going into a riot.

3:06 p.m.: The refugee camps are everywhere. Tents upon tents of people, Heaps of garbage with pigs and goats, rubble everywhere.

3:07 p.m.: Riding on a heap of luggage in a truck that sways with every turn.

3:08 p.m.: Very hot and sunny, stopped for a pear soda.

3:08 p.m.: The boys are in shock.

3:08 p.m.: So am I. I never saw such poverty and disarray.

8:24 a.m.: Tried sleeping on the deck which was cooler but between the squawking donkeys, the barking dogs, and the giant tarantula, sleep was unrestful. The 5 a.m. cockling roosters was it and I went inside.

8:25 a.m.: Awoke to a crowd of smiling children waiting for some food. Oh btw they sang for us before we went to sleep.

8:26 a.m.: The women were coming out of the hills with bushels on their heads, pulling loaded donkeys singing as they go.

8:30 a.m.:Sister Eunice approached me last night to ask me if I would go to a refugee camp and, of course, I am game.

8:30 a.m.: She seems very excited to set up a clinic there so we will travel the 7 mile bumping ride this a.m.

8:30 a.m.: The boys will start working on the school.

8:30 a.m.: Hope all is well.

8:45 a.m.: The road to Cabaret is filled with women walking, loaded donkeys for market with wood, , chickens, bananas, and charcoal. Kids are everywhere waiting for food or candy. Now headed for the refugee camp.

8:47 a.m.: The homes in the mountains are mostly thatched. Kids hang around barely dressed, no shoes, and they walk right over rocks no problem.

[Message from later that night reflecting on the day]

Today at the refugee camp was indescribable. They had no water for days. Babies were on death’s door. We delivered a baby. She delivered onto a wicker mat. The people are starving, infected, and sick, yet joyful when dealing with them. They live on dirt floors in mostly makeshift shelters. It is utter chaos.

While I was at the refugee camp, Danny and Jeremy helped build some shelves in the clinic, which we are reorganizing tomorrow with all the new supplies. Then when we realized how many people were near death from dehydration, we called them to come with the other truck to bring water. Danny and Jeremy came to the refugee camp with water and served 100’s in line water while we all took care of the sick and the new mother

It was an unfathomable day.

9:11 p.m.: [Back at Desab] Danny won’t [go to the bathroom] because of the palm-sized tarantula next to the toilet. We took a picture of the tarantulahim.

9:24 p.m.: We are going to church. Easter Sunday is supposed to be one of the biggest, most festive holidays and the boys are game. It is dark and they are singing in the church, practicing for tomorrow.

9:27 p.m.: Sister Eunice is our leader and calling a meeting so good night.

8:23 a.m.: So we had a meeting last night and we all had to discuss our days. Pretty incredible discussions. Found out a lot about the others—very diverse and amazing group. Many were prior COTY participants. One woman is here to take back two boys for education. One guy is a freelance producer. A school teacher, set designer, executive of a dance theater, etc. etc.

8:26 a.m.: A Haitian described Port –au- Prince, which we will tour on Friday. He described almost every building like pancakes over 300,000 dead in the streets. Bodies were bulldozed and lifted into a dump truck and brought to a mass burial. He said he had to move to a different part of his house because of the rotting bodies still buried alive.

Last night, a boy sung a song before we all went to sleep. It is unbelievable how smiley and demonstrative and happy these villagers are.

Our tent was near the bakery and little did we know that they would be baking bread all night for Easter. It was a unque scene to see these men working by a brick oven by candle light cutting and forming and another guy at the oven, glowing in the dark.

8:33 a.m.: [Last night] I rolled over in the tent and you should have heard the boys. They were in shock debriefing the day and I cannot believe I heard the words out of Danny that he said to Jeremy that he never knew how lucky he is. Jeremy said he cannot believe how desperate they were for water and how he thought there would be a riot and how in Short Hills we have pools of water.

8:36 a.m.: Awoke at 5 a.m. to the same cacophony of the most unusual sounds. Goats sounding like distressed babies, roosters, and these ugly donkeys sounding like broken trumpets. Went to the hut for coffee and there was an enormous tarantula dominating the cooking area, which Sister Eunice calmly brushed out the door.

8:39 a.m. The village is readying for church, which we will go to. We are then going down to the refugee camp to set a tent up for the family who has the newborn. They currently lived in a 4x4 dirt makeshift space, now dirty with her delivery. They will soon be moving into the "Ritz" and will be one of the very few families with a floor and well protected from the anticipated rainy season.

We then plan to hike further up the mountains to a water fall, the source of our water. There is now running water, no electricity.

The boys are playing some board games awaiting church. There is a crowd of very cute children around me trying to understand what I am doing.

8:45 a.m.: [in response to question re: safety of boys at the refugee camp] They were fine and giving out water. They are using Purel religiously—do not worry.

8:47 a.m.: One woman in our group got diarrhea. I treated her but she has been here a week and was not cautious in what she ate. I injected another woman with a pain killer for a bad migraine and the teacheranother came with an infected elbow, which I mayl lance and treat with antibiotic.

11:48 a.m.: Well, we were all "baptized." We took some great videos of the villagers dressed in their pastels, their Sunday best. Those that were not cleaned were not allowed in the church. We set up the shower bag and cleaned up.

11:50 a.m.: Now we are loading the truck with water and the tent and heading back to the refugee camp. They asked me to take the medical bag just in case. I just treated two more of us with diarrhea. Let’s keep our fingers crossed that we all do not get sick.

1:51 p.m.: In the camp. I set up the tent and there was a crowd watching. Too bad only one family has a new tent. We gave out soccer balls and even dehydrated, they are playing soccer. The boys are still giving hundreds of people water but we are almost out.

The [Haitian] boys are begging for my shoes and food. It is really patheticheartbreaking. It is really hot but I do not want to drink in front of these people.

2:11 p.m.: We’re now out of water and there is arguing. Sister Eunice is asking for a leader. We need to find a leader to distribute some supplies. There is major arguing. We may have to leave.

2:13 p.m.: We’re taking off. Too crazy and uncontrolled by desperation.

2:18 p.m.: . Before leaving, the boy with the crushed and infected hand in the quake, which I had drained, came up and hugged me.

2:20 p.m.: This is an unbelievable adventure and way beyond belief.

6:28 p.m.: The boys went on a hike to the water fall with some of the other team members and some of the village boys. I punked out with way too much sun and was way too tired. I will do it another day.

6:45 p.m.: Fennel, the village leader, was previously at Winadu. He was at the University in Port- au- Prince, in the a.m. session, on the earthquake day. Most of his friends in the p.m. session died and were crushed. The University went down like a pancake. Now his education is on hold. Fifty percent of all Port –au- Prince students died along with their professors.

7:40 a.m.: So the event last night was the aggressive, giant tarantula that took possession of the entrance to our tent. The boys were spooked. It did not respond to stones and kept coming towards us. The villagers were laughing and one boy soccer kicked to a pile of stones.

Was awakened last night to loud chanting and drums at 1:00 a.m. I found out it was a voodoo ceremony. It lasted until 5:00 a.m. So weirdunusual for us.

Sister Eunice and Bob left at 6:00 a.m. to go to Port au Prince to buy a cistern, a 500- gallon water tank for the refugee camp. If they have one, someone will fill it with water.

7:50 a.m.: Some stats. Port- au -Prince had 2 million people. 300,000 are known to have died and thousands are still unrecoverable. The mountain villagers have a life expectancy of 43 and 1 in 17 women die in pregnancy, either due to complications of pregnancy, hemorrhage or infection postpartum. Haiti has the highest infant and maternal mortality rates in the northern hemisphere. Most births are not attended by skilled people. The hospitals turn accident victims away if they caused the problem because they are overrun with patients; if you caused the problem you are sent away.

7:58 a.m.: Danny and Jeremy are working in the children’s camp in the village this a.m. and when the others come back from Port- au- Prince, they might start construction of the school that is in rubble from the quake. They are playing soccer and other games, and coloring with a bunch of children. The kids seem to really love them.

12:21 p.m.: Clinic is very difficult. Aside from the interpretation, different words mean different things. Like anemia does not literally mean low red blood cells but just weakness. They all have many symptoms and it is tough to know why they are really here. Example. One man had headaches and when it came down to it, 1-1/2 minutes later, it was visual symptoms. I gave him my extra glasses and his headache was instantly gone.

8:23 p.m.: So the first day in the village started off slowly and I had a false sense of security. The nurse practitioner, who is great, is mostly an adult practitioner, so I wound up seeing children with viral illnesses. I thought it was like the SMG evening clinic.

Just as I gathered us to ask for tighter triage because I was seeing people who did not need a doctor, the scene changed. I should have kept my mouth shut.

First, I see a boy with a dirty bandage. I asked if he needs it changed and he agreed. Then I finally got an interpreter to find out what happened. He was working in the field and was punctured by a sharp stick. Upon peeling away the bandage, I saw a hand, very swollen with a putrid smell and a large open wound in the web. I called Dr. Momeni at SMG and got advice as to how to surgically explore the lesion and debride the wound, to avoid the nerves, etc. Just as I was getting ready to do the procedure, another young adult came in with a deep machete injury and an obviously severed tendon. Then, came in a young girl who fell and had a large laceration of her tongue, followed by a 13-month old girl with a fever of 103 and completely dehydrated.

I had to prioritize all the patients and, of course, the children came first.

I called at least four SMG physicians and the team realized we had a large group. It was like "So You Want To Be A Millionaire" and I got to "phone a friend."

The crew who went to Port- au- Prince to get the 500 gallon cistern did not get back until 3:00 p.m. so Danny and Jeremy did not start rebuilding the crumbled school yet. Instead, they helped the 20 boys who are headed to work at the camp group this summer fill out their health forms so we can do their pre-camp physicals.

The Port au Prince crew brought the cistern to the refugee camp and we all hope that some relief organization will fill it up.

8:45 p.m.: I was showering in the dark with our shower bag and a feral dog came out of the brush scared the heckll out of me. I found out that the crew had dumped some meat or some food by my shower and we suspect the dog was protecting his cache.

I found out that the all-night voodoo service was due to a death in one of the villages.

Sister Eunice brought a projector and some French tapes and the village kids are, , watching a movie, -by generator.

There is an unusual smell in the mountains and I found out it is the slash and burn farming, I think mostly banana trees.

I e-mailed Dr. Mendiola today to figure out how to treat this man at the Obama IIE refugee camp who had a maggot-infested chest wound, after he was injured in the quake.

I also did not know what to tell the woman who had a punctured eye leaking vitreous fluid. They will not take her in the hospital.

I know this was random, bit too much to tell you and cannot wait to show you the videos and photos. We all feel like we have been here for a week, just so much is happening in a short period of time.

8:55 p.m.: Goodnight.

8:14 a.m.: Awoke at 5:00 a.m. to the animals again and saw the boy with the puncture wound waiting outside my tent for the antibiotics. We were unable to procure augmentin, so I e-mailed Dr. Mendiola to discuss different combos of antibiotics for him.

Jeremy and Danny are working in the camp in the morning doing construction and assorted repairs in the compound.

I am headed to another village five miles away, called Braley, to open a clinic for the better part of an afternoon. I am hoping to be back early enough to go to the waterfall and take a bath.

By the way, the water we get is from the falls and Sister Eunice pays these young boys to carry five gallon buckets on their heads several miles to fill our cistern.

I am going down to the village clinic to pack up supplies.

7:34 p.m.: So, went to Braley on a road that you would not believe a vehicle could navigate it was so steep and rocky. The town was slightly more affluent than Desab with a gathering of about 20 thatched or stone huts and a church that doubles as a one room school.

7:35 p.m. [aside] Danny and Jeremy are talking now not knowing I am hearing. They are making plans to come back next year. They are trying to figure out if Gregg would come and, if he did, how he could contribute.

The village boys are outside singing s, not to mention the animal symphony.

7:43 p.m.: Back to Braley. On the way, we see Combis, groups of men in the field with a lead chanter getting them to sing and hoe in rhythm. We set up the clinic in the church and our exam rooms were outside in the yard. The villagers put up a sheet for privacy although several kids sat around and watched me at my exam table, which was two benches put together with a mattress laid on top.

Droves of people walked in and it was again tough to decide who was there for a serious illness and who just wanted a well visit. Sister Eunice said we are closing soon so we tried to weed through and triage a bit.

My first patient was a 63-year old woman who looked 80 and had multiple complaints but looked sick. As opposed to classic medical school teaching that the history is most important, in Haiti with the cultural and language barriers it is all about the physical. I found her to have a classic exam for a lobar pneumonia.

Then, I saw a young woman with severe shortness of breath and pneumonia. I asked for oxygen and Sister Eunice looked at me like I was delirious. She said, "now you know why you should help us develop a village hospital!"

Also saw several severely malnourished and dehydrated infants.

7:59 p.m. [digression about Jeremy] He is such a good kid and friends with all the adults and the village kids. He seemed to pick up quite a bit of Creole. He is clearly having a great time.

8:01 p.m.: So back to clinic. One of our last patients was a one-year old who drank kerosene. I called the SMG UCC and an unmentioned doctor said transfer the patient to the local emergency department. I laughed sadly. Little did he know we were an hour plus from the nearest hospital, which may have been destroyed in the quake, over run by patientsand good luck getting to Port au Prince.

Came back to Desab at about 3:00 p.m. and we poured down the usual – rice and beans.

Went on a seven-mile hike with Jeremy and Danny guided by the village teens, 14 and 16. It was absolutely incredible to walk along these foot paths passing through all these small villages with barefoot women carrying buckets of water on their heads walking faster than us. Men in the fields. Kids around thatched huts. Fields burning. Pigs, goats, chickens, cows running around.

One of the teens was anxious to have us see his house and meet his family. We veered off the path and came to a stone hut with a thatched roof. The boy’s mother was kneeling outside mending some clothes. His sister was in a thatched shed peeling breadfruit and other vegetables and his brother was cutting some wood with a machete.

Along the path, we saw several half gourds hanging by string. Danny looked in one and found a Haitian coin which he removed to look at it more closely so he took it. Well, that is a voodoo ritual and I was spooked unsettled. The village boys advised him to throw the coin away.

We found our way to a stream where families were bathing and cleaning their clothes.

The five of us went up to the falls and took a very refreshing shower.

It was so beautiful walking back, cooler, sunset and everyone saying bonswa, which I believe is the correct Creole spelling.

What I have learned about the mountains in Haiti is that it is all about the water.

If you live near a stream, you are better off because you can grow bananas, the more valuable crop and you do not have to walk miles to get water.

8:24 p.m.: Done summarizing for today.

8:21 a.m.:　 [Note: it appears that some of Rob’s BBM’s did not go through, including some relating to Jeremy and Danny’s activities.　 This is a recap from yesterday] Danny and Jeremy spent yesterday morning crushing up the rubble from the crumbled school.　 It was hard labor with sledgehammers.　 They also helped with the camp in the afternoon and organized a soccer game.　 Then we went on the hike.　 Their hands are now blistered, whereas the Haitian boys already have callus.

8:22 a.m.:　 The boy with the kerosene ingestion, we just observed, gave bread and he did well.　 But I won’t really know until I return to Braley.

8:25 a.m.:　 There is an argument in the kitchen area between Sister Eunice and a gentleman who feels he was discriminated against in that he was not included in the group going to Camp Winadu..　 He also claims he is not getting paid as much as the others.　 There are a bunch of guys arguing about this in both English and Creole.　 What a scene! It is very tough for Eunice because they are all desperate.

10:20 a.m. Saw the boy with the puncture wound and terrible infection that I debrided.　 I was afraid he could lose his hand.　 Well, he was so much better.　 Aside from the surgical debridement, the antibiotics really worked.　 I suspect that the bacteria are much more sensitive to antibiotics here with less resistance as in the States where we overuse antibiotics.　 They barely have any medicines here.

The Desab Clinic is flooded today.

Danny and Jeremy are in the camp until the villagers get together to start mixing cement and the rocks the boys crushed yesterday.

11:16 a.m.:　 I have a man with an incarcerated hernia and they cannot take him to Port au Prince.　 Sister Eunice suggested we send him to Paul Farmer’s clinic to try and arrange for surgery.　

It is very frustrating when I cannot offer anything, no oxygen, not the right antibiotics, no prescription for scabies, no surgeon and no way even to get glasses or an optometrist up here.　

I was given a prescription for scabies called neem, which is an oil from the neem tree. It is the best I have right now.

4:05 p.m.:　 Well, since my last bbm, I had droves of patients including two siblings 5 months and 3 years, both in severe respiratory distress.　 They made me incredibly nervous especially without oxygen.　 I started steroids, hydrated them using a plastic cup as a mask and sprayed some albuterol and started antibiotics, just in case it was a bacterial pneumonia.　 Both their lungs sounded horrible and they were tugging away for air at 60　 to 70 breath per minute.　 I did what I could.

I got a quick bite of, yes, rice and beans, and then came back down and they both looked so much better.　 But it is very frustrating to face the risk of not being able to help.

6:31 p.m.:　 Well the work crew to help us pour the cement on the school house floor just did not show up.　 Danny and Jeremy seemed fine and worked at the camp instead.　 In the afternoon, we realized we were out of water and the boys took a trip into Cabaret to purchase some processed water.　 They were also hoping to go to the Cabaret market where all the mountain villages sell their crops and goods. I gave Danny some money to spend.　 They should be back within the hour.

6:35 p.m.: Sister Eunice wanted me to clear the x-rays on the positive ppd boys going to the States this summer but not being a radiologist I had to defer and called Summit Radiology, who agreed to read them when I return.

6:46 p.m.:　 The boys are back and seem good.　 They retrieved water but did not have time for the market.　 I will find out more.

6:56 p.m.:　 The village girls seem to really like Jeremy and Danny.　 They are smiling and waving at them.

The staff　are making blt’s for dinner and the three of us are opting for the freeze-dried Mountain House meals I took.　

6:51 a.m.: After dinner last night, they cranked up the generator and projected "Jaws" onto one of the walls of our porch. We heard some noise in the woods and a flashlight revealed a group of villagers watching with us.

6:54 a.m.: I went to bed early last night, before the boys, and awoke at 5 a.m. to the unique sound of a not-too-distant Combi. To me, it sounded like a really loud heart beat with a murmur. The chanter would call out what almost sounded like "WORK" and then there would be a thump in the ground made by many farming tools and this was repeated at least 40 times per minute. I have no idea how these guys could keep that up.

7:04 a.m.: It dawned on me that there are really two Haitis. One is the mountains, where the people are what they call "scratch farmers," subsisting on the land. Then there are the city dwellers, who were completely reliant on an urban infrastructure. Ironically, the seemingly better-off urbanites were decimated by the earthquake and forced to live in the severe conditions of the refugee camps. The mountain villagers did not lose their huts or their infrastructure except for the cement schools and churches.

It makes me wonder who would survive a cataclysmic event like a nuclear war.

8:34 a.m.: We are hoping to pour the cement today for the school. It looks good because Sister Eunice gave the workers "HE%#" for not coming yesterday so the boys will most likely be very busy today. The alternative for them is to patch the cracks in many of the walls.

I am headed with the medical team to Braley. I am anxious to follow up with several of the patients who were fairly sick.

8:35 a.m.: We are planning to go to the Obama Two Refugee Camp tomorrow.

8:39 a.m.: This place is hopping at 5:00 a.m. The kids are all up and about and the animals are all wandering around.

Tonight is our last night in the tent so we can bring it to the refugee camp. We will be staying in the house instead. The dilemma is to whom do I give the tent???

8:41 a.m.: Several members of our team have a GI illness but Sister Eunice said diarrhea is part of being in Haiti. We will be very lucky not to get it but I am still optimistic. We have been very careful.

8:44 a.m.: I will post the photo’s on a website when we get back. I am certain you will not accuse me of not taking enough pictures. I am definetly the trip shutterbug. That camera chip is clearly my most valuable material possession since these memories will be priceless to us.

8:45 a.m.: It is going to be difficult to switch gears and get back into work. Even though we are working hard, it is very rewarding.

9:51 a.m.: Never thought I would see Danny doing hard labor. Danny and Jeremy are, in fact, working on the floor of the school, carrying cement bags and wheelbarrows full of cement.

9:55 a.m.: Saturday, we stay in a beach resort with showers and air conditioning!

2: 30 p.m.: Prior to leaving for Braley, I took an unbelievable video of Despagne, describing his experience when the earthquake hit.　 Despagne, is the gentleman who worked in the maintenance at Camp Winadu.　

Headed to Braley. I am still amazed how any vehicle can navigate the mountain road we traveled.

On the way to Braley, they pointed out a thatched amphitheater-like arena that is used for cock fighting, which may be the second-most popular sport after soccer.　 I have to admit I am probably less sympathetic than I used to be about the cock fighting after being awakened by hundreds of roosters every morning.

2:52 pm.: Most people fast once a week, mostly on Fridays.　 The irony is that some are malnourished and still fast once a week. Incredible!

3:16 p.m.: I got to Braley and there were very few patients.　 When we asked the village leader about that, he indicated that some of the villagers are upset with us because we did not give all of the patients medicines.　 Apparently, some of the Haitian physician uses antibiotics more loosely-- just like some physicians I know back home in the States,stes a different expectation for patients. (Not at SMG of course!)

Our team (the NP and Sister Eunice) agrees that we need to use discretion with respect to giving out antibiotics especially since they are so scarce.

3:19 p.m.: I saw a few new patients and all the follow-up patients I had requested.　 Surprisingly, the follow up patients had done well.

Of course, I cannot go a day with out an adventure and just before we left, in came a 20-year old woman who looked like she was suffering in great pain.　 She said she had a headache and I went down the usual path of questioning for headache.　 Have you had headaches in the past, where, how long, etc etc.　 Then, when I asked her to point to where her headache was, she pointed to her left lower molar.　

It did not take a dentist to diagnose a massive dental abscess.　 I had all kinds of thoughts running through my head as to how I would help her until Sister Eunice informed me that the leader of all 9 villages, who lives in Braley, is not only a farmer and a minister but also a dentist! Well, who would have believed it?

I inquired about his training and he had six months of training after school. When I mentioned the dentist to the patient, she shook her head no.　 Apparently, she went to him but he has been out of local anesthesia for a long time and she was not willing to go through what others in her village had suffered through.

So, in walks Toto, dentist, a tall distinguished-looking proud leader who you would guess to be about 65 but may have been younger. He carried a bag full of, crude looking dental tools. I calmed the patient down greatly when I told her that I would numb her mouth. I gave her a shot of Toradol, an intramuscular painkiller, and proceeded to give her local anesthesia, trying to remember the path of the mandibular nerves – sheer luck, I got her numb.

The "dentist" sat above and behind her while I retracted and held a flashlight as he spent ten minutes yanking her tooth out.

We gave her pain medication and antibiotics and she walked home alone.

Before he left, I gave Toto a supply of alcohol to clean his tools, lidocaine, and needles.

3:36 p.m.: We drove home and found Jeremy and Danny still working on laying the floor of the school, one bucket of cement at a time and looking like they took in a bath in a pond of cement. They look like they are taking this very seriously and they are both totally bonding with the construction crew. They will be tired tonight.

My fear is that the cement will dry before they clean up and then they will be stuck!

3:40 p.m.: Three team members are really sick with diarrhea and fever. One got better this morning after taking Cipro last night. I put the others on Cipro and am hoping the rest of us stay well.

3:42 p.m.: Very excited about going to the Obama II refugee camp tomorrow and following up with the patients. I want to see if our effort to deliver the cistern was fulfilled (no pun intended).

May take a hike this evening and will definitely set up the shower for the boys.

More later.

7:28 a.m.: We had another one of our debriefing meetings last night. One of the team members, a high school teacher, who worked with the boys yesterday said he could not believe how tenacious the boys were, hanging in there without a complaint and always a great attitude.

The entire team clapped for Danny and Jeremy.

I felt really good for them. Danny said doing the work made him feel good. Jeremy spoke enthusiastically about the work and was proud of their accomplishments, after all, "how many boys in Short Hills could say they laid down a cement floor?"

7:34 a.m.: I was up at 5:00 a.m. again. Soon thereafter Danny made a b-line to the outhouse. He did that two more times over the hour and, yes, I started Cipro and Immodium. Two other team members just got sick as well. I am starting to believe we have an imperfect filtration system. The good news is that with Cipro it is over in 24 hours.

I am strongly considering having Jeremy and I start Cipro as well since it appears to be inevitable.

7:56 a.m.: Diagnosed a team member with scabies and we are out of premithrin so we are using the local treatment, Neem.

[Editor’s Note: There was a request for on-line research concerning neem. It does appear that there is a recognized organic, alternative use of neem for a variety of ailments, including scabies. According to HealthNewsDigest.com, neem oil has been used as a medicinal herb for nearly 5,000 years. Neem oil, leaf and bark are used externally for skin, scalp and hair and the leaf and bark are used for internal supplementation. It is also said to have powerful antioxidant properties. The researcher, who keep in mind has no medical training whatsoever other than raising three children and being married to a doctor, was unable to find any serious side-effects but probably not a good idea for pregnant women, young children, or long-term use. According to Rob, neem trees are ubiquitous in the area of the village. ]

3:45 p.m.: To start with, Danny is feeling better. He is up and out of bed and drinking fluids. No fever. Jeremy and I are still fine but I set aside some med’s to start at the first symptom.

On the way to Obama II refugee camp, I realized that the two lane road is really three lanes and I have no idea who is supposed to drive where. For people that are so laid back, they drive like maniacs.

4:07 p.m.: I was just interrupted to help one of the women on our team who was sick. She was lying down, trying to rest up and a bug crawled into her ear. She was running around holding her ear. I directed her to the clinic and looked in her ear to find a large ant on her eardrum. We irrigated the ear and the drama ended.

4:10 p.m.: Now back to Obama II. We handed out over 1000 Life Straws, first to women and children, and when we started to run out there was a near riot. Theat really frustrating thing was that the cistern we delivered was, in fact, filled and empty within a few hours and you need water to use the Life Straws. I suppose some of them will use them in the few putrid streamsor puddles that are scattered around.

4:15 p.m.: The clinic line seemed endless and we were in a very hot tent. We blocked the one end with our truck, with the doors accessiblewhich I was happy about in the event we need to make a quick getaway. We blocked the other end with some benches so we could control the crowds. Therefore, there was absolutely no ventilation and felt like a sauna.

The kids were peeking their heads through the holes to see what we were doing. Very cute!

The diagnosis for almost everyone was thirst and desperation. Those with symptoms other than dehydration were treated the best we could. Cough, fever, and poor lung sound were prevalent. Pneumonia? Yes, but what type, I will never know. Which antibiotic to use? The one we had. Was it TB? No means of telling. No x-ray. No time for a PPD, etc. Will they get better? Possibly. But I will never know.

4:22 p.m.: The patients I saw in follow-up seemed to have improved and were doing much better. The children looking through the tent holes were so cute – smiling, asking for water, and I could not help myself. I gave them some pedialyte and when we ran out and I knew the end was near, I gave them my water.

It was very upsetting to know that our help was so miniscule compared to what they need. It is so patheticdistressing.

4:29 pm.: We went back to the village and found Danny and Jeremy lounging in the sun. They had painted the cooking area for Sister Eunice pastel blue. The other guys made bakery shelves and storage containers for food and other supplies.

When we stopped for some drinks in Cabaret, I downed three 8-ounce bottles of juice and a Gatorade. Guess I was a bit low on fluid. I have no idea how these people in the refugee camp are surviving.

4:35 p.m.: We are packing and cleaning up now, getting ready to go to the breach tomorrow and bring a nice, clean relaxing end to our adventure.

9:58 p.m.: While we are happy to leave so we can get cleaned up and a get a shower and some rest at the beach, we are definitely sad to leave these really nice people. They are happy, friendly, always trying to be helpful, and very appreciative.

Many of the villagers came up to our bunk house and serenaded us.

Danny and Jeremy had kids all over them, picking them up and giving them hugs. It was an unusual scene.

10:02 p.m.: Sorry about the insect stories but they continue. A member of our team was in the outhouse when she looked at the wall and saw a very large scorpion. She let out a shriek and several people came running. Pierre, my translator, squashed it.

10:05 p.m.: We had a meeting about cleanup and closing down of the bunkhouse. We were all saying that it felt as if we had been there a long time. It is probably because so much has happened in such a short time period.

Dan seems much better and Jeremy has no symptoms.

[Editor’s Note: Rob wanted you to know that Summit Medical Group is hosting an Exhibition of Haitian Art on Friday, April 16, 2010, from 5:00 – 9:00 p.m. at Summit Medical Group, 1 Diamond Hill Road, Berkeley Heights, Lawrence Pavilion Lower Lobby Gallery. There will be music, spoken word and paintings by local Haitian artists. Additionally, Rob will give a talk on his trip. The paintings will be available for sale and a portion of the proceeds will be used for Haitian relief. This event is open to the public. Hopefully we’ll see you there! SDE]