I got done with surgery not too badly today, about 8:30 pm, then had a bunch of patients to sort out in the hospital with Drs. William, Morose and Adult. Overall, doing well. Frenel is going home tomorrow, (my first amputation), then coming back in a few months to be the first amputee to get a prosthesis, the Lord willing and the program cooperating. The lady with the buttock loss, who had virtually nothing on the right side due to crushing injuries, has healed pretty well, only about a 6 inch by 2 inch by 1/2 inch deep hole left, it is a bit gunky, but hope we can clean this back up.

I saw my ruptured appendix back in the clinic today, one tough lady, she had walked around with the rupture for 2 months before she came to me, had been to 2 different hospitals without the right diagnosis, not that it is always that easy to diagnose here. She looked great, at 46, minimal scar, and wanted to know if she could get rid of restrictions of any sort. Very encouraging to see her. We continue to see delayed problems, a lot of nonunions of fractures treated who knows how. We had one that had an open reduction with plating, then went to the leaf doctor for treatment (using herbal remedies, poultices, etc) now has burned the skin and has infection in the hardware/metal inside the arm. A real problem anywhere, especially here.

The trip here was rather uneventful, thankfully. The baggage delivery system in the warehouse can only be described as total chaos. The bags are unceremoniously tossed through the opening in the larger steel doors and then are supposed to be brought to a central storage area, but it essentially turns into a free for all. I was rather glad that I had both yellow duct tape stripes and the grey ones, as many had one or the other but not both, there must have been at least 500 bags just tossed everywhere. I had the spinal anesthesia and Ketamine well packed, my most prized commodities, as doing surgery both here and for the team at Bonne Fin would be difficult without that. We did find a little spinal for sale here in Cayes, about 4 times the price per dose and no where near as good quality, so thanks to Keith Knepp for finding it for me. I am hoping to get it ordered from IDA in Amsterdam soon, but haven’t heard if Herby, the customs clearing agent, has returned since the quake.

As mentioned, the patients that are now coming from the quake are more chronic ones with nerve damage from the crush injuries, many of whom have still rather painful memories of the friends that didn’t make it and seem traumatized psychologically as well as physically. It is harder to encourage these to push themselves to try to regain function. Sometimes, the Haitian attitude of “Si Bon Dieu le veut,” (if good God wills It) is great, as they can better adjust to the difficult fate that awaits them here in this struggling country. However, from a rehabilitation standpoint, it can be rather frustrating to try to maintain function while waiting the months it may take for nerves to regrow as much as they possibly can. The same attitude can be rather fatalistic and not produce much effort.

A team that arrived last week Wednesday or so for our sister hospital, Bonne Fin, said their volume has reduced considerably. Ours is still up, though more manageable. However, the injured are still stumbling in, especially since some have heard that we are gearing up to do more physiotherapy and prosthetic work. Although I am technically responsible for that aspect, I am also technically challenged and will oversee it only as needed from the medical standpoint. We are still providing a solid meal daily to each patient and some of the family members, this has been a real encouragement to them. We try to provide high protein intake, with beans, some meat, etc, plus the daily fare of rice. No one seems to complain about the limited variety and the cooking takes place right behind my bedroom, so it smells nice even hours after the food is done. Of course, I am known to eat anything and everything around, so maybe that isn’t as impressive an observation. Hopefully we will be shipping a large amount of rice on the next container to go, as we can get it for around 1/4 the price here.

It does seem that when bad things happen, they just continue to happen in the sad places. As you may know, long before the earthquake hit we had planned to bring at least 3 teams from our churches/family/friends, with quite a few veterans on each team so that we could hit the ground running, both at the hospital and at the camp the Wrays are renovating. Because of the quake, the first team, Duane/Dan/Kevin, et al, was not able to come for the planned 2 weeks since there were no commercial flights in. In addition the places where work was to be done at both places were full of hordes of homeless and traumatized patients and other people. Nonetheless we continued to hold tickets for a second group, organized again with my sister’s church, Faith United Reformed. Their previous team was in Les Cayes two years ago when there were riots, and they had to evacuate in rather unique ways. We also added 4 more nurses to the one nurse and family practice doctor that had already planned on going. Two of the nurses came a week early via the Bahamas route to stay for three weeks. They had a day delay in getting here due to missing the flight in to Cayes and their baggage came 6 days later, so they have been making do. They have fit in excellently and we appreciate their work very much – they both have lots of energy and this tends to rub off on those around them.

Our group left Friday at noon from GR and we picked up the other 2 segments in Florida that evening. I had been up finishing up my charts the evening before til 3 a.m. so while the rest of the group went off in search of dinner, I ate a sandwich which my wife had sent along and was fast asleep before the rest of the group came home. When we arranged the room through Harvest International, the Wray’s mission board, we were assured they had 24 hour shuttle service, since we figured we had to be at the airport at 5 am for our early flight out. The first shuttle didn’t go until 5 a.m. (so much for 24 hr) and it was first come first served, so we figured we had to be there at 4:45. Since I had two young men sharing the room with me and they weren’t back from dinner yet, I set the alarm early figuring that I would take a shower and get out of the bathroom earlier to give them a chance to clean up. I forgot that young men have different ideas about preparing, they only got up 10 minutes before we had to leave and the first question was, “What’s for breakfast?”

There was a line of people waiting for the shuttle, so half of us took taxis and we all got to the airport in time. Unfortunately the plane for Port then didn’t take off for almost an hour after it was supposed to, and when we arrived we saw the terminal was too damaged for use. We were loaded onto buses (American Eagle, like the shuttle buses in the US, wonder how they got there?) and taken to the dilapidated old American Airlines cargo storage warehouse at the other end of the airstrip. Here, Customs, Immigration and AA have set up temporary work stations. Needless to say, any faint resemblance to USA airports was coincidental but we were thrilled that ALL of our luggage arrived with us, practically unheard of since AA started flights again as planes are overfull and baggage comes when possible. Both the 17 in our group and another group of 12 ACC people going to Bonne Fin for the week were waiting to travel overland. Our luggage was banged up a bit as there were no baggage handling belts and all baggage is thrown into the warehouse through a side door and then dragged out to the waiting passengers with little regard for the contents. With the makeshift settings, we couldn’t manage to move as a group, and Jeff, one of the 3 in our group who had never been to Haiti, somehow didn’t get his customs form stamped, so he wasn’t allowed to get out of customs. When I tried to go backwards through the line, I took a good yelling at (at that point, I didn’t let them know I understood a little Creole), and was chased out before getting close enough for him to even see me. I waited a bit and tried again, having left all my stuff with my sister in case I got in more trouble, and I managed to persuade the hostile customs guy to let my friend out without the proper stamp as immigration had long before left the building and its makeshift setup, so my first thought to have him go back through immigration was not an option. [It turns out that Harold, my brother in law, also didn’t have a stamp but somehow managed to get out.]

The AA warehouse is right on a main road in Port au Prince so the van (with open trailer) and bus that Tim Reinhard had arranged to pick up both teams and take us back to Cayes had to park on the side of a busy road and we had to cross it with our luggage and a horde of “helpful porters” all wanting to help for profit. The police yelled at us a number of times as traffic, as usual, takes up at least 4 lanes of a 2 lane road, so even the roadside is used for some semblance of progress. We finally loaded up the top of the van and the trailer with all of our luggage as the chartered bus would only take 27 of us with one carry-on each. Tim Reinhard and the family practice doctor stayed behind to guard the load and wait for 4 more people of the Bonne Fin team that were coming on the 12:40 flight. Tim then said that there had been deluges of rain on the southern part of the island and that the roads were flooded in places, so urged us to get going and he and I would stay in phone contact when he took off.

Traveling through Port again, seeing the extensive destruction and the seeming thousands of people in tent cities along the road, in any open space and often in the middle of the road, was amazing and discouraging. We made pretty good time for the first 3 hours, getting halfway across the mountains without a hitch. We could see that the sky was very dark and Dr. William had called me to see when I would arrive. He had several possible surgicals waiting for me, but his house was flooded, as was most of the town of Cayes, so he needed to make plans to care for both the hospital and his family. When we hit the southern side of the island, there were many places where the water was so deep as to fill up the well by the door of the bus. When we got out of the water, we would open the door to let it out as the rubber weather stripping that was supposed to keep the water out acted more the opposite. We did pretty well for about another hour, but by 3 pm (now 5 hours into the normally 5 hour max. trip), we were literally dead in the water, with larger trucks stuck in the mud and those trying to get around at times tipped sideways or washed away further down the road; plus it was pretty dark. One of the nurses who had never been to Haiti observed, “it seems that no one uses any common sense on the road here, such as staying in a reasonable file, trying to take turns across narrow bridges where the water is running several feet OVER the bridge and no one really knows where the edges are.”  I think we made less than 1 mile of progress in the next 3 hours and then stood for another hour in the pouring rain. The assistant driver, who covered himself with a tarp, would often go out and scout the road and then direct us through some touchy areas after having gotten information from people in the area. Neither he nor our driver spoke anything but Creole and mine is very limited. We often would make 30 feet of progress, only to then stand another 30 minutes, all the while beginning to be driven by some urgency to find a bathroom, as was now was over 8 hr since we had left Port and some bladders were struggling. I called ahead to Beth Newton and Dr. William, asking how it was between us and them. After checking with the UN in Cayes, they said the UN was using whatever equipment they had available to try to clear the roads of wreckage, mud slides and boulders from the earthquake which had now moved down the mountains with the floods, but probably wouldn’t get to us until the next day as there was a bus well stuck in the road and blocking all passage. We didn’t have any drinking water left by then and hadn’t had much to begin with, only what was in our backpacks after getting through security in Miami. We hadn’t planned on drinking too much en route as what goes in will come out, and white people trying to use the trees for facilities often draw a crowd. Since turning around wasn’t an option and there were no “facilities”, we were planning on settling down for the night and under cover of darkness, some of us made bathroom breaks behind trees; some associated slippage made some unfortunates come back with more than they bargained for and no means to clean themselves off except the rain, not giving any names 🙂

We now were believing ourselves stuck for the night, waiting for the water to abate some and then trying to move when daylight came, when suddenly several UN trucks came barreling by. Although they were 4 wheel drive, high riding trucks and our bus was low to the ground, our driver decided we might be able to follow them.  We started again, now in the dark and not knowing exactly what part of the mud was safest nor where the road lay.   We were waiting off to the side for some trucks to pass from the other direction (rarely was the road wide enough for 2 vehicles to pass), when one truck clipped the back of our bus and bumped us further off the road, but we could continue. I would hate to see the bottom of the bus in daylight, we scraped it on so many rocks that had been washed onto the road and couldn’t be seen in the dark. By the grace of God, much prayer and sometimes singing to keep up sagging spirits, we made it to Cayes late that evening, maybe 9 p.m.

I don’t remember the time, but I was in the O.R. with an incarcerated hernia, 4-days-old with dead bowel, within 30 minutes after I arrived at the hospital. I asked Dr. William why he didn’t refer the patient elsewhere, as the patient had arrived just after Dr. Jim Webb, a surgeon covering for a week of my absence, left. He asked me where he should have sent the patient, as apparently there is now no place to send patients for general surgery. Bonne Fin is doing orthopedics but they send us the general surgical, and the government hospital is in dire straits. We finished the case at 12:30 and I crashed until this morning, thankful that we made it safely and that we could do the surgery for this suffering lady.

I have two other bowel obstructions waiting that I am trying to treat nonsurgically. The place is still totally full, so pray for wisdom as we start this week with a rather interesting and busy beginning. Everyone seems to have adjusted as well as possible, quite a few slept in borrowed scrubs last night as the luggage didn’t arrive ‘til much later. We are thankful to the Lord that we are safe and well, but grieving over the many who have now lost in the flood what little they had left after the earthquake. In our area, many have even lost their lives. No numbers are out yet, but entire houses have been washed away, so who knows what has happened to those in tents. Who would even know when they disappeared, it would seem, not sure how well one gets to know neighbors in the tent city.  Please continue to pray for the people in this horrible situation and emotional strength and wisdom for the team members and missionaries trying to help.