Kenia & Kafka

I keep seeing Kenia's chubby 4-year-old face getting cross with me because I won't pick her up for what seems to me the zillionth time.l Now I wish I'd done it once more.

Kenia, I think I've mentioned before, came to the clinic in Grand Bois in February 2007. Her mother had a new baby, and apparently couldn't feed two kids. She came into the clinic too weak to cry, literally on her deathbed. Dr. M had to put the IV in her foot.

Now she bounces around the clinic like she owns the place. When amused -- and she's easily amused -- she laughs a deep belly laugh.

A couple in the US would love to adopt her. Michael had an appointment at the US embassy today to see what they could do to smooth the way. The appointment means standing on one side of a plastic window and, after a very long time and for a very short time, having someone not be very helpful. Frustration, here, is a way of life.

So, too, was Dave's mission to get wire to finish electrifying the school in Grand Bois. He found what he needed -- but they wanted $300 for $60 worth of wire. Overpaying for wire is a poor use of precious funds. So the next ServeHaiti group will have to carry the wire from the US.

Illustrating the Kafkaesque aspects of this city was a trip we made to the Presidential palace in the heart of the city. It's an immense white mansion. Just across the very broad avenue is a broken-down hovel. And in between is a monumental statue of a slave with a broken chain and a broken sword, blowing a chonch horn with all his breath. Freedom! Yet all around are homeless people sleeping on the concrete and boys, mothers with infants, and legless men begging for coins or food.

The main Cathedral has broken windows. Across the street from the cathedral gate, a homeless man sits in a hollow he's made in the dirt between the curb and a cement wall, picking nits from the hair of a frail little boy.

Geert was here when we got back to the hospice. He was supposed to have left today, but spent the day dealing with bureaucrats who were supposed to help him avoid customs costs on his boat. After a whole day of this, he had to pay anyway. When we saw him, I asked why he was still here.

"Have you ever read much Kafka?" he asked.

Yes, we have.

A Death and a Life

Shortly after dawn this morning I stumbled downstairs and out onto the front porch of the ServeHAITI clinic in Grand-Bois, Haiti. I was looking for Dr. Michael, whose 18-year-old patient had been in labor all night. I'd been looking forward to assisting at the birth of her first child.

An elderly woman approached, half carried by a man. I rushed down the stairs to help; she collapsed at my feet.

With fear in her eyes she half raised herself on one arm and cried out for help. Dr. Leo and Dr. M appeared and we carried her into the clinic. As we eased her into a cot, she cried out to God and gasped the kind of gasp you may never have heard but would instantly recognize. She was dying.

Michael sent me running for a piece of plywood board that he'd been planning to use in building beds and shelves. We set it behind her back, and I began CPR compressions while the staff scrambled to find some atropine (we're set up as a public health clinic, not an ER -- but there's nowhere else to go around here). Eventually someone found some epinephrine and the Michael injected her. The oxygen machine was broken, but Michael gave her air with a mechanical ventilator while I pushed down hard on her chest, arms locked, one hand on the other, forcing blood through her heart, over and over. Through her thin skin, it felt exactly like what it was: holding her heart in my hands.

We kept working for a long time, perhaps a half hour or more. Dr. Leo hooked up an EKG and we got a faint reading -- but when I stopped doing chest compressions, the line on the graph flattened out. At last, Michael put his hand on my shoulder. "Let's give her some peace," he said.

A little later, Michael and I decided to run some wiring at the dilapidated school a couple of miles down the road. It's where 400 local kids get primary and secondary education. We were planning on setting up some outlets for a few donated computers (even though there is no Internet access. Or, for that matter, much of anything except chalk and a few blackboards).

That's when a dusty truck pulled up with men carrying a stretcher. On it was a man, age 60 or so, screaming in pain. Janvier, our interpreter (and a skilled nurse, as it turns out) relayed the story. The man had been running to jump onto the back of the truck but slipped and fell under the truck on the rock-strewn road. And then the truck ran over him.

His leg was torn open in a 14-inch wound that exposed the muscle beneath in a wide, jagged cut. There were a couple of smaller, equally deep wounds as well as a serious 3-inch cut on the sole of the foot, from which muscle protruded. All the wounds were deeply impregnated with dust and rock and bits of the filthy fabric that had been used to staunch the blood.

And by now, his foot and lower leg was extremely swollen. Given the emaciated state of his other leg, the swelling was alarming but totally irrelevant to what Michael determined was his first need: pain control, wound cleaning and a lot of stitches.

Given the nature of the injury, Michael and I both thought his shin had been crushed. If that had happened, he'd have to go to Port au Prince for care -- a 5- or 6-hour drive. We began making preparation for this, but Dr. L happily determined that the bone was somehow not broken, and that we could treat him in the clinic.

Michael pulled on sterile gloves. He gave the man what pain medication we had, which was not particularly effective. I held the man down while Michael injected the wound with xylocaine anesthetic and cleaned the wound, first with water, then with peroxide, and finally with antiseptic. The man was very brave, but could not help crying out. It took two of us -- one of his coworkers and me -- to hold him down. It was a scene from a civil war movie, I kept thinking.

Then I scrubbed down gloved up. While Michael painstakingly ran a curved needle and suture through the edges of the wound, my job was to push the tissues back under the skin and hold the wound closed while he pulled the stitches tight. We illuminated the procedure with camper's headlamps we'd fortunately packed for the trip.

Michael ran two series of stitches down the wound. Every time I pulled the wound shut, the man cried out in agony. After about an hour of this, my head got very light and a cold sweat broke out on my neck. Michael noticed the symptoms, and we agreed I should take a break. Luckily, I got better after a few minutes and we resumed work.

None of this fazed Michael, who under brutal conditions worked steadily and with great skill. His sewing was sure and true, often making little circular stitches that almost miraculously pulled the wound shut in places it seemed there was far too little tissue for coverage. Several times, his work made me cheer.

At last the job was done, and Michael put a cast on the leg. Finally we could elevate the foot and bring in the man's family. They rejoiced to see how much better he looked, and immediately fed him a bowl of rice and beans, which he ate with great gusto.

And at about this time, Dr. L came in and jokingly chastised Michael for forgetting his other patient. Then he broke into a wide grin. "It's a boy," he said. Despite being in labor for over 14 hours, the mother and child almost immediately set out for home.

By now it was about 2pm, and there was a lunch of corn mash on the table. Just time to eat, when Dr. Leo said it was time to treat the kids with tungiasis.

The boy was about 5 and his sister about 8. Both had painful black bumps on their toes and soles. The boy went first. A nurse held his leg fast as Leo took a curved surgical scissors and carefully probed under the bump, about a quarter of an inch under the skin. He pried the hardened skin off the edges of the bump, and when the skin came off, it came with a soft white ball the size of a baby pea.

A close look at the pea revealed a tiny head on the end going into the foot, and a tiny orifice on the end going out of the skin. The animal is the variously named jigger flea -- a flea with limited jumping ability that burrows into the skin and becomes bloated from feeding on blood. When removed from the host, it looks like a spherical maggot. Each child had dozens of the fleas embedded in their feet. They were extremely brave, but for two hours their screams rang through the halls of the clinic.

When it was over, I gave them each a Tootsie-Roll Pop (I had a few with me). They laughed. I cried. They will fully recover with some antibiotics and bandages (though their house and grounds must be treated with insecticide to prevent reinfestation -- each flea leaves about 100 eggs in the environment).

For dinner we had rice with a bean sauce, whole roasted plantains, and a little piece of roast goat. Dave, who during all this finished wiring the well and burying the cable, shared a beer with me as we watched the sun set.

I really mean it -- it was a good day. Maybe a great day. Yes, there is terrible suffering. But: There is grace.