Thursday, April 18th, 2013
Yesterday, we were in Port au Prince for an appointment for both girls. Before leaving our hotel, Rose was playing on a couple of low stairs. I had taken her down once and when she climbed back up I chided her to get back down and began walking toward her. Before I could get there, she giggled with the pleasure of her own disobedience and hurriedly turned to go down the two stairs. As she turned she lost her balance and fell. At first I did not get why she was crying so much for an injury she usually recovers from so quickly, and felt a little angry that she was carrying on so, but when I tried to set her down she would not put weight on her left leg. She acted "shock-y" the rest of the afternoon, sleeping a lot and not wanting to eat. She whimpered when her leg was moved. At that point I was pretty sure she had some kind of break or serious injury. At the advice of a friend we splinted it once we were home and Rose slept for most of the night.
I have written about going to the Dr. once before, but the experience of accessing medical care here in Haiti is so unlike home, I thought I'd share another encounter with healthcare, Haiti style.
Let me start by saying that there are truly some lovely people to meet along the way. Despite the hardship Haitians face both in their work and in getting care, in general, I encounter patience, warmth, and friendliness along the way. This is one of the marks of goodness I so enjoy about this culture.
The morning begins just before 7. My cell phone sounds the "rise and shine", I get myself dressed and ready and then wake Rose.
I leave our place at Manna and walk over to COTP. Noah has decided to come along to help out and join in the adventure. After tracking down John, we get into the red pick-up and bump and jostle down the dirt road, until we get to the tar road that leads to Milot. I have been to Milot often enough to know my way around a bit, so I leave John at the vehicle and enter the front gate. He agrees to find me in about an hour to check in. The security guards ask nothing of me as I enter.
I am not entirely sure where to go for emergency care, so first I check out the pediatric clinic. The nurse tells me there is no doctor there and points across the courtyard. Not knowing exactly what she says I walk back across the yard and up the stairs to the second level to an entrance for hospital admissions. There I ask a guard where I can see a doctor for my daughter's leg. He shrugs and indicates I need to go back downstairs, so I do.
I walk to the peds unit. There the nurse points me to Urgent Care, which I have not before noticed, tucked in a corner of the wide courtyard.
The door has a padlock which hangs open and a nondescript door with a curtained window and a sign that reads Urgent/ Emergency. I knock lightly and then enter, squeezing in next to the others in the cramped entry. The area immediately within the door is a combined med room/ administration desk/ nurse's station/ waiting area all within approximately 10 x 10 space. I tell the young man behind the desk that I my daughter has had an accident and I believe she has a broken leg. He attends to a couple of other tasks while I share a single chair with Noah and Rose on my lap.
While I wait, I take notice of the room The rest of the space is sectioned off with curtains which fall too short to cover the areas they seek to divide. There are 5 spaces with beds, 4 of which are occupied with people in varying degrees of injury and/or pain. Two appear to be moto accidents with painfully abraded skin peeking through gaps in the curtains. Family members crowd beside beds to help attend to the injured. One large-breasted woman lays in her bed, topless, and while Noah is at the age to feel both curious and embarrassed by such nudity, in this setting he seems largely unfazed.
Back at the desk the young man writes out an order for radiology. Having been here before I know I must go and have the price of the procedure written on the form and then pay for it prior to accessing the service.
Noah and I leave the room, with me carrying Rose, back across the courtyard, down a narrow two-way sidewalk to the front entrance. I go to the information booth. No one is there. In the past when this has happened, pharmacy seems to fill in for the job, so I walk over to the pharmacy, which is in the same general area near the front gate. I wait in line behind 4 others until it is my turn at the plexiglass window. I pass my paper under the small arched opening. Cool, air conditioned air seeps out into the muggy hallway. The person inside informs me that the information attendant is now on duty.
I return to the information booth, wait my turn behind 2 others and then present my paper there. For some reason unknown to me, radiology fees need to be assessed in Archives (Records/ HIMS). I walk to the doorway next to the pharmacy and walk in. After waiting for one other to be served I present my paper. The man writes 500 and I leave. Next go to the Cashier to pay for the service. There are 5 people in line. I wait. Again. Rose's weight is wearing on my right shoulder muscles but she remains in a relatively good mood, and Noah is holding up remarkably well with all the waiting and searching, so I am thankful for that. I make it to the window, pass the attendant my 1000 Gould bill, ignore the flirtation, and return to the courtyard to find radiology.
Radiology is marked with a sign above the door, painted in green letters, like all the other offices. It sits on the far right end of a plaza of sorts, along with special services to the left, and OBGYN beyond that. There is a large outdoor waiting area with wooden benches witch are all occupied beyond capacity. I quickly scan the hands of those seated to see how many others hold papers like mine. Seeing none I am assuming and hoping that most of these people are here for "special services" or OBGYN. I mentally check off all of those with pregnant bellies and add a few extra to the tally as their friends and family, and am pleasantly surprised to see only a handful of others. We might get through this whole deal quickly!
It is difficult for me to tell what the proper procedure is for knowing when to enter an office or room, but sitting around doesn't answer it for me, so I go up to the door, squeezing around a man in a wheelchair with open skin. He was in urgent care with us a little while ago, and his attendant stands behind him with a paper like mine. I knock on the door and open it. An official looking man with properly trimmed hair and dress clothes, looks at my paper and tells me, "just a moment". I leave the room and prepare to wait as "moments" vary a great deal based on interpretation!
Waiting is a big part of accessing care, and of many other aspects of life here, and since I am now waiting, while still holding my chunky toddler in my weakening arms I decide to people watch. Though I have not yet specifically mentioned it, I should say that all the while I am at Milot I am being watched -- and talked to, and talked about, but mostly watched, so I feel less shame in openly staring as well.
There are improvements being made to landscaping in the grounds outside our seated area, and men are working on the landscaping. I find it somewhat amusing that one of the guys is dressed entirely normally in shorts, t-shirt, and baseball cap, but has somehow found it appropriate to wear over the knee toe socks. They have a red back-ground with a pink heart pattern for the majority of the socks with teal back-ground and white hearts from the ankle down, and flip flops between his conveniently separated toes. He works seriously and is not at all hindered in his diligence by being dressed ever so slightly like a circus clown. Noah does not even double take. His new normal has set in.
After 15 minutes or so, the gentleman I saw inside the radiology room pokes his head out searching the crowd. I lock my eyes on his, hoping he will notice and summon me with my white paper in hand, and he does.
Once inside I place Rose on the 1950's style x-ray apparatus, after the x-ray tech cleans the fresh blood off the table left by the previous patient. The gentleman gives me a lead gown, positions Rose as one might expect, goes behind a plywood wall and takes the x-rays. He then goes into a room labeled "dark room", processes the film, places the x-rays in a large envelope labeled "spine" and motions for us to exit the room. We leave and return to Urgent Care.
Once back inside the Urgent Care room, the young man behind the desk takes the x-rays looks at them without registering any concern. He gives them to a Dr. who tells me in English, "the bone is broken. We need to cast." I can see from the Dr.'s indicating that there are breaks in both the tibia and fibula.
At this point another piece of paper is written with a request for Rose's medical record. I need to return to Archives to get it. Back across the courtyard, down the narrow sidewalk, around the corner to Archives with Rose on my hip and Noah following behind.
Again we wait our turn for being served. I pass along the chart request along with her hospital card number. One problem. We don't seem to have the right number. Sigh. We are being helped by a most wonderful man, slight in stature, with Gandhi- like kind eyes. I happen to have a copy of Rose's birth certificate along, so after some precursory searching for the chart, Gandhi sends me away to an office with a computer to see if her birth day shows up.
ONCE again, back around the corner, down the narrow sidewalk single file, across the courtyards to accounting. There they look in the computer, but are unable to help. I follow my route back to the Archives office to tell them we have no luck. Gandhi tells me without the chart I cannot return to Urgent Care. I tell him I will go to the waiting area outside to sit until our driver returns. My cell phone died a few days ago and Kirk had texted the chart number to John when we could not find Rose's ID card that morning. So we wait. Noah goes outside the gate to buy some street food from the daily vendors. Rose and I entertain the other hospital patrons simply with our "white mama, haitian baby" routine. A man asks if her mother is dead. Not wanting to get into a long discussion, I tell him "yes". He asks me if I am her mother. I tell him I am. He then proceeds to explain to those around us, that the baby's mother is dead and I am now her mother. There are nods and murmurs. They watch me feed the baby. They watch me get her sippy cup out the backpack and hand it to her. They comment that the baby drinks. They comment that I give her a doll. They comment that she throws the doll on the dirty ground and that I give it back to her. Just when I am becoming quite weary of the fishbowl, Gandhi returns with wonderful news -- there had been a misspelling of her last name, but he has found the missing chart! I want to kiss him on his shiny forehead, but resist, and instead thank him profusely.
He walks me back to Urgent Care with our chart, where we are now able to receive services. We have now been at Milot hospital for 2 hours. Though others stand in the crowded room, we are ushered to a back corner. The Dr. asks a nurse to get a clean sheet which she places over the sheet on the exam table. I set Rose down. My bicep murmurs a weak thank you with a twitch.
The Dr.'s name tag indicates that he is the medical director. He demonstrates casting Rose's leg to 3 nursing students and two other young men in the room. The other patients and their visitors watch as well. Rose cries as sad wet tears roll off her cheeks into her ears and then it is over. She is casted from toe to thigh and we can go.
Almost.
John has not returned but Papito arrives. The nurse is happy to talk to him instead of me assuming he will translate, which he does. I have not yet been given a bill for the Dr. or casting so I ask if I owe something. The nurse leaves and returns with a piece of paper. 250 is written on it. I need to go back to the Cashier to pay and then return to Urgent Care with the stamped paper indicating I have paid.
Noah and Rose and I wait in line once again. There are 6, then 5, then 4, then 3, then 2 people ahead of us, when someone from Urgent Care comes out to the line to find us. He says, "the nurse says you can return". "Can?" So it's optional. I would rather stay and pay and then check what is needed, but he clarifies that we need to leave the line now, so I do, reluctantly saying good-bye to my almost- to- the-window spot in the cue, and follow the man back to urgent care.
The nurse in urgent care tells me they have given me the wrong price. It is too high. Too high I do not care about if I means we can leave, but then she looks at something else and says it is too low. She hands me a new paper with 600 on it.
We return to the line. We are once again waiting when a nurse from Urgent Care appears. I think this cannot possibly be a good sign, but she simply gives us Rose's x-ray. I smile say thank you, pay my bill and we can leave! Whew.
I find Papito in the front waiting area and ask where the vehicle is. He tells me he is on a moto. At this point I do not care how we get how home and Noah is practically giddy that we get to ride home on a moto so Papito gets on the moto, Noah snugs up behind him with the x-ray tucked between then, I throw a skirted leg over over the back and squeeze Rose in between Noah's back and me, and with back-pack on back we leave.
Urgent care at Milot is not the same as at home, but for $25 American, Rose has been seen and cared for and we are headed home. I think I need a nap!!!
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| Rose with her new cast - day 1. |
