Today my heart broke

A six year old boy presented with the classic symptoms of Duchenne Muscular Dystrophy. This is a rapidly progressive neuromuscular condition with a life expectancy of 13 years (in developed countries). His signs included a positive Gowers sign, a trendelenberg gait, frequent falls and an inability to hop or run. 

I turned to my Physical Manual for Neurological Conditions text to read “informing patients that their child has DMD causes extreme distress and should only be undertaken by the most senior member of the team, in an appropriate environment, with a support worker present who can maintain contact with the family”.

I felt so ill-equipped without the back-up of a whole multidisciplinary team. This really hit home the lack of basic services available to the Haitian population. The Neurology service is particularly limited.

The mother has approached various doctors but has no appreciation or understanding of the disorder. 

It is likely that she has been attending voodoo priests and the common belief would be that a spell has been cast on the child.

Perhaps she has seen a western style Doctor and has an acceptance issue, or a lack of understanding due to a cultural or language barrier, I am unsure. It worries me that empathy is lost in translation. I shed a tear of frustration on my way home from work. How do you give hope to someone, third party, when there really is very little hope to give? I can't imagine the desperation and pain of the family.

I went home to my mango tree with very intense feelings of loneliness and isolation, faced with a whole weekend of nothing to do and nobody to do it with. However, to my rescue came the adorable Jessica. She is a teenage daughter of the family I am staying with. She entertained me all evening with her bubbly personality and chatter. She even taught me how to count to 100 in Creole!

My light of life - the Mango Tree!

The first 3 days

I arrived safe and sound at Port-au-Prince. The view from the plane gave me a great appreciation of the size and population density of the city. The city sprawl appears to be limited on the west by the sea and to the east by the mountains. There is a wonderful chaotic Caribbean vibe with endless street sellers carrying their produce on their heads.

My host family sent a lovely tap tap driver named Anel to pick me up. He spoke no English, I spoke no Creole. Despite this, Anel felt obliged to give me a comprehensive language lesson. I smiled, nodded and repeated some random sounds!

It took two hours of proper four wheel driving on worse than country type roads through the city to get home (it's probably about 20km). There is no apparent use of any road rules. The nature of the roads reminded me of driving up the McCauley riverbed to access the Godley valley in New Zealand, just throw in a few million Haitians for effect. There appears to be no observance of any road rules. I have to admire the spatial awareness of Haitians. Trucks, tap taps, cars and people all miss each other by fractions of a millimeter!

Despite my exhaustion after a sleepless night at Fort Lauderdale airport (where the airport sheriff told me to “expect the worst down there” thanks mister, that added nicely to my nerves!), I went straight to the clinic.

Global Therpay have done a great job at getting an indoor clinic up and running. The clinic itself resembles a shed in the backyard of a house. It is small but functional. There is no toilet for patient use and to wash your hands, you have to go outside to the store room.

The Clinic!

I'm working with two very enthusiastic Haitian guys called Andrew and Frantzo, they have made me feel very welcome and are very eager to learn.

Andrew is the clinic manager and my translator. He has done such a good job that he will be funded this year to attend university in Minnesota to study a Physiotherapy Assistant program. Frantzo had recently graduated from a 9 month rehabilitation technician program in Haiti.

There is a rooster who greets me each morning and calls my next patient. I think I'll call him “The Secretary”!

The Clinic "Secretary"!

Inside The Clinic!

I am slowly learning Haitian Creole thanks to Andrew, Frantzo and some good people at Kansas University who complied a survival guide.

The patients appear to arrive all at once. There is no concept of scheduling. It works on a first come first served basis and people don't mind waiting for as long as it takes. It is my instinct to get stressed if there is a patient waiting for me, however, in Haiti, it may look chaotic and hectic but it is ok to work at a reasonably relaxed but efficient pace.

To date, the majority of patients I have treated have suffered CVAs. This is due to a large incidence of uncontrolled blood pressure as a result of a lack of primary healthcare. We also see a number of traumatic orthopaedic injuries and I have ordered a prosthetic lower limb for a lady who sustained a below knee amputation.

It appears that the patients are genuinely excited to receive treatment and each patient has a beautiful big smile, bigger than the next. The patients are exceedingly pleasant, courteous and appreciative of any intervention that you give them. I wonder if this politeness affects my treatment evaluation...? I will ask Andrew! They are eager to learn and appear to be particularly compliant with advice and exercises.

The following are some images from outside the clinic:

The kids from the house next door! They couldn't afford to continue school after the earthquake  so some kind Global Therpay volunteers are funding them.

Overcrowding due to a large population density.

Poor living conditions.

Hanging out the washing before the rains come.

From one Shaky City to the Next...

Some might think that it is ironic that I have left one earthquake stricken city for another. However, living and working through the devastating Christchurch earthquakes has emoted a compassion in me for helping survivors of earthquakes elsewhere. Perhaps it is a remnant of some survivor guilt, or just a desire to use my skills where they are really needed, or the realisation through years of rehabilitative work, that it is hope that fuels the human spirit. Maybe it is a self healing mission to help me put my own experiences in perspective. One way or another I am very excited to have the opportunity to work as a physiotherapist in Haiti.

The Earthquake:
Although the extent of devastation in Christchurch did not quite meet the magnitude of devastation in Port-au-Prince, I am curious to see the contrast in the recovery of these two vastly different cities.

"The 2010 Haiti earthquake was a catastrophic magnitude 7 earthquake, with an epicenter approximately 25 km west of Port-au-Prince, Haiti's capital. The earthquake occurred on Tuesday, 12 January 2010. An estimated three million people were affected by the quake; the Haitian government reported that an estimated 316,000 people had died, 300,000 had been injured and 1,000,000 made homeless" (ref. Wikipedia).

The Global Therapy Group:
This is a non-profit non-govermental organisation. They are part of the Haitian Governments Injury and Rehabilitation Disability Working Group. The team are working to provide sustainable rehabilitation services for the people of Haiti, run by the people of Haiti. As well as providing treatment to the local community, I will have a role to play in educating the Haitian employees, Andrew and Frantzo and in helping to develop the rehabilitation service. What compelled me most to work with this NGO is their forward thinking and their mission to strive for a more long term solution to the lack of rehabilitation services in Haiti. I believe that there is never a quick fix, investing in education and learning is the key to developing an appropriate and adequate service.

You may visit the Global Therapy Group website at:

 http://globaltherapygroup.org/Welcome.html and feel free to visit the donation page!

Salt Lake City airport 24/4/2012 

Sitting in Salt Lake City airport with only my Steinbeck novel and the butterflies in my stomach for company, I wonder why I am so anxious, and come to the conclusion that it is the dreaded fear of the unknown. I guess we all have a bit of a xenophobe in us. I reassure myself that the unknown is never as scary as we perceive, this I have learnt from many years of travel and adventuring in the outdoors.

I'm not sure what to expect and like any volunteer mission abroad one tends to learn much more than they actually make a difference. I am under no illusion in this regard! But if I can just insight some enthusiasm for learning in the local staff, or help to raise the profile of the Global Therapy Group, I will be happy, and if I get to make a slight difference to the lives of some individuals, then that will make me smile.