Hey everyone!  I am back in Haiti…and I am blown away by the changes since I was last here in May of 2011.  Almost ALL of the rubble and collapsed buildings have been cleared.  One of the ex-pats told me tonight that apparently some kind of UN contract that had been delayed finally came through…and the UN promptly zoomed around with a bunch of gigantic dump trucks and cleared everything right up.  Ah, world politics.  And, mosquitos.  In fact, one is eating me right now.  Ah, Haiti.  Hello, Haiti!

It’s Carnival time here in Haiti.  There was an amazing-sounding band playing a block away from the residence today, and you could hear the brass instruments crystal clear, and the drums and the partying, just like they transported over from a street in New Orleans.  Shops are open, there are internet cafes, restaurants…I even drove by a dry cleaners here in Leogane, shortly after seeing a kid walking down the street with dry cleaning he had picked up.  For the other volunteers who have been here…think about that…people picking up dry cleaning and walking down the street like normal, here in Leogane!  The tents that were lining the road to the field hospital are all completely gone, and the whole area is now a green field with cows.  And, sometimes cows in the road.  We almost tripped over one tonight in the dark walking to salsa night.  A moment of hilarity followed, imagining how we might relate that story to friends and family back home…how were you injured in Haiti!?  Crime?  Accident?  Disease!?  No, I tripped over a cow.

Oh, and someone apparently stole the field hospital.  Yeah, don’t ask.  I don’t get it either.

On more positive note, I shot a great video of a motorcycle ride today!  I mean, it’s awesome.  Carrie is trying to make me promise not to put it on youtube, because she didn’t know I was filming, and thinks she doesn’t look quite as modelly (new word) as she usually does.  I think she looks awesome giggling and smiling on candid camera as we zoom through Leogane.  You be the judge.  Coming soon to youtube!

To sign off for tonight, here is my happy thought for the day.  The Filariasis program has done amazing work here.  Nice work Bill Gates!  (I mentioned to one of the new guys here that Bill Gates built the house we are staying in, and he looked at me like I was crazy until I filled in the details).  Right, so…Gates Foundation.  Anywho, it really blows your mind (yet again), or brings a tear to your eye…or, both, to think about the fact that as you drive around Leogane, you are looking at hundreds and hundreds of people who have not gotten Filariasis and are not suffering – and don’t even know it, all because of the project.

Williamson is the kid Kathleen McCann, the neurosurgeon from Ireland, found in an orphanage last year and rescued.  He was sick with infections all over his body.  There is a photo of him sitting in the field hospital wrapped all over in bandages, and having his wounds cleaned.

I ran into my friend Christina Buchner on facebook IM last night, and she mentioned that Williamson is still sick with infections on his skin!  Christina stayed on in Haiti last year, and spent a lot of time helping out here, even after the field hospital closed.

The original plan for today was to help out at a clinic.  But, the clinics are always running.  If we could instead find one sick kid, a poor guy who has been sick for over a year, and who was in an orphanage before that – then the world is a tiny bit better of a place.  So, we went off to find Williamson.  Christina gave us the phone number of Yves, the night guard from the field hospital last year, and he apparently had a way to reach the woman who took in Williamson, Marouschka.

When Marouschka heard that there was a doctor looking specifically for Williamson, and that he had been sent by Christina to check on him, she had a friend bring him from where they live, almost an hour away, to her work, and she brought him over to the residence to be seen.  And indeed, he still has skin lesions all over his body!  After some careful diagnosis, and taking some photos to get second opinions from my friends in Infectious Diseases and Dermatology, Williamson went on his way.

In the US, this kid would have been hospitalized, had an Infectious Disease consult, a skin biopsy, all kinds of blood tests and lab work, a definite diagnosis, and he would have been quickly treated and cured.  Here he is, still suffering a year later.  He obviously has some kind of skin infection, and infections are treatable.

In my book, it is unacceptable that something like this happens in the world today.

About a year ago, at my old job, a patient gave me a hundred dollars.  She was old and weak, and didn’t have a way to get to a pharmacy when I called her and told her she needed to start an antibiotic for her urine infection.  I dropped off her antibiotic on my way home.  It wasn’t a big deal to me.  But, I guess it meant everything to her.  She invited me in, poured me some juice, and insisted that I take a hundred dollar bill from her.  I protested – I could lose my job, it was against regulations.  She started to get very offended and even angry.  So, I took the money.

Today was the follow-up appointment for a patient I saw two days ago with an open wound on his hip that is not healing.  He is in his early 40s and, except for a bit of a birth deformity on one of his legs, he is otherwise active and healthy.  Unfortunately, he has been unable to work because of the infection and the pain from it.  He had a surgery three months ago on that spot, and it hasn’t healed.  After meeting the patient two days ago, I discussed his case by email with Dr. Ralph Pennino, plastic surgeon and founder of Intervol.  Ralph got back to me right away with a plan of care.

So today, I brought a month’s worth of wound supplies to the patient, and spent half an hour with my translator carefully teaching him about sterility, how to do a wet-to-dry dressing change, how to use sterile gloves, etc.

But, the big picture is that the patient is stuck.  He can’t work because of his wound.  So, he can’t afford food.  So, he is malnourished and can’t heal properly.  And because he can’t heal, he can’t work.  I asked him what he had had to eat.  Today, he had a little bit of adult nutrition formula.  Yesterday, he had a little bit of rice.  The day before that, he had a little bit of rice.

So, I gave him the hundred dollars from a year ago, and I said – take this money (enough to eat for a month in Haiti), eat three large meals a day, and you will heal.

The highlight of today was treating the kids and their families who live along the street from the residence to the main road.  This started out casually yesterday, and when it started to get a little crazy, we made an official mobile clinic time for today at 1pm.  I saw about 20 patients.  Some of it was just like life back in the US, like the women who had repetitive stress injuries from doing their laundry by hand for years (instead of the Americans who all have repetitive stress injuries from their computer mouse).  And, some of it was stuff you would only see in Haiti.  One mother brought her child because she was worried his eyes were yellow.  After a closer look, I had him open his eyes really, really wide, so I could prove a point.  Everyone thought I was playing games and started laughing.  I convinced him to do it, and I pointed out to his mother that he did not have eyes that were all yellow the way people who are very sick do – his eyes were yellowish from irritation and living in poor conditions, but only on the parts that were routinely exposed.  On the sides, they were white and looked normal.

Oh, and the women who had pain in their shoulder blades from washing clothes also seemed to think I was crazy when I had them show me their washing motion, and then flip it in a mirror image and tell them they had to start washing that way at least half the time to balance the stress on their backs and muscles.

In other news, Peterson and I have been declaring “Tampico Time” every day around noon.  Tampico is an orange or fruit punch flavored drink that is sort of like Sunny Delight.  In a bottle about the volume of a soda, it has over 60g of sugar packed in.  Impressive.  And, there is nothing like an ice cold blast of sugar suspension keep you going in the heat.  Not quite as much fun as when the Tampico in the residence was being stored next to the insulin in the fridge.  Tampico and insulin, anyone?  See you tomorrow!

It’s the kids with malaria that really get me.  It’s like you want to stop and yell at the universe (God?  Someone?) to cut it out, and at least give them a chance!  They’re living in absolute poverty, in a tent, they are already weak, malnourished, and small for their age.  And now they’ve got malaria too?  Come on, stop it!

The kid today…his mom stopped us on the way by her tent and asked us to look at her son with a fever.  It was just Peterson (my translator) and I, and this was probably the tenth time we were stopped.  But, that’s why I’m here!   The kid looked sick and weak.  I knew right away malaria was on the top of the list of possibilities.  That was in the afternoon, and it was early evening by the time we were able to get back to him with a malaria test kit, and then start medication for him.

By the way – quick aside.  Bill Gates is awesome.  He took a look at world poverty and said look, a lot of the cause of this is illness, let’s try to hit the big illnesses as hard as we can.  And, he’s right.  If you’re growing up in a country like Haiti, you already have few opportunities…and then, as your life goes on, when you sometimes get the chance to get some education, or a good job – you can’t do it because your intelligence was damaged from malaria or another illness, or from malnutrition.

So, here I am, back in Haiti after almost a year.  The country looks much better, and much more back to normal.  I’m running into translators I knew and old friends all around town.  Hopital Sainte Croix was supposed to be slow this week, so I was worried I wouldn’t have enough work to do.  HA!  Last night, I found two clinics where I can help out, by just walking around town.  I didn’t even make it to either of them today.   The post-op wound checks on the hernia and hydrocele operations from the team that just left turned into wound checks on other patients…and a patient with parotiditis who needed IV antibiotics…and the kid with malaria…and man with a chronically infected hip wound…and the next thing I knew Peterson and I had been going for ten hours straight.

This is an amazing city!  It’s set in a valley between mountains, and it’s as lush and green as Ireland.  The weather is perfect.  They even have most of the chain stores they have in the US – KFC, Office Depot, even an Apple store.  It’s a bit like San Diego – except for the missile batteries guarding the airport.  We’re not in Kansas anymore, kids!

My first album has been released and is now on iTunes!  It includes four previously released songs (Dream Girl, California Night, Rockstar, and Perfume) in new album versions, and five new songs (Tennessee Girl, You’ll Be In Love Again, Forbidden, Highway, and Rainbow Tears).  Enjoy!

Thanks to the hundred fans who bought a copy of Rockstar in its first week!  My latest song, Perfume, is now available on iTunes and Amazon as a single.  I am currently in the midst of working full time on my album.  It should be done and released by the end of the month.

I saw 38 patients in the clinic today, including one little girl who came in with her mom and a story about having something possibly stuck in her nose.  Great, I thought, here we are in Haiti, without a lot of specialized resources, and some girl has something stuck up her nose.  So, I called in the ENT specialist, who came in with a flexible fiber-optic scope.  He called in the anesthesiologist, booked some OR time, completed his expensive procedure by removing the object and saving the day, and sent the patient without insurance a nothing-to-do-with-reality bill for $18,000.  Oh wait, my bad, that is the US.  I was in Haiti, and I was the ENT, and I was taking out the object with whatever I could find.

So, I went into the central supply room, rummaged around, and found a pair of sterile, long tweezers.  The best translator Sony, who has been working with me, held the girl, who was surprisingly cooperative.  I guess she wanted whatever was in her nose out as much as I did.  I looked in her nose, and saw some grayish substance about a centimeter up.  I figured well, this is snot, or some object, let’s give it a shot!  I grasped part of it with the tweezers….and out came some two centimeter long sponge that the kid must have rammed up there.  Everyone was much happier after the procedure was over.

Another highlight from today was the scabies baths.  A few children with especially bad cases of scabies were treated right there in the clinic with a specialized cream that is applied over the entire body.  Yes, head to toe.  I wish I had a photo, but you will just have to use your imagination.  Picture a totally naked kid standing on the middle of a table, in the midst of the busy clinic, having quite a gleeful and fun time, and being completely covered from head to toe in cream by one of the Haitian nurses we work with.  Who knew scabies could be so much fun!?

I am back at work at the clinic at the field hospital here in Leogane!  I saw 23 patients today, and diagnosed two cases of malaria.  The second one was a three year old boy.  He trudged into the clinic with his mother, looking weak and tired.  He had been having fevers, and the rapid malaria test came back positive.  So, we got him medication for treatment, and off he went with his mom.

In the US, I had previously only seen one case of malaria, when I was in residency at Lenox Hill Hospital in New York City.  It was dramatic.  The patient had come back from Africa, and then developed symptoms.  No one was quite sure how to handle it.  Frantic calls were made to the lab.  Did they have a diagnostic test for it?  Could they do a blood smear?  Would we have to send out the test somewhere and wait a week?  Medical students, pharmacy students, residents, and attending doctor swirled around.  Infectious Disease specialists were called in, to handle the infectious disease.  Malaria was severe, dangerous, and scary.  People could die from it.  The patient started to get better.  Everyone breathed a sigh of relief.

In Haiti, the kid with malaria trudged out of the clinic, looking weak and tired, just like when he had come in.  But on he went.