Hangertat for Humanity

Friday was the day we put into action a plan that I had been working on for about a week now. I call it “Hangertat for Humanity”. I spoke earlier about how Joel’s mom’s house was partially covered by her roof, since the time I saw it I have been working out the details on how take care of this issue for her and Joel. Our trip home from the beach afforded us easy access to the materials in St. Marc. We stopped at the local “Home Depot”, or at least the Haitian version of it, and picked up three 12’x6”x1” boards, 16 pieces of roofing tin, and an assortment of the needed nails. While we were in St. Marc, we also took advantage of having access to the local Deli Mart, a grocery store chain with actual air conditioning. I picked up some milk and cheese, items that aren’t readily available at the Deschapelles market.

As we were getting ready to head back home, Tim realized that we miscalculated and we only purchased half of the needed boards for our project. Thankfully he realized it while we were only five minutes away, as opposed to 45 minutes away. So we returned to “Home Depot” and picked up the additional boards we needed, then we were on our way. Another miscalculation on our drive home nearly forced us to return again. One of the boards came loose while driving through the valley and flew off the back of the truck. Luckily, no one was following too closely behind us, but when the board hit the road, a two foot section broke away. Joel quickly brought our truck to a stop and Franz, the owner of the truck, jumped out and ran after the board. Just before he got there, an on-coming vehicle ran it over instead of maneuvering around it. It broke the remaining 10’ board into two 5’ pieces. This created a new problem for us, seeing how the spans between the support beams on the house were 6’. But, instead of turning around and going back for a replacement, we decided to keep going and figure out a way to make it work when we got there.

We had plenty of time to figure it out because our trip was severely slowed by presence of multiple Ra-Ra bands. Ra-Ras take place for several weeks leading up to Easter. They are a makeshift band that marches down the middle of the road while a large crowd of young Haitians follow as they dance and celebrate. There is man with a whip at the front who will help guide traffic past the band by using his whip to keep people in line. This isn’t the first time we have run into Ra-Ra bands, but since it is the day before Easter, they were particularly prevalent. Historically, the Ra-Ra bands were used to help reduce inbreeding within the various slave groups. The bands were organized as social events and the man with the whip would prevent slaves from trying to run away. On one hand it was sad to think that the youth would continue a tradition that reflected the days of slavery here. But, on the other hand, they did look like they were having a lot of fun! Some of the crowds got so big that they clogged the street and created a human roadblock. Joel would turn us off the main road and we would find another way around. 8 bands later and we were home.

Saturday afternoon, on the 23rd, was spent doing the work on Lorencier’s (Joel’s mother’s) home. She was very excited and was expecting us. Joel and Franz drove all the materials up to her house so we didn’t have to carry them up the mountain. She lives probably 20 minutes away from the hospital, but is probably a third of the way up the foot of the mountain. It is not a very steep climb, but it certainly would not have been any fun having to carry all the supplies. Unfortunately, we still had to carry all the tools, including a 6’ ladder. But, we made the trek and didn’t waste anytime before we started working. Tim must have been sent from God because he had a lot of experience installing tin roofs and nearly put the entire thing up himself. It didn’t seem like long before we were out of sunlight, but we weren’t quite finished. We still had to install the peak of the roof, but that had to wait until another day.

Niekka Love returns & an update on baby Brahms

Monday brought a welcome surprise for me. Niekka Love returned for a follow up and adjustment. If you remember, this was the little girl that broke my heart when I didn’t get to say goodbye. Her mother reports that she has been doing very well and that Niekka said she wanted to stay for a few days. But, she is in school in Port-au-Prince and will be returning as quickly as she arrived. Since our time was limited, we didn’t waste a second. As soon as she was happy with the adjustment I made, out came the soccer ball. Michele joined us at the clinic, and got to kick the ball around with Niekka while I saw other patients. I’m glad she will get to see many of the patients I talk to her about. It is now a memory we can share, instead of a story I can tell.

Another patient she has heard a lot about, returned on Monday as well. Baby Brahms made an appearance for his first tune-up. It was difficult to properly align an infant. His tentativeness, lack of balance, and weak leg muscles masked a few issues that would normally be spotted at first glance.

Last week, when Brahms would stand or walk, it was mostly in a half crouched over position. Today, he was standing up straight, a clear sign that he was becoming more comfortable with his new prosthesis. It also clearly demonstrated that the initial height setting of the prosthesis was too short. When mom tried to let go of his hand, he would have difficulty balancing and wouldn’t take a step without her. After we corrected the length issue, Brahms took off after the soccer ball like a horse from the starting gate. It was probably as close to running as you could get without officially running. We also made an adjustment to the suspension sleeve that holds the leg on securely. We made it tighter, because his Mom said he could kick it off when he would throw a temper tantrum. I think the adjustment help significantly, because Brahms’ self confidence seemed to elevate rather quickly. In fact, I would later catch the little boy that would barely let go of Mom’s hand, walk across the clinic, go outside, and walk the entire length of the front walkway without any help at all. Not only that, but he would do it while carrying a beach ball! A small beach ball, but a beach ball none the less.

So, two of my favorite patients made the day for me. And you better believe that I got my goodbye hug from Niekka this time. Brahms, however, would be staying with us for a few days.

I got a big surprise on Tuesday that kept me busy for the next few days. On March 18th, a cargo ship left Miami carrying some supplies that would help sustain the clinic into the future. It was thought that the shipment would not be received for several months, after I would have already returned home. But, Tuesday would bring box after box of supplies. We took the opportunity to rearrange a few things in the shop to help accommodate the additional stock and it seemed like my first week all over again… counting inventory! It seemed like every time we would finish sorting and counting our stock, a new wave of boxes would arrive. This would happen for the next two days, and a few boxes would linger in during the following week. This particular week would end quietly though. Thursday and Friday was HAS holidays in recognition of Easter. I found the timing perfect though, it allowed my wife and me to take a few days off and enjoy an overnight trip to the beach on those two days.

Recap of the remainder of the week

Thursday and Friday were spent working on the models from Wednesday’s marathon casting session. It was an excellent opportunity to have our technicians gain more experience with the modification process. I asked Dave and Ken to step back as much as possible and oversee the techs while they modify, answer any questions, and show them the various methods we use to prepare the cast for socket fabrication. Everyone did well, but we have a few left over for next week. It will be nice to let the new group of practitioners get their hands dirty on the first day!

Sunday the 17th marked my halfway point for my rotation. I can’t believe it has already been a month and a half. It was also the day that my wife, Michele, flew in for a two week visit. Our first 6 hours together were spent at the Visa Lodge as we waited for another HAS member to arrive at the airport. It was a long wait, but having her there made it worth every second. Along with my wife, I picked up our two latest Hanger volunteers, Tim and Mark. This was Tim’s first trip to Haiti, but Mark had been here for two weeks nearly a year ago. I knew this would be a good group, because Mark was a veteran and Tim exuded enthusiasm. The 2.5 hour ride home was rough for him though. Our transport unit was packed with luggage, leaving minimal foot space. Tim is about 6’5” tall, so it did a number on his feet and knees.

Trip to Leogane

Wednesday brought a new adventure as well. A few weeks ago the Foundation received an email from a gentleman who recently returned home from a mission trip in Leogane. Leogane was the epicenter of the earthquake a year ago. This email described a speech he heard at a local church which mentioned the need for prosthetic treatment in the area. He passed along all the contact information and asked that we do what we can to help. Our friends at Catholic Medical Mission Board (CMMB) tracked down the gentleman who spoke that day and arranged for us to travel to Leogane to cast patients in need.

Ken and I left Deschapelles at 8am and embarked on a 6.5 hour journey. It was supposed to be a 3.5 - 4 hour drive, but the Port-au-Prince traffic had a different idea in mind. Every time we asked the driver how much longer it would be, he answered “thirty minutes”. It got to be humorous when he would say “thirty minutes”, thirty minutes after he said “thirty minutes”. But we finally arrived around 2:30pm and setup a casting area behind the church. By 3pm we began casting. Jill and Seneq helped setup the patients’ charts, then left to meet with another prosthetic group in the area.

The Johanniter group has been in Leogane for some time, but they have limited resources to handle the demand. They discussed how we could assist them with their patient load, and provide services to a back log of over 140 patients. Unfortunately, their limited resources only allow them to treat 6 patients per month. We may be able to help this group by providing the initial prosthesis to the majority of their patients and allow them to more efficiently continue with vital long term follow up care.

Ken and I continued non-stop with the castings for four hours. We took a break long enough to down half a bottle of Sprite, then we were back to it. By the time we got to the last two patients, we ran out of daylight. We moved around the corner of the building so we would be directly in front of our vehicle. My last cast of the evening was of an above-knee amputee by car headlight, yet another first in my career.
The final tally of casts were 8 below-knees, 10 above-knees (two of which were for a bilateral AK), 2 bent knees, and 3 partial feet. 23 casts in all. Not a bad days work, but I was beat and ready for bed. Good thing it is only “thirty minutes” back to our hotel…

Learning more about the Haitian culture

On Friday the 8th we received some bad news – Joel’s grandmother passed away. She lived a long life, but had been sick recently. Since Joel is one of the few men in his family with a steady job, the funeral responsibilities fell to him. Monday was the wake and the funeral yesterday. He asked me to go to the party after the wake, and I accepted his invitation.

Monday evening was the party Joel setup following his Grandmother’s wake. He was supposed to pick me up at 7:00pm, but got delayed until 9:30ish. I was tired and getting ready to head to bed. I figured he was busy and didn’t have time to get away and come pick me up. But, just before I called it a night, he pulled up on a motorcycle with Alix. I hopped on the back of Alix’s bike and we were off. The ride was quite bumpy and was made a bit more exciting when a goat jumped out from behind a fence in front of us. Alix is a good driver and handled the surprise well. After a few more minutes we were there safe and sound.

I was a bit surprised to see how many people were there at almost 10 o’clock. I would have to say there were at least one hundred people. The first stop we made was at Joel’s mother’s house. It was approximately 10’ by 20’, stone wall construction with concrete mortar. The roof was only partially finished. Maybe one third was complete and covered her bedroom. But, there was a 1 and ½ foot gap exposed over her room. So, when it rains, it rains in her room. She was very nice and invited me in. She kissed me on the cheek and offered me something to drink. It wasn’t long before two of Joel’s cousins came in to meet me, followed by two of his brothers. They were extremely friendly and spoke excellent English. I was happy to meet his family.

We walked around a bit and I tried to soak up as much as I could. There were so many different activities going on that it was hard to keep track. Some people were singing, some dancing. Others were playing cards or dominos. A few were cooking various types of food, while a couple of ladies were making coffee and tea in giant pots.

I found the domino game interesting. Not the game itself but the dynamic between the players. The game was being played on a makeshift table. One gentleman in particular would slam his domino on the table as if to say “take that!” All the dominos would bounce up in the air about 6” and land in a scattered mess. But, it was essentially a “nothing” move. I figured out that the real game had nothing to do with dominos. They didn’t even keep score. The real game was to identify how the other team was cheating. You see, the game was played in teams. The teammates sit across from each other. Everyone cheats. The trick is to figure out how they are cheating and call them on it. Once cheaters have been “found out”, they are kicked out of the game and replaced with the next team of cheaters. The guy who kept slamming his dominos was sending a signal to his teammate. The other team figured out what the signal meant and kicked them out.

While we were watching the game I started asking Joel some questions about his mothers’ house. I wanted to know why the roof wasn’t finished and how much it would cost for him to finish it. He told me what I already knew, which was that Haitians build their houses themselves. They build what they can, when they can afford it. I believe this is one of the reasons why there were so many buildings that failed in the earthquake. When you drive through a city like Port-au-Prince, you start to notice that when a building collapsed, one floor may have remained intact. For example, I saw a three story building in which the top floor crumbled into the second floor. The second floor remained largely in one piece, but the first floor crumbled underneath it. I think it demonstrates that when they build structures as they can afford them, some areas are made better or worse than others, and with better or worse materials. The cost of the materials that Joel will need to finish the house is exceptionally modest by US standards, $250. But in Haiti, that constitutes almost one quarter of the average income for an individual. What makes it more difficult in Joel’s case, is that he had to spend whatever money he had saved for his mother’s house, on his grandmother’s funeral. It was obvious that the roof issue weighed heavily on his mind. The rainy season is just a few weeks away and he doesn’t have the time or the money to complete the project before then.

It seemed as though I was shuffled off as quickly as I arrived. Alix received a series of phone calls from his wife before he finally said, “we have to go, my wife wants me home.” Without hesitation we all said goodnight and away we went. I think most of us married men knew that when the wife says it’s time to come home, it was time to come home!

Brahms returns!

Monday the 11th, was the day I had been waiting for, for a few weeks. Brahms came in! I have to admit that I was a bit nervous. I put a lot of pressure on myself and felt like there was a lot riding on this case since Brahms had never walked before the earthquake, and will never walk without the use of a prosthesis in his entire life. It is a concept that I have never experienced before and I found it difficult to express my emotions when I began his fitting. I can only say now, that it was one of the most “awe”some experiences of my life.I started the fitting with a very thin sheath, a minimal fabric barrier between his skin and the foam lining. It was loose, and I almost forgot what to do next. It was like I panicked and forgot all my training. When I snapped out of it, I went over to our supply shelf and picked out a couple of socks of various thicknesses. Using socks is a basic part of maintaining the fit of a prosthetic socket. I think that I put so much pressure on myself to make everything perfect, that I momentarily forgot the basics. When I fit the thinner of the two socks, I found that the socket fit well. What a relief!

Now it was time for Brahms to stand. I rolled up his suspension sleeve and his mom stood over him for support. I don’t know if he didn’t know what to do next, or if he just didn’t like everyone staring at him, but he didn’t move an inch. Then, one of the physical therapist had the idea to get out the soccer ball. And in an instant, Brahms took his first steps ever. He held on to mom’s hand, but when the ball got just a little too far for him to reach, he let go and took two steps all on his own and grabbed the ball. It was absolutely amazing to watch, and the smile on his mom’s face was worth every second of the angst I put myself through. She told me earlier that she just wanted her son to grow up and have a “normal” life, but she didn’t think it would be possible after his amputation. Today, we showed her that he will be able to do whatever he wants, he just has to want it enough. Sunday, that soccer ball would have been out of reach. Monday, we watched in awe as Brahms took his first steps of many, to reach his goal.

8-year-old Wanley

Week five brought a new group of practitioners, Dave and Ken, and a new special patient for me. This particular one was cast during my first group of practitioners. Her name is Wanley.

She was seen by Mike about 3 weeks ago. I remembered how shy she was, she wouldn’t even look at me when I said "hi". She just tucked her head or looked the other way. I learned that she was 8-years-old, but she had the outward appearance of a four or five-year-old.

Wanley’s shyness would soon be replaced by a giant smile and a young girl that liked to kick the soccer ball around. It was amazing to watch how fast she learned to walk and run with her prosthesis. But, it was even more amazing to watch her open up and become a fun loving little girl. By the end of her time with us it was hard for me to imagine that this girl, who would barely let go of my hand, would not even look at me a few weeks ago. I hope I get to see her again before I go.

R.I.P. Van Goat

Wednesday, April 6, 2011 was a sad day at Kay Hanger. Van Goat, our Haitian Hanger pet, died unexpectedly.

The day before, Max came down to the Klinik in the afternoon and asked for some money to take him to a local vet. He said it would only cost $5 so I gave it to him out of my personal money. I didn’t think anything of it, but when I got back to Kay Hanger at the end of the work day, I went around the side of the house to check on him. I noticed him leaning up against the tree, but my initial thought was that he got himself tangle up in his rope and couldn’t get loose. When I approached him, he tried to walk over to me. I saw that he wasn’t tangled up, but rather his legs were wobbly and he was using the tree for support. He could barely keep his balance and his eyes appeared to wonder. It was obvious that he knew I was there. His little tail wagged with excitement as it usually did, but I could tell he was sick and I didn’t want to get too close. As I walked away, I watched as he leaned back up against the tree.

When I woke up the next morning, I looked out my bathroom window and saw him lying away from his usual spot. He wasn’t moving and I knew he probably didn’t make it through the night. I walked outside and spoke to Max. He told me Van Goat died and he was clearly upset about it. Max took care of Van Goat and I imagine he thought of him as his own pet. I too thought of him as my adopted pet. I have three dogs at home, so it was nice to see a wagging tail again when I came home from the Klinik. It’s not the same here without him.

A first in my career

Week four ended with a first in my career. It was the first time I cast an infant for a prosthesis.

Brahms was just 6 months old when he was injured in the earthquake. I spoke with his mom and she told us his story. Brahms was lost in the earthquake and thought to be dead. His parents had given up looking for him in the rubble and knew it was unlikely that such a small child would have survived such a terrible ordeal. But, six days later, while searching for the remains of those who perished, Brahms would be pulled from the rubble. Unconscious and battered, he would spend the next three days in the hospital while the doctors tried to save his leg. However, the infection would not improve and his leg would have to be removed below the knee in order to save his life.

It did not dawn on me until a few days later, but I realized that the first steps that Brahms would ever take would be with a prosthesis I made for him at the Hanger Klinik. He is just shy of two years old now and I cannot wait to see how he does.