Anal Atresia: The Need for Number 2

Surveys have been cast aside.  Meet and greets have been postponed.  Town hall meetings, well there was never a repeat scheduled after the disaster of the first one.  But, regardless, they would have had to be canceled.  My new job is to get our patient the surgery to correct her anal atresia.  This won't be easy.

Haiti is a country where (at least by my "data") >80 % of births occur in the home.  If you look past ten years ago I would guess that number is safely over 90 %.  That means a lot of things.  Maternal and infant mortality are higher.  Not because midwives aren't trained well enough.  Most of the time the delivery drives it self.  Even med students can perform an uncomplicated delivery.  But when things go wrong it's very difficult to get the patients to a hospital quickly.  That's not what this post is about.  Everyone can pretty much assume that maternal and infant mortality will be higher as a result of home births.  An under-recognized complication of this is that there is no record of births.

Birth certificates are scarce in such a setting #Obvious.  After all, why would a family go get a birth certificate made?  It costs money and doesn't provide them with any real benefits.  Or, better yet, they get it made and then because of the living conditions and drastic weather the papers quickly become shreds.  This makes my job seem impossible.  When we inquired as to what it would take in order to get Begeka a medical VISA our response looked like this:

- Photos of the affected area #Creepy #Pervert #EasyToDo
- Birth Certificate of Child
- Archived Birth Certificate #WhatsTheDifference #NobodyKnows
- Birth Certificate of Each Parent #DoTheyEvenKnowTheirOwnBirthday
- Photo ID of Each parent #NickPapageorgioFromYuma
- Pre-Op Labs on Child: Malaria, HIV, H/H, ABO Compatibility
- Imaging needed by surgeons #CanIUploadToEPIC
- Letter from Haitian doc saying surgery can't be done in Haiti #MaybeALie
- Letter from Haitian doc saying patient is safe to travel
- Get Passport of Child
- Medical Power of Attorney signed over the host family
- Pay for VISA at a Bank
- Fill out online VISA form
- Have our org write a letter to embassy with our request and establishing me as the local contact
- BTW all documents will probably need to be in French and English

LOL

SMH

FML

Fortunately the family was able to get a birth certificate for the child and the father still had his from when they got married.  Two down, one to go.  There is an office in Arcahaie that we visited.  The cost for a hand-written "birth certificate" for an adult with no previous documentation: $300 Haitian.  The country is literally saying, "We will give you an identity and it'll only cost you a month's salary."  Three hundred Haitian dollars is roughly 35-40 US dollars.  The cost is cheaper the younger the person.  Again, these are hand-written right in front of you.  Gotta be legit, right?

I skipped over the Archived Birth Certificate because it appears that nobody really knows what that is.  I've been told by a group that has gone through this process before that it is a typed birth certificate copy  produced at some central office in Port au Prince.  After some pre-determined amount of time, all of the branch "birth certificate makers" bring their books to PAP where someone enters them into the computer #GladToSeeThereIsAPaperTrail  #WillSomeoneTeachThemGoogleDocs.  But I have yet to find a Haitian involved in the case who knows where to go or what it will take to get the document.

The pre-op labs should be easy enough right?  There is a state hospital just down the road from us!  So we went.  "Can we get an HIV test, malaria test, CBC, Chem 7, and a blood typing?"  "We can only do HIV and malaria."  "You can't give me a cell count?"  "Oh, yes, a 'hemogram'?  We can do that!"  "Yeah, and if you wouldn't mind counting those 'other' cells on the smear that would be great too..."  No blood typing.  No Chem 7 (even after describing what that entailed).  "That'll be $100 Haitian."  #ChaChing

So we went to Port au Prince.  A white guy with eroding patience, a timid translator who doesn't think on his feet, a quiet and slow-walking mother, a two-month-old without a butthole, and three birth certificates loaded up into a tap tap... with about twenty other people.  Dad was working and unreachable #NotHelpful.      At least I was able to purchase some street food for all of us before we departed.  #ProbablyGonnaRegretThatOne  #FeelSorryForMike

My aforementioned translator decided it would be best to get in a tap tap that would only go half-way to Port au Prince.  Guess he thought I could use a Chinese fire drill to stretch out my legs and get some Vitamin D.  Didn't foresee almost leaving the mother and baby in the back of a tap tap on its way back to Arcahaie.  Another crowd fills up around us #GetCozy.  At least I got to spend some time spelling the mother with holding the baby #WhiteGuy+HaitianBaby=Hilarious  #Apparently.

We finally get to Port au Prince.  I still haven't figured out the payment system for the tap taps.  Sometimes I feel like I get more change than the money I gave them.  I just hand them a bill and take solace in the fact that I just traveled miles for pennies where it would have cost me $20 to cross St. Louis in a taxi  #RipOff #TapTapsToBusch.  John then informs me that we need to take another tap tap.  Which in turn leads to another tap tap.  And finally a third tap tap that takes us in the general vicinity of our presumed destination, Croix-de-Bouquets.  #NotLikingThisPattern  Funny thing is, I had developed enough small bills where I would give them like $3 Haitian when we got out.  They rarely question it  #MathSkills  #BusinessAntiSavvy

We head to the municipal office that I hoped would hold the solutions to the Photo ID problem.  It didn't.  They directed us down the street to another office.  Manageable.  No tap taps to take this time.  We walk.  I cradle the baby in my arms.  She's swaddled like she's an Eskimo baby.  I don't think I need to remind people that it's hot in Haiti and this was the middle of the day #FirstTimeMotherProblems.  Again, white guy holding a Haitian baby prompts more than the usual amount of cat calls from the observers.  Not sure what I was saying "Wi" to, but they were getting a kick out of it.





John stalls.  No idea where we are or where we are going.  John, you just were in the office talking to the people about where we needed to go!  #CanIGetABobbyKnightChairThrowInHereSomewhere  I push him forward.  Finally I see what looks to be a government building.  Acronym matches what they told us.  #Success.  Line.  #Fail.  It's about 2 o'clock at this point.  We left the compound well before noon.  Time flies when you're crammed in the back of a tap tap listening to bad Haitian rap.  I tell John to find out what service they provide here.  He stands around.  WOULD YOU PLEASE TALK TO SOMEBODY?  He talks to a pair of adolescents who clearly have no authority on the grounds.  #YoureKillingMeSmalls  I "encourage" him to find some people who look a little more official.  He talks to the guard at the front door #StepInTheRightDirection.

Then we get approached by a man in a yellow button down and khaki pants #WhatsCuriousGeorgeLikeInRealLife?  He motions for us to follow him and he leads us back to the streets away from the government office.  We dodge a couple motos and cross to the opposite side.  He moves quickly, but not far.  Located almost directly across from the government building he ducks between two buildings where a woman waits in a little phone booth sized shack.  He explains that he can make the ID for us here for much cheaper than they'd ask us for inside.  That. Just. Happened.  Considering I had already had internal discussions about downloading a computer program to do the same thing, claiming the father to be deceased, or having John pose as the father for documentation purposes this actually seemed more legit.

Seventy dollars.  That's what the man asked.  Whatever.  Cheaper than the prices I had been quoted and at this point I'd take a Polaroid with her name Sharpe'ed at the bottom.  His female assistant dons some gloves and reaches into a box labeled as 'lancets'.  "Whoa, John, why do they need to take blood?"  He asked.  He got an answer.  He clearly didn't understand.  Either he didn't know what I was asking about or he didn't know what the guy said back to him.  This is way too commonplace.  But right now, I don't care.  "That's fine.  Bleed her dry.  If that'll help her get this ID quickly, let's do it."  Didn't really say 'bleed her dry' but you get the point.






I go buy a soda.  I need some reprieve.  I come back and the man is discussing things with John.  He takes the birth certificate - the $300, hand-written, only copy birth certificate - and my $70 Haitian and heads back across the street.  Please, Lord Baby Jesus, make this work.  Then the nurse said that she cost 100 Gourdes for her service.  Fine.

I step inside the "office" and take a glance at bottles sitting on the table.  "Anti-A Antibodies".  Holy Piki!  "Can you test the baby's blood?"  "Yes, for 100 Gourdes."  Done.  I pull out the lab sheet from the hospital and had her write the results on one of the blanks.  #AlmostOfficial

The man actually returns about fifteen minutes later.  There has been a snafu.  The Director who has to sign all of the documents has left for the day.  I mean, it was 3 o'clock on a Thursday after everyone in the country just had a week off for Karnivale.  Why on Earth would the guy still be at work?  "Can you just give us the card without the signature?"  "No, they won't sign it because they'll think it's fake."  (Well, it is fake...).  And that was that.  We didn't even get to keep the birth certificate.  We literally went all the way to Port au Prince and came back with less than we started with.  I didn't even think that was possible.  Correction, we now know our patient is O+ blood.  And by 'know' I mean that an untrained technician in a back alley told me that she had type O+ blood.  #OnlyInHaiti

So tomorrow my surveys will again be put on hold.  The data we were hoping to gather to give us some direction with community projects will remain stagnant.  I will again ascend into a tap tap surrounded by people that are either scared of me or assume that I'm there to hand out money.  I will switch tap taps at least three times each way.  I will both over and under pay for our transportation.  I will have no idea of where I am.  I will eat food that will likely give me dysentery.  I will drink water out of plastic bags that have never been washed but have been handled by countless people.  Those same bags will then end up on the ground, much to my chagrin.  But through all of this I will be accompanied by an adorable 2 month old girl who still needs to be able to poop.  And hopefully someone can start putting dominoes in place that will fall to form a red carpet leading to a United States operating room.