I had finally reached the house. Three hours and 5 rugged miles later I could lay eyes on this kid. Would he be lying on a bed - barely able to open his eyes with some purulent rash eroding through most of his skin? Hopefully he has a basic pneumonia with tinea. I can treat those easily with the travel pharmacy I have in my pack. Plus, that would be less medicine that I'll have to carry back #AlreadyDreadingTheReturnTrip.
It's neither. I see a little boy (obvious because he's not wearing any pants) who has hypo-pigmented all along his neck. He's standing - good sign - and looking right at me with big brown eyes #KindaAdorableEvenThoughHisSkinIsMessedUp. I actually start to doubt that this is the kid that they're worried about. Oh wait, he's supposed to be 3 years old. He looks less than half that. His growth is stunted and, outside of his moderately distended belly, he's skinny. His mom holds him and I proceed to conduct my H/P:
Rash and diarrhea for the past 24 months. Has 5-6 watery stools per day. Doesn't eat well. Rash has gradually gotten worse. Rash is non-pruritic. His swelling is not actively present.
HEAD: Normocephalic, atruamatic. EOMs grossly intact. Conjunctivae pale. Mucous membranes dry. Possible blunting of papillae on tongue. Questionable candida in oropharynx, but no other lesions (kid didn't want to open his mouth for me)
NECK: No masses. Skin has multiple coalescing hypopigmented and amelanotic patches.
CHEST: Lungs clear to auscultation bilaterally. Skin changes as above.
HEART: Tachycardic. IV/VI Systolic murmur heard throughout.
ABD: Bowel sounds normal. Non-tender. Mildly distended. Skin changes as above, but fewer than neck and chest.
EXT: Pulse regular and symmetric. Non-pitting edema present in hands and feet. Mid-Upper-Arm Circumference is Red.
The kid doesn't look extremely sick, but he's severely malnourished according to his MUAC. I can list multiple vitamin deficiencies that would cause his problems (Niacin deficiency = Diarrhea, Dermatitis, Death). Protein deficiency could definitely cause the swelling and distended abdomen. Worms or diarrhea of other etiologies can definitely cause malnutrition.
I decide to call Angie.
The phrase, "It's easier said than done," doesn't even begin to describe the obstacle I was told I would have to climb in order to get cell reception. They pointed 200 yards up a mountain and said, "go to the white rocks." There were no stairs. The path zig-zagged just as our journey leading up to this point. Only this time the incline had to be nearly 60 degrees. The zig zag was just to make the climb manageable. A young kid offered to escort me up. I had no idea where I was going, so I took him up on it.
Again with the bare feet. He skipped up the mountain, pausing every now and then to check back on me. I plodded along, bitter with every step. My decision to keep my wet feet in my shoes without socks was really coming back to bite me. I had developed blisters on 40% of my feet and they served as unwanted proprioception for every step. I reached the 'white rocks' only to find out that they were not the final destination. I decided to sit and 'try my phone' anyway. My shirt had somewhat dried from the sweat of my hike while I was examining the kid, but it was once again saturated. No service #CanYouHearMeNow? I start back up. Every other step slipping and sending dirt and gravel sliding down the slope. At one point I'm using my hands to help me navigate the 'path'. The kid makes it look a little too easy for me to feel any pride in my accomplishment. "He didn't have to hike 5 miles already today" I tell myself trying to restore some sense of confidence. I need a break. I take out my phone. No bars. Dial anyway. No tone. Ugh. I exhale and look up the mountain. "Ki kote?" "La" he says with a finger directed towards the top. We climb. A few more slips and another 'service check' pass before I finally reach the point where the boy sits down and says, "Ici." Thank goodness. I call Dr. Angie.
I'm out of breath. I think the first four minutes of our conversation was filled with me breathing really heavily into the microphone #CanYouSayCreeper. I give my synopsis of the kid and suggest that we bring him back so he can join our others at Cajale for nutrition management. She agrees. At this point I realize that I really didn't need to call her. I knew that this kid had severe malnutrition and would benefit from the other hospital. Why the hell did I just climb that mountain? #Idiot.
Down was no easier. I was exhausted and the footing was equally unstable as climbing - shocking. The little kid followed me this time. Pretty smart. If white man took a tumble, he didn't want to get caught up in the avalanche. Early on I tried to be meticulous with my steps. This didn't work. I slipped, often. Rocks weren't as stable as advertised and they decided to run away from my foot. I fell on my ass once and sliced my hand open in the process. This was met with a raucous roar from the 30 or so Haitians gathered in a yard watching my entire trip. I gave up at this point and just started treating the hill like it was snow or sand. Stepping on the slope and then allowing my weight to slide me down in a controlled fall. Talk about easier.
I return to the family's house, give a dollar to the kid who showed me up, and find my translator. I have him tell the mom that I think it's best that we take her kid back with us so we can get him to a hospital this weekend. She seemed agreeable. She knew he was sick. She knew we would care for him the best we could. She sent someone to fetch the boy's father. She and I went to making a batch of ORS for the boy to work on before we departed.
The father wasn't as keen on the idea of leaving as I had assumed. "He's had this for two years, he won't die any time soon." "I have business to attend to tomorrow." I about lost it. And for no good reason other than my own exhaustion. I implored him to let us take him today. Next week will come and go and I wasn't confident that he'd actually bring him. If those excuses would work today, who's to say he wouldn't reuse them? And then continue to reuse them until the child did pass away? I really didn't plan on taking "no" for an answer. Partially because I had just walked 5 miles over 3 mountains but mainly because I wanted what was best for the kid. And I was convinced that after 2 years of under-nourishment leaving would be permission for the trend to continue #Malpractice.
I tried brutal honesty. "There's a trend in this child's health that indicates that he hasn't been getting the appropriate nutrients. He may not die in the next week, but with the established precedent of your behavior it's safe to say that his trend will continue until he dies a very premature death." Needless to say that wasn't translated well. He wasn't budging. I didn't know why.
I moved closer, standing in the shade near where he was sitting. "Listen, I don't want to take your child from you. I want him to be healthy. That's all any of us want. We don't have the resources that I think he needs to recover from his illnesses at our compound, and he certainly needs more care than we can provide here. Let us help you get him to a hospital that specializes in taking care of kids like him. We just took two kids there earlier this week that were similar to your boy. The place does amazing work. I think that's the best care that we can offer your child."
"Will you help me with a moto from the mountain?" Holy crap. That's what was holding him up this whole time? Money for transportation? It hadn't even occurred to me. I thought it was inferred that we would cover expenses to get to the hospital and receive treatment. It wasn't. "I'll pay for your moto. I'll get you to Cajale. And I'll help you get home." He agreed. #PieceOfCake
The 'packing up' process took nearly two hours. Not sure why, but I appreciated the rest. The children were terrified of me for some reason. The older kids and young adults kept asking me to give them things. I am definitely used to this by now. There has been some conditioning that white people show up to Haiti and just give out things. Apparently this particular mountain village had been visited by a 'benevolent' white man in a helicopter who handed out about a month's supply of rice. That made a huge difference in their livelihoods... #Sarcasm
In an effort to entertain ourselves while we were waiting, my translator and I decided to try to get the kids to sing a song. I had my camera and the kids flocked to see their pictures. Then John began leading them in chante. It took a while, but they started getting into it. Again, I love my translator's character and passion. He loves JC and wears his heart on his sleeve. Can't say enough positive things about him.
After we were all songed out I decided we should refill our water bottles. The family we were escorting back were kind enough to dip out some from their water stores. Given the little boys diarrheal illness I thought it best to go ahead and zap the bottles with the UV Steripen that my Grandma got me for Christmas. Thanks, Grandma. Might've saved me from a few uncomfortable days stuck on the toilet.
We finally depart. My translator and I followed by the concerned mother carrying her ill child and the budget-conscious father carrying the family's sack on his head. The start is just how I remember the hike ending. We are either going down at a 45 degree angle or up at a 45 degree angle. Could you make up your mind, please? And to make it fun, we were walking east and north when the compound is south and west of our position #Logic. I need Dougie Smalls to design some fancy bridges to connect the mountain tops so we can cut out this roundabout crap.
John is the first to take a turn carrying the kiddo. The boy seems completely at ease, until John slips. Walking up a steep dirt path he hit a patch of dirt that decided to disintegrate under his shoes. But just like his acrobatics crossing the river, he caught himself with his feet before face planting. The baby was shaken up on the play, but managed to regain his composure.
So here I am, returning back to the compound nearly 10 hours after I woke up this morning. Still following two little feet. However, these feet can barely walk. They are at the end of two very short, skinny legs. There isn't an obvious deformity, but the support these legs can muster is meager. At this point I start thinking how the little girl was able to escape this fate. Her home life was certainly not any different.
We press forward. I feel like we're moving quicker than earlier. Maybe it's my second wind after having successfully negotiated transport of the patient from the mountains to a hospital or maybe it's because I am terrified of the sun setting on us while we are still on the mountain trails. Regardless, we're moving. Up hills. Down hills. We tackle them all with ferocity. The little boy indifferent with the change of scenery.
John eventually tires enough to give in to my offer to carry the child. I cradle the little guy...long enough for a photo op. And then I make the mistake of holding him so he can see his mom. That does not go well. Immediately he starts wailing. I start to press forward, but my dehydrated body can only take so much before I get a bad headache. I pass him off to his mom. I feel like an ass.
We pause often to offer water to the family. John and I buy some stale bread and semi-fresh "figs" to split up between the five of us. I try to keep us moving at our quick pace. We hit another stretch of steady incline and I offer to take the little tyke from his mom. She happily relinquishes him. He is less thrilled. I spin him. I do some space shuttle routine that used to work on Austyn. I make silly, American baby noises that apparently have no effect in Haiti. Nothing works. It is agreed that everyone can take a little crying so we can give his mom a break. I press on. Screaming and all.
Marche. We stop so the mom can grab a few things from a family member's house. John offers up his water to the family. At this point the path is a consistent down slope. Thank goodness. That helps our speed. Four o'clock has come and gone and the sun is not getting higher in the sky. There is still plenty of light to navigate the path, even when I question its existence against the steep fall to the valley below. The thought of watching either parent slip and the baby tumble had me constantly checking over my shoulder. The path seemed narrower and the falls further during the return trip.
Familiarity strikes me as we begin to climb into a town. If my memory serves me correctly the river is just up ahead. By this time everyone has had a turn carrying the child. However, no one else was quite as lucky as me #MissedOut. We get to the river. I wisely decide to take off my shoes and socks this time. John follows suit. My feet are not made to walk on rocks without any sort of cushion. I'm not proud of that fact. But I can't deny it. My feet must be spoiled.
We cross and opt for another water break before the final climb to the main road. It's one mile and I can't begin to estimate the altitude climb. It's not easy. I fill up John's water bottle with one of mine. He in turn offers it to the dad who promptly drinks it all. Curious. I give John the rest which he again gives to the dad. This time, the dad takes a decent chug, but then passes it off to the mom. I'm still not completely sure of their relationship. At one point in the discussion she commented that she couldn't bring the child without his blessing because she was 'his'. I wasn't sure what this was inferring. But I was happy to see that the dad actually shared some of the water with the mother of his child this time around. Unfortunately for John, neither of the parents saved any for him. I found this whole exchange entirely fascinating from a cultural standpoint.
We climb. And climb. The end is in sight. Just one more bout of diarrhea and a few burning quads away from reaching the top and the road. Success! But now what? I have John call the moto guys that brought us up. No price is discussed. No timetable for their arrival was mentioned. So we start walking. If they come they will see us en route.
A half mile down the road I see a lone moto coming up the hill. We get the family on the back and tell him that we'll meet them at the compound once the other moto picks us up. He assures us that the moto is on the way. He was right. About twenty minutes later the moto picks us up and we begin our engine-less descent towards the compound. You could count the number of minutes the engine was actually running on your hand. #GoingGreen
I take the time to reflect on the journey we just completed, but am quickly jolted back to the present with each speed bump that catapults my pack into my lower back. I look forward to the mega dose of Tylenol that I get to take before I lay down. I envision the cool water running out of the shower and over my face. And I think about the trip to Cajale that I get to take tomorrow to make sure the kid gets the treatment he needs. "Hey, a text message from Angie." "Let me know youre ok. I have a lady here in labor."...
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