I was awakened before dawn by the roosters crowing from the village near our guest house. Soon, car sounds, cat meowing, and dogs barking all mixed as a morning song of the village. What a wonderful morning.
I walked to the balcony of the guest house. The eastern sky was filled with brilliant color layers in the sky. I counted about 20 layers of colors with different degrees of light and shadow tones! Not far away from the village is Lake Azuei. The other side of the lake is Dominic Republic.
Our breakfast was relatively simple. We had bread, butter, ham, scrambled eggs, fruit, oatmeal, and juice. After breakfast, we went to the surgical center. The first day of our mission began.
When I passed through the post-operative recovery room, I saw three newborns sleeping soundly like little angels. They were triplets, born less an hour ago by caesarean section. This surgical center also did obstetric surgeries.
My first patient was a 72-year-old farmer. His hydrocele was symptomatic for the last 5 years. Before his illness, he used to grow corn, potatoes, and some vegetables. But in the last few years he was not able to work on the field. He never got married, but had three women, 14 children, and 32 grandchildren. He said that he had high blood pressure, which was diagnosed a few months ago. He did not take medicine since he could not afford it. His first blood pressure in the operation room was 230/120 mmHg. I did the measurement again, and the blood pressure was still very high. The patient seemed to be used to this high blood pressure. He had no chest pain, headache, nor other symptoms indicating end organ damage.
If the patient had lived in the United States, I would postpone the operation since this was an elective surgery, in case an adverse outcome would happen. If I cancelled the case, the patient might not have another chance to be treated again. He could not afford the surgery, the local hospitals or surgical centers did not routinely perform hydrocelectomy, and not many medical mission teams did hydrocelectomy for free.
His eyes were filled with expectation and hope. How could I deny his chance of healing? I asked the translator to explain the risks of anesthesia, including a heart attack or a stroke. He understood and wanted to proceed with the surgery. I silently prayed for him and the surgeon, then proceeded with spinal anesthesia. The blood pressure dropped slightly, but it was still around 210/110 mmHg. Labetalol was injected intravenously. His blood pressure lowered to about 190/100 mm Hg.
Since this was our first operation, Dr. Shu was very cautious. In the meanwhile, I chatted with the patient. I asked him how he knew our mission at this time and location. He said he heard from the radio. It turned out that Dr. Joliu, a urological surgeon working part-time at this surgical center, advertised the news about our mission to patients near and far through radio, WhatsApp, and churches. And he already did some screening for these patients.
I asked him how the hydrocele affected his life. He said that it hindered his labor ability and sexual life. He had not been able to enjoy sex with women as he used to. “Once you are cured of the disease, would you soon be close to women again?” I asked jokingly. He was a little shy and said he would stay away from women for a while. Then he smiled. During the surgery, about 600ml of hydrocele fluid was suctioned out.
The second, third, and fourth operations went well. Spinal anesthesia went smoothly. All these patients were relatively thin, which made placing spinal anesthesia much easier.
We did a total of 8 operations today. The last patient was a 28-year-old construction worker with a huge hydrocele. A total of 2500 ml hydrocele fluid was suctioned out. He lost his job due to the disease. He became very happy just thinking that he could go back to work again.
From an anesthesia perspective, the medical mission to Haiti has some challenges. First, the patients are not optimized for surgeries. They do not see doctors routinely, nor take medication for chronic diseases such as hypertension, diabetes, and cardiac diseases. There is simply no medical clearance prior to surgery. So, we would have patients who have undiagnosed medical problems. This creates higher risks.
Secondly, the equipment is often outdated and not adequate. Sometimes the equipment is so old, that we may not even know how to operate on it. For example, the ventilators in the operation rooms were so old that they had to be manually operated. I had to pull the blue bellow up and down to generate a breath. And the oxygen supply was from an oxygen concentrator!
Thirdly, medical supplies might be in shortage. We had to bring our own medical supplies for the whole trip. Due to my lack of mission experience, I brought only some spinal needles and local anesthetic medications. But I had to use needles, syringes, gloves, alcohol pads from the surgical center.
The postoperative recovery room (PACU) was a large room with 8 beds. There was only one nurse to check vital signs. The patient’s family members were the post-operative caregivers. Most of these patients stayed overnight in PACU because they could not find transportation back home on the same day.
I provided anesthesia for 4 patients today. When I brought the last patient into the recovery room, I checked on my first patient. He was laying on the bed with a big smile when he saw me. He said something to me in Creole, I did not understand. Another patient told me that he was saying “I love you!”. I was moved by his genuine affection. I hugged him and he suddenly kissed me on the cheek! These patients were so grateful.
We finished the last operation around 9 pm. This was a long day. I was tired.
I was planning to take some moonrise photos before we started the day. When we left the surgical center in the evening, the whole campus was filled with bright moonlight. The moon had already risen high in the sky. After dinner, I walked up to the top balcony of our guest house. Lake Azuei was beautiful shimmering with silver moonlight. The lights were still on in the surgical center. A sense of joy and peace came upon me when I thought about the 8 patients’ and their families’ lives that would be changed for the better. Yes, I missed the opportunity taking moonrise photos, but compared to the joy of these people, not photographing the lake or the moonrise became insignificant. This was a good day.
This was the second day in Haiti.
