Tet Chaje by Kathleen O’Neill

As the massive military truck laden with surgical supplies lumbered onto the compound of our small clinic in rural Haiti, I took a deep breath and braced myself in anticipation. In six months of working at St. Joseph’s clinic in Thomassique, Haiti, I had been finagled into giving a speech in Haitian Creole to the entire town, watched my partner fly off a motorcycle, had close encounters with five tarantulas, ,and had crossed illegally into Haiti over a river on a donkey. In that time I had also witnessed the immense and devastating suffering that crushing poverty and lack of access to medical care caused in our small rural town. Even though I had worked extensively on projects that addressed some of the roots of disease in our community, I personally had very few tools to help individuals in distress. This week was going to be different. The arrival of the truck meant that for five days the clinic was going to be transformed into a surgical center– pumping out almost 100 surgeries and thereby providing a very immediate, tangible service that could drastically improve people’s lives.

By the third day of the surgeries, I was exhausted— I can’t imagine how the surgeons must have felt. On that day, one of them pulled me over to translate for a young mother and her four-month-old baby, Ogdon. The baby lay in his mother’s arms while the doctor explained to me how they planned to surgically correct his relatively benign congenital condition the next day. The baby wasn’t crying or even really moving when Dr. M lifted his shirt and saw his thin little chest struggling for breath. The ribs and bottom of the thoracic cage pulled inward dramatically in chest retractions and the baby’s chest sounded like someone trying to pull air through a pinched rubber tube. We clipped on the finger oxygen monitor and saw that his oxygen saturation was at 76%, far lower than normal. We had no idea how long it had been that low. A four-month-old baby was dying from pneumonia right in front of us and we almost hadn’t noticed.

The surgical team was immediately whipped into a frenzy. Before long, they were breathing for the baby through a bag and hooking him up to an IV. He didn’t have the muscle strength to pull air into his lungs by himself, but once we started breathing for him, his oxygen saturation jumped up to 85% and then 90%– he was relatively stable, for now. After a little while, the head nurse came over to me. “Katie, this baby cannot stay here. We cannot treat him. He needs to be on a ventilator.” I had absolutely no idea what to do. I looked around and found the clinic’s director, a Haitian doctor named Dr. C, huddled in the hallway with the other local doctors who worked at the clinic.

“Dr. C, there is a baby with pneumonia that needs to be on a ventilator. Is there one at the hospital in Hinche?”

“I don’t know.”

“Do you know if there is one anywhere nearby?”

“I don’t know. I will call the pediatrician in Hinche.”

It wasn’t like Dr. C not to look me in the eye when he spoke, and it wasn’t like him to be so cryptic. While the American doctors and nurses tried all the techniques they had learned in an American ICU in order to save Ogdon, the other Haitian doctors simply watched. I was confused. This was an emergency, and the baby could die! Why wasn’t he upset?

Our clinic was small, though it was the only readily accessible one in the region. Usually, when there was a patient who needed help that was beyond our means, we’d refer him to Hinche Hospital, which had specialists and more advanced equipment. If Hinche didn’t have the ventilator, there would be nowhere else to go. It was two hours away on a rocky dirt road. A Haitian doctor on staff at the clinic, two nurses from the surgical team, Ogdon’s mother, and I all piled into the back of our truck. The ride was rough and dangerous, and our busted old Toyota Landcruiser had little to no shocks, so every bump sent shockwaves that endangered our patient. As we bounced around on hard, cracked leather bench seats, I watched helplessly along with the distressed mother who was quietly praying for her child. Ogdon lay delicately between the knees of a nurse who used a bag to breath for him the whole way to Hinche. The other nurse checked his blood oxygen level and periodically suctioned out his mouth. After a while, Ogdon’s mucus turned pink.

When we arrived at Hinche Hospital, Ogdon was surprisingly doing okay. He had survived the long car ride and his oxygen saturation was around 90%.

It was my job to translate for the team, so I ran ahead into the emergency department—a large, open room with cracked white walls and a few patients laying on stretchers. There was no staff in the room, so I frantically ran around looking for a doctor or a nurse to explain the situation. After what seemed like ages, a doctor finally came into the emergency room where the nurses were waiting for us with Ogdon and his mother. The nurses explained Ogdon’s condition and asked about hooking him up to a ventilator.

There was no ventilator.

The doctor directed us to the pediatric wing of the hospital, which was just another large room with scattered beds and dirty linens. At this point, we were still breathing for Ogdon. The two nurses looked at me.

“We need to decide whether to intubate the baby.”

Without a ventilator, the nurses weren’t sure how much good that would do—but if we stopped breathing for Ogdon, he would die. On the verge of panicking, I ran out and fortuitously found the pediatrician Dr. C had called. I brought him to the pediatric wing and translated the story once more for him. He didn’t say anything and wouldn’t meet my gaze. Up until that moment, I still thought Ogdon was going to live. As reality dawned on me, I asked,

“What should we do? Should we intubate him? Are there any other options?”

He didn’t answer for a few minutes and seemed uncomfortable.

“What happens when a baby comes into the hospital like this normally? Do they just die?”

“Yes, they die.”

Finally, we realized what the Haitian doctors had likely known all along. The nurse turned to the mother with tears in her eyes and told her that we couldn’t save her baby. We didn’t have the tools we needed to save him. The mother started wailing, praying incoherently out loud as I had seen before at Haitian funerals.

We stopped breathing for Ogdon, knowing full well he would die soon thereafter. His tiny body lay prostrate on the white linens of a rickety stretcher. His eyes rolled back as we watched him struggle for breath with tiny gasps. Unable to let him just lay alone as he died, the nurse picked him up, wrapped him and cradled him in her arms. She carried him over to his mother, who put her hand over him and prayed.

Ogdon died in Hinche Hospital that night, cradled in the arms of an American nurse, while the rest of us watched on in silence and defeat.

hroughout the entire drive home we sat in silence. It was nighttime by this point, so no one could see as I finally let the tears I had been fighting back roll down my cheeks. I had composed myself by the time we dropped the mother off at her home and laid Ogdon’s little body on the bed of her small but well-kept house. We went home.

When I walked into the staff house, Dr. C was in the kitchen waiting for us. Clearly distressed, I told Dr. C what happened. He didn’t seem surprised. He looked at me, put his hand on my shoulder and said, “Tet chaje.

Tet chaje is a phrase that literally translates to “loaded head.” During my year in rural Haiti, I heard it used almost everyday to describe a wide variety of situations. In general, it describes being overloaded—with anything: worry, anger, sadness, frustration or any of those in combination. It can describe a person, but you can also use it to describe a situation that is completely untenable. Haitian Creole is a beautiful language of few words, so oftentimes people use phrases or proverbs to describe feelings or issues—but there really are no direct translations for most of them. It was strange, but those two words described exactly how I felt.

In bed that night, my mind raced as it went over and over what had happened. The reaction of the Haitian physicians and Dr. C completely baffled me. Why didn’t they spring to arms to try and save Ogdon? Were the American doctors more compassionate, more caring than Haitian doctors? Were the Haitian doctors complacent? Callous? Do the American doctors somehow value life more?

It took me a long time to realize that Dr. C knew something that neither I nor anyone on the surgical team had ever really grasped. If the surgeons hadn’t been there that day, the mother probably wouldn’t have brought her baby to the clinic in the first place. Even if she had, local Haitian doctors would have seen that the baby was in severe respiratory failure, and known that he was probably going to die. They might have simply prescribed antibiotics and sent the baby home, where he would have died violently and silently with his family. Of course, the local doctors would have known that the baby was not beyond modern medical care, but they would have also recognized that he was beyond the level of care available in Haiti. Although the surgeons had been on countless service trips to Haiti in the past and I had been living there for over six months, none of us had ever fully grasped the ramifications of that fact. Not until we tried futilely to fix it for just one child.

I spent a lot of my year in Haiti being angry. This incident was just one in a long list of unjust things that happen all the time. Children should be able to go to school. Mothers shouldn’t routinely die in childbirth from preventable causes. People should have access to clean drinking water. Women should be able to control their bodies and make decisions about their family size. Children shouldn’t be hungry and malnourished. At first these things were shocking, appalling, unbelievable, devastating—and then I had to go to work. I couldn’t be furious all the time even though I should be. The number of unjust things happening all around me deserved my anger at every moment of the day, but I couldn’t sustain that emotion forever. So, I had to learn to accept things that were completely unacceptable—and I found myself having to remind myself to be angry, to see injustice and call it by its name even though the recognition was painful and I didn’t have the strength to fix it.

On the anniversary of Ogdon’s death, I forgot to remember him. I was back in the US, studying for a medical school exam, and I forgot to remember. All those unjust, unacceptable things are still happening in Haiti, and I have the luxury of forgetting even the ones that hit me the hardest. There is wisdom in acknowledging the things you cannot control—but along with it can come an insidious complacency that people fall into without even realizing. Even here in the U.S. doctors have to deal with unjust incidents that they don’t have tools to fix—the young man in the car accident with no insurance, an undocumented mother who cannot access prenatal care, victims of gunshot wounds caused by the endemic violence in their communities and on and on. Physicians who encounter these things on a daily basis cannot afford to be outraged, even when the situation deserves their indignation. Must we become indifferent in order to do our job?  It is a fine line; a balance that I certainly haven’t mastered—especially when it comes to the gross disparities in access to medical care between rich and poor nations—and I’m not sure I ever will. Tet chaje.

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