In April of this year I spent 10 days in Haiti volunteering with New Reality Int ernational, a Washington State-based non-government

organization providing medic al relief to hundreds of people affected by January's earthquake. The experience never did leave me. After coming home, I thought more about how f ortunate we are to be able to live in a country where we have potable water dire ct from the tap, access to world-class health care, flush toilets and solid roof s over our heads. When the world news started to highlight the cholera outbreak in Haiti, I knew I couldn't sit idle; I had to go back to Haiti and help the people that had touch ed me so deeply just six months before. Many asked me how I could afford to go back, but the question for me was: How co uld I afford not to go back. Once you become part of this experience, it is hard to separate yourself from it. Within 12 short months, Haitians endured a 7.0 ma gnitude earthquake, hurricanes and now cholera. How much more can this country t ake? So, there I was within a few weeks of the outbreak landing back in Port-Au-Princ e, Haiti, on Nov. 17. I wasn't quite sure what to expect. Ultimately, the differ ence between this experience and my first trip in the spring was as stark as bla ck and white. In April, we dealt primarily with chronic medical conditions that were a result of lack of access to health care (the earthquake destroyed more than 60 per cent of Haiti's health care infrastructure). This 10-day trip was all acutely ill patients requiring immediate, life-saving i nterventions -- which emphasized the need for the continued commitment of the in ternational community to help rebuild the health-care system Many of the NGOs cu rrently in Haiti are working collaboratively to maximize limited resources. Whil e I was officially a New Reality volunteer, I was also working closely with the J/P Haiti Relief Organization, the Haiti Ministry of Health and Partners in Heal th. Due to the violence surrounding the recent elections, it was initially unclear i f it was safe for us to head to Hinche, one of the areas hardest hit by cholera. It became quickly apparent that waiting for world peace was not an option. Whil e in Port-au-Prince, we received a phone call from Partners in Health based in H inche telling us: "If you don't send us any of your doctors and nurses you have available, people will die." A three-hour drive later along bumpy roads and through the Haitian countryside w e arrived in Hinche with the ever present UN military standing guard. Little tim e was wasted introducing us to the cholera tents and the plan of care. The treatment of cholera patients took place on the front grounds of the Hinche hospital in military tents set up solely for this purpose. It was very clear tha t they did not want to mix cholera patients or even their families with others v isiting the hospital as evidenced by a large plywood board installed to segregat e them. They have been fighting cholera only since Oct. 23, so systems are still being s et up to manage the dozens of people requiring immediate life-saving care. Even before the earthquake, Haiti was ranked 147 out of 147 countries in the Water Po verty Index -- only 27 per cent of the country benefits from basic sewage and 70 per cent of Haitian households have only rudimentary toilets or none at all. Now it may sound like I am exaggerating, but a patient infected with cholera can

become extremely dehydrated within as short a time frame as a couple of hours. It was no surprise that many of the patients that were brought to us were diffic ult to rouse. My first impression of the tent hospital was of shock. Stretcher upon stretcher of sick people with sunken eyes and taut skin. The occasional moan and the frequ ent sound of rushing watery diarrhea. Sometimes you could lead yourself to belie ve there were waterfalls nearby. While we came prepared with supplies, it became quickly evident that it was all not enough. Two of us nurses would take on an eight-hour shift and attempt to ca re for 90 or more patients with very few resources. The Haitian nurses were burn ing out fast. This is mandatory duty for them; seven days a week, eight hours a day with no end in sight. Our motto was: "We will try our best, because that is the best we can do." And t hat is exactly what we did. We rehydrated patients as quickly as we could with the IV supplies we had, made pediatric arm boards out of cardboard, strung IV bags up with the tent flap canv as loops, kept hypothermic patients warm by wrapping them in garbage bags, clean ed dirty bottoms with our limited supply of cotton baton and when that ran out c losed our eyes as the housekeepers would mop the floor, the bed and then the pat ients as really it was the best we could do at that moment. We worked through power outages and by the light of our quickly dimming headlamp s. We started IVs with gloves many sizes too big because that is all we had. We tried not to trip over the roots that were beneath the USAid tarp floors as we c hecked patients radial pulses and their IVs. We witnessed a parentless four-year-old pull a 12-inch worm out of his mouth and then proceed to vomit up another one. This inspired us to deworm the entire ten t (thank goodness deworming medication was available). We laid a nameless man to rest beneath the tree near the pile of burning trash w hose smoke would often blow into the medical tents. We worked on conflict resolution when the housekeepers wanted to strike. We consoled a patient who had already lost four children to cholera and wanted t o join them. We wondered many times if it was coincidence that the Haitian word for "ouch" so unded like "why." Every time we started IVs, were they asking us "why" there was all this suffering? We smiled at the locals as we tried to make the best of a supremely challenging situation. What I take home from the experience is the fact that we did make a difference. My face to remember is little four-year-old Francesca who, on her way to her gra ndfather's funeral, became acutely ill with cholera. She came to us in her mothe r's arms barely responsive with her eyes rolling back in her head. I will hold h er memory dear to my heart as the next day, after 24 hours of intravenous fluids , she asked for me and while laughing, smiling and giggling wanted to wave "bye bye." If we only made the difference for one person, the experience was all worth it. However, I can happily say there were many positive stories like Francesca's and it was an experience worth every moment.