4/28/2010 7:35 pm EST (8:35 pm EDT)
I hate telling patients that there is nothing I can do for them. A patient comes in complaining of eye pain when she reads. I think she probably needs glasses. I can't get her glasses. There's nothing I can do other than tell her to try to get some reading glasses. A patient comes in complaining of abdominal pain when he doesn't eat. He eats maybe 1 meal a day, 2 if he's lucky. I think he has hunger pains. I can't write a prescription for more food, and I can't just give him food. It doesn't ultimately fix the problem. A patient comes in complaining of lightheadedness and dizziness. It turns out she does not drink much water because she is afraid to drink the reservoir water (not safe; makes her sick) and she cannot afford to buy clean drinking water. I suggest she try to buy water purification tablets or try to boil the reservoir water for 10 minutes before drinking, to make it safer, but then she needs money to buy the purifiers or charcoal to burn to boil the water. A woman comes in with a chronic easy to dislocate index finger that is swollen and bothers her. I cannot tighten the ligaments that were stretched when her finger was first injured. I can tell her to go to an orthopedic surgeon, but who knows if she can afford to do that, or if they can do anything for her.
We take so much for granted in the US. We have clean drinking water delivered to our houses that comes out of faucets. We have relatively clean driveable roads (even in Cleveland with all the potholes, they are nowhere near as bad as in Haiti). There are plenty of soup kitchens and food banks for the poor and homeless to go get food. We have sewers that carry away dirty water so it's not running down the side of the roads. The even poorest of the poor can get emergency medical care, and there are numerous programs to help defer medical costs for many poor folk.
There is a light at the end of the tunnel even for some of the people of Haiti, however. The little girl from Cite Soleil with malaria who Dr. Joey had come to his hospital and who forgot her meds at home actually only got one of the two meds from home that she needed to cure her chronic malaria. They lost the chloroquine, and she only had doxycycline, which can help, but will not cure her. When some of the other patients heard that, the all chipped in a few gourd (Haitian currency) to help buy her more chloroquine. Hopefully she will get better with this treatment.
We had to turn away a patient this evening who has a history of spina bifida occulta and some sort of accident or injury that occurred 8 years ago resulting in her having chronic recurrent neuropathic pain in her right leg to the point where she can barely walk. She's been coming to Dr. Joey's hospital for quite a while, and he typically gives her an injection of pain medicines (paracetamol I think) once a month to quiet down her pain. We have no neurontin, and we gave the last dose of his paracetamol to the guy who came in with right upper quadrant pain (he looked much better after a liter of normal saline and his pain meds, and will get some bloodwork done to investigate what was going on with his pain). However, I have a bag of injectable medicine that I had received from the Brazilian guys, and I thought I had something that might help her. It's now sitting next to me in the hotel, and I will send it with Dr. Joey to bring back to the hospital. It has about a dozen or so little vials of diclofenac. I think that might work for her pain. Ultimately, I think she ought to be on neurontin, but Dr. Joey did not have any in his pharmacy. Maybe we can get a few bottles and send it down with the next crew in May. It beats trying to get her a medical visa to the US to further evaluate her pain, since the hoops that must be jumped through to make that happen are horribly difficult for adult patients (and are still pretty hard for kids like Ois, who is still sitting in Joey's hospital waiting for his medical visa to have his leg fully repaired).
I know sending a few bottles of neurontin is just a temporary band-aid for the woman we saw tonight, but I don't know if there is a cure for what ails her. However, maybe the bandaid will be enough to help her be a functional part of the Haitian community and help rebuild her country. That'd be pretty cool. Maybe I'm being too idealistic, thinking like the Haitians who keep having big families in hopes that one of their kids will grow up to be a doctor, but... you have to start somewhere, and there's definitely something to be said for hope.
-- Gina
4/29/2010 8:14 EST (9:14 EDT)
I am spoiled. Here I am, surrounded by poverty, with little boys coming up to me and patting their bellies and holding out their hands, young men asking me in broken English if I can give them money so they can buy a pair of sneakers, and multiple people who are waiting on me at my hotel asking me if I can give them any medicine for their assorted aches and pains. I tell them no, no, and see me at the hospital and I'll do a more thorough history to determine what medicines they may need before handing them pills. Then I go sit in my lap of luxury, with air conditioning and a ceiling fan and cool water to drink and a nice cool shower, typing away on my laptop.
Dr. Joey is going to share some food with the little beggar boy at his hospital, since apparently the kid was helping the Scientologists paint today. I've been told to be careful handing out granola bars and snacks willy nilly, because I could run the risk of getting mobbed by a bunch of people wanting the free handout. It's hard, though. It's easier to say no to giving money, though I have given a little money here or there for people who have been helpful to me (the boys who walked me home one day, for example, or the guys who fetch me lunch or sodas or water to drink). I don't think the guys at the hotel understand that I am not avoiding giving them meds at the hotel because I don't want to give them free meds, but because I don't know what I'm treating, and the guy translating for me at the hotel is not that good at medical translation. Well, part of it is also that I don't want to work at "home", but that's hard to explain to them. I keep telling them to come see me at Joey's hospital, and the guy who translates for me at the hotel has even walked with me there once, so he knows where to go, but they won't come. I think they are afraid they will have to pay to be seen there. I think I'll have to correct them on that at some point.
Dr. Joey spent the whole day in beaurocracy again, but after shuffling from office to office to office to office, he's finally got all the paperwork in order to unload the Scientologists' boat with the ambulance and other medical supplies on it. I think he's going to have a bunch of folks unload it tomorrow, but he'll also try to be at the LAMP clinic in Cite Soleil at least for a while. I'm betting Dr. Jacky and I will see the bulk of the patients, though, and I'm getting fairly comfortable with that. I guess I'm getting closer to ready to graduate. Still kind of scary, though.
The most interesting patient of today was the father of the girl from Cite Soleil with chronic malaria. She's getting better and went home this afternoon, I think. However, before she left, her father came to visit her and ask for an evaluation of his foot. He has diabetes and 7 months ago, he had the first 4 toes on his right foot amputated. It still isn't healed, and knowing what kind of housing is in Cite Soleil, I was afraid to remove that bandage. It was not infected, thankfully, but it did not look fully healed. There were some well healed scars, but the distal edge of the amputation site was open with some whitened tissue and not much granulation tissue growing. I think it needed to be debrided to put the wound into the acute phase of healing, as well as close monitoring of his diabetes to ensure he is doing well with his sugar control. Unfortunately, I do not have the experience to debride it properly, nor the supplies to do it. Dr. Joey doesn't generally do that sort of thing here at his hospital, either. I was bummed that I felt stuck unable to help him, but we at least made sure he is still taking his metformin, and hopefully we can set him up at a hospital somewhere.
I saw all the patients at the tent camp on Mais Gate 46 (Kay Lasante) today, since Dr. Joey was stuck in beaurocracy-land. The theme of the day was gynecology. Lots of women with infection vaginale (vaginal infections). Unfortunately, that's how they describe symptoms ranging from yeast infections to bacterial vaginosis to urinary tract infections to gonorrhea or chlamydia. I sifted through the history to cover for the most likely, but probably should have done more empiric treatment for gonorrhea and chlamydia. I really wish I could properly examine the patients with a speculum and do at least a wet prep and KOH, as well as a urinalysis. Then I could treat more specifically, rather than guessing from history. Kind of hard to do when I don't have speculums or a lab, and the clinic is a tent with a thin bedsheet for privacy.
-- Gina
4/30/2010 6:52 EST (7:52 EDT)
There's something quite refreshing about a cool shower after a long day of clinics. Today was the usual Cite Soleil day, starting a little before 7am to go to the LAMP clinic in Cite Soleil, followed by the Wharf Soleil clinic, followed by clinic at Hopital Medicare (Dr. Joey's hospital). What made things more interesting was that Tom, the guy who started LAMP, came with 3 other people to visit the clinics in Cite Soleil (both sites). Tom's apparently a human rights lawyer, and he comes to visit every couple months. He's thrilled with the progress at Cite Soleil, with the tile floor, the wood frames around the doorways, and the laptops, which we still aren't using due to technical issues, but which are close to ready to use for EMR. We had the generator hooked up, and fans going, which was nice in the one exam room and the pharmacy that had them (but I was doing patient visits in the room without... *sigh*). With all the white folks, we attracted a little more attention than usual at the Wharf, and we had some guys come up and ask for money. We were not impressed by their macho gansta looks, or their persistance, even after the LAMP guys explained that all the money they have is for medications and they have none to give away for free. These were healthy young men. They should have been out working, not hanging around pushing their way into my clinic exam room to stare at me while I work (I asked my translator to tell them to leave the room, because my patients deserve some semblance of privacy, even in a clinic that's a shell of concrete with no doors or windows and barely any walls), bumming around the free clinic when we're busy taking care of sick people. They should be fishing, or picking up garbage, or something productive. They do not have my sympathy.
The most interesting patients at Cite Soleil and Wharf were two older men. The first was at the Cite Soleil clinic, and he came in complaining of vertigo and malaise. His blood pressure was around 170/80, and while I was checking it, I heard occasional skipped beats. I checked his pulse and listened to his heart, and it seemed semi-regular, with the occasional skipped beat. I wonder if he has some variety of second degree heart block. Too bad we have no EKG machine. He had no crackles, but some trace pitting edema to the upper shins. I put him on atenolol and a baby aspirin as the best cardioprotective things I could find (well, there was some carvedilol, but I didn't think we'd have enough to continue it long-term, and didn't want to make him switch meds) and asked that he return in a week for a recheck. I'm afraid I'll make him orthostatic with the atenolol, but we'll see.
The other man was at the Wharf, and was the last patient I saw there. He had a painful swelling over his left eye on the lateral aspect, and it appeared to push his eye down slightly and affect his vision. It's been there for about 4 years. It felt too hard to be a lipoma, so I wonder if it is some other sort of tumor pushing out the bone. I recommended a surgical consult and imaging, and gave him some acetaminophen for pain. Who knows if he'll be able to get the consult or not. If Joey'd been there, I would have asked him if there was a way to send him to one of the free hospitals like Miami Hospital (the US Army hospital at the airport) or Medicins Sans Frontiers (Doctors Without Borders) or something similar. I'll run it by him tomorrow, though. (Dr. Joey stayed at Cite Soleil for about an hour before running off to an appointment at the Sanitorium to negotiate for a lab tech to do TB testing at LAMP, then help the Scientologists get the ship unloaded, since they didn't seem happy with just Dave in charge in lieu of Dr. Joey. He wasn't back by the time I left his hospital at around 6:00).
I then went back to Hopital Medicare with Dr. Jacky (thankfully, he was with me all day, and his friend Anthony, the medical student, was translating for me at Cite Soleil; I'd be lost without those guys) via Mimi's truck part of the way, then a couple tap-taps and a little walking. After a nice cold water and Coca Cola (with sugar!) and a late lunch of beans and rice and some sort of carrot and green leafy vegetable saucy thing, I was ready to work again for the afternoon, and saw maybe 20 patients from 3:00-5:45 pm. It got a little crazy, since I only had the one head nurse who was both translating and dispensing meds, so I tried to help her count pills to get folks out of there. She usually goes home at 5pm, but we had too many patients to see. Meanwhile, Dr. Jacky was apparently teaching the medical statistics class, and he taught them about the anatomy of the digestive tract. I watched part of the video he showed them. It was WEIRD. It reminded me of a French-speaking Bill Nye the Science Guy, with hanging cadavers and a naked man with abdominal organs projected onto his belly. They then proceded to dissect the hanging cadaver and show the salivary glands on one side of the head, followed by the esophagus, which was exposed by removing the back of the skull and spine. I'm sure they would have moved onto dissecting the abdomen, but I didn't feel like watching the whole thing since it was late and getting dark.
The most interesting patients at the hospital were a 15 year old girl who was 18 days status post cesarian section in for a post-op check, and her baby boy. She still had her sutures in, so I told the nurse they could definitely come out. Unfortunately, her skin was overgrowing the knots, so it hurt to get the sutures out and she was not happy. The way they take out sutures here is interesting. They use a scalpel blade (no handle) and hold onto a strand of suture in one hand and cut with the other. There's a high risk of cutting themselves or the patient that way, I think, especially since they tended to cut down through the suture towards the patient, instead of trying to get the blade under the suture and pull up. Two of the knots were giving her trouble and the patient was so uncomfortable that I offered to take the sutures out instead. I used my forceps (cleaned briefly with alcohol, but not sterile) to hold the sutures and pull them against the scalpel blade, cutting them as quickly as I could to minimize torturing the patient. It went a lot easier that way (though they still hurt). I gave the nurse my forceps afterwards and explained how to keep them clean with alcohol or betadine, between patients. They have a autoclave, but don't use it often, and for suture removal, clean is good enough. I also explained that sutures for cesarian sections should be able to come out at 7-10 days, and that would have decreased her pain since the skin wouldn't be trying to overgrow the knots as much. Whoever sutured her closed didn't make much effort to put the knots away from the incision, though, so that was part of the problem. I suppose it could have been worse. They could have used staples, and then I'd have to find a couple hemastats to remove the darned things (who knows if there's surgical staple removers there).
Her baby boy had a gauze wrapped around his waist and umbilicus, and when we managed to get it off, we saw that his umbilical stump had fallen off but there was still a translucent moist white spot at his umbilicus, as well as some desquamation of the skin below it. I think the baby was getting too moist under that gauze that they had over his umbilicus, and had developed essentially a diaper rash on that skin. I gave the mom some alcohol wipes for the umbilicus and zinc diaper cream as a barrier from moisture for the rash, and put a liberal smear of it on his belly where the rash was.
I hope that the mom gets on something for birth control, since she is so young and had a cesarian. I emphasized the importance of not getting pregnant for at least a year, to help her body heal. I hope that since I did this right after we tortured her with the suture removal, she may actually listen and get on something. I kind of wish she hadn't gotten pregnant in the first place, since she's so young, but I can't change the past.
Assuming there were 50 patients at Cite Soleil, 60 at Wharf, and the 20 I saw alone at Hopital Medicare, I probably saw around 70 patients today. Even if there were fewer at the Cite Soleil and Wharf sites, I probably saw 60. That's kind of frightening. I'm glad I'm not keeping a formal count.
One more week before I fly to Miami, then to home. Dr. Jacky is sad I'll be leaving in a week and probably won't be back for a year. We have exchanged email addresses, though, and hopefully I'll be able to work with him again someday. I've made some good connections here, and though the work is hard, especially as the solo outsider, I still love seeing the patients and trying to help deliver medical care in such a needy area. I'm also glad I've managed to learn a little Kreyol and can communicate at least in basic fashion with my patients here.
-- Gina
5/1/2010 7:53 pm EST (8:53 pm EDT)
Dr. Joey's computer is still out, so I can't get to the internet. I hope Tod's not too worried. It'll theoretically be back tomorrow, so I'll try to hop online as quickly as I can and email him.
Today was Labor Day in Haiti, which if it's a weekday means a day off for most people. As it's Saturday, it didn't really mean a whole lot. However, for Dr. Joey and his crew, it definitely was a work day. He had unloaded a fair amount yesterday from the ship, but returned to unload the rest today. I tagged along for the morning, since we figured there weren't going to be too many patients showing up at his hospital. Got a smidge more sun than I should have (forgot to put on sunscreen), but really not too bad. It was a beautiful area. Restricted access behind 3 security gates and customs, etc, so not too many people to litter the place with garbage. The ship is captained by an interesting guy named Tom Keegan, I think. He is disabled, wheelchair-bound, secondary to an accident a while back, but it didn't stop him from driving semitrucks and captaining. He says captains spend most of the time sitting on their butts anyway, and it started when someone asked him to captain a ship to Haiti, because the guy was having trouble finding anyone else to captain it. He'd helped to get the ship ready to go, since it was an old fishing boat with major issues requiring a lot of retrofitting, and he supervised that work, but he didn't think he could captain in a wheelchair. The guy offered to make it wheelchair accessable, though, and really wanted the help since he couldn't find anyone else to captain, so Tom agreed. He arrived with a load of food supplies at a port in Haiti and was greeted by a flock of little Haitian children with red hair, round bellies, and twiggy legs, and watched them get healthy with the food supplements in a matter of weeks. That got him hooked. He has continued to captain ships on charitable deliveries, and this shipload held things for maybe 9-10 NGOs (Non-Government Organizations), including the Scientology group's delivery for Dr. Joey. The captain has a boat that was a former hospital ship parked in Panama, that he wants to fix up and recommission as a hospital ship again. However, he needs help with funding and probably some guidance as well as docs to work on it. It sounds like the kind of ship that could accomodate major surgeries and imaging. I don't think there's a lot I can do to help him, but I gave him my email address. If any readers are interested in working on a hospital ship in any capacity, let me know.
I got to check out Dr. Joey's ambulance and new (to Haiti at least) diesel pick-up truck with a large water filter sitting in its bed, and help a little with unloading. If I'd known I was going to the ship, I would have dressed to haul crap, but it's hard to haul and clamber on and off a ship in a skirt. Oops. We managed to unload the remainder of the cargo for the Scientologists and Dr. Joey, with the exception of the ambulance and truck (since apparently he still has some customs issue to haggle over; the beaurocracy). I came back with the second truck-load and helped unload, then had lunch and sorted out some of the supplies I'd brought out of my suitcase and into the pharmacy. Tomorrow, hopefully we can tackle cleaning and organizing the pharmacy again, since there's a lot of expired meds. I'm going to be really sad to throw out all that birth control and furosemide, but a lot was expired. If we can junk the old stuff, though, we can make room for more of the meds stored in the spare room in Dr. Joey's apartment.
Oh, I also saw a handful of tough looking young Haitian men who were actually being resourceful in finding work rather than just coming up to us and begging. They came in to help clean the ship, since apparently there was a leak and a lot of the boxes holding the MRE's were destroyed, along with some of the vitamins and some other stuff, making a big mess on one of the lower levels of the ship. Dr. Joey made a deal with them; they cleaned all the garbage up off the ship, and they got the MREs that were out of boxes (since they were still sealed and perfectly good inside). They got 4 or so large boxes full of MRE's out of it, split among the 5 of them, though apparently they traded one box in exchange for a ride with a guy with a truck. They dropped all the garbage off at a dump, too, so everyone was happy. Well, almost everyone. Dave thought they got too many MRE's, but Dr. Joey felt the guys who cleaned the ship were in more need than the crew at the hospital, many of whom are fed regularly by the hospital's cook. I'm betting they all have families to feed, too, if not whole camps, and I would rather encourage them to work as hard as they did today to earn their meals than encourage the begging at the clinics or street intersections.
Aside from the ship unloading, I'd say the highlight of my day today was that I got to try more tasty Haitian food. We'd given a guy who was selling these little meat filled fried bread things a ride on the way to the ship, and bought some of his pastries. Yum. On the way back, we had to stop for gas, and Dave's sister saw someone selling cream soda (which we couldn't find on the way out, much to Dr. Joey's chagrin), so we bought enough for the five of us on the truck (Dr. Joey excluded, since he was still at the ship). The sodas in Haiti are all sweetened with sugar, which is awesome. The cream soda had a little bit of a gingery quirk to it, and was really good. So far, I've tried that, Fruit Champagne flavored soda, and a banana flavored soda, along with Haitian versions of Coca Cola and 7-up. I'm tempted to load up on a few bottles of Haitian soda to bring back to the US with me (though only in plastic bottles; they reuse the glass ones, so I may not be able to bring back all the flavors). Dr. Joey's cook is quite good. She made that greens and carrots and spicy sauce stuff with plain white rice for lunch today, and she really spices it well. I will have to look for another Haitian cookbook to try to reproduce some of these flavors.
As far as patient seeing, I only had a couple patients, a nice fat 8 month old with a probable ear infection and a man with probable strep pharyngitis, but complicated with a III/VI systolic heart murmur making me be a little paranoid about endocarditis. He didn't look sick enough for endocarditis, but we went ahead and covered him with two antibiotics anyways, since he looked and sounded sicker than just a strep throat. My translator this evening was Carlo, one of the kids who hangs out at the hospital and helps out. His main job today was inventorying everything that came in off the boat, but he also helped do laundry and translated for me. In exchange, I'm going to have to try and send a canister of Tang down with the next group, if they have the space in their luggage. That's apparently his favorite part of the MRE's that came in today, though he loves MRE's in general. I suspect he also likes them since they're different, and thus kind of a treat. I guess that's like me and those Haitian sodas, but at least Tang has vitamin C in it.
I'm really ambivalent. On one hand, I really really am looking forward to going home to Tod and the cats and Maine weather and the lack of dust and pollution and garbage (and fewer mosquitos!), and on the other, I'm sad to leave my new friends here in Haiti as well as all the patients in need. A lot of the guys here are bummed that I'll be leaving next week as well. I hope that they will like the other folks from Maine-Dartmouth and be able to help them out when they come next month, and that they're still around by the time I find time to come again. Dr. Joey wants me to come back with Tod again if I can. Maybe I can convince KK to come as well, and maybe some other Notacon folk. Dr. Joey's hospital would probably benefit from a good electrician and a wired network set-up to roll out an EMR someday. His LAMP clinic will run on wireless and probably be fine (though if it grows enough to have a full lab and radiology for his TB clinic, networking for easy transmission of digital radiology films could be nice). I'll have to talk to Dr. Joey about it and see what he thinks.
-- Gina
5/2/2010 8:43 pm EST (9:43 pm EDT)
Had a slow day medically, but a very interesting day outside of patient-seeing. Today had one of the greatest high points, but also one of the greatest lows.
I heard a rumor today that some volunteers from a religious group who were helping at the Miami hospital at the PAP airport recently chose to take a table full of medications intended to treat a specific class of conditions, and throw them away, presumably because they believed the medicines were morally wrong to use. I sincerely hope it didn't actually happen, or that they were stopped before the probable thousands of dollars of medications were destroyed, but I don't know for sure. I wish I could go into more detail, but I am concerned that this may be a legal issue (since it sure sounds like theft and destruction of property to me), and as such, want to obtain legal counsel before blathering on to the internet. I am just really really saddened, because while I am not particularly religious, I try to maintain a degree of respect for religious institutions in Haiti, since for the most part, they are here to try to do good for the Haitian people. I just cannot respect this sort of action, however, and rank it up there with murdering abortion doctors.
On the bright side, this evening Dr. Joey and Dr. Jacky took me to Mimi's house, presumably for a LAMP organizational meeting since some of the Americans involved in it were in town this weekend. It turns out that it was Mimi's birthday today, so they planned it to be a surprise birthday party. Unfortunately, Mimi wasn't surprised, but the rest of us were. It was the first birthday party Dr. Joey's been to since the earthquake, and he and I both felt that it was a really theraputic thing to help at least the few working at LAMP feel a sense of normal life (at least normal in Haiti) again. We had a veritable Haitian feast with beans and rice, fried plantains, french fries, piklis (pickled spicy vegetables that remind me of kimchi), roasted goat, and a birthday cake from Epidor. The generator was fired up and the stereo was playing some good Haitian dance music. I discovered that Dr. Joey and Dr. Jacky both dance, and Mimi's got some rocking hips.
From the computer geek (protogeek) standpoint, I offered to Dr. Joey to help set up a website for his hospital. I envision something like the "Sponsor a child in Africa" type things, only "Sponsor a nurse in Haiti" instead, with people donating to help pay some of the staff of his hospital. He needs to hire a nurse certified to give vaccines again, since the WHO will give him vaccines for free if he has the nurse to give them. He used to have one come once a week, but can't afford it anymore. At a salary of about $70-80 USD a month, that's pretty doable to fundraise. I'll have to talk to Dr. Joey about whether or not he has nonprofit organization status, since that will be pretty helpful in fundraising, but it can be set up if need be.
Politically, I learned something rather odd about Haiti. At least from Dr. Joey's perspective, the Haitian people in general would rather have the Americans occupy and govern their country than Haitians. Most countries don't want that (i.e. Iraq), but apparently there is such distrust due to the corruption of most if not all of the Haitian government, and such a strong presence of international aid work coming from the US and other countries that I can understand why so many would desire American aid over their own government. I suppose that's why I don't feel scared while running around in Haiti, in tap-taps, walking to Joey's hospital, or staying alone in my hotel. By the fact that I clearly do not look or sound Haitian, people realize that I am here trying to help in some way. Of course, there's still the folks who see me as a potential money source, but I am getting better as giving a firm no that they do not question.
I talked to Tod this morning (he'd called Dr. Joey when he hadn't heard from me for a few days due to lack of internet), and I will hopefully get online in the next day or two. I have a lot of entries to upload!
-- Gina
5/3/2010 7:32 pm EST (8:32 pm EDT)
You know, I wonder if Dr. Joey will ever get his computer and wireless internet antenna back. The driver supposedly was going to drop it off yesterday, and here I am today, still updating the same text file because I can't upload the thing to the internet yet. Good thing Tod called me yesterday. Otherwise I would have had no contact with the outside world all weekend.
I did not sleep well last night. I've been dealing with a very mild traveller's diarrhea and cramping abdominal pain for about 5 days now, but last night was bad enough that I kept waking up uncomfortable. Good thing I've got my own bottle of cipro, and read the chapter on diarrhea in Bill Alto's International Medicine book. I often wonder if medical students and to some degree medical providers are hypochondriacs, but I don't think I'm imagining my symptoms.
I suppose if the worst I get here in Haiti is a bit of traveller's diarrhea and a bunch of mosquito bites (which have been such a daily occurrance they hadn't merited a mention until now), that'll be pretty good. Last week, Dr. Julia was wondering if she would get scabies from hugging all the children with itchy rashes, and I still wonder if that guy I saw really only had a post-inflammatory vitiligo or leprosy. I really hope I don't bring anything interesting like that back to the US.
Since my stomach was still a little unhappy, clinic was a little less pleasant than normal, but Dr. Joey pulled me out of Cite Soleil to go with him to a couple public hospitals while he was interviewing lab techs to work at the LAMP clinic. I got to see the palace, which is still in the same state as just after the earthquake, at least from a distance. The lawn is green and fenced off, guarded just as before the earthquake, and I am a little sad that people aren't allowed to camp in that big open expanse. I also wonder why the palace is not being demolished to be rebuilt. I would have expected to see more government buildings being reconstructed, or at least operating out of tents in proximity to the original sites, but if they were, I did not see them.
The public General Hospital was interesting to see. There was a flock of people awaiting being seen in the yard, the lab was operating out of a UNICEF branded tent (though I think it's the original public hospital lab) and the ER and ICU are being run by mostly non-Haitians here as a part of an NGO. It was a striking difference from my last trip to this hospital in October. I'd toured the pediatric wing then, and it was dim, crowded, with families doing most of the care that would be done by nurses in the US, with grime coating the sinks and a dead baby covered by a sheet just sitting unattended in a hallway. The ER/ICU was well lit, clean, and relatively organized. The respiratory supply cart was still a little worn and dented, but clearly labeled and stocked, and there were plenty of medical providers of assorted types. A doc went outside when we were coming in, to see a woman who appeared somnolent and pretty sick, lying on a gurney outside, and after the initial eval, was quickly brought in. Most importantly (to Dr. Joey at least), the doc in charge of the department came over right away to chat with us briefly and offer the department's number in case we had anyone sick enough to need to be transferred to them. As he runs the ER, he has a sense of the entire General Hospital's capacity, and knows when certain departments are full or closed due to strike or can accept patients. Apparently, the senior surgery residents just graduated so the remainder are being asked to work harder and thus are striking. The OB/GYN department is also on strike, due to not being paid for many months. I cannot wrap my brain around the concept of going on strike as a health care provider, because where else would the people go? However, I also cannot fathom how anyone could get away with not paying their staff for multiple months. I guess I am too naive or idealistic. I understand why the quality of the public hospital was so poor, though, since if they weren't getting paid reliably, and had little financial support for materials, morale would be in the dumps and the quality of service would likewise drop.
Afterwards, we stopped by a tent camp where Dr. Joey had run a clinic previously, but apparently had to stop when the pastor who had been loaning him space declined to continue that service. Dr. Joey says that the pastor felt he wasn't getting anything out of it, because it was a free clinic with no financial transactions at all, but I would think that a healthy happy congregation would be grateful to their religious leader if he were the one to host the free medical clinic. I guess that wasn't enough, though. However, we talked to a guy who runs a little casino in an area shaded by a large tarp and walled off with poles and corrugated metal. He didn't require any persuading to agree to allowing Dr. Joey to use his space for a few hours a week to run a free clinic on Mondays. Maybe he figures it will attract more people to come to his casino and gamble. I kind of wish I could be here next Monday to see how it goes.
This afternoon, I ran clinic at Dr. Joey's hospital, and as I was starting on my second patient, there was an aftershock. Apparently I slept through one last night (so my stomach woke me up, but a small earthquake did not... weird), but the one today felt just like a very large truck driving by, and only lasted maybe 2-3 seconds. It was long enough to have everyone stampede outside, including Ois (though his stampede was more of a frantic roll in his wheelchair, and I helped to pull him up over the lip at the door to get outside. There was a mix of panic and laughter in the air afterwards, because it was such a triggering event for some, and it was so short that many felt relieved. The patients did not want to go back inside, however, so I set up to do clinic outside under one of the tarps in the yard and finished up the second patient that I'd started. Then, because of the aftershock, a handful of patients affected by it came in. One was a girl who was hyperventilating, being carried in by her family. I wonder if she might have fainted or become lightheaded when the aftershock happened. A guy with a bandana tied around his foot had apparently gotten a puncture wound with something still stuck in it. We dug at it and cut in a little to try to find the foreign body, but nothing came out. I suspect he felt the sensation of something there even if it was no longer there, and rather than cut his foot up more, we just flushed it well, slapped some antibiotic ointment on, and made arrangements for him to return again in the next two days to be rechecked. He wanted an xray to see the foreign body, but I told him that many foreign bodies fail to show up on xray. Besides, he'd have to pay for it, and it's be a waste of money. Dr. Joey then sent me off to have my belated lunch while he saw patients. Dave had gotten some food from his sister for our lunch, and she'd made rice, bean sauce, chicken with okra, and plaintains. Yummy.
After eating quickly, I returned to our outdoor clinic and took over again, because Dr. Joey was distracted by a flock of foreign visitors who had come to offer help in the form of physical therapy and medications, as well as a video crew who were filming to make a documentary of some sort. I am decent at ignoring when being videotaped or observed, but it's really hard when there's a giant boom microphone hovering over me and a big video camera shoving in between me and my medical supplies and getting into my patient's faces. I tried to cooperate as much as possible, though, since I hope that the documentary will be helpful to bring awareness of how much need is still here in Haiti. They got to record me interviewing a mom about her baby with scabies and probable intestinal worms, a man with poor appetite likely secondary to depression and possible post-traumatic stress disorder, and another mom about her daughter's bullous rash that started after the earthquake and was likely infectious in origin. They are going to be at it again tomorrow at the tent camp and Wednesday at Cite Soleil. The physical therapists are going to be joining us as well tomorrow, so I hope that we'll find enough patients for them to work on. We get enough folks coming in complaining of assorted aches and pains that with a slight nudge we can probably bias the patient panel to include more orthopedics or other cases for the PT folks to work on.
Dave told me today that the Haitian government mandated that all hospitals, public or private, be free after the earthquake, until June or July. He wonders if Dr. Joey's hospital will still be free afterwards. I'll have to clarify that with Joey tomorrow. Dave thinks that's why many hospitals actually closed after the earthquake, because they didn't want to or could not afford to be free. Dave wishes there were more doctors like me, who come down and are willing to see everyone who walks in the door, no matter when, and gives them full attention to figure out what they need. I pointed out that I cannot afford to do what I do in Haiti all the time, because it costs me a lot to come here, and I have to work in the US to pay off my educational debts and save to come here. I suppose I approach my patients in the US with much the same view, though, since if they need to be seen and I can accomodate seeing them, I'll squeeze them in, or give them as much time as they may need to be seen (though I have to be careful not to do so at the expense of my other patients). I hope I don't lose that attitude when I grow up and turn into an attending, but at the same time, I have to be careful not to let it burn me out. Otherwise, I do none of my patients any good.
-- Gina
5/4/2010 5:28 pm EST (6:28 EDT)
Dr. Joey got a call from the driver who has his computer, and is going to meet him to pick it up tonight. He dropped me off for the evening a little early, since he had to head out to a couple more meetings. We'll see if I can upload this file tomorrow evening or not...
Tomorrow would normally be a Cite Soleil day, but Dr. Joey is having the film crew and physical therapists go to Wings of Hope instead, and I asked to go along with them. Hopefully he can arrange that tonight. Poor Dr. Jacky is counting the days until I leave, and is sad that I have to go. I told him I'd come to Cite Soleil to help him on Friday before I fly out, and that more people were coming at the end of May as well, for a week.
Today I took the stitches out of the lady's finger who had the lipoma surgery last week. It smelled kind of bad, but I think that was due to excess moisture under the dressing, so I asked Dr. Joey to explain to the nurses to do a slightly drier dressing this time. The wound itself looked healed decently, though, and did not appear infected. Dr. Joey injected the finger with dexamethasone to prevent recurrence of the lipomas, which I found an interesting concept. I suppose it is like injecting cysts or keloid scars with steroids.
I saw patients from 9-12 at Joey's hospital (not sure how many), and then we hurried off to try to get to the tent camp by 1. We failed, partially due to me needing to stop at home to change my skirt (it got bloody), and partially due to horrendous traffic on Mais Gate. We got there around 1:50 pm and started to see patients. We had tried to book extra patients due to having extra doctors (myself, Dr. Jacky, Dr. Aksana? - one of the girls from the Scientology group who is a Haitian doctor trained in the Dominican Republic, and Dr. Paul Gallagher, who is visiting to wants to work with Dr. Joey and set up a telemedicine project. Dr. Joey saw patients as well for a little bit, and supervised setting up patients for the 4 physical therapists who came as well, before running off to the bank again to try to get money to pay his staff.
The highlights of the tent camp patients were a 2 year old girl with an abscess on her side that was about to burst, and a man whom I'd seen last week and diagnosed with PTSD and somatization disorder (he felt these weird feelings in his head). The girl was handed off to Adline, one of the medical assistants of Dr. Joey's, who lanced the abscess, and then was prescribed antibiotics to ensure the infection cleared up. Lee went with Adline to help and apparently the pus went shooting out as soon as it was lanced, which does not surprise me since it felt so tense. The man with PTSD and somatization showed up just before Adline and Lee finished. Dr. Jacky took his phone number to call him later when the psychiatrists who are apparently coming later are here, to set up an appointment for him. In the meantime, however, Lee offered to talk with him today. Mary translated for her, since the man spoke French, and the three of them found a corner to talk. I think she worked with him for at least 30-40 minutes, and it seemed to go very well. Apparently, he has not been able to really talk about the earthquake and how it affected him to anybody before today, and he felt it was very helpful. He wants to meet with her and talk again. Apparently he lives in Cite Soleil, so Dr. Jacky gave him directions to the LAMP clinic, and he'll see Lee there. I felt kind of in despair when I saw him last week and when I saw his name again today until Lee took him under her wing, and am so glad that she was able to help him.
I finished the day with a few patients at Dr. Joey's hospital before heading home. Before I left, Lele wanted me to see him, and supposedly was complaining of lack of appetite and poor sleep. Whenever he said that, though, Miss Midi laughed at him, as did everyone else. I've watched Lele pack away the MRE's, so I know he's eating. I think Miss Midi diagnosed him with crappy life syndrome, which is probably endemic in Haiti. He laughed too, so I think he'll be ok, but I wish I could do more for him. Maybe I'll give him a bunch of granola bars.
Once Dr. Joey dropped me off at the hotel, I finally remembered that I forgot to eat lunch today, so all I've eaten was some bread and cheese and tea for breakfast and a granola bar and Coca-Cola as a mid-day snack. I usually eat enough for lunch that I don't want much dinner, but since I hadn't eaten much today, I now have one of the guys from the hotel out fetching me a nice dinner. I told him I want yummy Haitian food, not too much, and some fruit and juice if he can get it. We'll see what he comes up with.
-- Gina
5/4/2010 7:13 pm EST (8:13 pm EDT)
Full... too full. My dinner was goat in a spicy sauce with rice and bean sauce on the side, as well as a papaya orange milkshake. Expensive, since the guy who fetched the food for me went to a restaurant that he knew would be able to make decent American-tourist-safe food, so it came to around $12-13 US, I'm guessing, but worth it. I just wish that I could buy a half-plate of food instead of a full one, because it's always too much food and I hate throwing it away. Unfortunately, there's not really a good way for me to save it for later, due to the lack of steady electricity. I keep looking at that excess and thinking about all those kids that I see with orangey hair, round bellies, and twiggy limbs, and sighing. I just can't really get my leftovers to them, either.
I wonder if Dr. Joey will be able to set Kay Lasante up to do a nutrition program at some point in the near future. He has Miss Flo doing a nutrition program handing out fortified peanut butter (with added powdered milk, powdered vitamins, sugar, and oil) and doing weekly weights at the LAMP sites, and the few children who consistently come for the program are doing quite well. It would be great to do something similar for the kids seen at the Kay Lasante clinic at the tent camp, but it does not exist yet. One little boy I saw was only 20 lb at 3 years of age, with that orange tinged hair that is classic for kwashiokor, as well as a cold and a skin rash that looked more bacterial than scabies-related. I emphasized to the mom that while the antibiotic will likely help him heal the sores that covered his legs, and may helt the cold (it sounded like bronchitis), the most helpful thing for him to get well was increasing the protein in his diet, and we listed off foods that would be good protein sources. She seemed very willing to try, and I hope she is able to get him something decent.
So many of the health problems I see in Haiti can be traced back to a lack of one or more of the following: secure shelter, safe and affordable drinking water, good sanitation, and good nutrition. I think that if these problems could be fixed, that would go a long way towards fixing the health issues that currently fill my days, and we could spend more time focusing on preventative and chronic care instead of urgent care. A girl can dream, right?
-- Gina
5/5/2010 7:59 pm EST (8:59 pm EDT)
I don't think I'd cut it in Hollywood. I just don't think I have the patience for working with Hollywood people. Today we went to Cite Soleil in the morning with the film crew (from Hollywood, it turns out), and they focused on Dr. Jacky and Dr. Joey and the pharmacy, as well on Cite Soleil in general. They tried to film me, but I think they got bored of me quickly, since they joined in right on the tail end of me diagnosing a woman with malaria and spent most of my time writing down the meds that I was prescribing her. I prefer focusing on my patients to catering to the film crew, and while I am willing to let them film me, I am not that interested in stopping my work to indulge them. Thankfully, they seem to respect that I am working and focusing on the patients.
I then rode with the film crew to Wings of Hope at their new home, while Dr. Joey and Dr. Jacky went to the Wharf. I think I annoyed them by accidentally taking some flash photography while they were filming. Oops. I was so glad to see the kids, though, and there were several that I remembered from last trip. Josephine is still a charmer, and was filmed walking with a walker and assistance. They also filmed Josee doing some superman type stretches on a large log thing with the physical therapists. He was the one who appeared to have a spina bifida occulta with lower extremity weakness and bony deformities in his legs as a result, though he does walk decently. He also demonstrated his ability to walk up and down the stairs with his walker. I was impressed. The new Wings home was retrofitted with some ramps to decrease how many steps there are, but it's still a feat to get the wheelchairs up and down, since they could not eliminate the steps due to lack of space. It's not perfect, but it works.
We had lunch at the Baptiste Mission, and of course attracted the attention of a number of vendors. They were too pushy for me to want to deal with them, and we didn't have a lot of time for me to wander up to the other vendors on the street to see what they were selling. I did shop at the gift shop at the Baptiste Mission, however, and bought another copy of the cookbook, as well as a coloring book and a bottle of vanilla concentrate. On our way down the mountain, we stopped at a scenic overlook with a skeleton of a concrete house on the edge, and the film crew set up to get some panorama shots, I presume to contrast the rural beauty of the land up in the mountains to the urban grunge of Port au Prince. Tomorrow, they will apparently go to St. Mark's, a city about 1-2 hours out from PAP, where Dr. Joey has a mobile clinic. He'll be back in the afternoon (supposedly, unless traffic stops him) for the Kay Lasante tent clinic. If not, I've no idea how I will get there, since Dr. Joey's car is currently stuck at the hotel where the film crew's staying, due to a flat tire. I don't relish taking a tap-tap out that far, though I am sure it would be doable.
It is raining! It's actually raining quite heavily, so I went outside of my hotel room to watch the rain for a bit. The rain is bringing the temperature outside down nicely, though I still am inside due to the laptop. I don't want it getting wet, or walking off. Maybe I'll watch the rain for a little longer before I go to sleep, though. Good night!
-- Gina
5/6/2010 8:36 pm EST (9:36 pm EDT)
Tonight is my last night in Haiti. I am sad to be leaving a lot of my friends here, but am really looking forward to Miami and seeing my friend Em, whom I haven't seen in several years, and then returning home to Tod Saturday.
I am sad to be leaving my friends Lee, Doucette, Mary, and Dr. Aksana, who are here working with the Scientologists but are struggling to merge their internal wishes and goals with those of their host organization. I gave Lee my email and blog and hope she passed them on to the other girls. I also hope she is able to continue to find time to update her blog with stories of the patients she sees. She was able to tackle some really challenging cases that I couldn't spend as much time on, and seems to have made good progress with several of them. Doucette has been a wonderful translator and cultural broker, and I hope she will be available to translate for the crew from Maine-Dartmouth.
I am sad to be leaving Dave, who struggles to be a gentleman and not say "Hey, give me a dollar!" like so many of the beggars here, but at the same time, is in equally dire need of things like a backpack to help him carry his things, and enough cash to bail out his driver's license (which was taken when he got a ticket while driving for the Scientologists last weekend, apparently). I hope he is able to get a job driving the ambulance for Dr. Joey.
I am sad to be leaving Lele, who gets laughed at when he complains of lack of appetite, but ends up being actually sick with an inflammatory infectious diarrhea and possible strep throat, but was ignored at first due to always having a smile on his face. He asked me if I could send him a camera, but I cannot give him mine. Maybe I'll find a cheap digital camera in the US to send to him with the next crew from Maine-Dartmouth.
I am sad to be leaving Carlo, who struts and preens and flashes a winning smile. I am glad he likes the MRE's that Dr. Joey got from the Scientologists, and I hope I can get him some Tang sent down with the next crew.
I will miss Miss Midi, who has been my constant nurse at Hopital Haiti Medicare, triaging patients and scheduling them when she best guesses there will be doctors to see them. She kept asking me to pack her in her suitcase, but I know she is needed here with her husband and son. She was late today to the hospital because she had to take her sister to the hospital due to labor pains. I hope her sister is doing well.
I will miss Adline and the others who hang out and help out at Hopital Haiti Medicare as well, whether they cooked, cleaned, counted medications, or just kept me entertained.
I am sad to leave Mimi, Toma, and the 3 LAMP nurses. Miss Flo was a wonderful translator for me, and a big help when I had pharmacy stock questions, able to find medications for me when I was unsure what we had available. I will miss the constant teetering balance of power between Mimi and Dr. Joey, who are both in charge in different ways as the office manager and medical director of LAMP. They butt heads sometimes, but things always seem to work out in the end.
I will miss Anthony, my medical student translator at LAMP. I am glad he was willing to chime in when he thought I forgot a medication, or helped me determine appropriate chloroquine dosings for the children. I hope he will be able to start seeing patients at LAMP on his own with Dr. Jacky supervising, since I think he's probably smart enough to do it now.
I will miss the staff at Kay Lasante. They are wonderful, passionate, and organized, as well as willing to teach anyone from nursing students that I drop on them unannounced today to my American and Canadian friends from the Scientology group. I hope that the crew from Maine-Dartmouth get to work at their camp on Mais Gate.
I am going to really miss Dr. Jacky, who is always working so hard at LAMP and the mobile clinics. Dr. Joey worries about overworking me, but I worry more about him overworking Dr. Jacky, though I think he carries the same passion to help those in most need, the way Dr. Joey does. I hope he is able to balance life and work and not burn himself out taking care of all those in need in this country. I hope I get to work with Dr. Jacky again in the future.
I suppose I will even miss Dr. Joey, as much as I tease him about always flitting about doing a million other things while I see all his patients for him. I am glad I came and was able to help fill in at his clinics, enabling him to get a lot of other things done instead. I saw a lot of really interesting cases and learned a lot about how to practice medicine in a restricted setting like Haiti. I will come back someday, and will be glad to work with him again, though I hope he will be able to afford more staff and have a more organized pharmacy by the time I come again.
I think I'll miss the patients most. Compared to the patients here in Haiti, so many of those I see in the US seem spoiled and take their health and health care for granted. They come and wait patiently, even when we are late to see them due to traffic, and try so hard to take good care of their children and have them cooperate for their visits. I think they are truly grateful for anything I can offer, and strive to help each other when they can, even in the economic dispair as this country is in. I am amazed at the patients who will give a little money to other patients to help them buy their needed medications, or will pay the fare for a tap-tap to get my whole crew home (with a sick patient that I wanted to hospitalize for IV fluid) when the car breaks down on the way home from the tent camp clinic. The only time I have ever had my recommendations questioned was by a patient's sister, who feared we were taking her very sick brother away to be experimented on with some sort of voodoo medicine (I wanted to take him to H. Medicare today to get IV fluids because he was dehydrated and vomiting and almost delirious with a high fever). Ok, I had a few patients question the need for a pregnancy test (though one came back positive and I saw her again today for a little bit of prenatal care) or for STD testing (I hope the guy at Kay Lasante gets tested, and asked Dr. Joey to hunt him down and remind him again next week). They were few and far between compared to the others.
Oy, all this, and I have hardly touched upon the cases I saw today! I will have to continue updating with stories of patients and things I saw in Haiti once I return to the US. For now, I should probably get some water and then go to sleep, since Dr. Joey is coming here early tomorrow morning to chat before I go with the film crew to St. Damien's Hospital before heading to the airport. Fortunately, I will be able to go through the airport with the physical therapists from London, Ontario, so I will have people to chat with and hang out with before our flights.
-- Gina
5/7/2010 1:52 pm EST (2:52 pm EDT)
I'm sitting at the airport, through customs, hanging out with the PTs from London, Ontario. They are flying at 4:20 pm to Fort Lauderdale, and I fly out at 4:55 pm to Miami. We went to St. Damien's hospital, which was founded and is run by Father Rick. It is the hospital where Dr. Joey refers his more complicated pediatric patients, and they have a program for amputees. It is an amazing hospital, clean, well-maintained, and organized. I wish I could have photographed it, because it was so lovely, but apparently people in the past have photographed it and sold the photographs without any proceeds going to the hospital, so they no longer allow photos. We toured the PT wing and the additional temporary building they constructed to accommodate post-earthquake patients. They essentially set up shipping containers as structural supports, with floors and roofs structured between them. They were working with a number of folks, and had a nice sized line waiting to be treated. They were able to do what they do because they have the parents of the kids or the patients help teach each other. It is a community effort. I think it was wonderful to see how good of health care can be done in Haiti, and made available for free to the people.
We then stopped to buy souveniers at a little metal shop on the way to the airport. I couldn't get as good of deals as I'd gotten at Croix du Bouquets, but I managed to wheedle the guy down a bit, and got a large sun, a gecko, and a little world with children around it. We also stopped at a supermarket (clearly only for rich people, since they sold dog food there!) so the PTs could get coffee and such to bring home. I got some yogurt drinks and mango juice to have for lunch and a fruit champagne soda for Tod (in a plastic bottle, but ah well). Patricia, the lady who's replacing Kez for the week, bought us some pate (little flaky rectangle pastries with chicken filling) to flesh out our lunches. Yum!
Tonight, I will be in Miami!
-- Gina
5/8/2010 6:33 am EDT
I had a lovely evening with Em. She picked me up from the Miami Airport and we went to the nearby Indian reservation's Hard Rock for dinner. It's a big casino with a bunch of restaurants, and reminds me of Las Vegas. A bit of a culture shock, with the dancing fountains, bright lights, and loud music. Had some tasty sushi, edemame, and girly drinks for dinner, before turning into a pumpkin and heading to her house. Her place is lovely, with these high wooden arches and vaulted ceilings, and a pool in the back yard (that I didn't take advantage of due to lack of time, but maybe I will next time). I showed her some of the pictures from the trip, then we went to bed because we had to get up and get moving early for my 7:15 flight. I am now sitting at the gate waiting to board. Then I'll be on my way to my Toddy!
-- Gina
5/8/2010 3:20 pm EDT
I'm home!
-- Gina
