Reflections on the country

4/27/2010 7:40 pm EST (8:40 pm EDT)
I realized the problem with people in Haiti.  They are so awfully busy trying to put figurative fires out everywhere, they aren't oriented to date or time.  For example, Kez had an appointment last Tuesday morning to see a couple babies for evaluation for medical visas, and one showed up in mid-afternoon (the other never came as far as I know).  A girl who was sick with malaria and dehydration seen at Cite Soleil yesterday was to come to Joey's hospital, and bring her malaria meds with her, and she was sitting there on IV fluid with her malaria meds back at home at Cite Soleil, because they didn't know they were supposed to bring them; the meds were eventually brought by a family member almost 24 hours later.  Dr. Joey thought it was Monday and not Tuesday today, so he didn't pick me up.  When I called Kez this morning to see if she could get a hold of him or if she knew where he was, she had to ask me what day it was.  It's a wonder that people make it to church on Sundays here, with how disoriented to time everyone is. 
I did tell Dr. Joey I was a little unhappy about being left to find my way to the hospital on my own, and left in charge of it essentially on my own (though honestly, I think that his head nurse was actually the one in charge, since she knew the flow and made sure that whatever doctor showed up saw the patients she had sitting in her waiting room).  I also let him know someone's got to take apart his pharmacy and pitch the old meds, since he's got Advair that expired last year and birth control pills that expired 2 years ago.  He also has duonebs (ipatropium and albuterol nebulizer medicine) and no nebulizer that we could find to deliver the meds to the girl with a bad asthma flare-up due to a cold.  His nurse eventually found a steroid inhaler that was not expired as far as I could tell, so we gave her that and told her she needed to come back if she was getting worse. 
What really was frustrating today wasn't being stuck on my own; it was being stuck in a place where the resources are so poor, when if I could only get a truck or even a little car, I could fetch all (well, much of) the medicine I need from the Pastor's house and my hotel room (except malaria meds, but I could have at least started the girl with malaria on doxycyline as a mediocre treatment until her chloroquine arrived from Cite Soleil). 
That's the true challenge in Haiti.  The resources are limited and poor, what resources are available are difficult to access, and the people of this country are under such stress they have difficulty keeping things straight in their head, resulting in tasks falling by the wayside temporarily or permanently as they run helter-skelter to try to make whatever they have correctly.  In a crazy world like this, no wonder everyone gets a little confused, and no wonder it is so hard to fix this country's problems.
-- Gina

4/28/2010 5:39 pm EST (6:39 pm EDT)
Poor Dr. Joey.  He was stuck in beaurocracy again trying to negotiate to keep his ambulance and unload the ship.  I saw him briefly this morning when he dropped us off at Cite Soleil (Dr. Jackie and me, and the staff), and then saw him again after finishing clinic at Cite Soleil and Wharf and starting at his hospital.  He arrived just in time to see a pretty sick guy with right upper quadrant abdominal pain, which I suspect is hepatitis of some sort.  He's now on IV fluids and pain meds (a little NSAID and a little acetaminophen). 
There was a guy selling art in Joey's yard at the hospital today, because of all the Scientologists (and me) being here.  I bought a small metal tap-tap (public transportation) art piece and a painting.  I may sell one or both in auction or raffle for more meds for the next Haiti trip, or may use them to decorate my future office.  I don't know yet.  The little tap-tap is very cute.
I'm about halfway done here.  I get to see Tod a week from Saturday. Yay!  I am enjoying the work, but I am tired and really miss Tod, and it gets kind of lonely down here sometimes.  Overall, though, I am glad I am here and able to help.  If I weren't here, many of Joey's patients would be stuck with nobody to see them with all the beaurocracy he's trying to fight through.
-- Gina

Viva Brazil!

4/26/2010 10:16 pm EST (11:16 pm EDT)
So, I skipped writing an entry yesterday, since I was out in Petit Goave, where I had joined the Brazilian mission group to help run a clinic today.  The past two days have been very good.  Yesterday started with Dave picking me up at the hotel and meeting Dr. Silvio and his friend Milton (two of the Brazil missionary crew) at Dr. Joey's hospital, where Dr. Silvio was meeting with a patient to have a large lipoma (benign fatty tumor) removed from her right middle finger.  Turns out that Dr. Silvio is a plastic surgeon (as well as an ICU doc before turning plastic surgeon).  The surgery was really cool to watch, and I learned some new techniques in watching.  She was to follow up with Dr. Joey today, and Dr. Silvio tomorrow morning to have the wound rechecked and the dressing changed, and will continue to follow up with Dr. Joey until the sutures need to come out in 10 days. 
I then met up with the Brazilian group at Pastor Visionaire's? church where I'd done clinic with them on Saturday, and we all loaded onto a little yellow school bus (one of those short buses...) and headed out to Petit Goave to meet with the Pastor's sister, who is a nurse in that area.  We set up camp in her yard, and someone there cooked us corn porridge (like a sweet polenta or grits) and bread rolls for dinner.  Some of the guys were a little nervous about what we'd be fed, but I pointed out that in this poor little community, they cooked us a dinner for an entire group of maybe a dozen missionaries (and me), and it'd be rude to turn it down.  I thought the porridge was quite good, actually, albeit a very simple meal.  After dinner, the Brazilians broke out their little guitar and drum and tambourine and maracas and had a lovely music session / church service.  I may feel a little out of place at church services sometimes, but church songs are awfully pretty, and the service they did was fairly neutral and all-inclusive.
So, the group that we went with consisted of Dr. Silvio, Dr. Julia (a family medicine resident in Brazil), Rogerio (my nurse translator), another nurse, a few pastors, a missionary guy, and a journalist, as well as a couple Haitian translators.  It's an interesting mix.  Their goal was to visit a number of churches and pastors in Haiti and offer support: moral, spiritual, financial, and medical.   They each had different roles to play, to help make the clinic run smoothly. 
The highlights of the patients: a diabetic man with a glucose in the 400s, who was lethargic.  Dr. Silvio took care of him, and I think they were negotiating getting the man to a hospital for evaluation and treatment, since the extent of our lab testing was glucose checks.  There was also a little girl, maybe 10-11, that Dr. Julia saw, who had a striking III-IV/IV holosystolic harsh blowing murmur.  We were wondering about a VSD.  The patient and her mother knew that she had a heart problem, but they kept going from doctor to doctor to try to find someone who could help them, before they showed up at this clinic.  Unfortunately, there was not a lot we could do, but I gave her the information to try to find Kez and Angel Missions (if they can find their way to PAP) to investigate a medical visa for cardiac surgery.  The most interesting patient I saw was a young man who presented with a large hypopigmented (white) patch on his left calf, with a little pinkish-red area within it.  He complained of burning and tingling in the area, and Dr. Julia and I thought it was probably post-inflammatory vitiligo.  However, a small part of me wonders if it was leprosy.  We treated it like a cellulitis and post-inflammatory vitiligo, but I told him to get further testing if the treatment doesn't help with the burning/tingling.  I hope it wasn't leprosy, but I did think of Dr. Bill Alto when I saw this guy (and I looked it up in his book!).
We wrapped up at around 2:00pm, and then packed up the bus to head back.  Before we left, though, we had a guy direct us to the ocean so we could walk on the beach for a bit.  It was a beautiful beach, or would have been if the sand and rocks weren't mixed with assorted bits of garbage.  I was tempted to shed the shoes, socks, and legs on my converti-pants to wade a bit, but I wasn't sure I wanted to walk barefoot on that beach.  Haiti has such beauty, but is marred by so much litter, it's sad.  The Haitian people seem used to it, but I wonder if they are as sad about the garbage as I am.  The little naked boy and his two friends who came running up the beach to check us out certainly didn't seem to mind (I will likely blur out a select portion of his photograph before uploading to Flickr).
We then departed Petit Goave and headed back to PAP, a long 3 hour bus ride back.  We had to stop just on the edge of PAP due to the bus engine getting too hot, so one of the guys picked up some sugarcane for everyone to nibble on (though I passed, due to not wanting to dislodge a bracket; my orthodontist is kind of far away right now).  We unloaded at the pastor's church, and after a cool shower at my hotel room (lit by flashlight, since for some reason the electricity is out tonight), I joined them for dinner at the church (it's just a couple blocks up the street, but I kept an escort with me on the walks anyways).  Dinner was black beans and rice and goat stew, and the missionary guy (he's spent his whole life as a missionary, I think), was picking away at the goat's head.  I was impressed.  I am glad I hadn't met the goat before he became stew.  It was a very tasty stew, and the pastor's wife then baked a cake in her little toaster oven, to celebrate it being the Brazilian crew's last night in Haiti.  We wrapped up with making music again, with a couple of the local Haitian women who are part of the church singing along with the Brazilians.  It was beautiful, and I wish I made a recording of one of the songs, because it was such a lovely merging of cultures.
So now I'm back in the hotel, typing away in the dark with no AC because the electricity is still out.  It's getting pretty late, so I should probably get to sleep.  I don't know when Dr. Joey is picking me up in the morning, but I'll see if I can have someone call him to check when I get up.  Hopefully he'll fetch me with wheels, so I can unload the meds and IV fluid from Angel Missions (turns out that they did drop the stuff off at my hotel for Joey, since it's easier to drive to the hotel than Joey's hospital) at his hospital to help restock it.  Hopefully in the next day or so, we can pick up some meds from the church and Pastor Visionaire? since the Brazilian group agreed to leave at least a little medicine for Joey's hospital in return for the meds he gave them on Saturday.  Good night world!
-- Gina

4/27/2010 5:28 pm EST (6:28 pm EDT)
Today... was a little screwy.  Turns out that Dr. Joey didn't know I was back from Petit Goave already, so he didn't check in on me, didn't send anyone to fetch me, and wasn't at his hospital all day.  I had a guy who has been helping me out at the hotel walk me down to his hospital, and got put to work right away seeing Dr. Joey's patients.  He has been gone all day negotiating with the Haitian government, trying to keep his ambulance that's currently sitting on a Scientology ship, donated to him by the Scientologists.  I attempted to hold things together for him here in the meantime, but I guess in the chaos of yesterday and today, he forgot it was Tuesday and I was already back, and that's why he couldn't get me.  His phone is also apparently dead, so that is why he didn't answer when I called.  I now have Dave's number, since I think he may be more reliable, and I should get Doucette's number as well.  That way, I have some safety net. 
As far as Haitian food goes, lunch today was interesting.  Had rice and bean sauce and a drumstick of overdone chicken and greens.  The greens weren't near as good as the ones Joey's cook made the other day, so I didn't finish them, but I wasn't sure what else to do with it, since throwing away food seems a little wrong.  I gave it to one of the nurses to make it vanish, and I suspect she threw it away for me, but at least  I made a token effort to have it not go to waste. 
The little boy I saw at the Pastor's house Saturday who's mom was concerned about his development came in today to be seen.  He wasn't walking at 13 months of age, but he was cruising well, and I bet he'll walk within the next month.  The mom was just really nervous because she is pregnant already and wants to make sure she's doing well raising her first child and willl be ok with her second.  I made sure she had a source of vitamins for the rest of the pregnancy and gave her a prescription for depo provera, since nobody would give her birth control options other than condoms after her first child was born.  She doesn't want more yet, but had no other option, and she and her husband doesn't like condoms.  Since they are married, I don't really blame her for not wanting to use the condoms, but she needed another option.  I hope she can get the depo.  I wanted to give her an IUD, but i don't think its practical to get one in this country, since I doubt Dr. Joey does them, and they are expensive up front.
Dave is going to walk me home tonight, and I told Dr. Joey he needs to drive to pick me up tomorrow, because we need to get the meds from my hotel room and the Pastor.  I think that will be doable.
-- Gina

mooching internet access

4/24/2010 7:55 pm EST (8:55 pm EDT)


A bit of a surprise day today. I was expecting to just work at Dr. Joey's hospital, which is fun, but a little trying at times, since the volume of patients comes in scattered throughout the day instead of in a big non-stop cluster, and the med stash is a little limited at times. However, I brought a bag full of meds to his clinic, so that helped with the med issue (he hadn't had me bring supplies, since I hadn't gotten the hang of when I would be going direct to his hospital instead of through LAMP, which is well stocked). That helped with the morning's patients. On the drive over, however, Dr. Joey stopped to talk to a pastor friend of his, who, as it turns out, was having a handful of doctors running a clinic in his yard today. Dr. Joey asked if they needed help, and so I ended up coming over for the afternoon to see patients with them. The group was largely from Brazil, and mostly spoke Portugese, though there were some who spoke English. My translator was a very cool nurse from... I have no idea where, maybe Brazil? Anywho, he works with WEC International, and has been an international nurse for 10 years. He was fluent in English, French, Spanish, Portugese, and a couple African languages that I can't remember. Wasn't fluent in Kreyol, but we made do. I must have ended up at the pediatric table, since the majority of patients I saw were children, but I got a few adults, including a woman who was about 5 months pregnant, who needed vitamins and worm meds, as well as her 13 month old son, whom she was worried about developmentally since he was not walking yet. I made arrangements for her to bring the child to Dr. Joey's for a little more evaluation as far as how well he could walk and to recheck on his cough. That way, she'll also know where he is for getting the remainder of her prenatal vitamins, even though she has an OB/GYN who cares for the pregnancy otherwise (she's apparently a repeat c-section or VBAC patient, since her son was born by c-section). There was also an older woman with severe hypertension, who had run out of her BP meds and came to get more, since she could not afford to buy them. Since she did not know what she'd been on before, we gave her HCTZ and captopril and set her up to follow up in Dr. Joey's clinic for refills. I tried not to send too many his way, since his hospital is completely free (and has been since the earthquake), and he's a little limited on medications to essentially what can be donated in. However, the last lady I saw was a heartbreaker. She was probably in her 30s, and complained of poor appetite and insomnia. It'd been really bad since the earthquake, but it turns out she was pretty poor and depressed before the earthquake. Her mother had died recently, and that put her into the depression, I think. Then the earthquake happened, and she is now on the streets, without a job, without a home, with nothing to her name. She has no support, no church or family or anything as far as I could tell. We asked if anything made her happy, and she could not think of anything. I gave her fluoxetine (this crew had SSRI's! Woo!) and set her up to see Dr. Joey next week to get a referral for the psychiatrist to follow up with her.

Thinking about that woman, I can't help but wonder if there was some way someone could adopt a block of neighborhood and offer to feed and shelter the inhabitants in exchange for them cleaning up and maintaining the neighborhood. It'd initially need an influx of money and food to support the clean-up, haul out the collapsed concrete walls, etc, but once that block was cleaned up and set up for decent water and septic, the people could be put to work doing some sort of other productive work that might help sustain them, like cooking good inexpensive food for neighboring blocks.

I guess Joey kind of does that, within his hospital, though. He has 5 paid staff people, and a number of volunteers who help out in exchange for the priviledge to stay in his yard occasionally and get a couple meals a day. Dave is one of those volunteers. He is the one who walked me home last night, and he walked me home again tonight. He is fairly fluent in English and French in addition to his native Kreyol, and translates for me on occasion. He's also apparently a decent driver, and aspires to be an ambulance driver. I hope he makes it. He's got a good heart.

Tomorrow and Monday are going to be a bit of an adventure. I'm going with Dr. Joey to his hospital for the morning and early afternoon, but then am going to hopefully go with the Brazilian group to a town a few hours south of PAP to run a clinic there on Monday. They will be camping and apparently have a tent and stuff I could borrow, and are willing to feed me in exchange for coming and helping do medical work. It'll be really neat to see another part of Haiti, and I think it will be a lot of fun. It means I'll miss Cite Soleil for a day, but I'll still have 5 more days out there (unless more extras crop up).

-- Gina
 
4/25/2010 2:20 pm EST (3:20 pm EDT)
i am at the church up the street from my hotel, mooching internet on a eee pc, to update.  i am waiting with the brazil crew to go to port au perl? to run a clinic there tomorrow.  It will be a long bus ride, but worth it, i think. and i can chat with tod today!

Series of updates from Haiti!

4/20/2010 6:58 pm PAP time aka EST (7:58 pm EDT)


I made it to PAP uneventfully. Flights went fine, and getting through customs at PAP was no problem. Dr. Joey did not end up meeting me at the airport, but I managed to get myself to Kez's shoebox, and spent the afternoon hanging out with a Sister from Michigan who works in one of the western provinces, and is in town to try to go back to Miami for a week to visit family. Kez then came and helped get me hooked up with Dr. Joey and the hotel, Le Cassagnol, to get me settled for the night. While waiting for transport, I toured what is now St. Joseph's (not the unstable parts, but the liveable building they purchased next door), and attended the beginning of their evening prayer session. I think I made one of the guys blush because I said he had a beautiful smile (they start their prayer sessions with bravos, and everyone gets some sort of bravo, no matter how big or small a thing it is).

While visiting Kez, I did get to start right in on doing some basic medical care. Kez had a baby girl with hydrocephalus come for a complete physical and to start evaluation for a medical visa to get her hydrocephalus treated. So, day 1: 1 patient. I hope it goes up from there. (:

Dr. Joey is going to come out this evening and meet with me to discuss what we want to do for the next few days. My priority (aside from doing lots of medicine, I hope), is to get internet access, so that I can update everyone and let them know I am ok. I love you all, and miss you.

-- Gina

4/20/2010 7:44 pm EST (8:44 pm EDT)

Met up with Dr. Joey at the hotel. We will be hitting Cite Soleil (one of the slums / very poor neighborhoods of PAP), followed by several tent cities, with Dr. Jack, a resident. I should have one of his nurses to help translate for me, and hopefully Mimi will be available to help with transportation. However, apparently, there's no gasoline in the country, so public transportation may be the way to go on at least some of our treks. Mental note: pack light. Thankfully, Cite Soleil is reasonably stocked for meds, so most of my supplies will be more useful in Dr. Joey's hospital.

My meds and supplies will likely stay here at the hotel, and I'll just bring my small camelbak, stethiscope, otoscope, and flashlight, along with some snacks and references.

While with Dr. Joey, he let me use his cell phone to call Tod and let him know I am safe and hooked up for work. Hopefully, in the next day or two, I will be able to get online and update you readers with these entries, but in the meantime, I'll just keep updating the notepad.

-- Gina

4/21/2010 7:46 pm EST (8:46 pm EDT)

Long but good day today. Started out the morning meeting Dr. Joey to go out to the LAMP clinic (the clinic in Cite Soleil that I'd been to before). Saw about 60 patients between myself, Dr. Joey, and Dr. Jackie. Saw one mucocele that I will be taking out on Friday, probably, and one 6 month old with a 2-2.5" mass on the back of his head, midline. I am concerned about neurological involvement, so the child is being referred to the pediatric hospital. Also saw the run of the mill colds, coughs, heartburn, and a couple malaria patients.

We then spent an hour or so waiting to get a ride to the Wharf in Cite Soleil, which is where they run another clinic. Dr. Jackie and a couple other docs went out there ahead of us via tap-tap, but we had the meds and a few more staff cleaning up the LAMP clinic, so we eventually hitched a ride with a driver who was in the neighborhood delivering wood and rebar for a construction project. I don't know if Dr. Joey knows the guy or not. He was nice, though, and gave us a ride. We left Mimi and some of the LAMP staff there once the patients were all seen (I only saw 3-4 of the 65 there, due to being later than planned), to dispense the meds, and went with Dr. Joey's mechanic (working on fixing his car) to grab lunch before going to Joey's hospital. Lunch was a nice little local restaurant with fairly decent food: pan-fried chicken, fried plantains, beans and rice, pasta salad, and a few bits of lettuce and tomato. The Haitian lemonade is about twice as strong as it needs to be, but... it was really refreshing, as well. Now, if only I could have gotten half as much food... but since it was by far my most significant meal of the day, I can't really complain.

We took a tap-tap to Joey's hospital, and I essentially ran his clinic for him (thankfully only seeing maybe half a dozen or so patients) while he taught a medical statistics class upstairs, to cover for another teacher who was sick. We had one girl come in with malaria, for which she'd been seen earlier in the day at another clinic and given IV fluids, but she was SO sick still, with tachycardia and tachypnea, and barely able to stand, we plopped her on more IV fluids and got her camped out at the hospital. Joey thinks she'll stay a couple days until she's better. She'd come to us because her sister is a friend of Dr. Joey's (and may help at the hospital, I think), and she'd said the girl was really really sick, so Dr. Joey insisted she be brought. She came in by piggy-back. I hope she'll be OK, but I couldn't find anything other than malaria to blame for her illness, so hopefully, the chloroquine will help.

I met a lot of nice folks staying at the Scientology house, who are helping rebuild Dr. Joey's hospital, which had some minor damage after the earthquake. There were a couple girls from the University of Iowa, one of whom is Haitian-American, who are going to be here for 2.5-3 months to help Dr. Joey and anyone else who needs assistance. I enlisted Doucette to help translate for me at times, so that my nurse could be just a nurse and triage people (her English is ok, but I think that Doucette will be my cultural broker as well as translator, if I can keep her). I don't know what I'll be doing with Lee, but I will find some work for her to do, if the two girls are going to be joining us on some of these clinic days. I'll have to think about it, since Lee is purely English-speaking, but she's got a great heart and I think she's bright and eager to learn and help. I suppose I shouldn't plan too much, though, since they are there to help Joey, but he's pulled in enough directions, I don't want them bored because nobody is there to put them to work.

Wrapped up my day with walking to the hotel with Dr. Joey. It's about a 10 minute walk, so not to bad, though the darkness made the walk a little more scary. Flashlights stand out a LOT in Haiti, though. I just had to use mine, to make sure that I wasn't stepping on loose rocks or puddles or anything horribly unpleasant. Now I'm basking in the AC, typing away, after a refreshing cold shower. Luxury. I should probably have a light dinner before bed, but... lunch was so big, I'm not actually hungry, and I can save my peanut butter and jelly on wheat tortilla stash for later. Probably breakfast.

Lastly, I need to drink more water. I made a little over 2L of polar pure sanitized water in the hotel, and drank just over half of it, plus 2-3 glasses of water/lemonade at lunch and a cold bottled water upon coming home. I think I sweated most of that off, though, so my kidneys probably deserve a little more.

Good night world! (at 8:27 pm EST... I'm old!)

-- Gina

4/22/2010 6:39 pm EST (7:39 pm EDT)

Slightly slower day today. Started off by going with Dr. Joey to his hospital, where we checked up on his two inpatients, a woman with severe hypertension coming down on amlodipine, and the girl we'd admitted yesterday with a bad case of malaria. They were both doing better today; the girl with malaria got a few bags of IV fluid and was actually feeling up to eating today! woo! I saw a few patients for Dr. Joey (he vanished upstairs, apparently, to take care of some paperwork or chart review, since he's hoping to go to an EMR soon and wanted to know what to port over). The first family was a mom and two of her daughters, who all essentially had PTSD. The 12 year old girl had poor memory issues, due to seeing so many of her friends die on 12 January. She also kept spitting compulsively. I think she spit more when stressed. She did not want me to examine her, but we made a game of it, and she let me hear her heart after I let her listen to mine. Her older sister (age 15) has had stomach pain and poor appetite / picky appetite since the earthquake, and the mom had headaches and poor appetite since the earthquake. Both of them were also having trouble because the mom has no job and no home for them, and so they have very limited money to buy food, and the 15 year old does not like the food that they can get. I wish I could prescribe jobs, and food, and safe shelter. I can't, though, so I just routed the family over to the girls from the Scientology group, since the one is a psychology major, and I asked her to talk with them and do some rudimentary counseling.

I saw a few more folks, but the morning ran down with just a few teenage boys appearing, all with headaches and anemia. I decided they weren't really sick when the one kept asking me in English where I live.

We then went out to a tent city up by Mais Gate 45, where Dr. Joey works with Kay Lasante to run a clinic there. Dr. Joey saw the scheduled folk, and I saw the walk-ins, which were generally a mom and two kids. The interesting one there was a little boy about 3.5 years old who I think had malaria. He looked relatively ok, but was a little tachycardic, so I asked that the community health worker look in on him in the morning, and put him on chloroquine. I also had a guy come in with a swollen ankle that he'd hurt several weeks ago. He couldn't walk on it initially, and since it was still swollen (though not as bad as before), I wonder if he had a minor fracture. He was walking now, though it hurt. I wrapped his ankle up in an ace wrap and instructed him on how to ensure it does not get too tight, and sent him off with some ibuprofen and instructions on how to stretch it to help restore some range of motion once it is less painful and less swollen.

I wish I knew what to do with an old man who had constant tearing in his eyes, though he had no other allergic symptoms. I think a steroid or antihistamine drop for his eyes may help, but we did not have any. It didn't seem to be lacrimal duct obstruction. He had the cutest granddaughter, who was 5 going on 40 years old, I think, and who took her job of helping care for her grandfather very seriously. I sent him off with a refill on his hydrochlorothiazide and aspirin for his hypertension.

We then headed back to Joey's hospital, though I didn't stay, due to Vanessa needing me to ultrasound a pregnant missionary woman and give her some initial pregnancy counseling. I think they were Mennonite, and they work up in the mountains several hours drive away. They were in town because their mother is flying out tomorrow morning, but will be heading back up to the mountains. Amazingly enough, Vanessa keeps an old ultrasound machine in her back room, so I was able to do a quick scan and confirm 1) she's pregnant with an intrauterine pregnancy, 2) she's probably first trimester (my dating skills suck), and 3) it's alive with a nice looking heart beat. I'm guessing she's between 10 and 14 weeks, probably on the earlier side. Now that I think about it, I may have felt more bladder than uterus, so she probably was more like 10, even though she felt a little bigger. I talked about avoiding cleaning litterboxes, no smoking or drinking alcohol, and avoiding specific meds (NSAIDs, dewormers that they normally prophylactically take, certain antibiotics). I couldn't give her full advice, due to not carrying my Little Black Book of International Medicine with me, but I will bring it with me for next time I see Kez, to give her the relevant bits.

Vanessa then fed me dinner and sent me home. I should go be social at the hotel now, and maybe get some fruit or juice before bed. They seem to think I keep going into hiding whenever I come back here, but I get tired early!

-- Gina

4/23/2010 7:14 pm EST (8:14 pm EDT)

Long day again. Mondays, Wednesdays, and Fridays, Dr. Joey works at the LAMP clinic in Cite Soleil in the mornings, so we start out at around 7am, and work there until 11:30 to see about 60 patients, then go to the satellite LAMP clinic in Cite Soleil on the Wharf to see another 60 patients (split between myself, Dr. Jackie, and Dr. Joey if he's not flitting around elsewhere). Today, I had a medical student, Ricardo, translating for me. He was actually a little hard to work with, since he could not understand me as well, or understand some of my questions, but I found him helpful in wrapping my brain around the Haitian way of doing medicine, and I tried to explain what I was doing as I went along, and why I chose the meds I chose. He wants to study psychiatry when he's done, and he was actually great from that standpoint, since he got into the patients and got them to tell us more. One young lady told us she was hearing voices and had headaches and lost her appetite since the earthquake, and he talked to her a lot. We saw a fair amount of PTSD / Depression / Anxiety today; most of my interesting cases dealt with this. (Well, all my really interesting cases, except for the guy with a genital issue... poor guy looked really uncomfortable, and I hope that the antibiotics and steroids I gave him help. Oh, and except for the guy who had AIDS, but I don't have the eye for identifying that yet; Dr. Jackie caught that one). Hard, when my other assistants, Doucette and Lee are here with the Scientologists, so Lee can't support my desire to hand out antidepressants. Apparently, it's against Scientology. Lee is Jewish, and wants to be a forensic psychologist someday, but while she's here with the Scientologists, she's trying to respect their beliefs.

After the Cite Soleil clinics, we got a ride from Mimi part of the way to Joey's hospital, and took tap-tap the rest of the way (with a little walk at the end, of course). Lee had a lot of fun riding on the back of Mimi's truck and the tap-tap, even though it was nerve-wracking. I got to act a little more mellow, though this was only my second tap-tap ride. Doucette looked right at home, though. She's fascinating and totally awesome in how much she wants to help her home country. I think it's partially because her parents were actually fairly poor to start, and are relatively well off now but only due to hard work and diligence, and they instilled the same in Doucette, as well a passion for their home country.

I was so wiped out by the time I got to the clinic, I wanted to collapse in a puddle, but I got some cold water and a nice hot meal (rice and spicy greens) and was good to go again. I then saw about a dozen patients at Dr. Joey's hospital on my own (well, with Lee and Doucette my totally rocking psych back-up and translator team), while he was teaching the medical statistics class again, and then just chatted with Lee and Doucette for a while before they left with the Scientology crew to go home.

Joey made arrangements for one of the guys who helps at his clinic to walk me home, and after a wrong turn and almost ending up outside the neighborhood, we found our way to Le Cassagnol. Joey had the guy there call him when I got in, since apparently Joey wanted to say goodbye before I left, but I didn't know any better. Turns out that Dr. Joey's got internet working on his laptop again! I am so excited, and I will have to send Tod an email and hopefully send this file to him to distribute.

I really miss Tod and the cats and everybody, but I am having a good time and am learning a lot.

Oh, and almost forgot! The guy managing the hotel got me some soda today, Fiesta Citron, and it's tasty! Quite a treat after a long hot day.

-- Gina

4/24/2010 9:29 am EST (10:29 am EDT)
I have internet! woo!

Haiti, here I come!

I leave for Haiti again in the morning.  Got a couple suitcases full of meds and supplies, and should be meeting up with Dr. Joey or his driver by afternoon.  I think everything's all set up. 

Also, I managed to track down Dr. Joey on the web; he is a staff physician for Lamp for Haiti.

I will try to update this blog with day-to-day happenings, but it will depend on how much internet access I have. Wish me luck!

Looking back and looking ahead

As a part of preparing for Tod's and my Notacon talk on our experiences in Haiti, we reviewed our photos from our trip last October.  I'm hoping that when I leave for Haiti next week, I'll be able to bring back a lot more photos to share and to show a little of what life is like in Haiti.