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