Haitian Courier #6: Pieces of My Memoirs

[This is a copy of the latest issue of my newsletter Haitian Courier, which was sent on July 26. To subscribe to the newsletter, please visit http://groups.google.com/group/haitian-courier]

Bonjou Mezanmi!

My last newsletter was a brief update just to let you know that I'm alive and well. This time I wanted to give you snippets of what I've been doing in Haiti for the past 6 weeks. Throughout this newsletter, you'll see words with web links, which will take you to corresponding entries on my blog.

First of all, I wanted to let you know that my return flight has changed from August 9 to July 31. The reason is that my older brother Sundo is getting married on August 2. So now I only have a few more days before I go home! Seems like my plans always change on the fly (last year I decided to stay an extra month in P-au-P). I can't believe my time here is almost over!

Secondly, I wanted to put a word out that the clinic here needs an X-ray machine to replace a broken one. Please let me know if you know anyone who needs to get rid of an old machine to replace it with a new digital one or for whatever reason. The one we have here has been broken for a while, and it would help so many people if we had a working X-ray machine.

Anyway, here are some of the things that I've seen and done so far. During the first week at the clinic, I learned how to do a breast exam, observed a vaginal exam, saw a patient with trigger finger and a very sick and hyperventilating baby. The fist weekend I went to the beach in Labadee with a bunch of people from different mission teams.

Second week, I saw several HIV patients including an old lady with an acute onset of dementia, practiced drawing blood, saw a fetus using an ultrasound, gave babies vaccine shots, and heard all sorts of lung sounds at the tuberculosis clinic. That weekend we went on a mobile clinic up in the mountains, where I got to draw lots of blood, and we brought down a girl with a machete wound to take care at the clinic.

Third week, I did some manual labor at the new seminary construction site, helped reduce a fever on a baby, saw tendons on a torn hand from a car accident, pulled a birthday prank on Vicki (another short-term missionary), and took lots of blood pressures for the hypertension/diabetes clinic. That weekend we went to Labadee again, and I went kayaking and snorkeling (for the first time). On Sunday, we saw a girl who had sickle cell crisis.

Fourth week started with the most emotionally draining day, where I saw a 6-year old boy with respiratory emergency, who turned out to have diphtheria, and two little orphaned girls who were tested positive for HIV. The boy ended up dying at a hospital, so I lost my first patient. We had saved the boy's life by bringing him to the hospital and having him intubated and put on antitoxin, but next day during the night he woke up and took out the tube on his own, and died. It was such a tragedy. Also that week, I dealt with many impatient (and non-patient) parents at the well baby clinic, got to eat a cheeseburger, and took a tour of downtown Cap-Haitien.

During the fifth week I saw a Haitian nurse open a closed hymen on a 7-month old girl, helped treat a delirious patient with fever caused by tuberculosis, learned how to take out stitches, sent Laura (another short-term missionary) on a birthday treasure hunt, rode a motorcycle, tried to resuscitate a 6-month old boy who ended up dying, learned how to start an IV, and learned how to properly clean wounds and change dressings from a Canadian nurse. On Saturday I went to see the Citadel, which was quite amazing.

This past week, I learned how to do vaginal smears, saw a lesion on a cervix through a speculum, helped take a boy with a broken femur to a hospital, distributed some food for tuberculosis patients, and attended a funeral of one of the Haitian doctor's mother-in-law. On Wednesday, there was a violent and insane woman, so we had to drag her out of the clinic.

I haven't written about the last couple weeks yet, but you can see some pictures on my web album. I will continue to write about my experiences after I come back home to the States.

Since all the other short-term medical missionaries have left as of last Saturday, it's been pretty quiet (and a bit lonely especially during breakfast and lunch), but I'm still enjoying my time here. Of all the mission trips that I've been on, I've seen and learned the most through my trip to Haiti this summer. I want to thank all the short-term and long-term missionaries that I've met here for making this such an enjoyable experience, all my friends and family for sponsoring me and for praying for me, and God for allowing all this to happen and for making this undoubtedly the best journey and the best summer ever.

Thanks for reading and for all the responses and comments on the blog!

Bondye beni w,

SunMin Kim

Blog: http://zanmihaiti.blogspot.com

Photos: http://picasaweb.google.com/doxadeo/Haiti2008

PS. Thanks to Laura, I now have a number you can call or send text messages to: +509-3727-7275 (but it's only good until July 31)

Baby Jaundice, Gunshot Wound, Diabetic Ulcer, Suture Removal, and Laura's Birthday

Monday, July 14, 2008 - Part 2

We saw a 5-day old baby boy who came in to get his umbilical area cleaned. In Haiti, they use alcohol pads to wipe it, so it looked painful. The baby was quite jaundiced so we advised the mother to let the baby have more sunlight (my classmates should know exactly how that works). It was cool to see in real life something that I had learned in class.

I also got to see a man with a gunshot wound that went through his right thigh. The man works in the Bahamas, so he could speak some English. He explained that a thief had robbed him, hit him on the eye with the butt of the gun, and shot his leg. It was neat to see a gunshot wound for the first time, but only because it didn't seem too serious... Ok, it would be kind of neat even if it was serious, but I wouldn't be saying that.

There was an old woman who had been having chronic skin ulcers on her legs since 1998. They were at least 10 cm (4 in) in diameter. Since she had been coming to the clinic for such a long time, she had a really thick chart. I wanted to figure out why she was having these chronic infections, but the handwritings were illegible. So I talked with the patient to get her history while Amy changed her dressing. I was kind of surprised how well I could understand her, but that's probably because she talked slowly. Hopefully I might be actually getting better at understanding spoken Creole. Anyhow after a longwinded story of how everything happened, she told me that a white doctor who was at the clinic long ago told her that she had high blood sugar. Well, go figure.

Then we saw Ruth, one of our Haitian staff from the OMS office, who lacerated her right shin and got 6 stitches a few days ago. The wound was healing well, and it was time to take out the sutures. Evan showed me how to take one out, and I took out the rest. I guess taking out stitches aren't that big of a deal, but first times always feel kind of special.

For the rest of the day at the clinic, Laura and I took turns giving shots. IM injections are pretty simple, but it was good to get some practice because each patient is different. Sometimes the needle goes right through, sometimes you have to really push to break the skin, and other times you feel a lot of resistance as the needle goes in and it feels like you're tearing through the muscle. You may be giving the same glute shots, but you will always have different butt cheeks.

Today is Laura's birthday, so Amy, Evan, and I conspired to do something for her. Throughout the day we mentioned "secretive" stuff in front of Laura just to psych her out. But of course the real planning went on when she wasn't around. Now, before Evan came to Haiti, Laura's mother had sent him a package to give to Laura on her birthday. Evan brought it with him, but Laura had no idea. So we decided to send her on a treasure hunt leading to the package. We also decided to make a certificate of honor and merit, and if you've been following my blog, you know that those are a big deal around here.

After the clinic Evan and I went back to our place to work on the treasure hunt clues and the certificate. At one point Laura decided to come visit us, so we had to scramble and hide everything. Good thing I randomly looked out the door and saw her coming from a distance. Evan entertained her by playing ping pong with her while I pretended like nothing was going on. Laura randomly uttered that she was craving for some chewing gum, so Evan got the idea of putting chewing gum with each clue.

Wadner helped us by wrapping the clues along with some chewing gum, and planting them on corresponding destinations while Amy, Laura, Evan, and I ate dinner at the Holiday House. During dinner the three of us psyched Laura out by saying stuff like, "You might not want to be wearing nice clothes tonight, and you'd probably want to wear trousers under the skirt," or "When you pass the radio station you'll know you're almost there..." as if we were going to kidnap her and drop her off somewhere in the dark.

I had told the kitchen ladies that today is Laura's birthday (this time I told them during breakfast, so they had enough notice), so they made us an upside-down pineapple cake and lit candles on it. I brought out the cake singing happy birthday, but the fan was blowing so hard that the lights were going out as I carried them. I tried to light them up again with the candles that were still lit, and I was still holding the cake when the song ended, so we had to sing all over again. Amy tried to help me, but we just gave up and let Laura blow out whatever that was left of it.

When Gavin joined us at the end of dinner, Laura went hiding because she thought he was going to take her away. Anyhow, we gave her the first clue with the birthday card we had signed (along with some people from the clinic, such as Ms. Ketlye, Ms. Prudence, and Dr. Rodney). The clue said to go to the house with the number 11 written on it, which is where Evan and I are staying. So Laura left for the treasure hunt with Amy as a "bodyguard." Meanwhile the rest of us put the package and the certificate in the gift shop in the Holiday House.

Laura thought she was supposed to go to the place where Evan and I are staying, but Amy convinced her that Dr. Rodney's house was the one with number 11 on it. So they walked all the way there, which gave us three guys time to catch up with them. Anyhow, she got to house 11 and got her first pack of chewing gums with the second clue, which said to go to a building with "4VEH" written on the wall. Laura thought she had to walk all the way to the radio station, which is about 20 min walk down the street. We were just walking across the compound when she realized that the old radio station building is within the compound. The building was old and creepy in the dark, so the four of us stepped back while Laura walked towards the door by herself. Just as Laura got to the door, I couldn't help myself, so I shouted really loud, which made her jump.

She found another pack of gums with the third clue which said to go where you get your blood drawn. Obviously it was the clinic lab, but being a med student that she is, Laura overanalyzed and thought it was the Red Cross (where you donate blood), and cross meant church, which meant seminary, so we took a detour all the way to one of the seminary buildings.

The fourth clue (found at the lab) lead her to the "Crazy Canadian's house" (isn't it obvious that Evan wrote the clues?), so we went to Amy's house, where she found a clue that said to go back to where we started, and to look "among many gifts." So we went to the Holiday House dining hall, but Laura didn't find anything, so she just stood around for a minute until she realized that there is a gift shop. So she finally got the certificate that we made and the package from her mom, which almost made her cry when she saw the handwriting on the label.

As a finale, Gavin decided to give Laura a motorcycle lesson. It took a while to get started, but soon enough she was going around in circles on Gavin's motorcycle. Then Gavin asked if I wanted to give it a try, so I got to ride a motorcycle for the first time ever.

When it started going, I panicked for a second and twisted the throttle, which made it go even faster, but I quickly regained control, and was able to make couple laps around the little loop. It was fun, but I don't think I'd ever use motorcycle as a mode of transportation... unless maybe if I'm a missionary doctor in a rural area where motorcycle is the best way to get around. But otherwise it's too dangerous. You know what the doctors call motorcycle riders who don't wear helmets?... Organ donors (That's from Chaos Theory).

Afterwards, we hung out at Amy's as usual, and watched episode 403 of Grey's Anatomy.

Tragedy, Repentance, Baby Hymen, and Paranoid Fever

Monday, July 14, 2008 - Part 1

This morning I found out from Gavin how the boy with diphtheria really died. On Tuesday night, he woke up when he was still intubated, and while no one was watching, he took out the tube himself, which caused his airway to shut completely. By the time someone came, it was too late. What a tragedy, and such a waste after all our efforts to save his life. How sad that the boy unwittingly killed himself, and that he died without his family around. It's one thing if he had died of the toxin, but he still had a very good chance of survival. If only he had been monitored or sedated...

We also heard a good news today. Ms. Prudence told us that the man who injured Madelene with a machete had come out from hiding, apologized to everyone at the church, and became a Christian! While he was hiding, Ms. Prudence's husband, who is the pastor of a church up in Souffrier, told him that Madelene is healing well, and that he should repent. It was really cool to hear that something good came out of what seemed to be an unfortunate event.

Most of our regular patients come on Mondays, Wednesdays, and Fridays, so we got to see many of them today. And by regular patients, I mean Madelene (machete wound), Augusma (torn hand and broken elbow), Kettelie (pubic sore), and Acephise (facial abscess). The more I work at the treatment room, the more I become familiar with these patients. It was great to see how each patient was getting better, except Acephise's abscess still seemed pretty bad. She had lots of green discharge which smelled awful as usual. Because the abscess is right on her cheek, she could hardly talk. We're still not sure if she's taking the antibiotics. I think she'll be coming to the clinic everyday now.

We also had couple of interesting cases today. Ms. Prudence brought into the treatment room a 7-month old girl whose hymen was completely closed. She wanted to show Amy how to open it. Basically she gently rubbed a tip of a cotton swab against the hymen until it opened up. It was hard to watch the little baby girl helplessly cry with her weak little voice. Ms. Prudence put some draining strip into the newly formed orifice so that it won't close up again. It looked like such a traumatic event for the little girl, but I suppose the earlier it's done the better. At least she won't remember that she had to get her hymen open. Still, it looked really painful.

Another interesting case today was an 18-year old boy named Eddie with a really high fever (105ºF) who was carried into the clinic by his relatives because he was so delirious and paranoid about everything. Whenever he saw gloves he'd say we're going to operate on him and kill him. He was scared of the thermometer and would try to dodge it. We tied him down on a bed so he wouldn't run away. We had to get three or four guys to hold him down while Gavin gave him shots of lorazepam (my class should know what this is and how it works) to calm his anxiety and sedate him.

We figured that Eddie might not be cooperative enough to take pills, so I ran to the pharmacy (within the clinic) to get some acetaminophen (Tylenol) in syrup form (which comes out to be quite a lot to match his dose). He wouldn't drink it claiming that it's poisonous. So we gave some to his cousin who had brought him in. Even after she took a sip, he wouldn't drink it saying that she didn't sip it. Then after a while of trying to convince him he finally took it and put the whole thing in his mouth. We all stepped back thinking that he's going to spit it out, but he gulped it all down. We had to repeat the exact same thing when we gave him chloroquine syrup (except the syrup was twice as much as the Tylenol) because we thought he might have malaria.

We had to get his fever down quick, so we used cold wet towels to wipe down his whole body. We kept telling Eddie to lie down and rest, but he refused saying that he would die if he lay down. We left him with his cousin while we went to lunch, and when we came back he was much calmer and was even laying down. Eventually his fever went down, so we let him go with an instruction to get sputum samples to test for tuberculosis.

Chapel, Blisters, Lightheadedness, and Cheeseburgers

Friday, July 11, 2008

This morning, instead of having a devotion at the clinic, we met at the seminary chapel with people from other OMS ministries. Dr. Rodney lead the devotion, all the different ministries shared their praise and prayer requests, and we all prayed together. We have these meetings once a quarter or so.

In the morning we saw some of our regular patients including Madelene (girl with machete wound) and Augusma (fractured elbow and sutured hand). Madelene's wound still seemed to be healing well. Last time she was here, we put some steristrips across the wound to bring the skin closer and make the wound narrower. The wound was a bit narrower, but there were a couple blisters under the steristrips. It may have been caused by friction from steristrips, or she could be allergic to them, so this time we just bandaged the wound. We'll see if the blisters are any better next time.

Then we saw Augusma, whose hand also seemed to be healing well. So Gavin took out the stitches while I held Augusma's arm so his elbow won't move. After 10 minutes or so I started to feel lightheaded, so I got Laura to cover for me and sat down. Earlier this morning I had some loose stool (probably a side effect from erythromycin). I hadn't had much water since then, and I could feel my heart palpitating (fast and hard), so I was probably dehydrated. Then my stomach started to feel queasy just before I felt lightheaded. Good thing I saw that coming and was able to hold Augusma's arm until someone took over. I sat and put my head between my knees for a while, went to the bathroom, and then I felt much better.

All the missionaries took a half day today and went out to lunch as a farewell for three long-term missionaries: John, Dorothy, and Scott. We went to La Kay restaurant, and most of us got cheeseburgers with fries. We don't get to eat much burgers in Haiti, so it was a treat.

In the afternoon I took a long nap to recuperate from my illness this morning. I feel all better now. After dinner we hung out at Amy's as usual.

Underweight Babies, Non-patient Parents, and Facial Abscess

Thursday, July 10, 2008

Today is Thursday, so we had Well Baby Clinic. Laura and I took weights and temperatures, and compared each baby on the growth curve. We put the underweight babies on the feeding program.

I saw one 13-month old girl who only weighed 5.9kg (13lb), which is way underweight. She was so small and skinny that I couldn't believe she was 13 months old. My heart aches whenever I see kids like that. I hope the feeding program will help her.

Some med students at my school have told me that they wouldn't want to be pediatrician, not because they don't like kids, but because they don't like dealing with parents. During my pediatric preceptorship last quarter, I've seen a few parents that were little difficult to deal with, but most of them were easy going.

In Haiti, parents are still parents. Most of them are easy going, but there are always some that are less patient when it comes to caring for their kids. One big difference here at the clinic is that they come at you all at the same time.

As soon as the mothers figured out that I can speak Creole, they started to bombard me with questions and requests. Some repeatedly asked me whether I had their kids' chart yet, and others kept telling me that they're only here to get their kids vaccinated so not to call them into consultation (they were probably worried about being charged for consultation, but vaccinations are free). Many of them giggled if I didn't pronounce the names right when I called them to line up behind the scale. Then there were some mothers that couldn't wait to get their babies weighed and tried to cut in line. So parents tended to make the work a little more difficult, but nonetheless I enjoyed working with kids today.

Later in the afternoon we saw a 67-year old woman named Acephise who has a huge abscess on her right cheek that had just erupted. I saw her couple weeks ago at Dr. Rodney's office with the same problem (before it erupted), but for some reason she hadn't been taking her antibiotics, so the infection had become worse. When I came into the treatment room, the abscess had been drained (Gavin said it was the size of a golfball), and the entire room reeked of rotten green discharge. I almost felt like puking. She now has a hole in her cheek about a centimeter wide. We gave her some antibiotic shots and explained to her that she has to take the medicine or she'll never get better. She'll be frequenting the clinic to get her wound treated.

After dinner we hung out at Amy's house and watched the first episode of Grey's Anatomy from the latest season. It was a real treat for Amy because she hadn't been able to watch it since she came to Haiti.

Death of a Boy, Booster Shots, and Pubic Sore

Wednesday, July 9, 2008

This morning Ms. Prudence told Laura and me that the boy with diphtheria died last night at the hospital. She didn't tell us how exactly, but perhaps the toxin was too widespread. I don't know. I feel like I lost my first patient. At least he survived Monday. I wonder if his family was with him when he died.

The first thing at the clinic this morning, I helped change the dressing on Madelene, the girl with the machete wound. The wound is healing really well, but it's still very wide. Somehow we'll need to make the skin come closer. We're going to try something next time she comes.

Since today is Wednesday, we had Prenatal Clinic. Laura and I took weights and blood pressures for all the pregnant ladies. Many of them had surprisingly low blood pressures. After all the vital signs were taken, I sat in with Amy and Evan, and measured fundus heights and fetal heart rate.

All the staff who had contact with the boy with diphtheria got a diphtheria/tetanus booster shot and those who were in the emergency room with him for a long time got oral antibiotics (erythromycin) for a week. Everyone was complaining all day that their arm is sore from the shot. Luckily, I didn't have to get a shot since I got a booster in February 2006 to prepare for my trip to Sierra Leone. Good thing I brought my immunization record to prove it.

In the afternoon, I worked in the treatment room (aka injection room) mostly giving IM injections. I learned how to give glute shots in Haiti last year to treat a friend with syphilis, but the only source of info I could find on how to give IM shots was some bodybuilding website. So it was good to have Amy (Canadian nurse) and Lizette (Haitian nurse) teach me and get some proper practice.

The last patient we saw was a 17-year old girl who screamed and cried like a baby as I gave her shots of antibiotics. She had a big sore on the upper pubic area. It looked very painful, and the girl was crying and yelling, "I'm gonna die, the doctors are gonna kill me!" Amy and I tried to calm her down as we cleaned up the wound and bandaged it. Looks like she'll have to frequent the clinic to get treated for a while.

Amy joined us for dinner and shared her testimony/life story. Afterwards we played some UNO and then went over to Amy's house to watch John Q. The content of the movie was pretty good, but the quality was shoddy. My favorite part was when the doctor flicked the rubber heart to restart it after the transplant. The movie was basically a political statement on the US healthcare system.

Diphtheria Discussion, HIV Support Group, and Flight Change

Tuesday, July 8, 2008

A huge contrast from yesterday, today was a pretty slow day.

After the morning devotions, about once a week we have a meeting to discuss interesting cases and to educate the staff, and diphtheria was the obvious topic for today. It was a miracle that the boy made it to the hospital, and thanks to Dr. Stefan, they were able to speed things up. Gavin talked about different diseases that could present with similar symptoms, and others that we should be able to distinguish.

For the first couple hours at the clinic, Laura and I sat in with the HIV support group. First, the HIV counselor checked in with each patient to see how they were doing, and I tried to translate for Laura. It wasn't so difficult to understand when the conversation was mostly one-on-one between the counselor and a patient, but then I could hardly understand anything when everybody began to talk.

What I caught were something about eating well to stay healthy, coming to the clinic right way if you're sick, and using a condom every time even if both you and partner are HIV positive. At one point they were talking about food and beverages, so I wonder if they were talking about back when they used to get something to eat and drink at support group meetings. Since the government has been cutting the budget for the program we haven't been able to give them food during the meetings for a while now. But honestly, I don't really know exactly what they were talking about.

Near the end, one of the ladies stood up and sang a song about having hope in Jesus Christ. I wish I could understand more of what she was singing. In any case it was good to see the patients having a lively discussion about living with HIV. At the end the counselor asked us if we wanted to say anything, so we just thanked them for letting us sit and listen to the discussion.

About two weeks ago, my older brother Sundo emailed me saying that he and Rachel got engaged and that they are getting married on August 2. Exciting, yes. But the problem with that was that my flight back to the States was on August 9! My brother explained to me that it was the only date that could work for both of them and the families, and that he really wanted me to be there. I was bummed because I was really enjoying my time here in Haiti and also didn't want to miss my brother's wedding.

At first I thought that God wanted me to stay in Haiti, but what changed my mind was when my mother said we are to serve God for His glory all our lives, so coming back a few days early would be acceptable. Also, she wanted me to spend a little more time with the family before I went back to med school in the fall. So I agreed to come back early to be able to attend the wedding.

So today I spent some time on the phone (Skype) with American Airline to change my flight. I ended up paying $170, but I think it's worth going to my brother's wedding. My new flight is on July 31.

I had a Creole lesson with Wadner this afternoon. I hope I'm getting better at listening.

Respiratory Emergency, Witch Doctor, HIV Orphans, and Diphtheria

Monday, July 7, 2008

Today was the most emotionally challenging day in Haiti so far. So many different things, one after another, kept burdening my heart. Even writing about them causes the feelings to well up again.

First of all, Vicki and Nadine went back to Canada after they had been with us for 2 weeks. It has been so much fun getting to know them through the clinic and just hanging out, playing UNO/dutch blitz, and watching movies. It was sad to see them go, but that wasn't the hard part. After all, we can still keep in touch via facebook/email, and who knows, we may one day see one another again. They both have a heart for medical missions, so I will most likely be in touch with them.

The really hard stuff started with the very first patient we saw today. It was a 6-year old boy who had been having difficulty breathing since Friday night. When he came in, his respiratory rate was about 30 breaths per minute (normal is 12-20), and his heart rate was way up around 160 beats per minute (normal is 60-100). He was breathing so hard that, his chest cavity sunk in every time he tried to breath, just like the baby we saw over two weeks ago. Through auscultation I could here loud turbulent noise during inspiration. Even without using a stethoscope, we could hear a loud noise with each breath. It sounded like his upper respiratory tract (airway above his lungs) was blocked. We could not take a look down into his throat because there was a big risk of further irritating the airway, causing a complete blockade.

We took him to our emergency room (formerly operation room) and put him on oxygen and nebulizer with various medications to open up his airway and gave him several shots of epinephrine, but nothing seemed to work. At some point his respiratory rate was up to 50bpm. I had to auscultate his heart to count his heart rate. I couldn't distinguish the pulses on his wrist because they were faint and beating so fast, even up to about 170bpm. It was horrifying to actually hear a heart beat that fast.

The boy was struggling so hard just to get a descent breath that he would try to take the nebulizer off of his mouth or move his arms around. We all had to work together to hold him up and still. It was especially hard for me to watch him struggle because he resembled Oliguch, one of the orphans with whom I spent 4 months in P-au-P last year. It was heart-wrenching to think that he could actually die if he didn't get his breathing back to normal. We prayed so many times for him as we waited for the medicine to work.

After 3 hours (8:30AM-11:30AM), despite all our efforts, he wasn't getting any better, so we had to take the risk of transporting him to Justinian Hospital, which is over half an hour away. Gavin, Evan, Amy, and Dr. Stefan went to the hospital, while Laura and I stayed at the clinic. Dr. Stefan used to work at Justinian Hospital, so Gavin figured he would be a great help there.

Meanwhile at the clinic, there was a woman lying on a mattress just outside the emergency room. She seemed very sick, and people were gathered around to see what was going on. Soon after we sent the boy to the hospital, a couple guys carried the woman away and left the clinic. Just as they passed by Laura and me, Ms. Prudence came up to us and explained what was going on.

The woman had been diagnosed HIV positive, but she did not tell anyone in her family nor her boyfriend. Now, she was so sick with AIDS that she couldn't even walk. The two men that carried her away were from her family, and they were taking her to a witch doctor because they didn't believe in western medicine. I had heard various things that witch doctors do to their patients, most of which are rather harmful if they did anything at all. It was dreadful to think what they might do to the woman, and how the family could also suffer the consequences of HIV because many of the rituals involve mixing blood or making cuts on people with razor blades.

Then Ms. Prudence told us about two little girls, 4 and 3-year olds, that were brought in by their grandfather a few minutes ago. Both of their parents had died of AIDS, and the grandfather brought them to the clinic basically to say that he doesn't want the kids because he can't feed nor clothe them.

The grandfather said the younger one is HIV positive, so Ms. Prudence had them both tested for HIV. The kids and the grandfather were waiting for the results while she told their story. Then Laura remembered that Gill, one of the long-term missionaries, has a stash of donated clothes at the office, so we went there and brought some down for the girls. I didn't know what to say to the grandfather, so I just walked up to him and handed him what we had. He said, "Mèsi," so I said, "Padekwa," but I still didn't know what else to say, so I just walked away. I felt sorry that this was all we could do for them.

After lunch, the results came back, and it turns out that both of the girls are HIV positive, and the younger one also has syphilis. They were both put on the HIV program and the feeding program, so at least they have access to palliative care and some food. Although, HIV program has been affected by budget cuts from the government, so I don't know what will happen to it in the near future.

Later on I asked the grandfather their names and ages, and he told me that Enya is 4, and Lovely is 3. They are both beautiful and innocent little girls. Ms. Prudence gave them some food to eat here before they went home. As I watched the three of them share a little bowl of rice and beans, my heart ached to think that the girls would have to suffer the consequences of their late parents' misbehavior. And they have no idea what is happening to them.

While Laura and I were still waiting for Gavin and others to come back from the hospital, the two of us assisted Lizette, one of Haitian nurses who works in the treatment room, change the dressing on Madelene, the girl with the machete wound. Augusma, the old man with broken elbow and torn hand, had also been waiting to have his dressing changed since the clinic opened this morning, but his case is more complicated so we waited for Gavin.

Gavin and others finally came back around 3:30PM. It turns out that the boy has, of all things, diphtheria. If you are like me or most people in developed countries, you know that you get vaccinated against diphtheria (usually with tetanus and pertussis) as a kid, but have no idea what diphtheria is. It was quite shocking to know that what I saw this morning was something I would never see in the States. Even Gavin, who has been working at the clinic for 2.5 years, had never seen diphtheria before.

Fortunately, the boy is now intubated (has a tube down to his trachea for ventilation) and stable. However, besides blocking the airway with the formation of false membrane in the throat, diphtheria can cause fatal heart and nerve damage by the toxin released by the bacteria. Antitoxin is being administered, but we really don't know what will happen to him, especially because he has already been very ill since Friday. We'll have to continue praying for him.

Since diphtheria is highly contagious, and we had been in close contact with him for 3 hours in a confined space with no air-conditioning (plus he was on nebulizer, which makes water droplets that helps the bacteria travel through air), we need to be concerned for ourselves and those who come in contact with us. As a precaution, all of us went straight home, rinsed our shirts, and took a shower. Thank God we're vaccinated.

At dinner there were just the three of us: Laura, Evan, and me. It was a bit quiet and lonely, but I'm glad I still have the two with me. Afterwards we invaded Amy's house, which we'll probably be doing most of the nights from now on, and watched Spanglish. I was doing stuff on my computer (writing email, catching up on blog writing/reading) so I didn't pay much attention to the movie, but it seemed like a good movie from what I got out of it.

Today was a very long and emotionally draining day, but a kind of day that I would never want to forget.

Sickle Cell Crisis, Cannonball, and English Bible Fellowship

Sunday, July 6, 2008

Gavin was in charge of taking us to church this morning. There were Laura, Evan, Vicki, Nadine, Amy, and Steve, who is here for a week to work on some projects with the radio station.

Gavin had been up very early this morning because he had been called in to the clinic because a 10-year old girl was having a sickle cell crisis. He had relieved her symptoms and she was resting at the clinic when we left for church. A few minutes after, Gavin got a call from the mother of the girl saying she was in pain again, so we turned around to go back to the clinic.

Gavin and Amy rushed into the clinic while the rest of us waited outside. I didn't want to bother them, but I got concerned about what was happening, so I carefully went in. I watched Gavin and Amy as they started an IV and tried to calm her down.

A few minutes later the girl's father came in. While Gavin was out of the room looking for something, the father asked me, "Doc, in your opinion, do you think there's a cure for this?" All of a sudden I felt a huge weight on my shoulders, as if I had to deliver a bad news. I almost choked, but said in broken Creole, "Well, Gavin is the doctor, so he would know better than me, but this is a genetic disorder so..." The father understood what I wanted to say, and he responded, "But we can control the pain, yes?" "Yes, we can," I replied, and he accepted my answer.

It seems that the father had already heard that there is no cure for his daughter's disease, but I felt awful to think that I might be the one to tell him there's no real hope. I had learned about sickle cell anemia many times probably since elementary school, but actually seeing how it affected the girl and her family had a profound impact on me. It made me realize how serious the disease is, and that the people suffering from them are not just numbers in statistics.

Gavin and Amy were able to calm her down after a few minutes, and we let the family stay in the clinic with her while we went to church. Since we were running late for church, Gavin decided to go to the church next to the OMS compound. We used a little portable audio system so Gavin could translate into a mic and we could listen to him through an earphone. He started to translate for a bit, but he left in the middle because he was called by the girl's parents again. I could only catch a few phrases because they talked so fast, so I couldn't translate. I need to practice listening more.

After the service, we went to Christoph Hotel as we usually have lunch there on Sundays. We took a dip in the pool afterwards. We did a few cannonball dives, and Laura and I threw Nadine and Gavin in the air like we did last time when we were at Christoph.

Later in the afternoon, we went to English Bible Fellowship, which is held at the Radio 4VEH station every Sunday at 4:00PM. There were a few short-term mission teams with different mission organizations. It was cool to see them and to be able to worship together in English.

On Sundays we are on our own for dinner, which just means that we don't have a cook to prepare us food or wash dishes, but they make pasta salad or something we can heat up in advance. We also don't have a long-term missionaries scheduled to join us, but Amy joined us for dinner tonight, just because she can.

Afterwards, we hung out in Vicki and Nadine's room as they packed their bags because they are leaving tomorrow. We watched the rest of Chaos Theory, which had a pretty good ending. It's going to be so sad to see the two leave tomorrow morning.

Healing Wound, Square One, and Ping Pong

Friday, July 4, 2008

First thing at the clinic today, we saw Madelene, the girl with a big machete wound behind her left leg. We had brought her down from Souffrier (site of mobile clinic) on Sunday. She has been coming here every day to get her dressings changed. I had seen her at the clinic all week, but this was the first time since Sunday that I got to see her wound, which was healing surprisingly fast and well.

Today was Hypertension & Diabetes Clinic, which we have two Fridays a month. Laura and I took weights and blood pressures, lots of them. Some patients had such high blood pressure (around 210/130) that I had to double check to make sure I got it right. It was a good practice taking so many blood pressures.

After we finished taking vitals, I sat in with Ms. Ketlye as she consulted patients. Mostly we just made sure patients were taking their meds regularly, and prescribe them meds for another month. Nothing too exciting, but sometimes it's frustrating when patients don't come for a few months until they get sick because they couldn't afford to come. In that case it's impossible to tell if the medication was working or if we should change the dose. It's as if we're back to square one every time they come in.

As I mentioned before, the clinic has been seeing much less patients since January because of rising food prices. It is sad that fewer patients at the clinic doesn't mean a healthier community but rather a poorer and sicker one.

Vicki and Nadine decided to do some manual labor at the seminary construction site, so they were painting the new library with Gordon and Neil all day today. At lunch there were only three of us: Laura, Evan, and me. It was a bit sad to think that it will be like this everyday from Monday when Vicki and Nadine leave.

In the afternoon, Laura and I sat in with Amy and Evan while they consulted. I got to practice abdominal exam on one of the patients who was having some lower abdominal pain. At school we learned all these physical exam skills, but we haven't got to practice them much, so it was good to refresh my memory.

Welcome Inn, the place Evan and I are staying, has a ping pong table. So after the clinic was over, Evan, Laura, and I played some ping pong. I'm really not good at ping pong (as a matter of fact, I'm not good at any kind of sports involving spherical objects), and I hadn't played in forever. Evan beat me, but somehow I beat Laura.

It was nice to have Vicki and Nadine back for dinner. They seemed pretty exhausted from a full day of manual labor. After dinner, we played some UNO, then watched 3:10 to Yuma in Laura's room. Lights went out near the end because it was after 10:00PM. Good thing we were watching it on my laptop. The movie was pretty awesome.

Oh, did I forget that today is American Independence Day? Yeah, pretty much... I'm surrounded by N. Irish and Canadians, and I'm not even American. And we don't have any fireworks. So no point celebrating, I guess.

Malnourished Baby, HIV Test, Wadner's House, and Vicki's Birthday

Thursday, July 3, 2008

Today was Well Baby Clinic, so Nadine and Vicki helped out by admiring the little babies taking weights and temperatures, giving vaccines, etc. Amy and Evan consulted patients (mostly babies today) together as they have been doing this week. I shadowed Dr. Rodney this morning, so I got to see sick patients including babies. We saw one 8-month old girl who weighed a mere 5kg, which is way below normal (lower limit is 6.5kg). She was so skinny and small, and it was heartbreaking to see her. Her mother brought her in because the baby was having fever and diarrhea. We gave her medicine for the symptoms, and put her on the nutrition program (part of the World Food Program) to help her gain the much needed weight. I'm so thankful that we have these programs to help little babies like her.

Another patient we saw was a young man who had headaches and some kind of rash on various parts of his skin. I can't remember exactly, but I think he also had a little abscess of some sort on his neck. He reminded me of a Haitian friend from last year who turned out to have syphilis. Just as I was thinking this patient might have some kind of sexually transmitted disease, Dr. Rodney asked the patient if he wanted to get tested for HIV. The patient seemed hesitant and concerned about the cost of the test, but I could tell that he was relieved when Dr. Rodney said the tests are free of charge. Dr. Rodney explained to the patient about the pre-test consultation where they educate patients about STDs and HIV as well as ask risk assessment questions. I didn't get to see the results (I was probably eating lunch when Dr. Rodney saw him again with the results), but it was good to see how cases like this was handled in consultations (and that my instincts weren't far from Dr. Rodney's line of thought).

In the afternoon, Amy, Nadine, Vicki (three Canadians), Laura, Evan (two N. Irish), and I reorganized the operation room into an emergency room. While we were going through stuff around the room, we found some circumcision kits, and had a little laugh while Amy explained how to use it. It's basically a metal clamp that cuts the circulation to the foreskin and act like a stencil to direct the incision. The others almost seemed appalled to see it, but I wasn't surprised at all because I had seen one similar to it at my pediatric preceptorship last quarter. Apparently they had never seem those in Canada or Northern Ireland... but I bet they use them, too.

Vicki and I reorganized the little storage room next door. I was impressed by the variety and quantity of stuff we had, but it was a bit difficult to figure out what should go where. Also the room wasn't well ventilated, so we were kind of sweaty. Overall, I think we got a lot of work done in both rooms.

Afterwards I had a Creole lesson with Wadner for an hour, then the six of us (three Canadians, two N. Irish, and me) took a walk outside the compound walls. We briefly visited Wadner's house. Wadner is 25, and since his father passed away, he's been looking after his mother, his three sisters, and his niece. He's building his own house on the land given to him by his grandfather. Wadner also built a pretty intricate workout machine in his uncle's house next door. I was thoroughly impressed by how he maximizes the little resources that he has.

Today is Vicki's birthday, and we had planned to give her a little gag gift. The plan was to steal some of her clothes, put them in a box, and give it to her as a present. I got this idea from my birthday two years ago in Kenya when some of the missionaries pulled it off on me. The entire time we were reorganizing the operation room (now emergency room), I was looking for a small cardboard box, which we eventually found. Luckily, just as we got back from the walk, a few of the local kids showed up wanting to play some football (soccer), so Vicki enthusiastically went out to play with them. Meanwhile, Nadine (Vicki's roommate) helped me steal some of Vicki's clothes. Actually Nadine ended up stuffing the box with most of Vicki's clothes. We taped it up and hid it up at the Holiday House (that's where we eat our meals). Soon after that, I realized that, since Vicki was playing football, she'll want to come back to her room to change before dinner. So I decided to join her to keep her playing until dinner time and convince her to go straight to dinner instead of changing. It worked out just as I had planned. Oh, the power of suggestion!

After lunch today I had asked the kitchen ladies to put some candles on the dessert tonight. They said that if I had asked them earlier, they would have made a cake, but instead they had already made some jello. So after dinner, we lit up a few candles on a bowl of jello and sang happy birthday for Vicki. Then I brought out the box and gave it to her. She looked excited and nervous because we were all giggling. She opened the box and the first thing she said was, "Oh, my skirt!" She dug further and said, "This is all my clothes!" We had a good laugh.

After dinner, we went over to Amy's house, and Vicki, Nadine, and Laura got a pedicure from one of Amy's Haitian friends while we watched August Rush. I really liked the soundtrack.

Goodbye Julie, Blood Drawing, Car Accident, and Augusma

Wednesday, July 2, 2008

Julie (physio from N. Ireland) left this morning. It's always sad to see people go because we all quickly become like family. She was the first person from Northern Ireland that I had ever met (then I met three more within a week). Now she's the first person from Northern Ireland whom I said goodbye to. It's been really cool getting to know her.

Today was prenatal clinic. Before seeing patients, Ms. Ketlye gave an educational talk to all the pregnant women. Vicki and Nadine helped out with weighing and taking blood pressures, and Laura sat in with Amy and Evan. Meanwhile I shadowed Dr. Rodney until he left to see Julie off at the airport. Then I went to the lab where I drew some blood and did a bunch of finger sticks. I drew three blood, two of them from little boys (about 10-12), and all of them went smoothly, so I think I'm getting better at this. But I still need more practice on patients with veins that are hard to see (Laura, are you still up for being a guinea pig?).

When I came back to the clinic from lunch, there had been a car accident where three people were brought to the clinic. In the treatment room (a.k.a. injection room) we had a 75-year old man named Augusma who fell on his right side and had people pile on top of him in the accident. I heard there were two girls from the accident in some other rooms crying very loud, but they were not in as serious of a condition as the old man.

When I came in, Augusma was lying quietly on the table as Dr. Rodney cleaned his wound. A big flap of skin on the back of his right hand had been teared open, so we could see his muscles and tendons. We could tell that he was in pain, but he was moaning very quietly. Gavin told us that in accidents like this, it is important to look for people who are lying quietly among others who might be screaming for help, because often times those who are silent are the ones in more serious conditions.

Gavin sutured his hand, including an artery that had teared under the flap and a small laceration on his right palm. Laura, Vicki, and I took turns keeping the big overhead lamp in place and holding Augusma's other hand. Meanwhile Nadine and Evan helped out with the prenatal clinic. After Gavin finished suturing and bandaged the wound, Augusma still had pain when moving his right arm, and the elbow was swollen, so we took him to the X-ray clinic, which is 10 minutes down the street from us.

As we waited at the X-ray clinic for the film to develop, Augusma shared how thankful he was that he survived the accident and praised God for sending us to take care of him. He prayed and gave thanks to God, and then started singing "Mwen renmen Jezi, mwen renmen Jezi, pou tout sa li fè pou mwen" (I love Jesus, I love Jesus, for all that he does for me). I was really inspired to see how much faith he had in God.

The X-ray showed that he had fractured the proximal neck of radius (bone of forearm on thumb side) and the olecranon (tip of elbow). So we went back to the clinic and put a cast on his arm. Augusma once again shared how thankful he was, sang the song, and prayed. He has such a bright personality. He'll be frequenting the clinic for further treatment. I'm looking forward to seeing him again.

Today was a very long day.

Tears, Baby Fever, Ankle Sprain, and Canada Day

Tuesday, July 1, 2008

After devotions at clinic this morning, we had a farewell party for Julie (physio from N. Ireland) because she's leaving tomorrow. She has been here for 6 months, and had become an invaluable part of the clinic. Dr. Rodney, who is one of Julie's best friends, gave a little speech and presented a certificate of honor and merit to her. Julie also gave a speech in Creole, then per her request we sang "Ala m kontan wè Jezi renmen m" (How happy I am to see that Jesus loves me) in the upbeat style. Tears were exchanged among many.

The rest of Tim's team (Tim, Mary, Christina, Carly, Anna, Emily, Beth, and Jen) left after lunch. It was really sad to see them go. They had become like family to me. It won't be the same without them. Lots of tears were exchanged here as well.

I shadowed Ms. Ketlye at the clinic today. One of the patients we saw was a little baby boy with a fever. I don't know exactly what was going on, but I assisted Ms. Ketlye by fetching whatever she asked me to bring. We did what we could to reduce his fever and then referred him to a hospital. I was impressed by how well Ms. Ketlye handled the case even with the limited time and resources.

In the afternoon we (those of us still here are Laura, Evan, Nadine, and Vicki) played football (soccer) with some local kids. While playing Evan sprained his ankle, so we didn't play for long.

Soon after that a truck from the World Food Program arrived, so we went over to help unload. Today is Canada Day, and most if not all of the food (rice, beans, soy/corn meal) that we unloaded were from Canada, so we, especially Vicki and Nadine, felt patriotic for Canada. Later on after dinner, Vicki and Nadine sang the Canadian National Anthem. Then we went over to Laura's room and watched Hairspray together. There are only 5 of us left now, but we still manage to have fun.

Mobile Clinic, Day 2

Sunday, June 29, 2008

We went to Ms. Prudence's church this morning. Her husband is the pastor there, and this is the church where we did our mobile clinic yesterday. During the service Gavin introduced us to the congregation, and each of us said something briefly. I said something in Creole, and I almost choked up, but I hope I said what I meant to say.

Just as we got out of church, there was a crowd of people gathered around something on the ground. It turned out to be a 14-year old girl who had been carried in on a stretcher from a village far away. She had a big laceration behind her left thigh. Some old man hit her with a machete on Tuesday, so she had an open wound for the last 5 days. Since it's been too long since the injury, we couldn't suture it. Instead we cleaned the wound, bandaged it, and brought her down with us. She'll be treated at our clinic everyday.

I'm in awe of how people here can just carry heavy loads on their head and trek over a mountain barefoot. Many of them were so willing to help out as well. On the way back, it started to rain a bit, and then it poured when we got on the truck. It reminded me of the time when I went to Zanmi Lasante, and rode through the pouring rain on a open-back tap-tap for over 2 hours. It felt good to be in the rain.

We got back around mid-afternoon, and I took a nice hot shower. Oh, I never mentioned, but we have hot shower here. It's amazing. After dinner we finished watching Enchanted at Laura's place. I think we all have the song "How does she know that you love her" stuck in our heads.

Mobile Clinic, Day 1

Saturday, June 28, 2008

Today we went up to a place called Souffrier to do a mobile clinic. Tim (lab professor) got sick this morning, and there was another extra spot on the truck, so Carly and Emily, two of the girls on Tim's medical team, came instead. Our team consisted of Gavin (doctor for N. Ireland), Amy (nurse from Canada), Julie (physio from N. Ireland), Evan (doctor from N. Ireland), Mary (lab technician from the US), Ms. Prudence and Ketsey (Haitian nurses), Joel (Haitian evangelist), Carly and Emily (girls on Tim's team from the US), and me.

On the way there we stopped by an ice factory to fill up our icebox. I had seen so many people selling ice on the street, so it was cool to see where they were getting the ice from. It took us about 1.5 hours to get to the foot of the mountain, then another hour and 45 minutes to hike over the mountain. There were many volunteers from the village we were going to, and they carried our boxes and bags for us. The guys who carried our boxes on their heads, most of them barefoot, took a shorter but steeper path, while our team took the longer and easier way. We walked along a stream, which we had to cross several times. Near the end we had to cross a river on foot, so we took off our shoes and socks. The girls made fun of us guys because the Haitian guide "helped" us cross the river by holing our hands, which we totally didn't need at all. In fact it would have been easier to cross if they just let us on our own. Anyhow, it was a fun hike.

Our hosts had prepared brunch for us when we arrived. It was about 9:30AM. We were told that we won't eat until we finish the clinic, so I ate a lot, but then we ended up eating lunch at 1:00PM. They had slaughtered a goat for us so we had it for lunch and dinner. It'll probably be our breakfast tomorrow as well. Usually when people slaughter a goat, they use every part of it. They make soup out of the gut and bones, which we had for dinner, and they even eat the head, which fortunately wasn't served to us.

We were able to set up the clinic surprisingly fast. We used the church building for the waiting room and consultation rooms, and the storage for the pharmacy. The lab was setup outside next to an amazing view. Gavin and Ms. Prudence consulted on their own while Evan and Amy worked together (they either say Amy was translating for Evan, or Evan was helping Amy confirm her thoughts). Julie, Carly, and Ketsey worked in the pharmacy. Mary, Emily and I worked in the lab. Joel walked around talking to people about Christ.

I greeted the patients that came to the lab, checked what tests needed to be done, and drew blood if needed. There were a few patients, especially kids, whose veins were so small that I couldn't draw blood from them. b helped me out by using the syringe technique. In all, I drew blood from about 20 patients and did finger sticks on a few. Emily did the screening tests. We had a lot of patients with H. pylori, a few with malaria, and a few others with Hep B. Mary did everything involving the microscope and all the rest. Since Tim wasn't there, she was quite busy.

Joel, our Haitian evangelist, did an amazing job, and lead 25 people to Christ today. That's 10% of all the patients we saw. Praise God!

TB Clinic, World Food Program, and Football

Friday, June 27, 2008

Once a month on Fridays we have tuberculosis clinic. We have all the TB patients come in with their empty plastic containers to make sure they've taken all the meds. After they've gone through 8 months of treatment, and if their sputum test comes out negative, we do a little graduation ceremony and give them a certificate. It seems like certificates mean a lot in Haiti. So the first thing we did was the graduation ceremony, and all the patients graduating from TB were given a chance to make a quick speech. I didn't catch what they said, but in the past, patients have said things like, they used to rely on witch doctors and never got better, but the medicine they got from the clinic really cured them. We hope that other patients will be inspired to comply with the treatment plan so that they can be cured, and so that they don't develop multiple drug resistant strains.

I got to work with Ms. Prudence for the TB clinic today. Ms. Prudence has been working at the clinic for over 20 years, and she is the head nurse. We'll be doing the mobile clinic at her husband's church this weekend. Since we had many patients as we usually do for TB clinics, we had to work fast. We asked each patients if they've been taking their medicine, check their lungs, and get their sputum sample. Ms. Prudence put me in charge of checking their lungs, and I got to hear wheezing, crackles, and rales, the lung sounds that I had learned about in class but had never actually heard before. They sounded just like I was told, but it's hard to imagine what it sounds like without actually hearing it. I could hear the abnormal sounds in patients who had just started treatment, but those who were well into to the program sounded much better.

To encourage the patients to come every month because it's very important that they come every month for 8 months, we give out some food through the World Food Program. So all the TB patients got some beans, oil, rice, and flour. I had always heard about WFP, so it was cool to see it in action.

While the food distribution was taking place, Vicki, Laura, Evan, and I sorted out some medical supplies in the depot. There were hundreds of birthing kits, which we packed tightly into boxes. Because of the power-line incident yesterday, the power had been going on and off today. Usually the depot is the coolest place at the clinic because of air-conditioning, but we were all quite sweaty at the depot because we didn't have power most of the time.

Afterwards we played football with some local kids. I hadn't played soccer in forever. I usually don't like sports much, but it was a lot of fun. Emily, Vicki, Wilfried, and I were a team, and we called ourselves Team Mango.

Amy and Julie got their power back, so we watched Enchanted at their house. The power went out (after 10pm), so we couldn't finish it.

We're going to mobile clinic at Souffrier tomorrow. I'm excited!