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.

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.

Labadee, Kayaking, Snorkeling, Starfish, and Priorities

Saturday, July 5, 2008

Today we got to go to Labadee again! This time we went to Columbus Beach, which is much more secluded than other beaches at Labadee, so it was almost like a private beach for us.

We brought kayaks, so I went kayaking couple times. Neil and I rowed out and met up with Evan and Nadine far from the shore. Nadine dared me to take a dip, so I took a dip in the deep water for the first time ever. I have no idea how deep it was. Kind of scary but exciting!

We also brought some snorkeling gears, so I went snorkeling with Neil and Nadine. We saw lots of little fishes, corals, sea urchins, etc. I had never snorkeled before, so this was another first time for me.

We found a big starfish, so I played with it for a while. I flipped it upside down and watched it flip itself over. It took like five minutes, but it was so cool that I watched it twice. It was a very exciting day at the beach.

During dinner at the Holiday House, the long-term missionaries take turns to join the short-term missionaries and share their testimonies. Today it was Gavin's turn for the first time since I got here, so I got to here how he decided to do medical missions. His testimony had a lot of similarities with mine in terms of wanting to do medical missions, so what he said really resonated in my mind. What especially struck me is when he talked about setting priorities straight. He told us how he had put so much importance in doing medical mission, but one day he realized that he needed to put God and relationship with Him first before missions. I realized that I had been putting so much emphasis and effort into preparing for medical missions that my relationship with God had come to a standstill. I believe that God has called me to do medical missions, but I need to let God prepare me for it and focus more on growing closer to Him.

Before serving dessert, the kitchen ladies called me over to the kitchen and told me that they made a birthday cake but didn't know who it was for. Apparently someone had asked them to make a cake for Vicki today (even though her birthday was Thursday). They weren't quite ready with the candles, so I just stood in the kitchen facing the dining hall, and everyone else just stared at me waiting for me to say something. I didn't know what to say because I didn't want to ruin the "surprise" so I just stood there smiling until the cake was ready. After a little bit of awkward moment, we celebrated Vicki's birthday again.

After dinner we were joined by Amy, and the seven of us played dutch blitz. Since we had an odd number of players, Laura played by herself. She had won every time we played, and somehow, even though she was on her own, she beat us all... How in the world? It must be the way she shuffles her cards... jk. Sorry for giving you such a hard time, Laura. You've proven to us that you're the best dutch blitz player in Haiti. For now anyway.

Afterwards we went over to Amy's house and watched first half of Chaos Theory. Kind of a random movie, but I'm interested to see how it ends.

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.

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.

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!

Problem Case, Sick Baby, HTN, Diabetes, and Counting Pills

Friday, June 20, 2008

This morning Gavin showed Laura and me what he calls a problem case. There is a man who has hydrocele testis (accumulation of serous fluid around the testis), and he used to come to the clinic get the fluids drained. One day he fell from a tree and broke just below the superior head of right humerus. He went to a local hospital where they put a cast on him. One problem is that they fixed his right arm against his chest so he could not move his arm and only barely move his wrist, which is stuck just below his neck. The cast goes around his chest and is so tight that his hand is getting stiff and numb. Another problem is that he has been using his situation to get money from the clinic, often by lying. Consultation here at BMC costs 5 Haitian dollars (about $0.66US), which includes about half of the medicine given out, but somehow it's well known that this patient can't pay anything at all. So he's been getting free consultations here. In the past he has come to the clinic with a receipt saying that he needs to buy this and that for his arm, and BMC has given him some money to get what he needs. He has also said that he needs some things but he had lost his receipt for various reasons. What really needs to be done is a surgery to put his humerus together, but the original doctor is supposedly already treating him (by putting a cast around his chest and arm), so there is an issue of stopping another doctor's treatment. Also, since the patient has been living off his situation, we're not certain that he wants a treatment that will really heal him. Very soon he will be permanently crippled.

Gavin put Laura and I with Ms. Ketlye today. Ms. Ketlye is a Haitian nurse, but like many nurses here she consults patients, especially on specialty clinics. Two Fridays a month we have hypertension and diabetes clinic, so most patients we saw today were hypertensive, diabetic, or both. The first patient we saw was neither, and it was a 6-month old baby boy. He had been sick for 8 days, and he was hyperventilating and hypertachycardic. He was breathing so hard and fast that his ribs were sunken in and his nostrils flared. We had other doctors including Gavin look at him, but there was nothing we could do. I'm not sure what we ended up doing for him, but I think we referred him to a hospital so he could get some oxygen. Before we let them go, Ms. Ketlye asked Laura to pray for him. It was a very difficult and emotional situation for all of us.

Throughout the morning, Ms. Ketlye let Laura and me take turns to auscultate, take blood pressure, and check ears and throat. It was a good practice for me to take some blood pressures since I will be doing a survey of BP during the mobile clinic next week. Interestingly, I measured one patient's blood pressure to be something like 204/110, so Ms. Ketlye rechecked and got around 187/80. Laura said the patient must have some sort of White Coat Syndrome (fear of doctors causing nervousness and rise in BP)... It could have been because I'm a blan ("white," I'm white here even though I'm Asian).

In the afternoon, Laura, Carly, Anna, Emily, Jen, and I prepared small bags of drugs for the mobile clinic next week. Counting pills reminded me of my time in Sierra Leone when I went there with a medical team. I'm really excited for this mobile clinic.

After dinner a few of us watched Wimbledon (movie) at Amy and Julie's place. It was mostly girls (well, most of us here at OMS are girls), but Tyler came so I wasn't the only guy... not that I'd have a problem if I were. I'm usually not a big fan of romantic comedy or sports movie, but I've learned to enjoy movies despite their unrealistic/predictable story lines. Although, Christina made it a little hard because she kept criticizing how silly the movie was. She was right, but I'd rather fool myself and enjoy the movie rather than regret watching a movie I didn't enjoy. Julie slept through pretty much the entire movie in her chair. She must have been so tired.

Shadowing, HIV, & Breast Exam

Tuesday, June 17, 8:40PM, 2008

I started "working" at the clinic yesterday, and I say "working" because it's what we say, but I'm really just shadowing doctors for now. Yesterday morning I shadowed Dr. Rodney, a Haitian doctor who studied medicine in Dominican Republic. I could understand most of what was going on while he talked with the patients, but Rodney kindly explained things to me in English. He seems like a really nice guy.

In the afternoon, Gavin (Irish doctor) asked Laura (Irish med student) and me to do some computer work. We compiled all the drug records from mobile clinics to see how much of each drug was dispensed in the past year. We didn't think it would take very long because we thought we just had to punch in numbers, but it turned out to be quite time consuming because sometimes we had hard time figuring out the handwritings. No wonder why pharmacists take so long to fill prescriptions... just kidding. But yeah, we felt how hard it must be for pharmacists who have to decode prescriptions everyday. That took us the entire afternoon. The data we complied should prove useful since we'll be doing another mobile clinic this month.

After dinner, Amy (Canadian RN) and Julie (Irish physical therapist) invited us (the short term team and me) to their place to watch a movie. I didn't think I'd get to watch many movies here, so it was a treat. We watched the new Pink Panther with Steve Martin. Not a great movie, but I liked the silly humor that made no sense. "I would like to buy a hamb&@#$er." That was pretty funny.

Today, I got to shadow Dr. Gary (Haitian doctor who studied medicine in P-au-P). He was also very nice and tried to explain almost everything to me. He didn't speak much English, so he spoke to me in Creole most of the time, which was a great practice for me. He specializes in HIV patients, so I got to see a number of them. Before we saw patients, the patients had a HIV support group, so I listened in with the group for a while. I could only understand about half of what they said, but it was interesting nonetheless.

In the morning we see most of the patients, then we get lab results in the afternoon, so we see the patients again then. So many patients stay here pretty much the whole day because they have to do labs. What surprised me was that many of them had multiple infections. Most of them, even non-HIV patients, had two or more of bacterial or fungal infections, e.g. combination of malaria, H. pylori, and/or syphilis.

The first HIV patient we saw was a 26-year-old woman. Dr. Gary had stepped out for a minute, so I decided to talk with her. First thing she told me was that she had just lost her 5-month-old baby, probably from complications due to HIV. She said it so plainly that I didn't know how to react. I wonder if things like this happen so often that they don't make a big deal of them, or if she's just coping well. She almost seemed apathetic about the whole situation. It was difficult for me to understand what was going on in her mind.

One of the non-HIV patient was complaining that she had pain in her breasts, so Dr. Gary taught me how to do a breast exam. I guess I wasn't too surprised that my first breast exam would be here in Haiti. We didn't find anything. Physical exams are much more direct here. We don't use the gowns here that we use in the US. The patients just take off their shirt and bra without hesitation. It makes things a lot easier. I think the gowns make things even more awkward.

While Dr. Gary was taking a break for a bit, I sat in with Laura in Gavin's office. It was a lot easier to understand what was going on because Gavin spoke a lot slower than the Haitian doctors. Although, I'm not sure if the Irish accent is helping or not (jk). One old lady had a stoke a while back, and she had right hemiparesis (Hey class, where is the lesion?). We didn't do a neurological exam, so I didn't get to find out where exactly the lesion was, but it was fun thinking about it in my head... probably somewhere between medulla and primary motor cortex. I can't believe I'm missing Basic Neurology from spring quarter already. It was a fun class.

The last patient we saw today had just been tested positive for HIV today, so Dr. Gary talked through things with her. He assured to her that this wasn't the end of her life, and that we're here to support her. She seemed to be taking things pretty well, but I can't even imagine what it would be like finding out that I have HIV... Perhaps it wouldn't be so devastating if I had access to antiretrovirals and could keep things under control, but in Haiti... At our clinic we don't have ARV, so we give them palliative care until their condition gets too bad or AIDS become fully manifest. At that time we would send them to a hospital where they could get treated with ARV, although I don't know what that would cost them.

Another group of short term mission team arrived here this afternoon along with couple of former long term missionaries and girl named Jen who is joining the current medical team for their last two weeks. The new group will be doing some construction work for 10 days or so, but I haven't heard much about them yet, and I can only remember a few of their names (Jacob, Tyler, Ali, Matt...) so I'll talk about them more later as I find out. Tomorrow morning I'll be going on a tour with them to see some of OMS International's mission sites (Radio 4VEH, seminary, etc.), so I'm sure I'll get to know them soon.