Aah, another day in Haiti. Another day at the clinic. Another 7 hours of screaming children and incomprehensible language. It´s hard work here and everyday tries my patience and stamina. Thankfully, though, I do have some wonderful patients. Today, I had 15 patients (a typical day for me) and none of them had impetigo (thankfully), but half needed bandages changed and the other half were children with a high fever. That´s about all the patients I see. Also mothers who are part of the program where we track them and their child. I think I mentioned this in the previous post.
Anyway, I had helped about eight of my patients when a seminarian here, Anderson, came into the clinic (this is fairly unusual since he´s usually at the school teaching or taking classes himself). He wanted to talk with Dr. Leo, but he was in a consultation with a patient with malnutrition and I had just finished with my patient and I went with him back to the school. He said there was a girl there who was sick and I said I would check it out and see if we could do something. When we got there, she was screaming and having what I´m assuming was a seizure. It seemed more like a tantrum, since she wasn´t truly seizing, she was more writhng around and being held down by three or four women. Her eyes shut tight, her teeth clenched, her little brother said she did this regularly, although I didn´t know how long this had been going on. This episode (of what I think was epilepsy) had lasted for about an hour and a half, off and on. This is a VERY long time to be having seizures and is called status epilepticus and we have no medications and no way to help with that at the clinic. Leo recommended she get sent to the hospital as soon as possible for medication and then be sent home once she stabilized. I will ask later if she´s alright.
Another girl at the clinic I referred to Hospital Saint Damian because I think she has bilateral femoral hernias. She´s only 8 or 9 and she needs surgery to correct this. I don´t know how or if she or her family can pay for it (it may be free-of-charge, but i´m not sure), I can only hope. It´s difficult to just send people on their way. We don´t have a lot of medication here and we have to refer people to hospitals to see specialists. It can get disheartening when you see patients like that and can´t help them.
Tuesday, I gave a number to a girl who was being carried by her father, a handkerchief wrapped around her foot. When I finally saw her, I unwrapped her foot, the most awful smell wafted out and she had a gaping wound on her foot, a huge infection that had burrowed into her muscle. She was trembling, but had no temperature, although I am almost positive she was septic. We had nothing to give her, but I put a clean and fresh bandage on her and sent her to the hospital who does emergency care for children. Again, I have no way of knowing if she went or how she fared, I can only hope.
On the bright side, the last patient of the day was a little baby, 7 months old, who was having a hard time breastfeeding. He was the happiest little baby, with a gummy smile, and I was able to give his mother some vitamins and powdered milk so she would be nourished enough to feed her baby. She was very grateful, which makes me all the happier. Sometimes, all the people want are medications and, when we run out of things like Tylenol for kids or Paracetamol (both for fever and pain relief), we can only say to give the kids lots of water and milk and bathe them and let them rest. This is often the best treatment for kids, instead of medication. It´s frustrating since I can´t speak the language well yet (I´m studying every day and trying my best, but with so many abbreviations and speaking so fast, it´s very difficult) and the culture is such that they are relentless in their search. It´s getting better and I´m developing a firmer skin and a better eye for real illnesses and needs. And most days I get to work with smiling children, which makes every day so much better.
30 September 2009
22 September 2009
Haiti, part 2
I said I was going to dedicate this post to the Creole food of Haiti, but after today at the clinic, I have to use this post to just vent for a bit. If you don't want to hear my rantings and complainings, skip this post.
Another warning, I mention a minor surgery during this post, so if you get queasy easily, you may want to skip that part.
Today started off as any other day at the clinic, I got there a little early, 7:30, and waited for Leo and Jorge to get there so we could go get started on triage. When we were all ready, we headed across the small lawn separating the clinic from the outer road. There were probably 300 people waiting outside and they formed two lines, one for "ti moun", children, and one for "gran moun", adults. Shortly after they were organized into lines and we starting triaging people, a fight broke out at the beginning of the lines, whic merge at the one entrance onto and away from the road. I don't know what exactly happened, but there were bags being flung at others and yelling and shoving, none of which helps the mob of people waiting their turn to see the doctors. Jorge got in the middle of it (Jorge is probably 6'4" or so and not a slight man, by any means. He's a great doctor, but he was almost scary when he tried to break up this right) and he managed to break it up, but we werew all pretty shaken up by it...I almost expected weapons to be drawn.
Back to the patients; we each have our own numbers we hand out to people, they are pieces of wood that have been painted a color (green, black, red, or yellow) and have a number on it. I have fifteen numbers, since that's usually sufficient, but today, I wrote an extra 18 numbers, so I had a total of 33 patients to see.
Triage starts like this: I start in the middle of a line and work backward and Jorge or Leo starts at the beginning and, if things go as planned, which they never, EVER do, we end at the same time. After I had seen about two children, people started to mob around me and shove their children at me and just yelled the kids' symptoms at me. People are grabbing you, wanting you to see their baby next. It's heart-breaking and absolutely infuriating at the same time, I couldn't decide if I felt like crying or screaming or just leaving them all out there.I tried to tell them to get back into line, but my Creole is so limited and they were so afraid they wouldn't be seen that they just continued with their mob.
It took about 30 minutes total, thankfully without another outburst, to finish the triage. By that time, Leo, Jorge, and I are ready to be done for the day. Emotionally drained and physically disgusting, Jorge and Leo take showers before seeing patients, but I had 33 to see and I got started right away.
In order to see patients at the clinic, you have everyone wait in a common room, outside, but covered and with plenty of seating. I go out to call my first numbers and nobody comes forward, so I think those people have left. I just allow the next person with my color of card to come see me and I get started with the day. I saw a man with a huge wound on his foot, he said he had had it for about 2 weeks, it was severely infected, and I got to wash it and bandage it (for all this griping, I will say I am getting MUCH better with wounds. They don't gross me out nearly as much as they did before coming here. And it's only been 7 days at the clinic) and he also spoke some French, which I am much more comfortable with and I also got some Creole words figured out with his help. I saw some babies which I examined for their 1 month checkup (at the clinic, we are keeping a record of some mothers who come to see us during their pregnancy and we follow them throughout their pregnancy and follow their baby for 1 month, checking in on them at 1 month, 3 months, 6 months, and 1 year). I also saw a little boy who has been to the clinic twice before due to a severe burn on the back of his hand (it's healing, but it's slow and it's still incredibly raw). The majority of the patients I see, however, are just babies who their mothers say have "mal a tet" or "mal o vent" or "pa manje". They all say their children have the flu, and indeed, we think the swine flu has hit Haiti pretty hard, but we just don't have the resources for giving medicine to everyone. If we gave medicine to each child who is reported to have the flu, we would be out of medicine in maybe two weeks.
(Just as a side note, if you are able to talk with your doctor or a hospital about providing medical supplies to this clinic, let me know and trust me, the medicines will be used well and will benefit many).
It was not all in all a terrible day, I did get to learn some more Creole and I also had some students follow me today, which is interesting. Although the group from today was not as well behaved as lasst weeks group. They didn't really help, they mostly sat around or meandered in the halls and just took up space. Maybe it's just because this is their first day. I guess we'll see. They did get to see a pretty interesting minor surgery, though, one which I will not soon forget.
Leo works across the room from me and he needed my help to lance an abscess on a baby's head, so I agreed to help. We help each other as much as is humanly possible, since we are all fresh out of school and figuring things out as we go. To lance an abscess, you usually numb it with some lidocaine or something, they you can make the incision. But lidocaine is used very sparingly, so we don't use it unless absolutely necessary. Leo made the incision and pus came out, which is absolutely normal. But the students were watching and I think some of them were ready to pass out. You have to also squeeze and flush out the abscess to make sure it is clean and there is no more infection left and the incision can heal correctly. (Warning: this may get graphic) Leo had to squeeze the abscess, the baby was screaming and wiggling all around, and the abscess must have popped or something and pus and blood flew onto the wall behind the baby's head. The students did not stay long after that. I don't blame them. But the abscess is gone and the baby is healling now.
The rest of the day, I gave out dried milk for babies who seemed under-fed or to mothers who had trouble breastfeeding because they didn't have enough nutrition for themselves and the baby. I also gave out Tylenol, Jr. almost like it was candy, which we also give out sparingly. I listened to so many hearts, lungs, and abdomens, I am hearing them in almost any quiet moment. It was an emotional day and a very, very long day (I was working from 7:30 to 3:15, with a 15 minute break for lunch. Not a typical day, either, since we usually only work from 7:30 to 1).
I promise to dedicate the next post to food, it will be a welcome change to this medically-themed entry. I hope tomorrow won't be so crazy.
Another warning, I mention a minor surgery during this post, so if you get queasy easily, you may want to skip that part.
Today started off as any other day at the clinic, I got there a little early, 7:30, and waited for Leo and Jorge to get there so we could go get started on triage. When we were all ready, we headed across the small lawn separating the clinic from the outer road. There were probably 300 people waiting outside and they formed two lines, one for "ti moun", children, and one for "gran moun", adults. Shortly after they were organized into lines and we starting triaging people, a fight broke out at the beginning of the lines, whic merge at the one entrance onto and away from the road. I don't know what exactly happened, but there were bags being flung at others and yelling and shoving, none of which helps the mob of people waiting their turn to see the doctors. Jorge got in the middle of it (Jorge is probably 6'4" or so and not a slight man, by any means. He's a great doctor, but he was almost scary when he tried to break up this right) and he managed to break it up, but we werew all pretty shaken up by it...I almost expected weapons to be drawn.
Back to the patients; we each have our own numbers we hand out to people, they are pieces of wood that have been painted a color (green, black, red, or yellow) and have a number on it. I have fifteen numbers, since that's usually sufficient, but today, I wrote an extra 18 numbers, so I had a total of 33 patients to see.
Triage starts like this: I start in the middle of a line and work backward and Jorge or Leo starts at the beginning and, if things go as planned, which they never, EVER do, we end at the same time. After I had seen about two children, people started to mob around me and shove their children at me and just yelled the kids' symptoms at me. People are grabbing you, wanting you to see their baby next. It's heart-breaking and absolutely infuriating at the same time, I couldn't decide if I felt like crying or screaming or just leaving them all out there.I tried to tell them to get back into line, but my Creole is so limited and they were so afraid they wouldn't be seen that they just continued with their mob.
It took about 30 minutes total, thankfully without another outburst, to finish the triage. By that time, Leo, Jorge, and I are ready to be done for the day. Emotionally drained and physically disgusting, Jorge and Leo take showers before seeing patients, but I had 33 to see and I got started right away.
In order to see patients at the clinic, you have everyone wait in a common room, outside, but covered and with plenty of seating. I go out to call my first numbers and nobody comes forward, so I think those people have left. I just allow the next person with my color of card to come see me and I get started with the day. I saw a man with a huge wound on his foot, he said he had had it for about 2 weeks, it was severely infected, and I got to wash it and bandage it (for all this griping, I will say I am getting MUCH better with wounds. They don't gross me out nearly as much as they did before coming here. And it's only been 7 days at the clinic) and he also spoke some French, which I am much more comfortable with and I also got some Creole words figured out with his help. I saw some babies which I examined for their 1 month checkup (at the clinic, we are keeping a record of some mothers who come to see us during their pregnancy and we follow them throughout their pregnancy and follow their baby for 1 month, checking in on them at 1 month, 3 months, 6 months, and 1 year). I also saw a little boy who has been to the clinic twice before due to a severe burn on the back of his hand (it's healing, but it's slow and it's still incredibly raw). The majority of the patients I see, however, are just babies who their mothers say have "mal a tet" or "mal o vent" or "pa manje". They all say their children have the flu, and indeed, we think the swine flu has hit Haiti pretty hard, but we just don't have the resources for giving medicine to everyone. If we gave medicine to each child who is reported to have the flu, we would be out of medicine in maybe two weeks.
(Just as a side note, if you are able to talk with your doctor or a hospital about providing medical supplies to this clinic, let me know and trust me, the medicines will be used well and will benefit many).
It was not all in all a terrible day, I did get to learn some more Creole and I also had some students follow me today, which is interesting. Although the group from today was not as well behaved as lasst weeks group. They didn't really help, they mostly sat around or meandered in the halls and just took up space. Maybe it's just because this is their first day. I guess we'll see. They did get to see a pretty interesting minor surgery, though, one which I will not soon forget.
Leo works across the room from me and he needed my help to lance an abscess on a baby's head, so I agreed to help. We help each other as much as is humanly possible, since we are all fresh out of school and figuring things out as we go. To lance an abscess, you usually numb it with some lidocaine or something, they you can make the incision. But lidocaine is used very sparingly, so we don't use it unless absolutely necessary. Leo made the incision and pus came out, which is absolutely normal. But the students were watching and I think some of them were ready to pass out. You have to also squeeze and flush out the abscess to make sure it is clean and there is no more infection left and the incision can heal correctly. (Warning: this may get graphic) Leo had to squeeze the abscess, the baby was screaming and wiggling all around, and the abscess must have popped or something and pus and blood flew onto the wall behind the baby's head. The students did not stay long after that. I don't blame them. But the abscess is gone and the baby is healling now.
The rest of the day, I gave out dried milk for babies who seemed under-fed or to mothers who had trouble breastfeeding because they didn't have enough nutrition for themselves and the baby. I also gave out Tylenol, Jr. almost like it was candy, which we also give out sparingly. I listened to so many hearts, lungs, and abdomens, I am hearing them in almost any quiet moment. It was an emotional day and a very, very long day (I was working from 7:30 to 3:15, with a 15 minute break for lunch. Not a typical day, either, since we usually only work from 7:30 to 1).
I promise to dedicate the next post to food, it will be a welcome change to this medically-themed entry. I hope tomorrow won't be so crazy.
15 September 2009
Haiti, Part 1
I decided to separate my posts about Haiti into a few different postings. There is altogether too much to include in just one post. In this post, I will be addressing the clinic.
The clinic is made up of 6 exam rooms and a pharmacy, plus a few rooms for storage of books and a few charts and things like that. I am actually working in my own room (it's not a room, really, just part of a larger room separated by the others by curtains which I don't always close) and I have a lot of autonomy when it comes to treating the patients. The doctors from Chile are wonderful and they speak very good English. The two practitioners are Jorge and Leonardo and the dentist is Pia. In the mornings, Jorge and Leo and I do triage for the 200 or so people who show up outside the doors to this compound. Both doctors have about 40 numbers they hand out to the most needy patients and I work with them to help treat problems that come up. I also work alongside a nun, one of whom is a nurse, and we see our own patients, mostly children with the flu or who are dehydrated or malnourished.
Some of the patients I saw: a young boy with partial-thickness burns over the entire back of his left hand, a woman with an asthma attack, helping Dr. Leo lance an abscess above a boy's eye, an infected wound on a girl's forehead. Not a lot of really serious cases, but there are so many people who cannot come to the doctor right away, they may live hours away (one woman traveled four hours to this clinic by tap tap - a sort of taxi/city bus - just to get her blood pressure taken). We are lucky at the clinic to be so close to the UN troops, they are stationed in Croix-des-Bouquets so they can remain close to the airport. They recently donated 7 tons of dry milk to the clinic and we are giving it away to children who are malnourished or have diarrhea.
I did triage this morning, only my second day at the clinic, and it was absolutely mad. The doctors asked everyone to line up according to their needs, one line for children and one line for adults. We then just went down the line to see what was the matter with each person. I need badly to learn Creole and I will be working on it and Spanish while I am here. I am so glad I can speak French, though, because it makes it easier for me to understand Creole. Anyway, triage lasts about 30 minutes, 7:30-8am, then the doctors start calling numbers. During triage, Sister LuzMarina also gives out numbers for nursing care, mostly for the kids and sometimes for adults who need their blood pressure taken.
The entire day at the clinic only lasts from 7:30a to 1:00p or so and then the afternoon is free for us to do what we like. That means there's about 6 hours of free time until dinner. I'm trying to figure out what to do with all that time and I'm usually reading or taking a nap. I am also thoroughly enjoying the meals here, so I'll probably dedicate the next post to the food. I have a lot to say about it.
My thoughts are a little scattered and not very linear, but that's because I'm a little exhausted and the heat is curdling my brains. Can't always think in a linear way. Will post more soon, hopefully with pictures!
The clinic is made up of 6 exam rooms and a pharmacy, plus a few rooms for storage of books and a few charts and things like that. I am actually working in my own room (it's not a room, really, just part of a larger room separated by the others by curtains which I don't always close) and I have a lot of autonomy when it comes to treating the patients. The doctors from Chile are wonderful and they speak very good English. The two practitioners are Jorge and Leonardo and the dentist is Pia. In the mornings, Jorge and Leo and I do triage for the 200 or so people who show up outside the doors to this compound. Both doctors have about 40 numbers they hand out to the most needy patients and I work with them to help treat problems that come up. I also work alongside a nun, one of whom is a nurse, and we see our own patients, mostly children with the flu or who are dehydrated or malnourished.
Some of the patients I saw: a young boy with partial-thickness burns over the entire back of his left hand, a woman with an asthma attack, helping Dr. Leo lance an abscess above a boy's eye, an infected wound on a girl's forehead. Not a lot of really serious cases, but there are so many people who cannot come to the doctor right away, they may live hours away (one woman traveled four hours to this clinic by tap tap - a sort of taxi/city bus - just to get her blood pressure taken). We are lucky at the clinic to be so close to the UN troops, they are stationed in Croix-des-Bouquets so they can remain close to the airport. They recently donated 7 tons of dry milk to the clinic and we are giving it away to children who are malnourished or have diarrhea.
I did triage this morning, only my second day at the clinic, and it was absolutely mad. The doctors asked everyone to line up according to their needs, one line for children and one line for adults. We then just went down the line to see what was the matter with each person. I need badly to learn Creole and I will be working on it and Spanish while I am here. I am so glad I can speak French, though, because it makes it easier for me to understand Creole. Anyway, triage lasts about 30 minutes, 7:30-8am, then the doctors start calling numbers. During triage, Sister LuzMarina also gives out numbers for nursing care, mostly for the kids and sometimes for adults who need their blood pressure taken.
The entire day at the clinic only lasts from 7:30a to 1:00p or so and then the afternoon is free for us to do what we like. That means there's about 6 hours of free time until dinner. I'm trying to figure out what to do with all that time and I'm usually reading or taking a nap. I am also thoroughly enjoying the meals here, so I'll probably dedicate the next post to the food. I have a lot to say about it.
My thoughts are a little scattered and not very linear, but that's because I'm a little exhausted and the heat is curdling my brains. Can't always think in a linear way. Will post more soon, hopefully with pictures!
07 September 2009
I'm leaving on a jet plane
Well, this is it. In two days, I'll be on a plane destined for Denver, then to Memphis. It's quite surreal that I'll be spending three months (or 12 weeks, as I like to see it) in a bloody hot country helping people with God-only-knows what illness, far, far away from anyone I know. That spells f-u-n for me. No, I really do think it'll be a fabulous opportunity and a chance for growth and learning, but it just seems so crazy for me to be doing this. Still hasn't hit me yet, I haven't had any breakdowns or crying fits (which I would usually have before such a trip). I'll bet once I get on the plane, surrounded by complete strangers in an enclosed space, I'll collapse into a puddle. Knowing my luck, this is the most probable outcome.
Trying to keep a record of what's going on and what I'm bringing (which, by the way, is WAY too much). Bringing: scrubs, skirts, jeans, a flannel shirt (it does get relatively chilly at night...into the mid-70's, even high 60's), a fleece blanket, a small inflatable mattress (like one for camping, very thin, packable, but in case I'm sleeping on a concrete slab with a wimpy foam mattress, I won't be miserable for three months), a webcam for skype (will get that working shortly), iPod and speakers, batteries, recharger, books (will list titles later...haven't yet decided), knitting projects (again, will list once they are decided), sandals, slip-on shoes, tennis shoes, cell phone and charger (in case of an emercency), and a ton of medicine (for malaria, intestinal upset, flare-ups, and a few others...odd to be carrying all that).
Books I'm paring down to bring:
The BFG, Roald Dahl
The Witches, Roald Dahl
Mountains Beyond Mountains, Tracy Kidder
Krik Krak, Edwidge Danticat
Jane Eyre, Charlotte Bronte
The Secret Garden, Frances Hodgson Burnett
Le Petit Nicolas, Sempe-Goscinny
L'Elegance du Herisson, Muriel Barbery
So, as you can see, I have to choose between all these...not an easy task. Now, knitting patterns:
Ene's Scarf with a nubby cotton fingering-weight yarn
Flower Basket Shawl with silk/wool blend lace-weight yarn
Hip in Hemp with Hempathy in a stunning red
Lacy Baktus scarf with Cascade Heritage sock yarn
bolero with Linares (I'll be making up that pattern based on Ash from Rowan 36)
So much to bring. I don't know if I'll have enough time to do all this, but I'd rather have too much and not finish it all than finish it all and be bored after two weeks. AND, who knows, I may be there for six months and then I'd be S.O.L. as far as keeping myself busy. (In all truth, I think I'll be plenty busy with working 7a-4p six days a week. We'll just see...)
I'll keep up the posting as things happen. 2 days now and I'll be posting soon after I get to the clinic.
Trying to keep a record of what's going on and what I'm bringing (which, by the way, is WAY too much). Bringing: scrubs, skirts, jeans, a flannel shirt (it does get relatively chilly at night...into the mid-70's, even high 60's), a fleece blanket, a small inflatable mattress (like one for camping, very thin, packable, but in case I'm sleeping on a concrete slab with a wimpy foam mattress, I won't be miserable for three months), a webcam for skype (will get that working shortly), iPod and speakers, batteries, recharger, books (will list titles later...haven't yet decided), knitting projects (again, will list once they are decided), sandals, slip-on shoes, tennis shoes, cell phone and charger (in case of an emercency), and a ton of medicine (for malaria, intestinal upset, flare-ups, and a few others...odd to be carrying all that).
Books I'm paring down to bring:
The BFG, Roald Dahl
The Witches, Roald Dahl
Mountains Beyond Mountains, Tracy Kidder
Krik Krak, Edwidge Danticat
Jane Eyre, Charlotte Bronte
The Secret Garden, Frances Hodgson Burnett
Le Petit Nicolas, Sempe-Goscinny
L'Elegance du Herisson, Muriel Barbery
So, as you can see, I have to choose between all these...not an easy task. Now, knitting patterns:
Ene's Scarf with a nubby cotton fingering-weight yarn
Flower Basket Shawl with silk/wool blend lace-weight yarn
Hip in Hemp with Hempathy in a stunning red
Lacy Baktus scarf with Cascade Heritage sock yarn
bolero with Linares (I'll be making up that pattern based on Ash from Rowan 36)
So much to bring. I don't know if I'll have enough time to do all this, but I'd rather have too much and not finish it all than finish it all and be bored after two weeks. AND, who knows, I may be there for six months and then I'd be S.O.L. as far as keeping myself busy. (In all truth, I think I'll be plenty busy with working 7a-4p six days a week. We'll just see...)
I'll keep up the posting as things happen. 2 days now and I'll be posting soon after I get to the clinic.
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