Haiti–Day #7–

February 26, 2011 Leave a comment
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FB: Haiti Day 7. I
spent the morning setting up Haitians with email accounts (and challenging
because I set them up on Yahoo in French). We then sent emails to each other.
Most of them had never used a computer: the touchpad was baffling. Several of them
already had email, and a few are on Facebook.

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Haiti–Day #6–

February 25, 2011 Leave a comment
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We rode in the back of a beat-up, land cruiser pickup truck
to a school in the mountains. Probably about an hour drive, forded a stream, up
fairly steep roads. When we pulled into the school yard, we could hear the kids
singing songs (maybe of the alphabet; they sounded like learning songs). They
came out an queued up; very organized. They sang us some songs, the local “head
of the chamber of commerce” gave them a pep talk about drinking clean water and
staying in school. We then setup our simple water filtration system, they
screamed out Merci! To the chamber dude’s encouragement. I spoke with two
soldiers from Argentina. They had side-arms and a 12 gauge shotgun. They were
supposed to check-in on five schools, but couldn’t find the fifth. Talking to
locals, it didn’t sound like there was another one. These guys were on foot.
It’s hot, dry, tough conditions! Lots of the kids held out their hands and
pointed to their stomach: the international sign that they want food. I sat
down with a few and said, “Zu swee Steve” They giggled and told me their names.

When we ride in the truck, or walk down the rural roads on
the way to the hospital, the kids all yell, “Blanc!”

In the afternoon, I went back to the clinic. Teeownee(sp)
was working with the doc. I gave about three injections.

Then I went to Antwon <sic> house. Crazy. We couldn’t
get change for my $1. We rode in one of those public buses (in the front seat)
to his town, which starts with an M. Then walked through the marketplace.
Filled with trash. Everybody stared at me. More foods than I expected, tomatos,
garlic, etc. I took photos, many from my hip. Then we stopped at a school where
he has his technical school. Broken down computers (only two work), but no
power. Then to his house. I took lots of photos of his family and they loved
seeing them. But what they really liked was seeing him at work. His mom had
never seen him with a stethoscope at work.

FB: Haiti Day 6 (morning). I rode in the back of a Land
Cruiser truck deep into the mountains, on this scrawny road, fording streams,
to a school packed with kids. There we installed a water filter that we created
from a 5 gallon ACE Hardware bucket and a 1 micron water filter that is used
for camping. It’ll clean 1,000,000 liters of H2O.

FB: Haiti Day 6 (afternoon). I road in this “taxi” to a
Haitian medical student’s home town. Dunno if “blancs” (whites) ever get on
these taxis…

FB: Haiti Day 6 (afternoon). The market place was in full
bloom in the medical student’s town. It’s poor (as it all of Haiti). Dirt poor.
It looked like pictures from Africa. Man I felt white! I met his mother and
showed her pictures of her son at work at the hospital (she’s never seen him at
work). I took (and then showed them) family photos.

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Haiti–Day #5–

February 24, 2011 Leave a comment
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I almost didn’t go to the hospital today, ‘cause I felt so unneeded on the last visit. I went, planned to go to the AIDs clinic (where the doc teaching, but you don’t do clinicals). I poked my head in and saw Navy, the Mexican doc and Antonio. They invited me in, I shoed off the other students and interpreter, and had a great day. Here is my patient log:
1. 59f. Fibromyalgia (the doc wrote something like, “neuropathic influwtorin” [I’m not sure of some of the letters in the second word, but that’s what it looked like]). I gave 1 amp of a pain killer.
2. 39f. “Sepsis Vaginal” I gave 1 amp of something. I think the same pain killer. No antibiotic (I don’t know why), but a written prescription (or maybe a slip for lab work).
3. 36f. Cervualgia (cell pain??). She was complaining of pain on the right side of her neck. The doc asked about other pain, and there was some, but most of the problem was touching her neck. I gave 2 ampules of something.
4. 17f. “Sepsis vaginal” (this time I “vaginal infection” and the Doc said yes). No tx by me (I’m guessing she was going for lab work).
5. 28f. “Sepsis vaginal”. I mixed cephalexin (I think) with 5 ml of H20.
6. 26f. Sepsis vaginal. I gave 1 amp.
7. 56m. Arthritis from bacterial. I gave 10 ml (in two injections) of Pcn, and 5 mg of a pain ampule. All in one honking needle. I was helping him stand up, by swinging his legs to the side, and Antonio said no, don’t do that. I think they want to keep distance and not be expected to add a bunch of caring. Seemed foreign to me.
8. 5f. I mixed 5 ml H2O in powder (probably amoxicillin), drew out 3, and then drew in 2 ml of H2O. This was a crying kid (even before injection). The kid shots need to be quick because the struggle and want it over.
9. Dashed out to check a cervix of a woman. It was 5 cm. Difficult for me to feel.
10. 56 f. I gave 2 meds (ampules) in one shot. Probably the pain killer plus one for her heart.
11. 24f. Sore throat. I gave amoxicillin (always a powder). She came back later (about five pts later). Her labs showed that she is anemic. I gave two amps of “ferus” stuff, and an antibiotic. Her iron was 7.5. I think the doc said normal was 12-15.
12. 11m. Parasites. Maybe giardia. I used the remaining amoxicillin.
13. 16m. Sore throat. Yucky white tongue. Red tonsils (although difficult for me to see without a depressor). I expect I gave her an antibiotic.
14. Dashed out to check a different cervix. She was 4 cm. Again, difficult for me to feel. I later realized that I expected the head to be hard, but it was still inside the amniotic sack.
15. F. Abrasion and sore shoulder. Doc examined. I asked, clavicle of AC? They said something else. Maybe the muscle. I gave 1 amp for pain w 4 ml h2O in amoxicillin.
16. 46f. She would touch her stomach and say, “Malad.” Doc: Vomit? Little. It’s interesting that they don’t take vitals for any pts, but I now realize it happened outside, but only bp (and always dropping the last digit and with the 1’s which looked like my 7’s). I gave 1 amp diazepam with 3 ml H2O and ampicillin. This was typical. One amp of pain killer, ampicillin or penicillin or amoxicillin, and often another med for the chief complaint.
17. F. Vagina infection. The pt said vaginal discharge, doc did exam and there wasn’t any discharge (and nothing in her underwear). Oxycillian?
18. Back to one of the pregnant women. 8 cm. The nurse asked Dr. Navy who I was and she said, “He is an American OBGY (that wasn’t the term) specialist doctor.” She said it in Spanish. As we walked out the door, I put my arm around her and said, “You told them I’m a specialist doctor in birthing!” She laughed and said, “You understood me!”
19. 1m. I gave an inj, 1 ampule. Antonio (that’s not his name, it’s more like Antwon) said, “Don’t press!” (because I’d press the hub of the needle into the patient).
20. 10m. I filled with 1 ampule, then with H2O to 5ml, shook, drew out 2.5, then drew 2.5 of H2), then injected. Then his dad received an inj from Adam Henry (the treasure).
21. Navy and I went to deliver a baby. Too much to write, but very slow coming out. Then Cathy came and said she would do it, so Navy left. I hope she didn’t feel pushed out. The nurse eventually got pissed because too many people, so I left. I then came back when the baby had been born. Not breathing, gray, no movement, no crying. I think a 1 or 3 in APGAR. Cathy asked me if I could resuscitate her. I said yes and asked for a mask, and was told there wasn’t one! (Now, as I type, I realize I had one in my pack!) Krista (from Park City) began compressions. The nurse rubbed the baby with alcohol, vigorously, slapped feet, and it began to move. It pinked up over several minutes. Damn, I wish I’d remembered my mask! Oh well, it lived. Head was very cone shaped.
Facebook Haiti Day # 5: I treated 20+ patients today–1 every 10 minutes. They’re all rubbing them bums cussing that sadistic gringo “doctor.” I worked with a woman doc from Mexico (trained in Cuba, see photo) all day. It looked like we were going to deliver two babies simultaneously (one for each of us). She told the nurses I was an American doctor who specialized in delivering babies! Yikes! Only one baby, very ill, not breathing, but we revived her (with no O2 or mask, EMS buddies!).

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Haiti–Day #4–Modern Haitian Farming

February 23, 2011 Leave a comment
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Took a walk-about of the property. I’m guessing we saw about 10 acres, which have been passed down through the family. It has to feed about 30 people. The owner, damn I can’t remember his name, studied agriculture in Dominican Republic and Africa, I think.
The frame is divided into small parcels, probably 50’ square. We saw where the water came from (from a spring in the ground), what they grew. We drank cocoa nut milk, ate the insides by scraping out the meat with a blade of shell. He showed where he had grafted a grapefruit tree.
He as trying all sorts of experimental stuff. One of the coolest examples was that they were growing rice using a new technique (in combination with Cornel), that used less water. The rice plot was small, maybe 50×50. When the rice was harvested, the straw from the rice was used as bedding for the chickens. After the chickens had soiled the straw, it was dumped in a small pond where the organic material (food and other stuffs, too) combined with the sun to create phytoplankton. When there was a bunch of phytoplankton, some of it was put into a small (25×25’) fish pond (with carp and tapila). When the fish grew, the large ones were fed to the humans and the small ones were dried, ground up, and fed to the chickens. No waste, no harm to the land, beautiful.
After the walk about, I spent an hour teaching Alexandra how the circulatory system works (because he asked why his heart beat faster when he walked up stairs). He didn’t even understand that oxygen only came into the body through our mouths and nose. I had him take my pulse, I took his, then we ran around and took them again. I showed him my blue un-oxygenated veins, etc. It was fun. He brought out a book with medical terms that he had written down. The truth is, he didn’t really seem to comprehend some of it. Later in the day, after jump roping with some kids, I asked him why my heart was going faster and he didn’t say, because your body needs more oxygen. It’s hard when you’re 19 to understand all these new concepts.
Facebook: Haiti Day 4 (struggling to post due to internet woes—third try): Toured our host’s sustainable farm. The leftover straw from the rice is used for bedding for the chickens. When soiled, it is dumped in a small pond to grow phytoplankton which is used to feed fish in another pond. The large fish are fed to humans and the small fish are grown into meal to feed the chickens. Very cool use of resources. We then met with a school teacher about installing a water filtration system tomorrow which was followed by a trip to deliver supplies to a local nursing school.

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Haiti–Day #3–Dry Arms, Wet Cholera, and Death’s Doorstep

February 22, 2011 Leave a comment
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Head for the hills

The rest of the medical group (i.e., Medical Student Missions) piled into a 4WD truck and went to the mountains with the Cuban doctors to check on Cholera patients.

The Cuban docs are all female. I hear they can be sent to other countries and won’t run away because they want to return to their families. I guess the male doctors just bail on their families. Lame.

Medical Crew Heading to the Mountains for Cholera Patients

Babies Galore

I’d planned to help at an infant immunization clinic, but they didn’t want the Blanc’s help. They’d probably heard about my 16-penny nails.

Baby Immunizations

Dry Arms

Feeling unwanted, I went to the lab to draw blood with Eric. I couldn’t get blood in my first two patients. I found a vein in the first, but couldn’t get much blood out. Eric restuck and got 2 mg, of the 4 we wanted. The next I couldn’t get anything, nor Eric, so the nurse in charge tried and didn’t get any. She had the pt hold a vial next to his arm and drip in the blood (she got about 1 ml). The next I just couldn’t find anything to stick, nor Eric, and the nurse tried. She dug
crazily and didn’t get anything. Well, I think she sucked about 1 ml out of muscle).

Wet Cholera

The cholera clinic is a tent.The first time I walked into the clinic, I stepped over the strange boxes filled with soaked sponges–I didn’t want to get my shoes wet.I quickly discovered that the chlorine-smelling sponges were there to clean our shoes of the cholera critters. It make sense once you’ve been in the tent. They’re continually wiping up the floor with bleach.

foot box mopping

there, an ambulance pulled up with a boy, probably 7 or 8 years old. They pulled-up his pants and helped him out of the ambulance. As he was standing there, being held up, he fainted. Eric and a hospital worker, or maybe a family member, carried him directly to the “C” pediatric tent. Eric tried to get an IV, said he got a flash, and the nurse pushed the needle in all the way and then slid up the catheter. He said he could see it blow out the vein. The nurse couldn’t get an IV in, they gave oral hydration, and he vomited on the floor.

Haiti-3-Cholera Boy-1

Collapsing

Dashing to the clinic

Immediate hydration

Death’s Doorstep

While I was hanging around with my translator, Alexandre Herold talking about life, languages, and Haiti, one of the Haitian nurses came and and said something to Alexandre in French. All I could make out from the conversation was, “Blanc” (a.k.a. whitey). He explained that she wanted me to look at a burn patient from yesterday.

I walked into a 20′ x 20′ open room that’s the hospital “lodging” and saw a 20-something year old woman, behind misquito netting, with partial and full-thickness burns on her bare chest. Our folks had helped debride the wound yesterday, and Eric had applied Second Skin (snot-like sterile burn dressings).

The woman was moaning and screaming, saying (in French) that her chest was burning and begging me me to take it off. Trying to mask my not knowing what to do, I proceeded to check her vitals (always a good time killer while seeking composure). Her pulse rate was a screaming 120 an weak, her respirations
rapid, and her hands were cold with pale fingernail beds. Signs of serious (spetic) shock. No good. Slipping away in front of me.

There isn’t really a hospital staff here–just folks providing random medical care in various rooms. I had Alexandre find one of the Cuban docs and in my Spanglish, explained to her that I had a patient with a “rapido” pulse (as I mimed taking my own pulse), “rapido” breathing (as I made my chest rise and fall raplicaly), and “blanco” nails (pointing to my own), and “freho” hands. She asked, “Shock?” and I said, “Si, hypovolemic.”

The doc followed me to the patient, felt her head, and said “Infermo.” She checked the mucus membrane around the womens eyes (they were pale), and agreed, saying something like “Si, septic, por un infection.” I wanted to start an IV, but I don’t think there was any fluid in the hospital. The doc say, “No. Transfusion. No hemoglobin.” I’m not so sure it was a hemoglobin issue, but I’m glad the doc saw it as seriously as I did. She filled out some paper which wuold allow the woman to be admitted to the neighboring hospital, the family loaded her up, and away she went, still screaming.

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Haiti–Day #2–Working at the hospital

February 21, 2011 Leave a comment
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Here we are commuting to work. It’s a little different from your typical American commute.

Daily Commute

The Water Supply

300 Feet Upstream of the Water Supply...

I worked in a “consultation room” in the local hospital with Dr. Neyvi and Antoine Jean-Remy. Neyvi is a Mexican woman from Acapulco who attended medical school, for free, in Cuba. Antoine is a local Haitian who was acting as a medical assistant and interpreter.

The consultations went something like this:

  • Antoine (in Haitian), “What is your name and age? What’s wrong?”
    The patient would reply in Haitian. Neyvi would write down their name and age, in pencil, on a sheet of paper. That’s the extent of the charting.
  • Antoine would tell Neyvi, in Spanish, the patient’s chief complaint.
  • Neyvi would tell me, in Spanish, what medicines to inject. (Every patient received at least one med, and usually too, from me, in the bum. The needle was the size of a 16 penny nail.)
  • I’d try to clarify the med and dosage by stuttering in Spanish to Neyvi and in French to Antoine. They’d laugh at my ignorance.

The hospital was insanely busy. It made the TV show “ER” look tame! There were more than 100 people waiting to be seen. The small “consultation” room was about 7′ x 7′. I treated patients from 2 years old to 71 years old, who had everything from Giardia and hypertension, to syphilis, diabetic emergencies, trauma w/infection, etc. (The patient details, for my medical friends, are below.) There were frequently three patients plus the three of us in the tiny room–at once. Basically, I gave everyone a huge shot in the bum with the med-de-la-ailment.

Busy Hospital

I tried to keep track of my patients (excuse the HIPAA law violation), but quickly lost count:
  1. 71-year-old female. “Sexual diseases.” She gets a shot from me, the “Blanc” (white person).
  2. 34-year-old male. Abdominal pain. Neyvi says he has parasites, “Giardia.” The patient was frustrated that I was given him a shot in his rear when it was his belly that hurt.
  3. 18-year-old male. Fever, back pain, and abdominal pain. They ordered several blood tests (I think a CBC, AIDS, and Glucose), but he didn’t get off that easy (another shot from the Blanc).
  4. 2-year-old male. Vomiting, diarrhea, fever. I gave a shot of amoxicillin. This was my first injection into a toddler; there’s a trick to bending their leg and holding it so they can’t squirm away.
  5. 24-year-old male. The Antoine said, “Do you know MRI?” I said “Yes, like an x-ray.” But Neyvi had the patient lean over and she did a rectal exam. Neyvi had me listen to the patient’s breath sounds (I’m glad they were clear, ’cause I don’t know how I would explain abnormal breath sounds in French or Spanish).
  6. 26-year-old female. Neyvi wanted me to take her blood pressure. There was a lot of confusion over my reporting the BP as my 168/124, because they always round to the nearest 10 and drop the last digit (i.e., 17/12)! I gave her an injection of some hypertensive med (yeah, crazy that I was injecting unknown meds!) and sublingual Nitro.
  7. 38-year-old female. Her blood glucose level was 358 (normal is between 80 and 120). Obviously a hyperglycemic diabetic. We didn’t treat her. Maybe she was sent to a different hospital. Maybe we were out of insulin.
  8. 63-year-old female. Syphilis. I was supposed to give her a full bottle of penicillin. I added 5 mL of H2O to the bottle, shook it, added a vial of what I assume was a pain killer (hey, the meds were labelled in Chinese or Spanish), and then 5 mL more H2O. I shook it up, filled two syringes with 5 mL each, and injected the first dose. I then switched the needle to the other syringe–I’d get fired in the USA if I did this (too likely to get a needle stick). I then tried to give the second injection but the plunger was “stuck.” I pushed as hard as I could (with the 16-penny nail-like needle in her bum) without success. Neyvi had me pull it out, she removed the needle (scary), pressed hard on the plunger and a clot of the concoction flew out of the syringe and onto the wall. She put the needle back on the syringe, passed it to me, and I injected it. Three shots, one 16-penny nail.
  9. 20-something year old female who was carried in by another 20-something female. She had nasty foot injection and the skin was literally sloughing off (see nasty photo). Neyvi filled out some forms so she could be admitted into a bigger hospital in another town. Her 105 lbs friend picked her up and staggered off.
  10. 21-year-old male. Crap. I can’t keep writing this stuff down!

Neyvi was the perfect mentor. If I was unsure about something, she’d say to Antoine, “No, him do it!” and she’d laugh with a huge, wonderful smile. Great day.

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Haiti–Day #1–Port-au-Print to Verrettes

February 20, 2011 Leave a comment
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As we were leaving the Port-au-Prince airport, a swarm of “sky caps” began arguing over payment. Most of them hadn’t touched our bags, but this appears to be how they make a living. I suspect most people give them a few bucks to be free of the conflict. Our driver, a Dutchman who has spent 10 years of the last 30 years living in Haiti, wouldn’t budge. “They think they can get away with this?!”

Third World Bartering

We had a three-hour drive due north from Port-au-Prince to the town we’ll be staying in, Verrettes. The sights and sounds in Port-au-Prince revealed the poverty.

First Sights of Port-au-Prince

Mass Transportation

Mass Trash

Post-earthquake housing

There was a welcoming party with the Haitians and Cubans (don't tell the State Department)

My bedroom. Good night.

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