In Which There is a Flood

Last night there was a storm. Oh what a storm. I am reminded of the story in Winnie the Pooh about the "Floody Place" in the Hundred Acre Wood, where Pooh and Piglet find their houses being washed away. Fortunately, our guest house is much sturdier, but we had a river running down the driveway into the gutter that runs underneath the house. Apparently the bedroom downstairs had 6 inches of water running through it, so the Haitian staff had to sleep upstairs for the night. The house has a tin roof, so the storm began as a quiet chatter. At its peak, we had to yell at each other over the din. I suppose it rains like that in Memphis as well, but the experience last night was amazing. We stood in the doorway to the guest house, watching the torrents of water fall from the sky and astounded at the force of it. Sleep was not an option at that point. I tried to get on the internet to blog about it, but was not surprised when no internet connection was available. I was surprised we had power at all.

Eventually it slowed down to a continuous thrumming on the roof, and with earplugs and Benadryl I managed to fall asleep.

Yesterday in clinic the nurses saw another large section of the St Vincent's students; we have seen 135 to date. Our goal is to do wellness assessments on all 250 children by the end of the week. We saw another child with an impressive heart murmur yesterday; this one is a followup from my last visit in November 2011. When I saw her then, I asked Jean Robert for help. He works at the school and speaks English well and always helps us with our many questions. In a previous blog post from years ago I wrote that the answer to every question is "Ask Jean Robert". At any rate, he told the mother to bring me any records she had for the child, which produced a copy of an echocardiogram report! One never knows what you might get by asking! The echo report was from 2009, and written in french, but valuable nonetheless. I could make out most of the french, but the numbers about gradients and ventricular size were beyond my family doctor knowledge base. I brought that echo report home to Memphis and faxed it to Dr Nancy Chase, a pediatric cardiologist. She explained to me the details of the measurements, and actually thought the defect was not critical and could be monitored at this point. She suggested we get an EKG to determine whether the child has RVH (Right Ventricular Hypertrophy). The EKG is easier to get and cheaper than an echocardiogram, and could give us an indication of how the heart is functioning at this point. Of course, "easier" is a relative term in Haiti. We don't have EKG equipment at St Vincent's. Getting one requires a visit to the hospital or to a local cardiologist, both of which are next to impossible for this child. Nonetheless I talked with the mother yesterday, using my broken Kreyol with Jean Robert to translate. I told her we had good news, that the child likely does NOT need surgery, and that I would talk with Pere Sadoni about if/how to get an EKG done to give us some updated information about how the child's heart is functioning now. So basically this was a cardiac consult, extended over 4 months and across an ocean (literally and figuratively speaking).

Other noteworthy events yesterday included a story Dr Jemison told me about trying to evaluate a child with "poor appetite". The nurses are assessing every child, and if they find one who appears to be sick or who has a significant complaint, they send them to one of the pediatric providers which includes me or Dr Jemison. So she had a child who was reported by the teacher as having "poor appetite". Her physical exam was normal. The key to evaluating children is often the history, which is difficult with a 7 year old child anyway, so it is always important to talk to the parents. Dr Jemison asked to see the child's mother when she came to pick her up from school, so she could get more information about any problems with eating. She described the situation to me this way: The child is deaf. The teacher is deaf. The parent is hearing, but speaks Kreyol. The parent does not sign. Dr Jemison does not speak Kreyol, and is using an interpreter. She can speak to the parent through the interpreter, but the parent cannot communicate with the teacher. How does one get an accurate history in this setting? The other factor is Haitian politeness. Haitians will often tell you "yes" to your questions, because they are being polite and they tell you what they think you want to hear.

AT THIS POINT THE POWER CUT OFF. AFTER ABOUT 2 MINUTES THE GENERATOR KICKED IN AND NOW I AM BACK. MERCIFULLY MY ENTRY WAS NOT ERASED, THANK YOU GOOGLE.

So, where was I? Oh yes, the history taking with no one able to communicate. The teacher says the child has poor appetite. The parent says the child eats everything on her plate. I think Dr Jemison concluded maybe the child does not like the lunch food at St Vincent's, or for some mysterious reason does not eat at school. At least that's the best she can gather from all parties involved. The situation highlights many of the barriers faced every day by the teachers and students at St Vincent's. How does a deaf teacher who sig

THE POWER CUT OFF AGAIN, I AM SENDING THIS NOW BEFORE WE LOSE POWER AGAIN

Susan Neslon
March 15, 2012