"Treatable and Not Treatable" - Shruti Reflection pt. 2

So, when I asked Dr. Nelson if I could join the trip, the only questions I asked her were 1. Will my being a vegetarian be a problem? 2. May I wear scrubs? 3. Will I be able to do laundry? (Yes, be proud, I packed for 6 days with a messenger bag...and I wore Chacos...on a plane.)


I didn't know until we were en route to our guest house from the Port au Prince airport that we would only be having two clinic days during our short trip. I'm pretty bummed. We'll be spending the weekend taking a day trip to the beach Saturday and attending a church service Sunday (hope scrubs is appropriate attire ;) ). Monday is our last day and we'll be spending it with the kids at St. Vincent's as they celebrate "something" (I forgot what Dr. Nelson told me was the name and significance of the day). I know that I'll like seeing other parts of Haiti, but I think not having clinic each day we're here takes a little away from the purpose.

Speaking of purpose. I just want to make one thing clear. I don't believe that I am really here to help these kids. I gain much more from working with these orphans than they do from a rag tag group of Americans that visit for a week. These kids teach me the significance of the word "appreciation," they teach me how to smile, they remind me that kids are kids everywhere. I'm not a "good person" for coming here. I'm not making any "sacrifices" by being here (I'm not saying I like cold showers or that I'm not getting antsy by not being able to go out for a run or explore outside the guesthouse/orphanage grounds, I'm just saying it isn't a sacrifice). I have such little patience for people who go on these medical tourism ("volunteerism") trips with an attitude that implies that they are "saving" the people of the developing world.

And on that note...

CLINIC DAY ONE

Morning:
We set out for St. Vincent's with our suitcases full of medical supplies, foodstuff and art/ school supplies at 8 on Thursday. I loved driving through the city and getting caught in the traffic because I could see more of what the city was really like beyond the stone walls and security of our guesthouse. Maybe it's the Indian in me, or maybe it's just that traveling makes me a calmer and (somewhat) more patient person, but I liked just staring out our bus windows and didn't get flustered by how long it was taking us to get to St. Vincent's. The commotion of the traffic, the "art" on the TapTaps (the Haitian equivalent of a "rickshaw"; a Toyota truck whose flatbed and truck cover are filled with passengers who "tap" on the window separating the driver and the flatbed...clever, right?), the tenacity of the street vendors...all of it just made me happy. And excited. Not in a gawking American way (hopefully). I just think there is something special about that scene. It's chaotic but serene at the same time.

ANYWAY. We eventually made it to St. Vincent's and immediately set to work unloading and unpacking the twenty two suitcases our team had brought over. Before the clinic was even ready to start seeing patients, a row of children in their uniforms of blue and white checked shirts with names embroidered across their waists and blue shorts/skirts lined up quietly and patiently in the clinic hallway.

My task was to see patients with Dr. Nelson in the morning. Marc-Klein was my first patient. A maybe 10 year old paraplegic child. In order to weigh him, I had to pick him up and have us weighed together. His "chart" (a rough excel sheet created by a group of nurses that had visited a few weeks before) indicated that he had "lesions" across his knuckles. These lesions were actually just calluses that had developed secondary to Marc-Klein using his hands to "walk" about. Seeing this boy set my tone for my day. I didn't do anything for him except help him get some iron fortified vitamins, but his smile and the way he cuddled up to me as I weighed him and carried him to the examining table made my day. (see above statement on "purpose").

All of the kids in the morning were sweet and fun to work with. The nice thing about treating pediatric patients is that they don't complain. The challenging aspect of treating pediatric patients is that they don't complain, so you don't know what's wrong with them. (I am also CLUELESS when it comes to dosing meds for kids.)

Two other kids that stuck out to me were Eilocha and Michena. Eilocha. Oh boy. What a drama queen! This boy made me shake his hand upon introduction, repeat his name until I had the pronunciation JUST right and after I performed my physical exam stole the stethoscope draped around my neck and began to listen to my heart. Eilocha presented with bronchitis and L sided weakness, so I sent him over to Jenn for PT after getting his antibiotics. I also sent Michena for PT. This was a girl about the same age as Eilocha and completely opposite in demeanor. It was quite fun having them as back to back patients because as showy and demanding as Eilocha was, Michena was shy and unassuming. Michena came to clinic because she had a persistent R sided weakness in her upper extremity. Her arm was positioned in what we learn in medical school to describe as a "waiter's tip" presentation of Erb Duchenne palsy (a nerve injury that can occur if a baby's shoulder gets stuck against the mother's pelvis during labor).

I probably should have mentioned that St. Vincent's is specifically a school for handicapped children, many of whom are orphans. Most of the kids seen by me had issues like bronchitis or eczema or scabies. Treatable illnesses. Deafness, blindness, lack of limbs or the inability to use them. Not treatable. It was really inspiring to see how these children dealt with their disabilities and how their limitations did not stop them from being kids. What was severely disheartening, however, was seeing a 14 month old with congestive heart failure secondary to a congenital heart defect who had subsequently developed an enlarged liver. No available treatment.

My afternoon was less laughs and playtime and a lot more real. I switched to Jenn's PT clinic for the afternoon. I wanted to diagnose everyone with cerebral palsy because they almost all had macrocephaly, poor muscle tone and some other developmental disability(ies). There were a lot of kids but baby Margaret, Diana and Auguste really stuck out to me. Diana doesn't have arms. Jenn was working with her on a floor mat when Diana spontaneously asked if she could "draw" for us. She grabbed c"olor markers between her toes and just started drawing for us! It was so AWESOME. Jenn was really furious with the lack of progress that had been with Baby Margaret so we went to Margaret's dorm to look at her bed support and chair. A room the size of my living room + kitchen was home to 14 children. The "slat" substitute for Margaret's bed was a piece of flimsy cardboard. If only I could describe the anger and look of incredulity on our faces. Jenn went to checkout the bathroom facilities. I didn't have the courage to so I stayed behind and played with the kids. It was actually really funny because they would come up and scratch my skin and feel my hair. The not black and not white girl with curly hair was quite an odd sight for them.

We finished clinic a little after four and headed back to the Healing Hands for Haiti guesthouse.

CLINIC DAY TWO

Our second clinic day was my FAVORITE. My supposed task for the day was to "register" the patients for the day and figure out the chief complaint with my broken French. Fifteen minutes into the start of our clinic day we were already slammed with patients. So, John decided that it was time for me to run my own clinic. He found an open room for me and just started channeling patients my way. My first patient, Madame Bissoni, known to have hypertension and diabetes, came in with a complaint of a "headache" and was found to have a blood glucose of 450, blood pressure of 180/115 and a urinanalysis demonstrating 1+red blood cells 4+glucose 3+ ketones. Hyperosmolar hyperglycemic syndrome. In the States, she would have been admitted to the hospital. Here, our only option was to increase doses and add medications. There were a handful of people with the "flu" or "headaches." Not terribly exciting, but it was still fun to play doctor. It was not fun to basically be scolding a pregnant woman with a hemoglobin of 5.6 (lower limit of normal is ~12 for women) for not taking her iron fortified prenatal vitamins. It also wasn't fun having to explain to a man who suffered from multiple joint pain complaints and muscle weakness after a motorcycle accident that he was going to have to live with chronic pain the rest of his life. It also really sucked that we didn't have any pain medications to give him. The biggest challenge for me was my inability to communicate with patients. Having Creole interpreters and Sherye as my "signer" was incredibly helpful, but not the same.

I ran out of patients to see by 2:30ish, so I spent the rest of the afternoon playing with the kids. There was one boy that I especially adored. Frenel is an 11 year old boy in the 3rd grade who is blind and perhaps the most affectionate and sweet child at St. Vincent's. He read Braille to us, told me about what he wants to study when he gets older, played the "slaps" game with me, and danced with Sherye. He won Robbie and I over. It was actually nice finishing clinic early because it allowed me to observe what the kids do after school. Before leaving for the day, we went over to the original site of St. Vincent's that had been decimated by the earthquake.