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.
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