Shadowing, HIV, & Breast Exam

Tuesday, June 17, 8:40PM, 2008

I started "working" at the clinic yesterday, and I say "working" because it's what we say, but I'm really just shadowing doctors for now. Yesterday morning I shadowed Dr. Rodney, a Haitian doctor who studied medicine in Dominican Republic. I could understand most of what was going on while he talked with the patients, but Rodney kindly explained things to me in English. He seems like a really nice guy.

In the afternoon, Gavin (Irish doctor) asked Laura (Irish med student) and me to do some computer work. We compiled all the drug records from mobile clinics to see how much of each drug was dispensed in the past year. We didn't think it would take very long because we thought we just had to punch in numbers, but it turned out to be quite time consuming because sometimes we had hard time figuring out the handwritings. No wonder why pharmacists take so long to fill prescriptions... just kidding. But yeah, we felt how hard it must be for pharmacists who have to decode prescriptions everyday. That took us the entire afternoon. The data we complied should prove useful since we'll be doing another mobile clinic this month.

After dinner, Amy (Canadian RN) and Julie (Irish physical therapist) invited us (the short term team and me) to their place to watch a movie. I didn't think I'd get to watch many movies here, so it was a treat. We watched the new Pink Panther with Steve Martin. Not a great movie, but I liked the silly humor that made no sense. "I would like to buy a hamb&@#$er." That was pretty funny.

Today, I got to shadow Dr. Gary (Haitian doctor who studied medicine in P-au-P). He was also very nice and tried to explain almost everything to me. He didn't speak much English, so he spoke to me in Creole most of the time, which was a great practice for me. He specializes in HIV patients, so I got to see a number of them. Before we saw patients, the patients had a HIV support group, so I listened in with the group for a while. I could only understand about half of what they said, but it was interesting nonetheless.

In the morning we see most of the patients, then we get lab results in the afternoon, so we see the patients again then. So many patients stay here pretty much the whole day because they have to do labs. What surprised me was that many of them had multiple infections. Most of them, even non-HIV patients, had two or more of bacterial or fungal infections, e.g. combination of malaria, H. pylori, and/or syphilis.

The first HIV patient we saw was a 26-year-old woman. Dr. Gary had stepped out for a minute, so I decided to talk with her. First thing she told me was that she had just lost her 5-month-old baby, probably from complications due to HIV. She said it so plainly that I didn't know how to react. I wonder if things like this happen so often that they don't make a big deal of them, or if she's just coping well. She almost seemed apathetic about the whole situation. It was difficult for me to understand what was going on in her mind.

One of the non-HIV patient was complaining that she had pain in her breasts, so Dr. Gary taught me how to do a breast exam. I guess I wasn't too surprised that my first breast exam would be here in Haiti. We didn't find anything. Physical exams are much more direct here. We don't use the gowns here that we use in the US. The patients just take off their shirt and bra without hesitation. It makes things a lot easier. I think the gowns make things even more awkward.

While Dr. Gary was taking a break for a bit, I sat in with Laura in Gavin's office. It was a lot easier to understand what was going on because Gavin spoke a lot slower than the Haitian doctors. Although, I'm not sure if the Irish accent is helping or not (jk). One old lady had a stoke a while back, and she had right hemiparesis (Hey class, where is the lesion?). We didn't do a neurological exam, so I didn't get to find out where exactly the lesion was, but it was fun thinking about it in my head... probably somewhere between medulla and primary motor cortex. I can't believe I'm missing Basic Neurology from spring quarter already. It was a fun class.

The last patient we saw today had just been tested positive for HIV today, so Dr. Gary talked through things with her. He assured to her that this wasn't the end of her life, and that we're here to support her. She seemed to be taking things pretty well, but I can't even imagine what it would be like finding out that I have HIV... Perhaps it wouldn't be so devastating if I had access to antiretrovirals and could keep things under control, but in Haiti... At our clinic we don't have ARV, so we give them palliative care until their condition gets too bad or AIDS become fully manifest. At that time we would send them to a hospital where they could get treated with ARV, although I don't know what that would cost them.

Another group of short term mission team arrived here this afternoon along with couple of former long term missionaries and girl named Jen who is joining the current medical team for their last two weeks. The new group will be doing some construction work for 10 days or so, but I haven't heard much about them yet, and I can only remember a few of their names (Jacob, Tyler, Ali, Matt...) so I'll talk about them more later as I find out. Tomorrow morning I'll be going on a tour with them to see some of OMS International's mission sites (Radio 4VEH, seminary, etc.), so I'm sure I'll get to know them soon.