Friday, June 27, 2008

Pregnant HIV, Ultrasound, TB, and French Braids

Wednesday, June 25, 2008

In the morning Laura and I shadowed Ms. Betsy and Lourd, both Haitian nurses, with the pre-consultation for HIV patients. We saw a few HIV patients and a few patients who came to get HIV tests. Before the test they have to fill out a questionnaire about STD and HIV. Today was prenatal clinic day, so we didn't have many HIV patients, but we had one 5-month pregnant woman who was just tested positive. I don't know if they understand what it's like to have HIV or AIDS, but there wasn't much of a reaction from her. She seemed very apathetic or ignorant of the whole situation. If I were pregnant and found out that I was HIV positive, I would cry for a very long time. But people here don't seem to react much to the news that they are HIV positive.

At one point the patient flow at the HIV clinic stopped, so I wondered around the clinic for a bit. I walked into Dr. Rodney's office when he was doing an ultrasound on a 8-month pregnant lady. He stomach was really big, so he wanted to see if there were twins. Dr. Rodney stepped out to find Gavin, so I played with the ultrasound for a bit. I think I saw a hand and a head briefly, but most of the time I couldn't tell what I was looking at. Gavin came and looked at the ultrasound, and said there's probably just one baby.

A 60-year-old woman had been coughing for a long time, and her TB skin test was positive, but her sputum test was negative. I saw her after Gavin had taken her to the X-ray clinic, and the results showed that her left pleural cavity (space around the lung) was filled with fluid at the bottom. Using the percussion technique I learned in ICM (Intro to Clinical Medicine), I could tell that the left bottom part of her lung sounded dull. At first when I auscultated (listened w/ stethoscope), I wasn't careful enough to listen at the bottom of her lung, so I had missed it, but Gavin pointed it out to me later. I realized how important it is to do physical exams thoroughly. I also realized how important the X-ray was in diagnosing that she actually has TB. i really hope we can get a new X-ray machine soon.

Gavin told us that 2 patients came to Christ today. Our clinic staff are very active with sharing the Gospel, and time to time patients pray to accept Jesus as Lord and Savior. I'm honored to be working with the staff here.

I keep forgetting that dinners are at 5:30PM on Wednesdays, not 6:00PM like other nights. This is the second time I came to dinner late because I thought it was at 6:00PM.

We played Dutch Blitz again, and some how Laura and Jen won by a huge margin... again! I'm thinking the game might be rigged because they used the same deck of cards as last night. Whatever, it's still a fun game.

Beth taught me how to French braid. We used Nadine's hair to practice. This is what happens when I'm surrounded by so many girls 24/7. They told me it will be good for my surgery skills... sure...

Thursday, June 26, 2008

Farewell, Phlebotomy, X-Ray Clinic, Walkabout, and Dutch Blitz

Tuesday, June 24, 2008

Julie (RN, former missionary), Kelly, Cindy, Mike, Heather, Tyler, Ali, Matt, and Jacob left this morning. They had been here for one week working at the new seminary construction site. Since I work at the clinic, I didn't get to see much of them during the day, but it was fun hanging out with them, especially over the weekend and in the evenings. It was sad to see them go. I forgot to get their email addresses, but thank God for Facebook, we'll probably find each other soon enough.

Julie Briggs (Irish physio) gave a talk about cerebral palsy to the medical staff this morning. She spoke in English, and Dr. Rodney translated into Creole. When someone spoke in Creole, Gavin translated into English. It's great that we can communicate so effectively even with the language barrier.

I decided I wanted to try learning some lab work today. I needed to refresh myself on how to draw blood, so Beth let me practice on her. I failed miserably and gave her a little hematoma (bruise), but she was very encouraging and said I was doing well. Then I tried to draw on a patient, who was anemic. He almost fainted because I bruised him as well... Ms. Leonice, a Haitian nurse and phlebotomist, helped me out and taught me how to do it properly. By the third patient I was pretty comfortable drawing blood. I ended up phlebotomizing about 10 to 15 patients, and most of the time it went really smoothly. I drew Julie's blood (she just wanted to test her blood), and I didn't bruise her (much) even though she says she bruises easily. Ms. Leonice taught me well, and thanks to Beth for being my guinea pig.

One of our security guard Jacquelaine injured his left thumb, so we took him to the X-ray clinic. Ever since our X-ray broke, we've been taking people there when necessary. Just to show the place, Gavin took Nadine, Vicki, and I with him. They have a couple big X-ray machines in a fairly small building. Fortunately Jacquelaine's thumb wasn't broken. X-ray at this place is very expensive, but sometimes the owner gives discounts or does it for free. In any case, it's been more difficult to get X-ray because of the cost. We used to be able to do X-rays for every patient who tested positive for TB skin test, but now we diagnose by symptoms most of the time, and send them for X-ray if it's uncertain. I hope we can get a new machine soon.

After we came back from the X-ray clinic, Gavin lead a group us on a walk around the back of the compound. We don't get to go out of the compound much, so it was refreshing. We climbed up a hill where we could see the entire compound, but since the place is full of trees, we couldn't see much. Still, it was a nice view of the neighborhood. On our way back it started to rain, and a couple feet behind where I was walking a transformer on top of an electric pole exploded with sparks and loud noise. Good thing it was on the other side of the street. It started to pour, so I ran back to my house.

Nadine brought a card game called Dutch Blitz with her, so we played it after dinner. It was a lot of fun even though Laura and Jen won by many more points than any of us. We'll have to play it again soon.

On the way back to our place, Nadine, Laura, Evan, and I saw an interesting bug that looked like a grasshopper with wings shaped like a green leaf. Nadine touched it, but it barely moved. So I tried to pick it up, then it flew right towards Laura, and she screamed and used me as a shield, even though the bug wasn't doing anything. Anyway it was a really cool bug.

Tuesday, June 24, 2008

Sickle Cell, HIV Baby, Dementia by HIV, and Six Newcomers

Monday, June 23, 2008

Beth and I shadowed Dr. Gary today with his HIV clinic. Beth is a premed, so she's been wanting to shadow a doctor here. Dr. Gary has a tendency to leave the room for extended periods of time even when the patient is there, so I got to talk to the patients while he was gone, and I translated for Beth. It takes a long time to get through each HIV patient because he has to fill out like 13 pages every time. There is a new building under construction, and it's going to be for consulting HIV patients. It will expand our AIDS program and will be equipped with computers so the files for HIV patients can be digitized and more efficient. It's been pretty exciting to see the progress of the new building.

The first patient we saw was a non-HIV patient. She had leg pains when walking, so Dr. Gary tested her for sickle cell, and she turned out to be positive. I wouldn't have been able to put leg pain and sickle cell together (and I can't remember her other symptoms, probably headaches), but apparently the increased hemolysis due to sickle cell, combined with dehydration, can cause blockade of blood supplies to the extremities, resulting in pain and ischemia during exercise.

We saw a mother and her 8-month-old boy. The mother was diagnosed HIV positive last time she came, which was couple months ago. At that time she did not want to be a part of the AIDS program, but she changed her mind and came here to register. She probably changed her mind because they were both having diarrhea, and the baby had blood in his stool. We can't be sure that the baby is HIV positive until 18 months old when his immune system is working. Otherwise we could get a false positive because the baby carries the mother's antibodies. But he had adenopathy (swollen lymph nodes), which is one of the first signs of HIV, and he is still being breast fed, so he is most likely positive. He was such an adorable baby, and it was so sad to think that he was born into this world with HIV when he had nothing to do with it.

Another HIV patient we saw was a 38-year-old woman who had been acting very strangely since Saturday. She was also skin and bones, and it was very hard to see her talk to herself and stand up and walk around randomly. I didn't know HIV could cause dementia and other mental disorders. Although watching HIV patients can be depressing, things like this motivate me to become a better doctor and to serve in developing nations.

We had 6 newcomers today: Nadine and Vicky from Canada, and a family of 4 from the States (Chuck, Doan, and their daughters Alyssa and Kelsey). Nadine is a RN (just graduated) and Vicky is a fourth year in nursing school. They will be working at the clinic for 2 weeks. Chuck's family will be working at the new seminary construction site for 1 week. Julie's (RN, former missionary) team will be leaving tomorrow. It'll be sad to see them leave.

X-ray Machine, Certificate of Honor, Christoph, and Fifth Disease

Sunday, June 22, 2008

Today we went to Pastor Daniel's church. Every morning before we start working at the clinic, we have a devotional with all the staff, and Pastor Daniel is the one who usually speaks. Pastor Daniel is an Haitian pastor who is also our X-ray technician, but ever since the X-ray machine broke, he's just been helping out with patent files. The X-ray machine at the clinic had been so crucial in serving the community. We are looking for a new X-ray machine, so please let me know if you know any one who's upgrading their machine and needs to get rid of their old X-ray.

The service started around 7:30AM and ended around 9:00AM. Pastor Daniel had made a "certificate of honor & merit" for each of us for coming to Haiti as short-term or long-term missionaries, and presented them to us during the service. Back home, people might think it cheesy, but it was very meaningful that he did that for us.

After church we went to a hotel called Hostellerie du Roi Christoph. There we swam in the pool and had lunch. Apparently this is where we usually have lunch on Sundays. Julie (Irish physio) taught Laura and I how to throw people in the air (Julie used to do gymnastics), so Laura and I were throwing people in the pool for them to do spins. It was a lot of fun, but our arms were sore later.

Anna had been sick for the past few days, so her sister Carly had stayed home with her yesterday as we went out to Labadee. Apparently their younger sister Emma had just gotten the Fifth Disease, and looks like Anna got it from her just before she left for Haiti. But she was feeling a lot better today, so both Anna and Carly came out with us.

It was a very relaxing weekend.

Monday, June 23, 2008

Photos on Picasa

I've uploaded some photos on my Picasa Web Albums, so check them out!

I'll be updating this album throughout the trip, so be sure to come back later for more.

Haiti 2008 Album

Beach Day at Labadee

Saturday, June 21, 2008

Today we all went to the beach at Labadee. I'm told that Labadee is the only beach in Haiti that cruise ships dock, so I'm assuming it's one of the best in Haiti. The beach is closed to the public when a cruise ship is there, so we enjoyed the beach with the local people. A few of us went to a part that was really rocky and flat, so we got lots of small cuts on our feet. We spent the rest of the time in a sandier part, which was much more enjoyable.

One really cool thing I saw was called Dragon's Breath. It's at the tip of the peninsula where there are rock formations, and wind blows through some holes in the rocks and sounds like a dragon breathing. I'll post a video when I get a chance.

Evan Sharkey, a new short-term missionary, joined us today. He's a doctor from Northern Ireland, so now we have 4 from Northern Ireland (Gavin, Julie, Laura, and Evan). Evan will be here for a month.

Problem Case, Sick Baby, HTN, Diabetes, and Counting Pills

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.