Thursday, July 10, 2008
Today is Thursday, so we had Well Baby Clinic. Laura and I took weights and temperatures, and compared each baby on the growth curve. We put the underweight babies on the feeding program.
I saw one 13-month old girl who only weighed 5.9kg (13lb), which is way underweight. She was so small and skinny that I couldn't believe she was 13 months old. My heart aches whenever I see kids like that. I hope the feeding program will help her.
Some med students at my school have told me that they wouldn't want to be pediatrician, not because they don't like kids, but because they don't like dealing with parents. During my pediatric preceptorship last quarter, I've seen a few parents that were little difficult to deal with, but most of them were easy going.
In Haiti, parents are still parents. Most of them are easy going, but there are always some that are less patient when it comes to caring for their kids. One big difference here at the clinic is that they come at you all at the same time.
As soon as the mothers figured out that I can speak Creole, they started to bombard me with questions and requests. Some repeatedly asked me whether I had their kids' chart yet, and others kept telling me that they're only here to get their kids vaccinated so not to call them into consultation (they were probably worried about being charged for consultation, but vaccinations are free). Many of them giggled if I didn't pronounce the names right when I called them to line up behind the scale. Then there were some mothers that couldn't wait to get their babies weighed and tried to cut in line. So parents tended to make the work a little more difficult, but nonetheless I enjoyed working with kids today.
Later in the afternoon we saw a 67-year old woman named Acephise who has a huge abscess on her right cheek that had just erupted. I saw her couple weeks ago at Dr. Rodney's office with the same problem (before it erupted), but for some reason she hadn't been taking her antibiotics, so the infection had become worse. When I came into the treatment room, the abscess had been drained (Gavin said it was the size of a golfball), and the entire room reeked of rotten green discharge. I almost felt like puking. She now has a hole in her cheek about a centimeter wide. We gave her some antibiotic shots and explained to her that she has to take the medicine or she'll never get better. She'll be frequenting the clinic to get her wound treated.
After dinner we hung out at Amy's house and watched the first episode of Grey's Anatomy from the latest season. It was a real treat for Amy because she hadn't been able to watch it since she came to Haiti.
Thursday, July 17, 2008
Wednesday, July 16, 2008
Death of a Boy, Booster Shots, and Pubic Sore
Wednesday, July 9, 2008
This morning Ms. Prudence told Laura and me that the boy with diphtheria died last night at the hospital. She didn't tell us how exactly, but perhaps the toxin was too widespread. I don't know. I feel like I lost my first patient. At least he survived Monday. I wonder if his family was with him when he died.
The first thing at the clinic this morning, I helped change the dressing on Madelene, the girl with the machete wound. The wound is healing really well, but it's still very wide. Somehow we'll need to make the skin come closer. We're going to try something next time she comes.
Since today is Wednesday, we had Prenatal Clinic. Laura and I took weights and blood pressures for all the pregnant ladies. Many of them had surprisingly low blood pressures. After all the vital signs were taken, I sat in with Amy and Evan, and measured fundus heights and fetal heart rate.
All the staff who had contact with the boy with diphtheria got a diphtheria/tetanus booster shot and those who were in the emergency room with him for a long time got oral antibiotics (erythromycin) for a week. Everyone was complaining all day that their arm is sore from the shot. Luckily, I didn't have to get a shot since I got a booster in February 2006 to prepare for my trip to Sierra Leone. Good thing I brought my immunization record to prove it.
In the afternoon, I worked in the treatment room (aka injection room) mostly giving IM injections. I learned how to give glute shots in Haiti last year to treat a friend with syphilis, but the only source of info I could find on how to give IM shots was some bodybuilding website. So it was good to have Amy (Canadian nurse) and Lizette (Haitian nurse) teach me and get some proper practice.
The last patient we saw was a 17-year old girl who screamed and cried like a baby as I gave her shots of antibiotics. She had a big sore on the upper pubic area. It looked very painful, and the girl was crying and yelling, "I'm gonna die, the doctors are gonna kill me!" Amy and I tried to calm her down as we cleaned up the wound and bandaged it. Looks like she'll have to frequent the clinic to get treated for a while.
Amy joined us for dinner and shared her testimony/life story. Afterwards we played some UNO and then went over to Amy's house to watch John Q. The content of the movie was pretty good, but the quality was shoddy. My favorite part was when the doctor flicked the rubber heart to restart it after the transplant. The movie was basically a political statement on the US healthcare system.
This morning Ms. Prudence told Laura and me that the boy with diphtheria died last night at the hospital. She didn't tell us how exactly, but perhaps the toxin was too widespread. I don't know. I feel like I lost my first patient. At least he survived Monday. I wonder if his family was with him when he died.
The first thing at the clinic this morning, I helped change the dressing on Madelene, the girl with the machete wound. The wound is healing really well, but it's still very wide. Somehow we'll need to make the skin come closer. We're going to try something next time she comes.
Since today is Wednesday, we had Prenatal Clinic. Laura and I took weights and blood pressures for all the pregnant ladies. Many of them had surprisingly low blood pressures. After all the vital signs were taken, I sat in with Amy and Evan, and measured fundus heights and fetal heart rate.
All the staff who had contact with the boy with diphtheria got a diphtheria/tetanus booster shot and those who were in the emergency room with him for a long time got oral antibiotics (erythromycin) for a week. Everyone was complaining all day that their arm is sore from the shot. Luckily, I didn't have to get a shot since I got a booster in February 2006 to prepare for my trip to Sierra Leone. Good thing I brought my immunization record to prove it.In the afternoon, I worked in the treatment room (aka injection room) mostly giving IM injections. I learned how to give glute shots in Haiti last year to treat a friend with syphilis, but the only source of info I could find on how to give IM shots was some bodybuilding website. So it was good to have Amy (Canadian nurse) and Lizette (Haitian nurse) teach me and get some proper practice.
The last patient we saw was a 17-year old girl who screamed and cried like a baby as I gave her shots of antibiotics. She had a big sore on the upper pubic area. It looked very painful, and the girl was crying and yelling, "I'm gonna die, the doctors are gonna kill me!" Amy and I tried to calm her down as we cleaned up the wound and bandaged it. Looks like she'll have to frequent the clinic to get treated for a while.
Amy joined us for dinner and shared her testimony/life story. Afterwards we played some UNO and then went over to Amy's house to watch John Q. The content of the movie was pretty good, but the quality was shoddy. My favorite part was when the doctor flicked the rubber heart to restart it after the transplant. The movie was basically a political statement on the US healthcare system.
Monday, July 14, 2008
Diphtheria Discussion, HIV Support Group, and Flight Change
Tuesday, July 8, 2008
A huge contrast from yesterday, today was a pretty slow day.
After the morning devotions, about once a week we have a meeting to discuss interesting cases and to educate the staff, and diphtheria was the obvious topic for today. It was a miracle that the boy made it to the hospital, and thanks to Dr. Stefan, they were able to speed things up. Gavin talked about different diseases that could present with similar symptoms, and others that we should be able to distinguish.
For the first couple hours at the clinic, Laura and I sat in with the HIV support group. First, the HIV counselor checked in with each patient to see how they were doing, and I tried to translate for Laura. It wasn't so difficult to understand when the conversation was mostly one-on-one between the counselor and a patient, but then I could hardly understand anything when everybody began to talk.
What I caught were something about eating well to stay healthy, coming to the clinic right way if you're sick, and using a condom every time even if both you and partner are HIV positive. At one point they were talking about food and beverages, so I wonder if they were talking about back when they used to get something to eat and drink at support group meetings. Since the government has been cutting the budget for the program we haven't been able to give them food during the meetings for a while now. But honestly, I don't really know exactly what they were talking about.
Near the end, one of the ladies stood up and sang a song about having hope in Jesus Christ. I wish I could understand more of what she was singing. In any case it was good to see the patients having a lively discussion about living with HIV. At the end the counselor asked us if we wanted to say anything, so we just thanked them for letting us sit and listen to the discussion.
About two weeks ago, my older brother Sundo emailed me saying that he and Rachel got engaged and that they are getting married on August 2. Exciting, yes. But the problem with that was that my flight back to the States was on August 9! My brother explained to me that it was the only date that could work for both of them and the families, and that he really wanted me to be there. I was bummed because I was really enjoying my time here in Haiti and also didn't want to miss my brother's wedding.
At first I thought that God wanted me to stay in Haiti, but what changed my mind was when my mother said we are to serve God for His glory all our lives, so coming back a few days early would be acceptable. Also, she wanted me to spend a little more time with the family before I went back to med school in the fall. So I agreed to come back early to be able to attend the wedding.
So today I spent some time on the phone (Skype) with American Airline to change my flight. I ended up paying $170, but I think it's worth going to my brother's wedding. My new flight is on July 31.
I had a Creole lesson with Wadner this afternoon. I hope I'm getting better at listening.
A huge contrast from yesterday, today was a pretty slow day.
After the morning devotions, about once a week we have a meeting to discuss interesting cases and to educate the staff, and diphtheria was the obvious topic for today. It was a miracle that the boy made it to the hospital, and thanks to Dr. Stefan, they were able to speed things up. Gavin talked about different diseases that could present with similar symptoms, and others that we should be able to distinguish.
For the first couple hours at the clinic, Laura and I sat in with the HIV support group. First, the HIV counselor checked in with each patient to see how they were doing, and I tried to translate for Laura. It wasn't so difficult to understand when the conversation was mostly one-on-one between the counselor and a patient, but then I could hardly understand anything when everybody began to talk.
What I caught were something about eating well to stay healthy, coming to the clinic right way if you're sick, and using a condom every time even if both you and partner are HIV positive. At one point they were talking about food and beverages, so I wonder if they were talking about back when they used to get something to eat and drink at support group meetings. Since the government has been cutting the budget for the program we haven't been able to give them food during the meetings for a while now. But honestly, I don't really know exactly what they were talking about.
Near the end, one of the ladies stood up and sang a song about having hope in Jesus Christ. I wish I could understand more of what she was singing. In any case it was good to see the patients having a lively discussion about living with HIV. At the end the counselor asked us if we wanted to say anything, so we just thanked them for letting us sit and listen to the discussion.
About two weeks ago, my older brother Sundo emailed me saying that he and Rachel got engaged and that they are getting married on August 2. Exciting, yes. But the problem with that was that my flight back to the States was on August 9! My brother explained to me that it was the only date that could work for both of them and the families, and that he really wanted me to be there. I was bummed because I was really enjoying my time here in Haiti and also didn't want to miss my brother's wedding.
At first I thought that God wanted me to stay in Haiti, but what changed my mind was when my mother said we are to serve God for His glory all our lives, so coming back a few days early would be acceptable. Also, she wanted me to spend a little more time with the family before I went back to med school in the fall. So I agreed to come back early to be able to attend the wedding.
So today I spent some time on the phone (Skype) with American Airline to change my flight. I ended up paying $170, but I think it's worth going to my brother's wedding. My new flight is on July 31.
I had a Creole lesson with Wadner this afternoon. I hope I'm getting better at listening.
Sunday, July 13, 2008
Respiratory Emergency, Witch Doctor, HIV Orphans, and Diphtheria
Monday, July 7, 2008
Today was the most emotionally challenging day in Haiti so far. So many different things, one after another, kept burdening my heart. Even writing about them causes the feelings to well up again.
First of all, Vicki and Nadine went back to Canada after they had been with us for 2 weeks. It has been so much fun getting to know them through the clinic and just hanging out, playing UNO/dutch blitz, and watching movies. It was sad to see them go, but that wasn't the hard part. After all, we can still keep in touch via facebook/email, and who knows, we may one day see one another again. They both have a heart for medical missions, so I will most likely be in touch with them.
The really hard stuff started with the very first patient we saw today. It was a 6-year old boy who had been having difficulty breathing since Friday night. When he came in, his respiratory rate was about 30 breaths per minute (normal is 12-20), and his heart rate was way up around 160 beats per minute (normal is 60-100). He was breathing so hard that, his chest cavity sunk in every time he tried to breath, just like the baby we saw over two weeks ago. Through auscultation I could here loud turbulent noise during inspiration. Even without using a stethoscope, we could hear a loud noise with each breath. It sounded like his upper respiratory tract (airway above his lungs) was blocked. We could not take a look down into his throat because there was a big risk of further irritating the airway, causing a complete blockade.
We took him to our emergency room (formerly operation room) and put him on oxygen and nebulizer with various medications to open up his airway and gave him several shots of epinephrine, but nothing seemed to work. At some point his respiratory rate was up to 50bpm. I had to auscultate his heart to count his heart rate. I couldn't distinguish the pulses on his wrist because they were faint and beating so fast, even up to about 170bpm. It was horrifying to actually hear a heart beat that fast.
The boy was struggling so hard just to get a descent breath that he would try to take the nebulizer off of his mouth or move his arms around. We all had to work together to hold him up and still. It was especially hard for me to watch him struggle because he resembled Oliguch, one of the orphans with whom I spent 4 months in P-au-P last year. It was heart-wrenching to think that he could actually die if he didn't get his breathing back to normal. We prayed so many times for him as we waited for the medicine to work.
After 3 hours (8:30AM-11:30AM), despite all our efforts, he wasn't getting any better, so we had to take the risk of transporting him to Justinian Hospital, which is over half an hour away. Gavin, Evan, Amy, and Dr. Stefan went to the hospital, while Laura and I stayed at the clinic. Dr. Stefan used to work at Justinian Hospital, so Gavin figured he would be a great help there.
Meanwhile at the clinic, there was a woman lying on a mattress just outside the emergency room. She seemed very sick, and people were gathered around to see what was going on. Soon after we sent the boy to the hospital, a couple guys carried the woman away and left the clinic. Just as they passed by Laura and me, Ms. Prudence came up to us and explained what was going on.
The woman had been diagnosed HIV positive, but she did not tell anyone in her family nor her boyfriend. Now, she was so sick with AIDS that she couldn't even walk. The two men that carried her away were from her family, and they were taking her to a witch doctor because they didn't believe in western medicine. I had heard various things that witch doctors do to their patients, most of which are rather harmful if they did anything at all. It was dreadful to think what they might do to the woman, and how the family could also suffer the consequences of HIV because many of the rituals involve mixing blood or making cuts on people with razor blades.
Then Ms. Prudence told us about two little girls, 4 and 3-year olds, that were brought in by their grandfather a few minutes ago. Both of their parents had died of AIDS, and the grandfather brought them to the clinic basically to say that he doesn't want the kids because he can't feed nor clothe them.
The grandfather said the younger one is HIV positive, so Ms. Prudence had them both tested for HIV. The kids and the grandfather were waiting for the results while she told their story. Then Laura remembered that Gill, one of the long-term missionaries, has a stash of donated clothes at the office, so we went there and brought some down for the girls. I didn't know what to say to the grandfather, so I just walked up to him and handed him what we had. He said, "Mèsi," so I said, "Padekwa," but I still didn't know what else to say, so I just walked away. I felt sorry that this was all we could do for them.
After lunch, the results came back, and it turns out that both of the girls are HIV positive, and the younger one also has syphilis. They were both put on the HIV program and the feeding program, so at least they have access to palliative care and some food. Although, HIV program has been affected by budget cuts from the government, so I don't know what will happen to it in the near future.
Later on I asked the grandfather their names and ages, and he told me that Enya is 4, and Lovely is 3. They are both beautiful and innocent little girls. Ms. Prudence gave them some food to eat here before they went home. As I watched the three of them share a little bowl of rice and beans, my heart ached to think that the girls would have to suffer the consequences of their late parents' misbehavior. And they have no idea what is happening to them.
While Laura and I were still waiting for Gavin and others to come back from the hospital, the two of us assisted Lizette, one of Haitian nurses who works in the treatment room, change the dressing on Madelene, the girl with the machete wound. Augusma, the old man with broken elbow and torn hand, had also been waiting to have his dressing changed since the clinic opened this morning, but his case is more complicated so we waited for Gavin.
Gavin and others finally came back around 3:30PM. It turns out that the boy has, of all things, diphtheria. If you are like me or most people in developed countries, you know that you get vaccinated against diphtheria (usually with tetanus and pertussis) as a kid, but have no idea what diphtheria is. It was quite shocking to know that what I saw this morning was something I would never see in the States. Even Gavin, who has been working at the clinic for 2.5 years, had never seen diphtheria before.
Fortunately, the boy is now intubated (has a tube down to his trachea for ventilation) and stable. However, besides blocking the airway with the formation of false membrane in the throat, diphtheria can cause fatal heart and nerve damage by the toxin released by the bacteria. Antitoxin is being administered, but we really don't know what will happen to him, especially because he has already been very ill since Friday. We'll have to continue praying for him.
Since diphtheria is highly contagious, and we had been in close contact with him for 3 hours in a confined space with no air-conditioning (plus he was on nebulizer, which makes water droplets that helps the bacteria travel through air), we need to be concerned for ourselves and those who come in contact with us. As a precaution, all of us went straight home, rinsed our shirts, and took a shower. Thank God we're vaccinated.
At dinner there were just the three of us: Laura, Evan, and me. It was a bit quiet and lonely, but I'm glad I still have the two with me. Afterwards we invaded Amy's house, which we'll probably be doing most of the nights from now on, and watched Spanglish. I was doing stuff on my computer (writing email, catching up on blog writing/reading) so I didn't pay much attention to the movie, but it seemed like a good movie from what I got out of it.
Today was a very long and emotionally draining day, but a kind of day that I would never want to forget.
Today was the most emotionally challenging day in Haiti so far. So many different things, one after another, kept burdening my heart. Even writing about them causes the feelings to well up again.
First of all, Vicki and Nadine went back to Canada after they had been with us for 2 weeks. It has been so much fun getting to know them through the clinic and just hanging out, playing UNO/dutch blitz, and watching movies. It was sad to see them go, but that wasn't the hard part. After all, we can still keep in touch via facebook/email, and who knows, we may one day see one another again. They both have a heart for medical missions, so I will most likely be in touch with them.The really hard stuff started with the very first patient we saw today. It was a 6-year old boy who had been having difficulty breathing since Friday night. When he came in, his respiratory rate was about 30 breaths per minute (normal is 12-20), and his heart rate was way up around 160 beats per minute (normal is 60-100). He was breathing so hard that, his chest cavity sunk in every time he tried to breath, just like the baby we saw over two weeks ago. Through auscultation I could here loud turbulent noise during inspiration. Even without using a stethoscope, we could hear a loud noise with each breath. It sounded like his upper respiratory tract (airway above his lungs) was blocked. We could not take a look down into his throat because there was a big risk of further irritating the airway, causing a complete blockade.
We took him to our emergency room (formerly operation room) and put him on oxygen and nebulizer with various medications to open up his airway and gave him several shots of epinephrine, but nothing seemed to work. At some point his respiratory rate was up to 50bpm. I had to auscultate his heart to count his heart rate. I couldn't distinguish the pulses on his wrist because they were faint and beating so fast, even up to about 170bpm. It was horrifying to actually hear a heart beat that fast.
The boy was struggling so hard just to get a descent breath that he would try to take the nebulizer off of his mouth or move his arms around. We all had to work together to hold him up and still. It was especially hard for me to watch him struggle because he resembled Oliguch, one of the orphans with whom I spent 4 months in P-au-P last year. It was heart-wrenching to think that he could actually die if he didn't get his breathing back to normal. We prayed so many times for him as we waited for the medicine to work.
After 3 hours (8:30AM-11:30AM), despite all our efforts, he wasn't getting any better, so we had to take the risk of transporting him to Justinian Hospital, which is over half an hour away. Gavin, Evan, Amy, and Dr. Stefan went to the hospital, while Laura and I stayed at the clinic. Dr. Stefan used to work at Justinian Hospital, so Gavin figured he would be a great help there.
Meanwhile at the clinic, there was a woman lying on a mattress just outside the emergency room. She seemed very sick, and people were gathered around to see what was going on. Soon after we sent the boy to the hospital, a couple guys carried the woman away and left the clinic. Just as they passed by Laura and me, Ms. Prudence came up to us and explained what was going on.
The woman had been diagnosed HIV positive, but she did not tell anyone in her family nor her boyfriend. Now, she was so sick with AIDS that she couldn't even walk. The two men that carried her away were from her family, and they were taking her to a witch doctor because they didn't believe in western medicine. I had heard various things that witch doctors do to their patients, most of which are rather harmful if they did anything at all. It was dreadful to think what they might do to the woman, and how the family could also suffer the consequences of HIV because many of the rituals involve mixing blood or making cuts on people with razor blades.
Then Ms. Prudence told us about two little girls, 4 and 3-year olds, that were brought in by their grandfather a few minutes ago. Both of their parents had died of AIDS, and the grandfather brought them to the clinic basically to say that he doesn't want the kids because he can't feed nor clothe them.
The grandfather said the younger one is HIV positive, so Ms. Prudence had them both tested for HIV. The kids and the grandfather were waiting for the results while she told their story. Then Laura remembered that Gill, one of the long-term missionaries, has a stash of donated clothes at the office, so we went there and brought some down for the girls. I didn't know what to say to the grandfather, so I just walked up to him and handed him what we had. He said, "Mèsi," so I said, "Padekwa," but I still didn't know what else to say, so I just walked away. I felt sorry that this was all we could do for them.
After lunch, the results came back, and it turns out that both of the girls are HIV positive, and the younger one also has syphilis. They were both put on the HIV program and the feeding program, so at least they have access to palliative care and some food. Although, HIV program has been affected by budget cuts from the government, so I don't know what will happen to it in the near future.
Later on I asked the grandfather their names and ages, and he told me that Enya is 4, and Lovely is 3. They are both beautiful and innocent little girls. Ms. Prudence gave them some food to eat here before they went home. As I watched the three of them share a little bowl of rice and beans, my heart ached to think that the girls would have to suffer the consequences of their late parents' misbehavior. And they have no idea what is happening to them.
While Laura and I were still waiting for Gavin and others to come back from the hospital, the two of us assisted Lizette, one of Haitian nurses who works in the treatment room, change the dressing on Madelene, the girl with the machete wound. Augusma, the old man with broken elbow and torn hand, had also been waiting to have his dressing changed since the clinic opened this morning, but his case is more complicated so we waited for Gavin.
Gavin and others finally came back around 3:30PM. It turns out that the boy has, of all things, diphtheria. If you are like me or most people in developed countries, you know that you get vaccinated against diphtheria (usually with tetanus and pertussis) as a kid, but have no idea what diphtheria is. It was quite shocking to know that what I saw this morning was something I would never see in the States. Even Gavin, who has been working at the clinic for 2.5 years, had never seen diphtheria before.
Fortunately, the boy is now intubated (has a tube down to his trachea for ventilation) and stable. However, besides blocking the airway with the formation of false membrane in the throat, diphtheria can cause fatal heart and nerve damage by the toxin released by the bacteria. Antitoxin is being administered, but we really don't know what will happen to him, especially because he has already been very ill since Friday. We'll have to continue praying for him.
Since diphtheria is highly contagious, and we had been in close contact with him for 3 hours in a confined space with no air-conditioning (plus he was on nebulizer, which makes water droplets that helps the bacteria travel through air), we need to be concerned for ourselves and those who come in contact with us. As a precaution, all of us went straight home, rinsed our shirts, and took a shower. Thank God we're vaccinated.
At dinner there were just the three of us: Laura, Evan, and me. It was a bit quiet and lonely, but I'm glad I still have the two with me. Afterwards we invaded Amy's house, which we'll probably be doing most of the nights from now on, and watched Spanglish. I was doing stuff on my computer (writing email, catching up on blog writing/reading) so I didn't pay much attention to the movie, but it seemed like a good movie from what I got out of it.
Today was a very long and emotionally draining day, but a kind of day that I would never want to forget.
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