Haitian Courier #6: Pieces of My Memoirs

[This is a copy of the latest issue of my newsletter Haitian Courier, which was sent on July 26. To subscribe to the newsletter, please visit http://groups.google.com/group/haitian-courier]

Bonjou Mezanmi!

My last newsletter was a brief update just to let you know that I'm alive and well. This time I wanted to give you snippets of what I've been doing in Haiti for the past 6 weeks. Throughout this newsletter, you'll see words with web links, which will take you to corresponding entries on my blog.

First of all, I wanted to let you know that my return flight has changed from August 9 to July 31. The reason is that my older brother Sundo is getting married on August 2. So now I only have a few more days before I go home! Seems like my plans always change on the fly (last year I decided to stay an extra month in P-au-P). I can't believe my time here is almost over!

Secondly, I wanted to put a word out that the clinic here needs an X-ray machine to replace a broken one. Please let me know if you know anyone who needs to get rid of an old machine to replace it with a new digital one or for whatever reason. The one we have here has been broken for a while, and it would help so many people if we had a working X-ray machine.

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.

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.

Malnourished Baby, HIV Test, Wadner's House, and Vicki's Birthday

Thursday, July 3, 2008

Today was Well Baby Clinic, so Nadine and Vicki helped out by admiring the little babies taking weights and temperatures, giving vaccines, etc. Amy and Evan consulted patients (mostly babies today) together as they have been doing this week. I shadowed Dr. Rodney this morning, so I got to see sick patients including babies. We saw one 8-month old girl who weighed a mere 5kg, which is way below normal (lower limit is 6.5kg). She was so skinny and small, and it was heartbreaking to see her. Her mother brought her in because the baby was having fever and diarrhea. We gave her medicine for the symptoms, and put her on the nutrition program (part of the World Food Program) to help her gain the much needed weight. I'm so thankful that we have these programs to help little babies like her.

Another patient we saw was a young man who had headaches and some kind of rash on various parts of his skin. I can't remember exactly, but I think he also had a little abscess of some sort on his neck. He reminded me of a Haitian friend from last year who turned out to have syphilis. Just as I was thinking this patient might have some kind of sexually transmitted disease, Dr. Rodney asked the patient if he wanted to get tested for HIV. The patient seemed hesitant and concerned about the cost of the test, but I could tell that he was relieved when Dr. Rodney said the tests are free of charge. Dr. Rodney explained to the patient about the pre-test consultation where they educate patients about STDs and HIV as well as ask risk assessment questions. I didn't get to see the results (I was probably eating lunch when Dr. Rodney saw him again with the results), but it was good to see how cases like this was handled in consultations (and that my instincts weren't far from Dr. Rodney's line of thought).

In the afternoon, Amy, Nadine, Vicki (three Canadians), Laura, Evan (two N. Irish), and I reorganized the operation room into an emergency room. While we were going through stuff around the room, we found some circumcision kits, and had a little laugh while Amy explained how to use it. It's basically a metal clamp that cuts the circulation to the foreskin and act like a stencil to direct the incision. The others almost seemed appalled to see it, but I wasn't surprised at all because I had seen one similar to it at my pediatric preceptorship last quarter. Apparently they had never seem those in Canada or Northern Ireland... but I bet they use them, too.

Vicki and I reorganized the little storage room next door. I was impressed by the variety and quantity of stuff we had, but it was a bit difficult to figure out what should go where. Also the room wasn't well ventilated, so we were kind of sweaty. Overall, I think we got a lot of work done in both rooms.

Afterwards I had a Creole lesson with Wadner for an hour, then the six of us (three Canadians, two N. Irish, and me) took a walk outside the compound walls. We briefly visited Wadner's house. Wadner is 25, and since his father passed away, he's been looking after his mother, his three sisters, and his niece. He's building his own house on the land given to him by his grandfather. Wadner also built a pretty intricate workout machine in his uncle's house next door. I was thoroughly impressed by how he maximizes the little resources that he has.

Today is Vicki's birthday, and we had planned to give her a little gag gift. The plan was to steal some of her clothes, put them in a box, and give it to her as a present. I got this idea from my birthday two years ago in Kenya when some of the missionaries pulled it off on me. The entire time we were reorganizing the operation room (now emergency room), I was looking for a small cardboard box, which we eventually found. Luckily, just as we got back from the walk, a few of the local kids showed up wanting to play some football (soccer), so Vicki enthusiastically went out to play with them. Meanwhile, Nadine (Vicki's roommate) helped me steal some of Vicki's clothes. Actually Nadine ended up stuffing the box with most of Vicki's clothes. We taped it up and hid it up at the Holiday House (that's where we eat our meals). Soon after that, I realized that, since Vicki was playing football, she'll want to come back to her room to change before dinner. So I decided to join her to keep her playing until dinner time and convince her to go straight to dinner instead of changing. It worked out just as I had planned. Oh, the power of suggestion!

After lunch today I had asked the kitchen ladies to put some candles on the dessert tonight. They said that if I had asked them earlier, they would have made a cake, but instead they had already made some jello. So after dinner, we lit up a few candles on a bowl of jello and sang happy birthday for Vicki. Then I brought out the box and gave it to her. She looked excited and nervous because we were all giggling. She opened the box and the first thing she said was, "Oh, my skirt!" She dug further and said, "This is all my clothes!" We had a good laugh.

After dinner, we went over to Amy's house, and Vicki, Nadine, and Laura got a pedicure from one of Amy's Haitian friends while we watched August Rush. I really liked the soundtrack.

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...

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.

OMS Tour, Prenatal Checkup, Vaginal Exam, Epilepsy, & Optometry

Wednesday, June 18, 2008

This morning I went on a tour of the OMS International mission compounds around Vaudreuil with the new team plus Jen. First we went to see the clinic, which is right next to where I'm staying, then we drove a few minutes down the road to the new Radio 4VEH station (VEH stands for Voix Evangélique d'Haiti or Evangelical Voice of Haiti, and 4V is the radio station code for Haiti). The old station is located in the compound where we're staying, and Radio 4VEH has been running for the past 58 years or so.

Next we drove to the new seminary site. They are still building the place, and the new team is here to help out with that. Jen and I returned to the clinic while the team stayed at the construction site to work there.

Just to introduce the new people that came yesterday: Julie is an RN who was a missionary here 6 years ago. She brought a team with her, 4 of them are teenagers from her church, Tyler, Ali (Alison), Matt, and Jacob. Then there's Kelly (high school social studies teacher), Cindy (middle school technology advisor from Tennessee), and a couple from Alabama, Heather and Mike, who is a pastor. Christine (lab technician) and Jen (college student) came with this group as an addition to Tim's group. So they're helping out at the clinic lab.

Wednesdays are prenatal checkup days, so I shadowed Gavin while he consulted pregnant women. I learned how to measure fundus height and find fetal heartbeat with a handheld ultrasound machine. One lady who is 3-months pregnant was having vaginal bleeds, so Gavin checked to see if the cervix was open and assess risk of miscarriage. This was the first time I've ever seen a vaginal exam done. It seemed painful for the patient, and definitely wasn't a pleasant sight, but it's something that I'll need to be familiar with some day.

One of the pregnant women was HIV positive, so Gavin told me that HIV+ pregnant women can get ARV treatment at a hospital for free. Like I said in my last post, people who are HIV positive are referred to a hospital for ARV treatment when their conditions become too bad, and I found out that they also get ARV for free, but only when their condition is bad enough.

One of the non-pregnant patient we saw was a woman who's been epileptic since she was little. One time she had a seizure and broke her left humerus (bone of upper arm) at two places. A while ago she had a surgery to put a big nail along the center of her humerus, but the tip of the nail sticks out under the skin at her left shoulder. She's been on carbamazepine (my classmates should know what class of anticonvulsant this is) and hasn't had a seizure since. She can't speak but can make sounds with her voice, and she's very outgoing and expressive with her arms and face. (Now, where's the lesion?) She was brought here by her mother from far away as many people travel several hours to get here.

Gavin was done seeing patients a bit early today (we've been having less patients since Christmas time because less people have been able to afford to come here due to rising food prices), so I joined Carly and Anna at the optometry. They brought a bunch of frames and lenses from the States and have been making glasses for patients here. Usually they just ask questions like, "Do you have problem seeing far or near?" but sometimes the answers aren't just yes/no or far/near. Some people give complicated answers like, "When the sun is high or if I cover one eye, I can't see well." Even I have to ask them to repeat several times to understand what they are saying, so I'd imagine it'd be a lot harder for Carly and Anna who hasn't spent as much time in Haiti. Nonetheless they seem to be doing a great job... and I'm not saying that just because they're probably reading this.

After dinner, one of the missionary couple's daughter Kaeli, who is 8 years old, brought a deck of UNO, so a few of us played UNO with her. I hadn't played UNO in such a long time. I think I should play more card games with my friends in med school. After we sent Keyleigh to bed, we played what my friends call Hillari-picto-pass, which is basically a chinese telephone with pictionary but you alternate between drawing and writing caption. As usual, it was a fun game.

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.