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.

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.

Goodbye Julie, Blood Drawing, Car Accident, and Augusma

Wednesday, July 2, 2008

Julie (physio from N. Ireland) left this morning. It's always sad to see people go because we all quickly become like family. She was the first person from Northern Ireland that I had ever met (then I met three more within a week). Now she's the first person from Northern Ireland whom I said goodbye to. It's been really cool getting to know her.

Today was prenatal clinic. Before seeing patients, Ms. Ketlye gave an educational talk to all the pregnant women. Vicki and Nadine helped out with weighing and taking blood pressures, and Laura sat in with Amy and Evan. Meanwhile I shadowed Dr. Rodney until he left to see Julie off at the airport. Then I went to the lab where I drew some blood and did a bunch of finger sticks. I drew three blood, two of them from little boys (about 10-12), and all of them went smoothly, so I think I'm getting better at this. But I still need more practice on patients with veins that are hard to see (Laura, are you still up for being a guinea pig?).

When I came back to the clinic from lunch, there had been a car accident where three people were brought to the clinic. In the treatment room (a.k.a. injection room) we had a 75-year old man named Augusma who fell on his right side and had people pile on top of him in the accident. I heard there were two girls from the accident in some other rooms crying very loud, but they were not in as serious of a condition as the old man.

When I came in, Augusma was lying quietly on the table as Dr. Rodney cleaned his wound. A big flap of skin on the back of his right hand had been teared open, so we could see his muscles and tendons. We could tell that he was in pain, but he was moaning very quietly. Gavin told us that in accidents like this, it is important to look for people who are lying quietly among others who might be screaming for help, because often times those who are silent are the ones in more serious conditions.

Gavin sutured his hand, including an artery that had teared under the flap and a small laceration on his right palm. Laura, Vicki, and I took turns keeping the big overhead lamp in place and holding Augusma's other hand. Meanwhile Nadine and Evan helped out with the prenatal clinic. After Gavin finished suturing and bandaged the wound, Augusma still had pain when moving his right arm, and the elbow was swollen, so we took him to the X-ray clinic, which is 10 minutes down the street from us.

As we waited at the X-ray clinic for the film to develop, Augusma shared how thankful he was that he survived the accident and praised God for sending us to take care of him. He prayed and gave thanks to God, and then started singing "Mwen renmen Jezi, mwen renmen Jezi, pou tout sa li fè pou mwen" (I love Jesus, I love Jesus, for all that he does for me). I was really inspired to see how much faith he had in God.

The X-ray showed that he had fractured the proximal neck of radius (bone of forearm on thumb side) and the olecranon (tip of elbow). So we went back to the clinic and put a cast on his arm. Augusma once again shared how thankful he was, sang the song, and prayed. He has such a bright personality. He'll be frequenting the clinic for further treatment. I'm looking forward to seeing him again.

Today was a very long day.

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...

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.