Vent fait mal

(Above: The twins, Asna and Asli. After collecting water at night from the pump)

Alas, the last day here rendered doctor Patti and me the patients. We got hit by some bug - which has hopefully worked it's way out. Thank goodness for Gatorade.

Amidst the not feeling well and spending some hours in bed, I was able to tie up lose ends. The nurses at the clinic gave us thanks and told us that the week was certainly satisfying. I took pictures of the kids playing in the school yard and conversed with some friends about Hatian politics. I napped. I read a bit. Almost like a vacation.

I will post photos on each entry when I get home. Keep checking back.

Aurevoir de Haiti. Na we plu tot...

Not for the weak-of-stomach

I left the clinic at 5pm today - dirtier than I care to admit. While showering (after a run (cous!) through the thorny mountains with our entourage of faithful supporters), I realized that the white wash cloth I was using was turning grey. How gross.

Things are just plain dirty here in general. Getting totally clean is hard amidst the loose dirt, the dust, the lack of roads and plethora of mud after a rain. Working in a clinic adds a new dimension: snotty noses cut up feet, reports of gross internal bugs and multiple diagnoses of the external ones (they will remain nameless for the weak of stomach). Showering today felt good - but while rinsing my grey cloth, I thought about Asna - the gorgeous young woman, one of the twins, whom I had just seen carrying her huge plastic bucket of water on her head with sweat dripping down her temples and face. Will she shower in that water? Or is that bucket, pumped from a well, the drinking, bathing, and cooking water for her entire family? Getting clean here for me is easy within the confines of these mission walls, but to most rural Haitians, this task is next to impossible. It is no wonder that worms and scabies (oops, I said it, I itch already...) are present in almost everyone we see at the clinic.

Worms: the theme of the day. Suprisingly, however, people do not present here with a chief compliant of worms, as I certainly would if I knew I had them. They present with "cough (tous), cold (gripe), stomach ache (vent fait mal), head ache (tet fait mal), fevers (fievrela) and chills (tremble). However, it only takes the question "do you (or your child) have worms?" to make an easy diagnosis with the answer "yes." Having worms must just be a way of life. Today, each child whose mother said she had worms, received a dose of medicine for the child, one for each of her numerous siblings, her mother, and father. We then gave them a bar of soap and a lesson on the importance of hand washing and the dangers of playing in the dirt. Hopefully this tactic will rid the family of a worm burden for a few months. Having worms is not just gross - but perpetuates a cycle of malnutrition. The worms eat the precious food and use the scarce nutrients from the food the kid eats. This makes them more malnourished, have a weaker immune system, and more likely to eat dirt (the food which often gives them worms). Yuck.

On a more positive and less gross note - things have gone very well at the clinic thus far. I have been working with one American partner and two Haitian nurses in our exam room. Today I felt that we truly collaborated with our ideas and skills. We took turns listening to lungs, peering into ears, pressing on pregnant bellies and shining lights on itchy skin. We talked about why we did and did not think that the patients before us had malaria, typhoid, a bacterial or a viral infection, and talked about what to do. The conversations were in French, mixed with my newly acquired Creole and their newly acquired English. At the end of the day I had no usual reservations about sustainability or importance of what happened today. I think that Narlane and Rita, the two wonderful nurses who I collaborated with learned (if they are lucky) as much as I did today. They gained a new perspective on the people they see every day - and I learned about how people look with illnesses I see only once a year.

On an even MORE positive note - I need to mention the World Cup. Folks here, like everyone around the world I suppose, are into it - and huge fans of Brazil. Yellow and green shirts (not dirty at all) pop up all over the place. I had one patient today who refused to wait for a Malaria test because "Brazil and Japan are playing in a half hour..." I jokingly smacked him on his head with the anti-acids I handed him and sent him on his way. Perhaps a radio version of a good match and a last minute goal from Rinhaldo is as good of a medicine as chloroquine.

SIDA

AIDS is a taboo subject here. I found out yesterday that people who are dying of AIDS or infected with the HIV virus are not told that they have AIDS – only family members are privy to that information. As an explanation, I was told “people die faster if they know what they are sick from, so they are not told so that they do not give up.”

This logic is so flawed that needn’t be discussed here – but the concept is no less disturbing. In an English lesson yesterday with two aspiring interpreters, we went over the chapter on health related terminology (I figured I could pick up some Creole at the same time). When we got to the word AIDS (sida, in Creole), I asked them. “Is there much AIDS in Haiti?” Jean-Willy responded, “Well, people say that the tests come up positive, but how can we believe them because no body here is dying from it.” That is disturbing.

One non-profit estimate that there are 190,000 people living with HIV in Haiti – 3.8% of the adult population - and 16,000 deaths a year from it. However, I am not sure that I trust these statistics. Tests for HIV are hard to come by and people are even more reluctant to go for testing because after a positive outcome – many services are rendered impossible, not to mention the social ostracism that must ensue. The EMT who is traveling with us explained to me that at the hospital in Gonieve where he had previously done some work, the surgeons did not perform surgery on HIV positive people out of fear. In this small village of LaCroix, I know of one woman who is dying (although she does not know it is from AIDS) and two who just died, orphaning a two year old who visited our clinic (he looked healthy, which is a good sign).

There is no public campaign here, from what I can see. There are no signs like “SIDA kills”, or a drawing of a scary monster chasing a healthy white blood cell present on the streets. I have not seen one condom at the clinic or on the street as trash. None of my patients report using condoms – if they are honest about having sex to begin with. In a conversation with Pastor Pierre, who is the resident expert on many topics, he said, “all the cases of HIV in Haiti come from people who travel to the Dominican Republic.” While there truth to the transmition via Dominican prostitutes and Haitian truck drivers, it is not good that the most educated man in town believes that if someone hasn’t been to, or isn’t sleeping with someone who has been to the DR, that there chances are nil. 190,000 people suggests that it is more wide spread.
I worry that it will become a public campaign when it is at crisis proportions. Dating publicly before marriage here is not ok – but people are certainly having sex. Haitian thoughts about the disease are mixed with ideas of voodoo causing sickness, of fear, of social taboos around sex, and most importantly, of a gaping lack of sexual and basic education. This is not the trip to tackle it – but it is on my mind and repeated fungal infections and thrush in young adults makes me wonder…

The blind leading the blind

Today's running mantra was 'do no harm,' and it is with that thought that I made most treatment and diagnostic decisions at the clinic today. Treating Haitian patients is fraught with problems and left me feeling unsure at the end of the day if what I did was right and if it helped at all.

One of the problems is that it's hard to get what the medical community calls a 'review of systems' because the answer is always 'yes.'

For example: a woman walks into the clinic and sits down in a chair (to sit: chite). "Sa ou gane?" (what do you have? or what ails you?) "Fievre." And then it begins.... 'do you have a cough?' 'yes' "do you have any nausea or vomiting?" "yes" "do you have trouble breathing?" "yes" and so on and so on until every differential diagnosis that has run through my head (Typhoid, Malaria, regular viral infection, etc) has been cancelled out and I am left with only the word "sick."

To make matters more complicated, the Haitian sense of time seems to be a bit different and many people explained, when asked "how long have you been feeling like this", "22 days." I do not know what is special about the amount 22 , but many people seem to have been sick since around May 28. Decisions about diagnosis and treatment were thus made around a physical exam (did they look sick? did they have a fever? were they losing weight?) and my mantra "do no harm". If medications for the potential illness could hurt, I did not give them. Thus, I treated many cases of malaria today, suppressed a lot of coughs, rehydrated those who may need it, reduced fevers, gave out vitamins, and treated some pretty bad looking fungal infections on little boy's heads.

When discussing this with Pastor Pierre, the leader of this project, his thought was that if they answer 'yes' to every question, we will give more medications and those can be used to treat other people in the family - or saved for the future. They pay a flat fee ($30 Haitian dollars, about $4USD) to use the clinic, and all medications are included. This sounds like a good reason to say "yes" to me.

All in all, the 33 people we saw today - and perhaps their family members - may sleep easier, breathe easier, and hopefully will feel well cared for tonight - as the Haitian heat pulses, the crickets chirp, and the heat lighting flashes...

Sunday in LaCoix

Haiti, Day 2

Outside the air is thick and heavy and while it is visibly clear, there is no breeze. I can see more stars than I new existed because without my mega-light (thanks dad), there is none. It is hot and if I was not trying to separate my self from the mosquito's and other flying insects, the best outfit would be a bathing suit.

Today, while the official day of rest, was full. It began with a two hour church service in which we (the seven Americans here) were treated as esteemed guests although we looked more awkward and sweaty than anyone, clutching water bottles and holding cameras. Upon entering the church, each member of the community shook our hands, and the old ladies kissed us wetly on our sweaty cheeks. Each person said welcome in their own way: my favorite? Baby Jeffrey that I was lucky to be holding peed in my arms. The church service, accompanied throughout by 17 year old Woodsie on the Guitar, two young drum players, and an aspiring keyboard artist, was full of music, of clapping, of lace on heads, and of joy. Truly incredible smiles and thanks in the midst of striking poverty.

After PB and J offered to us on white bread for lunch, we left for the clinic. I grinned to see that the pharmacy that Patti (the physician with whom I am traveling) spent many hours organizing and labeling last year was still organized. The clinic showed a striking improvement from last year when the pharmacy was cluttered and full of mouse-chewed bottles of expired meds. As we sorted our brought meds and placed them in their proper place on the shelves, I chatted with Judette, the the new nurse who works as a provider in the clinic. She impressed me with her knowledge of medication uses. She, a new grad like myself, works as a full provider in the clinic each day except for the two days a week when Cuban doctors visit. We shared blow-pops and laughed at funny uses for medications. Nurse humor, I suppose.

We then walked around the small village of LaCroix, flanked on either side by kids who ran to hold our hands and play games as we walked. Jason, a 19 year old, wanted to hold mine. I told him he was too big and chose to hold the hand of an adorable 7 year old with braids who spoke no French. After 'quel age ou' (how old are you) and 'what is your name?' we ran out of things to say, but we squeezed each others hands and enjoyed the scenery of the overflowing busses zooming past us. On the walk we past a coconut tree and all sampled warm coconut water released by machete. Some of the prepared kids whipped out spoons and began eating the soft meat. Note to self: always bring a spoon.

I am nervous about what tomorrow will hold. The plan is for an EMT from Vermont and me to run one exam room and Patti and a medical assistant from my old clinic in Vermont to run the other. As much as I learned this year, we did not learn diagnostic skills, and certainly did not specialize in tropical medicine. I hope that my knowledge of medications, my ability to give a darn good bed bath, and prior experience here will see us through.

In the words of my Haitian friend Mezier who is taking his national exam tomorrow - "Pray for me."

Nous sommes arrivee!

Haiti, Day 1

Or day 0.5, rather. I arrived, through billowing clouds, from New York to a place so totally different that it is hard to believe it is only 3.5 hrs by plane and in the same time zone.

It feels great to be in Haiti again. Greeted by live music as we walked off the plane, with the strong sun shining, I waltzed into this week smiling. The four hour, ninety mile bus ride only made me want to shoot photos and stop and explore.

Perhaps it is my bias, because I want to see improvement, but I have noticed changes since I made the same bus ride over a year ago. 1. The airport was more organized. We did not bribe the customs officials with Viagra and children's chewable vitamins to let us in, tax free. Instead, women and men in uniform inspected the bags and did not even ask for the lollipops on the surface (I, however, had no self control and took two for the bumpy bus ride). We were not mobbed by kids or taxi drivers, but instead found our new white four by four only needing to wave off one man who called 'maman!' through the gate. 2. There was more concrete on Route one, and therefore less huge pot holes. 3. There were no road blocks at all, whereas last year there were at least two. 3. There were no UN officials standing with loaded guns on the roof of their building. Instead, they were sitting in the shade and waved. Over dinner I asked Pastor Pierre, the boss of this complex, if it was too late to talk politics and if not, what changes he noticed since the election of Rene Preval. He said that it is calmer and there have been improvements, if only slight. I concur.

But some things are still the same, and for this, albeit selfishly, I am glad. The rooster still crows the announcement of sunset. The kids I met and played with last year still remember me and want to run ('Cous!!!'), stupidly through the thorny hills to accompany the silly Americans while we stretch our legs. The two twin girls whom I photographed last year still look like models, if only more beautiful.

Tomorrow we will set up our two exam rooms in the clinic with our brought medications and vitamins and prepare to open on Monday. If I can just sort out the French from the Spanish that are currently making word-salad in my brain, I will be all set. I am excited for what the week may hold and hope that I can leave as many smiles as received me.

Thank you to all who helped support this trip - both fiscally and emotionally. Keep checking back if you want updates. I will try to write daily if the power stayes on long enough.