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.