Tuesday, March 4, 2014

Tuesday, March 4:

  • 7 am: Breakfast

  • 8 am: One team departed for Simonette for mobile clinic and one smaller team stayed at HCM to run clinic and work on surgeries!

  • 10 am – 4 pm: Clinic at Simonette, 116 patients + dental patients today, plus 20 patients at HCM!

  • 6 pm: Return to HCM from mobile and meet up with our awesome OR team.

  • 7:30 pm: Dinner and team meeting (plus a few deliveries in the OB/GYN clinic!).

Thoughts for today’s blog provided by Jonathan B, Joanne B, and Jacob B. The A Team! 🙂

Unloading for clinic!Pharm TeamJA at clinicBus fun!Bus fun part 2

After a 2-hour drive, we arrived at the church in Simonette where we set up clinic for the day.  As I was working with adults instead of kids, I knew today would be pretty different, but I had no idea what we were in for.  One of the first patients in the morning came in and gave us her intake sheet – “breast mass”.  My heart sunk, as I realized the implications of that complaint in the remote village that we were working in.  I was hoping against hope as we asked the relevant questions: How hard is it? How long has it been there? Has it changed in size? Is it fixed or moveable?  None of the answers gave us much hope, and our fears were confirmed when we did a breast exam.  There was definitively a small, hard, fixed mass in her breast, and Dr. Harman also found some swollen lymph nodes whereby we concluded that this woman likely had breast cancer.  How do you approach such a diagnosis in Haiti?  In America, we could send her for a mammogram, then an ultrasound, then a biopsy, and then get a coordinated and focused team to handle her treatment.  It would be an intensely challenging several months or years, the treatment would be harsh, and there would be a lot of fear and uncertainty, but her chances of surviving, fighting through it, and coming out a survivor would be relatively high.  However here, none of those options were at our disposal.  With our resources, we were prepared to treat minor infections and straightforward pain, not cancers requiring a plethora of resources and specialists.  We were able to refer her to the Medishare Hospital in Port-au-Prince, but it was not a satisfying treatment.  Even as she was leaving, she asked how she would get there, whether she would have to pay, and what there was that could be done.  She deserved answers, treatment, and most of all hope.  But we were left helpless.  And I think it is important that the whole experience felt wrong.  We’re training to be doctors; we want to help people in their journey towards health, not merely put a diagnosis and send them off into the unknown, maybe to receive treatment, and maybe not.  I know that we have to take things one step at a time, but moments like this give me a desire to continue working for access to necessary health care here.  I want to be a part of bringing quality treatment to people who truly need it and have no other way of getting it.  And I think that’s part of what Project Haiti is trying to do, one step at a time.  While the rest of the day was certainly interesting, and we all learned a lot, that woman stuck with me, even as we were driving back home.  I hope she will make it to the hospital and be able to get treatment, and I know her story will motivate me to continue making partnerships like this a part of the normal rhythm of my medical life.

Of the patients I encountered today, Mrs. M was the most memorable. She was a slightly overweight Haitian woman in her late 40s, who wore a brown skirt, an oversized white shirt and a pair of dusty sandals. Mrs. M’s primary complaint was of intermittent lower back pain that traveled down both of her legs. Upon greeting her and introducing myself I began to ask her the usual questions: can you point to where your back pain is? When did you first experience the pain? Is there anything that prompts your pain? It soon became clear that the source of her back pain was how she washed her laundry; when washing her clothes, Mrs. M stated that she sat on the floor and bent forward. That is when she experienced the most pain. “M konprann [I understand]” I said as I nodded and scribbled it down. I then asked if anything made the pain better.  “Priye [Prayer]”, she said, “mwen priye epi doule a sispann [I pray and the pain stops]”. At that point I stopped writing and met her eyes. She was smiling. The people of Haiti truly had unwavering faith.  Faith in their God, faith in their community and faith in what we came to Haiti to do. Without their trust and confidence in our healthcare, we wouldn’t be here. For this I am truly grateful.

The rooster outside my window has become my best friend, at 4 am… Well, not really, but not having to set an alarm this entire week is a great reprieve. The fact that every morning I wake up and realize that I’m in Haiti is an amazing feeling. The days have been long and the roads have been tough, literally, but my experience thus far has been one of a kind. Between the orphanage, the 30 minute hike up a mountain for clinic, and the amazing patients I still can’t believe how much of a privilege it is for me to be a part of this trip. Today was especially memorable. Between the standard mix of complaints I saw a 24-year-old girl with a presentation I knew I had learned about, but never seen in person. She came to clinic with a 102 fever, generalized body pain, headaches, abdominal pain and joint pain, all of which had been going on for 3 days. I began asking her the generalized questions of when did it start, how long as it been going on, is it getting better, where does it hurt, etc. and I started to think about what she could have. The language barrier was proving to be extremely difficult and between the interpreter and another medical student we kept getting different time frames for how long she had been sick. Eventually, through some rephrasing, we found out that it been going on since February, always in 3-day cycles. We suspected malaria and we needed to get her tested and treated quickly. While today I learned a lot in regard to medicine I also learned a lot about barriers to healthcare. We didn’t have a way of testing for malaria and we didn’t have the meds to treat her either, they were all at HCM’s clinic. We contemplated our options and determined that the best was for her to go to the free government clinic to get tested and treated. We gave her some Tylenol for the fevers and sent her on her way, hoping she understood how serious this diagnosis was and how important it was for her to get treatment. I’ll never know if she will actually make the journey to get treated at the clinic, but I will always remember her. She was my first malaria patient, the first spleen I ever felt, and the first diagnosis I made that could save someone’s life. Becoming a physician is a long, tough road, but everyday patients like her remind me why I chose this field.