Haiti Day 3:
Today was great. We had a quick get ourselves together in the morning. They made oatmeal with condensed milk, delicious, must remember to do that at home. Yes kids, I will make you like oatmeal. The sun was really bright this morning and started out not too humid which was nice, I started taking photos of all the bougainvillea then we turned a corner and it was practically hard to breath or keep ones eyes open due to all of the dust from the road construction.
The morning was filled with lots of patients. We got a better flow and rhythm down as expected. Lots of young women today who had multiple small complaints and needed a well woman exam (a pap smear). Primary care is really unheard of here on a regular basis, thus for most of them it was their first Pap. Even those who had had children. I learned that cervical cancer has a very high incidence here which is heart breaking to hear since it is such a preventable disease but simply horrible if it gets past the easily treatable stage. The medical students were really relieved that the patients were so comfortable with them and allowed the guys to perform exams. We ran out of the solution for the paps in the middle of the day. Joel ran back to the house to pick up more. We caught an ACE induced cough in a older gentleman, gave out more condoms to the young ladies and their friends in the waiting room, treated head aches, belly pain, we gave pain medication for a young woman whose sister is dying from untreated breast cancer but is in the mountains with no access to care. During our debriefing one of the students expressed frustration and a sense of helplessness when she was worried about ovarian cancer in one woman but the patient was unable to afford the ultrasound. Unfortunately that is a very familiar frustration to the attendings from the uninsured in the US, but the expectation here, one of the most impoverished countries in the world is different (right? Well for some). Definitely learning that in Haiti things are much different in the city than in the mountains. There is health care in the city but apparently in the mountains is where they have nothing. The health care in Port Au Prince of course is very limited to what we have in the states. The patients usually are charged the equivalent of $5 to enter the clinic or hospital, but must pay for testing and doctor fees as they go, plus medications. The degree of testing and the acuity of the care available (such as ICUs, CT scans, ultrasounds) is limited, meaning close to non-existent. I also learned tonight that there was not a single ventilator in the entire country until after the earthquake. I understand now why Partners in Health have done what they had done and built a huge teaching hosiptal with a net work to go with it. I am not sure if we will get to see it while we are here.
Our afternoon was amazing! We went to an orphanage that is run by the same foundation that runs the Hope hospital. Carla, one of the other docs that is attending wanted to see the sick kids which was a huge relief to me since I had not treated sick children for 8 years. The orphanage named “Hope Village” is on top of a hill that overlooks a very impoverished suburb. By suburb I mean cinderblock houses with some tarp roofs some solid with no running water, no electricity, no paved roads. I did see a large water truck drive through but the translator I was talking to said he thinks that the residents need to buy the water. The orphanage however was lovely. The seemed to have water and electricity. So the sick kids were mainly with severe cerebral palsy, thus wheel chair bound, well actually mat bound (no wheelchairs until after the earthquake then a Canadian PT team brought really great equipment for these kids). Any way I got to see the really cute healthy kids. It was impossible to guess the kids ages since they were all tiny due to prior malnutrition. They are really being well cared for now, fed, looked after by a visiting pediatrician and have “house mothers”. What a blast. After diagnosing just about all of them with ring worm, intestinal worms (big bellies and decreased appetite), tinea corporus and capitus, viral URIs which all sound horrible as I write them but trust me very benign stuff...we got to play! They went nuts for our cameras, stethoscopes, penlights. I got great pictures and will up load them shortly for the blog. They all just wanted to be held and play. Brian, the photographer who is with us looked transformed. He does not have kids of his own but they really flocked to him which was so cute. I gave one kid a “tattoo” (my pen wrote on his hand) that spelled out “tattoo”, and it turns out that his name is Tattoo. He totally got a big kick out of it although I don't think he understood the whole joke. It was not heartbreaking as you may expect, just really kind of fun and light hearted. We were basically their entertainment for the afternoon. My sense is that their current situation is better than had they stayed with their family that cannot afford to feed them.
We returned to the hospital and picked up the others. The road construction at this point had some fresh concrete on about 10 feet of it, only miles and winding miles more to go. Hmm, a metaphor.