Clinic day 3...wed: We ran out of the vitamin/tooth brush packages tuesday. We were just giving out condoms as "gifts". We ran out of Aspirin by the end of the day. We still hadn't been able to get the Hemacue to work so the Anemia station was closed. We ran out of Buffer A for the chlamydia test so Jake and Kevin literally tasted it and decided it was basic, so they tried different acids like the iron elixir and crushed up aspirin and used Tums for a base and created a working Buffer A!!! I was pretty impressed! They need to go on Survivor or something! We were down to our last few bottles of iron elixir and had run out of iron tablets, thus we were giving adults the elixir. We also were down to our last few worm medicine tablets. So, pediatrics was limping along.
Dr. Gousse, Dr. Andersen, Joel, Ella, Melody and Virginia went to the elementary school in Mussote to see the kids but ended up having to make a worm and iron list. Not having the hemacue, the students and even Ella became pretty apt at diagnosing anemia by looking at the lower eye lids of the patients. Normal is nice and pink. The paler it gets, the more anemic one is.
I did triage most of the day. Every adult went like this: Bonjour! Comment ca va? Ca va bien. Hello, How are you? I'm good. Do you have hypertension? as I take their blood pressure. Yes. Do you take medications? No, not now. Blood pressure is usually like 180/110. The highest I saw was 220/138. Do you have chest pain when you walk up the hill? Yes. Most of these patients would be hospitalized in the states in the ICU. I sent them all to the hypertension station where they got the appropriate blood pressure medications according to the protocols...ever changing as we would run out of certain medications. We made sure the severe ones got Aspirin and cholesterol medication. The ones with chest pain received beta blockers hoping that would turn back the decades of damage to the heart. The fun part of triage was that several patients I told to come back for blood pressure checks came back! Hallelujah! Some had normalized and some were still high, so they were sent to the hypertension station. I saw one woman who was 92. Blood pressure....perfectly normal! The one person of all of Haiti over 60 without hypertension! She had knee pain. Easy peezy!
The woman from the previous day with a hgb of 5.3 came back with her "results". She had just had a thyroid panel...they were all normal. We did an HIV which was negative. Luckily, one of the pastor's sons who are Haitian doctors had joined ranks with us the whole time we were there! I told him about this patient and he gave her a referral with a very detailed note about her case and requesting her to be hospitalized for a transfusion. It was so great to feel like I had someone to direct the sick patients to.
That afternoon I resumed my frantic filling in where needed activities. Jake comes back, "I got the hemacue to work!" "HOW?" We had cleaned it frantically, called the 800 number, called Ellaine's husband to go on the web site to figure out the error code..."I wacked it!" I just didn't know what to say. Just around the time we got the anemia station up and going, Danielle picked up a patient with severe anemia by looking at her eye lids. She was complaining of weakness. Her eye lids were literally transluscent...I've never seen eyelids that white...her hemaglobin...3.1! We all agreed we had never seen an adult with that low of a hemaglobin! I was amazed that she was even upright! We checked it several times and then tested it on ourselves. It was working correctly! Back to the pastor's son! He looked at me in dismay when I told him in Spanish what her hemaglobin was. He immediately started talking to her, getting her history again. We checked an HIV test, which was negative. He wrote out another referral to the hospital. He sounded like I do when I'm trying to relay the importance of someone listening to my instructions."Are you going to go?" "Yes" "When?" "Tomorrow". "How are you going to get there." "I'll get transportation." etc...It was fun to find a Haitian version of me when it came to patient care :) Dr. Gousse and I were always on the same page, too.While Dr. Goulos (the pastor's son) was writing his referral, he said to me, "thank goodness you're team is here! can you imagine what would have happened to her?" That felt really good to hear. I often doubt if we're making a difference when we come for a week and dole out our meds for chronic conditions. I always try to emphasize to teach the patients the importance of always taking their medications, getting more before they run out etc...maybe it will stick with a few of them! We give out a lot of pain medicine, too, which I think is important to have just in case they need it. We always have medicines in our medicine cabinets in case we get a headache or a stomach ache...I like that we can provide that for these people, too. In fact we started getting low on all our pain medication supply, needing to start cutting tablets in half to make sure they last for more patients to come. We were giving out plenty of H.Pylori treatments as well. We never ran out of those or the acid reducing medicine!
The Gyn station was going strong. Every once in awhile someone would come and find me as they were often treating for trichamonas. As we ran out of gonorrhea tests we just started preventatively treating patients for that too if they had the appropriate symptoms. I had bought just enough Levofloxacin and metronidazole. We ran out of azithromycin for chlamydia treatment, so then we used doxycycline. We we ran out of that, we started using erythromycin. And the students were very savvy about treating the partners and giving out plenty of condoms. It was a well oiled station! Doing paps and treating for STDs is very satisfying.
That night during the huddle, the students wanted to tell the students for next year to create their own protocols, so they're not just doing something because they were told, but really understand why they do it that way. I thought that was a great idea. They were already jotting ideas for next year and how they wanted to orient the students for the different stations. It was great. In 3 days they became completely autonomous health care providers now taking leadership roles and changing things up. They wanted to combine belly and hypertension stations since they were getting similar histories and having to tease out if "belly pain" was actually chest pain. I really like letting the students flourish into leadership roles. It's a natural progression in medicine, but of course usually happens more in residency. Aline commented that she had seen more patients in 3 days then she had in her entire medical career. Yup, I think satisfyingly.
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