Sent from my iPadI wake up groggy..still on Pacific Coast time. There are 22 of us sleeping in Gladys's house...with 2 bathrooms. The door to the upstairs bathroom is shut. We all eat, make our peanut and butter sandwiches for lunch, grab snacks from our bountiful pile of one of many Costco runs brought from the U.S. and follow the narrow rusted-red dirt trail from Gladys' house through the rows of carrot tops to the church. The air was cool and crisp. Patients were patiently waiting for us when we arrived. We spent about an hour setting up and then allowed triage to start. Franklin, a young man with a huge smile and very good at calling out numbers (given out by the pastor a-priori) and keeping the order began, "Numero Un". I was running from station to station making sure everything was set right. Protocols taped up, alcohol swabs ready at the anemia station, every station has their tickets, every station has index cards for follow-up appointments, everyone had pens and sharpees, the gift station had the vitamins/toothbrush packs ready to hand out, Melanee and I read the directions to the STD testing that we had brought, Dr.Andersen, the pediatrician Elaine had recruited kept asking me dosing questions. I remembered that this has become my main job when in Haiti...trying to keep everyone organized, finding things that people need, cutting pills when needed, giving out tickets to keep the order and occasionally answering medical questions from the students. I kept popping in the gyn room to make sure Melanee was ok and a bit bummed that I couldn't guide her the way I wanted. I was hoping that my pre-printed protocols taped up were adequate. She seemed pretty capable which is why I put her there first. At first there were a lot of kids, so the anemia and belly station were full, so I jumped in to help with the belly pain station. Pretty easy...they usually would point to their upper stomachs complaining of belly pain. Trying to get how long they had the pain was quite a challenge. I really don't think that keeping time is part of their culture. Where as, my American patients will tell me the exact time of day, week and month that a symptom began usually telling me exactly what was going on to the T the moment they noticed something. We had plenty of gastritis medication and even tons of h.pylori infection treatment (the infection that causes ulcers and is super prevalent in Haiti!) thanks to our multiple packing parties! Kids with abdominal pain and decreased appetite...worms...give worm medicine. One man had a non-healing wound from a year ago on his leg. It was all crusty and oozing. Wound care has become one of my specialties from working at a needle exchange in skid row, so this was easy. Lisa was excited to get some fun Dermatology and I showed her how to debride a wound (clean off all the dead tissue). We told him to come the next day. The day was relatively light which was good since it took time to get a rhythm. The Gyn station got backed up and thus we didn't finish until 6pm. As, we were hanging around waiting for gyn to finish, one of the students was listening to a woman's heart in front of the church. She thought she had heard a murmur and called me over. Just approaching her, she looked ill. Her neck muscles were taught and she was breathing pretty fast. It wasn't a murmur, but her lungs where very tight making wheezing noises. She cooks over an open fire which can cause emphysema. I gave her an inhaler, taught her how to use it, gave her 5 days of prednisone and then a preventative inhaler to take as well. I told her to come back thursday. We hiked back to the house and ravenously ate our delicious dinner followed by our nightly huddle. My favorite presentation of the day was from Kevin who told me that he was seeing a man who was complaining of hip pain for one year status post falling off a donkey. We came up with ways to improve the clinic the next day...add another gyn room, more people in triage, Ella to help with the lab testing, the