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Haiti–Day #5: From blue to busy

February 24, 2011

I almost didn't go to the hospital today, because I'm feeling a little blue over my last visit—I felt so unneeded. I want to be here to learn and help, not just to learn. At times I feel like we're imposing our presence for our benefit, not Haiti's.

Despite my funk, I walked to the hospital. I planned to go to the AIDs clinic (where the doctor has a reputation for doing a great job teaching visiting care providers).

On the way to the clinic, I poked my head into the consultation room and saw Neyvi, the Cuban-trained Mexican doctor, and her assistant Jean-Remy. They invited me in and shooed away the other students and interpreter (sorry, folks). I had a wonderful day treating patients.



Haiti Blog Entries

Here is my patient log. Although most of these entries are a bit boring unless you're in the medical field, the last patient is worthy of a read.

  1. A 59-year-old female with fibromyalgia. I injected a 1 amp of a painkiller.
  2. A 39-year-old female with “sepsis vaginal." I injected 1 amp of the same painkiller. I didn't give an antibiotic (I don't know why), but she received a written prescription (or maybe it was a slip for lab work).
  3. A 36-year-old female with cervicalgia (a sore neck). She was complaining of pain on the right side of her neck and Neyvi asked about other pain, and she nodded yes, but most of the problem was neck pain on palpation (touch). I injected 2 ampules of some unknown (to me) painkiller.
  4. A 17-year-old female with “sepsis vaginal." No treatment by me (I'm guessing she was going for lab work).
  5. A 28-year-old female with “sepsis vaginal." Do you see a trend with today's patients? Me too! I mixed cephalexin (an antibiotic) with 5 mL of H2O. I'm unsure why some vaginal infections are getting meds and others aren't. There aren't many physical exams, just a few questions by Neyvi that are translated by Antoine.
  6. A 26-year-old female with "sepsis vaginal." I injected 1 ampule of something-er-other.
  7. A 56-year-old male with "arthritis from bacteria." I gave 10 mL of penicillin and an ampule of a pain med. All in one huge syringe. As I was helping this scrawny "old man" stand up, by swinging his legs to the side, Antoine said, "No, don't do that." I think he wants to maintain distance from the patients and not be too caring. It's rather an old-school approach to providing care (IMHO).
  8. A 5-year-old female. I don't know what ailed her, but I mixed 5 mL of H2O into powdered amoxicillin, drew out 3 mL, and then drew in another 2 mL of H2O. This was a crying kid (even before she met the sharp end of my treatment). Injections into kids need to be done quickly because they struggle and want it to stop hurting (even though quick injections are more painful).
  9. Neyvi grabbed my wrist, smiling, and pulled me to the door saying "Hurry!" There was a patient in the delivery room with her feet in stirrups. Neyvi checked her dilation and gestured for me to do the same. Wearing my game face, I felt her cervix. Neyvi told me it was 5 cm (I took her word for it).
  10. A 56-year-old female. I dutifully injected two different ampules of meds. I think one was a painkiller and one was for hypertension.
  11. A 24-year-old female with a sore throat. I gave an amoxicillin (it always starts as a powder). She returned about five patients later with paperwork from the lab. Neyvi explained that she was anemic. I injected two amps of some ferrous-something. Her iron was 7.5 (normal is 10-30 µmol/L).
  12. An 11-year-old male with parasites (probably giardia). I used the remaining amoxicillin from the 5-year-old.
  13. A 16-year-old male with a sore throat. He had a nasty-looking white tongue and bright red tonsils. I injected an antibiotic.
  14. Neyvi and I dashed out to check a different cervix. She was 4 cm and it was, again, difficult for me to feel. I later realized that I expected to feel a firm baby head, but I was feeling the amniotic sack.
  15. Female with an abrasion and pain on her shoulder (obviously from trauma). I injected an amp for pain with 4 mL of H2O in amoxicillin.
  16. A 46-year-old female. She would touch her stomach and say, “Malad." Neyvi asked, "Vomit?" The patient's answer was, "A little." It's interesting to me that they don't take vitals for any of these patients, but I later realized their vitals are checked outside when they are triaged, although they only get BP and weight (not pulse or respirations).  I injected 1 amp of diazepam (which is usually given for anxiety or seizures) with 3 mL H2O and ampicillin. This was a typical treatment: a painkiller, an antibiotic, and a medicine for the chief complaint. Next!
  17. Female with a vagina infection. The patient told Antoine that she had vaginal discharge, so Neyvi did an exam. No privacy here. I injected with an antibiotic.
  18. Neyvi took me back to the delivery room where the first woman was again in stirrups. Neyvi checked her cervix and told the nurse, "huit" (eight in French). Neyvi asked me to check the woman's cervix and asked me, "Cuánto?" to which I replied, "eight." Neyvi looked surprised at my accuracy (I'm so sneaky.) A nurse gestured toward me and asked Neyvi who I was. Neyvi replied (in Spanish), “Él es un American doctor especialista en OBGY." It didn't take much Spanglish on my part to know what she told them. I kept a straight face and nodded. When we were back in the hallway, I put my arm around her and said, “You told them I'm a specialist doctor in birthing!" She laughed and said, “Que comprendía?!"
  19. A 1-year-old male. Antoine, mom, and I all held the patient down as I gave the injection. Mean Dr. Blanc!
  20. A 10-year-old male. I filled a syringe with 1 ampule, then with H2O to 5ml, shook, drew out 2.5, then drew 2.5 of H2), then injected. Then his dad received an injection from Adam (another member of our group).
  21. Neyvi and I went to deliver a baby:

Delivering a Baby

Neyvi had been telling me all morning that since there were two women getting ready to give birth, she was going to deliver one baby and I was going to deliver the other. Um, okay, doc.

I'm not ambitious enough to write out this entire experience, but here is the abbreviated version.

The baby wasn't coming out. After examining the patient, Neyvi checked her gloved fingers and saw brown discharge, probably from a bowel movement from the baby. Then Cathy (a midwife in our group) came and offered to deliver the baby. Neyvi said that'd be fine and she left. (I hope she didn't feel pushed out.)

A Hatian nurse eventually got pissed because there were too many people in the room (all Blancs), so I left. I came back about 45 minutes later and the baby had just been born. She wasn't breathing, was gray, and wasn't moving. (Medical pals, she was somewhere around a 1 to 3 on the APGAR.)

Cathy asked me, "Can you resuscitate babies?" Being ridiculously unqualified and over confident, I said yes and asked for a CPR mask. Several people replied, "There isn't one." [Now, as I type this, I realize I had one in my book bag!]

Krista, a nurse from Park City, Utah, who had been in the room for the delivery, began two-finger compressions on the baby.

The nurse rubbed the baby with alcohol, vigorously, slapped her feet, and she began to move. She pinked up over several minutes. Damn, I wish I'd remembered that I had a CPR mask! Oh well, the baby lived.

Photo

Dead baby?

Photo

Krista suctions (after CPR)

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It's alive!