Hard to believe it will soon be time for our Spring seminar and I haven't written about the last one yet! The spring seminar will be in May this year and once an agenda is decided on it will be posted. Meanwhile for those of you who missed it, here's the 'wrap' on our Fall conference:
Our Fall Seminar was held on October 24th at Turf valley Golf Club and Resort, it was great!
We had a really good turn out, perfect weather and lots of enthusiasm. From the minute Claudia (Salomon4Nia.com) started us off by putting us through the paces of NIA there was great energy and excitement in the banquet hall.
The inital discussion was about obesity and why many diets seem to fail. We talked about the 'D'spot in the brain which controls the loss and redistribution of fat and how abnormal fat stores are kept in a vault that is difficult to access. We talked about ways to get rid of this fat and other weight control tips.
After this a doctor from the Vein Clinic talked about Fibroid embolization, Varicose viens and Venous congestion. The audience listened with great attention and had plenty of questions for the speaker.
We then got started on the subject of skin care and tips. Always be gentle with your skin even when it itches or you cant resist the urge to pick. Apply your anti-oxidant solution daily. I showed several 'before and after' pictures of skin procedures we do in the office including : removal of moles and other lesions, clearing up severe acne, melasma (dark pigmentation of the face associated with hormonal changes and pregnany)and then pictures of Botox and Fillers to prepare everyone for the afternoon demonstrations.
The morning ended with an in depth discussion of Andropause (Male menopause). Most of the men were nodding in agreement by the end of the presentation with the sudden realization that they do indeed suffer from symptoms of Andropause but had just never known what to call it.
The vendors/sponsors of the program were a great hit. People signed up for Viridian "green" electricity supply, Vitamin testing, NuSkin demonstrations, Vien assessments and Zumba.
Our afternoon program included live demonstrations of Botox and Filler and discussions of Bio-identical hormones. Some lucky participants won Obagi products and free vitamin testing.
We finished with a Zumba class!
Well, more fun is in the offing, Stay tuned! If there is any specific subject you are interested in that you would like discussed at the next seminar please let me know asap.
Meanwhile, Happy New Year and see you soon.
Friday, November 26, 2010
Monday, November 1, 2010
Return to Harvard
After 27 years I finally returned to Boston and the Harvard Medical area. Of course the area is very built up and now all the Hospitals seem to be one big collective conglomerate. In my day, Beth Israel was very distinct from the Dana Faber Institute and Deaconess but no more, where one ends the next one starts.
The T (the Boston mass transit system)is still fairly decrepid and jammed packed with people who all seem to be under 30, My Lord! I never realised when I was one of them, that 90% of the people on the T are students. I bet Boston has more students per square yard than anywhere else in the country. My husband and I felt like 'seniors'almost everywhere we went. Speaking of the T at least it now comes out to the airport negating the need for the old 2 hour sit in the tunnel.
Well, my purpose of going to Boston was to return to my old stomping ground. I find that people at Schools of Public Health are always so interesting and 'Global'. Full of ideas about how to change the World's health.
On my way in to the Alumnae event I had the distinct pleasure of meeting the chief investigator of the MRFIT trial, himself an alumnus. The MRFIT trial was one of those pivotal trials that proved that a high Cholesterol causes heart disease. That was big news back then! He smiled when I suggested I might need his autograph, I believe he was from the class of 47!
At the registration desk, I asked if anyone else from the class of '84 was there. "What did you say" one of the students asked, "2004 or 1994?" "err... that would be 1984 I responded" now feeling very flattered as they all looked incredulously at me. I was similarly astounded to hear myself, could time possibly pass that fast? I was looking at graduate students in my old school who were not even born when I was there. We were equally fascinated by each other. "Its nice to know your anti-aging program is working" joked my husband.
Later,we went to Harvard yard and bought Harvard sweatshirts, mugs and key rings. Did I feel at home? Not at all, I felt like a tourist and when I discovered that Filene's had been closed my heart sank. All these years, to tell the truth that's what I missed most about Boston, Filene's!
I am officially a Marylander, proud and happy to be back doing what I love practicing medicine! Its nice to be able to go back when you want to but nothing beats the present. I often say reliving the past only wastes the present and diminishes the future. The future is ours to live ! Stay healthy, feel great, do better!!
Sunday, September 12, 2010
Aging is no fun! ( However our seminar is will be!)
Let's be honest: the other title for this blog is "keeping it real".
Why? because aging, at least physically, really is not any fun. Aging is, after all a degenerative process and that is exactly why 'Anti-Aging' is so important.
With Anti-Aging, the process is not so daunting and we retard the rate at which our body degenerates,and slow the rate at which various organ systems become problematic.
On October 23rd 2010, I will once again be giving a seminar on how to feel good and look good as you age. It is about what YOU can do to help yourself maintain and reach new heights as you get older.
The goal is to maximize all our resources both inherent and external to contnue to feel vital, energetic and sexy as the years add up, at least on paper. In short we want to widen the gap between our chronological and biological age as much as possible.
Please mark your calenders:
Date: October 23rd 2010
Place: Turf Valley Golf Resort and Conference Center, Ellicott City, MD
Time: 10 am to 4pm (break for lunch 12 to 1)
Cost: $15 before October 15 $20 after October 16th
Its going to be even more fun than the last one with a Zumba/Nia class and lots of hands on demonstrations, Get all you questions answered. Hope to see you there!
Why? because aging, at least physically, really is not any fun. Aging is, after all a degenerative process and that is exactly why 'Anti-Aging' is so important.
With Anti-Aging, the process is not so daunting and we retard the rate at which our body degenerates,and slow the rate at which various organ systems become problematic.
On October 23rd 2010, I will once again be giving a seminar on how to feel good and look good as you age. It is about what YOU can do to help yourself maintain and reach new heights as you get older.
The goal is to maximize all our resources both inherent and external to contnue to feel vital, energetic and sexy as the years add up, at least on paper. In short we want to widen the gap between our chronological and biological age as much as possible.
Please mark your calenders:
Date: October 23rd 2010
Place: Turf Valley Golf Resort and Conference Center, Ellicott City, MD
Time: 10 am to 4pm (break for lunch 12 to 1)
Cost: $15 before October 15 $20 after October 16th
Its going to be even more fun than the last one with a Zumba/Nia class and lots of hands on demonstrations, Get all you questions answered. Hope to see you there!
Tuesday, July 27, 2010
Hi from Costa Rica
Hi I am in Costa Rica for a week. My husband teaches deaf students at Galluadet and he is here to oversee a summer project at the deaf school. It is the rainy season now, the season that is referred to as winter here and rain it does, everyday!
The terrain is incredibly lush and green and I am sure these rains are partly responsible.
I thought this country would have more of a Carribean flair but it doesn't, most Costa Ricans seem to take themelves very seriously!
Here are a couple of photos, unfortunately the volcano was shrouded in clouds this morning so I dont have good shots of that but plenty of other aspects of nature.
Watch for my 'Men's Blogs' and for our fall seminar which is coming soon.
As they say in Costa Rica "Pura Vida" (pure life)!
Monday, July 19, 2010
Growth Hormone the mystery reparative hormone
The majority of my Anti-Aging patients are male but the reverse is true when it comes to Hormone Replacement. Its an observation that I find interesting, why the difference? I'm not sure.
This month I am going to focus on issues affecting Anti-Aging specifically and many of them are more male directed intentionally because I think that sometimes women's issues are overrepresented.
What is Growth Hormone exactly and why is it so popular? Growth Hormone is naturally secreted by the pituitary it affects almost every organ in the body, it is a master controller of metabolism and muscle tone.
In my opinion, Growth Hormone is a misnomer,oftened referred to as HGH (Human Growth Hormone) it was originally named because children without it didnt grow. In adults once the growth plates are closed there is no opportunity for getting taller no matter how much growth hormone a person takes.
The name gives the impresion of a substance that can cause strange things to grow like horns and cancer, it actually does not. It is in fact HGH a reparative hormone which helps the body repair damage and heal faster.
I recently had a patient whose company sent him to a leading hospital annually for an 'executive' physical. This, and the fact that he had formerly been a triathlete led him to believe that he was very healthy. After he had some arthroscopic surgery last year he became very frustrated because he could not get back to his prior level of fitness. A friend told him he needed to find an Anti-aging physician and he found me. I ran a series of tests on the patient and started him on therapy. We optimized his vitamin, and supplement levels in addition to short course of HGH.
At his 3 month follow up visit, the patient told me he was 'back to 100%'. It took less than 90 days to get him back in condition, something physical therapy and working out had not been able to achieve.
I had another patient who was 35, also an athlete and when he was offered his 5th knee surgery decided there had to be another way.
The first patient asked me an interesting question, one in fact that I couldnt answer: "Why doesnt every patient who is getting surgery get treated like this from the get go?"
I have no idea, but it seems to make sense. Why should this be 'the medicine of the future' when we have the information to help people now? Why dont more orthopedic doctors refer their patients to get 'tuned up' before undergoing the knife?
I put all the patients who come to me for a 'pre-operative' physical on a healing regimen, afterall, surgery is just self-inflicted trauma. We can anticipate the damage that will be caused and limit it.
(For more information on Growth Hormone please see my website).
Another interesting point that this case brings up is: Do you really want your preventive medical care managed in a place that is totally focused on disease? It is fine to go to the country's best hospital for 'Treatment' but the goal of Preventive Maintenance is different. Be clear about exactly what you want from your 'routine' physical exams and what your doctor's focus is. Primary prevention is the art of preventing something before it occurs, secondary prevention (for example a mammogram) is detecting a disease early enough to do something about it and then there is the third option: fixing a problem that is already entrenched.
You choose what works best for you.
This month I am going to focus on issues affecting Anti-Aging specifically and many of them are more male directed intentionally because I think that sometimes women's issues are overrepresented.
What is Growth Hormone exactly and why is it so popular? Growth Hormone is naturally secreted by the pituitary it affects almost every organ in the body, it is a master controller of metabolism and muscle tone.
In my opinion, Growth Hormone is a misnomer,oftened referred to as HGH (Human Growth Hormone) it was originally named because children without it didnt grow. In adults once the growth plates are closed there is no opportunity for getting taller no matter how much growth hormone a person takes.
The name gives the impresion of a substance that can cause strange things to grow like horns and cancer, it actually does not. It is in fact HGH a reparative hormone which helps the body repair damage and heal faster.
I recently had a patient whose company sent him to a leading hospital annually for an 'executive' physical. This, and the fact that he had formerly been a triathlete led him to believe that he was very healthy. After he had some arthroscopic surgery last year he became very frustrated because he could not get back to his prior level of fitness. A friend told him he needed to find an Anti-aging physician and he found me. I ran a series of tests on the patient and started him on therapy. We optimized his vitamin, and supplement levels in addition to short course of HGH.
At his 3 month follow up visit, the patient told me he was 'back to 100%'. It took less than 90 days to get him back in condition, something physical therapy and working out had not been able to achieve.
I had another patient who was 35, also an athlete and when he was offered his 5th knee surgery decided there had to be another way.
The first patient asked me an interesting question, one in fact that I couldnt answer: "Why doesnt every patient who is getting surgery get treated like this from the get go?"
I have no idea, but it seems to make sense. Why should this be 'the medicine of the future' when we have the information to help people now? Why dont more orthopedic doctors refer their patients to get 'tuned up' before undergoing the knife?
I put all the patients who come to me for a 'pre-operative' physical on a healing regimen, afterall, surgery is just self-inflicted trauma. We can anticipate the damage that will be caused and limit it.
(For more information on Growth Hormone please see my website).
Another interesting point that this case brings up is: Do you really want your preventive medical care managed in a place that is totally focused on disease? It is fine to go to the country's best hospital for 'Treatment' but the goal of Preventive Maintenance is different. Be clear about exactly what you want from your 'routine' physical exams and what your doctor's focus is. Primary prevention is the art of preventing something before it occurs, secondary prevention (for example a mammogram) is detecting a disease early enough to do something about it and then there is the third option: fixing a problem that is already entrenched.
You choose what works best for you.
Saturday, June 26, 2010
The benefits of having your hormones balanced
For those of you who followed my blog from Haiti, thank you for reading it! It is amazing how stimulating an environment like that can be. With all the hardships the Haitians are AMAZINGLY strong people and I feel priviledged to have been able to go there and help in any small way. They say the first person to benefit from any service is the giver and it is so true! I will go back when I can.
In the meantime I shall refocus on what I specialize in and try to help more people here at home to feel better in a different way.
Everytime I meet with both new and old HRT patients I am inspired by how much good natural hormone balancing does for them. Professional people who are able to carry on with their busy lives without missing a beat, mothers who had babies in their forties but can still keep up with them as teenagers,and relationships that refind their zest. I see people who can come off anti-depressant and anxiety medications once their hormones are in better balance and young people throwing off PMS and bad periond cramps that used to keep them at home every month.
So this too, is a very gratifying field of medicine for me something that I enjoy practicing everyday.
My next blog will be about Telomeres,a fascinatng field of research in Anti-Aging.
Its good to be back .....do come and visit!
In the meantime I shall refocus on what I specialize in and try to help more people here at home to feel better in a different way.
Everytime I meet with both new and old HRT patients I am inspired by how much good natural hormone balancing does for them. Professional people who are able to carry on with their busy lives without missing a beat, mothers who had babies in their forties but can still keep up with them as teenagers,and relationships that refind their zest. I see people who can come off anti-depressant and anxiety medications once their hormones are in better balance and young people throwing off PMS and bad periond cramps that used to keep them at home every month.
So this too, is a very gratifying field of medicine for me something that I enjoy practicing everyday.
My next blog will be about Telomeres,a fascinatng field of research in Anti-Aging.
Its good to be back .....do come and visit!
Saturday, June 19, 2010
Devastated!
After two weeks of taking more pictures than I have ever taken in my life I lost my camera with the memory stick of 600 photos! I am truly devastated. I couldnt wait to get home and share them with you. Now I am really glad that I wrote a daily blog, that is how I will have to remember the small details of my trip. There will be others and as my insightful daughter (age 14) said, at least I am home safe and sound.
Thank you for reading my blog.
Now I will go back to Hormone replacement and Anti-aging and hope that in some small way I did some good.
Wishing you Good Health!
Thank you for reading my blog.
Now I will go back to Hormone replacement and Anti-aging and hope that in some small way I did some good.
Wishing you Good Health!
Thursday, June 17, 2010
A new birth!
Day 10
Well here I am packed and ready to go! I was really starting to get into a groove at the clinic. It helps to have cooperation, I believe there are many staff members who actually enjoy what they do. Unfortunately they have little or no direction and no personal experience or education to fall back on.
I asked about the staff member who had fainted on Monday and was told she was fine however she had not returned to the clinic. After consulting Denise the clinic manager we decided to do a home visit (“visite domicile”), I needed an interpreter and another staff member decided she would like to tag along as well. So the 4 of us set off among the tents, boy it was hot! A few minutes later we were at the lady’s tent. “She’s in there!” I was told, so I pulled back the curtain and there was a new born baby on the floor barely a foot from the doorway! I guess it’s the coolest place to be.
The rest of the team was unfazed, “where is Madame F ? they asked loudly. They were advised that she was in the opposite tent and everyone turned in pursuit . Whoa! wait a minute. Ummh about the baby, I said not wanting to appear overly dramatic. I had several questions like who, what, why and when. We started to question the mother. No ,she hasn’t seen a doctor since she delivered. Yes, the baby was born in the tent. Amazingly everyone was so matter of fact, I was still stunned at this sleeping miniature person and the surreal surrounding!
I gave Mom prenatal vitamins and a lecture on the virtues of breast feeding and visiting the clinic for a check up, photos taken and onward!
Our next visit was almost at the top of the camp wow! Up and up and up! Great views of Terrain Acra. We went into a tent and a man was fixing some kind of wheel barrow-like contraption , I talked to him. He said he paints pictures he had some on display, my impression was so-so talent. I asked him about the tent : how many people in this tent , 7 he said. There is an open area in the middle of the tent where cooking is done. The latrines in this camp have no doors because people have stolen them to add to their tent space. I asked how people maintained some dignity and was told that when they go to the latrine they concoct some kind of cover.
As I followed the clinic director further into the tent I got my second shock of the day. A 57 year old paraplegic man who looked like an AIDS or TB patient. He was really cachexic (thin) and his legs went in two different directions and clearly had not moved in a long time. The skin on his legs was like something I’ve never seen before! You could count every rib! He gave me permission to post his pictures. Apparently he was paralyzed by a car accident before the earthquake but he says things got worse after that. I gave him the only thing I had, a bottle of prenatal vitamins,and advised his family members to try to do a little physical therapy. I told him he would sleep better if he was adjusted to a 45 degree angle. He seemed to appreciate that piece of advice.
I later had a discussion with the clinic manager. I suggested they have a meeting with him and his family and discuss amputation. This may be the only way for him to get on with his life, he cant use his legs and they are just going to be a major source of infection and ultimately kill him. It is not easy to suggest cutting off someone’s legs.
NEWS hot off the press:
Someone knocked on my door this evening and told me there is an outbreak of typhoid. Apparently the Ministry of Health randomly screened 15 stool samples and all tested positive. They might need even more help if this keeps up.
And finally the Corail latrine update :
The Corail camp manager met with Oxfam today and they have agreed to back pay the latrine cleaners however they are still philosophically against paying people to clean up their own waste. The compromise is to back pay but none going forward, they are going to build more latrines now so that only 5 families share a latrine. They believe this will help the people take ownership of the cleaning process. That could turn out to be a pile of S…tuff no pun intended. At least a riot was averted for now. They also handed out more food rations today but only to pregnant women, so pregnant women came out of everywhere, once again food to last2 weeks and no more.
The only down side of today is dealing with a colleague who is a pediatrician and insists on talking to me as if I am a child! It is starting to get to me but Voila! Its my last day!
As always Desiderata proves inspiration:
Go placidly amid the noise and haste, and remember what peace there may be in silence.
As far as possible, without surrender, be on good terms with all persons. Speak your truth quietly and clearly; and listen to others, even to the dull and the ignorant, they too have their story. Avoid loud and aggressive persons, they are vexations to the spirit.
There is literally a new baby born every minute, even in Terrain Acra one can see the potential for the future that arises from every birth.
With all its sham, drudgery and broken dreams, it is still a beautiful world!
Well here I am packed and ready to go! I was really starting to get into a groove at the clinic. It helps to have cooperation, I believe there are many staff members who actually enjoy what they do. Unfortunately they have little or no direction and no personal experience or education to fall back on.
I asked about the staff member who had fainted on Monday and was told she was fine however she had not returned to the clinic. After consulting Denise the clinic manager we decided to do a home visit (“visite domicile”), I needed an interpreter and another staff member decided she would like to tag along as well. So the 4 of us set off among the tents, boy it was hot! A few minutes later we were at the lady’s tent. “She’s in there!” I was told, so I pulled back the curtain and there was a new born baby on the floor barely a foot from the doorway! I guess it’s the coolest place to be.
The rest of the team was unfazed, “where is Madame F ? they asked loudly. They were advised that she was in the opposite tent and everyone turned in pursuit . Whoa! wait a minute. Ummh about the baby, I said not wanting to appear overly dramatic. I had several questions like who, what, why and when. We started to question the mother. No ,she hasn’t seen a doctor since she delivered. Yes, the baby was born in the tent. Amazingly everyone was so matter of fact, I was still stunned at this sleeping miniature person and the surreal surrounding!
I gave Mom prenatal vitamins and a lecture on the virtues of breast feeding and visiting the clinic for a check up, photos taken and onward!
Our next visit was almost at the top of the camp wow! Up and up and up! Great views of Terrain Acra. We went into a tent and a man was fixing some kind of wheel barrow-like contraption , I talked to him. He said he paints pictures he had some on display, my impression was so-so talent. I asked him about the tent : how many people in this tent , 7 he said. There is an open area in the middle of the tent where cooking is done. The latrines in this camp have no doors because people have stolen them to add to their tent space. I asked how people maintained some dignity and was told that when they go to the latrine they concoct some kind of cover.
As I followed the clinic director further into the tent I got my second shock of the day. A 57 year old paraplegic man who looked like an AIDS or TB patient. He was really cachexic (thin) and his legs went in two different directions and clearly had not moved in a long time. The skin on his legs was like something I’ve never seen before! You could count every rib! He gave me permission to post his pictures. Apparently he was paralyzed by a car accident before the earthquake but he says things got worse after that. I gave him the only thing I had, a bottle of prenatal vitamins,and advised his family members to try to do a little physical therapy. I told him he would sleep better if he was adjusted to a 45 degree angle. He seemed to appreciate that piece of advice.
I later had a discussion with the clinic manager. I suggested they have a meeting with him and his family and discuss amputation. This may be the only way for him to get on with his life, he cant use his legs and they are just going to be a major source of infection and ultimately kill him. It is not easy to suggest cutting off someone’s legs.
NEWS hot off the press:
Someone knocked on my door this evening and told me there is an outbreak of typhoid. Apparently the Ministry of Health randomly screened 15 stool samples and all tested positive. They might need even more help if this keeps up.
And finally the Corail latrine update :
The Corail camp manager met with Oxfam today and they have agreed to back pay the latrine cleaners however they are still philosophically against paying people to clean up their own waste. The compromise is to back pay but none going forward, they are going to build more latrines now so that only 5 families share a latrine. They believe this will help the people take ownership of the cleaning process. That could turn out to be a pile of S…tuff no pun intended. At least a riot was averted for now. They also handed out more food rations today but only to pregnant women, so pregnant women came out of everywhere, once again food to last2 weeks and no more.
The only down side of today is dealing with a colleague who is a pediatrician and insists on talking to me as if I am a child! It is starting to get to me but Voila! Its my last day!
As always Desiderata proves inspiration:
Go placidly amid the noise and haste, and remember what peace there may be in silence.
As far as possible, without surrender, be on good terms with all persons. Speak your truth quietly and clearly; and listen to others, even to the dull and the ignorant, they too have their story. Avoid loud and aggressive persons, they are vexations to the spirit.
There is literally a new baby born every minute, even in Terrain Acra one can see the potential for the future that arises from every birth.
With all its sham, drudgery and broken dreams, it is still a beautiful world!
Tuesday, June 15, 2010
From Home visits to Brazil Haiti Day 9
On the way in to the camp this morning I discussed strategy with the medical director. He seems to have bought into my idea of offering prenatal care at the clinic but after asking for a prenatal flow sheet form for the 10th time and still not getting it, I think the chances of pulling it off before I leave are pretty slim.
Once we get the form the process would be, to teach the triage staff what to do on each pregnant woman and to develop criteria for referrals. The staff at the camp have a very low level of education and it takes several repetitions of the same thing to begin to effect change. Today ,I believe, was the first time every patient I saw had been weighed (that’s another story), I am now attempting to get a last menstrual period date recorded on every female patient (50% yesterday, 0% today). And then there’s the protocol for reading pregnancy tests another challenge which I think would work out with a little more practice.
On the subject of criteria, we need to develop some for ‘home visits’. I like the idea of home visits it gives a warm fuzzy caring kind of feel and who doesn’t like the doctor to come to them? I went to visit a lady whose right arm was broken during the earthquake, her leg was injured also but that has resolved . She is left with chronic pain in her wrist and arm and minimal motion. I demonstrated some exercises for her, she really needs to do physical therapy and I think I convinced her that in spite of the pain she must force herself to start using it. I gave her some pain medication and tomorrow I will give her a wrist splint. I am a little leary of giving her a splint because it may cause her to use her arm even less. She promised to do the exercises 4 times a day, regardless, so we will see.
As I was finishing up with her 3 able bodied women approached and sat down to be ‘seen’. They were all in the early stages of pregnancy the nurse told me and they didn’t feel like coming down to the clinic! I really have a problem with this kind of healthcare, I think it is a mistake to end up having drive-thru clinics and creating a dependency on them purely for convenience. The clinic is less than a five minute walk from their tents but they prefer to tag on to home visits. I think a lot of people think that prenatal care is just a matter of handing out vitamins. It is not. The patient needs to be weighed, the blood pressure checked, the length of the uterus measured and the urine checked for protein among other things. None of them had had tetanus shots and Haiti has the highest incidence of neonatal tetanus in the western hemisphere. I told them to come down to the clinic tomorrow. They weren’t overly enthused but I told them if they care about their babies they need to come to the clinic every month. I hope all this Aid that is pouring into Haiti does not create a ‘fast food’ approach to preventative care, were people feel entitled to door to door service without any need for effort on their part!
Viva Brazil! There is a huge fan base for Brazil in Haiti, tons of people were wearing yellow and green and the Brazilian flag was flying everywhere. There was palpable excitement in the air today and everyone (who wasn’t working) was glued to the radio or TV for the world cup match between Brazil and North Korea. At the camp a gunshot rang out when Brazil scored and you could hear the roar of the crowd. I was doing the home visit at the time, my first opportunity to actually wonder through the camp and see inside a tent that people are living in. Incredibly the average number of occupants per tent is 5. The one i saw had a sheet hung in the middle to divide the sleeping area from the sitting area. I hope to see more homes tomorrow.
Once we get the form the process would be, to teach the triage staff what to do on each pregnant woman and to develop criteria for referrals. The staff at the camp have a very low level of education and it takes several repetitions of the same thing to begin to effect change. Today ,I believe, was the first time every patient I saw had been weighed (that’s another story), I am now attempting to get a last menstrual period date recorded on every female patient (50% yesterday, 0% today). And then there’s the protocol for reading pregnancy tests another challenge which I think would work out with a little more practice.
On the subject of criteria, we need to develop some for ‘home visits’. I like the idea of home visits it gives a warm fuzzy caring kind of feel and who doesn’t like the doctor to come to them? I went to visit a lady whose right arm was broken during the earthquake, her leg was injured also but that has resolved . She is left with chronic pain in her wrist and arm and minimal motion. I demonstrated some exercises for her, she really needs to do physical therapy and I think I convinced her that in spite of the pain she must force herself to start using it. I gave her some pain medication and tomorrow I will give her a wrist splint. I am a little leary of giving her a splint because it may cause her to use her arm even less. She promised to do the exercises 4 times a day, regardless, so we will see.
As I was finishing up with her 3 able bodied women approached and sat down to be ‘seen’. They were all in the early stages of pregnancy the nurse told me and they didn’t feel like coming down to the clinic! I really have a problem with this kind of healthcare, I think it is a mistake to end up having drive-thru clinics and creating a dependency on them purely for convenience. The clinic is less than a five minute walk from their tents but they prefer to tag on to home visits. I think a lot of people think that prenatal care is just a matter of handing out vitamins. It is not. The patient needs to be weighed, the blood pressure checked, the length of the uterus measured and the urine checked for protein among other things. None of them had had tetanus shots and Haiti has the highest incidence of neonatal tetanus in the western hemisphere. I told them to come down to the clinic tomorrow. They weren’t overly enthused but I told them if they care about their babies they need to come to the clinic every month. I hope all this Aid that is pouring into Haiti does not create a ‘fast food’ approach to preventative care, were people feel entitled to door to door service without any need for effort on their part!
Viva Brazil! There is a huge fan base for Brazil in Haiti, tons of people were wearing yellow and green and the Brazilian flag was flying everywhere. There was palpable excitement in the air today and everyone (who wasn’t working) was glued to the radio or TV for the world cup match between Brazil and North Korea. At the camp a gunshot rang out when Brazil scored and you could hear the roar of the crowd. I was doing the home visit at the time, my first opportunity to actually wonder through the camp and see inside a tent that people are living in. Incredibly the average number of occupants per tent is 5. The one i saw had a sheet hung in the middle to divide the sleeping area from the sitting area. I hope to see more homes tomorrow.
Monday, June 14, 2010
Corail, Port au Prince, Haiti a planned tent community
Today was another interesting day, I have now taken a total of 440 photos!
After arranging supplies we loaded up the truck and headed off with the new doctor to the clinic.
I had volunteered to speak at the morning clinic meeting because I heard that when the second year resident who was volunteering at the clinic, had spoken on Saturday there had been some resentment about ‘Expat’ doctors. I spoke for several minutes aquainting the staff with my qualifications and experience and suggested that not all volunteers had the same experience. I pointed out the fact that although we are here to help the ultimate responsibility for the clinic rests with the Haitian staff and doctors. I then gave some suggestions on how I thought the clinic procedures might be improved, I told them they could take them or leave them. I think my presentation was well received for the most part.
As we were clearing up after the meeting one of the staff people fell flat on her face. This was not the same member who passed out twice last week. I treated her for heat exhaustion. My translator had called in the morning to say he wouldn’t be coming in today because he had diarrhea, I brought him in some Peptobismol. This brings to 6 the number of staff members I have treated in a week! The clinic is about 105 degrees with no air all the time (minimum). The new doctor had a good idea and we lowered the tent wall, this made it noisier but at least the temperature decreased by about 5 degrees.
We talked to the camp manager about the possibility of a generator for the clinic which would allow for a fan and use of the nebulizer. I get the impression that this is not going to happen however because of logistical and budgetary constraints.
In the afternoon I went out to the camp called Corail. This is a very interesting camp. It is what is called a planned camp. It was set up to move some people out of Terrain Acra and it now houses 5,000 people although people are drifting in and around it daily, I am sure it will be double thesize in a year. The difference with this camp is that it is structured, all the tents are in lines, with gravel on the ground. A few seedlings have been planted to create trees. It has problems though and apparently regular riots. The current controversies include the fact that food rations were given out 3 weeks ago and people are really hungry. This camp has no soil to grow food and no industry near by for jobs and none of the usual vendors, I didn’t even see the usual lottery booth. Oxfam refuses to pay people to clean the latrines and says the people should clean them of their own volition so the latrine cleaners stopped. Within 24 hours the latrines could not be used and a riot was brewing. ARC is temporarily paying the people but is unable to sustain it, there was a meeting with World Vision this afternoon and apparently they are saying they will pick up the tab, so we will see.
A stone slab has been set to allow the setting up of a primary school, which will be going up tomorrow, there is already a kindergarten. All the camps have kiddie friendly spaces, showers and a water supply. Oxfam ships in 10,000 gallons of water daily to the camp. The water balloon was deflated when I was there and the camp manager said he was not sure why Oxfam had not yet delivered the water.
While we were walking around the camp manager came and told me about a pregnant woman who was complaining of abdominal pain and crying and there was no one to transport her to the hospital. Everyone was stressing. Right place at the right time I guess! I examined her and fortunately I determined that it was probably a urinary tract infection and I just happened to have some medicine in my bag. Its hard to lecture a pregnant woman about drinking more water when there is none to be had! Anyway all is well that ends well……… I guess. At the end an ex-lover came up to us and started a long story about how she was a ‘bad woman’ and his girlfriend didn’t want her in their tent anymore and….
The best part of going to the camp? the kids, I gave out candy and the kids sang for us. There was a group of boys steadfastly playing soccer the whole time I was there oblivious to our visit. The worst part, people are hungry and thirsty something bad is going to happen.
After arranging supplies we loaded up the truck and headed off with the new doctor to the clinic.
I had volunteered to speak at the morning clinic meeting because I heard that when the second year resident who was volunteering at the clinic, had spoken on Saturday there had been some resentment about ‘Expat’ doctors. I spoke for several minutes aquainting the staff with my qualifications and experience and suggested that not all volunteers had the same experience. I pointed out the fact that although we are here to help the ultimate responsibility for the clinic rests with the Haitian staff and doctors. I then gave some suggestions on how I thought the clinic procedures might be improved, I told them they could take them or leave them. I think my presentation was well received for the most part.
As we were clearing up after the meeting one of the staff people fell flat on her face. This was not the same member who passed out twice last week. I treated her for heat exhaustion. My translator had called in the morning to say he wouldn’t be coming in today because he had diarrhea, I brought him in some Peptobismol. This brings to 6 the number of staff members I have treated in a week! The clinic is about 105 degrees with no air all the time (minimum). The new doctor had a good idea and we lowered the tent wall, this made it noisier but at least the temperature decreased by about 5 degrees.
We talked to the camp manager about the possibility of a generator for the clinic which would allow for a fan and use of the nebulizer. I get the impression that this is not going to happen however because of logistical and budgetary constraints.
In the afternoon I went out to the camp called Corail. This is a very interesting camp. It is what is called a planned camp. It was set up to move some people out of Terrain Acra and it now houses 5,000 people although people are drifting in and around it daily, I am sure it will be double thesize in a year. The difference with this camp is that it is structured, all the tents are in lines, with gravel on the ground. A few seedlings have been planted to create trees. It has problems though and apparently regular riots. The current controversies include the fact that food rations were given out 3 weeks ago and people are really hungry. This camp has no soil to grow food and no industry near by for jobs and none of the usual vendors, I didn’t even see the usual lottery booth. Oxfam refuses to pay people to clean the latrines and says the people should clean them of their own volition so the latrine cleaners stopped. Within 24 hours the latrines could not be used and a riot was brewing. ARC is temporarily paying the people but is unable to sustain it, there was a meeting with World Vision this afternoon and apparently they are saying they will pick up the tab, so we will see.
A stone slab has been set to allow the setting up of a primary school, which will be going up tomorrow, there is already a kindergarten. All the camps have kiddie friendly spaces, showers and a water supply. Oxfam ships in 10,000 gallons of water daily to the camp. The water balloon was deflated when I was there and the camp manager said he was not sure why Oxfam had not yet delivered the water.
While we were walking around the camp manager came and told me about a pregnant woman who was complaining of abdominal pain and crying and there was no one to transport her to the hospital. Everyone was stressing. Right place at the right time I guess! I examined her and fortunately I determined that it was probably a urinary tract infection and I just happened to have some medicine in my bag. Its hard to lecture a pregnant woman about drinking more water when there is none to be had! Anyway all is well that ends well……… I guess. At the end an ex-lover came up to us and started a long story about how she was a ‘bad woman’ and his girlfriend didn’t want her in their tent anymore and….
The best part of going to the camp? the kids, I gave out candy and the kids sang for us. There was a group of boys steadfastly playing soccer the whole time I was there oblivious to our visit. The worst part, people are hungry and thirsty something bad is going to happen.
Sunday in Haiti !
Today was a little more heart wrenching than I had anticipated. After staying home all day working on clinic inventory and helping the medical director with his mid-term report I thought I would go out and get some air. I asked the driver to take me to 2 camps I hadn’t been to.
He first took me to the ‘golf course’ camp otherwise known as the ‘Sean Penn’ camp. This massive camp is located at the Pentionville Club and houses about 50,000 people. At the gate are guards who allowed us in and waved vaguely in the direction of the camp. There is a huge red mobile clinic at the entrance, really fancy and new looking, Wow ! I thought as I turned to look across the way at two abandoned tennis courts. Then we proceeded down this really complicated stone road that seemed to head straight down a hill. To call it a bumpy ride would be a major understatement! Just when I was ready to stop bouncing there it was! Piece upon piece of plastic as far as the eye could see. Children running around, people selling small goods in front of their tents, hair being braided and just general busy-ness Wow, Wow, OMG Wow!
We made our way around the camp and I could sense the desire for normalcy. It is inconceivable how people are surviving and it is impossible to see an end to this.
Interestingly, along with the people vending on the main drag there are several lottery booths. In any other situation it might even have been funny, squatters investing in lottery tickets! After noticing the lottery booths in the camps I now see them everywhere sometimes 3 within a block of each other. It must be good business!
Also in the camp are churches and other facilities but everything is really cooped up and water is at a premium.
From this camp we went to Delmas 2 otherwise known as the old military airfield which at least had passable roads and thoroughfares, otherwise more of the same.
Each camp has a clinic but each one is run by a different NGO (non governmental organization). It was all very interesting and sad.
In the evening I went to eat at a Creole restaurant. The food was so so, the restaurant was showing the world cup game of Germany thrashing Australia.
I got a little email card from my daughter when I got back saying she was proud of what I am doing……. Nice!
Tomorrow will be busy. Bon Nuit!
He first took me to the ‘golf course’ camp otherwise known as the ‘Sean Penn’ camp. This massive camp is located at the Pentionville Club and houses about 50,000 people. At the gate are guards who allowed us in and waved vaguely in the direction of the camp. There is a huge red mobile clinic at the entrance, really fancy and new looking, Wow ! I thought as I turned to look across the way at two abandoned tennis courts. Then we proceeded down this really complicated stone road that seemed to head straight down a hill. To call it a bumpy ride would be a major understatement! Just when I was ready to stop bouncing there it was! Piece upon piece of plastic as far as the eye could see. Children running around, people selling small goods in front of their tents, hair being braided and just general busy-ness Wow, Wow, OMG Wow!
We made our way around the camp and I could sense the desire for normalcy. It is inconceivable how people are surviving and it is impossible to see an end to this.
Interestingly, along with the people vending on the main drag there are several lottery booths. In any other situation it might even have been funny, squatters investing in lottery tickets! After noticing the lottery booths in the camps I now see them everywhere sometimes 3 within a block of each other. It must be good business!
Also in the camp are churches and other facilities but everything is really cooped up and water is at a premium.
From this camp we went to Delmas 2 otherwise known as the old military airfield which at least had passable roads and thoroughfares, otherwise more of the same.
Each camp has a clinic but each one is run by a different NGO (non governmental organization). It was all very interesting and sad.
In the evening I went to eat at a Creole restaurant. The food was so so, the restaurant was showing the world cup game of Germany thrashing Australia.
I got a little email card from my daughter when I got back saying she was proud of what I am doing……. Nice!
Tomorrow will be busy. Bon Nuit!
Saturday, June 12, 2010
Como ye Aayiti (How are you Haiti)?
Como ye?! That is how Haitians greet each other, it means how are you in creole.
Feeling hot ,hot, hot! This heat index of 106 is killing!
I saw 17 patients in this morning’s Saturday clinic. The heat in the tent (clinic) is oppressive, I may have to suggest ARC consider a generator so we can at least have a fan. The staff member who almost fell on me when she passed out 3 days ago, returned to work today and passed out again! I lectured her on electrolyte balance and enough water and not staying in the tent for more than 2 hours straight, even as my head throbbed like it was going to explode.
It seems someone has set up a big screen TV for the World Cup, somewhere in the camp. As I was seeing patients there was this huge unanimous roar …………Britain scored! World Cup fever or Mondial is everywhere.
Haiti is very enamored of the World Cup and football, cars everywhere are flying flags, with Brazil and Argentina leading the pack. A man was walking down the street with a huge Argentinian flag around his neck and many wear T shirts.
This evening I am staying home but I can hear parties everywhere in this gated community where most of the UN personnel stay. Is it related to World Cup or just weekend stress release, I don’t know , but they sound like they are having a good time. The house I share with 5 others is like a ghost town! I plan on catching up with writing tomorrow.
I finally figured out why my computer will not recognize my scan disc. It is the one I bought for my Blackberry memory. I tried 3 different methods before it struck me. the pictures are perfect on the camera. If anyone can tell me how to download the pictures it would be much appreciated.
I have had the "Desiderata on my mind since the morning I woke up to begin my journey, i finally googled it this evening......
"Go placidly amidst the noise and haste and remember what peace there is in silence"!
Feeling hot ,hot, hot! This heat index of 106 is killing!
I saw 17 patients in this morning’s Saturday clinic. The heat in the tent (clinic) is oppressive, I may have to suggest ARC consider a generator so we can at least have a fan. The staff member who almost fell on me when she passed out 3 days ago, returned to work today and passed out again! I lectured her on electrolyte balance and enough water and not staying in the tent for more than 2 hours straight, even as my head throbbed like it was going to explode.
It seems someone has set up a big screen TV for the World Cup, somewhere in the camp. As I was seeing patients there was this huge unanimous roar …………Britain scored! World Cup fever or Mondial is everywhere.
Haiti is very enamored of the World Cup and football, cars everywhere are flying flags, with Brazil and Argentina leading the pack. A man was walking down the street with a huge Argentinian flag around his neck and many wear T shirts.
This evening I am staying home but I can hear parties everywhere in this gated community where most of the UN personnel stay. Is it related to World Cup or just weekend stress release, I don’t know , but they sound like they are having a good time. The house I share with 5 others is like a ghost town! I plan on catching up with writing tomorrow.
I finally figured out why my computer will not recognize my scan disc. It is the one I bought for my Blackberry memory. I tried 3 different methods before it struck me. the pictures are perfect on the camera. If anyone can tell me how to download the pictures it would be much appreciated.
I have had the "Desiderata on my mind since the morning I woke up to begin my journey, i finally googled it this evening......
"Go placidly amidst the noise and haste and remember what peace there is in silence"!
Thursday, June 10, 2010
Haiti Day 4
I am feeling very encouraged today, I spoke with the medical director of the clinic on the way in and he was very receptive to my ideas. In fact, he was so excited by some of my proposals that he put them into action as soon as we arrived at the clinic. I think my long email yesterday was very effective.
I personally saw 26 patients today half in the morning at Terrain Acra and the other half at a site where we went in a mobile clinic called Acacia.
One of the interesting cases I saw was a 17 year old with severe anemia, I concluded that it was iron deficiency because her mother said she keeps eating rocks (a condition known as pica). When I asked if she craved ice they both looked at me amazed and said Yes, she eats a lot of ice too. The symptom of craving ice is associated with iron deficiency anemia, did some I research on this earlier in the year hoping to find time to write a paper, which I would still like to.
After all the patients had left a guy came into the clinic complaining of pain in his eye after a piece of metal flew into while he was cutting something metal. Apparently it happened on Monday (3.5 days ago, not a good sign), he had a classic presentation of a corneal abrasion from metal with a very well defined hole right on his cornea. I later saw a guy sawing one of the metal rods that are all over the city from buildings collapsing and I could see exactly how he got the injury!
After the morning clinic I plugged in my IPOD and listened to Andrea Bocelli, I imagined him standing on top of the heap mound singing the song and of how much joy his gift would bring the people listening. Crazy huh? Well that thought lead me to another which made me smile to myself because I am so glad that I too have a gift or talent of a different kind that I can share ………. What a privilege!
In the afternoon, we went to Acadia. We had to get down from the car at some point on our way to Acacia because it was not passable and then we trekked over piles of rubble to arrive at our destination. We had to go under a massive pylon that was only being suspended by an electricity cable. Its pretty amazing what you DON’T notice after awhile!
We went to see people who cannot readily get to the clinic at Terrain Acra, even as we left the bulldozer was scooping up rubble, an amazing task. There are USAID crews everywhere trying to clean up stone by stone.
I personally saw 26 patients today half in the morning at Terrain Acra and the other half at a site where we went in a mobile clinic called Acacia.
One of the interesting cases I saw was a 17 year old with severe anemia, I concluded that it was iron deficiency because her mother said she keeps eating rocks (a condition known as pica). When I asked if she craved ice they both looked at me amazed and said Yes, she eats a lot of ice too. The symptom of craving ice is associated with iron deficiency anemia, did some I research on this earlier in the year hoping to find time to write a paper, which I would still like to.
After all the patients had left a guy came into the clinic complaining of pain in his eye after a piece of metal flew into while he was cutting something metal. Apparently it happened on Monday (3.5 days ago, not a good sign), he had a classic presentation of a corneal abrasion from metal with a very well defined hole right on his cornea. I later saw a guy sawing one of the metal rods that are all over the city from buildings collapsing and I could see exactly how he got the injury!
After the morning clinic I plugged in my IPOD and listened to Andrea Bocelli, I imagined him standing on top of the heap mound singing the song and of how much joy his gift would bring the people listening. Crazy huh? Well that thought lead me to another which made me smile to myself because I am so glad that I too have a gift or talent of a different kind that I can share ………. What a privilege!
In the afternoon, we went to Acadia. We had to get down from the car at some point on our way to Acacia because it was not passable and then we trekked over piles of rubble to arrive at our destination. We had to go under a massive pylon that was only being suspended by an electricity cable. Its pretty amazing what you DON’T notice after awhile!
We went to see people who cannot readily get to the clinic at Terrain Acra, even as we left the bulldozer was scooping up rubble, an amazing task. There are USAID crews everywhere trying to clean up stone by stone.
Wednesday, June 9, 2010
Terrain Acra Port au Prince
HAITI
Today is Day 3 of my visit here.
The first thing you notice when you arrive here is how hot it is! I have never sweat so much in my life, not even in Africa.
After a slight wrinkle at the airport on Sunday I made my way to the “group house” that is shared with 5 other people. It is actually a beautiful house in a ‘safe’, gated community. I sleep in a tent on the ‘balcony’ which fortunately is inside. Fortunate because this is the rainy season. It rains every afternoon, sometimes it is a thunderstorm with a deluge and sometimes it is lighter.
On the drive from the airport there were obvious piles of rubble and destruction and a fair amount of traffic.
I met my house mates and forced myself to stay awake until after we went out to dinner, getting to the restaurant took 40 minutes. The traffic in Port au Prince is really bad and I was to discover just how bad the following day. A large part of my time is spent sitting in traffic, after a stop at the main office and a security and camp briefing I finally got to the “Tent city” where I will be practicing for 2 weeks. It is called Terrain Acra.
Terrain Acra has to be seen to be believed, it is a community of 28,000 people displaced by the earthquake all living under pieces of plastic sheets. There is no running water or electricity, the temperature outside is between 97 and 103 degrees, this is magnified by the plastic sheeting and lack of air circulation. Children, goats and pigs rummage freely in trash piles that are everywhere. What is it about pigs that makes them smell so bad?
Terrain is a squatter settlement on the waste dump of a factory owned by 3 brothers with the last name Acra (I understand they are of Lebanese origin). The brothers have agreed to allow these people to stay on the land until January 11 2011 at which time they want their land back. The police have agreed to forcefully remove the people at that time.
The ‘clinic’ is a large tent donated by Unicef, it has been divided up into 5 examination cubicles and a table which represents the pharmacy. I was only there for a few hours on my first day and then I was told to return to the office. Once there no one seemed to know what I was there for so I guess I should have gone in the ‘mobile clinic’. In the office I was given a disc on key by the data entry guy. I tried to open it later on my own computer. There was nothing on it but viruses, my computer went crazy!
DAY TWO
My second day began with a quick breakfast and then the long car ride to the camp, on the way in, I could tell my stomach was starting to rebel. I had the dreaded thought that I might have to use one of the latrines (a hole in the ground which is used as a toilet). Try as I might I couldnt ignore it and the cramps got worse. Just in time to start the daily meeting ! Great, why didn’t it start before I left the house so I could take something? I checked in at the pharmacy table, No, they didn’t have any diarrhea medicines! I decided I had no choice but to bite the bullet and go to the latrine.
The latrines stand proudly with their graffiti covered plastic flapping whenever there is a suspicion of a breeze. I am not too proud and I do need to hurry up before I run out of options, I thought. Let me check them out.
I went back and got some gloves, I didn’t like the idea of toughing the plastic not even for the second it would take me to get into position. OK, now I’m ready! I picked up the plastic and the smell was overwhelming, I reeled back and rethought my strategy, Nah! I can wait!
Unfortunately my stomach had other ideas. The cramping got worse, I was dodging in and out of the meeting trying to look very busy without doubling over. I thought perhaps I could wear a mask and that might make it tolerable (“does anyone have a hazmat suit, I’m going in!”) but I couldn’t find one. Finally on my third attempt I stepped inside the latrine and held my breath. It sounded like everyone in there had similar problems! I tried to hold the plastic ‘cover’ with one gloved hand a failed attempt at some modesty and prayed it would soon be over. Added to this was the fact that the latrine temperature is a good 10 degrees hotter than the outside. Now, you can understand why in 3minutes you lose almost a litre of sweat and exit with near syncope (that means fainting). I recalled one of my colleagues had mentioned he was about to pass out the day before doing the same thing. I returned to the clinic tent sweating buckets and seriously nauseous just in time to hear the medical director announce “I would like to introduce Dr Tuakli, our new visiting doctor!” Showtime!
So why do I tell this graphic tale you wonder? Because it really brings home how these people are living on a day to day basis with zero options, it’s a wonder a massive epidemic of cholera or dysentery hasn’t wiped the whole camp out or that people don’t become despondent in the face of such living conditions. Compared to this the rest of the day was less traumatic. I saw patients in the clinic including an 82 year old resident of the camp and several children. There was some mention of me organizing the women and child care system for the camp , we’ll see how that pans out. I guess every little bit helps and I am glad to make my contribution.
Around 3pm I went with the medical administrator to a ‘cluster meeting’. This is where all the organizations that have health programs helping out in the various camps get together and decide on strategy. There are Aid organizations from all over the world mostly Europe and the US. They decided with the WHO to call on the Haitian government to stop forceful removal of squatters in camps. By the time I spoke to my husband on skype my voice was gone and I was wiped out, I thought it was just dehydration and a stomach virus, but No, this morning I woke up with a full blown cold.
DAY THREE
I have spent the day with a nose dripping like a faucet but in addition to that I worked in the clinic in the morning. I am discovering creative talents I did not know I possessed. Yesterday a lady brought a child in with a fever of 40 degrees centrigrade (normal is 36) and said the baby had begun to have seizures, requests for Tylenol were not working and after insisting I was told there was none in drops. The child had already been stripped and sponged but was still hot (big surprise in that tent!). Brain wave! I asked for a tablet then crushed the end with my otoscope and poured the powder into the child’s mouth. He didn’t like that and started to whine, next I grabbed my water bottle and dripped some water into his mouth, Voila! All washed down.
Today, a lady came in with a child with Hydrocephalus (a big head from too much water on the brain) the child is 15 months old and has a fresh scar on the head where some surgery has been done to relieve the pressure in the brain. A sad case, the child cant walk or talk, legs are paralyzed. Apparently the doctor she saw had given her a prescription for Amoxicillin liquid, which was not available so she was told to go and buy the prescription elsewhere. The child’s caretaker came to me and asked me to help. She said the child’s mother had died and she had no money. I spoke with the doctor, “well she can come back tomorrow and she can see if we have some then” she said. Ahh, I don’t think so! I went to the pharmacy and told them to take an adult pill and have them crush half of it three times a day.
I have treated four staff people so far!
A middle aged lady came in with a 3 day old baby, apparently it had been delivered ‘at home’ in a tent, the mother was not there. Unfortunately, this opportunity to intervene was missed, the clinic staff cleaned the umbilicus and sent the baby ‘home’.
This plus several other issues prompted me to send a long email to the program director. I’m not sure how popular I am going to be after this!
My mind is racing with ideas of things we can do to help the community at Terrain Acra .
I will keep you posted!
Today is Day 3 of my visit here.
The first thing you notice when you arrive here is how hot it is! I have never sweat so much in my life, not even in Africa.
After a slight wrinkle at the airport on Sunday I made my way to the “group house” that is shared with 5 other people. It is actually a beautiful house in a ‘safe’, gated community. I sleep in a tent on the ‘balcony’ which fortunately is inside. Fortunate because this is the rainy season. It rains every afternoon, sometimes it is a thunderstorm with a deluge and sometimes it is lighter.
On the drive from the airport there were obvious piles of rubble and destruction and a fair amount of traffic.
I met my house mates and forced myself to stay awake until after we went out to dinner, getting to the restaurant took 40 minutes. The traffic in Port au Prince is really bad and I was to discover just how bad the following day. A large part of my time is spent sitting in traffic, after a stop at the main office and a security and camp briefing I finally got to the “Tent city” where I will be practicing for 2 weeks. It is called Terrain Acra.
Terrain Acra has to be seen to be believed, it is a community of 28,000 people displaced by the earthquake all living under pieces of plastic sheets. There is no running water or electricity, the temperature outside is between 97 and 103 degrees, this is magnified by the plastic sheeting and lack of air circulation. Children, goats and pigs rummage freely in trash piles that are everywhere. What is it about pigs that makes them smell so bad?
Terrain is a squatter settlement on the waste dump of a factory owned by 3 brothers with the last name Acra (I understand they are of Lebanese origin). The brothers have agreed to allow these people to stay on the land until January 11 2011 at which time they want their land back. The police have agreed to forcefully remove the people at that time.
The ‘clinic’ is a large tent donated by Unicef, it has been divided up into 5 examination cubicles and a table which represents the pharmacy. I was only there for a few hours on my first day and then I was told to return to the office. Once there no one seemed to know what I was there for so I guess I should have gone in the ‘mobile clinic’. In the office I was given a disc on key by the data entry guy. I tried to open it later on my own computer. There was nothing on it but viruses, my computer went crazy!
DAY TWO
My second day began with a quick breakfast and then the long car ride to the camp, on the way in, I could tell my stomach was starting to rebel. I had the dreaded thought that I might have to use one of the latrines (a hole in the ground which is used as a toilet). Try as I might I couldnt ignore it and the cramps got worse. Just in time to start the daily meeting ! Great, why didn’t it start before I left the house so I could take something? I checked in at the pharmacy table, No, they didn’t have any diarrhea medicines! I decided I had no choice but to bite the bullet and go to the latrine.
The latrines stand proudly with their graffiti covered plastic flapping whenever there is a suspicion of a breeze. I am not too proud and I do need to hurry up before I run out of options, I thought. Let me check them out.
I went back and got some gloves, I didn’t like the idea of toughing the plastic not even for the second it would take me to get into position. OK, now I’m ready! I picked up the plastic and the smell was overwhelming, I reeled back and rethought my strategy, Nah! I can wait!
Unfortunately my stomach had other ideas. The cramping got worse, I was dodging in and out of the meeting trying to look very busy without doubling over. I thought perhaps I could wear a mask and that might make it tolerable (“does anyone have a hazmat suit, I’m going in!”) but I couldn’t find one. Finally on my third attempt I stepped inside the latrine and held my breath. It sounded like everyone in there had similar problems! I tried to hold the plastic ‘cover’ with one gloved hand a failed attempt at some modesty and prayed it would soon be over. Added to this was the fact that the latrine temperature is a good 10 degrees hotter than the outside. Now, you can understand why in 3minutes you lose almost a litre of sweat and exit with near syncope (that means fainting). I recalled one of my colleagues had mentioned he was about to pass out the day before doing the same thing. I returned to the clinic tent sweating buckets and seriously nauseous just in time to hear the medical director announce “I would like to introduce Dr Tuakli, our new visiting doctor!” Showtime!
So why do I tell this graphic tale you wonder? Because it really brings home how these people are living on a day to day basis with zero options, it’s a wonder a massive epidemic of cholera or dysentery hasn’t wiped the whole camp out or that people don’t become despondent in the face of such living conditions. Compared to this the rest of the day was less traumatic. I saw patients in the clinic including an 82 year old resident of the camp and several children. There was some mention of me organizing the women and child care system for the camp , we’ll see how that pans out. I guess every little bit helps and I am glad to make my contribution.
Around 3pm I went with the medical administrator to a ‘cluster meeting’. This is where all the organizations that have health programs helping out in the various camps get together and decide on strategy. There are Aid organizations from all over the world mostly Europe and the US. They decided with the WHO to call on the Haitian government to stop forceful removal of squatters in camps. By the time I spoke to my husband on skype my voice was gone and I was wiped out, I thought it was just dehydration and a stomach virus, but No, this morning I woke up with a full blown cold.
DAY THREE
I have spent the day with a nose dripping like a faucet but in addition to that I worked in the clinic in the morning. I am discovering creative talents I did not know I possessed. Yesterday a lady brought a child in with a fever of 40 degrees centrigrade (normal is 36) and said the baby had begun to have seizures, requests for Tylenol were not working and after insisting I was told there was none in drops. The child had already been stripped and sponged but was still hot (big surprise in that tent!). Brain wave! I asked for a tablet then crushed the end with my otoscope and poured the powder into the child’s mouth. He didn’t like that and started to whine, next I grabbed my water bottle and dripped some water into his mouth, Voila! All washed down.
Today, a lady came in with a child with Hydrocephalus (a big head from too much water on the brain) the child is 15 months old and has a fresh scar on the head where some surgery has been done to relieve the pressure in the brain. A sad case, the child cant walk or talk, legs are paralyzed. Apparently the doctor she saw had given her a prescription for Amoxicillin liquid, which was not available so she was told to go and buy the prescription elsewhere. The child’s caretaker came to me and asked me to help. She said the child’s mother had died and she had no money. I spoke with the doctor, “well she can come back tomorrow and she can see if we have some then” she said. Ahh, I don’t think so! I went to the pharmacy and told them to take an adult pill and have them crush half of it three times a day.
I have treated four staff people so far!
A middle aged lady came in with a 3 day old baby, apparently it had been delivered ‘at home’ in a tent, the mother was not there. Unfortunately, this opportunity to intervene was missed, the clinic staff cleaned the umbilicus and sent the baby ‘home’.
This plus several other issues prompted me to send a long email to the program director. I’m not sure how popular I am going to be after this!
My mind is racing with ideas of things we can do to help the community at Terrain Acra .
I will keep you posted!
Sunday, June 6, 2010
Headed for Haiti, Emotions!
Its 5 AM!
And so begins my self-inflicted adventure to Port au Prince in Haiti. I said goodbye to my worried husband around 7.15 am at BWI and boarded the flight to San Juan. I was very worried that my bags would be too heavy but we were able to include all the prenatal and kiddie vitamin bottles I had brought with me plus a 5 pound bag of candy for the kids.
What are my emotions? I am not sure, after having so many people,including my dear husband, tell me not to go, then the security advisories and disclaimers from the American Refugee Committee (ARC) the group I am going to work with,I feel mre anxious than I usually am when I leave for a volunteer trip. The positives include the possibility of perhaps making a difference to someone in Haiti and also the chance that I may actually get more rest there!
Apart from only getting 3 hours of sleep last night and getting up with a sore back, the past few weeks are starting to take their toll. In addition to organizing a women’s seminar and having to evict a tenant from a rental property, I have had to work through my son’s “senior pranks” and graduation plus get my practice ready to do without me for two weeks and prepare for Haiti, all the while reassuring everyone that I will be coming back alive! In retrospect its been a tough year so far – a sentiment I am sure that is shared by everyone in Haiti! That thought rapidly puts everything in perspective doesn’t it?
I am hopeful that I can maintain my enthusiasm but am a little scared of being overwhelmed by the squalor and misery. My other fears are another earthquake or hurricane making orderly functioning impossible, plus I am claustrophobic so I will not be one of those surviving for days under the rubble- and then there's security.
Clues to the security situation have been provided by ARC: a casual mention that I will be picked up from the airport by an armed guard and their repeated requests that I fill out a “proof of life” form. “What is that?” I finally asked. “Just a form that lists answers to questions only you would know in case you get abducted” Aaah, yes of course!
I am anticipating up to 12 hour work days and I wonder if arriving exhausted is really doing a disservice to my potential Haitian patients.
Enough about you, what’s going on in Haiti you ask. Well I don’t know yet, I’m on a little plane on the way there from Puerto Rico. The captain says it is 33 degrees centigrade at the moment – what is that?
I will write about my initial impression and emotions shortly. Meanwhile where are my tissues……..just in case!
And so begins my self-inflicted adventure to Port au Prince in Haiti. I said goodbye to my worried husband around 7.15 am at BWI and boarded the flight to San Juan. I was very worried that my bags would be too heavy but we were able to include all the prenatal and kiddie vitamin bottles I had brought with me plus a 5 pound bag of candy for the kids.
What are my emotions? I am not sure, after having so many people,including my dear husband, tell me not to go, then the security advisories and disclaimers from the American Refugee Committee (ARC) the group I am going to work with,I feel mre anxious than I usually am when I leave for a volunteer trip. The positives include the possibility of perhaps making a difference to someone in Haiti and also the chance that I may actually get more rest there!
Apart from only getting 3 hours of sleep last night and getting up with a sore back, the past few weeks are starting to take their toll. In addition to organizing a women’s seminar and having to evict a tenant from a rental property, I have had to work through my son’s “senior pranks” and graduation plus get my practice ready to do without me for two weeks and prepare for Haiti, all the while reassuring everyone that I will be coming back alive! In retrospect its been a tough year so far – a sentiment I am sure that is shared by everyone in Haiti! That thought rapidly puts everything in perspective doesn’t it?
I am hopeful that I can maintain my enthusiasm but am a little scared of being overwhelmed by the squalor and misery. My other fears are another earthquake or hurricane making orderly functioning impossible, plus I am claustrophobic so I will not be one of those surviving for days under the rubble- and then there's security.
Clues to the security situation have been provided by ARC: a casual mention that I will be picked up from the airport by an armed guard and their repeated requests that I fill out a “proof of life” form. “What is that?” I finally asked. “Just a form that lists answers to questions only you would know in case you get abducted” Aaah, yes of course!
I am anticipating up to 12 hour work days and I wonder if arriving exhausted is really doing a disservice to my potential Haitian patients.
Enough about you, what’s going on in Haiti you ask. Well I don’t know yet, I’m on a little plane on the way there from Puerto Rico. The captain says it is 33 degrees centigrade at the moment – what is that?
I will write about my initial impression and emotions shortly. Meanwhile where are my tissues……..just in case!
Shout out to sponsors!
I wanted to acknowledge those who sponsored our seminar:
Northern Pharmacy with a special shout out to April!
Vien clinics of America
Spectracell
Northern Pharmacy with a special shout out to April!
Vien clinics of America
Spectracell
Monday, May 31, 2010
Happy 90th birthday Ms. B! News about our great seminar!
Here is a picture of me with a patient of mine who turned 90 this month. Doesnt she look great!Happy birthday.
Last weekend I held an anti-aging and hormone replacement seminar entitled: looking good and feeling good after 40! It was great and very inspiring for me personally to see women so receptive to receiving new information.
The seminar opened with Claudia Salomon a renowned Nia (and Zumba) teacher helping us claim the space that we were in. What I thought was going to be a mild stretching exercise had me breathless when called upon to speak even though we performed the movements right where we stood. After lunch she gave us another 7 minute workout and for those who wished she did a full class at the end. So invigorating and energizing, after Claudia the excitement was palpable, the room was electrified.
The first discussion was about Bio identical Hormone replacement and evaluating what hormones need to be replaced. Over 40, the most important hormones to get in harmony are: Estrogen, Progesterone, Cortisol, Thyroid and Insulin. Many people were surprised to discover that all steroid hormones are derived from cholesterol and there is such a thing as a too low cholesterol.
We also talked a lot about women's sexual dysfunction, how to manage it, how hormone replacement can help and what Herbs maybe useful. Its interesting that "erectile dysfunction" is all over the airwaves now and is considered a socially acceptable topic of conversation but more women than men suffer from sexual dysfunction yet no one feels comfortable talking about it.
Wow! No one knows unless they ask. "Is this normal?"
Dr Kanter followed with a very concise presentation on body contouring with plastic surgery. He got rave reviews from all the participants. He covered the body from head to toe and kept the audience spell bound with his before and after photos.
After lunch Claudia's routine helped with digestion and then we were back to talk about Anti-aging and Telomeres.
Three scientists were given the Nobel Prize for medicine last year for their work in this amazing field. Its implications are profound for understanding the aging process.
(Call our office if you would like to get your telomere length measured).
I was able to discuss a full and comprehensive Anti-aging workup such as the one we perform, in great detail. A very important component being neurological testing.
Dr Comeau a local physician talked about Botox and Fillers and then did a demonstration on my office manager Cindy. Once again everyone was riveted with attention.
There wasnt a dull moment!
It helps to be a woman over 40 and with the number of women I see in my practice I know what subjects are of interest to Baby Boomers. It is my goal to keep bringing you seminars
that are relevant, interesting and exciting with the end result of bringing life to your years!
We shall be holding another seminar in early fall, if you would like to be notified of our events please call our office at 410 992 0011 and give us your email address or send it through the contact page of the website.
Next week I will be blogging from Haiti !
The seminar opened with Claudia Salomon a renowned Nia (and Zumba) teacher helping us claim the space that we were in. What I thought was going to be a mild stretching exercise had me breathless when called upon to speak even though we performed the movements right where we stood. After lunch she gave us another 7 minute workout and for those who wished she did a full class at the end. So invigorating and energizing, after Claudia the excitement was palpable, the room was electrified.
The first discussion was about Bio identical Hormone replacement and evaluating what hormones need to be replaced. Over 40, the most important hormones to get in harmony are: Estrogen, Progesterone, Cortisol, Thyroid and Insulin. Many people were surprised to discover that all steroid hormones are derived from cholesterol and there is such a thing as a too low cholesterol.
We also talked a lot about women's sexual dysfunction, how to manage it, how hormone replacement can help and what Herbs maybe useful. Its interesting that "erectile dysfunction" is all over the airwaves now and is considered a socially acceptable topic of conversation but more women than men suffer from sexual dysfunction yet no one feels comfortable talking about it.
Wow! No one knows unless they ask. "Is this normal?"
Dr Kanter followed with a very concise presentation on body contouring with plastic surgery. He got rave reviews from all the participants. He covered the body from head to toe and kept the audience spell bound with his before and after photos.
After lunch Claudia's routine helped with digestion and then we were back to talk about Anti-aging and Telomeres.
Three scientists were given the Nobel Prize for medicine last year for their work in this amazing field. Its implications are profound for understanding the aging process.
(Call our office if you would like to get your telomere length measured).
I was able to discuss a full and comprehensive Anti-aging workup such as the one we perform, in great detail. A very important component being neurological testing.
Dr Comeau a local physician talked about Botox and Fillers and then did a demonstration on my office manager Cindy. Once again everyone was riveted with attention.
There wasnt a dull moment!
It helps to be a woman over 40 and with the number of women I see in my practice I know what subjects are of interest to Baby Boomers. It is my goal to keep bringing you seminars
that are relevant, interesting and exciting with the end result of bringing life to your years!
We shall be holding another seminar in early fall, if you would like to be notified of our events please call our office at 410 992 0011 and give us your email address or send it through the contact page of the website.
Next week I will be blogging from Haiti !
Tuesday, February 9, 2010
Vitamin D the under represented vitamin
I first got interested in Vitamin D a few years ago when a professor of Dermatology at a high profile institution in the North East got kicked out of his job for recommending that people get more sunlight. I was a little curious as to what sparked such controversy as clearly, an Ivy League dermatologist would be unlikely to put his job on the line over a vitamin!
After that I started receiving emails from the 'Vitamin D Research Council' an organization apparently funded by a doctor who believed so much in the importance of vitamin D that he put his career and a fair amount of his own money into proving the point.
Initially I was a little skeptical of the apparently far reaching consequences of Vitamin D deficiency: from possible association with Autism and ADHD to an increase in Cancer and infections. Then my skepticism turned to concern, the more I read and the more I checked my patients' vitamin D levels. Almost 90% of my patients were vitamin D deficient and at least 50% severely so. As a result, I have been checking Vitamin D levels routinely in all patients presenting for an annual physical exam for at least 2 years.
Most patients are not aware that they are deficient and have no symptoms but sometimes people are markedly symptomatic. Fairly often I find that Vitamin B12 deficiency and Vitamin D deficiency go hand in hand.
Such was the case with a patient of mine who came in to my office complaining that she thought she was developing Alzheimer's. She was very distressed and told me a story of constantly forgetting things and her anxiety about this. She became emotional when she explained how she did not want her children to find out. I suggested she see a neurologist and get some labwork done while she was waiting for that appointment.
Apparently she was so demotivated and forgetful she didn't get the labs done, continued with the neurologist who told her she didn't have Alzheimer's but she could try some medicine if she wanted, in case it helped. She declined.
She came back to see me 3 months later more tearful and agitated than before, she could hardly get out of bed in the morning because she was so tired. Her legs hurt and everything was a struggle. This time she got her labwork done and both her Vitamin B12 and Vitamin D level were extremely low.
With replacement she is fine, two weeks later she was back working the garden she loves and now she laughs when I remind her that she was convinced she had Alzheimer's.
Most cases are not as dramatic but is Vitamin D deficiency another one of those 'silent killers'?
Andrew Weil recently wrote an article stating that he is raising his recommendation for Vitamin D to 2000 daily (something most of my patients are already doing) because of a recent study out of the University of San Diego California which suggested that raising vitamin D levels could prevent one-half the cases of Breast cancer and two-thirds the cases of Colon cancer.
Hello this is HUGE!! As Dr Weil points out: a 50 percent reduction in Breast cancer would have saved the lives of more than 20,000 American women in 2009.
Vitamin D is thought to affect the immune system, it controls the utilization of calcium by the bones and so is important for bone strength, lack of it contributes to fatigue, it helps seniors retain their balance. It is important for cardiovascular health, in Diabetes, Psychosis and every month a new article comes out with different attributes.
In short, we need it! You can get it through fortified foods like milk and cereals but the main way is either supplementation or the sun. The latter recommendation being what cost my dermatology colleague his job because he suggested patients go out in the sun for half an hour a day without sunscreen.
Bottom line vitamin D is beginning to be recognized as a critical vitamin, if you have not had yours checked, do it now and take the necessary steps to keep it above a level of 32 (ideally closer to your age).
As always wishing you good health
Dr Tuakli
After that I started receiving emails from the 'Vitamin D Research Council' an organization apparently funded by a doctor who believed so much in the importance of vitamin D that he put his career and a fair amount of his own money into proving the point.
Initially I was a little skeptical of the apparently far reaching consequences of Vitamin D deficiency: from possible association with Autism and ADHD to an increase in Cancer and infections. Then my skepticism turned to concern, the more I read and the more I checked my patients' vitamin D levels. Almost 90% of my patients were vitamin D deficient and at least 50% severely so. As a result, I have been checking Vitamin D levels routinely in all patients presenting for an annual physical exam for at least 2 years.
Most patients are not aware that they are deficient and have no symptoms but sometimes people are markedly symptomatic. Fairly often I find that Vitamin B12 deficiency and Vitamin D deficiency go hand in hand.
Such was the case with a patient of mine who came in to my office complaining that she thought she was developing Alzheimer's. She was very distressed and told me a story of constantly forgetting things and her anxiety about this. She became emotional when she explained how she did not want her children to find out. I suggested she see a neurologist and get some labwork done while she was waiting for that appointment.
Apparently she was so demotivated and forgetful she didn't get the labs done, continued with the neurologist who told her she didn't have Alzheimer's but she could try some medicine if she wanted, in case it helped. She declined.
She came back to see me 3 months later more tearful and agitated than before, she could hardly get out of bed in the morning because she was so tired. Her legs hurt and everything was a struggle. This time she got her labwork done and both her Vitamin B12 and Vitamin D level were extremely low.
With replacement she is fine, two weeks later she was back working the garden she loves and now she laughs when I remind her that she was convinced she had Alzheimer's.
Most cases are not as dramatic but is Vitamin D deficiency another one of those 'silent killers'?
Andrew Weil recently wrote an article stating that he is raising his recommendation for Vitamin D to 2000 daily (something most of my patients are already doing) because of a recent study out of the University of San Diego California which suggested that raising vitamin D levels could prevent one-half the cases of Breast cancer and two-thirds the cases of Colon cancer.
Hello this is HUGE!! As Dr Weil points out: a 50 percent reduction in Breast cancer would have saved the lives of more than 20,000 American women in 2009.
Vitamin D is thought to affect the immune system, it controls the utilization of calcium by the bones and so is important for bone strength, lack of it contributes to fatigue, it helps seniors retain their balance. It is important for cardiovascular health, in Diabetes, Psychosis and every month a new article comes out with different attributes.
In short, we need it! You can get it through fortified foods like milk and cereals but the main way is either supplementation or the sun. The latter recommendation being what cost my dermatology colleague his job because he suggested patients go out in the sun for half an hour a day without sunscreen.
Bottom line vitamin D is beginning to be recognized as a critical vitamin, if you have not had yours checked, do it now and take the necessary steps to keep it above a level of 32 (ideally closer to your age).
As always wishing you good health
Dr Tuakli
Sunday, January 3, 2010
Latest mammogram recommendations
I have been asked by some patients what my thoughts are regarding the new mammogram recommendations. Quite frankly they don't make sense to me and will not change my current management of patients at all. Why?
Well first of all they are exactly what they claim to be "guidelines", I can choose to follow them or not. In this case I would rather not.
Mammograms are problematic from the standpoint of radiation however I have seen MANY patients diagnosed with Breast Cancer as a result of them. One of the most concerning trends has been the discovery of breast cancer in younger and younger women, the idea that they would not be diagnosed because they would delay their mammograms to the age of 50 is scary.
The bottom line is, as with most things in medicine, tailor the recommendation to the patient. It is important to have an on going relationship with a physician who knows you and who will make recommendations based on his or her knowledge of you and your particular situation, not based on guidelines. For example prolonged use of certain contraceptives, family history, breast exam findings are all things that would change how often and when a particular patient should get a mammogram.
Remember guidelines come and go, they are not set in stone and neither is your wellness. It should be a dynamic process arrived at by rational thinking and on going education.
When insurance companies finally start paying for thermograms we will have alternatives that don't involve radiation that may be more appropriate for some patients.
Until then for most people mammograms are the best they can afford ......
If you are at high risk remember to avoid caffeine, take indole-3, do regular self breast exams, do not take Provera and follow your doctors screening schedule.
Wishing you a healthful 2010
Dr Tuakli
Well first of all they are exactly what they claim to be "guidelines", I can choose to follow them or not. In this case I would rather not.
Mammograms are problematic from the standpoint of radiation however I have seen MANY patients diagnosed with Breast Cancer as a result of them. One of the most concerning trends has been the discovery of breast cancer in younger and younger women, the idea that they would not be diagnosed because they would delay their mammograms to the age of 50 is scary.
The bottom line is, as with most things in medicine, tailor the recommendation to the patient. It is important to have an on going relationship with a physician who knows you and who will make recommendations based on his or her knowledge of you and your particular situation, not based on guidelines. For example prolonged use of certain contraceptives, family history, breast exam findings are all things that would change how often and when a particular patient should get a mammogram.
Remember guidelines come and go, they are not set in stone and neither is your wellness. It should be a dynamic process arrived at by rational thinking and on going education.
When insurance companies finally start paying for thermograms we will have alternatives that don't involve radiation that may be more appropriate for some patients.
Until then for most people mammograms are the best they can afford ......
If you are at high risk remember to avoid caffeine, take indole-3, do regular self breast exams, do not take Provera and follow your doctors screening schedule.
Wishing you a healthful 2010
Dr Tuakli
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