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!
Saturday, June 26, 2010
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
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