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.