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!
Showing posts with label Tent city in haiti. Show all posts
Showing posts with label Tent city in haiti. Show all posts
Thursday, June 17, 2010
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.
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