Getting to Work

It’s the end of Day 3, and I’m exhausted. By then end, I mean 8:30 pm. This morning, instead of walking out of breakfast to 7 or 8 people wanting to be seen, there were nearly 40.  Word had spread that the white people where here. Matt and I had to wait for our interpreters to arrive, who planned to arrive at 8. In the meantime, Matt told me to start sorting out people by who looked the sickest. Kids get priority.  One lady is lying on the ground, one lady is plumb pregnant, and many are looking wide-eyed patiently waiting to be chosen. Eventually we get a system. The community health workers begin handing cards with numbers to the patients we prioritized, and start a line to take their vitals. Pretty slick. Matt is seeing patients out on the sidewalk, and I took some back into the clinic room. We keep going back and forth to get each other’s opinions and show interesting findings. Matt directs me to a girl who is 17 and never had her period. She came down from the mountains, which means it’s a several hours of travel. She stayed nearby last night to arrive early today. I start chatting with her, and try to get to the bottom of it. Just by looking at her, she has well-developed secondary sexual characteristics (body shape, breast, etc), so she should be menstruating. “Any chance you could be pregnant?” “No” she bashfully says. I ask my interpreter, John – “Do you believe her?” “Well, she’s from the mountains, so it difficult to make sex”. Ok, fair enough. I explain to John that I believe no one, and got a urine sample. It was negative.  Next test is to take a look. We don’t exactly have any privacy in this two-roomed concrete schoolroom, and I’m not going to lay her on the ground, so I grabbed a sheet and took her to my bedroom. The community health workers have never done a vaginal exam or seen a cervix, so they want to come along. The patient said two of them could come along. I talk with Angie, who is a family medicine resident that worked with Matt back in Jan, she arrived late last night with her husband, about 5 hours later than planned due to a bridge collapsing. After telling her about the patient, she agrees and we head upstairs to my bedroom for the exam. I am not exactly sure what I am looking for, but one thought is that she has an imperforate hymen and she is menstruating normally but the blood is building up. Which would explain the abdominal pain that comes and goes. This poor girl is terrified. We’re in a concrete room with two open windows, a white girl telling her to drop her pants and spread her legs while she puts on a headlamp and cracks open a bottle of lube and a speculum – which is something that has never been used in this area before.  Before even using the speculum, I use my gloved hands and examine the external anatomy. This isn’t normal. Where her vaginal opening is supposed to be, there is a rubbery mass protruding. It is round, and almost looks like a cervix. Could her uterus be so full of blood that it is pushing her cervix outside her body? I try to push it in or move it around, this is very painful to the girl. I obviously can’t do a speculum exam at this point, and tell her to get dressed. I grab the phone and call Dr. Ryan, who luckily answers and is as puzzled as I am. Fortunately, an Ob-gyn surgical team is coming in January and will be equipped to offer proper evaluation and treatment. In the meantime, she suggests using hormonal suppression to prevent blood production, which is painful. Matt hops on the motorcycle with one of the translators to go to the pharmacy, and comes back with a depo provera shot to hold her over until Jan.

            Clinic resumes with a severely malnourished child, scabies, some usual aches and pains, and several women with dizziness and likely anemia. All three of them had recent pregnancy losses where they lost God-knows how much blood and managed it at home. Iron pills and close follow-up is all we can do.

            The real plan for the day was to teach the community health workers. I printed Creole books called “Where Women Have No Doctor”, yesterday when we had no interpreter I just instructed them to read the pages out loud and stop and discuss. I just sat by watching. These students are something, yesterday we went until about 7pm…they just want to keep learning! They could be talking about whatever they want or quitting at anytime, I am just following their fingers on the paper and trying to monitor their discussion – they really are into this. This group of students is interesting. There were 5 community health workers that I knew about from prior, but there is now a group of 12 – 11 girls aged 21-30 and one male.  Mahalia, the wonderful woman runs this mission, “rescued” them from the streets of Port-au-Prince to come live here. They help with chores, and she gives them food and faith. And has instructed me to teach them health and English, and to learn Creole. Yes mam.

            Today, the students are patiently waiting while I’ve been running back and forth with the impromptu patient clinic. They have their books, and are opened to Chapter 4 as instructed the day before. “Understanding your bodies”. Always a fun lecture. We covered everything from anatomy to periods and then finally to my favorite – pregnancy. Along the way, there were many questions and myths. Angie brought me some colored felt, so I had cut out the female organs to use in quizzing and demonstrating. They just couldn’t believe that women don’t make any new eggs, yet men make 10 million sperm every time they ejaculate. Still crazy to me too.  One interesting myth that we kept getting stuck on, is that women can be pregnant for years. Years. The call it Perdicion, and have heard all kinds of stories of this happening. Alright enough here-say – “Ok, who has actually seen this?”. Two girls slowly raise their hand. “Tell me about it”. One girls cousin was pregnant, and after 5 months of pregnancy she started to bleed, and she got her monthly cycle back and but she still hasn’t had the baby so she is still pregnant. Ouch. The concept of abortion and miscarriage is difficult to explain. Without ultrasound or prenatal checks, and if you never actually see a baby leaving your vagina, it’s tough to swallow that your baby is gone. I’m guessing this “disease” they are speaking of, is a product of women getting pregnant with sequential miscarriages, or even just that they don’t get periods due to malnourishment. I think we talked enough to maybe dispel some myths by focusing on the biology of the phenomenon, but science doesn’t always win. Consistence and persistence, I am learning are the key.

            Class kept getting interrupted by yet more people turning up to be seen in clinic. I wasn’t expecting this. How did they even know we were here? It wasn’t a health worker clinic day, they were here to see the “blan”. Matt and I stayed busy, never left the compound to fix our internet or go to market as we planned. At sunset, we were feeling pretty energized with the reward of patient flow and teaching. The last discussion we had was with one of the health workers who was a little chubby and asked how to be skinny. We tried to show her some easy stuff like jumping jacks, but Matt surprised the heck out of me by giving a clap and saying – “Let’s go for a run”. This led to quite a commotion among some of the kids whose parents work here, as well as a few community health workers. “Tennies?” Nods of “Wee!” get your tennies kids, Blan going running. We have about 5 women, 2 girls, and the cutest 6-year-old boy, just beaming with excitement to run with us. After jog down the gravel road into the community and back, the party kept going at home with different exercises and hurdles. Matt grabbed a stick for limbo and ran to get music. This limbo challenged turned into a dance party – and DJ Protégé brought out his mixing skills.  Keep in mind there are still only about 8 of us. We just had a blast into the nighttime, with the workers and kids coming out to join the commotion. Love Shack even made the playlist, and I’m brainstorming how this playlist can be utilized in English class…

            The fun ended for me a short while into dancing with Liza – the 3 month old baby I befriended the night before when painting a room with her smarty pants 10 year old sister. Well, she and I were mostly just talking while Matt painted. In fact, she make the remark “The boy like work. It dark, we no like work in dark”. Ha. Yes, the boy like work.  Anyways, Liza cozied right up into my arms and neck, and became so relaxed that warmth ran down my abdomen. I knew I was sweaty, but this was a bit much. I suppose diapers are expensive. I handed her off, and decided to hit the shower. When I was in the shower, I saw I left my watch from the night before and realized I had zero idea what time it was throughout the day. Just nutso busy from sun up to sun down, and it left me feeling refreshed and joyful.