Perspective

            It’s Monday, my first full day of waking up and withdrawing to sleep here, and I can’t help but compare how different life was just on Friday. Friday I woke up to my iHome singing my favorite “Good Morning” jam at 5:30am. Today, despite the night sky telling me to sleep, I laid in bed listening to a battle over who-ruled-the-roost coming from all windows rafters and doors. Cock-a-freaking-doodle-do. Get ahold of your circadian rhythms!  Needless to say, the chicken for lunch today was delicious.   

         

            For a Coralville breakfast, I’d grab a quick protein bar or oatmeal for the road. Today, Matt and I sat at the same table with no tv, computer, or test quizzing, and actually ate breakfast together.  It was warm cornmeal with chicken stock and some other seasoning. Mmm, warms the soul. Might take some getting used to.

            Then-off to work! Walking just downstairs resides the clinic room, which is run by the 5 community health workers whose training consists of 3 months of classes with Dr. Angie, Dr. Matt, and Dr. Mike last Jan. They are supposed to follow-up with patients who are seen by the visiting Iowan doctor teams. So I bring Charles to translate, and am hoping just to observe this first day, and see how things run.

            There are two rooms, one where people walk in and take a seat, waiting to be called. The next room has three desks, each with a health worker and an open seat in front of them. The wall is lined with shelves of medications. They are eager to start, and begin calling names back.  First patient is a 1.5 year old boy. Alright, kids are easy, I can do this – mostly education, developmental milestones, and vaccines, right?  His mom says he’s more tired than usual and has diarrhea for a day. Temperature – 104. The boy is very lethargic in his mom’s arms. I am pretty wide eyed at this point and can’t help but intervene with questions. “Is he eating?” “Not really, some breast milk but won’t take anything else”. “How long has he had runny stools?” “3 months.” I show Widlyne how to check for signs of dehydration, his pulse is 160, but he still has moist mucous membranes and good capillary refill. His mom also points to a bump in his groin. It looks like his inguinal lymph node. It is hard as a rock, and bilateral. Checking the baby’s other lymph nodes, it was apparent that he was fighting off some massive infection. Shit shit shit. So much for easy patient follow-ups. I should have paid more attention to infectious diseases when I was on my peds rotation – oh wait…I never saw anything remotely close to this. At this point, all eyes are on “Dr. Rachelle”, and my conclusion of how to fix this baby. I have no idea, without tests or imaging, I just have no idea how to diagnose the cause of this ongoing diarrhea and fever and am slightly panicking on the inside. I ask Wyndline “What is your diagnosis and plan?” I mean, she would be the one calling the shots if I weren’t here, right? She says, “Belly infection, I’d give amoxicillin”. Wrong answer. I teach her that amoxicillin does not help abdominal infection, and can even make it worse. We give the mom a home recipe for oral rehydration therapy, a prescription for children’s Tylenol (which we are out of in clinic-so lame), and albendazole for a probable worm infection. Not likely the primary etiology of her illness, but could lead to further problems. We instructed her to bring the baby back to the big clinic on Friday if he’s not eating. I’m not feeling good about this. No real diagnosis or treatment, just shots in the dark. The interpreter sees my despaired look and says, “Welcome to Haiti”.

            Among the next few patients, I see a 17-year-old boy who is hear to bring in his blind grandma. After we work-up his grandma’s pain and eye troubles, he tells us he is sick too. He has sharp belly pain daily immediately upon awakening, and some previous diarrhea, now with constipation. After an array of questioning and no specific idea of what’s going on, I took Matt’s advice from January and asked, “When’s the last time you had a good meal?” “About 22 days”.  But who’s counting, right?  Wow. I’d be counting the minutes, and started whining about 21 days ago. He also reported blood in his stool, weight loss, fever, and no appetite. All the things you don’t want to hear from a patient.  The differential for infectious causes of bloody diarrhea includes about 15 microbes – some of which get better with antibiotics, some of which get worse. What would I have done in the states? An abdominal x-ray, CT, colonoscopy, and stool sample to nail the responsible microbe. What can I do here? Give him tums, vitamins, and ORS, and tell him to come to the big clinic in a few days if he doesn’t feel better.

            The next case brings me a little more joy to tell you about, for the selfish reason that I could actually diagnose and treat. He is a 23-year-old male, complains of an “empty head” and “pressure” in his chest. Again, on the list of things you don’t want to hear from a patient – at least without an ECG machine and cardiologist on staff. Empty head – hmm. I decided to go for the depression screening. “Appetite?” “Not really”. “Sleeping?” “Not well”. “Losing interest in everyday things?” – “yes”. “Feeling guilty?” “Yes”. I probed. “Guilty about what?” Then flows the dirty love triangle. He loves a woman who is with his friend and on and on. Suddenly, giving a pick-me-up pep talk to a broken hearted man sounds pretty damn easy. We talked about his life, love, and Jesus. Pretty soon two other women workers nearby join in the questioning and counseling. He left looking a little lighter, with instructions to return as often as needed until his heart and head didn’t hurt so bad.

            Just last Friday, I was working in the surgical ICU and was also unable to communicate directly with my patients.  I experienced similar frustrations as now; the face-to-face exchange of words and emotions is what drives my investigations in medicine. In the SICU, I have interpreters as well: machines. My patients have several tubes in their body, with things going in and out every which way and screens like a NASA piolet that honestly still confuse the hell out of me – but can offer information as detailed as their lung capacity, ventilation rates, blood pressure by the second, fluid level in their veins/arteries, and the amount of carbon dioxide, oxygen, acid, base, and every other element possible – it’s all in the numbers. We can analyze and adjust treatments based entirely on these interpreters. As a side note, these interpreters cost near $10,000 a day to utilize. My interpreters in clinic this Monday are costing me $10 a day. They are able to convey the words while I study the patients’ expressions and responses to my touch. I’m grateful for their assistance, but I sure hope the Creole comes easy and I can ditch the dependence on a third party.

            On normal days, like Friday, I usually have some errands to run. So I drive my car when I want to, where I want to, and park at the store that I know will be selling my product of offering my service. Today, I trust my interpreter, (and new buddy) John, to get me to the bank and to market for some razor blades (to cut umbilical cords), bars of soap (my shower last night just wasn’t the same without any soap or shampoo), pick up a cell phone, and to exchange some money into Haitian Goude. So we walk. John hails down a friend with a motorcycle – and we both hop on the back. We’re whizzing around potholes, donkeys, and naked children like some crazy Batman finale scene.  Everyone we pass, stares. Some kids yell “Blan” at the white girl, but most people are just confused. It makes me laugh. I get confusing looks when traveling at home too, but that’s because I drive a car designed for an 80 year old euchre-playing, red hat lady. I am so much cooler now! No speed limits, no rules!             We then transfer from the moto to the “tap-tap”. The famous Haitian “tap-tap”, where there is always room for 1 more. Or when it’s completely full: 6 more.  John pushes me inside to a seat underneath the wooden cover, where speakers are blaring full blast. Again – huge improvement, the speakers in my Buick have been blown for awhile, and I haven’t been able to truly rock out in years. I’m in heaven - Minus the stench of BO and sweat mixing with my neighbors. We finally arrive at the market, where it’s just straight chaos and LOUD NOISES. We bustle from stand to stand looking for our goods. Traffic is whizzing in the middle of it all, and I think John had enough of my small town girl wide-eyed looking around, and just grabbed my hand to pull me along. Too much stimulation for a distractible girl – look! Bird! A few hours and dollars later, we were victorious and hopped on the back of another moto to take us home.