The "Discharge Station" Begins

The big team arrived yesterday afternoon, and is prepared to see the hundreds of patients headed our way. Matt and I will have a unique role, introducing the speculum exam into the crazy clinic flow.

Today started with mixed expectations. The day prior, my goal among many others, was to get my hands on a microscope. Matt designed an awesome study identify and treat vaginal discharge. Sounds exciting right? It’s actually a pretty big deal. In prior clinics, the majority of women complain of some type of vaginal discharge. White, yellow, thick, painful, etc… a variety of complaints make this a colorful category with many possible etiologies. It is difficult to pin down the cause of discharge without a speculum exam of their vagina and cervix, as well as a microscopic exam of the discharge. It is also very time consuming for a provider to find a private area to take their patient, perform and exam, and establish a better diagnosis that history alone could have, all the while patients are getting backed up and pushing their way to the front.

            At home, we’d send specimens to the lab where a tech will grow the bugs in culture media or run a rapid screening test, and all I’d have to do is wait for the result to pop up on my computer screen.  Yes, these simple tests exist, but when it comes down to it you really just need able hands, observative eyes, and a microscope. Back to the microscope escapades. One belongs to CHI, but it is currently missing with an unknown location. (what?) We developed a couple of leads, and were waiting on phone calls from a Dr. Mark and a Miss Phyllis (no idea how the phone trail lead us to them, don’t even care to ask). We finally touched base, and they had one but we could not take it from their premise, as they needed it for a busy clinic as well. Matt and I resolved to take our slides to them at the end of the day. Would it work? Probably not. Would we know without trying? Heck no. We’re doing it.

The only exam table of the clinic -we did our best to maintain sanitation and privacy,
but it was a little more difficult that back home. 

Working under Dr. Bybee to remove a lipoma.

            The microscope was the first of many challenges; to keep this simple I’ll just name the biggest hurdles. 1) we needed a way to clean the used speculums, we had soap, but really needed some bleach water. No bleach. No water. Luckily it rained last night and it ain’t someone’s first rodeo.  For the bleach, I delegated someone who delegated someone who went to a nearby house and bought a baggie of bleach. Just in time for our first string of patients. We had the only actual exam table in the whole clinic, so Matt and I also got the fun job of minor procedures. This includes removing sebacoue cysts from skulls, lipomas from arms and legs, keloids on earlobes, and stitching up machete bites. You really can fix a lot of the world with some lidocaine, a razor blade, and thread – right Dr. Bybee? Dr. Bybee was my first mentor on clinical rotations in his rural practice of Maquoketa, Iowa. He taught me resourcefulness and procedural confidence. On that rotation (summer of 2011), he told me of his many medical travels to Haiti, and I said, “Let’s do that someday, K?”. Well, we’re here, and I couldn’t be more grateful for his mentorship.

            Unfortunately, these simple tools can’t fix it all. In the middle of slicing through a 6 year old girls earlobe keloid the size of a plum (pierced ears + African skin = angry scarring), two of the nurses on the team are carrying a patient slumped between them.  She looks to be about 30, and is gasping for breaths. They act quicker than I can digest the situation, starting an IV and nebulizer within minutes. I refocus back to the bloody mess I am working on fixing up, and keep my attention on my patient in the midst of their controlled chaos. It’s only a matter of minutes when the gasps stop. Before I even complete my stitching, the woman has demised on the table next to us. Time of death – 9:54 am. On the first day of clinic.

            We soon learn that the male that brought her in is in fact a voodoo priest, and she had been staying with him the last several nights, but it was “never this bad”. We will probably never know what she died from or how it could have been prevented. But for now, I am embarrassed to say I felt too busy enough to feel sad or sympathetic towards the life of the unknown woman. At the time I was just frustrated, because it put our working space out of commission and we had patients backing up.

            Despite the hurdles of the morning, we performed 16 speculum exams. We saw several acute inflamed cervicitis, consistent with STDs, as well as some plain old bacterial vaginosis and some completely normal. To all you ladies who may be a future patient complaining of discharge to me - some clear/white discharge is normal!  After we finished up the last patient – Matt and I were excited to head out and check our slides. We hopped on a moto and headed out to a compound where an American doctor had us a microscope. Only one moto wipeout later, we arrived. Dr. Mark is a gracious man from Indiana who spends a couple weeks several times throughout the year to hold clinic, teach local docs, This compound is huge, and quite fancy by our standards. It is funded by Dr. Mark and his wife, through the support of their church. They boast an orphanage, hospital, lab, and even have a fancy operating room.  Matt and I were in awe. We got the microscope set up, and they even had an extra laid out for us to snag. We pulled out the day’s slides, and Dr. Mark hooked me up with a Coke – which made for an excellent dinner at 8:30pm. Deliciously refreshing. We again got busy, but weren’t too successful with identifying live bacteria on our dried up slides. Made for some comic relief and opportunity to work out the kinks of the the experiment's methods and protocol - which I had apparently been wrong for the majority of the time.  From slide prep to timing of manual exams and when to require patients follow up – we had discrepancies between each patient we saw. “Research protocol says do it this (my) way every time”, says Dr. Matt. Fine, you win. Even though I (still) think some of the rules are dumb, I know he’s right. If we want results, we gotta be tight with the protocols.  The first day of clinic was successfully under wraps – with over 200 patients seen and treated, and tomorrow would only be better!