Numbers and Diseases(Matt's Blog): Hypothermia part 1

Numbers and Diseases: Hypothermia part 1

The Climb

            No, this post isn’t going to be about a cheesy Hillary Duff song.  More like a bonus level of Mario Kart that is only unleashed only by double lapping Wario on the Chocolate Mountain. Or perhaps like Freaky Friday-ing with a stud motorcross athlete on a quicksand pile of rubble, sans helmet and neon leather jumpsuit.

            As alluded to yesterday, I promised to follow-up with the 23 day old baby who had been eating cookies and shitting bricks. Not funny, she was actually pretty sick looking. And the conversation with the parents revealed a lack of education that begged for a community visit. If this mother doesn’t understand newborn nutrition, she likely isn’t alone. Guilene and I plan to travel early in the morning. She has never been to this town, and I sure as heck don’t have a clue where I am going. I pack up a backpack of children’s and prenatal vitamins and a couple protein bars and Gatorade packets. In hindsight wish I would have packed bubble wrap and vacillated gauze. Or a helicopter.

            The trip starts smooth, the usual moto ride into town, dropped at the riverbank to walk across because the bridge collapsed. Hop on a taptap for a good 30 minute drive. Piece of cake. Then another motorcycle. At this point we meet up with my interpreter Smith who agreed to come along. I am not, ahem, sufficiently  “equipped” to do the proper breastfeeding education with body language alone. This moto takes us back down a dirt road with large loose stones. These drivers are impressive, sharing the road with mules, horses, and sometimes two other motos alongside. I prefer to sit on the back of our threesome, so I have any easy exit. You also get more air in the back, which makes the ride a little more exciting.

            As a preface, I took a moto expedition last week up a nearby mountain to talk with some women, and the ride home was horrifying.

As a preface, a couple weeks ago we took a nearby mountain by foot.  This proved a wise choice as those of us hiking watched two of our friends flip off the back of a moto trying to take on a steep climb; one whose spine was saved by her backpack, and the other who suffered a severe calf burn.  The following week I repeated the expedition on moto to go talk with some women (business and family planning). The ride back home was horrifying.  The feeling of “freefall” is not something you necessarily want to experience while attached to a motorcycle painting the edge of steep drop offs.  Freefall is an amazing feeling when, say, plunging into a Jamaican cove or off the back of a boat with a scuba tank. Must say my body is still a bit cautious from the most recent feeling of freefall in rollerblades down Dr. Freund’s hill. The wound on my knee is currently opened and being whipped we fly by weeds and thorns, reminding me of the bad decision. We are entering the mountainous ravines. I ask where we are going. The drive points up, where I see nothing but mountains beyond mountains”. Ok. “How much longer?” “One hour”. Alright, hold on kids. Let’s do this.

            Things are going, so-so. The steep drops are short-lived, and the hiking path is just generous enough for the narrow wheels of the bike. Things get worse quickly. The steep ravines expand beyond view of a flattening point. I really have no road vocabulary to describe the path – Level B is the worst we have at home. This is like level B with large, loose stones loosely piled on top of each other and steep cuts within the dirt road from the recent rushing waters of Hurricane Sandy. Combine this terrain with the steep climbs and drops, and you have one heck of a widow maker.  One slip of the back tire on a loose stone, and my calf is sandwiched between a muffler and gravel.  The further we drive; I am realizing the closest thing to a hospital is probably trapped trembling in my muddy shoes.  This was so stupid of me. The revving motor and tires peeling out below me in the rubble pushes my threshold. “Mache!” I say. I’d rather stop and walk than jostle on the back of this moto with a back wheel swaying back and forth to the rhythm of my funeral procession. Which is stuck in my head at the time. He says it is better for him to have more weight on the bike for downhills. I say it is better to not have dead weight for the way home. He agrees, and at the bottom of the cliff we resume positions on the bike. This trend ensues, we ride until the terrain is too nuts, and Guillene and I hop of to hike up or slide down the mountainous hills. Two hours of this later, we arrive to a slew of families. Asking around for our patient, we hike another 20 minutes straight up, and there sits the baby daddy we’ve been looking for.

            I still don’t see the baby, and begin to worry. I get up from the conversation centered on the moto driver’s plights (including him reminding me to pay him well for taking “hell road”).  I peek into the mud hut of a home, and see the mother on the bed holding the baby. She sees me and hands her to me.  Mom looks bashful, and almost ashamed to see me. I feel bad, I was probably too stern with her and should have been a little more gentle with the counseling. The baby looks the same. Doesn’t squirm or make a peep when in my arms, just stares past me. Her belly is swollen sounds like an inflated bongo. I asked mom when she last fed her. “Yesterday afternoon, when I was with you at clinic.” “How often do you feed her in one day?” “Twice.” I am frustrated. We come out into the sunlight to join the small circle of friends and family. Lecturing her clearly didn’t stick yesterday; let’s try another method. I ask the older woman, “What should new babies be eating?”  “Breast milk for the first 6 months” she astutely replies. I’m impressed, yet angry. “Do you share this information with new mothers? How did you learn that?”  “She didn’t ask the elders. She wanted to feed the baby her way.” Life advice people – ask your elders.  (sorry mom and dad)  More counseling ensues, with the elder peer pressure on my side. She wasn’t happy with me when I said the feeding schedule might require waking up in the middle of the night.  Upon request, she began breastfeeding the baby. The baby took like a champ. We sat and watched for about 15 minutes, and I was reassured that 1) mother could produce and 2) baby could suck. Was the 3 hours horrendous journey worth it for those 15 minutes of monitored suckling? I hope yes, but the whole ride back I had myself convinced the answer was no.

            The ride home went a little faster, but still involved hopping off the moto to “mache” when the inclines and terrain were too much. Nearly three hours of intense Haitian sun later, I had never been so relieved to see the paved road. The ride back I stopped focusing my energy on whining in my head and realized – she just made this trek with a 23-day-old baby. She walked for hours and hours just to come see us, to come get lectured, and to not have her baby “healed”.  I hoped that at least by going out there it instilled faith in her and her community that we care. Sure, it wasn’t too exciting – no lifesaving mission or emergency intervention where I can see a positive outcome. But that’s just selfish. What God packed into each breast lobule is 100% goodness, nature’s finest remedy.  What is my job if not to match resources and needs? I am beginning to embrace the simplicity and huge impact of basic education.  

24 day old baby girl with a belly full of air. Baby guts are lined with cells that love human milk and aren't able to digest much more...thus gas and mush build up to make a huge belly.

Checkin out the goods. Honestly, handing out the pack of vitamins was probably more for my benefit than theirs. Sucked to drive all the way there without "giving" something. Sorry kid, they taste pretty nasty. 

This is my attempt to create a fashion blog and bring back the overalls.
 When did they become uncool? Kipp, help me out here... 

Dear Danielle

Dear Danielle,

I am writing this to you today, because I have been thinking of you all day. I know it is your big opportunity to shine at state volleyball, and it hurts my heart thinking I won’t be there to cheer you on and watch your talent and leadership in action.  I know it’s lame, but this blog entry about my day isn’t meant to be an excuse for not being there or even calling you, but I hope by reading it you realize you were with me the whole time. Every day I can’t help but put on my big-sister pants and think of how I can teach you and guide you with little life lessons… this was especially true the last 24 hours.

The morning started with goodbyes. The Bellevue team of the beloved neighbor ladies Emily and Julie, and many more good friends, headed back down the mountain. With a 3-4 hour grueling drive ahead of them, I wasn’t envious. We had just made it up the mountain just two nights earlier, traveling on motorcycles as a last ditch effort to complete the long journey. We weren’t giving up. We left the house at 8:00 am on Tuesday morning, after having one driver bail on us that morning. We hit the road, dropped off a 2 year old and her parents in Port-Au-Prince to see an eye doctor for a surgery to correct her congenital cataracts and give her vision. VISION. Yea, that’s a big deal. Try closing your eyes for a minute, and tell me it’s not. She’s gone her whole live with her vision getting worse and worse, woth little understanding of what’s going on. Nice work Tyler for finding and diagnosing her.  Dani – never take that for granted. Try serving your zones blind. That should be easy. Now try blocking the middle blocker you just played against. Grateful now? And don’t forget that vision is more than just what’s in front of your face.

After sending her to the hospital, Matt and I had a mission of finding an orphanage that is looking for medical teams to come check on their kids. We didn’t really know the name of the place or where it was, so we picked up a passerby on the street who thought he had heard of it. He used Matt’s phone to communicate with the orphanage’s manager, and 10 minutes after he left the car we realize Matt’s phone (with all of our contact information for the week’s journey ahead) was missing. We turned that taptap around to find the punk responsible. We caused a near riot in this small town, with the town on our side yelling at the group of guys who were potentially guilty. I was ticked. Enough talk – I lined up the 4 guiltiest parties and gave them the full pat down. No luck though. It was gone. Lesson for the baby sister: don’t invest too much of your life in a cell phone. Or any material item for that matter. These things are transient and can’t be counted on.  Also – just because you get burned once doesn’t mean you lose faith in humanity. People do bad things for reasons we can’t always explain.  We have been blessed to never have lived in poverty or desperation where stealing is a means to eat dinner.

Once we reached the orphanage, we felt instantly energized and relieved. Connie (new friend) received us with open arms, and showed us around the grounds. Over 150 kids call this place home. Kids who were left on the doorstep by their parents, or found sick and dirty in the streets. (Check out Imagine Missions - http://www.imaginemissions.com/index.html) 

We were only there a few minutes and in walks two Canadian family physicians and their 3 daughters, here to do a clinic with the orphans. They visit twice a year to do check-ups, and their girls help with giving vitamins, paperwork, and reading/playing with the kids.  (Ready to sign-up Dani?) This trip, they had missed a flight or two and were behind schedule; so immediately upon arriving they were ready to get to work. Connie introduced Matt and I as health providers. They said – great! If we have 4 providers we might be able to get through all the kids’ exams today! Let’s get to work! We looked at each other with raised eyebrows… this was only supposed to be an hour pit stop to check out the location and see if it would be a good spot for our team. But are we going to turn down the offer to examine a bunch of energetic orphans in their Sunday best school uniforms? Heck no. In a matter of seconds we responded “Yea!” and got to work examining kids right there on the spot. Scalps, heart murmurs, ears, throats, and bellies were examined, and albendazole was force fed to the masses. In talking with one of the interpreters – we learned that our final destination was still quite a trek away – about 4-5 hours on a terrible road. It was 2:30 now, we had no choice but to get moving. We thanked the gracious Canadians for letting us join, and we hopped back into the back of the truck to finish our journey. Lesson here little miss Dani? Go through life with an open heart. You are very open-minded individual – continue to keep your eyes peeled for opportunities to learn from other people and share your gifts. Some of your gifts: encouragement, optimism, enthusiasm, leadership – use these gifts every chance you get! You never know what kind of difference you can make until you try your best to share what you’ve got.

Matt examining some kiddos 

Awesome Canadian FP doc 

 Two hours into the journey, we arrive at the base of the mountain.  Our driver stops for gas, and begins chatting with the locals. He returns with bad news – he’s not taking us any further. This road is too rough for his car. “What!?” We specifically asked him before leaving if this truck was 4 wheel drive and 4x4 (even though I still don’t know what that means), and he say yes. Now he sheepishy admits he lied, but thought it would be fine because it “has a really strong engine”. Yeah, well so does my mouth but I don’t have a balloon to fill with my hot air and land us at our target. Only option to make it to the top is on motorcycles. I asked a truck at the gas station if we could rent it from them, they said heck no. Soon word had spread that the “blan” needed motos, and about 15 guys were behind our truck begging for the job. Big job – 3 hours each way would earn them about $20. In the midst of al this I realize it’s going to be a long ride in a skirt. I’d learned that the hard way previously. I change into my cargos in the midst of the chaos. Lesson here? It’s coming…

Crazy moto driver

Gorgeous views, less scary looking from bottom up. No photos were taken from the top for fear of my life.
Yes, I am being dramatic. 

There she goes. 

Three and a half hours into the dark later, we have climbed and coasted through several mountains and arrived safely. Keep in mind these roads are unpaved, without street lights, without a middle line dividing traffic, and without a separate "animal crossing" lane. Upon arrival, Matt is bruised from colliding with a mule, I'm muddy from getting stuck in mud and feces, and we're all sore from holding our months worth of luggage strapped behind us. The crazy moto drivers are grinning like kids on Christmas - this challenge of speed on rough terrain with a girl screaming on the back is a teenage boy's dream. 

The exhaustion wears off immediately in hearing a familiar voice - "Rach! Rach! OMGGGG!" Emily and Julie come running down the stairs with open arms. The hugs are energizing. I can't stop smiling, and am so grateful for the hospitality of Cindy, Julie, Emily, John, Toby, Andy, and the whole gang. 

The little sister lesson here: 1) For all activities that thrill you to the point of terror, loosing your voice, and wetting your pants: you’re only allowed to do once, the second time will probably kill you.  Do this with prayers and for good reason. Doing it for the thrill or to test your luck isn’t a good reason. 2) Friends make bruises go away. Friends with licorice and beer waiting deserve payback in tenfold. Always strive to be that friend who gives hugs, licorice, shampoo, and clean sheets. Be that friend to everyone, not just your bestie snuggle bums honey lover (whatever other weird nicknames you guys have for each other). Got it? 

Bellevue reunion. Can't help but bust out the Girl Scout's theme song:
"Make new friends but keep the old, one is silver and the other gold"

            Today the awesome group left, and Matt and I needed to finish our mission, which involved a 5-hour hike even higher into the mountains. The remote town of La Fite had build a clinic building, but had no one to work it. Our group has many doctors, nurses, pharmacists, ect who are super gung ho and awesome about helping in new places. We are hoping to match the services, so Dr. Chris told Matt to check it out. We pack up our sleeping bags, protein bars, and half-clean underwear. Lace up the hiking shoes, fill the water bottles, and do some deep lunges and raises to warm the calves. Kidding about that last part – these calves were born hot.

            Only problem with leaving for our journey – there are about 60 patients downstairs waiting to be seen. Awesome, except our interpreters left. Dr. Leo (Haitian doctor who works/lives at the mission) told us to get to work so we could get on the road. We each have a clinic room and nurses leading patients in. Once I get past “How are you” “Does your head/stomach/back hurt?” “Do you have acid” and “Youre blood pressure is high”… I’m out of phrases.  I am running back and forth from my room to Dr. Leo’s, who is laughing at me saying “You’re fine just do what you think the patient needs!” Not okay. I bail on my room at join Matt’s. His Creole is better, and two heads are better than one. Matt led the way with his Creole and I did my best in talking with my hands (life skill I know you have mastered!). Eventually I was again frustrated. Communication is everything, especially in medicine. When a mother has a sick kid on her lap, traveled for hours to get here, and is going on and on about when it started, what symptoms she’s noticed, and what her concerns are – I need to hear what she is saying. Sure, I can garner a lot of information from listening to heart/lungs/belly, assessing their weight for age, and taking their vitals. Heck, just by looking closely at a person you can usually label them as sick or not. But when a patient just traveled for hours and spent a day’s wage to see a doctor, you damn well better give them the best care you can.  I sort of turned into a brat and told Matt this is dumb, we are better off letting these people just wait for Dr. Leo. I leave the room, Matt’s continues on and feels more confident about the situation. I went to check on the inpatients – there are 4 people staying the night here in a room with curtains between them. They are told to bring their own food, but 3 of these are kids who are staying here alone. They have no food; they are sick, and looking pathetically weak. One of the patient’s is a girl we admitted the day before who stepped on a rusty nail a week ago and was now septic. Another was a 7 year old boy with Typhoid. Another was a 22 year old male who weighed about 80 lbs and had pneumonia. The other two ladies I don’t even know what they had, but they looked ill. The good news about the Americans leaving today is it meant there was more food upstairs available to share. I know this is against hospital policy, but I’m feeling a little helpless and emotional right now. I go upstairs and load of plates of plantain, avocado, and PB&J to bring back down. All of the patients are barely strong enough to lift their head to swallow and require feeding assistance. Talk about rewarding.  Again, I think of you. Cheesy as it sounds, I am thinking about feeding you when you were a little runt. I am sorry for the times we played restaurant and I convinced you to eat my crazy creations, and for the spoonful of cinnamon. But it sure made me happy to fill your chubby little cheeks with spoonfuls of Gerber. Find a way to experience that joy. You may think there are no hungry people in Bellevue, Iowa…but there are hungry people all over Iowa and the USA. You don’t need a medical degree or even a high school diploma – you have a grocery store and a big heart – go feed someone. 

Snapping out of it, I resume to the clinic room with Matt, who has intelligently opened a Creole dictionary program on his computer. We are able to succeed in seeing a handful more of patients, and around 3:00 we are finally ready to get on the road. We buckle up our packs, knowing we need to hustle before dark sets in. As we are just two feet from the door, commotion abounds.

8 men are carrying a stretcher, followed by 15-20 other community members reeking of emotional havoc. We immediately drop our packs, and usher the patient to a bed around the corner. He is filthy dirty, shivering, and not responding. There are 12 people in my way, and my angst causes me to angrily point them out the door and shut the door in their faces. This guy is sick. Matt is already at the bedside doing ABCs. He yells – “No breath sounds on the right”. I yell “Oxygen!”. No one moves. Dr. Leo yells “Oxygen!”  The nurse scrambles to find the O2 machine and oximeter. He is satting at 82%. Matt is still assessing the patient's neuro and cardiovascular status. I begin tearing off his muddy, soiled clothes. The smell is horrible. We start to get the story: He is a friend of Dr. Leos, works in his garden. He has been missing for 2 days, and his friends just found him in a 70 ft hole. He has wounds on his hands indicating he was defending himself. Exam of his head shows two large gashes, filled with dirt, and no longer bleeding. Not a good sign. If he has wounds this large and is no longer bleeding he is severely dehydrated and sick. Along with the gashes is a large dent, we conclude he had been beaten over the head with a machete, and his hands tied tightly. This is horrible. Gut wrenching. Things are not moving as a trauma should. “IVs!” We need two large bore IVs with fluids on wide open. We need a warming blanket. We need a chest x-ray. We need to type and screen him for blood replacement. We need cultures, labs, C-spine stability and imaging. So much we needed, yet so little we could do. Once we get the fluids, warming mechanisms, and antibiotics going, we wheeled him out for a chest x-ray. The x-ray machine rolled out of the closet, and Dr. Leo began ushering everyone out of the way for the radioactive particle release. Matt and I are holding the patient, who is flailing his hands, fighting the IVs, and struggling to breath.  Neither of us really want to be in the way of the x-ray, Dr. Leo asks me if I could be pregnant. I say no it’s fine, and begin to cringe and protect my thyroid and ovaries. This doesn’t sit well with Matt, he played the hero and kicked me out to take the beam for the team.

We suspect a tension pneumothorax, and the x-ray shows us we are right. Trachea deviated to the left with chest expansion on the right. In short – his lung deflated/leaking and air was building up in the chest cavity.  Neither of us has managed this before. We tell Dr. Leo the Step 2 CK board’s answer of what is supposed to happen – we need to insert a needle in the 2^nd intercostal space to relieve the air. It's game time.

Back in Cedar Rapids, you are probably just being announced to the crowd. Shinning red uniform, braids, and a big smile. Thinking about it now is jerking my tears a little bit.  I’m proud, and incredibly happy for you and your team’s accomplishments. Wasn’t all that long ago that y’all couldn’t get your serves over the net, and for the love of God y'all made it look difficult to pass to a setter. But look at ya now, unmatched talent and hard work has served you well.

What happens the rest of the night is more medical jargon than you care for, so I’ll do it in a separate entry not dedicated to you.  I hope you accept my apology for not calling or being present. I know how much it meant to you.  I know you understand, but still are disappointed I couldn’t be there. Remember though, this is the first of many “game times” in your life, where you will feel scared, unprepared, or nervous to participate. Your athletic challenges have prepared you to conquer scary moments in life. Be grateful for this. Standing in front of the crowd, serving game points, shooting free throws, or even just running out without tripping (harder than it looks, right!?)– these are all challenges you have already succeeded at! Cool confidence – own it. When you work hard to master a sport/job, do your best and have confidence. Stay calm. Carry on.  Remember forever how you felt on the court when you did something well, and apply this to the rest of your life – races, interviews, tests, ect.

Even more than strength inside, is the strength you can get from God. Never discount this. When you anxious and nervous – pray! Today I read Joshua 1:9 and thought of moments like this. Whether it’s a state game, or a critically ill patient counting on you to work fast. “Be strong and of good courage; be not afraid, for the Lord thy God is with thee wherever you go!”  Big sisters try to carry this protection too. You have a lot coming your way in life, and I won’t always be there. I don’t always have the right advice or the best ideas. But, keep faith in your heart, make good choices, and know that I support you and love you more than you’ll ever know! Now I will anxiously await the next time I have phone reception to find out how the game went, but no matter the outcome – I love you and you’re amazing!

           

House call in a Hurricane

The skies have opened up today and the rain won’t stop. We were forewarned that Hurricane Sandy would be paying us a visit, and I wasn’t sure exactly what to expect. I work early on to the sound of rain. Just when I thought to myself that it was the hardest I have ever seen rain pound the earth – it rained harder.

            We spent the day organizing medicines, and teaching English to the eager students. Not as easy as I thought it would be – since I know enough Creole to say please and thank you – helping them translate common phrases is not easy. I go with pictures and actions, and we had a fun morning. In the afternoon, Matt and I debated how to go about making a house call we promised a patient the day prior. A 37-year-old woman came to clinic, carried by her husband. She is unable to walk, and while the story changed several times, it is apparent this started in the last year. She also reports double vision, and leg pain. Medical professionals– help us out here.  We argued back and forth over the differential, in the end I won him over. We’re going with burst and taper of prednisone, if it MS (2 deficits separated by space and time) or polymyositis (lower extremity proximal muscle weakness was the most prominent feature), we might see some relief in a week.

            The roads were rivers, and we stopped even watching where we stepped because there was no avoiding the swampy mess. Luckily the day we left, Lynn equipped us with some rain ponchos, so at least our chests and shoulders were dry. It was actually pretty run running and sliding around. If the medicine doesn’t help her, at least she will get a kick out of us sliding into home at her doorstep. We finally get to her house, and she lives in what looks to me like a doghouse.  She’s got a straw mat on the floor, water and a candle at her side, and most importantly - shelter from the storm. Not a bad gig, all things considered. She is ecstatic to see us. Again – we have few words for communication, but she takes the 60 mg of prednisone we haggled from the nearby pharmacy. We agreed physical therapy would be important, and the only real way to teach her was to sit alongside her on the floor, in the candlelight, and teach basic strengthening for core and quads. I hope future blog posts bring good news about her prognosis, for now – we’re placing our faith in prednisone and prayers.