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| Opening the clinic |
A lot of people (myself included) assumed that I came to Haiti to provide earthquake relief, but in truth most of the most effective programs have been working in Haiti for years before the earthquake hit, Mountain Top Ministries included. The village that I work in, Granmothe, was actually not directly affected by the earthquake. There was an influx of people coming out of Port-au-Prince after the majority of the city was devastated which has overwhelmed what little resources that there are here.
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| This little one had a burn on her lip |
Most of my time was spent in the lab area, which is a tiny little space, separated by a cubicle wall that houses the scabies treatment area and a shelf that blocks view into one of the treatment rooms where patients are seen by one of the providers. This assembly-line setup has meant that I don't really come into contact with the individual stories or illnesses. But I got pulled from the lab for a few hours and was able to help one of the nurse practitioners, Kristen, as she helped patients.
My job with Kristin was to keep track of the patients she saw, write out prescriptions on a pad, mark the diagnosis on a list, and gather the supplies that she needed. This was the first time that I was actually being a nurse, and I loved it!
The first patient that we saw had complaints of stomach problems and gas. Kristen laid the patient down and felt her tummy, then asked me to do the same. In the books, a patient with worms had what was described as “a doughy stomach” and I had been worried that I would not be able to recognise this. I shouldn't have worried, the woman's stomach felt exactly like a huge bowl of bread dough. This was incredibly common in Haiti. Fortunately, it was easily treated with a dose of Albendazole. Worms would also cause gas, as they would bloat the host. We have nearly every patient Albendazole, as nearly every patient.
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| Glaucoma (right eye) |
The next patient that we saw was a little 10 year old with a terrible looking eye. We called for a consult with Mary Kay, the pediatrician. We quickly diagnosed him as having glaucoma. This exciting moment of seeing this rare ocular disease was quickly tempered when we realized that we had no treatment. Without the correct eyedrops, the young boy would one day go blind.
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| Cataracts, conjunctitis |
The next two people that we saw also had eye issues. One lady had nasty cataracts and conjunctivitis (pink eye). She was easily treated with amoxicilian eye drops. In looking for these eyedrops, we also found some eardrops for another patient that we had seen with a nasty ear infection. Antibiotics are really a wonderful thing, and they are perfect for our purposes, as we would not see the patient again. However, I was worried about compliance. The people who worked in the pharmacy hardly had time to count off the pills and tell them how to take them, much less provide teaching on the importance of taking all the pills and not sharing them. Paul Farmer has done a lot of work with TB (which requires 6-12 months of treatment with a nasty antibiotic) to prevent resistance. With every pill that we handed out, I worried about what would happen if that particular bug became resistant, but other then not handing out the pill there was no other solution.
I helped Kristen to a pap smear (to pictures of that!) She needed me to hold up an otoscope so that she had a little light to see what she was doing. She and I had to lean over between the woman's legs, as I shined the pathetic flashlight into the speculum so that she could visualize the cervix.
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elephantiasis
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Near lunch we saw a woman whose leg was swollen with elephantiasis. I was back in the lab by the time that I met her, and didn't even notice that her right leg was double the size of her left until I got her on the table. She was also hypertensive. The clinic was closing, but I snuck her in to see Norma, the other nurse practitioner after getting her labs. In addition to the massive swelling of her legs, she also had a pulsing right carotid artery that could be felt easily on palpitation. Her right leg was swollen as well with pitting edema, but that was easy to miss with has massive other leg. Her right leg was probably edemous as well, but the elephantiasis hid that. She saddest bit, like the boy, was that the condition with treatable and preventable, but because she hadn't sought medical attention prior, her leg will always be terribly deformed.
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| Scabies |
In addition to these, we saw a few people and kids with scabies. For the adults, we treated with a pill, ivermectin, which is not approved in the US but works well nonetheless. For very young kids, We had to use the scabies cream. This involved taking them to the “scabies treatment area”, taking off their clothes, rubbing them with permethrin cream, then redressing them with new clothes. I worry about the effectiveness of this treatment, as they should really be re-treated a week later when the scabies eggs that are under their skin hatch, but we have no way of seeing them again. This makes the babies scream
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| Kristen and JM with the glaucoma eyedrops |
The Glaucoma boy had a happy story. While sitting on the floor to breastfeed, our trip leader, Linda, noticed a bunch of eye drops that were under a shelf. She got them out and saw that they were glaucoma drops. We asked around and managed to find out the address of the boy that had Glaucoma and were able to send a 4x4 with the drops to him. We passed along several bottles. Although this will probably only postpone the inevitable (blindness) it was still good that we could get him some treatment. Even if blindness is only postponed for a week, I tried to think of all the things that he would see during that week that he would have otherwise missed. As Kristen said, we can only do what we can do.
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