Friday, February 26, 2010

Clinic day 3: NGO speed

After an expected slow Thursday in clinic, we had an unexpectedly slow day today--and I realized that we've hit third world NGO speed, which is somewhere between first gear and neutral. There are plenty of needs and people to help WHY AREN'T THEY SHOWING UP IN MY CLINIC TODAY!!!

The morning wasn't so bad. I saw 27, we saw 40 total. Not a bad morning with 2 docs. The afternoon we had 3 docs total, and probably saw only 20 patients. A little confusing--where da patients at? So I decided we needed some signage and created a committee consisting of me to make a sign for the clinic. It is pathetic how hard this was. I mean, it's just a sign. Not a billboard. It ain't got no neon lights, Lt. Dan. Just a little sign with an arrow. That, my boy, will bring us the shrimp! Our clinic is in a church, down the street from the main road/highway 2. I surveyed the main road--tons of traffic. It was a mess, actually. I was almost run over like 4 times, once by an old lady with a cane. Lorenz in the headlights for sure. Anyways, it's not like there's an office depot down the street with fingerpaint for me. So I'm basically going through rubble and trash to create a sign. I settled on cardboard from some of the medicine boxes, and used a sharpie to write KLINIC GRATIS in Creole. I slapped that badboy up on this utility pole on the busy street, quite proud of my little sub-kindergarten level art creation. After I put the sign up, we had 2 people come in. I wanted to give her a little survey "How did you hear about us," and would have paid her if she checked the "I saw your sweet sign at the road" box, but I refrained. Turns out one of the ladys was there for church, not even the clinic, and they other lady didn't come in for the sign. Just depressing. So I gave $20 to this "artist" friend of the pastor, who we then commissioned to make the sign. We'll see if I just kissed that twenty goodbye or not. You watch, when that sign gets up, we will have established the next Haitian healthcare conglomerate! A couple more patients would be fine, too.

John, the other doc, suggested paying a taxi (tap tap) and doing a mobile clinic if it gets slow again. You know what I want? A backpack and a motorcycle. But there are more important things to be done. We need to get a better established referral system. Many come in with basic stuff I can do little about--pregnancy, glasses, TB, HIV, outpatient surgery (hernia, gallbladder)--and I refer them to "the stadium" which is down the street, but I don't know that anything happens. I've heard the Canadian hospital is packing up their bags and going home. We need some recon to establish some reliable referrals. And we need the end-all sign. And there is a clinic at this mormon church by the stadium that is closing, we need to get their meds and supplies so they don't go to waste. The medical motorcycle dream dies another day...

GERD/Heartburn (7)
Vaginitis (4)
Headache (3)
High Blood Pressure (3)
Wound Care (3)
Dry eyes (3)
Myopia (2) Need glasses
Ringworm/fungal infection (3)
Chronic abdominal pain
Urine infection (2)
Cold (2)
Dysentery (2)

I've had a couple of dudes coming in with bloody diarrhea, fever and abdominal pain. I treated them for dysentery, although can't be sure that's it. Also, a 20 year old girl with a year of enlarging lymph nodes on her neck. They were rubbery, she didn't have any other "B symptoms" like night sweats, weight loss, etc. I don't know what she has, but referred her for an HIV test to the stadium.

Can't wait for the sign to be finished tomorrow...

Thursday, February 25, 2010

Clinic day 2

Today the clinic was only open for the morning, so of course we had to figure out something to occupy the afternoon with: TO THE BEACH!!!

List of my diagnoses today:
Ringworm (3 cases)
Chronic Backpain
Chronic knee and buttock pain
Itchy eyes (2)
Myopia (near-sighted)
Chronic diarrhea
Knee pain

Definitely a list of clinic complaints above. We did have a 20 year old male virgin with 2 weeks of cough, night sweats and weight loss. Probable tuberculosis, I think. We referred him to another facility for x-ray, TB treatment and HIV test--a blood test of that virginity, ahem ahem. There's a fair amount of TB in Haiti, and often HIV presents as TB. Jason was in a closet (literally) with this guy for 10 minutes--he had a wound in a private part that and didn't want to drop trow in front of the other patients. Sure, you can have some privacy--at the cost of Jason's lungs, not mine. I don't think the exposure was too significant. I thought Jason should get a PPD when back, not necessarily 6 months of isoniazid and no beer. (Can't drink alcohol with those pills). Jason initially wanted some meds for his exposure. After I informed him of his alcohol status for the next 6 months, he agreed with my test before treat plan.

I'm kinda in charge of the clinic. The last resident passed on the key and money to pay the translators. We try to make it better in little ways. Jason reorganized the meds, which were in a little confusing disarray, putting labels on them. We made notes of meds we need; I think a scale would be helpful, especially for the little ones like that 7 month old with chronic diarrhea. Clinic tomorrow and Saturday should be much busier and all day.

TO THE BEACH. The problem was we had no idea where we were living, and how to get back from the beach. There isn't really an address, or cross streets. We are on HWY 2 in Leogane across the street from the big green and yellow sign. That's about it. This is nuts, but Jason's IPHONE saved us. He's got a googlemaps app on it where you turn it on, and with a little pin, it shows where you are. EVEN IN HAITI! I think technology often unnecessarily complicates and disconnects our lives, but damn. That was pretty cool. And it got us to the beach and easily back.

Like everything else, the beach was a mess. Tons of trash washed up on the beachside, with beachside resorts in shambles, but still clear blue warm Carribean waters. I thought about my incoming babygirl and picked up a pretty shell for her. A brilliant orange. Then we got taken advantage of by this dude who wanted 60 Haitian Gourdes for 4 beers, about $1.50 (as I later found out). When I stupidly pulled out a $20 and was trying to figure out how much a gourde was worth, his buddy saw an opportunity and took it, swindling us for our cash. I knew we got worked and wasn't happy. Then he trailed us the rest of the way, looking for more cash. Guess I should be happy they didn't rob us. In protest, I didn't drink the beer. John and Jason doubled up, and didn't seem to mind. Then on the way back, we hitched a ride in the back of a truck like bus with 32 Haitians. That was safe. The number of times I should be dead because I've been in an automobile in Latin America...Lord. It makes riding my motorcycle look like riding in a sedan with a childseat and helmet. When in doubt, just honk your horn, floor it and close your eyes and everything will be fine. I can't believe I haven't seen those roads lined with cars on fire and bodies running around in flames, but whatever. Guess it works for them.

That's one of the things I like about the third world. It's the jungle, man. The psuedo-civilized wild. I'm surprised there isn't more crime here in Haiti. I don't have numbers, but it feels safe--although it's got this brink-of-chaos feeling to it. What's to stop it? I'd heard there's all this international security here--and maybe there is near embassies or the big hospitals, but I haven't seen it. At the same time that you leave the safety of first world civilization behind, you can better connect into humanity and earth. I am in much better touch with my mortality and limitations, here. Any number of things could kill me here--from basic appendicitis to a car crash to malaria. Or even the next earthquake. And I'm aware of this. At home, I think I exist in denial of this basic reality, comforted by the illusion that everything is fixable at the local hospital. Which is nuts because I see people die all the time of things that we can't fix.

This morning, I woke up to the rooster's crow just before dawn. And I just sat there. I didn't have much to do. Didn't have a manufactured to-do list of important crap that absolutely must get done. It was nice, to just be, and kinda feel that rhythm of waking up when the earth gets up, and just breathe a little bit.

Wednesday, February 24, 2010

It's not that bad. Or is it?

After 6 hours in a van from D.R. to Haiti, we finally made it to Port-au-Prince. And my first reaction: where's all the destruction? I didn't think it was that bad. All those images I'd seen on CNN of building after building in rubbles...I wasn't seeing. Just didn't seem that bad. Maybe 1 in 10 was falling down. Most looked ok. I started to devise this media conspiracy plot to make it look worse than it actually was to get more attention and money to Haiti.

Let's just say I was wrong. And it feels worse to see all this in person. It looks just like it does on TV, except it never stops. You drive down a street and get sick of seeing all this rubble and concrete and mess. After a while, I was like, "Ok, I get it. Can we get a break here with a half-way intact block?" But it doesn't care, it just keeps going. It's exhausting and numbing.

Heart to Heart works a few clinics, and one main one is downtown, just blocks from the presidential palace and the hospital that went down. "Ground Zero" they are calling this area. There's just something about seeing such a monument as their presidential palace in ruins that puts an exclamation point on this earthquake's impact. Definitely gets that Keanu Reeves, "Whoa" when you first see it, even if you sweat you'd never sound like that goof. Across the street from the Nazarene church our clinic was at lies the rubble of a 5 story apartment building where 40 died. The other corner was a 5 level elementary school with over 200 lost. Their bodies are still there, somewhere beneath the pile of broken concrete. Creepy and chilling to think about. I couldn't see any body parts, and it didn't smell at all.

This morning we saw some patients. It's a basic clinic setup, not bad really. We've got a bunch of meds--several antibiotics like amoxicillin, keflex, flagyl, cipro, doxy--paracetamol (like tylenol), mobic (an NSAID), prednisone, liquid albuterol, pepcid. In a couple hours, I saw maybe 10-15 patients. Everybody complains of dry eyes from the dust everywhere, and we give them eye drops. #1 most common complaint. I thought they were a little bit needy with that one, but right now my left eye keeps clouding up on me. I might be blind. Or just sharing this dry eye syndrome. Another frequent complaint is "1 month of..." fill in the blank with any number of stress/earthquake related symptoms. Upper back pain (that lady's back muscles were really tight), headaches, stomach bloating (an odd common one that I havent quite figured out yet). Most are just related to being freaked out by the earthquake, or maybe are developing as people's lives are now changed in light of the disaster.

There were a couple good medical cases, too. A 12 year old girl with fever (102) and headache. Meningitis scares me, but she wasnt sick and had no stiff neck. No cough, shortness of breath or respiratory complaint, so I didn't think pneumonia. No diarrhea, so dysentery is out. No body aches or abdominal pain, so typhoid is less likely. And no palpable spleen, which might suggest malaria. We ended up treating her with malaria and giving her paracetamol for fever control, and I told her to come back tomorrow for a recheck. It's nice that the clinic is open 6 days a week so we can do that. With no lab tests or x-ray, that's the best you can do.

The other interesting one was a 50 year old man with chronic vomiting. This guy was cachectic, looked like a cancer patient he was so thin. His legs were the size of 2 of my fingers together (yes, slightly larger than my own calves). He had been vomiting most of the food he ate for 2 - 3 years. YEARS! This guy needs a doctor. Like in 2007. Anyway, we treated him for intestinal parasites and told him to come back in a few days. I want to do a CT scan of his belly and an upper endoscopy to look at his stomach with a camera, but I don't think they even have 1 CAT scanner in this country, let alone for me to use on this dude. X-ray studies with oral contrast is a realistic option, so if he isn't better when he comes back, maybe we'll refer him on to the big hospital, but who knows if they would do anything.

In the afternoon, Jason (the Mendocino from St Louis) and I were thrown out to the beach clinic at Leogane. Not the glamorous beach I hoped for. Actually, a Mennonite community where I already broke the no cursing rule when I was being devoured by those little mosquito fuckers. Nobody heard. Except God, I guess. And I think God would call them fuckers, too. Anyways, the Mennonites are very nice to give us a place to sleep, shower and eat. Word is they "fatten you up" at this place the food is so good, as opposed to the 2 squares a day at the other one.

At the afternoon clinic, there were 3 docs: 1 OB from KC (Children's Mercy), and 2 residents. I was on the sidelines getting a feel for how it goes, and then slowly assumed my thrown as alpha male attending, the one to rule them all. Not really. But I did circulate and help. The OB asked me about this guys infected hand and swelling, and I showed the med student how to numb it up and put a needle in there--lots of pus. Gotta love the success of draining pus. Another guy had a chest wound "from the earthquake" which we later found out he was really STABBED WITH A KNIFE. A little white lie I suppose. No pnuemothorax, he got wound care and antibiotics. We send the med students on him, too.

Other basic things so far: vaginitis, headaches, one prenatal patient 34 weeks along who hadn't seen a doc in almost 3 months, lots of wounds, burns, and even our favorites of back pain. Thank goodness there are no narcotics here. My nightmare: go to Haiti and get a clinic full of chronic backpain Haitians wanting Vicodin. Ahhhh. I'll take the abscesses and malaria every day.

Monday, February 22, 2010

Travel Day 1

I hate traveling. Sometimes. Like today. Jules and Audrey (my roommates) say I get "grumpy" when I'm tired. Well after a day of travel, I'm grumpy in the Dominican Republic. But at least safe and sound.

5 hour flight from SFO to Philly at 0830. After sitting on the runway for 2 hours, a 4 hour flight to the Dominican Republic, since flights directly in to Port-au-Prince are still unreliable. Had to get up at 430 to take BART at 530...blah blah blah I'm crabby and need a nap. It doesn't help that I worked a 16 hour shift in the Sonoma ER Saturday night, slept some Sunday day, then hosted 3 of our group (Jane, Jason and Jeanna) at the house, then decided to finish my Massachusettes medical license application and 2009 taxes instead of sleeping. Brilliant.

Airports are airports. I won't bore you with any further details.

But people are not just people. We met 2 Irish folks sitting in front of us on the flight to D.R. Part of the national network there, being sent down to do a Haiti story. It was interesting, they were kids like us, in their 30s. Guess kids are doing a lot these days. She talked about taking different angles to the story--international vs local control, the negative effects of US trade agreements with Haiti, and some other things that I found interesting at the time but just can't remember now of course. Jason shamelessly said they could follow us around..."We're both good looking." I quickly changed the subject, asking them more about Dublin. But don't get the wrong idea--I'm much more shameless than Jason.

The long day of travel had a happy ending--El Presidente light beer and pizza waiting for us at our hotel. I love Heart to Heart--the organization we are working with. They appear to have their stuff together. At the airport, someone was waiting with a little sign for us. One of these days there will be someone with a sign "Dr Lorenz" waiting for me with a limo or something. With some Cowboy cheerleaders, too. Maybe not in Haiti or the third world or ever really, but I think you get me. Anyway, the sign, van and pizza was nice. And I love shitty Latin American light beers. El Presidente light is basically Bud Light, Latin America version. After a couple of those, I'm ready for bed, and to get up in 3 hours for an 8 hour UN van to Haiti.

Two more things--the tile in the bathroom is amazing. Given my 2 recent tile jobs, had to include that shoutout and admiration of the Dominican handiwork. Finally, I get over 400 + channels in Spanish in this room. Don't worry, I'll be on the floor in a tent tomorrow. When the guy showed me the room, the first thing he did was find the 3 "adulto" channels on the TV. Hilarious. I asked him to find me some bad telenovelas and dubbed 80s action flicks with the governor of California.

Tomorrow, to Haiti...

Haiti blog

I haven't left yet. I have nothing to write. Come back later when we've something to talk about.