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.


rumberg said...

You have a genuine talent for writing! I can tell this will be an interesting non-media, apolitical perspective. Interested in hearing your thoughts on the sanitation impact on public health ramifications.

Lorenz said...

Thanks for reading and writing, Robin. There are many public health issues from the earthquake consequences.

Tent cities are an unfortunately fertile ground for infectious disease. A couple of examples: many people have scabies. Terribly itchy, we don't even bother treating it because 1) we don't have permetherine cream and 2) they are just going to go back to the tent cities and get it again. Try to wash and de-scabies a field of tents! Can't be done. Not to mention the increased risk to spread tuberculosis, infectious diarrhea, etc, just from living close together.

In many of the tent cities, they just dump their urine and pooh on the street gutter. Another nice increased source for fecal-oral infection.