Friday, July 8th, Droulliard

Mobile clinics are our team's house calls, on a whole village.  To prepare, we have to pack with us all the medicines that we think we might need, without packing the whole pharmacy.  We leave behind our oxygen and lab and hospital beds.  We can and do start IV's and give medicine IV or by injection.

We pack the night before, then get up early depending on where we are going.  For Jacmel, that meant 4 am, for Droulliard, it's only about a 45 minute drive. Once we get to the village, we set up in the local church, which is the only place that has enough space to accommodate that many people.  The pews are long wooden benches with backs.  The village pastor sends people running for desks from the school for the triage nurses to interview and collect vitals.  In triage, the nurses speak through their interpreters, asking about why they are here, what problems they have had in the past, and the other things that put the visit in context.  We depend heavily on our interpreters.  It is more than knowing how to speak both languages.  When a patient says "Mwen gen grip la. (I have the flu.)", the translator has to understand and convey that she is not diagnosing herself with Influenza A, nor is she saying she has nausea, vomiting and diarrhea, which is what people in mid-Missouri mean by "the flu".  She is saying that she has been having congestion and drainage in the nose.  The translator has to pick up on that.  They have to have enough medical knowledge to know what we are asking and enough facility with the language to get someone who has no medical knowledge at all to understand.  It can get very frustrating, and they are not perfect, but they do a good job.

    We rearrange the pew benches to make L shaped sections where patients sit in line waiting to see the provider, a physician (me or Gracia Nabhane) or nurse practioner (Sabine), and set up the pharmacy at the altar, blockaded by benches.  The pharmacy itself is medications spread out, organized by kind with IV start kits and supplies for mixing things.

Once the patient slides towards me on the bench, 

"Avanse. Avanse."  

"Papye, Souplé. (Paper, Please)"  

I skim it. "Li gen lafyèv? depi ki lè?"  

The mother looks at my translator Max, clearly I have a horrible accent.  Max says "Li gen lafyèv? depi ki lè? (She has a fever?  For how long?)"

  "Depi twa jou. (3 days). Epi li gen grip la. (and she has the flu (runny, stuffy nose)" 

Me again "Eske li gen yon vant fè mal? (does she have a belly ache?)" 

"Wi, li gen vant fè mal. (yes she has a belly ache) e li gen vè. (and she has worms.)"  

"li te gen vè nan twalèt li? (She had worms in her poop?)"

"Wi, e (several words I don't understand)" 

I look at Max.  "She said she is coughing up the worms, also."  

I examine the girl, telling her what I want her to do: "zòrèy,lòt zòrèy (ear, other ear), louvri bouch ou (open your mouth), respire, anko, anko, anko (breathe, again, again, again)"  She has an ear infection, I prescribe an antibiotic, worm medicine, Advil for pain and fever, and chewable vitamins.  Always vitamins. Even in this village, which looks relatively well-fed compared to where I have been. I write it on the paper.

"pote papye a nan famasi a. (take the paper to the pharmacy.)"

"Avanse. Avanse."  

"Papye, Souplé."....

As always, there are a couple that throw me.  One is a two-year-old who looks healthy, although her face doesn't look quite right, not quite normal, and she is the size of a six-month-old, and she can't walk yet....and she has a whopping heart murmur.  Imagine someone with a lot of saliva in their throat, making a hissing sound, 60 times a minute.  That is what her heart sounds like. I ask her mom if she has been hospitalized.  Through the interpreter, I get that she was in Port-au-Prince hospital for a month after being born because mother had been thrashing so much in labor that she fell out of bed, and when she did that, she hit the baby's heart and made it not work well.  They did an x-ray, but is was normal.  I ask about an echocardiogram, then have to describe it through the interpreter, and it doesn't sound like one was done, but the doctor assured her that the heart would heal.

I don't know how to put together her story, and I don't know exactly what she was told, but this baby has a heart malformation and probably a genetic syndrome.  She certainly didn't injure the heart with her thrashing,  I don't know the next time Dr. Serge Geffrard, the pediatric cardiologist, with Project Haiti Heart, will be down seeing patients at HCM, but I take her name and information so that we can hook them up, giving the mother all kinds of precautions that I pray she will remember. and some vitamins, and some worms medicine.

"Avanse. Avanse."  

"Papye, Souplé."....

At some point after three, the bus must have unloaded more children.  At about 4, a 12 month old, who is not wearing a diaper, empties his bladder on my shirt and scrub bottoms.  This is not altogether unheard of in my everyday life, but I usually have some way to clean up and a fresh set of scrubs on stand-by.  I have neither today, and 25 patients still lined up to see me.  I keep going.  I see the kids with colds.  The teens there for entertainment.  I see them all, happy both that I am busy, and that they are not particularly ill. Everyone gets their meds.  Everyone gets their vitamins, their worm medicine.

And mumps...Did I mention I saw a boy with mumps?

Doug