MacGyver Medicine

Somehow I seem to always end up talking about gastrointestinal distress but this story is too good to pass up. We recently had to say goodbye to Jim and Dean Sackey (who were replaced by Dr. Green and Steve Cohen) and we were joined by the Egan family clan of Jacksonville, Florida. Dr. Egan who came down to work in the pediatric clinic was accompanied by her husband, her grandmother and her two sets of teen age twins (apparently twins run in the family). Tim Traynor, a chain cigar smoking, motorcycle riding, gruff around the edges force of nature and semi-boss of CRUDEM immediately put them to work power washing and repainting the hospital walls, digging ditches and any other hard manual labor he could think of. They took on the tasks with an admirable stoicism, but unfortunately for the twins Grace and Neely the Haitian food did not agree with their constitution. Both spent an unfortunate day throwing up everything they had eaten for the past month. As the night progressed Grace’s nausea showed no signs of improving and she was becoming dehydrated.

Chris, an ICU nurse that is staying down here until September, offered to grab a bag of saline and an IV line and find some Zofran from the hospital. The moment she got back it began to rain in the biblical get-your-ass-on-the-ark sort of way. This impressive downpour was accompanied by thunder and lightning that was almost strobe-like in in its frequency. At the time Eric, Spencer, Sophia and I were trapped at the hospital with our computers and had no way to get back. We ended up searching through the OR and found 4 trash bags which we punched holes into to make ponchos. We all started running once we got out of the hospital but all of a sudden Eric was 100 feet ahead of us; I’ve never seen someone in flip-flops run that fast. Spencer commented to me as we ran back that he felt like we were in Vietnam in the middle of a firefight. Running along the dirt road with jungle on either side it really did remind me of Apocalypse Now.

We arrived at the porch, soaked, out of breath and looking like four ninja turtles (I was obviously Leonardo). We arrived to a very strange scene: Dr. Annie had found an empty water bubbler tank and stuck a long handled paint roller in it for a make shift rack on which the saline bag had been hung. Grace lay on a plastic lounger with the IV needle in her arm as rain pounded the gravel around the porch and periodic lightening split the dark. There will be a video forthcoming.

I was very impressed with the Egan kids. Had I been put in their place at my age, spending an entire vomiting after working hard labor I would have been bitching and moaning but all weak I didn’t hear a single complaint from any of them. Grandma Neely spent hours cleaning up the compound, pruning hedges and planting flowers. Papa Egan directed the washing, painting and digging. While I didn’t get a chance to spend a day shadowing Dr. Egan in the clinic, everyone who did really enjoyed the experience. We all appreciated Dr. Egan taking the time to talk about sickle cell disease and treatment. At the end of the week the Egans gave us the best gift I’ve ever received: two blocks of cheese, two packages of Oreos and various other supplies to help us get through the next four weeks. Thanks so much guys!

Sunday morning Eric, Spencer, Andrew, Maggie, Dr. Green and I ran our first hypertension clinic at the Baptist church across the street from us. We got there around 8:30 AM and soon had a line snaking around the small patio we had set up on. We had to shoo people into the church and promise to come back after the service. By the end of the day we had taken about 100 blood pressures. The next day we were shipped off to Carrefour de Pere in cramped back of Monsieur Tattoo’s ambulance where we held another BP clinic bringing our grand total to around 140. Dr. Bryant, an ER doc from Lahey joined us that day as well.

Tuesday, for those of you who don’t know, was the most important day of the year because it was the day I was born. I started out the day by following Dr. Green in clinic. Haitian patients are very unique in many ways. Haitians seem to have a major problem with chronicity; they find answering the question “how long have you had this symptom for” extraordinarily hard. I think the reasons for this are manifold; Dr. Pearlmutter remarked that because access to health care is so rare, when Haitians do make it to the clinic they tend to dump years of built up illness on the exam room desk making it hard to separate individual symptoms, timelines and diseases. Dr. Kernisan, a Haitian-American anesthesiologist that came down with the CT team, made the interesting observation that Haitians do not see disease as a cause (of symptoms) but as an event, another challenge from God. Thus the linear timeline of cause and effect is less important to them. Finally, Haitian creole lacks tenses which complicates questions having to do with the past.

If you were to ask the entire Haitian population if they smoke or drink you would find maybe five or six who said yes to either of those questions. There seems to be a social taboo against these two activities because they will often laugh and say “Of course not, I’m a Christian!” With Dr. Pearlmutter, Dr. Sackey and finally with Dr. Green I’ve noticed a pattern of patients who present with a benign chief complaint but are really there for something completely different. One patient, a young woman, complained of shoulder pain. After running through an unremarkable physical exam she mentioned that she was also having pain with urination and discharge. Another young man came in complaining of folliculitis after shaving; Dean Sackey gave me a look that conveyed “really?” and told him not to shave so close the next time. Right before he was about to leave he decided to mention that he was also having pain with urination. Inevitably when you ask these patients whether they are sexually active they will laugh awkwardly and try to avoid the question. Apparently they are so embarrassed by even a benign yeast infection that they will lie to the triage nurse to avoid telling anyone until the last minute. In any event, Dr. Green and I saw our share of pain with urination and epigastric pain (probably the two most common symptoms).

After lunch we relaxed some and Spencer went into Cap Haitian with Chris and Delnatus ostensibly to get Diet Coke. It began to pour and they were still gone when we sat down for dinner. I was halfway through a heaping plate of spaghetti bolognaise when Spencer sneaked up behind me and slammed down a Mango Smirnoff Ice on my plate which he then made me chug, kneeling, on a full stomach. The surprises weren’t over yet. As I was getting up to go Delnatus and co brought in two HUGE cakes (a pineapple cake and a vanilla cake) and led a chorus of Happy Birthday. Sufficiently embarrassed and red in the face they made me cut the cake to pass around. We finished off the night with some Haitian rum (Barbacourt three star “Rhum”) which was actually pretty decent.

We had originally planned to run a teaching session with the community health agents of Carrefour a Pere on Thursday but we learned the day before that Thursday was actually a national holiday known (at least in English) as God’s Day. No one goes to work on God’s Day thus we ended up staying at the compound (which gave me time to finish my John Grisham novel). Unfortunately, God’s Day is also celebrated with a street parade and loud music that starts in the evening and lasted through the night. We did not sleep well.

Today we trained the Milot community health agents (CHAs) in spinal stabilization, splinting and bandaging. Things went really well and the CHAs asked us to continue to conduct our trainings on a weekly basis which we will be happy to oblige them with. This evening we made our farewells to the Egan family as well as a Carlene and Sarah, ER nurses from Canada, and Tom, a Crudem board member who had been working with the facility personnel. Tomorrow we will be getting a group of 30 coming in so we will have plenty of company. Our group is also planning to hike to the top of the citadel de la ferierre at 5 tomorrow morning which means I should probably end this already rambling blog post here. Good night everyone!