The day dawned with roosters crowing and church bells ringing...it's the way life is in Chantal. I managed to sleep really well despite the ruckus of the indigenous fauna. I was told by the other guys in the Barracks that they were as loud and as frequent as the previous night, I just was too tired to hear.
Got up and dressed and headed to breakfast. I'd like to pause for a moment to mention a really delicious part of breakfast that I left out of my previous description: the coffee. Rebo Coffee is a Haitian coffee that is dark, flavorful and robust, but it's not acid. It's this last part that a lot of people on the team commented on the most. I enjoyed it thoroughly (enough that I brought some home). Because the beans are grown and roasted there in Haiti (formerly the leading exporter of coffee in the Caribbean) I encourage everyone to buy some from them (http://www.rebo.ht/index.shtml). The Haitian economy could really use the boost and you'll get a great cup of joe in return.
The team that was going to Canon piled into Father Yves pickup - a fairly new Toyota Hilux with a crew cab. There were 16 people and a day's clinic supplies in a mid-size pickup that has 5 seat belts. Over on Juliet's blog, there are pictures of what it looked like. I called it the Haitian Mobile ICU.
As the clinic opened we began the triage process with just three of us, Bill, Connie and myself. Because half the docs were gone, we had to slow down and even frequently stop the flow of patients into the waiting area.
The chief complaints were largely the same as before but we did note a bit of a twist. It was more difficult to get details of what can be described as "female problems" and, to a lesser extent, "male problems." This was because of the make up of the the team doing the questioning: a female nurse and a male translator. Over dinner this was discussed and many were attributing it to culture, but I think that gender-specific medcial complaints/problems are hard enough to discuss with your own gender in your own culture. This was a source of frustration for the physicians because there were a large number of women with a complaint of "vaginal infection" who also had a host of other problems that were undiscovered until they got into the examining rooms.
Around midday, Diana, Fred and I assisted Sarah with a 2 year old boy who had second degree burns to his right should, upper arm and chest. He had hot water spilled on him. Sarah was having to do a fair amount of debriding (removing the dead tissue to prevent infection and allow healing). She did a good job despite not having the tools she really wanted.
Sarah had Mom lay down (on a desk at the back of Dr. Rich Salkowe's examining room) and hold the boy to her chest. The boy was remarkably calm. He cried and fussed, but Mom didn't have the titanic struggle on her hands that one would have expected. There was no wrestling match, she simply had to hold him snugly. (One of Shelagh's co-workers, Chris, who has also been to Haiti, said that Haitian children are more tolerant of pain than American kids, probably because of expectations - Haitian kids don't expect life to be pain free, Yankee guttersnipes (and their parents) do. It's an interesting theory that seems to have applied here.)
Once Sarah was done with the debridement, she applied a layer of lidocaine cream, numbing the area. The poor kid needed it...when Sarah finished applying the dressing and the lidocaine kicked in, he conked out. The family was referred to the Medicin sans Frontier clinic in Les Cayes where he can get the definitive treatment he needs for free. This was where I had my first chance to tell a patient, "Bon chance" as they departed. Both parents smiled gratefully at my small comment. But there's no guarantee they will take the little boy to the MSF clinic...we can only hope they did.
While this was going on, Rich (aka 'Doctor Reeshard') was continuing to see patients. He maintained an admirably even keel, despite sharing his room with a crying child, a medic, a nurse and a medical student scuttling around the searching for and retrieving equipment, and his translator being forced to translate for him and Sarah at the same time. Rich was a picture of equanimity.
Returning to triage: The hypertension continued to be overwhelmingly prevalent and catastrophically high.
I learned that having a good quality stethoscope has a drawback in this setting. Good stethoscopes will press gently into your ears so that they seal out external noise. It's part of what makes them good. But after taking about eleventy-thousand blood pressures, my ears HURT. When the ache started I glanced at my watch. It was only 11a.m. I was pretty sore by the end of the day (with a rare case of otitis externia).
The day was long and mind-numbing. When the team returned from Canon we had dinner and debriefed over our Prestige beer. We also made plans for tomorrow's split team. Greg and I will swap: he will stay in Chantal and I will go up to Canon.
It was St. Patrick's Day but because of fatigue the celebrations were subdued. I could have been convinced that the Prestige was green beer as, A) it was dark on the porch while we were drinking it, and B) we were drinking it right out of the brown glass bottles. Who would know what color the stuff was? But then I overheard an odd, trying-to-explain-my-culture conversation between a couple of nurses and a couple of translators. The nurses were wearing glowing shamrock necklaces. The translators wanted to know why (there's not much of a link between the Irish brand of Roman Catholicism and the Haitian brand so the holiday is completely unknown to them). The nurses explained that it was St. Patrick's Day, St. Patrick is the patron saint of Ireland and his day is always a big party and the Irish like to drink a lot and shamrocks are a symbol of Ireland. It was simply not being grasped, probably because the Haitians weren't going to understand why Americans were celebrating an Irish holiday in the first place. It was kind of like listening to somebody trying to explain baseball to a Martian.
At that point, I knew my beer wasn't green and I went to bed.
