You're fired!

This was the first week of clinic without Dr. Sarah and Dr. Sean and all things considered it went pretty well. It is always nice to be able to have your close friends working side by side with you-bouncing ideas off of an laughing about things only other docs in the clinic would find funny. Working makes me miss them more but it also makes me remember why I am here which is to help the community stay healthy. We decided to run 2 peds days and 2 adult days this week. We have more than enough patients and we are able to take most of the return patients that are really the most important ones as it is better to bring a smaller number of patients to a point of sustainable health than it is to treat hundreds minimally. Here we do something in the middle…we see all the returns that we can and we also take a few new patients each day. Today there were no returns as it was an odd day to have clinic so we saw 15 new adults. That was quite the undertaking as adults always have a slew of problems and inevitably needs UA’s, acupuncture, pregnancy tests, body work etc which adds time too. I am happy to provide the necessary care for our patients it is just part of figuring out how many patients we can take each day.  Regardless, the point of the story is that Santo and I saw 77 patients this week which is a personal record for sure!! Santo has been learning how to do intakes which allows be to be able to see twice as many patients in the same amount of time. Patients are happier and I am happier-it’s a win win. Today one of my favorite patients came back, he is the 72 year old we do acupuncture on who always gets up dancing and singing us praise for making him “young again”. He always says, “I know there are so many people that need your care, I don’t want to come unless I am sick or else I will take someone elses spot.” I have tried to assure him that we love treating him and he can come back whenever but he is insistent. Today, he had a mild cough he wanted help with. I sent him home with a months worth of fish oils, multis and some vit C. He was grateful as was I that he is doing so well. He was in so much pain when we first started with him, it is really remarkable to see the progress.

Jacques, my fav!

Today seemed like the day of sexual education for me. I spoke at length about the need to use protection if you are not in a monogamous relationship and that STI’s are spread back and forth between partners if both are not treated. It was also a lesson in the lack of apparent monogamy here in Haiti. Most of the pts, men or women who I asked said they, “didn’t know” if their partner was monogamous. Huh? Excuse me? You don’t know? They all said THEY were not seeing anyone else but had no idea if their partner was. This kind of norm plus minimal sexual education make for increased diseases and need for more moments like these that can be spent teaching people about their bodies and their rights.

Today also brought my first “firing” of a patient. A woman who we see regularly has always gotten under my skin. There I said it, I am not a fan. She brings her grandson in and pulls him around, doesn’t let him speak and always tries to monopolize the visit. The grandson is visibly affected by this and I am affected by her mistreatment of him. She is also incompliant with a rising blood pressure and intermittent swelling of one leg. I have asked her many times to please go and have blood work done or at least to get on BP meds as what we are doing is obviously not working. Caveat-our treatments would likely work if she would take them and come back regularly or if she would increase her water like I asked. Anyway, she came today and wouldn’t let me get a word in edgewise about her BP, she kept telling me about her leg and back pain. I asked why she didn’t follow up or follow my instructions and again she blew me off. I finally reached my limit and I told her that if she was not going to work with me then I couldn’t work with her. I told her if she had the testing done and brought back the results or the rx for BP meds, I would consider taking her on again. I had a supervising doc in school who used to say that we should be patient and understanding of patients like this as, “that was their disease”. I agree. I also agree it is important to know where your boundaries are and what ‘diseases’ you don’t feel comfortable treating. Today I found mine.