Adults, adults everywhere

Today was adult clinic day and if you have been reading my blog then you know it is not my favorite day of the week. Now please, don’t get me wrong-I love to treat people and I love to practice medicine, however I really have never been a big fan of adults as patients. They always have a million concerns, they are not as cute as kids (joking…kind of), they tend to be less impressed with my games of peek a boo and they don’t crack a smile at a Dora the Explorer sticker. I mean, come on…who doesn’t love Dora!?!

Lucky for me the SCNM students are still here and they were the primary caregivers for these adults. Each clinic day we try to give the students a little more freedom to see patients on their own while still being available for consults and obviously all treatments are run by us first. The students have been working hard all week perfecting their chart notes, differential diagnoses and treatment protocols. This is their last day in the clinic before they head home Monday so it was time for them to show us what they have learned being here. It was really great to see them with “their patients”, taking the treatments seriously and understanding that they will forever touch the lives of the patients they have taken care of.

The day started out with two of my favorite patients so far. First was a 70-ish year old woman with excruciating Osteoarthritis in her knees causing her to rely on a cane for walking. She came last week for treatment and her only desire was to, “be able to attend church on Sunday’s” as her pain has prevented her from going. We did some acupuncture for her as well as loaded her up with some great vitamins and minerals 

including a product with curcumin and boswellia for decreasing inflammation. She came back this week and when she saw me she began speaking a mile a minute. The translator relayed that she was thanking me profusely for helping her last week as she made it to church for the first time in months. She told me she prayed for me in church and continued to thank me as I told her that it was my pleasure to be able to treat her and that her ability to go to church after treatment is one reason I practice medicine. I was humbled and thankful that the treatment allowed this woman to be able to do what was so important to her.

Awesome patient number two is a 72 year old man who came to us last week with symptoms of BPH including difficulty with urination and back pain. He wanted us to do whatever we could to, “make him younger”. Previously we treated his urinary symptoms and did acupuncture for his low back pain. At the end of the treatment he jumped off the table and said, “I am young again” gyrating his hips around (please try and picture this sweet grey haired man, all 5’3” 115lbs of him). I fell in love right there and he almost singlehandedly caused me to add geriatrics into my desired patient base. Today the student’s continued to work on his chronic low back pain with some cupping (Chinese medicine technique), acupuncture and massage. I think we have a patient for life as I heard him thanking all the students on his way out.

Score two for us.  I guess today was not such a bad day after all…it’s all about perspective right? J

News from yesterday

I guess I kind of left you all hanging after the last post so here is some more info…The girl with measles is just fine; she was on the tail end of it so we treated accordingly. The baby with total malnutrition was brought here this morning at the urging of the doctors and was accompanies to the hospital by our Haitian midwife Marie. This case has been particularly hard for us to watch as it unfolds as this sweet little girl has her cards stacked against her at such a young age. Her mother passed away and we saw her first a month or so ago when her sister brought her in for care. She was 7 months old but appeared the size of a 3 month old, unable to hold her head up and edematous due to malnutrition. She was surviving on cookies, sugar and water and her father was not interested in having her in the picture so her 20 year old sister stepped up to the plate and began to care for her. We gave her some formula and instructed on re-feeding procedures. When she returned a few weeks later (she was supposed to come back the following week) the baby had lost another pound. We questioned the sister intensely about whether or not the formula was going to the baby or somewhere else (we are concerned that it might be being sold on the street). Unfortunately the sister’s stories at each visit are riddled with inconsistencies which make it hard for us to know what to believe. We sent her home on the second visit with more formula, instructions to go to the hospital for blood work as we were concerned about the weight loss even with re-feeding, money for a tap tap and instructions to please come back to the clinic once the results were in.

We also reiterated the severity of the situation and that this baby will die without any intervention.

Third visit, she came back and the baby had lost another 6 oz.  Damn.

Initially the sister had said, yes, the child had been taken to the hospital and had blood work done which all came back normal but when questioned more thoroughly it came out that she had not taken her. Damn again.

 After much consideration and a very thorough talking to by the docs, a midwife and our amazing Dietician it was decided that sister and baby would come back today and be escorted to the hospital by Marie so we could make sure things were taken care of. She showed up this morning albeit almost 2 hours late and off they went.

This is one tough case and it is even harder as there is a sweet little baby in the middle of it all who is just trying to survive in the world. I will keep you all posted on her progress. 

Mwen gen fatig

I am tired. I need a nap but it is 8:00am and we are doing another clinic today.

                The students have been working so hard since they got here on Monday, the week has just blown by! Yesterday another 32 patients were seen and we had some very interesting cases come through the clinic.  Most of the students’ had their first exposure to measles, a girl with suspected Down’s Syndrome with new onset seizures-occurring in office, a malnourished baby we have been seeing who is failing to gain weight even with re-feeding and a many cases of worms and ringworm.

                Some patients such as our friend with the new onset seizures we had to refer out to the local hospital  as there needs to be imaging and blood work done to rule out more serious concomitant conditions. We gave the family (her brother and sister brought her in) money to head to the hospital with instructions to please come back to the clinic when her results come in as we would love to have her as a patient. They were thankful for the information about the possible causes of her seizures as well as for the money for a tap tap. It was really great to see a family bringing her in as it seems the norm here in Haiti is to keep those with disabilities in their homes and out of the general population as much as possible. I do not believe there is rampant mistreatment of this particular population however I think it is more of a lack of understanding about certain conditions and a fear of how others will react. I know we have seen many patients who come in for care and then tell us about family members who need care but cannot come in because they are “dumb”…this seems to translate into the inability to speak or act in a typical way. Children with special needs or as I like to say “exceptionalities” hold a very special place in my heart. I would like to do some outreach work for this population but have had trouble finding out exactly who to contact. It seems that some children born with exceptionalities are kept at home with the families and that some are given up for adoption, I am hoping to locate orphanages or group homes that may cater to this group in general as they can benefit from our medicine immensely. The healthier we can get these kiddos the better their lives will be. This is my next mission while I am here…wish me luck!

Community gardening and Vodou ceremony

                Yesterday we went over to the orphanage to check on some seeds and starts we planted last week. With the last group we spent the afternoon building a chicken wire fence, planting the starts the kids had taken care of and then letting them pick more seeds to plant. They loved it and it was so great to see them all getting into this project, especially since most of the kiddos are under 7 years old. This week we wanted to check out the progress as the Pastor who runs the house was not there last week so basically we left all the instructions in the hands of a 11 year old boy who seemed to really take an interest in being in charge. This week the Pastor was back from his trip and so we asked how things were going…well scratch that, we didn’t have to ask as we saw the moist ground and the plants growing like crazy the minute we walked in!!! I swear some of the plants grew 2-3 inches from the time they were planted last Thursday! The children were delighted about how well the plants were growing and the Pastor said they were all very interested in helping to maintain the garden on a daily basis. It made my heart melt to hear that. Here we had this amazing group of children who were dealt a bad hand early on and to see them become that passionate and excited about something made my day…shoot, it made my week! I think we have our first group of community gardener’s ladies and gentleman!!  We told them we would come back on Friday with more seeds and work together to plant the rest of the garden. They sang for us like they always do (imagine the most precious thing you have ever seen and multiply it by 100) and we thanked them for their hard work and headed home.

                The second part of the story lies in the cultural event we saw on the way home. We were drawn to a little house by some playing of music and artistic dancing around. As we got closer I recognized it as a Vodou ceremony. It was an interesting cultural experience though I have to admit my hesitancy to join in. Not solely because it was a Vodou ceremony but mostly because I cannot speak the language yet and I have reservations about any ceremony that I cannot understand. I like to know what is going on and things that are being said as you never know what kind of energy you might pick up from a situation like this. I was happy to be an observer and to appreciate the culture and the traditions of this community. It was nice that they let us in and asked us to be part of the ceremony (apparently it was for a little girl who was sick…a healing ceremony so to speak.)

This was my first experience with Vodou in Haiti so far and it left me with many questions about the religion, the culture and the ceremonies in general. I plan to find some literature and inform myself some more of this ancient practice.  

Some of my favorite pictures so far!

 Student Patrick and I with our little helper planting a garden at the Orphanage in our village.

Bastyr students teaching a patient to stretch his piriformis to reduce symptoms of sciatica.

Marie our Haitian midwife with Edie a volunteer American midwife after one of the births.
*Mama gave full consent for pictures*

Students and babies, babies and students...

New day, new group of student arrive at the MamaBaby Haiti Clinic. This time there are 8 students from our alma mater, Southwest College of Naturopathic Medicine. It was great to welcome a new group of faces and to know that their lives will be forever changed after this experience…I wish this opportunity would have been available to me in school as I would have  been able to get my clinical feet wet a bit earlier. In medical school we do clinical rotations in the last 2 years so for the first two years we spend the majority of the time studying, going to classes, studying, going to classes and oh yeah, studying. It is so nice to be able to get some real patient contact and to learn to take an accurate blood pressure or to understand what it is like to be in the room with someone who is having symptoms of one of those conditions we learned about in class. Some of the new curriculum changes at our school have the students getting to do clinical work such as blood pressure and other vitals earlier which in my mind will lead to better patient care when they finally do get to be “clinical students”. It’s all about the patient’s right?

Though we have been having a little drought in regards to the midwifery component of the clinic we did have 2 false labors in the past few days. This morning I woke to the sound of Santo our head translator calling to the midwives that there was a woman in labor (one of the downfalls of living in the midwife’s room, haha). This sweet woman apparently walked 2.5 miles down the mountain (trust me when I saw the mountains here are not paved and no pregnant woman should be walking down them) because she heard we were here, she has never received prenatal care with us so I imagine she has not received it anywhere. This is a scary thought as there are so many unanswered questions when a woman shows up without a history of care though our midwives are amazing and I know they will be able to provide her with the best care possible as this situation is not unique to our center. She has come to the right place and I am again thankful we are here!

Doctor heal thyself

OK so just so you don’t think we take care of ourselves like the good Naturopathic Physician’s we are, I thought I would let you in on a little secret we found here. A swimming pool!!! It is an oasis in the middle of the city, off the beaten path. It is a place for weddings and receptions (and for students and docs who need to cool off). It was cool, refreshing and there were speakers we could hook out IPOD’s into it! Simply amazing!!

We spent the last day with the students floating in the pool, laughing and listening to music. It was so insanely nice to be able to lie in water (no, sweating all the time does not count) and being a self proclaimed “water baby”, I was living the good life. We were the only people there which was not surprising as they charged $5 USD for 4 hours of swimming, far more than the average Haitian would and could spend in an afternoon. I felt a bit of guilt for lounging around all day at this pool that most people cannot afford to go to. On the other hand I know that if I am a burned out, overworked, tired doc my patients will get burned out, overworked, tired care. I know that even when I am feeling less than well rested the patients are not receiving the top notch care that they deserve so I imagine what kind of care I would be providing the next day (on adult clinic day) if I had not taken the opportunity to relax…after we oversaw the students and all 310 patients we treated in the two weeks they were here J