Tuesday, June 10, 2014

Mobile Clinic

I had the unique pleasure of working with a group of medical students and doctors from the University of Mississippi this week as they went out into rural areas in the Leogane area to provide care. I could talk about it for hours, but I will leave it to a few points.

Confession: This is actually a picture from a different trip, but just to give you a sense of what "rural" looks like 

I have learned a lot in a year here, though it is not necessarily the kinds of things you want to learn. I spent time sitting alongside of doctors as they assessed and treated patients. Sometimes, I was clueless. Sometimes, I was really thankful for my Physiology and Virology that made me sound like I sort of knew what I was talking about. And sometimes, well,  I was a rock star. But not in the way that you want to be a rock star. Turns out, after seeing enough cases of lymphatic filarisis walking around, you can diagnose elephantiasis on the spot and know right away that there is nothing you could do for them. I can diagnose severe malnutrition in an infant with a fever faster than a 4th year med student (orange hair means that a black baby is so deprived of amino acids that their body has stopped making melanin). And mosquito-borne illnesses? Let me tell you about them. These are illnesses I will see rarely, if ever, in the USA but are incredibly common here. 

Malnutrition is heartbreaking. Let’s go back to this orange-haired infant. She comes in and she is one sick little baby. So we give her medicines and some vitamins but… it isn't going to be enough. You know this baby is going to just get sicker and sicker and there is nothing you can do. Mom doesn’t have money for food, there are 2 other kids at home, and we are highly suspicious that the mother is infected with HIV. So I do what any other else would do: I search around to see what leftovers from lunch we can offer them. Someone finds a container of baby food to give to the mother. But really, what does that PB&J sandwich mean a week from now? How about in a month when the children’s vitamins run out? I did what I could do in the day we saw them, sending them off with toothbrushes and soap and sandwiches and medicines, but I just can’t get this family out of my head. Lottery of birth put us on opposite sides of the table and I would hope that if roles were reversed, she would be having the same thoughts.

Chronic diseases are still chronic, even if we can hand you a month of pills. “Ma’am, has anyone ever told you you have dangerously high blood pressure?” “Yes, I had some pills that the last group gave me but I ran out a couple of months ago.” Medical missions are desperately needed in Haiti and fill a gap in rural and desperately poor areas that the Haitian medical system cannot handle. Still, the gaps remain. Limited supplies mean each person gets a 30 day supply and then these people are out of luck if they cannot afford more medication to carry them between groups. There are some groups that work in conjunction with the nursing school to address this gap: they hire a nurse to go to where they held their clinics on a monthly basis to manage long term care, but this is not an option for all groups.   

Haiti has hooked me. As I walk through my final 5 weeks on this little island, I am immensely and continually happy about its geographic location. I have a privilege that many of my fellow YASCers do not have: the ability to have a long and intimate relationship with this country. Throughout the week, I found myself making notes for when I am back, leading medical groups. Nursing student friends talk about the rural places they want to go and work with me as a physician in the years to come. Someone said to me once that Haiti gets under your skin and you can never truly let go of it once you get infected. But I think it has also gotten into my heart. And I am so incredibly happy that this relationship does not end in a little over a month, but can continue on. 

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