From Kate Westrate 3/26

So I’ve been getting some prodding to post on the blog…I’ve been e-mailing home all week, but here some excerpts from those e-mails regarding some of the work we’ve done in clinic.  I just copied/pasted these from the e-mails so they aren’t in any particular order.
 
Some of the interesting things we saw today included rheumatic heart disease, post-anthrax rashes, lots more post-traumatic stress disorder panic attacks, and I got to help with a pretty serious toe injury. This guy came in with his foot all wrapped up and he said a tree fell on it last Saturday. We undressed it to find a gangerous, 1/2 necrotic big toe that just looked terrible, and yes, of course I have pictures! 🙂 I worked with one of the docs to get some of the infected tissue and out. We gave the guy IM antibiotics, rewrapped his toe, but he has to get to hospital soon or he will lose his whole foot. The sad thing is the closest hospital is an hour away and patients/their families have to provide the food and medicine for the person in the hospital. This guy has no car to get there and will probably have to walk and will need to bring enough food with him for the expected length of stay. The kid we found to have rheumatic heart disease too, badly needs a valve replacement or soon will develop heart failure and die, but valve replacements are unheard of here in Haiti.
 
It was a bit of a crazy day at the clinic. We opened up around 8:30 after breakfast (farmer’s omelet made with turkey hot dogs!). We saw close to 400 people today! I think the word is getting out that we are here and now and people are traveling from all over. For some this is the first time they have ever been seen by a doc. You should see it too– they are all cleaned up and in their baptismal best to see us. It’s the event of the year for most of them. We had a 99 year old lady today who walked TWO HOURS just to see us to tell us she has pain everywhere in her body. Other than that, she was amazingly healthy. She just wanted to be seen by the docs. Before we started today we sat down with the docs and wrote out our “formulary”–what drugs we had to offer and what they wanted us prescribing for certain things. We had 8 stations today– so they had to get us more interpreters, which is just great! I’m being stretched and challenged in every way as far as my nursing skills are concerned, but you know I love it!! 🙂 Let me tell you a little bit about what we saw today….

-We had one kid- 18 month- that was septic pneumonia with a fever of 104 degrees, lethargic and retracting breathing with a pulse ox of 81%– probably would normally be admitted to the ICU in the US. We were able to find a 22g IV start kit and were able to give him fluids and IV antibiotics and oral albuterol. The kid perked right up and started eating (breastfed) and had a normal temp by the time he left for the day. We are having his mom bring him back tomorrow so we can follow up with them. He was a sick, sick baby, but we did what we could for him

-My buddy nurse and I, Jan, actually diagnosed Parkinson’s disease in a 60 y/o guy today. I was pretty excited that I knew all the symptoms. We have a Haitian doc with us here right now that actually works in a hospital an hour away so he is making referrals (free of charge) to the people that need follow up work. That has been really great. He is going to do some drug trials for this guy and will see if any of his symptoms improve.

-We saw a lot of malaria and worms today. The clinic here tries to deworm everyone at least twice a year, but some of the younger kids still have them really bad. Malaria is pretty prevalent and today I definitely became an expert on diagnosing and prescribing the meds for it. It’s quite exciting when the doc confirms I actually know what I’m talking about….haha! 🙂

-I think probably the most interesting case I had today was a 48 y/o lady who had a miscarriage 2 years ago and came to us today because she has been bleeding off/on since then and wanted me to give her pills to make her baby grow again. She had been told by the root/herbal docs in the parish that she was still pregnant 22 months later! Because she has had bleeding off/on she thinks the months when she’s not bleeding that her baby is growing again. There was NOTHING I could have said or explained to tell this woman she wasn’t pregnant and was probably going through menopause. My interpreter talked with her a great deal and we got the Haitian doc involved because this is very much a cultural thing. They have no biology education and if the root docs tell them one thing, that is what they are going to believe! Upon further investigation and questions this lady most likely has uterine fibroids that are causing some bleeding. Therefore, she probably feels somewhat pregnant (something really is in her uterus) and with her cultural beliefs that after a miscarriage the spirit of the baby remains in you and lack of education she was convinced beyond a doubt that this baby was still viable and just needed some pills to make it grow. I ended up just prescribing some multivitamins because it will help her overall condition anyway. She was pretty upset with us that we didn’t believe her.

One of the first patients today was the little baby from yesterday that was septic, and he was doing SO well today! God answers prayers. He was feeding vehemently from his mother, had no fever, and was breathing great! A little IV antibiotics did this little buddy wonders. Jan and I almost started crying with happiness because we really thought the little guy was on his way out yesterday. The mother was just grinning from ear to ear and is just the cutest little mom ever. Very soon after our little happy high, another mother brought her 2 year baby in who had pretty advanced hydrocephalus– swelling in the brain caused by lack of folic acid in pregnancy. The baby’s head was enormous and she look like she was having almost continuous petit mal seizures. She will never walk, as her muscles are underdeveloped and she most likely has some severe developmental delays from the pressure on her brain. In the US the baby would have been treated early with a shunt of some sort and with proper health care their life expectancy is quite good. Here in Haiti, it is a terminal diagnosis and there is no treatment. We pulled the Haitian doctor over to look at her and he pretty much shook his head and said there was nothing that could be done. There is only one neurosurgeon in Jeremie and he really doesn’t do all that much. Even though I’ve worked hospice for a couple years now, this case just ripped me apart. I then went and found the doc that is with us from Holland ER and asked if there wasn’t something we could even give her for the seizures to at least make it so it was a terrible decline/death for her family to watch. We only had dilantin and phenobaritol to work with, so we figured out a small dose of phenobarb that would be appropriate for her. We then got a couple of the organizers of the parish involved. They said that once we get back to the states there are a couple organizations and hospitals that we could petition to take this girl on as a case and that no, it was not a lost cause for her yet. So that is what we planned to do. We took down the mother’s name and made sure the priest of the parish knows who she is, because that’s the only way to contact her as they have no phones, and once we get back we are going to see if we can get them the help they need for this little girl. It was heartbreaking though because this mother (who is all of 80lbs.) struggled to even carry this child with a very large head and she is 7months pregnant. I’m not sure if the husband of this young mother is involved at all, but man, we had to take a little break after we saw them because of the tears that started to flow.

We had a lot of the farmers come in today and everyone seems to have indigestion (give them some Pepcid or Tums) or back pain. These guys are pretty hard core and it was a big thing for them to give up part of their farming day to come in to see us. There’s a lot of suspected diabetes, but we have no way of testing that here, so we can really only treat the symptoms at this point. One of the other nurses found a large sinus tumor is a 20 year old guy that will need some sort of referral to an ENT, but it looked pretty cancerous.

Another case I will share with you was a young guy about 28 years old who had some sort of confrontation a while ago and got a powder of some sort thrown in his face. Since then he has had extreme headaches in the back of his head and some neuro deficients including memory loss and tremors. He went to a voodoo doctor who told him he has been cursed and had a death sentence on his head. This boy was SCARED and having panic attacks beyond belief. There was nothing we could have done to convince him we wasn’t cursed and that he might just be having migraines or was being psyched out by a traumatic experience. We ended up just prescribing him some excedrin for his migraines, but I’m pretty sure our interpreter slipped in the med instructions that these were “special pills” that would help him–with some indications of magic etc. If it will help this guy get over his panic attacks, I’m fine with it. It’s hard when you don’t know the language and can’t have heart-to-heart talks with these patients. Our interpreter did a great job, but he has a hard time with the ignorant culture of his own countrymen.

After clinic today, a couple of us decided it was a nice humid day for a walk down the gorgeous valley that our house sits one. We were going to brave it without any local guides, but just as we were about to head out 4 little boys about ages 10-12 came and were pretty excited to our tour guides. They spoke very little English but would point at things and say them in Creol and then want to know what the word was in English. They were such little gentleman. Two of the boys wanted to carry Jan and my water bottles, picked us flowers for our hair, and would grab our arms if we slipped on the trails. It was absolutely adorable! The hike was amazing!! We got to see some of the garden/fields planted on the side of the mountain, an old (which was a BIG no-no to go walk in), and walked to this huge cliff that overlooked the river bed below. It was great exercise, and who needs a gym when you have a mountain in your back yard?! We were completely soaked by the end of the hike but it was SO worth it. We paid our little guides with packs of tuna and $1 each which they were pretty excited about. They gobbled up their tuna packs right away and will probably give the dollar to their parents for food.

At clinic today we saw a lot of the same things we saw earlier this week- lots of scabies, STD’s, and malaria but today pneumonias were pretty prevalent too. All us have just gotten into the flow of things so nicely with the interpreters and it’s hard to be believe that we have disband our medical clinic already tomorrow. I just want to take everyone home with me and continue this in my back yard or something. I know that’s a pretty common feeling while on a trip like this, but I’m telling you this place is really something special. A huge part of it too is the medical team and interpreters that I am working with too. We’ve come to anticipate one another’s thoughts and needs and know our strengths/weaknesses inside and out. It’s pretty amazing how God brings people together like this to do His work. There’s a lot of talk circulating around right now about return trips later this year or next year, so if any of you are interested–medical or not, please let me know. There is always work to be done. I know I am going to try to be a part of it, but am still trying to figure out how that plays out in my life.
That’s all I’ve got for now, enjoy!! -Kate

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