Saturday, June 30, 2012

Guess who just became the first member of the triple rectal exam club amongst the Tufts in Haiti group?  Me.   Well sort of triple, did another exam and then an external exam where I saw an external hemorrhoid not to gross any of you out.  Maybe that puts me in the 2 ½ rectal exam club.  In other exciting news being in clinic, I had to give a patient an IM gluteal shot, the first shot I ever gave aside from practicing on each other.  I didn’t think the first shot I’d give would be in the butt but it happened.   The patient had hematuria (blood in the urine), and given his symptoms and urine test, he either has chlamydia or gonorrhea, so we had to give a shot of ceftriaxone.  I was terrified to give him the shot.  He complained afterwards that his whole leg hurt, so I was absolutely petrified I had accidentally injected into his sciatic nerve, but I was reassured if I had, he would’ve been screaming and writhing in pain.  In hindsight, I was nowhere near where the sciatic nerve even is (not all my anatomy has been forgotten).  Even during the interview he said he had all these symptoms during the interview, and on exam he never winced.  He seemed to be generally overreacting.  The thing I really hope is that he brings his partner because she may be asymptomatic but have the disease.  We tried to reinforce that if she doesn’t come in, he has the risk of being reinfected if she has the disease.  I also don’t think he was too happy about no sex for 7 days, or it might’ve just been him being angry with me for giving him the shot, maybe a combination of both.   The infectious disease residents who also live on the compound thought it was funny that I was so excited to give my first shot haha.  Such a newbie.

The group seems to be a little burned out now that we’ve almost reached July!!  (<12 HOURS!)  A group of electricians were here since the 2nd week of June with us, but they just left on Wednesday.  It was definitely difficult for the group.  They were here the longest, and every week we say goodbye to a new set of people.  Plus, they were so much fun to be around and all around great guys.  They were mostly retired electricians (except a couple of young guys) who were here to work on the generator system here that’s basically on its last legs.  We feel constantly abandoned when people leave.  We’ve been so lucky to have such a great rotation of physicians, including Dr. K and Dean Sackey, who have taught us so much about medicine.  This upcoming week is our last week with American physicians (one who is a gastroenterologist at Tufts), so we’re running out of mentors fast.  It’s beyond quiet right now on the porch, the quietest it’s ever been.  There is another group here, natural family planning.  I’ll keep my opinions to myself on that one.

While we were in Limonade on Thursday, I took a sample of the day care center which was right next to the dispensaire.  I should’ve taken a picture with the kids because they were adorable and clamoring at me, trying to hold my hand and shouting “blanc” haha.  I think they see me as a very strange looking white person.  Talking with the locals here about drinking water, I was so surprised that even in the villages, people knew a lot about how to treat drinking water, or just buying treated water.  My suspicion though is that the villages we go to, though they seem remote, are the 3 closest villages to Milot which probably means that a lot of NGOs are around.  I’m sure if we were in the absolute middle of nowhere, that would not be the case.

Yesterday I had to give a presentation to the community health agents about water sanitation and diarrheal illnesses.  Let’s just say, the group had a great day talking about poop.  But, I was really happy that they were very participatory in the presentation.  They asked a lot of great questions so it felt great that I was hopefully giving them information that would be useful in the community.

For the last day of June, the majority of the group went into Cap-Haitien, the second largest city in Haiti and where we originally flew into.  This is walking along the pier, so it's much less busier than the central part of the city (and less dirty).

First stop was Croissant Dor, a bakery in town.  Let me just say, it was absolute heaven to have a pastry again.  I did become a fatty again and ate a cheesecake (more like custard) and something like a croissant.  I died of heaven.  Skinny bitch diet just went down the drain.

Well, I thought I died of heaven until I went to the American shop next store, and then I really died of heaven because I found these gems: Cinnamon Toast Crunch and Coke Zero, the jackpot.  It cost $7, but I was surprised it wasn’t more like $10+ so I took that happily to indulge in myself.  Nothing hit the spot like the Coke Zero.  I’m saving the Cinnamon Toast Crunch for tomorrow when I hit July although it’s staring me in the face to be eaten.


Final stop was this posh hotel in Cap-Haitien.  It was just $4 to enter, so I lounged by the pool for hours on end, reading Water for Elephants.  In just an afternoon, I read more than a third of it.  Sometimes island life is pretty sweet.

Lisa used to be a synchronized swimmer, so then Alec tried to follow her.

Nadya and Alec apparently have the same sized arms, so they decided to compete in an arm-wrestling match.  Alec did win, although he was in some pain afterwards HAHA.

Beautiful flowers, reminds me of Hawaii!!  Who can complain about island life when I get to lounge by a beautiful hotel with beautiful hibiscus flowers?  There are some great hotels and resorts in Haiti that are so under-appreciated.

All in all, I’m definitely trying to take in everything for the last 2 full weeks, since I expect to do very little work during the half week in mid-July before I go home.   I still need to do some hikes I haven’t yet explored, get souvenirs for everyone, and just sit on the porch and absorb the last bit of island life.  But, now that July is in sight, the countdown begins!

Saturday, June 23, 2012

I didn’t think I would have made it this far but I did – the halfway point.  Around Wednesday and Thursday, I felt really homesick, somewhat depressed.  It’s weird, whenever I’m in school, I don’t really get homesick often but I think it’s because I know home is only 4 hours away, and theoretically I could go back whenever I could.   That isn’t happening here.  But, after talking with my parents and Kevin, I felt a lot better.  Both reinforced that the second half will fly by, so I need to take advantage of every opportunity I have here which is absolutely true.  This is an incredible opportunity which I know I’ll miss when I leave.  Talking with them also makes me miss them (and everyone) even more!

Dr. Early was our mentor this week, and he took some amazing pictures.  I already mentioned about our village trip to Carrefour des Peres on Tuesday but he took way better pictures than I did.

This is the local dispensaire/clinic in town.  This is where most of the group will be centered for their projects.

I look too happy to be holding an E. coli and coliform infested water sample.  I forgot to mention, I had a bag of samples, and a woman was asking if she could have one for her son to drink.  I felt sad, but it was in her son's best interest not to drink that at the moment.

And take 2 of the cute baby and me.  Gahhh why couldn’t I take this little boy home?

All the schoolchildren wear a uniform.  Each town has a different uniform, but they’re all so cute matching.  I especially love all the bows in the girls’ hairs.

Wednesday was rough.  I saw my first patient code right in front of me.  Leslie (an internist who actually went to Tufts for medical school) and I had finished being in the adult outpatient clinic early, so we decided to visit the ED.  We weren’t expecting anything, but there was a 22 year old male who just graduated high school, unsure when he was actually admitted but when he came, he was comatose.  We were both shocked that his oxygen saturation was in the 70% range.  If someone is below 95%, it’s considered hypoxic.  It was absolutely shocking that he wasn’t at least on an O2 mask with the oxygen turned up all the way.  We could also barely feel his pulse.  He was jaundiced and had mottled (blotchy) skin.  He was also obviously febrile.  Even though we knew very little about his history, seeing his condition, we rushed him off to the ICU which wasn’t open at the time.  So, we had to find the chief medical officer at the hospital for permission to open the ICU, which was granted as long as the doctors here were willing to staff it (which they were of course).  We rushed him from the ED to the ICU, and we could not get a pulse on him at all.  So, we had to find a board which took some time to do proper chest compressions.  All the guys were rotating to do chest compressions as fast as they could, and everyone was just on their toes.  One of the surgical nurses intubated him to ventilate him.  A central line was set up to push fluid into him as quickly as possible.  The monitor read a blood pressure and oxygen saturation, but we could not find a pulse anywhere, not even a carotid.  We listened for a heartbeat, nothing.  I don’t know if the machine was faulty, but he was gone.  The family at least took it decently well.  They were grateful for our last attempts at helping him, but they saw how sick he was.  They live really far away, so it took him a long time to get to the hospital, so he had been very sick for a while.  I think all of the medical students were in a little bit of shock, since none of us had ever seen this.  We had a debriefing with the 3 doctors who were leading the code.  With his multi-organ failure from the septic shock, he couldn’t have been saved.

Thursday was another trip to Limonade.  It was a grueling day, and I had the whole group with me that day since they hadn’t heard back from the IRB at that point (though later in the evening everyone was approved!)

Lumarc leads the pack for our group.  Legit, I would not be able to do my project without him and Joseph, the other translator we mainly work with.  They’ve slaved over my informed consent and 7 page questionnaire to be properly translated to Haitian Creole, and walk in the brutal heat with me to collect water samples.

Ditches generally run along the side of all the roads.  Thought highways were polluted?  These are even worse.

We saw a turtle in one of the wells, so we all got very excited.  One of the locals fed it bread so it would come up to the surface so we could see it.  I'm sure all the Haitians thought we were weird for finding a turtle so exciting.

The “blancs” are here, so we had children running after us, following us for a while.

One of the homes had a well it shared with its neighbors, so I sampled that.  I noticed that there were many roosters tied up, just like this one.  Cockfighting here is actually pretty big, which makes me a little sad but what can you do…

Hard at work talking to people and collecting samples.  And yes, those are urine sample cups I have in my bag, just hoarding them as I go.

Lazy weekend again… except that while one of the maintenance men struck a pipe, and water was going everywhere.  Thankfully it’s fixed.  Otherwise, I’d be very smelly for a while.  Tomorrow though, I have to do part of the crazy hike I did my first weekend to collect samples.  I may die.

Tuesday, June 19, 2012

I’ve finally gotten IRB approval!!   So exciting =D  I’ll be finishing up the majority of my water sampling this week, and for the remaining 3 weeks I have for the study, I’ll be doing mostly surveys.  Unfortunately that means I won’t get as many samples as last year’s study, but I’m also doing two studies as opposed to the one.  I’m supposed to still take samples of water  from wells where people I interview get their water, but I’m pretty sure I’ll have already sampled the majority of these places already.  At least, these are the major ones and on roads we should stick to.

Last Friday was actually sad to say goodbye to so many volunteers who were leaving the next day.  Dr. Marc (orthopedic surgeon), Dr. Karen (internist who teaches clinical rotations at UMass Medical School) – I never found out their last names since they introduced themselves by their first names only, Dean Sackey (obviously one of our deans, and an internist), and Dr. Rosenthal (infectious diseases) all were here, so we had such a great group of teachers.  All really took the time to teach us something about medicine and their experiences.

Even in Haiti, I can’t escape the sorority squat.  Will I be doing this 10+ years from now?

Apparently I was the smart person in not going to the beach.  First off, it was pouring all Saturday evening through the morning.  I think about 14 people went to the beach in this somewhat crappy van called a tap-tap, which has an open back, music blaring.  The road to the beach is a little treacherous, with hills and rocky terrain.  Apparently on the way there and back, the van couldn’t make it up the hills so people would have to leave the van, walk up the hill, and go back on.  Then, on the way back, the driver never showed up so they had to wait.  Black smoke was also coming out of the van which is never a good thing.  The tap-tap broke down at one point too.  So, they arrived at 8:30 PM (dinner is normally served at 6:30 PM), drenched because also the pouring rain would obviously go through the open back of the tap-tap. 

Then there was me.  I actually had a fantastic Saturday to myself.  Sometimes, having alone time is the best thing especially when you’re surrounded by people 24/7, as much as I love my group and think they’re fun to be around.  I watched a lot of Curb Your Enthusiasm, read some more of Atonement, and did yoga.  I actually think from now on, I’m not going to go to these beach trips except maybe the last visit or so because having the whole day to myself was beyond amazing.

I had a productive Sunday though, took 6 samples.  Since it had just rained, I wanted to compare if the rain would have impact on the bacteria in the water.  There are probably a lot more, but I stuck with the ones on main roads.  I did feel really excited about my project because one of the people who happened to speak English told me he was really excited I was testing the water because no one does that here, and his entire family actually last night all got sick and are in the hospital.

Here are 6 samples that I took before I added any of the bacteria food and magic:

A little more than 24 hours later, here’s what they look like.  Yummmm I know.  The first 5 all have coliform (yellow), and the last one has coliform and E. coli (fluoresces under UV) which wasn’t surprising, since it was river water.  The river water is absolutely disgusting with a ton of trash and pigs swimming in it.  Everyone knows I love animals, but I don’t want animals swimming in my water.

Monday I was in the pediatric and adult outpatient clinic with Amelia and Dr. Early, who’s our faculty advisor for the week.  I’ve never worked with pediatrics in a clinical setting, so that was great.  I got to see all the typical problems kids have, like ear infections.  I learned something really valuable today, that sometimes the patient’s chief complaint isn’t necessarily the most important.  One child had scabies, but the bigger problem was the child’s left foot that clearly had cellulitis that needed surgical consult.  In the adult clinic, this woman had some constipation post-op, and as I was about to discharge her after giving her some medications, she tells me she’s had migraines for months.  I didn’t know much about how to assess of course (what does a rising second-year medical student know… nothing), so my preceptor helped with the exam.  We looked in her eyes, and she has what we think is papilledema, though we were unsure.  What was clear was that something was very off about her eyes.  She also has left-sided headaches, never on the right which makes us more suspicious.  Migraines, though people can experience them more on one side, will have pain on either side at some point.  What’s concerning is that papilledema is a sign of increased intracranial pressure, like from a mass or tumor in her brain.  She’d have to go to Port-au-Prince or the Dominican Republic to get a CT scan… likely not feasible for her.  We’re trying to get into contact with a neurologist or at least an ophthalmologist from Cap-Haitien to get a consult.

Another thing that only happens to me in Haiti: while I was in pediatrics, Dr. Early all of a sudden notices that there’s a little lizard (probably 5 inches) is on me.  I surprisingly didn’t really freak out but just tried to shake it off.  I just didn’t want it going inside my pants or something haha.

Today we were at Carrefour des Peres.  I collected 10 samples since it would be my only day of doing basically all my sampling at Carrefour.  I was walking around the town with one of the translators, Lumarc, and people were so excited for me to test their water.  Everyone wanted me to come to their household well that they share with their neighbors and for me to test it.  They’re all curious about the results of course.  The last half week I’m here, I’ll be making a handout to give to the dispensaires/clinics and community health agents that will explain what I found, and what people can do about it.  Hopefully I can make even a tiny difference, even if it’s localized to 4 villages.  A lot of these people have wells, and so they use buckets to get the water.  Here’s one of the wells, and unfortunately one of the buckets looked like this:

It’s little things like telling people they can’t keep buckets on the dirt, etc. that make a difference.  No matter how clean the well, if what you use to drink it is dirty, what’s the point?  There was another well where children were just drinking straight out of the bucket.  Ayyy….

I finished my water sampling about an hour early, so I went back to the clinic and it was crazy.  This mother could tell that I thought her baby was absolutely adorable, and so she motions for me to hold it.  Omg, I wanted to take the baby home.  Basically, I melted at his cuteness, giggling the entire time.  What would customs think if I just brought a Haitian baby back with me?

There’s also a school nearby, and all these sweet girls came up to us.  We had stickers, so we gave them out.  Somehow the heart stickers ended up on our faces instead haha, but they were all such sweethearts.  I showed them how to play Angry Birds on my phone, and one even called me pretty.  She’s too kind… in this dead heat as I sweat profusely, this is the least attractive I think I’ve ever been.

Afterwards, we went to Children of the Promise which is an infant care center.  Most of the children are under 2, though there are a few that are older.  Unfortunately when we got there, most of the children were sleeping, so we didn’t get a chance to play with them.  BUT THEY HAD NORMAL DOGS!!!  All of us were so excited to play with dogs that definitely did not have rabies (they’re all from the US, belonging to the volunteers there).  Unlike here where I dodge all the dogs...

It’s very self-sufficient, including getting the majority of its power via solar panels:

Tomorrow marks the 3 week mark, home in a month!  And for the usual, nonexciting things in my life: I continue to be bitten by mosquitoes, and food dream #3: Chinese food.  I still don’t get why I keep dreaming about foods I very rarely eat.

Saturday, June 16, 2012

HAPPY BELATED BIRTHDAY GABY!  I can't believe I'm missing one of my best friends' birthday.  Sighhhh.

Tuesday I was in Limonade, while Thursday I was in Thibeau, 2 of the 3 villages aside from Milot that we’ll be visiting throughout the rest of the 4 ½ weeks.  All of us are still awaiting IRB approval for our projects which has been the most frustrating thing in the world.  At least now, we’ll be IRB experts by the end of this, although likely none of us will ever want to go into research.  My latest obstacle?  Part of my project included doing a workshop on solar disinfection and chlorination as a method of treating water.  Both methods have been proven to be really effective and extremely cost-effective in developing nations.  Solar disinfection, which I think I mentioned before, involves filling plastic bottles (your ordinary water and soda bottles) and placing them on the roof or courtyard, basically any spot that gets strong sunlight, for about 6-8 hours.  Chlorination is just using diluted bleach in a certain amount of water, and letting the chlorine sit for at least 30 minutes to kill bacteria, just like pool water.  Anyway, the IRB responded that because both interventions are used for the prevention of disease, that it’s a “medical device,” and so I’d need to develop a manual, set of instructions, have them translated to Creole and back-translated, as well as filling out additional forms.  The fact that a water bottle is a “medical device” is absolutely ridiculous.  We only have 4 weeks left to do our projects, and we go out to these villages just twice a week.  Milot, I at least can do on weekends and will give me something to do besides just sitting on the porch.  Considering the extremely short time frame, my PI and I decided we’re going to entirely scrap doing a full-blown workshop on solar disinfection and chlorination, and not doing the pre and post-intervention surveys.  I’m just mad that they’re telling us this NOW.  We’ve been doing 2 weeks of revisions, and we just keep getting more and more requests.

Half my project thankfully doesn’t require IRB approval so I’ve been at least able to do this part of my study.  I’ve been testing all types of wells and basically anything people use as a source for drinking water, for E. coli and coliform.  At the end of our project, we’re going to give a handout to the community health agents and clinics pointing out which wells are safe for drinking.  For the ones that aren’t, people can at least boil, chlorinate, etc. or go to a different well.

This is one of the Living Water International wells with hand pumps.  LWI is an NGO that installs wells, and usually they’re great.  Almost all are contaminant free and safe to drink from, though I still stick with my chlorinated water.

This is the garbage dump site for Limonade… which was right across from one of the LWI wells.  There’s a very shallow ditch that separates the 2 but I’m sure the garbage can seep into the ground.  Yikes.

This is the church in Limonade, on the left, and at Thibeau on the right.  I’ve found that usually, the town may be rundown, but the churches are all maintained really well, at least from the outside.  I haven't had the chance to look inside.

Limonade was relatively lively and more urban, but Thibeau is much more spread out.  This is the dispansaire, or clinic, in Thibeau located right along the same hill as the school.  Sad to say, we tested the school water a couple of weeks ago, and it had both E. coli and coliform.  They said they chlorinate the  water for drinking, but for washing dishes and cooking, I think they just use it straight out of the faucet.  The one on the right wasn't for the school, but right across from the dispensaire in front of a little stand which you can see behind, and located between homes.  I don't think it's as obvious in the picture, but it was very muddy and trashed around the faucet.

This is one of the homes in Thibeau.  Palm trees in both Florida and Haiti, but I doubt any house in Florida looks like this.

People can also get water out of plain faucets connected to wells I assume.  This one isn’t too great because water collects which is a haven for mosquitoes, and also bacteria just pools in there.  It's tricky for people because the water looks clear, but they don't realize that there's all this bacteria in there.

We roamed in Thibeau for about an hour at least walking in 100 degree heat, no shade.  I was dead the entire day.  When the rest of the group gets IRB approval, we'll be in the fields much longer, meaning 100 degree heat for at least 3 or 4 hours. 

Clinic work continues to be great.  Note, everyone should eat healthy and take care of themselves so that you don’t get diabetes.  I had to clean two diabetic feet (google it if you dare, but word of caution), and really, this is something you do NOT want.  One woman, probably over 200 pounds with bilateral 3+ pitting edema (the highest grade of edema) and huge feet, basically did not want to lift her leg voluntarily.  So, for about 10 minutes or so, I was holding up her leg, trying not to pass out from the weight of her leg and heat of being in a 90 degree room, while wearing scrubs and a surgical gown.  2 layers do not work well.  Despite doing essentially bikram yoga which includes triceps dips and planks, I’ll have to say my arms are not bigger by any means nor are they stronger.  In the afternoon, I worked with an orthopedic surgeon on clubfoot consults.  I didn’t think so many children had clubfoot.  In addition, there was this one child, who in addition to having clubfoot, had a congenital clubhand.  He has no radius, which is one of the two bones in the forearm.  His ulna, which is the other bone in the forearm, is probably rudimentary and barely exists.  Surprisingly though, his hand is fully functional.  The nerves have to travel all the way from the spine to the hand, so it was pleasantly surprising that the nerves weren’t compromised by any means.   His other arm, his elbow is contracted, so he can’t flex or extend it fully.

Yesterday I got to work with one of the deans of the medical school, Dean Sackey, in the adult medical clinic.  She's an absolutely wonderful, approachable teacher who takes the time to teach pathophysiology, physical exams, and differential diagnoses.  I'm just going to say it, yesterday I did my first rectal exam and saw 2 cervical exams.  Dean Sackey explained how to do it, but thankfully I didn't have to insert a speculum under these circumstances - no correct table for doing a proper exam, etc. so it would've been really hard for me to do.  Anyway, I feel really lucky that I got to work so close with one of the deans of our school.  I probably looked like the typical med student vigorously writing notes in my little notepad.

Weekend ahead of… probably nothing.  The rest of the group headed off to the beach, but I don’t really feel like going to the beach since it costs in total, including food, about $50.  Plus, I just sit in the shade so I won’t burn, since I am possibly the pastiest person.  I mean, I love the beach and all, especially because this place is so beautiful, but it’s not something I want to do every weekend.  Plus, this is the first time ever that the compound is quiet (basically everyone went including non-Tufts people).  I’m with these guys almost 24/7, so I also enjoy having some quiet time and space for myself.  Everyone probably thinks I’m a weirdo.  I'm happy to say I have a lovely day of Curb Your Enthusiasm and reading Atonement (actually really long, and I'm not enjoying it very much so far... but what else do I have to do here?).

4 1/2 weeks until home!  More obvious reasons that I miss the food back home?  I dreamed about cake the other day... haha.   I probably won't write another entry for a few days, so happy Father's Day to the most wonderful dad in the world.

Love <3

Tuesday, June 12, 2012

Major sign I’m missing the lifestyle back in the US: so we were talking about the foods we were craving, which is probably too early to discuss (it’ll just make us miserable).  Ironically but not surprisingly, I had a dream last night that I was eating chicken quesadillas and that they were really good.  I don’t really eat these very often either… and if anything actually, what I’m craving are apples, watermelon, and other fruits not here (bananas, pineapple, and mangoes are part of the daily routine here instead).  It’s also probably some of the chloroquine talking (which is the anti-malaria prophylaxis that we’re taking), as one of the side effects is hallucinatory dreams.  I can’t say I’ve been hallucinating thankfully but I have really bizarre, vivid dreams, some of which I can’t remember but I do wake up feeling like I had something crazy going on in my head overnight.  Is that weird?

We just had our first torrential downpour for the first time since we’ve been here.  It’s supposed to be rainy season now, so it was surprising it hadn’t rained until now.

2 of the chickens also decided to hide under the porch during the rainstorm.

Clinic work here is absolutely incredible as I’ve already mentioned before.  Though, I desperately miss EMR’s already.  It’s so difficult to read these charts sometimes (aside from them being in French).  Friday, I was in the cardiology adult outpatient clinic with Dr. K, a friend of Dr. Pearlmutter’s who came down for the week.  He’s a hysterical guy who just hung around with us , but he’s obviously a great clinician and very knowledgeable.  He teaches a summer course at Hopkins on tropical medicine, so he gave talks on tetanus, rabies, malaria, cholera, and filariasis.  They were a lot of fun to learn about although you need thousands of bites to get filariasis, well, let’s face it.  Among anyone in my group to get it, it’ll probably be me haha.  Kidding, mosquito bites actually have been decreasing significantly now that I wear pants to sleep.  My old ones are fading, though they now look like old bruises.  Hopefully they go away, but at least they’re not taking up half my leg now.

Anyway, he let me take the lead completely, having me sit in the doctor’s chair in the middle, and he just sat on the side to provide guidance.  I was absolutely terrified at first, but this was probably the most informative clinical experience I’ve had.  I was forced to think by myself for the most part on the questions to ask, make a differential, etc.  Dr. Dupee would be happy to know that one of the six patients I saw in the morning actually had a case of chronic cough!  I just had a homework assignment in CAP (where we work in primary care once a week), where Dr. Dupee asked us to look up the 5 most common causes of chronic cough.  It turned out that the patient had both gastric-esophageal reflux disease and was on enalopril, an ACE inhibitor for hypertension, 2 of the 5 most common causes.  I was actually able to do the differential diagnosis by myself!  She wasn’t getting anything for the acid reflux, so I decided to prescribe her ranitidine (Zantac) to see if the cough would go away and to treat the acid reflux anyway.  If it didn’t, I told her to come back so that we could change her medication which could also be the cause.  Pretty much every patient had hypertension, so I got some practice asking cardiac history questions and doing a full cardiac exam.

Weekends and afternoons in general are very lazy.  Proof?  Dr. K sleeping on the porch.

All of Sunday though, I was without internet because unbeknownst to any of us, we each have a weekly bandwidth limit.  I was freaking out the entire time that my computer was dying, and that I’d be wifi-less for 5 weeks.  Then I found out about the limit, got it reset because none of us knew.  My dedication as a Celtics fan and streaming Game 6 probably did it for me.  No more Facebook either so I can reserve my bandwidth for Gmail, Skyping, and blogging!

Yesterday, I worked with another one of the American internists visiting for the week.  We were mostly in the adult inpatient clinic and saw some crazy cases and pathologies.  I heard my first S3, S4 gallop, saw a ton of CHF patients with edema, 2 severe cases of diabetic ketoacidosis who would normally be in the ICU in the US with IV insulin and monitoring (not here though), JVD, a patient with severe hepatomegaly (we could feel her liver 10 cm below her costal margin/rib, and for any of us, you can barely feel it below the ribs so yeah, it’s huge).

I’ll discuss a couple of really interesting cases I think everyone will find interesting.  Patient 1, I believe late 20s female who recently came out of a diabetic coma.  Her family claims she didn’t have diabetes previously, so likely she had gestational diabetes.  Her blood glucose is now 106, and she’s out of the coma.  Though she can speak, her language is unclear.  Unfortunately, she had given birth to an 8 month old stillborn child.  We ordered a Chem7 and CBC on her since we needed to monitor her electrolytes with her continuing diabetes, as well as her blood sugar.  After checking her labs in the afternoon, it said her blood sugar was 36 which is absolutely nuts, when the glucometer said 106.   We think though that the lab results were messed up because the blood sample probably sat around for a while, and so then the red blood cells start eating up the sugar.  The tests were repeated today, so not sure of the results today.  Anyway, when we came back, she had a seizure where her BP was 175/152 during the seizure.  Her eyes were completely fixed to the left, she was febrile.  No one ‘s really sure why she had the seizure, but in case, they prescribed her IV diazepam (Valium) for the seizure.  Word today though is that her family can’t afford any of the medications, so I don’t really know what the hospital can do at that point if she continues to have a fever, uncontrollable blood sugar, and is seizure-prone.  It’s so sad that this is such a common case here, where people don’t take medications that they need because they just can’t afford them.

Patient 2 is a 21 year old female patient who delivered her child on May 15.  8 days after delivery, she slipped into this coma-like state.  For 16 days now, she’s awoken but she’s in this bizarre, altered mental status.  Her eyes are open, but she doesn’t speak, doesn’t respond to command, doesn’t go to the bathroom, doesn’t eat, and doesn’t stand up.   Her jaw is as if she has lock-jaw, really weird.  Her eyes are not completely fixed to the left, but she doesn’t move them beyond the normal position (like she doesn’t ever look right).  She also has hyperreflexia, and a Babinski reflex which would suggest upper motor neuron lesions.  Yet, there is something really strange about her.  During Patient 1’s seizure, we all could swear that the patient was watching the doctors and nurses the entire time, and if you motion your hand as if to shake her hand, she kind of motions her hand forward but that’s it.  She didn’t have any signs of frontal lobe lesions.  One of the physicians here thinks she could have extreme post-partum depression because she has seen something crazy like this before, a bleed in her brain, or a post-partum thrombosis (blood clot) in her brain.

Started part of my water sanitation project today!   I’ll provide information about that later though including the results I get.

Thursday, June 7, 2012

Week 1 has gone by!  I feel like I’ve been here for ages already until I realize it’s only early June.   6 weeks ahead.  I think it'll go by faster when we can get started on our projects, but the IRB unfortunately is giving all of us a hard time.  I wouldn't be surprised if we had to wait another week until out projects get approved.

We got an email saying that everyone passed Red Block (what we call the Scientific Foundations of Social and Behavioral Medicine, Evidence Based Medicine, and Ethics) which means 1 thing: OFFICIALLY A RISING 2ND-YEAR MEDICAL STUDENT!  WOOOOHOOOOO.

I’ve attempted to start getting back in shape by doing 2 miles of running at 6:30 AM and an hour of yoga every other day.  I would normally run more but I have 3 obstacles: I’m still monstrously sore from the hike.  Also, there’s nowhere really to run… I run about a mile to the Palace, and back.  Then it becomes too uphill and torturous.  People don’t really exercise here so I just look stupid running and get many stares.  Sometimes people clap… which is also really weird.  Most of the day after I’m out of the hospital, I sit on my lazy bum under the porch since already things are winding down around 3 or 4 PM.  It’s much too hot to do anything anyway.  I’d prefer not to have another fainting experience!

Right now I’m covered in 20+ mosquito bites.  My left leg/ankle is suffering the worst:
That was from 3 days ago.  They're a lot less itchy and regressing, but they're just being replaced by new ones:

On Tuesday, I worked with Dr. Sisse who is from Africa and doing his residency in Hopital Sacre-Coeur.   I scrubbed in a resection of a fibroadenoma, which is a benign tumor of the breast common in young women.  I got to scrub in, actually hold instruments, and feel the tumor.  It was a lot bigger than I expected and rubbery.   That was one of the coolest things I ever got to do!  Then we followed up on 3 post-op patients, 2 children with ileocolic resections and a woman with really bad osteomyelitis (bone infection) in her mandible.  We had to drain the pus around her mandible, and the infection had also spread to her temple too.  My heart just went out to her as we drained it, because it just looked so painful, and she was obviously in so much pain.

Wednesday I was in the pediatrics unit and NICU.  I learn about so much pathology here it’s unreal, things I definitely don’t see in the US as often: just yesterday, I saw pneumonia (A LOT), all kinds of anemias, heart murmurs, systolic clicks, cleft palate, Hirschsprung’s, Kwashikor, acute glomerular nephritis, etc. just in the pediatrics unit!  The doctor I worked with spoke little English but thankfully enough medical terminology overlaps.  He asked me to teach him Korean, so I taught him to say hello, and also wrote it out in Korean.  He looked at it, beyond confused, and said "okay that's good enough for me" haha.  The doctors here for the most part are great, and they take the time to explain things even though they have a hard time with English.  I've started making a list of things I see in the clinic so I can look them up after I get back for the day.   I'm really loving the clinical experience here.

Today is a Haitian holiday, so everything was closed.  We decided to go to the most touristy beach in Haiti, which isn't very touristy (it is Haiti after all), called Cormier Plage.  It's absolutely beautiful:

 Food unfortunately wasn't as good.  $15 for tiny shrimp (I was expecting big, grilled shrimps) and okay vegetables on the side.  I'm starting to get sick of the very starchy meals here already.  Uh-oh.

I am a pasty Pasty hah.  The beach was pretty empty when we first got there around 10, but later in the afternoon it got crowded with other Americans in Haiti volunteering, and Chilean UN workers (there's a UN office near Milot, in Cap-Haitien).

Untapped paradise!  The ride there and back was interesting.  We rode in a tap-tap, which is this open back van.  Normally, you tap on the side when you want to get out, but we reserved this one for the day.  The terrain was not paved for the most part so it was interesting.  Also lanes, kind of exist but not really.  Cars and motorcycles just weave in and out, no helmets for people on motorcycles.  Ay carumba.  I'm never riding one of those motorcycles.

 I can't believe I'm missing basketball right now.  Every day I wake up, I check the score immediately, reading the play-by-play and wishing I could watch the games.  GAME 6 TONIGHT!  I'll continue to mope in Haiti from sadness, not being able to watch KG, Pierce, Rondo, Allen, Bass... sighhhh.

Continue to send emails please!  I love reading about everyone's updates back home.   Love and miss you all <3

Saturday, June 2, 2012

First weekend in Haiti.  So far it's been amazing, but VERY VERY hot.

Before I start, I need to wish Kevin the BEST OF LUCK ON THE CFA!!!  I'm sure you're kicking ass on it.

Okay, back to Haiti.  I had my first experience at the hospital working in the OB clinic Thursday morning.  It's very different here, where mornings are completely devoted to patient visits (around 7 - 11 AM), and afternoons are for delivering lab and radiology results, so I'm in the clinic mostly in the morning.  I shadowed one of the OB doctors in their inpatient ward.  He spoke fairly good English which made it so much easier for me (my one semester of French is extremely limited...), and he let me do little things like measuring fundal heights of pregnant women and listen for the fetal heartbeat.  I was also apparently the signing MD for the lab results but um, that seems like a very normal thing since we're all just told to sign off on the lab results the doctors tell us to order.  He's a very nice man, and so he'll be teaching me some Creole, while I teach him more English.  Also he wanted to learn some Korean which seems of very minimal use but he was very enthusiastic to learn.  Many of the physicians here are wonderful.
(FYI, the pale blue scrubs just brought back memories of Anatomy...)


Yesterday, we watched Haitian nurses train the community health agents and cholera workers on recognizing cholera, how to rehydrate patients, etc.  I didn't understand any of it for obvious reasons but it was still really interesting to see it.  It's an obviously really important focus for the hospital, so I'm hoping my project can be useful for them and that we can get the cholera focus of my survey approved.

Afterwards, we rode the bus to Cap-Haitien where we had landed, where there's also another hospital, Justinian Hospital.  We were in the van sandwiched between each other, and it didn't help that there was bumper to bumper traffic (just like Friday rush hour traffic in the US!).  I ALWAYS get shafted in squeezing people in cars.  I guess I'm usually the smallest person so that means I get the smallest amount of space.  My back was rotated probably 90 degrees for about an hour, clutching because only half my butt was on the seat.  BUT, I did get the closest seat to the AC so I think that's a fair trade-off.  I wasn't sweating at least =P  (it's mid 90s during the day usually)

This is the entrance to Justinian Hospital which is one of the 2 only level 3 (highest level of medical care)  hospitals in Haiti.

Courtyard in Justinian Hospital, beautiful view.

Maternity and cardiology wings are here.

After going to Justinian Hospital, we went to the Meds and Food for Kids factory nearby.  They make this paste that's high calorie for malnourished children.  The amount of calories varies depending on the severity of malnourishment.

The pastes are made with peanut, milk or soy flour, and other completely natural ingredients.  Look at all the peanuts!

This morning we hiked up to the Citadel at the bright hour of 6 AM.  We walked through the center of Milot which was dead at that hour.  Most of Milot looks just like this, with little stores or restaurants right next to each other.  It's also a Saturday, so most people weren't out.  During the weekday though, it's crazy.  Haitians are trying to sell tons of different things like fruit, sodas, random foods, etc.  I think I have to say no meci more than I can count.

First leg of the journey is to the Palace (more pictures later) . The road was pretty smooth here but we'd found out later that that would not continue for most of the way.  Summary of the journey: 8 mile hike (4 miles each way), going all the way up to a 3000 feet above sea level landmark on a path that is very rocky so your feet are constantly trying to grip.  My ankles were rolling around everywhere trying to adjust to the terrain.  We could've taken motor vehicles up for the majority of it and just hike up the last 40 minutes which happens to be the most difficult part of the journey.  But no, we're all doing the beach body workout so 8 mile hike, here we go.  Our mantra to motivate us?  BEACH BODY WORKOUT.  Regardless, it's going to be a very long morning.

About a little more than a mile in, we hit the Palace at the edge of Milot.  I kind of zoned out when we got the history of this which we got at the end of the hike on our way back because I was too dehydrated and zoned out to pay attention.
This is one of the many water sites we would see along the way.  It looks clean but most likely it has a ton of different bacterias that get people sick a lot.  My project will be taking samples of water sites like these and testing them for cholera.  People use the same water for a lot of things like drinking water, washing clothes, and bathing.  I didn't see any latrines sooooo my guess on the water quality?  Not good.  I'll be starting this Monday at a village called Thibeau to assess different water sites.

Maybe about 15% of the way there, we start to get some elevation and see all this beautiful greenery.  Dr. Pearlmutter and Dr. Hyde decided to take a "shortcut" with one of the Haitian guides, Michelle.  We also got a couple of other "guides" who tagged along hoping to make money.  One of the guides Fabian, was my personal escort essentially to make sure I wouldn't die.  He stayed behind when I needed a break so that I wouldn't get lost.  He also taught me some Haitian and helped me fend off people harassing me to buy jewelry and other trinkets that I had zero interest.  Maybe in 6 weeks when I start to buy souvenirs for everyone, I will (note, souvenirs likely will be jewelry, little animal figurines, or who knows what else).  He has also volunteered to buy mangoes and other fruits for me in the markets since they'll charge me probably 600% of the value as an American.  So he'll get it for me for dirt cheap, and I just have to tip him a couple of bucks.  New BFF?  Anyway, this is where we met up with Dr. P and Dr. Hyde, but I don't think it was a good shortcut since they came later than we did.  Part of the group on the way back went down the shortcut but their account?  Many falls and cuts.  My long way won.


Dr. Hyde decided to turn around because well, we still had 3+ miles to go uphill hiking (starting from basically sea level to 3000 feet above sea level on rocky terrain in blazing sun?  I don't blame him).  We walked maybe a mile or so and look at the sweat, specifically Alec's beach body workout abs.  The sweat is clearly a sign that the workout is working.  We look relatively in good spirits but soon, that would fade.  Well, mostly me and Julian were lagging a little behind.  I think it's a Jersey thing.  The hike uphill was so difficult that my heart was racing probably 110 beats/minute at its peak, and I could feel the palpitations off my chest.  I swear I was tachycardic, and I thought I was going to die.  But with rest, it went back down.  Plus, my legs just got into the rhythm of moving forward that stopping too much made me even more tired.

 There's the Citadel in the back!!   So close yet so far.

2 hours later from the onset of the hike, we reach THE CITADEL!!  There were so many cannons, cannoballs.  20,000 people died building the Citadel which is nuts.  I don't think I mentioned it yet, but the Citadel I think was built when Haiti was divided and there was a civil war within the country.  This may be entirely wrong because I was just too happy to be up there that I couldn't absorb any information.

Loads and loads of cannonballs!
 The Citadel from the back view.
Proof that the group made it!!  
In our stupidity, we all decided to lean over the edge and look.  I was terrified and beyond nauseous.  In the USA, I'm sure there would be rails and fences but nope, not here.  But, it was a surreal view and something I can't do anywhere else.  Dr. P didn't participate which was probably a good thing.  He's the only real doctor on our trip so he's essential for this trip.  We're disposable.
Alec has declared to be my BFFL now.  He loves the sorority squat, so we had to do the second most popular sorority photo position: pop the hip and arm.  What a pro.  Along our journey, here we also met UN Chileans and Ecuadorians touring the Citadel (there's a U.N. office run by Chile in Milot).  They were very excited to see us and wanted us to be in all their pictures.  Frankly, I wasn't sure if they were more excited to see the Citadel or us.  Based on the 10 minutes with them, I think we were the bigger Tourist attraction.  Behind us was the Citadel prison.  There are very small jail windows near the ground (maybe a couple of inches high to let minimum sunlight in).

 Look at how high up we are!!  This is from the highest point in the Citadel.  On the other side we could see the Grand River of the North, Milot, Cap-Haitien, and other villages.  It all looked so tiny!

I thought the walk back would be a piece of cake because we were going downhill.  I was completely wrong.  In addition to sweating profusely because it was ridiculously hot at 11 AM, downhill on an unsteady terrain meant a lot of pressure on the knees.  Halfway down, I ran out of my 2 liters of water so I was sweating profusely without replenishment.  We did end up taking one "shortcut," a different one.  It was this highly inclined path, maybe a foot wide separate from the main road.  I thought I was going to slip the entire way down, so one of the tag-a-longs, this man who's probably incredibly old for a Haitian (maybe around mid 50s?) grabs my hand and escorts me so I don't die.  They think he was trying to "woo" me but don't worry Kevin, you're the only one!

Anyway, we got a tour of the Palace like I mentioned before.  Not really sure why I look huge because I'm pretty sure I shed half my body on this hike but anyway... that was the final part!  I trudged my tired butt back to the medical compound, finally returning at noon.  After a 6 hour, 8 mile hike and walking around the ginormous Citadel, beating sun, I came back NOT BURNED!  Thank you profuse SPF 50 and giant hat.  My legs now though, 4 hours later, feel like jello, and my feet are beyond blistered.  I plan on just sitting here for the rest of the night.

This hike is probably the most accomplished I ever felt!  I can't say I'll do it again but I feel great now.  Likely tomorrow I'll wish I never did this when I really feel the soreness.

I promise these entries will get shorter once I stop doing touristy things!  I couldn't upload all the pictures because these already took ages to upload.  Hope everyone is enjoying the first weekend in June back in the States.

Oh and YAY CELTICS FOR GAME 3!  I have faith in my boys to take it.