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

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