Dr. George’s Observations 2

We arrived at the Des Granges Clinic just after lunch. Ben had only a few more patients remaining. Sky was there. I was so happy to see them both looking so well after all our months of separation. All the volunteers looked extremely healthy and full of enthusiasm for the mission. I met Noah, whom I found to be very intelligent, resourceful, and tolerant.

The response of the volunteer Haitians to the presence of Floating Doctors was one of heartwarming affection and support. Sky introduced me to a couple of the young orphans who hang out on the clinic campus during the day. Many of them have come to regard her as an angel. They will miss her when the Floating Doctors move on to other venues.

The Czech Republic has set up a psychology clinic on the grounds of the Des Granges Clinic, where they are doing various forms of pediatric group therapies to help the young victims of the earthquake tragedy recover as best they can. To have seen things like your mother’s corpse being devoured by dogs after you have been suddenly orphaned into a society which does not have the resources to care for you is a kind of psychological trauma it is difficult to even comprehend.

When Ben finished, we had lunch–provided by the clinic–and headed for the boat. Lunch was slightly different every day, but always included a lettuce and tomato salad (which I was never stupid enough to eat), boiled white rice or beans and rice, bread fruit (what they were carrying on the Bounty before the mutiny, and which is quite tasty), and a boiled plantain (which is about as tasty as a stick of flour paste). There would also be some boiled conch in a sauce, a small piece of chicken (like maybe a drumstick from a rather small chicken), a bit of goat, or some strange fish.

The clinic had some water that we could drink, and, in the heat and humidity, I found it difficult to drink enough to stay well hydrated. I was rather cautious in my oral intake–cooked food served hot, fruit you can peel, and boiled water. Still, it is impossible to use hand cleanser every time you have shaken someone’s hand or touched an object previously handled by someone else.

During my stay in Haiti, I saw many cases which were undoubtedly typhoid or paratyphoid. The Haitians sometimes think it’s funny that we can’t drink their water or eat their food, but on the other hand–first, I was treating their gastrointestinal infections; they were not treating mine. Second, many of their cohorts had died in infancy while the Haitians were acquiring their immunities. I probably wouldn’t die, either. But I might have, like their cohorts did, and I didn’t feel like taking that chance.

A large portion of Haitians are typhoid carriers. Some patients probably have malaria but might have typhoid. Some patients probably have typhoid but might have malaria. And some, undoubtedly, have both. Therefore, in the interest of prompt treatment of patients, who might not return, and in the interest of efficiently cramming as many patients into the day as possible, every suspect got treated for acute malaria and typhoid/paratyphoid. I got a few positive malaria smears back, but then quit ordering them. The problem is that the symptoms of early malaria and typhoid are the same–fever, malaise, headache, abdominal pain. In reality, all Haitians have malaria infestation without active disease; it occasionally activates.

At the clinic we could order malaria smears, blood cell counts, pregnancy tests, and urinalyses. Each patient seen gets a de-worming pill. The translators all got one, too, as soon as they realized what it was, as all the Haitians carry some worm load and were delighted to dump it at the first opportunity. The only time we withheld that medicine was when we thought there could be a dangerous reaction to it (as in those patients with elephantiasis (Wuchereria bancroftii). These were referred to the local hospital.

In addition, we saw vast amounts of STD’s–as we would in the States, if we accumulated several years’ worth, and then saw them all at once. We saw poorly healing infected wounds, skin fungus and chronic persistent urinary tract infections.

As I am an internist, I refused to see children (pas enfants), so Ben is more familiar with the range of their problems. We did some minor surgical procedures, but I drew the line at any entry of a body cavity, even at a cystocoelectomy. Conditions in the clinic could just not be made clean enough for that, especially since many patients scared the heck out of me by failing to return for wound checks.

There were few diseases of abundance–hypertension, atherosclerotic cardiovascular disease. Some patients whom I saw had been told in the past of these conditions but had never been treated. I started treatment and told them to return for follow up. I believe many will, as they are beginning to have confidence in the clinic.

I’m certain that I saw several cases of tuberculosis. One patient, in particular, had “amphoric breath sounds” over the superior segment of the right lower lobe. To initiate treatment would be irresponsible and productive of highly resistant strains, so this type of patient was referred to the hospital.

A brief note about voodoo. All Haitians in Petit Goave believe in it. Most have consulted witch doctors at some time or another. Practically all believe that tuberculosis is the result of evil magic. This does not hinder their acceptance of Western medical treatment just as it would not for a fundamentalist Christian who prays for a speedy recovery and then goes to the doctor.

More later (plu, pluta). GL