day off, kind of

today was my first day off, but i spent it in the clinic shadowing dr. alex for the first time. this morning we got a "talking to" bc yesterday when we went from construction to the new property we didn't change out of our shorts and back into our skirts. apparently girls in haiti do not ever wear shorts (i hadn't noticed this), so we are not supposed to wear shorts in public. someone had commented yesterday "oh, i thought those girls were christians"...this idea made me laugh, but i also understand that i just do not understand the culture yet and am still looking through euro-americocentric lens. i think i'll refrain from any shorts from this point on so as not to offend anyone. honestly, the thought never even crossed my mind, but apparently it is a big deal.

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one thing that's been bothering me is that i've noticed that i've become less and less phased by the drives through the villages. they are still just as distressing as that first ride through port au prince, but it has begun to elicit less and less emotion. i'm surprised at how easily this has happened, but at the same time it has given me a different perspective. i think this must be one of the important realizations of staying an extended period of time. it helps for the mind to let go of some of the raw emotion to make room for pragmatism. my thoughts have gone from "this is so awful and sad, how does this happen??" to "this is so awful and sad, what is it that these people need the most??" it is a subtle difference, but you need a healthy dose of both to first understand what is wrong and secondly maximize your impact. feeling guilty achieves nothing, so there is no reason for it. getting angry achieves nothing, unless of course it serves as an impetus for a plan of action. when i asked lawrence how he and dr. cheryl decided to move their family down here, he explained that she was the more emotional one, while he grappled with what was and wasn't practical. both aspects were absolutely necessary to make the transition down here, and it is evident in the amazing things that they have achieved together... emotion as a tool for motivation, and pragmatism for optimizing a feasible impact.
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dr. alex is a great teacher and he is able to make diagnoses extremely quickly. often he will have diagnosed the patient before even physically examining them. again there were lots of malaria and typhoid cases... i finally realized why the two often present together. mosquitos breed in stagnant unsanitary pools of water which the patients drink....typhoid from the dirty standing water, malaria from the prime mosquito breeding ground. simple as that. i've also begun to pick up on the tell-tale signs of certain infections and diseases, as well as the best drugs and combinations of drugs to prescribe.

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the day ended with a case that completely blew my mind, something that few if any doctors have seen. the patient was an older man who was a poor farmer in the outskirts of town. he had been in a car accident (or hit by a car?) 7 months ago, but had no money to pay to go to the hospital. he had acquired some old crutches and had been dealing with the extreme pain for over half a year before he came to the clinic. he was a sweet old man and he had seen dr. cheryl a few days earlier ...she said he came in and said "one of my legs is shorter than the other"...she asked if he had pain and he said "yes, some". sure enough his one leg was way shorter than the other and she felt what she thought was his greater trochanter far above his hip socket. she sent him off for x-rays, with which he returned today. the x-rays, however, showed that the head of the femur (ball) was completely in place in the socket and that the femur had broken at the neck and had shot up nearly to his waist line. the break had somehow miraculously just missed the femoral artery which would have caused him to bleed to death almost immediately. it had been so long that the displaced femur had become imbedded in the tissue, while the head remained in place. he had adjusted to the pain so much that he was actually able to sit despite the fact that he no longer had a joint (i don't even know how this is possible). he had not been able to afford so much as a single pain medication/ibuprofen in the 7 months since the accident. he will have to have surgery, so i'm sure dr. cheryl will do her best to work something out. unfortunately, the last of the naproxen had been given to the man in the motorcycle accident two days ago, so the best we could give him was ibuprofen. dr. cheryl asked if he could afford the 50 goudes (~ $1 american)...he said hesitantly that he could, then she said, "well you will really need twice that amount. do you have enough for that?" and he again hesitantly responded that he had enough (~$2). then she asked, "if you buy this medication will you have any money left?" to which he responded, "no, but i will buy the medications." fortunately, cody (one of the male interns) picked it up for him, for which the man was endlessly grateful. so basically this man had a broken bone nearly protruding far from it's normal position, must have been in agonizing pain for the last 7 months, and only now had he found the money to make the trip to the hospital with the complaint that one leg was shorter than the other making it hard to walk. there are so many unbelievable aspects about this case, i don't even know what to think. it seems to defy logic in every way, yet we have seen it with our own eyes. only in haiti.

the man with the gas ganrene did not come back today.

i spent the rest of the afternoon with blondie, the pharmacist who i think is absolutely brilliant. not only does he know every drug and dosage, but he knows every mechanism of action, every contraindication, every susceptibility, and every bit of biochemistry involved. he is the perfect person for the position bc when certain medications run out, he is able to come up with alternative treatments while they are waiting for reinforcements. today he put me to work in an all-french pharmacology book finding antibiotic contraindications for possible alternatives for some of the antibiotics that we are running low on. he also educated me on some inside aspects of haitian healthcare and its present outlook. he explained that all HIV/AIDS and TB treatment in Haiti is free and that there is an excellent HIV/AIDS hospital in Port au Prince called GHESKIO (Groupe Haitien d'Etude du Darcome de Kaposi et des Infections Opportunistes) which is funded by the Bill Gates foundation...the only problem, however, is that a lot of the meds need to be taken with certain foods to be fully effective which is a problem in a country where so many people are starving. he also explained to me that cancer is equivalent to a death sentence because there is no chemotherapy or radiation in all of haiti. it made me think of that young girl with the large lump in her breast a couple days ago...

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well that's it for today. i'm really excited for tomorrow bc it is graduation for the schoolchildren and it is a really big deal. then in the afternoon i am assigned to one of the groups, so we will probably do something in town. i've especially been looking forward to saturday bc i think the interns are chaperoning a beach trip for all the Hope House (orphanage) kids....

it's been a busy day. peace and bonswa.