Haiti Day 4: Sweating it out on New Year's Eve

It's Day 4 of the Haiti Medical Mission Trip with International Medical Relief and today we were at a community that looked a bit like an enclosed compound. We drove through a high gate and into a walled in area where about a dozen structures were set up. Some of them were metal silos with a bunch of bunk beds inside and others were made out of concrete cinder blocks with crushed stones for a floor and nothing else inside.

We set up the pharmacy in one of the metal silos, while triage and community education shared one of the cinder block homes. Well- and sick-care were set up under a tarp outside. At 7:30 in the morning it was already hot, so we needed the shade we could get. 

Many of our patients came in with the same symptoms we had seen at the other locations: UTIs, STDs, dehydration and worms. But there were some interesting cases. We saw a woman who had cataracts in both eyes and was so anemic her teeth were bleeding. She looked like she was an older woman (like in her 60s) so we were surprised to learn she was only 40. Unlike in the U.S., getting surgery to remove it from a person’s eyes is rare in Haiti. 

“It’s sad. She’s so young and already the cataracts has made her nearly blind,” said med student Caitlin.

We are always learning something new on this trip -- even those who have been in the medical field for a while. Nurse Patti took the lead on what we called our mini clinic. Our location was by an orphanage. We had 56 children and adults come over that needed treatment. She sat them all down in a room and with the help of two other mission volunteers, they treated them all and made sure they all got worm pills.

But with the good times, there are always those moments that bring us back to reality and the importance being there. Nurse Amy had a infant who came in with its aunt. The poor baby was so dehydrated, the soft spot around its head was sunken in. 

“It was crying and was so hungry, yet there were no tears,” said Amy. “We started giving it some water and now it has tears. Its also so much more happy and content.”

Another first was this six-year-old girl who came in complaining about ear pain. We took a look inside her ear and saw she had a fly in there. Judging by the amount of wax that had built up around it, the fly had been in there for a while. 

“At first we tried to get it out with a tool, but it was too deep. We had to use a syringe,” said nursing student Mackie. “The girl was so scared. She was flailing and trying to get away from us, but eventually we were able to calm her AND get the fly out.”

We set a new record that day by seeing 329 patients plus the 56 from the orphanage. Already, we are beginning to run out of medications to treat many of the fungal infections and other common issues the people had. We also ran out of Tums. We can’t believe how many we have given out, so if you ever come to Haiti on a mission, bring Tums. Lots and lots of Tums.

Related posts:
Haiti Day 1: Start of Medical Mission Trip
Haiti Day 2: Transforming a school to a medical clinic
Haiti Day 3: Venturing out to help in rural areas
Haiti Day 4: Sweating it out on New Year's Eve on a Mission Trip
Haiti Day 5: Final day of the International Medical Relief mission
Haiti: The boy with the foot

Haiti Day 3: Venturing to the rural areas

Getting on the bus this morning was the beginning of a new adventure. We had to get up an hour earlier, but it was worth it to help the people living in the rural areas of Haiti.

Outside the city, the walls are gone and the mountains takeover the horizon. There’s green grass, little farm crops, palm trees and tiny villages. We also saw goats (and the cutest baby goats EVER), sheep, cows and donkeys in the fields. There aren’t herds of cows like you would see in the U.S.; they only have enough animals for the family to live on. There weren’t any stores or shops by the little village we visited, so basically the family needs to grow or raise their own food to survive.

Our set up today was in a church, which meant we could use the benches for patient/provider seating and creating natural barriers for each station. Just like on the other days, as soon as we rolled in, people started to line up outside the door. One of our first patients was an farmer who came in with one shoe and resting his weight on a stick. His other foot was shoeless because it had a nasty burn on the top and infection was starting to set in.

He told us it happened eight days ago. He was making peanut butter, and when he was heating the oil to mix into the peanuts, it fell off the stove and spilled on his foot. He’s been in a lot of pain since and hadn’t been able to sleep. We cleaned the burn to reduce the infection and then showed him what he would need to do to keep it clean and help it heal.

There were a couple cases of TB again today. While that’s no longer new to us, what was new was that the people knew they had TB but were not able to afford treatment so were living with it. But it was the kids that stole our hearts again at this location.

Unlike the patients from the camps, these patients came dressed in their best clothes. The little girls were in dresses, and we could tell the parents took special care in getting ready and making sure everyone was clean to see the doctor. Malnourishment was a common issue, and many of the people and babies hadn’t eaten for a day or even two days.

“You can tell they haven’t eaten because when I listen to their intestines, they sound hollow,” said Dr. Amanda. “Normally, you would hear sounds in there because of the food.”

But what made the situation more desperate was when a family came in with a young girl who had a tummy ache. It turns out the girl was so hungry she had been eating dirt. They try to mix it with water and make a soup out of it. Some of families are able to grow some food but they often end up selling it as that’s their only means of income.

To help them, our team handed out supplements and tried to educate them on nutrition. We also educated them on worms – and how to reduce their chances of getting them. Worms are so common in the locations where we are conducting our missions, that nearly every patient is prescribed pills to get rid of them. We even had a 3-month-old baby who we suspected had worms. Every time we touched it’s little tummy, you could tell from the kicking feet that it hurt.

Alex, our 15-year-old super volunteer, had her best day so far. Alex has been assisting our fearless leader Linnea on the mission and has been going non-stop. Today she got the chance to work in the community education station. “I want to work in the medical field more than ever now,” she said. “Today I got to interact with the patients more by teaching them about personal hygiene and it was so fun.”

In total, we saw 331 patients, the most we have seen in a day so far. Again there were numerous STDs and patients with low iron, but we also had some critical patients, including a 19-year-old girl we had to transport to the hospital.

“She had malaria before and was treated for it. But now all her symptoms are back. She’s got a fever at night, she’s vomiting after eating, she’s lost weight, etc. So she’s worried she has it again,” said Dr. Amanda.

 Listening to her lungs wheeze and watching her gasp for breath, helped us make the decision to send her to the hospital, but because the village was located in the middle of nowhere and she was unable to get there herself, IMR took care of the transportation costs for her.  It's a small thing, but it just may have saved her life.

Related posts:
Haiti Day 1: Start of Medical Mission Trip
Haiti Day 2: Transforming a school to a medical clinic
Haiti Day 3: Venturing out to help in rural areas
Haiti Day 4: Sweating it out on New Year's Eve on a Mission Trip
Haiti Day 5: Final day of the International Medical Relief mission
Haiti: The boy with the foot

Haiti Mission: The Boy with the Foot

I'm learning that with every mission trip, there are a few patients who we will never forget.  So far on this trip, it was the one we call "the boy with the foot."

He came in towards the end of our first day.  He was 15 years old and was limping. When he took off his shoe we saw why. His foot was deformed.

He told us that he had been in fire when he was a year old.  His foot had burned so much that the tendons were destroyed. Then because the tendons were gone, when the burn healed and the skin grew back, the toes ended up healing on top of his foot as there was nothing to hold them in place.  In other words, they were curled up over his foot.

“What was so amazing was that his chief complaint was his foot was itchy. He didn’t complain about his foot being deformed and he has been living with it for 15 years. That wouldn’t happen in the U.S.,”  said the med student watching Dr. Amanda treat the teen.

The boy had come in with a severe case of athlete's foot.  Because of the way the toes were, it was easy for fungus to grow.

"In the U.S. we would have removed the foot and fitted him with a prosthetic years ago.  But here that won't be possible. Instead, I'll show him how to clean out the fungus and how to keep the area clean so it doesn't get itchy again," Dr. Amanda said.

What amazed all of us was how accepting the boy was to his condition.  He didn't expect miracles or complain about the way the foot looked. He just wanted it to stop being itchy.

Related posts:
Haiti Day 1: Start of Medical Mission Trip
Haiti Day 2: Transforming a school to a medical clinic
Haiti Day 3: Venturing out to help in rural areas
Haiti Day 4: Sweating it out on New Year's Eve on a Mission Trip
Haiti Day 5: Final day of the International Medical Relief mission
Haiti: The boy with the foot

Haiti Day 2: Transforming a school to a clinic

What’s always amazing is how IMR is able to transform any space into a clinic. Today it was a school, but it didn’t look like any school we had in the U.S. This one was a long narrow structure made out of plywood. The floor was dirt and the partitions between the rooms were chalkboards.

When we got off the bus and saw the location, you could tell we were thinking, “Okay, now what?”. But within minutes Dr. Amanda and our team leader Linnea had a plan for the flow of patients and it was time to scramble to find benches, tables and chairs to make it work.

Our little team dramatically improved upon the day before and had already figured out improved ways to do things. We understood the routine, the amount of patients we would be seeing and the space needed to be efficient and provide quality care at the same time. Cases like possible TB and malaria were also no longer a novelty. We also had the mask situation under control – and each section was warned to “mask up” when a possible case was entering their station. 

When we arrived we were told Chikungunya was going to be one of the most common cases that we would be seeing. It’s something passed on from mosquito bites and has infected 250,000 people in the last seven months in the area. We had seen multiple cases on day 1 and the same on day 2, many of the people suffering from the pain in the joints that lasts after the disease has been treated. 

“We can give them something for the pain in their joints but that’s about all we can do. The body will eventually heal itself,” said nurse Amy.

Severe dermatitis was also something we were seeing. Today a young woman came in with her legs covered in dark bumps. While they looked bad, they were curable just with better hygiene. “If they don’t exfoliate enough, the dirt can build up and cause the problem,” said Dr. Amanda, while testing the bumps by scraping off a bit of one to make sure it was only dirt/skin. 

She said you see this in the U.S. on people who can’t bend over and scrub their legs. After exfoliating her legs and showing the girl how to do it herself, she was on her way.

Young mothers and young babies seem to dominate our clinic, and nurse Amy’s most memorable patient of the day was one of them. A tiny newborn was brought in dressed in 6 layers of clothes. The poor thing was wheezing. After undressing the little girl and letting her cool off a bit, she started looking a little better and we could finally examine her to see if the wheezing was heat related or something else.

There are times during the day when you are seeing patient after patient that you wonder if what you are doing is helpful.  But then you get a case where you know you may have just saved a life.  This is what happened when a 10-year-old boy came in with malaria. His mother had no idea what was wrong with him. She said he slept all day and was tired all the time. 

“You knew something was wrong with him by looking at him. He looked sick,” said nurse Jodie. “We tested for malaria and it came back positive.”

We let the mother know and referred her to the hospital. “I hate that we don’t have medicine to treat it here, but at least we could diagnose it and let her know so she could get help,” Jodie said. “It’s times like this when you know what you are doing is worthwhile.”

Related posts:
Haiti Day 1: Start of Medical Mission Trip
Haiti Day 2: Transforming a school to a medical clinic
Haiti Day 3: Venturing out to help in rural areas
Haiti Day 4: Sweating it out on New Year's Eve on a Mission Trip
Haiti Day 5: Final day of the International Medical Relief mission
Haiti: The boy with the foot

Day 1: Haiti Mission Trip

A street in one of the villages in Haiti

It's been two years since my last medical mission and I've been wanting to do another one since then.

The first one I did was in Guatemala in 2013 and that one was fantastic (read blog here).  This time I picked a mission through International Medical Relief (IMR) - http://www.internationalmedicalrelief.org and it took place in Haiti just after Christmas.

Sleeping in our bug tents as the area was at risk for malaria

When our team of nearly 40 volunteers arrived, it was clear Haiti was still struggling after the earthquake that happened in 2010.  Our first day at clinic was in a camp that was set up after the earthquake as temporary housing.  But these weren't houses like we have in the US.  They were temporary tents and makeshift structures constructed out of plywood and tin that were still being used as homes for families.

Many of us hadn’t seen poverty like this before, but there wasn’t time to let the reality of the people’s life soak in as we had so many things to do.

As soon as we set up triage and the community training stations, patients started arriving by the dozens. 

Our very first patient was an elderly woman who was literally carried in by her son (or it may have been her grandson -- she was 68). She told us that about a year ago her limbs started feeling numb and she could no longer walk. She also said she was also diagnosed with pneumonia in November and hadn’t had her prescription filled yet, most likely because she couldn't afford it.

Because we were just a day clinic, there was only so much we could do for the people there.  We couldn't perform any surgeries and we couldn't do anything that would require follow up care with a doctor as we would only be there for a short time.

As a result, there was nothing we do for her numbness or to help her walk, but we could fill the prescription for pneumonia.

It was a sad way to start the day as the family had waited so long for us to arrive and were so hopeful that we could help the old woman walk again.  It was devastating to watch her family carry her out at the end, but there was only so much we could do with the tools we had.

One thing that surprised us was how many young children and babies came in with their parents or grandparents. 

One of these little guys was an 11-month-old baby with a fever of 103.2 and a bit of pneumonia. With his temperature so high, we needed to treat him while still in the clinic. Without immediate treatment and reducing his fever,  the doctors were worried he would seizure. 

Another sad case was this dad who came in with his three kids asking if he could have blood for his wife. All of the kids were dressed as if they had come to the clinic straight from church. They all sat quietly in a row, waiting their turn.

He told us that his wife had given birth to another baby a few weeks ago, but the baby had died. She really needed blood but they couldn't afford to go to a hospital. It was so sad to hear his desperation.

But we weren't a hospital; only a portable clinic.  We had medication, but blood or even medication that required refrigeration were not items we could carry.

Natalie, one of our nurses said one of the patients that touched her on this first day was this tiny baby who came in with a skin infection. The babies body looked like it was cover is red blisters and in some areas, it was so bad the skin was scaling off.

“With her skin like this, she’s at risk of infection…if there isn’t one in there already,” she said.

In this situation, IMR transported the baby, grandmother and mother to a nearby hospital to get medical attention there.

While we were able to help this family, there were some serious problems in the community we couldn’t treat.

“What’s been disturbing this time around is the number of sexual abuse cases we’ve seen in young girls,” said Dr. Amannda, who was on her third Haiti trip.

We saw so many patients with STDs. It was surprising.

“It’s because of the lack of knowledge. They don’t know the risks….and then you have the lack of hygiene,” she said. "They don’t know how to clean. There is dust and dirt everywhere, and then there is the garbage. It’s simply thrown at the side of the streets and because of the heat, it often self combusts. Kids, many of which don’t own shoes, fall or step on the burning pieces and end up with burns or lacerations."

She says many people working in missions wonder if they are helping in vain. “But if only one person listens, they may tell their sister or their cousin and you never know how far the knowledge will go,” she said. “You help because it’s the right thing to do. You help even if it only helps one person that day.”

Tomorrow we’ll be at a different camp…but after day 1, we’re now prepared for what we’ll be doing.

Related posts:
Haiti Day 1: Start of Medical Mission Trip
Haiti Day 2: Transforming a school to a medical clinic
Haiti Day 3: Venturing out to help in rural areas
Haiti Day 4: Sweating it out on New Year's Eve on a Mission Trip
Haiti Day 5: Final day of the International Medical Relief mission
Haiti: The boy with the foot