Today was a très cool day at the clinic. I rode on the moto with my three compadres. It was market day so four adults on a moto was nothing exciting. I saw not one, but two pigs literally hog-tied and being held on a moto by two people. Everyone seemed to be carrying a chicken. I couldn't stop smiling to myself. We reached the clinic and it was full of people. It was going to be busy like the market.
I saw a 21yo man with white floaters in his eyes and loss of vision over the past three years. Pupils reacted only minimally on exam, check out the size of the pupils (even with flash and a light shining from the side) and zoom in to see the anterior chamber. He had some ?major illness 3 years ago that caused his body to feel "paralyzed" and persistent body pain. He started to gradually lose eyesight afterwards. He never had a health examination for the prior illness. There was not much I could do at this point other than treat his pain. His mother agreed to take him to one of the local hospitals to see a specialist.
I also had an elderly gentleman with knee pain for 22 years after a fall from a horse for which he did not receive care. His knee was highly abnormal. He said he also had scrotal pain for the past 22 years after the fall. Each testicle was firm, approximately 18-20cm in diameter without nodules, fluctuance, hydrocele. He did not want a specialist evaluation. He was given Tylenol for pain. I have a picture of the knee only :-)
There was a lot of high blood pressure to treat. Haitians have a very high salt diet. It is not uncommon to have many patients with a diastolic pressure >100. I used up my amlodipine but still have plenty of HCTZ. I do a lot of dietary counseling for this (decrease salt, etc) but, like the U.S., the patients don't seem so interested.
I also had follow-up with the burn victim and little girl with the eye problem from last week. Check out the pictures.
After seeing patients, we set ourselves to organize the pharmacy. It was a lot of work but we got most of the suitcases unpacked from the prior team and at least some of the medication organized. When we were almost done, the rain started. Then, a torrential downpour started and it still hasn't let up. Edelin came to get us as the moto was unlikely to get up the muddy hills with four people. The drive home was crazy even in the SUV.
Since I got back I have been soaking up the floor with towels in between trying to separate a rather large bag of "papa" aspirin from the "baby" aspirin which we found on the pharmacy shelf today. Despite what it may sound like, I feel pretty zen. The water's not hurting me, the aspirin activity kept my mind zeroed out. As my friend Jay Chamberlain always says "It's all good."
Summing up Day 11: The chronic presentation of diseases that could have been treated had the patients had access to care still kind of blows my mind. When I get home, I promise to schedule a physical :-)