Today I woke early in anticipation of seeing patients in the new clinic. Pam Burwell, PA-C (CEO of Peaceworks Medical, humanitarian, and all around amazing human) came to Haiti after the 2010 earthquake and brought teams to facilitate clinics in Ranquitte ever since. In March of this year, she made a more permanent commitment by building a free-standing clinic in nearby Gard Hiram. I am staffing this clinic with a Haitian nurse practitioner, Colleen, for the next two weeks.
This morning, Edelin drove Colleen, Michael (pharmacy tech and translator) and myself to the clinic. When we arrived, the courtyard and porch was already full of patients. I took a few moments to familiarize myself with the medications available and then went to a large exam room with a single shelf, square table, and three chairs. The patients came in twos and sometimes three at a time usually mother with one or two children all wishing to be seen. Before today, I was worried about not knowing how to treat tropical diseases but it turned out to be good old fashioned primary care mixed with a few cases that still have me puzzled.
The most common maladies were stomach ache, colds, joint pain and a few sinus and ear infections. Taking a history was challenging as most people do not know or admit their age. Everyone was "cinquante" (50) even when they are really about 80yrs old. They all reported chest pain and fever regardless of complaint. There is a lot of poorly controlled hypertension, so taking this lightly was not an option.
The most difficult case logistically was a 10yo girl with right eye tearing and "white spot" on her cornea x 2 months. Her mother reported it had turned red initially but then pain and redness resolved. She had a steady stream of tears and a white 1mm rough exudate/lesion in her cornea with surrounding hazy circle approximately 3mm in diameter. Foreign body? Fungal keratitis? Any guesses would be welcome. My host recommended she see an ophthalmologist in Cap Haitien but travel alone is too expensive for the family much less the cost of a specialist and possible procedure. We will likely send her by moto to Cap Haitien tomorrow for the consult and go from there.
Another woman in her ?20s had a sore throat for 15 days with abdominal pain and vomiting blood for one day at onset if illness. She was treated for an unknown disease at a hospital at the time. No other URI symptoms, GI issues resolved. She had a fiery red patch on her soft palate with mild ulceration noted. She also had BP 164/112 with normal rate and rhythm. I am still searching for a good diagnosis. I treated her hypertension, gave acetaminophen for pain and rinses for her mouth. I asked her to return in a few days to follow up.
There were many others that I could not treat due to lack of medications or testing but it was still was a good first day in the clinic and a great day to be a PA.