Today seemed to move slowly. As Edelin's truck needed repairs, the staff and I took a taxi to the clinic. On the way the staff told me that sometimes they cannot afford the taxi to go to Gard Hiram ($5) so they walk 1-1.5 hours there and again on the way home. The taxi driver also uses his car as an ambulance when needed. He drove slowly and carefully allowing me to see things I have missed over the past few days. There was a woman and two children sitting in a square outlined by two layers of cinder block...the beginning of their home. They were going about their activities as though the roof were simply lifted off so I could see inside. Children along the way said "Good Morning" trying out a phrase on perhaps the only "Blan" person they had met. One little entrepreneur told me I should give him $1 for attempting English.
The clinic went easily enough with a few interesting cases. A woman stating she was 50yo (more like 70yo) came in with stomach pain, severe bloat, headache, and weakness. She reported painless hematuria (blood in urine) x 1 year. I treated her for possible UTI but am suspicious for malignancy. She agreed to follow-up next week. If no improvement, I will send her for further evaluation with a specialist.
Also, a 6yo boy came in with multiple bug bites on his arms. He was mildly tachycardic, febrile, and ill-appearing without further findings on exam. This is one of those times when the illness must declare itself. It is possible mosquito-borne illness (Chikungunya, Dengue, malaria...) versus any number of childhood illnesses. He did have report of joint pain, fever and stomach pain. Dengue and Chikingunya present similarly with exception of type of joint pain (asymmetric vs symmetric) and when the fever stops in Chikungunya the illness slowly resolves with exception of some residual joint pain. In Dengue, when the fever stops, the worry starts. It is during this time that patients may begin to hemorrhage. Luckily the family lives fairly close to the clinic and will follow-up tomorrow.
After work I went on a hike and finally made it up one of the mountains. It was worth the huffing and puffing. I had the most amazing view and met a lovely family at the top. When I got back to town a girl no more than 2-2.5yo stood in front of me with her hands on her hips and asked "Why are you white?" in Kreyol. I had to laugh. I had no good answer for her.
Summing up Day 5: I felt like I took off some training wheels today. It was as Robert Frost wrote: "Two paths diverged in the woods, and I, I took the one less traveled by, And that has made all the difference."