A Quest for Haiti: Reflections on a Year in Haiti: Katie W., BA and RN?

Compared to the previous day, Wednesday was much less action-packed. I translated for Tammy again and lots of the patients had the same complaints from before. We did have several interesting people come in, however. One young man came in with white patches on one of his cheeks and wanted some kind of cream to make it go away. Crystal said it was a skin condition called Vitiligo in which patches of skin lose pigment over time. Michael Jackson had this. I did my best to explain to him what it was and that it wasn't bad, but that it was something that he was going to have to live with for the rest of his life and it will get worse. I can't imagine what this young man was thinking as I was telling him, and I don't blame him for not understanding completely, even when I asked Jean to explain everything better. I never thought that I would ever have to deliver news like that to someone.

We had another gentleman come in who was having trouble breathing. He said that he had been in a car accident and had gone to the hospital, but this had happened several months ago and he was still having chest pain. It turns out that one of his lungs had collapsed. A tube had been put into his lungs from the side of his chest to reinflate it. Crystal said that he needed to start working on strengthening his lung muscles again. She suggested getting a straw and taking very deep breaths 20 or more times a day in order to do this. This was one of the instances where I noticed that doctors doing this kind of work need to be creative. Hospitals may have special instruments that you can breathe into to help build muscles, but we didn't have this kind of specialized equipment, so she had to come up with an alternative solution.

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Thursday was the last day that the team was going to be at the clinic. The day started out with Tammy and Denise finding me on their way up to the dispansè and saying that there was another woman in labor. I started mentally preparing myself, but it turns out that she wasn't even 1cm dilated and was having what are known as Braxton-Hicks contractions, or false contractions. She stayed for most of the day and received some IV fluids, before she was placed on a mattress frame and carried to the hospital in Gros Morne.

The previous days had steady streams of people, but it was nothing compared to the last day. There were so many people waiting! I started off translating for Tammy again, but Johnny showed up and I was sent to help out in the pharmacy, where they were counting and handing out medication. They didn't really need any help, so I cleaned up trash and sorted through empty pill bottles to make packing everything up in the afternoon a little easier. As the morning wore on, however, and more and more people were waiting to see the doctors, it became evident that something needed to be done.

We knew from the first few days that many of the people in the waiting room had pain and heart burn and really just needed Tylenol and Tums. In order to make it easier for Tammy and Crystal to actually see all the people that needed to see the doctor, we needed to figure out who really needed to see the doctor and who just needed Tylenol and Tums. (To throw in a medical term, this is called triaging.)

So, I got myself a stack of note cards and a pen and got to work. I walked into the waiting room with 25 or so people and told everyone that there were too many people and not enough time for the doctors to see everyone. I told them that I would go through and talk to each person and if they had general pain and heart burn, I would write them a card and they could go directly to the pharmacy to pick up their medicine. (Mind you, I'm doing all of this in Creole.) I went person to person, asked for their name and their age and what the problem was. If they had anything beyond pain and heart burn, I asked the questions that Tammy usually asked and wrote their answers on the card so Tammy and Crystal had as much information as possible. For example, if people said they had stomach pain, I would ask if they had diarrhea and if their "dèyè" was itchy (signs of worms). If they complained that they could not see or read, I would explain that we didn't have any glasses left, but that there was an eye doctor who came once or twice a year that they could see. In the meantime, I advised wearing a hat with a brim and trying not to strain their eyes. If they had other eye trouble, I would ask if there was any itchiness or fluids leaking out and what color it was. If people said they had a cold or were coughing, I would ask how often they coughed and when they did, did any gunk come up. If this was true, I asked what color it was. If they complained of dizziness when walking, I would tell them that we didn't have medicine for that, but they needed to take breaks when they started to feel their heart pound or feel dizzy and to drink plenty of clean water. One kid came in and showed me his ear, which had a kind of bubble it in. I was pretty sure that this was some kind of ear infection, but just to be on the safe side, he waited to see the doctor. One woman came in and said she was having constipation, so I was able to write what she needed and she never had to see the doctor. I was able to narrow the line to see the doctors down by at least half, and incredibly, Tammy and Crystal were finished by noon (when they said they needed to be done) and everyone that needed to be seen was seen or had gotten instructions to come back and see Sr. Julienne next week.

As the week went on, I became more aware of how difficult it is to do work like this. Supplies are limited and once a medication is gone, there is no way of getting more. Creative solutions to problems are necessary. Medications that may not typically be used for certain ailments may have to suffice. There is also no way for people to get all the medicine they actually need. Yes, we are able to give things for worms, vaginal infections, ear infections and other things like that, but what happens if it comes back? Then, they are right back where they started. People only received a month or so of pain medicine, Tums and vitamins, so after that, they either have to find money to buy more or live without it. I also wondered whether or not people actually did what they were supposed to with the medicine. I was buddies with one of the little boys who came in with "boutons" and when I asked him the next day if he had put the medicine on, he said no.

I also learned that there are some things that we didn't know. For example, we had several mothers come in and say that their child's eyes were white. When we looked in, there was no visible sign of infection or anything wrong. I asked about this when I returned to Gros Morne and they said that they meant that the lower eyelid was white, which is a sign of anemia. We also had a handful of people come in and say that they had fevers at night. Tammy would take their temperature, which would be normal. It turns out that night-time fevers are a symptom of malaria.

I found out that in order to do what Tammy and Crystal were doing, you can't just be a surgeon or a psych nurse. You have to be a pediatrician, an OB/GYN, a geriatrician, a cardiologist, an eye doctor, and everything in between. You have to be knowledgeable about all kinds of sicknesses and how they are treated as well as alternate medications that can be used to treat them. On the first day I was there, Tammy said something about how she wasn't an eye doctor (or something like that), and Crystal's response was "You're everything today." I thought that this was very fitting.

Overall, it was a wonderful experience. I learned so many new things and surprised myself at how much I liked what I was doing. I never thought that I would work in a medical clinic, especially one where I was so involved. I am so thankful for Crystal and Tammy and their team for letting me participate and putting so much trust in my Creole and in my "nursing" abilities. Although I don't think I'm going to sign myself up for med-school when I get back to the States, I definitely know way more about health care in Haiti now than I did two weeks ago.