By Shivani Murthy, MPH
MARMONTE, Haiti–Today during our first day of clinic we were stationed at a school in la Bègue, which was identified by our translator, Jeff as “a very remote area within a very remote area (Marmonte).”
Over 150 people in line waiting for us when we arrived, many mothers, children, adults, all with their green medical record forms (distributed earlier that morning by Project Medishare) in hand. We split up the medical and public health students amongst three physicians – three students were with our internist, Dr. Summer, treating adults; and six students were with our pediatricians, Kristin and Brian, seeing children, babies and pregnant women. Dr. Summer’s group was situated in a very run-down former church with gaping holes through slats in the wall, which actually provided ventilation for the doctors, students and waiting patients inside, while the pediatrics group was located in two empty classrooms within the school.
Two public health students, Camille and Eva, ran the pharmacy, dispensing medication to patients who were treated by the three teams of students/doctors. There were also a few students organizing the triage area; Rose, Hanna and Maureen were in charge of taking blood pressures for all the adult patients waiting to be seen by Dr. Summer and his team of students. One local doctor, a phlebotomist, was also present at our clinic, conducting HIV and syphilis tests from the back of his van in the shade behind the pharmacy, playing music from his stereo as he saw a long line of patients.
It seemed that all around, today was both extremely educational and eye-opening, as we learned from the colorful and varied anecdotes related during our group debriefing session at the end of the day. On the adult side, most patients presented with some degree of hypertension; many also had cataracts, pterygium or potential glaucoma. These patients were given an opthamology referral for surgical treatment.
At first it was a little slow going as we were seeing two patients at once, but each patient had to be translated by our translator, Paul and also have their medical diagnosis reviewed and prescription approved by Dr. Summer. As the day went on, we picked up more and more Haitian Creole as well as familiarity with the most common symptoms and conditions and were able to work more independently of Paul and Dr. Summer, which sped up the treatment process.
For the most part the patients waited to be seen somewhat quietly, with the occasional squabbling, pushing, shoving and verbal exchanges to be next in line, but there was also some line-cutting going on by the healthier patients, as we found out when we had a preponderance of sicker, older, weaker patients to treat at the end of the line at the very end of the day.
In the classroom where the pediatricians were seeing patients, it was fairly chaotic at the beginning, as the teams of students and physicians tried to develop an efficient system of seeing pregnant women and children. Initially, many of the children (mostly under 5) were terrified of being examined, and that certainly slowed the process. It also became congested and loud, as more and more parents and children filled the waiting area, and one or two urinated during the examination (one even vomited in the examining room). Eventually we split into two rooms – one where pregnant women and their children were being seen, and the other just for children. This quickened and streamlined the process. Many of the children had coughs, colds and fevers, and were treated mainly for those symptoms. Some had scabies, ringworms and other infections, and were treated accordingly. There was one uncommon case of congestive heart failure in a 9 month old baby, who happened to be the second patient seen by the doctor. It was surprising to me that many of the children seen were relatively nourished. We did not have a scale to take weight measurements, but we did take mid-upper arm circumference (MUAC) measurements of all the children seen. Using “13.5” as a cut-off point, where below this would be an indication of malnourishment, we only saw a couple of children with a number below this. We did not see signs of wasting, but we did see some children with red hair, which could have been a sign of protein deficiency.
In general, we found the experience very enlightening. We saw a lot of scenarios that were different from our expectations, and we are sure that we will see even more of this as the week goes on. Time to go help count pills for tomorrow… bonsoir!!
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