Cheers

As my time in Haiti has come to an end, I assure those who have been following my blog:  I have not forgotten.  In the midst of all the craziness that has consumed my final weeks, I felt I did not have adequate time to attempt to give you the blog you all deserve.  Therefore, I have decided to combine my last weeks into one very long post.  In keeping with my efforts to pretend that I am a writer, I have decided to break this post up into chapters.  Enjoy . . . .

‘The Honeymoon is over’

So . . . there I was, the start of my final week at OSAPO . . . and my concerns began resurfacing.  I know that I may seem like somewhat of a, well, complainer . . . perfectionist . . . negative Nancy . . . glass half empty . . . you take your pick.  The thing about work in areas like this, if you aren’t trying to encourage people to make things better (specifically, if there is nothing to make better), then your work really isn’t needed. 

The weekend before, Judy had come up and had a repeat in service on instrument cleaning.  It turns out that the solution being used is way too harsh on the instruments, something she had taught the previous time she had been there.  Unfortunately, it was a little too late as two of our coated speculums had already been destroyed; a couple days into the week, essential screws to another coated speculum had been lost in the cleaning process, leaving us with only 2 usable speculums for performing LEEPs.

One afternoon, as I was working with my two assigned nurses, one of them got board as we were counseling a patient, so she blew up her glove and accidently popped it.  I’m not one for scolding, but I could not believe the inaptness of the matter . . . I told her it was extremely inappropriate to do that in a professional setting, especially when you are in a room with a patient. 

All of these things, any time I try to give ideas, counseling, advice, etc, I feel goes in one ear and out the other.  I know I keep on saying that at least I’m helping the people I’ve seen in my short time here, but the whole idea was to create something life long . . . something that could continue working even when I’m gone.  Four months may not be long enough to change the ways people have spent a lifetime learning. 

The Haitians I’ve worked with have a tendency of anti-preparation . . . wait until you are completely out of something, then scramble to get what your out of, creating a daily struggle to just to have the essentials.  What’s going to happen when they run out of the things you can’t get in Haiti . . . LEEP loops, coated speculums, monsels . . . our essential list that is attainable, but it will end up taking several weeks to get ordered, shipped, and through customs . . . I would start thinking about it, and wonder:  What’s going to come of all of this?   Honestly, in that final week, I still didn’t know.

‘And the band played on’

[Just to clarify, I did not come up with this name all by myself.]  In keeping with my goal of reading more than just medical related topics, I decided to do a little recreational reading during this stint in Haiti.  I have always found HIV an interesting topic . . . a disease still so much in its infancy, but has come so far in treatments.  During residency, my first big publication was all about HIV prevention, a topic that I also lectured on for my grand rounds.  As I was researching the disease, a friend recommended that I watch the movie ‘And the Band Played On,’ as it illustrated the surfacing of AIDS in the 1980s, and focused on the many mistakes that were made in controlling the epidemic.  Although I never had time to watch the movie, in searching for a decent piece of literature, the book (aka, what comes before the movie) popped up, so I decided to give it a whirl.  What I didn’t consider . . . It may not be the smartest idea to read about the AIDS epidemic when you are working as a physician in an AIDS endemic area.

My first weeks working at Pierre Payan, there was some viral ailment that was striking many of my team members.  I had gotten a little sick in my first few days visiting the states, so I was hopeful that I had built up some type of immunity.  As I started developing symptoms, I was deep into the book, which follows multiple characters from the start of their acute retroviral symptoms to full blown AIDS.  Suddenly, I was starting to identify with those symptoms . . . I had swollen lymph nodes, fatigue, myalgias . . . just like the characters in the book.  All of the sudden, I was identifying with the characters, I was even writing my own story in my head.  I was convinced that I had somehow contracted HIV.

Now, I realize at this point, I probably sound crazy.  I am very well aware of how you can contract HIV [and just for the record, I have not been participating in any ‘high risk’ sexual behavior down here in Haiti].  Hospitals in Haiti do not operate under the same ‘cleanliness’ guidelines that they do in the states . . . and I have never been convinced that everything in my gyne room is 100% clean.  I was paranoid . . . what if the speculums weren’t adequately sterilized and I held one I though was clean with my bare hand that had a paper cut?  All the dirty instruments are brought upstairs to be cleaned . . . what if I picked something up off the ground that had a microscopic amount of blood on it, and then I put my contacts on with that same hand.  What if I had a hang nail that time my glove ripped during surgery, and the patient’s HIV test was falsely negative? . . . I had become your typical medical student hypochondriac.

I was so paranoid, that one day, I actually mad my interpreter go with me to an HIV clinic down the mountain to get an HIV test.  Suddenly, going down the mountain on a moto was not so scary (the last time I had gone down the mountain on a moto, I continuously though . . . if we hit just one big rock the wrong way, hello brain injury, goodbye career).  So . . . the test was negative, and in case if you were wondering, I don’t have syphilis either.

The next time any of you think you are being a hypochondriac, you can just think of this experience I’m sharing to remind yourself that you are nowhere near as paranoid as I was! 

‘Angels and Demons’

In keeping with the trend of book tittles, I assure this again is an appropriate one.  I know I have alluded to the fact that this time around has been very different than my first couple months in Haiti.  The one thing that has made the biggest difference is the fact that there have been so many missionaries/volunteers here.  It seems that the winter months are the trendy times to come to Haiti.  I can’t imagine why no one would want to come work in the blistering heat of August and September.  There are some people who just come for a couple weeks with medical teams, and there are some people who come for a more permanent 6-7 months, and I have had the pleasure of meeting and spending time with two such people:  Annie (from Michigan), who runs an orphanage for handicapped children, and Judy (from BC), who I don’t think I can adequately summarize everything that she does (running of ORs, organizing, providing sanitary products to young girls).  It has been so nice having the two of them around . . . definitely takes out the loneliness aspect. 

Of the many projects Judy has been involved in, one big one is called ‘Days for Girls.’  In many developing countries, girls don’t have access to sanitary products, so they just use washcloths.  Many girls will skip school, and wont go out and work while they are on their periods because they are embarrassed.  It is my understanding that the organization’s first project started in Uganda, where disposable sanitary products were provided for all the young girls . . . it didn’t take long for people to realize what a strain this was no the sewage system.  Disposable products would not work, so they developed reusable sanitary kits.  Each kit comes with to ‘shields’ that have water proof lining, with 8 reusable pads, made out of flannel.  When the kits are distributed, the girls are taught how to care for them, clean them, and how to properly dispose of the water that is used to clean. 

These kits are being made and distributed in many different countries . . . now including Haiti.  During my second week here, one of Judy’s friends, Linda, came to join us in Haiti with the many kits that had been made in Canada.  In my final week here, several more Canadian nurses joined us with more kits. 

Obviously, this was a project I found quite intriguing, given my interest in public and community health.  I also just happened to have an interpreter working with me who was a young female who is now very knowledgeable about the female body.  It turned out that OSAPO had just started doing youth sexual education on Saturday mornings, for the adolescents of surrounding villages.  We had a perfect set up for success, and it was.  Marceline, my interpreter, interpreted, Linda and Judy gave the lecture, the girls were behaved, asked appropriate questions, couldn’t have asked for anything better.  I wasn’t aware as to how much I appreciated this crowd until the following Friday. 

Thursday was my final day at OSAPO.  We completed clinic, I deemed Ernot capable of VIA and LEEP on her own, and I headed back to Annie’s to be welcomed by a full house.  Four more Canadian nurse friends of Judy, Linda, Annie and myself, all laid out on blow up beds made for an adult sleep over, although the extreme heat and lack of circulation in the rooms made it a little less fun.  We all attempted to get our beauty sleep in preparation for the adventures we had planned the next day. 

We were taking the kits to La Grange . . . I community in the middle of nowhere in which Annie had been affiliated with.  We had a ‘church’ reserved as our community center for education and distribution, and we brought lunch for the girls, at the pastor’s request.  I honestly think the place should be renamed la Grunge.  After a 2-3 hour drive down windy ‘roads’ (and by roads, I mean dirt path which may or may not be able to accommodate the big blue truck that carried us all), we were in the middle of the dirty desert village, where it was uncomfortable just standing because of the heat. 

Just to clarify, my feelings for this place have nothing to do with the heat, the dirt, the lack of air circulation . . . it was the people.  The minute we got there, people were rood, grabbing us, the boys were trying to get inside this church (none of the windows were glass, and there were holes big enough for people to get in) . . . and it only got worse.  We had thought that things had maybe settled down when we initiated the lecture, but things escalated to an unbelievable extent.  Initially . . . all the boys were just sitting outside, banging on the doors, trying to sneak in, and by the end, they were grabbing at me through the windows, trying to steal the food, trying to steal the hockey bags full of the feminine products . . . it was ridiculous.  And, unfortunately, they were not the only ones who were inexcusably poorly behaved.  Once the kits were distributed, the women and girls became monsters . . . we had unleashed a beast that was uncontrollable.  They were taking extra kits and handing them out the window, trying to hide the ones they received so they could get two, and they were extremely unappreciative of any of the work that went into making them.  The only thing that provided me with some hope in humanity in this place were the very young girls.  We allowed them to come in and listen to the lecture, but decided they were too young to give a kit to.  When the kits were handed out, they were instructed to go to the back of the room, and they were the last ones to receive lunch.  These little girls were so well behaved . . . not once did I see them try to steal or cut in line . . . they just sat patiently waiting to be allowed to get their food. 

By the time we got back to the truck (which was a little walk as the roads got to be so bad we could not take the truck further into the village), I think we were all ready to get the f*** out of there.  I road in the back of the truck on the way back, which was actually quite pleasant . . . we had little chairs, all I needed was a nattie light in my hand and you had a redneck Christmas card. 

The following day, we wend up to OSAPO, and unfortunately did not have enough kits for the EXTREMELY well behaved young girls.  Their behavior was like night and day in comparison to the previous day.  On the bright side, we were even more able to appreciate how lucky we were to work with such nice young girls.

 

My Legacy

I’m 28.  I’ve still got many years of my career ahead of me . . . in fact, it is really just beginning.  I don’t want to give the impression that I’m this phenomenal, amazing person, nor that I see myself in that manner.  I’m just a person who saw an opportunity to possibly make the world a better place, and took it.  Now, whether or not I’ve made a huge dent, only time will tell, at least I’ve maybe made a small dent.

To different degrees, I think we all have a fear of failure.  To be completely honest, I’m worried that these past several months will be considered a failure.  Things did not go as planned, and the thought of going back for an extended amount of time is exhausting for me (especially seeing as I’ve come to realize how much I hate hot weather).  I think there is always more that can be done, and you start asking yourself, ‘am I a failure, because I could have done more?’  If I decide I want to go to an orphanage in Liberia, or work in a clinic in Nepal instead of go back to Haiti, does that make me a quitter?  All of these questions have been going through my head a lot these past several days.

When I look back on my experiences, I don’t regret going.  That being said, words can not express how happy I am to be home.

B-E A-G-G-R-E-S-S-I-V-E

[What I really mean is be assertive, but there is no cheer that goes with that.]  First off, I need to apologize for how badly I’ve been keeping up with my blog . . . here I am, two weeks in, and this is only my second blog.  This country has been keeping me more than busy.  By the end of the day, I barely have time to reflect on the occurances, let alone make attempts to create a whitty recap for my blog.  Any thing I may have been able to piece together would have been worse than having a discussion with me off my ADD medication . . . disorganized and maybe half way make sense.

I’m honestly not sure where I should start in my attempts to update all of you as to what I’ve been doing these past couple weeks . . . there have definitely been some memorable moments . . . singing ‘It’s a hard knock life,’ as I cleaned the OR floors; the chicken who scared the crap out of one of our team members in the work room (who we later found out was waiting for her chicks to hatch); my first ride on a tap tap; further getting to know some great Canadians who, as it turns out, came to Haiti to work on a project that is right up my alley; . . . the list goes on. 

If I did not say it earlier, I have been truly blessed with the people I have had the privilege to work with during my time here.  Our entire team at Pierre Payan was better than anything I could have asked for.  [I don’t want anyone to feel left out . . . but I feel it necessary to say that Judy Douglas, you are a saint . . . you seem to have twice the stamina of someone half your age . . . your kindness, generosity, positive attitude and work ethic astounds me . . . you inspire me.]  When multiple people of different ages, locations and backgrounds come together to do work in Haiti, one may think there is only one common denominator (whether it be medicine, religion, etc).  My experiences have proven that theory FALSE.  [A friend once told me he couldn’t believe that most of my closest friends were also doctors . . . how boring, right . . . but medicine is not the reason we are friends, it’s just the thing that brought us together prior to realizing we had so much more in common.]  I found out that one of the general surgeons on the team (Dr. John Reidell) had pitched in the minor leagues while he was in medical school.  His father, brother, and nephew were also major league pitchers for the Yankees and Reds.  [Although I was unable to watch the games with my favorite fans, watching with him, with his commentary, was definitely the next best thing . . . those moments are something that I’ll never forget.] 

The second week I worked at Pierre Payan, I operated with Dr. Reidell.  Very much a gentleman, he asked my permission to assist me in my surgeries.  What I did not realize was that he literally meant assist.  He wanted me to do the entire hysterectomy (for those of you who don’t frequently watch abdominal hysterectomies, you usually have a surgeon on each side, taking turns ligating vessels and pedicals).  I told him that one of my mentors use to make residents operate the same way . . . so if there was a complication, you have no doubt who is responsible.  His response . . . ‘Sounds like a very wise man.’  [I never had the chance to do any major surgeries with Dr. Griffin, but I almost felt that I was this past week . . . an unexplainable feeling, that made my eyes smile].  On his last night in Haiti, he told me not to be afraid to be assertive [among some other personable words of wisdom, which I have taken to heart].

Now, enter my last weeks at OSAPO.  I honestly did not know what I should expect.  I can’t remember how much I revealed as to the issues I’d been having here . . . specifically the lack of support, unwillingness to provide an interpreter, providing a reliable nurse to work with EVERY day, the charging for screening and treatment (and EXTREME lack of communication regarding anything relating to the program).  Issues which, after time, made me begin to feel hopeless for any long term success. 

With the help of an independent donor, we have been able to convince the powers that be at OSAPO to let us start screening people for free, and the word has spread like wild fire.  Women from all over have been coming to OSAPO for screening.  I have two new nurses I’ve been working with this past week, and we’ve already screened over 100 people, and performed 18 LEEPs (over half have been women I screened previously and was unable to treat secondary to lack of supplies).  The nurses are asking if we can start clinic earlier in the day, as they want to see as many patients as possible so that they can learn.  Another independent donor has paid for my daily interpreter for the time I’ve been here, something I felt necessary in order for me to really take control as to what’s going on here.  I don’t know what the future holds here, and I don’t want to be too optimistic, but I really feel like I’m in control, and not at the mercy of a higher up who is not listening to me.

I know that this whole blog has been slightly disorganized . . . my ‘turning life into stories,’ professor in college would probably be very disappointed in my jagged flow of events.  I hope to be more structured in future posts, but no promises!!

I'm back!!

October 26, 13

Yes folks, I’m back in Haiti . . . and what a different experience this has already been.  I’ve actually been in the country for about a week, but I have been so busy I have not had time to write.  The pure exhaustion I am experiencing may make it difficult for me to keep of this façade that I am actually capable of writing!!

About a year ago, in my second trip to Haiti, I jointed a team (whom I had never met) from the east coast, in attempts to get a little more experience being in the country prior to making this long-term journey.  For some reason, they liked me enough to request that I join them for two weeks the next year . . . so here I am.

You may ask, how is this different from what I had been doing? . . . being here with a team means having ten or so people who are probably more eager than myself to really get the work completed, 24/7 anesthesia coverage, days starting at seven am instead of 9 am . . . comparing to my recent experience, it is night and day.  This past week, we’ve done a total of 5 hysterectomies (4 abdominal and 1 vaginal), in addition to many other hernia repairs, and other minor procedures. 

I also went up to OSAPO for a day to cram as many LEEPs as possible, which unfortunately only meant about six (I pray that the twenty or so that needed the procedure will come at some point this next month).  Being there made me realize how much of a change I really needed.  Even though I’m here, MISSING THE WORLD SERRIES, I feel truly blessed that I have such a wonderful group of people to be working with. 

Being back at OSAPO brought up all of the BS and frustrations that I had left behind.  When I started this whole thing, I was so optimistic that I myself, a newly graduated gyn resident without any public health training, could successfully start a cervical cancer screening and treatment clinic in Haiti.  I really hate to admit this, but I am fearful that this whole setup will fail. 

Now, I realize my wording sounds very negative, but I think it’s healthy for me to admit my fears . . . but after this week, I have also realized that I am looking at this the wrong way.  In this situation, there is no such thing as failure.   Just preventing one person from dying a cervical cancer should be considered a success. 

I’ve been trying to think of some way to ensure that screening efforts will continue once I’m gone, but it’s not all up to me.  I’m only one person, and there is only so much I can do.  Over the last few months, I felt myself slowly loosing faith in people (I need to emphasize that there were definitely some phenomenal people at OSAPO, and if it weren’t for them, it would have been difficult for me to have the stamina to keep going).  Being with these people for just a week has rejuvenated my spirit and faith in humanity.

So . . . I’m going to take all of my negative thoughts away; I will continue working my big butt off for the next week; I will continue to resurrect my stamina and faith; I will continue listening to every cards game (as our wifi connection is not strong enough to stream), praying that the internet does not go out; and I will pray that I will at least screen as many people as possible in my time remaining at OSAPO.  I will say au revoir for now (and will hope that it will be less than a week before I have time to blog agai

A final night at the round table

10/3/2013

[Disclosure . . . the table at OSAPO is not round, it’s long and rectangular.]

I’m currently sitting in the airport, enduring the beginnings of a VERY long day of travel.  I’ve been in Haiti for two months . . . it’s time for a little vacation (and by vacation, I mean 2 weeks in the great city of St. Louis . . . more importantly 2 weeks of experiencing the post season for the greatest team in baseball!).  On the long ride from OSAPO to the airport, I couldn’t help but smile as I reminisced over the way I spent the previous day . . .

I was finally able to have another day in the OR.  I don’t think words can express how stressful operating here actually is.  [Don’t get me wrong . . . I LOVE being a surgeon, but your talking about a completely different beast when you are in a third world country.]  To start off with . . . there really is no set schedule.  When the anesthesiologist says she will be there at seven, she really means nine, which mean your day does not start until 9:30 or 10:00.  Even though we attempt to keep a schedule of patients, they are unpredictable as to when they will actually show up.  There are some days where no one will come, and some days where many will come and you need to send them away.  Then, there is getting the equipment prepared.  Every sterilized tray is like a piñata of surgical instruments . . . you never know if you will have the instruments you actually need . . . and if you don’t, then you are scrambling to find the essential instruments you actually need, with the patient asleep on the table.  It is literally impossible to be efficient and conserve resources.  [Oh, and don’t get me started on the lack of sterile technique of everyone else in the OR, you not only have to focus on your actions, but you are also manning everyone else.]  Once you actually get to the actual operation, you are exhausted just from making sure everything is in its place. 

Last week, when I was operating on my own, I was reminded just how much I enjoyed it (both the challenges and success of knowing you did everything according to the books, and that you truly did help someone).  Yesterday, I did a hysterectomy with the assistance of one of the surgeons in Haiti, who prides himself in his speed.  I don’t want to go into too much detail, but I realized why he is so speedy yesterday.  Those steps of Identifying the ureters, double ligating all the serious vascular pedicles, assurance of a dry field, completely out the door.  I realize that I’m just out of residency, and he has been a surgeon for many years . . . so I did my best to be respectful, yet challenge things I didn’t feel appropriate.  It could have gone more smoothly.  [Janna, if you are reading this, I did not say it before, I have so much respect for everything you did the first time we came down here.  It’s a different game when you are the one in charge.]

So . . . back to my day . . . there were a couple of minor cases I had scheduled for the afternoon, but unfortunately the anesthesiologist had to leave early, and alas they were canceled.  As I was going through my ‘office,’ making sure everything was in place, Carine said there was another patient, who had just been admitted who I needed to see.  70 year old female, vaginal bleeding, hemoglobin of 7.  Carine told me she had gone to see another doctor, but they wanted me to see her, too.  My response was, not until the other physician actually does a pelvic exam, (she assured me that he did, but I’m somewhat skeptical).  [Now, just a little clarification . . . the frustration that I have with no one doing pelvic exams here is a much different type of frustration than that which I had in residency, when you would get called in the middle of the night to go perform an emergent pelvic exam on someone with vaginitis.  This roots deeper than the frustration with pure laziness of others.  At least in residency, people made sure that patients received the proper care necessary.  Here . . . when I leave . . . there is no one else to do it.  If people don’t start performing much indicated exams, no one will, and significant pathologies will continue to go undiagnosed.]  This poor old lady appeared to have dementia . . . luckily did not appear to be in too much pain.  Speculum exam:  big fungating tumor originating from the cervix.  Bimanual exam:  IIIB (at least) cervical cancer.  Just a little shout out to the powers that be . . . I get it . . . I’m still passionate about my work here . . . I don’t want any more reminders. 

So . . . up to this point, I’m sure you are wondering, what about this day made me smile . . . I’m getting to it.  My nightly schedule here is pretty much the same . . . work out, shower, eat dinner and visit with the OSAPO nurses/staff (who, for the most part are female).  It is always very entertaining for all . . . it feels so good to laugh with others.  Last night, one of the nurses (Andre . . . someone who I’ve really enjoyed working with . . . she is the one who helped me make my bat free room in the office) was asking me what my plans were in St. Louis.  I mentioned going running with my dad.  Her response:

            ‘You will not be able to run.’

            ‘And why is that?’

            ‘Because you are too fat.’

            I started laughing, ‘Andre, I am the same size now as I was when I got here.’

            ‘No, your butt and legs has become too fat.’  By this time, some of the other girls were engaged in our little conversation. 

            I chuckled even more, ‘Nope . . . they’ve always been this big, it’s just the way I am.’

            One of the other girls needed to translate this for her . . . her response with big wide eyes and a big smile on her face, ‘Ooih.’

            ‘You know, it’s not nice to call people fat.’

            ‘But I love your big fat butt.  It dances every time you walk.  I find it very sexy.’

            At this point in time, I was almost crying, I was laughing so hard.

            She continued, ‘I want your butt.  Mind, I do not like so much.’

            ‘Well, thank you.  Now, I think it’s time for bed.’

To really get (even more so) the comedy of this conversation, I’ll provide a little background information (and don’t worry, I’m not going to dive into the whole body image, insecurities, etc . . . I am by no means skinny or completely satisfied with how I look, but what woman is).  For those of you who don’t know me, I am very much pear shaped, and yes, I have a ba donka donk and thighs.  I am also very athletic, and it seems that my butt and thighs are what tend to bulk up the most.  I have ALWAYS had a complex about my lower half, but have come to find it more a topic of humor than anything else.  When I was getting measured for clothes in Vietnam, when measuring my thighs, one of the woman said, ‘hoooooaaaaa,’ in a deep voice as she widened her eyes.  Also, Andre has many a nights commented on my big butt (one night, she asked why my waist was so small, and my butt so big).  She is also one of the most lively people I’ve met . . . between her persona, the cultural differences, the literal translations and my apple bottom complex . . . I don’t think I could have engaged in a more entertaining conversation.

Now . . . time for me to relax.  For the first time in two months, I actually have goose bumps (AC in the airport).  Time to allow all my frustrations and unpleasant experiences dissolve.  Time to keep the happy memories on the surface.  Time to bring the Cardinals to the World Series!!!

[For anyone in St. Louis, you should go to Sybergs (Dorsett) tomorrow night . . . A fabulous band will be performing . . . and I’ll be there, too, hopefully celebrating after the Cards game].

The Starfish (Janna, this is different than the one we sang about in oncology years ago)

(For the record, Sandra has been an amazing voice for me here . . . she's almost loud enough to be heard here in Haiti from Missouri . . . any success can be greatly contributed to her efforts)

Is any one familiar with the little story . . . the man on the beach, and all the starfish that had been washed up on the shore.  As he walked down the beach, he would throw every starfish back into the ocean.  Another person noticed what he was doing, and forewarned him that there was no way he was going to get to every starfish . . . there were miles of shoreline, tons of starfish, and only one person.  The man picked up another starfish, threw it back into the ocean, and said ‘Well, I made a difference for that one.’  This concept is the only thing that is getting me through these past/upcoming days before I take a little break and head to St. Louis (that, and plans of Cardinals and the playoffs . . . woohoo!!).

When I was 18, I went to Hilton Head for our extended family vacation.  In July, the coast is covered with jellyfish, many of which had been washed up on the shore.  My cousins and myself performed our own little rendition of the starfish story, throwing the jellyfish back into the ocean.  Now, I’m not exactly sure the purpose of jellyfish within the animal kingdom, but at least we were maybe preventing people from stepping on them.  [I also think I created good juju for myself as there were several times I swam into jellyfish on that trip and did not get stung.  Unfortunately, my little sister was not as fortunate with the sea urchins as she was stung by a sting ray . . . a very memorable trip for us all.]

This past Thursday was by far the most exhausting day since I’ve been here (on multiple levels).  We were finally able to get the nurse anesthetist to come (a SIGNIFICANT challenge in itself . . . so frustrating that I still don’t feel like going into detail).  When she said that she would come at 7:00, she really meant 9:00; When I told her I wanted a spinal for a cervical conization, she figured I did not know what I was talking about, so she just did IV sedation.  I don’t think I have every been so frustrated with anesthesia in the OR, and trust me, there were some challenges during residency. 

Even though I was operating, they continued to allow patients to pay to see me (oh, and did I mention previously, that it was decided to charge patients more to see me . . . something I was never notified about, it was only mentioned in passing several weeks after they started doing it).  So . . . following a long frustrating day of cases, there were 14 people with pelvic pain waiting to see me.  At least we had enough speculums to screen every one of them.

By the end of the day . . . I was exhausted, however I had agreed to help the man in charge with a graduate/public health paper.  As we began discussing the program, he mentioned of plans to charge people for screening . . . a fact that I was not at all pleased to hear about.  It’s been bad enough that the person I’m teaching how to screen is maybe here 60% of the time (if that), but now charging people just for screening!  I’m starting to become skeptical as to whether or not this will be successful once I leave.  I am a person full of knowledge and ideas (especially from a public health standpoint), and at times I feel as if I have no voice here. 

Unfortunately, we are out of LEEP loops, so the LEEPS have come to a halt (I’ve done maybe 15 or 20 . . . and will be doing a lot more when I come back . . . it’s a good thing that everyone here has cell phones as we’ve been keeping track of everyone who needs to be treated).  I’ve screened nearly 250 patients.  A small number in comparison to how many people are actually in Haiti, but I’m happy with that number nonetheless.  So . . . I’ve been doing my best to lead the OSAPO hoarse to water, what if it doesn’t drink?  At least I’ve made I difference for the people I’ve seen here.

My life as a musical

A couple nights ago, I was listening to the Glee rendition of a classic ‘Annie’ song.  For those of you who are not familiar with this fabulous musical, one of the well known songs is ‘You’re never fully dressed without a smile.’  [I remember many an afternoon as a young child, my favorite thing to do was get a large cardboard box from Sam’s club, and sit in it in the family room as I watched great classics like ‘Annie’ and ‘The Little Mermaid.’] 

During residency, I worked with a great group of L&D nurses . . . one in particular who loved musicals just as much as I do.  I always loved when we worked together as it would end up being a very theatrical evening (one which tended to drive everyone else crazy).  [Nicole, I miss working with you.]  Life is so much more enjoyable when it is made up of songs . . . 

In my short time here, I have also become quite accustomed to many non-verbal forms of communication as a means to enhance any relationship I have with the people here.  Hugs, pats on the shoulder, holding the hand of a patient when I give them bad news . . . but the best (and easiest) non-verbal form has got to be a smile.

Throughout my time here, many of the employees have come to see me for various gynecologic concerns, including cancer screening.  It seems that after I have seen them as a patient, our relationship has somehow changed.  I’m no longer that odd white doctor who gets anxious when we have really sick patients, and does Zumba in her room alone . . . I am now someone they have an established connection with. 

Yesterday morning, I was sitting at the breakfast table, when one of the lab techs (whom I had just seen in clinic the previous day) walked by.  All I did was smile, and her eyes brightened up, she smiled back and said bonjour Vonde.  Then, I started singing in my head ‘Hey, hobo man; Hey, Dapper Dan’ You’ve both got your style, but brother you’re never fully dressed without a smile!’ . . . which only made me smile more.

In the afternoon, as I was seeing yet another patient who came with the false impression that the white doctor could cure every ailment in one clinic visit, I felt like I was in the temple scene of Jesus Christ Superstar . . . [see my eyes I can hardly see, see me stand, I can hardly walk, I believe you can make me whole . . . will you touch, will you mend me, Christ?]  (I am not comparing myself to Jesus by any means, but there are times where I want to scream/sing ‘There’s too many of you, don’t push me, there’s too little of me, don’t crowd me!)

So . . . I’ll admit, there are many of times that I have seemed to randomly break out into song, but I assure you that 1) I’ve probably been singing that song in my head for a while and 2) it actually does have relevance to what’s going on in life.  I also can not recall a single time where that was happened and the response of my surrounding peers was anything less than a smile.  As Buddy the elf said, ‘The best way to spread Christmas cheer is singling loud for all to hear, ‘ . . . in my opinion, it’s the best way to spread any kind of cheer.  Musicals just make life more fun.

Mother knows best

Last night, I had a nice chat with my mother via skype.  We were discussing many of the frustrations I’ve had while working here . . . specifically some aspects of patient care.  [Just a quick update, on my stage IV patient . . . we ended up finding not only fentanyl patches for her, but also Vicoden.  She went home feeling relief of pain for the first time in several months.] 

In the states, when people don’t have money, or insurance, if an operation is absolutely necessary, we work out a payment plan.  That really does not exist here.  EVERYTHING is private . . . you don’t have the money, you don’t get the surgery.  Last week, I saw a young girl with a complex adnexal mass . . . I suspect that her ovary has twisted on its blood supply, meaning that she is in a lot of pain and absolutely needs a surgery.  She still has yet to have her surgery as she has yet to pay.  I have tried to explain the situation to the folks here, but they don’t want to set a precedent of ‘not taking accountability.’ 

As I was discussing this with my mom, she asked if she could pay for the half that the patient has yet to pay for.  Now, whether or not she would be able to do that is beside the point . . . just the fact that she offered (which is not something out of character for either of my parents) made me feel less alone in my struggles here.  I am very lucky to be surrounded by such generosity.  [At this point, I also want to thank everyone . . . (especially Dan Jackson and Lindsey Smith) for your persistent comments.  You make me laugh, and you make me feel less alone in such a foreign world.]

Today, I saw two patients who had recently self-medicated to induce abortions.  Now, I do not want this blog in any way to become some kind of political or religious platform.  [I’ll save those discussions for the Howie family vacation after everyone has had a few drinks].   These two young girls had gotten the medication off the street . . . no counseling, no written instructions for expectations or reasons to see a doctor, nothing.  They both came in for ‘hemorrhage,’ which lucky for me meant they had just passed the pregnancy (the only D&C equipment they have here is a sharp curette, meaning that would be my only option if there were retained products of conception . . . meaning that I could potentially cause some type of scaring affecting future pregnancies). 

In Haiti, there is this ‘black market’ (which is really just the market) of drugs, and it’s not your typical market that you think of.  Antibiotics, cytotec, etc are all readily available for people to buy and take as they please.  The whole thing baffles me as I would say at least 75% of the patients I’ve see here have taken part in this self-medicating, when many times they don’t have the education to know exactly what they are taking or treating. 

Obviously, the culture here is quite different than what I’m used to . . . medications on demand (no need to be seen by a doctor); also scans on demand.  I cannot count the number of patients who have come to see me saying they want an ultrasound to make sure everything looks fine.  Just last week, a 28 year old actually refused to have any type of exam from me . . . she said that she just needed an ultrasound (after about 15 minutes of explaining why things don’t work that way, she finally decided that I might be correct).  The whole patient care thing is somewhat ironic here . . . on one hand you have specific things that patients make the decisions (ie, when to take antibiotics, when to have imaging studies, etc); on the other hand, you have patients who blindly follow recommendations . . . (like surgery, as I’ve discussed earlier, I don’t know that patients are actually given the option for conservative management).