First Day in Clinic in Port-au-Prince

Today we finally got to see patients in clinic in the very poor Bel Air area of Port-au-Prince. See my latest photo album. We are using the top floor of a Nazarene church with no structural damage, neighbored by two huge piles of unidentifiable rubble from two collapsed buildings - a school and an apartment building. The days and hours before clinic we gathered and arranged our medicines and supplies and planned how we would treat the prevalent diseases with our very limited current supply.

Around 9:30am (later than planned) we climbed aboard a rented "taptap" (named that since you tap the side to request a stop), the main form of public transportation in Haiti. It is a small pickup truck with its bed covered by a partial camper top with view-holes up front, windows on the side, and a wide open back (no tailgate) with a rail with grating on the sides. You sit on 2x8-board benches on the sides of the bed, and all your have to rest your back against is a jagged metal ledge jutting out. The roads are of course the craziest bumpiest obstacle course ever, and there is not much to hold onto, but you have to be careful not to bruise your arms, break a rib, knock your head on the roof, or fall out the back. Most taptaps are painted in unique colorful and beautiful Christian Haitian cultural murals, but ours is a bland unmarked one, though just as run-down and shock-less. The 45-minute ride into downtown Port-au-Prince is the craziest dustiest stinkiest bumpiest route I've ridden, and now I understand why I was advised to just not look while the laid-back drivers weave across the entire road to avoid 2ft-deep potholes and pass all traffic possible without more than an inch or so margin. They honk for everything, and pedestrians including kids are barely jumping out of their way. There are a few traffic lights working, but they just create more rules to be broken.

The concrete dust and diesel/gas smog (and occasional stench of corpses) are all quite overpowering, though a bit better with sunglasses and a mask I wear sometimes. The destruction is simply everywhere and is just overwhelming. Rubble is still overflowing into most of the streets, even though Canadian crews have already hauled miles of rubble to the outskirts of the city, on top of which incidentally people are already staking out tent space, since any space is such a premium. The bustling population is so amazing to watch constantly doing everything they can to survive in this disaster and chaos, and so many emotions are etched in all their faces.

Today was the first time to use this facility for clinic. Until the three days of mourning, Heart To Heart served in the large bowl-shaped Stadium where thousands have been camping out since the earthquake. They decided to move the clinic out because the with no sanitation or ventilation and with tense crowds. When we arrived at the church there were already 50 people lined up on the benches inside to see us. We have our clinic area in the rear loft of the church, overlooking the chapel on one side and the destroyed city and the seaport on the other. To get there you have to climb three flights of stairs, the last with no railings or sides. (Like a cardiac stress test on the way in!) We have someone assist elderly up and down those last stairs. The loft floor is rough dusty concrete, and rebar and blocks are sitll lying in one area from the fallen little tower that was on the roof, but the space has lots of great natural light and ventilation through the windowless concrete frames. We set up three provider stations and one wound care and one pharmacy station. We frequently help out with each other's patients. It runs pretty smoothly. We work well as a team, and our translators help keep things moving. They are all pretty decent and kindly are helping me to learn Creole. The translators and our drivers are young men whose studies or jobs were derailed and now they have scrambled to get these very nice jobs at $20/day, and numerous friends of theirs are always trying to volunteer with hopes of them getting paid too. Any job is a Godsend right now, especially considering that PRE-earthquake Haiti's legitimate employment rate (not UNemployment) was a mere 7% and median income was less than $2 a day.

We saw 115 patients today, with the doors apparently having been closed at 4pm for a few more non-urgent cases to come the next day. We had a small lunch break in the middle, where we shared powerbars with our translators. I saw 25 of my own patients personally, similar to the others' numbers. The statistics I was quoted before of 60-100 patients per day per provider turned out to be an exaggeration, but 6 patients an hour is already alot faster pace than I've ever had in clinic in the States (the barebones charting helps!).

With a slower pace than I had imagined, I enjoyed taking a moment to learn about their homes and families and sleeping conditions and express my condolences for their great losses. About 90% reported sleeping on the loud rocky street under occasional rain in front of their destroyed home (Bel Air was hit hard), hence understandable the myriad complaints of back pain and insomnia! Everyone lost someone close to them in the quake, some lost many family members. The prime minister of Haiti announced that 270,000 people have been buried in the mass graves alone. We gave out lots of Benadryl for itching scabies (no ivermectin cure pills yet) and insomnia. What they really need is tents and sleeping mats and a safe place to camp. Of course when hurricane season comes the tents won't help much though. Also, the UN-run food an water distribution is really not enough and not reaching anywhere near everyone who needs it (everyone).

My first patient was a tough young man in flip flops (his only shoes, just like most people here) with a large abscess on his heel from an injury from climbing on rubble a week ago. He asked for gauze to bite while a friend held his head and hand. Our smallest needle at the moment was a large 21-guage, so that part was not comfortable, but he got a decent block and was feeling better after I incised it and drained a bunch of foul pus. For antibiotics I gave him the last of our Omnicef solution; now it turns out we have tons of Omnicef tabs too, our main antibiotic in store currently. He'll be back in 2-3 days for recheck and to get more Omnicef, this time in tabs.

One unfortunate patient I saw was a 1 or 2-yr-old baby (the mom didn't know her child's age exactly, which is very common!) with diarrhea, vomiting, and weakness. We perked her up with some oral rehydration therapy, which we're using on alot of people of all ages. I did see a couple people with probable typhoid and malaria, but I had to refer them to the nearby Cuban field hospital because we still don't have Cipro or chloroquine available for respective treatment.

We send people there for chest x-rays with bad chronic coughs (some report coughing up blood) or for lab tests if they look severely anemic (everyone looks at least somewhat anemic) or need other tests or surgery. Referrals can be messy though. I sent the Cubans an elderly lady with what I feel is osteomyelitis of the tibia that has developed from a wound from rubble a week ago, but they apparently sent her away with nothing more than a prescription for hypertension medicine to be filled at our "pharmacy," so I'll have to somehow find her again and make sure she gets adequate IV/IM antibiotic use for the bone infection.

We are seeing alot of patients who are seeing a doctor for their first time ever or in many years. The most common complaints are irritated eyes and insomnia/back pain, but some have fevers, diarrhea, wound infections. I've seen lorger goiters here than I'd seen before in person. Many also have thrush and yeast pharyngitis, so I wonder if they have HIV and am hoping the Cubans will check for that as requested. This experience is really teaching some reliance on a good history (difficult with the language/cultural barriers) and physical exam.

So it was a great day, and I'm very excited to finally be out serving the people of Haiti! How grateful and humble they are! People here have so much endurance and a positive attitude to boot! This trip is really giving me some amazing perspective. I hope you are able to experience some of this through this blog. Thanks & take care!