Thursday, May 19, 2011

USA

On March 18, 2011, we made it home safely in the US without problems.  The ex exhiled president was returning.  Our ride to the airport was very scary.  There were riots, traffic, fires, street closures, and pure chaos.  But... we made it.  First stop in the Miami restaurant - a restaurant to get a cheeseburger, a beer, and a phone call to my family.

I really hope you enjoyed reading a little about my experience.  It continues to be something I reflect on, miss, and a reminder to step back from my life, breathe, and apply the "Haitian faith".  I hope if anything, this journal may have inspired you to consider a mission trip -- even if it's not medical or religious based.  It opens your eyes to the world -- forces you to "look down from your roof", if you may. 

I want to thank those that donated or offered their support.  I love, love my family and friends.  I truly am blessed. 

3/17/2011 9:00 pm LAST CLINIC DAY

FIRST OFF: HAPPY ST. PATRICKS DAY! Happy birthday my little Ty-Ty -- turning 2 years old!

Total Patients today:  287!!!!

Total Patients seen this week:  944

Today was the last day.  It's sort of sad.  Today I felt more confident as a clinician.  It almost made me believe I am ready to do this on my own... almost haha. 

Saw another patient with a blood sugar of 390 and a BP of 190/100.  Put her on metformin 500 mg twice a day and hydrochlorithiazide.  HCTZ is very effective in lower BP of African American patients.  SAw a female who was 27 and was needing a pregnancy test because she thought she might be pregnant.  We ran the test in our make shift lab and it came back positive.  She was pregnant and so happy!  Her and her husband had been trying. 

A lot of the tent city children we saw where there.  Those poor families.  Most of them were there just to be seen.  We had sent over tap-taps to pick them up.  Apparently families were just tossing their kids in just so their kids could come and be seen.  Even though they were from the tent city they were still dressed in their "sunday best".  They were so grateful for evetything.  I feel like I can't even take in all I saw.  I feel accomplished but a little defeated at the same time.  I wish I could just help them even more.  I just want them to have the same basic resources - or just clean water at the very least.  There was a 2 year old boy with extensive 3rd degree burns to his little finger that won't get proper treatment.  There was a girl I saw who was 8 with a serious eye infection taht wasn't pink eye.  She needs to see a specialist.  Being in tent community, she has no phone or way to communicate with anyone.  We couldn't even get in touch with her if we needed to.  I wish her the best...

I have to say, I was sad to leave my translator.  He was an extremely nice (and PATIENT!) young man...even if he does like kobe bryant!  I'm sure if he was in America, we would have been good friends.  It was funny because by the second day, he knew the order of questions I was going to ask and would try to ask them before I finished.  Sometimes I'd say, and does she have problems with acid or does she have a burning pain in her chest after she eats, and he'd talk to her in creole then say "YESSSSSSSSSSSSSS!!" as if I just solved a medical mystery.... not just describe heartburn.  :)  Our last day, he gave me a Haitian coin that is 1 gourde or 1/5 of an american dollar.  I was shocked and so touched.  That is a lot of money for him.  He lives in the community.  It will forever be my lucky charm and a reminder of where I've been, what I've seen, and all I've accomplished. 

I have to say, I'm a little nervous about going home and practiving medicine.  I know I'll see Americans in 1000x better situations feeling like they are owed everything, complaining, irritated if they wait 15 min, ungrateful if you don't prescribe vicodin or xanax.  It goes the other way too.... those that can't get the treatment they need because it's either getting a lab test or paying the water bill.... healthcare in the US can make you cynical.... something I want to avoid -- at least when i'm starting!  It will be difficult to step back from that and not think about my Haitian patients.  I'm so ready to go home but part of me will miss the generosity, the respect and how much the Haitians and their culture has inspired me.  I don't think it's common to miss a 3rd world country but part of me wishes I could have the best of both worlds.  I really hope this mission trip continues.  This will be something I know I will continue to do in the future. 

So excited to be home tomorrow.  I need a hug from my family. 

Brittany

3/16/2011 830 pm CLINIC DAY THREE

Patients: 215
Total in 3 days: 657

Today I spent the first hour in pharmacy then went to the floor to start seeing patients.  Wow, I was way more nervous than I thought it would be.  I felt very unsure, especially since my rotations to date did not include family med, pediatrics, ER, urgent care.  At least I had some internal medicine background.  I was praying most of my patients were ortho...or ob/gyn.  It didn't help that my first couple of patients were more complicated. 

My first patient had a BP of 210/109...not good.  Not only that but her blood sugar was 410.  Diabetic and hypertensive.... You don't see many diabetes patients like you do in America---they are all not overweight and eating processed foods...

My 2nd patient was an 8 year old boy with typhoid fever..  Not having having pediatrics really didn't make a difference since I'm pretty sure none of my classmates or even PAs for that matter had seen a case.  I guess there is a thought around Haiti that if you have TF that they shouldn't drink milk or eat certain foods.  This kid was getting dizzy because he was not eating properly.  The most we could do was hydrate him and give him an antibiotic. 

By the time we started up for lunch, I felt more confident.  Working in the pharmacy def helped.  I'm sure tomorrow will be even better.  A lot of my patients were women with headache, vaginal discharge, and acid reflux/heartburn.  My translator kept saying "she has the acid".  I did see a couple of arthritis cases. 

I have to say, I really just want to be able to make a telephone call, brush my teeth without using my waterbottle, and not wear DEET 40 after I take a shower.  Oh yeah, hot water would be nice.  Also, flushing after I pee.  Also, not hearing a rooster at 3 am.  Also, not eating powerbars so I don't pass out.  Also, being able to drink water from a facet.  Also, not having to wear sandals in the shower.  Also being able to blow dry my hair and straighten it.  Also to not wear a fannie pack 24/7....  WOW GUESS YOU CAN'T TAKE THE AMERICA OUT OF THE AMERICAN.

Courtney made an interesting comment when we were showering.  She said that she would feel guilty about going out for a friends birthday party in Chicago and spending $8 on a drink, especially when most people here are lukcy to make that in a day.  Our translators were getting $20 a day and that was alot.  That really made me think -- especially since I do enjoy going out to dinner and spending money on a glass of wine or beers.  Def makes me want to be a lot more frugal. 

Someone from the church group that is also staying here made a comment about how there is a signma in the US about Americans feeling entitled.  Entitled for everything... SO TRUE. 

I noticed that the Haitians are so well dressed when they come to clinic.  Ironed shirts, women in dresses with blazers or sweaters (it's 95 degrees out).  The children are in bows and dresses.  Some are even wearing like princess halloween costumes.  They are so unbelievably grateful that you are able to sit with them, hear their problems, and try to help them out.  THIS IS WHY I WANTED TO BE A PHYSICIAN ASSISTANT AND WORK IN HEALTHCARE.

Sitting here now, it looks like I could be on a tropical vacation.  The mountains are all lit up, the stars are twinkling and the palm trees sway.  The weather is beautiful.  From the roof, everything is heavenly.  Just a few feet below, the people are sleeping in tents amongst goats, bathing in man made holes of dirty water.  Isn't that sometimes we live our life?  Keep our head up and look through our rose colored glasses.  US may not be a 3rd world country but PLENTY of our citizens are struggling -- without access to the things they need to be healthy and survive in this world -- our world.  It just doesn't all sink in yet.  I take a benadryl at night just so my thoughts don't race and I can get some sleep.

One thing the Haitians have that I feel like I lack in my life is faith.  It's incredible that I have so much in my life but I'm not near as happy as the Haitians are.  I feel happy, accomplished, satisfied... I'm not sure the right word... but I know I still want more....I still think things could always be a little better.  Maybe I'm a little world of settling or of accepting mediocracy... however... there is a line.  Appreciating, smiling, really being happy is something I need to accept from how I feel on the inside.  Not judge it on what's happening on the outside.  I have my family, school and my career, friends, Jon, Ty-Ty, my independence, my freedom, my apartment, all the places I've been so fortunate to travel to, memories of college and high school, my health, my families health, tons of clothes, shoes, cable, food, a car, SO MUCH.  This past year was very, very, very difficult for me.  Last summer I had my heart broken TERRIBLY.  I was lied to and deceived.  I was depressed.  I stopped eating.  I allowed someone to make me feel like I did something wrong.  That I was selfish for going to school and studying and working hard and wanting to have a great career and make money.  I allowed someone to tell me lies and make me feel less of  person.  I allowed myself to be blinded by all the things I was so FORTUNATE to have and focus on this one loss.  Sitting here now, I'm so lucky that it happened.  It also made me do a lot of soul searching, especially since that person made a lot of comments about my personal character and the fact that I couldn't keep relationships with females.  It really hurt me and made me examine who I was as a person, who I was with him, and who I wanted to be.  You know, thinking back now, it doesn't need to take a huge moment to happen before you start working on yourself as a person.  I can look back now and there are friendships I wish I still had, maybe choices that I wish I would/wouldn't have made.... but i have no regrets.  Those are only "what ifs".  I'm so, so happy now.  There will always be "what ifs".  I can only continue to work on me and be proud of who I am. 

Much love to family,
Brittany

3/15/2011 930 pm CLINIC DAY 2

Patients: 226

Today was a good, long day.  Woke up at 530, ate mango and powerbar.  Worked the pharmacy all day.  Saw a ton of patients in the morning.  2 cases had to be rushed to the ER.  A 16yo female came in with acute abdomen, appendicitis.  (I def know how she's feeling...)  We also had an 80 yo male with chest pain and tachycardia (rapid heart rate).  We suspected a heart attack.  His blood pressure was through the roof and not controlled with the meds we gave him yesterday.  We gave him an aspirin to help if he was having a heart attack.  Andrea (the PA and faculty member in charge) said they went to St. Catherine, the Doctors without Borders hospital.  THeir ER triage is a tent where they get a label - red, yellow, green based on symptoms and diagnosis.  I would have loved to tour a hospital in Haiti.  A lot of the MDs are from all over the world and Haiti. 

Tomorrow I have to help out with the pharmacy initially to help with the transition, since we are switching positions.  I am extremely excited about seeing patients.  On certain rotations, I'm allowed to see patients on my own.  I then go back and brief the PA or MD.  This time, I can make my own clinical judgement and prescribe meds...without someone double checking every single time.  It makes me nervous but I am not afraid to ask for a second opinion or help. 

Had rice and beans for dinner.  That's by far my favorite Haitian meal.  We played catchphrase a lot tongiht which was fun.  I have to say, I'm ready to go home.  Time hasn't gone by as fast as I wanted it to.  I think being cut off from communication has been liberating, yet at the same time, I miss Jon and my family.  Sometimes, all you need is to hear their voice. 

Oh, saw a woman with elephantitis of her foot and a baby with a horrible rash.  I'm sooooooo excited to see patients tomorrow! Ahhh :)

Love to my family,
Britt

3/14/11 730pm FIRST CLINIC DAY

Patients: 215

Today we got up at 5 to get started at the clinic.  Breakfast was fresh pineapple and coffee.  It was so beautiful to get up when the sun was coming up...granted we go to bed at 8.  You could already hear the Haitian music and the start to their day. 

Running pharmacy was fun.  Sarah was the patient education girl with the translator.  Larissa ran back and forth between her and I.  My job was to get the order ready -- whether that was hand the pre-made baggies or count pills.  Up front we had a triage area that took vitals and stuff, typical to what nursing does when you get to the ER.  Then we had 6 providers (3 certified, 3 students) seeing patients.  In the pharmacy, I found myself wanting to be in control asll the time, which I know I can be bossy at times.  Something I already thought about trying to work on.  I'm really going to try hard to relax and seem like I'm having more fun.  Fun, though for me, is being efficient and quick.  Looks like I'm my mother's daughter.  I really didn't get to see any patient interactions.  I'm very glad I've gotten to become more familiar with the drugs though.  I think that will make me more comfortable as a provider.  It's hard for me to have confidence, so I think I need to just take a deep breath and do the best I can do.

We saw a lot of patients with GI problems - esp GERD (heartburn) (tums and omeprazole) and pain relief (ibuprofen, tylenol).  Also gave a lot of allergey meds (benadryl and claritin).  Saw some ringworm or fungal infections (mostly on scalp) and some scabies.  I think one person commented how the Haitians kept saying how grateful they were for our help.

One thing that bothers me is that we come in and give meds enough to last a month, week, or less.  But that's it.  AFter that they are on their own  to figure out their problems.  I saw one woman hobbling in on a cane and I just imaginged what her xray looked like.  it's hard to know that most of what they need are just over the counter meds we have in our medicine cabinet at home.  we can just go to the store at anytime and pick some up.  WE carry around tums in our purse while Haitians wait in line all day for a mission group before they get theirs.  The last mission group before us had been awhile.  I mean tums.  Tums.  It's sad because we had to mark tsp and mix the childrens suspensions with our own clean water because they may not have clean water.  Plus, you're suppose to refrigerate the antibiotics...  It's not like they can go home and make the suspension like we can.  Its those things we take for granted.  Clean water.  Fresh air.  I can't see any patient in the US wait around for hours and then be so grateful and pleasant when they leave.  It always comes back to gratitude. 

Our laundry was odne last night.  The women handwash our clothes in buckets while we did the clinic.  Pretty amazing.  They smell good too. 

Our translator for pharmacy was very nice.  His name is "Junior".  He's going to school to be a nutritional scientist and wants to be a businessman.  He wants to get a masters and go to school in the US or London.  He is obviously from a well off family.  Funny, when we were talking to him, he asked us "where do you see yourself in 5 years".  Between Larissa, myself and Junior  - we all wanted the same thing - healthy family, marriage, children, successful career, financial stability.  So different - yet we are all 25 with the same goals in life.  It's pretty amazing how values can be so similar in diverse countries.  US or Haiti - as citizens of humankind, we want family and purpose in life.  Both of which may be the key to happiness.

Missing my family,
Brittany

3/13/11 1030 pm

Just getting into bed.  I hate putting on Deet then going to bed.  Emailing Jon has been a saving grace.  There is a computer here they we can all share.  You don't always realize how much you rely on someone until you don't have them.  I wish he could experience this as well.  I don't know how I'll be able to go back and describe what I saw, or smelled, or heard, or felt even.  It's unimaginable until you are here.  I can't wait to hear his voice and listen to him ask me a million questions!

Dinner tonight is....rice and beans!!! They serve chicken here, but not sure I can try it.  I said i would be open and so far I have, but not sure I can do the chicken.  So far no GI problems (stomach issues) and I want to keep it that way! 

After dinner, we set up the clinic.  We have the pharmacy organized by drug class.  It will be interesting how everything will run.  I'm so anxious and excited.  THIS IS WHAT WE CAME TO DO!

Missing my family and JC a lot today. 

Brittany

Reflection

"We tend to forget that happiness doesn't come as a result of getting something we don't have, but rather of recognizing and appreciating what we do have"

Frederick King

"Material-based happiness is transient at best"