Clinic in Quartier Morin...with Dr. James

Here's the journal about the medical clinic I mentioned before....enjoy!

June 3,2008
I went out to Quartier Morin today with Dr. Steve James, Kennedy, and Vicky. Dr. James has practiced in Haiti for many years. He spent many years working at the Samaritan Hospital, but now travels mainly to four different clinics. He no longer sees large numbers of people, instead he goes to the clinic sites mainly to encourage and support the national doctors and staff members.
It took us about half an hour to drive out to Quartier Morin. We got there around 9:30, and did the many introductions. Dr. Steve introduced us to all the staff members…and was sure to tell each one that I could speak Kreyol, and that I was studying to become a nurse. Staff members included one national doctor, several nurses, the pharmacist, several lab technicians, and the director.
Dr. Steve has his own room for patient consultation. It’s actually one large room, with four beds in it, portioned off with curtains (hung on PVC pipes). His first patient was a little tiny elderly woman with diabetes. She had been seen at the clinic last week, and had been given medication. She returned with a complaint that every time she took the medication, she became very dizzy, and would have to lie down. She was supposed to take 2 pills every day…but admitted she had only been taking one a day. Dr. James used a glucometer to test her blood sugar, and found it to be very high, 513! He also checked her hands and feet for sensation/lack of sensation, as well as her for edema, especially in her feet. He gave her a shot of insulin, both regular and NPH. He also sent her home on the same medication, with same dosage, but instructed her of the importance of taking the medicine with food. He wanted to send her home with a glucometer, so she could check and record her blood sugars at home, so that they could know if the dizziness was from high glucose levels or low glucose levels. Unfortunately, the only glucometer that he had with him that he could give her, did not have any more tester strips, so he was not able to give it to her.
It was really interesting to see this diabetic woman, who was so thin and frail, definitely not your typical diabetic patient. She couldn’t have weighed 100 pounds…and there was just nothing to her! So heart-rending....
The second patient, a young man, came in with complaints that he his eye was hurting, that he had an “infection in his head”, that he had a “far away spirit,” and that his arms and legs felt dismembered. He said he had not had any trauma to his head or his eye. His left was very red, and there was a white spot on his eye. Dr. said it was definitely an infection of the cornea, and that there was bleeding into the vitreous. He was considering the possibilities of it being Herpes, or possibly syphilis. I believe he had an RPR done on him, but it came back negative.
His third patient was an elderly woman, whose husband had brought her to the clinic with a complaint that her conversation was not comprehensible, that she talked all the time, but it made no sense. She also has hypertension, but is on medicine for that. Her CBC and urine tests had come back normal, her BP was 150/60, and she had an irregular heart rate. In an attempt to understand which level of dementia she was at, he questioned her according to person, place, and time. She new her own name, and that of her husband, she stated she knew what the date was, but continued to say it was February 30th. When asked where she lived, she stated “February,” when asked a second time, she was able to tell us she was from Fort Liberte. Dr. James said that although there is no treatment for dementia, he always tries to treat the possible causes, such as Vit. B12 or Folic Acid deficiency, other possibilities in her case could be syphilis or cerebrovascular insufficiency. The husband wanted to know what hope there was for her situation, and for her future. Dr. James said they would discuss this, after he had an RPR done to test for the syphilis. Later, after the Syphilis test results had come back negative, he gave her B12 vitamins, as well as a small bottle of Aracept, along with a prescription for more, if they can find it in O’Cap. They were about to leave, when the husband again asked, “But Doctor, what hope is there for her?” It was the so heart wrenching to hear him ask this…know the answer. Dr. James told him that, medically, there was really nothing that could be done to make her better, that God is the only one that could heal her. He told the man that he would pray for her, and encouraged him to pray for his wife. They walked out of the treatment room… the woman smiling, laughing, totally oblivious to what had just been said, while the man held her hand and walked beside her, his shoulders sagging under the weight of this new burden.
The next patient came in with complaints of a “hot mouth,” stomachache, abdominal pain, and dizziness. Dr. James discovered she had hypertension, and also examined her abdomen, before ordering several lab tests for her. He ordered a Hematocrit count, an RPR, and an H Pyloric. The results came back from the lab that her hematocrit was 38%, and she tested positive for both Syphilis and H Pyloric. She took the news of this diagnosis well, but was very quiet as the Dr. wrote out her prescription.
The next woman complained of a burning sensation in her chest, and a “fever in the blood” for the past 15 days. (Fever in the blood is a common expression/complaint here in Haiti. Seems to have similar manifestation as a “hot flash.”) He examined her abdomen, and found she was slightly sensitive to his touch. He diagnosed her with Gastritis, and sent her home with a liquid anti-acid, but asked her to return for reevaluation in two weeks.
Another man came in with reports of having head trauma in 1996, and is now suffering from random times of unconsciousness. Dr. James said it sounded like he might be having seizures. He also discovered he has and overactive thyroid (Graves Disease). The man also complained of back pain, and could barely bend over, because of the pain and tight muscles. Dr. James believed all the symptoms were trauma related, and sent him home with Diazepam(for the seizures) and Ibuprofen ( for the back pain).
The last patient seen by Dr. James this afternoon was a young woman with hyperthyroidism(Graves disease). She has had Graves disease for three years now, and is on medication. She also gets her blood checked every three months. Upon reading the blood test results, and examining her, Dr. James stated that she seemed to be doing better. Several months ago, after they had put her on medication once a day, her T4 had come back 22.7. They increased her medication to twice daily, and her T4’s today were down to 15.9. In an effort to continue to bring her T4’s down to the normal level of 12.0, Dr. James decided to change her medication to three times each day.

…and so the clinical day ended! Although the day had gotten long near the end, and we were all very warm and very hungry, it had been a really great day. I had learned so much, and seen so much, and although I hadn’t really done anything myself, I learned so much about what to look for with specific diagnosis. Also, how to approach diagnosing certain complaints.
On the way home, the Haitian doctor was telling us about two of the unfortunate cases she had seen today. One was a teenage girl who had a large, draining ulcer on her chest, who had been diagnosed with TB. Dr. James had wanted Vicky and I to see the ulcer, but when he saw that she was not taking the diagnosis very well, he decided it was best for us to stay out of that exam room. The other case she was disturbed by was the nine year old girl who had been diagnosed with HIV. The girl’s mother had died at her birth, and she is now living with her aunt, but the doctor was concerned about the kind and quality of care that the girl would be able to receive from the public health department here.