TIH: Kwonik (Chronic)

Oh-Six Hundred hours came too quickly. I awoke in my bug bivy to the crowing of roosters and beeping of portable alarm clocks, and stumbled outside to shower. Our showers were outdoor cement stalls, with buckets to fill with faucet water. The water used would be recycled through a complex system of drains and tubes, beneficial both financially and environmentally. The showers were constructed with privacy in mind, but I was hesitant. Considering that I am more "prude" than "exhibitionist", showering outdoors was another new adjustment. Would I be seen? Should I avoid showering? Again, this was Haiti. For the consideration of my teammates, I quickly washed and donned fresh scrubs. 

I discovered the delicious combination of Haitian coffee, powdered milk, and pure cane sugar in the kitchen, along with fresh mangoes, bananas, avocadoes, and soft bread. We made peanut butter sandwiches for lunch, and packed the bus for our first clinic experience together. On the ride to the site, I reviewed my notes on tropical infections. Would I be able to recognize Leishmaniasis? How should one treat Dengue fever? Having read journal articles and media reports of infections plaguing younger populations, I prepared for scores of pediatric patients. 

My first patient, surprisingly, was an older gentleman. In fact, he was 99 and a half years old. He did not have tuberculosis, Typhoid fever, or malaria. He was experiencing frequent headaches, intermittent periods of decreased sensation in his fingers, and wondered if he may have diabetes. I checked his blood sugar, tested his cranial nerves and reflexes, assessed his cognition and memory, looked in his eyes to view the retinal vessels, and listened to his heart and lungs. All normal. What was the next step? In the US, we may refer him to a neurologist, obtain a CT scan of his head, ultrasound his legs for possible clots, and consider a trial of medication based on those results. But, this was Haiti. This was an acute clinic. The attending physician and I educated him about dietary changes, exercise, and hydration. We gave him some acetominophen (Tylenol) to be used as needed for his headaches. He thanked us for our time, and carefully left with cane and medication in hand. 

That day, we saw 294 patients. Many had chronic problems -- GERD, low back pain, irritant conjunctivitis, hypertension. Quite a few had been seen by primary care physicians and prescribed medication, but they now needed refills and couldn't afford them. Our group did not stock medicine for these conditions; after we left Haiti, the patients would be in the same situation -- unable to afford a refill. Could an acute medical mission team effectively help patients with chronic conditions? 

The answer lay with my undergraduate training in health promotion and education. While the quick, more effective treatment may be in the form of a pill, we would be able to protect and prevent complications through education. The providers discussed methods to lessen acid reflux -- raising the head of the bed with books, avoidance of spicy foods and meals before bedtime, and eating smaller portions more frequently. A highly skilled occupational therapist taught patients how to lift heavy items while protecting the back. Small community education groups taught CPR, dental hygiene, oral rehydration, nutrition and handwashing techniques. Akin to the "teach a man to fish" proverb, we were impacting chronic conditions through short encounters. And the patients? The hundreds we treated were appreciative and content with receiving the knowledge, even though many exited the clinic empty-handed. 

[to be continued]