Excerpts from the Third World, Part II……

I’ve been back almost exactly a month now. I’ve taken Step 2 CK (in 6 hours flat thank you very much, I wanted to be done NOW) and finally submitted my residency application this week. I’ve finished all the work I’d left waiting at home, the initial rush of activity has died down and now, frankly, I am bored. I just finished my first week of my internal medicine sub-i, and while my attending is pretty much the nicest guy ever (I chose to follow him for a reason) and I really enjoy the solely hospital-based work, business is sloooooooooowwww. After the constant, almost 24/7, fast-paced, challenge of work in Haiti, all of my rotations at home since have been, well, boring, by comparison.

As I sit, all day, waiting in vain for an admit, something, anything to do, checking my phone every two seconds for interview offers, I think of Haiti.

Week one……

Morning conference is in the hospital’s library every morning at 07, the medical staff gathers and led by the chief of medicine, the going’s on in the different departments are reviewed (the number of cholera cases still, thankfully, trending down) and then there is a short educational presentation……

The hospital's main courtyard.

After conference we go to the med/surg ward to round. We’ve had a couple post c-section patients to check on. We ask about pain, activity, diet, flatus, admire the babies (okay, that’s just me), check incisions and write notes and orders. Then we head to Maternite (labor and delivery) to check on patients there. The nurses handle most of the vaginal deliveries, so the MD’s role is mainly to check in and write orders……

After Maternite we go to clinic. The OB/GYN clinic consists of a block of 4 small rooms in the hospital, just down from L&D. The rooms are, for lack of a better term, grungy. There are 2 offices and 2 exam rooms all connected, divided by makeshift curtains. In the exam rooms there are a couple of exam tables, an old ultrasound machine, and in one corner a pile of ‘sterile’ packages that I ransacked this morning to find a cache of speculums and something, anything (*besides* a 20 ga hypodermic needle, ACK) to break a patient’s waters with. We have sink for handwashing with a faucet that refuses to completely shut off, and now after sweet talking the nurse, a nice new bottle of Spanish (?) antimicrobial soap to go with it……

The central corridor. From the hospital blog. Patients wait for hours, sometimes days, in the corridor to be seen in the differnent clinics. At night hundreds of people camp out in the halls, sleeping on the floors and benches.

We work with a nurse and an interpreter. Our interpreter, I have decided, is pretty much a used car salesman in interpreter’s clothing. I have no idea how he ended up with us and I suspect he requested it for some (probably borderline nerfarious) reason. He immediately hit on me on day 1 as soon as my attending wasn’t around, and though I flatly shut him down, he started today off with a bold request that I give him my clinical reference book and, while I’m at it, take him back to the US with me when I go. Then he called me “a mean old lady” when I firmly told him no, stop asking me stuff like that or I will ignore you. Luckily he had other things to occupy his time including trading in (what I can only assume was) black market perfume and diapers between patients and hitting up patients for their digits or chatting on his cell phone while I’m in the middle of history taking. Our translator, the con artist.

When he is not busy with other matters, our interpreter does push us to see as many patients as possible. So far we have been seeing 40-50 per day. We are so busy I’ve been quickly thrown into seeing patients with simple issues on my own, consulting my attending when necessary, writing notes, orders and scripts. It’s been overwhelming and a little scary, but in the way that the most amazing learning experiences are overwhelming and a little scary. I am learning at warp speed here. Honestly, it grates against my previous training to some extent. I am concerned that we give patients the best quality of care possible, but we just don’t have the resources, time, lab, microscopes, etc to be as thourough as I’ve been taught I should be. Part of me hopes also that I’m not inadvertently learning some bad habits, but here we are doing the best we can with what we have. Everyone is….

The observation ward, sort of the equivalent of an ER. From the hospital's blog. It is always full, often to overflowing.

There has been a good variety of patients so far. Mostly gynecologic complaints and high risk OB’s because less serious issues like routine prenatal care are dealt with in outreach clinics. We see alot of people with heavy or irregular periods, patients who have had miscarriages, and for some reason A LOT of patients for pelvic masses. We have 5 surgeries scheduled so far to remove huge fibroids (the last one we scheduled today looked like she was 9 months pregnant, in fact we all thought she was pregnant until she told us she was there for her surgery for fibroids). We have a couple c-sections in the works as well. The surgical suites have just been remodeled and are actually very nice. I am really excited about our first cases tomorrow. A day in surgery anywhere is a good day…..

A couple highlights in clinic so far were getting to tell someone for the first time that they are pregnant (a happy surprise for both of us, and a good reminder that the number one cause of amenorrhea in a woman of childbearing age is pregnancy, way to go genius), getting to tell a patient (and actually being able to tell on ultrasound!!!! getting LOTS of ultrasound practice) the sex of their baby, and an extremely fastidious elderly patient with a pessary, ripping ripping our interpreter a new one (Afterwards he demanded that I fire her. No way pal.Too. Funny.)…..

Haiti does not have much to offer as far as local goods, but they do have a long tradition of unique, characteristic and very beatiful art. Mostly paintings and metalwork. This is an example hanging in the hospital's main corridor.

The hardest part has been the language barrier. Communicating with patients is my specialty, hands down my best, most useful skill for proivding the best quality care and expressing compassion for, and connecting with patients. I was really at a loss yesterday without it. Today was a little bit better, I can say a few phrases in creole or french now (today I learned how to ask – does it hurt when you pee – an extremely useful phrase in a gyn clinic, pretty proud of that one) and tonight I actually sort of ended up translating for my attending when we went to check L&D one last time after supper. That felt so good and I hope, hope, hope that it keeps getting better. It felt so great to actually understand and be able to communicate, even a little, with patients and staff today. To see them smile at the connection. The best.

Children playing outside the hospital. From the Hospital's blog.