Another day, another record - February 4, 2010

Thursday, February 4, 2010

Another day, another record. We saw 310 patients today, far oustripping our capacity. It is like patients are coming out of the woodwork, and the level of acute illness increased substantially. We are now seeing the delayed effects of this tragedy: severe dehydration with attendant complications, gastrointestinal infectious disease from the contaminated environment, and mental health problems from the unbelievable trauma.

The clinic is still a gathering place for the community. Two groups stopped by to join us today. Several otolaryngologists appeared and helped out with the medical care. A group of volunteers from the U.S. brought 1800 emergency ration meals, and then distributed them from our building. There was a high demand, as many do not have enough food to eat but every 2-3 days.

I was a pediatrician today, because…we needed one. The pediatric nurse that came with our group had to go purchase more antibiotics, and I was all there was to see the kids. Not exactly my specialty, but I was certainly better than the alternative. I have now given up using paper on the exam table, as it is in too short supply. It just gets wiped down and on to the next patient. These are not the most hygienic conditions, but it has to be this way for now. At least the building is solid and has a cement floor; many medical tents in the city have surgeons operating on tables or stretchers on the dirt.

To some degree, this is a little like being on the TV show “House”. I saw a young girl with unilateral gynecomastia, and called the States to get a differential diagnosis. As I went through the list, I eliminated diagnostic possibilities not because they were ruled out as the cause but rather because I had no capacity to investigate or treat them. Requires a blood test? We have no lab. Mammogram? Not available in the city. HIV? Sorry, we cannot treat it. Tuberculous abcess…yes, we have medications for that, so let’s try the treatment for TB. Hugh Laurie would be proud.

The community continues to offer their support. When the patients come to the clinic, they wear their nicest clothing whatever their malady. Not that they have much to choose from, but it never fails to get my attention when a young woman comes in like she is ready for church, only to lift her skirt to show me a major laceration extending to the bone with blood caked along her thigh. The courtesy and respect is both heartbreaking and heartwarming.

One more full day of care tomorrow, and we will then head back on Saturday to the Dominican Republic. I will miss this, but it will be time to go back to my life in Wisconsin. I will return with countless mosquito bites, hair that may never recover, and enough memorable scenes to keep me awake for a lifetime.

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