November 10, 2008

The ceiling fan above us rotates lazily, stirring up a gentle breeze that drifts down on us as we sprawl out on the bed unwinding from the day.  Patrick is reading a book to help guide his spiritual thoughts; I turn to writing to help funnel out the activities of the day from my mind.

I woke this morning feeling happy, excited for the week of clinic planned.  Although nervous that we were beginning a little prematurely (by MY clock!), I was looking forward to seeing the children of the school in clinic today, and working out the flow with M. Fano.  At the Parent/Teacher meeting last week, Francois invited the parents of the children to start bringing them in for consultation.  She organized a schedule: kindergarten on Monday, 1^st & 2^nd on Tuesday, and so on.  Suddenly our clinic was up and running 4 days a week at CONASPEH and one day a week at Karfou.  

Patrick, unfortunately, woke stuffy and with the Haitian Hack that can be heard by many a person in Port-Au-Prince.  A cold or a reaction to the pollutants in the air, we’re not certain.  But being sick in a foreign country is not fun, and he struggled with exhaustion before the day began. 

After getting dosed with a health supply of antihistamines, Patrick forged into English classes once again.  He is beginning to see progress with his teaching, which is exciting.  And the children navigate towards his easy presence.  When not teaching or studying Creole, he was helping entertain the wee-ones waiting ever so patiently for their turn in the clinic.  Patrick is a favorite around the school; he greets staff by name, and finds a way to joke with them even with his limited Creole.  He’s anxious to move on to the next step, and start involving himself in the teachings of the Seminary, but patience until his language develops more fully is needed. The ministry of his presence, however, is felt even at this early stage. 

This morning, after cleaning off the dust that had settled in the clinic over the weekend and stocking our little pharmacy with the few medications M. Fano had purchased with CONASPEH funds, we opened the clinic doors.  The waiting bench outside quickly filled with little miniature people, all looking rather solemn as they waited their turn to see the big bad doctor.  Patrick helped lighten the mood by passing out paper and crayons, and giving some of the more terrified looking children a piece of candy. 

The children that came in ranged in age between 3 and 5.  Often I saw several children in the same family.  The complaints were very similar with slight variations: diarrhea, stomachache, lack of appetite with or without weight loss, with or without blood, with or without fever.  Some had a cough or a headache thrown into the mix.  Some children looked like they were fairing fairly well.  Others caused me great concern.  One little boy, aged five, weighed 32 pounds—his 3-year-old brother weighed the same.  He smiled at me and was patient as I did a full exam, discovering a loud heart murmur, dully active bowel sounds, a warm forehead and pale mucus membranes.  Only one of the many children I saw today had complaints less than 1-month duration—most reported symptoms for 5 to 8 months.  This was the first time they could see a doctor.

Initially feeling confident with the labs, x-rays and medicines I was ordering, after a while with the similarity of the reported symptoms, my differentials didn’t look broad enough.  I feared I was missing subtleties in the history that would lead me down a more certain diagnosis… that would prompt better teaching.  Of course I’m missing subtleties: my conversation is limited to “yes/no” answers when I propose such detailed questions as “Fever? Diarrhea? Cough? A lot?”  Since I was the first doctor these children had seen in months (ever?), I feared I was getting a summary of the child’s years of complaints instead of their acute state at the moment.  Symptoms were always defined as “for a long time.”  --sigh--  Again, a plea to the language Gods for insta-learning.  Where’s the Matrix and those fancy plug-ins they have for the brain when you need them? 

The children patiently let me lift them, listen to them, peer in their ears and mouths.  I wondered if their docile nature was cultural or the lethargy that comes from just not feeling good enough to be afraid.  Most of the children, after discovering that I wasn’t going to give them a shot, wasn’t going to pinch them or take them away from their parent, offered me a bright smile when I told them, “fini!” (finished!). Their little smiles both filled my heart and tore at it.  If only I could do more.

And again the familiar worry that no matter what I ordered for these children, that certainly their parents wouldn’t be able to afford even the cheapest of labs, the most affordable of medications.  We handed out what was appropriate, but often the needed antibiotic was not on the shelf.  By the gaunt looks of the parents escorting the tiny children in, I knew that money wasn’t in plentitude and that feeding the family was a challenge by itself.

The public hospitals remain closed.  The health crisis here is extreme.  And I struggle with doubts that I am doing much in reality to change the state of this neighborhood’s health.

I have to chant the mantra often that I just adopted thanks to a book written by Margaret Trost, “On That Day Everybody Ate.”  Margaret started a not-for-profit funneling fund into a community in Port-Au-Prince that provides a food program, scholarship network and summer camp for the children in the community.  Her book is a beautiful account of her transformation in Haiti, the struggle her spirit went through in coming to terms with the immense need of this country in light of her own privileged American position.  In the book, she reminded me that we are called here to love--to love first and foremost.  And that “piti piti na rive” (little by little we will arrive).  The last saying reminds me that in the face of such seemingly insurmountable need that exists here, we can take faith in the little things we are able to do as a building block to the foundation of change. 

So when I started to panic internally today, desperate for a better solution, a better insight into the diagnoses and treatment of the precious children sitting on my exam table, looking up at me with big, serious brown eyes, I forced myself to take a deep breath.  Today, at least I loved.  And I pray that some of my recommendations will be attainable, that some of the medicines I handed out will heal.  I pray that somehow the parents of those precious children will be able to help nourish their little bodies back to health. 

Tonight we spent some time on the roof, letting the cool breezes of the early evening find us at our lofty perch.  We followed satellites as they moved across the sky as wind rustled the leaves of the coconut and mango trees surrounding us.  The roof is a nice place to let go, to regroup, to whisper our fears of inadequacy to the wind and let them float out and away.  Tomorrow is another big clinic day, a big teaching day, a day to struggle with what we are able to do and what needs to be done.  We search for mantras that will re-center us, remind us to be present in the moment and to love if nothing else.