Continuity Day

This week in the CONASPEH clinic, amidst countless new faces with fevers, coughs and new complaints of aches and pains lasting months to years, I celebrated a record number of people following up for care, whether for acute problems or chronic illness. For a family doctor who enjoys the relationships built with patients over time, this was no small reason for me to celebrate.

In Haiti, regular health check-ups and follow-ups aren't something that has traditionally been valued or economically possible. When people follow-up at our clinic, a clinic that asks for a small "participation" (as CONASPEH calls it) in exchange for medication, a clinic where no free drugs, food or goodies are handed out, it means that these people have risked enough trust in our medical recommendations and are investing time and a few goudes in their health and wellbeing. In a country where every goude is important for food, water, clothing, schooling and other trappings of life, I feel honored by such participation.

Among the faithful patients coming back for more this week, I saw:

* A baby with diarrhea. Last week I met this tiny two-month-old girl and her desperately thin mother who reported that baby had lots of diarrhea and tummy pain. After gathering a bit of a history, we found out mom had been supplementing her breast milk with powdered cows milk and broth. We chatted for a long time last week as both Miss Fanor and I tried to convince mom to rely and trust in breast feeding, informing her of the perfect nutrition she alone makes for her baby. Not knowing if she would trust a white doctor with such crazy information (how can LESS be MORE??), I held my breath as I said goodbye and asked for her to bring her baby in the following week so I could keep a close check on her. Today mom came in beaming. HER FOOD saved the day. The diarrhea was gone, baby was eating vigorously, and mom was eating a little better thanks to money she was saving on powdered milk. She nodded full of smiles when I asked to see her and baby weekly for weight checks, if for no other reason than to celebrate a little baby thriving despite the poverty that surrounds her.

* An elderly woman with diabetes. This bright smiling grandmother of 9 was accompanied once again this week by her daughter who has been helping with medications and blood sugar checks since we started treatment a month ago. We all had reason to celebrate today when after several weeks of adjusting insulin and doing diet education, the glucometer finally gave us a reading in the normal range. My patient was just happy she could SEE again as the high blood sugars had been reeking havoc on her vision.

* A young woman following up for wound care. While making dinner for her family a few weeks ago, this patient accidentally spilled hot oil and bean sauce on her legs and suffered horrible 2nd degree burns over her calves and feet. She was faithful about wound care and vigilant with medications. Today she practically danced in, bandages gone, skin pink and healthy.

* A pregnant woman. This mother of 3 is now 7 months pregnant. She came in to do a routine follow-up for her pregnancy, talk about how she's feeling, refill her vitamins, show me her lab results and listen to the heart beat of her little growing child. Every time a pregnant woman comes in for care, it gives us the chance for a little teaching, a lot of encouragement and hope that mom can understand how best to care for self and body.

* A teenage patient with a troubling type of cancer. K came in today with her pastor to talk about plans to go north to Milot in January where volunteer physicians will evaluate her and potentially give her a surgery to remove the cancerous tumor overtaking her mouth. After receiving news about a possible surgery, she doubled over in tears. Seeing my confusion and concern, the pastor reassured me that she was overcome with happiness because she has been suffering so long and praying for a reason to hope. They assured me she could find a way north. She talked with her hand covering her mouth that no longer closes completely due to the bulk of the tumor. Both Miss Fanor and I were shocked at how quickly the mass is growing. I was grateful for a secret stash of narcotics donated by one generous visitor or another willing to part with their powerful post-surgical pain pills if they could offer someone relief. Today they did. I rarely use the medications for pain, but this week I was happy to hand over a month's supply to the girl who bravely suffers with such a painful and disfiguring condition. Medications and possibility thanks entirely to a network of friends.

*A 50-year old woman. I see this easy going woman monthly for blood pressure checks and medication refills. Today she came in earlier than her scheduled appointment to show me her lab results that revealed a recent bout of high fevers was due to malaria. Once again my patients amaze me with their incredible ability to suffer through illnesses that would leave most of us moaning in bed.

*A CONASPEH teen concerned with a possible STD. I often field frequent visits from teenage students in the CONASPEH school wanting advice over weight gain, acne and "infections" (that always mean genital). When I insist on a formal consultation and exam for such "infections" and elaborate on why I'm not just passing out antibiotics for what could be a natural physiologic process or a prophylactic for free love, I don't always get a faithful following. But yesterday a shy girl came in, braved an exam she had never had before and took my efforts on sexual education like a little girl growing up too quickly. Miss Fanor is the sexual education and health teacher for the school which makes her instantly popular with all the teens. I prefer the one-on-one setting where I can encourage self-preservation and respect in an age of consequences marring each "in-the-moment" decision. I'm always grateful for a moment with a young woman not yet sure of herself to celebrate all she is capable of and the power she has over her life. Although blushing with the subject material, our young patient sat steady and came back today to discuss lab results. One teen at a time.

*A 65 year-old woman with hypertension. I've treated Madanm C for 6 months now for staggeringly high blood pressure. What bothers Miss Fanor and I the most is her obvious depression. Once in a while we make her laugh. LIfe is hard, she tells us. She can't always pull together the time or effort to come in for a blood pressure check, and often misses a few months of medications and follow-up. Eventually, though she faithfully wanders back. This week she checked both herself into clinic as well as her grandson with a chronic cough.

* A young woman with a swollen leg. She had come in last week suffering with significant swelling in one of her legs. I was immediately concerned about a blood clot yet also worried over evidence of cording and inflammed lymphatic channels. She had told me she would TRY to get an ultrasound to look for clots, and in the meantime I treated her for lymphangitis. Today she came in to let me know that her pain is finally gone. She hadn't yet gone for an ultrasound prompting me to once again rehashed my concerns that she might be toting around a life-threatening condition. She seemed more concerned that her hugely heavy leg makes it hard for her to walk in heels. If her fashion sense is what helps her find her way to the hospital, than so be it!

* A little boy with fever and diarrhea. Despite having been seen in an emergency room over the weekend, the boy was brought in on Monday by his concerned dad who wanted "his doctor" to check the medications and make sure I agreed with the treatment plan. I felt honored that he trusted my judgement and proud that the father was being so careful with what kind of medications he administered to his son. So often I see patients taking medications without any real understanding of what they are or why they are taking them. After discussing why each medication was indicated, I reassured Dad that the hospital had given excellent advice and prescriptions and that likely he could trust in their care if another such situation should arise. I smiled to myself, happy with a patient protective enough to seek out understanding and glad that our clinic functions as much to treat as to educate.

Continuity means continued chances to encourage, teach, re-adjust treatment plans, and accompany patients through life that is riddled with challenges to health and well-being. Sometimes continuity means suffering with people through situations no one can fix. Other times it offers reason to celebrate. Most of all I savor the simple relationship that takes shape, the trust between doctor and patient, face to face that evolves. It is why I became a doctor and what keeps me inspired to mush on ahead.