A group of Akron Children’s doctors, nurses and staff travel regularly to Haiti to help care for the sick children at St. Damien Pediatric Hospital. This post is the second installment of a 3-part series by Dr. Grace Smith, who gives a first-person account of her most recent medical mission trip there. Read the first installment and last installment.
The rooster crowed at 4 a.m. In my groggy haze, I was 7 years old, waking up with my sister in my grandmother’s bed in rural Taiwan.
As the sun came up, the Muslim call to prayer blared over the neighborhood loud speaker. I slipped into scrubs and took my anti-malarial pill, Malarone.
The shuttle van took Diane, Carson and me to St. Damien’s. The roads were rough, dusty and without sidewalks. We saw girls in plaid uniforms walking hand-in-hand to school. There aren’t any traffic lights or stop signs in Port au Prince. People drive and walk by instinct.
At the hospital, we set up our equipment and patients started trickling in. There is no clinic schedule. Parents are instructed to bring their children at 8 a.m. Some parents will wait all day to be seen.
Carson was our triage point man. He got the child’s name, vital signs and parents’ contact info, and then photographed the child for the chart.
Our 22-year-old interpreter, David, stayed with Carson to provide translation. French and Creole are spoken in Haiti, and medical charts are in French, usually cursive French.
Most adults in Haiti are illiterate. They often don’t even know how to spell their names. The hospital wards are named by a fruit, such as orange room and mango room. Parents can then recognize the fruits and know where their child’s bed is.
On the first day, we didn’t have any medical charts. Each patient was essentially a “new patient” to us. We figured out their congenital heart defect based solely on physical examination and echocardiogram.
Almost every infant suffered from malnutrition. Cachexia – caused by malnutrition and congestive heart failure – is often seen in babies with heart malformations. Thin arms and legs, or peripheral wasting, is the body’s way of conserving energy for the most vital organs – the heart and brain – at the expense of skeletal muscle.
By the end of the first day, Carson could visually pick out a “really sick” baby or child in the waiting room. This is a highly important skill in medical training that’s difficult to teach and best learned by experience. Developing a sixth sense of sorting the truly sick from the not-that-sick requires you to pay attention to your internal voice.
In Haiti, you rely heavily on clinical skills and instincts. Advanced imaging modalities simply aren’t available.
We slogged through 23 patients the first day. At day’s end, we piled into the shuttle van, hot, exhausted and hungry.
I made grilled cheese and diluted a can of condensed tomato soup.
Afterwards, Carson and I sat on the porch with a laptop and stack of the day’s notes. I read out loud each patient’s data while he laboriously typed.
We found 4 potential surgical candidates, including Joe Marvens V., the 9 month old identified by the Rhode Island residents. We finished at 10:47 p.m.