But the US isn’t the only
country with a claim to abdominal pain.
Haitians frequently complain about it.
It comes with a myriad of characteristics. And by characteristics I want to let everyone
know that I found it impossible to articulate a translator and then have them
articulate to the patient who would then respond in such a manner that the
translator would be able to express the exact nature of the pain. “Did if feel like something was pushing on
your chest, stabbing your chest, or lighting it on fire?” Three steps later, “it hurts in [his] chest.”
Not helpful. The same can be said
for the abdominal complaints. Although,
enough Haitians have received tums to let it be known that if you use the word
‘acid’ at all you’re going to be getting something in return. And sometimes I wonder if it isn’t game just
to see how many magical pills you can get in one clinic visit. But most of the time I just want to try and
rule out big scary reasons why they would be having abdominal pain.
To be honest, I didn’t see a single patient where the thought of a big, bad, scary pathology was going on in the belly. I could’ve guessed some peptic ulcers, maybe. Definitely some endometriosis. Lots of parasitic infections, including pregnancies. I certainly hope I didn’t dismiss anyone inappropriately. I tried my best to perform my due diligence and convince myself their aorta hadn’t ruptured. Pretty sure someone else did notice a large AAA in our clinics, so we were mindful of these conditions. However, it wasn’t until our last day of clinic outside of Port-au-Prince in a little town called Bonnet that my eyes were opened.
A small Haitian boy who couldn’t have been more than 12, and looked even younger, came up to me and told me that he had stomach pain as well as a few other complaints that he had accumulated over the past few months. So I began asking the usual questions, “When did it start?” “Can you point to where it is for me?” “What does the pain feel like?” “Is it there all the time?” “Nausea/vomiting/diarrhea/constipation?” “Any blood in your poop?” “Any problems peeing?” “Does anything make it better?” “Does anything make it worse?” And then I asked a question that I didn’t expect would have the impact it did. “What does eating do to the pain?” “It gets better.” So for those who tend to be medically inclined, you ask that question when you think that the pain is a result of an ulcer and you’re trying to delineate whether the ulcer is above or below the gastric outlet. If it is above the gastric outlet then food will make the pain worse because the additional acid secreted over the ulcer burns. If the ulcer is in the duodenum then eating actually causes basic solutions and neutralizers to flow over it, effectively calming some of the inflammation. But this was a 12 year old kid, did I really think he had a peptic ulcer in his duodenum? I didn’t have Dynamed cued up to search the epidemiology of PUD in pre-teens. So I asked probably the most insightful questions I’ve ever asked any of my patients, “How often do you eat?” “Two to three times a day.” Hmmm, that seems pretty reasonable. Well, it’s about 2 o’clock now, so let’s see… “Have you eaten today?” “No.” Okay then. “Did you eat yesterday?” “No.”
Well, shit. I can’t go 4 hours without eating before my stomach starts yelling at me. And here’s a kid with “abdominal pain” likely because he hasn’t eaten in two days. How many kids did I let pass without asking that question? Too many. I asked some, but I also stopped when they responded with the “Two to three times a day” because I assumed they were telling me the truth. I have my doubts now. Even during my interviews in the community I’ve found that the Haitians are very adept at repeating what they think we want to hear or what is supposed to be the ‘norm’.
So I completed my interview and exam.
He wasn’t malnourished. He was
small and skinny, yes, but not the feeble, withered bag of bones that people
envision when they hear malnutrition.
His belly was a little distended.
Could he have worms? Most
definitely. We treated him for them
because it’s easy enough and could make a world of difference. But this kid was dressed in a school
uniform. Very soft-spoken and shy. And he could’ve slipped through my fingers
before I realized what the true etiology of his abdominal pain was. But what could I do? We had some little snacks at our clinic
because most people end up waiting for us starting at 4 am. But that isn’t a solved problem. That’s not an intervention that will cure his
abdominal pain. This kid needed food
security. And you know what, now that I
think about it I would wager that about two dozen other children that had a
similar complaint over the course of my trip would benefit from food
security.
In talking with our host, I’ve come to learn so much about Haitian
culture. For those who aren’t familiar
with who I am staying with, she was a former assistant to a Prime Minister of
Haiti. She and her husband have a few
very successful businesses in Miami and elsewhere, and enjoy the luxury of
being able to leave Haiti whenever they’d like.
This is far from the situation most Haitians experience, so I try and
recognize the perspective I’m getting when we talk about the local
culture. And before you ask, her and her
husband’s hearts are ginormous and they want nothing more than to see a
successful Haiti. But she told me that
most of the time the parents have no idea where their children are, and are not
held responsible for the caregiving like in the United States. That’s not too surprising. But when she went on to say that sometimes
the kids can be away from the parents for a couple days at a time and a lot of
times the parents don’t go out of their way to make sure the kids eat I was
taken aback. I look forward to the day
that I can labor over and spoil my child/children. I’m excited to advance their diet and teach
them to love all the flavors that the world offers. All the textures that I’m struggling to
digest even while I’m down here. That
sentiment is not shared here, according to my host. And as evidenced by the number of “hungry”
children but well fed adults. I haven’t
seen too many adults who struggle to take in enough calories. Sure there are micronutrient deficiencies,
but plenty of diabetes, overweight bodies and hypertension suggests that the
adults are not struggling to find their food.
I don’t write this entry to make people feel bad like those depressing
commercials featuring the “starving children” seen on tv. Yes, childhood undernourishment and food
insecurity is a huge problem in Haiti.
Dieticians would seize if they tried to do a food diary down here. But I wanted to write this so that other
people would be encouraged to ask that question - the “So, do you really eat?”
question - even though the answer may make you uncomfortable. Sometimes being in Haiti sucks. What sucks worse is when you go to Haiti but
then avoid the stuff that is gonna make you sick when you go back home. And thinking about that hungry kid is gonna
make me sick when I go back home. And
I’m glad, because if people didn’t get sick at stories like this then nobody
would ever make an attempt to change it.
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