So, I'm not really sure of the spelling of the title of this post. On our last ride as a large group the translators were trying to teach the girls some new words before they headed back to the states the next morning. Some of these were common greetings, whereas others would be found on the Haitian adaptation of UrbanDictionary.com. "Zo po pe" would be one of these. As best as I can remember and could understand, this phrase is used to convey the message of, "I'm horny." Forward? Probably. But the toilets flush the other way down here, so maybe this is the sort of thing the ladies respond to. Needless to say, I got a kick out of the translators trying to explain the concept to our group as we were driving through PAP.
But that's not a disease...is it? Being aroused? I mean, there are paraphilias in which someone is aroused by something that is not considered conventional. And those are often investigated as psychiatric illnesses. However, I wouldn't guess that a great deal of people reading this would dare to admit to "zo po pe" due to an inanimate object. I bet the number would creep up if we included the number of people who were too distracted by arousal to maintain attention at some job or task though. I've certainly been "distracted" before.
Sex. Sex is a huge part of human life and Haiti is no exception. Pop culture quotes that humans think about sex hundreds of times a day. And in the world of medicine, sex is a multi-billion dollar industry. I assumed my personal exposure to such a topic would be diagnosing and treating various sexually transmitted infections. Although, it's not like we have dark field microscopy, GC or chlamydia PCR, or even HIV ELISA tests. But our approach has been to error on the side of treatment. And condom distribution. Funny thing is that for the first couple days we had a couple of the interpreters in charge of distributing them and only a small group of guys received the bulk of the condoms. Bros stick together I suppose.
Ceftriaxone in the butt is a pretty good disincentive to engage in unprotected promiscuity if you ask me, especially if you have an inexperienced M2 administering the injection. #VeryAggressive. #NormanBatesStyle. The Z pack is much more tolerable.
Yes, sexually transmitted infections have been the norm down here. Dysuria and discharge very common complaints. One patient, I thought, was leading me down that path only to pull a complete 180. He was 28. Educated. Well-dressed. And he was complaining of erectile dysfunction.
Awkward. This subject is difficult enough when it's just you and the patient, but add in the translator and the obvious language barrier and it is a mess. I thought STI first. Then I thought he wanted "it" to be bigger (#DontWeAll). Before I finally figured out that he wasn't satisfied with his erection. Hmmm. In the states, the few times I've seen family practice docs discuss this issue with patients, they pretty much just cut them off, handed them some samples of Viagra, and told them to report back with the results. Sparing the details.
I'm torn. Do I do the appropriate family medicine workup? Do I ask about his regular sexual behavior? Do I ask about erection variability? Can I just give him some Men's Health pointers? Or do I just sweep the issue under the rug because it isn't something we'll be able to pharmacologically manage anyways? I'll take option five #AvoidTheIssue #NotThatTorn.
It wasn't until I reminisced about the issue later that I realized that ED is probably a big deal down here. The two most common causes are hypertension and diabetes. And as surprising as this sounds, those two diseases are super common down here. Probably not the issue with the 28 year old that appeared in good health, but in the general population I wonder how many men would love to be able to talk with a specialist about erectile problems.
While that sort of complaint is certainly not something you'd forget about, I did push it to the back of my mind. Until our last trip to the marche. As we were low on supplies for every medical condition not treatable with Ibuprofen, I tried to look in as many pill baskets as possible. The market in Arcahaie is quite the experience. Perhaps I'll have to have a more descriptive post another time, but for the time being just imagine people walking around with large baskets packed full of blister packs of colorful pills. Some of them are labeled. But from what I gather people buy according to color and presentation. I, however, was bound and determined to find useful meds and then try to haggle with the dealer to buy them. Tylenol cold. Ciproheptadine. Paracetamol. Ampicillin. Nothing too helpful. And then an older gentleman walked by with his own basket. I began digging. Usual stuff on the edges. But what's this dirty, crinkled box on top? I pick it up. Sildenafil. #VivaViagra. I laughed and tossed it back onto his pile. We made eye contact. And we immediately start cracking up. His 5 yellow teeth glimmering in the sunlight as he staggers to his left. He knew what they were for.
So it's not uncommon and apparently one old dude is familiar with the pharmaceutical cure for it. If I were smart, I would've seen how much he was selling that box for. In a place where you can buy a course of ciprofloxacin for 150 Gourdes I can only imagine that Viagra is relatively cheap compared to the U.S. ($20 a pill is really tough when you're using student loans to pay) Granted your supply is probably less assured than in the states, but now I know that the next time that a gentleman comes to me with concerns over his erection I can kindly deflect any further line of questioning and direct him to find the #LittleBluePill in the marche. If I haven't bought all of them already, that is. #DontReallyNeedThem #SupplyandDemand #ZoPoPe
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