Have you ever been in a situation where you know that you're going to be punished for trying to be polite? That seems to happen a lot in Haiti. It could be the polite gesture of someone offering food out of their 'kwizin'. I haven't found anyone who truly has an abundance of food like we know in America. Most of the time they know exactly how much to make so that everyone they're trying to feed is satisfied. Heck, they know how much they need to take to the market to buy that food. Yet here they are offering it to a 'blan'. Some times you have enough excuses ready to turn the food down. But other times you suck it up and take a few bites knowing full well that your GI tract is going to retaliate.
The frequency of transmissible illnesses down here is crazy. As a U.S. med student, I assumed I would get sick for a couple days on pediatrics. Tons of kids are coming in with the crazy new batches of viruses that get passed around the grade schools and you can only be so diligent with hand-washing. So I planned on one or two days of a cold-like illness. Other than that, the U.S. is relatively devoid of communicable illnesses when compared to Haiti. I just want to point out that I'm not including sexually transmitted infections in this discussion. While sex is a large part of both cultures - In fact one of the CHWs asked me today why, "Haitian women enjoyed sex so much" - I do not plan on exploring or discussing the topic on a personal level.
But the namesake of this post is scabies. Otherwise known as the "Seven Year Itch." And understandably so. This mite - highly contagious mite mind you - burrows under the skin and bites, claws and poops its way through different parts of your body. The trail it leaves is fairly easy to spot. And the creepy crawly sensation you feel after examining a patient with it is also diagnostic. Kids do not know that this 'grate' is so contagious. So, while I'm sitting there trying my hardest not to let my clothes touch him/her they still feel compelled to give me a hug after I've informed them that we can treat their rash. Sweet. To be fair, it takes way more than a hug to contract scabies. But knowing that doesn't stop the creepy crawling sensation from sending shivers down my spine.
In a U.S. carpool the greatest concern is someone letting loose a fart. After having just spent all afternoon in a tap tap shared by 20 people - including one whom I was taking to a hospital for evaluation for probable tuberculosis - I found a whole new meaning to the phrase #SilentButDeadly. By twenty people I mean that at its max the tap tap had 20 passengers crammed in the back or hanging on for dear life. The total number of passengers served was well over 30 as many would get on for just a short distance. That's a lot of exposure. By comparison, if a patient is concerned to have tuberculosis the hospital goes into lock down mode. They are immediately admitted into a negative pressure room and everyone has to have specially fitted masks in order to enter #TheyNeverTellTheMedStudentTheseThings. Think back to the dude that hopped on the airplane for his honeymoon in Greece #BigNoNo. He got in all sorts of trouble by all the public health gurus. Why? Because we care? No. Because we understand.
We have the luxury of knowing how different diseases spread. A large amount of that information is now considered common knowledge thanks to aggressive public health campaigning. It took time and money, but people in the U.S. know that HIV is transmitted through contact with body fluids such as blood or semen. In Haiti, it's "common knowledge" that if you have sex in the ocean that you cannot contract HIV. And that's why there are so many couples at the beaches... #MakesMeRegretSwimming. In the U.S. we trust in the Germ Theory and recognize that there are bacteria smaller than the naked eye can see that cause us to be sick. In Haiti they attribute food and water borne illness to poison, curses, or dirt.
This came to a head last Friday as Mike and I took the CHWs to a house where three of the family members had just been to our clinic complaining of a rash. You guessed it. Scabies. I saw this as the perfect opportunity to get the CHWs out of the boring clinic/classroom setting and into the community where they belong. We brought some chlorox and a scale for dosing Ivermectin. We were going to de-scabie the entire house. They didn't want it. They wanted our medicine, sure, but they didn't want us to clean their clothes and sheets. The family was skeptical. And why shouldn't they be? A couple of white dudes with their posse of Haitian ladies come and say they need to "clean the family's sheets." Sounds like a curse or poison waiting to happen. And so we left. Seven people lived in that house. At least five of them had signs/symptoms of scabies. One of them was a two month old baby. One was my sixty-year-old woman with probably TB that I tried to take to another hospital today. And the rest were assorted family members. All living under the same roof. All sharing the same bed, comforter, sheets, etc #MitesDontMakeGoodSnuggleBuddies.
I predict that the CHWs will continue to struggle with trying to convince the community of the Germ Theory. To be fair, it took years for it to be generally accepted in our society. First a doctor had to report that less women died when he washed his hands after cadaver lab before going to the obstetric unit. And then someone else had to see the little bugs under a microscope. From then on we caught fire with discovery after discovery. But that happened in our country, discovered on our turf, was reported in our papers, and written in our language. Haiti has no such connection to these scientific discoveries. They have us.
Seven years itch- now that's an appropriate name.
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