The
hurricane’s rains brought more than the obvious destruction. Haiti has been struggling with an outbreak of
diarrheal illnesses ever since the last set of natural disasters. When infrastructure is devastated the
incidence of disease grows. Makes sense
though, right? The rural poor of Haiti
already can’t afford to build latrines and don’t pay to treat their water. Or at least that’s what my limited personal
experience has shown. Cholera ravaged
the country during the last rainy season and I think we encountered our first
patient after this storm.
He was a
sixty year old man and by the time he got to our clinic at nine in the morning
he had already had five stools. It took
him a little over an hour to reach our clinic.
I try to not think about where he would have defecated along the route. He has crampy abdominal pain along with his
watery, clearish diarrhea. No one else in
his family has it, but he reports with an ominous tone, “They will be struck
soon.”
His blood
pressure is 90/60 but he is not tachycardic.
His oral cavity carries a terrible odor and his four teeth look like
petrified wood #FossilMouth. However, it
was still moist. I perform my abdominal
exam and note that his aorta is fairly obvious.
His pain is worst in the mid upper epigastric region. His lower quadrants are relatively
benign. No guarding. No rebound.
Otherwise normal exam. I discuss
with Rachel the advantage of treating him for severe cholera. He can tolerate PO, so that should remain the
crux of his therapy. We teach he and his
a wife how to prepare ORS and prepare a liter for him. He lives far away and it has been our
practice – and others before us – to over treat especially when someone lives
far away. So we opt to give him the 300
mg Doxycycline recommended for moderate to severe cholera infections. We ask him about dehydration symptoms. Chest pain?
Dizziness? Light headedness? Syncope?
Weakness? Yes. Yes. Yes. No.
Yes. Of course. Just like everyone in Haiti. #OverTreat
#OverTreat I keep telling myself.
I get the equipment ready and Rachel places an 18 Ga needle in his left
arm. We run in a liter of fluid wide
open.
He says he
feels “much better” but we still give him a
tortilla with peanut butter to help him with a little more strength for
his long journey. Mr. Matay, our
translator for this patient encounter, has to remind him to say thank you for
us helping him out. It’s okay. A lot of patients who should be saying thank
you in the United States certainly don’t either.
He waves
back as he leaves the compound and promises to come back and see us. He kinda missed the counseling about us
leaving the country in a couple days.
Raymond quickly seizes the opportunity to plug that we should relocate
here permanently because there is such a need.
“Did you not hear? I am starting
a residency program here! The paperwork
should be finished just in time for you guys to be the first class!”
#PeaceOutERAS
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