Bon Bagay

She sauntered into the exam room like the twenty or so patients before her. At first shocked to see white skin, but, let's be honest, she had already heard about the blan at the clinic from the community. Her dossier was limited and very much in Kreyol. Name. Date of birth (she actually knew hers). Her place of residence. And whom was responsible for her. Probably not as applicable to this twenty six year old, but obviously important for the "timoun" (children) we see in clinic.

"Sa gen?" John starts off, knowing me well enough that he can go ahead and get the encounter started without me saying anything. "Oh tet fe mal... vant fe mal... la gripe..." She went on. John knows he doesn't have to interpret the basic stuff for me, but does so out of professional courtesy. I begin in with my exam. Head looks pretty normal. Eyes are normal and her conjunctiva are pink. Teeth are rough, but better than most. Ears are clear. Neck is supple with a few smallish lymph nodes, likely from her teeth. Her heart is regular and her lungs are clear. Hmmmm, her abdomen is a little more plump than normal. Like, American plump. "Ou ansent?" She smiles sheepishly. "Wi." "When was your last period?" John rattles off the Kreyol version. You'd think after all this time I would know that phrase. "Nine months ago." I pull out my iPhone and when she offers the actual date I plug it into my OB wheel app. She's 32 weeks and 2 days. "Are you feeling baby move?" She says yes. #FunFact I've had women in Haiti tell me they've felt movement at 12 weeks. #JustGas

"Konbyen fwa ou ansent?" "Twa fwa." I feel around on her abdomen trying to locate the uterus. I look through her patient chart and find two other visits documented during this pregnancy. One in June and one in September. Interestingly enough neither documented heart tones. She's on the chubby side even for an American woman, so I'm struggling to find a defined uterine fundus. Hmmm... I grab the doppler and flip it on. Nothing. I smack it. There's the static. I place it on her abdomen and start searching. Mom's... Mom's... Mom's... Nothing over 80 beats per minute. She's still smiling. Dr. Ulysse is sitting at the desk behind me and I call her over for assistance. I ask the patient if she's had any bleeding this pregnancy. "Wi." At five months along she had two days of bleeding but it stopped and hasn't recurred.

Dr. Ulysse palpates the patient's abdomen aggressively and looks over at me. "Li pa ansent." And she laughs. She rattles off a lot of Kreyol to the patient that leaves me completely lost. The patient's demeanor never waivers. I finish my clinic note as the patient exits.

There are a number of things I would be doing right now if this situation were happening in the states. First, we just told this patient that she likely miscarried. That is relatively devastating news to some young women. But in Haiti it's just, "You have a cold." or "You lost your pregnancy." and the world keeps turning. From a medical standpoint I would order both a urine and a serum hCG test. I would order a transvaginal ultrasound if either of those were positive. And I would check the patient's blood type and antibody status. Typically we have a sono in the clinic room with transabdominal probes, but not this trip. It's getting repaired and/or replaced in Port-au-Prince. Also, turns out, we don't have any urine pregnancy tests available. This was the fifth patient who came in reporting a missed period that I couldn't tell was pregnant or not. Generally it's okay to write for a month's worth of prenatal vitamins and have them come back to the clinic for either the pregnancy test, a sono, or both. However, in this particular case the test was relevant as she could have retained fetal parts.

Dr. Ulysse and I settled on making a referral for ultrasound in Port-au-Prince. But this brings to light a much larger issue - needed supplies. I had no clue that we were out of such a basic test or else I would have been freaking out every walgreenns clerk in Wichita because some random dude would be buying handfuls of urine pregnancy tests. Instead, I brought several vials of local anesthesia and a few IV start kits that I had accumulated during my shifts at Wesley hospital. Turns out the clinic is loaded up with both of those things, and my contributions will likely expire on a shelf.

I've had several people send me supplies to take down on my trip and they are absolutely wonderful. I couldn't thank them enough for their generosity. And I've never had this sort of instance come across, but several stories of #AidGoneWrong exist in our world of nationally broadcasted disasters. Whether we are talking about Hurricane Sandy devastating the U.S. Eastern seaboard or a giant tsunami striking the coast of India, people are aware of the devastation immediately (thanks Twitter #Hashtag) and feel compelled to contribute. But when people are sending Hurricane Sandy collection centers their tattered clothes that they've been meaning to throw out for years then something is amiss. Old Halloween costumes and half used scented candles have also made the list of less-than-helpful donations.

WTF were people thinking? I know it's easy to get swept up in the desire to "help" but at some point you gotta ask yourself, "How is my gift going to be used? Is there an active need for this donation? Would it be more efficient to contribute cash? What larger implications could my gift have (i.e. am I going to impair a local business or economy with a donation)?" #CashIsKing in most places. Haiti, not so much all the time. But certainly I've learned that I can buy school supplies down here for cheaper than the states. I can buy toothbrushes and toothpaste for very reasonable prices, even with the "blan tax". Medical supplies are so hit and miss that I would hesitate to rely on buying those specialty items in country.

But it's no secret that countries like Haiti are heavily reliant on foreign assistance. This could be direct aid to the government as well as NGOs operating with donations from generous civilians. Certainly both ServeHaiti and CHI couldn't operate without the generous contributions of donors and volunteers. This entry isn't to request donations, but it is to encourage you to choose wisely how you donate. Although it is probably inefficient, I always suggest personal travel. The experiences you glean have the potential to change you. But for some travel isn't feasible. So I encourage anyone interested in "helping" to pray on their decision and ask themselves the questions above. If I had asked the right people the right questions I could have provided better care to the patient instead of dropping off more clutter.