I woke at three, aware of the weather. There was a huge shushing outside that was either wind or the surf, and a generally wet noise suggestive of rain. The wind coming through our partially open door and open shutters set my mosquito net to shimmering. I was aware instantly of where I was: on a mattress on a table in a cement-walled school with two mango trees in the courtyard and Yoella asleep on a table on the other side of the room. It felt safe. And tropical. At four, I woke again, this time for good, staring into the lightening darkness, feeling the mosquito net against my skin. Yoella got up to prop open the door to stop its creaking, then went back to bed. I got up around five, thinking I could shower in the rain, but when I went outside in my bathing suit, there proved to be more sound than fury. I had a bit of a wash using my bandana and water bottle, feeling all soap sudsy afterward, which is better than grimy. People rose slowly, scuffing around in their sandals, wondering about water and food and toileting. The translators ran back and forth between Jo’s house and an as yet unfinished cement building where we are to take bucket showers; it seemed to me too much work to figure out where to get the water, to run the risk of waking people I can’t speak to. I’m going to have a shower after work today, and it is going to be excellent. For now, breakfast and then clinic.
First morning of clinic is complete. After a breakfast of coffee in a big soup pot served with ladles, dense white bread with a runny peanut butter called manba, scrambled eggs, a mystery juice and bananas, we went back to the clinic to begin setting up. A bit of understandable mayhem ensued as we established our registration desk, optometry room, a height & weight station, three triage stations, two doctors room and a pharmacy. I was in triage with Alex as my translator. Triage, I quickly learned, is not really triage. I took a history (awkwardly), recorded vital signs, and did a directed physical exam (after I tracked down a mattress for patients to lie on), reviewed the story quickly with Tiffany (who was seeing patients in her own room), then sent my patients to the lab, the pharmacy, or home with pills for aches and pain and upset stomach. I saw about ten people, all women, with backaches, burning pee, constipation, abdominal pain, breast pain, and one woman with a pendulous mass in her armpit that was too big for us to take off given our resources. We stopped for lunch after seeing 63 patients (out of a scheduled 75). Lunch was something like a cross between a pancake and an omelette.
The first morning has shown me I will have a lot of autonomy here as a medical student. With no imaging and very limited history-taking ability, I feel nervous about dismissing people with a bag of what would be simple over-the-counter medications in Canada. At home, people can always come back or go to the emergency department if necessary; here, not so.
Clinic is about to start again. The temperature creeps.
After clinic finished up in the afternoon, I collected used urine cups from our examining rooms and dumped them one by one the one toilet available to us in the school/clinic. There was a sudden flash of rain. We saw a purportedly 100 year-old man, which is remarkable considering the average life expectancy at birth for a Haitian is 57 years. But Karen reminded me someone’s stated age can be deceiving, because people don’t necessarily know how old they are, and will often give a number that seems reasonable.
I sat down beside Carolyn and asked her how her day went. She had worked in triage and taught Ann-Suze, one of the local women who helps out in the pharmacy, how to take a blood pressure. Carolyn felt today was a slow day, compared to previous trips; she said we’ll have a better taste of how things usually are tomorrow, when we’re scheduled to see 150 people, double what we saw today. She was impressed by the number of people carrying cell phones. “We can’t be sure they have enough to eat, but they all have cell phones.” I wondered how they charge them, without electricity in their homes.
Karen took up her old role as pharmacy Jedi and also felt the day was very controlled. She gave out treatments for sexually transmitted infections, urinary tract infections, high blood pressure, and six cases of scabies.
Eunnie worked in triage and pharmacy. “So much stress,” she said. “Everyone’s got GI problems, high blood pressure, headaches, and what can you do? At least we made it through today.”
After work, we assembled by the beer cooler on the gazebo and ventured out for a swim, taking our first walk through the village. Dozens of kids, some racing boats in a small lagoon that was once a soccer pitch, some skipping rope, some following along asking for photos, others just staring. Many had the distended bellies of malnutrition, lots weren’t wearing any clothes. The beach is covered in garbage – torn up shoes, bits of net, innumerable bits of plastic jetsam. We walked about a kilometre through town, over to a stretch of beach between two mighty trees and waded out into the surf. A reef lies a short distance offshore, so massive breakers rolled in just beyond where we were swimming. The water was grey with who knows what, but it was cool and it was the first bit of refreshment I’d had since arriving in Haiti.
We swam for a bit, then headed back to the compound for supper. I hauled a bucket of well water over to the cement building shell and had a wash in my shirt and bathing suit – double duty showering and laundry. As I toweled off, bats broke over the fence, doing impassioned cartwheels in the semi-darkness. Supper then – rice and goat and a salad, with real lettuce and avocado. Another meeting after supper, then the translators broke out the dominoes, slamming the pieces against the handmade table.