|Haiti Pt 2
||[Jun. 13th, 2011|03:01 pm]
[written two days ago, posted now because I'm back and have Internet access]
Man, who would have guessed you could get so sick just by going to a third-world tropical country filled with unfamiliar diseases and having very close contact with a few dozen sick people all day?
...that attempt at sympathy didn't work very well. Maybe a better question would be why everyone else in my group has gotten off scot-free. I'm already resigned to my father being unnaturally good at everything, but my tiny 21-year-old pale-white cousin from Rhode Island got off without so much as a cough. How annoying.
I was too sick to participate in probably our most interesting mission so far. We got a call into one of the tent cities to transport a cholera case.
So first, about the tent cities. After the earthquake, hundreds of thousands of people were left homeless, so the UN and other charities sent in tents. These got put up on any vacant land to form vast tent cities with tens of thousands of people each, supported mostly by UN food handouts.
Lately these tent cities have become controversial. According to a legend going around, new president Michel Martely (formerly reggae musician "Sweet Micky") visited a tent city one afternoon and was welcomed by thousands of residents. Then he visited the same tent city that night, demanded everyone there come show themselves, and found only five people. The implication was that lots of people hang out in the tent cities during the day to get the free food handouts, but have real houses to return to at night.
Like a lot of these sort of "welfare queen" type stories, these are not entirely false but maybe a bit exaggerated. We did a clinic at a tent city one afternoon and the tent city certainly seemed pretty densely populated by people who looked like they'd seen better days. The sanitation there was pretty terrible too, which brings me to the cholera.
Tropical diseases are all pretty bad, but cholera's in a class of its own. Charlotte taught me the most important rule of thumb about cholera: 8 hours after infection you start feeling symptoms, and 8 hours after you start feeling symptoms, you die. As if that wasn't scary enough, it's extraordinarily transmissible by the "fecal-oral route", a medical term for "you get it if you eat someone else's poop".
This sounds like the sort of thing that should never happen, but it's more common than you think. Someone wipes themselves after using the toilet, doesn't wash their hands well enough, shakes hands with someone else, that next person eats some food with their hands, and fecal bacteria make it into their mouth. Or sewage mixes with groundwater (not exactly an uncommon occurrence in countries where the toilet is a hole in the ground) and contaminates water in a well somewhere. This happens all the time in first-world countries, let alone in Haiti, so the rule is that once anyone has cholera, everyone nearby is at major risk unless extreme measures are taken.
Haiti's not usually very good at public health, but it seems to be taking cholera very seriously. A cynic might say this is because there's a strong suspicion that cholera was accidentally introduced into the country by UN peacekeepers, making it politically useful for the government and giving international aid agencies a reason to feel guilty about it. Whatever the reason, the country has a number of excellent free cholera treatment centers which are, according to our guides, out of all proportion of the number of people who actually have cholera.
Our mission was to transport a suspected cholera case from the tent city where he was diagnosed to one of these treatment centers. My father and his team arrived at the tent city in the Partners in Development SUV and loaded the man into the trunk. He looked absolutely awful, basically skin and bones. Cholera is a diarrheal disease, you die by losing all of your body water, and this man looked well on his way.
When the SUV reached the cholera treatment center, the man was received by workers in total isolation suits and rushed into a bed. The workers then bleached the SUV, everything the team was carrying, everyone's clothes, and everyone's bodies. The workers also gave very very explicit advice that if anyone on the team so much as got a stomachache in the next twelve hours or so they should implement an Andromeda Strain-esque panic and get them to the treatment center right away.
That was our only run-in with cholera for the week, although we got a few false alarms at the clinic. The Haitian staff had been trained to err on the side of caution - which is reasonable - so every time someone came in with any sort of diarrhea they were liable to isolate them and start phoning up the cholera center - at which point my father would come in, take a look at the patients, declare it wasn't cholera, and send them home with a smile over the protests of the Haitians. It was a bit gutsy, but he was always right.
Now we've finished our week of clinic work, and our team celebrated this afternoon by going to the beach and drinking. First of all, let me just say that you can say a lot of things about Haiti - scorching hot, swampy, polluted, bug-infested, cholera-ridden, impoverished, corrupt, uneducated, whatever - and yet in its favor, it has some of the best beaches in the world. But the real treat was getting to hear some of the stories my team started to tell when they were a bit tipsy. I don't drink, so I usually miss the opportunity to hear this sort of story, which is too bad because other people's half-drunk stories are exactly the sort of thing that should go in a blog. This one is from L, a nurse working with us in the clinic.
L is from Irvine, a very gentrified town with a small African-American population. In her line of work she has to do genital exams sometimes, but she'd never done one on a black person and she'd always been a bit curious whether the rumors about their, um, size were true.
So she comes to Haiti, where everyone is black, and sure enough one of her first cases is a man complaining of pain in the genital area. So she tells him to take his pants off for a genital exam. The man is a bit shy, so he takes his pants off but covers his penis with his hand, so that only his scrotum is visible.
There's a condition called a hydrocele. You don't see it a lot in developed countries because it gets detected early and fixed by surgery there. You do see it a lot in underdeveloped countries, where there's no medical or surgical care so people with hydroceles just leave them. A hydrocele is an abnormal collection of fluid which causes the scrotum to swell up. In really bad hydroceles, the scrotum can swell really big - grapefruit sized or worse.
So L's patient's pain was caused by a really bad hydrocele. She takes a look, still wondering whether the stories about black people are true, and all she sees is his grapefruit-sized scrotum. She gasps and can't believe what she's seeing, and then the doctor comes in, takes a look, does a brief examination, and says "Ah, obviously a hydrocele."
Sort of reminds me of an old medical student joke about a professor who asks what organ can expand up to five times its original size when stimulated. One girl guesses the penis, and the professor says "I can tell two things from your answer. One, you didn't do your reading on stimulation of the pupil. Two, one day you're going to be very disappointed." I think L was very disappointed.
Moving on to the exact opposite of being very disappointed, I leave Haiti tomorrow. On one level it's too bad, because I feel like I finally got my stride in clinic work on Friday and started to know what I was doing a little better. On another level, it's not too bad at all, because I get out of Haiti. I will probably be back at some point - probably next time my father offers to take me - but I don't think I can handle it for more than one- or two- week intervals at a time before I decide I need a while with hot showers and air conditioned rooms before continuing. My respect for those people in my class who are doing one- or two- month rotations in Africa has gone through the roof.
Pictures as soon as my father gets them to me.