January 29, 2013

Week 2: Fresh, Clean Water and Nutritious Food

I spent my second week of my Haiti experience in the outpatient pediatrics clinic. Overwhelmingly, the cases were centered around the need for reliable sources of nutritious food and clean water. I saw many ramifications of that in the form of intestinal worms and kwashiorkor malnutrition. Also, almost every kid had terrible tinea capitis. This meant a lot of referrals to the (soon-to-be rebuilt) nutrition center for children and prescriptions for mebendazole, griseofulvin and metronidazole. After being pleasantly surprised by the relative luxuries that the town of Milot had in terms of availability of fruits in the mountains and fresh water, I was shocked to see how many children came in with distended bellies and no weight gain over the course of months to years with "failure to thrive" as the tumbled off their growth curves. In some cases, new mothers didn't even know how often to breast feed their children thinking that their children needed more sleep and would only feed 4-5 times a day. It needs to be closer to 10-12 times per day! That made me wonder if the babies would initially cry from hunger and then after a period of dehydration and weight loss, decide to conserve that energy and just sleep most of the day. It was also in the small single pedi clinic room with three other providers, a Haitian pediatrician, a Haitian resident (here for his year of social service) and a nurse practitioner from the States that I learned how History taking could be a team effort. Quite often, while I was talking with my patients, the pediatrician would interrupt my translator or whip around with a chastising voice and lecture the mothers about their children for five minutes in the middle of her own clinic visits. I'd watch the exchange, initially amused by the response to my (what I thought of as) fairly benign questions and advice. And when pressed, my translator would simply say "they disagreed with my translations." Sometimes women seemed reticent to offer their opinion on the medical situation unfolding. Other times, the translator or resident would chuckle at their responses and tell me "they think it is a Haitian thing." It took me a few days to realize that this actually meant that there were non-Western beliefs at work; Voodoo beliefs that the patients or their parents held and in some cases, delayed care in deference to voodoo ceremonies or treatments.

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