Monday: Clinic in Faveau

Today we held a clinic in Faveau, a small town about 15 minutes from Cabaret.

Evelyn, giving an educational talk about hygiene to patents at the clinic

In order to provide privacy, we had sheets set up in one corner, and patients saw one of the two doctors in a make-shift "treatment room

I had two jobs; nutritional counseling, and I helped out in the pharmacy; filling prescriptions, counting pills, mixing re-hydration solutions, etc.

Each patient is given a 8 ½ x 11 sheet, double sided, at registration which accompanies that patient with them through the various “stations” of the medical clinic; registration, education, triage (nurses), and then pharmacy. Additionally, the nurses can decide that a patient needs to visit any (or a combination of) the following: a doctor, vision care (to get fitted for eye glasses), the lab (for urine tests, including pregnancy tests) or a nutritionist (myself). Because there was no nutritionist or dietitian present last week, the nurses and doctors found ways to make do (usually by providing the education themselves). So today was a bit of an adjustment. I saw 5 patients today; a tiny lady with severe type II diabetes, a lady with hypertension, two mothers whose young children were malnourished, and a lady with acid reflux disease. Some patients are closed off and seem very disinterested in nutritional support/advice (both mothers whose children were malnourished).... others seem genuinely curious and seemed very responsive to the advice (e.g. the lady with diabetes). For the most part, the patients only spoke Creole, and so we hired local translators to help us. Most of the translators were students from Port-au-Prince who stayed with us for the duration of the trip.

Photo credit: Angela Lau :)

Providing nutritional advice in a third-world country has proven to be much more challenging than I ever anticipated. For one, there seems to be very little they can change in regard to their diet, even if they wanted to. They have very little money for food, and there is very little variety available. After speaking for a while with two of our translators, I determined that the diet of the average person consists mainly of rice and beans, sometimes with fruit (mango, papaya, bananas), very rarely with vegetables (plantain, carrots), and they almost never (in some cases, never) get nuts, dairy products or meat of any kind. Sometimes they eat porridge, or cornmeal, and other starches and grains (millet, cassava) but nothing particularly nutritious. The children eat raw coffee beans because they fill them up and give them energy. They also have access to, and eat a fair bit of candy, French fries, and junk food.  

Me holding one of the 15-day old babies who came into the clinic (photo credit: Angela Lau)

In Haiti, there seems to be a bit of a social stigma against breastfeeding children; almost no children are breast-fed to 1 year (the WHO recommends 2 or even 3 years in developing countries), and some children are never breast-fed at all. This is devastating in a country like Haiti because breast-milk is the most nutritious, the healthiest, and the cheapest form of food for their babies. Not to mention that when formula is mixed with unclean drinking water, those infants are terrible vulnerable to water-borne diseases like Cholera. At the clinic today we saw two very young babies (15 days old), neither in the company of their mothers, who had never, and would never be breast-fed. One mother was so anemic after childbirth (so we were told) that she couldn’t bring the child to the clinic, so the grandmother brought it, and the other was brought in by a relative because the mother appeared to be suffering from postpartum depression and had stopped caring for the child.  Both infants were healthy and would likely be fine. We sent them home with a 3-month supply of formula.

There will be another clinic here in 3 month’s time, so all the prescriptions for long-term medications (e.g. ACE inhibitors for hypertension) are given in 3-month supplies so that the patient can get more medication when they visit the next free medical clinic in 3 months.

We saw many children with fungal infections, (whom we sent home with tubes of Loprox; a topical anti-fungal medication) and scabies (treated with sulfur paste, and antibiotics if there was a secondary infection). Both of these conditions are extremely easy to treat, but will persist indefinitely, or cause secondary complications, if left untreated.

A large amount of patients were dehydrated (given oral re-hydration solution), and there was a young baby (15 months) with Cholera. Everyone received a month’s supply of multivitamins, and worm medication (if they hadn’t received any in the past 3 months). Anyone who didn’t own a hat was given one, and many people got sunglasses and footwear too. UTI’s and yeast infections are rampant, as were headaches (a combination of no sun protection, dehydration, and stress). For very small children, we had to crush the worm medication, mix it with water, and then coax the small children to drink it, which needless to say... they didn't want to.

We saw over 260 patients that day, most of whom we were able to fully treat.

That morning, Veneta had asked me to give a talk to 8 or 9 “den mothers” (the women who care for the boys at the orphanage) at 5:00pm, about nutrition. I ended up speaking to over 120 women, of various ages, at around 6:30pm (as things tend to go in countries like this). I had spoken with one of the MD’s earlier about what I was going to say and was urged to add a tid-bit about breast-feeding into the talk, since we really wanted to encourage mothers to breast feed to at least a year, preferably longer.

When I raised the matter of breast-feeding at my chat, there was immediate mumbling, and disagreement. One women, who was visibly agitated, said that she tried to breast feed her kid,  but that it cried and cried when she tried, but when she gave it formula, it was happy. It’s hard to respond to statements like these, since she genuinely believes that breast-milk isn't good for her baby, and you don’t want to tell her she is making it up, or imagining it, but they don’t seem to be interested in heading about the benefits of breast-feeding.