Tuesday, July 25, 2006

When Grandma is Gone....

July 21, 2006

We are working at a clinic in Port-au-Prince right across the street from the hospital where we admit the sickest kids. We walk to this clinic in the morning and pass three Haitian police. The officers, one with an automatic rifle, stop the oncoming traffic to check the registration of the vehicles and verify the driver’s license. Several weeks ago a Haitian lady was attempting to stop a carjacking just outside our clinic in the middle of the day and was shot to death in the street by the thieves.

In the recent couple of weeks, the kidnappings have increased in the capital and all the Haitians tell us the “streets are bad”. Many memos on the internet talk of the renewed chaos and violence in Port-au-Prince. Dozens of kidnappings apparently occurred this month. Deposed President Aristide’s birthday was the other day, so he was blamed again for the violence, even though he now lives in South Africa. We were warned by an American friend, who was a kidnapped last fall, not to walk the streets in this part of PAP, and he offered us a vehicle he sent down for our use. But we feel safer on foot and taking public transportation.

Today was a potpourri of pathology in the Haitian pediatric clinic. All pathology is bad especially if you are the one that has it, live in Haiti, and almost no one cares.

One of our first patients today was a baby girl named Tamaika who weighed about ten pounds and was nine months old. She had been having vomiting and diarrhea for one week and had a temperature of 105 F. Her mother stressed the fact that she has no job or money and could not take the baby to the doctor before today.

The baby was obviously very dehydrated and severely malnourished. Her eyes were sunk and her skin tented when pinched. Her arms and legs were sticks—almost completely devoid of muscle. But, as a true Haitian would, she would swing her arms at me and fought when I attempted to examine her.

A baby like this can be septic along with the dehydration. We brought down Rocephin and gave the baby a big dose immediately and admitted the baby to the hospital for IV antibiotics, fluids, and work up.

A five year old girl, Cynthia, came with chief complaints of two weeks of shortness of breath, fever, lack of appetite, and crying with abdominal pain at night. Her attentive father and mother offered the history at the same time. The girl looked well developed but would scream out in an irritable fashion and then almost fall asleep the next second. Of note were the bounding carotid pulsations on the left side of her neck and the hyperdynamic pulse at her right elbow. This meant that her blood was so thin it was causing her vessels to expand and collapse quicker than normal thicker blood would do. Her conjunctiva where white and her tongue and mucous membranes were very pale. Her liver and spleen were very big and intimately involved in her anemia. Her heart rate was only about 100, so she had compensated for her anemia. In my opinion Cynthia had been this way for awhile. Sickle cell is most likely with some iron deficiency contributing to her severe anemia.

We admitted her also. Her blood was very thin and looked like pink Kool-Aid.
Her hemoglobin returned very low at 2.5 and her white count was very elevated at 59,000. Her father will need to go to the Haitian Red Cross and donate blood and obtain blood for her transfusion.

A beautiful five year old angel was one of our last patients and was brought in by her grandma who appeared to be about 60. According to grandma, the child’s mother had died one and one-half years ago when “she had abdominal pain and became thin” in a city 12 hours from Port-au-Prince. Grandma is now doing another family’s laundry in Port-au-Prince to support the little girl. The girl’s check up was pretty good except for anemia and pneumonia.

At the end of her exam the little girl kissed my wife Maria when she got a piece of gum. As grandma and the little girl left the room Maria wondered what would become of the little girl when Grandma is gone.

No comments: