Tuesday, October 12, 2010

If you've travelled in the tropics you know it's hot, humid, hazy.  You know that if you are in the sun you sweat right through your shirt in no time.  You know you need to keep drinking water and most of the time you look like crap unless you are lucky enough to have a shower and change into some cool outfit. And then it's very temporary.

Well let me tell you about the residents and attendings who work here in the public hospital where I am stationed for the week.  There are some 20 pediatric residents and another 6 or so attendings who start making rounds in the morning at 7am.  When we arrived at 8:30, lines of feverish kids and mothers, swaddled in all manner of towels and rags were waiting in the sun to be triaged into the outpatient clinic. the clinic is a series of long pavilions, about twenty feet wide, made of plywood; they are clean, airy and light, but densely crowded.   The residents, many of whom have been up all night tending very sick children in the emergency ward, are in full makeup, coiffed, perched on high heels with pedicured toes, some in pressed linen blouses.  Some of the men wear ties; all wear shined shoes, and no one looks or at least acts uncomfortable.

The dignity and professionalism of these doctors is remarkable.  When asked yesterday what he thought the program's biggest strength is, Dr Evillard (head of the Haitian Pediatric Society-SPH)told us: "It is the commitment of the staff." That was certainly in evidence today.

In the course of the day which ended for me at 2:30 I never saw them eat, drink, or complain.  Sweat they did, especially when twenty of us were sitting around the table in a crowded conference room where my colleague, Meera, and I gave our talks.    And yet they rose from the lectures and went back to work in conditions that are as close, crowded and dramatic as any one can imagine.

Particularly heart wrenching were the eight month old with Down Syndrome abandoned by her family and the malnutrition ward where the children have the classic forms of malnutrition called marasmus and kwashiorkor.    Kids with marasmus are the skinny, crying, hungry, whining ones. Those with kwashiorkor might look plump but it is all fluid (edema), or leaking fluid due to a lack of protein in the system;these children are lethargic and disinterested.

Here are a few photos so you can see for yourself:
The crazy permanence of impermanence:tents are anchored and file cabinets are at work.This is the general hospital.

The neonatal ICU.  Love the hat.
 Unfortunately, I will not be able to upload more photos as it requires a lot of time and twice now, while I waited I lost my internet connection.  More to follow when I can. I am taking pictures and collecting stories all the time.

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