Wednesday, April 7, 2010

Haiti: Day 5


Today was our first full clinical day: scheduled to see patients from 8AM to 5PM. Bright and early, we arrived and set up shop...shooing away the goats and chickens to make room for the head shrinkers. We saw several patients today, with diagnoses ranging from likely PTSD to likely Schizophrenia. A word on diagnoses later... The students worked with us all day, and were very helpful in translation and appreciation of cultural nuances. I've started to be able to appreciate a few more subtleties in our work thus far, and I'd like to share them.

The nursing students' need for psychiatric consultation is even greater than I expected. After meeting with most of the students yesterday, I did feel that the discourse went well...but I've been somewhat surprised at their response to us thus far. What we've found already today and yesterday is that many students have been significantly traumatized by the earthquake. Either by rotating with us, or nonchalantly sliding up to us in an incognito fashion, many students are coming to us, and sharing their experiences. Some of their fellow students died. Many of them lost family members, even their own children. Many of them are not doing well and, as the only psychiatrists in Leogane, they need our help.

The tricky part is how to best help them. We are not here to pathologize our patients...let alone the students of the school of whom we are guests. On the other hand, though, we were asked to come and help. If you ask me to come and do what I do, what I come to do gets done, does it not? (Now say it three times, fast) But we have to respect the confidentiality of those who are coming to us for help. We also do not want to jeapordize in any way, subjectively or objectively, the students' educational pursuits. I'm not convinced that the school is prepared to handle the fact that a good portion of their student body is having significant difficulties. Maybe they are, since they called us, but sometimes organizations (especially board members of organizations) just want either a quick fix or a clean bill of health to make them feel better, and aren't really ready to deal with reality. When they ask for a report (or if they read this blog) all of this will be in it. Without patient specific information, or course. I just hope that moving forward, there may be some resources mobilized to provide some continued services.

Other tricky situations between medical staff...which humorously remind me that often, unfortunately, the more things change, the more they stay the same. I had one tense moment with the medical director of the Hospital Sainte Croix. It seems no one had told him that we would be working there, and he, understandably, was wondering who this guy with "Dr. Kobie" scribbled on a piece of medical tape stuck his chest was doing seeing patients in his clinic. He barged right in on one of my consultations, and demanded to speak with me at once. We quickly saw eye to eye, though, once I summoned my French and overcame our language difficulties (my French is should I put it? Pauvre...and Dr. Frenchy was away at the time). I apologized for the miscommunication, he apologized for interrupting my session, and thanked me for my help. So..just like back home...turf wars.

The other all too common situation is that of getting..let me not call them bad, just questionable consults. The amount of consults that I'm getting for so-called anxiety that are truly medical issues is disturbingly high. But hey...what else is new? Another day in the life of the Consult-Liaison shrink.

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