Tuesday, April 13, 2010

Haiti: days 10 & 11

Slow Times at Leogane High

Things have slowed down way too far for my taste. The flow of psychiatric referrals has slowed down to a trickle. There's a new team of physicians this week, and though we continue to remind them to send us patients, they still come too far and few between. Worsening things, nursing participation with the team has been volunatary this week, but today and yesterday that translated into nonexistent. I have some clear suggestions for the next team, to make sure they are maximally effective. Today, I actually was scheduled to ride on the mobile clinic (which basically consists of Evans, some students and supplies on a truck) into some of the more remote parts of the area...I was really excited about it, too. Unfortunately, the truck was in need of repair today, so we couldn't go. So this morning, sitting around waiting for patients, I was on the verge of grabbing a hammer and some nails, and running off to find Sean Penn in an effort to be productive. (He'll make it all better...)

Patience though, not one of my stronger traits, proved to be most useful for me today. I got a referral from the pediatric nurse, who had just seen a severely malnourished baby, and wanted us to interview the mother. The mother, it turned out, was severely ill. She suffered from chronic auditory hallucinations, gross thought disorganization and inappropriate affect. Though she was only twenty-two years old, she said the baby was 18 years old. She initially said she lived three minutes away, but then said she lived eight days away. She was disoriented to time, saying it was "year two." She denied SI/HI, or thoughts of harming the child, however.

I, of course, felt uncomfortable sending this child home with she and her mother in their present conditions. I was able to find one of the doctors on call in the hospital, who agreed to consider the child for acceptance into the nutrition program. After some "liaison" with the nutrition team (they were initially leaning toward sending them home) they began an assessment of the child, and of the mother's ability to feed her. Very luckily, a local assistant on the team knew the patient from her neighborhood, and knew of her family. On further examination, the baby proved to be underneath their weight/height ratio requirements for hospitalization, and they agreed to keep the child overnight. Complicating factor--the patient has been breastfeeding (not adequately), but clearly needs an antipsychotic. We have a good solution, though. Tomorrow, we will all go on a home visit, assess her support system, and hopefully enroll her in the hospital's baby formula program, in which formula can be provided indefinitely. Once we have them enrolled, mommy begins her trial of risperidone. So, win/win. Mommy gets treatment, baby gets fed. Family gets ongoing social follow-up, with an option to involve the Save the Children program and their social services/ child protective services if needed. All and all, a good day's work, even with one family. Maybe I'll just be content doing my thing, and let Sean Penn do his.

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