Model Patient

After a week of “Gade” (“look” in Haitian Creole) and the patients proceed to move their heads left, right, up, down, and every way away from you.

And patients placing their index fingers on the chin rest of the NCT when I asked them to “mete manton ou isit la.” (“Place your chin here”, pointing with MY finger at the chin rest.) Only the finger gesture got across in the translation…

I finally witnessed the model patient!

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5 Days In…

It down poured last night around 8:30. And sometime in the middle of the night, power went out in our rooms and is still out. I’m surprised the clinic Wifi is still powered. The roosters in the neighborhood are crowing nonstop like crazy, I suppose the weather has something to do with it? It’s a nice cool morning today, and the entire courtyard smells of fresh vegetation with faint wafts of lilies from the abundant flowering trees.

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Day four yesterday was a calmer day, must be that midweek lull. We started the day by giving a quick eye anatomy and glaucoma 101 education to the general practitioners that work at the regular clinic here. Besides a lady with extensive hypercholesteremia in her retinal vessels, there were just a few glaucoma patients that we started treatment on. We have run out of Lumigan samples so now we’re putting patients on Alphagan as first line treatment after ensuring good blood pressures. The two red eyes came back looking better, so we’re staying the course on treatment.

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I have now gotten into the daily routine of breakfast at 7, clinic at 8, working till 1/1:30 and break for quick lunch and be done by 3 or 4 for pool time, internet and shower. The cold water shower is actually quite nice and enjoyable, the only thing that took some adjustment to was the diverse shower buddies that have come to join you.

Dinner the first 3 days have been at 6, but monday night until Thursday, another group came to stay at the clinic-guest house compound and caused dinners to be pushed back to 7pm and breakfast to have peanut butter but no bananas. This group is here working on new expansion programs for the Foundation of Enfant Jesus, the organization that runs the regular health clinic for the community.

The organization is running out of grant for the regular health clinic, and is in process of securing more funding to sustain the clinic into the future. The docs, Graidi and I are here on our own funds, we spent $455.40 each for the flights, and pay $75 a day to stay and eat at this compound, which I think is quite overpriced, but maybe they are using this money to sustain their regular clinic a bit? I’m not real clear in the finances of this organization. We are making a big difference with the care we provide. The big question is how can we create sustainable and affordable clinics for communities everywhere on this big planet?

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Day 3

Sunday we had a day off. We went up to Fort Jacques and paid a convenience fee of $15 to walk around the rubles with a local boy trying to explain over and over the year it was built. We then ate an over priced restaurant that over-looked much of Port-Au-Prince. Finally, we drove through different neighborhoods in Port au Prince looking for mango and grapefruit and picking up meds at the foundation head quarters.

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The popular mode of transport here are tap taps, which are small trucks whose beds are converted to two benches that seats up to 6 person per side, with standing room for two at the very back of the truck. I’ve seen more than 14 people cram in one truck bed though.

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Today, what had begun to look like retina day quickly turned out to be a comprehensive optometry day. We saw a total of 36 patients including some clinic staff. Dr. Dean started with a two-month old mac-off retinal detachment patient, and I saw one lady with a superior hemi-branch retinal vein occlusion in her right eye, .80 glaucomatous nerve with inferior notching, and a whopping macular hole that was 1/2DD in size in her left eye, roughly 20/70 VAs. Yowza, how many problems can one cram in a pair of eyes?

We then proceeded to see a liquified lens in a light perception man, it was a white jiggly lens that blocked the view of the retina. He had a pressure of 8 in that right eye and 24 in his left eye with a glaucomatous nerve. We saw another light perception patient, this time a lady with bilateral hyper- hypermature cataracts. NO, zero, nada. zilch view of retina OD, barely visible, super hazy glaucomatous looking nerve OS:(

We finished the morning off with two acute red eyes. One had mucous discharged and had been red for 7 days. Another had pan corneal SPKs and semi-severe corneal neocascularization from 10 to 1 O’Clock right eye. She’s been feeling bad for 2 months! We gave the first our only bottle of tobradex and gave to second moxeza and durezol drops and a bandage contact lens. We’ll be seeing both tomorrow afternoon, hopefully with improvement.

Everyone here has complaints of dry, itchy eyes and we told everyone to do warm compresses. At the end of the day, I had the docs check out my whopping hoof bruise and was prescribed warm compresses as well! It’s feeling a lot better, I can run around, and I hadn’t taken any pain killers since yesterday morning:)

I am also having better luck with animals. Ron gave me some mosquito coil for my room last night and I have almost perfected the installation of my mosquito net. I think/hope the Chinese buffet has slowed down in it’s business. After clinic, Drs. Dean, Jerry and I went over to the old orphanage next door to see the honey extractor centrifuge and I was able to snap pics of some of the animals along the way. I think the piglets and the guinea pigs like me:)

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Stop Horsing Around!

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Yesterday I discovered peanut butter and bananas! OMG, most delicious breakfast combo ever! Day 2 of clinic went quite smoothly after the main clinic staff finally arrived more than half an hour late, never did figure out the hold up, but the patients didn’t complain too much.

We saw 27 patients. Our 66 mmHg patient came back in the morning with a pressure of 8 and 9 in his right and left eye! Yay!!

We gave our bus driver an eye exam yesterday. He’s been diabetic since 2009, but it looks like his blood sugar has been uncontrolled for a lot longer. There were so many hemorrhages, looks like a firework display of tiny blood vessels popping everywhere, that was my first >2A, also cotton wool spots, beady veins, and exudates in the macula, the right eye looked worse than the left. It was eye at the brink of proliferating into permanent vision loss! This is also the driver who is responsible for the daily survival of the lawless Haitian traffic of the regular doctors and clinic staff! After extensive education, I hope he understands how precarious this situation is. We told the clinic docs to make sure his blood sugar gets under control and asked them to get him a carotid study for the asymmetric hemes.

We saw another high pressure glaucoma patient, 45 each eye. We were able to lower his pressure to low twenties before releasing him for the day. We’ll see him back on Wednesday.

The good news is we saw a lot more glaucoma suspects and early glaucomatous nerves with good vision that we may be able to prevent from going blind. I hope the patient education is getting across in translation.

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After clinic yesterday, we visited some unattended beehives, Dr. Jerry took measurements to make some replacement panels for the hives so the community can procure their own honey. After the bee visit, I managed to get kicked by a horse, and now I have a swollen left knee. I took some Advil immediately, and haven’t been bothered by any pain, it’s just an awkward stiffness when trying to walk around and flex my knee:(

Dr. Jerry petted the horse. Dr. Dean and I both fed it. Somehow the horse managed to walk around the tree away from me, and the next thing I knew, I was sent flying backwards to land on my butt a couple of feet from where I had been standing. I guess I wasn’t much of a horse whisperer as I had imagined. I’ve always liked cows better anyway. I just hope for a full recovery soon so I can climb again!

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It wasn’t what I was expecting!

Day 1 of clinic, we saw 26 patients. There’s a huge need here for eye care. I started the day with a blind gentleman guided by his daughter. I was hoping for dense cataracts, but didn’t see much in his size 6 pupils during retinoscopy. His pressures turned out to be 26 ou and cupped to the rim 360 in both eyes. There’s nothing left to save in his eyes, no light perception either eye:( I quickly tono’d his daughter, 17s, and scoped her nerves, 0.4, good rim, so I told her it’s really important for her and her siblings to get eye exams every year.

The next patient came in saying the vision in his right eye goes black some times. His right cornea looked a little hazy. I tried 5 times to get a pressure with the NCT with no luck, so I moved to the left eye, which easily registered 22 . I then took pressures with the Perkins tonometer and got 50, it had maxed out the tonometer. We put him in the exam chair and got an IOP of 66, .90 cupping OD, 0.3 OS. We dropped him with combigan, dorzolamide, timolol and more of the 3 for the next couple of hours, pressure barely budged. We sent him away for lunch to come right back, and pressure finally lowered to 22 OD, and 8 OS. We dropped him with pilocarpine in the right eye and sent him home with Combigan and travatan Z and told him to come back tomorrow morning. Hopefully we see him today and pressures are down in the teens or low 20’s at the most.

We proceeded to see 5 other severely cupped glaucoma patients today. We sent them with 3 months supply of meds each. I’m scared we might run out of drops before our week ends.

There was also a young woman, 30, with a 2 month old baby. She’s got severe retinitis pigmentosa, the nerves weren’t too pale but definitely very attenuated retinal arteries, and bone spicules spreading in the posterior pole. Told her to eat more carrots, eggs, and squash, but unfortunately her vision will only get worse:(

We saw the most cooperative 4 year old boy. The mother says he can’t see well at school and holds things really close. I proceed to ret -4.50-6.00×180 in the right and -5.00-9.00×180 in the left. I apart ran out of lenses in the ret rack, it only switched motion when I went to from -12 to -15 in the 90 meridian! He definitely needs glasses stat regular eye exams to prevent bilateral amblyopia!

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It’s incredible how much need there is for eye care. I wasn’t expecting this much glaucoma in the community, and definitely not a glaucomatocyclitic crisis on the first day. Drs. Jerry and Dean Barcelow are incredibly generous for volunteering their time and donating so much equipment to this clinic. It’s their second year here and they’re planning to come back again next year. They haven’t really done any fundraising, but they have collected some glasses from the community and they’re making some prescriptions at their office to send back. The biggest need I see is more glaucoma meds to sustain the community for the year. Hopefully, we can get other docs to come so people can get more frequent follow ups.

Lunch yesterday was tomatoes, cucumbers, and mango again, but there was a dry cassava wafer and tuna and chicken, so I made sort of a tostada for lunch. There was also papaya in addition to the mango. Dinner was delicious rice and beans, boiled carrots and broccoli, and chicken drumsticks in a yummy mole like sauce. I guess we’ve ate up all the mangos by now, there weren’t any at dinner.

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As a side venture, I decided to try my luck in opening an all-you-can-eat Chinese buffet. It’s the first in the neighborhood and it became an overnight success! There was only one paying customer though:<10532774_10103030139248553_2711166212050903340_n

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Haiti

I am currently in my 4th rotation of final year of optometry school. It’s unbelievable how quickly time has passed since I started this blog and now I am nearing the end of my optometry school journey. This rotation, I was fortunate to be placed at a lovely private practice in rural Bethel, VT. I work with Drs. Jerry, Dean, and Becky Barcelow. They are an incredibly humble and generous people. Dr. Jerry and Dr. Dean started to go to Haiti to give eye exams last year, and they offered me the opportunity to join them this year. Being a little travel addict that I am, I instantly jumped on the offer and later started to worry about chikungunya, political instability, how to explain to my family my decision, which lead to apologizing for not thinking thoroughly through this decision, and promising to be safe, yadi, yada. Then, I arrived, deplaned, passed by a group of musicians in the corridor, paid the $10 due for immigrants. We got out of the airport, but not before being harassed by people who tried to hustle a few bucks by “helping” with our luggage, and by the customs agent who told us in broken English that typically there’s a deposit involved in bringing outside equipment in, but he’s waiving it just for us, but we should pay him a little gratuity, but not in the airport. Welcome to Haiti;)

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We finally found Ron, our contact/guide from Foundation Enfant Jesus, the organization through which we will be providing eye care. We briefly drove through north part of port au prince from the airport. It’s pretty run down, shanty homes and shops all along the way. We arrive at the village of Lamardelle, where we will be for the next 7 days. The compound we live in is a really nice row of guest rooms sharing the same fenced in yard as the community clinic. There’s a swimming pool, showers, and modern toilets. Only thing lacking is warm water, but that’s no big deal in the warm tropics.1964768_10103027854023163_29499984468417009_n11061775_10103027853913383_7063507130200246420_n21268_10103027853823563_5199364184262192048_n

Dinner tonight was a delicious peas soup, some fresh heirloom tomatoes and cucumbers and most importantly, a heap of some of the 10+ delicious Haitian mangoes my doc bought from side of the street for $5 USD. I’m not really sure what the conversion rate is in this country and I’m not even going to attempt to figure out what the normal prices are for people who actually live here and how much we’ve been ripped off:P They’re wonderfully delicious!10407663_10103027853738733_5827519904584398861_n

The night came quickly after dinner. I suddenly became aware of my exhaustion. Letting my eyes adjust to the natural darkness, I lazily trudged back on the pebbled path in my flip flops from the dinning gazebo in the center of this compound to my bedroom. I was just thinking how the bleating of neighboring goats and the loud cicadas above my head is a nice warm change to the chilly quiet Vermont of the past month. Both are calmly rural, but with very different feels. Then, there was a semi-firm squish under my left heel.

Oh poo, I must have stepped on a dog doo doo. There’s a really chill German Shepard, Ashi, and a tiny, adorably yappy Pomeranian, Sofi, that share the yard with us. So I turned the flashlight on my phone to check my damage: I had stepped on a toad!

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Sleepless Night in Istanbul

No, I did not party the night away in Taksim Square, I actually have not set my foot there yet. I got on a seven hour flight from Boston to Amsterdam the night of the November 23. During the three hour layover, I somewhat comfortably napped at the KPN internet station bench (the gate for my flight to Istanbul did not open until one hour pre-takeoff), I queued up to go through security check at the gate and safely landed in Istanbul by 5PM. I impressed the passport agent at the airport with my newly learned Turkish greetings and found my way to the metro station.

Prior to arriving, I had learned about the istanbulkart, abikil, and the token system for riding the metro. However, when it came time to purchase my fare, I furtively hovered near the istanbulkart machine trying to decipher the three options listed. A kind young Turkish man helped me understand that the first option is 10 TL for 3 rides and non-reloadable, and the third is 10TL with 4 TL ride credit that is reloadable. The ride costs 3TL with token, but with the istanbulkart, it’s reduced to 1.99TL. I figured if I could use it for 6 rides, I’d be able to break even the cost of the card. (We’ll see if I’ve made it worthwhile:) Indeed, I’ve made a worthwhile purchased. I explored other parts of Istanbul outside of tourist central:)

The transfers on the Istanbul public transit is not free. I took the metro from Ataturk Airport and transferred to the tram to arrive at Sultanhamet station, and that cost another 1.99 TL. When I got off the station, a man claiming to be from the Airport tourism information desk offered to guide me to cheers hostel, but somehow convinced me to check out a tour company to buy a Cappadocia, Pamukkale, Efes 5 day package for $450 USD. He seemed kind and helpful, so I was hooked, lined, but soon they were so pushy trying to make the sale that I grew increasingly uncomfortable. I told them I have to think about it since I am a student on a budget, and finally escaped to my hostel.

I was checked in by Olga, a Russian girl who speaks nearly-fluent Turkish, and she offered helpful tips for Istanbul. I later went with her to a different travel company and booked a similar package with a couple of non-guided free days for $365. I also added a 130 Euro hot air balloon package. I’m not sure if I was too rash in my decision, if I should have bargained more, but that was what I did. (I ended up canceling that tour package, I did not enjoy the though of guided tours, I am in the process of requesting money back.)

Then, returning to the hostel, I went to dinner at Cheers Light House with a Canadian Teacher, a software designer frok Cyprus, another tech guy from London, a Disney employee from Miami, a Costa Rican NGO guy, and an Australian mining metallurgy guy. We most likely way overpaid for our dinner, but we had a great time.

We finished the night at Erenler Nargile with rosemint and apple-flavered hookas, and some Turkish coffee. I wouldn’t recommend the coffee, however, they made it too gritty there. I did attempt to read my own fortune, I definitely saw a huge happy face on the side of the cup, that must be a good sign:)

By an unfortunate combination of coffe, jetlag, and excitement, I had a really rough time falling asleep. By two a.m., I was desperate for some shuteye. By three a.m., I was getting really nervous. By 4 a.m., I started messaging my friends back home still unable to sleep, and by 5 a.m. I was composing this blog post.

I finally heard my first morning prayer, and after some time, I heard another, and I must have finally drifted off into slumberland.

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