Dr. Rachelle vini nan Ayiti

Sorry all for the hiatus in posting. I think that I will be making many short posts so that I can be convinced to post more often.

So for those I haven't filled in about my work here, I am working in a semi-independent TB hospital on the grounds of l'Hopital d'Universitat du'Etat du Haiti (or the General, L'hopital General....etc) in Port-Au-Prince. It is a 6 tent unit with 70 patients, all with TB or presumed TB and 30% coinfection with HIV. A lot of our patients arrive acutely ill with oxygen saturations in the 50s and 60s (normal being of course 100%, but 90% generally considered the threshold for applying supplemental oxygen) and many of the adults are 70-80lbs after being ill for several months.

What is tough about the diagnosis of TB in PAP now is that it is really hard to grow TB in the lab and 20% or more of people never grow it despite having the disease, with this being a harder diagnosis in HIV. So most people around the world rely on the clinical syndrome for a suspected case, since confirmation often takes 1-4 weeks, if they're in the 80% with positive sputum tests. Things like weight loss, fevers, night sweats, loss of appetite, and cough (sometimes with blood) for more than 2 weeks are strong indicators.

So if you're interviewing patients in PAP, most of whom referred for suspected TB are of course very impoverished and living in tent cities, you ask" Do you have fevers?" " Do you have weight loss" Do you have a hard time eating?" Do you have night sweats?" The answer is yes. Since when "apres tremblemant la (since after the earthquake)."

Everyone has had weight loss (no work, no food, lots of depression), night sweats (hmm living in 100 degree weather in a tent) , and cough (living in rubble in a tent with open fires)....

Despite this, TB is very rewarding, because it is a lot of thinking to make the diagnosis, even if the treatment is the same for almost everyone (4 drugs in 1 fixed combination pill provided by WHO).

And even better is coming back 4 months after I was last here and seeing some of my previously starving and near-death patients, who are walking back into the clinic to pick up the last month of medication (it's a 6-24 month treatment depending on if you have resistant TB, 6-9 for most folks!)...and these skeletons are fleshed out lovely people who are happy and healthy and occasionally back to work (there's no work obviously). But there are also 8 patients still hospitalized or rehospitalized since my trip in June, so I have several friends in the tents who are excited to see the same face 4 months later. A few of these are teenagers without family who just need to hang out with us (one's on 02 still and likely forever because of his pulmonary hypertension from the TB) because they are too weak to go to a tent city somewhere.

Great to be back.