practicing medicine in flip flops

Marcia sent me the link to a family practice doctor's blog. he recently got back from spending a couple weeks in Haiti. he says this in one of his posts:

I achieved the pinnacle of my profession on my first day in Haiti. I practiced clinical medicine while wearing my Reef flip-flops. Every day, including for the delivery of a baby.

Long have I pondered where in the world I might have the chance to be a doctor and still wear the greatest shoes ever invented on planet earth, and I think I finally found it. Haiti.

...

My singular goal in life - if you press me - is to find a job where I can wear flip-flops with impunity.

As you can see, I found my professional soul in Haiti…through my flip-flops. My very first case was a baby delivery, in fact, and nobody said anything about the irreverent shoes (sandals, really, footwear of Jesus, clogs of the Gods).

ha! I LOVE this! I've always said that in my ideal world I would wear flip-flops 24/7/365.

going back...finally!!

in case anyone ever checks this blog...just wanted to let you all know that I'll be back in Haiti in a little over a month, and I cannot wait to get back. for one thing, I'm sick of being cold. but more importantly...there's lots of people in Haiti I'm really excited to see. I'll be there for almost 2 weeks, both in Port and in the south (in Cayes). I'll be blogging while I'm there (well, I have high intentions of blogging...hopefully that will translate into at least 1 or 2 posts).

(pictures taken by Marcia Erickson)

this and that

thanks for all the nice comments on my last post...you guys are great!

so I've been home for a week now...I gotta say, I kind of feel like life is moving in slow motion these days. that's not a bad thing, though. I've gotten a lot done in the past few days.

I took & passed the MN driver's test (the same one I took 15 years ago). the reason I had to take it is a long story that involves me moving to Massachusetts (MA) for residency 4 years ago, paying almost $90 to get a MA driver's license, the MA DMV people taking away my MN license (instead of just cutting off the corner and giving it back to me, like everyone else does), then me moving back to MN 3 years ago but never bothering to get a new MN license. then I was at the post office last week and had to show then my license to cancel my mail forwarding. the worker kindly reminded me that you're supposed to get a new license within 60 days of establishing residency in MN. apparently they can give you a ticket for that if you get pulled over. so....I decided I better just do it. turns out if I'd come in about 2 weeks ago (within a year of my MN license expiring), I wouldn't have had to take the test (something I probably would have figured out if the MA people had given my old license back to me, cause I would have realized it was expired). it wasn't that bad (though the question I got wrong make me laugh...who would've thought that figuring out what certain road signs actually mean would be do hard?? and who the heck knows exactly many feet you're supposed to leave between your car and a biker? isn't it enough to know that you should stay far enough away so that you don't hit them? seriously.)

we watched the LOST season finale last night...oh my gosh it is SO good...I won't say anything else in case you haven't seen it yet...but I think it really was the best episode ever!! T&T...Paige is going to freak out multiple times, so be prepared :)

as I mentioned in the last post, over the past week, Jamie and Aaron Ivey have been documenting the work of Real Hope for Haiti (RHFH) on their blogs as part of the the RHFH campaign. I want to share my own experience with RHFH. over the course of 4 1/2 months of working at the clinic this past spring, I sent around 6-7 severely malnourished kids to RHFH's rescue center. many of these kids are still there, because most malnourished kids will stay in the rescue center for anywhere from 6-24 months. if not for the rescue center, there wouldn't have been any other options for these kids. the rescue center is doing beautiful, kingdom work.

consider the following:


you can donate online via paypal by clicking on the following image:
or you can send your donation to:
Real Hope for Haiti
P.O. Box 23
Elwood, IN 46036

all donations through online paypal and their ministry address are tax deductible. Real Hope For Haiti is a non-profit organization, which allows your gifts to be tax deductible. any contributors will receive a statement at the end of the year detailing gifts given. also, 100% of the money given via the above link goes directly to their paypal account (minus a small fee that paypal charges) and is available for immediate use.

there are many worthwhile ministries and organizations out there that need help. this is one of them. if you feel led to help, please donate what you can. thanks.

back on the other side of the world

pictures from our last morning in Haiti


Tess & I left Haiti last Thursday morning and had a very uneventful day traveling home to Minnesota. I've done this back-and-forth from Haiti to MN many times, and the way it affects me has changed a lot since my first trip 10 years ago. The main difference now is that the reality of the poverty and suffering that exists in Haiti (and all over the world) isn't ever that far from my mind. Neither is the reality of my life in the U.S., even after being gone for several months. It still takes a few days to get used to each place, but it's not the shock it used to be.

One of the biggest things that always strikes me when I come back to the U.S. from Haiti is how "enclosed" life is here. Most homes in Haiti are really open. For better or worse, the sounds and smells filter into every aspect of your life. When this includes roosters crowing at 5 AM, it's not so nice. But mostly I love this aspect of living in Haiti. Here in the U.S. we're obsessed with keeping our living/working/recreation/etc spaces as clean/climate-controlled/noise-controlled as possible. Which means that, more often than not, we keep the doors and windows closed, turn on the AC (at least in the summer), roll up car windows, and so on. But in the process we close out life...we miss out on the sounds, smells, the warm summer air. I don't get it---here in MN we spend 8 months of the year freezing, then when it's finally warm enough to take off the 3 layers of clothing you need in the winter, you find that you actually still need them if you're planning to go anywhere inside during the summer. Bizarre.

I miss living with the Livesays. I miss Tara & Troy and the fun times we had hanging out, watching LOST & The Office, living life together. I miss working in the clinic with Paige and listening to her perfect Kreyol. I miss Isaac's constant questions. I miss Hope's singing, Noah's silliness, Annie's laugh. I miss Phoebe saying "jen jen" every time she sees me. I miss Lydia's huge smiles. Moving from Port to La Digue to live with them last January was a bigger blessing than I ever could have imagined.

In regards to the medical stuff, I already miss the work I was doing. I hate knowing that there's kids in the village and from the mountains that aren't getting the medical care they need & deserve. I've been listening to this song by Sara Groves called When The Saints....it talks about people who are doing kingdom work all over the world. It's really moving. Makes me miss Haiti all the more. Here's the lyrics:

Lord I have a heavy burden of all I've seen and know
It's more than I can handle
But your word is burning like a fire shut up in my bones
and I cannot let it go

And when I'm weary and overwrought
with so many battles left unfought

I think of Paul and Silas in the prison yard
I hear their song of freedom rising to the stars
And when the Saints go marching in
I want to be one of them

Lord it's all that I can't carry and cannot leave behind
but your word has compelled me
when I think of all who've gone before me and lived the faithful life

And when I'm weary and overwrought
with so many battles left unfought

I think of Paul and Silas in the prison yard
I hear their song of freedom rising to the stars

I see the shepherd Moses in the Pharohs court
I hear his call of freedom for the people of the Lord

And when the Saints go marching in
I want to be one of them
And when the Saints go marching in
I want to be one of them

I see the long quiet walk along the Underground Railroad
I see the slave awakening to the value of her soul

I see the young missionary and the end of the spear
I see his family returning with no trace of fear

I see the long hard shadows of Calcutta nights
I see the sisters standing by the dying man's side

I see the young girl huddled on the brothel floor
I see the man with a passion come and kicking down the door

I see the man of sorrows and his long troubled road
I see the world on his shoulders and my easy load

In the totally mundane category, I think the amount of mail we get here is ridiculous (I spent yesterday going through 5 months worth of mail, 95% of which went straight into the recycling bin) and I hate that it's still cold. The news people are talking about the wind chills for tonight. Ridiculous. It's almost June! But I've been shivering since I got back. I've always said that I'd rather be too hot than too cold...which means that living in MN makes absolutely NO sense. Except that I have amazing friends and family here. So I put up with it.

It really is good to be back though. There's the little things---I like having a car and how easy it is to get around. I like that I just loaded 3 pictures onto this post in less than 30 seconds. I love SuperTarget. I love being able to go for walks outside without being stared at. And there's big things that are nice about being back too--like reconnecting with friends & family. Summer is MN is my absolute favorite time of the year...and I've got tons of fun stuff coming up this summer. Including an NDY concert to benefit Providence Ministries at O'Gara's bar in St. Paul on June 6th. If you live in the Twin Cities, consider coming out to O'Gara's that night. It's going to be tons of fun!!

I have a few more stories to share over the next few weeks, and I'll be posting some of the pictures that Marcia took of the clinic. I'll also be linking to Jamie and Aaron Ivey's blogs over the coming week as they document the work being done by Licia and Lori in Cazale and the needs of this amazing ministry. Please consider doing whatever you can to help them out with the Real Hope for Haiti Campaign.

So what's next for me? Last summer, after graduating from residency and before I left for Haiti, I worked as a hospitalist and in the ER at our local children's hospital. I'll be picking up some hospitalist shifts over the next 5 weeks. Then in July I'm starting a three year pediatric emergency medicine fellowship. Sometimes it feels like I'm a glutton for punishment for starting yet another training program (as if residency wasn't enough), but I'm actually looking forward to it. Once I'm finished and pass my boards, I'll be fully certified as a pediatric emergency medicine physician (in addition to being certified in general pediatrics). In theory, this will give me a more flexible work schedule than just about any other medical field. Meaning (hopefully) that I'll be able to get back to traveling and working in the developing world again. Besides the potential scheduling benefits, I also love working in the ER setting, and I'm looking forward to just being able to do that (in contrast to residency, when we rotated through all of the pediatric specialties).

Thanks to everyone who's followed along over the past 9 months and for supporting and encouraging me!

update

Following Tess's lead, here's the news from the past few days:
--we have no internet at home, not sure when it'll be working again. we're in a nice little coffee place in Petionville that has wireless today.
--my dad visited for a few days this past week, it was his first time in Haiti and he saw a lot---2 days of clinic (including one crazy busy day yesterday), hiking up the mountain to petit bwa, going to the beach, etc. it was fun to have him here, he left this AM.
--Greg & Marcia Erickson have also been here for the past week...Troy & Greg have been working on the internet and Marcia's been taking tons of pics and hanging out with us...it's been super fun having them around.
--we took a very sick little baby to Cazale last night and didn't get back until after 11. this was after getting up at 5 to hike up the mountain. it was a long day...
--a 12 year old girl came in early this AM with a big deep dog bite on her leg. ouch.
--I had a great 30th b-day with everyone at the beach...we tried out a new beach (Club Indigo) and it was awesome.
--there's tons of new pics from the past few days but can't post them now...hopefully later!

any ideas? part 2

This is Rose-Starlin. She's 12 years old. The following pictures were taken at 3 week intervals.















By the time she came in, she'd had scalp sores and hair loss for the past 2 months. At her initial visit I treated her for a bacterial scalp infection and tinea capitus (a fungal infection of the scalp). I treated her with a week of Keflex and started her on Griseofulvin (it's hard to tell from the pictures, but she had a lot of pustules on her scalp, as well as diffuse hair loss and other lesions that looked very much like tinea).















At her first 3 week follow up visit, I continued Griseofulvin for another 3 weeks.














These pictures are from her 6 week follow up visit. At this point, I gave her Griseofulvin (this time Ultramicrosize) for an additional 3 weeks.

As you can see, her hair loss has gotten worse over the past 6 weeks. From what I've read, when tinea capitus goes untreated for a long period of time, it's possible for people to have ongoing (and sometimes permanent) hair loss, even after treatment is started. I'm guessing this is what is happening in this girl's case. She could also have something completely unrelated to tinea too...
I feel really bad for her. I can't think of anything else to do...any ideas?

Another case--yesterday an 18 month old girl came in with what I'm 99% sure is chicken pox. She's actually been doing pretty well (most of the lesions are crusting over), and she doesn't have any signs of any of the more common complications (skin/soft tissue infection, pneumonia, encephalitis, etc). The only weird thing is that her feet are very mildly swollen. Normally in kids here the first thing I'd think of is protein malnutrition, but this girl doesn't have any other signs of this. Besides the mildly swollen feet and chicken pox rash, she looks really good. No other edema, no skin infection, no pulmonary issues, nothing. I'm planning to see her in clinic every couple days to see how she does. Hopefully the edema, whatever it's from, will resolve on its own. If it doesn't, or if it gets worse, I'll send her to another clinic where they can do some labs and figure out what's going on. I have some ideas about what might be going on, but without labs, I can't really narrow it down. Anyways, I'm just wondering---has anyone heard of any association between varicella infection and mild edema like this?
Thanks!

burns and abscesses

New burn from last week (1 1/2 year old boy named Djouca, scalded with hot tea), before and after debridement the day he came in:

This was about a week ago, and he's doing okay, though I'm worried he's going to end up with a burn infection because several times already he's shown up with his bandages off and the burn dirty (a couple days ago he came in with dirt embedded in parts of the burn...not good...AND someone had dropped a dumbbell on his chest, which caused the burn to bleed. Ugh.)

The other child I wrote about earlier who was burned in hot water (1 1/2 year old Sansly) is doing great. Here's before and after pictures (about 1 month apart):























The past couple weeks have been an abscess-draining fest. I've seen way more pus than I ever wanted to see. Here's a few:




7 month old Wisnel (hip/back)








18 month old Lovelie (knee)








23 year old Reynaldo (this one was particularly gross, and it didn't help that this...um...dramatic young guy wouldn't stop moving and screaming "I'm dying, I'm dying, you're killing me" the whole time I was draining it. His friend even had to hold him down. I understand that what I was doing hurts...but still).






1 year old Givenson








12 year old Guirlene