day at triage clinic

(written 3/10)

Yesterday I staffed the triage clinic in front of our camp, and we saw over 400 patients. It was crazy - like medical speed dating. The triage clinic was originally started to determine what patients should be seen in the emergency room (or admitted), and has evolved into more of an ambulatory care clinic.

Patients start lining up at 7am, even if we're not open until 9 or later. They wait - for hours, in the hot sun - to see a medical provider. For many of the patients, this is the first time they've ever seen a doctor. In one day I saw everything from hypertension and diabetes to wound infections and STDs. Almost every patient was dehydrated, none of the pregnant women had received any prenatal care.

Back home I work part time at a compounding pharmacy, and have joked about being "a witch at the Apothecary" - mixing lotions and potions in the laboratory - well, never has that been more true than here in Haiti, especially my day at the triage clinic.

We've had supplies donated, but way more in "adult strength" than children's doses. Armed with Lexi, Sanford, and a calculator, I didn't realize I was literally going to MAKE medicine all day.

It started with ear infections and no ear drops. Simple enough - eye drops can be used in the ear, no problem (unless they're vancomycin - which I had to stop a few times - you know, that whole "ototoxicity thing"...). Then an asthma patient, whose been having exacerbations since the quake. We've had no albuterol inhalers for days - but you can drink the nebules and still get some effect (there are just more systemic effects, so I was sure to check to see that the patient wasn't tachycardic).

Before I knew it, I was splitting antibiotic capsules to make suspensions, a few variations of "magic mouthwash", and combining some childrens benadryl, tylenol, and a touch of lidocaine to make cough syrups, and then it just snow-balled. For a clearly dehydrated boy who wasn't eating - oral rehydration salts in a liter of water, with a "chaser" of megace to stimulate appetite... I know I made MacGuyver proud...

We had no bottles to dispense liquids, so we used (clean, new) urine cups with screw-on lids. Directions were written in sharpie on the side.

Pharmacy - medicine in general here - has to be "outside the box". We have a staff or rotating volunteers (that turns over weekly), and the majority of our supplies are donations. We do the best that we can with what we have, and what we have is always changing.

By the end of the day, I was exhausted, sunburned, and the wind had blown the dust through my scrubs and embedded it in my skin. A 2-minute cold shower never felt so good!

~PJ