PATHOLOGY FROM HAITI

I just now finished going through all the pathology reports from the specimens we brought back.  There were 11 specimens from ENT.  I don't know about Urology or OB/GYN.

I've made an individual page for each patient to return to Dr. Gardy, the Haitian doctor who administers the hospital in Pierre Payen.  Each page has the name, location of the biopsy and diagnosis along with a photo of the patient or tumor.  It was hard to keep them all straight.  The handwritten names were hard to read and I had some spelled differently than the lab, so it took very careful comparisons.  Fortunately I kept a written list on my phone of all my operative patients and their diagnosis.  I'm very glad I took as many photos as I did.  Many photos included the specimen bottle right over the registration paper with the patient's name on it.  I'll e-mail them to Haiti, but also hand deliver them when I see Dr. Gardy in May when he travels to Nebraska.  We are hoping to have him speak at Federated Church either May 18 or 25th.

Of the 3 massive thyroids, 2 were multinodular goiters and one was a Hurthle cell adenoma.  Not cancer.

Multinodulaar goiter, 32 years old. She did great!

We had one Hodgkins lymphoma and one squamous cell carcinoma in the ear.

Hodgkin's Lymphoma.  This is a very treatable and potentially curable type of cancer.  I have been in communicaiton with him via the internet and he may be coming to the US for treatment.  Pray for him.

The cheek lesion in the 12 year old boy, even with a generous biopsy is inconclusive.  I put my money on a parasitic infection, but they didn't see any parasites.  Very weird.

Cheek mass.  Parasite? 

There was the worse fungal sinusitis I've ever seen without being a 'face-eating fungus'. It was eroded into the eyes.

Fungal sinusitis.  If you look closely you can see polyps in her nose and the left eye deviates outward. 

The massive facial tumor looks like a salivary gland malignancy.  This was posted a few posts back and is worth looking at if you haven't seen it yet.

The massive jaw tumors included ameloblastoma.  There is another picture posted earlier.

Ameloblastoma.  A low grade, slow growing malignancy which could be cured by removing his jaw.

Squamous cell carcinoma of the jaw.

Squamous cell carcinoma of the jaw. 

 An odontogenic cyst.

Odontogenic Cyst.  The oral pathologist from UNMC is still looking at this.

There was nothing straightforward in Pierre Payen.

We have so many "worried well" here (yes, there is even a diagnosis code for "worried well"), that it just messes with my mind to see so much really dramatic and terrible pathology so concentrated and so advanced.
Please pray for all these folks who did not ask to be born in a country without the capability to treat these early.

Ciao. NN

GUEST BLOGGER - KIM HARM

Today's guest blogger is Kim Harm, BSN, APRN, PhD.  Kim has worked in primary care and is opening her new business, Harmony Health and Wellness.

The trip to Haiti was life-changing. I was able to go on the trip with wonderful people including my husband and my best friend. I feel so blessed to have met others on the team who have such high character and devotion to serving God and their fellow humans. It was an honor to work along-side these wonderful people. I felt part of a great team in our clinic setting. I was so glad to get to work with my husband but it was great to meet and work with Dr. Mark, Linda, Dr. Shirley, Kristie, Kate and Molly.

I was initially struck by the poverty. I felt it hard to choke back tears on the ride from the airport. I prayed God would not give me more than I could handle here. I have seen poverty on TV and in pictures but seeing in person impressed me beyond my ability to express.

Laundry day at the stream.

I had the opportunity to work at the poorest part of the hospital, where those who cannot pay are placed. The conditions were deplorable. I was sickened. There was no privacy offered to a woman with intractable diarrhea and vomiting at the bedside, in the middle of a room, with a bucket. The beds were lined up in the room and privacy must be for those with money. I was able to see Dr. Joe evaluate a woman who had been suffering with abdominal pain for 2 months at home and then suffered for 9 more days in the “hospital” before she was seen by a physician.  She had not had a BM in 10 days.  Finally on this 9^th day of moaning in pain in the hospital with no diagnosis she was seen by Dr. Joe. 

The community hospital across the street.  We filled in for nurses while they went to the seminars.

Community hospital.

This was my first sobbing episode among all the tears shed. I cried for her suffering, I cried for the lack of care available, I cried for poverty. At home if she were this poor she would have Medicaid and could go to the ER after one hour of pain and demand sophisticated tests to rule out every possible life threatening issue. She had been not suffering for an hour but for weeks and weeks. I shed tears from some shame of the abundance and waste of my own culture. I shed tears feeling there was nothing I could do. So I prayed. Fritzi caught me sobbing and I rambled about all these feelings and she talked me down. She said not to feel any shame but instead be empowered and offer what I could do. Shame only promotes negative feelings and we as Americans have a lot to make up for when it comes to Haiti. We have insight in how to elevate their status by education so I worked to educate on self-care as best I could. This is what I love to do at home and I found many opportunities to educate in the clinic.

Molly, Fritzi (from NYC) and Kim at the front entrance. 

My second opportunity at the poor part of the hospital was a quiet afternoon. All the staff were in the educational sessions offered by the team and I and an interpreter were “in charge” in case anyone needed anything. So I prayed again so that they would need only what I could handle. Then I got to visit with my interpreter who only came back to Haiti 3 months ago. He had been living in the US since he was 11. We compared and contrasted the cultures. He reviewed the history of dictatorship in the country and what he thinks would improve the status of Haiti. It was easy to see how superstitions develop with those who are poorly educated trying to make sense of the suffering and illness. We talked a bit about voodoo and how this developed to help explain and treat suffering and illness. It makes sense when witnessing poverty how one might feel cursed when they get a large tumor on their neck. I visited a woman whom Dr. Novotny removed a huge thyroid. She was lying quietly in bed that afternoon. She grew a huge smile on her face when I checked her incision and talked with her about how much better she must feel without that football at the base of her neck. Her whole face lit up, her eyes were bright. I did nothing heroic in Haiti but I was proud that my friend with her surgical skills did. She helped this very poor woman who likely had little hope of being cured of her curse. More tears, more prayers of thanksgiving. Then among the poor conditions of the hospital with the heat and sweat a wonderful cool breeze came through and lovely blossoms from a tree I had not noticed were falling like the snow I left back home. It was beautiful. I felt I was where God intended me to be at that moment. So many friends at home were praying for our trip and I felt it. I felt prayed for.

Dr. Novotny with thyroidectomy patient. The mass was as big as a large eggplant. 

I was also touched that despite the widespread hunger and daily stress of trying to exist in poverty, everyone wore their very best to the clinic. Haitians are very proud people it seems. One elderly gentleman was in a threadbare button down shirt but it was neat and tucked and he wore a belt. His hem was tattered but trimmed neatly, his worn out shoes were laced, and an old hat he removed when entering the room. One woman was very sick with metastatic cancer and could barely walk with leg pain using a stick as a cane and she was coughing up blood. Even she was dressed up in what seemed like her finest dress and hat. She was found to be dying of metastatic lung cancer spread to her neck and her femur. Ethically she was difficult for me because her family refused to allow us to give her the diagnosis of terminal cancer. The son was upset that nothing could be done and asked what we would do in the US.  Even at home this advanced of disease could not receive curative treatment. They could not afford pain medication and there is no system in place for refills of pain medications I ordered. I talked to our pharmacy team and Sandy graciously said she would give them everything she had to allow this woman to go home and die without the terrible pain she was in. As a former hospice nurse I have seen how painful metastatic cancer seems and it was humbling to think that despite all the poverty, hunger and daily suffering of these individuals, they still must suffer even more. More tears. More prayers.

A treadmill in the carport. 

After I was done with clinic one day I snooped at the hospital side looking for my friend Wendie. The asthmatic young woman many have written about was in the hospital. Everything is open there and a group was gathered at her door. (So open in fact that I saw chickens walking through the hospital). I joined in even though I knew I had nothing to offer. I was impressed by the breathing pattern I saw, she was gravely ill. I was touched by Kelsey’s description of the efforts to save her with limited resources. Her deep caring and effort to work so hard on her tells us all what a wonderful physician she has become. I prayed. I prayed harder for her than I think I have prayed for anyone except for the children with cancer in my community. She is so young and otherwise so very healthy. She was still with us the next morning and maybe it helped, maybe it helped Kelsey get the strength to stay up with her all night. Whatever, I hope it helped.

Chicken in the hospital.

In my practice at home I try hard to live my faith. I look for Jesus in my patients, even the drug seekers who resort to all sorts of storytelling and manipulation.  But in Haiti, there is no need to look. Jesus looks at you with big brown eyes in every room, in every encounter. Jesus is everywhere. God is great. Those who have done anything like this know what I mean. I returned from the trip and was amazed at how I felt. I felt good that I did something good for our global community but was it enough and what can I do to serve more? More tears. More prayers.   

Kim