Journal entry after the 1st day of clinic work:
A garrulous, ebullient, colorful people. Haiti teems with energy and noise. The creole language sounds like a brook hurriedly scrabbling across smooth stones. At first, you think you hear French; those soft contoured and drawn-out vowels. And you are. But more, too. It’s French plus native. Plus pride. Plus individualism and cultural distinction.
Creole is French drenched in the personality and attitude of a people.
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.
I think the prohibition against open-toed shoes in medical practice is probably much more about Victorian anti-sexual, social dictatorial fashion strictures than any true sterile or safety issue. I wore my flippers every day in med school…I even wore them under my gown at graduation, flapping happily across the stage to get my powerful and awe-inspiring diploma.
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).
The case began while everyone was still sitting around the breakfast table. We planned on getting an introduction to the mores of our makeshift clinic, led by a highly capable nurse who oversaw things each time she made the trip to Haiti.
Before I could even see my clinic area however, a voice blared over a hand-held loudspeaker from outside the church walls, crying “Le bebe! Le bebe!”
Even I knew what that meant.
Quickly we settled the woman onto a rather uncomfortable wooden table with stirrups drilled into the sides. Shortly thereafter, the woman’s, amnion ruptured with thick meconium staining. Missed my exposed toes by inches.
Mec, especially when thick and gooey like this, suggests a very stressed baby. In the “real world” we call pediatric hospitalists to be present for deliveries like this because a resuscitation will likely be needed.
Just next to my exam “room”, we just happened to have a pediatric ER doc down from Miami. While she provided a welcome level of expertise, supplies were in short supply. We had no resuscitation equipment. No baby warmer. MAYBE a pediatric IV, but we would have to give adult saline.
One of the things we didn’t have was a welcome omission, however. Adding to my joy about the flip-flops, we also were without a fetal heart tone monitor to watch obsessively. I hate those things. I blame them for thousands of needless C-sections a year. It’s only because of the prolific lawsuits of John Edwards that we worship at the altar of FHT strips anyway. No science even supports their use.
I could have done without the mosquitoes and flies buzzing around, the open window behind me (and directly in line with the woman’s exposed perineum as numerous couplets of eyes looked on), and the flimsy shower curtains that separated us from other exam “rooms”. But overall, I could not have been happier, hovering around my new patient, waiting for new life in Haiti.
The baby came out small, stained and floppy. One unintended benefit of malnourishment is that babies don’t get too big, and don’t often get stuck in the birth canal. The delivery itself went rather smoothly. Minimal tearing. Things started off slowly for the baby, but our noble pediatrician performed some equipment-less magic, and the baby came around after a few minutes. Eventually, he looked good enough to go home by the end of the morning.
That’s right. 3 hours later, the lady slowly tottered out the front door, heading home. As I sent her out – consternation swirling in my chest at sending a stressed baby home on the day of delivery – I asked her to bring the baby back tomorrow so we could check on him. The mother agreed, and appeared as promised almost exactly 24 hours later with a clearly healthy baby boy.
Only on her return did I learn that she lived 3 hours away…on foot. The day before, the woman walked 3 hours to our clinic in labor, and then returned home the very same day, carrying her new baby. Without complaint, she returned to the clinic again. Another 3 hours. Just routine for people like this, I guess. Never a complaint. Only dignified, quiet gratitude.
And nary a word about my flip-flops.