Wednesday April 2 early morning

It is 5 AM and here I am typing in the dark again. Our EDH power goes off at 3 AM and we will switch over to the generator when Dick wakes up. So I am sitting here, with the aid of my flashlight and the laptop screen and blogging again. This will be a lot of rambling thoughts that I made some notes on last night. After I signed off last night I made a trip up on the roof for a few minutes of star gazing. It is one of my favorite past times while I am here. There is very little ambient light and the stars glisten in the night. One is able to see the entire sky. As I type, Jeremy is preparing to leave for Port-Au-Prince. He is ready to go home. He has been a great friend, a wonderful caring doctor, a patient teacher, and we have had a good time. Thanks again to Lori F for sharing you man with us. I will miss him
Every morning, as soon as the sun comes up, one can hear sounds from the property to the West of the clinic. The sounds are being made by 1 or 2 men as the try to break up the rocks with a sledge hammer and throw the rocks into the bed of a dump truck. This goes on until almost dark. I am told that the property is being cleared for a resort, at the current rate of rock breaking and the rocky nature of the land it will be many years before the resort is a reality.
I was told by Lynn yesterday that I need to do a better job of proof reading before I post to the blog. I told her that I had heard that request time and again and the advice never seems to sink in. I’ve been thinking about buying a voice recognition software program. I have always been a two fingered typist and it takes quite a bit of time to put the words on the page. I wonder if that is available at Overstock dot com.
Another first on this mission was the arrival of a drug rep. Two men drove up with a van filled with boxes; Dr Nelson had invited them to visit. Papa Dick and I spent about 45 minutes and I will be bringing back samples of their wares for the pharmacy committee to evaluate. I will also be bringing back their current price list so that I can convert it into USD. We did purchase all of the cough syrup that they had on their truck as we had just run out of our supply and every patient we seem to see yesterday had a cough. I ended up splitting the 4 oz bottle into some of the empty bottles that I had left from previous missions. Mark will need to purchase more 2 oz dropper bottles, 2 oz amber grads, and 4 oz amber grads for the May team. We have used the bottles to send home a variety of medications. One of the most interesting is the suspension of Griseofulvin that we must prepare for the children. We only have 500 mg tablets available so we calculate the child’s weight in kilograms, multiply it by the dose per kg, multiply that by a 30 day supply. Then we have the total number of milligrams required. That number is divided by 500 and we have the number of tablets that we now must grind up in a mortar with a pestle for our mixture. Next we add water to make the suspension and dispense it in the dropper bottle with a dropper that puts out a 1 ml dose. Why, you ask, don’t we purchase it already made? The answer is the cost is prohibitive. On previous teams we were able to purchase some short dated bottles at a great price but I have not seen that since.
On every mission we constantly hear the complaint that our patient has run out of medicine and we discovered a new reason yesterday. Several patients have complained that they were told to take the medicine twice a day by the interpreters in the pharmacy when the order was written for once a day. The great folks a triage brought me a sample early yesterday morning and I was easily able to see how that could happen. There was a comic strap that I have not seen for sometime. The character was named POGO and he often would say “We have met the enemy and it is us.” Yes, our poor handwriting and abbreviation shortcuts got us into problems again. One of the physicians, and I will not name names here, had written for the drug to be given 1 q day however the q looked very much like a two so either we could have written for two doses per day on the bag or, more likely, our interpreter, who reads the orders off of the dossier and not off of the bag of medications, could have told the patient to take it twice. This issue will have to go to the pharmacy committee and the medical advisory committees for discussion. I will be bringing back a copy of the order. I will also be bringing back some of the concerns of this team that they want to address to the medical advisory committee. That will be a longer meeting that the normally long ones that I have attended in the past.
More random thoughts: The suppliers that made the visit had medications from a company in the Dominican Republic so the labels were in Spanish. They did have some horse Viagra available but I told them we did nit have a protocol for that medication. By the way, we did have several requests for Reglan and I am sorry that I did not think to order it.
I may have already told you in a previous blog that I heard from my friend in Malaysia since I have been here. She manages to catch me on line via MSN Messenger. It blows mind that one can talk with someone on the other side of the world from a computer in a third world county.
I seem to have inspired another blog. You can find it at www.xanga.com/sunandsea. I have enjoyed teasing Davis with it and now my son has written to the author and that caused a red face on David again. Ha! Speaking of my son tonight is his night with the kids so I hope to be on line sometime when they are also on line. Also a note to Liz’s sister: thanks for the ammunition. I had a blast with her once I found out her age. Keep up the good work.
For my readers from previous teams, this is my scruffy period when I do not tae time to shave but home is coming soon so it is off with the scruffy today, sometime or another.
Another important fact is that beet potato salad is great but it goes in red and exits at the same color. Nuff said there.
We will run out of Ivermectin today. I want to refer you to Diana’s blog (www.xanga.com/aniaDiana) to read the song that I first hear from Dt. Bill about Ivermectin. We have exceeded the 1200 patient level that was predicted so now we will do the best that we can. We are also out of stool softeners and I’d recommend that we order a larger supply.
Time for breakfast and then to work so I’ll try to get this posted. Weather is cooler today but the sun is out so that will not last long. Please keep those comments coming.