Tuesday, March 12, 2013

Haitian Clinic

March 12, 2013 

I am not a Doctor.  These are my personal non-clinical observations of this third day of clinic in Haiti.  The parasite problem is a much bigger problem than I realized.

A.  PARASITES 101:  The risk of people having them is enormous. The sad truth is that when the earthquake rattled their land, it sent millions of worm eggs/spores into the air which, then, landed on their world.  Larva hatched into the water and the extreme filth that followed the earthquake promoted the ingestion of the worm eggs.  Many patient symptoms point toward the slithering of worms.  Below I have pasted an excerpt from a text discussing the symptoms of intestinal worms by Dr. Annette Bosworth with Meaningful Missions:  

In some people, intestinal worms do not cause any symptoms, or the symptoms may come and go. Common signs and complaints include coughing, cramping abdominal pain, bloating, acid reflux,  flatulence and diarrhea. In more serious infections, diminished sex drive, skin-itching, fever, nausea, vomiting, or bloody stools may occur. Some parasites also cause low red blood count (anemia), and some travel from the lungs to the intestine, or from the intestine to the lungs and other parts of the body.
At first I lacked confidence that worms were such a universal problem.  By the 3rd day, however, I was sure that every single person I had seen hosted a colony of worms.  The adults will not complain of troubles, but, after further reading, I’ve discovered they may not have any symptoms.  Their immune system keeps this problem in check just enough to keep the worms out of the stools.  The best boost to my confidence came when I began asking more questions about the cough.  "It is a dry cough, Docte` that seems to start about an hour after I lie down at night."  The worm migrates to the top of esophagus where it tickles the cough reflex.  Oy! What an image! 
When patients take vitamins or antibiotics, the worms drastically change the absorption of the meds and surely consume much of the nourishment from the vitamins.  I instructed patients to take 400mg of albendazole in front of me, watched them chew the medication, and then handed them a piece of candy to kill the terrible taste.   Chewing increases the surface area of the drug which apparently improves the parasitic kill. This should be repeated in 48 hours.  
 I instructed patients to start the vitamins and any antibiotics I thought were needed for other issues several days after the second worming medication.  Children chewed a 200mg dose in front of me and were instructed to chew another 200 mg in 48 hours.  By the end of the week, I was also giving mothers dosages for any children that were not in the clinic.  Be wary that the medications can be sold on the streets for quite a price, but usually the graphic descriptions of the worms and the need to kill them appeared to motivate people in the right direction.  Albendazole is useful after for patients over two years of age. 

Worms infection will also halt proper peristalsis and, in turn, causes reflux symptoms. Many patients asked for acid pills and the interpreters often jumped to the summary statement that the patients had heart burn.

The chronic skin problems I have been told are a result of the weakened immune system not being able to fight off the simple infections.  The immune systems are weakened from parasites.

The current major cause of parasites is the poor drinking water.  There is NO easy fix for this problem.

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