Thursday, September 16, 2010

Things That Make You Go Hmm

As I've been studying for my Primary Care Pediatric boards today, I'm reminded a lot of Haiti. Understand that pediatric healthcare in Haiti is much different than here. However, with the increased MISUNDERSTANDING and blatant DISREGARD by Americans for immunizations and healthcare in general, there is a ever increasing need for pediatric providers to identify and treat diseases that were almost extinct from our continent.

One review question just read:

A 17-year-old student is seen in the school-based clinic for a fever and sore throat of 4 days' duration. The results of the rapid strep screen confirm the diagnosis of streptococcal pharyngitis. The student has had a problem remembering to take other medications, and the PNP wants to ensure compliance with an antibiotic. The PNP decides to give:


In Haiti, right after the earthquake, I came in contact with probably 500 children. All broken in someway. If not physically then emotionally. Socially. Spiritually. We gave out thousands of prescriptions, vitamins, over-the-counter analgesics. And lots of shots. Rocephin. That's what we had.

Now as a pediatric trauma nurse, we don't do a whole lot of shots. Contrary to popular belief, shots don't cure all. But somehow this idea is multi-cultural. The Haitians see a cure-all in a good old fashioned shot, too.

This summer I was present for probably 200+ immunizations during my clinical time in a pediatric primary care clinic. About 80% of the time we had to wrangle and struggle and LAY on top of kids - OLDER KIDS sometimes to give them their immunizations, only to be kicked, grabbed, spit on, you name it - it happened.

Engrained forever in my visual memory is a young Haitian boy about 7 or 8 (maybe older? they are all skinny and short due to malnourishment...) who walked over the the "pharmacy" in which I was the "pharmacist" for the day and handed me his little piece of torn off paper with a smile. This paper acted as his "prescription" from one of the doctors he just saw.


Got it. So I sat him down in a chair, spoke to him in my broken French and pulled up his sleeve. He was there alone. No parent holding his hand. No onegiving him the pep talk, or telling him he could have ice cream when we were done. So I gave him that nurses look deep into his eyes that said, "this will hurt, but only for a second." He nodded at me, took several deep breaths in and out, and with eyes open and not a flinch or a tear, he took that whole IM needle into his skinny little arm and said "merci" when it was over.

And that was it. No drama. No crying. No fighting. And no parent to encourage that behavior. He took his sticker that I gave to all my patients, and went on his way.

So I think of this brave young soul who survived an earthquake, who may have lost family members but most certainly lost friends and shelter. I think of him being brave enough to endure a needle in a malnourished arm with the hopes that western medicine can make him well. Because he knows what it looks like to be ill. He has seen death from flu and diarrhea and pneumonia and other preventable illnesses. He's seen the value in protection and treatment.

I think of him as I read the review question about a 17 year old who can't remember to take his medications but is sick enough to walk into your clinic. And I'm sad it's even worth bringing up on a test for pediatric care licensure in America.


  1. I love your blog Tiffany! It's nice to be reminded that we should not take these things for granted.

  2. And the answer is???? Don't leave me your blog by the way!


  3. Thanks for sharing your experience. Reminds me how much I take for granted. Keep the blog going. Great Stuff!