Thursday, October 16, 2014

Tuesday in Leogane 2014

Jean Marc encouraged me to spend some of my brief visit here working in the lymphedema clinic that Notre Dame and Hospital St. Croix jointly run as an outreach to those already permanently disfigured by lymphatic filariasis. In many ways these are the patients who Notre Dame, CDC, and IMA World Health, couldn’t get to in time. Lymphedema develops after years of chronic filarial infection.

Eradicating the transmissible blood borne microscopic filarial worms is one matter (Diethylcarbamazine aka DEC is being distributed to kill the worms), while tending to those who are irreversibly suffering from damaged lymphatic valves (lymphatic system works like the arterial and venous blood systems but pumps serous lymph instead of blood) is a practical matter of providing compassion, hope, and engendering good will in the community. Once the body’s immune system reacts to the worms and attacks/damages the lymphatic vessels there is no cure. Lymphedema from venous insufficiency and other causes is common in the United States. Lymphedema from lymphatic filariasis can be controlled in the same way - with pressure stockings and close attention to skin folds which are high risk spaces for fungal infections. Notre Dame (in addition to preventative measures with DEC distribution and symptomatic control with the lymphedema clinic) brings down urologists to operate on those with filariasis induced hydroceles (scrotal swelling). Hydrocele is the only component of Lymphatic Filariasis/elephantiasis that can be surgically reversed.

Last week a group of lymphedema experts and doctors from Nova Southestern University in Florida (Osteopathic medical school) came down to Hospital St. Croix to teach several Haiti Program staff osteopathic lymphatic pump techniques that have been shown to reduce lymphedema over time if performed on a regular basis. Additionally, they set a system in place for monitoring the size and progression of the disease with circumference measurements in 5 locations on the legs each time the patient comes in for treatment. One of the staff who was selected for training happens to suffer from a tremendous “gwo pie” – big foot/elphantiasis himself and is especially pleased to have received this new skill.  I encouraged him to become further trained if possible. It must be therapeutic for him to see so many of his fellow countrymen suffering from his same condition pull up their pant legs on a daily basis and look to him for guidance.  While I saw an incurable and grotesque disease, he saw a unique opportunity to empathize and give hope. He was treating the person and not the disease.  I personally felt out of place in the clinic, unable to find the same hope and optimism necessary treat these patients. The smells, the incurability, and the seeming futility of the techniques, left me feeling that with only 1 week’s training he was the “real doctor” in this situation. I was just a machine going through the lymphatic pump motions.

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