Where There Is No Diaper

Caution: This post isn't for the faint of heart.  If bodily fluids gross you out, stop reading.  Continue readingat your own risk.

Being a doctor who works with kids, it's inevitable that you will get peed on, pooped on, slobbered on, snotted on and vomited on at some point in your career.  In school when Dr. Mitchell my attending physician on several of my pediatrics rotations informed me of this, I noted it but since it never once happened to me during school I admit, I didn't really believe her.

Since living in Haiti there has been an ABUNDANCE of bodily fluids landing on our floor.  Fortunately the entire house has a tile floor so it's easy to clean up but still shocking each time it happens.  At least once a week a baby will pee while it's here for a visit and it's not wearing a diaper so it goes all over our floor.

I learned long ago not to judge a book by it's cover and since moving to Haiti I've learned that just because a baby has a super-frilly dress complete with a headband and frilly socks on does NOT mean that child has a diaper on and so I should NOT just pick up the child unless I want to get peed on.  This is an important lesson all of you should learn if you ever come to Haiti.

Also about once a week a child vomits all over our floor too.  Just out of nowhere we're doing an intake and "bhhhlllaaaatttt" there it is.  I wish the parents would tell us right away the child's been vomiting so we can get a trash can ready.

We also have some women who pee in our showers instead of the toilet when we send them to the bathroom for a urine sample because they're not used to using a toilet.  This makes me sad as it brings the realities of Haiti to the forefront: there are no decent places to do your business (you're lucky if you find even a latrine) so grown women are to scared of our toilets and opt for squatting in the shower instead.  I wonder how we can get them more comfortable with the toilets because nobody likes pee in the shower.  Please let me know if you have any ideas.

The other night we were hanging out upstairs after dinner when Santo came up and said there was an "emergency visit" here to see us.  Sean, Zeenia and I must have been bored because all three of us went down to investigate.  We found a young mom and her 6 month old, afebrile son who presented with several bouts diarrhea and vomiting over the past 24 hours.

We knew we needed to rule out cholera so we asked the mother what the diarrhea looked like and she couldn't really give us an answer since she hadn't been caring for the child that day but she told us he was having diarrhea every 15 minutes or so.  So we thought, "great we'll wait 'til it happens and then we'll see what it looks like and then we can decide whether we need to refer him to the cholera treatment center or not".

This baby was super cute, cooing and talking to us and chewing on everything in sight.  After a few minutes we heard him fill his diaper so we asked the mom if she had another diaper with her.  She said yes and took the first diaper off.  The stool was yellow in color and loose but not super-watery with no mucous (cholera stool is sort of a dark tan color, is very watery and profuse with whitish mucous) so we knew it wasn't cholera and could just treat the child for generalized gastroenteritis.  Plus he was playing so much that we knew he wasn't so sick that he was in danger.

We said "OK you can put the new diaper on" but she just sat there with the child standing between her legs on the floor and didn't make a motion to get the new diaper.  We were all starting to get worried as this was a 6 month old with diarrhea and this is a situation where a diaper is ABSOLUTELY necessary but she was not making a motion to get a new diaper on.

I looked around her and saw she didn't have so much as a purse or a diaper bag in the treatment room and I couldn't figure out where this mysterious diaper was and why she wasn't reaching for it.  So I decided to take action and left the room to go grab her one of our cloth diapers when I heard a splat hit the floor and sure enough, this sweet little baby was having diarrhea all over our floor.  I just started shrieking "where is the diaper!?!?!" and Santo was translating this to her, and the mom still just sat there as if her child wasn't having diarrhea all over our floor.  Most moms I know will jump at the knowledge that their child is having diarrhea all over someone else's floor but not this lady.  She just sat there.

By this time it was getting dark and since the power was out and it was hard to see what was going on I knew I had to grab my headlamp as well as the diaper so this allowed for even more diarrhea to get on the floor.  By the time I got back to the room with said items, a man (must have been the baby's father) came in from the porch, with a diaper bag containing the diaper this woman had claimed to have all along.  She got the diaper onto the child's bottom and we bleached the floor like it's never been bleached before (read I put gloves on and bleached the floor...yuck) and all was well.

We still can't figure out why this woman just sat there and wasn't running for the new diaper or asking us to get it for her if she knew it was on the porch all along.  Apparently there isn't a sense of urgency relating to bodily fluids in this culture that we so obviously have in our own culture.  We ended up giving the mother some instructions on how to keep him properly hydrated and gave her warning signs of dehydration and sent them on their way.

As I say so often here in Haiti, life is NEVER dull.

Thanks for reading,

Dokte Sarah