"Li pa ka pale"

      I was on call this past weekend. This was the emergency Chancela and I left church to go deal with. There is a moto waiting just outside the church yard to carry the nurse to the "emergency ". I got on the moto for the short ride theough Oriani to the clinic. No one is there. So I ask the moto driver where is the person with the emergency? "They are coming. They are in a machin in Oriani". So I unlock the gate, unlock the clinic, check to make sure my exam room is ready for whatever this emergency might be. Still no patient... Meanwhile Chancela gets to the clinic also,  she opted not to ride on moto. Looks like I should have done the same, but it is too late now. I ask her if anyone told her what the emergency is. No, she doesn't know either. We are both waiting at the clinic when  a kamyon (a big farm truck used to haul produce and everything imaginable to market) pulls up by the gate. They want to bring the kamyon right on the yard so someone opens the gate wider so they can back in. Then someone decides they should really back up as close to the front door of the clinic as possible so more revving of engines and hollered directions are given. The truck comes very close to smashing into the front of the clinic because they didn't  turn as sharply as they wanted to but it comes to a stop with a few inches to spare. The " emergency" that is obviously in the back of the kamyon is still very much of a mystery to us. The "tailgate " of the truck is lowered and several young men hop up in the back to assist those already in the back with getting the patient into the clinic. About 6 people carry a metal bedframe with a lady on it to the back of the truck where several more are waiting to carry the bed to the clinic door. So, surely this patient is deathly ill right? We don't let them attempt to bring the bed in the front door so they stop on the porch and probably 4 people manhandle and carry the lady in to the exam room and put her on the table. She is young with no obvious injuries. She does have a few tears on her cheeks. We ask what the problem is... " li pa ka pale". The literal translation is... she can't talk.  Ok. Wow! There are several ladies there who say the patient fell this morning and now she can't talk.  Chancela asks if the husband is around. Yes, he is outside. So she brings him in and asks him to tell us what happened because the patient is not talking. She just looks at us and will occasionally shake her head. His story is similar, she fell this morning and now she can't talk. We ask if she is angry. No, she isn't angry. There have been times we have had patients who will not talk because they are very angry at someone. There have also been times " pa ka pale" is a severe case of indigestion... at least that is the only thing we have been able to determine is wrong. Two ladies stay in the room with us,  we send everyone else out. Chancela begins asking questions. The lady refuses to talk or even open her mouth at first. We give her some pedialyte with a syringe. At first she just holds it in her mouth but eventually she does swallow it so we give her some more, via syringe. She swallows it, though reluctantly at first. While Chancela is asking questions, I took her vital signs. Completely normal, all of them. I check a blood glucose and since we needed to do a finger prick for that anyway, went ahead and did the rapid test we have for HIV and syphilis. Glucose is 99, the other tests are negative. We give her a Tums to chew and some more pedialyte. By now Chancela has convinced her she can sit up without support. She is starting to talk a little too. Shakes her head that she can't lift her arm to her head but does not resist when we lift it for her. So, what shall we treat her for? Your guess is almost as good as mine. We check her urine for a UTI and do a pregnancy test, all negative. She says she hurts but we really don't get much more information. Something is going on though because a tear will occasionally slip down her cheek. If she is angry or sad she does not tell us why. After we get the urine sample we do not help her back up onto the exam table but rather let her lean against it and give her a small cup of pedialyte to drink by herself. The other two ladies who are in the room are happy when Chancela gives them each a small cup of pedialyte to drink also.  She is talking some now and is leaning against the exam table without support from anyone else. We have not discovered anything else to treat so get some Tylenol, iron,  and some more oral rehydration powder to send home with her. I throw in some vitamin b powder also for good measure.  One of the ladies goes outside to collect the payment from the husband- 500 goudes ( approximately $5) - for an emergency call.  They say "thank-you, thank-you nurse..." The two ladies walk on either side of her supporting her- one of them takes off her own shoes and gives them to the patient because she doesn't have hers along. They support her to the edge of the porch and then a couple guys pick her up and carry her just outside the clinic gate while a couple others carry her bed. We lock the gate and leave them there to figure out is the best way to get this lady and her bed back to their house.  We gave her a Tums and some pedialyte... who knows what the whole story was. But she left the clinic able to walk with assistance,  able to talk, and able to drink. Chancela and I got back to church in time to get in on the last few minutes of the service.