Two Ends of the Spectrum

This morning, we went back to St.Luke’s and assisted again in the clinic and the ED. During the night, a 26-year-old female presented with altered level of consciousness and hypotension. Hx of a stroke with a right-side deficit, post-partum. The doctor interpreted well; I could tell she was a very good clinician. The group had commented earlier that morning on her skill. She has no choice but to be very, very sound in her assessment skills, as she doesn’t have any other diagnostic equipment. She had assessed this patient and realized there was an S3 gallop. This patient was not doing well.

The Haitian doctors were looking for Vahe to perform and interpret an Echocardiogram on the patient, as the physician’s staff didn’t know how to do the procedure. Vahe performed the ultrasound on the patient’s heart, and found a vegetative growth that resulted in an inability of the heart valves to function correctly. This young girl had endocarditis. The diagnosis was helpful in creating a treatment plan. They began her on antibiotics.

We saw 3 CT scans this morning. All severe hemorrhagic strokes. Over 45% of the patients present with a stroke. The hypertension epidemic is out of control, resulting in all these strokes. No one can afford anti-hypertensives. The hospitals do not have them. They do not have much.

Yesterday, I borrowed Reneau’s phone and called back to work in Cambridge. Pro was reacting as usual, already making plans to help with supplies. I emailed Bill, and although we both knew it wasn’t sustainable to send a few cases of fluids and glucometry strips, he was already working on getting supplies down here. He emailed me back, “Call again, I have JJ here and he can order what you need.”

Jeremy and Reneau stayed at the hospital to teach another BLS class. The rest of the crew, including the medic students, rode in the van to the General Hospital about 4 miles and 45 minutes away. The ride was very hot and bumpy. Along the way, we picked up a doctor and his interpreter from St. Damien’s Hospital. Eric was at the end of his one-month rotation and had not yet been to the largest hospital in the city. We exited the van but couldn’t even take a breath. We felt like gasping for air but that made it worse – the smoky air was so heavy and filled with the smell of trash and bodies and ….. eew. I can still smell it.

Our arrival was quickly elevated to the Medical Director, a distinguished gentleman in his sixties who spoke English remarkably well. After a bizarre yet motivating conversation, he agreed to let our team inside the gates. Initially, he didn’t want to let us in but I pushed him. I wanted to see. He said, “This is not what I think medicine should be.” We were not there to judge. We were not even there to help, but to see and understand how St. Luke’s was not that bad. To understand how we could add value to that place. There was nothing here for us. I thought maybe there could be.

The bodies were everywhere. Jamie had once described how there was a patient in every possible place, in every nook and cranny of the hospital. He was sadly accurate. We slowly walked through the halls and open areas of the hospital. There was clearly a place for the records, or archives as they call them. I was not yet clear on where the patients checked in. This was a tragedy. Medical students were performing wound care on a bench. There was a man clenching his abdomen and writhing in pain. It was so distracting and we felt very sad. We exited and passed by the children’s hospital about half a block away. There were small, small babies. So sick. So sad.

We went back to the 100 degree van and, due to traffic, we took a shortcut. We passed the ruins where the national cathedral once stood. Women holding babies were hanging onto the windows, asking for money to feed their kids. In Boston, we would doubt the money would be used for food; here, there is no doubt.

We showered and waited to be picked up to go to dinner. We drove into the mountains and photographed million dollar homes that we didn’t know even existed! We had dinner in a restaurant with a jazz singer and a smooth saxophone. We could drink the water and didn’t have to get a bottle. We had ice. It was more like home. The weather was perfect, no longer hot in the mountains. We turned around. Baby Doc was dining at a table behind us. We saw the poorest in the morning and the richest seven hours later. We felt relieved though. We needed a touch of what we thought was normal. They have never known this. I guess it’s all relative.

Posted in 2013 April, Clinical Experience, Haiti, Patient Stories

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