Wednesday, July 18, 2012

“Please don’t send me to City Hospital, I will certainly die if you do.”  It was probably the most complicated statement this quiet woman had made to me since I first saw her in the Emergency Room three days before.  She said it with her usual very subdued and meek manner, looking away, with a face full of sadness.  What was it that drained her spirit?  Fear of death?  A general forlornness pounded in by years of poverty followed by earthquake?  A worry for her unborn child, four months in her womb?  This I could not say, but I was moved.  However, with recommendations from local providers and administration, I requested she be sent.

Three days prior, she had been brought to the emergency room, the triage doctor quite accurately predicting a large amount of fluid around the lung.  After drainage, she was discharged with antibiotics, and fear that she had tuberculosis.  The next day she was back with even more fluid and required oxygen to breath.  Today we had drained the fluid for the third time, and again suspected TB.  Because initial tests were negative, we could not treat her under our hospital’s TB program, and thus the need to transfer her to another hospital, with its expanded resources.

This was my third week-long volunteer trip to Haiti.  Working with Project Medishare, where doctors and nurses fly in for a week or more to augment and assist the staff at Bernard Mevs hospital.  This project started as a massive tent hospital for surgeries after the catastrophic 2010 earthquake, with U.S. volunteers supplying the manpower.  The project evolved as required surgeries slowed down and local hospitals started to get up and running again.  At this point Medishare partnered with the Bernard Mevs hospital and packed up the tents.  Personnel from the U.S. and Canada still come and integrate as hospital staff, doctors, nurses, physical therapists, and others, with a constant local staff of translators and an extensive logistics and long-term component.  It is a very unique relationship.

It was not until after dark that the ride could be coordinated and the patient left Bernard Mevs.  An hour later I was in the emergency room again when the phone rang.  I answered it, fearing a French-speaking doctor was going to confuse and embarrass me in my rudimentary language skills still remotely in my brain from a childhood of French classes in the Canadian school system.  But it was Jerome, the night-time translator, who was at City Hospital with my patient.  “Dr Paul” he said, “they don’t have any oxygen at this hospital right now. I tried to remove the patient’s oxygen but she was very short of breath.”  No surprise, we had only today been able to get her off the oxygen mask and on to the nasal prongs.

But how could they not have oxygen?  This was supposed to be the place with more resources!  Well, though I had noted dramatic improvement in the infrastructure and the progress in earthquake recovery on this last trip (no tents or rubble in our drive from the airport, and signs of rebuilding and growth everywhere), certainly Haiti remained a challenging place to live.  And certainly a difficult place to be a pregnant patient with fluid around the lungs!

I had to think quickly and make a decision.  Our hospital beds were already filled.  I had been advised to transfer the patient.  But I did not have the heart to make her stay at City Hospital with no oxygen, and risk dying just from that!  So I told Jerome to bring her back.  Somehow we found a place for her and continued treatment.

The challenges of providing quality healthcare in Haiti are legion.  One of the most difficult things for me as the visiting doctor is trying to figure out what the standards are—as things are so different in Haiti than the U.S.  So many treatments are unavailable.  Newer and more expensive medications, more familiar to me, are out of reach.  Or often yes, there is some medication or procedure available – possibly at another hospital across town or if the family goes to a pharmacy for purchase. 

Another great difficulty in working in a medically needy setting is the reason one goes in the first place:  the need.  It is difficult to see people suffer and die, especially of something they would not die of back home.  But if you hope to save someone, you must go to the place where the problem is.  To give of your time, talents, and resources.  And that indeed can be draining.  Frankly, it is easier to help someone who really doesn’t need the help.  To doctor someone who can pay your mortgage, your car, and a boat besides.  And yet, a doctor doctors.  A helper helps.  And “blessed are the merciful,” said Jesus.

My patient improved with more antibiotics, and did not require any more fluid to be drained.  She managed to get off oxygen, and baby and mom were doing well when I left for home.  I hope the best for her, in her medical and other needs.

Overall, the Bernard Mevs hospital is doing well.  The Haitian doctors and nurses have grown in leaps and bounds in the practice high quality medicine, ICU care, and quality standards.  U.S. providers are needed less and less.  There is a CT scanner up and running now.  TB and HIV programs are reaching many.  A full array of clinics are open to outpatients.  And construction is underway on a needed expansion.  If you ask me, Project Medishare is a good organization to put some charity dollars into. There is still room for help:  in work, training, care, continued financial support for the many patients who cannot afford medical care.

God bless Haiti.  May those committed, hard-working people, seeking to bring their country up from despair, be rewarded with a bright future.  And may those with a lingering sorrow, my patient among them, find lasting comfort and rest.

-trip to Haiti, June 2012
-printed in the Olympian July 2012

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