HEAL Haiti 2015 Dr. G's Second Post

March 31-April 1, 2015

Our first day of seeing patients was busy.  We saw over 200 people that day.  The elderly sick folks tend to show up the first day.  One woman had a stroke 2 days prior to our arrival and was paralyzed on the left side of her body.  Jimmy, the brilliant and caring ED resident who joined us this year, and the students saw her, not much they could do except give blood pressure medication, aspirin and go over some PT type exercises.  Many of the people we saw last year I recognized this year.  Many were thrilled with the medications we gave them but they ran out, they were excited to see us again.  We proudly gave them enough pills to last an entire year this time around.  One woman laughed with joy at the number of pills she received.  One woman was in atrial fibrillation, had a blood pressure of 210/100, heart rate was 110.  She received Diltiazem, aspirin and Lasix.  She came back today with a heart rate of 85, BP of 175/89, not perfect but Much better!  She is someone who would have been hospitalized, on IV therapy, echocardiograms etc., in the US or any western country.  This is simply not an option here.

 Carol Anderson, our pediatrician saw a 2 year old child (the size of a US 10 month old baby) yesterday that had an acute abdomen, obviously sick, in pain, vomiting, intusseption (telescoping of the bowel) was a concern.  Dr. Goulos the local doc we work with was concerned that she would not go to the hospital due to the expense to the family and it was decided to give her IM antibiotics due to the likely diagnosis of Typhus, try to feed her and follow up the next day.  The baby was listless this am, with rapid heart rate, dehydrated, still tender to the abdomen and now not crying…  quiet in Mom’s arms (an ominous sign in pediatrics).  The mother felt the child was better but she sure did not appear that way.  We managed to have the supplies, Carol started an IV on the baby, and Dr. Gousse brought her by car to the hospital.  We are going to cover the expenses for the family.  Dr. Gousse also left money so the mother can buy meals since the hospital is a 45-minute drive from Mussote.   So many questions; will they have a CT scanner, a surgeon if needed, get enough care to keep her alive, how is the baby going to get home once she is better?  Susan mentions that in the US when you hear about a 13% mortality rate for children under 5 in Haiti is a “Oh what a shame” shrug, but seeing and caring for 1 child that may die in the next 24 hours is a whole different dimension. With adequate access to health care is this a preventable death?  How many are like this? Apparently families wait until the last moment to bring their children due to inability to pay for hospitalizations.  HEAL gave the $58 to pay for the child to be hospitalized.   

Andrea Walker was able to take time away from her busy OB/Gyn residency to join us.  We had already been doing Pap smears on all the women we see between 16 and 60.  We were very excited to offer “See and Treat” for early cervical cancer this year.  Gladys was able to secure a Nitrous Oxide tank here in Haiti and HEAL is still raising $2000 to pay for  the cryo-therapy equipment to bring to Haiti.  All the women we see are screened with a spray of vinegar to the cervix to look for early changes consistent with cervical cancer.  It only takes treating 6 patients to prevent one from getting later stages of cervical cancer.  In the US women are used to getting routine pap smears to prevent cervical cancer, a horrendous disease once it gets past the cervix.  We rarely see cervical cancer in the US. The screening for this cancer is so effective.   A woman came to the clinic today complaining of inability to urinate or defecate.  Her pelvic exam showed advanced cervical cancer, sure to bring her a painful death.  Her one son who has disabilities will be orphaned.  Such heart-break is unbearable.   Unfortunately, cancer screening and treatment is something that rarely or never is available in Haiti.  Our hope is that the cryo we bring to Haiti this year will prevent another woman from facing this fate.