April 4, 2015
Today is Saturday and our last clinic day. Susan had a premonition that it would be very busy today, which makes sense since word had gotten around that we were here and most were off from work. We were also under pressure to be done by 3 so that they would have time to clean the church for Easter Services. Over 300 people arrived today. We saw all of them. Carlos and Joel did an amazing job controlling the crowd outside at triage while the students and Susan took blood pressures and pointed the patients in the correct direction. The detailed history that a third year medical student takes towards the end had to be thrown out the door so we could get everyone seen. We had already run low on some of the medications yesterday so the pressure was really on. We did have to jump to second line therapy for some complaints. We were out of just regular Tylenol thus moved to Tylenol Cold for pain. We ran out of medication BPH complaints days ago, antifungal creams went, visine was gone, we ended up bringing our snacks and crackers from the house to hand out as gifts once the packages of soap, condoms and tooth brushes were gone. After a very long wait, when each patient arrived to the front of the line they would pile on the complaints. There was a bit of desperation in everyone’s eyes. They were facing their last chance to receive our examinations, attention and free medications, a few tablets for pain relief of a toothache, a burn, a sprained ankle, a broken wrist. I tried to decompress the line a bit as the students worked through each patient. We found patients that were only there for eye drops or cream for their hands and fulfilled their requests and tried to send them on their way. Magically we saw everyone and done before 3! The gynecology station was typically last to finish due to a more involved exam and testing but we only brought 200 speculums, thus empiric treatment became necessary. This week we saw over 1000 patients, did 150 Pap smears, treated 100’s of adults for hypertension, 100s of kids for worms and anemia, relieved some suffering from the knee, back and hand pain of these hard workers.
After we cleaned up the Pastor of the church graciously invited us to his home. His wife had made a full Haitian meal for all of us. The food here by the way is fantastic. A typical meal is rice and beans, pickley (pickled shredded cabbage), beet and potato salad, chicken or goat with a tangy red sauce, Yucca , and the ubiquitous mangos. The attendings with Lisa and Aline met with the sons of the pastor who are both doctors. They had both helped us through the day and see patients in Mussote for a total of 3 days per week. The meeting was held in Spanish since it was the most commonly shared language at the table. They both know Spanish due to going to medical school in Cuba and have returned to give back to the community. From what we gathered they took 3 days per week to give medical care to the community, a financial loss form them since the visits cost more than what they charge. They did not see patients regularly for primary care since the people there were not used to the concept of seeing a doctor routinely but also due to cost. Even though their consultation was only 75 gourds (about $1.50) and by the time that they bought the medication it was 200 gourds ($3.80) most of the people there could not afford it.
The Fan Fan brothers were familiar with the community health care worker since it is available in Cuba and like the families in Mussote that were asked on the survey were also enthusiastic. The vision is that they will find a community member who is well respected there. HEAL will look into the training which will likely occur with the Partners in Health group that already has a training program in place. HEAL will fundraise to pay their salary. The health care worker will do home visits and perhaps help run some clinic visits. Check on families, check on who needs medications, needs to see the doctor, needs nutrition, etc. This has been shown to work well in many communities across the world that does not have health care access. It will also fulfill the need to provide continuity in the community and have a lasting impact from our too short stay and intervention.
We also found out that the Fan Fan brothers are frustrated in not being able to get the sick patients to the hospital due to their inability to pay and often pay the cost themselves after trying to do what they can from their clinic. Our thought was to see if our organization to pay for at least all the children who need to be hospitalized. After meeting all of them, it would be unbearable to see another unnecessary death that could have been covered by $58.