Tuesday, January 6, 2009

Hospitals in Haiti---and Some News

It's been five months, so I figure it's time for a new blog!  I wouldn't want to overload any of you with news of Haiti and myself by writing too often, you know?  Actually, life's just been super busy with wedding, medical and optometry mission conferences, work, new house, new marriage, and holiday visits to the stateside folks.  But now I've finally found a couple of minutes and a high speed internet connection, so I'm taking this opportunity to update my much-neglected blog.
   The topic of this blog is Haitian Hospitals, because they've been on my mind a lot lately.  For personal and professional reasons.  As you all know, health care in Haiti is a funny thing.  And I mean funny in the tragic sense of the word, of course.  I was very happy to move to Christianville and I've been overwhelmed at how much nicer it is to practice medicine in a facility with a full lab, xray capabilities, and ultrasound.  It makes diagnosis 100 times easier than it was in Seguin.  However, there remains one frustration.  Seguin was two hours from any hospital, and Christianville is only five minutes from one, and about one hour from dozens of others.  So I thought that moving here would eliminate some of my hospital frustrations, but it turns out they are only magnified by working so close to civilization.   Why?  Because whether you are five hours or five minutes from sub-par hospitals doesn't change the fact that they stink.  There are a few exceptions to this rule:  a Doctors without Borders hospital for pregnant women (but they only take the very sickest cases and turn all others away), a free Catholic hospital for children under 13 (but they are often full and have to turn patients away), and a Harvard funded episcopalian hospital (that is four hours away by bus for our patients).  Besides these hospitals, we shudder each time we have to refer a patient for hospital care.  Here are some examples from patients of mine.
In October I saw a woman who had been bleeding for more than one year straight.  It was like she stepped out of the biblical story where the woman with the "issue of blood" came and touched Jesus' robe.  Only I couldn't offer her Jesus' robe.  I did pray for her, and sent her to a hospital for treatment.  She had a hematocrit of 7 (normal is 36 and anyone with a count under 10 should probably not be alive... definitely should not be standing in my exam room having a conversation with me).  All this woman needed was several blood transfusions and a hysterectomy.  I sent her to the hospital, and the next time I saw her was two months later.  She had a hematocrit of 13 (still very dangerously low), and had a tissue sample in a cup in her hands.  She said the hospital had given her one unit of blood, made her lay in bed for weeks, and then taken a biopsy and sent her on her way to go get it analyzed and bring back the results (a process which could take weeks in Haiti).  She was still actively bleeding.  I gave her more iron, sent her on her way to go get the biopsy analyzed, and tried not to bang my head against the wall.
Another patient of mine was a young man whose wife brought him in.  He could barely stand up and was complaining of a huge headache.  I examined him and found neurologic deficits.  Jim came and looked at him and saw a cranial nerve palsy.  We sent him to Ryan to have his eyes examined and Ryan found cranial nerve problems as well.  All this led us to believe he had a mass or bleed in his head.  He needed a CT scan right away.  Sandy gave him the money to go get one done, and he came back the next day with the results.  There was a large amount of blood pooling in his brain.  He had had an aneurysm that burst, most likely.  He needed immediate surgery.  We called a neurologist, who told us to send him and his wife (they were both very pleasant people and appreciative of everything we did for them) to the hospital.  The neurologist said he would meet them there.  Perhaps he did, but if he did meet them there, he did nothing during his visit to help them.  The man died that night.  His distraught wife came to cry on Sandy's shoulder the next day.  Perhaps this man would have died in the States as well, but at least an attempt would have been made to save his life.  In Haiti, he was just left to die in his hospital bed.
  Perhaps you all remember me telling the story of the pregnant woman in Seguin who gave birth to twins and then started to hemorrhage.  It was 10 at night.  I had no pitocin.  I needed to get her to a hospital.  She bled all night long in my truck as I went from one hospital to the next looking for help.  Four hospitals and 8 hours later, I finally found help for her.  That is the state of hospitals in Haiti.  Why am I telling these depressing stories, and why do we have a Hospital Fund, if this is what the patients get?  Well, many times patients do get the help they need... it's just not as fast or as neat as we are used to in America.  Patients do need CT scans and surgeries to remove cancer or repair ruptured bowels or broken bones, and the Hospital Fund helps make that happen.  It's just frustrating for us to send our patients out, knowing that they won't get timely care, but praying that they will get the care they need before it's too late.  Please pray with us for our very sick patients.  Pray that they will receive mercy at the hospitals that they are sent to, and prompt treatment.  Pray that we will have wisdom to choose the right hospital for each different case.
Now for the personal side to these stories.  I've been thinking a lot about hospitals in haiti, because I may need to use one this year.  It turns out that the honeymoon that Ryan and I took in the Dominican was not only relaxing and wonderful, but also reproductive.  We got pregnant!  I'm due in early July.  It would be easiest for us to stay in Haiti to have the baby, but knowing all that I know about hospitals in Haiti, we have decided to try to come stateside for the birth.  We won't be moving permanently back to the States.  We'll still live and work in Haiti after the baby is born, but we are currently planning on coming to Minneapolis in June (or May) to prepare for the birth of the wee-one.  Please pray for us as we decide when the best time for our trip home would be.  Timing is everything, and only God knows when this little one is coming.
   Happy New Year!