Working in Haiti, even for such a short time, was an extremely large experience, and I struggle to find any narrative inroads which will allow me to talk about it in any way that feels responsible or complete. I worked at a tent hospital which is located within the grounds of the Port au Prince airport (seen in the photo to the right) for a week, during which I spent one day in the Port au Prince public hospital, the Hospital Université d'Etat d'Haïti. I spent the most time working on the wards (the second tent from the right in the picture) which are shown in this Associated Press shot:
This is pretty much what they were like when I was there. There were basically four of these rows of cots, each about a foot apart, extending from one end of the tent to the other - about thirty-three beds or so per row. The rope running overhead between the rows was for IVs and bed numbers. The daily modus operandi was to start at the beginning of a row and work your way to the end, doing whatever you thought the right thing probably was as you went. Each row had two nurses (at most) who ended up working much harder than me since their responsibilities tend to be more time-consuming and physically active.
The facilities were exceptional when compared to those available in the surrounding area, but nonetheless rudimentary - there was a diagnostic X-ray machine, a lab which could to basic blood tests, and a pharmacy which consisted of several shelving units behind a folding table stacked with donated drugs.
Now that the wave of acute trauma caused by the earthquake is mainly over, the tent hospital is functioning as a general hospital for the area and seeing what I guess is a typical range of urban Haitian pathology. This consists, as far as I could tell, of a lot of trauma (earthquake or not), from car accidents and gunshot wounds (more of the former and less of the latter than in my West coast teaching hospital), a lot of infectious disease, mainly malaria, HIV, and TB, and an undertone of familiar conditions which I see a lot of here, e.g. diabetes, hypertension, emphysema, etc.
I complain frequently about the lack of resources and funding at my county hospital, and I will continue to do so, but as you can imagine I now have a rather different perspective. Next to the tent hospital, the county looks like the Mayo Clinic. One of the things that was most frustrating, however, was not the absence of some piece of diagnostic equipment or therapeutic intervention, it was the lack of any kind of continuity. Except for wound care, we had no capacity for an outpatient clinic or any of the infrastructure (particularly medical records) that one requires, and in any case most of the volunteers were only there for a week. This made for a lot of extremely sad and frustrating discharges, where we were sending people out from the hospital basically to tent cities or just to the streets, and not only could we not get them housing or other material resources we couldn't even tell them to come back for a check-up. This was particularly maddening for me as a primary care physician who is deeply committed to a model of chronic care. Ironically, I felt relatively comfortable with cases of malaria since they can be cured - cases of diabetes or hypertension were upsetting because there was no real choice available other than palliative care for what are essentially treatable diseases.
That's as close as I can get to a five-minute summary. I'll try to intercalate some discrete stories in later posts.
Posts
