Thursday, April 15, 2010

Haiti: Day 13


Well, today was the last day of clinic. Again, we saw many patients, ranging from a follow-up of my first psychotic patient (bumped her risperidone up to 2mg po qhs) to a consult on a patient who felt his lips were swollen (his lip was swollen...we never did quite nail down that appropriate consult thing.) The provision of care here, for all the medical teams including ours, has obviously been limited by the confines of our resources. Many resources we take for granted in the States, such as proper waste disposal units, a functioning lab, and adequate imaging equipment. Medication is probably the most valuable and obvious limited resource. Three other resources, though, have had a particularly significant impact on the way care is delivered, and may not be so immediately obvious.

You know, I really can't emphasize it's very hot here. The heat and the sun affect almost everything that is done, especially in the clinic. Being outdoors, the clinic is exposed to the elements...and so are the patients. Remember, there is a long line of patients formed outside the clinic daily at six AM, and patients often come steadily until five PM. The location of the line shifts throughout the day, following of course, the shade. Clinicians must make sure they avoid excessive sun as well, as they are exposed day after day. It should be no surprise that by the time patients are seen by their providers, many exhibit signs of dehydration. Though the pharmacy is located indoors, it still gets very hot and humid inside. Those conditions directly degrade the viability of the medications inside... a factor whose importance should not be underestimated in a pharmacy stocked almost entirely by donated meds.
And I've yet to mention the effect of rainwater. Three days ago, the entire clinic moved from outside the nursing school to just outside the hospital. There were three recently built wooden structures there, but they had not yet been completed. After the rains last week, conditions in the clinic became very wet, muddy and quite frankly, grossly unhygienic. In no small part due to Dean Alcindor's outrage, a drainage ditch was dug, tarps were placed over the structures, and the clinic was moved to higher and drier ground.

There is almost nothing that can be done here without the help of a translator. Most of the patients here speak only Creole, maybe a little bit of French, and rarely a tiny bit of English. Most of the humanitarian providers don't even speak a word of French, let alone Creole. Several providers, especially those who have made several trips here, have taken it upon themselves to learn quite a bit of Creole. But for the large part, nothing happens without the help of a translator. There are about 20 translators on staff (all young males, for some reason). Most of these guys are self-taught locals, who continue to learn as they work more and more with the hospital and providers. They are informally led by Peterson "Much respect...I'm a businessman, you understand?" and formally by Jack, whom I've never seen without his big, Kanye West-style shades on. Love them or hate them (I love them), nothing happens in the hospital without them. That was never more painfully obvious than this past week, after Ali was gone. Unless a patient spoke very good French, we just could do absolutely nothing until a translator became available.

The world's eyes will not be turned toward Haiti forever. The temporary hospital and steady influx of doctors are not permanent. From our standpoint, there's just only so much you can do in two weeks. It's extremely difficult to provide good care, provide good follow-up care or have something approaching a legitimate impact on the mental health of even a small region of Haitians in two to four weeks. Treatment takes longer. Proper education takes even longer. And establishment of adequate systems and this country...I hate to think of how long it might take. If anything is going to happen of significance, its going to take more time. But we all know what they say time is...

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