January 12th, 2011 by Angela Quinn
A medical career spanning 35 years allows a certain perspective regarding medical care in a third world country such as Haiti. Travel to a third world country with a devastated infrastructure offers significant challenges due to a virtual absence of technology and provides the opportunity to call on old skills that preceded the technological revolution in medicine. In the years following medical school, I practiced medicine without the benefit of ultrasound, CT scans, MRI scans, point of service laboratory testing that evaluate hematologic, electrolyte, liver, kidney and heart function or home testing such as glucose monitoring. Subsequently, all of these technologies have become integral to the practice of medicine and are utilized on a daily basis throughout the United States to provide quality medical care.
During the most recent Bless Back Worldwide mission trip to Haiti we accepted the technological deficiencies and took on the medical challenge armed with the basic tools for physical examination: urinalysis dip sticks, blood pressure cuffs, glucometers for glucose readings, the Epocrates data base via I Touch, our basic knowledge and common sense and an arsenal of carefully chosen medical supplies. Assisted with insights from the Haitian physician Dr. Don Derat, we quickly adapted to the reality of the diagnosis and treatment of medical problems in Haiti.
Our base of operations was the orphanage clinic in Cambry. At this site we provided well child visits for all of the orphans and provided care for hundreds of adults from the nearby community. Our efforts included painting, cleaning and reorganizing the clinic so that the facility was able to function as an urgent care center. Hundreds of pounds of medical supplies and medications were provided for the clinic. In view of the ongoing cholera epidemic in Haiti we transported 400 liters of IV fluids and the necessary IV administration sets, appropriate antibiotics and large amounts of WHO rehydration salts.
As a result, we were well prepared on a typical busy morning at the clinic when a critically ill patient arrived, transported by a motorcycle cab. This elderly man’s history, obtained from a non-medical translator, was four days of vomiting and diarrhea. Today, in Haiti, these symptoms indicate cholera until proven otherwise. He was profoundly weak, diaphoretic and his mental status was impaired. The clinic was crowded with children and adult patients and no examination rooms were available
In view of the high likelihood of cholera, he was quickly directed to a covered outside corridor that became our cholera ward. Initially seated in a wheelchair, he became hypotensive and unresponsive and the concrete floor was converted into a hospital bed. Our team of medical and nonmedical volunteers responded within minutes achieving IV access and administering life saving fluids and antibiotics. As our patient improved, additional oral antibiotics and rehydration salts were given. This improvement was gauged by the resolution of his diaphoresis, his improved mental status, his improved pulse and blood pressure readings and adequate output of pale urine. There were no laboratory results to guide our treatment and intervention. Throughout the intense course of treatment, cautionary measures were followed to avoid the transmission of cholera to our team members. Dr. Derat arrived following the successful fluid resuscitation and concurred with our presumptive diagnosis of cholera. Incredibly, our patient improved, was provided additional oral antibiotics and rehydration salts and left the clinic on a motorcycle cab – all within a typical morning of outpatient medicine in Haiti.
Dr. Roy Blank, MD