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HEALTH CARE IN RURAL HAITI
In many parts of Haiti there is only one physician for more than 50,000 people. CarrefourBerth and surrounding areas of Belot, Bongar, Grande Source, Bois Major, Godey, Bolosse, Chauffard, Nouvelle Tourainne, Furcy, Berly, Resencourt, Ti Place, etc) has a population over 40.000 people, but are without a single doctor. As a result of this, many Haitians have a fatalistic perspective on illness. Because people do not have the money to pay for good medical care, or access to such care, they rationalize non-action by blaming illnesses on voodoo. In late 2008, I was working at the Baptist Haiti rMission Hospital when a woman brought her husband to the hospital. He had a fever, muscles pain, weakness, jaundice and had been vomiting for several days with severe dehydration. She told me that she did not expect me to save him because he and two other ones had been voodoo cursed and the other two had already died. I told her I would still do my job as she nodded with resignation.

A quick blood test showed a high white blood count- a sure sign of a bacterial infection. I prescribed a broad spectrum antibiotic with intravenous rehydration. He was able to return home ten days later. Although she was happy her husband survived, she was very sad that her two friends had died. I then realized that if there was a clinic with very low cost which could have administered some intravenous antibiotics and IV fluid, those people would probably have survived.

During my last year as a medical student, I worked with a foreign medical team for a week running mobile clinics in two different churches, seeing close to 200 patients a day. Even when we were in a different part of the country, the picture did not look very different. I realized that it is the system that fails to provide adequate medical assistance to the people of Haiti. The problem was not medical but structural. One needs structure to be able to provide care. To be able to reach certain parts of Haiti, one would either have to walk for hours,or go on the back of an animal. There were minimal to no roads in some parts of the country. Even when local physicians want to help, it is impossible for them to move and live in these communities when they have a family and children who need to go to a good school.

OUR COMMUNITY CLINIC
Even though I had to wait until January 2011 to start the clinic project, the mobile clinics that I had organized in the previous 4 years have had a tremendous effect on the health of many people. The people of CarrefourBerth are grateful to the Baptist Haiti Mission and its pastor, who have offered to let us use their vacant building. The people of the community have offered to get involved in repairing the building. A very good friend of mine, Ian Mackay flew from Canada to volunteer for the first months at the clinic to get our inventory and pharmacy in working order.

The first day of work at the clinic was an exceptional experience. About 100 people were waiting in front of the clinic when we showed up. It was just three of us: the nurse, Ian and myself. We saw 72 patients that day and a lot of people returned home, disappointed not being able to be seen. I felt very bad the next day when a tiny lady returned with her three children because they didn’t make it the first day, they had to come back traveling a four hour distance back and forth. The mother was finally diagnosed with tuberculosis and has been treated since at the Baptist Mission’s outpatient clinic. Tuberculosis treatment is a major challenge for those peasants because of the length of treatment. Once a patient shows signs and symptoms of TB, they are sent to the Mission’s hospital where they screen them with no charge and the medications, given monthly to our nurse so the patients would not have to travel long hours which is a major cause of treatment abandon.

Let me tell you about some of our other patients. The day before the official opening of the clinic, an 11 year old girl was carried in by her mother. She had the worst Staph skin infection that I had ever seen. This is a very painful skin condition that causes skin to abscess and rot. The closest medical clinic was a rugged 4 hour walk away and she had suffered with this for over a week. The sores had spread over her entire back, down her legs and into her genitals. The sores on her legs had wept so much that her upper legs had sealed together, and urination was excruciating. The sores were also infected, and death from blood poisoning was likely. The tragedy here is that staph is generally very easily treated. I prescribed some antibiotics and other medications to deal with the complications and assured her mother that within a week, her daughter should get better. Because of the generous hearts of people she would never meet, two weeks later, a laughing little girl with clear skin and a full life ahead of her was able to return to school.

One morning, while working at the clinic, a man came in and told the nurse that a lady from Berly had been in labor for two days and was being transported ; it took about five hours before she could get to the clinic. After realizing that the baby was in severe distress and there was nothing we could have done at the clinic, Ian and I rushed her to the hospital for appropriate management. Without the transportation we were able to offer, the baby would have not have survived.