In the first few days of the stay in LaCroix, we had the opportunity to visit two clinics. The first clinic was a short walk from the guesthouse, also sitting on the main highway, Route National 1. Just outside of the gate a number of street vendors sat under tarps set up for shade, selling food and purified water pouches. Motorcycles and trucks zoomed past, beeping and kicking up dust. Just on the inside of the gate, there were a few other vendors, set up next to a case full of tiny glass bottles. At first glance, it looked like they were selling single servings of rum—a little surprising on hospital grounds, I thought. But, when I took a closer look, I saw that the glass bottles were empty. "They're for medication," our Haitian friend, Bobi, explained.
We passed the bottle vendors and continued down the palm-tree lined driveway toward the hospital. There were other trees on the grounds too, providing shade and beauty for those waiting to be seen by a doctor. We squeezed past patients getting their blood pressure checked in the front room of the clinic, and continued by a row of people awaiting consultation with Dr. Patricia.
Dr. Patricia was a lovely woman. She is Haitian born and trained, and was gracious enough to allow Susan and I to sit in on her consultations for a couple hours. Susan, one of the members of our team, is an emergency room nurse, and I got to tag along as a translator. Dr. Patricia, one of two doctors at the clinic, seemed young, around my age. I found out later that she and Dr. George, the other physician at the clinic, are committed to working here for 2 years after having completed medical school, which had been funded by this ministry.
The consultation room was simple—maybe 8 feet by 8 feet, with an open window on the far wall. A fan rotated, moving the air, humming, and bringing a momentary respite from the heat. The room had an examining table close to the window, which was not used at all during the time we were there. Doctor Patricia wore a lab coat and stud earrings. Her manner was attentive and compassionate toward her patients, but not overly sentimental. She sat in a cushioned chair in front of a plastic table-cloth covered desk which seemed to be the center of her paperwork operation. Of course, nothing is computerized—she jotted quick notes on a piece of paper for each patient, and then tucked it away under her purse, which also served as a paperweight. The only other furnishing in the room was a metal folding chair for the patient.
When each patient came in, I wondered how long they had waited, but didn't have a chance to ask. Hellos were exchanged, and a brief explanation of Susan and my presence was offered. Then, right to business. Sa ou genyen? What's wrong? That was the central question that would guide the next few minutes. No time to spare for extra tests, or anything not related to the identified problem--not even a quick look in the eyes/ears/mouth or to listen to heartbeat or breath. Dr. Patricia explained this between patients--the way they approach medicine in Haiti is different. They have such limited time, and such limited resources. The approach becomes simplified, focusing only on the problem, so that the line will move along and every person who comes to the clinic can be seen. Each day, the two resident doctors see about 150 patients, so there is little time to waste.
One after another, the patients came in. The complaints were varied. There was a toddler with malaria carried in by her mother. The child barely woke up for the exam and seemed distant and weak. There was an older woman who was so thin and feeble that the doctor couldn't even hear her breath. "Silans," she said, after trying to listen for it a few times. The problem for this woman and for many others was malnutrition—she simply does not eat enough. The doctor urged her to eat vegetables, especially spinach, carrots and watercress, all of which are relatively inexpensive at the outdoor markets. Even in the quick few minutes that Dr. Patricia spent with this patient, she gave her a cooking lesson. "Make a little soup," she urged. "Put some hot water over the spinach and carrots and boil it." When the patient stepped out, Dr. Patricia explained that many people don't have much education about health and nutrition, and they are only used to eating rice and beans.
One child came in with his mother. He wasn't very big—I assumed he was 8 or 9 years old. Dr. Patricia looked down at her form, at the boy, and up at us. "He is 14," she said. "He weighs 78 pounds." Because he went to school he at least got one hot meal per day, but for a growing boy, this just isn't enough. Another common complaint is stomach pain, vant fè mal. This problem is also related to malnutrition—instead of eating, people drink strong coffee that wreaks havoc on the lining of the stomach, causing reflux and acid buildup.
Lack of health education was apparent in a few other patients. A young woman came in complaining of a vaginal discharge. The doctor asked some follow-up questions, and it started to sound more and more like a normal part of the menstrual cycle. Dr. Patricia offered education and reassurance to the young woman. Women, she explained to us, don't understand their own bodies. They don't receive any kind of sexual education in school, and mothers (if they are still living) differ in how much they explain to their daughters. “When a young teenager gets her period for the first time,” Dr. Patricia explained, “Sometimes she comes to me because she thinks she is ill. They don’t understand ovulation or birth control, or how to access it.”
There were other random illnesses, too. One man had a severe foot rash. Another woman had asthma. There was a young man with possible TB. A child with bronchitis. A woman with a UTI. Several people with headaches. A few with earaches.
A few people noted that they had already been to a couple other clinics or hospitals. Dr. Patricia said that people often do this. She said, “Haitians are dissatisfied.” They keep going from place to place until they get the answer they want. So, if one doctor says something they don’t like (e.g., “You need an HIV test”) they may just move on to the next one.
And so the day goes on. One patient sitting down on the metal folding chair after another. One set of problems after another. One prescription or test after another. About 150 times per day, 6 days per week. And bit by bit, the health in this valley improves. Bit by bit, diseases are treated, babies are born and immunized, and lives are saved. At one point, I try to figure out in my head how many people are served in this clinic in a year. But as I’m trying to do the multiplication in my head, there is a knock at the door—it is another patient who has come to see the doctor. And at this moment, this one seems more important.
(But, in case you’re wondering, it’s 46,800.)