Re-entry from Haiti to American Healthcare

Our January 2016 medical mission trip marked the 10th anniversary of my first trip to Haiti. During those first few years it was always a culture shock as I entered Haiti and dealt with the cacophony of noise, the smells of burning garbage and rotting fruit and the difference in hospital resources. More recently, I have found it easier to slip into my role as a temporary physician in Haiti and harder to re-enter the physical and psychological world of American healthcare. As pictures are often louder than words, I will use them to illustrate the differences between the two healthcare systems.

Providing health care in Haiti, though limited in scope, is sorely appreciated by the people who often wait months to collect enough funds to afford a surgery and then for a surgical team to arrive. They arrive on the designated day of surgery waiting in line to be examined by the “blanc” doctors and then waiting some more for their surgery. 190

While we are busy in the operating room performing the surgery, the family is busy preparing the patients room for their arrival immediately after surgery. The family is responsible for providing sheets and pillows, food and a bedpan as the hospital does not have adequate bathroom facilities for patients and their families.

As there are few nurses available, families often sleep on the floor by the patients bed so that they can be available to help with feeding and getting the patient out of bed.

Most American patients expect a private room and bathroom when in the hospital.  Our post -op rooms have 3 narrowly spaced beds and are filled on a first come, first serve basis. This means that there could be both men and women in the same room as well as multiple family members. The wall sockets are usually stacked with cell phone chargers.

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Although this may look chaotic, there is a semblance of order that runs throughout our day. Potential surgical patients are screened in the morning with surgeries starting around 10 am and lasting until 5-6 pm. Emergencies are triaged as they are sent from clinic and when one of the surgeons is between cases. We make surgical rounds in the early morning and again after dinner, doling out pain medications and encouraging patients to eat and walk. Haiti has no electronic medical record. While I am sure that some American doctors would whoop with glee at this announcement, it is beyond irritating to write the same operative note three times in three different places while trying to gather patient clipboards from the nurses station and around the ward.

Privacy in the US medical system is a sacred law known as HIPPA and one that has serious consequences if violated. Privacy in Haiti can be difficult when rounds are made in a three bed ward with family members of each patient listening in to our conversations. That doesn’t include the numerous visitors in the courtyard that can look in thru the open air windows.

By the end of a 5 day surgical week, we have usually performed 40-50 operations.  Some of these surgeries are lifesaving, while the majority improve quality of life. Our complications are no greater than in the US and outcomes just as favorable. We use far less resources with only minimal lab tests available and no blood bank. I am exhausted, my feet ache from standing on the concrete floors and my back is sore from the uncomfortable beds. And yet, the satisfaction and feeling my heart full is so much more than I feel at the end of a week of work in the US.

Now I find re-entry into the hospitals of the US more disturbing than my week in Haiti. The amount of waste that occurs on a daily basis with medical equipment in this country is mind boggling and one of which we should be ashamed. Surgeons demanding expensive instruments and multiple suture choices are difficult to listen to.  Most patients are appreciative of the care they receive, but wouldn’t be able to grasp wait times and lack of access to healthcare that is present in the developing world. Thankfully, the end of each Haiti trip brings with it plans and ideas for the next trip.

 

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