The Paradoxes of Haiti

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My first week back after a medical mission trip to Haiti presents many difficulties – some physical (I won’t expand on the topic of GI issues after eating rice, beans and potatoes every day for a week) but most psychological. At 10 am on Sunday I was enjoying the feel of sand between my toes and salt water on my ankles as I walked down the beach, knowing that 12 hours later I would be arriving to Minnesota and freezing temps. That is the uncomplicated part of the transition. The psychological transition is still a part that I struggle with and sometimes do better than other times. Following are just a few of the thoughts that have created a wrestling match in my head this week.

  1. We were able to prevent a woman from dying due to a bad infection in her foot by amputating her lower leg. She has very poorly controlled diabetes due to poverty, low IQ, and lack of resources for adequate administration of insulin. One of the last patients  I saw before I left for Haiti also has poorly controlled diabetes – due to lack of motivation to check her blood sugars and take medication, both of which are provided thru her insurance.
  2. Maternity was very busy the week we were in Haiti and our nursing volunteers spent many hours working with Haitian staff to improve breast-feeding and care of patients in labor. It is much easier to teach the mechanics of nursing care than it is to teach respectful care. Slapping and yelling at patients during labor is all too commonplace.
  3. Cervical cancer continues to be a preventable disease that kills all to many mothers, disrupting their families. We screened 67 patients for cervical cancer, treated 10 pre-cancerous lesions and diagnosed 1 locally advanced cancer that is untreatable and will be the cause of death in this woman within the next year. A combination of low-cost screening and vaccination with Gardasil has the potential to completely eliminate this cancer throughout the world. Due to unfounded fears of vaccines in this country, only 40% of young girls and boys are vaccinated with Gardasil.
  4. Motorcycles are the primary mode of transportation in Haiti. We treated 3 victims of moto accidents, one a  16-year-old girl who will have permanent scarring on her leg that impedes her ability to walk in the future. Once their wounds were cleaned, stitched and dressed, we sent them home on a motorcycle
  5. Most of the hysterectomies that we perform are due to fibroids (benign tumors of the uterus) and heavy menses. One of the patients that we saw was 41 years old and had not been able to conceive a pregnancy. She was severely anemic but her husband decided that they would pray to God for a miracle child rather than allowing her to have surgery. Another woman looked 8 months pregnant due to her enlarged uterus and her hemoglobin was 3 (normal is 12-15). She was in danger of bleeding to death with her next period. In the US, she would have received 4 units of blood before surgery. She received one unit of blood that was donated by a relative and infused during her surgery. She was also unhappy as she has only one child.
  6. A young man presented to clinic with a large abscess on his arm. His HIV test was positive, as was his syphilis test. He did not believe the results and declined government-funded HIV meds or antibiotics. We could not operate on him as he was at high risk of complications with active HIV.

When co-workers see me this week they often ask, “How was Haiti?”. Trying to find the words to describe the above and more can be difficult, if not impossible,  in a few minute passing conversation.  Do others really want to hear the confusion in my head or do they want to hear that we performed 49 surgeries, 67 cervical cancer screenings and 104 dental exams?  To say “Great job and thank you for what you do” and then move on. But what we do in one week is not enough. And that is the Paradox of Haiti.

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