(this excerpt is cross-posted from Dr. Khare’s blogsite, found here )
1st Day of Work:
Got up at 6am, grabbed coffee and walked a mile to the Justinian Hospital. I gave the 1st lecture on Acute Myocardial Infarction (heart attacks). The night before, I had to make major revisions because the hospital does not have any cardiac biomarkers (lab work like Troponin). Interesting to give a lecture on heart attacks without the main way we diagnose it. The other different thing was that we had a translator to translate our lectures from English to French. The physicians spoke and understood English, but at our lectures we had many nurses and nursing students. There were a total of 40 students at the lectures, all extremely attentive and smiling, many taking notes. It was great to see. We had a lot of interaction, which is not the case for most Haitian students. I asked a lot of questions, many of which I was curious about… They don’t have PCI or thrombolytics. In theory, they have aspirin, Beta-blockers, statin, Ace Inhibitors, and Plavix (I have not seen anyone on these medications while I have worked). There is no dietician to discuss low-fat diet, which is almost impossible here, as most food is fried, large amounts of rice, and a desert of fruits and vegetables. In theory, these patients are written for the above medications but the absolute truth is, they don’t take them or the patients stop taking these medications due to cost.
Working in the ER – Same Problem, Different Country
One thing that made me chuckle is that the Haitians run into the same problem that we have in the US (and the same thing I research). They are “over crowded” due to keeping admitted patients in the ER (ie, boarding these patients). The senior resident, who is 1 of 2 MDs that run the ER asked me: What do you all do about this in the US? Ha, I thought and they told him to develop relationships with the medicine teams, develop protocols, engage the hospital administration, etc… He said, “yeah, right.”
We worked until 6pm. I was pretty exhausted, but extremely amazed at the students’ gratefulness. I did 2 hours of didactic lectures, 1 hour of small group, saw 5 patients with the resident while doing some bedside teaching. Pretty awesome day.