The blind leading the blind

Today's running mantra was 'do no harm,' and it is with that thought that I made most treatment and diagnostic decisions at the clinic today. Treating Haitian patients is fraught with problems and left me feeling unsure at the end of the day if what I did was right and if it helped at all.

One of the problems is that it's hard to get what the medical community calls a 'review of systems' because the answer is always 'yes.'

For example: a woman walks into the clinic and sits down in a chair (to sit: chite). "Sa ou gane?" (what do you have? or what ails you?) "Fievre." And then it begins.... 'do you have a cough?' 'yes' "do you have any nausea or vomiting?" "yes" "do you have trouble breathing?" "yes" and so on and so on until every differential diagnosis that has run through my head (Typhoid, Malaria, regular viral infection, etc) has been cancelled out and I am left with only the word "sick."

To make matters more complicated, the Haitian sense of time seems to be a bit different and many people explained, when asked "how long have you been feeling like this", "22 days." I do not know what is special about the amount 22 , but many people seem to have been sick since around May 28. Decisions about diagnosis and treatment were thus made around a physical exam (did they look sick? did they have a fever? were they losing weight?) and my mantra "do no harm". If medications for the potential illness could hurt, I did not give them. Thus, I treated many cases of malaria today, suppressed a lot of coughs, rehydrated those who may need it, reduced fevers, gave out vitamins, and treated some pretty bad looking fungal infections on little boy's heads.

When discussing this with Pastor Pierre, the leader of this project, his thought was that if they answer 'yes' to every question, we will give more medications and those can be used to treat other people in the family - or saved for the future. They pay a flat fee ($30 Haitian dollars, about $4USD) to use the clinic, and all medications are included. This sounds like a good reason to say "yes" to me.

All in all, the 33 people we saw today - and perhaps their family members - may sleep easier, breathe easier, and hopefully will feel well cared for tonight - as the Haitian heat pulses, the crickets chirp, and the heat lighting flashes...