I’m spending this week with the Zanmi Lasante program at St Nicholas Hospital in St Marc, lecturing on medical education and a few general internal medicine topics. My first time here; I’m impressed (but unsurprised!) at the high quality of medical education, faculty, and residents that I’ve seen to date.
As ever, the question of the setting rotate around making diagnoses and treating patients with far fewer studies or therapies than we’d like. Crusted scabies undergoes some third line therapy, absent ivermectin; sepsis with jaundice has LFTs sent away for testing, likely to return in 2-3 days; a teen with a stroke with visible clot in his cardiomyopathic heart is faced with a choice of taking warfarin with a good chance of not being able to check INRs at times, versus the much poorer benefits of aspirin. The faculty here very reasonably bemoan the limits they face and the tightly packed wards which patients are crammed into – the same conditions that exist throughout the Haitian medical center, at every hospital I’ve been to.
No easy answers, and no Kickstarters to fix these problems; just the knowledge that it will take a growing economy to provide the funds needed to lift the general population here from poverty, and that that in turn will require a stronger government (on which the book I’m reading now, Why Nations Fail, has some fascinating thoughts. More on that next time).