Mother knows best

Last night, I had a nice chat with my mother via skype.  We were discussing many of the frustrations I’ve had while working here . . . specifically some aspects of patient care.  [Just a quick update, on my stage IV patient . . . we ended up finding not only fentanyl patches for her, but also Vicoden.  She went home feeling relief of pain for the first time in several months.] 

In the states, when people don’t have money, or insurance, if an operation is absolutely necessary, we work out a payment plan.  That really does not exist here.  EVERYTHING is private . . . you don’t have the money, you don’t get the surgery.  Last week, I saw a young girl with a complex adnexal mass . . . I suspect that her ovary has twisted on its blood supply, meaning that she is in a lot of pain and absolutely needs a surgery.  She still has yet to have her surgery as she has yet to pay.  I have tried to explain the situation to the folks here, but they don’t want to set a precedent of ‘not taking accountability.’ 

As I was discussing this with my mom, she asked if she could pay for the half that the patient has yet to pay for.  Now, whether or not she would be able to do that is beside the point . . . just the fact that she offered (which is not something out of character for either of my parents) made me feel less alone in my struggles here.  I am very lucky to be surrounded by such generosity.  [At this point, I also want to thank everyone . . . (especially Dan Jackson and Lindsey Smith) for your persistent comments.  You make me laugh, and you make me feel less alone in such a foreign world.]

Today, I saw two patients who had recently self-medicated to induce abortions.  Now, I do not want this blog in any way to become some kind of political or religious platform.  [I’ll save those discussions for the Howie family vacation after everyone has had a few drinks].   These two young girls had gotten the medication off the street . . . no counseling, no written instructions for expectations or reasons to see a doctor, nothing.  They both came in for ‘hemorrhage,’ which lucky for me meant they had just passed the pregnancy (the only D&C equipment they have here is a sharp curette, meaning that would be my only option if there were retained products of conception . . . meaning that I could potentially cause some type of scaring affecting future pregnancies). 

In Haiti, there is this ‘black market’ (which is really just the market) of drugs, and it’s not your typical market that you think of.  Antibiotics, cytotec, etc are all readily available for people to buy and take as they please.  The whole thing baffles me as I would say at least 75% of the patients I’ve see here have taken part in this self-medicating, when many times they don’t have the education to know exactly what they are taking or treating. 

Obviously, the culture here is quite different than what I’m used to . . . medications on demand (no need to be seen by a doctor); also scans on demand.  I cannot count the number of patients who have come to see me saying they want an ultrasound to make sure everything looks fine.  Just last week, a 28 year old actually refused to have any type of exam from me . . . she said that she just needed an ultrasound (after about 15 minutes of explaining why things don’t work that way, she finally decided that I might be correct).  The whole patient care thing is somewhat ironic here . . . on one hand you have specific things that patients make the decisions (ie, when to take antibiotics, when to have imaging studies, etc); on the other hand, you have patients who blindly follow recommendations . . . (like surgery, as I’ve discussed earlier, I don’t know that patients are actually given the option for conservative management).