By Shayla Hesse
BOUCANTIS, Haiti–While yesterday we took in the lay of the land and got acclimated to our new surroundings, today we rolled up our sleeves and got to work. After a fortifying breakfast we broke up into teams, each one focused on a specific patient population. We received a quick briefing and then climbed into the 4x4s. As it turned out, their off-roading capabilities proved absolutely essential to our conveyance to the clinic site. Perched atop a modest mountain, the clinic site seemed utterly remote. I was therefore somewhat surprised to see the throng of patients gathered when we pulled up.
Patients ranged in age from the suckling newborn to the wizened elder. The first patient that my team saw was one of the latter. He was old; that was the first thing I noticed. He had dementia which became apparent soon after. He looked gaunt and walked slowly over to us with his back hunched.
Sake pase, monsieur?
He spoke softly, explaining that he recently hasn’t been able to keep any food down. His face was stoic and his eyes, calm. Okay, I thought, a mild GI disturbance in an elderly man with age-related decline. His physical examination revealed a different story.
In his clothes he looked thin, but without them he was emaciated. His barrel chest, a likely product of his history of smoking, accentuated the prominence of each rib. His thoracic vertebrae were severely kyphotic, perhaps a complication of a past TB infection. His heartbeat was faint, indicating the presence of a pleural effusion. His vision was impaired by cataracts and adhering to his cornea was a whitish mass. Yet he complained of none of the above. Our team discussed his condition and had to accept the reality that we could not treat him for everything. His dementia and limited mobility imposed great obstacles to his care. The thought of sending him on foot tens of miles down a dusty, rocky road to the nearest hospital was absurd. On the other hand the situation, though dire, was not hopeless. Dr. Fournier pointed out that this man had options now that were never available before the work of Project Medishare. With a hospital in Thomonde, mobile clinics scattered throughout the countryside and designated health agents working in local communities, Project Medishare has established an efficiently stratified, vertically integrated system of healthcare that has had significant impact on the health of the Central Plateau. The old man we saw from Boucantis may or may not make it to the hospital in Thomonde with the help of the community health agent and our referral from the mobile clinic – demonstrating both the amount of need in the Central Plateau and the amount of progress that has been made.