Medical Clinics: Days 1-3 River of Grace

by Reid Boswell, MDDay 1

Monday: 

There is an Episcopal church and elementary school in Matthieu, not far from Leogane. We have been there before, setting up our clinic in the courtyard between the school and the earthquake-ravaged church. The last time I was there, the church was a shambles, pews scattered, roof useless, altar unrecognizable. This year, to my delight, the church had been restored, the pews carefully arranged, the altar and nave were pristine, and the floor, though dusty, revealing the original tilework and the mausoleum stone of the church’s founder on the floor in front of the nave.  

It felt at once sacrilegious and at the same time absolutely appropriate to set up our clinic in the church, pharmacy in front of the nave, triage at the entrance, dentist in the sacristy, chaplain along the east side, our optometry station in what I presume is the baptistry, and the docs situated on a private porch just outside. The clinic flowed reasonably well and I settled into my rusty primary care mode with fits and starts. It was a joy to see the smiling Haitian people, greeting me with an earnest “bonjou.” The medical needs were familiar: fungal infections, high blood pressure, diabetes, dyspepsia, aching joints…the kinds of complaints that one would expect from a people living in stress, close to the ground, and genetically cursed with the chronic ills of their ancestors. 

At one point, I looked over at my colleague, Gloria, who said “this is so fun, I mean what would you be doing now if you weren’t here.” I replied, “let’s see, answering stupid e-mails, arguing with insurance companies, watching the clock to make sure I stayed on time.” Indeed, as a physician, this is medical care at its most basic: no insurance wonks looking over our shoulder, no threat of entitled patients threatening to sue, no administrators expecting patient quotas. I was shocked back to reality when a small boy appeared to see our Haitian doctor, Alex, right next to my station. A painfully thin child, with the characteristic swollen belly of extreme malnutrition, covered with scabies, an unfortunately common parasitic skin infection in Haiti. I had to turn away, tears in my eyes, now defibrillated back to the consciousness of the desperate conditions in so many parts of this country. 

And yet this child smiled as wide as any other, seemingly oblivious to his plight. This is not to say that Haitians don’t understand their poverty or the unfortunate circumstances thrust upon them through no fault of their own. But the sight of this boy to me felt like a metaphor for this country: a joyful people, dealt a hand of cards that only Job might understand, fully expecting God’s redemption and grace.

Day 2 Tuesday

The time-honored and highly respected humanitarian organization Habitat for Humanity has built a cluster of homes resembling a village in Sarbousse. Just across the “highway” (I use that term loosely), there is a small compound where we were to set up our second clinic. The pharmacy was squeezed into the front “parlor” of the main house, the dentist in the “living room”, and triage, docs, and optometry station sharing a tight space under a canopy that was probably provided by “USAID” after the earthquake. It was hot, no breeze, and my recollection from two years ago was that we should expect a crush of patients. The flow of patients was difficult and, as predicted, there was no end to the line of people seeking medical attention. From my perspective, the morning ambled rather slowly, only to come to the realization that the crowd of people weren’t finding their way to the doctors because of the difficult geography of the compound. By the afternoon, we were straight out, barely catching a breath between a child with tinea corporus and an elderly woman with a blood pressure through the roof.

I reluctantly share a little secret about doctors: we get tired late in the day like everybody else. In the morning, fresh from our hearty breakfast and thick, delicious Haitian coffee, I was eager to explore the nuances of each of my patient’s symptoms, earnestly trying to correlate their medical complaints with their occupation, living conditions, and emotional state of being. By late in the day, after the 250^th patient had walked from the make-shift triage bench to my little rickety table, I have to confess that I could do no more than check off the meds that they expected to receive. “Want fries with that?” I don’t mean to be flippant about medical care, the late in the day patients were not ignored. But it was a difficult day for all. However, what I realized is that our team now was really a team. Several of us have only met for the first time this mission, and we coalesced around the difficulty of space and people and emotion.

Day 3, Wednesday

Today, I was looking forward to the long ride out to Fayette, along the river bed that will soon be swollen with water when rainy season comes. We bounce our way through village after village until we reach the river bed. The trucks wind their way to the far side of the river, between the mountains, until we reach an earthquake- ravaged Catholic church where we have held clinics in years past. The church is still almost in ruins, but continues to serve the people of Fayette as a place of worship. Like Matthieu, the church space lends itself to a smooth flow of patients: triage in the back, docs and chaplain in the area where the pews would be found, pharmacy in the nave and dentist and optometry station under a separate canopy out back, This is a desperately poor area, possibly the closest location to the epicenter of the earthquake that we will visit. In past clinics, my recollection was that, while there will be somewhat fewer patients, the pathology will be more desperate.

The translator assigned to me, Peterson, has been with me on all three trips to Haiti. We bonded early on and he has become like “Radar” from the old TV series M*A*S*H. He has already asked and has an answer to the next question I will ask my patient.  “Epigastric pain?” Before my next word, Peterson has told me “worse before meals, eats greasy food, too much salt.” He has already given a nutritional diatribe before I have even circled the word “Gastritis” on the medical card.

Unexpectedly, we ended up seeing at least as many as we did in Sarbousse, running out of vitamins and some antibiotics. The dentist had to cut off the line of people waiting to see him and our clinic ran very long. My only explanation is that for the first time, we had reading glasses available and I suspect word got out that an “eye doctor” was part of the clinic. For the record, our outstanding podiatrist Dr. Dan stepped up to honor his dad-in-law’s profession as an erstwhile optometrist. We collected reading glasses from all over, especially the Lion’s Club, as well as other donors, and our patients marveled about suddenly being able to read or thread a needle. Such a simple thing. Cheaters bought at CVS or Walgreen’s by my middle-aged comrades are magic to poor, isolated people. They came to our clinic with real medical issues, but sometimes kind of made-up ones just to access the “EYE DOKTE.”

In the end, our team saw all who needed to be seen, young and old, sick of body, heart or spirit, met by our triage team, lifted up by our chaplain Jason, delivered medication by our outstanding pharmacy team, dental needs met by Dr. Bastien, eyes opened by simple glasses provided by Dan and Henry, and we hope, received a bit of grace as our team received a river of grace.