Clinic

April 27th, 2019 by leahtourtellotte

Haiti Health Ministries is unlike any American conception of a clinic. As early as 7am, patients start arriving and waiting in line. There are several long benches outside and, without fail, become jam packed with patients.

 

The doctors meet at 8:30 for a little conference where our steadfast leader, Dr. Jim, talks about a topic we’ve recently encountered. Dr. Jim is an American doctor. He established the clinic with his wife who manages the clinic. The clinic has moved but they’ve been in Haiti for 20 years. There are two permanent full time Haitian doctors and a half time Haitian NP. There is an American PA, ultrasound tech, diabetes and lactatation educator, and two Haitian nurses that round out the crew.

 

We pray for the day and then head out to our clinic rooms about 8:45-9ish. Patients come inside and wait on benches along the hallway of the clinic rooms. Follow ups are assigned to days and not times (wouldn’t work here!) and we see patients based on order of arrival, whether they have an appointment for that day, and some triage. Without appt times, I just take however long or short of a time I need with the patient.

 

There is a room with two beds that serves as the emergency room. We are able to give oxygen, nebulizers, IV fluids, limited IV and IM meds, take an EKG, and wound care. One large room is designated as the lab. Lab tests are limited and can depend on availability. We can do rapid hiv, malaria, sickle cell, VDRL, PPD, hematocrit, CBC with a diff of lymph/neutrophil percentage, creatinine, glucose, pregnancy, prolactin, TSH and free T4, AST, ALT, potassium, and vaginal smear. Right now we’re out of TSH and free T4, creatinine, CBC, and PPD. Hemoglobin A1c is never available; I make medication changes off the fasting blood glucose from that morning. Another room along the hall is for ultrasound and X-ray. And the last room at the end of the hall is the OR. Dr. Jim has a schedule every day for biopsies and mass excisions. Lots of I and Ds are done too.

 

In a separate adjacent building, there is a pharmacy. The formulary is limited of course due to cost. We do have a pretty good arsenal of antibiotics: amoxicillin, augmentin, doxy, Bactrim, cipro, metronidazole, keflex, and IM ceftriaxone. Diabetes meds are limited to metformin, glyburide, and NPH 70:30. Atenolol is our only beta blocker. Warfarin is limited, so usually only given to those with mechanical valves. Topical diclofenac isn’t an option, nor are triptans. Our only inhalers are SABA and beclomethasone. I diagnosed a lady with hyperthyroidism, probably Grave’s, but found that she was pregnant. We only have methimazole. :/ Food is also stocked in the pharmacy for patients that cannot afford food.

 

Everything is very low cost. For example, a clinic visit is 20 Haitian dollars, equivalent to a little over 1 US dollar. An X-ray is 50 Haitian dollars, equivalent to 3 US dollars. Some labs are free, like pregnancy, hematocrit, and glucose. TSH and free T4 together are 80 Haitian dollars, equivalent to almost 5 US dollars. Medication prices are variable, many are free. Medications that are donated are not sold and are given for free. If a patient really cannot pay even those prices, then we will still see them/do labs/perform imaging/give necessary medications for free.