Saturday, December 24, 2005

A Working Doctor’s Day in Haiti:

John’s workday is slightly more productive than mine. While I head for my courtyard seat, he passes through the waiting area of the clinic, lined with mothers sitting on wooden benches holding babies, to the office that he shares with Dr. Jean-François, a young Haitian pediatrician. They will spend the next several hours examining and treating sick babies and children. Dr. John and Dr. Jean-François are physicians cut from the same scrubs; they love to consult with each other about patients and discuss different protocols for treatment.

We met Dr. Jean-François about a year ago. He is 38, drives a Toyota Tercell, which he’s owned for seven years, and dresses in neat long sleeved cotton shirts, always adorned with a tie. He is a short, compact, friendly man, who exudes competence and calmness. The first day we came to clinic, he burst into the exam room laughing with happiness at seeing John. It’s great for him to have an American doctor to talk with.

Dr. Jean-François is an excellent pediatrician; during his residency, he was the head resident. He is very precise in his exams, his documentation, and his prescriptions. He loves to teach, as does John, so they teach each other. John brought him some Christmas presents: several issues of the New England Journal of Medicine and The Lancelet, a British medical journal.

The last patient the two doctors are seeing today is a three-month-old baby with a terrible grunting cough and a temp of 102. His parents from Croix des Boquets (Cross of Flowers), a town on the outskirts of PAP, where much of the area’s beef comes from, look as poor as the dirt on their clothes. John has given them 500 gourdes (about $12 U.S.) to help pay for the tests and any medicines that will be prescribed. Sometimes parents will bring their child in for an exam ($2 U.S.), but they won’t have the money for the blood tests, xrays, or medicines that are needed. This is one of the frustrating realities of practicing medicine in Haiti, especially for American docs.

This baby likely has pneumonia. The question is: what is causing it? The cause will determine treatment. Due to the baby’s dry cough, Dr. Jean-François feels 80 percent certain a virus is the culprit. He declines John’s offer of a heavy duty antibiotic, Rocephin, generic name ceftraxione. We have brought this precious medicine from the U.S. as it is expensive and in short supply in Haiti.

In the U.S., not giving this sick of a baby an antibiotic could result in a malpractice suit. As a rule, bacterial pneumonias kill more rapidly than those caused by viruses (untreatable) or tuberculosis (treatable). As John points out, if Dr. Jean-François is wrong about the cause, he is taking a big risk not giving the baby antibiotics. Dr. J-F looks at it a little differently. In Haiti, Rocephin is as scarce and valuable as gold; his philosophy is that he doesn’t want to waste it on a baby who doesn’t need it. Plus, it’s never good for a baby who doesn’t need an antibiotic to receive it; it leads bacteria to become resistant to the medicine.

John is picturing what he would do for this baby if he presented at the emergency room with these conditions: blood tests, x-rays, antibiotics, and an admittance to the hospital would greet the baby. Anything less could be grounds for a lawsuit. Dr. J-F understands the differences between practicing medicine in Haiti versus Miami. It’s just that he’s in Haiti.

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