The Learning Curve Part II

As I had predicted in my first week here, I learned a lot this summer. And continue to learn exponentially more each day - about Haitian healthcare, politics, culture, and how to care for patients. But what I never predicted a month ago, is that one of my greatest teachers would not be Dr. Cleonas, or the doctors/ mentors from Dartmouth and CHI/HFM, but a three and a half month old, malnourished baby. Baby Joseph has taken (and continues to take) me away from the healthcare provider chair and put me on the patient's side. He has forced me to see the inequities within the system - from transportation and economic difficulties for those living in rural Haiti, to the need for better education for new mothers, vaccination programs initiated by Community Health Workers, and better collaboration amongst the hospital staff here. He has forced me to get angry inappropriately and challenge professional relationships. He has taken me away from hours of data collection projects, forcing me to stay up late to get my work done, so I could wait for his pee to dribble into a specimen cup for the lab. He has forced me to wait in long lines at the pharmacy and for his labs to be drawn. He has convinced me to use my extra spending money for antibiotics and diapers instead of spending each weekend at the beach or buying myself lots of Haitian souvenirs. But most importantly he has made me fall asleep each night with my mind racing about future ideas for Haiti.

By showing me an inside view of the Southern Department of Haiti, he has inspired me with so many future project ideas that I hope I (and hope local healthcare and community workers too) can undertake. There were so many points in the system where Baby Joseph's condition could have been prevented. If his mom had access to better information about family planning, she would have less kids. If there were more Community Health Workers in the rural areas working on childhood vaccinations and public health education, maybe some of his infections could have been prevented. If the mom had received better breast feeding information (from mass education done at the local clinics and via Community Health Workers) he might have gotten more milk from her despite originally being a poor feeder because of his various illnesses. If there was a better transportation mechanism and referral system in place between Les Anglais and Les Cayes hospital, even if the blan team wasn't there, he would have safely gotten to HIC in Les Cayes and been admitted and given the medicines he needed. If there were patient educators at the hospital, the mom would have known how to go to the lab, x-ray, get his medicines, properly care for him as an inpatient, etc. without needing me there to help her navigate all these things. If MSPP (and the overall government) was forced to keep better tabs on their money donations from places like USAID, then there would be enough money available to pay for patients' medicine so they don't have to spend the $50 US to buy it themselves (after all if a child is in the malnourished unit, he or she probably isn't from a rich family). From the list above alone, now you understand what I mean when I say he keeps my head spinning with ideas of were future systemic changes need to happen...

Several other blan, many of whom are doctors, told me how this would be a good learning experience for me (my investing probably a little too much time, energy, and money into Baby Joseph). And they were right, but in a way different from what they expected. I don't regret getting too close to Baby Joseph, so in that sense, I dare to disagree with them. But I learned a lot, in that I learned it is okay to get really close with patients and try to use every tool in your doctor, medical student, blan, etc tool-kit. After all, I have been guilty of getting really invested in certain patients as a hospital employee and volunteer in the states before. And that's okay. It's okay to get close to certain special patients, as long as, like investing in a bartering sale at the local market, you are willing at some point to walk away even if the outcome isn't how you wanted it to end up.

Another doctor I recently became friends with, gave me even better advice about my learning experience with Baby Joseph. She and I talked about a radio report, by a firefighter, on the importance of not letting oneself take credit for people's lives. The firefighter apparently said - I don't take credit for people being alive because of what I did, because I am not willing to take credit or ownership when people die. I think this advice she gave me is very true and very important. I am willing to admit I am not a strong enough person to hold ownership for every patient the team and I sent home from Les Anglais clinic who probably won't be alive by the time I make it back to the states. I can't let myself feel responsible for every child who leaves the malnourished pediatric unit to go home to heaven, because I am just one blan and I don't get to think I can save the world. If I told myself that I am the reason Baby Joseph is alive, then I would be discounting Dr. Abby and her team, the mom's friend who brought him to clinic, the pastor who got him and his mom on a tap tap to Les Cayes, the doctors and nurses at HIC who have ordered and given his meds and provide him with his high calorie milk every 3-4 hours. But most importantly, if I wasn't honest about him being a true miracle and tried to take the credit, I would have to take responsibility should he or many other patients die. And I have learned that one person is not strong enough to do that and still get up and go back to the hospital the next day...