Monday, June 1, 2009

Not Mass General

I've just been to visit L. at the General Hospital in Port-au-Prince. As with most official buildings of any kind, you enter through a gate. (Excuse the uncropped photo - I can't find that tool on this computer.) Once inside the main gate and dropped off, we walked to the main door of the ER, where a guard turned us away, pointing us around the side of the building. There was a small crowd waiting at the padlocked gate, behind which there was a guard. A sign was posted: ER visiting hours 7-8AM, 12-1PM, and 4-5PM; it was 2PM, but no one was leaving. Someone came out; another person was let in. And again. Ah. Limits on numbers of visitors, perhaps. Water bottles were handed through the gate for someone inside. We waited. Someone inside recognized Sr. Marjorie Raphael, and eventually all four of us were let in - two sisters, two Foyer Notre Dame employees.

L. was still in the emergency room because they think she is dying, so there is no use in finding her a room, so Sr MR surmises. She was lying on a bed in her short nightie in the large open ER area, a washcloth on her forehead, hooked to an IV; the IV pole held not only her IV, but also that of the man in the bed next to her, a foot away. It was bed after bed along all the walls and in any open space. It was obvious why multiple visitors are not usually allowed: we had to thread our way through people to get to her. There were quite a number of what looked to be very young nursing students, green and white uniforms and white caps, but I was unsure as to what they were doing, if anything. Not that there was much space to do anything in.

As for the room itself, people had tracked in much grime from outside, and I had the powerful desire to fetch a gallon of Lysol and get to work on the walls and floor... but even if there had been such a thing available, how one would do so with so many people in there, I don't know. I remembered my CPE training at the Massachusetts General Hospital in Boston, recalling how we were told over and over again to use hand disinfectant before going into any room and on the way out. Calstat, Calstat, Calstat! No Calstat here. I would rather not be a patient here, to put it mildly, but it is the only public hospital in the city, so it is the only choice for most. There are private hospitals as well, but only for those who can prepay.

L. was unresponsive, but Sr. MR had brought a hymnal. L. loves to sing hymns, she told me. So the four of us crowded together as best we could in the narrow space by her bed and sang to her in French. We prayed the Lord's Prayer (I can't tell you how thankful I am to my Catholic school French teacher for making us memorize it!), and they said the 23rd Psalm, which everyone here seems to have memorized. I must do so soon, as I can already tell I will need it for my many weekly housecalls.

As we were not all supposed to be in there at once, three of us left fairly quickly; I thought I was hearing some talk of picking up medication for her at the pharmacy, but my Haitian Creole still isn't good enough to follow a conversation when people are speaking quickly.

On the way home, Sr. Marjorie Raphael told me about a man she had met who had fallen into a hole on the street and hurt his leg. He needed a tetanus shot, but he had no one with him to go buy it. Someone finally was able to go to the pharmacy to buy the serum and the syringe - but what people do when they have no one or are unconscious is unclear to me.

She also told me of a dedicated doctor and nurse she had known who had been very devoted to their work there; both had caught HIV due to the lack of available precautionary sanitary measures (all that handling of blood, I suppose) and had died. And yet medical personnel continue to do their best, some taking advanced study abroad and returning to help, to work under such conditions. How tough it would be to do so I can't begin to imagine.

Those of us used to U.S. medical care, I think, would be completely unable to cope in such a setting. We do have major problems with our health care system, and some of the conditions are appalling. The video that went around the internet earlier this year of the woman who died in an ER (in California?), with no one paying any attention, should attest to that. Yet even so, we fail to realize fully that even the basics (like decent sanitation!) are missing in some parts of the world. I know I had been told, but hearing is one thing, and seeing is another. It's going to take me time to process this - along with much else.

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