Confessions of a Radiologist in Haiti

Confessions of a Radiologist in Haiti
-How I Learned to Stop Worrying and Love Mebendazole-

For years I have told people that one should, in order to progress as a person, get out of one’s comfort zone. Well, I can now announce to the world that I have done so. Boy, have I ever! After more than 20 years of reading MRI’s CAT scans, mammograms, X-rays, etc. and seldom examining a patient, let alone in a tropical setting, I have just spent the last four days desperately trying to interview, examine, diagnose and treat a never-ending stream of people here in Haiti, of all sizes, ages and degrees of illness. Did I mention I know only three phrases of Creole? And that any training in tropical medicine I had was at least 25 years ago? Oh---and the only diagnostic tools I had were stethoscope, otoscope and ophthalmoscope which I haven’t picked up in years? And that we worked either under HOT tarps or in HOT, rubble-strewn concrete rooms using tables and chairs we brought with us on the beat-up old school bus we traveled in? And that the only drugs we had were the ones we bought at the giant pharmacy in downtown Port-au-Prince the first full day here? And that I will never know if any of the diagnoses I made were anywhere near correct or the treatments I prescribed were appropriate? Did I mention it gets HOT and HUMID here? It’s enough to make a radiologist want to crawl into one of the darkrooms we used to have (before the digital age when everything went computerized!) and just curl up in a ball!

But even with all the stress, this has been one of the greatest experiences of my life thus far. Dr. Milem and I have worked with three Haitian doctors and I do believe we have made a positive, if only temporary, difference in the lives of nearly two thousand Haitians. We have seen everyone from tiny infants to elderly frail men and women. Most suffer from relatively minor maladies such as parasites( hence my new-found love for mebendazole), gynecologic infections, nutrition-related issues such as anemia, and a variety of skin conditions made worse by the dirty humid environment in which they live. We did see one apparently starving infant whose mother had abandoned it and a couple of male patients with large hernias needing surgery. Obviously we could not do real surgery, but Dr. Milem did stitch up some lacerations and drain an armpit abscess.

Of course, diagnosis was for me (and I suspect for Dr. Milem) mostly based on what each patient said through the interpreter. There was no time for detailed questioning or physical exam (and no privacy or exam table anyway). The result was a lot of guessing and a lot of treating-- to the extent we could with limited pharmacy—for several possible diagnoses.

I can’t speak for Dr. Milem, but the people I saw were slightly healthier than I had anticipated. That is NOT to say they are thriving---far from it. They are desperately poor, with no money whatsoever for even basic medical care, let alone something major like surgery. Perhaps just as importantly, the public health system could really not be much worse, with no reliable clean water system, no sewage system, no good mechanism for following patients on a regular basis (and this was true even before the earthquake). We in the U.S. never even think about these things, but I believe they may be more important for the general health of the population than what we doctors do. There are Haitian doctors, but not enough, and in a cash-on-the-barrelhead system, a person with no money gets no medical care.

We met dozens of patients who had been injured or lost family members in the earthquake, though the serious quake injuries have by now resolved one way or another. I spoke with several whom I know were clinically depressed because of these losses, but all I could do was convey my sorrow to them through the interpreter.

In spite of everything, I was and continue to be struck by the dignity and calm demeanor exhibited by even the poorest of the people we encountered.

After almost a week here, I have come to believe that Charles and I have indeed done some good, and that even a radiologist—though with only a few weeks of feverishly studying tropical medicine books and learning about worms, scabies, malaria, etc etc---can make things better in some small way.

I am grateful to everyone at Bellevue who allowed me to come along on this trip, and to Jerry Cheatham and everyone at Mission Support International who welcomed me, fed me, and helped me, at least partially, to expand my comfort zone to include Haiti. Their love for God and for the people of Haiti is a marvel to behold.

John Mulligan MD

"Declare his glory among the nations, his marvelous deeds among all peoples"
1 Chronicles 16:23-24