Have I mentioned how hot it is here? It probably only runs in the mid-90s thanks to the coastal “breeze” but the heat index is probably closer to 100 degrees. It’s hot, but not as hot as other parts of the country or world. However, at least in the US, we have the luxury of air-conditioning at home and in the workplace. Here, all of us -- the therapist, the patients and the translators – are experiencing a mixture of sweat, grime and dust. When the electricity goes out for even a few minutes, as often is the case and the standing fan stops, it doesn’t take long for the heat to rise to an unbearable level.

One area that has taken some adjustment to is the lack of medical information on what has happened to a patient and the diagnostic work-up. Have they fractured an area? Is it healed yet? Did it heal in an aligned position? What is a safe level of weight to bear? How was it treated (i.e. is there a rod in place in the joint) such that reasonable return of range of motion is realistic or is it stiff because of prolonged immobility? These are just a few of my questions as a treating therapist. Few medical notes are passed on and if they are, little information is legible. The patient may know some, but sometimes very little. It is difficult to develop plans, make goals and predict outcome. You don’t know if your efforts are futile. You don’t want to do more harm than good. Diagnostic workup is limited to lab tests, basic x-rays and physical exam all with a high price involved and a lengthy wait. MRIs are unheard of here. Having strong evaluation skills, diverse experience and strong clinical decision-making and judgment are critical here.

Patients are forced to weigh their options if going to the doctor is worth the cost. One patient who fell backwards onto his head from his wheelchair weighed the options and decided not to seek additional medical care. To be forced to make these decisions…!

Even if there were diagnostic testing and cost was not an object, the luxury of the support of a full complement of a medical team is not there. As there is not enough medical support here -- such as nurses, doctors and social workers -- we are left to determine what is best for our patients. One patient complained of malaise and faintness. She has diabetes which is not regularly monitored, peripheral vascular disease, hypertension… and that is just what we know of. We were left to make a decision on how to proceed with therapy that day without the consult of a nurse or even a blood pressure cuff. The responsibility can be overbearing at times.

Medical supplies are in short supply. Back home, we would readily hand out braces and canes… unfortunately, we cannot do the same here. We need to carefully determine the level of benefit that this person would gain from the device as there may be another patient with greater need for it down the line. As a way to control the demand, patients are expected to exchange what they have if they want another device. Shoes are also in short supply.

Carmen and Marvin, the Nicaraguan prothetists, put out amazing prostheses for patients with limited supplies, space and spotty electricity. For $80, they can produce a new artificial, highly functional, limb using the Red Cross System. Back home, a more sophisticated artificial limb using lightweight and more aesthetically pleasing materials would cost in the hundreds, if not thousands, and in most cases insurance would cover the cost.

Despite all of these hardships and challenges, the Haitian people endure and find hope in their lives. They are quick with a smile and continue to persevere.