I'm sitting in a little cafe in our Casa de Campo resort, taking advantage of wifi and air conditioning, an entire world apart from where I've been working all morning. Along with a handful of other med students and a pediatric resident, I've been spending a good portion of the day walking through Bateye 16, home to a few hundred or so migrant Haitian workers. The setting is similar to the communities in Guatemala where I worked previously, populated by coffee plantation workers. This time however, the men work on a sugar cane plantation owned by an absurdly large and overarching company called Central Romana.
I'm a week in to this trip and continue to feel as though I learn so much about the people around me and their countries--both home and adopted. My project endeavors to sketch a portrait of their lives, specifically within the context of healthcare. I'm interested in their relationship with various healthcare providers--hospitals, clinics, health promoters--and what barriers keep them from accessing such care, be they monetary, personal, or work-related. In my interviews, I ask each person about their lives, when and why they moved to the DR from Haiti, feelings about their job and their health, thoughts about their families and moving back to Haiti.
I've found myself in some rather interesting conversations, some disheartening, some entirely outside the realm of logic (these data points might have to be thrown out for unreliability). I think I'll try to take some photos of the more intriguing stories and type up little blurbs when I'm stateside next.
During these daily community survey visits, we've encountered some interesting clinical cases. Annie, another med student and good friend of mine, is working on a hypertension study. As part of her interview, she measures blood pressures of each of our subjects. The number of HTN cases we've found is almost unbelievable. I've heard our translator run through the Creole version of HTN management so many times now, and every time am disappointed by our inability to provide medication or any sort of support other than dietary and lifestyle modification tips.
Toward the end of last week, we interviewed a middle-aged woman, at the end of her 10th pregnancy. Her BP was 230/110 which is absurdly high, pointing toward preeclampsia. We took her to the hospital that afternoon and spoke with the big boss man about her case. The treatment for preeclampsia is to deliver the baby, if he/she is viable. Turns out our patient was full term, though she had reported being 8mo pregnant. There was talk of preemptive and non-consented tubal ligation to prevent future cases of pre-eclampsia...the medical ethics part of me is throwing a fit just thinking about it. At the same time however, I can understand his perspective--families living in the bateyes can't generally afford quality healthcare, nor do they have enough time away from work to seek it out. Hospital visits tend to occur in the most emergent of cases, and issues that don't impact their ability to work rarely gets the clinical management it should. Still, a secret tubal is probably not the best policy.
When we went to visit her the next morning, she asked about her baby whom she hadn't seen since the delivery. We checked in on her newborn and found her to be doing well, tucked away in one of the two incubators in the tiny one-room NICU. She was one of the most beautiful little babies I've seen. I wonder what would have happened had we not interviewed this woman that day. Having worked in the public health field for some time, I am not as affected by the situations I see as I once was. Even in my early, though mild, case of cynicism, I found our encounters with this woman to be heartwarming. Getting her to the hospital, seeing her through the process and safely home again, gave me such a sense of fulfillment as I haven't felt in awhile. I only wish solutions were so easy to come by in all of the other cases. I'm curious to learn more about how this whole event fits into this woman's life, from a social standpoint. We essentially kidnapped her and within 24 hours, she had a baby girl and her family had yet to find out. And what about the tubal? What implications will that have on her life?
It's been an interesting experience working with this community. I've learned a lot from their stories and am always left wishing I had the power and the means to do more than just nod sympathetically. I am learning a bit of Creole though. It's been fun. The guys we're working with are great--helpful, fun, and committed to their community. It's really nice to see.
Impoverished and vulnerable communities like Bateye 16 are far from lacking in the world. Having worked in similar settings does not make it any less upsetting to hear about and see the difficult lives they lead. But my interactions with such communities fuels my motivation to learn about the body, medicine, healthcare, in the hopes of changing the world one life at a time. I read something once that comes to mind now:
"Certain things catch your eye but pursue only those that capture your heart."
I think I've found that thing, and I fully intend to do just that. Sometimes school just gets in the way of learning.
Haven't uploaded pictures yet, but will do so when I'm stateside!