by Orly Avitzur, MD, MBA, FAAN
Even before the devastation from the earthquake that struck on January 12, medical supplies and resources were scant in Haiti, the most impoverished nation in the Western Hemisphere. Jeffrey K. Bigelow, MD, MPH, a 2010 Palatucci Advocacy Leadership Forum graduate, and currently a third-year neurology resident at Yale-New Haven Hospital, has been to Haiti four times. Fluent in Haitian Creole, he began to travel there in 2000 with an organization called Healing Hands for Haiti, and has volunteered there on four separate missions.
During his most recent trip in May of 2009, Bigelow spent three weeks at the Hôpital Albert Schweitzer in the mountainous city of Deschapelles, where he was the first neurologist ever to set foot in the 100-bed hospital. He cared predominantly for in-patients with tuberculosis and HIV, and for out-patients with conditions such as seizures and strokes.
Conditions in the hospital were chaotic, and the capacity for treatment was irregular. Little diagnostic equipment was available, and there was no access to EEG, EMG, or CT equipment at all. No antiplatelet therapy could be administered to stroke patients because it was not known whether their strokes were hemorrhagic, and the hospital pharmacy had a fluctuating medication supply. This meant that, for example, a patient who was prescribed carbamazepine once might be treated with diphenylhydantoin with the next refill. Patients who were thought to have meningitis received antibiotics without lumbar punctures because analyzing cerebrospinal fluid took too much time and resources.
Bigelow spent his last week at an out-patient rehabilitation clinic in Port-au-Prince where, even if he prescribed an EEG or CT for patients with apparent advanced hydrocephalus, strokes, head or spinal trauma, most patients were unable to get transportation to the facility, much less afford the test.
On his last weekend, he traveled to Casse, an isolated village in the mountains that had not been visited by a physician in 200 years. Care was frustratingly limited by a lack of supplies and treatments. Although the sickest diabetics or hypertensive patients could be started on some medication, there was no possibility for future refills.
Prior to the earthquake last week, Bigelow had been planning a trip for May, to help start an education program in the hurricane-ravaged city of Gonaives, but he now believes that more basic support will be needed. "When you have such a huge disaster, food, water and shelter trump all else," he reflected.
For more news on Haiti, see the upcoming issue of Neurology Today®.