Reflections on a return to Thomonde
By Amanda Harrington, MD
This morning after another hearty breakfast we headed out of Thomonde proper for a more remote area. The trip was shorter than yesterday, but the road was significantly more “bumpy.” As each SUV navigated the struts in the road, we watched to see if the vehicle ahead would clear the “bump” with spinning tires and less than four wheels in contact with the ground.
We set up clinic at a school and divided up patients into pediatrics, general adult, ophthalmology, or women’s health stations. Today, myself, Gaby (our trip coordinator and a wonderful translator) and Kavita (a first year medical student) tackled the mass of adults seeking treatment for a variety of medical illnesses. We diagnosed patients with upper respiratory infections, urinary tract infections, anemia, hypertension, GERD, and many post-traumatic musculoskeletal conditions. As a team we had fun teaching Gaby to take blood pressures and letting Kavita hone her history and physical exam skills.
I was surprised and excited to learn that most of the patients we saw with severe hypertension had been diagnosed previously and had been on anti-hypertensive medications. Many presented with the chief complaint “I have high blood pressure” and had come to the mobile clinic seeking refills on medications. I found myself thinking back to my first trip to Haiti with Project Medishare in 2001, when I myself was a second year medical student. Back then, Medishare clinics were held in central Thomonde. There was no hospital, and beyond the direct observed therapy programs, there were no community health agents in place to assist with patient follow-up. Seven years ago, there was little hope that newly diagnosed hypertensive patients would return for medication refills when their 30-day supply was completed. Now, under the improved structure which Medishare provides, patients are developing relationships with community health agents and beginning to understand basic concepts related to disease and regular treatment. It is exciting to know that progress is possible, and that chronic disease treatment can be a reality in the future.