Medical students and doctors experience uncertainty in medicine
By Jessica Cohen
I’m back in Thomonde for the second time. It’s familiar and cozy—I know the town, one of our drivers remembered my name, and the taste of beans, rice, and chicken at the end of the day is as delicious as I remember it. That said, the familiarity of the situation does not, in any way, assuage the overwhelming feelings that come over me and the intensity of the time that we spend in Haiti. I thought I would be more efficient and more helpful this year because I have another year of medical education under my belt and I’ve been here before. That was not the case.
I spent the day in the Pediatric clinic. In the morning I helped one of our doctors examine patients and listen to their chief complaints. In the afternoon, I worked on our anthropometry measurements and on our survey. The two small rooms were constantly full of children—babies crawling on the floor, five year olds holding their baby siblings, toddlers waddling in and out, moms breastfeeding and all ages crying out of fear of our stethoscopes and strange measuring tools. Most of the moms complained of fevers, colds, rashes, loss of appetite, and diarrhea. I took the history of one 17 month old girl. She was beautiful and smiley and seemed quite healthy. Her mom started describing fevers that came at night. The fevers were accompanied by sweats and the baby wasn’t sleeping very well. Immediately my mind jumped to Malaria. Malaria it could be, but it could also be a number of other things. No one else in the house or neighbourhood was sick, the baby appeared healthier than many we saw, and she was one of the few we saw who wasn’t anemic.
The doctor and I pondered what to do. We couldn’t order a smear or a test of any kind so confirmation was out. Should we treat under the assumption that it is Malaria? Should we send the mom to a hospital hours away to get a confirmation? Or should we giver her paracetamol for the fever and our standard de-worming? What ever option we were going to choose it was going to have to be a guess. As we were guessing we had to weigh what would be best for the child, most convenient and plausible for the mother, and the best choice from a public health point of view. The bottom line is that we didn’t know the right answer.
There is always uncertainty in medicine. Even in the US where we have tests and imaging and cohort studies to help us decide what to do, sometimes we just have to make a best guess. In Haiti the sense of uncertainty is exponentially higher. We have fewer choices on every front: fewer medicines, fewer tests, fewer doctors, and fewer opportunities to get to know our patients. Not knowing can be uncomfortable. Today I realized that even our doctors, who have been practicing medicine for years, feel inefficient and overwhelmed.
We saw over one hundred children today. We saw some very sick kids and some pretty healthy kids. Most of the time we had a pretty good idea of what to do for them, but sometimes we didn’t know. As we drove away from the clinic site the sun was setting and rain clouds were threatening us with their ominous greys and a yellow-tinged sky. We had been driving for about fifteen minutes when we passed a woman I had seen in clinic walking with her two children on the side of the dusty road. She was walking a few miles home in the dark and the drizzle because coming to see us was worth her time and effort. I realized then that though we may not always know exactly what to do, the patients know that Project Medishare is there for them if they ever need medical care. I don’t mind the uncertainty if I can give the people of Haiti some more certainty and security about their health and well-being.