Haiti

As things continue to fall apart in Haiti post-earthquake, the stark inequalities in health care (and building practices) are painfully obvious. I think I'm particularly sensitive to this right now since I'm in the world of Peds Hem/Onc and the NICU where it is not at all abnormal to spend upwards of a million dollars trying to save one child. I'm not implying that shouldn't be done, how on earth can you deny available treatment to a kid when it might save their life? But just think what that money could do in Haiti...save 10,000 kids or 100,000 kids by giving them vaccines, anti-virals, food. In third world environments, actual health care is only part of the problem...sure you can give people antibiotics, but if they don't have clean water to take them with, you're doomed. The resident on hem/onc is from Pakistan and he was telling us about the one Peds Hem/Onc clinic at their main teaching hospital. They have most of the necessary drugs and can follow the recommended treating protocols, but when the kids are immunosuppressed at all they must keep them in the hospital or the infection rate is just astronomical due to general unsanitary conditions. Health care inequalities are really just one manifestation of overall inequality.

Today was rough...one of the patients I saw on my first day who had a lytic lesion in her leg which we hoped was just a brodie's abscess got her pathology back today and it turns out the lesion is a high grade osteoblastic osteosarcoma. Not good. Then we were consulted on a 5 month old in the NICU with end stage liver failure. She has major coagulopathies since her liver is pretty much nonfunctional and because she's not a candidate for a liver transplant there's really nothing that can be done. Maybe someday soon we'll be able to create new livers in a lab, no problem, but that might just widen the health care gap. At least in the U.S. most kids won't be denied treatment from inability to pay...but sadly for this little girl science just isn't there yet. Then we have our patient who might be a vampire...

I wish I had the training to go and help in Haiti. At least Partners in Health is still relatively intact since it was based in rural areas. I've been rereading Paul Farmer's "Aids and Accusation"...health disasters in Haiti are hardly new, how much can one country take?