Clinic

Clinic starts at 9am, but the patients begin accumulating on the benches around seven. Although there are some scheduled referrals, many come when they learn of a surgical team in town. The setup is amazingly efficient. A nurse writes down the complaint on a piece of paper, in Creole, which is clipped to the paper chart pulled from the storeroom. Patients are called in the order they arrived. I see them in one of the two exam rooms, and with an interpreter, ask about their concerns. Often their response involved disrobing to point to the pathology. There is an amazing comfort with the human body, and no embarrassment in doing so. Many of the problems were the same that I had seen in the states, like hernias and lipomas. Others are remarkable in the stage of pathology. There are advanced breast cancers, large sarcomas, and a healthy man whose massively enlarged spleen was the result of undiagnosed liver disease. We rely on history and physical. Laboratory and xray s are not available on weekends, with the exception of true emergencies. Pathology is sent to Cap, as the number of cases generated could not support a full time pathologist. Radiation and intravenous chemotherapy are not an option, and this leads to us being creative surgically to control the disease. Radical mastectomy with skin grafting has led to prolonged survival. And we often use exploration to make a diagnosis in unclear cases.

I found this approach both terrifying and enlightening. Without the concerns of litigation, we use our best clinical judgment in lieu of ordering multiple tests. Although the patients do not know us, they arrived dressed beautifully, and are gracious and appreciative. My Creole is minimal, my French a bit better, yet what is reinforced every time, is the power of a simple handshake, smile, and look into the patient’s eyes. Not everyone who wants surgery gets it. I make decisions to defer when risks due to resources exceed chances of success. Could we do these cases in the States? Perhaps, but at great cost and pain to the patient.

The St Barnabas team arrived late due to delays in Turks. I had finished clinic and met them at the compound. Abe Huong and I had worked together after the quake. I kidded him about having to teach him how to take out a gallbladder through an incision rather than a laparoscope, and that there was one on the schedule. We sat down and briefed about the patients I had seen that he and his team would care for over the next week. The language of surgery is universal, yet each patient is unique. After a week of working with logistics, it was good to get back to my roots as a clinician.

And Abe promised to let me know how things turn out.