By Dr. Briana Zachary –
I was diagnosed with type 1 diabetes when I was 2 years old. I was born in a developed country and my parents were able to provide access to state of the art medical care. I have an insulin pump which provides insulin in a manner similar to the pancreas and allows for flexibility with timing of meals and exercise. So, by the grace of God, I am still healthy, 36 years after I received my diagnosis. I have no complications- no kidney disease, retinopathy, neuropathy or heart disease. If I do develop some of these complications in the future, I still have access to state of the art healthcare. I could have laser surgery for retinopathy, dialysis for renal failure, coronary angiography and stenting or bypass grafting for heart disease.
The access to state of the art healthcare is drastically different in Haiti. RHFH treats about 10 type 1 diabetics. Patients come to clinic each month and receive a bottle of insulin (70/30), shots and a bottle of alcohol and cotton. 70/ 30 insulin is the easiest to find in Haiti. Other insulin such as lantus, levemir, humalog, novolog are much more difficult to find, often can not be found and are very expensive when available. It is more difficult to achieve stable glucose with 70/30, but it is what we have to work with. None of our patients have refrigerators at home- so they do the best they can to keep the insulin in a cool place. Thankfully, none of our type 1 or type 2 diabetic patients (45 type 2 diabetic patients) have serious kidney disease so far. Chronic dialysis is not available in Haiti. So if a person develops end stage renal disease, they will die. In addition, kidney transplant is not available in Haiti. There is not a single coronary angiography lab available in Haiti (for angioplasty and stenting) and coronary artery bypass grafting is not done in Haiti. Diabetes greatly increases the risk for heart disease. There are eye doctors in Haiti, however, I have not been able to determine yet if they have the capability to treat retinopathy.
As a physician, it has been quite a challenge to adjust from providing healthcare in the United States to providing healthcare in Haiti. There are many standard medications and standard treatments that are simply not available here in Haiti. And if they are available, most of our patients can not afford them. I worked as a hospitalist in the United States. If a patient needed a test, procedure or medication, I simply had to put the order in the computer. Social workers worked with the patient if a patient did not have insurance or could not afford the co pay. A needed treatment was never withheld because of lack of money. In Haiti, if a patient needs a treatment that does not exist or they can not afford it- I have to figure it out. Often times, the solution is not satisfying.