This is my first blog post. I am Briana Zachary, I am married to Casey Zachary. I am an internal medicine physician and started working at Real Hope for Haiti this January. It has been a bit of a transition for me to move from practicing medicine in the United States to practicing medicine in Haiti. That is a bit of an understatement. Whoah. The following story is an example of the extreme differences in medical practice and resources in Haiti compared to the United States.

R.L. is a 30 year old woman who I saw in clinic several weeks ago. She reported a recent history of dysfunctional uterine bleeding. She had very pale conjunctiva, poor capillary refill and had a fast heart rate.  She had her hematocrit checked at the lab across the street and her hematocrit was 12%- very anemic. To put this in perspective, patients in the United States receive a blood transfusion when their hematocrit decreases to 20%.

So, no big deal, give her a transfusion. Well, blood transfusions are very hard to accomplish in Haiti. In the United States, any hospital can give a blood transfusion. A patient’s blood is typed and crossed at the nearest blood bank. The blood is pre- screened for numerous viruses and blood borne pathogens. The whole process takes maybe a couple of hours and then the blood is sent to the hospital and the transfusion is started. In Haiti, only hospitals that have a certain status with the Haitian department of health can give blood transfusions. So, a patient who needs a blood transfusion has to be taken to one of these hospitals, wait to see a physician (which may take multiple days), have their hemoglobin and hematocrit checked (go to the lab), wait for the lab results and then the physician decides if the patient needs a blood transfusion. If the physician feels that a blood transfusion is appropriate, then a prescription is written, which the patient must take to the nearest blood bank. I am not sure how many blood banks there are in Haiti. 2 units of blood must be donated for every unit given to the patient. So typically, 2 family members or friends go to the blood bank with the patient for every unit the patient needs. So if a patient needs to be transfused with 2 units of blood- he or she is accompanied by 4 people. The family members need to wait their turn to donate blood- which may take all day. Then the patient is typed and crossed. The blood must be placed on ice in a cooler provided by the patient. The blood is then taken back to the hospital. At this point, the treating physician may transfuse the blood or decide to save it for another patient. There is no guarantee that those precious units will go the patient, and the whole process can take days.

So, I referred this patient to a hospital that is able to perform blood transfusions and also has gynecologists. I also gave her iron just in case she was not able to get a blood transfusion. I asked her to please follow up after her hospital visit. I am still waiting to see her.

I hope to make arrangements with a near- by hospital (1.5 hours away) to create a fast track for some of our patients (inpatient and outpatient) with severe anemia to receive a blood transfusion. This is a work in process. Lori and I have the details worked out in our heads- we will see if the hospital likes the details. Please pray for our success! Thank you.