L.C. is a 9 year old girl who came to clinic on March 1^st with a fever and cold symptoms. We gave her Tylenol and a follow up appointment for the next week if her symptoms did not improve. She returned to clinic 3 weeks later. Her temperature was  104.9. Her mom explained that, while her child’s fever continued, she did return to clinic earlier because she did not have money for transportation. L.C. did not look well. Her cold symptoms resolved, but she now presented with abdominal pain. She had diffuse guarding on palpation of her abdomen- meaning she flexed her muscles to guard against the pain of palpation. This is a concerning sign, however, she did not have focal pain- did not have more pain in one area. Labs did not contribute to determining a diagnosis.

The question was what to do. A CT scan would be preferable, however there are only a scattered few  CT scanners in the country- and they are not working consistently. Hospitalization at a hospital with a CT scanner and a surgeon competent in GI surgery would be ideal, but there is absolutely no guarantee that this combination would be available. The option left to the patient is the arduous tasks of traveling through gang controlled areas to arrive at such a hospital, with her mom already without the means to return to our local clinic. So, after a long discussion with her mom, we made a space as clinic for  L.C. and her mom. We treated her with high dose, broad spectrum antibiotics and did serial abdominal exams with plans to transfer her if her exam became more focal. We prayed. Her high fever continued throughout the night and then stopped. Her abdominal pain continued for 2 days but did not get worse and she started to eat. On day 3, she was sitting outside, laughing and talking with another patient. I stood there looking at her in amazement. I don’t know what made her so sick or what made her better- antibiotics or a God given miracle? But regardless, I am very thankful.

Sometimes determining what level of care our patients’ need is extremely difficult. There is no guarantee in Haiti that a hospital will provide adequate care for a patient. They might not have a surgeon working that day or a patient may not receive surgery in a timely manner because the hospital wants blood to be in house at the hospital in case the patient needs a transfusion or the hospital doesn’t have a necessary medication and sends family member to a pharmacy to buy it but the pharmacy is closed. The list seems endless to the potential roadblocks for our patients to get the care they need for the best outcome possible. Also, travel to Port au Prince is dangerous right now. And most of our patients do not have money and are too frightened to try because of the country’s insecurity. So when possible, we provide care for our patients. Sometimes it is obvious the patient needs a higher level of care, such as for a cesarean or orthopedic surgery for a broken bone or for dialysis or a blood transfusion. But then there are patients like L.C. where the answer isn’t obvious. The best scenario would have her transferred to a hospital, get an emergent CT of her abdomen and other lab tests that we cannot provide such as blood cultures. But those healthcare options simply are not available in Haiti at present. We are grateful to God that, in His mercy,  L.C. was discharged on Friday, after 8 days of inpatient care, healthy, happy, and heading home.