Imagine that you are working in your garden. You’ve been working in your garden all day, it’s now mid- afternoon. Your family depends on the produce from the garden for food. You start having some chest discomfort. You get heartburn from time to time and don’t think much of it. But it persists and then starts to get worse. Then you start to feel short of breath. The chest pain becomes crushing and you fall to the ground. You are having a heart attack. You call for family members. They come running. But there is nothing they can do for you right then. You live in the mountains, accessible by a dirt road. There is not an ambulance in Haiti that will come to you. The closest clinic is a 3 hour walk. You survive the heart attack, but you are not the same. You now have a very poor exercise tolerance, an hour working in the garden exhausts you.

This somewhat terrifying scenario is reality for some Haitians. There is an ambulance system in Haiti, but it is composed of volunteers and they are limited in the area they can cover. They come only if they are able- if there is an ambulance available and they can access the roads to get to the patient. Don’t get me wrong, this ambulance system is a huge benefit to Haiti- much better than what was available previously, but definitely different than what we are used to in developed countries. You call 911, an emergency medical team arrives- usually within minutes.

In a developed country, if you are having a heart attack, you are taken to an emergency department. If evaluation in the emergency reveals a heart attack, you are taken to the cath lab and a procedure to relieve the obstruction in your coronary artery is started within 90 minutes of arrival to the ED.

There is no cath lab in the entire country of Haiti. There are other treatments available for myocardial infarction at some hospitals in Haiti, but patients do not usually arrive in time for these treatments to be of benefit. So the answer for now is prevention. Prevention is always better, but particularly when there is no treatment available. We educate our patients on the importance of treating hypertension and diabetes and the importance of complying with treatment regimens and coming to follow up appointments. It seems simple, but often is not so easy as many patients do not take us seriously until they have a stroke or heart attack. Keep at it!