I received a call late one Saturday morning from Dorcas, who was  the nurse working in the dressing room. She said a woman presented with shortness of breath and that her oxygen was 85%. The patient was 15 days post partum. The patient was receiving supplemental oxygen via nasal cannula at 5 liters per minute when I saw her and her oxygen was only 92%. She was sitting up and looked terrified. Her respiratory rate was 40 breaths per minute (normal is less than 18 at rest). Her heart rate was rapid at 146 beats per minute. She did not have a fever. She had normal breath sounds and she had edema in both of her legs. We suspected heart failure with decompensation, possibly pregnancy induced cardiomyopathy. Pulmonary embolism (blood clot in the lung) was also a possibility. She needed to go to a hospital where she could get diagnostic testing- echocardiogram and possibly a CT of her lungs. HERO emergency services was called and they sent an ambulance to Cabaret. One of our trucks was with the mechanic and the other was in use in Cabaret. So we paid a man who lives in Cazale and has a vehicle to take the patient to Cabaret to meet the ambulance. The patient traveled with Dorcas and portable oxygen to the ambulance. The patient was admitted to the ICU at St. Luke’s Hospital.

The patient was discharged 5 days later. She came to clinic and looked much better. Her oxygen was 100% on room air and she was breathing much more comfortably, though her respiratory rate was still elevated at 26 breaths per minute. She had quite a few prescriptions. From the prescriptions, it looked like the physicians at the hospital had diagnosed her with heart failure. Unfortunately, she also had a prescription for an echocardiogram (ultrasound of the heart), so she hadn’t had that much needed diagnostic test. Most hospitals in Haiti will prescribe medications that inpatients need during their hospitalization and then family members go and purchase the prescribed medications- sometimes at a pharmacy within the hospital and sometimes at an outside pharmacy. She had a number of prescriptions that were prescribed while inpatient- I’m not sure which if these medications she received. But the patient has improved remarkably- Praise be to God! This patient was really sick when she presented to clinic on Saturday. It is quite remarkable how well she is doing now.