A 49 year old man presented to clinic today in distress. He was breathing fast and seemed very uncomfortable. He had trouble telling us about his symptoms. His said that he has had trouble eating for the past month. His blood pressure was very high, 220/120 and his heart rate was very fast, 120 beats per minute. His family said that he was diagnosed with hypertension 1 month ago. They also said that he had a chest x-ray that showed his heart was enlarged. He appeared very anemic, so he had some lab work done to evaluate his kidneys and to screen for anemia. Results showed that he was very anemic (hematocrit 18%) and he had severe renal failure (creatinine 6.1). Additional labs indicated that he needed dialysis urgently (potassium 6.7, BUN > 140, venous pH 7.140, HCO3 3.0).

Emergent dialysis is very difficult to coordinate in Haiti. Especially now because so many specialists have left the country due to gang violence. We tried to call a dialysis technician to learn which hospital we should refer him to, but he was not available. We called another nephrologist who recommended several hospitals. Meanwhile, the dialysis technician responded and said that the nephrologist we contacted was in the United States and the hospitals he recommended are not capable of performing dialysis currently. The technician informed us that many dialysis supplies are obtained from the Dominican Republic and that supplies are becoming scarce due to the border closure. The technician gave us several contacts for nephrologists who are in the country. Fortunately, we were able to speak with a nephrologist and she recommended a hospital for the patient and is awaiting his arrival. Please pray that he is able to arrive safely to the hospital as he has to travel through several areas controlled by gangs. And please pray that the nephrologist and dialysis technician will be able to arrange urgent dialysis for this man.