An Internal Medicine Rotation in Mirebalais, Haiti: Some Reflections from Two Weeks in Haiti

Anastasia Vishnevetsky

Resident in the Partners Neurology Program, preliminary year in internal medicine at Brigham and Women’s

PGY1

An Internal Medicine Rotation in Mirebalais, Haiti: Some Reflections from Two Weeks in Haiti

It’s been now almost two weeks that I have been in Mirebalais, so here are a few reflections from my time:

1. On daily life as a resident: 

A first year resident in internal medicine at Mirebalais, starts their day around 6:30, with prerounding and seeing approximately 8-10 patients. At 8:00AM, most residents go to the resident’s lounge for a quick breakfast. At 8:30, they have ‘morning report,’ which is a formal presentation of all the new admissions from the previous nights with the internal medicine attending physicians and all of the residents. There’s usually some informal teaching and discussion at morning report as well, which is completed around 10AM. After morning report, residents will break off to the different wards (women’s ward, men’s ward, or isolation ward for patients who are being ruled out for TB) for ‘small rounds,’ which are bedside rounds with the senior resident and sometimes the attending as well. This continues until noon, with the residency gathering again at 12PM on Tuesdays, Wednesdays, and Thursdays for an interesting case presentation on one of the wards. Everyday, except Friday, there is a teaching conference around 1pm, and around 2pm the residents go for lunch. The interns are on a Q5 day call schedule, staying for long call until around 2AM every 5^th day.

The intern day here is quite different from Boston. There’s significantly less paperwork and fewer labs to follow up, consults to call, or orders to put in - a natural consequence of fewer medications available, limited lab test availability, and few specialty services. The days are just as long however, with group case presentations taking up almost half the day.  The interns have shared housing on the campus of the hospital and work 6 days out of the week.

Writing notes at the hospital

The Arbonite river flowing through Mirebalais, about a 10 minute walk from the hospital. This is the river that was affected by the cholera epidemic brought by the UN in the aftermath of the 2010 earthquake. Signs demanding reparations from the UN can be seen throughout the city, and anti-cholera vaccination efforts are ongoing.

2. On practicing medicine in Haiti:

Life as a doctor in Haiti is hard even after training, and many of the residents have their eyes set on foreign medical exams after residency. The government provides little public funding for physician salaries, and most needy patients have neither insurance nor the capacity to pay out of pocket for health care. Equipment and lab testing is difficult to come by, and costs can be very high. Healthcare is often provided by foreign NGOs like Partners in Health, which provide free care, but there are a limited number of attending positions at these institutions.  One co-intern who has thought about trying to move to Spain after residency, laughed when I said Haiti needs doctors to stay in Haiti: “Easy for you to say.” Indeed, easy for me to say. He added that of course he would want to stay in Haiti and make a living here, but at some point ‘you have to think about where you want your kids to grow up and what kind of life you would want for them, and so if you have to leave, you leave.” It’s a sad thought, especially looking at some of the talented residents I’ve worked with here in Mirebalais. On admitting nights, I’ve worked with one of the best residents I’ve worked with all intern year, whether in Boston or Mirebalais. I joked that I came down to Haiti just to learn from this brilliant resident, but in all seriousness, I think it would have been worth it for him alone. I heard later that he is studying to take the USMLE.

3. On the importance of language:

The vast majority of patients and people in general in Haiti speak Haitian Creole amongst themselves. French is only used in official and administrative settings (including between doctors in the hospital or during presentations in the hospital). English is rarely used at all, though some doctors can speak it, and most residents can understand it to some degree. The language barrier creates an immediate division between expats and locals that is troublesome and makes it difficult to form deeper and more significant local relationships. For me, speaking French has allowed me to get closer with many of the residents and function as a resident in the hospital, but I still wish I could speak in something other than the former colonialist language. The requirement to speak French, which is spoken almost exclusively by the Haitian elite, in official settings and also to study in French in schools perpetuates the inequalities in Haitian society. Creole is incredibly similar to French in terms of vocabulary, but learning to understand spoken Creole from a base of French is much more difficult.  It was very worthwhile to learn some Creole before coming to Haiti, and I wish I had learned more.

My co-intern at Saut d’Eau, a famous Haitian waterfall with great importance in the Vodou tradition. We took the trip about 25 minutes outside of Mirebalais on our Sunday off.

4. A reading recommendation:

‘The Big Truck that Went By: How the World Came to Save Haiti and Left Behind a Disaster.” This book, which was recommended to me by another doctor who has repeatedly come to Haiti, was one of the best books that I’ve read in a long time. It is written by the AP journalist who was in Haiti at the time of the earthquake in 2010, and who later broke the cholera epidemic story. I’d particularly recommend it to anyone interested in global health or development, or to anyone interested in coming to Haiti and understanding the complex and often fraught relationship that Haiti has with foreign aid.

5. On Haiti:

Haiti is incredibly beautiful. I had heard that Haiti was mountainous and beautiful, but the landscapes here truly blow me away. The mountains, beautiful sunsets, which then roll into a perfect turquoise Caribbean Sea have to be seen to be believed. The fact that Haiti is not overflowing with tourists speaks to the infrastructure problems, as well as to the negative mythology that surrounds Haiti. I’m still a few weeks away from leaving, but I can tell I’m going to miss it!

The view from Saut D’Eau,