Medicine and Dermatology in Mirebalais, Haiti - Part 1

Emily Baumrin MD

Resident in combined internal medicine and dermatology at Brigham and Women’s Hospital and Harvard University, PGY4

February 8^th, 2019

I am spending 3 weeks at Lopital Inivesite Mibale (Hospital University of Mirebalais) in Mirebalais, Haiti. Hospital University of Mirebalais is a 205,000 square foot 300-bed hospital which serves Mirebalais and 2 nearby communities. However, it attracts patients from a larger catchment area including the central plateau and Port-Au-Prince due its specialty services as well as low cost to the patient. Hospital University of Mirebalais is a teaching hospital to Haitian medical students, nursing students, and residents.

My time at Hospital University of Mirebalais is an educational and clinical exchange with the dermatology and internal medicine departments. During my first week, I spent 2 days of the week with the hospital dermatologists. There are 2 Haitian dermatologists who provide clinical care at the hospital, each dermatologist is present 1 day per week spending the rest of their time at clinical sites in other cities. We saw patients in clinic together. The disease burden is quite different from Boston with the predominant presentations infectious in nature including dermatophyte and candida infections, scabies, and secondary infection of atopic dermatitis. The formulary is certainly more limited here with only 1-2 options for topical corticosteroids, oral and topical antifungal agents. There are no systemic treatments available for atopic dermatitis or psoriasis. However, I was surprised to find the number of effective topical treatments that they use here that we do not use at all in Boston. I have learned alternative therapeutic regimens for a number of common dermatologic conditions.

I spent the other days with the internal medicine residents and attendings. Their day is structured much like ours starting with a morning report where new admissions are discussed with the entire department, followed by rounding, a noon didactic conference, and time to work and admit patients in the afternoons. I have been struck by the burden of cardiac disease that they see particularly post-partum cardiomyopathy and right sided heart failure from chronic lung disease and TB. The residents here are excellent ultrasonographers and have taught me many skills to take home. We have had a number of dermatologic cases including drug induced bullous pemphigoid and acute lupus. I will teach a series of case based lectures to the internal medicine residents next week on medical dermatology. Stay tuned!