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Haiti Trip

Recently I again traveled to Haiti alone to work as a volunteer with some local Haitian ophthalmologists ( friends ). I have visited Haiti 10 times the last 30 years and my ophthalmic colleagues unfortunately all state Haiti is no better off nor the eye problems less. I usually go to Haiti by myself as it is less trouble for my host ophthalmologists and I get to know them better.
I saw many patients in their 30's with advanced glaucoma--- an IOP in the 30's ( mm ), C/D ratio 0.9, pale discs, and poor vision,OU. This was the initial presentation for most of these young patients. However, one young man told me the drops he had recently obtained in the Dominican Republic were not working as his vision was still poor.

My take home message is patients with African ancestry, especially with a family history of glaucoma or blindness need to be checked regularly starting at age 25. Checking once is not enough.

I unfortunately forgot to bring my ocular prosthesis which can be obtained rather cheaply from various Indian vendors at our Academy meeting. You need 20 or more prosthesis so as to have different sizes / shapes. Having a dull milky ( cafe-au-lay ) scleral appearance is better than a bright white scleral coloration. I always see patients who would cosmetically benefit from a prosthesis.

Many developing world ( esp. low-income ) ophthalmologists do not use a 78D nor a 90D or a 66D diagnostic lens but only a direct ophthalmoscope. Need to encourage using a 78D lens ( or whatever ). Dilate both eyes. That should be stressed.

The leading cause of tourists and also medical volunteers getting killed in a developing world country is not malaria, cholera, hepatitis, TB, HIV, snake bites, rabies, hippos, elephants, etc. but road accidents. So wear your seat belt and don't let your driver do dumb ( scary ) things.
Don't eat off the street / sidewalk. May be some of the locals can do that but for you it's a good way to end up with diarrhea, cholera, thyroid fever, or hepatitis, etc.

Do not send patients esp. poor patients off for futher expensive evaluations / tests ( CT, MRI, biopsy, etc. ) if no result whatsoever will alter the medical treatment / course. This is esp. true if the patient has to travel long distances ( out of town ). With a Western mind set this can be difficult to fully appreciate. I have seen over and over poor families spending a lot of money they did not have to get an unnecessary test on a family member when the money would have been better spent on the kids' school tuition or school uniforms. Poor folks can get ripped off in a health care system anywhere.

A surge protector with many outlets ( 8 or 10 )is a useful gift to leave behind.
Many developing world ophthalmologists do not check for a Marcus Gunn pupil / Relative Afferent Pupillary Defect ( RAPD ). This needs to be taught and stressed.If you see someone with a RAPD, then have your colleague examine the patient and tell you which eye has the RAPD. Then show him / her the abnormal pupil movement.

Over one billion persons worldwide lack a secure source of safe drinking water. In Haiti many people are having more trouble obtaining safe drinking water -- where to get it, how to store it, is it safe to drink, etc. I was some how more aware of the drinking water problem / concern than on previous trips.

If clear water is left in a clear plastic or glass container in direct sunlight for 10 hours, then it is safe to drink. The water initially has to be clear not murky ( muddy ) and the container has to be transparent ( remove the label ).

I did tour the new Partners In Health hospital ( Paul Farmer MD - Mountains Beyond Mountains ). I was quite impressed - well designed, well built, well staffed teaching hospital. Lots of young Haitian physicians on board.

At an outlying eye clinic ( hospital ) I was able to get a second slit lamp up and running ( functioning). This was esp. helpful as the second year eye resident from Port -au- Prince and the attending ( my friend ) had been sharing one slit lamp. Try always to communicate early with your host and figure out what he needs and what you can bring.
Peace, Baxter

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