Vincent DeGennaro, Jr. is an internal medicine physician and president, Innovating Health International. He blogs at An American Doctor in Haiti and can be reached on Twitter @DoctorGlobal.
The U.S. response to coronavirus reminds me of recent disasters when official facts were at odds with the reality I encountered.
Governments have a long history of lying to their people about the risks of illness, either as a way to minimize political damage or to drum up hatred for “the other.” China was accused of covering up the true breadth of the SARS epidemic in 2003, …
The water continued to rise as the rain pounded Marsh Harbor, a town on Abaco, one of the 700 islands of the Bahamas archipelago. Hurricane Dorian plodded along, nearly slowing to a stop directly over their meager homes. The rain and wind continued to lash their wood and aluminum dwellings, but the real threat came from the sea. Changes in climate mean the ocean started higher than it did only …
“Let’s start the powwow,” a man with a brown jacket and braided ponytail said with a smile. Nineteen adults and one child filled the back conference room of the hospital. The hospital had made an industrial cylinder of coffee for the meeting, and it was almost completely drained. I hung the stethoscope around my neck, knowing I wouldn’t use it as anything but a prop to signify my training and …
“I have the CPAP machine. I’ve had it for a year, but I don’t have electricity in my house. I stayed with my aunt who has electricity but things didn’t work out,” said the young Navajo man, his massive belly protruding out from underneath the tray table.
The old Navajo man with Parkinson’s disease, unable to walk fast enough to make it to the outhouse in time, had started taking anti-diarrheal …
He struggled to breathe, progressing from deep breaths with wet sounds reverberating in his lungs, to guppy breathing — opening the mouth like a fish, contorting the entire face. His heart rate slowly decreased, from 150 beats a minute — a pace attempting to keep up with the oxygen demands of the body — to 50 beats, to 40 beats, to that which is incompatible with life. The nurse pushed …
Tom’s feet are shackled so he can’t bolt from the hospital bed when the prison guard isn’t looking. The guard places handcuffs on him when he walks to the bathroom and stands just outside the door as Tom relieves himself. Despite being treated for a deep tissue infection in one finger, Tom is in generally good shape — lean but muscular with the strong hands of a workman. Back in …
“How long have you had the bleeding?”
“About seven years,” my patient replies stoically.
Ange’s angular face no longer retains the beauty of her youth. The sharp lines around her mouth speak of a long life packed into a brief 42 years. She is well dressed, but her manner of speaking betrays the poverty in which she exists.
Ange has advanced cervical cancer — a completely preventable disease. In fact, cervical cancer can …
“Do you know the visa process in the U.K.?” Yousef asks me nervously in the physician work room at our hospital in Florida. “I’ve spent the last two weeks looking up the different countries where I might be able to work — Canada, Australia, New Zealand, and South Africa.”
Yousef goes on to list the various visa and medical licensing procedures in each country and has clearly done his research. As …
The Haitian doctors’ strike ended recently, and it is unclear if there are any winners. The conditions in which the striking doctors — medical residents in Haiti’s public hospitals, to be precise — work are appalling, and the low pay was galling, but without the doctors, hospitals shut their doors and the poor were left to take care of their own illnesses and injuries for nearly five months.
At issue were …
“Fifty-three-year-old homeless woman with diabetic ketoacidosis and severe emphysema exacerbation.” And suffering from adomicilia, too, I added in my head.
Much like apraxia means the inability to perform purposeful movements (praxis), adomicilia jokingly means those who are not domiciled, a pretentious attempt at gallows humor in the medical profession.
I read through the patient’s electronic record imagining a withered woman, wrinkled from years of drinking and smoking, perhaps with signs of schizophrenia. Most …
Micheline came to Project Medishare’s women’s health center in Port-au-Prince as many of my patients do — with advanced cancer. At only 46 years old, she still had two young daughters and a family that needed her income selling clothing on the street. Micheline has cervical cancer, a disease that literally takes years to form and grow, is easily detected with simple tests, and is entirely preventable.
We initially launched the …
“I’m doing my part. I want to get better and go home,” Dorothy says as she looks up at me from the hospital bed. We talk about her family and work life, and she tears up several times during the conversation especially when she talks about how her mother died of cancer. “I’m afraid to go that way,” she divulges. Her 450-pound body fills the oversized bed entirely, and the …
“Either way, no matter what we do, you’ll live less than 12 months, probably less than nine. Even if we were in the United States, your disease is incurable.” He nodded slowly in understanding. Jean Dominique was only in his 40s and had teenagers at home. “We can treat your pain and other symptoms, but we can’t do anything to treat the …
“Doctor, I have trouble breathing when I walk up stairs, and I cannot lie flat in bed, so I have to sleep sitting in a chair. I feel much worse than before I got pregnant.” I recognized the diagnosis at that point, but I continued the appointment to confirm my suspicions and to revel in the art of medicine.
I listened to the young woman’s lungs, full of crackles from fluid backup, …
“The patient’s pain is still 9/10, doctor. We’ve already given morphine IV and then changed to Dilaudid IV and then we increased the dose of Dilaudid. Can we give it every two hours instead of every three hours?” the nurse asks me over the telephone. I sigh heavily into the receiver, unsure what to do, feeling more like a drug dealer than a doctor. The patient is on horse-sized doses …
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