Cross Cultural Medicine
I’m gradually, creepingly learning some rules about being a good health care provider in Haiti.
Here are a few of the things I’ve learned:
1) If you want to awe your patients with your insight into their health problem simply observe which part of the body has a rolled-up piece of fabric tied around it. A cord tied tightly around the waist? Backache or in pregnant ladies round ligament pain. A handkerchief tied headband style around the head? Headache. Around the knees? You guessed it—knee pain.
2) Even if a scratch seems minor, never simply wash it and smear a little antibiotic ointment on it. Always cover it. This will prevent wind from entering into it. If wind would enter into it it could cause the patient to have gas; all kinds of pain in various parts of the body. Wind entering into a wound is what causes it to swell. It is also what causes umbilical hernias (protruding belly buttons) and inguinal hernias. Unfortunately I still haven’t figured out an impressive way to take wind out of a wound.
3) Always reassure a patient they may bathe the area in which they’ve received an injection whether this is for the purpose of injecting medicine or for withdrawing blood. I regularly forget this and was surprised the other day when a week after his first dose of benzathine penicillin as treatment for syphilis, an elderly gent returned for his second dose with the bandaid from his first injection still intact.
4) Here, as everywhere, a listening ear can soothe a multitude of problems.
5) Never underestimate the power of a stethoscope. I first realized the great importance attached to being really, thoroughly “stethoscoped” upon hearing an elderly woman relate with great gusto her experience of having a doctor “stethoscope” her upper arm. Now as far as I know there is absolutely no reason (other than checking blood pressure of course) to “stethoscope” a person’s arm, but just out of curiosity I have tried it a few times in patients complaining of arm pain. They are inevitably delighted. “Yes, ahhhhh, yes, right there!!!” If nothing else it makes the patient feel as though you are taking their complaints seriously. People seem to attach almost mystical power to a stethoscope, seeming to think it can somehow magically whisper a person’s diagnosis into your ear. There are plenty of times I wish it would.
6) There are (at least) three types of fever. Fever that makes your body hot, fever in the blood and fever in the bones (aching, as far as I can decipher). Therefore when a person complains of fever it is wise to find out which type of fever.
7) And then there are the ways of describing problems that keep a westerner such as myself somewhat mystified. “Anba kè-m vid” (Under my heart is empty). That’s a very common complaint, but I think I’ve come to finally understand it—that gnawing, nauseous feeling that accompanies low blood sugar. “M-gen yon van nan zorey’m” (I have a wind in my ears). My best guess is that this is what we would call fluid in the ears. The list goes on . . .
All newborns must come to the clinic for medicine for gas.
9) A baby’s back should not be broken (bent) until it is a month or two old and when you do “break” it you can expect the baby to have diarrhea or a fever similar to teething. Therefore the mothers lay their newborn infants across their laps and bend down to nurse them.
10) Twins are easily jealous of each other and may bring curses to other family members. Therefore if they are brought to the clinic care should be taken to give each twin similar medications otherwise the family may chose to give each twin the other’s medication just to keep things even.
11) Congratulate patients for gaining weight and commiserate with them if they’ve lost.
12) Vitamins have tremendous power (especially in liquid form) and are believed to be appetite stimulants. If someone is saying that don’t have an appetite and are becoming smaller, reassure them that you will prescribe vitamins for them.
13) My idea of what is causing an illness and my patient’s idea of what is causing an illness are often worlds apart. Recently a woman brought her infant son to the clinic. He appears to have an abdominal tumor. Treatment is not an option. Upon discussing her son’s condition with her I assured her there was nothing she could have done to prevent it. I don’t know if she believed me. Her neighbors had other theories. Her sister-in-law died from complications of AIDS earlier this year. Afterwards she took in her orphaned 18-month-old niece who, although testing negative for HIV, died several months later. Her neighbors say it was because of that baby’s spirit that her son was becoming sick. They had warned her not to take in her orphaned niece. They knew it would make her own baby ill. Others shook their heads and said it was because of her set of twins—they were a bad omen who had cursed this baby. I cannot convince them of my point of view; but I can present it as another option and I better be aware of what perspective they’re coming from.
14) Almost every death can be blamed on a curse—even if the person was aged and ill for a long time often someone is accused of cursing the person and thus causing the death.
15) IV fluids have supreme power and are to be desired above all else for giving strength.
16) If a baby is born at 7 months it has a chance of surviving, but if a baby is born at 8 months it is sure to die.
17) Although this has changed, long ago the placenta of a baby was buried in the dirt floor of the house, underneath the bed. A fire was then built over the place it was buried using wood from three different types of trees.
18) If a person has a seizure you should take the clothes the person was wearing when he/she had the seizure, burn them, then take some of the ashes and have the person who had the seizure drink them to prevent them from having more.
19) If a nursing lady experiences a great shock or surprise (ie witnessing an accident; experiencing a sudden death in the family, etc) she should be given special teas as a treatment ASAP. Otherwise her milk will go to her head causing all sorts of problems in the future such as mental illness. The infant should not be given its mother’s milk for a little while following the shocking event either.
It is fascinating to learn more about the health beliefs and practices of the area. It is also challenging and sometimes makes me wonder how surprised both me and my patients would be if we could get inside each other’s heads and see the rationales each one of us is operating under.
Pray that I can care for my patients in a way that makes them feel valued while also pointing them to the One who can provide freedom from fears of curses and has power to overthrow sickness and death.
Thanks!
Bethanie
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