Today, in the third and final entry (see Parts I and II) of Pierre Valette’s journal from Haiti, we experience the first fully electronic patient encounter at the St. Boniface Hospital and learn more about 16-year-old Mamaille; she had been crushed by a falling building at a Port-Au-Prince school, abandoned on the Haitian border, and eventually brought to St. Boniface.
When reading Pierre’s entries, I can’t help but think of how fortunate we (U.S. citizens) are to have the level of health care that we do in the U.S. Sure, there are many things we need to improve (such as data sharing and the ability to shop for care), but those pale in comparison to the day-to-day struggles some Haitian caregivers and patients have to overcome. – Michelle, Social Media Manager
My last day. Our fifth day here.
We now have running cold water. Yesterday, the plumber made the eight-hour round-trip drive to Port-Au-Prince to buy a new pump for the water cistern on the hospital roof. This means we no longer have to carry buckets from the well in the courtyard up to the bathroom to bathe or flush the toilets. We may have lacked running water over the past few days, but the rhythm of the hospital never dissipates. Each day, hundreds of patients arrive as they always do—on foot, by motorcycle or via donkey—to receive the level of care that only the St. Boniface Hospital can provide.
Over a dozen babies have been born since we arrived. Three babies are in the NICU (Neonatal Intensive Care Unit), kept thriving by ventilators powered by ever-humming power generators. In the small pediatric ward all beds are occupied by children suffering from HIV, malaria or other ailments that plague Haiti. Their parents sit by their sides. At night, they curl up with them on their beds to sleep.
Dr. Desiree arrives late for his electronic health record (EHR) go-live today after performing an emergency C-section in the hospital’s operating room, supplied with donated equipment from a Florida hospital. Without taking a breather, he comes straight from the OR to our makeshift training area, a big smile on his face, ready to begin his first electronic encounter for the Spinal Cord Injury (SCI) Program. He will be seeing Mamaille (photographed, right), the 16-year-old girl abandoned on the Dominican border about two years earlier. Though she seems healthy by all appearances, Mamaille currently suffers from persistent infections caused by her wounds. In fact, on our third day here, when Jackie Mow, head of the athenahealth video team, filmed two of the SCI kids going to the nearby school (carried in their Walkabout wheelchairs due to the school’s lack of ramps), Mamaille had to stay behind because her wounds had become irritated.
Dr. Desiree logs onto athenaNet and is now ready to see Mamaille in his office, conveniently located across an open walkway from Mamaille’s room. There’s just one hitch. No Mamaille. Realizing that she might be photographed, Mamaille is delayed in her room, unsure of what earrings to wear. She fusses with a bag full of earrings she has made over the past year—the output of the SCI’s vocational program that has taught her basic jewelry-making skills. The normally soft-spoken Dr. Desiree calls out to her from across the hallway. Je m’habille,—I’m getting dressed—she yells back. A little white lie. Appearances are important here in Haiti—especially to Mamaille.
With the perfect set of earrings dangling from her ears, she makes her way to see Dr. Desiree’s office. To start, he encounters a small problem entering her name. Seems he hasn’t perfected the “Search Patient” function on athenaClinicals, entering far more letters than necessary. Jamie Mercurio, another member of the athenahealth implementation team, shows him that he only needs to type a few letters of her last name. He enters "L-E-J." Mamaille LeJeune’s record immediately pops up.
Dr. Desiree takes her vitals and enters the discrete data into the system. As he talks to Mamaille, he selects the patient's chief complaint and quickly documents the history of her present illness—all in Creole. At the end of the encounter, he enters her prescription into the system. It’s a short visit. More of a test than anything else. Dr. Desiree is slowed down a little by having to visually scan the screen for fields he’s not yet familiar with, Jamie helping him search for the prescription he needs. But with very little training and only a modest amount of assistance, Dr. Desiree successfully documents the encounter into athenaClinicals.
As Mamaille leaves the exam, Jamie and Dr. Desiree exchange a high five. Dr. Desiree did it! The St. Boniface Haiti Foundation’s SCI Program has its first electronically documented patient care experience. One small step for EHRs, one giant leap for health care in the Third World countries.
I ask Dr. Desiree what he thinks. He confides that the process took a little longer than “de documenter avec un stylo.”— to document with a pen. “Is it worth it?” I ask. “Bien sur”—of course—he responds. He’s confident that he and the care team at St. Boniface Hospital will soon develop the muscle memory needed to use the EHR efficiently.
That learning curve will be worth it as athenaClinicals begins to provide the data needed to track progress and coordinate care more effectively. Betsy Sherwood, coordinator of the SCI program couldn’t be happier. For months she’s known that this experiment in implementing electronic health records at the SCI Program could only succeed if Dr. Desiree was on board. He was indeed and has taken the first step. The staff can now follow his lead.
It’s a good day. The cloud did what it was supposed to do—bring rural Haiti an efficient and effective means of documenting, tracking and managing patient care across all care providers. Dr. Desiree is satisfied. And I can now go take my first shower since we arrived.
Look for a guest post from SCI program coordinator Betsy Sherwood later this month where she’ll speak in greater length about health care in Haiti and the day-to-day struggles physicians are faced with.