February 2nd, 2017
From Leogane to Longwood: How Different Are Our Patients?
When I worked in family medicine, I considered my practice to have two very distinct patient populations — the pediatric population I served from their birth to adolescence and the adult population — each with a very different set of needs. Now that my practice has changed and I care exclusively for patients over age 18, I am focused on a more limited set of diagnoses and issues. Returning from volunteer work doing patient care in Haiti a few weeks ago, I thought about the Haitians and my U.S. patients: Are these now the dual populations that I serve? Are these two different worlds to be straddled? Or are they more similar than they seem?
I believe that the differences appeared starker to me when I first arrived at Toussaint L’Overture Airport in March 2011. The landscape and population needs —one year after the massive earthquake that is still a defining point of Haitian history — were like nothing I had ever seen.
I was raised in a small New England town and have lived my entire adult life in Boston. However, as I spend more time in Haiti, the edges continue to soften, the lines to blur. And during this year’s trip, it seemed clear to me that there are more commonalities than disparities between my Haitian patients and those who visit me in the Longwood Medical Area of Boston.
One clear example is a clinical visit involving a mother and child. Working in Brockton, I saw many patients for their first newborn visits and then for subsequent well-child checks or urgent concerns. In Haiti, due to the sporadic nature of our clinics, I cannot provide the continuity of care that American children receive. However, mothers there have the same urgent care questions, expressing their concerns over an earache, a loss of appetite, or a fever that leaves a child sweating through their pajamas. They want to know: Are their kids getting what they need? Are they as mothers providing the right interventions? What is “normal”? The American mother and the Haitian mother care equally about their children, regardless of differences in health care and other resources. They share a core desire to understand and help their children. And they both need and respond to the reassurance that a healthcare provider can give, the reassurance that is, 99% of the time, the most important part of an interaction with a patient.
Discussions with adult patients also share common themes, like work-related health effects; outdoor laborers have dry eyes, those who do physical work are more apt to complain about musculoskeletal pain, etc. Age and involvement of family can affect a patient’s ability to obtain care, in both Haiti and Boston. A patient with no one nearby to offer care sometimes presents when a concerned neighbor or friend finally brings them to a visit. Often, these patients are more likely to have mental health issues as a result of their isolation. Although social barriers to health may be present on a wider scale in one place versus another, they are present in both places.
Finally, the truth remains that the anatomy and pathophysiology of disease in one human are largely the same as in every other human. Even as we advance our understanding of the effects of ancestry and genetics on health, by and large, our assessments and interventions are the same because one patient does not vary so significantly from another. Each blood pressure we measure in Leogane is done the same way as one measured in Boston. A diabetic person is more prone to heal slowly from an infection in either city. A severe stroke has the same debilitating consequences in either place.
In recent days, we have heard much on the news about the differences between people both within and outside the borders of our country. From my unique and privileged position as a healthcare provider, it seems to me that now is a good time to be reminded of the basic human commonalities we all share; we really are more the same than we are different, from Leogane to Longwood and around the world.