November 2009--The Patient Becomes the Teacher
November 19, 2009- Mrs. Elizabeth Dumay and Dr. Patrice Severe visited WCMC to speak to first year medical students about their experiences with healthcare in Port -au -Prince, Haiti.
Recently, first year medical students had the opportunity to meet Dr. Patrice Severe and Mrs. Elizabeth Dumay, both of whom traveled from Port-au-Prince, Haiti to teach the students about HIV illness and treatment in a resource poor country. Mrs. Dumay, who is living with HIV and now works as a peer counselor at GHESKIO, recounted her story about how she tested positive for HIV after her husband died of AIDS. When asked why she didn't test sooner, knowing that her husband was sick, Mrs. Dumay replied that her husband loved her very much and he didn't want to die knowing that he had infected her as well. She struggled with the decision to tell her daughter, family, friends, and church community, and her experience, early on, was marked by discrimination and stigma. Now things are better- she is doing well on ART and working as an HIV counselor at GHESKIO, but the discrimination and stigma still exist in Haiti.
Her message to the students was to pay attention to every aspect of a patient’s life, not just the illness. In Haiti so many factors contribute to a patient's ability to be tested and remain adherent to treatment regimens, poverty ostensibly being the main contributor. For example, in a country that can only produce 42% of the food needed to feed its population, malnutrition is prevalent. A poor patient who has no food will not take medications on an empty stomach warned Mrs. Dumay. Patients sometimes stop treatments due to religious or cultural beliefs, other patients don't show up for check-ups because they are afraid of someone finding out. In the face of all these obstacles, she stressed that psychological and emotional support is critical for patients who must make difficult decisions such as whether to divulge their status, or whether to have a family.
Dr. Severe then spoke to the students about how GHESKIO addresses many of the issues Mrs. Dumay raised. GHESKIO (Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes) is a clinic located in the slums of Port-au-Prince dedicated to treating HIV and related illnesses like tuberculosis and sexually transmitted infections. The staff at GHESKIO has developed ways to remove barriers to treatment, including providing free ART, providing money for transportation and prepaid cell phone cards to remain in touch with patients, cultivating a force of field workers and couselors, and working with an NGO to provide food baskets to patients on ART. Offering additional needed services like dental and eye care as well as STI, family planning, and microcredit programs has encouraged patients to continue treatment despite stigma. Dr. Severe’s advice to the first years was to learn to ‘listen’. A good doctor will listen to everything a patient needs to say, even if it seems irrelevant.
Mrs. Dumay and Dr. Severe run a break-out session where students were asked to construct their own hypothetical clinics in Haiti.
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