Treating a Preeclamptic Patient in Haiti

ASSESSMENT: 38 year old gravid, at term female with a history of preeclampsia presents with severely elevated blood pressure, blurry vision, headache, urine spot with protein present, consistent with the working diagnosis of preeclampsia.

PLAN:

1. Intravenous fluids

2. Beta-blocker to lower blood pressure

3. IV Magnesium Sulfate

4. Hike through the mountains for an hour to get to transportation, drive for 3 hours to Port-au-Prince, and transfer patient to care at the hospital.

Never did I imagine in my life that hiking would be a part of my plan for a patient in one of my “write ups” that I entered in the drchrono EHR. Only in a third world country such as Haiti did it finally happen to me.

Our team was running our last day of our free health clinic in the rural mountainside of the village of L’azil, when we became aware of some riots occurring in Port-au-Prince. We had heard someone was shot protesting the announcement of which presidents would be on the ballot. Collectively, our team decided to end clinic an hour early so that we could ensure we would arrive back to Port-au-Prince before nightfall.

At this time, an 8 and a half month pregnant Haitian was found to have severely elevated blood pressure, protein in her urine, a history of preeclampsia, blurry vision, and a headache. Worried about preeclampsia, the team decided the best thing to do was treat her hypertension, start some IV fluids, and take her to Port-au-Prince with us to a hospital to prevent any complications to her pregnancy. She was at risk for severe seizures and even death to both her and her unborn child.

It was an incredible experience to provide medical care in this rarest of environments as an American doctor. I am thankful that she came to visit our mobile clinic that day, and I am grateful that our drchrono EHR was able to capture the patient’s story for the betterment of her future health care provided by World Wide Village’s Community Health Initiative who will return to see her in April 2011.

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