Every Thursday at 9:30am Dr. Rony St Fleur gathers residents, nurses and attendees in the pediatric services for ‘Grand Rounds’ to discuss treatment options for difficult cases at the hospital. In October one day one such case arrived at Justinien University Hospital (JUH). Dr. St Fleur and the staff members began to treat the patient, a 13 year old boy with cyanotic heart disease, a defect that prevents oxygen-rich blood from reaching the tissues of the body thus producing a bluish tint to several areas of the body.
This case was particularly unique in that the patient did not exhibit weight loss which is a characteristic of the disease. For this reason, collaboration was required by the hospital staff members to discuss how the situation may be explained, as well as to determine the next steps that ought to be taken. The outcome of the Grand Rounds discussion was an agreement that the patient ought to be taken to Milot, a commune 12 miles south of Cap-Haitien, to a hospital with access to an echocardiogram machine that can confirm the initial diagnosis.
Dr. St Fleur has long understood the benefits of these kinds of collaborative discussions and has advocated for their regular introduction into the protocols and processes at JUH. He stated that they are a benefit to everyone that is involved and ultimately lead to better and more thoughtful patient care.
After the trip to Hopital Sacre Coeur in Milot, it was revealed that the patient had Eisenmenger syndrome brought on by the aforementioned disease. While this discovery was certainly meaningful, the limited resources found within the Haitien healthcare system means that there is unfortunately no treatment available locally. A trained medical specialist is typically required for this kind of issue as the ideal long-term solution would be a heart transplant. Even then, the clinicians at Hopital Sacre Coeur and JUH did the best that they could to care for the patient.
According to Dr. St Fleur, early detection of the syndrome represents the greatest chance for patient success in instances like these and the collaborative process implemented here will continue to be used in the future towards this end. In this way, the Grand Rounds being conducted at JUH can be seen as an advancement in a system that still needs more support to provide quality care to the people of Cap-Haitien.