Bedside Assessment in Haiti

There is a lab at the hospital where I will work in Haiti but the availability of even routine tests will likely be limited.

Lab tests are usually an expensive component of health care costs. The equipment is expensive and often needs servicing. Two of my six post-grad years were spent in a University of Toronto laboratory where I did bench research. For my research, I used equipment that measured sodium, potassium, chloride, TCO2, pH, and pCO2 in blood and urine specimens. The equipment was always breaking down. Some days I spent literally hours cleaning, standardizing, and repairing the equipment. Technology has definitely improved, but my point is that high technology often requires constant servicing, and this has a cost. Supplies for the equipment is now a huge cost for the new technology. Salaries for personnel to run the equipment are another cost.  

In Canada the costs for laboratory tests ordered by a physician are paid for by the government at no cost to the patient. The hospital protocol in Haiti is that some patients are expected to pay for lab tests. Does the hospital expect that the patient can afford to pay? Is there just not enough money to pay for even limited tests? Or, is this policy a method to make the physician think twice before ordering a test? Perhaps all three? I don't know, but I do know that making a decision about a lab test in Haiti will be more complicated than a similar decision in Canada.

Health care is a right but cost is a concern that must always be considered. Many years ago I read an excellent article in the New England Journal of Medicine by one of the foremost health care economists of the time. This individual suggested that there were three factors to consider in health care - quality, access, and cost. Simply put, only one or two of these three factors could ever be excellent in any health care system. Canada has excellent quality, very good access, and a high cost per capita. The United States has excellent quality, poor access for the lower third of the population, and less cost per capita compared to Canada. Haiti has terrible access, modest quality, and a very low (excellent) cost per capita.

One of the challenges of health care anywhere in the world therefore, is to offer good care and access at an affordable cost.

After thinking about the lab tests in Haiti, I decided to take along some technology to perform routine bedside tests in Haiti. I will bring urine dipsticks, a blood glucometer, and a device to measure oxygen saturation (see photos above). Urine dipsticks cost about 50 cents each, and a glucometer test strip costs about a dollar. I will take sufficient supplies to do 200 urine tests and 200 blood sugar tests. The oxygen saturation device has no cost apart from a battery. This intervention will save the hospital and the patient the costs for these routine tests.