Continued…

At the local hospital outpatient clinic in Belladere Haiti, there seemed to be an endless parade of people being brought in by family members after change in status at home, many without a clear understanding that the change was due to a recent stroke. One memorable male patient was brought in relatively early by his son (that is 24-48 hours) with a clear understanding that there was a stroke with new and dense hemiparesis (one sided weakness)

and difficulty speaking. Blood Pressure (BP) was on the relatively low side of normal, with counselling that the BP be followed closely in follow-up. As a physician, all one could do is make best judgement that the deficit had stabilized over 48 hours and maybe not hemorrhagic, and maybe evidence might suggest that giving aspirin in another day might not be completely outrageous. While seemingly trivial acute phase intervention, it might at least alleviate the guilt that otherwise there was absolutely nothing to do beyond the empathetic statement that you understand and are really sorry, and in the difficult days of recovery ahead “take care of your dad”. There was suffering, and it was palpable, and it was bilaterally shared. That therapeutic quandary and desire to go beyond nihilism has led to the CIC/WHAG approach.

Our experience in urban hospitals in Port au Prince Haiti, observing many acute stroke related deaths, especially in young people, was a very different experience from the rural areas where hearing about stroke related death was often anecdotal after the event. We discuss the connection of passion and suffering, independent of statistics. We do not know how many of these mostly anonymous deaths of the rural destitute poor souls even had the basic human dignity of being recognized as a hypertension/stroke statistic.