HAITI: Day 7 -- PIH and some R&R

06-25-11

We packed up said goodbye to our modest little home of the last week and headed back to Port au Prince for a day of rest and relaxation with a stop at Partners in Health (PIH) along the way. When you enter the gates of PIH, you feel as if you’re entering a major compound. The driveway winds up to rows of concrete buildings. Some of the buildings serving as the hospital, others as homes for the patients, and other as community centers where women are taught skills to start local businesses. One of the community healthcare workers started us off on a walking tour of the outside of the compound.

At one point, we ran into a little boy who called himself Anyo. As he saw me, he asked me “Kreole? English?,” and I tried to explain to him that I only spoke a little Kreole…could he speak English? He told me yes and then proceeded to tell me “My name is Anyo” in perfect English. He was so friendly and outgoing, and the first child I met that could speak any English.

As we continued the tour of the compound, spiraling higher and higher (the compound is built on a mountain/hill), the views kept getting more and more beautiful. We finally reached the peak where you could see “mountains beyond mountains” (the appropriate name of the book about Paul Farmer and PIH in Haiti). After enjoying the view, we headed back down to tour parts of the hospital. We toured the internal medicine ward, the surgery ward, the maternity ward, and the TB ward. By “toured” I mean we would go to the entrance of the ward and a hospital worker would tell us some facts about the logistics of that specific ward. It was interesting to see in the maternity ward, posters of the treatment protocol for raped women as well as promotional material for the contraceptive injection. The hospital is the best medical facility I have seen in Haiti, and overall, PIH impressed me.

After a very bumpy (think huge potholes and crazy,/no rules, traffic), we arrived to our hotel in Port au Prince—Karibe. It was such a strange feeling going from working in makeshift clinics in the dirt where finding clean water was a huge problem to a five star hotel with a massive pool containing a built in bar. It very much typified the contrasts of Haiti—the huge disparity between the wealthy and the poor, the beautiful scenery dotted with makeshift shacks for housing, the smiling baby covered with a festering skin infection.

We enjoyed our time at the hotel, taking advantage of the pool and everything else the hotel had to offer—a celebratory ending of our trip to Haiti.

Overall, I enjoyed my trip to Haiti. It was fulfilling, frustrating, heart breaking, heartwarming, educational, and incredibly fun. The country has countless problems, but the people are resilient, and that gives me hope.

HAITI: Day 5 & 6 --working in clinics

06-23-11 -- Clinic in La Hoyt

Today was market day in Thomonde. The local women had put out all of their homemade goods to sell -- beautiful embroidered tablecloths and colorfully embroidered scrub tops and dish towels. They also had all kinds of carved wooden bowls and other decorative items. I ended up getting a great tablecloth with "Haiti" embroidered in the center.

After the market, we again made good use of our rented landrovers as we crossed rough terrain to reach a rural clinic. At one point, the drivers even stopped to evaluate if they could even travel further on the "road." When we arrived at the clinic site, we saw it was a local's house. They gave us use of their kitchen for our pharmacy and 2 other bedrooms for our other clinic rooms. One of the local doctors from the nearby town, Casse, joined us -- Dr. Jean Baptiste. At times there was some tension working with him, but having him there helped us see a lot more patients.

I was assigned to the adult clinic in the morning and the pediatrics clinic in the afternoon. My first patient was the sweetest 80 year old lady who was complaining of generalized pain (abdominal, knees, hips). We ended up giving her some pain medication and antacids. Another one of my patients was a 40 year old man who had his 10 year old son with him. As we were talking, he kept coughing, and when I listened to his lungs you could hear crackles/wheezes in all of his lung fields. As we continued talking, he admitted to smoking cigars everyday for as long as he could remember. I suspected he had COPD complicated with an infection and Dr. M agreed, so we gave him an antibiotic and an inhaler.

In the afternoon, I saw the healthiest/happiest baby I've seen in all the clinics. She giggled as pulled my stethoscope out to listen to her heart. She turned out to be perfectly healthy, but as we were wrapping things up, Lenny, the translator, suggested that I have a sexual history discussion with the mom since she looked VERY young. I agreed, and although she seemed a bit embarrassed, she ended up deciding to get an HIV test at the clinic.

I ended clinic feeling hot, tired, but happy about the patients I got to see that day.

06-24-11

Our last day in clinic...it came so fast.

The night before, as Sameer was confirming our clinic day with TonTon (another medishare liaison), we discovered there had been some kind of miscommunication and there was no clinic scheduled for our last day. After Sameer talked to TonTon to see if there was any way we could still do clinic, Tonton agreed to see what he could set up for us.

Thus, our hopes weren't very high as set out for our last clinic day thinking we were just going to be helping out Dr. Jean Baptiste (the Haitian doctor from the day before) in his clinic. As seems to be the case in Haiti though, you never get what you expect. We were pleasantly surprised as our drivers dropped us off at a school building with about 50 moms with babies waiting for us, so we could set up clinic as we had the days before.

Wet set up clinic in the concrete school classrooms with windows cut out from the wall that the local children peered through all morning and afternoon.

I started off the morning in the peds clinic working with Allison (one of the peds docs). I saw a lot of healthy, happy babies, which was fun and uplifting. There was one 4 month old in particular that just kept smiling at me in the most adorable way. The rest of the kids mostly had minor illnesses -- sinusitis, URIs, and abdominal pain.

I spent my afternoon in the adult clinic with David (our internal medicine doc). There were a few patients that had the same complaints we had been hearing all week -- URI, headache, generalized pain, but I also had some other, more unusual, patients. The patient that touched me the most was an elderly man who presented with generalized pain, but Youseff (who was triaging patients that afternoon) said that something seemed off about him, and when I started asking him questions, he was barely able to respond. His wife then described how he had been acting bizarrely for the last week or so...almost going into hysterics at times. When we asked if anything in his life had changed recently, his wife revealed that their son had been in horrible traffic accident, and that's when the husband's bizarre behavior had started. David thought he might have the beginning stages of dementia and referred him to the nearest hospital for evaluation. Afterwards, Youseff was telling me how often times, elderly patients can get something called post traumatic dementia after a particularly distressing experience. I can't even imagine what that poor man must have been going through, and there was nothing we could really do to help him except refer him to a hospital for more testing.

HAITI: Day 4 -- Clinic near Marmot

As we set out for our second day of clinic, we stopped by the newly finished Marmot Maternity Center. Staff includes 3 ambulatory nurses and support staff. They are still looking for a doctor and a midwife, but Marie said they were currently talking to a midwife who would most likely fill the position. The clinic had 2 NICU beds, and observation room, and a maternity ward. It's definitely progress and will fill a huge need in the community.

We then continued on to our clinic site. Rough roads again, but not quite as bad as the previous day. Looking out my window and seeing all the little kids -- on horses, carrying water, waving at the passing car-- I felt hopeless. Haiti/Medishare is making progress -- the maternity clinic and the nutrition factory, but the way these happy, outgoing kids were living just made my heart ache.

I spent the morning in the pediatrics clinic with Susan. It was so hot (no air flow) that I was trying my best just to not sweat on our patients. We even had a few students who were sweating so much that they soaked through their scrubs. Our patients had a lot of non specific abdominal pain (most likely due to worms) and some upper respiratory infections. We also had a girl with rectal prolapse. Apparently she had an operation for it a few months ago, but it had reoccurred. The mom was very worried about it, and said every time it happened, she had to push it back in. There was very little we could do for her, so we just suggested she returns to the surgeons who did the operation.

In the afternoon, I worked on pediatric triage with a local nurse. This included height and weight measurements, temperature, and arm circumference. The local nurse was invaluable -- she could communicate with the mothers and children to get the most accurate weight and height measurements. Triage also provided some down time to just play with the adorable little kids. There was one 3 year old wearing her mom's wide brimmed hat who came over and decided to play peek-a-boo with me --so adorable :)

It turns out we got done with the pediatric patients before the adults, so I moved outside to try and triage the adults since we probably wouldn't have time to see them all. I started off taking vital signs and sent in patients with extremely high blood pressures. We then realized we had time to see even fewer patients than we though, so I started going around with a translator to get the patient's chief complaint. While we were walking around, Woon Cho came out and spotted a sickly looking man and looked at his health record where it stated he might have HIV. Woon Cho immediately took him inside. One of our doctors, David, works at the AIDS clinic in Atlanta, so we took the patient to see him. Since we have no HIV medication, David wanted our patient to go to the nearest hospital to receive treatment. After finding out the man could not afford transportation to the nearest hospital, David collected money and gave it to the man.

While I was triaging, there was another woman complaining of an eye problem. I unfortunately had to tell her that we had no eye medication we could give her. On the ride home, we discussed how it would be really helpful to bring an opthalmologist on the next trip since so many of our patients had eye complaints related to working out in the bright sun without any eye protection.

On the second day of clinic there were quite a few interesting cases in the adult clinic where we could either provide treatment or refer the patients to a center where they could receive care. Overall, it was starting to feel like were having some kind of impact.

HAITI: Day 3-- Clinic in the Mountains

06-21-11

Before heading out for our first day of clinic, Marie offered to give us a tour of the Akamil nutrition factory and the new Medishare compound.

Akamil is a legume and micronutrient enriched millet. The main goal of the Akamil plant is to improve malnutrition in the area. The plant also aims to provide microbusiness to the community through women precooking the millet before selling it as well as providing jobs as factory workers for local community members. Right now, the plant is funded through outside grants, but the goal is for it to be self-sustainable. One of the ways they hope to accomplish this is through mass production and sale in larger grocery stores in Port Au Prince. Other parts of the plant are used for chlorine packet production (for treatment of water) and water container buckets. These buckets have a spicket and no handle, so they can only be used as the family’s water container.

The new medishare compound is very impressive and should be completed with in the next year. Not only will it include updated living facilities, it will also include a conference area where Medishare can host potential donors and collaborators.

We then headed out to clinic in an extremely remote part of Haiti. We had rented 4WD vehicles for our trip, and the journey to the clinic site made me see why – we traveled through rivers, across rocks, through mud, and up mountains. A little nerve racking, but our drivers were very skilled.

When we finally reached our clinic site, we found ourselves in a local church that was home to quite a few tarantulas. The presence of people scared them away soon enough and we started setting up our supplies. I spent the day in the pediatric clinic with Allison (the other pediatrician on our trip). Our first patient was a little girl with a severely burned arm. We debrided the wound and gave her mother some ointment and additional dressing to keep taking care of it. We also gave her some antibiotics to keep any skin infection away. The rest of the cases mostly consisted of stomachaches, diarrhea, and upper respiratory infections. We had to leave a bit earlier than expected due to rain (and the extreme roads that would become worse in this weather).

I left clinic feeling sad for these people in these destitute conditions and thinking, “Are we really making a difference?” Sure, we treated 1 acute case – the girl with the burns, but the other problems are just symptoms of larger societal problems – access to healthcare, access to clean water, access to education, access to foods with proper nutrition, and access to proper housing.

HAITI: Day 2 -- Community Health

6-20-11

Morning seems to come too soon as we start our first real day in Haiti. As we sleepily make our way to the patio, we discover a breakfast of pasta, boiled eggs, and a fruit platter of mangoes and pineapples. Although I don’t think I’ll start eating pasta for breakfast here on a regular basis, it was pretty good.

After breakfast, we head out to shadow the community health care workers (HCWs) as they do their home visits. My group traveled out to the Marmot area, across dirt roads to a few muddy, wooden shacks. As the HCW spoke with the family, he asked for the vaccination records. The vaccination records were provided by WorldVision and you could see the mothers worked really hard to keep the record safe and clean. We then asked them what their biggest health concern was, and the father replied “cholera.” He then proceeded to show us the village’s water source – a capped well that has a faucet to collect the water (pretty good). The father also explained that he is a sustenance farmer. He grows what he can to feed his family, but not enough to really sell at big markets. This poses a problem as it costs money to send the kids to school. I’m not sure how he manages, but so far, all of his kids are attending school.

As we were walking from the water source, on the villagers asked us to come see a family with a cleft lipped baby that was not doing well. We got the house where a young mother brought out her 4month old baby that didn’t look older than 1 week – severely malnourished. With the cleft lip, the baby could not properly breast feed. The mother had just recently gotten an NG tube and some formula to feed the baby, and she said it was due to get an operation in October. The baby didn’t look like it was going to make it to October, but again, it had only recently started feeding through the NG tube. Susan (one of the pediatricians) gave the mother further instructions on feeding the baby (increasing the frequency to 8 times a day) to ensure that the baby would have some chance of survival. A cleft lip---something so easily fixed in the United States—was preventing this baby from thriving, where it so hard for the mother to access not only a surgeon, but even just a doctor to give her formula and a feeding tube.

We saw a little more of the economy of the village as the HCW showed us some mango pickers and a man who made charcoal to sell to the people in the bigger towns. The charcoal maker had a pretty bad cut on his thumb, with a bloody rag tied around it. Unfortunately (and frustratingly) we had come to the home visits without any of our medical supplies and could do nothing for him.

After leaving the village, we went back to the compound for lunch. After lunch we set out for the Thomonde Hospital where the medical director gave us a tour. Hospital staff included 3 doctors, 5 nurses, and 10 nursing assistants, and the hospital was equipped with some imaging equipment and fairly decent lab. Hundreds of patients sat around waiting to be seen with flies swarming around them in the unbearable heat. The hospital also had cholera tents set up outside – a triage area, an observation tent, a severe/moderate cases tent, and a discharge tent. IVs ran from makeshift poles and patients lay in cots under trees. Leaving the area, our feet and hands were sprayed with clorox solution.

Our last stop of the day was a mobile maternity/child clinic. It consisted of a small shack that had an ultrasound machine and a separate area outside. Outside the shack, under a shaded area, babies and children were being seen and prenatal vitamins and other medications were being given out. It was comforting to see the attention to prenatal care even in such primitive conditions.