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.

HAITI: Day 1 -- arrival in Thomonde

06-19-11

It’s 5am when we arrive at Hartsfield Jackson to check-in for our trip to Haiti (via Miami). We stand in the long check-in line (who knew so many people were flying to Miami at 5am on a Sunday?). I’m one of the last ones in line from our group. The air travel agent is having some trouble finding my ticket in the system. He consults with another agent who has also been checking in our group. It’s confirmed – I don’t have a plane ticket. We call over the trip leader to sort it out since he made the travel reservations through a travel agency. At this point I kind of want to cry but laugh instead because with my flying history, it’s not traveling for me unless something goes wrong. It turns out the travel agency somehow deleted my ticket, so the trip leader ends up just buying me another one (thank goodness there were open seats on the flight).

After that rough start, we set off to Miami where we encountered a 2 hour delay to Port Au Prince due to problems with the plane. When we finally arrive in the Port Au Prince airport, we hear something similar to “island music” played by a group of local Haitians to greet us. As soon as we pass through customs, we have to fight to keep hold of our bags as the airport is crawling with “employees” who want to carry your bag for you – for a small fee of course. After hauling our personal belongings as well as 50 pound medical supply bags to the ground transportation area, we find our Medishare contact, and are off for the 3 hour drive to Thomonde.

The drive through Port au Prince was rough. There seems to be no rules that govern traffic and major potholes all along the roads. My first impression driving through the earthquake devastated city was how dirty, broken, and crowded it seemed. Among the dirty streets, there was still some beauty. Instead of your standard graphic printed signs, everything is painted. The local transportation buses also serve as a canvas and are all painted in colorful scenes. As soon as you get out of the city though, you are surrounded by beautiful Haitian countryside. Rivers, mountains, and valleys surround you and the road becomes more evenly paved.

We arrive at the Medishare compound in Thomonde and I’m surprised by how nice compound looks. There is a nice little garden surrounding an open patio that serves as the common area. Behind the patio are a few small buildings that contain bedrooms, bathrooms, and the medishare offices. As Sameer gave us our sleeping arrangements, I found that I was in a room with Cathy and Caity with beds and a fan – again, much better than I expected ( I thought we were going to be sleeping on air mattresses). After settling in, we all moved to the patio and just relaxed. All around the compound, the Haitian children were peering in behind the fence, very interested in what these foreigners were doing. Some of the boys decided to go an play Frisbee with them, which they loved.

Marie, the director of Medishare, spoke to us before dinner and gave us a general introduction to the role of Medishare in Haiti and to what we would be doing for the next week. Medishare serves as a NGO collaboration (with WHO, unicef, PIH, Haitan minister of health) that focuses on health and community development. Their goals include 1) HIV screening and referrals (treatment takes place at Partners in Health) 2) reduction of childhood mortality 3) reduce malnutrition 4) reduce maternal mortality. They accomplish this is several ways, mainly working through community healthcare workers (HCW). When HCWs do their home visits, one of their main focuses is making sure the children on healthy and receive treatment when they are not. They also spread the word about mobile clinics in the area. To decrease malnutrition, medishare hosts educational workshops with local farmers and they are working to produce a nutritionally enhance breakfast grain (Akamil). To reduce maternal morality, they have set up a local maternity center in a nearby town that includes an observation room, NICU beds, and several nurses and a midwife on duty.

After Marie’s introduction, we have dinner (beans and rice, chicken, and carrots) and decide to explore the town a little bit. The sky quickly became dark and it looked like a storm was coming, so we quickly turned back and spent the rest of our evening in the compound playing card games and getting to know each other.