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.