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.

Proud to be an American Immigrant

These last two days, I had the chance to attend the annual Merage gathering in Washington, D.C. The Merage Foundation (http://www.meragefoundations.com/mfad.html) is the organization through I received my fellowship for the first two years of med school.

It. was. so. inspiring. incredible. motivational.

But let me start from the beginning.

I won the award last year, but Ben and I were on our honeymoon during the ceremony in 2010. So, I got the opportunity to go this year as a second year fellow. I was a little apprehensive about meeting the other fellows. Would they be friendly? Would I be able to relate to them? Am I out of my league? I was SO pleasantly surprised. Everyone I met and talked to was so nice, so real...so much like me. I arrived at Ronald Reagan airport in D.C. and took a cab over to the Park Hyatt where we were staying (gorgeous hotel). I checked in and found out I would be rooming with two of the other fellows but they had not arrived yet. I got into the room, unpacked, settled, and got ready for the dinner that evening. As I was waiting in the lobby for the shuttle, I had the chance to meet some of the 2011 fellows. One was going on to pursue her PhD in physics at Harvard and the other her PhD in geology at the University of Houston -- impressive right? Let's just say everyone I met this weekend was impressive, yet so humble and down to earth.

When the shuttle arrived, we headed over to an apparently famous restaurant in D.C. -- 1789 (Obama had just eaten there with someone last month). Paul Merage and his family (founder of the Merage Foundation) were hosting a welcome dinner for all the fellows there. The food was great, and the company was better. I met a few of the 2010 (my year) fellows -- one pursuing a masters in economics and planning to write a book on sustainable development in India and the other one working on urban development in Cambodia (again--so impressive). As the dinner drew to a close, Paul Merage welcomed us and asked us all to introduce ourselves. The Merage family was so welcoming,so approachable, and you could feel how proud of us they were and how much they want us to succeed. It was a lovely way to be welcomed to D.C. and the Merage Fellow family.

I ended up going out in Georgetown with a few of the fellows after dinner and had a great time getting to know them even better.

The next morning, we attended a colloquium on immigrant integration in the United States. I wish my parents could have been there. It was basically about how immigrants to the United States (first, second, third generation) are integrating on all levels (economic, social, political, etc...), and it turns out-- immigrants are integrating especially well and really contributing to American society. Most immigrants WANT to learn English (and do), they WANT to blend into American society, they WANT to contribute. I feel that a lot of people who are scared of the immigrant issue (and have misconception about immigrants) would have benefited from the discussion.

We then attended the Merage board meeting where they discussed the progress of their projects this last year. Their main project is a dual language school (turned community development project) in California called El Sol. This charter school is incredible! They really take a comprehensive approach to education, and their standardized test scores show that it's working. My favorite part -- they have an on site, fully equipped clinic (with lab and electronic medical record system) that not only serves the children, but the entire family. They also receive free referrals to the nearby tertiary care center for any major procedures. Other components -- an after school program that serves as extended learning time for students, an enrichment program that encourages involvement in the fine arts, an integrated social resources base for the use of the families in the school (just to name a few). Overall, it sounds like a REALLY cool project, and I would really like to get involved somehow.

We had some free time in afternoon which I used to catch up with Heather. She is taking her step 1 board examination on Saturday -- so be thinking about her! It was so nice to be able to see her, even if it was just for an hour.

That night was the awards dinner at the National Press Club where the honored the contribution of specific community leaders who also happened to be immigrants. This year they honored ANOUSHEH ANSARI, DEEPAK BHARGAVA, CARLOS M. GUTIERREZ, DR. ERIC R. KANDEL, DR. FAREED ZAKARIA. Hearing about these immigrants' accomplishments in America, their love for America, their pride on being immigrants to America was just so inspiring. Each of the fellows also got personally recognized, and there were so many people who came up to us afterwards to offer us personal words of encouragement.

It was the first time I experienced the pride of being an immigrant. I wasn't just the girl with funny accent or the one who lived in huts and played with lions ;) I was someone who was contributing to America. I was someone who is making a difference.

Afterwards, I personally thanked Paul and the rest of the Merage foundation, and he again just reiterated how proud he was of me. This multimillionaire, successful, Iranian immigrant was proud of me-- genuinely. It just warmed my heart and really further motivated me to make sure that I DO make a difference in America, that I DO become a leader in my community , that I DO represent what immigrants contribute to society.

So there it is --- I am proud to be an American immigrant, and I will make the most of this opportunity I have been given.