What Now?

HAITI AGAIN

Here is what we know so far…Hurricane Matthew was a category 4 hurricane (the highest level being a 5), hit Haiti directly with 175 mile winds and flooding many areas, blowing off their tin roofs, and destroying perhaps the majority of their sustenance farming.  Salt water from the ocean has ruined soil on many farms.  The hardest hit areas were in southern Haiti, which is were Musotte, our adopted village, is located.  Since Musotte is on top of the mountains, the salt water is not going to be an issue but the wind and mud slides have been devastating.  Our sister NPO is the United States Foundation for the Children of Haiti, or FEH (Fondation Pour Les Enfants D’Haiti) is gathering a team from Port au Prince and bringing supplies into Musotte.  They are collecting donations for food and medical care.   FEH will initially focus to help the families of the Musotte students to rebuild their houses, yards, & farms.  Please see their website and donate.   http://www.usfch.org/  

 Poor beloved Haiti gets hammered again.  Our hearts are breaking.   How can the world just face this again?   Should we just give up, move on, is that suffering too much for us to get our heads around?  and how much does the rest of the world really care…there is so much suffering everywhere, how can we possibly make any difference at all?  

I have two answers that will help move HEAL and our supporters forward.  The first answer is resiliency.  Matthew chewed up and spit out Haiti’s homes and farms.  Yet the images that we manage to find of Haiti are those of people picking up pieces of lumbar, picking up bodies, as if this is something that they are used to, as if it were a set of chores for the day.  There are no images of faces pleading for help, asking “why did this happen to me?”  they just keep moving, surviving.  It is really quite incredible. When I reached the translator Chandler, and he said “we are safe, thank God”  then bothered to ask , and “how are you? “  I have no idea how to answer that.  I have a roof, running water, and live in a palace, with western type worries about hair cuts and football games. How am I?!  …

Haitians are the most resilient people on earth.  Getting to know Haiti is to understand humanity’s spirit and life.  They live in suffering, they expect nothing but suffering, yet they are some of the most joyous people I have met.  They have no expectations from us,  the “us”that have everything in comparison. When help trickles down to them they take that in stride as well.  They know that we get more out of these “mission” trips than they do, but appreciate the help.  What sustains them and what keeps them going is part faith, part constantly living in survival mode, and and part hope.  There is always hope, I think because it is easy to see the potential of Haiti, see the possibility of a thriving, prosperous , beautiful Haiti.  

Answer number two is that our adopted area that we assist is now our family.  H.E.A.L. has taken a stand for this village of Mussotte.  We are not giving up on our children, on our sisters and brothers in Haiti, on our grandmothers in Haiti.  Though we are worried and frustrated that we cannot swoop in there and shelter the whole village, we need to continue with our plans of a sustained healthcare clinic there, with the building of the trade school that the Children of Haiti Federation has put together.  For now, it is survival mode, and please help FEH with funds to save lives in Musotte.  But let us keep our eye on the possibility and the future of Haiti, a beautiful, cheerful, tough and resilient family.  

HEAL Haiti 2016, last Post

June 30th

 Thursday was Dianna’s birthday (one of our translators for the gyn shack…a pretty impressive one too! She would take time to explain what a pap smear was and why it was important. She started nursing school last year. When I asked Joel if that was from her experience working with us over the past 5 yrs, he said, “Absolutely! She used to want to be a construction worker!”) So Carol (the pediatrician) decided she wanted to throw a party for her. We were on it! Doctor Susan (the gynecologist), myself and Joel jumped in the back of Dr. Gousse’s pick up while Carol and Osmain sat in the car (it sounded like a good idea at first…until my newly “washed” hair became caked in Mussotte dust.) So lets talk about the roads in Mussotte. Imagine an English Muffin spray painted orangey-red and cut in a rectangle. Now take out pieces of the muffin to make some holes and put those pieces on other parts of the muffin to look like rocks. Now make it on a slope in a surreptitious direction. Now plant lots of trees on the sides and place chickens, goats, dogs and cows along the road. That’s the Mussotte road! We went all the way to Miraguan (the nearest city and nearest hospital) which took about 35 minutes as we dodged the holes and the rocks and the various farm animals. Now imagine being in the back of a pick up truck! As I nauseously entered the little store…we found a cake, birthday party gear (hats/plates/napkins), ice cream, candles and a large bottle of Crema (kinda like Baileys Irish Cream…but with Rum). Joel was able to get Dianna out of the house as we set up our party. He brought her back and she was indeed surprised.  We played music and danced and partied in our rural village of Haiti.

      Saturday was surprisingly not as crazy as anticipated. We were done with the medicine patients by 3pm with hema-cues and ISTATs to spare! However, every day was crazy for the Gyn Shack.  Around noon, Dr. Susan made an announcement that she would not be taking any more gyn referrals as they already had 50 signed up by then. Triage wassending all women to the gyn shack where they would get the “Pap Talk” from Dianna and thus decide if they wanted it. Many women from last year came back and so if they had normal paps, they didn’t need another one. Occasionally I would see a 70 year old have the gyn station circled and I would redirect them to the adult station. They don’t need a pap! They saw about 200 women and did over 150 paps and about 6 cryos total for the whole week. We had several people come back for blood pressure follow-ups or lab testing. Sam precepted with me about a patient she was concerned about. Thepatient had a hard mass on the right side of her face.  With so many patients that the students see, one of the skills we want them to master is who is really sick and who’s not.  So with this one, we spent more time getting a better history…no nausea or vomiting or diarrhea. She had it for 6 months. We did a through oral physical exam…just the hard mass. I called Dr. Gousse who had just left to return to Port-au-Prince. At first I couldn’t get a signal, so I asked the pastor in French if I could use his phone. He took my hand and escorted me to a corner of the church and viola….I had service (just in that spot!). Dr. Gousse notified me that Hope Hospital would be having visiting Oral Surgeons in November. So on an official “Hope Hospital” prescription paper I wrote for her to show up for consultation with the oral surgeons. I made sure she had the means to get there and a place to stay. Hope that works!

      Near the end of the day, a man showed up showing us pictures of a friend. His back looked like it had hypo-pigmented splotches…kind of likevitiligo. He would walk us to his house. With some back and forth, Joel figured that it would be pretty far to walk, so we waited for Dr. Goulos to come home. So around 4 pm we piled in his SUV and ventured to his house. Now remember the roads? Now cut a piece of the muffin to the size of a strand of fettuccini and make it more squiggly…keep the holes and rocks and cows and goats and dogs though. It took about 20 minutes to drive maybe 3 miles! We were definitely in the jungle! When we met the man with the skin problem, we all just looked at him quietly. None of us had ever seen anything like it. He just wore boxer shorts and covered his torso with a quilt that went over his shoulders. His entire body was like elephant skin covered in blisters and ulcers. Tiny gnats flew around him as a continuousfilm of activity. He looked very skinny and very miserable, yet very stoic and humble. We decided to take the fettuccini road back to the house where all our meds and supplies were by then and return to take some biopsies. We gave him two jugs of silvadene cream, which we use for burns but should help with the ulcers. We brought him the rest of the indomethacin (family of ibuprofen for pain) and the rest of our antihistamines, which should help with the itch and sleep. We used lidocaine and a scalpel to make a few holes in his skin and put them in the pap bottles for the pathologist to read back in the states (along with the paps). Carol was curious and came with us and helped. Elaine, Joel and Goulos also went. We did an HIV and Syphilis test on him which both were negative. I asked Goulos to check in on him and he said he would. Weirdly, the wife said they took him to a “Dermatology Hospital” and had no answers for him. I have a hard time understanding that. Maybe they couldn’t afford the testing and treatment. Anyhoo…I hope the meds we left him will allow for some comfort. It’s patients like him that make me feel impotent at times. 

     Luckily, we didn’t see too much tragedy. Joel commented that he thought the community was healthier than usual. We saw over 700 patients in 5 days! We did get to see the satellite clinic in Mussotte where one can go for vaccines and TB testing, but the woman there wasn’t very welcoming and didn’t really want to show us around or talk to us. Goulos thought it was because when he had his clinic, she felt he was taking patients away from her. Oy vey! Samantha was keeping track of the kids who were vaccinated. Most kids had vaccines but theparents didn’t know which ones except for BCG (the TB vaccine) and some mentioned polio. They didn’t know if they were completed though and ironically…most went to the hospital (braving the rusty-English Muffin-holey –rocky- farm animalie roads!)to get the vaccines and not at the local clinic (probably because the lady is so mean!).

     So last year, we were excited to see that the Fan Fan brothers had started a clinic at the church and that they were staffing it 5 days a week between the two of them, but alas, this year, the clinic had closed. They weren’t able to sustain it, since they had no funding. Elaine and I were peppering Goulos with questions as we drove back and forth to the skinman’s house. “How much does it cost to run the clinic?” Answer :$1500 per month; “How much does is cost to run it 2 days a week?” Answer $600 per month. Elaine and I were, as usual, on the same page. That’s doable! Joel continued to talk to Goulos and by the end of our driving back and forth, Goulos agreed to reopen the clinic and Joel would help withthe business plan. His plan is to ask every household to donate $25 per year like an insurance plan. Some can pay the full amount, some might just pay half and some won’t be able to pay at all, but it will allow for the clinic to be sustainable. Elaine had already looked into a grant to support a Community Health Worker, but we hadn’t settled on what the worker would focus on. In our discussions with Goulos, we decided that a pregnancy advocate would be the ideal beginning. Goulos and the doctor in Paillant confirmed that even though prenatal care and deliveries are free, the people don’t routinely come to the clinic nor choose to deliver there. It’s part of the culture to not trust hospitals (and the roads are also a real barrier…imagine that!) So having someone doing prenatal checks in the home would be a start. We decided to not rely on the designated Ministry of Health Community Health Care workers. Our Community Health Care Worker would be supervised by the Fan Fans out of the clinic that we will help support. Elaine and I had plenty of time to strategize, prioritize and recreate our purpose in Haiti (while resorting 2 days at the beach!) We continue to be dedicated to students early in their careers in order to give them an experience that will shift their career trajectory toward one that includes poverty medicine. We’ve adopted Mussotte as our community of choice to work with. I had a discussion with my son Joel that it’s time for him to take on more of a leadership role with H.E.A.L and we discussed what that would look like. He has agreed to be the lead operator for the clinic in Mussotte as far as coming up with a business plan, who to hire, how much to buy, and keeping in close contact with the Fan Fans. He ultimately wants to create an EMS system in Haiti (aka 911) ,which they don’t have and I think this would be a good beginning project for him. “But the most we can do for Mussotte,” I told Joel, “we have to get the roads paved!” I told him he’s in charge of that, too!

 

     When I was checking in at the airport to fly home, by suitcase weighed 53.5 pounds. The Jet Blue guy said, “That’s ok. You’re my mama. I take care of you.” I thought, ok, I can take on being Haiti’s mama (or big sister, maybe) LOL!

     For those that wanna join in the sisterhood (or brotherhood) we’re looking for people to be on our Board to help w fundraising, treasury and all around support. We want to play a bigger game. We would like to reach out to philanthropists, universities, companies etc so that we can sustain our impact in the world and with students. Let us know if you feeling pulled to be a part of our leadership team! Also, let me know if you would like to continue to help support the clinic in Mussotte on a more long-term basis. We couldn’t do any of this without all of you and so I am incredibly grateful for everyone’s perpetual generosity! 

 

Hugs! Dokta Susan P

Heal Haiti 2016 , 3rd Post

Thursday was a bit of a less busy day…since it was marche day (market day). The Gyn shack found a woman with a large infected cyst that they resected. She came back Friday doing fine! The woman with the infection in her armpit and the older lady with the hand infection have been coming back every day for wound care. Josh looked up how to do an ulnar block and it worked!!! We found a woman with a hemoglobin of 5.3 (would be getting transfused in the US) when we did an HIV test it was positive so we sent her to the hospital in Miraguan and had two confirmatory tests that were negative (whew!). We’ve been adding to the list of people we are sending to Hope Hospital for the surgeons to operate on. We have two hernias and and a tonsillectomy lined up. Friday it was back to busy where every bench in every station was filled up. Floaters would be rechecking blood pressures and checking blood sugars in all the hypertensives. We’ve started to just diagnose people with anemia by looking at their eye lids since we were down to the last few hemacues. Even Elaine’s kids are expert lid-ometers. We’re down to about 15 ISTATs (measures for anemia, glucose, electrolytes and kidney test! Lent to us from Abbott) We are using them for those with diabetes and heart failure and have been quite useful. We’re starting to thin out with our hypertension meds so we’ve been cutting them in half so they’ll last longer. We still have plenty of H.Pylori treatments and acid reflux medicine (and tons of Tums…thanks to Grateful Heart who set us up w cases of Tums). Gyn did 2 cryotherapies today…I’m eager to compare them to their pap smear results. Most of the people we’ve had to come back for follow-ups have returned…sometimes taking their meds…sometimes not. This year we received bags of glasses from an organization called New Eyes. Some were children’s sunglasses that the peds station was handing out (it was pretty cute seeing all these kids in cool sunglasses). But most are reading glasses…so at the end of all the stations we show them the reading glasses (as someone who has just become blind when reading up close and appreciated having reading glasses myself!) It’s pretty cute watching them try on all the different glasses and realizing how much better they can see. Eventually the busy stations were thinned out and by 3 pm the stations in the church were done. Gyn usually goes until 5pm, but we try to do as much as possible (such as testing) while they’re waiting to get their paps. They’ve seen 150 women so far. One of the students has been doing surveys on women about family planning…she gets them to come to our house after hours and gives them gifts of rice and beans and oil. I overheard one interview where the woman explained that a life without children would be a "miserable life". Another one revealed that a common belief is that when one is on birth control they need to be more sexually active or the birth control will cause the white blood cells to decrease which will cause an ovarian cyst! How’s that for “operator”? This definitely was food for thought during our nightly huddles. The students have been amazing. They have become extremely well versed practitioners given such the large volume of patients they see. They still have high energy levels, smiling, enjoying what they are seeing and experiencing. We’ve been preparing them for tomorrow…usually the busiest day of all…the last day. Ella, Elaine’s 15 year old chimed in “the chaos is part of the experience”! Our new mantra!

Heal Haiti 2016 Second Post

2nd day of seeing patients: Today was crazy!!!! Each station was full to maximum capacity! Every student was in full patient care mode…working hard. Yesterday was an easy first day. We saw about 150 patients, but  we were done around 2pm! We saw someone with heart failure and were able to check his creatinine (a kidney test) which was 2.3 (very abnormal). So all the meetings and packing and putting things in order and labeling everything on baggies and walls was all to prepare for today! Lisa, Sara, Joel, Elaine and I went to visit the “Health Center” which was about a 20 minute drive down the hill, so we got to the church around 10 pm to a bustling crowd. I went into the church and it’s all a blur but I just went to all the patients checking their charts and checking blood sugars and hemoglobin (to check for anemia) as students came up to me asking me questions. Actually even before I got out of the car when I first arrive, Josh announced that there was a woman with an abscess on her hand and he wanted to open and drain it (future surgeon). The hand was pretty inflamed and the abscess was quite big. We numbed it, opened it and packed it in our surgical suite (on the steps outside the church). We saw several diabetics all with pretty high sugars and soooooo many high blood pressures! I think the highest we saw was 240/130. She felt fine (that’s a hospital admission in the U.S.!) One 19 yr old had a positive HIV test (twice) so we’re going to send her to the hospital in the city to get a confirmatory test. We checked her boyfriend who was negative, so hopefully it’s a false positive.  The gynecologist picked up a breast mass that she was worried about. The doctor that usually joins us (Dr. Gousse) came up today and we were able to ask how to handle this. It just so happens that a group of surgeons are coming to Hope Hospital the first week in July, so we just have to pay for her transportation to Port-au-Prince. We saw several adults with pretty severe anemia. There was one 18 year old, developmentally delayed…super tall and skinny with probable TB (weight loss, coughing up blood, coughing for 2 months)…we now knew to send him to the local clinic where they do sputum testing and give out free treatment. So this morning we visited the Health Center in Paillant (which is a bigger city down from Mussotte). We met the director, ironically or serendipitously named Dr. Paillant who was trained in Cuba, so I was able to communicate with him directly in Spanish. We learned so much! For instance they do free prenatal and postnatal visits, deliveries, family planning (pills, condoms, the injection and the implant), TB testing and treatment and HIV treatment and vaccines! All for free! And, they said that they did have community health workers (5 in Mussotte) to look for those with TB, HIV and pregnant women…which is what we’ve been talking about for the past year. In fact 2 of the students last year did house to house surveys asking about a community health care worker program and no one mentioned that there was one already. Hmmmmm.

HEAL Haiti 2016 1st post

First Post June 28th, 2016:

Pure joy! I forgot how much I love Mussotte…the crisp air, the dark green vegetables growing in the rust colored dirt, the cows and the goats and the mules and the smiling Haitians greeting each and every one of us as we march by. Not to say we didn’t have a few bumps in the road so far such as a 6 hr delay in my flight, thus not being able to sleep Saturday night, Elaine having to go to got to the state dept in Philly the day before leaving hoping to get her kids’ passports renewed, Joel’s plane being delayed and serendipitously our bus being delayed…so having to wait several hours in the airport parking lot…but I eventually got to Haiti, Joel got in and the bus arrived. We were transported to a nice outdoor café where we continued our “wait” with ice cold water, cokes, sour-sop smoothies and beer! Eventually we left around  5:30 pm from Port-au-Prince toward Mussotte. We passed through the grimy part of the city where mounds of garbage spew into the streets and into the river and a large outdoor market where huge pigs roam amongst the various kinds of food rubbage. Soon we were on the road to Mussotte where the road is lined by tall mango and short banana trees. People burn garbage along the road, but as you leave the city, there is less and less random street trash. I yelled twice tonot hit a dog and once to swerve out of the way of a calf. No animals will die in Haiti on my account! The road is paved but peppered with potholes and at times completely washed out. There are no side-walks, just dirt and gravel.  I was in the Dominican Republic (on the same island as Haiti) one month ago for Joel’s wedding (Joel is my unofficially adopted son whom I met after the 2010 earthquake and we’ve been family ever since).  The roads in the DR where nicely paved…like in the U.S….with traffic lights and lines painted on. Also, it was much more lush and greener. In Haiti many of the mountains are brown due to deforestation decades ago. Mussotte however is green as ever and actually feels like it’s own country! Gladys greeted us at the gate of her home, which becomes the hostel for 10 students, 4 attendings, 8 translators, 2 teenagers (Elaine’s kids got their passports), Gladys and Trina  (her best friends daughter who grew up in the states). Marquis, the head house mom, squealed with delight when she saw me and gave wet neck kisses! I was home! I slept well last night, woke up refreshed and started my day with Haitian coffee. I have Haitian coffee at home, but for some reason, Haitian coffee in Haiti is just better, and followed by mangoes for breakfast was the beginning of my day of pure joy. We collected our upteen luggage of medications and supplies and piled them in Gladys’ car and brought them to the church. We walked to the church throughour skinny path between carrot tops and cabbage patches and began our first work-day. 

This year we decided to dedicate the first day to set up all the stations, get organized, label things and and orient the students to each station and all the meds. I realized that this orientation day may just be the secret of a very successful clinic week. Usually the first day, we would maybe take an hour to set up and then start seeing patients. Then I would start organizing everything. This way the students got to participate and contribute to setting things up. It was pure genius! Dr. Ballagh is our recent addition to the team. She’s a gynecologist at a county clinic and jumped on board with full gusto. A huge relief and blessing. It was a full day of setting things up, labeling w neon pink duct tape, organizing the medications, handing out hand sanitizer to every station, writing up the protocols for: dosing the iron elixir for anemic kids, what antihypertensive to give as first line, 2nd line, 3rd line, when to give Tums vs an acid reducer pill vs 3 medicines that treat the infection that causes ulcers. It was a very successful day with lots of enthusiasm, suggestions, and taking initiative. The student leaders, Jasmine and Erica have been phenomenal…really taking charge, super organizing, addressing problematic areas and brain storming resolutions and just making everyone’s experience less stressful and more enjoyable. They are future leaders for sure!  We came home to an amazing home cooked meal, hung out on the roof to watch the sunset over the ocean, played board games, created an assembly line to add water to the bottles of clarithromycin powder to make the ulcer treatment kits and added labels to them with the new picture instructions to taking meds (the student leaders addition to this years’ inventions).  

Thanks to all our donors, packers, well-wishers, shoulders, dog/cat sitters (more for me!), emotional supporters, students’ parents and friends! Stayed tuned for more from Haiti Medical Voyage 2016….

 

HEAL Haiti 2015 Dr. G's Sixth Post

Today was a sentimental good bye to Mussote.  Thanks to Lisa and Aline’s study and the home visits by Dr. Puuvula and the team, plus the 1000 patients and the amazing group of translators we have we really learned more about the community this year.  The students are already reviewing the data they collected and I look forward to posting their hard work here and we anticipate they will publish it in medical journals.  I just love this country.  It is beautiful.  The angular mountains, the tropical plants and sun, the afternoon tropical rains are delicious. As much as the physical beauty here, it is the people that I love.   Most that I have met are gentle, kind, and have a great sense of humor.  Given Haiti’s history and the abuses it has endured from the US and the rest of the developed world they have no reason to be kind to us.   

We squeezed into the bus with our now empty suitcases and took the bumpy, twisted ride back to PAP.  I intentionally did not take Dramamine so I would be awake for the trip back, which was regrettable.  On the other hand I got to talk to Chandler, our newest translator added to the group.  He is in school to become an auto mechanic.  He is the oldest of 4 siblings.  His family is not wealthy.  His father is a welder and mother is a merchant as many of the women are in Haiti.  One sees women selling old clothes, mangos, vegetables, charcoal, peanut brittle on the streets everywhere.  Not many actual shops in Haiti other than the colorful lottery booths.  It turns out that Chandler and his family lived in a tent for 2 years after the earthquake.  He used a shared bucket as a toilet for 2 years until his home was repaired and deemed safe to return to.  He states that aide came to them for about 2 months after the earthquake and then stopped.  Then they were on their own for food and survival.  Through all of this he continued to go to school and work.  He says this was all “Okay”  he is safe now, his family is back in their home and none of the family was fatally injured in the quake.  My mind goes to whether I would survive living in a tent for 2 years and be just fine with it?!  I can barely look out the window when we reach Port au Prince.  There is so much trash on the street and men are there scooping up the sewer water into plastic water bottles and I am too nauseous to imagine for what?  Many men are dressed in suits and women in dresses on the dusty streets heading to church for Easter Sunday.  Most Haitians are  on foot, some are on motorcycles, and Taptaps which are colorful taxi’s that fit 10 people into the back of pickup trucks with covered benches.    From our bus we can  peak into the open doors of the churches.  Inside the church it appears to be a clean oasis a few stops off the grim of the street. 

Upon Further discussion with Chandler, we talk about his plans after school.  He worries about employment once he is done his training.  He is taking his skills very seriously and plans on being excellent mechanic but feels he may have to go to the Dominican Republic in order to have any chance of finding a shop to work in.  Lately there has been horrible tension against Haitians in the DR including a lynching (unbearable).  Both our minds went in the same direction.  As I was about to offer to buy him the tools that he needs for his next level of school he had asked.  Equipment is quite expensive in Haiti since most things mechanical need to be shipped from elsewhere to the island.  Thus the plan to ship him the wrenches he needs is in motion.  The next plan is to start a crowd sourcing… start up campaign so he can open his own mechanics shop in Port-au-Prince.  He smiled from ear to ear, imagining himself employing classmates, providing for his younger brothers and sisters while they go through school and giving to his parents.  Chandler was always smiling but this one was particularly broad.   He replies to the idea “What you have just said makes me very happy.” You could see his world just open up. I am imagining all the Chandlers in Haiti who have gone through school despite living in huts and tents.   Can we help enough of them to have the opportunity to turn the city into one that the merchants are in stores not on the street, there are restaurants, clean streets, full of small businesses, offices, hospitals that have full labs, radiology, surgery rooms, ICU capabilities?   Thus the “empowerment” part of HEAL was in full motion this trip on many levels.  I am happy to give my small part and start with one Chandler, and one small village in the mountains. 

HEAL Haiti Dr. G's Fifth Post

April 4, 2015

Today is Saturday and our last clinic day.  Susan had a premonition that it would be very busy today, which makes sense since word had gotten around that we were here and most were off from work.  We were also under pressure to be done by 3 so that they would have time to clean the church for Easter Services.  Over 300 people arrived today.  We saw all of them.  Carlos and Joel did an amazing job controlling the crowd outside at triage while the students and Susan took blood pressures and pointed the patients in the correct direction.  The detailed history that a third year medical student takes towards the end had to be thrown out the door so we could get everyone seen.  We had already run low on some of the medications yesterday so the pressure was really on.  We did have to jump to second line therapy for some complaints.  We were out of just regular Tylenol thus moved to Tylenol Cold for pain.  We ran out of medication BPH complaints days ago, antifungal creams went, visine was gone,  we ended up bringing our snacks and crackers from the house to hand out as gifts once the packages of soap, condoms and tooth brushes were gone.  After a very long wait, when each patient arrived to the front of the line they would pile on the complaints.  There was a bit of desperation in everyone’s eyes.  They were facing their last chance to receive our examinations, attention and free medications, a few tablets for pain relief of a toothache, a burn, a sprained ankle, a broken wrist.  I tried to decompress the line a bit as the students worked through each patient.  We found patients that were only there for eye drops or cream for their hands and fulfilled their requests and tried to send them on their way.  Magically we saw everyone and done before 3! The gynecology station was typically last to finish due to a more involved exam and testing but we only brought 200 speculums, thus empiric treatment became necessary.  This week we saw over 1000 patients, did 150 Pap smears, treated 100’s of adults for hypertension, 100s of kids for worms and anemia, relieved some suffering from the knee, back and hand pain of these hard workers. 

After we cleaned up the Pastor of the church graciously invited us to his home.  His wife had made a full Haitian meal for all of us.  The food here by the way is fantastic.  A typical meal is rice and beans, pickley (pickled shredded cabbage), beet and potato salad, chicken or goat with a tangy red sauce, Yucca , and the ubiquitous mangos.  The attendings with Lisa and Aline met with the sons of the pastor who are both doctors.  They had both helped us through the day and see patients in Mussote for a total of 3 days per week.  The meeting was held in Spanish since it was the most commonly shared language at the table.  They both know Spanish due to going to medical school in Cuba and have returned to give back to the community.  From what we gathered they took 3 days per week to give medical care to the community, a financial loss form them since the visits cost more than what they charge.  They did not see patients regularly for primary care since the people there were not used to the concept of seeing a doctor routinely but also due to cost.  Even though their consultation was only 75 gourds (about $1.50) and by the time that they bought the medication it was 200 gourds ($3.80) most of the people there could not afford it. 

The Fan Fan brothers were familiar with the community health care worker since it is available in Cuba and like the families in Mussote that were asked on the survey were also enthusiastic.  The vision is that they will find a community member who is well respected there.  HEAL will look into the training which will likely occur with the Partners in Health group that already has a training program in place.  HEAL will fundraise to pay their salary.  The health care worker will do home visits and perhaps help run some clinic visits.  Check on families, check on who needs medications, needs to see the doctor, needs nutrition, etc.  This has been shown to work well in many communities across the world that does not have health care access.  It will also fulfill the need to provide continuity in the community and have a lasting impact from our too short stay and intervention. 

We also found out that the Fan Fan brothers are frustrated in not being able to get the sick patients to the hospital due to their inability to pay and often pay the cost themselves after trying to do what they can from their clinic.  Our thought was to see if our organization to pay for at least all the children who need to be hospitalized.  After meeting all of them, it would be unbearable to see another unnecessary death that could have been covered by $58. 


HEAL Haiti Dr. G's Fourth Post

April 3, 2015

Today the group saw 173 patients.   The home visiting team saw the man who was bed bound after a stroke reported that he was better today.  No word on the sick baby.  Two dentists arrived yesterday and are continuing their work today.  Global health providers often say that to really relieve pain and suffering in impoverished areas bring a dentist.  None of the patients complained to us about tooth pain but apparently many or most of them are walking around in chronic pain with multiple abscesses.  Even the dentists were impressed.  They just pulled teeth all day.  The patients ranged from small children to elderly.  The students have definitely reached a tipping point and are running with their stations fairly independently with less 1:1 guidance.  Everyone was tired, by the end of the day particularly the translators. They work so hard; I think we are all looking forward to this being done soon.  Every night after dinner we huddle (aka “cuddle”) to discuss the day.  Great ideas come out regarding how we can improve for next year.  Everyone seems excited on the “stand” of making true, lasting impact on the people’s lives here.  Lisa and Aline’s “Needs Based Study “seems to be very encouraging so far.  The   community is enthusiastic about making health care more available here. No inkling of resistance to it by those that were interviewed, nor an inclinging to the local Voodoo or medicine men.  At dinner Gladys showed us a picture of the land where she is going to build the tech school and clinic with plans to start small and then grow big and build a “top-notch” university and hospital.  If anyone can make this happen it is Gladys.  Maybe the children in the neglected patch of the mountains of Haiti that dream of growing up to become doctors and nurses can be a reality. 

HEAL Haiti Dr. G's Third Post

April 2, 2015

Today went smoothly.  Everyone kept an experienced pace and we were all in good groove.  I work in the “General Medicine” department on the left side of the church.  Lots of headaches, joint pains, joint effusions, back pain, asthma.  Procedures that occurred where knee taps, wound debridement, cerumen irrigation.  We had some women follow up for blood pressure checks with good improvement.  They stated they felt well.  The students are giving good feedback regarding the gyn station, the women are feeling so grateful to have the attention and reassurance that things looks normal.  One woman had the cryo therapy today and was so thrilled to have had it. She announced that she planned to have it done every year. 

Jyoti Puuvala, 2 students, Joel and Douglas did some home visits today and attended to a man whom was bed bound for weeks.  The community thought he was distressed due to his wife’s recent death, but upon taking a detailed history and physical it was clear he had a stroke last week. 

Lisa and Aline, our 4th year student leaders design a “Needs based Study” that requires a door-to-door survey.  The questions are really designed to see what sort of access to health care the people have now and if they would be open to a trained health care worker in the community that can look after the people here.  Douglas and I went along and joined several of the other students and the translators.  We split up and each took a dirt path to people’s home.    Carlos the translator, Doug and I, stopped at one family’s house.   The house is cinderblock with dirt floor, the baby is running around with no diaper, covered in dirt, the front door was a sheet held up by nails.    I have never been in someone’s front porch that was this impoverished. The family was   sweet.  They were interested and answered honestly to all the questions.  Douglas had a list of questions from his classmates that he asked the older daughter.  She eats spaghetti for breakfast, wants to be a nurse when she grows up, thinks the US is a beautiful country and the one thing she would change about Haiti would be she would like to learn how to drive when she grew up.  They had no problem when I asked them to smile for a picture. We marched on to a second home that was more like a villa where 10 of them live.  One house is a grass hut with a tin roof, the next a colorful cinderblock home next to a grey larger and darker home.  The cooking occurs outside in an open fire pit (a source of chronic cough and dry eyes in many of the women we saw).    The husband was bringing in bricks that he carried on his head and over the back of his donkey.  Farms surround the huts.  The little boy there did not know what to say about his opinion of the United States but knew he wanted to be a doctor when he grew up.  Apparently spaghetti is a popular breakfast item.  They must not know how much we have, how much we waste, how much food we throw away, how we despair over kitchen renovations, how we spend time and energy deciding which car to buy next, how much we spend on knee replacements, plastic surgery, flat screen televisions, home video grams, nights out to dinner, dog grooming, hair styles, make-up, Disney cruises, gluten free bread, latte’s.    We showed the Haitians the pictures we took of them, they laughed and then hide their faces, and it occurred to me that may have never seen their own image before.  No bathroom, no mirror, no running water, no electricity. 

HEAL Haiti 2015 Dr. G's Second Post

March 31-April 1, 2015

Our first day of seeing patients was busy.  We saw over 200 people that day.  The elderly sick folks tend to show up the first day.  One woman had a stroke 2 days prior to our arrival and was paralyzed on the left side of her body.  Jimmy, the brilliant and caring ED resident who joined us this year, and the students saw her, not much they could do except give blood pressure medication, aspirin and go over some PT type exercises.  Many of the people we saw last year I recognized this year.  Many were thrilled with the medications we gave them but they ran out, they were excited to see us again.  We proudly gave them enough pills to last an entire year this time around.  One woman laughed with joy at the number of pills she received.  One woman was in atrial fibrillation, had a blood pressure of 210/100, heart rate was 110.  She received Diltiazem, aspirin and Lasix.  She came back today with a heart rate of 85, BP of 175/89, not perfect but Much better!  She is someone who would have been hospitalized, on IV therapy, echocardiograms etc., in the US or any western country.  This is simply not an option here.

 Carol Anderson, our pediatrician saw a 2 year old child (the size of a US 10 month old baby) yesterday that had an acute abdomen, obviously sick, in pain, vomiting, intusseption (telescoping of the bowel) was a concern.  Dr. Goulos the local doc we work with was concerned that she would not go to the hospital due to the expense to the family and it was decided to give her IM antibiotics due to the likely diagnosis of Typhus, try to feed her and follow up the next day.  The baby was listless this am, with rapid heart rate, dehydrated, still tender to the abdomen and now not crying…  quiet in Mom’s arms (an ominous sign in pediatrics).  The mother felt the child was better but she sure did not appear that way.  We managed to have the supplies, Carol started an IV on the baby, and Dr. Gousse brought her by car to the hospital.  We are going to cover the expenses for the family.  Dr. Gousse also left money so the mother can buy meals since the hospital is a 45-minute drive from Mussote.   So many questions; will they have a CT scanner, a surgeon if needed, get enough care to keep her alive, how is the baby going to get home once she is better?  Susan mentions that in the US when you hear about a 13% mortality rate for children under 5 in Haiti is a “Oh what a shame” shrug, but seeing and caring for 1 child that may die in the next 24 hours is a whole different dimension. With adequate access to health care is this a preventable death?  How many are like this? Apparently families wait until the last moment to bring their children due to inability to pay for hospitalizations.  HEAL gave the $58 to pay for the child to be hospitalized.   

Andrea Walker was able to take time away from her busy OB/Gyn residency to join us.  We had already been doing Pap smears on all the women we see between 16 and 60.  We were very excited to offer “See and Treat” for early cervical cancer this year.  Gladys was able to secure a Nitrous Oxide tank here in Haiti and HEAL is still raising $2000 to pay for  the cryo-therapy equipment to bring to Haiti.  All the women we see are screened with a spray of vinegar to the cervix to look for early changes consistent with cervical cancer.  It only takes treating 6 patients to prevent one from getting later stages of cervical cancer.  In the US women are used to getting routine pap smears to prevent cervical cancer, a horrendous disease once it gets past the cervix.  We rarely see cervical cancer in the US. The screening for this cancer is so effective.   A woman came to the clinic today complaining of inability to urinate or defecate.  Her pelvic exam showed advanced cervical cancer, sure to bring her a painful death.  Her one son who has disabilities will be orphaned.  Such heart-break is unbearable.   Unfortunately, cancer screening and treatment is something that rarely or never is available in Haiti.  Our hope is that the cryo we bring to Haiti this year will prevent another woman from facing this fate. 



HEAL Haiti 2015 Dr. G's First Post

Haiti 2015

March 29-30

Well, the most difficult part of the journey thus far was getting here.  Who would have guessed that Port au Prince airport is better run than American Airlines and the Miami airport.  Our 1 1/2-hour flight took about 18 hours by the end of it.  Delay in flight, smoke in the cockpit, a turnaround mid air, a 5 hour line in Miami airport, a night in a hotel in Miami, a 330 am taxi to Fort Lauderdale, a 2 hour line to get on the plane, a 1 hour ordeal to get our bags through customs but finally a familiar face in the dusty hot parking to greet us.  Joel emerged from the crowd in a nice cap and un-scuffed Nike airs.  Haiti now feels familiar.  I know people here.  It feels like a visit with family I have not seen for a year. It is odd because I am aware I don’t really belong here.  I leave my comfort zone every time.   With each visit I can anticipate a very real experience.  I keep learning.  I am working hard now to give more to Haiti than what I feel I have gotten out of it. 

Instead of all arriving on one flight as planned, we arrived in small groups. We loaded up the bus with so many suitcases stuffed with supplies and medications that we sat 2 to a seat and took the 4-hour trip to the town of Mussote.  Before we left Port au Prince Gladys Thomas, the CEO of USFCH, popped into the guesthouse in PAP where we were waiting for the others to arrive, she was really excited.  She had mentioned that she wanted to buy land in Mussote to build a hospital last year but got caught in a bureaucratic nightmare with it.  Well, the deal went through, and she has seed money to build the school she is dreaming of.  She has a vision of building a technical school that will train plumbers, electricians, engineers, computer engineers, and then to add a clinic and then a hospital.  This was incredible.  I have been reading a bit and getting up to speed on global health, and the theme that really makes sense is teaching those who stay in Haiti is the largest gift you can give.  Anyway, this would fit perfectly into H.E.A.L.’s purpose of empowerment.  As quickly as we saw Gladys she had to go.  She looked beautiful.  Always elegant and well dressed.     

Next move, squeezing most of the group into the bus, 2 per seat to make room for the massive number of 50 pound suite cases filled with medications and supplies, then about 15 of for a 4-hour bus ride to the mountains.  Upon arrival every year there is the dismay of the trash and crowded misery of PAP, then the ahhh when we finally reach the top of the mountain of Mussote to the guesthouse.  It is spectacular with the farms, the hills, the ocean the bright green grass next to the red dirt, the cool air, after the rough journey it is always a sight for sore eyes.  The hired chef, and lovely little house mama made a refreshing evening meal.  We slept well. With 23 people, 2 bathrooms and 9 beds, 10 floor mats, 3 hours of electricity, limited water we somehow made it work. 

 

 

 

 

 

 

 

Heal Haiti First Post Dr. P. April 2014

Sent from my iPadI wake up groggy..still on Pacific Coast time. There are 22 of us sleeping in Gladys's house...with 2 bathrooms. The door to the upstairs bathroom is shut. We all eat, make our peanut and butter sandwiches for lunch, grab snacks from our bountiful pile of one of many Costco runs brought from the U.S. and follow the narrow rusted-red dirt trail from Gladys' house through the rows of carrot tops to the church. The air was cool and crisp. Patients were patiently waiting for us when we arrived. We spent about an hour setting up and then allowed triage to start. Franklin, a young man with a huge smile and very good at calling out numbers (given out by the pastor a-priori) and keeping the order began, "Numero Un". I was running from station to station making sure everything was set right. Protocols taped up, alcohol swabs ready at the anemia station, every station has their tickets, every station has index cards for follow-up appointments, everyone had pens and sharpees, the gift station had the vitamins/toothbrush packs ready to hand out, Melanee and I read the directions to the STD testing that we had brought, Dr.Andersen, the pediatrician Elaine had recruited kept asking me dosing questions.  I remembered that this has become my main job when in Haiti...trying to keep everyone organized, finding things that people need, cutting pills when needed, giving out tickets to keep the order and occasionally answering medical questions from the students. I kept popping in the gyn room to make sure Melanee was ok and a bit bummed that I couldn't guide her the way I wanted. I was hoping that my pre-printed protocols taped up were adequate. She seemed pretty capable which is why I put her there first. At first there were a lot of kids, so the anemia and belly station were full, so I jumped in to help with the belly pain station. Pretty easy...they usually would point to their upper stomachs complaining of belly pain. Trying to get how long they had the pain was quite a challenge. I really don't think that keeping time is part of their culture. Where as, my American patients will tell me the exact time of day, week and month that a symptom began usually telling me exactly what was going on to the T the moment they noticed something.  We had plenty of gastritis medication and even tons of h.pylori infection treatment (the infection that causes ulcers and is super prevalent in Haiti!) thanks to our multiple packing parties! Kids with abdominal pain and decreased appetite...worms...give worm medicine. One man had a non-healing wound from a year ago on his leg. It was all crusty and oozing. Wound care has become one of my specialties from working at a needle exchange in skid row, so this was easy. Lisa was excited to get some fun Dermatology and I showed her how to debride a wound (clean off all the dead tissue). We told him to come the next day. The day was relatively light which was good since it took time to get a rhythm. The Gyn station got backed up and thus we didn't finish until 6pm.  As, we were hanging around waiting for gyn to finish, one of the students was listening to a woman's heart in front of the church. She thought she had heard a murmur and called me over. Just approaching her, she looked ill. Her neck muscles were taught and she was breathing pretty fast. It wasn't a murmur, but her lungs where very tight making wheezing noises. She cooks over an open fire which can cause emphysema. I gave her an inhaler, taught her how to use it, gave her 5 days of prednisone and then a preventative inhaler to take as well. I told her to come back thursday. We hiked back to the house and ravenously ate our delicious dinner followed by our nightly huddle. My favorite presentation of the day was from Kevin who told me that he was seeing a man who was complaining of hip pain for one year status post falling off a donkey. We came up with ways to improve the clinic the next day...add another gyn room, more people in triage, Ella to help with the lab testing, the

Heal Haiti second post Dr. P. April 2014

Sent from my iPad2nd day of clinic went smoother.  We saw about 130 patients Monday and about 170 on Tuesday. I went around making everything was running smoothly. I did triage for a bit. That was fun. I tried to get as much info as I could in order to help out whoever was going to see the patient. A few patients had borderline blood pressure numbers so I gave them an index card telling them to return the next day for a repeat blood pressure. Ella, Elaine's 13 year old daughter ran the gyn lab where she was running the STD tests. The students found her priceless. We saw a woman who was complaining of shortness of breath when she walked. Her hemaglobin was 5.6 (normal is 12). Her HIV test was negative. I asked Dr. Gousse to talk to her. It turns out that she had some lab tests done in Port-au-Prince and she had the results at home. We asked her to return the next day with the results. We both were wondering why she wasn't given a transfusion. The belly station was running strong and tons of people with outrageous hypertension. We were doling out tons of blood pressure med, aspirin and cholesterol meds (which we couldn't find the first day, but thankfully I found them along with the "missing" iron tabs). My friend Julie had taken on the task to prepack all 10,000 cholesterol pills...I was so glad to find them! We also found the gel used for Pap smears...we were using antifungal cream instead! Near the end of the day, the hemacue  (the anemia machine) stopped working. We told some kids to come back the next day hoping we would get it to work the next day. The leg guy came back for his dressing change which was fun for Lisa. Gyn was still behind but ended a bit sooner then the previous day. Every once in a while I'd pop my head in but the students were doing great. We treated many people for STD's and their partner. We also gave out tons of condoms. I was surprised how comfortable people were in accepting them. We came home feeling more accomplished. We ate, huddled and played more games.

Heal Haiti third Post April 2014 Dr. P

Day 4
Clinic day 3...wed: We ran out of the vitamin/tooth brush packages tuesday. We were just giving out condoms as "gifts". We ran out of Aspirin by the end of the day. We still hadn't been able to get the Hemacue to work so the Anemia station was closed. We ran out of Buffer A for the chlamydia test so Jake and Kevin literally tasted it and decided it was basic, so they tried different acids like the iron elixir and crushed up aspirin and used Tums for a base and created a working Buffer A!!! I was pretty impressed! They need to go on Survivor or something! We were down to our last few bottles of iron elixir and had run out of iron tablets, thus we were giving adults the elixir. We also were down to our last few worm medicine tablets. So, pediatrics was limping along. 
    Dr. Gousse, Dr. Andersen, Joel, Ella, Melody and Virginia went to the elementary school in Mussote to see the kids but ended up having to make a worm and iron list. Not having the hemacue, the students and even Ella became pretty apt at diagnosing anemia by looking at the lower eye lids of the patients. Normal is nice and pink. The paler it gets,  the more anemic one is. 
    I did triage most of the day. Every adult went like this: Bonjour! Comment ca va? Ca va bien. Hello, How are you? I'm good. Do you have hypertension? as I take their blood pressure. Yes. Do you take medications? No, not now. Blood pressure is usually like 180/110. The highest I saw was 220/138. Do you have chest pain when you walk up the hill? Yes. Most of these patients would be hospitalized in the states in the ICU. I sent them all to the hypertension station where they got the appropriate blood pressure medications according to the protocols...ever changing as we would run out of certain medications. We made sure the severe ones got Aspirin and cholesterol medication.  The ones with chest pain received beta blockers hoping that would turn back the decades of damage to the heart. The fun part of triage was that several patients I told to come back for blood pressure checks came back! Hallelujah! Some had normalized and some were still high, so they were sent to the hypertension station. I saw one woman who was 92. Blood pressure....perfectly normal!  The one person of all of Haiti over 60 without hypertension! She had knee pain. Easy peezy!
    The woman from the previous day with a hgb of 5.3 came back with her "results". She had just had a thyroid panel...they were all normal. We did an HIV which was negative. Luckily, one of the pastor's sons who are Haitian doctors had joined ranks with us the whole time we were there! I told him about this patient and he gave her a referral with a very detailed note about her case and requesting her to be hospitalized for a transfusion. It was so great to feel like I had someone to direct the sick patients to. 
    That afternoon I resumed my frantic filling in where needed activities. Jake comes back, "I got the hemacue to work!" "HOW?" We had cleaned it frantically, called the 800 number, called Ellaine's husband to go on the web site to figure out the error code..."I wacked it!" I just didn't know what to say. Just around the time we got the anemia station up and going, Danielle picked up a patient with severe anemia by looking at her eye lids. She was complaining of weakness. Her eye lids were literally transluscent...I've never seen eyelids that white...her hemaglobin...3.1! We all agreed we had never seen an adult with that low of a hemaglobin! I was amazed that she was even upright! We checked it several times and then tested it on ourselves. It was working correctly! Back to the pastor's son! He looked at me in dismay when I told him in Spanish what her hemaglobin was. He immediately started talking to her, getting her history again. We checked an HIV test, which was negative. He wrote out another referral to the hospital. He sounded like I do when I'm trying to relay the importance of someone listening to my instructions."Are you going to go?" "Yes" "When?" "Tomorrow". "How are you going to get there." "I'll get transportation." etc...It was fun to find a Haitian version of me when it came to patient care :) Dr. Gousse and I were always on the same page, too.While Dr. Goulos (the pastor's son) was writing his referral, he said to me, "thank goodness you're team is here! can you imagine what would have happened to her?" That felt really good to hear. I often doubt if we're making a difference when we come for a week and dole out our meds for chronic conditions. I always try to emphasize to teach the patients the importance of always taking their medications, getting more before they run out etc...maybe it will stick with a few of them! We give out a lot of pain medicine, too, which I think is important to have just in case they need it. We always have medicines in our medicine cabinets in case we get a headache or a stomach ache...I like that we can provide that for these people, too. In fact we started getting low on all our pain medication supply, needing to start cutting tablets in half to make sure they last for more patients to come. We were giving out plenty of H.Pylori treatments as well. We never ran out of those or the acid reducing medicine! 
    The Gyn station was going strong. Every once in awhile someone would come and find me as they were often treating for trichamonas. As we ran out of gonorrhea tests we just started preventatively treating patients for that too if they had the appropriate symptoms. I had bought just enough Levofloxacin and metronidazole. We ran out of azithromycin for chlamydia treatment, so then we used doxycycline. We we ran out of that, we started using erythromycin. And the students were very savvy about treating the partners and giving out plenty of condoms. It was a well oiled station! Doing paps and treating for STDs is very satisfying.
    That night during the huddle, the students wanted to tell the students for next year to create their own protocols, so they're not just doing something because they were told, but really understand why they do it that way. I thought that was a great idea. They were already jotting ideas for next year and how they wanted to orient the students for the different stations. It was great. In 3 days they became completely autonomous health care providers now taking leadership roles and changing things up. They wanted to combine belly and hypertension stations since they were getting similar histories and having to tease out if "belly pain" was actually chest pain. I really like letting the students flourish into leadership roles. It's a natural progression in medicine, but of course usually happens more in residency. Aline commented that she had seen more patients in 3 days then she had in her entire medical career. Yup, I think satisfyingly.
Sent from my iPad

Heal Haiti April 2014 fourth post Dr. P

Our last day working in Mussote. The adult station and htn/belly combined station were packed. I tried to weed some out and treat easy things or I would repeat blood pressures. The pastor's other son brought a glucometer but alas we couldn't find the huge bag of metformin we had brought (diabetes medicine). I found 3/4 of a worm tablet and broke it in 3's. I looked for kids in the belly station, checked there card, confirmed that they had belly pain and decreased appetite, squeezed their protuberent belly and shoved a quarter tablet of pyrantel in their mouth to chew. They chewed it compliantly. (It tastes like a chewable vitamin). 
    At one point I see a pregnant woman at triage. Joel tells me he's sending her to the htn station. I look at her pressure and it was 170/110. This woman would be hospitalized in the states! I get Joel out of triage and ask her if she sees a doctor. She does. Do you take medication? She does. Do you have it? She takes it out. She's taking methyldopa 500 mg 3 times a day. Did you take it today. Yes. Did you take it 3 times yesterday? Yes. I go through all our medications and find the one least harmful using my special phone app for medications. Amlodipine is ok. So I start her on10mg at night in addition to what she's taking. I tell her to see her doctor next week and show him/her what I gave her.Her hemaglobin was normal. Her HIV test was negative. 
    Later in the day the anemia station is seeing a guy that looks super skinny. Like concentration-camp-skinny. His hemaglobin was 8.9. HIV negative. I brought Dr. Goulos over. He started talking to him. He eventually turns to me and says that he was treated for TB for 6 months. That's probably what it is then...resistant TB. Another referral!  
    We finished relatively early. We had done 70 paps in all in Mussote. Crazy! The pastor couldn't stop thanking us. Dr. Gousse had told me that the foundation wanted to build a hospital in Mussote. That would be great. In the meantime, we'll try to do what we can. Elaine decided she wants to get people to sponsor patients so that we could provide enough medications for them year round...especially the ones with chronic conditions like hypertension. What a great idea for our organization to work on! Elaine and I have started and NGO called H.E.A.L. (Healthcare, Empowerment, Advocacy & Learning). Hopefully we'll have our tax id by next year!
   The next morning, as we were packing up the bus, Danielle finds a suitcase full of more vitamin/toothbrushes and aspirin! Ok, I'm going to have to be better organized next year. Well, we're putting on a health fair at one of the schools/orphanages for monday and tuesday so I'm sure we'll use them there!
    Friday we headed out to Club Indigo, the resort at the beach that I look forward to going to every year...amazing water, great food,  the perfect break! Sunday we dropped Dr.Anderson off at the airport and we pick up my "lost" bag. It was like Christmas! More blood pressure medicine, all the baggies and labels, my fan, the urine dipsticks, the urine cups, makeup that my friend had donated (we can use them as gifts for monday and tuesday) and lots more condoms...we had almost finished what we had. When picking up the bag, to insure that the bag was mine, they asked me what was in there. I said baggies and condoms. "Lots of condoms?". She must have gone through the bag since the lock was unlocked. "Yes

Dr. P. Haiti April 2014 Fifth Post

It's hard to go back to work after a couple days in Paradise! Especially in dusty, trafficy, crowded, HOT Port-au-Prince! Monday, we went to one of the school's supported by the Foundation. I have been there before and was greeted by the Principle Adelaine. Not too many people were waiting for us which gave us a chance to get organized and figure out how to see people. We had a gyn station in the principle's office, with a bed with stir-ups! What a luxury! Alas...we forgot the luggage of vitamins! Errrrr! But had plenty of condoms, aspirin and even purchased some more iron and worm medicine. It was a short day but we were all melting and overheated. Margaret had somehow got the message to the driver that she wanted ice-cream and we stopped at a super market. "What are we doing here?" I ask groggily. "Margaret wants ice-cream." And soon we all stumbled out of the bus into the wonderfully air-conditioned market and came alive with idea of buying cold drinks and ice cream. Best idea yet! 
    That night we had our last "huddle" where we shared our favorite experiences and accolades. Elaine and I congratulated the students on a job well done. Everyone lauded Ella for her hard work. She even mentioned that she now "might" consider medicine! Ha! We all thanked Dr. G for her generosity and good teaching. I am soooo thankful to her. Who would have thought over 20 years ago when we were medical students we would be leading a team of students to Haiti together. And yet bringing her eldest kid?! How cool is that?! We worked on our "by laws" for our NGO on the patio in the breeze outside of the guest house Monday eve. Pretty cool! I hugged her good bye early the next morning as she and Ella left for the airport. One more day.
   That day we saw scores of patients. A lot more kids...we brought the vitamins, hallelujah! Each kid and many adults received the vitamins (with iron) and a toothbrush. As we ran out of prenatal vitamins, many were instructed to take 2 kids vitamins a day...and brush your teeth :) The rest were given to the orphanage, so I'm sure they will be used well. Overall, there seemed to be less anemia and not as many people with super high blood pressures compared to Mussote. Alas we ran out of pain medication, so we used the aspirin (it took me a while to remember that we could use aspirin for pain relief!) that we had found and the pediatric ibuprofen that we had a ton of...3 doses of 400 mg in each bottle. not bad!                           
    There was one woman in her 20's that came in with her husband carrying her.  Apparently, she was unconscious for 2 months and hospitalized for 6 months. She progressively lost her ability to walk. We were thinking maybe MS but then Ella said "polio?" Yes! That was probably it! On the drive to Mussote, I spoke with Dr. Gousse to understand the vaccination situation in Haiti. Vaccines for polio, diptheria, meningitis, hepatitis, measles, tetanus are free but each person needs to take their kids to a hospital that participates in a vaccine program. Most of the small town hospitals can't afford such a program and the rural folk have no access to vaccines at all. If there was a hospital in Mussote, they would start a vaccine program. Because these infections aren't endemic to Haiti, there's not a big push to vaccinate everyone. However, I know that after the earthquake, many people died of tetanus, especially kids.  I'm adding vaccinating all kids to my list of many wishes for Haiti...the working list is sanitation, trash pick-up, roads (though there has been improvement with that), traffic lights, recycling, food security, housing security, security, health care for all, job opportunities, free education, reforestation, care for all street animals/spade&neuter. As we see the many kids that play with us and spend time with our friends in Haiti (especially the 5 Stooges....I've dubbed as the 5 translator boys who all call me mom), the people here are full of life and laughter and good spirits. It's the rest of Haiti that needs continued structuring to best provide these human rights that we all deserve.
    We saw 150 people in 2 days at the school...giving out lots of "acid stomach" medicine. We did 51 paps there in 2 days. The students will probably have done more paps in the last 10 days than most doctors! We did 70 paps in Mussote for a total of 121 paps! Last year of the paps we did, one came back "high grade" which means near cancer. It's great to be able to do paps on women who many times never had had a pap before! We treated a lot of STDs and gave out 3,600 condoms!!!! We saw more patients this trip then ever before, which feels great. We had a lot of blood pressure medicine, cholesterol medicine and aspirin medicine left over, which I'm giving to Gladys to give to Dr. Goulos to continue treating the hundreds of people we saw in Mussote with hypertension. We also had a lot of acid reducer left which we were also able to give to Dr. Goulos. I emailed him saying to tell his father to start preaching the importance of medicine compliance. I'm sure it's in the bible somewhere! Hopefully he can continue their medication throughout the year. That's my goal: to make sure those with chronic conditions have treatment year-round.
    I was reflecting on our trip and I realized that in the last 5 years, 37 students have experienced poverty medicine in Haiti through this program. That's a lot of future doctors that will commit to working with the impoverished in their future lives and through the ripple effect touch thousands of people's lives in ways we can't even imagine. Already, many students have committed to working with the poor and work internationally. Many have expressed they want to be able to bring students to impoverished areas when they are attendings.  Many have continued their leadership roles with this program. Three are officers for our latest venture, H.E.A.L. I love contributing to creating leaders that make significant differences in people's lives. I met a UN officer today at the Port-au-Prince airport. We shared stories. He's from Columbia. I told him about my life. He ended by saying, "I wish you well in your perfect life." I said, "I'm not sure it's perfect." He quickly replied, "But it is." He's right. It is perfect. He made me say it to him. "My life is perfect."
    Thank you so much to everyone who has contributed to my "perfect life". If you feel moved/inspired to contribute financially, we're still accepting donations to pay for this past "perfect" trip.  Hugs to all. "Dokta" Susan. :)

 

Dr. G. Day 1, 2013

Day 1 ...early morning awakening (245 am), at Philadelphia airport by 345, waited to Delta personnel to arrive, once in JFK, I waited for my Flight to PAP in the same gait as a crowd going to spring break to Fort Lauderdale. One crowd was white middle aged parents with their teen age kids, and 20 year olds with Abercrombie across their ass on sweat pants and flip flops, which boarded first. “this gate MOM? Thats not right, its going to France!” “No thats Port of Prince, thats Haiti” “HAITI?!”

I fit much more into the first crowd.

For my flight sat muscular black men, with acid washed jeans and baseball caps atop their carefully tight haircuts and with their slightly less well quaffed wives. I feel pale after a long winter, my hair is red, I'm short, I'm Jewish, suburban, and my jeans are 5 years old. I definitely stood out. I was too self conscious and too ridiculous to read my Paul Farmer book I brought on Haiti, so I opted to the New York Times magazine and an old medical journals I never got to read at home. My seat row mates were a sweet couple from Haiti and the Dominican Republic who were visiting the wive's mother in PAP. That laugh and smiled very easily and at everything, including me, but I was part in on the joke, not the butt of it.

Haiti looks and feels like Mexico only with more rubble and striking mountains, and a land mass that you can take in at nearly all at once from the air. Otherwise the streets and buildings and vegetation that I have seen so far are exactly the same as the non-resort parts of the Yucatan. The airport is apparently brand new this year but yet had guys in red shirts ready to grab your luggage despite you begging them not to “you can pay me now, $20 is good”... They looked like they had been doing this scam for years. I loved the live music as we walked in (that was more NOLA like).....I found Susan outside the airport, thank God. Although it really was not that hard once I tried to find her with my eyes rather than the cell phone. The medical students that were supposed to meet me got delayed in Miami so we took a van that was hired by our group back to the house. The van will go back later to collect the 4 students stuck in Miami.

The streets are steep, and definitely no strict rules... or any rules...about turning or which lanes to stay in. There are still tarp homes and shanty shacks and bare foot kids with homemade kites from discarded plastic bags along the side of the road. What a maze. The house we are staying in was untouched by the earth quake. There is an iron gate and stucco construction. There is a middle entrance floor that has the kitchen and dining area. Some really friendly gentle guys are in the kitchen trying to figure out how to serve the vegetarians in our groups and asking if canned sardines are ok? (well, stick to just vegetables) I met the other two women that are the attendings on the trip, all 4 of us will be staying in the room together. Its officially named by Linda “the faculty lounge” Its humid, I am still getting used to the smell of my super potent deet on my skin, and drank way too much coffee this am to sleep now. Talked to Susan for a while and reassured that most of the medicine we will be doing is basic primary care stuff. Whew, I can trying to absorb anything from my used tropical med book aside. Apparently hypertension is rampant and mostly untreated. The people are all thin, and not a salty diet, its genetic but walking around with 200/100 blood pressure is common. Childhood immunizations Susan was told is the job of the health department but one wonders “what health department” but she was dissuaded from approaching that aspect. We are joining a organization call the “United States for the Children of Haiti” which was started by a haitian woman named Gladys who I expect to meet later. She coordinates groups that come to Haiti and clinics where they are needed. She and Susan met through a friend and when Susan looked into coming to Haiti only 2 weeks after the earth quake. We will be housed and fed in this large (and yes appears sturdy) home for much of the next week.   

Dr. G. Day 2, 2013

Haiti Day 2:

Awoke at 730, breakfast was amazing Mangos and pancakes, the coffee is really wonderful, a total surprise since I was expecting to go without a decent cup for days. The night before we reorganized sorting what seems to be around 10 suitcases full of medications. We carted those suitcases to the hospital in the hired van again.

Waiting at the hospital were 6 translators. The translators were all trained by Joel (pronounced Jo-elle) as it turned out. So Susan met Joel with her first trip to Haiti. It turns out that he knows Kreol, French, Spanish and English and acted as a translator for her. He is also very empathic and as it turns out was dreamed of being a surgeon. There are no medical schools in Haiti. Susan, in all here amazingness “adopted” Joel and has sponsored his medical education in DR. He is currently in his third year and fits right into our group. Anyway this energetic young man has trained his friends to speak english with intensive training for 6 months. These guys are also really good hearted guys. Most of our day was spent orienting and getting organized, mainly in our imported pharmacy. There were about 15 patients seen and treated. Most of the complaints were abdominal pain, one cyst incised and drained, 10 PAP smears done. We gave out tons of condoms and interestingly no one was embarrassed to ask for them and seemed to understand their importance. The 2 fourth year students taught the nursing students that are training at the hospital, then we offered to treat the nursing students several of whom jumped at the opportunity. My role is mainly to precept the students. Most of them are 3rd year thus really new to medicine and getting used to talking to and touching patients. The added layer of the language barrier, the cultural barrier and lack of testing equipment is a real challenge for them but what a great way to get exposure to it all. I forgot how much I used to not know and how hard it was in the beginning. Dosing tylenol was one of the questions. Cute. I really need to be patient and let them do the talking and examining, conclusion making. Its hard to hold back but will get used to this new pace. I do enjoy teaching and its nice in this situation since there really is no pressure to see lots and patients and quickly. The focus is providing good care under the circumstances and the experience for us.

I talked a bit to one of the young translators. He said his life did change after the earthquake. He mainly only elaborated that his faith in Christ really escalated and he is alive so that must mean something. He asked me what I thought of his country. He feels what they need are training in what they need to do and security is a big issue. The security issue came up when they talked to the nursing students as well. The people I have met from Haiti so far are incredibly gently and sweet, smiling, joking. Its lovely here but the streets are so broken. Dusty not paved, construction going on. We intended on going to the local orphanage but the roads were blocked and lack of secured transportation.

The hospital we are working in is Hopital Espair which translates to Hope Hospital...it was originally a children's hospital exclusively but now admits adults at well. From what I could see only outpatient services were going on. There was an ER which was 2 beds in a small room, there was an ICU which was also 2 beds and 2 monitors, they actually had 2 OR s and a recovery room. We met 2 doctors that work there but not sure if its full time, one was in the ER, one pediatrician, they had a gynecologist today but sounds as if most of the sub-specialists come once per week. We also met the medical director there who speeks, Kreol, French and Spanish but no english.

The pace was slow today but fun. Getting to know everyone in our group. A really great goup of students, the “faculty” and a photographer. 13 in all. Hope we have more patients tomorrow and better flow. The thought was that with the road as a barrier it kept the volume down today.

We walked home from the Hospital which is close. Its hot and humid and dusty. The trickle of a cold shower was luxuriously welcomed. The cook here is really good. Fresh pineapple, spaghetti for dinner, and lots of water!   

Dr. G. Day 3 2013

Haiti Day 3:

Today was great. We had a quick get ourselves together in the morning. They made oatmeal with condensed milk, delicious, must remember to do that at home. Yes kids, I will make you like oatmeal. The sun was really bright this morning and started out not too humid which was nice, I started taking photos of all the bougainvillea then we turned a corner and it was practically hard to breath or keep ones eyes open due to all of the dust from the road construction.

The morning was filled with lots of patients. We got a better flow and rhythm down as expected. Lots of young women today who had multiple small complaints and needed a well woman exam (a pap smear). Primary care is really unheard of here on a regular basis, thus for most of them it was their first Pap. Even those who had had children. I learned that cervical cancer has a very high incidence here which is heart breaking to hear since it is such a preventable disease but simply horrible if it gets past the easily treatable stage. The medical students were really relieved that the patients were so comfortable with them and allowed the guys to perform exams. We ran out of the solution for the paps in the middle of the day. Joel ran back to the house to pick up more. We caught an ACE induced cough in a older gentleman, gave out more condoms to the young ladies and their friends in the waiting room, treated head aches, belly pain, we gave pain medication for a young woman whose sister is dying from untreated breast cancer but is in the mountains with no access to care. During our debriefing one of the students expressed frustration and a sense of helplessness when she was worried about ovarian cancer in one woman but the patient was unable to afford the ultrasound. Unfortunately that is a very familiar frustration to the attendings from the uninsured in the US, but the expectation here, one of the most impoverished countries in the world is different (right? Well for some). Definitely learning that in Haiti things are much different in the city than in the mountains. There is health care in the city but apparently in the mountains is where they have nothing. The health care in Port Au Prince of course is very limited to what we have in the states. The patients usually are charged the equivalent of $5 to enter the clinic or hospital, but must pay for testing and doctor fees as they go, plus medications. The degree of testing and the acuity of the care available (such as ICUs, CT scans, ultrasounds) is limited, meaning close to non-existent. I also learned tonight that there was not a single ventilator in the entire country until after the earthquake. I understand now why Partners in Health have done what they had done and built a huge teaching hosiptal with a net work to go with it. I am not sure if we will get to see it while we are here.

Our afternoon was amazing! We went to an orphanage that is run by the same foundation that runs the Hope hospital. Carla, one of the other docs that is attending wanted to see the sick kids which was a huge relief to me since I had not treated sick children for 8 years. The orphanage named “Hope Village” is on top of a hill that overlooks a very impoverished suburb. By suburb I mean cinderblock houses with some tarp roofs some solid with no running water, no electricity, no paved roads. I did see a large water truck drive through but the translator I was talking to said he thinks that the residents need to buy the water. The orphanage however was lovely. The seemed to have water and electricity. So the sick kids were mainly with severe cerebral palsy, thus wheel chair bound, well actually mat bound (no wheelchairs until after the earthquake then a Canadian PT team brought really great equipment for these kids). Any way I got to see the really cute healthy kids. It was impossible to guess the kids ages since they were all tiny due to prior malnutrition. They are really being well cared for now, fed, looked after by a visiting pediatrician and have “house mothers”. What a blast. After diagnosing just about all of them with ring worm, intestinal worms (big bellies and decreased appetite), tinea corporus and capitus, viral URIs which all sound horrible as I write them but trust me very benign stuff...we got to play! They went nuts for our cameras, stethoscopes, penlights. I got great pictures and will up load them shortly for the blog. They all just wanted to be held and play. Brian, the photographer who is with us looked transformed. He does not have kids of his own but they really flocked to him which was so cute. I gave one kid a “tattoo” (my pen wrote on his hand) that spelled out “tattoo”, and it turns out that his name is Tattoo. He totally got a big kick out of it although I don't think he understood the whole joke. It was not heartbreaking as you may expect, just really kind of fun and light hearted. We were basically their entertainment for the afternoon. My sense is that their current situation is better than had they stayed with their family that cannot afford to feed them.

We returned to the hospital and picked up the others. The road construction at this point had some fresh concrete on about 10 feet of it, only miles and winding miles more to go. Hmm, a metaphor.   

Dr. G. Day 5 2013

aiti day 5 April Day 4

Really interesting day. Another morning in the clinic with more nursing students with multiple small complaints. We did get to see a couple of men today which was a welcomed change. One was an Ethiopian gentleman who worked for the UN and is now retired. He has lived in France but has decided to retire in Haiti. I asked him how he liked the country and he had only positive things to say. I think he is probably able to live cheaply in a big house and is apparently used to third world style living. Most of the students packed lots of packages of medications in anticipation of tomorrow. We then left the hospital and walked back to Gladys's house. The sun today was incredibly strong, the dust was not quite as bad due to a really heavy storm the other night. More concrete being poured on the street. We finished packing our suitcases and waited in the mid day humid sun as we watched the interpreters perform the impossible. They loaded about 10 heavy suitcases full of medications plus all of our individual bags in the back of the bus, then on top of our bus, while it was at a pretty sharp angle leaning into the street, then finally making room for 18 of us to then sit. I think we were all a little worried about being a next day news story.

The bus drove us to a local supermarket where we loaded up on local wine and coffee, then off to the mountains! The translators chose to sit in the back and were cracking up the whole time. I think they were laughing at the bus driver who was cantankerous and complaining about the situation the whole time, which admittedly was not easy. We then drove through down town Port Au prince. Oh god, now I realize that we were staying in the nice part of town. We had a trickle of water pressure, no air conditioning and limited bathroom space, our conditions would probably feel like we were slumming it to most people of our Philly local suburbs. Trust me, we were in luxury at the house. It wasn't so much that the people were living in shacks, but in tarp covered boarded up shanty town that looked like they had been there for years. The most disturbing thing is the amount of trash everywhere.Piles and piles of trash. Susan mentions excitedly that there is so much less trash in PAP. What?! 70% unemployment in the country. Everyone seemed to be sitting on the side of the street selling stuff that consisted of either clothes and shoes, water and coke bottles that would become more trash or mangos. I don't think pictures would really explain it, we have all seen the pictures of the streets in third world countries, but driving through it you understand. Haiti is particular frustrating because you can see the potential for something so much better. The land scape is beautiful, the people are lovely, its heartbreaking that its all due to bad politics, much of which has to do with the US that its so impoverished. To go only a few miles took over an hour. The traffic is terrible. We saw UN trucks drive by full of armed, dressed solders. Joel tells us that “they do nothing but add to the traffic”. Many tam tams which are local pick up trucks painted with religious quotes colorfully painted with benches built into the back where about 8 people sit for 25cents per ride. Finally made it through the city and started winding high into the mountains. The road was paved for the first several miles which was new since last year Susan tells us. Then the road is unpaved and winding. The translators again are cracking up perhaps nervously this time at the travails of us, the driver and what could potentially be not very funny. The bus turns a corner and suddenly the mountains open up. The cinderblock shacks are out of view and the ocean appears. Everyone sighs “oh... wow”. More cinderblock, some carefully painted graves, children, adults staring out on the road. More are smiling now, fewer are selling things. Some waves. Then farms! Not a lot, but some. And they are beautiful. Wish I saw more. From what I have read so far most of haiti used to be rural but due to politics and the US selling haiti subsidized cheap food from the US most of the farmers moved from the mountains to the city and the farmer went out of business. We kept going up and up until we were literally at the top of the mountain, and now found Gladys's mountain home. She and her friend were here and a helper was cooking dinner. The bus drivers was totally pissed now after miles of dirt mountain road and a huge heavy bus and now he has to drive the suit bags full of medications to the church. We all took in the view from the house. The back balcony looks over the mountain and to the ocean. Its a bit hazy so the whole this was not fully visible but I cant wait till the morning. Its chilly which is sooo refreshing and we all threw on jackets and climbed to the roof. We are on top of haiti. The unspoiled, naturally at peace haiti. Fantastic. Back to business, Phillip on of the students gave a talk on intestinal worms which was excellent before dinner. We had dinner, some Chilean box wine that Gladys brought out. We are doubling up on beds and cots its really fun, Lynda opened up her Haitian rum and we all took sips from cups. Its excellent. I don’t think anyone drinks in haiti except the tourists. Well more rum for us I guess. Good night!