Casse community clinic renovations complete

With renovations completed, Project Medishare doctors and nurses are treating patients in the clinic again. For almost two years the clinic shared a space with a school down the road. Photo by Jennifer Browning.

By Jennifer Browning

Project Medishare began overseeing the government clinic in Casse in 2007. With a grant provided by Cross International through the government from USAID/PEPFAR, the Casse clinic renovations began in 2009.

During renovations, a local school agreed to share space with Casse medical staff. And although there is still a need for some furniture and some equipment, today the clinic is once again serving the community at its original location.

Altagracia Pierre, 18, who brought her sister’s baby for check up to be vaccinated, said she is happy the renovated clinic is operational.

“When the school shared the clinic there wasn’t much room. Here it is more comfortable and there is more space,” she said. “The service seems better too.”

Pierre said she is appreciative of Project Medishare’s efforts to provide healthcare in her community.

“Here at the clinic it doesn’t cost as much to see the doctor as some other places,” she said. “Also the doctors here do whatever they can to help you. If you need medication and they have it available they make sure you get it.”

Project Medishare nurse Viergerlie Guerrier triages a patient at the newly renovated clinic in Casse. Photo by Jennifer Browning.

Chantal Guerrier, 37, came in for her family planning consultation. She said she loves the renovated clinic.

“It’s beautiful and nice. If you are really sick and you have to stay for the day, there is now a place for you to lie down,” she said. “Before, there was nowhere to rest if you were very sick and waiting to see a doctor.”

She too likes having a clinic nearby in her community also because it helps save money on transportation costs.

“It is good when you have your clinic near you because the healthcare if very close, you don’t have to walk a long distance or take a donkey. It is accessible; it is close which is good especially if there is an emergency,” Guerrier said. “It also helps us save money because we don’t have to spend the money to rent a motorcycle or a donkey. That means I have more money to feed my family.”

Louis Anelus, an auxiliary nurse at the Casse Clinic, worked at the clinic before the renovation plans were in place. He said he can tell that people in the community are happy to have the clinic renovated.

“People were so happy when they heard that improvements would be made to the clinic,” he said. “They were desperate for improvement.”

Anelus said the clinic is so important to the people in the community.

“The clinic here is so important for people because before this clinic, people didn’t have money for healthcare,” he said. “Now with Project Medishare here operating the clinic they pay so little and the community is so happy.”

In the former clinic (seen here), there was no for a laboratory. Today the newly renovated clinic has a lab technician available to run a variety of tests. Photo by Jennifer Browning.

With renovation also came staffing improvements.

“In the old clinic there was a space for a lab, but there was no funding for personnel to operate the lab and run the tests,” he said. “Now we have a lab technician and the lab can function fully.”

But it isn’t just aesthetics and improvement in staffing that excites Anelus, but also that the community is part of what is happening in regards to the improvements in healthcare.

“I am so happy that we have the clinic again and that it is renovated. When we were sharing space with the school down the road we couldn’t see very many patients,” Anelus said. “Here we can see more patients, and I feel that the people in the community are proud to have this clinic here and they feel like they are a part of what is happening. And that is so important.”

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Hours left to make a 2010 tax-deductible gift to Project Medishare

When Project Medishare community health agents met 16-year-old Ninitte at a local event in Casse last year, she was severely thin and complaining of pain in her chest.

Ninite (second from the left) with her brothers and sisters at their home in Casse. Photo by Jennifer Browning.

One of Project Medishare’s community health nurses took charge and helped her see a doctor at the hospital in Cange. Ninitte was diagnosed with tuberculosis.

Ninitte improved seven months later and health agents helped her return home where they monitored her condition several times a week.

We hope that today, just a few hours away from the New Year, that you will click here make your 2010 tax-deductible year-end gift so that our medical staff and health agents can continue to help young girls like Ninitte.

But it is important to know that Project Medishare’s health agents didn’t stop after Ninitte returned home.

Our health agents knew Ninitte’s mother had passed away, and that when she returned home, it would be Ninitte’s sister, Angeline, primarily caring for her. Health agents provided consistent home visits to not only make sure Ninitte’s health continued to improve, but they also worked with Angeline in teaching her how to cook healthy meals for the family.

“It was very helpful to have training in order to teach me how to cook healthy meals,” Angeline said. “Now I can not only help my sister get better, but hopefully help keep our family healthy.”

If you have given already, we thank you for your continued support of our programs, like the Community Health Program, that not only assisted Ninitte in growing healthy again, but also serves over 100,000 people in Haiti’s Central Plateau.

There are less than 24 hours left to make your tax-deductible contribution to Project Medishare this year. If you have not given, please click here to make your year-end contribution online now.

Happy New Year to all of our supporters and their family. Once again, thanks for all of your support you have all provided this year and in years to come.

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Community health program provides rural residents better access to healthcare

By Jennifer Browning

When Asefi Jean woke up this morning, she noticed her 16-month-old daughter Annkeri had a fever and an infection in her eye so she brought her to the clinic in Casse.

For Asefi to visit the clinic today, it is a 15-minute walk, but before the clinic was available for the community of Casse/LaHoye a simple visit to the doctor was an all day affair.

Asefi Jean and her daughter Annkeri wait at the Project Medishare clinic in Casse. Clinics like these help rural residents gain easier access to healthcare. Photo by Jennifer Browning.

“It used to be more difficult to take my children, or myself to see a doctor,” Asefi said. “If there was not the clinic here, I would have to rent a donkey and take my daughter to the clinic in Thomonde. I am so thankful that there is this clinic here.”

To rent a donkey, Asefi would have to pay 100 gourde, which would mean Asefi would have little to no money to buy food at the market for her family.

Most rural areas in Haiti have little to no access to healthcare, making residents susceptible to otherwise treatable diseases. Project Medishare, through the community health program in the Central Plateau, works to provide more than 100,000 people with better access to healthcare. Over 95 local staff of Haitian doctors, nurses, LPN’s, health agents, and administrative staff provide this care.

Nancy la Paix , who also brought her one-month old daughter, Chelsea, to the clinic today, agreed with Asefi.

Nancy lives in Paredom, which is a 30-minute walk for she and her daughter. When Nancy was a child, she said she remembers a family friend placing she and her mother on a motorcycle so they could go see a doctor.

“It was much further. We had to go to Las Cahobas and this would take an hour and a half ride on a motorcycle,” she said. “Then we would take a boat to cross the river to get to the clinic.”

And for those residents who aren’t as fortunate to have a clinic close by, Project Medishare conducts at least three mobile clinics to reach out to provide care to those living in hard to reach areas like Boucantis and Baille Touribe , which are situated high in the mountains. Children in the Central Plateau are more likely to receive important vaccines at rally posts and mobile pediatric clinics set up in local schools.

With a hospital in Thomonde, mobile clinics scattered throughout the countryside and designated health agents working in local communities, Project Medishare has established an integrated healthcare system.

An hour later, with the sun beating down on them, Asefi carried a sleepy Annkeri away from the clinic to begin her walk home down a bumpy dirt road. Her daughter will need to return next week if the eye drops don’t help clear up her infection.

“It would be very difficult if this clinic wasn’t here,” Asefi said. “I thank God for the doctors here.”

**Laurene Leger contributed to this story.

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Home visit in Haiti’s Central Plateau: Emory students interview locals to gain better understanding of mental health in rural Haiti

By Nayla Khoury*

Rosanna stood in the middle of a circle of benches, outside of Medishare’s compound in Casse; her hands were raised and waving. She was speaking about Jesus and to no one in particular. I asked Wilfred, our newly trained interpreter, to translate for us.

“She is talking about someone who is trying to kill her with a machete,” He told me. “She is praying to Jesus for the sick.”

I asked him to speak in the first person and to try to follow her speech, however rapid and rambling.

“She is not making any sense,” He told me. “She is fou.”

This was my first impression of Rosanna, a small and energetic 74-year-old woman whom we have begun to know over the past two weeks. In our effort to learn about mental illness in rural Haiti, “fou” or “crazy” is a term that we encountered early on.

Some people described fou as someone who does bizarre things, walks around with tattered clothes and talks to him or herself. I had seen quite a few people labeled as “fou,” who even Project Medishare nurses stayed away from, telling me that a “fou” could be dangerous. The western medical student in me wanted to translate this into a term I could understand; “fou” it seemed, referred to someone with severe mental illness, perhaps overt psychosis.

The next week, I accompanied Aimée, a public health student, on a home visit to Rosanna’s house. After the Medishare motorcycle could no longer navigate the rugged terrain, Juno, a local Haitian, led the way to Rosana’s house on foot. The walk to her house was beautiful; from this elevation, we could see the Thomonde River to our left. I saw fields surrounded by mountains to our right. Juno explained that he had worked on these fields in the past and that he knew Rosanna. He described her as a sweet old woman who likes to pray a lot. He denied that she had any mental illness.

After a 30-minute hike in the mountains of “Vingt-Cinc”, we turned right onto a skinny path that crossed a field. I could see Rosanna from afar, her body bouncing up as she walked toward us; she was carrying wooden chairs in her hands. She smiled broadly and kissed Aimée, Ken (our translator) and me on the cheek. Juno enveloped her in a hug, lifting her off the ground and swinging her tiny body. She squealed.

Rosanna introduced us to her son and grandson who lived next door, then took us on a tour of her house. We told her that her place was beautiful. She shook her head, saying, “Not when it rains.” She apologized for not having more to offer us and for the state of her small house.

Her house was certainly small; her bed was within arms’ reach of her kitchen table. Yet it was clearly a home. Outside of her house hung nicely arranged pots of purple plants.  Her belongings were neatly organized:  boxes were stored on wooden planks above her bed, every inch of her space well utilized. She showed us how she lined the walls with decorations, which consisted of many seemingly random magazine pages.

Afterwards, the four of us sat down under the mango tree next to her son’s house. Rosanna talked to us about her life. She explained that her role in the community is to pray for people. She spoke rapidly and with passion; from time to time, Ken was able to put a hand up to pause her in order to translate for us.

Rosanna explained that she first took Jesus into her life when her son was younger and had a sickness. She explained that a Loogau, a person who comes to take babies, caused her son’s sickness. Rosana discovered that she had special powers sent by Jesus that enabled her to detect the Loogau and throw away the bad spirit. She spoke of animals with wings and other stories we could not follow, even with our translator by our side.

Later conversations would reveal that a Loogau is actually commonly understood as a normal person by day that can manifest into any form at night. Our research assistants excitedly explained that one could become a Loogau by going to a Hougan or voodoo priest. It was a way to make money, one research assistant explained, since Hougan’s needed people to be sick to stay in business. Often, however, a person did not even know that he or she was a Loogau because it could be inherited. If one’s grandmother was a Loogau and you were the first to cry after her death, you might become a Loogau. Loogau’s could transform babies into animals that a parent might unknowingly eat.  Our research assistants joked and laughed while sharing these stories, but one explained that he had goosebumps while talking about such a “creepy” subject.

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Project Medishare volunteers and Bernard Mevs staff find day hectic, but productive

The pediatric ward was up and running today in spite of the hectic atmosphere created by Sunday's move from the field hospital to Bernard Mevs. Photo by Jennifer Browning.

By Jennifer Browning

Today was a monumental day of sorts as Drs. Marlon and Jerry Bitar, owners of Bernard Mevs Hospital;  Dr. Arthur Founier, co-founder of Project Medishare; and Dr. Michel Dodard, Director of the Global Institute, addressed the current Bernard Mevs staff that will be working with Project Medishare’s medical volunteers.

“Project Medishare’s first meeting was here in 1994 at Bernard Mevs,”  Dr. Fournier said. “We have now come full circle.”

Project Medishare began in 1994 and brought down, Dan Kairys, the first medical student in 1995. Kairys was a first year medical student at Dartmouth, but was working in South Florida with Dr. Fournier. Back then, Project Medishare used to work primary care at Bernard Mevs and visited orphanages in Port-au-Prince.

Eventually Project Medishare started bringing medical mission trips to Haiti’s Central Plateau, the poorest region of Haiti.

In 2003, The Green Family Foundation funded a joint project of the University of Miami Pediatrics Department and Project Medishare. Project Medishare began a donor-funded Community Health Program in the community of Thomonde in the Central Plateau of Haiti, which now provides access to health care services for over 100,000 living in the district of Thomonde, and the surrounding areas of Marmont and Casse. Today, over 100 Haitian doctors, nurses, health agents, mid wives, lab and pharmacy technicians and administrative staff have achieved amazing feats such as increased the number of pre-natal visits for pregnant women from no pre-natal visits to an average of three visits for each woman, and decreased mortality among the population from 698 deaths in the first year of the program to 483 in the third year.

Project Medishare continued efforts in Port-au-Prince through specialty surgery programs such as the Pediatric Neurosurgery Program, which focused on children with hydrocephalus, and the Plastic Surgery Program, which focuses on children with cleft-lip and cleft-palates.

It was the years of working with the people and the Ministry of Health in Haiti that allowed Project Medishare to respond so quickly to the country’s urgent needs after the January 12 earthquake. Such relationships are what has allowed Project Medishare to bring volunteers to Haiti to provide healthcare this tiny Caribbean country needed.

While there is still a long road ahead, for Dr. Fournier, there has been a small victory achieved in providing the Haitian people access to healthcare.

Patients lined up waiting to be seen at Bernard Mevs. Photo by Jennifer Browning.

“There is truth in the old Haitian proverb: Ak pasiens n’ap triomphe,”
Dr. Fournier said. “With patience we will triumph.”

And patience will continue to be an important factor, especially today as volunteers and staff work to transition into Bernard Mevs.

After the meeting with the joint medical staff, the atmosphere was chaotic. There were boxes of supplies to sort through, generators to move in and put in place, and patients to care for, and so in a way, business continued as usual.

Today, the staff was greeted with a line of people waiting to see a doctor, and surgeries continued on schedule.

“We had a large number to come in for outpatients services, we were happy to see that people could find the new hospital so that they could continue to get treated,” Alyson Cavanaugh, a physical therapist from San Diego said. “It was amazing there was a line of people, but we were able to work with the doctors to make sure everyone was seen. “

Cavanaugh said that while the transition has been a little hectic, she could see a light at the end of the tunnel.

“In patient wise, everything is getting more organized,” she said. “The units are getting set up with everything they need. It is starting to look like a real hospital.”

Funding is still needed to keep our efforts going in providing access to healthcare to the people of Haiti. Click here to make an online donation today.

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Young girl gains ability to perform everyday tasks after receiving necessary plastic surgery

By Jennifer Browning

At 9-months old, Julisa was toddling across their house with the support of small chair when she stumbled into a small pot of boiling water. She received serious burns on her right arm and left hand. Now at age 12, she experiences burn contractures on both limbs.

Project Medishare nurse Rose-merline Pierre Louis checks Julisa's arm to see how it is healing after surgery. Local staff through Project Medishare's Community Health Program are seeing that those who had plastic surgery two weeks ago have follow-up appointments. Photo by Jennifer Browning.

During a visit to a clinic, Rose-merline Pierre Louis, a Project Medishare nurse, found Julisa, who is now 12, and noticed her burn contractures, which are permanent, shortening of burn scar tissue that pulls joints out of position and results in physical impairment.

As the burns on her arm began to heal, Julisa’s right arm contracted so that she couldn’t straighten her arm. This made it difficult for Julisa to do simple tasks like eating, washing clothes, or doing other basic chores.

Rose-merlin thought that Julisa might be a good candidate for plastic surgery to correct her condition. Rose-merlin called, Project Medishare nurse liaison, Maguy Rochelin who informed her that a team of plastic surgeons were coming to Port-au-Prince as part of Project Medishare’s Plastic Surgery Program.

In mid-May, Julisa traveled to Haiti’s capital to hopefully get her burn contracture corrected so that she could one day soon begin doing simple tasks. The plastic surgery team from Miami felt Julisa was a good candidate and scheduled her for surgery.

While she is still recovering, Julisa said she could already tell the difference with her right arm.

“Before I couldn’t wash myself or feed myself because I couldn’t bend my arm and my hand was deformed,” Julisa said. “I am happy that the doctors could help me. It was painful the first week, but my arm is much better now.”

While Julisa’s arm could be corrected, not all of her fingers on her left hand were able to be relieved of the burn contracture. Julisa’s grandmother Ersile said she is a little disappointed that the hand could not be fully fixed, but she is happy to see improvement in her granddaughter’s arm.

“I am happy because I see the improvement for her arm,” Ersile said. “Before Julisa couldn’t help me cook and wash up after a meal, but now I know that if I have to go out that she can stay and help with the younger children.”

But even more important to Ersile is that Julisa will be capable of caring for herself, if necessary one day.

“Most of all, I feel better knowing that if something should happen to me, that Julisa will be able to take care of herself when she gets older,” Ersile said. “That makes me happy most of all.”

Julisa still has a long road ahead of her. For the next few weeks she still needs to follow-up at the clinic in Casse to change the bandage and check the progress of her healing.

In addition to receiving the surgery, Julisa is also a participant in the Presidential Emergency For AIDS Research (PEPFAR) Program.

As one of five organizations in the Cross Haiti Alliance, Project Medishare received a three-year PEPFAR NPI grant in December 2008. Project Medishare has been focusing activities in the very remote community of Casse/Lahoye located in the commune of Thomonde.

Program objectives are to enable indigenous NGOs to develop their capacity and capability to deliver orphans and vulnerable children (OVC) services at the community level; provide care and support services for HIV/AIDS OVC’s; prevent HIV infection among adolescent and youths; and provide access to palliative care for people living with HIV/AIDS and affected households.

Project Medishare’s local staff has agreed to live in this remote area. The community is also mobilized and participating, which has a positive impact on the community.

After Julisa was born, she never received a birth certificate. Through the PEPFAR grant, community health agents were able to assist Ersile in getting her granddaughter the proper documents.

The same grant also provides tuition so that Julisa can continue to go to school.

Julisa said that she loves attending school.

“I like geometry because I love working with shapes and tracing with the rulers,” she said, “and I love to draw. I hope that I will become better at drawing when my arm heals.”

Dorval, a community health agent standing next to her smiled.

“She is already a very good artist,” he said. “She makes beautiful drawings.

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UTHSCSA medical students finds inspriration in the resilience of the Haitian people

By Saray Stayer and Valerie Libby*

Our day began winding through the dirt roads of an unknown country as we made our way to LaHoye clinic in Casse. We drove past vibrantly painted, boarded shacks, beautiful mountains (though sadly barren of trees and birds), and corner stores consisting of little more than a crooked, wooden table full of goods. However, as we approached our destination, the barren landscape turned into vibrant energy full of Haitians carrying their goods on their beasts or their heads as they made their weekly trip to the market. Despite the lack of shoes, muddy roads, and long treks, these people seemed impervious to any obstacle.

Women on their way to market. Central Plateau, Haiti.

Our mobile clinic team began to triage patients towards one of three areas: Pediatrics, Internal Medicine, and Ob-Gyn. We learned not only of our patient’s illnesses, but also of their lives. One woman in particular had unforgettably sad eyes and came to us complaining of neck pain-a result of the weight of the water she carries on her head daily. We realized, however, her greater problem was feeling the weight of the world on her shoulders. She was a middle-aged schoolteacher for first and second graders and a mother of five children. She hadn’t been paid her salary in the past two months and she had a husband who was never home. While explaining her situation to us, tears began to well up in her eyes. As our attention turned into sympathy, she remembered her strength and proudly declared, “I can work a hoe!”

This lady exemplifies the resilience of the Haitian people. Despite all of the hardships, they utilize their resources, take pride in their energy and try to lead vibrant and fulfilling lives. We are proud to serve such an inspiring people through Project Medishare.

*Saray Stayer is a 2nd year medical student at the University of Texas Health Science Center at San Antonio. Valerie Libby is a 1st year medical student at the University of Texas Health Science Center at San Antonio and are spending this week working with Project Medishare’s Haitian medical staff during mobile clinics and home visits. This is their first trip to Haiti.

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Emory medical student realizes scary realities regarding healthcare in Haiti

By Woon Cho Kim

BATILLE, ,CASSE DISTRICT, Haiti—Three whole days of rural outreach clinics and couple of hundreds of patients later, my mind is absolutely overwhelmed with too many thoughts, reflections, and emotions. Coming to Haiti as a young medical student in training may just be one of the best decisions I have made in my academic career so far.

As soon as we set up the clinics this morning, an 80-year-old woman stumbled into the OB/Gyn clinic, moaning in pain. Sameer had spotted her from the crowd in the waiting area and quickly referred her to the clinic. She was in so much pain that she could not walk on her own. After getting her trembling body on the bed and going through the translators, we learned that she hasn’t urinated in the past three days. This is how the next hour panned out: after a quick pelvic exam, the attending diagnoses her with final stage of cervical cancer.

She only has a few days to live.

Through a translator, the attending delivers the grim news to the family members. While the family listens to the doctor, I feel a weak squeeze on my hand. The old lady, too exhausted to move, had reached out to hold my hand.

I will never know why she did that. Perhaps she needed to communicate, or maybe she wanted a human touch at the moment. I have never been so appreciative of the scorching heat—I think my sweat masked my tears pretty well.

In the end, she is sent back home with a packet of Tylenol to relieve her pain. I watch her leave the dusty compound with her family, transported on a horse.

Not that modern medicine could have cured her cancer; plan for treatment and care would have been very different for someone in her situation back home. Extreme poverty, lack of access to medical care, and inequality in health resources are all scary realities here in Haiti. And many other parts of the world, U.S. included. The amount of injustice is an unsettling feeling for me. It is even more disturbing to be reminded how easy it is to forget what it is like for the majority of the people in this world.

I am grateful for the opportunity to be here, to be part of the reality of the people. The reality that we should face as medical professionals is a grim one, but it is a noble task. My trip to Haiti is making me realize just that.

Woon Cho Kim is a first year student at Emory Medical School.

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Emory medical student finds global health demands patience and persistence

By Sameer Kapadia

CASSE, Haiti—First day of clinic and I started off in pediatric triage. It was wild. I have never felt as much anxiety taking a blood pressure reading as I did taking the first one of the day.

Let me set the scene: it was really hot, me, another med student, and about 25 Haitian children and their parents crowded around us to watch what was about to be done to them.

I’ve worked in low-resource clinics before and triage always seemed like the most simple and often, least significant part of a person’s care. This is absolutely not the case in Haiti. Triage gives us an indication of distress, malnutrition, anemia, and dehydration. These factors are incredibly important here and are signs of the most prevalent causes of illness. With that said, I have also never been this pressed for time in taking these measurements, appropriately called “vitals.”

My colleagues and I had to develop…a dance, a perfect balance between time, rhythm and specificity. Like any dance worth learning, we tripped and fell for a while until we worked out a system that worked for everyone. In this case, that meant adding another person to our two-person team. By the end of the day, by making this a trio instead of a duet, we had figured out a rhythm that would ensure that our patients got the care they deserved.

This experience showed me that above all, global health demands flexibility, patience, and persistence.

Sameer Kapadia is a first year medical student at Emory Medical School. This is his first trip to Haiti with Project Medishare. Emory Medical School takes a yearly medical trip to Haiti every November.

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