Volunteer returns to find progress in Haiti’s Central Plateau

By Dr. Tisha Titus*

We arrived in Haiti six months to the day after the 2010 earthquake, not quite knowing what to expect the conditions in Port-au-Prince to be. Would we be safe in transit? Would the roads taking us out of the city be blocked or damaged? Were the conditions really what had been shown on the news?

Flights into the country were difficult for us, in part due to a massive influx of relief workers and other organizations, but also in part from damage to part of the airport that was in the process of being repaired.
As we walked the several blocks to the temporary parking, the lines for outbound flights were out the door and down the street. As we winded through the city, there were some small areas of damage, but massive piles of rubble were notably absent. As we continued, most of what I saw seemed striking similar to what I had seen before the earthquake – in progress construction, demolition, renovation and the occasional unfinished project. Then came the tent cities.

As we neared the outskirts of the city, the sea of white tents came into view. Definitely suboptimal living conditions, but tolerable given the circumstances and lack of other options. As we passed through, there were UN guards at the entrance to one area with a line of port-a-potties seen in the background. A few scattered faces walked through the maze of tents, mostly women and children tending to daily chores that provide some semblance of normalcy as they work to rebuild their lives. In the few seconds it took to pass the tent city, we could all see the aftermath of the quake – not so much rubble, but shattered lives of the many who had lost nearly everything.

As we talked about what we saw and made comparisons from past trips, we all settled into our seats, gearing up for the ride to the Central Plateau. Those of us, who had come previously, already knew the road “experience.” We had told the new folks in great detail about the bumpy roller coaster ride up and over the mountain. Fast moving trucks close the edge of the cliff, abrupt darting to miss potholes the size of small cars, and intermittent games of highway chicken – all part and parcel for the ride once the pavement ends.

We continued to brief the new folks on what to expect during the daily clinics and then I noticed something. I recalled that last year a short section of the road had been paved, complete with drainage and cliff barriers, but I did not recall any intersections on that stretch of road, and we had just driven through one. I started to pay better attention to the construction and also noticed what appeared to be concrete power poles lining the road. There were also diversion culverts being put in to prevent the usual road wash-out during the rainy season.

I was amazed. The drive that took us over four hours last year was only about two and a half hours this year, with an overwhelming majority of the road paved, tarred or graded and a least two or more lanes wide. There were trucks, backhoes, packers and graders for the actual road construction, but the intricate details of the roadside drains and much of the culvert work appeared to be done without the benefit of machinery. The newly transformed road and soon-to-be power poles took us right into Thomonde, where there were piles of pavers waiting to be put down for the roads there. We started each clinic trip on solid pavement, which significantly reduced our travel time…except for the day our lead truck settled into foot-deep mud. It was also our safety when the rains shut down our clinic early and we scurried like mad to get in the trucks and get out – the pavement let us know that we were on solid ground and would make it back to Thomonde without the risk of getting stuck.

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Emory surgical team saves a hand, saves a life

By Jennifer Browning

At 13, Amos spends his summer vacation working to help support his family. At sunrise, he goes down to the river, collects the sand on the bottom, places it in large buckets and then carries it to a central location.

Amos and his mother Ann. Amos is recovering well from his first surgery. Today, surgeons will perform a skin graft. Photo by Jennifer Browning.

Over a week ago, Amos fell and punctured his hand while at work. Not wanting to worry his family, he told no one about his injury. Within a week, Ann, his mother, began to notice Amos wasn’t sleeping.

That’s when Amos showed her his hand, which was swollen and showed signs of infection. Ann brought her son to the government hospital in Hinche last week where doctors prescribed antibiotics and tried to clean the wound. They recommended that Amos return to see the doctors arriving from Emory.

When the doctors from Emory met Amos, his hand was enormously swollen and he was complaining not only of pain in his right hand, but all the way up to his shoulder. His forearm was already showing signs of swelling. The surgeons determined that Amos was suffering from necrotizing fasciitis.

“He is the bread winner in his family, he fell and probably had wood penetrate the wound, those are dirty wounds in general, and they are set up for rapid bacterial overgrowth,” Dr. Jahnavi Srinivasan, a visiting surgeon from Emory said. “So when he got here he was actually septic, he had a very high fever, he couldn’t move his fingers at all. If this had gone on too long there wouldn’t have been a chance of his hand coming back.”

The infection was so bad that there was a possibility Amos could lose his hand or had the infection worsened, his life.

The surgical team comprised of Dr. Srinivasan and Dr. Viraj Master decided to perform surgery to relieve pressure from the wound.

“He had global body wide infection and non-use of his hand,” Dr. Master said.

Ann said she is thankful for what the doctors could do here.

“The Lord has given me grace to help my son. I prayed for something to come, and the Lord sent me these doctors to help my son,” she said. “I am very happy. After thanking God, I thank the doctors for coming here. The doctors are very nice and professional.”

Three days after the surgery, the surgical team says that Amos’s wound is overall healing well, but there are still concerns for the young boy.

“The concern is that it is going to form a bunch of scar tissue, and as the scar tissue forms, the skin is not going to be as elastic as regular skin,” Ira Leeds, a third-year Emory medical student said.

Leeds explained that this elasticity problem would prevent Amos from being able to open and close his hand properly. In order for him to regain full use of the hand, he will require a skin graft and long-term physical therapy.

Dr. Srinivasan and Dr. Master plan to do a skin graft on his hand today, because they are not sure when he will have the opportunity to see a plastic surgeon. And if the wound care isn’t done properly, the hand could become infected again.

“He would have died if we hadn’t debrided this and if it gets infected again he could die,” Dr. Srinivasan said. “Normally when you have a wound like this you wait seven to 10 days just to make sure the superficial bacterial counts from the fresh tissue has gone down because it gives you a better chance of the skin graft taking and healing.”

The surgeons are hoping the skin graft will take. Project Medishare’s nurse liaison, Maguy Rochelin, is staying in touch with the patient so if Amos needs another skin graft she can possibly schedule Amos to see the next plastic surgery team arriving to work at Bernard Mevs/Project Medishare hospital in Port-au-Prince.

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Emory medical students study mental health in Haiti’s Central Plateau

By Jennifer Browning

Students from Emory University have been working with Project Medishare staff in Haiti’s Central Plateau this summer trying to understand how mental health is understood in rural Haiti. The students hope that this is the first of many trips to work toward improving psychosocial services in the Central Plateau.

“This summer is the first of hopefully many steps,” Bonnie Fullard said. “Right now we are trying to lay the groundwork for some type of psychosocial support through Project Medishare. We are trying to understand the needs the way mental health is understood and discussed in rural Haiti and the resources that are already in place.”

Fullard who is a second year Masters in Public Health (MPH) student also working toward her doctorate in anthropology is spearheading the focus group discussions on the project while working training the research assistants.

“We are working at mapping these current local resources available, but at the same time we are using resources used in the U.S. and sort of adapting them here,” Fullard said.

Hunter Keys, a first year nursing student at Emory, said one of the major challenges the research group faces is the language. While the group has been taking Creole lessons at the university to prepare them for this project, there is still an issue about how the language translates in regards to mental health.

“I think one of the challenges is getting a sense of the language and an understanding of the language barriers,” Keys said. “We are really trying to get an understanding of the local language and how mental health is expressed here.”

To assist them with this, the research group found four English/French translators who also are serving as research assistants to help them understand the true understanding of mental health in the rural area.

“One of the examples is the concept of emotions, for instance, a word that we use to describe as emotions for example is the French word, sentiment, is feelings,” Keys said, “but we have been told that in Creole sentiment is reserved for amorous relationships, so sitting around in a group talking about sentiment might conjure up the wrong images. “

Keys said that even the Creole word for mental health doesn’t necessarily translate.

“Even the translation for mental health in Creole, santé mentale doesn’t necessarily translate among rural Haitians. Maladie mentale –a mental illness is immediately thought of as being on the extreme end of mental illness and we are trying to take a more global approach to a more encompassing view of mental illness.”

Fullard agreed with Hunter in that in rural Haiti there is not an actual term for mental health.

“In that sense it is something that is not really talked about,” Fullard said. “When it is talked about it is a really stigmatized topic where people here immediately describe it as “fou” or “crazy” so that it is hard to talk about the things we want to get to, which are the more mild to moderate disorders such as depression, anxiety, and post-traumatic stress disorder(PTSD).”

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Safe Water Project seeing progress in Marmont

By Jennifer Browning

Emory Medishare’s Dr. Rick Spurlock recently visited Marmont to check on the Safe Water Project’s sodium hypochlorite production building. Construction is progressing as planned. Dr. Spurlock is hoping to start implementation in the next few months.

Project Medishare's sodium hypochlorite production facility construction is progressing. Photo by Rick Spurlock.

Implementation of the project will include purchasing equipment and supplies for the sodium hypochlorite production facility, as well as hiring and training  local personnel regarding how to make the solution and how to distribute it throughout the communities.

As a part of the Community Health and Development Program, Project Medishare is not only continuing to provide healthcare in Haiti’s Central Plateau, but also develop a sustainable community that will be able to thrive in the future.

Project Medishare and Emory School of Medicine hope to have the program up and running by this summer, however the program still needs financial support and funding. Emory Medishare still needs to raise $20,000 to make this project a reality for the people of Thomonde, Marmont, and Jolivert.

The water project is in line with the Millennium Development Goals (MDGs) set in 2000, which specify eight objectives, including improving health, promoting gender equality, reducing poverty, ensuring environmental sustainability, and enhancing access to education, to be achieved by 2015. Goal 7, “Ensure environmental sustainability” focuses attention on reducing “by half the proportion of people without sustainable access to safe drinking water and basic sanitation.”

Click here to make a donation to Emory Medishare’s Safe Water Project and join in the goal of providing safe drinking water for all in Haiti’s Central Plateau.

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