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Archive for January, 2008

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By Julie Megler

Thomonde, HAITI–Tonight officially marks the closure of our trip. Tomorrow will be our last day in the field. Today brought yet another highlight for all of us. A little more than a year ago, Zami Lasante (Partner’s in Health), opened an umbrella hospital in Thomonde. The hospital was miraculous; it was the first well constructed building other than the Project Medishare home we’ve seen since Port-au-Prince. The hospital had seventeen beds, several rooms for consultation, a maternity unit, and a small room for emergency care.

Dr. Mario, a young Haitian man educated in Port-au-Prince, took us under his wing for the day. The majority of the patients appeared to be pregnant women, either in for their prenatal visits or to deliver. For most of us we spent our day massaging bellies checking for the babies’ presentation, measuring uterine height, and listening for fetal heart rates. The hospital scene in rural Haiti is a tad different than the typical experience in Jackson Memorial, to say the least. Maternity women were standing over buckets as their membranes ruptured, IV fluids were administered by drip factor rather than pump, and the whole family unit took on the nursing role. A breeze of warm air rang through the rooms and hallways, adding harmony to the occasional hum of a prayer being sung for the men and women residing in the hospital for the day.

It was fascinating to see that a hospital could be fully functional without all the technology we rely on to achieve the simplest tasks in an American hospital. This held true especially for the climactic moment of our day. Earlier there was a young woman we had seen dilated at four centimeters. Shortly after lunch, a beautiful little baby’s head was cresting. For many of us, it wasn’t until we traveled to Haiti that we got to see a completely natural vaginal delivery.cimg2530.jpg

Valerie was ready for the part, as soon as Julie shouted out that the woman was about to deliver, she was there to help and comfort. Valerie grasped the baby from the doctor’s hand in a towel, elegantly cleaning the new girl. As soon as the baby rested safely in Sarah’s hands Valerie returned to the woman, massaging her fundus and delivered the placenta as if she had done it before in the past. The midwife sewed the new mother’s episiotomy, as we tended to her comfort. The grandmother appeared shortly after the baby’s first cries holding up two outfits, one pink and the other blue. We pointed to the pink one, and dressed the child in her first dress. As the mother relaxed, Valerie asked her what she would name the child, she responded saying that she did not yet have a name but wanted us to name her. Valerie excitedly shouted over, “what are your favorite names? We get to name the child!” Sarah said, “Eva” and Valerie, “Isadora.” Moments later the mother moved to a bed, resting with Isadora Eva by her side.

The end of the day brought closure, as we observed the crude nature of the life cycle. In the same room we had shared the joy of birth, we were presented with an elderly woman who had just suffered a stroke. After days of seeing ailments foreign to the U.S., such as GI parasites, AIDS and TB, we were hit with what we had previously thought of as a disease of a developed nation. The woman laid their, pupils unreactive, the left side of her body paralyzed. Her blood pressure had been 240/160. She had lost consciousness as she was riding a motorbike, leaving her feet bloody as they had dragged on the road.

It made us all sad inside, but it made us reflect on life. Her daughters, husband, and neighbors were there. Something also foreign to us back in the U.S., we love our families but we all live separate lives from them. Here in Haiti, families are intertwined, they find strength together, and here in Haiti we discovered the beauty in that power.

*Photos by Gabrielle Denis. 

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By Julie Megler

Thomonde, Haiti–The seventh evening of our adventure and we’re indulging in our nightly ritual of counting pills as we listen to music off of Gaby’s Ipod. There are thousands of them by the bottle. The whole process is meditatively monotonous, and we spend about twocimg2514.jpg hours each evening preparing medications and separating them into individual baggies for the next day’s set of patients.

Today we separated ourselves into the same groups we were in yesterday, but flipped jobs. Those of us who performed house visits spent the day at one of the local schools and vice versa. The school visited today was full of about 50 or so first through fifth graders dressed in yellow and white-checkered shirts and khaki jumpers or shorts. We systematically went into each classroom recording each child’s weight and height. Being that we weren’t suspending the children in harnesses floating off of the ground, they were much more cooperative than cimg2499.jpgour last group at the rally post as we placed them on the electric scale. After visiting each classroom we then stationed ourselves in the main room of the school. Half of the room was used to administer medications, the other to assess the students with Dr. Pentro.

Dr. Pentro has been a beautiful mysterious presence in our lives for the last week. He stands about six feet tall with a Santa Claus-like belly, a clean-shaven face, and a white closely cut head of hair with a defined widow’s peak. He spends his evenings pacing the front courtyard with Marie Chery as they discuss issues that we fantasize have tremendous wisdom. Today we had the opportunity to work with him closely. As he called a child’s name out they would first visit one of us students. We would assess their bodies in the typical head to toe fashion. Specifically we looked at their skin, their scalp, felt their lymph nodes, checked their eyelids and conjunctiva for signs of anemia, palpated their stomachs for signs of parasites, and then checked their teeth for rotting. After our initial assessment we’d pass the child on to Dr. Petro who looked specifically at what we had found, listen to their heart, write down a list of medications on a scrap piece of paper, and then pass them on to the makeshift pharmacy side of the room. Each child was given vitamin A, an iron supplement, medication for worms, and anything needed for infections.
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Working with Dr. Petro allowed us find understanding in an observation we had all made early on in our trip. The children we have been seeing in Thomonde, as angelically beautiful as they all are, lacked something we were all used to seeing amongst youth, a smile. It felt as though it took a tremendous amount of coaxing, teasing, and playfulness before you could get a child to exchange a smile with you. The school children were much healthier than many of the children we had been seeing, but as we ran through our assessments almost every child had one ailment or another. They ranged from skin infections such as scabies to distended bellies, from malnourishment or parasites to teeth that were rotting down into the gums, and infected tonsils. The hardship of life seemed to meet them at an unimaginably young age. In between assessing the students we would play games with the school children in the neighboring classroom. Thin overlaying planks separated the classrooms, and those in the neighboring class were always fascinated by the “blans” (the white people) they could peer at through the cracks. As we waited we’d play a quick game by sticking our fingers through the holes and quickly pull back until one lucky student was able to grab it bringing a roar of laughter. Finally we had seen our last little patient, school was dismissed, and we loaded our supplies to head back to Project Medishare.

*Photos by Gabrielle Denis

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By Julie Megler

Central Plateau, HAITI–Today we split into two groups, half of us continued with another round of house visits and half visited one of the local schools.  The house visits began with another rally post.  We stood in thatched roofed structure with five or six rows of benches facing a 10 by 15 foot stage.  Today’s rally post focused on education.

Before Gaby began translating from English to Creole, the group sang an old song and then led a prayer.  We then taught the mothers and children about breastfeeding and treating dehydration.  Following the rally post we began our walk along the dirt road stopping at houses along the way.  The community leader we traveled with had already been through this village recently, so today’s visits were focused on revisiting the households he knew had ill members.

One house that stuck out in particular was set up on top of a hillside overlooking the nearby mountain range and river valley.  We were dumbfounded that so much hunger and struggle could occur in such a serene location.  A young boy obviously with some form of congenital deformity, was having difficulty gaining weight.  His nostrils were flaring as he struggled for breaths, his legs nothing but skin and bone with his belly protruding.

We paid our respects to an 82-year-old man laying in bed, staring off in the distance as he took what would be his remaining breaths. His grandsons were finishing the construction of the family tomb in the front yard.  Somehow it was settling to see the whole family surrounding the man, embracing his life cycle, something so unfamiliar to the way we handle death back in the U.S.

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By Julie Megler

Marmont, HAITI–Once again we found ourselves being tossed around like a bunch of hot potatoes in the back of the Medishare truck. We were accompanying Anna and Theresa, Medishare’s Cuban doctor and nurse, to the clinic in Marmont. We arrived to an overflowing crowd of men, women, and children dressed with the same elegance as they had for church. Many of them had already been waiting for a few hours, some walked up to three hours just to get to the clinic and spend the day waiting. We unloaded from the truck and smiled as we shuffled past a crowd of welcoming, but already exhausted faces, through the door of the clinic. It was a small structure with green painted walls, one large waiting room, three examining rooms and a small back room that served as the pharmacy.

With about a hundred people waiting, we organized ourselves quickly and split into groups assisting Anna and Theresa in consultations, counting pills and mixing solutions in the pharmacy, and doing primary assessments in the hallway, which served as the triage unit.

The first patient seen was a young woman suffering from ascites. She had already been to the hospital for paracentisis, but the cause of her problem still hadn’t been determined. She was in need of an ultrasound for proper diagnosis, but could not afford the trip, nor did she have any remaining family unit to get her to Port-Au-Prince.

A young healthy woman carrying her petite child sat waiting to be assisted. Her baby girl showed obvious signs of malnourishment; she was underweight, small for her age, and struggled to keep her head up. In addition to her weakness her lips and the inside of her mouth were covered in ulcers, likely indicating HIV. The baby was treated for malnutrition, and the mother was advised to return to the clinic for HIV test for both her and the baby.

While sitting in the pharmacy, monotonously counting and organizing pills of all colors, shapes and sizes, the occasional visitor would pop their head up to the barred window. They’d hand over their prescription slips, a torn in half sheet of white paper with a Project Medishare seal stamped on the front, to the pharmacist. The middle aged Haitian woman would briefly halt her current task to gather the medications that were scribbled on the slip, and hand them over to the patients in need.

Exhausted by the day, we gathered our belongings as clouds started to crowd the sky. A calming storm opened up on the ride home as we added a handful of skids in addition to the usual jolting bumps to the now muddy roads.

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University of Miami Nursing student Julie Megler vaccinates a child at an immunization rally post in Circa, Haiti. Photo by Gabrielle Denis.

By Julie Megler

Circa, HAITI–Today we got a chance to see what community health really means first hand. We traveled to a “Rally Post” in the village of Circa. A rally post focuses on the immunization and malnutrition of children under five years of age, as well as pregnant and lactating women.

At the rally post we participated by assisting in weighing children, and administering shots and vitamins. We lined up and manned our positions while a Haitian community leader read names off of each Childs’ health cards. The kids were first tossed into a harness and hung from a hook dangling several feet off of the ground to be weighted on a scale that resembled those of the produce department of the local Publix grocery story. After a few moments of fussing and howling a child would calm down to a point where an appropriate weight could be recorded. Once removed from the harness they were reunited in their mother’s arms at which point one of us would squeeze their cheeks together and squirt fowl tasting Vitamin A into their mouths while two other UM nursing students would restrain and stick the child with deTab, MMR, verisila into their chubby deltoid muscles.

In between the rush of caring for the children who’s names were presently being called, we took the time to admire and stare into the crowd that surrounded us. Word of the rally post had only started to travel two days before, and that was enough time for a whole community of women to collect their children and wait for us starting at 6:30 a.m. We didn’t arrive until 11 am. We admired how older siblings as young as eight, handled younger siblings with the care and grace of an experienced mother. In our observations we saw the differences between the American family unit and that of a Haitian family. These Haitian children had wisdom years ahead of their age that they gained from sharing family responsibility at a young age. As more names were called, the line grew shorter till no one was left in the enclosed yard where we had treated several dozen women and their children only moments before. We gathered our belongings, and started walking back up the dirt road to meet the Medishare truck and returned back to our home base.

After a light lunch of PB&Js and Ham and cheese sandwiches we went through a walk through the streets of Thomonde. In the evening after dinner Marie sat down with us and described the ropes of community health. We all sat attentively with our minds churning with questions, as Marie explained the importance of community involvement, microfinance, and collaboration with other organizations in order to affectively improve the health status of a community in a way that is sustainable allowing these villages to remain independent.

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By Julie Megler

After a grueling three hours of waiting for a new part to fix a mechanical problem in our American Airlines flight from Ft. Lauderdale to Port Au Prince, and a short hour and twenty minute flight we found ourselves eagerly holding our passports in Haiti’s customs line. Once through customs it was a free for all with hundreds of people bussling about asking to carry our baggage or if we needed a taxi. Marie Chery’s familiar face popped up and led us to the white 4×4 Toyota that would be transporting us to Thomonde.

Driving from the airport I was met with the familiarity of poverty. It’s amazing how across cultures it has the same appearance and smell as it does on the other side of the world. As we pulled out of the airport parking lot there was a run down UN truck putting behind us before it was engulfed by a crowd. The drive from Port Au Prince to Thomonde was a rugged three hours through the mountains of the central plateau. Our drive began around sunset leaving most of the country side in a mystery as we drove through the darkness. Lots of bouncing around with fast accelerations, and sudden dramatic stops in attempt to slowly roll over immense pot holes. I’m always fascinated to see that in countries like Haiti, cars have the right of way over pedestrians. A mere tap of the horn to tell someone to get out of the way because they aren’t slowing down. We passed through Cange, where Dr. Paul Farmer started the Partner’s in Health clinic.

Once in Thomonde we were welcomed by Project Medishare staff with an amazing meal of fried plantain, rice and bean, chicken, pasta (macaroni au gratin), and cabbage waiting. The accommodations are simple, but clean and comfortable. We were pleasantly surprised to see that power was generated through the night, although the rest of town was still powerless. I giggled as I prepared myself for my first night of sleep, and looked over to find my friend Ms. Preying Mantis watching me as I brushed my teeth. My sleep was immaculate until about 4:30 a.m. Awaken by startling cries of a goat outside my window I found myself lying on a deflated mattress on the cold tile floor.

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 As part of the University of Miami nursing program, the university’s nursing students travel outside the United States for field work. This week they are traveling to Thomonde, Haiti to work with Project Medishare’s in country staff, doctors, nurses and health agents.

During their time in Haiti’s central plateau they will participate in all aspects of the community health program and school health activities. This includes doing home visits, working in the clinics and participating in the school health immunization program.

Project Medishare’s Program Coordinator Gabrielle Denis and the UM nursing students will be sharing their images and stories from the field between now and January 11.


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