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Archive for August, 2009

During a prenatal exam in Savanne Perdu, Dr. Tisha Titus and a Morehouse Medical student uses a portable doppler to allow their patient to hear her baby's heartbeat. Photo by Jennifer Browning.

During a prenatal exam in Savanne Perdu, Dr. Tisha Titus and a Morehouse Medical student uses a portable fetal doppler to allow their patient to hear her baby's heartbeat. Photo by Jennifer Browning.

By Tisha Titus, MD, MPH

After several hours of rapid fire pregnant women in search of their first, and potentially only, prenatal visit, there is one patient for this day that stands out in my mind. I will wonder what has happened to her for months and maybe even years after returning home. I would like to say that this remembrance is due to the stellar care that I was able to provide to her and her baby or my great clinical skills that caught the often missed rare diagnosis, but this is not the case. She stands out in my mind for what I was not able to do for her.

She was in her early twenties and had come in the first trimester of her first pregnancy with the usual complaints of fatigue and lower abdominal pain. As it is not uncommon for dates to be off by several months, I began to feel her belly and watched as she winced when I pressed near her pelvis. Through the interpreter I asked her to tell me about the pain – where was it, how bad was it, did it hurt all of the time? She pointed to her left side and I apologized as I began to feel that area to sort out what I was dealing with. A mass that caused considerable discomfort. With her positive pregnancy test, my options quickly all converged to an ectopic pregnancy.

I know what to for an ectopic, but I had no idea how to get it accomplished in the environment of a bush clinic with nearly no resources an absolutely no capability for urgent surgery. After some quick discussion we found the referral form to send her to the nearest hospital and a second local interpreter to discuss this with her. She had come to the clinic with other family and her children were at home being tended to, but before she was willing to go to the hospital, she needed to find her sister and the children that had come with them and then head home to make arrangements to have all of the children watched. Transportation was another issue – she was going to walk home and then to get back to a main road to try to find a ride to the hospital.

The urgency of the situation was explained several times by the interpreter, but she held firm that her family needed to be tended to first and her looming medical crisis would have to wait. I had no other option but to hand her the hospital referral slip and beg to her to go as soon as possible knowing very well that she may not go at all, or may rupture and die on the way.

This was the only ectopic pregnancy, but definitely not the only concerning encounter regarding prenatal care. Many of the women were having their first prenatal visit well into their third trimester and a fair number of them also had a sexually transmitted infection or urinary tract infection requiring treatment. Many of them were planning on have a midwife assisted home birth, but in a number of instances this was not appropriate because of the high risk for complications due to fetal presentation or previous c-section.
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By Jennifer Browning

Tropical storm Ana grazed by the tiny Caribbean country and Bill missed it completely. For now, Haiti can take a deep breath as it continues to take a deep breath during the 2009 hurricane season.

About this time last year, hurricanes Faye, Gustav and Hanna ravaged many of the areas Project Medishare serves in Haiti’s Central Plateau. Project Medishare and its staff were personally affected by the storms. Many schools and homes were damaged from fierce winds and many, including several Project Medishare Haitian employees lost their homes.

For now, Haiti waits in hopes to ride out the hurricane season which last year brough devastation, destruction and along with it many health complications including disease and malnutrition. The storms caused water sources to become more polluted and with much of the land deforested, many local crops were destroyed.

Project Medishare is standing by the communities of Thomonde, Marmont, and Casse in hopes that this season leads Haiti to some sort of safe passage in avoiding such devastation experienced last year.

For now, Marie Chery, Project Medishare’s Country Director says Ana and Bill have only brought rain to nearby Port-au-Prince leaving Thomonde with sunny skies.

This week the Associated Press wrote about the challenges Haiti faces this season and how the scars of last year still remain. Read the full story here.

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By Jennifer Browning

Rumors that Paul Farmer was under consideration for the position of USAID Director have been put to rest. Last week, Paul farmer was appointed Deputy U.N. Special Envoy to Haiti. Former President and U.N. Special Envoy to Haiti, Bill Clinton said Farmer’s “credibility both among the people of Haiti and in the international community will be a tremendous asset” to their work in Haiti. This position will allow Farmer to once again work full time on Haiti.
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By Jennifer Browning

Haiti is no stranger to Kenneth H. Merten, the new U.S ambassador to Haiti. Merten worked in the small Caribbean country twice before taking over the diplomatic mission.

For his first tour in Haiti Merten worked as  the economic section chief. After working as an economic officer for the U.S. embassy in Bonn, Germany, Merten returned to Haiti to serve as vice consul in Port-au-Prince.

His Washington assignments include two tours in the State Department Operations Center and service in the Bureau of Economic and Business Affairs and on the Cuba Desk, as well as a year as Special Assistant to the Special Advisors on Haiti.

Click here to read more about the new U.S. ambassador to Haiti.

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By Jennifer Browning

In an effort to strengthen Haiti’s agriculture and support its sustainable development the World Bank Country Director for the Caribbean and the Haitian Ambassador to the U.S. have signed a $5 million grant.

World Bank Country Director for the Caribbean Yvonne Tsikata said with the grant the World Bank hopes to support the Ministry of Agriculture by catalyzing the use of public sector and donor funds for agriculture in Haiti.

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Local farmers in Thomonde, Haiti work in a Project Medishare trial field. This is the second trial field in the area. The first field agronomists are testing corn, soy beans, peppers, and a variety of grains. This field includes mango trees and peanuts. Project Medishare hires local farmers to help plant and manage the trial fields. The fields are overseen by Haitian agronomists Ronal Bien-aimé and University of Florida’s Florence Sergile. Photo by Jennifer Browning.

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