Archive for the ‘Emory Medishare’ Category

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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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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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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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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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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By Jennifer Browning

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.

One of these ways is through providing safe drinking water. Currently, Rick Spurlock and Emory Medishare are still working toward the Safe Water Project. Construction on a sodium hypochlorite production building is underway in Marmont. The facility is located next door to the new Maternal Health Center.

Training for the project workers will begin in the next few months with the help of Deep Springs International coordinating these efforts between Thomonde/Marmont and Jolivert.

Project Medishare and Emory University 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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By Katie Lee

HICAGNE, Haiti—While I haven’t spent Thanksgiving at home in quite a few years, this was the first that I’ve spent in a country that doesn’t celebrate Thanksgiving! Today was the last day of clinic, and it was a perfect end to the week: I got to follow a patient from triage to transfer. She was a 17-year-old girl with a tiny lethargic five-month-old baby. The baby’s lethargy scared me.

If there’s one thing that’s been reinforced this week, it’s that screaming babies are a good thing-it means they have enough health to realize when they’re not feeling well. This baby was listless, merely staring at us through eyes covered in a white film as we took her blood pressure, temperature, and pulse. Her mother’s chief complaint was that her daughter was vomiting so much that she couldn’t eat anything, and she was losing a lot of weight. When we asked her if she breast fed, she said a doctor said she couldn’t because it hurt her too much. Physical exam revealed lethargy, no tears when crying (a sign of severe dehydration), and a couple of rashes on her cheeks and buttocks. The doctor working with us discovered that the mother was HIV positive. This could have been the reason the doctor told her not to breastfeed, since the HIV virus can be transmitted through breast milk. The mother was a restavek, an orphan who relied on strangers to take her in, and it would have taken her eight hours to walk to the nearest hospital. We decided to take her to Cange at the end of the day.

The hospital in the town of Cange was started by Paul Farmer, an American most famous for the book Mountains Beyond Mountains about the creation of Zanmi Lasanti (Partners in Health). This organization strives to improve overall health conditions in Haiti through acute hospital care, community health care workers who directly observe therapy at the home, and preventative services. After spending the past five days in Haiti, walking into the Zanmi Lasante compound was like walking into Disneyland. Everything was clean, concrete, and huge. Inside the infant unit, the walls were painted white, there were hand sanitizer pumps at every bedside, and in the corner I even saw a television.

We presented our case to the doctor working the unit, who agreed to admit both mother and child. We had to leave after she was admitted, and I’ll never know what happened to that mother and that baby. Zanmi Lasante is known for their social support network, and hopefully they can provide some assistance to a girl who literally has no one. All I know is that although this one case obviously did not change the dire state of health in Haiti– or maybe even changed the course of this woman’s life, we were able to help her as much as we can for as long as we saw her. That individual attention to care is why I’m a part of Project Medishare, and eventually part of the international health community.

Katie Lee is a first year at Emory Medical School. This is her first trip to Haiti with Project Medishare.

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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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By Constance Harrell

HINCHE, Haiti—Meeting the Hinche commune’s minister of health was both inspiring and revealing of how much of the international medical work connects with the local health workers. Kathleen, Jen, and Matt, three Gyn/Oncology doctors from MD Anderson who have been running our OB/Gyn clinics on this trip, are starting a new trip in conjunction with Project Medishare to focus on obstetric and gynecologic surgical and clinical needs. It’s been tricky setting up the trip to figure out what the community needs, and what is currently available so that we can best work within the local health system and expand their potential from within as much as possible. Costs are a big factor too; if we bring our own anesthesia machine, CONE or LEAPS machines, and nursing assistants, we need start preparing yesterday.

The Health Minister, Dr. Raphael, ushered us into his sparse but nonetheless clean and air-conditioned office to discuss why we came. A posh fellow in a suit, drastically different from the often half-clothed patients we see just 30 km away, Dr. Raphael spoke to us in perfect French and Spanish, which was eloquently translated by Project Medishare’s Program Coordinator Gaby into English to ensure we could all understand. Our conversation, which was a repeat of conversations held yesterday with other Hinch VIPs, confirmed that we would be welcome to work in their hospital for a week this spring.

But to put together a surgical trip, we can’t just know we’re welcome – we need to know every detail in advance to ensure that when we come, we do good, not harm. How many patients with cervical or breast cancer do they see, who treats them and where, what screening is done, what instruments and machines are used, what are the conditions in the operating room? To figure out these details, we met with the hospital’s medical director, Dr. Prince. We found him in the hospital seeing patients in clean but crowded and poorly lit rooms ventilated only by fans and windows. He gave us a better sense of what is needed and what is available, but still more needs to be learned.

I write this post in order to raise awareness about how hard it is to pull this kind of trip off. One week takes hundreds of emails and telephone calls, and months of hard work in addition to the thousands of dollars to treat the patients we see who are so desperately in need of care, and expanded access to care.

Constance “Bene” Harrell is a first-year medical student at Emory. This is her first trip to Haiti.

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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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