Archive for the ‘medical trips’ Category

By Gina Epifano, PT

There’s something about Haiti that gets into your heart and just won’t go away. It’s impossible to meet the people and not leave a piece of your heart behind. The only solution I have found is to keep going back!

I’ve volunteered as a physical therapist at Project Medishare three times since the earthquake, and am inspired by the transformation of the physical therapy department in one year.

Gina Epifano with Nadine who was recovering from skin graft surgery and walking for the first time!

In April of 2010, I had my first experience at Project Medishare’s Field Hospital as a PT. I spent my week in pediatrics, helping children learn to move and walk again.
Working at the tent hospital was a special experience…so many clinicians working together to save lives, doing whatever it took to get the job done. I knew I’d be back.

In June of 2010, I returned to Project Medishare, which had recently moved to new location and partnership with Hospital Bernard Mevs. The Rehabilitation Department at Hospital Project Medishare Bernard Mevs now consisted of two long-term American physical therapists. Jason Miller was beginning to develop an amputee program while Alyson Cavanaugh was creating a specialty rehabilitation program for spinal cord injury patients. They were also starting to train local Haitian rehabilitation technicians to assist in care provision. So much progress in two short months!

When returned to Hospital Bernard Mevs Project Medishare this month, I was immediately aware of how far the Rehabilitation Department had come. I was whisked into an amputee running clinic that was being held as part of the grand unveiling of Project Medishare’s state-of-the-art Prosthetics Lab, built in partnership with Ossür and Knights of Columbus.

In September, Knights of Columbus began partnering with Project Medishare to provide every amputee children with a prosthetic limb and the physical therapy necessary to learn how to use the new limb. In addition, Jason has begun his own fundraising efforts through his website http://www.helpinghaitiamputees.com. Through the site Jason created, individuals can sponsor adult amputee patients to receive prostheses as well.

Rehabilitation department at Hospital Bernard Mevs Project Medishare. Photo courtesy of Gina Epifano.

Jeff Mcnutt, PT, has joined the long-term rehab team and manages the wound care program for both in-patients and out-patients. He continues to train local Haitian staff in appropriate wound care techniques. Locally trained technicians are now providing daily care in both out-patient PT and the Spinal Cord Injury Unit.

Project Medishare’s Rehabilitation Department has come a long way in a year, but there is still work to be done. Volunteers are still needed; supplies are still needed. Consider sharing your time and skills with our neighbors in Haiti. Maybe I’ll see you there…

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By Jennifer Browning

This week Dr. Adam Goldstein and his medical team from Jewish Healthcare International are working with Project Medishare’s community health team in Haiti’s Central Plateau.

A mobile clinic in very rural Boucantis, Haiti. Jewish Healthcare International is working with Project Medishare's local medical staff this week. Photo courtesy of Dr. Adam Goldstein.

Yesterday, the team worked with Project Medishare’s local medical staff at a mobile clinic in Boucantis where they

drove almost two hours over mountains and canyons to meet the 200 patients that awaited them. On his blog Your Health, Dr. Goldstein talks about his team working with the Haitian medical staff to treat those at the clinic set up in an open air one-room church.

Inside the church, at least 150 people are lined up on three walls to see providers: a wall for pregnant and breastfeeding women, a wall for the dozens of children, and a wall for adult males and females. Dividing up quickly and taking our cue from the one Haitian nurse practitioner and intern on-site for the day, we dive right in, with interpreters, and a mobile pharmacy with a fairly effective though limited formulary. Several thousand dollars of samples we brought do prove helpful in some cases. Severe hypertension, severe arthritis, reflux and ulcers, iron deficiency, worms, urinary tract infection, eye infections, hernia, headaches, rashes and contusions, from those who had traveled 1-2 hours on foot to the church. Two cases of goiter and hyperthyroidism, one almost certain congenital heart disease in a 5 month old not thriving. We help, reassure, treat, and recognize that a paved road to these rural areas is more potent a pill than any we can deliver.

—from Poverty, Roads, Health and Hope on You Health

After working with Project Medishare’s local staff, the Jewish Healthcare International team traveled to Hinche to visit the regional hospital and another cholera treatment center who yesterday received 50 new cases at the site.

Another make-shift cholera camp set up at the front entrance. Yesterday, all had hope the disease might wane. Today, 50 new cases on top of 50 in treatment. 100 now in a tent hospital. Several died again because they got there too late. Heroic Ministry of Health administration and Partners in Health clinicians making a difference. Medishare, our host, providing supplies, training, and additional personnel.

—from Poverty, Roads, Health and Hope on You Health

The Jewish Healthcare International team will be working in Haiti for the rest of the week. You can read Dr. Goldstein’s full blog post Poverty, Roads, Health and Hope here. Dr. Goldstein plans to blog about his experiences throughout the week on Your Health.

Project Medishare’s community health program is operated by over 100 local staff comprised of Haitian doctors, nurses, pharmacists, administrative staff and community health agents. To learn more about Project Medishare’s community health program in Haiti’s Central Plateau click here. If you would like to donate towards the community health program you can make an online donation here.

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Pediatrician Dr. Heidi Sandige and neurology resident Suzanne Schindler measure 9-month-old Shaina Shirley Vil’s head to asses the child's condition before recommending surgery. Dr. Sandige and Schindler are part of a pediatric neurosurgical team led by Dr. Keith Rich from Washington University School of Medicine. Photo by Jennifer Browning.

By Jennifer Browning

A pediatric neurosurgical team is working this week at Hospital Bernard Mevs Project Medishare. Last weekend Dr. Keith Rich was at the hospital participating in a neurological assessment of prospective surgical patients, as well as providing follow-up care to others.

Pediatric neurosurgery teams have been coming to Haiti since 2003 to provide surgeries to children with hydrocephalus. Those surgeries in the past have been primarily performed by neurologist Dr. John Ragheb and his team from the University of Miami Miller School of Medicine. While Dr. Rich and some of his team have participated in Project Medishare’s specialty surgical trips with Dr. Ragheb, this is the first time Washington University School of Medicine has organized their own pediatric neurosurgical trip to Haiti.

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By Jennifer Browning

After turning off of National Road #3, the SUVs tossed,  tumbled and slid across the mud caked roads saturated after the downpour the previous night.

Traveling to the mobile clinic location this morning, the lead SUV with all the medications was deterred by the mud. After about 30 minutes, the truck found its way out and Project Medishare staff determined an alternative location for today's clinic. Photo by Jennifer Browning.

The caravan halted just a few miles down. The lead truck with all of the medications was stuck.

“My primary concern was is there another route or how are we going to get to the clinic,” William Moore, a second year MPH student from Morehouse School of Medicine said. “We prepared so much this morning to leave earlier than before to assure that we could provide as much as we could for today’s clinic, when we saw this obstacle, I thought we weren’t going to be able to service as many people as we originally planned.”

With the road impassable, once the lead truck made its way out of the mud, Project Medishare staff worked out an alternative location which ended up being the property and house of a resident in the community. A messenger was sent down to the original clinic location to tell those waiting to be see,  that the location had changed. Patients walked 45 minutes to get to the alternative location.

“It just impresses upon me how people here make such personal sacrifice traveling in the heat, traveling in the mud, being able to walk carrying their kids long distances to get to the mobile clinic location,” Bande Mangaliso Virgil, a pediatric resident from Morehouse Medical School said. “It says how much faith they have in us as physicians and that is humbling. They walk one, two hours or maybe even a half a day to receive healthcare.”

Erica Shantha, second year medical student at Morehouse School of Medicine, agreed.

“I thought it was great. A local allowed us to improvise and basically take over their home and land to do today’s clinic,” Erica said. “I thought it was amazing how the people could

Erica Shantha, a second year medical student at Morehouse School of Medicine takes a patient's blood pressure at the triage unit at the mobile clinic. "Everyone worked to gether today as a team. We saw the most patients, and it was all set up and organized. It was the most productive day we've had all week in spite of the change in clinic location." Photo by Jennifer Browning.

come there so fast. It seemed to take them 15 minutes to get word that the clinic had moved.”

Normally for the mobile clinics, Project Medishare operates out of a local school house or a church. This provides separate rooms for the various specialties. Today, the whole clinic operated under a sprawling Mango tree and the Obstetrics and Gynecology clinic operated in the back of an SUV to offer some sort of privacy.

“You do what you have to do to get the job done, and that was the only private secure place we had to see our women, so we made it work,” Dr. Tish Titus, assistant professor at Emory University School of Medicine. “The women were so happy to come lay in the truck and listen to the sound of their babies on the portable doppler.”


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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 Jennifer Browning

While some will be basking in the sun by their barbecue grills or lining up their fireworks on Sunday for Fourth of July celebrations, Emory Medishare, in partnership with Project Medishare will be arriving in Hinche, Haiti in the Central Plateau to begin a week of surgeries. Above is a sideshow, produced by Emory University and narrated by Dr. Viraj Master regarding the realities in operating in rural Haiti.

This will be the third year Emory will be working out of the government hospital. Check back to the Project Medishare Blog for updates regarding their specialty surgical trip.

Click here to read posts from previous Emory surgical trips in Hinche.

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Genia Francoi smiles at her 7-month-old daughter Violonda as they wait to see what doctors find out from lab tests. Photo by Jennifer Browning.

By Jennifer Browning

Not all children scheduled for surgery head to the operating room. Sometimes complications occur such as a fever or signs of possible infection.

Violonda, who was originally scheduled for endoscopic third ventriculostomy (ETV), awoke with a fever, so doctors postponed the surgery. In addition, doctors took a sample of brain fluid to send to the lab to check for an infection. If Violonda doesn’t have an infection, and her fever returns to normal, then doctors will proceed with her surgery.

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By Jennifer Browning

Fifteen-month-old Margaret giggles and coos at Marie Lourdes as she kisses the child’s face. Marie, a cousin, started caring for Margaret after the child’s mother died during childbirth.

Today is especially hard for Marie, because it is Mother’s Day in Haiti. Tears stream down her face as she begins to talk about her cousin, Margaret’s mother.

“I am happy that even though she is sick, that she is able to smile,” Marie said. “But it should be Margaret’s mother here today, on Mother’s Day, making her smile.”

Fifteen-month old Margaret is all smiles before doctors prep her for surgery.Surgeons performed endoscopic third ventriculostomy (ETV) on Margaret this morning to cure her hydrocephalus. Photo by Jennifer Browning.

When Margaret was four months, Marie began to notice that something wasn’t right. As Margaret started trying to sit up, she wasn’t able to hold her head up.

“That’s when I noticed that something is wrong, because I have two kids and they never had this problem. I knew that something wasn’t right when she couldn’t hold her head up and sit up right.”

Marie took Margaret to the pediatrician who told Marie the child may have a brain problem and recommended a CT scan. After viewing the scan, the doctor said that it looked as though Margaret had hydrocephalus.

“The problem was that there was no one in Haiti who could do the surgery Margaret needed,” Marie said.

In most places, hydrocephalus is diagnosed shortly after birth, a somewhat simple operation allows a child a greater chance at a normal life. Unfortunately, this is rare in Haiti; instead when undetected, the cerebrospinal fluid (CSF) that flows normally through a healthy baby is blocked or unabsorbed. When this happens, the fluid creates pressure on the brain causing swelling, severe damage and eventually death.

Months later another doctor told Marie that he knew of a program that treated hydrocephalus at Hopital Universitaire de la Paix, which is where Project Medishare’s pediatric neurosurgery team worked out of before the earthquake. The doctors at La Paix directed Marie to Project Medishare’s nurse liaison Maguy Rochelin who assists with the pediatric neurosurgery program.

When Marie found Maguy, the nurse was working at Project Medishare’s field hospital.

“When we arrived at the hospital, to look for Maguy, doctors examined Margaret, because they could see her head was large,” she said. “They called Maguy to come see Margaret, and that is how we got into the program.”

Surgeons performed endoscopic third ventriculostomy (ETV) on Margaret this morning. This type of surgery allows for the CSF to escape relieving pressure on the child’s brain.

“I am so happy for what Project Medishare is doing, everyone here treats all patients as equals,” Marie said. “This hospital helps a lot of patients. I believe in the doctors who have come here to help Margaret, and I am so thankful.”

Click here to learn more about Project Medishare’s Pediatric Neurosurgery Program.

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From May 21-24, Dr. Seth Thaller led a plastic surgery program to Haiti through Project Medishare’s Plastic Surgery Program. Of the 18 procedures performed by the team, six of the surgeries were cleft lip and one involved correcting a cleft palate.

Project Medishare has a continuing partnership with Haiti’s Ministry of Health and the University of Miami Department of Plastic Surgery for cleft lip surgeries.

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By Jennifer Browning

Children’s Hospital Boston sent a group of 26 clinicians to volunteer at Project Medishare’s field hospital in Haiti between April 10 to 18. THRIVE: Children’s Hospital Boston’s health and science blog features the refelctions of several  volunteers who staffed Emergency Department reflect on their experience.

You can read about these volunteers experiences here, here and here.

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