Well, after a nice weekend, tonight I am prepping for a couple more days of work at HIC, and then Wednesday it's off to Les Anglais with the CHI/HFM team. As I prepare for the mobile clinic in Les Anglais in a few days, I still lie awake some nights wondering how to effectively care for HIV + patients, while keeping their status to the rest of the community a secret. It's important obviously for an HIV infected individual to get access to care at either HIC or Port Salut hospitals, because without care the outcomes don't look so good. But, I still really struggle with the stigma issue. If people in a community know you're HIV+ they might not buy from you at market anymore. Many of the female patients who test positive are so afraid of the stigma attached to the diagnosis that they don't even tell their husbands, for fear that their husbands would leave them. Others up and move without telling their community health workers, who encourage patients - no matter what their medical condition is - to return to the hospital/ clinics regularly for check ups and makes sure they're taking their medicines. They are so afraid of returning to the hospital and people finding out about their positive status that they feel the only option is to move without leaving a trace of where they might have gone.
Tomorrow or Tuesday I am going to be trained by the nurse educators at HIC on what to say to patients once they receive a positive diagnosis at clinic in Les Anglais. Hopefully, this will help me to at least know how to council patients before we arrange for their transportation and continued care at Port Salut hospital. But this training still doesn't solve my stigma concern. My main project this upcoming week will be to test patients and then have an educational session with the HIV+ patients before arranging for their transportation to Port Salut. Since I will mainly be doing only HIV diagnosis/ care, how do I keep myself from being known as the "blan HIV doctor." I am fearful that once this happens, no patient is going to want to talk to me again in Les Anglais. And fearful of what will happen to the patients that I speak with if that were to happen. I don't want to be responsible for socially ostracizing patients, but I also want to get them the care they need.
And then there is the issue of transportation. The team and I need to figure out a way to transport the patients to Port Salut without locals figuring out what's unique about the patients in our tap taps. Why they're the few that are chosen to go to Port Salut... Perhaps I could just send the names of the patients onto the infectious disease doctor and social worker at Port Salut, and help the patients get a ride on a regular tap tap that goes back and forth between Les Anglais and Port Salut? I can give them instructions on what they're supposed to do and hope they go get the care they need. After all, the team and I cannot force people to seek treatment, and the problem of people with positive tests not coming back for necessary care is an issue that Haitian staff, like Dr. Cleonas, are working so hard to fix at HIC. So many people are engaging in collaborative efforts to deal with this complicated situation, and yet the problem remains...
So tonight, as I get excited for my data collection project to start tomorrow and for the team arriving on Wednesday, I am filled with some nervousness for the week to come. If anyone has any good advice for this complicated situation, I welcome any and all support. Praying everything turns out okay and that my name by the end of the week is not the "blan HIV doctor"...
Sunday, June 23, 2013
Thursday, June 20, 2013
The Learning Curve
In medicine people often refer to a "learning curve" when talking about medical education. For instance, if a person would create a graph of how much one learns during college, it would be a linear relationship with time... but then medical school starts and the line on the graph changes drastically. The amount one has to learn in little amounts of time keeps increasing and increasing, all the way through residency training.
I have only been in Les Cayes, Haiti for about a week and already the Haitian team at HIC hospital and the family I am staying with have taught me so much. The hospital is completely Haitian run - administrators, doctors, nurses, nurse midwives, pharmacists, social worker... you name it and it's taken care of by Haitian leadership. I am constantly amazed at what outcomes they are capable of with very little resources. Our CHI volunteer team isn't the only one to put together mobile clinics. I spoke with the social worker at Port Salut Hospital this week and discovered they have been hosting mobile clinics in Les Anglais once per month for the last few months because they recognized a need there. The social worker told me how even though they are short on funds they had to do what they could to address the needs of patients in Les Anglais. They will stretch funds as much as they need if it means Les Anglais patients can have more access to the care that they deserve.
At HIC, Dr. Cleonas is busy with overseeing Dartmouth infectious disease project in Les Cayes and seeing his own patients. Yet, he will often quietly reach over the desk we share as I make my handwritten notes or emails in French to the Haitian medical personnel I am working with and correct my spelling and grammar errors. He continues to help me improve my French. The social worker is busy tracking down patients who miss appointments and is helping train me on how to work with his Community Health Workers to track down HIV+ patients who were lost to follow up. He and his team are working hard so we can get these patients back into care and back on their needed medications.
Sure, I could spend a lot of time explaining certain gaps in the system, certain types of diseases that are treatable in the states, but have poor outcomes here, but this week I am impressed by the positives. I am impressed by how the Haitian healthcare workers can have so little and yet still accomplish what they do. They run prenatal clinics, manage difficult infectious diseases, perform surgery, are building a whole new ob/gyn center as they try to improve maternal health outcomes (note to self - convince my roommate to do some educational work here when she's done with her residency), and just opened a brand new lab complete with high tech equipment including the soon-to-arrive GeneXpert (http://www.pepfar.gov/press/releases/2012/196090.htm).
And then there's Edward and Djeune. They continue to teach me what it means to truly be a humanitarian. I live in the apartment above their house, where they live with their 4 children. The two oldest boys are adopted and the youngest boy and girl are their biological children. The oldest boy they found as a baby, malnourished, in a shoebox under a bridge, shortly after they got married. They spent 6 months in the hospital nursing him back to good health, took him home, gave him a name and an age. The love for others didn't stop there. They adopted another son, they run two orphanages in their "spare time," and work with NGO's from Iowa to help reconstruct villages that were swept away by Hurricane Sandy. I have personally seen Edward buy the food of the person standing behind him in the grocery line, and he is constantly on the phone helping people with favors that they need. When I return home in 6 weeks, I hope I can show my family, friends, patients, heck even strangers, just a small fraction of the love I have seen Edward and Djeune shower onto those around them.
I have a feeling that while I learned a lot this week, the rest of my short time in Haiti is going to be filled with many more lessons. Most likely the learning curve has just begun...
Pictures of Edwards and Djeune's sons. Don't let the cute, angelic smiles fool you... they are officially on summer vacation and ready to cause some mischief ;)
I have only been in Les Cayes, Haiti for about a week and already the Haitian team at HIC hospital and the family I am staying with have taught me so much. The hospital is completely Haitian run - administrators, doctors, nurses, nurse midwives, pharmacists, social worker... you name it and it's taken care of by Haitian leadership. I am constantly amazed at what outcomes they are capable of with very little resources. Our CHI volunteer team isn't the only one to put together mobile clinics. I spoke with the social worker at Port Salut Hospital this week and discovered they have been hosting mobile clinics in Les Anglais once per month for the last few months because they recognized a need there. The social worker told me how even though they are short on funds they had to do what they could to address the needs of patients in Les Anglais. They will stretch funds as much as they need if it means Les Anglais patients can have more access to the care that they deserve.
At HIC, Dr. Cleonas is busy with overseeing Dartmouth infectious disease project in Les Cayes and seeing his own patients. Yet, he will often quietly reach over the desk we share as I make my handwritten notes or emails in French to the Haitian medical personnel I am working with and correct my spelling and grammar errors. He continues to help me improve my French. The social worker is busy tracking down patients who miss appointments and is helping train me on how to work with his Community Health Workers to track down HIV+ patients who were lost to follow up. He and his team are working hard so we can get these patients back into care and back on their needed medications.
Sure, I could spend a lot of time explaining certain gaps in the system, certain types of diseases that are treatable in the states, but have poor outcomes here, but this week I am impressed by the positives. I am impressed by how the Haitian healthcare workers can have so little and yet still accomplish what they do. They run prenatal clinics, manage difficult infectious diseases, perform surgery, are building a whole new ob/gyn center as they try to improve maternal health outcomes (note to self - convince my roommate to do some educational work here when she's done with her residency), and just opened a brand new lab complete with high tech equipment including the soon-to-arrive GeneXpert (http://www.pepfar.gov/press/releases/2012/196090.htm).
And then there's Edward and Djeune. They continue to teach me what it means to truly be a humanitarian. I live in the apartment above their house, where they live with their 4 children. The two oldest boys are adopted and the youngest boy and girl are their biological children. The oldest boy they found as a baby, malnourished, in a shoebox under a bridge, shortly after they got married. They spent 6 months in the hospital nursing him back to good health, took him home, gave him a name and an age. The love for others didn't stop there. They adopted another son, they run two orphanages in their "spare time," and work with NGO's from Iowa to help reconstruct villages that were swept away by Hurricane Sandy. I have personally seen Edward buy the food of the person standing behind him in the grocery line, and he is constantly on the phone helping people with favors that they need. When I return home in 6 weeks, I hope I can show my family, friends, patients, heck even strangers, just a small fraction of the love I have seen Edward and Djeune shower onto those around them.
I have a feeling that while I learned a lot this week, the rest of my short time in Haiti is going to be filled with many more lessons. Most likely the learning curve has just begun...
Pictures of Edwards and Djeune's sons. Don't let the cute, angelic smiles fool you... they are officially on summer vacation and ready to cause some mischief ;)
Wednesday, June 19, 2013
Which NGO are you with?
As I boarded the plane on early Saturday morning I couldn't help but notice I was one of the few people traveling alone. The small groups of Haitians were probably traveling with family and friends, headed back home or perhaps off to visit, having moved to the states or Canada. All of the "blan" (the Haitian term used for white people) were nicely organized into groups, complete with matching t-shirts. While waiting in line and on the plane, I heard constant discussion amongst my white counterparts that went a little something like this: "So where are you going to be volunteering?" "So where does your church group do their mission work?" "So which NGO are you with?"
Now don't get me wrong, I love working with CHI (Community Health Initiative) and HFM (Harvest Field Ministries). Both are great NGO's (nongovernmental organizations... aka nonprofit orgs) and I am very proud that they let me be a part of their group. But many of the reasons I am so proud to be a part of these groups is they spend much of their time working ALONGSIDE Haitians. They listen to Haitian healthcare teams who are on the ground all the time and fill in the gaps where they are needed. And while I love my comfortable CHI t-shirt, we will not be seen parading throughout the Port au Prince airport saying things like "we're here to help you this week, yep we're going to do a lot of good." I think this is because CHI and HFM understand that the people who really deserve to be patted on the back are the Haitians we work with. The ones who have more resiliency and love for their own people than I could ever begin to put into words.
I can only imagine that if I was to take a vacation in the near future to a place like Dominican Republic (the country on the other half of this island of Hispaniola) or Jamaica or Cancun, etc. the conversations I would hear throughout the plane would be very different. It would probably go a little more like this: "oh so where are you vacationing?" "aren't the beaches so beautiful?" "I am so excited to get to my resort." Haiti also has beautiful beaches and the hotel where I stayed on my first night here was gorgeous.
And so I have been wondering the last few days why Haiti has to be so different. Why Haiti has been written off by so many blan as not tourist worthy or in need of so many handouts. I know it has taken me the last few years of working in Haiti and working on global health education in the states, to come to realize the important difference between a hand out and a hand up. And I applaud the NGO's, the Haitian government initiatives, the local projects, etc. that help to employ Haitians, buy local materials, and work on systemic economic and health changes.
As I chatted with Dr. Cleonas today on our way back from the Port Salut hospital, we had a beachfront view for half of the 45 min ride. Our discussion ranged from "work talk" about our projects for better access to HIV care to why Haiti is the country it is today and our views about the current situations. He seemed hopeful for future infrastructure changes and possibilities for a tourist economy. We talked about the importance of NGO's working alongside the current Haitian healthcare infrastructure (Did I mention he too likes CHI/HFM's method of helping the local system up?). We talked about our own visions for what Haiti could be in the future.
After this chat today, what I realize now is that helping people out is okay, but helping people up is great. Perhaps the advice I'll give to myself and others when they ask me what I think about the current situation in Haiti and how the NGO's are doing down here is this: give a man a fish and he eats for a day. Give a man a job as a fisherman and he and his family could eat for life... and the neighbors from whom he buys rice or mangos or homemade bread could also have jobs and eat for life too...
Now don't get me wrong, I love working with CHI (Community Health Initiative) and HFM (Harvest Field Ministries). Both are great NGO's (nongovernmental organizations... aka nonprofit orgs) and I am very proud that they let me be a part of their group. But many of the reasons I am so proud to be a part of these groups is they spend much of their time working ALONGSIDE Haitians. They listen to Haitian healthcare teams who are on the ground all the time and fill in the gaps where they are needed. And while I love my comfortable CHI t-shirt, we will not be seen parading throughout the Port au Prince airport saying things like "we're here to help you this week, yep we're going to do a lot of good." I think this is because CHI and HFM understand that the people who really deserve to be patted on the back are the Haitians we work with. The ones who have more resiliency and love for their own people than I could ever begin to put into words.
I can only imagine that if I was to take a vacation in the near future to a place like Dominican Republic (the country on the other half of this island of Hispaniola) or Jamaica or Cancun, etc. the conversations I would hear throughout the plane would be very different. It would probably go a little more like this: "oh so where are you vacationing?" "aren't the beaches so beautiful?" "I am so excited to get to my resort." Haiti also has beautiful beaches and the hotel where I stayed on my first night here was gorgeous.
And so I have been wondering the last few days why Haiti has to be so different. Why Haiti has been written off by so many blan as not tourist worthy or in need of so many handouts. I know it has taken me the last few years of working in Haiti and working on global health education in the states, to come to realize the important difference between a hand out and a hand up. And I applaud the NGO's, the Haitian government initiatives, the local projects, etc. that help to employ Haitians, buy local materials, and work on systemic economic and health changes.
As I chatted with Dr. Cleonas today on our way back from the Port Salut hospital, we had a beachfront view for half of the 45 min ride. Our discussion ranged from "work talk" about our projects for better access to HIV care to why Haiti is the country it is today and our views about the current situations. He seemed hopeful for future infrastructure changes and possibilities for a tourist economy. We talked about the importance of NGO's working alongside the current Haitian healthcare infrastructure (Did I mention he too likes CHI/HFM's method of helping the local system up?). We talked about our own visions for what Haiti could be in the future.
After this chat today, what I realize now is that helping people out is okay, but helping people up is great. Perhaps the advice I'll give to myself and others when they ask me what I think about the current situation in Haiti and how the NGO's are doing down here is this: give a man a fish and he eats for a day. Give a man a job as a fisherman and he and his family could eat for life... and the neighbors from whom he buys rice or mangos or homemade bread could also have jobs and eat for life too...
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