For my first week or two in Haiti it was easy to hear about poor outcomes or great outcomes and shrug them off either way. I went through lots of charts for retrospective data for a summer research project. And no matter how many times I saw words TB or HIV positive it didn't phase me. I would write down in my data sheet that a patient died and no matter what the age - 10, 35, 72 - I continued on in the same manner I used for studying in medical school this year - memorize/ speed read through the lists of awful diseases and continue on. After all, time in medical school, like my time here in Haiti, is precious. So I planned to use it as efficiently as possible.
It's a lot harder though to rush through and treat a person sitting in front of you as merely a set of vitals, a disease to commit to memory, or a data entry point for a summer study. Last week in Les Anglais was wonderful because it gave me the opportunity to see the person behind the chart. I had the privilege to sit down with many patients and hear their stories. My interpreter, Julmis and I, went through sex education with each of the HIV negative patients because we believe that information is 1) empowering for patients and 2) a lot cheaper for the healthcare system here than a lifetime of ARV meds for a HIV + patient. Hearing patients responses to our educational questionnaire (the one that the wonderful Haitian nurses from HIC gave me) provided me with a lot of high and low points for my days.
I got to hear about how one girl refused to have any boyfriends or get married until after she completed school. She told Julmis and me: "I have a dream/ vision for myself. I am going to finish school, get a good job, and accomplish my goals. Then after that I can think about boys. For now I am focusing on me." Julmis and I started smiling and I wanted to shout out loud "You go girl!"
Sadly, this patient was followed by other more somber stories. Seeing teenage girls, who looked like little babies to me still, answer my question of - if their boyfriend, husband, or another man approached them and they didn't want to have sex with that individual, would they feel comfortable speaking up and say no - with their shy and sad "no" was heartbreaking. There was one little teenage girl I felt like picking up, putting in the back of our tap tap truck, and whisking away; letting her be mothered and grow up first before she had to face some of the awful realities of the situation she lives in.
But through the good and the bad, I loved that I got to be there with patients to hear their stories. Someone once told me that it's important for people to be able to share their stories because it validates them, gives dignity and shows they are important and that someone cares. I think this is very true. After all, the sweet older woman who suffered from malnutrition was no longer another data entry point. She is a woman who lost her husband a year ago and while she and her children are starving, she is still a proud and dainty enough woman to borrow a pink sharpie from someone and "paint her fingernails." I have never seen a bigger smile as when I and the other blan told her how beautiful her nails were. We exchanged hugs, I told her she was beautiful - she reminded me of my grandmother - well-kept and dignified no matter how bad of a situation she found herself in, and sent her on her way.
I was only able to truly make a difference in a handful of these patients' lives in Les Anglais. But it's my hope that after spending a week listening, educating, and advocating for, the patients there know they are no longer a set of vitals or diseases for me to mark down. They're real people that received care and attention from someone who will never forget their stories. From someone who is going to continue to try to work with them and slowly try to improve their situation one step at a time. From someone who will continue to remember that there is always a person behind each chart she reads.
Monday, July 8, 2013
Freedom is Not Free
On this 4th of July weekend I washed a blanket that Baby Joseph's mom was using for him while he was in the hospital. It was very dirty and I have been trying to keep Baby Joseph in at least a semi-clean environment while he finishes fighting off his infection. Then it will be time to just send him home and hope for the best... The irony of the situation was the blanket was an American one. It had an American flag, an eagle, and the words "Freedom is Not Free" written on it. The mom probably had no idea what the blanket said (after all she couldn't read Creole, let alone English). She probably just received the blanket as a handout from a group of blan.
But what was so thought provoking to me while I sat there and washed the blanket - while many of my family and friends were probably celebrating back in the states with fireworks, buffets of food, ice cream, parties (all of the frivolous, but awesome displays that remind me just how rich we really are as Americans) - is that Baby Joseph's mom probably understands those words way better than I do, than many of us do really. Because when Haiti successfully gained its independence - back in 1805 - the French said they would acknowledge Haiti as an independent state on one condition - that they pay France for the economic loss that would result from them no longer owning Haiti as a slave colony. So while Haiti was the only successful slave rebellion resulting in a free nation in the history of this planet, Haiti also immediately became one of the poorest countries on the planet. The debt they owed France was equivalent to 21 billion US dollars today. Thus Haiti's freedom was not free at all - it literally came with a price tag.
Because of this debt (and the international politics associated with it), Haiti has suffered for the last 2 centuries from economic hardship. Many Haitians are literally born into a culture of debt/ poverty and so for them, to live in a free nation, it means they have had to pay for it. This includes Baby Joseph's mother. Baby Joseph's story comes with highs and lows. His story has also showed me how quick I am to judge mothers here. How I look at them through my American-culture lenses and ask why they make some of the choices they do. How I want to blame them for not knowing how infection is spread to their babies, for possibly choosing to not take care of some of their babies so that the babies who are already healthy can have a better chance at surviving. But then I realize I don't have the right to judge them, because I have never walked even a half mile in their shoes. I wasn't born into a life of poverty, born into a culture where the survival of the fittest isn't just an evolutionary phenomenon that you learn about in science class, but it's a way of life. I have never had to make decisions in such poverty about which of my 6+ children should live, because there would be no way to feed and cloth all of them. I have access to healthcare and family planning so if I don't want to have 10 children I don't have to. I am a female that is privileged to have an education and will have a nice job, so I didn't need to rely on marrying a man as a teenager in hopes of having some of my basic needs (like food and access to some money) met.
So this past 4th of July weekend, while I washed Baby Joseph's and his mom's blanket I realized that I don't get to judge her or other moms here in her same situation. Because while I am thankful that many men and women in the past fought hard so I could grow up in a free country like the US, I am also honest. I am honest enough to admit that my freedom is so much freer than Baby's Joseph's mom because I never had to pay a life of poverty for it.
But what was so thought provoking to me while I sat there and washed the blanket - while many of my family and friends were probably celebrating back in the states with fireworks, buffets of food, ice cream, parties (all of the frivolous, but awesome displays that remind me just how rich we really are as Americans) - is that Baby Joseph's mom probably understands those words way better than I do, than many of us do really. Because when Haiti successfully gained its independence - back in 1805 - the French said they would acknowledge Haiti as an independent state on one condition - that they pay France for the economic loss that would result from them no longer owning Haiti as a slave colony. So while Haiti was the only successful slave rebellion resulting in a free nation in the history of this planet, Haiti also immediately became one of the poorest countries on the planet. The debt they owed France was equivalent to 21 billion US dollars today. Thus Haiti's freedom was not free at all - it literally came with a price tag.
Because of this debt (and the international politics associated with it), Haiti has suffered for the last 2 centuries from economic hardship. Many Haitians are literally born into a culture of debt/ poverty and so for them, to live in a free nation, it means they have had to pay for it. This includes Baby Joseph's mother. Baby Joseph's story comes with highs and lows. His story has also showed me how quick I am to judge mothers here. How I look at them through my American-culture lenses and ask why they make some of the choices they do. How I want to blame them for not knowing how infection is spread to their babies, for possibly choosing to not take care of some of their babies so that the babies who are already healthy can have a better chance at surviving. But then I realize I don't have the right to judge them, because I have never walked even a half mile in their shoes. I wasn't born into a life of poverty, born into a culture where the survival of the fittest isn't just an evolutionary phenomenon that you learn about in science class, but it's a way of life. I have never had to make decisions in such poverty about which of my 6+ children should live, because there would be no way to feed and cloth all of them. I have access to healthcare and family planning so if I don't want to have 10 children I don't have to. I am a female that is privileged to have an education and will have a nice job, so I didn't need to rely on marrying a man as a teenager in hopes of having some of my basic needs (like food and access to some money) met.
So this past 4th of July weekend, while I washed Baby Joseph's and his mom's blanket I realized that I don't get to judge her or other moms here in her same situation. Because while I am thankful that many men and women in the past fought hard so I could grow up in a free country like the US, I am also honest. I am honest enough to admit that my freedom is so much freer than Baby's Joseph's mom because I never had to pay a life of poverty for it.
Saturday, July 6, 2013
Let Them Eat Cake
If anyone knows me well, then they will know I have the biggest sweet tooth in the Western Hemisphere. I also realized something else about me today - I am truly a spoiled American. It has only been 3 weeks and a day since I arrived in Les Cayes, Haiti. But today it finally hit me - I could not take another bowl of porridge with bread for breakfast, another protein bar I had brought with me for lunch each day, or another serving of rice and beans for dinner. I have not had a single real dessert since my plane left Miami and while for most of the world this is the norm, I have had the rich comforts of American desserts my entire life and my stomach was having a very hard time forgetting about them this week.
Luckily Mamma Djeune (as the boys call her) must have heard my stomach's rumbling pleas today. Tonight we celebrated my birthday (a month early). I think they thought I said my birthday was July 5th, instead of August 5th. And so my tummy was filled with homemade soup complete with homemade dumplings (the soup they make for special festivities such as birthdays). Following dinner, Mamma Djeune presented me and the boys with a frosted cake and at that point, when the boys eyes lit up and they exclaimed in unison "gateau!" I could not ruin their surprise. I let them sing me Happy Birthday (in both English and French of course) and then my tummy for the first time in 3 weeks was filled with a deliciously satisfying sweet!
After tonight's feast, I couldn't help but think about how many people in this world eat, what I have been eating for the last 3 weeks, everyday. And often they are not in a situation where the family they rent from has enough money to afford cake. That's when my views on global food scarcity started to change. Previously my view on food globally has been: if every man, woman, and child around the world is able to go to bed each night with a full belly then we have satisfied the basic human right of not going hungry. However, if someone told me that I was going to eat rice and beans every night for the rest of my life, if I were to forget about ever having gateau (cake) and ice cream again, and that I should be satisfied with this situation, I would look at them like they were crazy. That's when I realized how easy it is, to sit at my American kitchen table, complete with a variety of delicious foods and desserts, and tell the rest of the world how they should be happy because they get to go to bed with full tummies. It's easy to give advice when the cheesecake is on your side of the table I think. And while I am not advocating for global diabetes with cake at every meal, I think our Millennium Development Goals should be higher. Instead of ending childhood hunger or trying to fix global food scarcity with rice and bean handouts, maybe we should strive to improve local economies worldwide. And then we can say we have finally achieved our goals when people everywhere, both in the mountains of Haiti and the mountains of Vermont, can afford to go to market and buy their family cake for a special celebration.
Oh and if anyone around Les Cayes asks, yes my birthday is July 5th...
Luckily Mamma Djeune (as the boys call her) must have heard my stomach's rumbling pleas today. Tonight we celebrated my birthday (a month early). I think they thought I said my birthday was July 5th, instead of August 5th. And so my tummy was filled with homemade soup complete with homemade dumplings (the soup they make for special festivities such as birthdays). Following dinner, Mamma Djeune presented me and the boys with a frosted cake and at that point, when the boys eyes lit up and they exclaimed in unison "gateau!" I could not ruin their surprise. I let them sing me Happy Birthday (in both English and French of course) and then my tummy for the first time in 3 weeks was filled with a deliciously satisfying sweet!
After tonight's feast, I couldn't help but think about how many people in this world eat, what I have been eating for the last 3 weeks, everyday. And often they are not in a situation where the family they rent from has enough money to afford cake. That's when my views on global food scarcity started to change. Previously my view on food globally has been: if every man, woman, and child around the world is able to go to bed each night with a full belly then we have satisfied the basic human right of not going hungry. However, if someone told me that I was going to eat rice and beans every night for the rest of my life, if I were to forget about ever having gateau (cake) and ice cream again, and that I should be satisfied with this situation, I would look at them like they were crazy. That's when I realized how easy it is, to sit at my American kitchen table, complete with a variety of delicious foods and desserts, and tell the rest of the world how they should be happy because they get to go to bed with full tummies. It's easy to give advice when the cheesecake is on your side of the table I think. And while I am not advocating for global diabetes with cake at every meal, I think our Millennium Development Goals should be higher. Instead of ending childhood hunger or trying to fix global food scarcity with rice and bean handouts, maybe we should strive to improve local economies worldwide. And then we can say we have finally achieved our goals when people everywhere, both in the mountains of Haiti and the mountains of Vermont, can afford to go to market and buy their family cake for a special celebration.
Oh and if anyone around Les Cayes asks, yes my birthday is July 5th...
Photos of the boys enjoying the cake as much as I did :)
It's the Little Things in Life
I never thought I would be so excited to see drool in my entire life. Yes, drool. Something so ordinary to anyone who has ever had a baby, watched a baby, or smelled delicious food. But yesterday, when I went to the hospital and fed Baby Joseph his bottle he drooled for the first time since I met him at the clinic in Les Anglais. I started beaming and the mother couldn't understand why I was so excited. She thought: Are they letting him go home? Are we done being in the hospital? She didn't seem as excited as me when I pointed at him smiling and drooling. I explained to her that his lips were no longer chapped and he was able to drool because he was no longer extremely dehydrated. Mucous membranes moist? check! Mark it off on his chart as normal.
Not only is Baby Joseph no longer dehydrated, but his fever has come down. Lots of his tests came back negative for really serious infections so the residents moved him from the Les Cayes, Haiti version of a NICU to their general pediatric inpatient area. He continues to suck down his bottles of formula like a champ and has been gaining weight each day. He responds to my voice and even starts kicking his legs and grabs my finger with his hand when I sing to him after his feedings. I am hoping with a good toy to grasp and play with, when I am not there to entertain him, that his brain will develop normally despite this infection.
This must be how new moms are. Super excited when their child takes their first crawl forward, their first step, has their first piece of solid food, etc. The rest of the world could probably care less, but to them it's like Christmas came early. Like Baby Joseph's pseudo-mom I have also been tracking his brain development like a hawk. I talk on FaceTime at night with my significant other and we discuss the importance of Baby Joseph playing, needing an interactive toy, human touch, and lots of calories right now. I think to myself, maybe if we get him back on track his brain will develop perfectly. Maybe someday his mom will tell him about the blan med student who fussed over him when he just a few months old. Maybe she will tell him how he's a miracle baby. Maybe with this story he'll grow up and want to be a doctor someday, or an ethical dignitary wanting to improve the Haitian healthcare system...
And then reality always seems to set in and I am reminded that as a rural, poor Haitian he probably won't get to go to school. He'll be a miracle child if he survives this next year. So for now I guess I will celebrate the little victories - like the drool and smile that awaited me at the hospital yesterday...
Not only is Baby Joseph no longer dehydrated, but his fever has come down. Lots of his tests came back negative for really serious infections so the residents moved him from the Les Cayes, Haiti version of a NICU to their general pediatric inpatient area. He continues to suck down his bottles of formula like a champ and has been gaining weight each day. He responds to my voice and even starts kicking his legs and grabs my finger with his hand when I sing to him after his feedings. I am hoping with a good toy to grasp and play with, when I am not there to entertain him, that his brain will develop normally despite this infection.
This must be how new moms are. Super excited when their child takes their first crawl forward, their first step, has their first piece of solid food, etc. The rest of the world could probably care less, but to them it's like Christmas came early. Like Baby Joseph's pseudo-mom I have also been tracking his brain development like a hawk. I talk on FaceTime at night with my significant other and we discuss the importance of Baby Joseph playing, needing an interactive toy, human touch, and lots of calories right now. I think to myself, maybe if we get him back on track his brain will develop perfectly. Maybe someday his mom will tell him about the blan med student who fussed over him when he just a few months old. Maybe she will tell him how he's a miracle baby. Maybe with this story he'll grow up and want to be a doctor someday, or an ethical dignitary wanting to improve the Haitian healthcare system...
And then reality always seems to set in and I am reminded that as a rural, poor Haitian he probably won't get to go to school. He'll be a miracle child if he survives this next year. So for now I guess I will celebrate the little victories - like the drool and smile that awaited me at the hospital yesterday...
Wednesday, July 3, 2013
Breaking the Rules
His name: Baby Joseph. Okay so that's not his official name, but it's the nick name the team and I have given him over the past week. He is three and a half months old. He only weighs about 9 pounds and most likely has bacterial meningitis. But he has the cutest little mouth and the adorable face he makes when you give him his bottle is enough to get anyone hooked.
I always vowed I would never do this - never be the "blan" who gives lots of handouts to one person. That's why I am participating in the collaborative projects this summer with Dartmouth/PEPFAR/CHI/MSPP. I figured this work would be longer lasting, more sustainable, help more people by helping improve the system that cares for them, etc. That's why I didn't bring a suitcase full of toys for an orphanage or food for malnourished children. I really only packed for myself. This reasoning is why I usually turn away when random Haitians on my way to work say "Hey blan, gimme one dollar!"And for the last 2 and a half weeks I had been sticking to my plan pretty well. I have made lots of connections, sat through lots of meetings, collected a lot of data, spent all afternoon on emails, working tirelessly on changing/ improving the system...
But then Baby Joseph's mom brought him to mobile clinic this weekend in Les Anglais. I know, many will tell me that there are a ton of baby Josephs out there, many with the same cute faces and just as in need of medical treatment and baby formula for food. But with the encouragement of the Haitian doctor in Les Anglais and the blan team supporting me, I helped get Baby Joseph to Les Cayes. With the help of Pastor Yivonne and some donations on the American side, Baby Joseph's parents tracked me down at HIC yesterday - probably was pretty easy since I am the only blan medical student that works there. I checked them in and held Baby Joseph while the interns and the Pediatric team poked and prodded. The Pediatrician - a bubbly, middle-aged Haitian woman - was awesome. She admitted him to the inpatient infant area of the ward, ordered his medicines and lots of tests and then rounded up all of her interns and residents to go over the case - looks like Baby Joseph is getting to be the little star around here.
I again broke the rules and helped pay for his medicines, chest x-ray, and labs. I literally sat there all afternoon today waiting for pee to dribble into his specimen cup while I held it. I couldn't stand seeing him in dirty clothes, all smelly, when he was trying to fight off infection. So I gave him a baby-wipe bath and put him in a clean diaper and a little blue onesie I purchased at market. The mothers milk has dried up and she couldn't remember what she did with all the bottles of neonate formula we had given to her in Les Anglais (she probably sold them or gave them to her other toddlers at home - but more on that part of the complicated story later). So I went out and bought powdered formula and prepared a bunch of little bottles for him. I fed him this morning, over my lunch break, this evening, and even took a moto tonight to give him his nighttime bottle. Each time I changed his diaper, cleaned him up and made sure his fever medicines were on schedule. The nurses here are amazing. They have been giving me the update on his antibiotic schedule and they let me hold him when they do his blood draws. They even act as my interrupters - translating my French into Creole so Baby Joseph's parents can understand my instructions.
The last few days have taught me that life is complicated. While it's important to try to play by the rules and follow the original plan, life is not black and blan. Sometimes an exception to the rules, a very cute exception, comes along and it's okay. So tonight I decided that for my next four and a half weeks here I am going to work very hard at my original projects, but I am also going to try my hardest to take care of the cute little exception I found. I think if you saw him smile at me today during one of the feedings, you would also agree with this plan...
I always vowed I would never do this - never be the "blan" who gives lots of handouts to one person. That's why I am participating in the collaborative projects this summer with Dartmouth/PEPFAR/CHI/MSPP. I figured this work would be longer lasting, more sustainable, help more people by helping improve the system that cares for them, etc. That's why I didn't bring a suitcase full of toys for an orphanage or food for malnourished children. I really only packed for myself. This reasoning is why I usually turn away when random Haitians on my way to work say "Hey blan, gimme one dollar!"And for the last 2 and a half weeks I had been sticking to my plan pretty well. I have made lots of connections, sat through lots of meetings, collected a lot of data, spent all afternoon on emails, working tirelessly on changing/ improving the system...
But then Baby Joseph's mom brought him to mobile clinic this weekend in Les Anglais. I know, many will tell me that there are a ton of baby Josephs out there, many with the same cute faces and just as in need of medical treatment and baby formula for food. But with the encouragement of the Haitian doctor in Les Anglais and the blan team supporting me, I helped get Baby Joseph to Les Cayes. With the help of Pastor Yivonne and some donations on the American side, Baby Joseph's parents tracked me down at HIC yesterday - probably was pretty easy since I am the only blan medical student that works there. I checked them in and held Baby Joseph while the interns and the Pediatric team poked and prodded. The Pediatrician - a bubbly, middle-aged Haitian woman - was awesome. She admitted him to the inpatient infant area of the ward, ordered his medicines and lots of tests and then rounded up all of her interns and residents to go over the case - looks like Baby Joseph is getting to be the little star around here.
I again broke the rules and helped pay for his medicines, chest x-ray, and labs. I literally sat there all afternoon today waiting for pee to dribble into his specimen cup while I held it. I couldn't stand seeing him in dirty clothes, all smelly, when he was trying to fight off infection. So I gave him a baby-wipe bath and put him in a clean diaper and a little blue onesie I purchased at market. The mothers milk has dried up and she couldn't remember what she did with all the bottles of neonate formula we had given to her in Les Anglais (she probably sold them or gave them to her other toddlers at home - but more on that part of the complicated story later). So I went out and bought powdered formula and prepared a bunch of little bottles for him. I fed him this morning, over my lunch break, this evening, and even took a moto tonight to give him his nighttime bottle. Each time I changed his diaper, cleaned him up and made sure his fever medicines were on schedule. The nurses here are amazing. They have been giving me the update on his antibiotic schedule and they let me hold him when they do his blood draws. They even act as my interrupters - translating my French into Creole so Baby Joseph's parents can understand my instructions.
The last few days have taught me that life is complicated. While it's important to try to play by the rules and follow the original plan, life is not black and blan. Sometimes an exception to the rules, a very cute exception, comes along and it's okay. So tonight I decided that for my next four and a half weeks here I am going to work very hard at my original projects, but I am also going to try my hardest to take care of the cute little exception I found. I think if you saw him smile at me today during one of the feedings, you would also agree with this plan...
Sunday, June 23, 2013
The HIV Doctor
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"...
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"...
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 ;)
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