May 2011 Medical Mission: Dr. Tracee Laing and Paul Hammond arrive in Haiti on the 17th, followed closely by the arrival of Dr. Leslie Mihalov and Dr. Marlie Dulaurier on May 20th. Dr. Leslie is the Division Chief of Emergency Medicine at Nationwide Children's Hospital, a member of the HAM Board of Directors and a frequent member of HAM's medical mission teams. Dr. Marlie, a Haitian American, is a Pediatrician/ER Fellow at Nationwide Children's Hospital and was a member of HAM's medical mission team in March, 2010. Dr. Tracee, Dr. Leslie and Paul were all in Haiti this past January as part of HAM previous mission. You can read posts from the January trip here.
Below are posts sent directly from the May Mission.
Tuesday, May 17th: Dr. Tracee and Paul's travel day to Haiti began early, leaving Columbus at 6:30am for Chicago, then onto Fort Lauderdale and eventually arriving in Port-au-Prince about 3pm. As usual, they used up  their full allotment of luggage space with equipment and supplies for the clinic. American Airlines has recently changed their rules for international travel and now only allow one piece of luggage under 50 pounds for free instead of two pieces as in the past. However, an extremely nice agent at the counter waved the additional $30 per bag fee upon hearing about the work Tracee and Paul were doing in Haiti. Nice things do happen!
The trip was thankfully uneventful and the team were met at the Port-au-Prince airport right on time by their ever-faithfull, right-hand-man Charles, and driver Joel for the drive to friend Carolyn's house, where the team will spend the first few nights until the new living quarters at the clinic are supplied and ready. Upon arrival, the weather was pleasant, in the mid-80's and slightly cloudy. At about 7pm, just as Paul sat down at the computer to write this and post it on the website, the sky's opened up and it poured rain for several hours. When it rains in Haiti, the internet does not work...period. Wednesday morning, it is clear and bright and beautiful...and the internet is working. Greetings from Haiti!
Wednesday, May 18th: Today is Flag Day in Haiti, a National Holiday where most every business is closed in  celebration of the anniversary of the date the first purely Haitian flag was adopted, May 18, 1803, when Haiti was still fighting their revolutionary war. Tracee and Paul went out to the Dumay clini  c (only the cholera clinic was open) to check out the cholera treatment facilities and assess supply needs for housing volunteer teams there. The cholera clinic has expanded to 12 beds, the majority of which were filled today. It now consists of a tent for the patients and a second tent for the nurses and community health workers, and supplies. There is a water tank between the tents which is used to supply chlorinated water. When we arrived, 5 cholera patients had recovered, and were ready for discharge. We were able to give the children new clothing donated by "Outside-In Kids" of Santa Cruz, CA. for the children of Dumay. We will have the best dressed k  ids in Haiti  leaving our clinic over the next couple of weeks! Thanks Outside-In Kids! On the way home we stopped in Croix-des-Bouquets to purchase some great metal art for the silent Auction in Asheville, NC this fall. We had the pleasure of seeing
Serge Jolimeau
at
work in his shop. HAM has been buying art from Serge for many years and have watched as his success in the art world has grown. In fact, he has an upcoming show in Santa Fe, NM in July. Unfortunately, as his success has grown, so have the prices of his work and we are only able to afford a very few of his pieces for Art From The Heart auctions these days.
Photos: (top right) Sign for cholera clinic inside Dumay clinic listing HAM's partners; (top right) Cholera patient tent; (bottom left) Well dressed Dumay kids; (bottom right) Artist Serge at work
Thursday, May 19th: When at the Dumay clinic yesterday, we noticed a few
additions besides the new tents we  should point out. First, when we were last
here in January, there had been a  large hole dug as the waste pit so that we
could have separate latrines for the cholera area, but only the hole existed. As
you can see in the photo behind Charles and Paul, there now stand two
port-a-potties set into a cement slab poured over the hole, compliments of one
of the major NGO’s now working in Haiti. The bottoms have been cut out so the
waste falls directly into the pit, crude but effective. Another important
addition is the incinerator shown here, created to burn medical waste. We have
discovered in Haiti, simple solutions are often the best ones. We were also
pleased to find the sign at the entrance to the clinic grounds had been
completed, as  show, and windows had been added to the pharmacy so that patients
can now wait outside for their prescriptions to be filled, instead of clogging
the clinic hallways. There is even a roof over the outside area to protect
those waiting from the sun and rain. All these additions show the progress that  continues at the clinic, progress made possible by the support of our friends
in Haiti and in the U.S.
Today was one of resourcing for the volunteer quarters at
the clinic. There were many items needed to make sure our current and future
teams would be able to live at the clinic when working there. The list was long
and varied, from paint to seal the sleeping porch floor and walls, water
barrels (Charles and Joel are shown in the photo scrutinizing the selection on
the street) to support the bucket toilets and  showers should the water pump not
work (as is the current status), cleaning supplies, pots and pans for cooking,
plates and cups, and much more. We had chosen to purchase some specific types
of items in Haiti instead of the US and  bringing them down in our luggage, as
they are readily available here at competitive costs so we can support the
local economy. Shopping in Haiti
is an extremely slow process as there are no malls or major discount stores
with huge inventories, so one has to go to many different locations to find
goods. Exacerbating the issue is the horrible traffic, as it can take hours to
drive only a few miles. We started at 8am and finally returned home about
6:30pm, but thankfully we were able to find the majority of items on our list.
In the final 30 minutes, it began pouring rain as we slogged our way through
stop and go traffic, arriving home tired and soaked, but no worse for wear. As
you can see in the picture, Paul and Tracee made the most out of a dollar
poncho they shared in the back of the truck.
Friday, May 20th: After another night of torrential rainfall,
once again it was a clear and beautiful morning. Unfortunately, the internet
did not come back on after the rains last night, either at Carolyn’s or the
Dumay clinic, so  yesterday’s and today’s postings will be on line as soon as it
is working again.
Tracee and Paul headed out to the Dumay clinic early. Tracee and Dr Jacques saw patients
until 2pm. After that, Tracee and her crew of Charles and interpreter  Johnny
painted the bunk beds and the floor of the sleeping porch so it would all have
time to fully dry over the weekend. The Dumay clinic has become quite the
community center of activity with our services now including pharmacy, lab, eye
clinic, prenatal care, family planning clinic, filiriasis prophylactic program,
and of course our 24/7 cholera clinic.
There is even a moto-taxi stop just inside the clinic gates, as our
patient base seems to be expanding to the  further reaches of Dumay.
After spending his morning working on operational issues at
the clinic, Paul headed off to the airport to pick up Dr. Leslie Mihalov and
Dr. Marlie Dulaurier, the remainder of the team for this trip. While the
Port-au-Prince airport is only about 8 miles from the Dumay clinic, as the crow
flies, it took an hou r and a half to get there and another hour and a half to
get to Carolyn’s house afterwards, an even shorter distance. You can see one reason
we all look forward to moving into the new living quarters at the clinic.
Pictures: (top right) Our newest staff member, lab technician Junia; (top left) Chris, Joel and Charles taking inventory of glasses supplied by Direct Relief International; (bottom right) Moto-taxis waiting for customers at Dumy clinic; (bottom right) Patients waiting outside Dumay clinic.
Please excuse the delay in getting these posts up on the website, but we've had no internet connection until today, Tuesday, the 24th. Thank you for your understanding.
Saturday, May 21st: Our now complete team, consisting of
doctors Tracee, Leslie, and  Marlie, along with Paul, left early, with our
Haitian staff, to spend the morning at Dr. Joey’s hospital in Del Mas 33. The
doctors saw at least 75 patients by noon with a variety of ills, from basic
infections, GERD, and arthritis to a seizure patient who could be treated with
medications we had brought. One memorable procedure was a most satisfying drainage
of a large abscess on a man’s hip.
 Paul’s morning was spent in the all too familiar process of
chasing down an auto mechanic to fix a problem with the truck. This time it was
the power steering. After great scrutiny and challenging translations, we were
able to pinpoint the problem to the hose connection from the pump to the gearbox,
replacement of the gearbox being the initial recommendation. Fortunately, we
seemed to be able to fix the problem and be back at Dr. Joey’s by noon to pick
up the doctors and leave for our next appointment.
We arrived just after 1pm
at Comite Artisanal Haitien, where we purchase much of the  non-metal artwork we
sell at Art From The Heart auctions. It seems they had changed shop hours since
we were last there in January, and they close at 1 instead of 2 on Saturdays.
Fortunately, Dr.  Tracee has been such a long time patron of the shop we were
let in and able to make our purchase of some wonderful pieces for the upcoming
Art From The Heart auction in Asheville, NC this fall. Afterwards we drove a
few blocks to the historic Olofson Hotel for a late lunch meeting with Dr.
Jacques, HAM’s medical director in Haiti. We are preparing a proposal to
UNICEF, at the request of the Ministry of Health, identifying what future
disaster response capabilities HAM and the Dumay clinic could have with funding
from UNICEF. Our success with the cholera treatment program is leading us
toward further partnerships and potential programs - Another long but
satisfying day.
Pictures:(top right) Dr. Marlie and patients at Dr. Joey's; (top left) HAM truck at Haitian auto mechanics; (bottom right) Dr. Tracee seeing patient at Dr. Joey's; (bottom right) Dr. Joey with new glasses, thanks to Dr. Janine
Sunday, May 22nd: Everything is closed on Sunday's, so we decided to take our crew to Wahoo Beach for the day. A fun day in the beautiful Caribbean sea was had by all.
Monday, May 23rd: We left Carolyn's early with a load of medicine and  supplies, headed for our first full residency at the Dumay clinic. There were many, many patients waiting, and the doctors had a full day of practice. Dr, Leslie had one particular patient who was most enamored with her white skin, as pictured here. The little boy could not seem to keep his hands off her, which tickled the doctor pink. Of the many younger patients seen today, despite the various states of well being, all seemed in good spirits as demonstrated in these pictures. In the afternoon, following seeing patients, doctors Leslie and Marlie turned their efforts to more domestic matters and readied the volunteer quarters at the clinic for our first overnight  stay.
Meanwhile, after dropping the doctors and the first load off at the clinic in the morning, Paul headed back to Port-au-Prince to shuttle our friend Nate, who works with All Hands Volunteers in Leogone, from a hospital in Petionville to the airport. Nate had an unfortunate accident working in Leogone three months ago and shattered his ankle. After surgery in the U.S. and the installation of plates and screws to repair his ankle, he was released by the doctor to return the Haiti, with limited mobility. Unfortunately, after just a few weeks back here, an infection from the surgery surfaced and he was hospitalized late last week. We wish Nate a speedy and full recovery back in the U.S.
After dropping Nate at the airport, Paul picked up the remainder of the necessary supplies in Port-au-Prince and headed back to Dumay just in time to pick up Dr. Tracee and Dr. Jacques to drive to Croix des Bouquets for a meeting with the mayor. Dumay is under the jurisdiction
of the mayor of Croix des Bouquets, and HAM's long term presence in this community is dependent on the good graces of the Mayor there. It seems the mayor had sent some agents into the community to find out how the population felt about HAM's presence here. Mayor Darious was mightily impressed with the response, so he said, and he made a commitment of full support for our clinic that will hopefully surpass his tenure as mayor. He said he would do his best to help us get whatever we need!
Our first over-night at the clinic began with a torrential downpour and thunderstorm that literally shook the rafters of the sleeping porch. Fortunately, things calmed down after a few hours and everyone seemed to sleep relatively soundly. The sleeping porch has full exposure to the east, and we were all woken by a beautiful sunrise, though a bit early at 5am.
Tuesday, May 24th: Ironically, after our first over-night, we were scheduled to return to Port-au-Prince today. Doctors Leslie and Marlie spent most of the day working at Hospital Haiti Medicare, Dr. Joey's hospital. The hospital is located in an area of Port-au-Prince called Del Mas 33, and his patient base consist of those from the very poor local neighborhood, both children and adults. One 13 year old girl had cholera and was immediately admitted. A mother and daughter who had pneumonia (possible TB) were treated and told to f/up if not improving. A man was treated for a bad infection in his foot and ankle, which had been badly broken during the earthquake and initially repaired by one of the international emergency response medical teams. This is another example of the importance of the type of long term health care needs HAM is addressing with our projects in Haiti.
After dropping the other doctors off at Joey's, Dr. Tracee and Paul headed to Petionville to visit Access Haiti, the internet provider for the Dumay clinic, as we haven't had internet service there for the past week. As with most  processes in Haiti, things move slowly and after our morning visit to their offices it took the remainder of the day to actually get the service problem resolved. Thankfully we had a connection by early evening. Then it was off to meet Dr. Jacques for the weekly Health Cluster meeting near downtown Port-au-Prince, an occurrence
where all of the health sector NGO's (humanitarian Non-Governmental Organizations) meet together with the Haitian Ministry of Health to help coordinate their work. It was a long meeting in a warm room, all in French, which made it a challenge from Tracee and Paul to remain focused. However, we were updated on the cholera epidemic statistics: from October 20, 2010 to May 10, 2011 here have been 302,401 cumulative cases of cholera reported, with 162,651 hospitalizations and 5234 deaths. Unfortunately, after a drop in new cases reported in April, there has been a significant spike in the number as of the first two weeks in May, attributed to the heavy rains. The epidemic is anything but over.
Following the Cluster Meeting, we visited the main branch SogiBank to attempt to open an organization checking
account. Here we encountered one of the most frustrating aspects of the Haitian bureaucratic system. We are told we need to be officially recognized by the Plantification office to open an organizational bank account, but we need an organizational bank account to be officially registered with the government Plantification office. Just a sample of the hoops we often struggle to jump through in working in Haiti.
After the failed attempt at the bank, we picked up the other doctors and headed back to Dumay, where we enjoyed a respite from the city traffic and celebrated Paul's 56th birthday.
Pictures: (left) Waiting for the Health Cluster meeting to begin; (right) Paul with Haitian birthday cake
Wednesday, May 25: Our first full day at the clinic after a night here as we didn't have to  drive anywhere, YEAH! The doctors had a full day, seeing patients until 2pm. Dr. Leslie assisted  Dr. Jacques with a facial mass surgery and a hernia surgery, both on small children. It's so gratifying to see the clinic operating in full swing with patients seeing doctors, getting lab tests and prescriptions filled, the vaccine clinic open, and surgeries going on...and let's not forget the cholera clinic! Speaking of vaccines, a young woman showed up at the clinic last night with an eyelid laceration, which Dr. Tracee and Dr. Marlie attended to, telling the woman to return today for a tetnus vaccine from our vaccine clinic, which she did. It is most satisfying to experience firsthand how effectively the Dumay clinic seems to be meeting the needs of the community.
 While the doctors saw patients, Paul attended to some maintenance issues such as installing a replacement battery monitor so we can monitor the solar power system over the internet. Thanks once again to Keith Hare's efforts in  designing the solar collection and storage system at the clinic. Paul has also been working on the water well pump, storage and distribution system at the clinic. While we were able to use the solar system to drive the electric well pump in back in January, the pump no longer seems to be able to run off the system. Furthermore, the majority of the fixtures at the clinic are old and leaking  and even when we can fill the watertank on the clinic roof using a 220 volt generator, it is a challenge to keep from loosing all the water in the tank down the (literal and proverbial) drain. HAM will be on the lookout for someone with good plumbing skills to join a future mission and help us sort out these issues, just in case any of you know someone who might be interested in volunteering their expertise! 
The late afternoon was spent starting to clear an area outside the sleeping porch where we will start planting trees and a garden. Everyone pitched in and a real transformation has begun. Our living quarters are taking shape nicely as everyone is participating in making this our home-away-from-home in Haiti.
Pictures: (top left) Patients fill the halls of the Dumay Clinic; (top right) Child with IV in cholera clinic being bathed by parents; (middle left) Vaccine clinic; (middle right) Local children with fabulous new clothing, thanks to Outside-In Kids; (bottom left) The beginning of our new garden; (bottom right) Evening time in the sleeping porch,
while it pours rain outside.
 Thursday, May 26th: Today, Dr. Jacques had lined up a mobile clinic for us near  some tent camps between Port-au-Prince and Dumay, an area called Ti Mache Gwo Jean (little market, big John). When we arrived, Nurse Carmel was already there creating dossiers for patients ranging from newborn to the elderly. Nurse Carmel signed the patients up and took their vitals, Charles organized the patients and controlled patient flow, while Dr. Jacques, Dr. Marlie, Dr. Leslie and Dr. Tracee saw patients assisted by translators Chris and Johnny, who also helped with pharmacy duties. Dr. Marlie is Haitian-American, grew up in the Miami area, speaks Creole, and is always of great assistance with cultural translation as sometimes translating the words simply doesn't communicate the entire picture. Paul is still functioning as our driver and  helped out with the pharmacy when not running errands and attending to logistical issues. The doctors saw over 100 patients, ranging from elderly patients with diabetes and HTN to children with pneumonia and otitis media. Dr. Leslie saw a young woman with a severe corneal ulcer she had to send to an Ophthalmologist in PAP. We agreed to pay her consultation fee. Charles later called the Haitian specialist and found out she was treated and given a follow-up appointment. Dr. Leslie also treated a child with septic arthritis that began with a dog bite the young man was afraid to tell his mother about. 
We got back to Dumay mid-afternoon with the intention of working on the garden, but soon after we arrived the rain began. We changed plans, and spent a leisurely afternoon making lists of things for the living space to bring back on the next trip. Marlie and Leslie packed for their trip back home tomorrow morning.
Pictures: (top right) Patients waiting to see doctors in Ti Mache Gwo Jean; (top left) Nurse Carmel in "pharmacy", foreground, while Dr. Leslie sees patient in background; (bottom left) Dr. Jacques with elderly patient; (bottom right) Dr. Marley connecting with her patient.
Friday, May 27th:
Last night about 10pm, just as we were heading for bed, we
heard a knock on our gate. It was Remus, one of our regular clinic staff who
was working an overnight shift in the cholera clinic. He told us a nine-month
old girl had been brought into the cholera clinic and the nurses were having
difficulty helping her. Our  three doctors immediately went to the cholera tent
and found a child weighing only about 14 lbs, severely dehydrated, sunken eyes,
weak pulse with rapid and shallow breaths, in the death throws of cholera. Dr.
Leslie, a pediatric emergency doctor immediately took charge assisted by Dr.
Marlie, a pediatric emergency fellow at OSU, and Dr. Tracee. The difficulty was
that her circulatory system was shutting down and it was becoming impossible to
insert an IV line. It took about 30 minutes for Dr. Leslie to get the IV line
into her scalp, while Dr. Marlie inserted an NG tube made of IV tubing,
creative improvisation. It was an extremely tense situation with the little
girl so close to death, but thanks to our HAM medical team, the child was
revived and by this morning her improvement was astonishing. Pictured here with
her mother this morning, she is unrecognizable from the emaciated child the
doctors found last night.
Doctors Leslie and Marlie
departed for the airport and their return to Ohio about 7:30 AM. Before Dr. Tracee began seeing patients
at the clinic we experienced an important serendipitous coincidence. Wilberne
brought Dr. Tracee and envelope that was left for her some days before. It contained
a letter from Ferdinand, a health worker for the community of Demier, where HAM
funded a community health worker, latrine construction and a clean water program.
Demier is located southwest of Port-au-Prince, deep in the mountains between
Leogone and Jacmel. The clean water program was part of Gift of Water, the
large water project based next to the Bethel clinic that was a casualty of the
same unfortunate circumstancess that shut both the Bethel clinic and Gift of
Water down in 2009. Ferdinand had his letter translated into English and it was
very formal, profusely thanking Dr. Tracee and Richard Hood for all they had
done for the community of Demier. The letter also contained a plea for
assistance with clean water, as their water purification systems had begun
breaking down and supplies were unavailable to maintain them due to the closing
of the Gift of Water program. It
was a very moving letter and we have agreed to do what we can to help their
community. Developing a new clean
water program for the community of Dumay, since the demise of Gift of Water,
has become one of HAM’s top priorities, even more so with the cholera epidemic.
Not an hour after receiving the letter from Ferdinand, we had an unexpected
visited from Lamothe, the Haitian manager of Gift of Water. Since leaving the
Dumay area in 2009, Gift of Water changed their organizational structure, now being
managed out of Carmel, IN and building the purification systems in the U.S. and
shipping them to Haiti. Lamothe visited us because he wants the Dumay community
to be part of the Gift of Water program again. They are also looking for a new
location to set up a new factory to build the purification systems in Haiti
once again, and we have already begun the process of lobbying Gift of Water to
consider locating the new factory on the larger compound in Dumay adjacent to
our Clinic. We also initiated plans to
again sponsor the Demier community
in the new Gift of Water program by signing Ferdinand and his brother
Calixte for the next water technician
training session in PAP.
All of this before 9 AM on our final work day in Haiti…not
bad!
Saturday, May 28th: Dr. Tracee and Paul flew home today without incident, but we wanted to share a few other events from the day before.
 Dr Tracee saw patients in the  morning on Friday, before packing up to leave the clinic in the afternoon. One of her patients turned out to be the father of twin girls who were born premature in 2007, and she was the first doctor to see them a month after their birth. The father was so excited that Dr. Tracee recognized him and asked about the twins, after his exam he raced home to get the twins and bring them back for Dr. Tracee to see. Pictured on the left are the girls at one month with their parents, and on the right are the girls, in the foreground, with their older sister, father and Dr. Tracee. This is another example of HAM and the Dumay clinic's function in the community as the main primary health care provider in the area.
About 10 AM, the Mayor of Croix des Bouquet arrived for a tour of the Dumnay clinic, his first time there. Paul, Dr. Jacques and Charles took Mayor Darious on an extensive tour of the compound, explaining in detail all our programs. The mayor wanted to see first hand what he was told by his people he sent out to Dumay. Apparently everyone was extremely positive and supportive of HAM, and the mayor assured us he would do all within his power to support HAM with our work in Dumay, now and beyond his tenure as mayor. We also successfully solicited the mayors support in encouraging Gift of Water to base their factory next to our clinic.
 On the way back to Port-au-Prince, where we stayed the night, we drove to Double Harvest to buy some trees to plant at the clinic. Double Harvest is a horticultural non-profit based in the U.S. with the mission of working in Haiti to "start productive, profitable agricultural businesses in places where there is poverty and famine." There are now four mango trees and three avocado trees being planted around the new garden behind the volunteer quarters.
Friday was a most productive final day in Haiti, capping off a great May mission! We look forward to returning in October.
Pictured left: Dr. Tracee and Charles amongest the baby mango trees at Double Harvest.
|
May 2011 Mission
