|
Letter from Tracee about the June 2004 trip.
I went to Haiti with no medical team for the first time, and an agenda
that consisted of more fact finding and organizing than hands on patient
care. Being free of the concerns of an entire medical team and of a
fast-paced clinic, I was able to take the time to talk to our Haitian
clinic staff, and travel to other clinics and hospitals to learn more
about how they deliver patient care.
We are almost ready to start HIV treatment in Dumay. The recent coup in
Haiti set plans back a little, but we are once again on track. Nathan
Dieudonne and I took Seurette and Wesner, our first 2 accompagnateurs,
community health workers being trained for the HIV treatment program, to
Darbonne. The St. Croix Episcopal Hospital program in Darbonne trains
Haitians from all over the country to deliver basic health care and
education, in a 3 month program. While Nathan and I were in the area, we
toured the St. Croix Hospital in Leogane. It is a full service hospital
that cares for patients on a sliding fee scale. They welcome volunteers
from the USA. The grounds include a school, and sleeping quarters for
volunteers. The CDC maintains offices in the hospital.
I wanted to observe the very successful HIV treatment program currently
in Zanmi Lasante, Cange before beginning our own program. With the help
of Loune Viaud and others working for Partners in Health and Zanmi
Lasante, I made the long arduous trip to Zanmi Lasante. The distance,
which is probably about 20 miles from our Dumay Clinic “as the crow
flies” takes 3 ½ hours by truck. It curves over steep, rocky mountains
and through muddy creeks, on roads with potholes the size of our truck.
I was extremely nauseous the entire trip, while the Haitians I rode with
took it all in stride. On the road, we passed the dam that forced the
people of Cange off their fertile land and onto the rocky hillsides. Mud
and stick 10x15 foot homes dot the roadside. I have a great deal of
respect for all these people who find a way to survive day to day with
so few resources. How do they find enough to eat every day?
Zanmi Lasante is an oasis, a walled village with schools, a sewing
center, a cafeteria, an Episcopal church, living quarters, and most
importantly the Hospital with surgery, internal medicine and pediatric
floors, an infectious disease center, eye center, and women’s health
center. On arriving, I met a team working on improving agriculture in
the outlying community. There are also smaller Zanmi Lasante clinics in
the surrounding area, and other projects involving health, education,
environmental, and economic development. I had the privilege of a guided
tour of the facility by Dr. Evan Lyon, an internal medicine resident
from Boston who is doing ½ of his residency in Haiti. I met many of the
doctors and nurses on staff, and found the answers to most of my
questions about the HIV treatment program. After that, I met Frennel and
Jacob, brotherswho work as accompagnateurs, delivering HIV and TB meds
to Zanmi Lasante patients 2-3 times a day. They graciously agreed to
take me on their mid-day rounds, a 2 hr walk (probably 1 hour without
me) up and down the mountainside to 6 homes where people who are being
treated for AIDS and TB live. The homes we visited were the same 10x15
foot homes we passed on the way to Cange. Jacob and Frennel find their
patients, help them pour a glass of water, place the medications in
their hand, and watch them swallow pills. Most of their patients need to
take medications twice a day, but one who is either resistant to first
line HIV drugs, or cannot tolerate the side effects requires 3 doses
each day. I could not ask a lot of questions, because they spoke no
English, and I spoke very little Creole.
They kept asking me if I was hot and needed to rest, because I was
drenched in sweat and out of breath. I drank 2 liters of water during
this trek, while Jacob and Frennel drank nothing and appeared rested. I
needed a 2 hour nap, and they do this 3 times a day.
I am amazed by what is being accomplished in Cange.
The Dumay Clinic, a priority of this trip was to come up with the best
system for keeping the pharmacy stocked and the lab equipped. We
obtained a price list from a medical wholesale supplier in PAP, and
discussed the needs with the clinic staff. On comparing prices, it is
clear that in spite of difficulties and costs of getting drugs through
customs in Haiti, there is a huge cost benefit when drugs are ordered
through the International Dispensary Association in the Netherlands. Due
to delays in orders and immediate unforeseen needs, we will still
purchase some medications in Haiti.
The Dumay clinic lab is better equipped and organized. As usual, we
identified more needs. We hired a lab technician, and made a list of
supplies not found in Haiti, to purchase in the USA.
Doctors Romain and Jean Louis (clinic general practitioners) were given
the latest World Health Organization resources on HIV treatment in
resource limited settings. We discussed their concerns, including the
need for more public education on HIV/AIDS. A pamphlet was produced with
basic information. The doctors agreed to hold community informational
meetings in the next few months. When Seurette and Wesner complete their
training program, one of their responsibilities will be community
education.
We hope to offer family planning services in the Dumay Clinic. Dr.
Serant (OB/Gyn.) will offer oral contraceptives, Depo-provera shots, and
possibly tubal ligations. We still need to figure out the best way to
purchase the depo shots, and we need to purchase some surgical
instruments before the surgeries can be done.
Dr. Flood sent medications needed to start glaucoma treatment, and
glasses needed by some of her Dumay patients. I saw the glaucoma
patients Dr. Flood had identified in January, and started them on
medication. Dr. Hudicourt (ophthalmologist) agreed to work one day per
month in the Dumay clinic and to do one to two cataract surgeries per
month on the patients identified in the eye clinic.
I was able to discuss with our current Dumay clinic community health
worker, what is offered in Dumay through government health programs. She
holds bimonthly maternal/infant clinics, where she distributes vitamins
to pregnant women, monitors infant weights, and offers health and
nutrition education. Teams come to the clinic monthly to administer
childhood vaccines.
To manage the ever expanding staff and improve record keeping, it became
clear that we need to hire a clinic administrator. Nathan is working to
find the right person for the job. Also, the entire Dumay complex
(school, water filtration factory, church, and clinic) is going to be
connected via computers to each other and to the internet, improving
both communication and record keeping.
The Dumay school is planning to add a teacher’s conference room at the
same time Healing Art Missions is planning to donate the materials
needed to set up a formal library. Ms. Kay Bork (librarian and former
high school French teacher) is organizing this project. The teacher’s
conference room will be a great location for the new library. One wall
will be fitted with shelves to house the books. Donations of books in
French are needed, esp. a set of encyclopedias.
In the zone of Demier, where our clean water program is located, the
first latrine has been completed. We hope to build at least 10 new
latrines in the area where 4 poorly constructed latrines were previously
available to a population of 400. Paster Sauveur, who is in charge of
the project, was given the funds to build 2 more latrines. We also
purchased 70 more water filtration systems needed for the zone. The
clean water program has greatly reduced infant/childhood mortality in
the zone. |
