Thursday

[This is the last post in the blog... to start at the beginning, use the navigation bar on the right to select the earliest post]

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Thursday was our final day of clinic, and this time clinic was to be held right at our camp, in Cabaret. In the morning before clinic we walked into town to explore the local market. 

 

It was a bustle of activity and stretched for many blocks. I found it interesting that there were hundreds of vendors selling nothing but plantains, melons and mangoes. The variety was limited, but the produce looked lovely.

 

Aside from the plantain, mangoes and melons, there were many vendors selling street food, knick-knacks and junk. A used "Montreal" Swiss-Army knife for sale reminded us all to keep an eye on our belongings. There were tiny little stalls selling everything from used cell phone chargers to door hinges to belts. 

Back from the market, we set up clinic again for the last time. Today, we were seeing patients from the local village and all the boys from the orphanage. Allison, one of the medical doctors on our trip, kindly allowed me to shadow her for the morning. I was delighted to be offered the opportunity to find a fetal heart rate using her portable fetal heart rate monitor (easier said than done), and look in people's ears, listen to their lungs, and palpate lumps. These are opportunities that are hard to come by in Canada, since due to strict privacy regulations non medical students can't shadow medical doctors.As always, scabies was one of the most common diagnoses. 

Tuesday & Wednesday

Both Tuesday & Wednesday's clinics were held in Saint Marc, a coastal port town 100km north of Port-au-Prince. Each day we drove back and forth each day between Saint Marc and Cabaret, by school bus, about a 1.5 hour drive. We got to see some of the Haitian country-side; a mixture of pebble-littered barren pastureland, and some mountainous treed regions.  Saint-Marc was not nearly as affected by the earthquake, however, not a single medical team had visited the town in 3 years, so we saw just as many desperate cases.

In the maps below you can see where Saint-Marc is located relative to Port-au-Prince, and the epicenter of the earthquake.

Unfortunately, Tuesday began on a very stressful note, when our school bus struck an elderly, nearly blind pedestrian who cut out in front of the bus. Fortunately for everyone involved, we happened to be a bus full of medical personnel, medical supplies, and local translators. Our team worked together to get her stabilized, with IV, and immobilized on an old door/make-shift spine board, and transported her to a local hospital (well two, since the first hospital wouldn't take her). The team paid for all her medical expenses, and by the end of the day, the news was very optimistic that she would make a full recovery. We arrived in Saint-Marc several hours late and began to set up for another full day of clinic. Understandably, many people on the team were pretty shaken up. There are very few pictures from this day, my mind wasn't really there, and once were were at the clinic, we were BUSY. This photo was taken out the bus window while we waited outside the second hospital for news, and to collect our team members who were inside assisting with the pedestrian case. 

Clinic in Saint-Marc was on the top floor of a church. You could climb up onto the room (which is where I sneaked away to for a few minutes, to nibble on my stale white bread & peanut butter sandwich). Many of us sneaked up to the roof to eat out "lunch" since it feels almost wrong to eat (no matter how basic the food) in front of people who may only get one meal that day.This is the view from the roof.

Here is one of the temporary treatment rooms:

Here is part of the clinic set up. Triage was in the left corner, registration in the center at the back, and in the front of the photo you can see benches set up for the education part of the clinic.

 

In between nutritional consultations, I spent most of my time helping out in pharmacy. I became very familiar with a lot of the drugs we carried, and their dosing. Lisinopril (for hypertension) was one of the most frequently prescribed drugs. Each time, I counted out 90 little pink pills (a 3-month supply).  Some of the drugs were purchased by the team (using the money we fund-raised), while other were donated by pharmaceutical companies.  

 

The patients I saw mostly suffered from diabetes, hypertension or malnutrition. I was very surprised to see as many of these cases as we did in Haiti. It had a lot to do with caffeine and excessive salt intake, and stress. While there were a few "interesting" cases (AIDS, tuberculosis, malaria, typhoid), most of the cases in Saint Marc were in the same spectrum as the cases we saw in Faveau. One patient came in with albinism, and her skin was very severely affected by the strong Haitian sun. She was also 4 months pregnant, and had very poor eyesight. We provided her with prenatal vitamins, sunglasses and a hat, and some medication for some of her other health issues.

By the time we had finished and packed up, we were all ready for a quiet, uneventful ride back to Cabaret. But it was not to be. Less than 100 meters away from the clinic, we somehow got wedged between a dump trunk and cement wall, in an alley, with a traffic jam building up on either side. In this picture you can see how the dump truck was right up beside the bus. The bus would inch forward a couple centimeters, and the dump truck actually moved UP (accompanied by that terrible metal-on-metal sound). Many people were yelling in Haitian, and people were honking, but no productive solution seemed to emerge for quite some time. After a while it became obvious to the dump-truck driver (and the bus driver) that we weren't getting past each other, and so we started inching backwards, but by then traffic had built up on either end and it was just one huge traffic jam. Did I mention we were in an alley with 10-foot cement walls on either side? Traffic accident number 3 (we did eventually get out of this sticky situation too). 

 

A few hours later, safe and sound back in the dorms, I found this little guy hiding under my pillow:

The following day, we returned to Saint Marc, and I managed to get some more pictures of everyday life in the town. No wonder there are so many accidents involving motorcycles. They ride 2 or 3 people on these tiny motorbikes, without helmets, and 3 bikes wide on the road! This is not just a lucky photograph, it was pretty common place.

 

Men transporting huge block of ice down the road:

And loads of wood:

A street-side motorcycle repair "shop":

 

Another example of the garbage problem in Haiti. This "canal" right in the middle of the city was completely full of garbage. 

You had to keep an eye on the little kids because there were fascinated by the pharmacy, and kept trying to sneak in.

 

They also LOVED having their photograph taken, and would beg for you to take a picture, then giggle and smile when you showed them the screen. 

Monday: Clinic in Faveau

Today we held a clinic in Faveau, a small town about 15 minutes from Cabaret.

Evelyn, giving an educational talk about hygiene to patents at the clinic

In order to provide privacy, we had sheets set up in one corner, and patients saw one of the two doctors in a make-shift "treatment room

I had two jobs; nutritional counseling, and I helped out in the pharmacy; filling prescriptions, counting pills, mixing re-hydration solutions, etc.

Each patient is given a 8 ½ x 11 sheet, double sided, at registration which accompanies that patient with them through the various “stations” of the medical clinic; registration, education, triage (nurses), and then pharmacy. Additionally, the nurses can decide that a patient needs to visit any (or a combination of) the following: a doctor, vision care (to get fitted for eye glasses), the lab (for urine tests, including pregnancy tests) or a nutritionist (myself). Because there was no nutritionist or dietitian present last week, the nurses and doctors found ways to make do (usually by providing the education themselves). So today was a bit of an adjustment. I saw 5 patients today; a tiny lady with severe type II diabetes, a lady with hypertension, two mothers whose young children were malnourished, and a lady with acid reflux disease. Some patients are closed off and seem very disinterested in nutritional support/advice (both mothers whose children were malnourished).... others seem genuinely curious and seemed very responsive to the advice (e.g. the lady with diabetes). For the most part, the patients only spoke Creole, and so we hired local translators to help us. Most of the translators were students from Port-au-Prince who stayed with us for the duration of the trip.

Photo credit: Angela Lau :)

Providing nutritional advice in a third-world country has proven to be much more challenging than I ever anticipated. For one, there seems to be very little they can change in regard to their diet, even if they wanted to. They have very little money for food, and there is very little variety available. After speaking for a while with two of our translators, I determined that the diet of the average person consists mainly of rice and beans, sometimes with fruit (mango, papaya, bananas), very rarely with vegetables (plantain, carrots), and they almost never (in some cases, never) get nuts, dairy products or meat of any kind. Sometimes they eat porridge, or cornmeal, and other starches and grains (millet, cassava) but nothing particularly nutritious. The children eat raw coffee beans because they fill them up and give them energy. They also have access to, and eat a fair bit of candy, French fries, and junk food.  

Me holding one of the 15-day old babies who came into the clinic (photo credit: Angela Lau)

In Haiti, there seems to be a bit of a social stigma against breastfeeding children; almost no children are breast-fed to 1 year (the WHO recommends 2 or even 3 years in developing countries), and some children are never breast-fed at all. This is devastating in a country like Haiti because breast-milk is the most nutritious, the healthiest, and the cheapest form of food for their babies. Not to mention that when formula is mixed with unclean drinking water, those infants are terrible vulnerable to water-borne diseases like Cholera. At the clinic today we saw two very young babies (15 days old), neither in the company of their mothers, who had never, and would never be breast-fed. One mother was so anemic after childbirth (so we were told) that she couldn’t bring the child to the clinic, so the grandmother brought it, and the other was brought in by a relative because the mother appeared to be suffering from postpartum depression and had stopped caring for the child.  Both infants were healthy and would likely be fine. We sent them home with a 3-month supply of formula.

There will be another clinic here in 3 month’s time, so all the prescriptions for long-term medications (e.g. ACE inhibitors for hypertension) are given in 3-month supplies so that the patient can get more medication when they visit the next free medical clinic in 3 months.

We saw many children with fungal infections, (whom we sent home with tubes of Loprox; a topical anti-fungal medication) and scabies (treated with sulfur paste, and antibiotics if there was a secondary infection). Both of these conditions are extremely easy to treat, but will persist indefinitely, or cause secondary complications, if left untreated.

A large amount of patients were dehydrated (given oral re-hydration solution), and there was a young baby (15 months) with Cholera. Everyone received a month’s supply of multivitamins, and worm medication (if they hadn’t received any in the past 3 months). Anyone who didn’t own a hat was given one, and many people got sunglasses and footwear too. UTI’s and yeast infections are rampant, as were headaches (a combination of no sun protection, dehydration, and stress). For very small children, we had to crush the worm medication, mix it with water, and then coax the small children to drink it, which needless to say... they didn't want to.

We saw over 260 patients that day, most of whom we were able to fully treat.

That morning, Veneta had asked me to give a talk to 8 or 9 “den mothers” (the women who care for the boys at the orphanage) at 5:00pm, about nutrition. I ended up speaking to over 120 women, of various ages, at around 6:30pm (as things tend to go in countries like this). I had spoken with one of the MD’s earlier about what I was going to say and was urged to add a tid-bit about breast-feeding into the talk, since we really wanted to encourage mothers to breast feed to at least a year, preferably longer.

When I raised the matter of breast-feeding at my chat, there was immediate mumbling, and disagreement. One women, who was visibly agitated, said that she tried to breast feed her kid,  but that it cried and cried when she tried, but when she gave it formula, it was happy. It’s hard to respond to statements like these, since she genuinely believes that breast-milk isn't good for her baby, and you don’t want to tell her she is making it up, or imagining it, but they don’t seem to be interested in heading about the benefits of breast-feeding. 

Port au Prince & Food Distribution

Today was hard to describe... an experience. Eye-opening.

Early this morning we headed into Port-au-Prince to look around before heading to our food distribution center. First we stopped at one of the main cathedrals that was completely destroyed by the earthquake.

There are meters of rubble, surrounding by partial walls, and chunks of concrete still hanging from re-bar. Children and adults run around on the piles of rubbles, and there are people begging everywhere, and workers are slowly chipping away at the structure, taking it down, to recycle the re-bar.

A spoke a little bit with some of the kids, but many of them don’t know very much French, and are shy. An elderly woman with a dislocated elbow was begging and Sydney (one of the MD’s) tried to put it back in place, but it had been dislocated since the earthquake last year, and he wasn’t going to be able to fix it without surgery. Below you can see the woman showing us her elbow, then Sydney trying to fix it.

From there we went to see the presidential palace, and the adjacent slums. The presidential palace looks almost exactly the way it did right after the earthquake, 16 months ago. I was amazed at how little seemed to have changed since the earthquake.

There are entire “tent cities” built mostly from UN and other foreign aid tarps, rubble and scrap metal and wood.

In the photo below, notice the little boy peeing in the street... I had no idea he was peeing when I took the photo!

The kids are friendly, and come out to play. They are always excited to see the cameras, and some of them seem like the happiest kids on earth despite the fact they live in a tent on the side of the street.

People are very negative about the government, and refer to the presidential palace as “the Devils House”. They explained to us that they can’t understand how they have slum cities right across from the presidential palace (which is still in ruins) and no one is helping them. A year and a half after the earthquake, they are still living under tarps.

 

Coconut water anyone? Looking back, I'm not sure I would have indulged, but at the time his little coconut-station looked pretty organized and tidy, and the coconut water was very refreshing, right from the shell! It was also relatively sanitary, since he cut the coconuts open right in front of us.

I took some photos to document the state of the city of Port-au-Prince. The rubble still litters the street and most of the building which were damaged or collapsed remain exactly as they were 16 months ago.

There does not appear to be a [functioning] system in place for dealing with garbage in Haiti. You see dumpsters, empty, with months and months of garbage piled all around them on the street. Garbage piles up among the rubble, and even just on the side of the street. 

Here, people are lined up with buckets at a clean water station in downtown Port-au-Prince.

Then we went to the food distribution center. When we got there were already crowds waiting, even though we arrived nearly an hour early. We arranged all the bags, with beans, rice, vegetable oil to last a family for 4-6 weeks, and a large bottle of water. Tickets had been handed out to families in need at the clinics last week, and we were expecting 500 families. 

The food distribution was taking place inside of a locked compound, and even though we could control the flow of people into and out of the distribution center things got very chaotic and stressful; people would try to sneak back in to get “seconds”. 

There were far more people waiting outside that we had food supplies for, and we quickly ran out of water, then out of oil. Initially we were also putting the rations in reusable shopping bags (like Lulu lemon, and Walmart ones), but those ran out quickly, so we started using pillow cases, then rice bags, then finally shopping bags, and boxes, and once those ran out we just had to hand people the bags of rice and beans. Once we ran out of oil, people started getting upset, because they were told they would be getting oil. Even though we only handed out tickets for as many food rations as we had, somehow we ended up with 45 people in the compound (many more still outside waiting to get in), and only 15 bags left, so we opened up all the bags and divided the rice and beans into 3 parts, but then people were frustrated that they didn’t get a full ration. It was stressful because you are trying to do a great thing, and yet you feel guilty because there are families of hungry people who have been standing in line, in 35+ degree weather, for hours, and you don’t have food to give them. 

Myself, and a number of other people in the group even handed out our sandwiches and pop that we had for lunch because at least we’d breakfast that day, and we felt guilty eating when we knew how badly these people needed food. Some people were very grateful and thanked you very sincerely when you gave them their rations, but I was amazed at how some people look at you, know you have a lot you could give, and glare at you because all you are giving them is rice and beans. It’s a bizarre feeling. But in reality, the majority were thrilled to get the rations, and was these people I will try to focus on. 

After the food distribution we stopped at the mass grave on the way home; it is now covered up, and decorated with many little black wooden crosses, but after the earthquake it was a massive open pit where the put all the unclaimed bodies from the streets of Port-au-Prince. There are somewhere between 250,000 and 300,000 people in the grave. 

 

A lot of the crosses had fallen over, and so we stood them back up and pounded them back into the ground, out of respect. We discovered a lot of black widow spiders on the crosses, which was eerie. 

On the way back to our camp at Cabaret, there was a major accident on the highway between a motorcycle (carrying 3 people) and a a "Tap-tap" (a popular method of local transportation; a pick-up truck, with wooden-crate type back, carrying lots of people, without seat belts). We were one of the very first vehicles on the scene following the accident, and in Haiti they don’t have the services in place to deal with accidents like that properly, even though they happen all the time, and so there were mangled bodies all over the road, and no traffic control and no one had covered up the bodies. It was shocking, to say the least, and difficult to talk about. Many people on our team pretty shaken up from this, and everything else that had happened during the day. We had a quiet night back at camp, and prepared for another day of clinic.