Monthly Archives: July 2012

Experiencing the ripple effect of one great leader in global health

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Today’s post comes to us from GHF Elizabeth Lilly.

Great job recounting our day, Elizabeth! Enjoy!

Today I feel that we were able to experience firsthand the past, the present, and the future of health care in Haiti. We began our day with the future: a sparkling new training hospital in Mirebalais. We were met there by Suzy, the Operations Manager of the Mirebalais Hospital project, who gave us a tour of the extensive premises. She explained that the hospital would place a heavy emphasis on women’s health, and that the official opening date was yet to be determined due to the complex nature of such a venture. As we walked through the clean, white corridors, all of us were not only struck by the size of the hospital, but excited for the people in this area who would soon have access to such extraordinary care. In nearly every room we went into, a combination of UV lights, open windows, and fans created a system of constant ventilation and sanitation. Plenty of space was provided around each bed to fit both doctors and residents/trainees. At each bed station were plug-ins for vital medical gases, and the seamless design of the floors allowed them to be cleaned easily and quickly.

One particularly vibrant aspect of the hospital’s beauty was an extensive collection of mosaics. Scattered throughout the hospital (and most prominent in the pediatric ward), the artwork will serve as a bright spot in a place which by its very nature will see suffering in the coming years. The hospital will offer nearly every kind of care imaginable; for the first time in our trip, we saw dental exam rooms on the second floor. There were even (Granddad, I’m sure you’ll appreciate this) a few endoscopy suites!

We headed up to the roof to see the large collection of solar panels which will power the entire hospital during the day. PIH is looking into a solar battery, which will allow the excess energy created during the day to be used at night. Suzy also explained that PIH and the city of Mirebalais are working to use some of that excess energy to power sections of the local grid.

The Zanmi Lasante hospital in Cange, I think, accounted for both the past and the present of Haitian healthcare. We were somewhat familiar with the history of the place, based on our reading in Mountains Beyond Mountains. Upon our arrival, all of us uttered some variant of the words “This is not what I expected.” The hospital sat atop a verdant hill rather than the desert most of us had been anticipating. But it wasn’t just a hospital. As our van rolled into the parking lot, we were met by the strains of violin music from nearly every direction. To our left, a group of young children with violins formed a semicircle around an enthusiastic instructor. Others, their feet dangling off the thick stone walls, played by themselves without music. On our tour, led by Katharine Mathews, we learned that all of this was a result of a wildly popular summer music camp that drew to Cange hundreds of children from across Haiti and even Florida.

Our tour continued as we offered a greeting of “bonswa” to nearly everyone we encountered. The layout of the hospital made quite apparent its organic growth; its winding staircases and clustered buildings suggested that it had grown from the inside out since its founding in 1987. We were able to peek inside a few maternal and pediatric wards. Katharine, the Oncology Program Coordinator, was particularly enthusiastic about a new building which would house chemotherapy patients. As someone who perhaps sees a future for herself in oncology, I asked which the most common cancer among their patients was. She gave her answer without an ounce of hesitation: breast cancer. She also cited cervical cancer as common, further cementing the already prevalent notion that women’s health is a monumental concern in Haiti.

In front of the original clinic building run by Dr. Paul Farmer in Cange.

Our official tour concluded at a small shop on campus run by sewing extraordinaire Jackie Williams. Her store sold all sorts of beautiful handmade goods; dolls, paintings, and wooden figurines covered the shelves.  Dr. Sara Mansbach of Partners in Literacy Haiti later led us to the library, which housed books in Creole, French, and English.

With the artist, Jemson, of their purchased paintings.

After a quick look at the library, we were invited to eat lunch at the Zanmi Lasante staff cafeteria. We ate on an outside porch that provided breathtaking (I mean that quite literally) views of the mountains and, far on the horizon, the Dominican Republic. Afterward, we hopped back in the van and drove on to Hinche, where we got settled in our (pink!) Midwives for Haiti guesthouse. As we prepare for our first night without air conditioning, we are all looking forward to a new, considerably more rural view of Haiti.

Aneesh’s Highlight of the Day: Touring the Mirebalais hospital, a medical oasis surrounded by poverty and poor healthcare.

Brian’s Highlight of the Day: Speaking and learning Creole with the ladies at Midwives for Haiti.

Bridget’s Highlight of the Day: 1) The car rides. 2) Visiting the amazing new hospital in Mirebalais.

Elizabeth’s Highlight of the Day: Seeing Suzy’s face light up with excitement as she talked about the incredible new hospital in Mirebalais.

Stuart’s Highlight of the Day: Enjoying the music from the music camp at Zanmi Lasante.

Wyatt’s Highlight of the Day: Trying to speak in Creole with the cooks here at Midwives for Haiti.

Witnessing social medicine in Haiti

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One sentence sums up today. “I have never, ever seen this before.” Spoken by Wyatt as we walked through one of the most impoverished communities I have ever visited.

We spent the greater part of the morning preparing for our visit to Medan Bélize, a community of 340 individuals settled on the arid banks of stunning Lake Azuéi, the second largest lake in Hispaniola. We helped to make 350+ food packets, consisting of peanut butter sandwiches and hard-boiled eggs, to distribute in Medan Bélize as part of an upcoming and sustained school feeding project slotted to begin in September.

Dorothy Louis, of OBI, prepped us for our visit by describing the demographics (25% under the age of 5) and terrain (arid land and brackish water = absolutely no drinking water) but we were all shocked when we saw it with our own eyes. A huge, beautiful blue lake right out in front of you, and there is no water to drink. As we made our way down the road to the village, we saw several individuals on their way to collect water by foot or by hired motorcycle. Upon arrival, we met the community leader, Profit, divided into two groups and traveled from household to household to distribute the food. The houses were tiny structures built from straw, mud, tin, and tarp. Many people were at market for the day or out fishing on the lake, but the people we met, especially the children, were so friendly and appreciative. We brought some sporting equipment and stuffed animals with us to give to the children, and we thoroughly enjoyed playing with them before we left (especially a competitive game of soccer!).

The protein-rich food we distributed is obviously just a start, and it was exciting to hear the plans in store in the near future for this community. OBI and the Clinton Foundation will be expanding the local school to include more grade levels (including hiring teachers), will sustain a 5 times/week school feeding program, and will continue to investigate water and food security issues. In addition to distributing food, we had planned to distribute water, as well. OBI’s water truck (pictured in yesterday’s blog post) had a few mechanical issues en route to the village today but made it out there after our departure.

We headed back into town and stopped to tour St. Luc’s and St. Damien’s hospitals, just right around the corner from OBI’s guest house where we’re staying. The story behind these two hospitals, like much of what we are seeing here, is an incredible testament to the power of one person to make a difference. St. Damien’s, founded by Father Rick Frechette, is the premier pediatric facility in the country and provides all services free of charge. We enjoyed touring the impressive facility colored by statues of wild animals in the green courtyards and a beautiful chapel where daily services are held. It was exciting to hear of a residency program through CHKD to be held at St. Damien’s and to see the facility in person where Dr. Hanson and her team hold their ultrasound trainings.

 

St. Luc’s is the adult hospital that emerged in the aftermath of the earthquake out of sheer need. What once was a field of medical tents is now a collection of semi-permanent buildings that house an emergency room, a cholera ward, an ICU, and a soon-to-open surgical unit. Teams from the Mayo Clinic come down frequently to train, teach, and collaborate with the staff of St. Luc’s, and when they are not present in person, they converse about cases via Skype. It was quite an eye-opening experience for our team to witness for the first time formalized healthcare delivery in a resource-limited place.

In my opinion, the best part of each day is the downtime between activities when there’s a chance to digest what we just saw and ask endless questions to our knowledgeable hosts. During our car rides today, our conversations included the role of international NGOs in a context such as Haiti, the varying ways you can work to affect change either on the ground or from a diplomacy/policy standpoint, the state of the economy (both formal and informal) here in Haiti, natural disaster relief, the United Nations system, and how to make difficult decisions (e.g. choose to treat one patient over another) when resources are limited.

Tomorrow, we head to Hinche with stops in Mirebalais and Cange en route to tour the Partners in Health hospitals we’ve read so much about in Mountains Beyond Mountains and Haiti after the Earthquake.

A quick note: I know a picture is a worth a thousand words. Fortunately and unfortunately, during some of our experiences, it is inappropriate or distracting to have a camera out. It allows us to fully absorb the moment we’re in but it makes documentation of our experiences a challenge. I hope this at least offers a glimpse into what we’re up to here.

 

Aneesh’s Highlight of the Day: Noticing how even the poorest kids in the world can also be the happiest.

Brian’s Highlight of the Day: Realizing how out of shape I am while playing a competitive soccer match against the kids of Medan Belize.

Bridget’s Highlight of the Day: Giving back by making and distributing the food packets in Medan Belize.

Elizabeth’s Highlight of the Day: When smiles of joy lit up a desert wasteland in Medan Belize.

Stuart’s Highlights of the Day: 1) Interacting with and providing food for the kids and families at Medan Belize. 2) Car ride conversations.

Wyatt’s Highlight of the Day: Connecting with the kids in Medan Belize while playing soccer with them.

Haiti Day One: “The Day that Felt Like a Week”

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On the way home from today’s last activity, Stuart exclaimed, “this day has felt like a week!” and I know every member of our team would agree. Our day began early in Miami with a 4:00 AM wake-up call and a 6:55 AM flight to Port-au-Prince. A quick two hour flight later, we were descending into the capital city with amazing views of the “mountains beyond mountains” in the distance and the sprawling ‘burbs of P-au-P. We navigated the airport with ease (and none of our bags went missing!) and met our Operation Blessing, International (OBI) hosts, Crawford and Dorothy, outside the terminal in a “mass of humanity” as Scott Fowler called it. We zigzagged through the city, passing roadside stands of artisan wares, piles of used tires for sale, telephone recharge stations, even horses and cows, on our way to OBI’s RELAX guest house.
After unpacking in our comfortable air-conditioned rooms, we watched the short film featuring the creation of the Sun City Picture House. I encourage you to check out the film which tells a very inspiring story of a group of individuals that designed, built, and decorated a movie theater post-earthquake in the middle of a tent city. We headed to the scene of the crime after our film viewing to see the tent city’s Picture House in person and to visit a water chlorination and distribution system. The site of tent after tent after tent, made from USAID tarp, made the reality of life post-earthquake accessible and overwhelming. Two and half years after the earthquake, it is estimated that around 500,000 individuals are still living in these tent cities, with each tent housing an average of 5-10 people.

After lunch back at the guest house, we headed to Zanmi Beni, the disabled children’s home that is a joint effort of Operation Blessing and Partners in Health. We were met by Frankie Lucien, the Haiti Education Coordinator for Partners in Health, and she and Crawford of OBI offered us a joint tour of the facility. This home serves as an oasis for these children, offering dignified housing, care, and physical and art therapy. Zanmi Beni’s grounds are also home to a tilapia fish farm project which is marked to contribute to communities nutritionally and economically in the short and long term. Our visit to Zanmi Beni concluded with a very interactive and informative talk with Frankie Lucien of Partners in Health and her colleagues from Rwanda, Peter and Alice, who had just come from the International AIDS Conference in D.C. Frankie took us through the history of PIH and explained the reasoning and background of PIH’s mission to always offer a preferential option for the poor. We discussed the accompaniment model of using community health workers for prevention, education, and treatment previously thought impossible. We ended our conversation by discussing medicine versus social medicine, and I think everyone left the room feeling even more jazzed about our four years together to continue these thought-provoking exchanges.

After saying goodbye to the precocious kids at Zanmi Beni, we headed to the baseball field. In the week leading up to our trip, I asked our fellows to watch the short film “Baseball in the Time of Cholera” to gain a deeper understanding of the cholera outbreak that struck Haiti last year. Visiting the place and people featured in the film was exciting enough, but then our group took to the field and played some ball. Coach Fowler was in heaven! Definitely an incredible ending to “the day that felt like a week.”

After a delicious dinner (including homemade cookies and ice cream!), more conversations, and some journaling, we’re hitting the hay to prepare for another “week” tomorrow.

Aneesh’s Highlight of the Day: Playing baseball with the Haitian kids.

Brian’s Highlight of the Day: Interacting with the Haitian kids playing baseball.

Bridget’s Highlight of the Day: Playing with the kids at Zanmi Beni; meeting all the great kids at baseball.

Elizabeth’s Highlight of the Day: When a dirt patch in Haiti became Yankee stadium.

Stuart’s Highlight of the Day: Baseball and meeting Joseph.

Wyatt’s Highlight of the Day: Discussing the main goals of PIH with Frankie, Peter, Nadish, and Alice.

Global Health Fellows Head to Haiti!

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The inaugural cohort of Global Health Fellows (GHF) officially commenced their four-year exploration of global health today! Our group of six fellows, Ms. Massey, and Mr. Fowler convened for a few hours on the Norfolk Academy campus for a mini global health “boot camp” before embarking on our week-long excursion to Haiti.

We began the afternoon with the arduous task of packing all of our supplies and donations. About an hour and several weigh-ins later, we had successfully squeezed all of our personal belongings and donations into twelve 50-lb suitcases. That might sound like excessive baggage for just a week-long trip, but we are carrying a variety of donations with us for the organizations and people we will be working with this week. These donations range from Lifesaver water filtration jerry cans to bathroom scales for a nutritional campaign to school supplies to diabetes test strips to sports equipment to clothing. Shipping or mailing supplies to Haiti is often hit-or-miss (most likely a miss) and so nonprofit organizations and individuals living in-country typically rely on volunteers and travelers to carry down supplies for them. More information on all of these supplies and why we are bringing them to come…

After our packing extravaganza, Dr. Ed Lilly, the grandfather of GHF Elizabeth Lilly, presented an informative lesson on Haitian history, its modern day challenges and values, and provided personal examples of the collaborative learning and training he experienced while working in-country several times since 1990 through Physicians for Peace. He shared anecdotes and statistics that illustrated the reality that the developing world endures 90% of the global burden of disease with only 10% of the medical resources. He shared with us the well-known adage: “Give a man a fish and he will eat for a day; teach a man to fish and he will eat for a lifetime.” We will carry this notion of sustainability with us in the days to come as are introduced to various development projects in both urban and rural Haiti. We will strive to critically consider and evaluate different models of public health interventions during this next week.

Following Dr. Lilly’s presentation, Dr. Lisbet Hanson and Dr. John Kenerson, parents of NA alums Rose and Mike Kenerson, addressed our group. Drs. Hanson and Kenerson have been the single (or double) most instrumental force in helping to craft this first GHF experience in Haiti. Both practicing physicians in the Hampton Roads area, they have devoted much of their professional life to developing health training and delivery models abroad, most notably in Haiti. They have been involved in global health in a myriad of ways and their knowledge and expertise has proven invaluable to us.

Dr. Hanson started off with a brief Creole lesson to help us converse while in Ayiti (Creole for Haiti). She set the stage for the sights and sounds we will be experiencing, from the tap taps (public transportation) to the artisan wares to the infrastructure to the mountains beyond mountains to the singing and dancing. She outlined the variety of projects they have been involved with in Baptiste, near the Dominican border, ranging from blood pressure screenings to traditional birth attendant training to anti-parasite programs to ultrasound training. One sentence really stuck out to me: “In 25 years as an ob-gyn in Virginia Beach, I’ve never lost a mother. Within a few days of being in Haiti, we lost a patient. The sole difference in the two scenarios is access to resources.”

Dr. Hanson and Dr. Kenerson left us with the charge to keep our eyes open this next week. At times, the poverty and lack of resource can be overwhelming, but we do not want to miss the beauty of Haiti and the inspiring individuals we will meet. Dr. Hanson encouraged us not to judge but to absorb the experience. Dr. Kenerson predicted we will be “humbled by the enormity” of what we see and experience.

Thank you to Dr. Lilly, Dr. Hanson, and Dr. Kenerson for setting the stage of what is sure to be an exciting and fulfilling week! Thank you to Mr. Wetmore and Mr. Manning for seeing us off. Many thanks to others who have been active in developing this experience: Jon Gellman and Dr. Terri Babineau of Eastern Virginia Medical School; Angela Cruciano and Crawford Nelson of Operation Blessing, International; Nadene Brunk of Midwives for Haiti. We are most grateful for your guidance and support throughout the planning process.

GHFs with Dr. Ed Lilly

Overnight in Miami tonight, and on four hours of sleep, we’ll be flying to Port-au-Prince in the morning!

A quick note: In retrospect, today’s “boot camp” of sorts really began months ago. During final exam week, the GHFs convened for a discussion with Richard Vander Burg, the Vice President of Humanitarian Affairs for Lifesaver, the organization that makes the water filters we will be distributing this week. Hailing from Australia, Richard has an impressive background in global health. Before joining Lifesaver, he worked for Project HOPE and then Operation Smile as their Chief Strategic Officer for several years. Richard guided us through the history of global health within a public health framework and introduced us to the ideas of health inequity, monitoring and evaluation, and the drivers of mortality and morbidity in developing countries. He charged the fellows to become familiar with using common public health jargon: “force multiplier vs. vertically isolated intervention” and “daly: disability adjusted life years.” He challenged our team to think critically when analyzing the health interventions and “best practices” we encounter. We look forward to reflecting upon our week in Haiti with Richard, a clear global health guru, upon our return.

Highlight of day: That this day is finally here!!