Dr. Paul Farmer says a few words to our inaugural group of Global Health Fellows from the first ever National Conference on Social Medicine held in Port au Prince, Haiti in March 2012. After reading about his life’s work in Tracy Kidder’s Mountains Beyond Mountains and then visiting PIH’s hospitals in Cange and Mirebalais, we are hoping to meet Dr. Farmer in person before too long! He continues to be such an inspiring leader in the global health arena.

Our final full day here was filled with moments that offer us hope for the future of Haiti. We headed across the Guayamouc River to the village of Fort Resolu, a large settlement of 6,000 individuals, several who arrived in the aftermath of the earthquake to live with their extended families. At the top of a hill overlooking the expansive village stands a church, a school, and an administrative office for the village leaders. The primary school is merely a series of three open-air “rooms” protected from the elements by a flat tin roof and simple tarps as walls. 7 volunteer teachers instruct 150 students in that space.

In one of the “classrooms,” we joined a matron (traditional birth attendant) workshop organized by the village president, Mr. Joseph Ewins, and directed by very knowledgeable Midwives for Haiti’s instructor Jeannette. About 25 women and men from surrounding villages convene every Saturday morning for this series of comprehensive maternal and child health workshops. Today’s topic focused on family planning, and it was fascinating to hear some of the misconceptions held by some of the matrons. In a remote village, a matron is many times the only “skilled” birth attendant available during the common at-home birth. It was highly encouraging to witness accurate information being disseminated to these volunteer community health workers, and the power of education as intricately tied to quality healthcare delivery was as evident as ever.

Following the matron workshop, we were introduced to members of the Fort Resolu community who had been deemed recipients of the Lifesaver water filters we brought down with us. Unfortunately, a large shipment of the jerry cans has been stuck in customs for the past two months so we were unable to distribute all that we had planned. Once they clear customs, about 40 more filters will make their way to this community through a group from EVMS.

After a cold drink in the administrative office, we headed out into the village to see the water filters previously donated by EVMS in action. Each home we visited, while humble in size and material belongings, was immaculately clean and well kept. The Lifesaver jerry cans stood prominently in their homes, and they were more than willing to answer our questions regarding the water filters: How often did they use them? Had anyone in their family been sick since they started using the filter? What, if any, problems had they encountered with the filter? How many people were using the filter? When we heard that 6 individuals in this community had died from cholera within the last six months, the significance of these filters really hit home. While a more permanent system is definitely necessary to alleviate the water security issues this (and so many other) villages in Haiti face, these water filters are the perfect temporary solution in the interim as they provide immediate, point-of-source filtration.

After lunch, we headed back to Maison Fortuné to spend some more time with our new friends. Competitive games of soccer and basketball filled the afternoon before gathering for a final cross-cultural chat. Brother Mike and three of the oldest boys of the orphanage sat down to talk with us about growing up at the orphanage, their schooling experiences, and their hopes and dreams for their own futures and the future of Haiti.

Tomorrow morning, we’re planning to rise early and watch our last sunrise in Haiti together as a group. We will help out with the community English class at Maison Fortuné and then head to the airport in Port-au-Prince for our afternoon flight back to the States. Mesi anpil (“thank you very much”) for following along on our journey with us this week. The real work now begins!

 Aneesh’s Highlight of the Day: Talking to the children from the village Fort Resolu.

Brian’s Highlight of the Day: Saying our final goodbyes to the kids at the orphanage who have become our friends.

Bridget’s Highlight of the Day: Seeing the happiness on Mr. Joseph’s face when we brought all the donations for Fort Resolu.

Elizabeth’s Highlight of the Day: Distributing Lifesaver jerry cans at Fort Resolu.

Stuart’s Highlight of the Day: 1) Epic soccer game. 2) Seeing the school at Fort Resolu and learning we might be able to redesign it. 3). Getting the girls to play soccer with the boys at Maison Fortune.

Wyatt’s Highlight of the Day: Having a discussion with three Haitian kids about their school experience and comparing the differences and similarities to my own.

Today we really experienced rural Haiti for the first time. We headed out of town just half an hour to the community of Clory but it felt light years away from our reality of the past few days. Lines of cacti served as fences, keeping in livestock and demarcating pieces of property, as we strolled up to the village from the main road, lugging two Lifesaver jerry cans and two suitcases filled to the brim with donations.

The sight of a football (soccer) field always signifies a school isn’t too far away. Once we caught a glimpse of the bare field, we saw the marriage of both old and new. A mason was mixing concrete in front of the brand new school building, yet next door, unstable-looking structures built from banana leaves, bark, and wood, stood, completed the school complex. Manno, House Manager of Midwives for Haiti, and his friend, Theard, founded this rural school in Clory.  Theard, who grew up in the outskirts of Clory, had to walk two hours each way to school each day. This new school in Clory is slotted to educate 300+ students come the start of the school year in September. With the mason putting the finishing touches on the concrete porch, we filled the empty supply closet with school supplies, sporting equipment, and even two teams’ worth of soccer uniforms donated by Beach FC.

As a few people from the village gathered around, we demonstrated how and explained why to use the Lifesaver jerry cans we had brought with us. Access to clean water is a constant struggle for this rural village, and they were so appreciative of the filters. Though we could only leave two filters today, more will be coming to the community in the months to come through EVMS (and hopefully us, too!).

We walked to a hilltop lookout in the village where we had the most incredible view of the environs. Humble homes dotted the mountainous landscape and the brown water of the Guayamouc River winded around the curve below. Looking down on that water source, we were affirmed in our decision to bring the water filters to this village and were happy to have made a small difference in this community’s access to clean water.

After lunch back at the guest house, we watched a video documenting the history of Maison Fortune orphanage, started by a Haitian, Jean Louis Fortune, who graduated from Virginia Tech and returned to Haiti determined to help his people. Xaverian Brothers Mike, Harry, and Bill also help run the day-to-day life of the orphanage, which is home to about 250 children and supports 130 more through its school. About 50% of the children have lost both parents; 25% have lost one parent; 25% have parents who are unable or unfit to raise them. We spent a few hours just hanging out with the children, playing soccer, putting together puzzles, practicing English, coloring, and dancing and singing. We then joined Brother Mike in the school’s impressive library for a discussion reflecting upon our time here and the topic of healthcare in a resource-limited place. He encouraged us all to empty out our hearts, wipe clean our agendas, and approach this whole experience ready to be filled up…with some answers, with many more questions, and most importantly, with relationships with others living in different circumstances than our own.

One story of healthcare access in Haiti we heard today has really stuck with me. There is one child at the orphanage that has juvenile diabetes, and it is extremely difficult to access and afford the medication and testing equipment he needs to survive on a daily basis. Thanks to the generosity of the Diabetes Center at EVMS, we were able to carry down about 500 donated test strips so he does not have to act blindly in attempting to maintain proper insulin levels. I would say it was one of the most important deliveries we could have made this week. According to Brother Mike, he would have died long ago if he had not come to the orphanage, a community with a network in place to more easily (though still not easy!) access his life-saving medications.

This week in Haiti has served to frame and provide context for the topic of our four-year study together, social medicine. All the Global Health Fellows have written mid-week reflections that are posted on their individual webpages (click on the Fellows tab to access these pages).Please check out their initial musings on Haiti, resource-limited settings, and healthcare access and delivery!

Aneesh’s Highlight of the Day: The view from the village, Clory, which made me realize that the poverty of the Haitians distracts people from the country’s natural beauty.

Brian’s Highlight of the Day: Distributing the Lifesaver jerry cans to the people of Clory.

Bridget’s Highlight of the Day: Filling the school’s empty supply closet in Clory.

Elizabeth’s Highlight of the Day: Singing with the girls at the orphanage.

Stuart’s Highlight of the Day: Seeing the school in Clory and how much hope it offers for the village going forward.

Wyatt’s Highlight of the Day: Seeing the road from Clory to Hinche and being told that it cut down a 3-hour walk to transport the sick to a 30-minute drive.

(This post summarizes our day yesterday, August 1, 2012.)

Today, we continued to explore the spectrum of prevention, treatment, and care found here in Haiti. This morning, we walked through the dirt roads of rural Hinche, passing donkeys loaded up and heading to market, ox-drawn carts, roadside food and drink stands, and friendly, waving neighbors, to St. Therese Hospital, the local health care facility run by the Haitian government.

Carrie Wortham, the In-Country Administrative Manager for Midwives for Haiti, and two translators from MFH, provided us a tour of the facility. We weaved throughout the green and white campus and quickly made mental notes of the vast differences between this place of care and the health care facilities we are accustomed to at home in the United States. We began our tour by visiting the maternity ward where midwives trained by MFH assist in delivery on average 85 births per month. We toured the pre-op and post-op wards, the pediatric unit, and saw the HIV and TB wards off in the distance in the back of the hospital. Both Partners in Health and Midwives for Haiti have a strong presence at the hospital, most notably paying the salaries of many of the health care providers employed there.

While Carrie took us anecdotally through the day to day workings of the hospital, we were shocked to hear that families of patients have to provide and maintain all linens, bed pans, and food and water for the patient; the hospital is there only to provide the direct care. Even after a woman gives birth, the family collects the soiled linens, etc. in a bucket and carries them as they make the trek home. Many times, a woman will walk or ride a moto the more than two hours home within a few hours after giving birth. Perhaps even more shocking, at times there are no surgical gloves to be found in the hospital. Midwives for Haiti stocks their own supply room for the maternity ward so that is not an issue, but the rest of the hospital is vulnerable to supply shortages. As we made the walk back to our guest house from the hospital, conversations brewed amongst us trying to make sense of what we had just seen.

Back at the guest house, we convened for a Creole lesson conducted by Pierre Kenel, who gives private lessons to our host, Carrie. The fellows were studious pupils, taking notes and practicing pronunciations amongst themselves. I have been most impressed by the commitment of our fellows to learn the local language.

After an afternoon rain shower cooled us off, we headed to the Azil, a malnutrition center for children that is run by nuns of Mother Theresa’s Missionaries for Charity. We arrived right at feeding time, and we helped bottle feed the youngest children a nutrient-rich formula. The children at the center usually stay from 3 weeks to 2 months for treatment, and their parents are required to visit them every Monday. Many arrive at the center with severe malnutrition, stomachs bloated with fluid and worms, and hair with a blondish red tint to it, signaling lack of nutrients. We saw a variety of cases, but the most jarring was the sight of a 3 month old baby that looked like she had just been born months premature. After the older children had had their afternoon snack of mangoes and milk, they joined us in a small classroom where we brought out educational coloring books. The books, designed by Virginia Beach local Jean Mackay Vinson, tell the story of a Haitian brother and sister while teaching proper hygiene and sanitation to prevent gastrointestinal parasites. The Azil is about to celebrate its 25^th year of operations here in Hinche, and it was incredible to witness a community center devoted to free care to treat the health of the youngest.

We concluded our day’s activities by visiting Maison Fortune orphanage, where we will spend a part of each of our remaining days in Hinche. Today’s visit was merely a meet-and-greet and while the boys played a competitive game of soccer, the girls visited the girls’ home to paint nails, sing and dance, and assist in practicing their English. More on the history and mission of Maison Fortune to come…

Stimulating conversations and sharing reflections on the past few days rounded out our evening.

Aneesh’s Highlight of the Day: Playing soccer at Maison Fortune.

Brian’s Highlight of the Day: How one game of soccer can be a uniting and hopeful force.

Bridget’s Highlight of the Day: Realizing that what seem the smallest details in medicine can be the most important (e.g. the availability of gloves in a hospital).

Elizabeth’s Highlight of the Day: Hearing the girls sing at Maison Fortune.

Stuart’s Highlight of the Day: Coloring with kids at the Azil.

Wyatt’s Highlight of the Day: Feeding a baby formula for the very first time in my life.