Over the past few months, the Global Health Fellows, Class of 2016, have led one another in analyzing case studies exploring successful public health interventions across the globe.

Ms. Massey kicked off the presentations with a look at Preventing HIV/AIDS and Sexually Transmitted Infections in Thailand. Elizabeth Lilly ’16 reflected, “Previously I’d felt a little uncomfortable with the topic of HIV/AIDS. It’s such a huge issue in the global health arena, but I didn’t know anything about it before Ms. Massey presented. I was so glad that I learned about it so fully. As for Thailand’s approach to the problem, it was fascinating to see how a huge media push could produce such booming and widespread results. It’s a personal topic, obviously, but keeping it in the shadows is only going to make the situation worse.”

Elizabeth Lilly ’16 presented a thorough look at a few women’s health issues before leading the cohort in a fascinating discussion about Reducing fertility in Bangladesh.

Wyatt Miller ’16 led a discussion on Controlling Chagas Disease in the Southern Cone of South America. Stuart Luter ’16 reflected, “ I thought that it was interesting to read and discuss a case study that deals with prevention versus treatment. It was interesting to see how effective prevention can really be, and how essential it is to prevent a disease especially when it can’t be treated.  The most interesting part of the case study was the way in which the countries came together to solve a health crisis. Relationships between countries play a huge factor in health, and it was interesting to observe the parallel between International Relations and Global Health.”

Stuart Luter ’16 taught the cohort about Controlling onchocerciasis in sub-Saharan Africa. Elizabeth Lilly ’16 reflected, “It was interesting once again to learn about an exotic disease with which I was not familiar in the slightest. The multinational approach to combating the problem was something we’d seen in Wyatt’s case study on Chagas disease, and in the case of the OCP it merely reinforced something we’ve been learning for a while: that to truly make global change, countries must work together. Merck’s distribution of Mectizan is incredibly inspiring to me – here is a company with a vision to change the world, and they live up to their promise.” Wyatt Miller ’16 adds, “Before Stuart led this case study, I had no clue that blindness due to this disease was such a problem in Africa. I think that the success of the program has greatly to do with the enormous amount of countries that it included and also the fact that the company Merck was kind enough to donate meds “to anyone who needed it, for as long as it was needed”. Large health interventions that encompass many countries seem to be more successful than smaller health interventions because the countries involved pressure each other to continue to participate. Also the fact that Merck was willing to donate so many meds was incredibly helpful. The tech breakthrough of discovering Mectizan and then the distribution of this drug to Africa averted many cases of blindness and many losses of DALYs.”

Bridget Dickinson ’16 led the group in exploring Treating Cataracts in India. Elizabeth Lilly ’16 commented, “This was one of the first diseases/health concerns that we’ve studied which is also seen stateside; of course, here, we don’t really see cataracts that often since they are surgically removed so quickly after they arise. What I found particularly fascinating about this case study is the Aravind Eye Hospital, and Dr. Venkataswamy‘s “franchise” approach. He does have a point: if one can buy the same quality burger from the same quality establishment from nearly any McDonald’s in the world (and there are many), why can the same not be true for adequate eye care? The hospital’s approach of asking those who can pay to provide for others’ surgeries seems to be working well, especially since the cost of a single surgery is a mere $10.”

Brian Peccie ’16 taught the group about the highly contagious respiratory disease, measles, and looked at Eliminating Measles in Southern Africa. Wyatt Miller ’16 commented, “Brian’s case study on measles taught me a lot about the harmful and fatal effects of measles on children. What is most appalling about these deaths is that with a vaccine and a booster shot basically all of these deaths can be averted. Seven countries in Sub-Saharan Africa proved their ability to fight this disease after introducing a program which provided vaccines to children. This program caused an almost 100% drop in cases of measles and a 100% drop in death from measles. I believe that the huge success is due to the innovative ‘Catch Up, Keep Up, Follow Up’ program. This program made sure that all the countries not only caught up to the others in its distribution of vaccines but also continued to distribute them. The fact that there is a successful vaccine that can prevent children from getting measles also makes it much easier to fight the disease. Therefore the effective program along with the distribution of vaccines to southern Africa led to the enormous drop in measles cases and deaths.”

Aneesh Dhawan ’16 explained the infectious disease tuberculosis to his peers and directed a look at Controlling Tuberculosis in China.

The Global Health Fellows ’16 were fortunate to spend a Sunday afternoon with Dr. Lisbet Hanson, who led the group through a Harvard Medical School case study, “Treating Malnutrition in Haiti with Read-to-Use Therapeutic Foods.” The group enjoyed returning to the context of Haiti and working again with the always inspiring and engaging Dr. Hanson.

On January 16, the Global Health Fellows, International Relations Fellows, and Norfolk Academy students, who will be participating on our first exchange experience to China this upcoming summer, were invited to attend a presentation by Caryn Cobb (Norfolk Academy Class of 2011, Brown University Class of 2015, Brown Medical School Class of 2019) on Traditional Chinese Medicine. Caryn, a student in the Program for Liberal Medical Education at Brown, spent part of her 2012 summer at Zheighang University School of Medicine in Hangzhou, China. She educated us on the practices of acupuncture, cupping, and herbal medicine, while also offering insight into the beliefs supporting these practices, such as the ying/yang balance and the chi channels of the body. She shared anecdotes that offered glimpses into Chinese culture – food, language, public transportation adventures. For a more in-depth synopsis of her experience, visit her “Summer 2012 Recap” entry on the PMLE blog.

Some Reflections on Caryn’s Presentation:

Thomas Ferguson, International Relations Fellow ’16: I think that Caryn’s presentation throws China’s domestic position into sharp relief. It shows a society that is attempting to modernize, but still has its roots deep into the past. From an international perspective, this tells us the China is willing to embrace new practices, but not at the expense of losing its heritage.

Wyatt Miller, GHF ’16: I really enjoyed the presentation and I think its interesting learning about another culture’s views. I learned that Traditional Chinese Medicine is based on the flow of your Qi and the balance of Yin and Yang throughout the body. Health is a result of your body’s balance of Yin and Yang and the flow of your Qi. Though many of their ideas are intriguing, it seems like many of them are not based quite as much on science as western medicine. Therefore, I believe that if Traditional Chinese Medicine wants to have staying power alongside Western medicine, it would have to prove scientifically that it works. It seems to me that its most successful results come from reducing certain pains; that positive result perhaps could be more psychological than physiological.

Jessica Williams, International Relations Fellow ’16: Listening to Ms. Cobb speak about East Asian tradition and medicine gave me a better understanding of how different the culture in China is compared to Western ideals and medicine. I was most interested in how older traditions are still being kept alive in a modernizing world. I feel as if every culture can relate to losing ancient or even just newly historical methods of living. Ms. Cobb mentioned that most of the Eastern medical patients were from an older population, suggesting a recent generational shift away from older methods. Overall, I believe that traditional Eastern medicine has some natural cures and will stay. International cultures are constantly being influenced and changing but traditions seem to stay ingrained in society.

Elizabeth Lilly, GHF ’16: I thought that Caryn’s presentation was fascinating! As she said, it’s always interesting to learn about how different cultures view the human body and how it functions. It’s easy for us as Westerners to be “grossed out” by some of the more unconventional aspects of Chinese medicine (eating insects and anteater skin, for example), but Caryn reminded us that it’s extremely important, especially in this field of study, to keep an open mind in order to understand the patients’ beliefs and ultimately be more compassionate toward them. Without a cultural education, even the most innovative and intelligent Western-educated man in the world would not be able to solve some of the globe’s greatest problems.

The Operation Blessing, International Peru staff piloted the Global Health Fellows’ sanitaiton curriculum in Lima before the holidays. Once the academic year in Peru begins in March, the staff will visit the schools in Iquitos to run the workshops and distribute the handwashing stations. Check out these awesome photos from the pilot workshop in Lima to see the fellows’ ideas and creation in action!

The first cohort of Global Health Fellows has had quite a busy and productive first semester of their four-year experience. A few highlights, in chronological order:

September:

Inspired by the widespread water security issue witnessed in Haiti, ninth grade biology teachers Scott Fowler and Elizabeth Glassman challenged all of their students to research, design, and build their own water filters as a collaborative project during the opening month of the academic year.

A week before “Bottle-Palooza” (the unveiling of the creations), Richard Vander Burg, the Vice President of Humanitarian Affairs for Lifesaver, came to campus and offered an engaging, interactive presentation to the entire ninth grade class that served to inspire and charge the students into their final week of the project.

October:

For seven Wednesday afternoons throughout the fall semester, the Global Health Fellows traveled the 10 minutes down the road to Operation Blessing, International’s headquarters in Virginia Beach. Working with Angela Cruciano Dart, the Manager of International Health Programs, and Keffenie Beyl Quezada, the International Manager of Vulnerable Children’s Programs, the Fellows were challenged to develop a sanitation curriculum for OBI to implement at 373 preschools in Peru to help mitigate the prevalence of intestinal parasites.

After weeks of researching, writing, Skype-ing with Sandra Arbaiza Canedo, Programs Manager for OBI Peru, and crafting props, the Fellows test-drove their prevention workshop with the first grade classes here at Norfolk Academy. A few tweaks later and the program was piloted by OBI Peru staff in Lima. Along with this educational workshop the Fellows have devised, the campaign will include the distribution of anti-parasite medicine and TOMS shoes to each child and hand washing stations to each school in Iquitos, Peru.

The Fellows were so excited about the project that they ran a holiday fundraiser in the Norfolk Academy Middle School. At a daily morning chapel, they gave a presentation about the history and work of Operation Blessing, International, the prevalence of intestinal parasites in the developing world, specifically in Peru, and offered a way our school community could help. They sold holiday cards, each representing a $15 hand washing station, and in just over one week, they had raised a total of $4032, which will supply about 270 hand washing stations for the project!       

November:

Three times a year, the entire Center for Civic and Global Leadership (Global Health Fellows, Chesapeake Bay Fellows, and International Relations Fellows) comes together for an evening that serves to demonstrate to the Fellows what is meant by “civic leadership.” For our fall evening meeting, Jay Leutze, lawyer, activist, and author of Stand Up That Mountain worked with the 22 current CCGL Fellows. Though his professional work falls in the realm of environmental stewardship and is more directly applicable to the Chesapeake Bay Fellows’ course of study, his story of standing up and fighting against an injustice left everyone present feeling empowered that they themselves can become agents of real change.

December:

On December 5, the Global Health Fellows spent the afternoon at the downtown Norfolk headquarters of Physicians for Peace for a medical mission debrief by Norfolk Academy parents Chris and Diana Behling, Ob Right Program Manager for Sentara Healthcare.

Chris and Diana shared insight into their eleven-day child and maternal health medical mission to Mwandama, Malawi, one of the Millennium Villages of the Earth Institute. The Virginian-Pilot featured an article on the presentation – check it out!

Fellows’ reflections on the presentation:

Brian Peccie, GHF ’16: After Ms. Behling’s presentation, what struck me the most was that Malawi currently has a female president. One of the most important issues with developing healthcare is gender equality and how women are seen in many societies. Many countries and cultures still believe that men are superior over women. Mostly in low-income countries, the women have one main job–to have babies. One of the Millennium Development Goals (MDGs) is to obtain gender equality within the upcoming years. Women deserve to be on a much higher level in society than they are in many countries. Hearing that Malawi now has a female president, I began to think about how it affects the world. Hopefully this will spark a change in the way women are viewed in society.

Aneesh Dhawan, GHF ’16: During Ms. Behling’s presentation, she mentioned the average life expectancy of  a  Malawian is 52. Although we were exposed to the miseries of a developing country during our summer trip to Haiti, this statistic caught me off guard.  As Americans, we take nutritious food and excellent healthcare for granted. We can walk into the nearest supermarket and purchase a variety of goods. In Malawi, a country that relies heavily on subsistence farming, the people cannot afford nutritious food like we can. The lack of nutrition has devastating effects on the people of Malawi. The presentation has reiterated that the basic needs we take for granted are luxuries for most of the people around the world.

Bridget Dickinson, GHF ’16: In the presentation, there was an astonishing statistic that 27% of neonatal death is caused by preterm birth. It impacted me because the deaths can be prevented by supplying tools and educating the communities in those countries. In the United States we have access to machines and devices that help babies breathe and if we train health professionals in these countries with interventions such as NeoNatalie we could potentially lower death rate.

Elizabeth Lilly, GHF ’16: I was particularly affected by the fact that 300 of those bricks — which Malawian workers would strenuously labor every day to make — would be worth only one US dollar. Additionally, $20 would pay for a semester’s worth of school. Especially during Christmastime, when there is so much “I want” and so little “I’m thankful for” after Thanksgiving has passed, I am reminded more and more of our own trip to Haiti, and how lucky we are to live in the United States. It’s a somewhat cliched sentiment, but still it rings true.

Stuart Luter, GHF ’16: Before Ms. Behling’s presentation, I did not know much about Malawi. After listening to her presentation, I have a greater understanding about the culture of Malawi and the problems Malawi currently faces. I also learned the main causes of maternal death. Malawi reminds me in many ways of Haiti, where we went last summer. Haiti, similarly to Malawi, has limited access to clean water and basic health care. It was interesting to compare and contrast Haiti and Malawi. Ms. Behling’s presentation did have an impact on me. The fact that people in Malawi live on less than the equivalent of $1 per day was shocking and hard to fathom. I was also shocked to learn that people living in the rural parts of Malawi obtained water from a spring, which did not always provide water during the dry season. I can’t imagine living for months without a reliable source of water.

Wyatt Miller, GHF ’16: I learned from Ms. Behling that the reason it is so hard for organizations to provide clean drinking water for villages in Malawi is because in Malawi the villages are spread out over many miles, so one well can only provide water for a few families. This made me realize that solving a problem like a lack of clean water is not as simple as getting the money to dig a well. To actually provide people spread out over a large area with clean water you must, at least at first, provide them with means to clean their own water such as filtering devices, and then you can move on to the more permanent solution of digging wells. I also learned that the poor in Malawi are virtually stuck in a never ending cycle of poverty that they can’t escape. The people farm for a living but most of the crops they farm they must eat, so they never make much of a profit. This poverty can only be stopped if the people’s basic needs are filled, like having enough food and water, so that they can then focus on getting a job to make money rather than just farming enough so that they can have another meal.

Inside the classroom:

While time is always an issue, the Global Health Fellows try to convene once or twice a week to work together to build their knowledge base. They have been reading Global Health 101 by Richard Skolnick – learning about health determinants, indicators, equity – and will analyze case studies in the spring semester.

Thank you to all who supported us in launching the Global Health Fellows Program in 2012! We look forward to continuing to work together in 2013!

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.

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.

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.

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.