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The harsh reality of rural Haiti

To spend a day at Port-au-Prince’s Bernard Mevs hospital is to see people suffering the worst of the worst – things like enormous tumors, horrible strokes, malnourishment to the extreme.

But a day in the northern village of Bord de Mer Limbe is to see where the worst takes root. It’s a place without running water, without electricity, without paved roads. Set against the ocean, it’s a place where prior to the earthquake, 14% of the population lacked adequate sanitation. Nothing has improved.

This is where Team Broken Earth’s rural team started their clinical work in Haiti. They reopened for a day the shuttered clinic at the village’s edge. By the time the gates swung open at 8 am, 50 or so adults were lined up at front. An impromptu market of a dozen sellers set up at the gates, peddling drinks and fried plantains.

The team divvied up the available clinic space. Two paramedics triaged patients at the front, dietitians worked in the open-air courtyard and the physicians split the exam rooms – two physicians to a room. That meant two physicians, two translators and two patients in each small examining room.

TBE’s rural team treats patients who lack regular access to any healthcare provider. Their goal is preventative, aiming to halt the progress of problems that are prevalent at places like Bernard Mevs.

Dietitian Jen Woods used photos and measuring cups to demonstrate to her patients how much they should be eating, and what, in order to ward off malnourishment, which leaves the region’s children extremely prone to infections.

Among adults, hypertension is prevalent. Villagers don’t have access to a doctor or nurse who could check their blood pressure regularly. Even if they did, there are very limited medications available. I saw the region’s makeshift pharmacy one afternoon. It’s a beat-up jeep driven by four men who illegally sell pharmaceutical drugs, real and fake, from their vehicle. They advertise by calling out to villagers through a tin loudspeaker strapped to the roof of the jeep. “Do you have a belly ache? Do you have a headache? We have pills!” they shout.

James Rourke, Dean of Medicine at Memorial University, said patients in Port-au-Prince have much more access to medicine than those in rural areas. “There, at least, they can get cheap medicines on the street.”

Even when medications are available, there’s little monitoring of blood pressure in Haiti, resulting in what Dr. Rourke called the “tragedy of untreated hypertension.”

“That was brought home to me on my last visit to Port-au-Prince. At Bernard Mevs, we saw 45 and 50 year olds with strokes. Our goal here is to give people medication to control hypertension and prevent strokes, and give them medication at a cost they can afford.”

– Christina

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Posted by on October 9, 2014 in Uncategorized

 

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The Rural Haiti Adventure Begins…

I’ve left Port-au-Prince and arrived in a small village in the Bas Limbé region of northern Haiti. I’m with a Newfoundland-based TBE team that will provide basic medical care in remote villages over the next week.

It’s about an eight-hour bus ride, or a 30-minute flight plus 90-minute bumpy beautiful drive to get here from Port-au-Prince. But in many ways, these places seem worlds apart.

In Port-au-Prince, TBE lives in quarters attached to a busy urban center. We often hear gunfire outside. An armed guard is required to accompany us 10 metres across the street.

Here, our guesthouse looks out at the ocean. Kids play soccer in the sand outside our house. They hold our hands and follow us around wherever we go. It’s an area virtually untouched by the 2010 earthquake.

But Bas Limbé does share a sad similarity with the Haitian capital: people die from a lack of basic medical care. It’s not unusual to see six-week-old babies that weigh six pounds or less. Local toddlers appear chubby but you learn quickly to look for the thinning, frizzy hair that’s suggestive of low protein, despite their fat bellies. HIV rates are high. Infections, worms and skin diseases are rampant.

In 2007, a Canadian physician Tiffany Keenan set up Haiti Village Health (HVH), an organization that provides some basic medical care to these hidden-away areas accessible only by single-lane gravel road. In the last year, many HVH clinics have closed due to lack of funding. It’s unknown if these closures are permanent.

I’m here now with a Newfoundland-based TBE crew of nine physicians, two paramedics, a nurse and a dietitian, who continue the work of HVH. Over the next week, they’ll set up day clinics in five different villages in the region. They hope to treat about 160 patients a day, primarily mothers and children. Tickets have been given out through the region for families who fit the HVH mandate. Patients with urgent care needs will also be seen.

I think the events of our first few hours here speak volumes about the need. We arrived in the village in the late afternoon. We planned a quick swim, a relaxed dinner, an early night before a long first full day.

But as soon as we walked in from the beach, two women walked up to our gate. One carried a tiny baby, the other woman held a brightly colored umbrella to offer shade.

They explained that the infant was born 15 hours before. The little girl was now feverish and listless. Still in beach clothes, the team took the baby up to the terrace. They rooted through luggage to locate a thermometer because we didn’t yet have access to the village clinic, and gave the baby antibiotics and water through a syringe before arranging a transport to the nearest hospital.

Meanwhile, a pregnant woman from the village knocked on the gate. She was having sharp pain in her belly. We walked over the former clinic behind our house (passing three skinny goats and a skinnier baby goat in the yard). There, one of the physicians diagnosed her with an infection and dug through the pharmacy to find antibiotics. She went home late in the evening with a request to return if anything changed.

We visited her this morning in the dark, small one-room hut where she sleeps on the floor with her family. She’s still having pains but less severe and less often.

We asked what services were available for her when we leave. The answer: hope for a normal delivery or she’ll have an emergency ride to the nearest hospital with whatever vehicle they can find.

– Christina

 
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Posted by on October 6, 2014 in Uncategorized

 

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It’s like it’s a flooding river.

“Help me! My baby fell off a tap-tap and his leg is broken!”

The story – a common one in Haiti – is, this time, not real.

The “baby” is a plastic mannequin of a toddler wearing navy blue sweatpants three sizes too big and missing an arm; his “mother,” a tall blond Canadian pediatric nurse. The “nurses” hurrying to help are Haitian nursing students demonstrating how they’d respond when a mother arrives in emergency with her injured child.

Though the story line is make-believe, the benefits are real – Haitian nurses will be better trained to deal with this kind of emergency when it happens because they’re learning through hands-on simulation training.

This kind of teaching is the key reason that Team Broken Earth’s nurses and doctors come to Port-au-Prince.

Four years ago, when Team Broken Earth was founded in the aftermath of the earthquake, Haitians needed surgeons, doctors, nurses and physiotherapists from other countries to fill the enormous gaps in the beleaguered Haitian medical system.

But, today, efforts are increasingly focused on building the local medical system local healthcare workers. For Team Broken Earth, that’s meant a shift from practicing medicine here to teaching it.

Over the last four days, Canadian nurses and doctors have taught nursing students and nurses, medical students, surgery residents and local physicians. Sometimes, they squeeze into tiny single rooms on the hospital ground, or take students across the street to the vacated building across the street. They’ve taught outside under tents, in hot sweaty ORs and in the frenzy of tbe emergency department.

Suzanne Westcott, a nurse who has been down to Haiti three times with Team Broken Earth, said she’s spend more hours teaching on this trip than any before. This last one has been the most rewarding – “and it’s because of the teaching.”

“I feel like I’m not just filling a role; I’m really giving back. It’s like it’s a flooding river. When you come here just to do clinical work, you’re plugging a hole somewhere. But when you teach, I feel like you slow down the flood.”

– Christina

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Posted by on October 5, 2014 in Uncategorized

 

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The Daily Dose of the Unfathomable

This is a place where the unfathomable is often the everyday.

This morning, we woke to news that a five-day-old baby died in the pediatric ICU during the night. He was a tiny thing who was supposed to be one of the first surgical patients of the day. One of our docs put his head in his hands and cried in frustration after the discovery.

Later, a 10-year-old boy with an amputated leg arrived, brought by his adoptive mother. Through a translator, one of the surgeons asked the mother how her son lost his leg. She explained that the boy’s birth mother dumped the boy out a yard soon after he was born. Pigs gnawed much of the baby’s leg off before he was rescued by a woman who later adopted him.

Perhaps most telling, the translator passed on this information without reaction, like it’s a story he’s heard before.

Children are abandoned at this hospital every month. Abandoned or orphaned babies are easily to pick out in the row of cribs in the pediatric ICU. They’re covered in flies because they don’t have parents there to fan bugs away from their faces.

I don’t mean to give the impression that all the stories are sad here at Hospital Bernard Mevs. They’re not. Earlier this week, Team Broken Earth met a five-year-old girl who arrived dressed in a princess dress. She can’t attend school because of her clubfeet. She grinned proudly for docs as she demonstrated her “walk” – a system of shuffling along on her knees. An operation will give her the opportunity to walk for the first time in her life. With that, perhaps she has a chance for an education.

Today, I saw the country’s new air ambulance service, which is funded privately by a former helicopter pilot in Florida. An air ambulance is an unusual luxury for a country like Haiti where babies die from lack of basic nutrition. But the air ambulance service is creating the first comprehensive network of hospitals and medical services in the country. Unfathomable though it is, no such list existed before.

This afternoon, our Team Broken Earth crew delivered bags of donated goods to volunteers from a Haitian orphanage, Tytoo Gardens. We met the orphanage team last year after several of their kids came to Bernard Mevs for evaluation by Team Broken Earth. This year, we brought toys, clothes and soccer balls, along with necessities like medications, soaps and toothbrushes for the orphanage.

Tonight, at their seaside compound, I know 30 or so kids are experiencing a new kind of unfathomable. That makes this all worth it.

– Christina

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Posted by on October 4, 2014 in Uncategorized

 

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The Art of Improvisation

In Haiti, you learn to work with what you have.

Often, that isn’t much. Things that Team Broken Earth has had learned to work without today: running water (for a brief time); an x-ray machine and, now, the intraoperative x-ray, as well (indefinitely); some blood tests (recurring); sufficient beds for patients and volunteers (recurring); Internet access (periodically); pants for little children who wet themselves in the recovery room post-surgery.

The list goes on.

Doctors and nurses say to me repeatedly that you have to practice medicine differently here. Never unsafely but always differently. You learn to rely on what’s available and not what you’d like to have available.

For three months, it’s been the only x-ray machine available at the hospital because the standard x-ray machine isn’t working. A new x-ray was supposed to be installed the day before the Team Broken Earth group left Calgary. The machine arrived but it’s out-of-date and no one here knows how to get it working.

Here, members of Team Broken Earth have to consider factors that they’d never think about in Canada. How do you keep a wound clean if you have no roof over your head? What do you do with body parts after surgery as the family sometimes asks to see what has been removed? What do you do with patients when you have no beds left on site but the patients are afraid to travel home because it’s dark and the streets are unsafe?

Today, a 26-year-old Albino Haitian woman arrived at the hospital. Skinny and scared, she’s quite unforgettable. She has severe melanoma – the result of years of her unbearable pale skin broiling under the relentless Haitian sun. Her white skin is now dotted with large black asymmetrical spots, an effect more like the markings on a leopard than moles on a human. But what’s brought her in now is the massive golf ball-sized lump that protrudes above her left eye. It causes her endless pain, especially in the hottest hours of the day, she says. She winces as the surgeon gently palpates the edges of the lump. Its top caves inward like a crater; the edges white, the center black.

The surgeons want to operate on her tomorrow. The OR suites are booked today. But this woman and her husband have travelled more than an hour to get to the city. They are afraid to travel at night. Our surgeons are afraid that if they book her for tomorrow, she simply won’t come back. That happens all too often.

There’s no bed to keep her here tonight in advance of tomorrow’s surgery. So they’ve decided to operate as soon as they can tonight. One of the surgeons is napping on a chair in the hallway right now as there’s no telling when that will happen.

In the meantime, I’m going back to the PICU to hang out with a three-year-old boy. He learned the art of the selfie earlier today with our nurses and he can’t get enough of watching himself grin for a camera.

– Christina

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Posted by on October 3, 2014 in Uncategorized

 

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First, do not harm.

First, do not harm. A saying I’ve heard countless times. Today, I saw firsthand how difficult that can be.

I arrived in Port-au-Prince yesterday, travelling with two Calgary-based plastic surgeons, Christiaan Schrag and Duncan Nickerson. They’ve taken the week off from their busy practices to join Team Broken Earth. They’ve left young families to come down to Haiti. They’ll deal with anything that comes through the door for them over the next five days — burns, tumours, neglected injuries from the earthquake. Mostly, though, they’re coming for one 30-year-old single mother with a disfiguring, debilitating benign tumour that’s bulging out of her jaw. A solid rock mass as big as a large cantaloupe, the tumour has swallowed up everything between her neck and her lower lip. She can’t eat properly, making her noticeably skinny even for Haiti.

Back in May, a Haitian plastic surgeon emailed her photo to Dr. Nickerson to ask his advice. Sadly, there wasn’t anything to be done here in Haiti that could improve the quality of her life.

That could’ve been where the story ended. But the Calgary surgeons couldn’t get this case out of their heads.

For months, they worked with a Haitian surgeon, a surgical prosthesis manufacturer and an engineer to develop a plan. They created models of her jaw based on CT images from Haiti. They laid out an intricate plan for an operation in which they would use parts of the woman’s right fibula to reconstruct her jawbone.

The case was booked for Tuesday, today. Working with the Haitian surgeon, they planned to start at 8 am and work all day. The local staff called a camera crew to cover the story. It was the first time this type of extensive jaw reconstruction using a fibula graft would be done in Haiti.

We discussed this case over and over on the 24-hour trip here — the risks, the benefits, the what ifs, all the possible scenarios.

Almost all. Sometimes, Haiti throws you curveballs. When we arrived yesterday afternoon, the surgeons learned there was a new twist — the woman was HIV positive. She started antiviral medications in July but only intermittently. All this had been missed in the pre-op evaluations.

Even last night, the surgeons believed they might still go ahead with the case. The deciding factor was this morning’s CD4+ count, a blood test that would show the strength of the woman’s immune system and her ability to fight infection. It came back below 200 — woefully short of the cutoff the surgeons had set out.

Perhaps back in Calgary with a fully supported ICU, a specialized team to monitor the patient and a higher CD4+ count, they would have done it. Perhaps. But not in Haiti.

You could see how much it bothered the surgeons — they’d had so much hope to change the life of this woman who washes clothes for a living. But now the surgery is so risky that, ethically, it was a not an option.

“First, do not harm,” said Dr. Nickerson.

The patient took the news stoically, a word I hear over and over to describe people here. Sometimes it seems as they’ve seen so much hardship that they’re immune to new sources of pain. Or perhaps her stoicism is from the tumour itself. Maybe she’s even lost ability to show any emotion on her face.

So went our first 24 hours.

– Christina

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Posted by on October 2, 2014 in Uncategorized

 

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Every stone’s throw created a ripple.

I’ve been lucky to meet some truly talented people. Outliers. Originals. The kind of people that inspire you by how they’ve made a difference simply by being themselves. Alan Doyle and Brendan Paddick spring to mind. And Andrew James O’Brien is one as well. Andrew is an award-winning musician with a big heart. He’s always been a huge supporter of Broken Earth and has joined us on our latest mission to Haiti to experience it first hand. That takes guts. But for an artist like Andrew, there is no other way.I asked Andrew to write a guest blog for us. Please, have a read.

– Andrew Furey

 

It’s 12:38am. I’m lying under a mosquito net listening to a child cry. Our bunk room is adjacent to the emergency room, which has been full of activity every day since we arrived here in Port au Prince. It’s tough to hear that sound and not want to get out of bed and help.  My personal qualifications are limited to say the least but the nurses that work the night shift are the best at what they do despite the heat, Mosquitos and the limited resources at their disposal. It’s a surreal thought to think that that child may not make it through the night but equally profound to know that he has a team of tireless and heroic people doing all they can to help him through to morning.

I have seen things here that have changed me in many ways. I’m still trying to make sense of everything down here. The poverty and day-to-day adversity that these people face is staggering. Mental, physical and spiritual duress is constant and seemingly unrelenting. Yet in the face of all this they are resilient, determined and stoic. Fathers stand over their children’s beds until nightfall then sleep uncovered in the open-air courtyard until morning when they return to the bedsides again. Unwavering love.

Patients don’t shout praise from the rooftops. They don’t thank surgeons on their hands and knees for the invaluable service they provide. Instead, they are quietly, deeply thankful. Their’s is a stoic appreciation. Their silence is intensely profound. They are tough and strong willed. They have to be.

I am grateful to the doctors and nurses. I, admittedly have taken for granted, living in Canada, how immensely crucial their services are and seeing them work here in Haiti with limited resources, less than ideal work spaces and literally thousands of patients who all deserve their attention, is absolutely incredible. They work with what they have and when they don’t have what they need they problem solve and push though.

This group consists of some of the most incredible and vital people in the world.

Inevitably, they’ll all return home to their regular jobs and, no doubt, their work will on some level be taken for granted by the ordinary public like myself. Perhaps that’s nobody’s fault. We live in a society where we come to expect their service without thinking or concerning ourselves with what that entails.

I know what it entails now. I’ve seen it firsthand. It’s branded on my brain.

I want to thank them. All of them. So does the man who’s femur was reinforced so he can walk for the first time in three months. So does the mother who’s infant’s heart can pump blood on its own again. So does the girl who had a cleft lip and was kept away from the rest of society. She smiles now.

Profound.

These doctors and nurses do this on their own time, for free, away from their families so that some of the millions of displaced Haitians can have a chance at life.

Dr. Greg Browne, General Surgeon said to me, “We can’t and won’t save everyone. Not even close. But maybe we’ll save the person who will have the answer to all these problems down here”.

Every stone’s throw created a ripple.

– Andrew O’Brien

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Posted by on October 30, 2013 in Uncategorized

 

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