Friday, April 30, 2010

Need for Health Care Workers in Haiti

The roosters started crowing sequentially. I rolled over and looked at the clock and thought, it can't be that time already. I felt like I had just gone to bed. At 6AM I managed to drag myself from a horizontal to a vertical position, got dressed, gathered everything that I needed for the day, i.e. bottle filled with water, power bars, two phones that almost always appear to be attached to the sides of my face, my camera, date book etc, and headed over to Alumni hall.

Alumni Hall is one of the dorms on campus that house volunteers while they work at Hôpital Albert Schweitzer and or the Hanger clinic. Here I met the new Project HOPE volunteers, and assisted them in getting their first day started at HAS. At 9:30 AM, I headed to the Hanger clinic where a potential candidate for the case manager's position was waiting for me. Mr. L is an accountant by profession, but presently is unemployed and is therefore excited about the prospect of having a job again. Mr. L is scheduled to shadow me for the day.

Although excited about this possibility of finding and hiring someone into the position, I hold some concerns about the lack of basic medical knowledge. Is a medical background necessary? I was asked this question several times, by different volunteers and non-volunteers in the clinic. Some have suggested maybe not. However, I have some reservations and feel that the position requires that the person of choice have some medical knowledge even if very limited. Why? A number of the candidates that come through for physical therapy and prosthesis fitting have non-healing wounds. These wounds almost always require dressing changes and monitoring for major skin breakdown that might cause the inability to wear prosthesis and progress through therapy successfully. I believe the case manger should have the knowledge and skill set in making these appropriate decisions with the team, in caring for such patients safely and effectively.

Nonetheless, in as much as I believe the need for a person with a medical background is of importance for the case manager's position, I can be convinced to think otherwise if Mr. L or any other potential candidate exhibits some very important qualities, i.e. willingness and eagerness to learn, has excellent decision making and organizational skills, has personal initiatives and fortitude, is able to work independently, has effective communication skills and last but definitely not the least, is able to work as part of a team well. If these qualities are exemplified then one could easily overlook the medical aspect of the job. In this situation the physical therapist could potentially take on the role of the medical care provider. Knowing when to seek medical assistance from appropriate medical staff, i.e. nurse or a doctor as needed.

Thanks for reading-Project HOPE volunteer Joy Williams

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Thursday, April 29, 2010

Never Underestimate the Determination of a Child

Candidate W has recovered completely from his viral illness. He is now again his rambunctious little self, getting into things that he's not supposed to and testing his limits with everyone in the clinic-a typical 8-year-old. Today while at the clinic for physical therapy, the new therapist Nancy was searching about for him, but without much success.

Suddenly she found him coming from the bathroom with his prosthesis securely strapped in place, and a big smile on his face. So proud he was of himself for having done this, all by himself. Not just going to the bathroom but so proud that he was able to put his prosthesis on and walk without assistance except for one crutch supporting him.

If you remember, from a previous blog entry, Candidate W’s initial fitting and attempt to ambulate made him so incredibly nervous that he did not want to take that very first step. Not for anything. He has now gotten past that fear where he is strapping his own leg on, walking by himself, and taking the prosthesis off when he is tired and wants to go for wheelchair race around the clinic.

Never underestimate the determination of a child. Now there is no stopping him.

So where do we go from here. First and foremost is to call the orphanage and alert them of the change and the upcoming discharge date, for candidate W. Instead of the anticipated 3-4 weeks stay at L'Escale, Candidate W will be discharged back to the orphanage after spending only 7 days at the Hanger clinic. How about that progress?

Thanks for reading-Project HOPE volunteer Joy Williams

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Wednesday, April 28, 2010

Treating More than Earthquake Injuries in Haiti

Provided at Hôpital Albert Schweitzer (HAS) are many different services to address the needs of the people of Deschapelles and its surrounding communities. All the services provided are of importance but I find that I most appreciate the clinic for the malnourished children and adults in and around the community. The majority of the individuals that arrive at the clinic are not only very poor, but they are often from the high hills where adequate agricultural support is sparse. This therefore, makes it very difficult to grow food that is high in protein, vitamins, and other very important nutrients.

As a consequence of poor nutrition, many children and adults suffer from malnutrition, and depending on its severity, exhibit not only physical but intellectual and emotional symptoms. Typically growth is stunted, and they are often intellectually delayed. Many times when the children are brought to the malnutrition clinic at HAS, moderate to severe malnutrition already exists and the children are already exhibiting signs and symptoms as a result. Symptoms such as change in hair color, difficulties seeing at night and or night blindness, decrease in body weight and the disproportionate size of the upper arms in relation to their age. The classic distended abdomen, small skinny legs and arms, sunken cheeks and bulging eyes, are observed, in its severest form.

Treating severe malnutrition can be very challenging; therefore all efforts must be made to prevent the advancement to this level. To try and prevent the severe form of the disease and alleviate some of the problems that comes along with it, fortified milk, peanut butter, different kinds of beans and peas are usually added to their diets here at the hospital to provide extra source of calcium, protein, and vitamin A. Included in their daily dietary intake are supplemental doses of vitamin A and vitamin C and other important vitamins.

Psychosocial needs are also addressed within this population. To encourage healthy psychosocial development, external stimulation such as singing songs, playing games, and massages, are also implemented in their daily routine, at the hospital. As parents and or guardians are admitted along with the children they are encouraged to participate in these activities. During inpatient period the parents are taught and trained in how to buy and prepare nutritious foods, on a very low budget. The hope is to have this practice continue at home. After discharge from the inpatient program, patients and their families are followed at the outpatient clinic where evaluation and treatment continues, so as to prevent a relapse.

Thanks for reading-Project HOPE volunteer Joy Williams

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Tuesday, April 27, 2010

At Age 8, He's Learning to Walk Again

New Life Children's Home, an orphanage in Port-au-Prince is now the home of Candidate W, a very happy, active, inquisitive and precocious little boy. Candidate W is 8 years old, and prior to the earthquake, most likely was a carefree, easy going child living with mom and dad at their family home. This all changed after the earthquake in which his mom perished, and Candidate W lost his right leg. His dad, grieving the loss of his wife and saddened by the loss of his young son's leg and losing all of the family's earthly possessions, had no choice but to take his only child to the orphanage for care.

Approximately one week ago, Candidate W was brought to the Hanger clinic by care givers at the orphanage for prosthesis fitting and physical therapy. During the earthquake he sustained such severe injury to his right leg that he required a very high above the knee amputation (AKA) to save his young life. Since receiving his prosthesis and with much support, Candidate W is gradually learning to take precious steps again, he appears happy but sad, cautious and scared at the same time. His assisted steps are taken with much hesitation, and what appears to be fear. Nonetheless, slowly but surely his steps become less cautious and apprehensive and more certain and free. Here's a video clip of patient W learning to use his prosthesis.

On Saturday morning Candidate W was brought to Hanger clinic for his usual therapy session. As he was brought into the clinic he was observed to be very quiet, droopy, almost lethargic and extremely hot to touch. Candace the physical therapist concerned about the state in which he was, called me to assess his condition. He indeed appear ill, but not seriously so. We agreed that laying him on one of the examination tables, giving him Tylenol, placing cold compresses to his skin and encouraging him to drink as much fluid as he could tolerate, should take care of the matter. Just about 2 hours later, he was not only cooler to touch but he was up and about. He was laughing, pushing himself around on one of the clinic stools as he played with his new found friend, a ten- year-old prosthesis candidate. He was looking well and appeared to be feeling much better so we decided that physical therapy should continue. After therapy was completed, he was driven back to the dorm with his escort and the other prosthesis candidates.

At 4 PM, I was called and informed that Candidate W was now very difficult to arouse and again extremely hot to touch. As I was not available to assist at this time, Madame Melon, otherwise known as Madame Billy thankfully was able to take charge of the situation. (Madame Billy is a descendant by marriage of the Melon family who built and started the Hôpital Albert Schweitzer (HAS) in Deschapelles, Haiti some 50 plus years ago. Madame Billy has been traveling back and forth to Haiti for nearly 30 years, supporting the work here at HAS.) Madame Billy not only drove to the Candidate W's dorm to check on him, but also took him to HAS and stayed with him while treatment and eventual admission for further evaluation took place. Lab tests were completed, intravenous fluids and antibiotics were started, but definitive diagnosis was not clear until he was discharged on Tuesday with a severe case of viral infection-not malaria as most of us had anticipated.

While in the hospital, Candidate W was visited frequently by Madame Billy, who brought meals and fed him - as it is expected that family members provide care for their loved ones while being treated at the hospital. She also kept him entertained by reading to him, telling stories and playing games with him. Candidate W was also visited by many of his friends from the Hanger clinic and as each entered his room, his precious little face would just light up with the biggest, brightest smile that made you want to just hug him and smother him with kisses. Nonetheless, although he was very excited and thrilled to see his friends from the Hanger clinic, during his most febrile state of 40 degrees Celsius, all he wanted was his papa, and that's who he called for all the time. But papa was never going to come, never to hold him or feed him, not now. The question is, will he ever?

Thanks for reading-Project HOPE volunteer Joy Williams

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Monday, April 26, 2010

Volunteer Offers Help to Haiti's Mothers-to-Be

Angela Ferrari, a nurse midwife from Massachusetts General Hospital, recently completed a volunteer mission for Project HOPE at Hôpital Albert Schweitzer (HAS), helping to strengthen the hospital's midwife program. While working at HAS, Ferrari made a day trip to Bastien Dispensary, a more rural medical facility that often times refers women with high risk pregnancies to HAS. The following is a blog of Ferrari’s day at Bastien.
Today was the most amazing day. The trip to Bastien went off without a hitch and we left Hôpital Albert Schweitzer (HAS) at 8 am, hot and sweaty already, only to arrive to the cool breeze of the mountain at the site of Bastien Dispensary.

Still, it was an even more harrowing ride than the one from the airport to HAS on my first day in Haiti! From the airport to the area of Deschapelles was a twisting ride of hairpin turns through a mountain road. The ride to the dispensary, on the other hand, was straight up rock much of the way. The very capable jeep rocked us to and fro but must have had decent shocks because it actually seemed fun! What looked hard were the travels of the many, many people making their way up and down the mountainside on the rocks by foot - I couldn't call it a road as it wasn't—it was a path, really. Women with tremendous bundles or baskets balanced on their heads, young and very old alike climbing in the heat without any obvious discomfort or even strain that I could see. I imagined they make that trip often. Most were on their way to the market down the mountainside with their wares.

Arriving at Bastien was like a cool, sweet reprieve. It was nestled into the small dip of a hill and was clean and well organized. The woman who ran the clinic and the RNs who saw the patients for their visits ran a very tight ship and were polite and somewhat forthcoming which surprised me given that my visit might seemingly have no purpose to them and I cannot imagine that I did not seem intrusive. My intention, which I think was lost in translation despite my capable interpreter, was simply to gather an understanding of the care of lower risk pregnant women in the broad referral area of HAS. I wanted to know how women were cared for before they were determined to be high risk or experienced an emergency and therefore were referred to or taken urgently to HAS. Further, many pregnant women without risk had seemed to wander into HAS to deliver over the last week of my stay and I wanted to understand something of their 9 month experience with health care prior to their moments of labor and delivery at HAS. It was my understanding that most women are birthing at home in Haiti and I was confused by the presence of normal birth at the high risk facility of HAS.

The RNs at the dispensary allowed me to sit in on several pregnancy visits and they explained all of their documentation to me and I was truly, truly impressed. Basically, they hope to see their patients 3 times in their pregnancy and they schedule all of the patient’s appointments when they come for their first visit. The tools of the RN’s trade are a fetoscope and a tape measure --they seemed apologetic about their simple tools and the interpreter translated, “This is all they have.” But I am a midwife and I understand that it takes few tools or instruments to give good care as long as providers are skilled. I have noted often that having few tools to your trade makes you develop incredible skills, sometimes far superior to providers with many instruments to depend on. I tried to reassure them they had all they truly needed to give good care!

The first visit I witnessed was of a woman who was just into her second trimester. Her belly was measuring appropriately for her gestational age (with the tape measure just as we use in the US!). She was reporting vomiting but able to eat, and she was checked for anemia by looking at the whites of her eyes. I had seen this assessment of determining anemia and or oxygen carrying capacity of blood, too, when a woman came in with retained placenta earlier in the week at HAS. Again, I was impressed with the few tools you need to give good care. At the institution where I work in the US, we are easily able to send off blood work to the lab to determine anemia and don’t need other ways of assessing anemia. Without easy lab capabilities here in most of Haiti, they are equally able to quickly ascertain whether someone might be low on iron by physical assessment. This is much cheaper than lab work! Lastly it was too early to look for heart tones with the fetoscope and off the table the woman jumped after this exam. This young patient was given a copy of her records and everything was recorded meticulously by the RN’s. HIV and RPR are done as initial lab work and documentation made that she was vaccinated against tetanus.

The second patient was in her last trimester and so it was her last prenatal visit. There was a special "labor planning form" filled out (just as we do for our pregnant women in the US) and I was impressed with how thorough and appropriate it was. First, the RN’s asked where she planned to deliver and noted this information on the form. Most women plan to deliver at home with what is commonly understood by the world as a traditional birth attendant or TBA but here is called a “matrone” and refers to a woman trained in her community with a midwife who attends birth in the home. Occasionally, a woman reports that she will plan to birth at a hospital. I suspect that as the rest of the world has moved toward birthing in hospitals, a small but definite influence is exerted on Haitian women to do this as well and the RNs report to me that sometimes women tell them they plan to birth at the hospital. The form further documented all necessary addresses: hers and the hospital that she would need to go to in case of emergency, most often HAS in the case of the Bastien patients. The form also recorded the name of the midwife, the patient’s due date, and contained a list of meds/supplies the patient would need to get from the hospital in advance to prepare for birth. By the way, going to the hospital to get supplies is no small trek as I had witnessed on the way up in the jeep! It must be a day's journey in and of itself just to get to the hospital. Further, I have no idea how much it would all cost, something else that would make this simple list difficult to accomplish. But each woman must get these supplies as listed so that she would have the supplies ready at the time of her birth and waiting for her midwife’s arrival at her home. This would help ensure a safe birth for mom and baby.

Interestingly, the RNs mentioned to me that the ‘matrones’ currently get their sterile supplies especially for cutting and cleaning the cords of babies from HAS. I had just read about the program started out of HAS in 1960 called the “clean cord cut kit” which was a modification of a WHO program at the time. This program is still sustained by HAS today. In the 1960s’s, along with the vaccination program for pregnant woman, the clean cord cut kits and a public education effort allowed HAS to squelch a tetanus epidemic.

I found that though the maternal and neonatal morbidity and mortality statistics in Haiti continue to be among the worst in the world, excellent programming and care is being accomplished by HAS and in the outlying communities to help combat this staggering reality. I left the cool (relatively speaking of course) hillside of the Bastien Dispensary with the same joy as I had noted many of the women and children displayed who were playing and talking at the well aside the clinic. My heart was made lighter today.

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Friday, April 23, 2010

Making Room for More

As I arrived at L'Escale, I noticed that most of the patients were sitting out on their verandas. The girls were combing each other’s hair and or sitting around chatting, while the boys and some of the older ladies were playing cards or dominos. I went about the houses checking to see how everyone was getting along, and also assessing room availability.

There will be 15 new prosthesis candidates arriving in the morning from Port-au-Prince. I therefore need to determine how many of these new candidates can be accommodated with room and board. As of this morning there were three different organizations seeking housing for incoming patients; New Life Children's Home, an orphanage in Port-au-Prince, Catholic Medical Mission Board, our largest referral site to date within Port-au-Prince, and Bon Samaritan, yet another orphanage just outside of Port-au-Prince.

Of course we also have individuals that come to us for prosthesis by way of word a mouth. In unique situations, some of these individuals require lodging on the same evening of intake due to distance traveled.

One such candidate was a young woman with a left below the knee amputation. She and her companion arrived mid afternoon at the clinic seeking care. They were welcomed to the Hôpital Albert Schweitzer - Hanger clinic, registered and were given instructions about the process. On intake, patients have their stumps casted and evaluated by the physical therapist. After this process is completed they are then sent home, to return in one week for fitting, adjustments and more physical therapy. As the process was explained, both the candidate and her escort looked at each other and said something in Creole. Without even understanding what was being communicated, I knew exactly what was going on.

Traveling distance was making it impossible for them to return home on the same day. Both traveled approximately 10 hours by Tap Tap (taxi) and walking, to arrive at the clinic. Even if we expedited the process and everything went smoothly to have her discharged by 3 pm, it would still be too late to travel the return distance home. Accommodations had to be made at L'Escale for them, even though there was no available room.

In one house the residents were willing to downsize their space so that the candidate and her escort could spend the night. There was a glance, a smile and a sigh. All was well for now for this particular patient. There is a place to stay for the night, at no cost.

I found out later, that this patient was one of the January 12th earthquake victims found under the cement rubble of fallen buildings in Port-au-Prince 7 days after the earthquake. When she was found she was barely alive and survival was deemed very grim. Looking at her now, one would never know how close she came to death. Such resilience. Such strength. Such smiles and such hope. Life goes on. She is here now, ready to receive a prosthetic limb to move forward with her life.
Thanks for reading-Project HOPE volunteer Joy Williams

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Thursday, April 22, 2010

Volunteer Reminded of "Home"

It's Thursday evening at 1800 hours, a not so very busyAdd Image day ended with my visiting L'Escale. L'Escale is the area where the dorms are located and it's about a 10 -15 minute walk from the Hôpital Albert Schweitzer - Hanger clinic.

It is a very scenic walk, although some might find it very difficult to appreciate. As you walk along your senses are enticed to be more aware of the surroundings. The landscape is mostly dry, dusty, barren-appearing land, that craves a good rain fall. The outside marketplace is built from nothing but pieces of zinc, and some palm or coconut branches that make up the thatched roofs.

Along the road as you pass the private homes of the villagers. Some of the houses are very well built, while others are nothing but shacks, appearing as if ready to fall over.

The nearly dried-up canal that runs along the market place seems to collect anything and everything, except water.

The sun is very bright and very, very hot. As you walk, whether quickly or slowly, the sweat drips down your face and back, forcing you to make the effort of drying off with a hand towel.

In the not-so-far distance, you can hear the chattering, laughing and going-ons of the women in the market, as they buy and sell. The young children, not yet in school, laugh, play, and sometimes work, while moms monitor with watchful eyes. The goats, pigs, chickens, dogs and cats all roam freely, with not a care in the world, all trying to get their fair share of whatever scraps are left over in the market.

The smell of the different kinds of food cooking can either have your mouth watering or have you wondering what is that smell? In the background the music blares - at times too loudly - a mixture of pop, Michael Jackson singing Billy Jean, reggae and of course Haitian calypso.

The constant tooting of the horns is a reminder to get out of the way as cars try to speed over unpaved very, very bumpy roads. The motor scooters, bicycles, Tap Tap (taxis), cars, jeeps, and oh yah, the horses, donkeys, mules, pigs, cows, goats, chickens, pedestrians, etc. all try to get their fair share of traveling on the road. You name it and they are there.

So reminds me of my country of birth, Jamaica. Aaah memories...

Thanks for reading-Project HOPE volunteer Joy Williams

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Wednesday, April 21, 2010

Amputees Require Individual Care

So does one care for the pregnant woman with an above-the-knee amputation (AKA) and prosthesis any differently than the average non-pregnant woman with the same amputation? Is the prosthesis made any differently? What does the practitioner like me need to know or be concerned about, in caring for her? Is she any more susceptible to falls? Will she need to have a new socket made? Or are major adjustments necessary before and after the baby is born? If so, what adjustments and how quickly after the delivery should this occur?

These are some of the questions I asked myself after learning that one of our prosthesis candidates, Patient S, is five-months pregnant. With all these questions flowing through my head and without any good answers, I decided to direct them to the experts in this area, the prosthetist and the physical therapist.

As I spoke with the prosthetist, Dale, about my concerns and lack of knowledge regarding pregnant prosthetic wearers, he indicated that it is necessary to make prosthesis with a socket that splits from the proximal to the distal end. This therefore makes it possible to adjust the socket to the desired size, thereby increasing support and comfort as the candidate’s weight and size increases and decreases throughout her pregnancy. The split is made on the thigh over the rectus femoris muscle, and straps are secured to the socket to allow easy adjustments. As per the prosthetist, this particular prosthesis with adjustable socket is not very comfortable and or durable, but it allows for accommodation of the inevitable weight changes, as the woman progresses through her pregnancy.

The physical therapist Candace stated that most pregnant women usually do very well, but they do need to use assisted devices, such as crutches or a four-pronged cane as they advance in their pregnancies. This is to ensure greater stability with ambulation as size and weight increases over the course of the pregnancy.

Patient S is already a mother of six children, and she is very anxious to complete her physical therapy and be rid of the crutches, so she can be more independent, and hands-free to care for her home and her children. She was not very happy when she was informed that she will need to continue using assisted devices as she advances in her pregnancy.

As the discharge planner, I tried to provide re-enforcement about the special care she will need to take during her pregnancy, and also provide her with encouragement. Soon, our patient realized that the extra care and precaution, while inconvenient, was all was for the safety and wellbeing of herself and her unborn child. Patient S will be discharged from the physical therapy program soon, of course with frequent follow-ups to monitor her progress.

Thanks for reading-Project HOPE volunteer Joy Williams

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Tuesday, April 20, 2010

Amputees Build Community of Support

Early morning in the community of L'Escale is not unlike that in any other rural village. Residents wake to the sound of roosters crowing. Long shadows are cast as lines take shape at the communal well. But in this community, the shadows are of the pie-slice spokes of a wheelchair, the Eiffel Tower lines of a figure on crutches.

Here, the morning routine takes a little longer as residents gingerly navigate the rocky terrain on new metal legs. Double amputees sit on mattresses to bathe from plastic basins set out on smooth concrete porches of the eight brightly painted villas.

L'Escale is a unique community of amputees brought together by the Hôpital Albert Schweitzer (HAS), which has received an overwhelming number of amputees since the January 12 earthquake.

Timing could not have been more fortuitous for the hospital, which in October had shuttered the compound it had been using to isolate contagious TB patients. "We were going to meet Jan. 15 to decide what to do with these empty buildings. Then the earthquake came and solved our problem for us," says Ian Rawson, managing director of HAS in Deschapelles, Haiti.

"In a hospital when you are ready to let someone go you write on their chart, 'discharge home,' relates Rawson. "You might write that very cavalierly, but [since the earthquake] you have to look at it and think, 'wait a minute,' and cross out 'home' because they may not have a home anymore."

In the days after the disaster, patients with the most need and no home to return to were discharged to L'Escale until they could find more permanent lodging. With the opening of the Hanger clinic-- the hospital's new prosthetics and rehabilitation center-- at the end of February, a new need arose. Hanger patients, mostly earthquake victims from Port-au-Prince, needed a place to stay during the two weeks or more of the physical therapy required to be fitted for and learn to use their new limbs. Without L'Escale, the three-hour commute to the capital city would have made these daily visits impossible for most.

The village is now bustling with activity. Vans shuttle patients the half-mile from village to clinic several times a day. After seeing patients at the clinic, Project HOPE physical therapist Claude Hillel and his team make rounds at L'Escale in the late afternoon. The team is eager to reinforce correct exercise techniques in an environment that more closely resembles a patient's home.

Each of these eight-person homes houses four patients and their escorts-- patients are allowed one helper, usually a family member, to stay with them. And each dwelling has taken on its own character.

The porch of the blue villa has become the de-facto gathering place for those who have just received new legs. A woman use its three wide steps to relearn how to climb and descend as a man sits quietly staring at the shoe on his lower leg prosthesis unstrapped next to him. From the yellow villa a passerby might hear the strains of a hymn or a pop song sung by two young women who have become fast friends. Cell phones ring. Kids gather around a table at the white villa for dominoes while men play cards from a nearby bench.

In a country where amputees have not always received the best treatment, L'Escale residents seem comfortable in this environment, where they are surrounded by others facing the same struggles. A small crowd congregates to watch physical therapist Philippe Menard teach breathing techniques to a back injury patient. From their perches on the blue villa porch, women exchange tips on compression wrapping their stumps.

"It's a community," says Rawson. "They've created a community and they take care of each other."

Story and photos by photojournalist and HOPE volunteer, Allison Shelley.

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Monday, April 19, 2010

Emotional Scars Sometimes Worse Than Physical Injuries

The earthquake that took place on January 12th, 2010 took a devastating number of lives and left a country that cares very little about the handicapped, with thousands of handicapped individuals. Individuals now with a lost arm, a leg, both legs or both an arm and a leg or others being left paralyzed, from the neck or from the waist down.

Haiti is a country where many believe you must be mobile to survive, or you will be considered a dependent burden that will quickly exhaust families' resources. Emotional and psychological needs or problems are not an exception, and often times people will turn a blind eye on those suffering with mental health issues. If it cannot be seen it does not exist.

Each individual expresses his or her emotional state differently - some quietly and uncommunicatively, others vocally and physically and still others that sadly regress to a child-like state.

The psychologists here at Hôpital Albert Schweitzer(HAS) have continued to see some of the patients individually and in group sessions. I am told that things are going well, and each within the group are talking freely and sharing their experiences.

Nonetheless, I have concerns for V.C. the 19-year-old woman who lost her entire family in the earthquake, except for a newly found cousin. (I blogged about V.C. on previous entries on April 2 and April 5.) V.C. is doing extremely well with her physical therapy and is therefore ready for discharge. Unfortunately, her depression seems to continue. She appears to talk very little with those around her. She does not seem to hold any relationship or connection with any of the girls in her age group. Furthermore, it appears that most of her spare time is spent sleeping, by herself, or interacting with the men that are around.

Today one of the physical therapists brought a doll to V.C. V.C had put in several requests to the therapist for this doll and would always ask when the doll would become available. As I started to hand the doll to V.C., I asked her who the doll was for, with a great big smile on her face, she replied through the interpreter, “It's mine, I want a baby doll to play with.”

Why would a 19-year-old want a doll baby to play with? This is a little strange. My initial thought is that V.C is regressing to a child like state. This information will be communicated to the psychologist to hopefully encourage further evaluation and treatment as necessary before discharge. V.C. will most likely be sent to live with her cousin. This she does not want and has expressed concerns and fears regarding the possibility of having to sell stuff in the market, if she goes and lives with her cousin. V.C. wants to go to school.

Thanks for reading-Project HOPE volunteer Joy Williams

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Friday, April 16, 2010

Volunteers Rewarded With Patient Progress

It is incredibly difficult to believe that I have completed 3 weeks of my 6 weeks rotation already. So quickly time has sped by. Thankfully, I do not believe a moment has been wasted. The clinic has gotten progressively busier and busier. Nonetheless, with continued team work, much success is seen as all the processes fall into place. As we move forward in accomplishing sustainability, the decision has been made to hire a permanent staff, to take over my position as the case manager. This is an exciting moment for me.

Presently during clinic hours we are evaluating and treating approximately 10 new intakes per day. This is fantastic but unfortunately it has certainly made my job a great deal more difficult. Finding room and board for all the candidates requiring admission has me juggling beds and admission dates.

Sometimes although very infrequent, the challenges come along with heartbreak and sadness. Having to inform someone that he or she has to be discharged when there is no physical home to be discharged to is extremely hard. This sometimes causes difficult choices to be made. It is during this time that I find certain aspects of my job most hateful and unrewarding, one that I could most definitely do without.

Today during clinic hours we cared for approximately 40 patients, with varied needs including physical therapy, adjustments, measuring, casting, fittings, suture removal and wound care. All the candidates to date are doing very well in completing their physical therapy and progressing to their ultimate goal of being discharged. They want to return to their everyday activities and routines and soon as possible.

Most patients complete physical therapy successfully within a 2 -3 weeks time frame. Unfortunately for the bilateral above the knee amputees (AKA) this process is a great deal more difficult and therefore requires a longer time to accomplish successfully. These candidates must relearn to balance themselves on new legs and learn walking all over again. Sometimes a simple action that the average person takes so much for granted; like getting from a seated position to standing or getting up to go to the bathroom, becomes challenging and sometimes frustrating. Nonetheless, the exhilaration and excitement that is felt when such simple but difficult task is achieved, is immeasurable.

Presently there are 3 candidates within our group that have a bilateral AKA ; one as a result of the January 12th earthquake and the other two candidates congenital, and the unfortunate loss of legs as a consequence of severe lower extremities burn as a young child. Although much difficulties and frustration are experienced individually and at different levels; ongoing encouragement, sheer determination and the desire to succeed allow great strides and successful achievements.

Slowly edging oneself to master the art of walking again allows one to frown on dependence and embrace independence, a wonderful reward. This is a tremendous success story in itself. The three candidates are accomplishing a great deal.

Presently one of the candidates is learning how to skate board, how cool is that. Check out Candidate M on his skate board.

Thanks for reading-Project HOPE volunteer Joy Williams

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Thursday, April 15, 2010

Volunteer Engineers Help HOPE in Haiti

Five engineers joined Project HOPE to help assess the structural and workflow issues of several Haitian hospitals with which Project HOPE works-- including Hôpital Albert Schweitzer (HAS) in Deschappelles and Hôpital Sacré Coeur (HSC) in Milot. Following is a post by Walt Vernon, CEO of M+NLB (Mazzetti, Nash, Lipsey and Burch, a consulting and design firm focused on the engineered systems of buildings) about the team's visit to Hôpital Albert Schweitzer.

John Pappas, a Principal Mechanical Engineer with M+NLB, and I travelled together. There are five us on this team, plus one representative of Project HOPE. Mike Olson is a Medical Planner with The Innova Group, we are joined by a Medical Equipment Planner from the US Army, Terry Dover, and Eric MacFarlane, a structural engineer from Dekker/Perich/Sabatini in Albuquerque.

Some observations… First, HAS is like a small, self-contained city. When we drove up, it was about 9pm and quite dark. All around us, we passed through numerous houses and little villages. There were maybe a half dozen lights we saw on the entire trip. But, about half an hour before we arrived at the hospital, we saw this blaze of light up on a mountain. It turned out that this was the hospital; the only source of electricity and clean water for miles and miles and miles.

They rely heavily on day light. In fact, in many ways, this is kind of like the perfect green hospital—self-provided water (from a continuously refilled aquifer, daylight, natural ventilation). This is such an elemental place and an elemental way of life, that the facility is sort of the poster child for being a green building icon.

The hospital generates its own power using a diesel generator. It has four generators, including two new ones rated at 410 kW. They run one generator at a time every 12 hours. They are really concerned because it is very expensive to get fuel for the generators; the tanker trucks have to traverse this arduous four-hour journey from Port-au-Prince. Right now, they are able to get fuel from Venezuela at a fairly low price. But, they operate on such a thin margin that they are constantly looking for ways to reduce their fuel consumption.

HAS has approximately seven circuits that serve buildings other than the hospital. These are 480 volt circuits, and go for hundreds of feet. The problem with these feeders is that the rest of the community that surrounds the hospital has no electricity. And, there are trees that grow up next to the power lines. So, the people hire children to climb the trees, and cut into the insulation. If they survive, they thread a bare wire around the bare part of the feeder and pull it into the tree. From there, it goes down, and eventually to the inside of a house, where they wrap it around a coil and create a transformer to provide their home with a little bit of usable electricity. HAS dislikes this for at least two reasons. First, it is causing injuries to the kids in the community they serve. Second, it creates a constant leakage of power and this costs them money.

This hospital provides the most remarkable kind of services imaginable under very difficult circumstances. They make use of every possible resource, and they do it with skill and patience and courage. We were so impressed with the people we met, and with what they were able to accomplish with what resources they have available. They have a sliding scale of payment—people from the surrounding area pay almost nothing for services, and people from farther pay a little more. But, they don’t turn anyone away. It puts into perspective the things that we expect and that we obsess over in our facilities in the states. In some ways, it makes me think we worry a lot about how many angels can dance on the head of a pin—compared to what they people here are doing.

At the end of the day, I hope that we were able to provide these folks with something that can help them do their job a little bit better and take better care of a few more people.

Photos by photojournalist and HOPE volunteer, Allison Shelley.

Help HOPE provide long-term medical relief efforts in Haiti. DONATE NOW

Wednesday, April 14, 2010

White Tank Top Elbow Gang Brings Smiles to Volunteers in Haiti

It's an unlikely gang. Their uniform: white tank tops and arm slings. Their mark: pieces of medical tape stuck to their foreheads reading NPO (a Latin acronym meaning "do not feed," a common pre-op instruction). They roam the halls of the Hôpital Albert Schweitzer (HAS) together sometimes holding IV bags for each other. They are about 8- years-old and are affectionately known as the White Tank Top Elbow Gang by Project HOPE volunteers working in the OR.

"The boys know a few words in English so they always say 'hello' and ask our names," relates HOPE volunteer, RN Tina Bergstrom, an OR nurse from Massachusetts General Hospital. "But the curious thing is that all four have elbow fractures."

Fellow HOPE volunteer, Dr. Tom Witschi, an orthopedic surgeon practicing at Elmhurst Hospital Center in Queens, NY, has a theory. “It's mango season,” he says. “When the mangos are ripe, the kids climb the trees to get them. And what happens when kids climb trees? Sometimes they fall.”

Bergstrom, Witschi and RN Michelle Wall-Kerwin, another HOPE volunteer and Massachusetts General OR nurse, have spent much of their first week at HAS helping to set pins in these little elbows. The injuries, which might be set in a cast back at home, are requiring surgery thanks to the lag time from injury to medical care.

With only a few days notice, the HOPE trio has been working together since they arrived-- on Easter Sunday-- to help relieve the OR staff.

The hospital's two general surgeons are supplemented by teams like this one from Project HOPE, which provide expertise or simply a fresh perspective. But even with most of the earthquake victims out of the critical care phase, Witschi points to cases like these to emphasize the hospital's need for more staff, including a full-time orthopedic surgeon.

"We're supposed to be helping the surgeons with their operations here, teaching as we go along, but they are so busy that we're being given many of the surgeries to do ourselves," says Witschi.
Today the team operated on a 21-year-old male patient with a tibia fracture suffered in the earthquake. After the surgery, which involved cleaning the wound and removing dead tissue from around the infected leg, the patient's body began to shudder, possibly a symptom of septic shock according to Witschi. The patient had already undergone multiple skin and muscle grafts and been fitted with external bone fixators. "Unfortunately, what this man needs is an amputation," says Witschi.

The three volunteers admit that while the week has not been without its challenges, they are positive about their mission and the role they are filling at the hospital.

"I told my husband that I really NEEDED to go," says Wall-Kerwin, who has been on similar medical missions with other organizations to Ecuador, Chile and Peru. "When you leave countries like Haiti after doing this kind of thing, you feel like you really helped someone.”

The team will be at HAS another week.

Story and photos by photojournalist and HOPE volunteer, Allison Shelley.

Help HOPE provide long-term medical relief efforts in Haiti. DONATE NOW

Tuesday, April 13, 2010

Haitian Children Now Receiving Care in U.S.

Two children cared for by Project HOPE volunteers onboard the USNS Comfort are now in Boston receiving following-up care.

Dave and Gedline, both seriously injured in the January 12th earthquake are currently being cared for in the U.S. at HOPE volunteers’ home hospitals, Massachusetts General Hospital (MGH) and Shriners Hospital for Children Pediatric Burn Center.

Dr. Marjorie Curran, who served onboard the Comfort is helping coordinate the children’s care.

“Gedline is currently an inpatient at MGH right now,” Dr. Curran said. “Dave is staying at a host family's house, and will be treated at Shriners, receiving a bit more plastic surgery and receiving his prosthetic leg and rehabilitation.”

Dr. Curran said both patients are being visited by the volunteers who cared for the children on the Comfort.

Monday, April 12, 2010

Additional Volunteers Join Medical Mission in Haiti

Four new Project HOPE volunteers hit the ground running on at the Hôpital Albert Schweitzer (HAS) in Deschapelles, Haiti, on Tuesday for a two-week rotation, joining volunteers Claude Hillel and Joy Williams. By the end of their first day, which began at 7:30 a.m. and didn't end until midnight, the team had not only had a hospital orientation tour, but had rounded on patients, delivered a baby and treated victims of a multi-fatality car crash.

During her tour of the maternity ward, Massachusetts General Hospital nurse midwife Angela Ferrari was handed a chart and asked to see a patient while the attending physician, Dr. Maria Small, dealt with an emergency. "It was nerve-wracking being thrown into a situation where I didn't know the chart system and then learned that the patient wasn't even pregnant," admits the petite Ferrari, sporting a t-shirt reading "Midwives. Helping People Out." Before she could even finish reading the chart she was whisked away to help deliver the retained placenta of a woman who was at risk of a life-threatening hemorrhage.

"You know what you're doing in your own setting," says Ferrari, who works with a large group of midwives at Mass General-- an unusual situation in a field that mostly comprised of small private practices. Ferrari was asked to come to HAS to help restart the hospital's midwife program, which was abandoned in 2008 when the hospital's sole midwife left the hospital for another job.

HAS runs six health centers and helps to support seven others in the region. While most mothers have traditionally given birth at home, the centers have made it possible for safer deliveries and thus have lowered the region's infant mortality rate. Mothers-to-be bring their midwives and have the benefit of medical help if a problem were to arise during the birth process.

"The problem is finding the midwives," says HAS medical director Rolf Maibach. "It's not a field where you get a certification-- the knowledge is passed on from mother to daughter. These days young women want a diploma so they are not as interested in these traditional things." Maibach hopes to be able to reignite interest in the field by staffing not only the main hospital but also the health centers with nurse midwives who might one day be able to provide training for women in the community.

Ferrari's third patient of the day arrived at the hospital from one of these clinics and without a midwife. The woman's screams were loud enough for staff to pull the woman out of line at the OBGYN clinic. In her second day of labor, sweat caused her thin white dress to cling to her swollen body. Her husband and mother-in-law supported her weight as she was moved to a bed in the maternity ward. Without a translator present, Ferrari held her hand. "I wish I could explain to her what I need her to do to make her more comfortable," said Ferrari, using a combination of pantomime and French to ask the patient to sit up, then take a short walk. Ferrari's face contorted in empathy with each of her patient's painful steps.

It wasn't until 11 p.m. that the baby boy-- Cemesier Renatho-- was delivered, with a vacuum delivery tool and a full head of hair. A rapidly dropping heartbeat necessitated the speedy delivery and he was immediately put on separate IV's for antibiotics, glucose and saline. Without the extra care, Dr. Small fears that the child may have had a much worse fate.

At the end of the day Ferrari finally changed into her scrubs. She was excited about her role at HAS. "I definitely now feel that I have a sense of how I could be useful. It's exciting to be able to be a part of such an important relationship between midwives and HAS." She added, "But before I come back next time, I'm going to learn some Creole!"

Story and photos by photojournalist and HOPE volunteer, Allison Shelley.

Help HOPE provide long-term medical relief efforts in Haiti. DONATE NOW

Friday, April 9, 2010

Never a Day Off for Volunteers in Haiti

Today was somewhat on the quiet side, but it was not one of complete rest as I had to get caught up on emails and get my discharge list completed to alert Dianne of (Christian Medical Mission Board) CMMB as to the number of patients that would be returning with her to Port-au-Prince on Tuesday.

The rest of the morning was spent in St. Marc, about a 1-hour’s drive from Deschapelle to shop for paint. We bought some beautiful bright colors that we will use to paint some of the exam rooms in the clinic. After lunch and a short nap, four of us headed to the Hanger Clinic where we started painting. We put on some music on and while we listened, sang and chatted, we were able to complete 1 ½ rooms. One room was painted neon yellow and the other deep sea blue. Yahhh, Awesome.

While we were at the Hanger clinic we were visited by a group from In Touch Ministry in St. Marc. They informed us that they heard of the Hanger clinic and the service we were providing the amputees on the special report by MSNBC. As we all talked, the leader of the group stated that they had a number of clients that they would like to bring to the clinic for prosthesis. Information was taken and follow-up will be made.

Thanks for reading-Project HOPE volunteer Joy Williams

Help Support Project HOPE's long-term efforts to help the people of Haiti. DONATE NOW

Thursday, April 8, 2010

Helping Patients at HAS and Beyond

Project HOPE’s physical therapist volunteer, Claude Hillel, along with Maryann and prosthetists Jay and Gil, went to Cange to provide prosthetic service for the amputated patients. Cange is a medical facility affiliated with Partners In Health (PIH) that was started by Dr. Paul Farmer some 20 plus years ago. It is located about a 2.5 hours’ drive north of Port-au-Prince and 2.5 hours east of Hôpital Albert Schweitzer (HAS). The team works with patients that were casted the previous week and are now being fitted with their new prosthesis. They also help make necessary adjustment and set a course of physical therapy.

New patients are also measured and casted, then the information is brought back to Hanger Clinic and the prosthesis are made for the coming Saturday. On occasion, patients are transferred to HAS for continued adjustment and more aggressive therapy.

While this team was at Cange, the remaining staff members stayed at Hanger Clinic to complete work on other prosthesis and paper work that is a nemesis for most of us. I spent most of my day at L'Escale, planning discharges and making sure patients and their families' needs are being met. I encouraged everyone to wear their prosthesis all day while doing their daily activities. I also stressed the importance for continuous use of "shrinkers" to avoid swelling and thus pain and inability to wear prosthesis while prosthetic is not being worn.

Patient F., the now famous 30-year-old ballerina that lost her right leg below the knee, finally came to have her prosthesis fitted and adjusted today. I am told that Ms. F. was one of the first patients that was measured and casted for a prosthesis, just about 2 months ago. She never returned for her prosthesis and no one was able to get in contact with her. Finally, she was contacted by a CMMB (Christian Medical Mission Board) worker name Diane. Diane informed me today that Ms. F. has been very depressed and has been having a very difficult time accepting the loss of her leg. Diane an amputee herself, gained the trust, confidence and friendship of Ms. F by calling and visiting and encouraging and supporting her. With this new found relationship, Diane was able to encourage Ms. F. to follow through with her fitting and to begin her therapy. Diane shared her story of losing her leg in a plane crash about 4 years ago with Ms. F. This has helped her to start accepting her situation. She is now ready to not only have her prosthesis but to wear it and begin physical therapy. After wearing her new leg, Ms. F. was actually very pleased with what she was experiencing, so much so that she wanted to take her leg home. We were not able to support her in this, as more adjustments needed to be made. She will return on Tuesday and at this time assessment fitting and therapy will be completed and Ms. F. will hopefully be able to return home to Port-au-Prince on Thursday.

The day ended with discussion for the opening of another dorm that will accommodate about 8 more patients each with one family member. We hope to get staff in place by the beginning of next week.

Thanks for reading-Project HOPE volunteer Joy Williams

Help Support Project HOPE's long-term efforts to help the people of Haiti. DONATE NOW