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Enfin c'est la derniere jour a Haiti! Alas, our final day in Haiti has come! We bid adieu to Jeremie early this morning, boading our 16-seater 'puddle jumper' bi-prop plane to Port-au-Prince. To say that we were sad to leave would be an understatement. Jeremie and the people of Haiti have left an indelible impression upon us. Upon arriving in Miami, Anthony spotted a true public health celebrity upon leaving the plane. Imagine our surprise to see DR.PAUL FARMER disembarking from the same flight! Dr. Farmer is best known for co-founding the organization Partners in Health that has worked for many years in Haiti's central plateau, among other international locations. Dr. Farmer was recently featured in a segment on CBS's 60 Minutes. A number of us have been reading Tracy Kidder's book Mountains Beyond Mountains about Farmer's work in Haiti. Undaunted by Dr. Farmer's celebrity, fearless Anne Cavett approached Dr. Farmer at baggage claim introducing Team Haiti. Anthony risked the wrath of TSA and boldly asked for a picture. Dr. Farmer was more than happy to oblige the students that were present. Holding a brief salon, he congratulated us all on our recent efforts in Haiti and the importance of social justice. He acknlowledged the importance of nursing in global public health activities and even quoted our very own Bloomberg School of Public Health's motto, "Saving 1,000,000 lives at a time". Celebrity sitings aside, the encounter was a perfect way to wrap up a perfect global health expedition. It should be said that Sheila was delayed at passport control. However, we quickly whisked her over to Dr. Farmer for a brief introduction and handshake while he was wheeling his baggage cart away. Overall, we were impressed with how personable and willing he was to engage us with our interest in public health nursing in Haiti. As a final note - *MERCI AN PIL* to our true public health leader and unsung hero, Dr. Sara Groves who's fabulous insights and relationships made our trip an unforgettable experience! Signing off - TEAM HAITI
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May 24, 2008 After savoring a delicious rainfall overnight to cool the air, we sat down as a group and talked with the head cook chez Bette to gain a better understanding of the social network here in Jeremie. It was fascinating to hear about her relationships within Jeremie, her social groups, her church and her family structure. She’s been working for Bette for 14 years, and one of the most striking things she said was that she goes to Edwin (Bette’s husband) and Bette first if she has any sort of problem or need. It speaks highly of her relationship with them. We walked into town and had an amazing tour given by Roxane. After the tour, we spent the day at the Sisters of Charity. The Sisters are dedicated to service, doing truly inspiring work of taking care about 50 kids spanning from a month-old infant to school-aged children. Additionally, the Sisters care for over 50 adults, both men and women, who are recovering from major illness and/or dying. The most common diagnoses for the adults are HIV/AIDS and tuberculosis. Despite very limited resources, the Sisters do an amazing job of providing a place where children and adults who are hungry, sick, or dying can find a home. We arrived about a half-hour before lunch and engaged the children in coloring pictures, which was a blast (thanks for all of the coloring book and crayon donations!!) A few of the visiting family members even colored with us. When lunch arrived, we all helped feed the youngest babies. Many of the children come to the Sisters of Charity to live because their families simply do not have enough food or resources to take care of them, not necessarily that their parents have passed away. Needless to say, many of the children arrive very malnourished. Rocking one small child in my arms today, I was in disbelief that the child I held was one-and-a-half years old: she could not hold her head up, did not make a sound and maintained a listless expression on her face. The baby that Cezanne was feeding could barely eat because he coughed so much (most likely pneumonia) that he kept choking. With care and good nutrition, the children show remarkable changes, and transform into bundles of energy. After saying our goodbyes to the children, we began our activities at the adult hospice (men and women live in separate buildings). We made tissue-paper flowers, painted the women’s nails and gave the men hand massages. Seeing the smiles and excitement of everyone was incredible. Leaving the Sisters of Charity left us, as Sara says, “ just one hill more to walk up.” The hill, however is a solid one-mile uphill hike that made even the fittest of us a bit winded. On our way up, we stopped off at another community-run orphanage that housed about thirty kids. These kids were incredible. We walked in to drop off coloring books and other supplies and were treated to one of the most surreal experiences of a very surreal day: two teens brought out musical instruments for all of the children, who then chose their appropriate musical instrument: tambourines, reed flutes, drums, clappers, a keyboard piano. The children then began to sing perfectly choreographed hymns in English. We all sang along to “This Little Light of Mine” and “The Saints Go Marching In.” It is hard to convey in words the enthusiasm of these kids, swaying back and forth, singing their hearts out. Incredible. Just incredible. As we finished our sweaty walk up the one hill of Jeremie-- a long, long hill--we were overwhelmed by the immense need in Haiti, yet uplifted by the spirit and work of the people of Jeremie.
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Friday, May 23, 2008 Today we traveled to Robin, a village near Bonbon (the beach we visited yesterday). A group of visiting American nurses and doctors also joined us, along with a number of HHF employees (health agents, midwives, etc…). We went to help with the health post prior to doing our teaching and screening with the adolescent girls. Sadly, we almost lost two nursing students to car sickness while in route to Robin. Luckily, as Hopkins nursing students, Kishma and Cezanne were able to throw up, recover and then proceed to work. They also had the help of our experienced ED nurse and graduate student Michelle. It was a close one. We dove right in to working once we arrived in the village. Meghan and Anne proceeded to do all the weights and blood pressures for the prenatal clinic. Meghan also tested their hemoglobins prior to the women receiving their syphilis tests. Anthony helped one of the visiting American physicians and one of the RNs do pediatric assessments, helping with their diagnoses and interpreting medication names for them. Megan worked with a family practice doctor doing adult and pediatric assessments, providing all the charting and some translation. Susan weighed babies, helped with screening the adolescent girls and helped with neonatal assessments. All of us had the opportunity to also work with Sister Sophie, who was kind enough to walk us through prenatal assessments (measuring fundal heights, discovering the babies’ positions, and using dopler to listen to the babies’ heartbeats). We also saw her do sonograms, and a few of us actually did them ourselves! We were so busy with all the health post activities, we decided to split up and half of us worked with the adolescent girls. Cezanne and Kishma, somewhat recovered from their car sickness, joined with Michelle and our fearless leader, Sara, to perform the skits and do the teaching and screening for the adolescent girls. It felt like between us all we saw the entire village!
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Today was a fun day! A group of us got up early and walked downtown to watch the Corpus Christi procession – lots of singing, praying and beautiful flowers everywhere. Later, we drove out to Bonbon, a small fishing village by the beach. We spent the day swimming, reading, sunning ourselves, and stuffing our faces with juicy mangoes. We bought ingredients for lunch at the local market and a woman prepared it for us while we were at the beach. Half of us went ahead to the woman’s house where we got a glimpse of the food preparation and life in Haiti. We spoke with her and her family and did a brief home assessment. We had a delicious meal of poisson boucané (spicy fish stew), boiled plantains, and soda which we shared with everyone. Miam miam!
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Haitian proverbs for the day:
Deye mon, gen mon.
(“Beyond the mountain is another mountain”, i.e. what can be seen is not necessarily all there is)
Yon sel dwet pa manje kalolou.
(“You cannot eat okra with one finger”, i.e. we must all work together to succeed).
Bonswa, tout moun! Today was yet another jam-packed day of public health activities in and around Jeremie!
After a hearty pancake breakfast, we gathered our duffle bags filled with supplies and hopped sardine-style back into the Land Rover. Our first stop for the day was the nursing school in Jeremie. Interestingly, the building serves as the town’s nursing school by day and law school by night. We were greeted by the French nun who runs the school and introduced to 1st and 2nd year nursing students. The third (and final) year nursing students were out in the field doing public health work with the national tuberculosis program. Cezanne, Anthony, and Meghan served as our French-English translators for our discussions. The students are studying familiar topics: pathophysiology, anatomy, psychology, and pharmacology. Tuition costs $15 per month, which is significant considering that the average Haitian family earns about $365 per year. The students informed us that nursing positions are rare in Jeremie, and that they will have to move elsewhere to find positions. Given that the nurse-to-patient ratio in Haiti is 1:1,000, they will no doubt be put to good use. They were particularly interested in asking us about scholarships and jobs in the States… We were grateful for the opportunity to visit and see what nursing school is like in Haiti.
After the school, we then headed to the public hospital in Jeremie. The hospital’s one luxury is its breath-taking million-dollar view, set atop a hillside overlooking the ocean. Compared to other hospitals in the developing world that we’ve visited, we agreed that this facility was relatively calm, quiet, and surprisingly devoid of crowds. This is probably because of the prohibitive cost of care, the distance from villages, and general lack of supplies (including running water and medicine). Many of the providers are Cuban doctors, who travel throughout the developing world providing health care service to those in under-resourced communities.
We visited the pediatric unit, where we saw an infant with jaundice (recovering well) and another with possible bacterial meningitis or malaria (and a poorer prognosis). We then visited the maternity unit, which has a tiny delivery room with two beds for delivering and catching babies. (Most Haitian women deliver at home with lay birth attendants; Haitian Health Foundation and KOMBIT health workers aim to identify women with pregnancy risk factors so that they can deliver with skilled providers).
At the hospital, we also saw the post-surgical recovery area for women post C-section. Unfortunately, we learned that most women forgo pain medications after C-section because of the prohibitive cost of medications.
After the hospital, we piled back into the Land Rover and headed off for a lively drive along bumpy dirt roads to the remote village of Douraton. If you closed your eyes, you might swear you were on a ferry, not in an automobile. The unpaved roads had obstacles such as big rocks, ditches, and a river, but our trusty Land Rover (and driver!) ensured that we made it safely. The 1.5-hour drive to the village was breath-taking—passing through dense groves of palm and mango trees set amid rolling hills and occasional ocean views. Traveling through this remote and verdant department of Haiti, it can be hard to believe that the rest of Haiti is so deforested and dry.
We arrived at the village health post around noon and immediately started assisting the health workers with pre- and post-natal visits. We measured fundal heights, used a Doppler to detect fetal heart tones, checked blood pressures, tested hemoglobin levels (for anemia), and weighed newborns. After assisting with maternal visits, we got to work setting up for our THIRD health screening with the HHF village soccer girls! We conducted this screening entirely outside in a setting atop a hill overlooking rolling green hillsides beyond. With help from our Haitian translators BaBa, Mundi, and Missus, we performed our first aid and choking skit for the third time to an attentive group of teen girls. At this point, all of us in Team Haiti can all teach basic wound care and the Heimlich maneuver for choking in our sleep!!
After the skit, we provided anemia, blood pressure, and BMI screenings for 59 girls and tested their retention of what they had learned. Like yesterday, most were able to remember key teaching points from the skit. We provided iron supplements for the three girls identified as anemic. Happily, we had a lower number of girls with anemia in this screening—perhaps the mountain air and remote village life is protective?? :)
After packing up and saying our goodbyes (Bye-Bye in Haitian Creole), we piled our sweaty—but content—selves back into the Land Rover, and headed back to Jeremie… Tomorrow, we’ve got a day off for the national holiday of Corpus Christi. We’re celebrating by heading to a festival in town and then the beach, of course! Should be another interesting day in Haiti, bon chance! Alo, nou fatige! Mesi, tout moun!
(Now, we are tired. Thank you, all!)
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Today was another amazing day in our public health clinical rotation. We woke up early and headed to the Haitian Health Foundation for our introduction to the KOMBIT project, the program working towards reducing maternal and neonatal mortality (for which our clinical instructor was the director!). It was great to see the staff perform two modules from the Home based life-saving skills program. This is a program designed to for community education purposes to teach village birth attendants, expectant mothers, and families the proper care of mothers and newborns and the danger signs surrounding pregnancy, delivery, and the postpartum period. The teaching session was great to see--the performance was amusing and educational at the same time, and it was impressive to see the participation of the audience of waiting patients. Once this orientation was down, we toured the Akamil mill. Akamil is a food product made of two parts cereal (rice, corn, millet) and one part beans that is ground together to create a powdery substance that provides appropriate nutrition. We have purchased a good deal of this to give to the girls who attend the health fairs, and it was great to see this being made.
We then headed off to do the second of our health fairs. This time, the site was Fond Rouge Dayere, a village located up a steep, rocky mountain road. After a bumpy ride getting there, we were rewarded with cooler temperatures and beautiful views. We proceeded with our "usual" activities: the girls sang a welcome song for us, we performed our skits on first aid techniques and the Heimlich maneuver, and then performed the health screening. Our skits went very well today, and the girls seemed to learn well. We even saw the girls teaching each other the things that they learned later! The screening process (heights, weights, blood pressures, hemogloblin checks) went smoothly. The girls received their first aid kits and loved them! They were easily able to identify the items in the kits, which made us happy for our evaluation for our final paper! With our health fair complete, we headed down the mountain to see the Jeremie wharf. Today was the day that the large boat is filled with people and every good imaginable to head to Port-au-Prince. What a sight to see! We then broke off into groups to divide and conquer our tasks needed for tomorrow. Tonight we celebrated quite an event--Sheila's birthday! We had brownies, special cookies made only in Jeremie, M&Ms, a new straw hat as birthday gift, balloons, and oragami! We'll post pictures soon! Overall, it was quite a day. The scenery continues to be beautiful, and our experiences continue to impact us! We will look forward to posting more pictures tomorrow and sharing more of our stories. For now though, it's off to bed for most of us before the start of another early day tomorrow.
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This is Team Haiti 5 blogging from Jeremie, Haiti! We arrived in Port au Prince last Saturday with 16 enormous bags packed with medical supplies. After zooming through customs, we boarded a small 2 propeller plane for a short hop west to our destination Jeremie. Since then we've been busy, packing first-aid kits and orienting to the Haitian Health Foundation Klinik Pep Bonye-a facilities. Our first health promotion presentation and anemia screening for 100 adolescent girls was a true team effort. Each member of Team Haiti 5 would like to share a brief thought with you... ANTHONY PHO - Now that I'm actually in Haiti, global health and community health is no longer an abstract concept for the lecture hall. Healthcare here is raw and real: counting a child's respirations to assess for infection, a shower curtain becomes a delivery pad for childbirth! There is much to learn from the Haitian people and it is both inspiring and humbling. MEGHAN GREELEY - Already, we have seen so much during our short time here. The Sisters of Charity-run orphanage left the biggest impression on me thus far. Walking into a room of 25 cribs of babies was a bit overwhelming, knowing that there are never enough people to tend to all of the children. It was amazing to see what they were able to accomplish! ANNE CAVETT- It is incredible seeing all the need and the many differences between most of the U.S. and Haiti. Yet at the same time, there is such similarity. Teaching a group of adolescent girls to do the Heimlich Maneuver and watching their attempts full of nervousness, giddiness, excitement and reluctance was just what it would have been with any group in the states. MICHELLE CHARRON-There are so many new experiences here. I am learning so much everyday. There is beauty of the ocean and the jungle and the sunshine. Then, in contrast, there is profound poverty and undernutrition that affects everyone's lives. I am inspired to continue to learn how to make a valuable difference in the world. MEGAN MARX- Conquering my biggest fear of small planes to arrive here in Jeremie was only a small step in beginning my public health rotation. Holding the littlest of the orpans at the Sisters of Charity, introducing myself in Creole to a group of 100 Haitian girls for the first time, testing more girls for anemia in a two hour period than I ever thought that I could...this is a whole new part of my Hopkins education. SHEILA ORMOND- Our first full day in Jeremie, Haiti, (Sunday) set a festive tone; we were fortunate enough that our visit coincided with Flag Day, which was celebrated with colorful fanfare in Jeremie. The streets and people were adorned with red and blue (the national colors), and a parade of young performers and representatives of community organizations marched throughout the main streets. In the 24 hours following the festival, we have seen and experienced so much more than one blog can cover, from young orphans gleeful for the opportunity to be held (and later wailing upon our departure), to a two-year-old with the characteristic golden hair distinctive of Kwashikor, to the 30-plus soccer girls we determined to be anemic today, to the girls at church laughing as we erroneously stood when only the choir members should have (un faux pas); I can only imagine what the next 24 hours will bring. Bon chance.
SUSAN NORRIS - This trip is the culmination of many years of anthropological training and nursing education. Although I have travelled throughout the develeloping world as an anthropologist, Haiti is the first country I am seeing through a nurse's eyes, and the scenes I am taking in are incredible. Children blinded by vitamin deficiencies, deformed by malnourishment, orphaned by AIDS. There is much work to be done here, and it has been a joy and blessing to do it. More thoughts from Team Haiti 5 soon!
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