Trip summary Haiti May June 2013

Trip summary Haiti May-June 2013 (departed 5-23-13 returned 6-3-13) 2013 Photos

Rather than a detailed account of a recent adventure in Haiti, this is just a brief recollection.  The trip helped bring the Haitian team together, run mobile clinics, and stimulate discussion on future mobile clinic plans.  It was helpful to learn about visions from the Haitian team members.  Upon my arrival, there was a flood in the area of the house I’d be staying in Tabarre in Port au Prince (PAP).  It created some challenges with electricity being out and required some creative approaches: different size boards laid out to walk over the muddy water to get in the house and candles used to light the house at night. The house was big and warm, and I really liked the lime, coconut, and avocado trees  in the back yard.  A friend made sure I got settled.  I awakened in the tropical climate with the sun shining, a good start to the day.  With getting in later than planned the day before and luggage getting delayed it put a change in the plans which were to go to Jacmel with the group the day I got in town. Instead, we headed to the airport Saturday to hire a driver with a truck or van in lieu of renting, which seemed like a safer option. We made plans to meet up with the Haitian doctors along the way picking them up in different parts of town as we were heading to the countryside town of Jacmel, about 3 – 4 hour driving from PAP for a retreat at the beach.  Our driver was a nice pastor, and we had a really clean large van with plenty of room for all of us and our bags.   I decided to treat everyone with us to a weekend getaway out of my own personal expenses.  It was a token of appreciation for the work being done through mobile clinics, plus a way to have fun and take time for rest. Recognizing the importance of team building, rewarding service, and motivating the team to plan for more clinics, this weekend was also chance to reach for these goals.  The doctors shared hopes they had and even wanted to take me to meet someone in the political arena, I think a senator in Jacmel which sounded like a good way to build connections and get us established.   I hope we can these collaborations in the future on the next trip, as we were only in Jacmel for the weekend so time was limited.   The town seemed peaceful, had much more of a laid back, less crowded and chill feeling than the busy city did.  We enjoyed relaxing at the beac,h and they played soccer, a favorite sport in Haiti.  We stayed in a charming hotel, the Hotel Florita, not far from the beach, with many rooms, so everyone had plenty of space.  I liked the Haitian food from a restaurant or food stand in town we had when we arrived.  The hotel staff prepared a spread with meat and rice for dinner for the group.   Everyone eats together, the sense of family and sharing we lose touch with back home. I was surprised to find the group patiently waiting for me to arrive downstairs before we all ate.  A couple of the doctors found some club to go out to;  good they got to take time out to play as they work hard.

We headed back to PAP Sunday night.  We had time that week for planning mobile clinics.  We went to Valiere Pharmacy to stock up on medications for mobile clinics.  It is a really challenging task to obtain an array of medications and get enough stock a mobile clinic.  It’s hard not knowing the amount of patients who’ll present with various common ailments, even with lists of medications available from different resources and having experience buying medications for the mobile clinics it’s tough.  I brought a variety of over the counter medicines with me in the country put together back in Oregon in medication packing parties and also sorted and packaged by high school girls through the school I attended St. Mary’s Academy.  Still, anticipating the appropriate medications to potentially cover an assortment of chronic and acute diseases, have an adequate amount of medications of each kind of drug, other supplies like syringes, first aid, diabetic supplies and wound care materials presents quite a huge at times tough task.  This coupled with the art of negotiating with the local pharmacies in Haiti to get the best deals requires a lot of patience and persistence.  I was able to bring some supplies for the doctors such as thermometers,  gadgets to check oxygen levels and heart rates examine eyes & ears but this to can be challenging to manage in terms of trying to get the best deals and pack objects appropriately for international travel. My goal is to get each doctor their own portable diagnostic kit kind of a motivator kit for doing clinics.  My Dad has given me guidance with ideas for items to include since he has an organization pending nonprofit status that focuses on training locals on the repair of biomedical equipment in developing countries.  Long-term goals would include at least one or more portable EKG machine to be shared in the kits.  I plan to put together kits with basic diagnostic equipment, like oximeters, thermometers, blood pressure cuffs, low cost otoscopes / ophthalmoscope devices and some supplies for some common simple diagnostic tests in the clinics like urinalysis strips and pregnancy tests.  The vision is for each of them to have their own tool kit in a bag for use ideally solely for the clinics so they don’t have to use their own equipment.   Possibly someday we will expand and get a stationary clinic, my dream is one on wheel like a big mobile clinic van.   I’ve explored stationary clinics pricing them a bit as it could serve as a base for mobile clinics.  Having this base with a small lab for diagnostic techniques would be good, but keeping tests practical and cost effective is the objective with mobile clinics.

Back in town, I had a chance to walk around and explore the neighborhood I was staying in Tabarre which is walking distance from the United States embassy in PAP.  I felt nostalgic in this area as it was not far from the first site, Bojeux parc, a field hospital with outpatient clinic care that I served at in Haiti in 2010.  It was an amusement Park turned into a clinic in response to the traumas of the earthquake in 2010.  I did clinics at this placed in Haiti when I volunteered with another organization at that time.  I learned that the clinic shut down which was, I can imagine, was difficult for the patient’s who benefited from the healthcare services rendered and maybe even depended on the care.  I used to walk to the market Belmart that was a well stocked convenient store by the clinic so I had a chance to do that again.  I met the translators that helped to inspire me to run the mobile clinics while I was serving at that site.  Most all of them went on to complete Haiti’s first paramedic training program and are working as medics, a much needed skill in high demand in Haiti.  One of the translators, Windy, particularly inspired me with his ambition.  He helped me go to an orphanage that we later held a mobile clinic at and provided care for deserving children. Windy, in spite of any obstacle he faced, trained in the medic program, helped get a school / clinic started in Cite Soleil notoriously known as endangered slums.   Sadly for those that knew him, Windy succumbed to an illness, lacked sufficient access to medical care and left this life at age 26, January 6, 2012.  I think of Windy and how just maybe these mobile clinics can make a difference in preventing such suffering in another patient like Windy, with such a promising future, but by circumstance a lack of access to medical care.  Just maybe, these clinics can be a platform to make someone’s burdens a little lighter, health outcomes a bit stronger, and life ahead a lot better.  So onward we continued after mobile clinic planning to carry on mobile clinics through the week with a goal of having them grow to spread in different places in Haiti and be sustained by the local Haitian team.

Opportunities for improvement

We spend a fair amount of time going to a local large pharmacy, Valiere Pharmacy by the Iron Market the downtown PAP.   Each time I go here I meet individually with one of the presumed owners, a woman in their office in the pharmacy.  It is easiest to use this method in order to compare prices and negotiate so we can get the best bulk deals on large purchases for an assortment of medications to stock the clinics.  I have also obtained medications at a variety of pharmacies in Haiti and a seeking one to partner with where we can arrange for mobile medical clinics kits to be purchased electronically online from the states for pick up by the Haitian team members to use for clinics in Haiti.  I tried to work out a deal with this pharmacy, but it requires per report, selecting medications individually basically each time.  Additionally, it was suggested that to open an account with a bank in Haiti for the transactions.  These are not the ideal processes so we will continue to seek out options with perhaps Valiere and / or other local pharmacies in Haiti where we can establish a partnership for future medication exchanges.  I made purchases at the local pharmacies to obtain medications.  It is hard to determine the correct number of patient’s and amounts to buy of different medications.  Bringing a pharmacist on the next trip to help us collaborate with a local pharmacist will help improve this process.

Hiring a regular driver can be expensive in Haiti and while striving to negotiate the lowest prices with different drivers met from networking usually with someone I knew there or a friend of a friend.   It seems kind of common for drivers to rent taptap (the local truck mode of transport there, called a taptap presumably because you tap to get it to stop).  The costs of renting if for a day can be spendy, maybe up to $100 I think was the max I ever paid. Negotiations for prices can be a bit of an obstacle.  Gas prices and cars are relatively expensive in Haiti.   Finding a driver to take a group of us for a mobile clinic at a price that I’m willing to pay was a challenge, though we managed to do it each time.  Balancing the costs of food for the doctors and myself, housing, travel (i.e. flight) and other ancillary costs out of my own expenses and medications, supplies and equipment out of the Global Mustard Seeds Missions (GMSM) organization budget is delicate and takes careful attention.

Mobile clinics

To prepare for clinics we picked up bulk pens and notepads to be used for record keeping.  A short-term goal is to put together a standard one page form for the clinicians to use for the histories & physicals on each patient.  I also want to get a pharmacy form put together for use with the mobile clinic pharmacy with GMSM letterhead on it.  It will include patient’s vital signs and basic information.  This will help with record keeping and also give a chance to double check order for medications against the vital signs. I’d like to get a carbon copy with these records for the patient’s to have a takeaway form that they can return with or take to an outside pharmacy when indicated.  I worked at a different clinic with another organization in Cite Soleil and the patient’s returned with their prior health history forms which was nice to have as a reference.  I’d like to have our records scanned into a database after the clinicians get done seeing patients.  This way they can be uploaded into the computer and used to track patient data or even referred to for return visits of the patient’s seen.

It was good to be able to return to Cappva, the tented camp in Cite Soleil where there are still many people living in financially impoverished circumstances.  The community leaders seem to welcome us with open arms.  I feel secure and protected even those these areas have bad reputations in terms of safety and a history of being riddled with crime and problems.  I see it as a chance to serve where the help is really needed and make a difference in delivering health care where it may otherwise be lacking.  Plus when walking out God’s calling on your life I believe there is a hedge of protection that comes with it, so He covers each of us in the midst of it all! I enjoy returning to a place where we have hosted clinics before and having a comfort level in the camp leaders stepping up to provide organization and a sense of security.

Learning from previous experiences of high patient volumes, the Haitian doctors actually helped us take the initiative of distributing numbers of cards to patients which helps with crowd control and maintain order so we don’t get overwhelmed from high volumes of patients seen. We had on average about 3 or 4 Haitian doctors with each of the mobile clinics we did.  I appreciate being to work with the locals as they are likely used to working with high numbers of people with a lot of complex patient histories and they are familiar with the management of endemic tropical diseases.   I worked with all Haitian teams this trip and did not have a volunteer just for the pharmacy so the doctors each set up tables to see their own patients and I worked in the pharmacy to dispense the medications.  I needed a translator to help do the teaching so I had some folks come along at our different clinics who helped me with patient teaching.  Our clinic was held in a wooden shelter that had benches and tables of different sizes with some chairs. I had a separate small room about the size of a small closet that I set up different medications on to try and keep organized

We also ran surprise mobile clinics at a place called Village de Dieu which means Village of God which was great to be able to set up makeshift clinics in an area we’d not worked in and provide needed services.  It was enroute to the beaches in the North which are nice so there was a warm, welcoming view of the ocean from the outskirts of the Village.  We set up the clinic in a wooden shelter area but it was smaller and there was not as much space, but one learns to improvise so we made do.  The doctors shared tables.  We had an extra doctor work with us that we’d met at a pharmacy when negotiating medications to purchase.  It’s always a Blessing to have additional help to see patients.  We received warm thanks from the clinic site for the unexpected visit.  We decided to return to have another clinic there that week, realized sometimes the best outreach is that which is unanticipated without plans. We stopped by a roadside food spot for some spontaneous Haitian food which is always good to me.

Midweek we ate a Haitian restaurant for dinner- the food is always tasty and I really like the ambience of dim lights and authentic feel for the culture at the places I’ve been in for dinner.   A group of us topped off the end of the trip at a trip to the beach Kaliko much closer to the city.  We spent some time that night before talking about their hopes for clinics; their dreams of coming to U.S. institutions to get training; their desire to have American doctors come work alongside them (in the mobile clinics).  All of these seem like achievable dreams.   Hearing their desires motivated me to take the discussion back to my hospital with administrative persons in a position to help create potential connections.  My friend knew the manager on duty which was nice so we got to tour the beach at the resort for free where there’s usually a charge.  My plan was to get back in time for church at Port au Prince Fellowship, a place I love going to for worship, but with stops along the way at a town we made it there after service was over. My friend shared the powerpoint from the sermon with me so at least I got to read on the message.  It’ll definitely be one of the stops planned for my next trip to Haiti.  I left medications with the Haitian doctors with the doctors to carry on mobile clinics in my absence.  

Reflections and updates : 

Prior to the last trip in May 2013, we submitted our first grant application to the Bill Gates Foundation.  It was done until tight deadlines, and could have been better prepared with more detail and research, but there was a lot learned in the preparation of the application that will definitely give us an advantage for future grant proposals.  We have not yet received the decision on the grant. 

I have been pleased that the Haitian doctors have done mobile clinics and made plans for more requesting medications.  Seeing the beginning of the dreams I have for GMSM come to fruition through these leaders who I believe make a difference in giving hope to each individual they serve is encouraging.  Trying to find a systematic process where we can together come up with a solution for a long-term sustainable mission with Haitians helping Haitians is challenging.  Maybe this could be done in part with enough funding from outside resources as we continue to grow.  Ultimately though, the objective needs to be based on more than just funding.   In the past we talked about charging patient’s minimally a flat rate for services rendered.  Those who cannot afford to pay would of course not be denied care.  I’d been advised that there is a value associated with services received with a charge.  I would expect to have the Haitian doctors charge no more than $1-2 US dollars per visit maximum and less for follow-up visits.  This fee would include the consultation and medicine received.  We have not discussed yet where testing prices for labs would come into the fees.  Considering that the average income of those receiving care is little to none, we would not want to create a financial burden for people.  It was recommended that we do not charge those persons living in tented camps. The four venues that we have focused on with mobile clinics are churches, tented camps, schools and orphanages.   Reflecting on what activities thus far is educational and provides a platform for growth.

As we plan for future clinics, I want to get a system established to track the patient’s seen with records scanned electronically so that we are documenting cases on more than written records.  This will be a goal for the next trip planned for December 2013.

In Portland OR, a fundraising committee has come together to meet and plans are under development  for the next benefit for Haiti, Taste the Tropics II to be held at Mercy Corps to support GMSM mobile clinic initiatives in Haiti.  The details of the event are being organized with prayers and plans for it to be very successful will be revealed as it unfolds.  There is a plan to have the Haitian community locally involved.  Two of the Haitian volunteers from within Haiti, the local President of GMSM in-country operations Dr. David Renelus and Logistics Coordinator, Adonique Denis both have visa appointments through the embassy to seek approval to attend the event.  The hope is that they will be able to participate and present their perspectives on life in Haiti and serving in the mobile clinics.  It would be great to showcase the work these leaders have done in Haiti, notably voluntarily.  Haiti is a country filled with determined people who overcome in spite of suffering an often inequitable share of setbacks and hardships.  These leaders step up and lead by example, extending their talents, energy and skills to make life a little better for those less fortunate.   We are reminded that whatever our call or path in life, we should strive to do it with love and passion. Our theme for the event is promoting service and hope in keeping with the GMSM motto to “Make your drop a big splash (D. Schuster).”