Public Health Team Graduates

When I started the Public Health Education Program back in July, I began by teaching five bright and highly motivated boys, ages 16-20, who were residents of Castel Pierre Village, information about a variety of issues pertaining to public health including hygiene, sanitation, nutrition and water quality along with testing, treatment and prevention strategies aimed at reducing the incidence of several diseases endemic to the area. Last night, the boys graduated from the program and received a certificate, stipend and lab coat. Thanks to the generosity of several people in the states, the Public Health Team (PHT) will also be receiving "Sante Piblik" (Public Health in Creole) t-shirts, backpacks, hats and scrubs.

The purpose of the program is to spread as much knowledge relating to public health as possible, in hope that through education we can empower those most vulnerable in rural Haiti--the children. In order for this program to be a success it is crucial that the teaching is done through peer education, teaching Haitians to teach other Haitians. For this reason, I wanted to find a reliable and motivated student who can serve as my apprentice, who can then go on to teach a small group of interested “public health workers,” who will then go on to teach their peers in schools throughout nearby villages.

As public health workers, they are helping to teach health education classes, running mass treatment programs for scabies, ringworm and tuberculosis, and doing daily surveys of the living quarters looking for health hazards and accompanying children who are sick to the clinic and making sure that the children on TB and Malaria meds are adhering to their regimens. Paul Farmer had it right when he said that the only way to make it sustainable was to teach Haitians to treat Haitians. It won't happen overnight.

The program I have designed was made specifically according to the needs and interests of the residents at Pwoje Espwa and nearby villages. The lesson plans are translated into both English and Creole. Accompanying each topic covered, is an oral/written exam and or an oral/written project assignment for the students to complete. These means of evaluation are in place to ensure that the public health students retain a firm grasp on the material so that they may teach their peers in both informal and formal settings. The program is designed to be completed in three months time, which includes a 2-week period of mock-teaching, where the public health students will take turns presenting all of the material we have covered over the span of the program.

The following is a list of the topics covered in order as to which they were originally taught:
· Malaria—testing, treatment and prevention
· Scabies—treatment and prevention
· Prevention vs. Treatment
· Home Remedies and Popular Beliefs
· Witchcraft, Magic and the Evil Eye
· Common Causes of Sicknesses
· How to do a Physical Exam
· How to Care for a Sick Person
· Alternative Medicine
· The Healing Powers of Water
· The Use of Antibiotics
· How to Give Medicine—Measuring Doses
· First Aid
· Nutrition
· Prevention via Cleanliness
· Prevention via Sanitation
· Parasites—testing, treatment and prevention
· Prevention via Vaccinations
· Prevention via Other Habits and Behaviors
· Dehydration, Diarrhea, Dysentery and Vomiting—treatment and prevention
· Tetanus and Rabies—treatment and prevention
· Ringworm
· Teeth, Gums and Mouth Health
· Sexually Transmitted Diseases—testing, treatment and prevention
· HIV/AIDS—testing, treatment and prevention
· Children’s Health
· How to Teach



Ambroise (Sam) Mackenzy
Webert Constant

Delince Pierre

Marckenson Gedna

I'm so proud of these boys and am excited about what comes next! Their first public health presentation for the 650 children of Espwa will be this Sunday. The topic is on oral hygiene, with a focus on how to properly brush our teeth. After the program, they will be handing out toothbrushes and toothpaste (donated by the Athens Medical Group) to all of the house monitors for the children.

On Sunday evening, they will also be going house-to-house with Elimite cream and mass treating all of the children for scabies.

The purpose of my running the Cayman marathon next Sunday is to raise money for programs such as these. I know this was a long post but thanks for hanging in there!

TB Treatment Programs

This post is for the man working in Gonaives, Haiti who contacted me regarding where he can send patients with active TB. The organizations I have found to be the most helpful and the most equipped in handling active TB patients in your area are PIH in Cange, GHESKIO in PAP, Missionaries of Charity in PAP and Hospital Albert Schweitzer in Deschapelles. If you're interested in any of these places, let me know and I will give you any contacts I have. Email is the best way to reach me willinhaiti@gmail.com Best of luck!

Surgery

In the pharmacy, reading up on what to do with a Filariasis patient.

Going over the list of available meds on the first day of clinic.

Learning how to work the ultrasound machine.

Fritz and I in the lab. I'm running a hematocrit while he checks for sickle cell in a blood sample.

Assisting Dr. Saydjari on a minor hernia.

For the last two weeks, we were visited by a group of four doctors (2 family practitioners, an ER doc and a general surgeon), a nurse practitioner, nearly a dozen nurses and technicians and a handful of civilian volunteers. With their help, we saw 800+ patients, held 3 mobile clinics in areas even more rural and seemingly unreachable than where I’m stationed and performed two dozen surgeries. They came down with thousands of pounds of medicine and other medical supplies, thousands of toothbrushes and toothpaste along with action packers full of school supplies, sneakers and sandals for those patients who come to clinic barefoot.

We worked out of abandoned houses and used giant metal shipping containers as our clinic dividing the space into a pharmacy, laboratory, two exam rooms and an ultrasound room. We used the space in between the two containers as a consultation area and had triage positioned under a pavilion made of palm tree branches. There were 100 + people waiting outside every morning, hoping to get a bracelet that would allow them to be seen by one of the doctors. Examining up to six patients at a time, we saw everything from impetigo to walking pneumonia to elephantitis and hydroceles.

The amount of information I learned and experience I obtained these past two weeks was incredible. Allowed to assist on several major hernias, hydroceles, lypomas and other minor surgeries, I quickly realized how there was nothing fake or unrealistic about the work I am doing. The ability to remove a tumor from a woman’s breast or give a man back his ability to walk by replacing a massive hernia is nothing short of amazing, considering the lack of a sterilized operating room, 90 degree heat, and little to no electricity. The doctors and nurses who visited are some of the best in their fields. The speed, accuracy and grace in which they operated, treated and cured the patients they saw was nothing short of inspiring. These past few weeks reminded why I want to be a doctor.

Update on Lixier

Our baby boy with hydrocephalus has been back in Haiti for nearly a month now and doing well, until last week, when his mom paid us a visit. She was worried that Lixier's shunt was infected again. The shunt was infected once already while he was still in the states but they were able to replace it before he returned to Haiti. An infected shunt in Haiti is a death sentence. The only pediatric surgeons to come to Haiti are visiting ones, who spend little more than a few weeks of the year in the capital city. The only option would be applying for another emergency medical visa and trying to get Lixier back to the states for a replacement. With the help of Dr. Brodie and Dr. Stern from the states, we were able to get a few replacement shunts sent down to us. However, we would still lack the most important part, someone to perform the procedure.

Luckily, a visiting doctors group was here when Lixier's mom came by. Within minutes, we had a neurosurgeon from the states on the phone instructing us on how to "tap" the shunt (withdrawing cerebral fluid to determine if there was indeed an infection). The fluid was to our relief, crystal clear, meaning that there was no apparent infection.

It's hard to believe that Lixier is already 8 months old. It's been nearly 5 months since I helped get him a visa to the states and he looks great. I realized that day, as we were performing the "tap" how much it would affect me if we were to lose him after so much effort was put into saving him. It wouldn't be easy.