Knowledge does not only come from reading books.

Yesterday we saw a 60 something woman who was having abdominal pain and headaches. She was eating one time per day, cooking for 16 extended family members and seemingly ashamed of taking time to come to seek care when there was so much work to do at home. We offered her a glass of water which she promptly drank and subsequently doubled over in pain. To her, this was another episode of abdominal pain but for us, this was not an average every day event. We kept her for observation while we ran through differential diagnoses…peptic ulcer, gastritis, biliary colic, cancer, pancreatitis, bowel obstruction.  In my mind, the point was that this woman experienced this pain every time she drank water without food as she did so often because food is so scarce. She lived through the pain so she could continue to care for her children and grandchildren; taking care of hesrself was the farthest thing from her mind. 

The dedication to caring for one’s family I see daily here amazes me. Not only to your own family but to the family members who cannot care for themselves and even for other children who have lost their families to illness. The matriarch of the family puts her needs aside to make sure her family is taken care of, most likely until the day she passes away. It really makes me think about how we treat the elder generations in the United States. The inadequate treatment of those living in care facilities has always caused me much distress. These are the people who should be respected for being the wisest; those who have been through wars, catastrophes, historical events, multiple presidents and have witnessed the changes that have shaped our current societies views and beliefs.

I think one thing I have always loved about traveling is learning from the elders or hearing stories passed down from generation to generation. Recipes, medical treatments, home remedies, understanding of the culture and common misconceptions are all examples of things we can learn from the elders in our communities. It makes me wish my grandparents were still alive so I could ask them all the questions I was too young to know I needed to understand back then. There is so much for us to learn in our lifetime, I don’t want to miss out it. Knowledge is power, this I know for sure.

Hope and Perseverance

Clinic day 3 with the students ended with many of the same feelings as the last two…hope being the overriding of the two but perseverance was also present.

Today was a children’s clinic and we saw about 40 patients, these students are some of the hardest working I have ever met. I know this experience will shape their future practice in ways they do not understand yet and has also touched so many lives. The patients love all the extra attention, stickers and new faces that the students bring to the table as well as the best care possible when you have so many people working together. There is not nearly as much chaos as I would have guessed would be present with all these people in one building and the relative lack of clinical experience most have. If you were to look in on an intake you would see professional compassionate men and women dedicated to patient care. I could not have asked for a better group of students to come, I am hopeful for the future of our medicine and those who benefit from it.

Emotionally it was a difficult day today as there were many challenging cases diagnostically, children with painful infections and the worst case of failure to thrive I have seen.  A young mother brought her one month old child in to see us as he was “not happy”. The students did their best to elicit what this meant and mom noted that the child had seemed to be less apt to cry, wiggle around and fuss. As most babies are when they come to us, this little guy was all bundled up in blankets with only the top of his sweet little head visible. As the lead clinical student began to undress the baby to listen to his lungs I noticed his clavicles were very prominent (lack of anything but skin and bones is a better actually an adequate description). As we undressed him we were horrified to find an emaciated, dehydrated 2.5kg baby. The baby was listless and we could not elicit a good response from him, get him to nurse or take sugar water. The midwife came down and confirmed my decision to send him to the hospital. We made sure to let mom know she had done the right thing by bringing the baby to the clinic when she noticed he was acting odd though in the back of my mind I still wondered how a parent could look at a child this sick and not know something was wrong. Education. It all comes down to lack of education. This was a young mother who did not know any better. She had seen a doctor two weeks ago at a hospital and the baby had weighed in at 3kg, presumably healthy as the doctor did not make any other recommendations.

 Perhaps a little more time spent with a young mother to discuss how often to feed would have been enough as this mom was feeding only 2-3 times per day. It is probable that if she had learned the signs of malnutrition and dehydration before she gave birth she would have been more apt to come in promptly. Of course, this is all speculation. This was the best case scenario as we were there to make the referral and to insure proper care of this child. What would have happened if our clinic was not here? The answer scares me as I know what happens when there is not adequate care…you end up with statistics like you see here in Haiti, the worst in the Western hemisphere.

But we ARE here and things WILL get better, one day at a time.  We will persevere and so will all the patients like our little guy today, if given the chance to have access to adequate medical care.

Little pieces of string...

Sometimes I feel like all of the stories that come out of Haiti and care for those in Haiti tend to sad and depressing. Some would say ‘obviously’ as there is so much despair, sadness and disease how could there be a plethora of happy stories. Well, as someone in the field I understand the depths of sadness and diseases here in Haiti though I also have come to love and respect the ability of the Haitian people to laugh, smile and joke around. Children with enormous smiles and the adults with their boisterous laughter, ready to lend a helping hand whenever possible. Today the pastor at the orphanage where we completed a village clinic brought all 16 of us coconuts from his tree (that he and the older children harvested and cleaned for us) as a thank you for seeing his patients. After 6 hours working outside seeing patients, fresh coconut water has never tasted so sweet.  I laugh here so often that sometimes I need to remind myself that I am in a country in which 54% of the people live without sustainable water sources and less than 50% of children are able to go to school. The future is promising as there are many effective NGO groups here in Haiti that are beginning to band together with the same goal in mind; creation of organizations and other sustainable projects to help Haiti help themselves.

We know that the best outcomes occur when organizations have clear outlined goals and are of the understanding that coming into Haiti for a short period of time to “help” really causes more harm than good. What are needed are groups who are here for the long haul. Groups committed to empowering the local Haitian community to be able to stand on their own two feet. Groups who can aid current organizations or appropriate infrastructure as well those willing to find out what local communities want and need and helping them to get it. I am happy to be part of an organization that strives to reach these goals while keeping the most important goal in mind, we are here to help not to take over and run the lives of a community in need.

I will be honest, this blog has taken quite a turn as I began speaking of the joys of living in Haiti but hopefully the above rant will give a little insight into what it feels like as a foreigner living in a country with so much need, so many aid workers (Haiti has close to 10,000 NGO groups working here) and so much headway still left to make.

 As my anatomy professor would say after an intense lecture, “you have a million pieces of string in your brain; you just need to figure out how to tie them together”. 

When a cough is more than a cough...

Another day, another patient who touches your heart…one reason I love my job so very much.  Today, not once but twice I felt like everything I have sacrificed and all the support from my family and friends really went directly towards saving a life.

My first patient was a 2 month old baby with a cough accompanied by grandma and mom. As I began to inquire more about the health of the baby and the symptoms of the cough I learned that breastfeeding was an issue as mom had some of her own health concerns and that the baby was being fed teas and flour with sugar mixed in as it was all the family could afford. As I proceeded to check the baby it was clear that this child was severely malnourished and was hungry beyond belief. We mixed a bottle of formula immediately and began to feed her. She weighed in at less than 6lbs. She is lucky to have a family who cared enough to bring her to see a doctor even if it was for a different concern. Although too weak to breast feed she is quite the fighter with a solid cry and no other signs of impairment.

 She will survive.

For each one of these success stories there are plenty of unsuccessful outcomes and patients who never even make it to our clinic in the first place. There is an immense lack of education surrounding newborn care and childhood nutrition as well as limited access to care. More than ever we need to reach out to these communities and help them to be able to stand of their own feet and regain their health. I am hopeful that when the students come and we are able to open the clinic up every day we will get the word out to more and more people in the community. The more people that know about us the more we decrease the incidence of untreated illness and even death as we are at least a free, available option for people to utilize. Even if we can’t treat them, we can refer them out.

What Haiti needs more of are available options that lead to sustainable health. They need educational materials and classes and they need appropriate affordable health care. On top of all of this they need people who are willing to do all of these things without any ulterior motives; providing care because it is the right thing to do.

I love my job and I love Haiti, I am honored to be here helping these fantastic people. I hope to be teaching them at least as much as they are teaching me along the way. Every day I grow stronger in my ability to diagnose and treat disease as well as in my ability to take in what I am seeing and use it constructively. I could spend every night crying about the horrible situations I have seen or I can find a way to make the situation a little better. I guess you could say I am a fixer…and I am ok with that.

Proper health care for everyone is a must!

This morning was ‘adult day’ at the clinic. As our main priority are children and pregnant woman throughout the week we only have the ability to see non-pregnant adults on Saturdays (another reason to have more docs and more translators! This will hopefully become a reality in the future). Today was relatively slow as Dr.’s Sean and Sarah had to make a trip into Cap Haitien to speak with a local Haitian OB-GYN who runs a clinic near here; we only saw 13 patients. The last was a couple who had brought their children in earlier this week for care. The father had cut his hand I was told and was unable to work so we were going to give him some of the rice a local Pastor donated to us…when he sat down I noticed he had the most amazingly calm, soothing eyes I had ever seen, as well as what appeared to be a stiff left hand. He and his lovely wife sat down and we began the consult, they had come for her and so I listened as she told me of her symptoms. The entire time I could not push the desire to know what happened to her husband’s hand out of my mind as it seemed to just ‘sit there’ on his lap. I finished my exam with her and we got her on the road to optimal health, then I turned my attention to her husband’s hand. I wanted to make sure there were no signs of infection as it appeared to have two visible 3-4 inch healing lesions on the dorsum of the hand. They looked well taken care of and as I turned the hand over gently I asked what had happened.

 Rule number one in medical school, the poker face is hands down one of the most important tools.

 I am glad mine has been perfected by many hours of clinical practice because the palm of this man’s hand appeared as if a dog had taken a bite out of it. The thumb was contracted medially and there was a hole large enough to put the tip of a pencil in, directly in the middle of the palm. The skin was pink and tender with some of the previously exposed deep structures now healing. Apparently the machine he works with caught his hand and pulled it through a series of gears. I asked where he had it surgically fixed and he told the translator he had not had it fixed.

Wait, what!?! You had your hand severely mutilated on the job and never saw anyone for it; this is what my inside voice was screaming while outside I asked politely if he had any cream for it and then proceeded to get him some ointment when the answer was no.

I try not to be shocked and horrified by things like this as I should be thankful that this kind man is doing so well, he may not have full use of his hand back but at least he still has his hand. This is a stark contrast to a woman we saw last week whom I had to tell that her fingertip was gangrenous and needed to be removed asap if she wanted to save the finger; all this from washing some clothes with bleach, stream water and a probable open sore.

 I cannot begin to count my blessings and be thankful for my health and for the health of my loved ones. I know there are some things that are inevitable however I refuse to believe that going without care because you cannot afford it is one of those inevitabilities, regardless of where you live. I am also thankful for MBH and the other doctors I work with who are here working to facilitate health and healing here in Haiti. Without their visions and hard work there would be no clinic. Without a clinic people would not receive care. I like to think I am doing my part in taking the initiative to help others, as I would hope others would do for me.

Port-au-Prince trip

The last few weeks have been a whirlwind of events that culminated with our trip to Port-au-Prince this weekend. Fellow volunteer Melissa Chappell and I made the arduous bus trip with our friend and lead medical translator Santo. Five hours on a school bus with 71 of my closest friends sitting six to a row driving at an average speed of 60 mph was an experience I will not soon forget. Neither will my neck, back and gluteus maxima. Once arriving safely after only getting into only one head on collision with a truck (everyone was fine) we drove to the Oloffson Hotel. There we were greeted by a close friend of Melissa’s, Stuart Farmer who owns and operates Open Air Cinema. The company manufactures large inflatable screens for movie watching and has invented a smaller, lighter prototype to travel overseas. They were contracted to come to Haiti and to work in conjunction with Film Aid to show the National Debates interspersed with educational videos on nutrition, sexual abuse hotlines, prostitution and other key issues. The viewings were a major success and the reason for the trip on my part was to try and secure this equipment for use in Cap Haitien and the surrounding areas. One thing we have found is that there are so many common issues and misconceptions regarding health, nutrition and family planning that we are   coming across in consultations. Though we can educate each patient during the visit, some key issues such as Cholera prevention, food introduction, coffee intake in infants and sexual education topics that are seen across the board would be most effectively taught to large numbers of people, empowering the community as a whole. This is where Open Air Cinema comes into play. Stay posted for more of our collaboration with them as they are planning to come up and show some videos here at MamaBaby!

We also took this opportunity to tour the tent cities where those displaced by the earthquake reside. These aid tents have morphed into miniature homes and the entire area feels like a community of houses. This pleased me though to my dismay there is still so much to be done regarding reconstruction of homes and reassurance that people are safe and they can return to living in buildings, something many are too scared to do. Maybe it is too soon, I will never be able to truly understand as I did not have to go through such a traumatic experience. Either way I know that I was in awe at how ‘normal’ life was in PAP. Among the fallen buildings and rubble were school children walking to school in their uniforms, taxis going to and fro as well as street vendors selling their wares. All of the documentaries I have seen so far have highlighted the devastation in PAP and although it was present, the more palpable feeling was that of a community bonded by this catastrophe and whose resilience shines through.

Guess who's staying in Haiti!!!

My initial plan regarding my trip to Haiti was to come for three months. I knew quickly that I would by no means be able to leave Haiti at the end of the allotted time. So quickly I grew to love everything about this beautiful country, including the people, the way of life and the amazing stories of perseverance and survival I saw day in and day out in the clinic. I began to send out emails to family and friends in order to secure some donations for my living expenses here in Haiti, which by American standards are probably what a person would make in less than one week. Unfortunately in this economy most people were unable to donate and the majority of my friends are fresh out of school, starting families or trying to get on their own two feet. It quickly became apparent that I might not be able to extend my stay as time was running out for me to collect donations and I knew that without them, I would be unable to pay my bills, however small.

Then as if it were meant to be, raw food chef Melissa Chappell came to MBH and began her volunteer work. Not only is she an amazing chef but a savvy business woman with a heart of gold. After seeing the work we do here and how passionate about it I am, she linked me up with several of her friends from Utah who have decided to sponsor me to stay in Haiti for another 6 months!! I am a firm believer in the fact that things will work out as they are meant to be however for a moment I was nervous that my desires to stay in Haiti would be limited by my least favorite rate limiting factor, money. I cannot begin to describe how happy and thankful I am to all the donors as well as how much it makes my heart happy to see that there are people in the world who are willing to step back from their lives for a moment and see the bigger picture. Everything we do to help those in need is not simply for them, it is for us all and for the greater good of the world we live in.

Thank you to all who helped and know that your donations are going directly towards providing patient care in Haiti. One more Physician on staff can increase the patient load hugely, we can now continue to see over 100 patients per week, teach more educational classes and add on more clinic days! I will try and blog about more patient cases with pictures and stories so you all can see just what is going on here at the MBH clinic…all contingent on power that is ;)

Patients, patients everywhere!

Another successful day in the clinic has come to an end. We had a well oiled machine running on high power today with three doctors two translators and over 30 patients! Dr.'s Sarah, Sean and I are are getting more and more comfortable with the conditions we are seeing here and with our treatment options so we are spending less time figuring things out and more time with hands on patient care, I love it!
We have decided to see children only on Mon/Thurs and adults on Sat which is great to be able to focus on certain populations...you know how much I love the kiddos! Today was rash day and we saw numerous cases of tinea, some impetigo, shingles, insect bites, pustules, and boils to name a few. We have so many GREAT Naturpathic treatments for the above mentioned conditions and it has been wonderful to see our patients getting healthier and happier with every visit!

What's new in Morne Rouge

It has been a slow week here at MamaBaby Haiti, mostly due to the torrential downpours we have been experiencing. Apparently in Haiti people have a severe aversion to the rain, this is funny to me as I grew up in Oregon but when the rain puts such a halt on your activities of daily living, I can see how you might be hesitant to go out in it. Edie, the lead midwife thinks we will have a huge flood of babies since we have been having a dry spell which would be okay by us as we are eagerly awaiting more sweet little babies to be born here! The clinical side of things is moving along as normal, less patients show up but we still have full days of seeing patients with three Physicians working-I guess “slow” is a relative term. We have been seeing many return patients which is great as we can track how out treatments have been working and are able to know where we might need to tweak protocols. The limiting step is still the medications, supplements and botanicals that we have to ration out for each patients treatment protocol. I cannot even imagine what it would be like to have all of the botanicals we would like to use or an endless supply of things like vitamin C and quality multivitamins so we can give a few weeks worth at a time. In my view of medicine, not only do we need to treat the underlying pathology or illness but we need to be able to support the body while it heals. If we can get people to a healthy baseline, they are less likely to contract many of these illnesses that can be fought off with an effective immune system. Keeping our patients healthy is as important as treating their diseases. One of our most remarkable cases has been a young girl who had impetigo so severe it looked as if she had burns covering her entire face, ears, and some of her extremities. She was also severely malnourished, delayed physically and was barely able to sit up. Her mother was quite diligent about bringing her back for routine checkups and she has now been seen five times. We saw her last week for a cough and she looked phenomenal! A completely different child, her skin is healing beautifully, she appears stronger every visit-sitting up, looking alert and most important she is becoming a happier healthier child.

Blog #1

My experience so far here at MamaBaby Haiti is hard to put into words. Having never been to Haiti but having traveled to many other countries in need I had notions of what to expect though for me, traveling to a new country always brings with it individualized experiences, new memories and life changing adventures.

Here in the northern part of Haiti, we are surrounded by beautiful mountains, kind gentle people and intense poverty and despair. I have felt welcomed by the locals and I am grateful for the staff and friends of MamaBaby Haiti who have opened their home and their arms to the volunteers, making this experience even more rewarding.

As a Physician who has always had a passion for working with populations in great need, I feel my work here in Haiti has satisfied my calling to help my brothers and sisters as well as to provide the highest level medical care for people who are generally so underserved. The look on a sick child’s face when I try and use my broken Creole, or the delight in a mothers eyes when she returns and her child has been well after a long bout of illness are the driving forces behind why I feel such an intense connection to practice medicine here in Haiti. We have given nourishment to starving children, treated severe skin conditions, halted voluminous diarrhea and given parents what they should all have; a sense that their children are safe and well taken care of. I believe our patients know we would do anything to make sure they are free of disease and being able to help provide that reassurance makes me grateful beyond words. I became a Doctor to help children who are ill; I am living my dream working here in Haiti and am creating as much happiness within myself as I hope to be helping others to achieve.

The current staff of Doctors, Midwives and volunteers here is some of the best I have seen. Their dedication to their chosen crafts is evident when they rise in the middle of the night to deliver babies, work through illnesses of their own and continue to push themselves to the limits to care for one more patient so they don’t have to go home without seeing someone after waiting 8 hrs. Never have I felt that anyone here regrets the decision to come to Haiti, lacks the desire to truly understand this wonderful culture or takes this experience for granted in the least. I am humbled and in awe everyday of their work ethic and the desire to help those in need. I am grateful to have been able to spend so much time with such an amazing group of people; we have built a bond that will never be broken.

I am excited to see what the next two months hold for me here in Cap Haitien, I hope the end of my stay does not come too quickly though as I feel there is so much more to learn and understand about this beautiful country!

Dr. Zeenia Junkeer 

Heading to Haiti!

Now that I am a fully licensed and board certified Naturopathic Doctor, it is time to get out there and save the world! Or just get to work providing care top notch care for people in need. It must have been fate that in Oct 2010 I learned about two of my classmates/colleagues, Dr. Sarah Preston Hesler and Dr. Sean Hesler and their new position as medical directors of a clinic in the Northern part of Haiti. I called them immediately and a few months later I was on my way to Cap Haitien, Haiti to stay at the beautiful MamaBaby Haiti Clinic and Birth center. What started out as a 3 month stay to work as an N.D. here has morphed into a life changing experience that I feel compelled to blog about...ENJOY!