It's peanut butter time!

 Today we visited the large community hospital in Cap and met with the Medika Mamba team and finished the training and the introduction to the Medika Mamba program. We were able to see a young girl be weighed which occurs weekly in the program and then we headed over to the Medika Mamba factory which is about 20 minutes from us. Eyleen was a great tour guide as we donned hairnets and lab coats to visit the lab and the processing facilities. It was amazing to see how their place was set up, it was in a house however once you got upstairs it appeared just like a research lab and a commercial kitchen, complete with fancy machinery and aflatoxin fluorescing machines. The whole process is so cool and I am so glad we were able to see how the peanuts were taken from shelled nuts from different parts of Haiti to packaged RTUF (ready to use food) that I hear tastes like the inside of a peanut butter cup J

Every batch of Medika Mamba is tested in house for aflatoxin and then sent to the states for more testing. When we received our shipment we also got a letter certifying the batch, ready for use. We also received the other equipment including scales and height board and the cute little hanging baby holder to weigh the kiddos. The first part of the grant allows for 100kg of Medika Mamba to be donated to the program to begin with. We are very excited as there are a few kiddos we have seen in the clinic that we know would be great candidates for this program and now we can offer it here, outside the city limits. As we get the word out that we can run the program locally I am sure we will get more and more kiddos and soon the initial phase we can run with 10-12 kids will be finished. Luckily if all goes well we can have the Medika Mamba program here at MamaBaby for good! Our patients would benefit immensely and we could potentially save the lives of those who can’t make it to the other program sites.

Way cool if you ask me.

Thanks for the experience Floating Doctors!

Pardon the severe delay in getting this blog out, the electricity has been off more frequently and as hard as I try to wake up when it comes on in the middle of the night, my desire for a full night’s sleep wins. This is usually how it goes after we have a bout of the electricity being on more often than not…the next week it is the opposite. This week it has been steadily coming on anywhere between 1am-5am and then remaining off the rest of the day. Bucket showers are actually pretty fun and my Kindle gets 3G internet so I can check my emails. Again, it is difficult for me to drag myself out of bed during the middle of the night to do other power-requiring activities. Anyway, I am up today at 5am just to update everyone on this last week. You are all so welcome… 

On Wednesday I took two of the community volunteers with me to work with a group called Floating Doctors who are stationed (I guess that would be docked) Northwest of here. They travel around providing care for countries all over the world and they have been here in Haiti for a while now. There was one doctor (Dr. Ben) and one Physical Therapist, a Physiotherapist, the community volunteers and our translators. Oh an me too.

 ….OK, the electricity just went off *insert sigh and mild annoyance* so I will continue this then post it later. Damn my need for beauty sleep…

So we all head to this community clinic where we meet with the head nurse who tells us that she was unaware that anyone was coming and that she would have gotten the word out if she had known. Well, it is a good thing that getting patients around here is NEVER (and I mean NEVER) a problem. Dr. Ben asked her kindly to please open the clinic and that he promised people would show up. She then came up with a multitude of other excuses as to why she could not allow us to be there, the last one was that she needed to charge all of the patients 50 gourds for care. The latter being the most important as clinics here still need to make a profit. This is one of the main issues we have run into with the Haitian doctors who work near us as well, they are upset that we are providing free care as this takes away from their profit. I understand this point though I must counter with the fact that most of our patients cannot afford the 50 gourds to see the doctor (about 75 cents) and that this leads to more chronic conditions and increased health risks as the patients do not come to the doctor initially when they are sick, they come in dire situations when they can finally rationalize spending the money to seek care. This was the same if not even more present in the community we were in with Floating Doctors as it is even poorer and more remote. Before I knew it we had decided to hold the clinic in a school house down the road and we begin the trek over with at least one hundred patients who had come to the first clinic. Let it be noted these patients were less than happy with the clinic for trying to charge them for care provided by a non-profit group and they were voicing their opinions loudly the entire way to the next site.

Just as a rolling snowball gathers more and more snow we gathered more and more patients on our way to the school. By the time I got there at least 200 hundred men, women and children were lined up (I use this term loosely, very loosely) in front of the school. We finally put out things down in a small cement room about 10 x 13 ft. Now mind you, normally when we do clinics at MBH we hand out numbers, we only allow those in to see us who have numbers and we are generally pretty good with crowd control-see the part about handing out numbers in advance and being very firm about only seeing those patients with numbers. All I can say about the crowd in front of the school building was that it was comprised of people desperate for care in an area with one clinic that charges more than they can afford. In other words it was sheer chaos. Think pictures of Michael Jackson concerts in Europe where the people in front are getting trampled and there is not nearly enough security to secure anything. Ok so there were not 10,000 screaming fans but there was definitely more pushing, shoving, throwing children over our barricade into the clinic and yelling than I have ever experienced. Did I mention the term chaos yet?

Inside the ‘school house’ we set up and had volunteers begin to triage the patients as myself and Dr. Ben began to do intakes. I was on his turf that day which meant working more like a M.D. than an N.D. This means no more vitamins, homeopathics, botanicals and other supplements; simply antibiotics, antifungals, anti parasitics  antihistamines, anti-itch cream and cardiac/BP meds. Good thing my med school training covered all of this; I felt ready to work quickly and efficiently with the medications provided. I was excited to see they had Albendazole for each child which is what the Minister of Health is trying to implement in Haiti as the cases of worms here are massive.  We worked for 3 hours, saw 79 patients (one Haitian nurse was also seeing patients) when finally Dr. Ben had to call it to a halt after trying to warn the patients that they needed to move back and to stop pushing or we could no longer provide care. It was too dangerous for the patients to keep working, there was a constant sea of people pushing and shoving outside in the extreme heat. We were having children come in who had been hurt in the crowd, probably getting heat stroke as well as being pushed up against all those bodies in the middle of the day with the sun beating down on you. Dr. Ben said it was the “craziest” clinic he has seen so far here in Haiti. I concur.

As we headed home that day I was thankful for our clinic, our patients and our numbering system. I know there is so much care that needs to be provided here and there are many groups trying to help. I think the next thing that needs to happen is that the short term groups link up with long term groups so patients can continue to receive continuous care. There also needs to be more outreach to rural communities or those who are less able to come to the city for medical care.

Updates and relaxation...

Update day!

We met with Eyleen who works in “Peanut Processing” at Medika Mamba (what a cool graduate fellowship huh?) and we are planning on heading over to the local hospital Tuesday morning to see how the program is run at the Justinian hospital (the big community hospital in Cap Haitien). Medika Mamba has received a grant to fund sites for use of the program which will include enough Medika Mamba to reefed 10-11 children per month as well as other medications used in the program and some of the supplies needed to assess the children’s growth. I am so stoked that we got hooked up with her and we also learned that the manufacturing plant is only about 15 minutes away so we are planning on heading over there on Wednesday to check things out. We will be receiving our supplies to implement this fantastic program as soon as the training is complete!

Yesterday we met with the directors and one of the nurses of a program that is about 30 minutes from here in a rural area just south of us. It is called Children of the Promise and they are a center for children who need medical assistance as they are too sick to be at home, most cases appear to require re-feeding as the children are severely malnourished or for children who have parents that can no longer take care of them. Currently they have 48 (If I remember correctly) kiddos at their center with an amazing 3:1 or 2:1 ratio of nannies to kids!! The goal is to help the children regain health and then to reunite them with families if possible. If they cannot go back to their families then COTP facilitates adoptions for the remaining children and provides care while the adoptions are in the works (read many, many years). They are great people who are working hard to make sure that these children are getting the care they deserve. I am excited to go out and visit their facility and to have them as a potential resource for those who need a little extra TLC.

The newly planted seeds in the shade houses are growing like crazy! It has been a little over a week and the seedlings are now anywhere between 1-3 inches tall! Our last volunteers also planted some collards, onions and radishes in the main garden that are also growing substantially. I guess the last few days of rain have been really good for the crops because I can literally SEE things growing. As the avid greens eater than I am, I have been overjoyed at the large amounts of arugula, beet greens and chard we have been eating at least once a day. Even our fantastic cook Deila has taken it upon herself to go out and harvest some of the greens for salads-this amazes me as most of the Haitians want to have nothing to do with our “bitter” greens J

We have the next few days off as Easter is a big holiday around here so most Haitians have Friday-Tuesday off to celebrate- our staff has taken a much needed break! I will be taking this time to study some of the botanicals that the students brought that I have never heard of, research some of the other outreach projects that I am excited to try and implement during my time here and to sit around and watch movies…all completely contingent on electricity but I am hopeful that they will be nice and give us many hours as it IS a holiday weekend and all.  

Some more pictures for your viewing pleasure.

 Our lush garden growing like crazy!

A sample of the delectable foods we can get at the market...

The 'school' at the orphanage here in Morne Rouge where we hold clinics for the kids.

For the love of gardening!

As you all might have guessed I have a new obsession…or at least a new drive here in Haiti. Besides seeing patients during the week I have become very excited about the prospect of community gardening. So far we have managed to grow a phenomenal flagship garden at the clinic complete with shade houses and ready to eat veggies; have helped children at the local orphanage start a garden (well I don’t think we can take much credit as those kids were natural gardeners) and have a couple more community garden projects in the works in local villages. To me the idea that people can grow their own food seems simple enough, put seeds in the ground and watch them grow. Then eat the food. Not so easy though when you have to cart 5 gallon buckets of water on your head from the local water pump. Let’s not forget the goats, cows and chickens that roam about…they love to eat seedlings and plants so a fence around the garden is a must if animals are present.

Ok, so let me get this straight, you will give me seeds to start a garden and all I need to do is haul water a half a mile on my head and kick my animals out?

Well, I guess I never thought about it like that. We are so lucky to be able to have access to water, land, dirt, fencing and tools such as shovels, wheelbarrows etc. It seems like such a simple project to be able to help people learn to feed themselves from their own garden sustainably however it is a much more complex task. I guess if it was easy to feed the world there wouldn’t be such rampant starvation huh? Well, that’s another blog and one I don’t desire to get into but truly, food production in resource poor areas is not easy. It is easier to go out to the street and buy a Tampico, some sugar laden coffee and some processed cheese puffs for 50 cents. It is easier to buy ‘junk’ food from local venders that it is to grow nutritious foods such as beans and vegetables.

Every country I have traveled to has had its share of junk food, usually in the form of chips and cookies plus sodas and sugary drinks. Look, I understand that every now and then your body craves something artificial and hydrogenated..er…something like that. My main problem with the rise of cheap processed foods in many countries is that as a Physician I am seeing the effects daily in the clinic. Mothers with 4 month olds who have ‘gas’ or ‘colic’-eating flour and sugar mixtures and drinking coffee. Five year olds with chronic ‘belly aches’ who are eating cookies and drinking Tampico and cola daily. Overweight adults who are on their way to becoming diabetic who, “cannot afford to eat three meals per day” but somehow manage to buy bread, pasta, juice, coffee and cookies daily. And rest assured I am not talking whole wheat breads and pastas and fresh fruit juices. In a country where mangoes, papayas, pineapples and guavas grow wild people are choosing to drink bottled corn syrup, red 40 and a laundry list of other ingredients. When we speak to them about diet in the clinic it is always the same answer which is essentially there is no money to eat well. Junk food is sold cheaply and the community is suffering because of it.

Though it is a bit of a digression from my love of community gardening these are the problems and considerations that we are coming up against as we try to help the community members get healthier. We offer seeds and education but already in their mind they can get cheap food without much effort. The quick fix idea that is so rampant in the U.S. is ever present here too. 

Guess we aren’t so different after all.

Medika Mamba

After having to send three patients to a re-feeding program at the community hospital 45 minutes away, we sat down to re-evaluate our ability to really help the community when it comes to malnourished and starving children. We are lucky that most of our patients are eating at least once per day; most have access to food 2-3 times per day though quantity is limited. We are not usually seeing the sickest of the sick though if we were capable of implementing the re-feeding program here children who might not be able to make it all the way to the hospital might have access to proper care. Dr. Sarah did some research and emailed the people in charge of the Medika Mamba program here who have said they would be happy to come and train us in how to properly re-feed severely malnourished children. This is one more huge step for us in being able to help the community attain and maintain health!

Medika Mamba (www.mfkhaiti.org) is a local organization started by an American Pediatrician to provide ready to use food (RTUF) to treat malnourished children. The program is great as it uses local Haitian resources and provides jobs for Haitians as well by creating a sustainable company here in Haiti (it’s a win-win-win). It is essentially a peanut butter, vitamin, mineral and oil mixture that is designed to provide maximum calories, fat and carbohydrates in the appropriate ratios to re-feed sick children. One of the many things I am learning here is that it is tricky to re-feed children who are severely malnourished. There are specific techniques and proper ratios as well as a strict schedule that must be followed. This makes sense though as the body has been starved for so long that the introduction of too much food too quickly can send an already sick child into a downward spiral. We are very lucky to be able to learn from the people at Medika Mamba and hopefully become a resource for families living in our area as well as the other surrounding villages. This fits in perfectly with our desire to begin community gardens and create sustainable food sources for our community here. With the success of our garden I know we can make an impact on the health and nutritional status’ of our patients and friends here. There may even be a possibility of giving some a source of income if they can grow food not only for their families but also enough to sell at the market (another win-win).

So many new projects on the horizon! As always I am happy to be able to be a part of this great venture and am learning so much everyday about medicine, life and building relationships with others. I am continuing to work on my Haitian Creole as well so I can hopefully communicate directly with patients and people I meet in the community!

Shade Houses!

We have 3 hardworking men Joe, Jamie and Ron from Global Compassion Ministries are here building shade houses this week. Joe has been gardening in Haiti for over 15 years and is an expert when it comes to what to grow around here. Jamie and Ron have also been to Haiti multiple times and they accompanied Joe here this time to build shade houses for MBH. It has been a great process to watch and I am learning so much from these experienced gardeners. The shade houses are in the back of the property, will provide 40% shade and will house hundreds of plants! Project MamaBaby Garden is in full effect!!

Our initial garden is also growing like crazy and we have already harvested some green beans, beets, carrots, bundles of beet greens, chard, bok choy and the spiciest arugula around. Our melons grew but in all honesty were not super tasty but the cucumbers were certainly delicious. The tomatoes are ready to go crazy as there are so many unripe fruits weighing the branches down Santo took it upon himself to stake them up...it has been great to see how excited everyone here is about the garden project. We hope to be able to teach the community to garden using our garden as an example of what came grow with some water and TLC.

Student shift numero tres comes to an end...

The last 3 weeks have come to a close as the last of the students from Southwest College of Naturopathic Medicine left this morning. They were a great group and worked very hard to make sure our patients got the best care possible. I saw compassion in their eyes as they worked with sick children and adults and I know this group, like the others, will forever be changed by their time here in Haiti. I am also sure that this time here will make them more well rounded doctors who will have a head start when they enter the clinic or will be even more advanced when they return to their current clinic position.

It’s funny because I always thought I was one of those people who always wanted to be around others. As  I get further along in my life I realize I might not be. Haha. Ok so I really really loved having the students here and it was great getting to know them all but it was also like being back in the college dorms (well, I take that back, in college I only had to share my bathroom with 3 other girls, not 10+ other people). I am thankful that this beautiful building has an amazing roof that doubles as a great ‘get away’ spot as well as a garden that I can find myself getting closer to the earth in. I find so much happiness in just being outside; gardening with aspirations of growing food for our community here or planning other outreach programs with the children I can see from the roof in mind. There is so much I want to do while I am here and I am beginning to get the sense that I need to make these visions a reality as 6 months will fly by like that! We have been gardening at the local orphanage and I cannot wait to go back in a few days to see how great the plants are growing! I was literally blown away last time at the fact that we planted watermelons from seed and one week later we had 2 inch seedlings! In a country where food is scarce this could be the answer to so many problems. Obviously it is not as easy as getting seeds to people, we need to take into consideration the land people have-or lack thereof, the ease of getting water and the general knowledge of what and how to plant for success. Where there is a will there is a way I guess…

Departing with the students were two other wonderful volunteers, Susan Moray a fantastic midwife (and a former hairstylist who gave us all amazing and much needed haircuts) from Portland and Nancy Becker a seasoned Dietician with knowledge about sustainable nutrition programs in resource poor areas. They were intelligent, hilarious and full of passion for their work and the work being done here. Susan was in on two births and worked with our midwifery student and other midwives imparting her years of knowledge about the process of birth and extensive understanding of what women need in order to have a healthy home birth. Nancy taught mini nutrition classes to the patients waiting for care and also tried to get a better understanding of what knowledge patients had regarding healthy eating habits by simply asking those in the community what they thought about certain foods. The kids loved it as did the adults and I know the information she was able to give to the people here will be passed on to families and friends. She also went to market and took note of varying prices of goods so we are able to tell our patients things like, “save your 30 gourds you spend on Tampico and cookies and spend it on 5 peppers”. Susan and Nancy also came up with a great idea for keeping our patients fed and hydrated while they wait for care, sometimes for 6 or more hours. More to come on this idea as we get it going, the idea is for Santo our head translator to be in charge of project ‘Happy Meal’.  

Adults, adults everywhere

Today was adult clinic day and if you have been reading my blog then you know it is not my favorite day of the week. Now please, don’t get me wrong-I love to treat people and I love to practice medicine, however I really have never been a big fan of adults as patients. They always have a million concerns, they are not as cute as kids (joking…kind of), they tend to be less impressed with my games of peek a boo and they don’t crack a smile at a Dora the Explorer sticker. I mean, come on…who doesn’t love Dora!?!

Lucky for me the SCNM students are still here and they were the primary caregivers for these adults. Each clinic day we try to give the students a little more freedom to see patients on their own while still being available for consults and obviously all treatments are run by us first. The students have been working hard all week perfecting their chart notes, differential diagnoses and treatment protocols. This is their last day in the clinic before they head home Monday so it was time for them to show us what they have learned being here. It was really great to see them with “their patients”, taking the treatments seriously and understanding that they will forever touch the lives of the patients they have taken care of.

The day started out with two of my favorite patients so far. First was a 70-ish year old woman with excruciating Osteoarthritis in her knees causing her to rely on a cane for walking. She came last week for treatment and her only desire was to, “be able to attend church on Sunday’s” as her pain has prevented her from going. We did some acupuncture for her as well as loaded her up with some great vitamins and minerals 

including a product with curcumin and boswellia for decreasing inflammation. She came back this week and when she saw me she began speaking a mile a minute. The translator relayed that she was thanking me profusely for helping her last week as she made it to church for the first time in months. She told me she prayed for me in church and continued to thank me as I told her that it was my pleasure to be able to treat her and that her ability to go to church after treatment is one reason I practice medicine. I was humbled and thankful that the treatment allowed this woman to be able to do what was so important to her.

Awesome patient number two is a 72 year old man who came to us last week with symptoms of BPH including difficulty with urination and back pain. He wanted us to do whatever we could to, “make him younger”. Previously we treated his urinary symptoms and did acupuncture for his low back pain. At the end of the treatment he jumped off the table and said, “I am young again” gyrating his hips around (please try and picture this sweet grey haired man, all 5’3” 115lbs of him). I fell in love right there and he almost singlehandedly caused me to add geriatrics into my desired patient base. Today the student’s continued to work on his chronic low back pain with some cupping (Chinese medicine technique), acupuncture and massage. I think we have a patient for life as I heard him thanking all the students on his way out.

Score two for us.  I guess today was not such a bad day after all…it’s all about perspective right? J

News from yesterday

I guess I kind of left you all hanging after the last post so here is some more info…The girl with measles is just fine; she was on the tail end of it so we treated accordingly. The baby with total malnutrition was brought here this morning at the urging of the doctors and was accompanies to the hospital by our Haitian midwife Marie. This case has been particularly hard for us to watch as it unfolds as this sweet little girl has her cards stacked against her at such a young age. Her mother passed away and we saw her first a month or so ago when her sister brought her in for care. She was 7 months old but appeared the size of a 3 month old, unable to hold her head up and edematous due to malnutrition. She was surviving on cookies, sugar and water and her father was not interested in having her in the picture so her 20 year old sister stepped up to the plate and began to care for her. We gave her some formula and instructed on re-feeding procedures. When she returned a few weeks later (she was supposed to come back the following week) the baby had lost another pound. We questioned the sister intensely about whether or not the formula was going to the baby or somewhere else (we are concerned that it might be being sold on the street). Unfortunately the sister’s stories at each visit are riddled with inconsistencies which make it hard for us to know what to believe. We sent her home on the second visit with more formula, instructions to go to the hospital for blood work as we were concerned about the weight loss even with re-feeding, money for a tap tap and instructions to please come back to the clinic once the results were in.

We also reiterated the severity of the situation and that this baby will die without any intervention.

Third visit, she came back and the baby had lost another 6 oz.  Damn.

Initially the sister had said, yes, the child had been taken to the hospital and had blood work done which all came back normal but when questioned more thoroughly it came out that she had not taken her. Damn again.

 After much consideration and a very thorough talking to by the docs, a midwife and our amazing Dietician it was decided that sister and baby would come back today and be escorted to the hospital by Marie so we could make sure things were taken care of. She showed up this morning albeit almost 2 hours late and off they went.

This is one tough case and it is even harder as there is a sweet little baby in the middle of it all who is just trying to survive in the world. I will keep you all posted on her progress. 

Mwen gen fatig

I am tired. I need a nap but it is 8:00am and we are doing another clinic today.

                The students have been working so hard since they got here on Monday, the week has just blown by! Yesterday another 32 patients were seen and we had some very interesting cases come through the clinic.  Most of the students’ had their first exposure to measles, a girl with suspected Down’s Syndrome with new onset seizures-occurring in office, a malnourished baby we have been seeing who is failing to gain weight even with re-feeding and a many cases of worms and ringworm.

                Some patients such as our friend with the new onset seizures we had to refer out to the local hospital  as there needs to be imaging and blood work done to rule out more serious concomitant conditions. We gave the family (her brother and sister brought her in) money to head to the hospital with instructions to please come back to the clinic when her results come in as we would love to have her as a patient. They were thankful for the information about the possible causes of her seizures as well as for the money for a tap tap. It was really great to see a family bringing her in as it seems the norm here in Haiti is to keep those with disabilities in their homes and out of the general population as much as possible. I do not believe there is rampant mistreatment of this particular population however I think it is more of a lack of understanding about certain conditions and a fear of how others will react. I know we have seen many patients who come in for care and then tell us about family members who need care but cannot come in because they are “dumb”…this seems to translate into the inability to speak or act in a typical way. Children with special needs or as I like to say “exceptionalities” hold a very special place in my heart. I would like to do some outreach work for this population but have had trouble finding out exactly who to contact. It seems that some children born with exceptionalities are kept at home with the families and that some are given up for adoption, I am hoping to locate orphanages or group homes that may cater to this group in general as they can benefit from our medicine immensely. The healthier we can get these kiddos the better their lives will be. This is my next mission while I am here…wish me luck!

Community gardening and Vodou ceremony

                Yesterday we went over to the orphanage to check on some seeds and starts we planted last week. With the last group we spent the afternoon building a chicken wire fence, planting the starts the kids had taken care of and then letting them pick more seeds to plant. They loved it and it was so great to see them all getting into this project, especially since most of the kiddos are under 7 years old. This week we wanted to check out the progress as the Pastor who runs the house was not there last week so basically we left all the instructions in the hands of a 11 year old boy who seemed to really take an interest in being in charge. This week the Pastor was back from his trip and so we asked how things were going…well scratch that, we didn’t have to ask as we saw the moist ground and the plants growing like crazy the minute we walked in!!! I swear some of the plants grew 2-3 inches from the time they were planted last Thursday! The children were delighted about how well the plants were growing and the Pastor said they were all very interested in helping to maintain the garden on a daily basis. It made my heart melt to hear that. Here we had this amazing group of children who were dealt a bad hand early on and to see them become that passionate and excited about something made my day…shoot, it made my week! I think we have our first group of community gardener’s ladies and gentleman!!  We told them we would come back on Friday with more seeds and work together to plant the rest of the garden. They sang for us like they always do (imagine the most precious thing you have ever seen and multiply it by 100) and we thanked them for their hard work and headed home.

                The second part of the story lies in the cultural event we saw on the way home. We were drawn to a little house by some playing of music and artistic dancing around. As we got closer I recognized it as a Vodou ceremony. It was an interesting cultural experience though I have to admit my hesitancy to join in. Not solely because it was a Vodou ceremony but mostly because I cannot speak the language yet and I have reservations about any ceremony that I cannot understand. I like to know what is going on and things that are being said as you never know what kind of energy you might pick up from a situation like this. I was happy to be an observer and to appreciate the culture and the traditions of this community. It was nice that they let us in and asked us to be part of the ceremony (apparently it was for a little girl who was sick…a healing ceremony so to speak.)

This was my first experience with Vodou in Haiti so far and it left me with many questions about the religion, the culture and the ceremonies in general. I plan to find some literature and inform myself some more of this ancient practice.  

Some of my favorite pictures so far!

 Student Patrick and I with our little helper planting a garden at the Orphanage in our village.

Bastyr students teaching a patient to stretch his piriformis to reduce symptoms of sciatica.

Marie our Haitian midwife with Edie a volunteer American midwife after one of the births.
*Mama gave full consent for pictures*

Students and babies, babies and students...

New day, new group of student arrive at the MamaBaby Haiti Clinic. This time there are 8 students from our alma mater, Southwest College of Naturopathic Medicine. It was great to welcome a new group of faces and to know that their lives will be forever changed after this experience…I wish this opportunity would have been available to me in school as I would have  been able to get my clinical feet wet a bit earlier. In medical school we do clinical rotations in the last 2 years so for the first two years we spend the majority of the time studying, going to classes, studying, going to classes and oh yeah, studying. It is so nice to be able to get some real patient contact and to learn to take an accurate blood pressure or to understand what it is like to be in the room with someone who is having symptoms of one of those conditions we learned about in class. Some of the new curriculum changes at our school have the students getting to do clinical work such as blood pressure and other vitals earlier which in my mind will lead to better patient care when they finally do get to be “clinical students”. It’s all about the patient’s right?

Though we have been having a little drought in regards to the midwifery component of the clinic we did have 2 false labors in the past few days. This morning I woke to the sound of Santo our head translator calling to the midwives that there was a woman in labor (one of the downfalls of living in the midwife’s room, haha). This sweet woman apparently walked 2.5 miles down the mountain (trust me when I saw the mountains here are not paved and no pregnant woman should be walking down them) because she heard we were here, she has never received prenatal care with us so I imagine she has not received it anywhere. This is a scary thought as there are so many unanswered questions when a woman shows up without a history of care though our midwives are amazing and I know they will be able to provide her with the best care possible as this situation is not unique to our center. She has come to the right place and I am again thankful we are here!

Doctor heal thyself

OK so just so you don’t think we take care of ourselves like the good Naturopathic Physician’s we are, I thought I would let you in on a little secret we found here. A swimming pool!!! It is an oasis in the middle of the city, off the beaten path. It is a place for weddings and receptions (and for students and docs who need to cool off). It was cool, refreshing and there were speakers we could hook out IPOD’s into it! Simply amazing!!

We spent the last day with the students floating in the pool, laughing and listening to music. It was so insanely nice to be able to lie in water (no, sweating all the time does not count) and being a self proclaimed “water baby”, I was living the good life. We were the only people there which was not surprising as they charged $5 USD for 4 hours of swimming, far more than the average Haitian would and could spend in an afternoon. I felt a bit of guilt for lounging around all day at this pool that most people cannot afford to go to. On the other hand I know that if I am a burned out, overworked, tired doc my patients will get burned out, overworked, tired care. I know that even when I am feeling less than well rested the patients are not receiving the top notch care that they deserve so I imagine what kind of care I would be providing the next day (on adult clinic day) if I had not taken the opportunity to relax…after we oversaw the students and all 310 patients we treated in the two weeks they were here J

Tap taps and Hypertension

More often than we would like we see patients who need to be sent to the hospital for immediate care. This usually means we pay for a tap tap to take them there (not a problem at all and with more fundraising I am hoping we can have some money put away to send those who truly need care to the hospital) and then have them come back with any lab results so we can treat appropriately. Since we have a little to no hypertension meds on hand (we are always accepting donations!) we usually advise them to purchase this at the pharmacy. Sadly, there is a large proportion of the population who cannot afford the medications and with the rates of hypertension we are seeing here it is apparent there needs to be more free care. It is not uncommon for us to see a BP of 200/90 (120/80 is about normal) and some can even go as high as 250/120. If this occurred in the US the patient would be admitted to the ER immediately as the risk of stroke and or heart attack are immanent if the pressure remains elevated. We do what we can regarding pushing for patients to seek care at the hospital, the use of medications (it’s funny that everyone thinks Naturopathic physicians are completely opposed to the use of pharmaceutical drugs, personally I am opposed to the use of inappropriate and incorrect use of pharmaceuticals but I have the utmost respect for the advances we have made in treatment options for patients who really need the care. But I digress…) and discuss dietary modifications that can have long lasting effects on their health. We also have some amazing supplements that we use daily with great results, things like magnesium and high dose arginine are essential to the treatment of hypertension in patients who warrant that particular kind of care.

With all the treatment options there are often patients who come to see us who are in need of a higher level of care than we can provide. Today I had a woman with new onset headache and a BP of 220/106. Given the symptoms she needed to go in and have her hypertension taken care of stat. Again, if we had the medications to use we could alleviate all the other unnecessary steps (finding money for a tap tap, making sure she would go seek the care, having her come back with her medications so we can follow up etc) and just prescribe her an appropriate med without worrying if she is going to stroke out on the way to the hospital. I wish I could say this was uncommon but I have referred many people to the hospital for care since I have been here and I am sure it is not something that will cease anytime soon. Hopefully with our nutrition classes more and more people will begin to adopt some of the fundamental ideas surrounding health which will lead to great overall health but also lowering BP tremendously! 

Follow up care

By popular demand I have decided to write an update about the woman I spoke of in my last blog (sorry for the delay, the power has been less than friendly the past week.) She came to see us at a village clinic last week and I followed up regarding our treatment protocol, we had given her some supplements to help repair the lining of her stomach as well as some probiotics, a mineral blend and some multivitamins as she was eating only once per day.  She was not in any acute distress this time and stated that she was having less severe reactions to food than before but was still having a cramping in her lower abdomen which was better with hard pressure. The latter symptom is a keynote of a particular homeopathic remedy so I gave her one month’s worth of the medicine and made sure she had our phone number to call us if she did not feel better in a few days. In the US we would have referred this patient out to the hospital for some imaging and lab work immediately however here in Haiti most people cannot afford to go have these procedures done. Basic blood testing might be an option if she had money to take a tap tap (think pickup with a canopy and seats bolted to the inside) and then money for the consultation plus whatever medications they might prescribe for her. Though the fees would be considered nominal in our world, for most Haitians this is not something that would happen easily. Most reserve their visits to the hospital for severe illness and traumatic events, otherwise there is simply no justification for spending weeks’ worth of money just because they feel “ill”… a feeling that for most is not a foreign concept.

 As for the patient, I awaited her call and compiled a list of alternative treatment options in my head but I never heard from her. I know for a fact she would have called if she had not been feeling well as she sought us out at a clinic in the middle of another village just to tell us she was doing a little better, compounded by the fact that close to 90% of our patients have cell phones so getting a hold of us is not a difficult task. I have found that patients do quite a bit of follow up here and are not afraid to come back and let us know that our treatment was unsuccessful. It is a great way for us to learn what is and what is not working here and it is also comforting, I imagine, knowing that if you are still ill after treatment all you need to do it go back to the doctor and they can provide you with more care, free of charge. I often tell patients I am immensely worried about that they are welcome to call or come by at any time of day or night if they need anything, and a few even take us up on that offer which really makes me feel like our clinic is becoming a safe place for people to come when they need care and that the community is aware of this.