Life by the sea

When kids come to the clinic, their mothers have usually dressed them in their best clothes and scrubbed them within an inch of their lives.  So if we take their picture, they look like kids out of central casting for a Disney film.  

To get a glimpse of real life in rural, coastal Haiti, one needs to walk around and try to get candid photos like this.  This girl is in her yard gathering some food to eat.  She is barefoot of course and wearing an old but frilly dress.  She is no doubt wondering who are the strangers walking down the road in front of her house by sea. 

Finally, ...

We know its overdue.  Admittedly, even long overdue.  But we do hope our friends and supporters will make some allowance for the enormity of the task.  After all, how does one describe and distill the work of  VHF into a single, bi-fold brochure.  Of course, we could have used a very small font and and a great many words to try to convey the rich variety of stories and cases that the clinic encounters.  But then we would need to furnish a magnifier with each brochure.  Instead, we opted to use a few more pictures and many fewer words and try to capture something of the essence of Visitation Clinic.  I know we failed to do so.  However, not doing anything would have been a bigger defeat.  So begging for forgiveness in advance, here it is.

Portico

To me, the most striking feature of the clinic is the portico. I'm always impressed by the arches, the beams, the small hospital crosses that are also vents, and the overall proportions. It was built by skilled Haitian craftsman who are true artists in concrete. We don't have their names, but I hope they took satisfaction in doing a job well.  Its designer is clinic architect, Alan Dooley, who spent untold hours as a volunteer creating the design and drawings of not just the clinic, but the campus and even future buildings. 



Full moon rising through the arches

Every morning our patients wait in shade underneath this exquisite entryway.  They seem to appreciate having a place out of the sun to sit while waiting.  Some, who aren't feeling well, lie on the benches and look up at the beams and arches.  We hope it brings some ease and comfort while they wait.

   

The Word Is Out

In Haiti medical graduates spend their first year in "social service".  This involves working, at very little pay, in needy clinics or hospitals.  Since there is a perennial shortage of trained medical people, the clinics and hospitals do their best to attract good residents.  But the interns themselves have a large say in the matter.  In fact, those at the top of their class get first pick in choosing their assignments.

Now, one would expect that a new and relatively unknown place like Visitation Clinic would have some difficulty attracting good residents.  After all, we are not a historic and renown institution that their family or professors would have known.   And we are in a rural area that takes three hours to get to and where there is not much to do except work.  Not to mention that our patients don't come from the Haiti's wealthy families.

Well, these logical and common sense expectations would be mistaken..  We've become a preferred choice by top graduates from medical and nursing schools.  For instance this year our social-service resident, Dr. Delva, had many options but he chose to work at Visitation Clinic.  The main reason: the strong recommendation of our previous resident, who was also a top graduate.  It seems we're developing a reputation among medical students for being one of Haiti's best clinics.  We will be doing our best not to disappoint.   

Water worries

In order to operate a clinic in rural Haiti, you have to provide all your infrastructure.  This includes  buildings, storage, food, residential quarters, water, electricity, security, communications,  and so forth.

Of these, water can be one of the biggest challenges.  Even though we are connected to the municipal system, we also have to  collect rainwater from the roof, maintain a cistern for storage, and have pumps and a water tower to create adequate pressure.  Then, if you want to make it drinkable, you need to install a filtering and purification system (a project we have underway). 
 

Of course,  water has a way of going where it shouldn't.  So right now we are also dealing with a leak in a buried pipe and another in a roof.  Probably both were caused by the earthquake. 

Still there can be unanticipated benefits to having all this.  One is that you can climb up the water tower and get a wonderful view.  In the photo, we see the coastline, campus, clinic, and, expecially, the setting sun.  Almost makes it all worthwhile. 

   

Bahama Visitor

One thing we strive to do at Visitation Clinic is to become a model for how rural healthcare should be provided, not just in Haiti but anywhere in the world.  As such, we want the clinic to be the kind of place that is modern, impeccably clean, and the staff is highly competent and compassionate.  But it is hard to know how good a job you really are doing.  After all, most of our patients come from nearby and they don't have a great deal of mobility.  So even when they express gratitude and appreciation, we are never quite sure how we would measure up on the world's stage.  But on occasion we do get some feedback from a traveler who finds himself in the poor, but picturesque, town of Petite Riviere and requires some health care.  Today's email brought such a story from our administrator:

A priest from the Bahamas, Fr. Alain Mary L., attended the clinic while visiting his relatives in Petite Riviere de Nippes. He said that he was very satisfied to the kind of service that he received at the clinic, and particularly to the welcoming and satisfying clinic atmosphere. ''I have never seen and attended a pleasant and clean clinic like this in Haiti'', he said. ''I hope to come back next year and bring some of the Bahamian community to see this marvelous development in PRDN"  

The Downside of Roadwork



This little fella was in the clinic Thursday for a double whammy.  He is from the nearby town of Charlier where roadwork is underway on a river-crossing bridge.  Well, the road crew cut the water pipe that supplied most of the houses.  After several days of not being repaired, the people had little choice but to revert to taking water directly from the river, which has long been their water source.  Unfortunately, in recent months there has been major change in the river waters of Haiti,  - the cholera bacteria.  So in the past two weeks we have seen a spike in patients coming from Charlier to the Cholera Treatment Unit. 



Carrying Water after the Pipe Was Cut



Most cholera patients recover quickly and return home after a stay of a day or two.  But this boy's mom noticed that even though his cholera symptoms had abated, he was running a fever.  We moved him to the main clinic for tests and found that he also had malaria.





In this photo (taken late in the afternoon after all other patients had gone), our dedicated nurse Ms. Samdie, is explaining to the mother what medications to give our unhappy little patient.  

This whole episode illustrates the big difference a modern clinic can make in people's lives.  Not only were we a location that people knew they could rush to when cholera struck, but we have a staff that responds to unusual or emergency conditions that others would tend to ignore.  Not to mention the fact that we had the lab tests and pharmaceuticals for diagnosing and treating the condition. 

You can help kids like this by donating here
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Power to the People

How do you keep a clinic running in Haiti?  Sometimes with old fashioned Haitian ingenuity.   This morning is a case in point.  It started badly, for instead of being greeted with a cup of hot coffee, there was only a message from our administrator - the generator wouldn't start.  I knew instantly that this could be a serious problem.  How so?  First, if it was a simple problem, they would have already fixed it.  Secondly, anything that delays morning coffee is serious.

Dr. Betsy's dental hose put to better use.



We walked out to the generator, hoping the problem was just the starter battery.  But it was able to crank the engine into starting, where upon we we discovered the issue - fuel was dripping from a hose..  Calling a mechanic was an option of course, but it would be a week from Christmas before he got here. 

We had to try to fix it.  I hoped that maybe we could loosen the clamps and just re-secure the hose.  Sure enough, when we started the engine again the fuel was no longer driping - now it was gushing.  Panic.  What to do?  We scoured the clinic looking for a piece of hose..  Killy found some catheters - too small.  Then I remembered the dental compressor.  Surely Dr. Betsy wouldn't miss a 2 inch piece of hose coming from the compressor.  Should I call her and ask permission?  Of course not.  With two snips the hose is harvested and it's back to the generator.  Looks too small we all thought.  But Micheal, our security guard, knew better.  With a lot of pushing and shoving the hose was forced over the fuel line.  Half-hour later, we're all smelling like diesel fuel, but we're done.  The generator cranks, runs, leak is gone. 

Of course, there are alsways side effects.  Every bite of breakfast smells like diesel fuel and what will happen when Dr. Betsy finds out.  But these concerns melt away with a cup of coffee.

The Road to Insulin

The cost of providing healthcare in Haiti can be surprisingly high at times.  So we do everything we can think of to reduce expenses.  For instance, road trips are planned to serve as many purposes as possible.  Yesterday was a good example.  Our trip from Port-au-Prince included an airport stop, then a downtown meeting with another NGO, then a rendezvous with our accountant to drop off a tax-check, followed by a stop at a provisioner who had secured some food at a good price, then a quick sandwich which we ate while driving to Leogane to see if we could buy some insulin. 

These days our normal wholesaler is out of insulin more often than not.   So we first stopped at a large hospital to see if they had a good source.  The answer was negative and they explained that they rely on visiting US medical teams to get insulin right now.  After more searching and phone calls, we finally resorted to buying three vials from one pharmacy, and two from another.  The retail price was $18 each.  Not a bad price on the US market, but in Haiti it's more than three-day's pay.  And when you run a clinic where diabetes is not uncommon, and you only charge $1.20 per patient, including exam, lab and meds - it's not hard to see why we work at reducing other expenses. 

During the rest of the drive, I could only reflect on the fact that if you are poor and live in Haiti, it's best not to get diabetes.  If you do, the margin can be very thin between a healthy life and one that is difficult and short.  The margin might just be a 100ml vial, which is located two cities and three paydays away.  Might as well be in Nashville.