How do we provide low-cost but high-quality care to over a thousand people a month?   Here is a key factor.  Every year we attract a number of new graduates from Haiti's medical or nursing schools.  As a condition of their education, they agree to spend one year in "social service".  This means that they work at a hospital or clinic in an underserved area for a small stipend.  But, the assignments are not made randomly.  Rather, the top graduates get first choice on where they will be assigned.  And in recent years, they've been choosing Visitation Clinic because of our reputation.

This year, we were assigned two doctors and one nurse.  One of our bright and talented young doctors, told us this:   "I was blessed to find Visitation Clinic for my social service work."  It turns out that she faces some of her own health challenges including very strong allergies.  But this hasn't been a problem for her because our cleanliness is so high.  She concluded "I don't think I could have succeeded in my social service work at any other place." 

Mothers and Children Report

This past week the last of our summer interns returned home, but they probably have as much work in front of them as their actual internship.  For, we request a formal report to give us guidance on what we should be improving.  We recently received our first report form Dr. Sristi, who returned earlier.  Her report, "Maternal and Child Health at Visitation Clinic", was very well done and gives a glimpse into life in rural Haiti.  Here are some excerpts:

Households:  "Most of the respondents (70.9%) lived in 3-generation families.  These types of families include the respondent and her spouse, their children as well as their parents.  25.5% of respondents lived in nuclear families while 3.6% lived in joint families, where in addition to parents, the household included respondent's brothers and sisters and their respective families." 

Childbirth:  Among 26 women who had recently given birth,  21 delivered at home.  "Among the home deliveries, 90% of them were assisted by midwives, while 10% were un-assisted."

"None of the respondents were aware of the their child's birth weight"

Midwife training:  "The respondents who reported using assistance of the midwives for delivery were asked if they were aware if the midwives had any formal training.  59.4% reported that their midwives were trained, 15.6% reported that their midwives were not trained, and 25% were unsure of the training status of their midwives.  For most midwives who were trained, the place of training was reported as a nearby dispensary."

"Transportation is another major issue faced by the patients as well as the clinic.  Most patients either travel on foot, or use local transportation services like a motorcycle.  The would be a major issue for a patient in labor.  A hospital ambulance service, especially for women in labor would be helpful for the community."

The entire 15-page report is replete with similar insights and facts.   It reminds us that there are still challenging healthcare needs in our community, and it suggests some good ways to respond to them.  For this we are most grateful.  We only hope that our interns know how appreciated there work is.  May they be blessed with the deep sense of satisfaction that comes from a job well done.  

Michaelle's Story

She was 13 when her father brought her to Visitation Clinic.  Michaelle was listless, loosing weight and obviously ill.  Even though her parents were poor and lived in the remote mountains, they had heard good things about our clinic, so they decided to make the journey, even bypassing a much closer health-center.  She was, after all, their oldest daughter and they were desperate not to loose her.  Our doctors quickly diagnosed the problem - diabetes, type I.  Such news is distressing to receive anywhere in the world, but in rural Haiti it is especially foreboding.  Insulin is expensive, hard to find, and there are no refrigerators or electricity to keep it cool.  Plus, patients need a clinic nearby to help them monitor the disease.

Our staff realized the grim predicament that Michaelle and her parents faced.  If she returned to the mountains, there would be little likelihood of controlling the disease, and her young life would be difficult and short.  But people in rural Haiti have a long tradition of sharing burdens and helping each other out.  So a solution was found.  Michaelle would move close to the clinic.  Where would she stay?  One of our own housekeepers volunteered to house her.  What about school?  Our administrators stepped forward and offered to help out.  How about medical expenses?  Visitation Clinic would cover them. 

So, for the past three years, Michaelle has become one of our success stories.  She comes by the clinic every afternoon for her shot and a meal.  In return she helps out with kitchen chores and cleaning.  She is now in fourth grade and is on track to finish primary school next year.  And as the pictures show, her ready smile and sweet disposition are far from the dour little girl who came to our doors three years ago.

Sometimes you need a reminder

about why we do what we do.  Recently we received  a pair of emails that did just that.  One was sent by a friend of a Haitian woman, M. who was sick and wound up at the general hospital in Port-au-Prince. 
"It is very tempting to give a play by play of events but in an attempt to be brief -  patients stay for free at the hospital with the idea that they pay for daily examinations and keep up on necessary prescriptions. There is a terrible bathroom provided (I saw it) but no one uses it. Most people have chamber pots next to their cots. Sheets, blankets, pillows and hospital gowns are provided by the patient. M. kept her blood samples on ice in a cooler next to her bed- which was also provided by herself and/or benefactors. Basically if you needed it, you brought it or bought it. When her husband went to talk to the doctor, M. pulled me to her ear and told me that she could not handle being in the hospital any longer. The conditions were terrible and she was afraid of catching something that would kill her while in her vulnerable state. Each cot was about 2 feet apart and in a large room separated only by a nurses station. It resembled a military hospital inasmuch as the density of patients gathered in a single room. Patients were even laying on the ground.... (The hospital doctor)  said that even though he provides care, he is not responsible for anything except for words. He writes prescriptions and does examinations. ...  I inquired about getting M. out of the hospital so that she may live at home until her operation. He agreed and wrote her 2 prescriptions to take home. As we began to gather her things, people started to bicker about who would receive her bed. This caused us to leave in a timely fashion and M. was happy to be gone."

In contrast, the second email was a brief note to our administrator from one of our interns:

"I also wanted to thank you for making my stay at Visitation Clinic very comfortable and pleasant. Your concern for all guests there including me was much appreciated. Your hospitality humbled me. The staff at the clinic was so nice and I appreciate the fact that they went out of their way to make me feel one with everyone else.   ... I was very impressed to see a clinic that provides good health care in rural Haiti. I am sure that the quality of care provided is exceptional and that people are very happy to have the clinic. I sincerely hope that the clinic expands and starts multiple services for people. I see that the work that you do is appreciated in the community and I do hope that continues forever."

Olympic prep?

On any given day, there is no predicting how many patients will come to Visitation Clinic for help.  Neither can we foretell who the patients will be, or how far they will travel, or what their needs will be.  So our staff is accustomed to the unexpected.  But this past week, we were all surprised to receive a particularly unusual patient with an fractured wrist.  The patient was our own medical director, Dr. JF.  Everyone who knows him recognizes that he is probably the most risk adverse person in VHF.  He is known for his safe driving, for his promotion of preventative medicine and educating the staff and patients about reducing risk and exposure to disease.  And how did he sustain his injury?  Playing football (i.e. soccer).   Now this was not the normal pick-up game of football that one sees all over Haiti on any sized parcel of land, street or alley.  No, this was on our own field with a group of local youths that Dr. JF works with and coaches.  Since formal coaching is rare is rural Haiti, the fact that there is the making of a local team is, in fact, just one more example of how Visitation Clinic is improving life in our area of Haiti. 

Nonetheless, the injury did require surgery this past weekend, and we understand that the procedure was successful.  So we send Dr. JF our condolences and well wishes for a speedy recovery.   And we can't help envisioning a future Haiti where serious disease and other injuries have diminished to such an extent that our major concern will be the occassional sports injury.  Perhaps we can even dream of a future Olympics held in Haiti, centered around Visitation Clinic which has become known as the the thereupitic sports center of the Carribean.  When this time comes, we do hope that everyone will remember that Dr. JF paved the way, even if it wasn't necessarily in the manner that he planned. 

Trucking

Ever wonder how we get supplies and equipment to the clinic?  Sometimes this isn't an easy task.  There are no routine delivery services like FedEx or UPS.  There isn't even any mail delivery in rural Haiti.  So when equipment and supplies are shipped from the US on a container, our administrator has to hire someone with a big truck that is willing to drive the 70 miles.  Well, the truck came today with a wide variety of cargo.  It included dental equipment, 600 buckets for water purifiers that will be distributed to families, office supplies and even four tires for our vehicle.  How do we get all this stuff in the first place?  Well, some is donated, but most things we have to buy.  It is only by contributions from generous supporters that we are able to do so.  In appreciation to them, we are posting these photos showing where their money is going.  We also wanted to share the wisdom of our Haitian truck driver below.  In English it is:  "With God, nothing is impossible" 

Quarrelling with Flannery O'Connor

is usually not advised.  But she did claim that good men are hard to find.  We're not convinced.  For instance we do know that this summer three pretty good women have found us and are volunteer interns at Visitation Clinic.  Today we welcomed our latest arrival, Dr. Sristi.  She is a recent MPH graduate from Johns Hopkins University  who also has a medical degree from India where she worked at a rural clinic.  Even though she aspires toward a career working with the world's refugees and displaced persons, she agreed to spend a week at Visitation Clinic assessing the Maternal and Child Health needs in our region.  We are delighted to have her.  We were are also intrigued by the circumstantial way that she found out about us.  It turns out that a professor at Georgia Tech had become aware of our clinic, and also had worked with her husband.  Not only did he make the connections, he even has volunteered to cover the week's costs.  So, Ms. O'Connor, you may have been mistaken. 

Planning a Hospital

Ever wonder what all the board members and volunteers are doing in the US to support VHF's mission in Haiti?  Well, currently we are spending a great deal of effort planning our next steps. In particular, we have a very active group that is laboring over the question of how to design and build a cost-effective surgical center that will be more effective and sustainable than the standard hospital.  This is the big challenge in Haiti as well as throughout the developing world.   There are, unfortunately, too many empty hospitals throughout the world that were built but couldn't be sustained.  For instance, a survey of a few large hospitals in Haiti shows that their yearly operating costs can be 2/3 thirds of the initial building costs.   We hope to do much better by not overbuilding and by intelligent design.  Right now we are in the phase of soliciting comments from medical professionals and others who have worked at the clinic this year.  

Interns

This summer our clinic is honored to host a couple interns, one from Vanderbilt University, the other from Cornell.   Each will be working on a different project related to health care in the region that we serve.   Here is a email from Magdalena, who was born in Haiti:

Today I had an opportunity to go to clinic and meet all the staff and to see
the rooms. It is a busy day at the clinic. I was only 8:30 when there were
already 101 patients waiting to be seen, so everyone is working hard. Wish I
was a doctor already and could help, but alas not quite there yet.

Heather, the intern from Cornell and I visited the market today; lots of
good memories returned to me, especially of the tasty fruits. The people are
very friendly and the view of the mountains and the sea here is splendid!
Looks like this is going to a wonderful summer here.

Be blessed,

Magdalena

Marketday in Petite Rivierre

The Secret

Want to know the secret to success?   First you have to realize that it isn't that secret.  A Haitian farmer knows it as "Piti, piti, wazo fe, nich li".  Japanese call it "Kaizen".  US businesses talk about "continuous improvement".  Sports coaches quote Bill Riley "If you are not getting better, you're getting worse".   Even Ben Franklin expressed it - "Without continual growth, words like success ... have no meaning."   Still it's good to see concrete examples.  Today's email from our administrator brought one:  

"Being concerned about reducing as much as possible the load on the energy power of the clinic, I had discussed with the logistic tech of MSPP ... in order to see how we can change the system of the vaccine refrigerator to propane gas, and that MSPP would provide us those gas. The negotiations and agreement are successful, and last weekend the logistic tech came to change the system of the refrigerator .  ...  Ever since the load of the refrigerator was out of the energy system, the electricity stayed longer and never cut off until now."

Steps like this are the reason we have a reliable supply of vaccines for children.   It will probably also reduce our energy bills, because we have to generate all of our own electricity at the clinic.  And it's just one example of how our staff work to try to constantly make thing better.  

By the way, the Haitian proverb above can be translated as "Little, by little, the bird builds it's nest." 

Healing Hearts

Today's email is great example of how technology can have a big impact on medical care in rural Haiti.  These are echo-cardiograms of one of our young patients who might need heart surgery.  Our doctors picked up on the problem using time-proven techniques of just listening to childrens' hearts.  The next step was getting these "Echos"  which today were  scanned into our computer at the clinic and emailed to the US using our satellite Internet system.   We've sent them to a pediatric doctor at Johns Hopkins University, and she will be conferring with some cardiac specialists to help decide the best treatment.  When that step is complete, we will begin the process of getting visas and agreements to get the children to the US for surgery.  Meanwhile, its great to see the first steps going as they should.  None of this would likely have happened before the clinic was built.  

More Red Flowers

It's not hard to look around the waiting room at Visitation Clinic and see the special bond between mothers and children.  Invariably small children will be sitting or lying on their mother's lap.  If the children are older, they might be sitting next to their mothers.  But certainly not running around the clinic or  getting into something that they shouldn't.  All it usually takes is that special look from a mother to make a child sit more still and or wait more quietly to be seen by a doctor.  

  

In Haiti Mother's Day will be the last Sunday in May and Haitians have a special way of honoring their mothers - wear a single flower all day.  It will be red if their mother is still alive, and white if she has passed on.  You can help us bring more red flowers to Haiti on Mother's Day.  Just give your own mother, wife or daughter a special pack of flower seeds.  Details are here.  

How far?

Where do our patients come from?  Actually, the answer is surprising.  For several reasons.  Perhaps the biggest surprise is that we actually know the answer, in detail.  This is because Visitation Clinic is unusual in Haiti in that we maintain a computer-based medical record system.  Not only does it store most of our patient records, but we can access it from the US and quickly look for emerging issues, as well as long-term trends.  For instance, we can create maps like the own shown here which portrays how many patients came from which towns and villages in the month of April 2012.  Furthermore we can analyze this data quantitativly and ask questions like what is the average distance that our patients live from the clinic?  (Answer:  4.9 miles).  Or, within what distance does 90% of our patients live?  (10  miles).    s

Facing surgery

Why do these kids look so solemn?  Well, I wonder how you would feel if you've just been through a bunch of lab tests at the clinic you're familiar with, but now you find yourself at a crowded hospital in a nearby city.  You had to ride in the back of truck or motor bike to get here, which was exciting, but now they've dressed you up funny and are going to stick you with a needle and then you will feel really strange and confused, but you can still see and hear.  Then they will put you on a bed and roll you into a big room where a group of people with masks on are going to fix that bump on your stomach that you always wanted not to be there.  Then they want you smile for a camera?   Forget it. 

Four step dental program

Want to get an entire dental clinic to Haiti?  It's really quite easy and only requires a few simple steps.   Shown here is: Step 2, Acquire equipment, Step 3.  Box it up.  Step 4.  Ship it.   Now, perhaps the perceptive reader will note that Step 1 was omitted.  That is because it requires a bit more time and effort and the description "easy" no longer quite fits.   It is listed below. 

Step 1.  Raise the funds to pay for everything.

Muddy waters

These five hard-working women are some of our most valued employees.  Ordinary you would find them cooking, cleaning or washing something.  They are the reason that visitors remark about how impeccable the clinic looks. 

But this past week they had other things on their minds - their homes had been flooded by the spring rains.   With the cholera bacteria loose in the land, we and they were justifiably worried that they sanitize their houses properly,  As our administrator Killy (right) emailed us "the clinic decided to donate some items to them in order to help them in their process of recovering the organization of their houses where all stuffs are spoiled with dirty water. Laundry soaps to wash their clothes&sheets, and hand soap liquids that can be used to wash many other stuffs were donated to those employees this morning before they started to work. Those items were donated to VC by either Direct Relief International(hand soap liquid) or by Doctors of the World Belgium(laundry soap) to which we are addressing our sincere thanks."

Their response?  Many smiles and Janitor Yvana Louse was translated as saying, ''This is an excellent gesture to us that proves how much Visitation Clinic cares about its employees welfare, and I'm proud to have been working here since the opening''  

Can't fool the rain

There is a Haitian proverb that a leaky roof can fool the sun, but it can't fool the rain.  It means, of course, that there is a big difference between looking good and actually being effective.  Well, this is the rainy season in Haiti and yesterday the storms were heavy and flooding occurred.  In most communities people have to fend for themselves in times like this.  But our staff at Visitation Clinic don't think that their concerns stop at the clinic's boundaries and they have once again demonstrated how effective they are.   Here is the email and photos that our administrator just sent: 

The rain of yesterday afternoon caused lots of flooding in Petite Riviere de Nippes, mostly in Dupuy I and II, Charlier and Laguimond near the Clinic. 7 families near the cemetery are the most vulnerable and need emergency response to decontaminate their house since water from the cemetery go down to their house and may cause disease.
Dr JF and I just met with some members of a Civil Protection Crew of PRDN and discussed about what can be done quickly for the 7 families most affected(see attached) and how Visitation Clinic can help them with the disinfecting of their houses.

In my intervention I defined a quick action plan that can be implemented:

1- Set up a representative core committee between them to meet with leaders or institutions for help
2- Draining the water from families victims near the cemetery ( talking to the company Vorb&Fils for help with their bulldozers)
3- Set up an executive crew for the decontamination process with chlorine and cleaning in removing mud from the families house.
4- Proceed with the decontamination(disinfecting) and cleaning before the families can use the houses.

Help from Visitation Clinic:
- Donation a big bucket of chlorine
- Donation of 3 big sprays for pulverization

And the children keep coming

This week we are again hosting a team of pediatric surgeons from Maryland and California who have years of experience working in developing countries.  Even though Visitation Clinic doesn't yet have an operating room, the group was previously so impressed by our clinic and staff, that they wanted to use us for everything except the actual surgery.  This includes patient screening, lab work, pre-op meetings with the children and parents, and post-op follow up. 

Many of the children require ambulatory surgery for a variety of issues including umbilical hernias, hydroceles and undescended testis.  In the US, these conditions are common and are treated before children are a year old.   But in
Haiti, its a different story and we have a list of over sixty children who need help.
Right now, we are actively planning on adding a surgery and other hospital facilities.   You can help us write a new story for rural Haiti by donating here.

Deserving

Why do so many volunteers who visit our clinic want to return as soon as they can?   For instance, this week we have a group of surgeons who first visited clinic two months ago.  Even though they had to raise the funds for travel and supplies, and even though they have to commute for an hour or two to use the operating room in an overcrowded hospital, they wanted to stay at Visitation Clinic.  Moreover, they wanted to focus on our region's children who have a long-deferred need for surgery.  So the children are making the commute too. 

Well, part of the answer is simple enough.  Visitors quickly see how deserving and endearing are the young people who live in our part of rural Haiti.  For instance, if they need care,  they and their families will come to our clinic early, dressed in the their cleanest clothes, and wait patiently for hours to be seen.  This photo is a candid picture taken during a recent pediatric dental mission.  There were so many children that morning, that were probably quietly waiting for hours when this picture was taken.  Later on, we figured out a way to pass out tickets so that they knew when to come back.  After all, kids like this deserve a break, and we, and our volunteer visitors, are trying our best to see that they get it.

After hours

It's hard to describe to people in the US how much difference a well-run clinic can make in the lives of families in Haiti.  In so many rural areas of Haiti, medical care is hours away.  And late in the day, or on weekends, most clinics are locked and help may not be available at all.   At Visitation Clinic it's not unusual to see scenes like this.  Even though it is after normal hours, when these worried parents arrived with their daughter, our staff re-opened the clinic to help. 

It's also notable, and not unusual at all, that both parents have journeyed with their child to get help.  Parents in Haiti will do anything for their children and they work hard trying to earn the money to pay for school tuition, food, or health care.  They know that Haiti is changing.  They see it in the quick spread of cell-phones, motorbikes, the new road, and in Visitation Clinic.  We've been open for over four years now and the community, which has seen other groups come and go, seems to have a new confidence and they are daring to dream of a better live for their kids.  You can help make this dream continue by donating here.