Midwives

Most of our blogs are about activities at Visitation Clinic    This one is different.   Its about something we want to do and are trying to figure out how.   First some background.   Groups like the World Health Organization collect healthcare data from around the world.  They track statistics like mortality rates among mothers (MMR) and infants (IMR) and also the fraction of births at home without professional assistance.   Not surprisingly, these are all related.   For Haiti, the news is both good and bad.  The good news is that Haiti's MMR and IMR has dropped by about half over the past forty years.   The bad news is that Haiti's is still highest in the Western Hemisphere.  Plus, there are big differences between income levels and between urban and rural areas.   Our patients are both poor and rural and we estimate over 98% of births occur at home without proper assistance. 

Attendees of Visitation Clinic's first meeting of  midwives.   (Dr. JF was taking the photo.)

So we are trying to reach out and help.   Earlier this week we organized a rare meeting among some nearby midwives.   They reported numerous challenges including minimal training, lack of certifications, no supplies, no ambulances to call upon, ... the list went on and on.   The challenge, for us, is that the group  estimated that there were about fifty other midwives just in their commune, and there are 37 communes just in the Department we serve.   So, this meeting will likely be one of many as we try to get our arms around this problem.  We've got some ideas on how to proceed, and we've got a prospective volunteer who is interested in spending a month or so this summer trying to help devise a program.   So this is just a first step and we've got work to do.   You can help, of course, by donating here.                 





Not Everyday



 



Dr. JF, Nathaelle, her parents and family.  

It's not everyday at Visitation Clinic that as you finish breakfast you're told some people are waiting to see you.   The people turn out to be Nathaelle and her parents and family.  Nathaelle is a friendly15-year old who was in our clinic for two days with acute gastritus.  Her parents had sent her to us from a distant town on a motorcycle, even though there were closer hospitals and clinics.  Dr. JF had already told me the story of how Nathaelle was unresponsive to the normal antibiotic regimine and how, as her conditioned worsened, he had conferred with a surgeon in Port-au-Prince who advised us to rush her there. 




SUV to ambulance



 

As we converted our SUV to an ambulance, Dr. JF had tried a last-ditch IV of a new and potent antibiotic.  Everyone piled in for the long, late night ride with a risky outcome.   We were surprised when the vehicle returned early in the morning with promising news.   The antibiotic seemed to be working and the pain had subsided.  So  Dr. JF had detoured to Dr. Delva's (our former resident) clinic in Port-au-Prince where Nathaelle would be close to surgical help, if needed, but in good hands otherwise.  She was so improved the next day that we were able to bring her home. 

 

But why did her family want to talk to me?  With great formality, they said through an interpreter what was on their mind.  It was simple enough, "We want to thank you for saving our daughter's life."   Astonished, I tried to tell them I had nothing to do with it, that Dr. JF was the healer.   They agreed, but were not to be disuaded.  "We know", they replied, "but the clinic would not be here if it weren't for VHF.  So we want to thank you, so that you will tell everyone that they saved our daughter."   They still weren't finished.   Hesitantly they went on, "We could only send  Nathaelle to you, but we could not come until now.   She told us that everyone here was her mother and father while she was so sick."  I remembered how even our cooks were spending time with Nathaelle, comforting her and holding her hand in her distress. 

 

I could only promise to do my best to relay their gratitude.  That is the purpose of this message.  Would that every reader could have been there to see their faces.  You wouldn't soon forget them.        

 

Perhaps you would like to help future Nathaelle's.   You can do so here    

 

   





 

 

This past week Visitation Clinic was gifted with the a pediatric delegation organized by Sr. Karen Schneider, MD who is an Assistant Professor of Emergency Pediatric Medicine at Johns Hopkins University.   It was a big group consisting of six residents, three RN students, a pediatric surgeon from California, another sister who has a PhD in nursing from New York.  Some helped out at the clinic, some participated in mobile clinics, and the pediatric surgical team worked at a government hospital in nearby Miragoane.

Pediatric exams an a rural school in the Nippes Department of Haiti

 

The week began somewhat leisurely as it coincided with Carnival - Haiti's exuberant celebration of the beginning of Lent.   Still the mobile teams visited several nearby villages and screened children for a wide variety of diseases.  Healthcare needs don't take vacations, though, and when the clinic opened on Thursday, an all time high of 156 patients were at our doors.   Our staff was most grateful for the help from the states.  

PAP - II

As word spreads that women can, for the first time, get a PAP test, they have come to the clinic in record numbers.   So far this week our volunteers from New Jersey have performed 333 tests and at noon today we have over 200 waiting.  Some we won't be able to see, as we are running low on test supplies.   When you live in rural Haiti, basic tests like this are difficult to get.  In fact, this morning our administrator, Killy, emailed  that some patients were pleading, ''There's no place in the area I can do the test please let me do it'', as they were loosing hope to be seen today which is the last day.   We can only hope that our volunteers return next year, now that we all have worked out how to get the supplies.  This has been an important first for Visitation Clinic.  


Women waiting on our back porch.   Some have come from distant towns such as Petite Guave (25 miles) and Port-au-Prince (71 miles).



Even though there may a crowd outside, each patient getts individual and dignified care.   One of VHF missions is to avoid the sometimes gruff treatment that too often accompanies poverty in low-resource countries.

.   YOU CAN HELP RURAL HAITI BY DONATING HERE

First PAP

This week brings a new service to the people that Visitation Clinic serves. For the first time, women in our region will have access to PAP testing for cervical cancer. These tests, which are routine in the US, are quite rare in Haiti. In fact,  it took an unusual amount of determination and planning to make this happen. The key players were a group of doctors and technicians from New Jersey and our administrative team in Haiti. In order to perform PAP tests, we needed to get particular dyes, stains and reagents, which can't be found in Haiti and can't be carried on airplanes. In fact, it took a network of contacts and interminable phone calls to find a source in the Dominican Republic. Then it had to be purchased by an agent and shipped on a bus to Port-au-Prince, where our administrator waited  to meet it.  On Sunday our team of eight from NJ flew in with the rest of the supplies and set up a temporary second laboratory just for these tests.  So far this week, over 120 patients have been screened.     

Our auxiliary lab dedicated to PAP tests.

Cytotechnologists Rachael and Ilia



Patients waiting on the back porch.   Visitation Clinic cared for
141 patients on Tuesday - an all time high.

 

YOU CAN HELP THIS WORK ENDURE - DONATE HERE

Five Years

Today marks a special day for Visitation Clinic.  It was five years ago that the clinic officially opened.   On 19 January 2008, a caravan of buses and cars carrying American visitors came to pack into the town's church with a huge contingent of  local residents for an opening day mass.  Yesterday we commemorated this event with a similar celebration under the clinic's arches.   The local pastor , Fr. Rebecca, told stories  

of the many times since then that people have told him of the life saving difference the clinic has been.  "My baby was about to die from cholera, but Visitation Clinic get her back to life" was one of the quotes he used from a mother.   

Our administrator, Killy, emailed, "... we could hear some patients praying for the clinic's sustainability and also for all its donors and leaders in the USA and Haiti who keep it running every day."  He want on to describe how afterwards, many of the day's 72 patients greeted and hugged the staff, thanking them for having saved or treated a particular member of their family from a certain disease during the past years.

That afternoon, there was a dinner for the staff, who had decided to give each other gifts for this special day.   These carefully wrapped presents to a randomly chosen co-worker expressed their appreciation for each other during sometimes trying times over the last five years.  It was a memorable day for all.

A Christmas Reflection

Another December is upon us in America, bringing, as usual, the long solstice nights and the beginning of winter. It is always a marvel that the coldest and darkest season is begun with the warmest and most cherished holidays. What other season has such a spectrum of observances? They range from houses festooned with lights, to the ubiquitous music and carols, to the incredible variety of movies, plays, books and stories. It seems no matter how difficult the year has been, or how shear the looming fiscal cliff, the holidays bring a respite from worry with its reassurances that Santa doesn't forget, Scrooge can be transformed, the Menorah will be lit, and the Infant has been born. Among the season’s timeless stories, one is especially appropriate for a clinic in Haiti. In fact, it inspired Visitation Clinic’s name. It was written by Luke, a physician, who tells of two Jewish women, one young, one old, who find themselves unexpectedly pregnant. The older one lives in the southern mountains and being six-months pregnant, she needs help. The younger one is a poorer relative who lives in the north, but when she hears of her cousin’s need, she hastily sets out to assist her. The distance is over a hundred miles, and donkeys are expensive, so she most likely walks the entire way. The journey is difficult and risky, with, perhaps, the danger of rejection, since she is unmarried and her older relative is the respectable wife of a priest, and the daughter of the high priest. So Mary greets her cousin first. But Elizabeth is not just welcoming; she feels her baby leap and exclaims her delight and honor by the visit. She proclaims her blessing and seems to know that their babies will change history. The story ends with the young Mary proclaiming her own gratitude, praise, and her affirmation of one of the great inversions found in scripture, “He has put down the mighty from their thrones, and has exalted the lowly. He has filled the hungry with good things, and the rich he has sent empty away.”   She then stays for three months to help out.

In our times, Haiti is where you can find the “lowly”, especially in the southern mountains and countryside near Visitation Clinic. To get to the clinic, most our patients walk at least four miles round trip. Half will be women, and more than half of those will be carrying either a child or a pre- or post-natal baby. Some will walk from the hills around the clinic, which makes the trek even more difficult. Because they can’t get to our clinic quickly, over 80% of mothers will give birth at home with the help of a neighbor, midwife or relative. Whoever assists usually has minimal medical training. Consequently, Haiti has the highest maternal and infant mortality rates in the western hemisphere. Yesterday was the Friday before the holiday weekend. But births and other health needs don’t take holidays, and we were as busy as ever, caring for eighty-one patients, including thirty-nine women, twenty-nine children. When we ask, they tell us of the difference that Visitation Clinic has made in their lives. Still, we worry about those who can’t travel, or who need hospital care. So we are planning to expand both our services and our outreach. We have the expertise, staff and plans to do so. All we need is a relatively modest (by US healthcare standards) level of funding. For instance, you can adopt one of our assistant nurses for only $200 a month. It’s easy to donate. Just go to: www.visitationhospital.org/donate On behalf of the staff and board of Visitation Hospital Foundation, we wish you a merry Christmas and the happiest of holidays. Art Judy Executive Director

A Busy Day

Every day is different at Visitation Clinic.  There is no predicting how many people will come to our door, or what our staff will have to deal with.   Some days it will just be routine cases.   The next day we will have multiple crises.  Today was one the busier ones.  As recounted by this report from our administrator, here is just a few of today's cases:

Patients in the cholera center.

- 2 cholera patients from O'rouck (about 15 miles from the the clinic), one of them was in a critical state(unconcious) and is feeling better now after 6 liters of IV fluids L.Ringer donated by Direct Relief...The cholera center was damaged after the hurricane and I got two hygienists to make some improvment in it in order to receive the cholera patients.

- One pregnant woman came early from about 6 miles and delivered a baby at the clinic with the assistance of our tireless doctor and head nurse.

- One man nearby came very early this morning at 2am with a sort of intestinal infection (bacillary dysentery) and was kept on observation after a first care with some medicines and sodium chloride 900mg/100ml donated by Direct Relief

- One man came this morning also with a urinary retention with suspicion of STD. He is also kept on observation ...

 

It is evident that we rely heavily on donations of medicines and supplies from other organizations.  Less obvious is that our biggest expense is just paying our staff's salaries.  Their skill and dedication, combined with your donations,  keep our doors open.  It's easy to donate, just go here.

Recovering

Road crew at work

After repair

Big hurricanes can remind us how small our planet is and how  sometimes we all share the same burdens.   Right now, from rural Haiti to New York City, people are digging out and trying to recover.   Sometimes the only difference is the tools and resources at hand.   For instance, we weren't able to find anyone with road grading machinery  near our clinic, so we relied on the resources we could find; namely picks, shovels and workers who were eager to earn some money.   As these pictures show, it all worked well.  

Washed out road earlier this week

 

Sandy III

The storm has passed, the sun has returned. and our solar panels are making power again.   Now the clean up begins and we try to figure out how to repair the road.  Meanwhile our latest email brings these pictures of the mother and baby who waded through the rain and mud yestereday to come for help.   As Killy describes:  "He came with a high fever and signs of respiratory distress...  His mother came with much anxiety and left with hope."

Sandy II

It's still raining in Petite Riviere today, yet people are beginning to dig out of the mud.  Actually, you don't have much choice if you don't have anywhere else to sleep.  In Haiti, if you have a house at all, you  consider yourself fortunate.   If you have a cement floor and metal roof, you are even better off.   And if you ride out a hurricane without being inundated with mud or your roof being blown off, you thank God for your blessings.   Haitians are known for their resilience.   One just wishes that it wasn't tested quite so often. 

Meanwhile, the upper part of Visitation Clinic's road is washed out and impassable for 4-wheel vehicles.  Our latest email brings this: 

"Flooding increase in town and access to the clinic becomes worse. Despite of that, we are open to receive emergency patients and we received this morning a baby of 4 months who was really bad and couldn't breath, we did the best for him and he's feeling better now but we do keep him for a while and will tranfer him later" - Killy

Sandy

At Visitation Clinic we welcome most guests. But if we had a choice, we would  have politely turned our most recent visitor away.  Her name was Sandy and she came calling with lots of rain and 105 mph winds.   Right now, we don't think we've sustained any major damage, but we don't know about the town.   Here are some excerpts from our administrator's mail:                    "... flooding in the town of the petite riviere, hard rains and wind since yesterday, trees are dug up in the yard of the clinic, the way to the generator is blocked with a tree that fell down, the fence of the cholera center is gone, many employees living in town are victims, they move to other places and leave their own houses as they are flooded."

 

"It's hard to go in town now to get pictures, it's raining and the wind is hard." - Killy

 

Break of the Day

This time of year, sunrise is around 6:00 am at Visitation Clinic.  If you want to catch it, you need not set an alarm - the roosters will happily announce it.  With the right amount of cloud cover, the rising sun can be beautiful and the dark Haitian landscape makes it all the more so.  It can be a good time to try taking some low light pictures.  Usually the solar power batteries have run out of juice during the night and there are no building lights to compete with the sky.  On this day, thankfully, the cholera center was dark and empty too,  with the last case being more than six weeks ago.  So we were fortunate to get this nice photo of the arches at the entrance of Visitation Clinic silhouetted by the palm trees and tropical vegetation.   

 

 

Then we noticed  another remarkable event unfolding.  People were already beginning to arrive at our gates.   Even though the clinic wouldn't open for another two hours, patients were beginning to arrive by foot and motorcycle.  In fact, though, this is  a routine occurance.  So much so that the local town has now installed a solar powered street light just outside our gate.  We are, of course, most greatful.   Undoubtedly, our early-bird patients are even more so.

Angel with a mop

 

On any given day, a wide variety of people come to our clinic's doors.  About the only thing that is predictable is that there will be a good number of children.  This is especially true on Tuesdays when we offer free vacinations.  Even parents who are poor and cannot read or write know the importance of this.  For instance this little girl is about five, and her only previous visit was when she was one and came for her shots.  Even today, she was just accompanying her mother for her little brother's vaccination.  She was happy until we asked her name, but this made her afraid that she would get a shot too and she wouldn't tell us.  So we were calling her Moppet because she was fascinated by the mop and rolling bucket; perhaps never seeing one before.  When we

found out her real name, it was surprisingly  appropriate.  Her last name is Cherubin.  Her exact age is unkown, because like many of the poor, there is no record of her actual birthday.  Not that she isn't cared for. Her clean dress and carefully corn-rowed hair speak to that.  And her mother's smile was radiant when we showed her these photos.  But you can tell when children come from the poorer homes - she was barefoot, small for her age and didn't have any plastic barrets in her hair.  So even though she will never have a birthday party, we can help her have a healthy and happy life.  Is there anyone who deserves it more, or less?

  

 

            

Some humor from Haiti ...



We've always wondered what babies are thinking and doing as they wait to see our doctors.   So we engaged some eminent child specialist to study the issue.   What they reported was most surprising.  It seems the children have organized a secret auction that the adults are unaware of.  We didn't believe it either until our specialists shows us proof of shoelaces going for 2 goudes. 

(Sorry, we couldn't resist a light-hearted blog when we saw how happy and healthy some of our babies are.)

Are we making a difference?

For the last few weeks we've been deep in a dark dungeon known as a computer trying to do some data mining on tens of thousands of patient records.  We wanted to see if we could show whether Visitation Clinic was making a difference in the overall health of our patients.   This can be difficult to ascertain because most people don't come to the clinic unless they are not well.  So we came up with the following scheme.   We looked over the past three years to see what were the top dozen diagnoses and whether they were changing or not.  What we saw is most encouraging.  Some of the most common diseases are trending down.  A few dramatically so.  For instance, the anemia rate is down by 50%, IGU (urinary track infection) is down by more than 50% and malaria has decreased by 90%. 

 

There is actually another piece of important news in this chart.   And that is that we have it.     Visitation Clinic is unusual in that we not only aspire to provide good care.  But we are also committed to putting in place the tools that let us measure how good a job we are doing.  The clinic's records are acquired on a solar powered, networked computer system that we can access remotely and we can monitor daily.   This is incredibly important.  These days smart donors want to know two things:  first that there is a need, second that we will be effective.  The need in rural Haiti is undeniable.  We think we have just as compelling a case for our effectiveness.  

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."