Access to basic health care continues to be a matter of life and death for the Bottom Billion. We, the students of Loma Linda University School of Medicine's Class of 2010, recognize our responsibility as future physicians to make a difference. We believe we have been charged not only to recognize the needs, but to take steps to bring about change. To that end we have partnered with Hopital Adventiste d'Haiti in Port Au Prince, Haiti.
This website features stories of our classmates and their mission experiences. We hope to bring together a community of people who believe that together we can make a real difference.
Just wanted to write an update about our Haiti project! I just got the opportunity to spend a week down in Haiti last week! My fiance is doing an ortho rotation down there for 3 weeks so I decided to go join at least for a week. It was amazing to see how the hospital has changed since last year when I visited!
Landing in Haiti brought back memories of when I visited exactly one year beforehand. Driving back from the airport to the hospital, I noticed that there were still many tents along the side of the road where people had been living for over a year. They now appeared well inhabited. We drove by the palace, which still stood looked crumbled, identical to how it was 1 year ago. The cathedral was torn to peices, and everything looked as if the earthquake had just happened yesterday. Haiti has been through so much political turmoil in the past year it has been very difficult to get anything accomplished. There has been some progress, however progress in haiti is very slow.
However, driving into the hospital grounds, I did feel like there was a radical change. No longer were there hundreds of tents crowding the campus. It was clean, pristine, and there were very few people walking around. It almost felt empty in comparison to last year. The hospital hallways were clean, the supplies ‘neatly; tucked away in a storage building. There were no longer cots lining the hallways upstairs for volunteers to sleep. Also, for the most part, the haitian doctors and nurses have resumed full care of the hospital. There are still 9-10 long term volunteers that have made a year committment to stay at the hospital to make changes, but they are trying their best to support the haitians to run the hospital. The hospital administrator is Nathan Lindsay along with Emilie Clotaire, and they have a new medical director, Dr. Simeon. Our friend Marc Julmisse who went with us to Haiti on our first trip in 2008 is now down there for a year or more, working as a nurse educator to help raise the standard of care at the nursing level. She has been doing an incredible job, organizing training seminars for the nurses, neonatal resuscitation courses, and sending some employees to the united states for more extensive training. She has a difficult task set before her, given that the nurses don’t all have the same training, very few of them actually have their bachelor’s in nursing.
Also there is an architect there for a year, who is making plans for constructing long term volunteer housing on the campus but not in the hospital building. This will allow more space for inpatients on the wing where they have been staying. Also, in the next few weeks, administration will be moving down to the building near the entrance of the hospital, where the polyclinique is, and pediatrics and maternity will be moving up to where administration currently is. So there are some big changes that will begin to take place soon.
As I mentioned earlier, most all of the departments have returned to being fully run by the haitian staff, except the Orthopedic program. Dr. Terry Dietrich, an orthopedic surgeon who is a graduate of Loma Linda and previously has been living in Wisconsin, has committed to staying at the hospital for 1 year. He and his wife have been working hard to provide free health care for the patients, as orthopedics is the only specialty that is being subsidized right now and is still free for anybody, including surgeries. It is much less chaotic than last year, but still there are many needs. Patients are coming in who have had problems for 10-15 years but have not had the money to have a surgery. Clinics are full every day with people lining the halls waiting to be seen, and they do 7 or 8 surgeries per day as well. Dr. Dietrich has also been working to raise money for long term support for the orthopedic program to become self sustainable and to continue to provide free care in the future.
I’d love to see what they’ve done with the ortho program happen in the other specialties in the hospital. Currently pediatrics is seeing over 800 patients per month. Also, I spent a lot of time working with the Ob/gyn doctors down there. They’ve had an ultrasound machine that was donated last year that they don’t seem to know how to use. I spent some time working with each of them showing them how to use it, which seemed very helpful. Also, there didn’t seem to be nearly the same amount of deliveries as there were last year. Dr. Saint Preux explained to me that when it was free to deliver there, everybody came. But now that it costs money, most people don’t come and instead deliver at home or at the public hospital. Because of that, there is a much higher infant mortality and I would imagine maternal mortality as well. On my last day there a patient came in seizing due to eclampsia. She had waited all throughout the symptoms of pre-eclampsia and didn’t come in until she was actually seizing. We did an emergency c-section on her, and she had beautiful full term twins thankfully! Anyway I’m just saying that the lack of access to health care is obviously causing problems in many areas.
Anyway these are my ramblings, I just wanted to update everyone on how things are going at the hospital. The people seem to be in high spirits and are thankful for all that they have, even when they still are living in tents. There’s still over 1000 people living in tents at the Adventist University down the road. They’re also having elections for a new president this coming Sunday so I’m sure there are some big changes around the corner.
All in all, we’ve chosen an amazing hospital to be committed to. I’m excited about our commitment, and I’m sure that we can make some really positive changes there. I think it will take working with the people that are there long term to really help, cause they’re the ones who know the ins and outs of the hospital. I think God has blessed us to be in the position to make a difference though, and I look forward to what the future has to hold for our class project, and I pray that we can use our endowment to further His work.
Post election results were released last night in Haiti. Not a good situation. Lots of rioting, fires, violence, etc. We are safe at the hospital but please continue to pray for everyone here. Many of our local staff risked their lives just to come to work today.
Haiti feared further catastrophe from Hurricane Thomas but was mostly spared as a current review shows six people dead from the tropical storm. Many more lives have been saved, but cities like Léogâne and Aux Anglais have been flooded. Roads also are cut, isolating departments across the country. Thomas leaves Haiti under several feet of water particularly in the Artibonite department where the cholera epidemic has started.
Good public information and other prevention measures have made the difference Haitian authorities say. In Port-au-Prince, this is a huge relief because many earthquake victims live in precarious camps of tents and plastic sheeting. When I talked to my parents this week, they told me that God listened to Haitian’s prayers because the country couldn’t face another big catastrophe 10 months after January 12 earthquake.
Efforts are now mobilizing to limit the cholera outbreak. Since this cholera epidemic hit the country in mid-October, the Health Ministry has recorded nearly 900 deaths and more than 10000 hospitalizations. The post-Hurricane Thomas floods are likely to increase these figures in the coming days.
According to WHO’s, Pan American Health Organization, action is essential to keep cholera from quickly spreading across the country. This week 73 cases of cholera were reported in Port-au-Prince, the capital where 1 million homeless live in overcrowded conditions where the disease can easily spread. Dan Epstein, a PAHO spokesman, has warned that there is a real risk of the epidemic crossing the border into the neighboring Dominican Republic. According to Haitilibre.com, three Dominicans have been admitted to hospitals due to cholera symptoms.
One of the cases was in Bernard Mews Hospital, where one of my physician friends encountered people with cholera symptoms who had moved from the Artibonite department, where contaminated river water spreads the disease. Last Monday, a three-year-old child who never left the neighborhood of Cité Soleil was treated for the disease. Already one person has died of cholera in this slum with 800000 inhabitants, and a hundred others were hospitalized with severe diarrhea. Hygiene conditions in Cité Soleil are catastrophic, so the disease can spread quickly there and remain persistently. The situation is now beyond control with local resources; health authorities and NGOs are talking about cholera becoming a national security issue. The water-borne disease has already spread to half of Haiti’s 10 regions. Flooding caused by Thomas Hurricane has exacerbated conditions and help the disease spread further. At the end of last week, the storm left 20 deaths with 36 injuries and 11 people missing. All state actors must be mobilized and concern is growing in Haiti but also in the international community.
Thanks to God, Hurricane Thomas left Haiti, but my country faces many other threats right now. This makes me wonder when Haiti will have a brighter future. However, Taiwan has pledged to support Haiti in reconstruction. Although this support has been slow to arrive (like that of many other donor nations), it is needed more than ever now.
Taiwan has been able to support Haiti with health services, including sending short-term medical missions to Haiti’s rural villages and helping to establish a national laboratory for HIV. I can only hope that this cholera epidemic will receive the same compassionate attention from Taiwan’s leaders and people
Nadjy Joseph, MD
School of Health Care Administration, Taipei Medical University
It has been six months since the earthquake and the need still continues. Some experts are predicting that it could take up to 20 years to remove all of the rubble. The U.N. estimates that 1.5 million Haitians are currently living in camps. Loma Linda University and AHI continue their work with Hopital Adventiste d'Haiti.
"Out of the Rubble" premiered at the General Conference session in Atlanta, GA. It will be making it's broadcast premier later this year on KVCR. We're also working on a "Sebastien cut", which will focus more on our friend Sebastien. We're hoping to send that version off to film festivals. Until then please continue to share "Out of the Rubble".
This post was authored by Scott Nelson, Director of Orthopaedics at Hopital Adventiste d'Haiti who returned to HAH on Sunday.
Return To The Mission
After a much needed 2 week hiatus from the chaos of the ongoing disaster relief efforts at Hopital Adventiste d'Haiti I returned yesterday to face the challenges. In spite of several recent events regarding reintegration, sustainability, and international communication breakdowns, today was an especially productive and reassuring day. The clinic was filled with patients, 3 operating rooms ran simultaneously, experts from around the Americas worked busily, and administrative meetings reaffirmed the commitment to our mission of serving those in need.
The acclaimed reputation of our hospital from years past has been restored and enhanced because of the excellent services and long term stability that this hospital has provided to the victims of the earthquake and others with urgent and often neglected medical problems. The inherent institutional political challenges after a tragedy of this magnitude have resulted in the following scenarios at other local institutions:
Well reputed hospitals have had to completely shut down due to lack of income to pay normal operating expenses and repair damaged infrastructure
Attempted survival while refusing the continued expertise of well intentioned foreigners offering free services and destroying the economic norm of local doctors and hospital operations
Completely expatriate operated institutions created by foreign NGO's. Some of which have terminated or diminished services due to difficulty with long term sustainability and rapid turnover of volunteers
A mission hospital is by no means immune to institutional politics. Quite the opposite. Many times they are political hotspots due to factors of finance, religion, communication barriers, racial issues, power struggles and small numbers of people working long hours in adverse conditions. In spite of many "challenges" and the inevitable hospital politics we continue to focus on our mission of serving those in need.
We owe our successes to several unique aspects of our institution. First and foremost is the grace of God who has enabled each one of us to serve here with a mission for our fellow man. Many visitors have been impressed that we have both the Haitian staff and our foreign volunteer staff have working together which they have not seen at many other locations around the city. In spite of the fact that we are the closest major medical facility to the epicenter of the earthquake our building did not suffer any significant damage. Although some pre earthquake deterioration had occurred, we have one of the best facilities in the region and have already accomplished major improvements to the physical plant and upgraded many needed pieces of equipment. The commitment of several long term volunteers combined with the efforts short term experts has allowed capacity, excellent services, and stability. We thank our supporting organizations such as the Adventist church, Loma Linda University, CURE International and other collaborators for financially supporting the operational costs during this time when extra services have been provided for thousands of patients who have no ability to pay.
God is with us.Syringofibroadenoma - Before 26 year old girl who suffered for years with a foul smelling tumor on her R foot is doing well after excision and skin grafting. Thank you to Dr. Dror Paley - surgeon, Dr. Craig Zuppan LLUMC pathologist who provided the diagnosis, and the LEAP plastic surgery team.
Last night a man was brought in to the hospital by a Haitian hospital volunteer. The man had been brutally beaten and left on the side of the street. Upon arrival to the hospital he was taken outside to be cleaned before being taken into the ER. When I found him out in the gravel behind the hospital, he was completely naked, emaciated, delirious, unable to communicate, drool and snot running down his face, jagged wounds all over his body, a ligature scar around his neck where he had been hung, a broken jaw, and maggots crawling out of deep lacerations on his head. The scene was shocking. I have never seen someone so completely stripped of their humanity. The staff did their best to wash him, then gave him clothes and brought him into the hospital for more treatment. Thinking about the whole situation afterwards, I realized that the Haitian volunteer that brought him in to the hospital was the Good Samaritan. He found the man, a stranger half dead on the side of the road, likely passed over by hundreds of other people, and had compassion on him. That realization made me question whether I would have done the same. It is easy to listen to the story of the Good Samaritan and look down on the priest and Levite who passed the traveler by. We automatically assume that they must have been inherently bad people, and that ourselves being so Christ-like, would have stopped and helped the traveler. To be honest, I don’t think many Christians would have stopped to help this man. He was delirious, appeared to be almost dead, and was not asking for help. It would have been much easier to pass him by and think, “wow, what an unfortunate situation, I feel so sorry for these Haitian people,” then keep walking. In the end, I can only pray that someday I will be as Christ-like as the Haitian volunteer.
The Centers for Disease Control and Prevention (CDC) has received reports of dengue fever among relief workers returning from Haiti, where the disease is endemic. Symptoms of Dengue FeverDengue fever (DF) is characterized by high fever plus two or more of the following: headache, retro-orbital pain, joint pain, muscle or bone pain, rash, mild hemorrhagic manifestations (e.g., nose or gum bleed, petechiae, or easy bruising), and leukopenia. The incubation period for DF ranges from 3 to 14 days but is typically about one week; therefore, illness may occur while the workers are stationed in Haiti or after they return to the US. Most dengue fever cases are self-limited and can be treated with bed rest, acetaminophen, and oral fluids. A small proportion of patients develop dengue hemorrhagic fever (DHF), which is characterized by presence of resolving fever or a recent history of fever lasting 2–7 days, any hemorrhagic manifestation, thrombocytopenia (platelet count <100,000/mm3), and abnormal vascular permeability evidenced by hemoconcentration, hypoalbuminemia, or abdominal or pleural effusions. DHF can result in circulatory instability or shock, and the risk for these complications may be increased among persons with prior dengue infection. Adequate management of DHF patients generally requires timely hospitalization and judicious administration of intravascular fluids and close monitoring of vital signs and hemodynamic status.
I had an 18 year old boy today with nausea since the earthquake, but no other symptoms. It didn’t add up, so I asked him what happened during the earthquake. He broke down in tears as he lifted up his shirt, showing me the scars where he was impaled by a piece of metal, then told me that his father’s leg had to be amputated and that his mother was killed. I think that’s the first time I have cried with a patient.
The post below was authored by Scott Nelson, MD, Director of Orthopaedic Surgery at Hopital Adventiste d'Haiti. Hopefully this will give donors an idea where their hard earned dollars are being spent. However, it goes without saying that the needs are great and more funding is needed to further renovate this facility. Please consider donating to the project here.
This post also demonstrates the need for qualified nonmedical volunteers. Please contact LLU Global Health to determine if HAH could use your services.
Volunteers donated US $1 bills to each of the young boys who filled a trash bag with the loose trash that was strewn around the campus. As the donations begin to run out before all the trash was collected the participants were glad to pick up 2 bags per dollar. Our campus is now clean.
Rooms in the southwest wing were never finished after the initial construction phase 5 years ago.
Plumbing fixtures and painting was completed by Dr Peter Nelson and Arpad Soo from San Luis Obispo, CA. The rooms are now ready for patients. We thank the generous donors of Amistad International for the plumbing hardware that was purchased locally as well as in the US.
One of the biggest challenges in preparing these rooms was fixing the sewer system which had been plumbed to drain the toilets onto the front lawn. Arpad, Jerry and crew worked day and night digging trenches around the raw sewage and placing the appropriate drain pipes.
Another peculiarity is why the toilet inflow was plumbed into the hot water pipes. Thank you to the expertise of our plumbing crew and their hard work most of these problems are now resolved.
Arpad worked most nights until after midnight repairing leaks and faucets around the hospital.
This very important sink in which we scrub our hands before surgery now has new foot pedals thanks to a donation from Ferguson Enterprises in Santa Maria, CA. It is important to use high quality materials as the elements are intense and these sinks sustain a high volume of use.
Liz Dickinson, RN, Vice President of Nursing at Loma Linda University Medical Center transformed our operating room with her friend Sylvia. We thank LLUMC and Liz for her hard work and the amazing improvements that were made.
Before this past week, there were still cupboards stuffed with instruments from years past. Liz, Sylvia, and the Haitian nurses sorted through all of them.
Some sterile packaging of unused instruments dated back to 1952.
The "before" shot below of the central sterilization area.
The "after" shot below. The newly painted cupboards are awaiting placement of well organized instruments.
New shelving was placed in the sterilization area after relocating the decontamination sink to a separate room.
In spite of our very low infection rate, measures are being taken to continue to make safety improvements for our OR. This decontamination sink had its faucets and drains replaced this week and it was placed in the decontamination room where instruments will be scrubbed prior to bringing them into the sterilization area for final wrapping.
Peter Nelson, DDS (on the right below) poses with Kyle Fiess of Maranatha. He used this hammer drill to make approximately 60 holes in the 10 inch walls of the southeast wing through which the entire plumbing system will be replaced. Prior to the earthquake the low pressure partially functioning water system delivered water to various plumbing fixtures, many of which were in disrepair. With the installation of a high volume inflow system and increased water pressure many leaks became apparent. This was causing a loss of approximately 7000 gallons of water per day into the walls, foundation, and electrical system of the hospital.
In chapel today at Loma Linda, Daniel Westerdale, David Puder, Marc Julisse and DJ Patton presented the Haiti project to the Loma Linda campus. A movie about the project as also shown. Daniel talked about how as a Christian community we all have various gifts which we contribute. DJ talked about how the transformation of one life needs to be the emphasis of any missional effort. Marc talked about how people just needed to get activated to help. My closing remarks was that all of life is a gift, being born is a gift, being saved is a gift, being given a new heart is a gift, and the chance to serve is also a gift.