A Short Walk - January 20

Trying to write this every night after being on your feet for most of the day is a challenge. It would be more manageable if it could actually be posted to the Internet. None the less I will try to collect a few reflection and highlights for each day.

We are supposed to leave at 7am but it is closer to 7:30 before all the interpretors arrive and the truck is packed. One interpretor reported that his bicycle had a flat tire, I tend to believe him. Once everything is pack we are off. It is 40 minute drive to where the trucks have to stop. From there we have 30 minute hike to St. Terese. In true Haitian form it is describe to us as a flat hike in the mountains. Fortunately we have a fleet of donkeys reserved to bring the drugs equipment. With a dental clinic this is no small feat.

Our 30 minute hike is closer to 40 minutes over rolling and twisting terrain. The sky is clear and the temperature is comfortable, so we set off while the equipment is loaded on the donkeys. There are a few small homes along the way. You can also see terraced farm land on the hill sides. St. Terese is a cluster of buildings behind a gate; a church, a school and some homes. The back of the village opens to a cliff over looking the Gulf of Gonave, which gives Haiti its “C” shape.

The first discovery is that the metal case, with the dental instruments did not arrive. They hoped to see 30 patients each day, now we have to wait. The dentists walk back to the drop off point and wait for the truck to return. The missing case was left under a seat and the trucks were part way down the mountain before it was discovered. With the case found the dental clinic opens.

We set-up triage under a tree in the main court yard. The medical team and the pharmacy set-up in two small rooms separated by a curtain. It is actually more like two sheets than a curtain. Next to us is a long narrow building that has three or four classrooms. This is the main school building, the church building also serves as a classroom. The dental clinic is set-up under a tent at the back of the village, overlooking the gulf and the coast.

The biggest challenge we face today is that we will need to stop seeing patients, close the pharmacy, and the dental clinic soon enough to hike back to the vehicles before dark. In all I believe we saw about 190 patients, 30 or so went to the dental clinic. The medical team wrapped up operations by about 4 pm. Due to the late start the dental clinic took longer to finish, so it was about 4:50 by the time the last of us start the hike back to the drop off point.

Below is a short video from the end of the school. The students all gather outside the main building and sing, the national anthem or a pledge.

Here is a selection of photos from our day at St. Terese.

First Clinic --Monday January 19

Monday's clinic was at the hospital. We set up behind the chapel, with the dentist at one end and the medical team at the other. The pharmacy set up operation inside the chapel, with the pick up counter at the side door. It started slowly got a major crush between 1 and 2 as we scheduled lunch breaks. For the most part the day went well. Although we took advantage of having the drug and supply room back at the guest house handy. We will have to do better when we go on the road the next two days.

We started the day with our three practitioners, by mid morning three Haitian doctors had joined us. While this enabled us to see additional patients, it had the unfortunate side effect of overloading the pharmacy as the day proceeded. We would learn from this by the end of the week, when we held the second clinic at the hospital.

Let me back up and spend a few moments describing the members of our team and the roles we played in running a clinic. Our practitioners are Dr. Chuck Sternbergh, Barb Kell, a nurse practitioner and Dr. Sandy Varghese in her third year pediatric residency. Each has a translator to work with while seeing patients. Patients start the day by signing in and paying a small fee of 25 goudes, that's about 60 cents. Once registered the patients are first seen by Ruth Ann Honneycut, who takes their temperature. Children are then weighed by the CNP health worker. Next stop is at the triage table, with nurses Dawn Rubin and Mary Sutton. Here their blood pressure and pulse are taken. Then working with an interrupter the basic reason for their visit to the clinic is recorded. Patients are then sent to the medical team or the dental team.

The dental clinic is staffed by two active dentists, Alan Crisman and Chuck Holt. Working with them are Jack Danner, as an assistant and Mary Thurmond working the the back table. At most clinics they are joined by Charlie Belcher, a retired dentist, who pitches in to keep things moving.

In the pharmacy you will find Jane Carney and Martha Sternburgh. Working with them is long time translator Mario. That leaves Bob Ried and Mike Thurmond, who coordinate the movement of patients, run errands for others and pitch in with an extra hand when needed.

Several students from the nursing school in Leogane came by about 10 to lend a hand. They helped with screening the patients, an extra set of hands in the dental clinic and with scabies treatments. For those who are not medical scabies is a bug that infects the skin and results in crusty sores, which can cover the whole body. The treatment is to apply an ointment over the whole body to kill the bugs. Since the bug can be in the clothing, we also provide a complete change of clothes for children that are treated. Then we provide follow up drugs and give the parents instructions to wash all the clothes and bed linens in hot water.

The doors opened at 8 am, although I am not sure when the waiting line outside the hospital started to form. At first the people came in at slow but steady pace. As the morning progressed the number people waiting to be seen by triage approached 30 to 40. Throw in a mix children, dental patients and a few vendors, selling snacks and drinks, and you can appreciate the atmosphere. The clinic was open from just after 8 until about 4 that afternoon. In that time the team saw 257 medical and 32 dental patients. That is about 32 patients per hour. At the end of the day the backup is at the pharmacy, since patients from all the doctors and some dental patients all go through the pharmacy before their visit is complete. With only Jane and Martha in the pharmacy it can be a challenge to keep up. By the end of the day others on the team lend a hand to keep things moving. Even so it can require an hour after the last patient is seen for the pharmacy to complete their day. All in all it was a good day.

Here is a selection of Photos from the Monday clinic.