Saturday, March 16, 2013

Getting Into the Swing of Things

            Well, here we are. Our last full day of medical work in Haiti. It seems so unreal that this past week has gone by this fast. Today was another early morning for us as we loaded up in the tap-tap and drove to a large public school in the mayor’s community. We had many of the mayor’s workers wanting to help us in any way they could in setting up our clinic because they are just SO grateful that we are here doing “good works” for their people.
            The clinic today was similar to yesterday where we had Mandy and Taylor checking vitals and de-worming patients. Then they would filter people either to me at my make-shift pharmacy or shuttle them into a waiting line to visit with Dr. Bosworth—who would give them a prescription (if they needed it) and send them back to me. Getting the prescriptions challenged me sometimes because it has been a while since I have read pharmacy “instruction shortcuts.” For example, “BID” means “twice a day.”
Forcing children to take medicine is not an easy process
            In total, I think we treated around 210 people for parasites today. We also tried to give everyone—especially the children—malaria medication. This whole week, some of the most difficult medication dispensing cases came from children and babies who absolutely did NOT want any medication for malaria or other antibiotics because of the terrible taste. You could tell that the parents wanted their kids to be treated, so they would help us hold the kids’ mouths open and force the medicines down their throat. One especially tough example of this happened today when there was a little girl, probably age 5 or 6, who we were trying to give malaria medication to. I tried to have her swallow the pills with lots of water but she gagged and spit them back out. Then we tried crushing the pills, adding it to ibuprofen (basically sugar), and using a syringe to get the medicine in her system…but she spit it out all over the floor. This little girl would seriously do everything in her power to get away from us; she cried, hid behind her mom, ran into a corner, and screamed at the top of her lungs. Mandy even tried bribing her with chocolate if she would take the medication. Finally, Michael came out from helping Dr. Bosworth and was successful in having the mother hold the little girl and got her to swallow the pills. It is not a good feeling to watch kids struggle as we force them to take medicine because we so deeply want to help them feel better.
Nothing says "hands-on experience" like watching a surgery
            The best part of my day was watching Dr. Bosworth perform a minor surgery on the man with the voodoo/magic armpit infection. It was AMAZING to witness this surgery. Before beginning this surgery, we had to sit down and consider one important decision: by carrying out this surgery, are we doing less harm than if this man did not undergo surgery at all? After making the decision to perform the surgery, because it was likely that the man would have no other option financially, we had to find a local anesthetic because the man would pass out any other time Dr. Bosworth would try to squeeze out the pus and other debris inside this wound. Michael contacted a clinic and was able to get an anesthetic, so we pushed together two large desks and got our gloves on. Without getting into too much graphic detail from the surgery itself, I had so many emotions running through my head. I was grossed out by the blood clots and debris that came out of this wound, nauseated by the strong smell of iron from the blood (not to mention there was barely a breeze coming from the one window in the enclosed room), amazed by Dr. Bosworth’s ability to perform such a surgery with limited medical supplies, and simply in awe of the man’s pain tolerance. This guy would always tell Michael that he had little pain or no pain—he only claimed to have intense pain once or twice. After we cleaned up our mess and bandaged the man up, Dr. Bosworth gave him instructions on how to care for his wound to prevent it from becoming further infected by bugs, dust, etc.
            This trip was only a week long, so I have mixed emotions about going back to the U.S. tomorrow. I have had so much hands-on experience that I want to keep going with this medical work in Haiti because I see the good that it is doing for the communities we have been reaching out to…but I also recognize that I have to get back to Augie and get back into my normal routine of studying and homework because Spring Break is unfortunately coming to an end.

Friday, March 15, 2013

The Power of Medicine

My own little pharmacy
            Wow! Today was incredibly busy! We treated the mayor’s employees and other people from the nearby community from 9 a.m. to 4 p.m. but it felt like we had been seeing people for three days straight without a break to regroup. The morning started out fine because we had a system of numbering each person’s card that had their name, age, and vitals…but after 20 minutes or so, there was a bottleneck of people waiting in line to see Dr. Bosworth; we had to think of another strategy because the situation was becoming out of control with people working their way ahead in the “line” and crowding the medicine area. With a smaller team, it was simple for us to recognize the situation and—with the help of a few of the mayor’s workers who spoke English—reorganize our clinic. Today’s clinic was a great location because there were office cubicle type rooms for us girls and a room for Dr. Bosworth and the translator. In one area, we had Mandy and Taylor checking the vitals—temperature, blood pressure, and pulse—as well as dispensing eye drops, blood pressure pills, and vitamins. If a person had a serious fever or health issue, they were shuttled into the separate room one-by-one to meet with Dr. Bosworth. After the patients visited with Dr. Bosworth, they were given a slip of paper that had what other medications they needed. This is where I came into play. I was in another room with all the medications and was in charge of getting individual dosages prepared for quick dispensing. Having me in a totally different room from both the initial health screeners and doctor was extremely beneficial in “calming the storm” of people because the patients would only see me—and all the available medicine—after they were treated with the basics or saw the doctor. Dr. Bosworth told us that sometimes the biggest problem with big clinics is that once people see the medications we have, they will often “fake” their symptoms to receive a certain prescription.
Little kids do not like the taste of antibiotics
            The range of symptoms and health problems that we came across today were unbelievable. We saw skin infections, super high blood pressure, anemia, diabetes, fungal infections, acid reflux, and indigestion. There was one very unique case: a man had a severe open wound infection in his armpit. When he was asked what caused the infection, he first told Dr. Bosworth and Michael that it was his deodorant. Then he said it was a “magical” cause like voodoo. It is amazing to see how many people will come to a doctor after a problem has progressed significantly but will not take the preventive steps early on—for instance, many people simply needed to exercise more.
We were so blessed to have Tony helping us today
            Another awesome part of today was when our other translators and helpers would come around and thank us for coming in. One of the translators, Tony, would always compliment me on my Creole even though I only knew how to say “Good morning/afternoon,” “Take one pill every day,” and “Thank you.” You could tell that all the English-speaking employees involved in our clinic were grateful for our help because they would offer to assist in translating or monitor the crowd control. In addition, although none of us college girls are “official” doctors, everyone treated us as if we were because they knew we were doing our best to treat their health needs.
            One important tidbit that I learned today was that the package inserts on prescription bottles are WAY more useful than you might think. A limited number of ZipLock bags only get you so far in dispensing individual prescriptions and when you have huge numbers of people coming through the clinic, you have to use your imagination in packaging their medicines. Tomorrow is going to be another hectic day because we are setting up our clinic at a large public school that has close to 1,000 students. We have our work cut out for us, but I think—at this point—we are absolutely ready to dive in and rise to the occasion.

Thursday, March 14, 2013

The First “Big” Clinic

            First off, I would like to wish everyone a Happy Pi Day! This morning started off with Dr. Bosworth and Chad meeting with a mayor to discuss the land that Preventive Health Strategies has purchased for the English immersion school and clinic. From what we found out, the meeting went very well and we are going to be treating the mayor’s people tomorrow—which will be another huge outreach for our team. The Haitian title of “mayor” is hard to fully describe because his position as mayor is not simply being the public face of a certain town, but rather, he controls the land, people, army, and a handful of other areas. In America, this title is probably better described as a governor. By helping the mayor and his people, this will open so many more doors of opportunity for our mission to grow further because he had informed Chad and Dr. Bosworth that 500 kids die each month in his community due to worms, malaria, and other completely treatable illnesses. 500 kids is an incredible number that we sincerely want to reduce, so with the mayor’s support on our side, we may be able to have access to other resources besides our own to fight this number.
One of the many girls that visited our clinic today
            After the meeting with the mayor, we packed up our buckets of medications and headed back to the first school we visited during this trip. The main guy in charge of the school, Warren, welcomed us and helped set up a classroom to use as our clinic. Dr. Bosworth instructed us in our Plan A of action, giving Mandy, Taylor, her three boys, and me specific jobs to help this process run smoothly. We started out by having each child come from their classroom, one by one, and treated them with the worming medication. If we noticed a fever or other noticeable health concern, we had the children wait in a line to see Dr. Bosworth. For the most part, the kids seemed to be in good health but they definitely did not like the bitter taste of the worming pill. After the first classroom or so, chaos broke out. There were kids everywhere and it was difficult for us to maintain any sense of order or organization; it was time for Plan B. We had our translator, Michael, helping us shuttle the crowds of children out after they had been seen by us while the other translator at the school, James, assisted Dr. Bosworth in consulting the kids. To help our team keep track of who has had the worming medication, we use a systematic approach—after we make sure the pill has been chewed and swallowed, we give each child a sticker and piece of candy because the candy will leave its mark on their tongues.
Once we treat all the school kids, the adults rush in
            Our new plan of order and “crowd control” seemed to work efficiently after that because we could hear ourselves think and listen in on Dr. Bosworth’s consultations. Shadowing Dr. Bosworth for the past few days has been extremely beneficial for both Mandy and me since we are both aspiring health care professionals. Dr. Bosworth has shown us how to look for anemia in the eyes, how to get hard wax build-up out of ears without hurting someone, and how to dispense appropriate dosages of medications based on children versus adults. Being able to think critically about what prescriptions can and cannot be given to children is an amazing skill because you do not have to spend time re-evaluating yourself, but you can move on to the next patient rather quickly—which is super helpful when you have people spreading the word like wildfire that a doctor is in the area.
One of today's ultrasound readings
            Once we finished treating people for the day, it was finally time for lunch and Dr. Bosworth’s three energetic sons could not have been happier. During our lunch, Warren informed us that he was going to be funding a water purification system for the local school where Taylor’s “kids” are. Currently, the community that this school is in has a water irrigation system where water flows directly from the mountains, so it is mostly clean but simply needs to be purified so that the community can safely drink and cook with the water. Warren showed us how these water systems work because he has them installed in all the schools that he runs in addition to solar power capabilities. The water purification systems are essentially a series of filters that are powered by a car battery—sort of like when you have to use jumper cables to start a car in the winter. The water purifier slowly traps unwanted particles, minerals, and eventually uses ultraviolet lighting to get rid of the micro-sized particles like ions as it filters the water out of the hose. Warren also taught us that these purification systems are capable of pumping out one gallon per minute. This is CRAZY to think about because simply having one water purification system can provide enough water for not only a school but the outlying community as well.
The outside of a nearby Haitian home
            To finish off our day, we made a home visit to see what a typical “well-off” Haitian house looked like. We found that this house had two separate rooms, each having a bed and some form of storage shelving; one room even had the luxury of a TV. The reason for this visit was to check on a pregnant woman to make sure she and the baby were healthy. The mini ultrasound device that Dr. Bosworth used was the coolest thing I have ever seen because it is so easy to take with us and gives a totally clear image of the baby just like you would get in a doctor’s office.
            I cannot wait to see what is in store for us tomorrow and the final days ahead because our clinics are becoming bigger, more involved, and pushing our thinking and organizing skills even more.

Wednesday, March 13, 2013

A Day in the Life

Chancellor helping guide some goats to the school yard
            Today was an interesting day because we had the chance to visit a Haitian market. To me, this specific market was a mixture between a shopping mall and a farmer’s market because you could seriously find ANYTHING you wanted to buy and simply had to roam around to find the best deals. Walking around this market was an excellent way to “people watch” because there were so many loud sounds, odd smells, and payment exchanges taking place. Michael, our translator and Haitian team leader, informed us that while many Haitian people barter for their bargains, if they see an American wanting to buy something, they will often charge more or not even budge on their prices. This caught my eye because thinking about it a little more, most Americans will give in and pay whatever price when they are shopping abroad. The goal for today’s purchases was to use the money that Prescott—Dr. Bosworth’s oldest son—raised to buy goats and pigs for the school that we visited yesterday morning. We tried to buy either pregnant animals or animals with babies because this would allow the schools to have meat or be able to have more baby goats and pigs to provide for each of the student’s families. It is hard to describe how extremely beneficial one pregnant goat will be to one Haitian school, and yet it is also so inspiring that Prescott, a 6th grader, has such a passion for helping others at a young age because it motivates us college girls to do everything we can to make an impact while we are here. I hope that Prescott continues to have this huge heart for making a difference in others’ lives because that is a quality that you do not necessarily find instilled in a lot of kids at that young age.
            In addition to the trip to the market, we were on a wild goose chase in trying to find more worming medications at local pharmacies because the last few days of our stay will be the biggest clinic settings with larger numbers of people to treat. Like I have mentioned before, finding the right medicine and the amount you want is not as accessible in Haiti as it is for us in the United States; we cannot just run to Walmart, grab a few boxes of medication, and be on our way in a couple of minutes. I think we stopped at four or five pharmacies before we found enough to enable us to reach out to at least 700 more kids. In the past couple days, I think we have treated somewhere in the neighborhood of 200-300 people—which is amazing because we may only be at a school or small community for an hour but people just keep pouring in to come see us. Word by mouth of our mission is such a powerful tool for the Haitians because I am sure that many want to be helped—they just need their health concerns to be recognized by others.
Prescott showing off the fancy metal work
            The last portion of our day consisted of us stopping by a few “metal shops.” Now, when I say “metal shop,” I do not mean a blacksmith or anything. These people would literally flatten out oil barrels and pound them into beautiful works of art. This art ranged from picture frames and mirrors to candle holders and huge wall art. Many of the metal creations were engraved by the person who made them and “shined up” to make the metal glimmer even more. It was fascinating to watch the process because we could tell that each piece was unique in itself and took a lot of time and patience.
            In short, today was a great day to experience more of the culture of Haiti and prepare ourselves for the days to come in our medical outreach.

Tuesday, March 12, 2013

Another Day, Another Journey

Treating the kids with Albendazole
            We started today by visiting a school filled with Taylor’s “kids” that she has been able to build relationships with during the past month in Haiti. After each kid’s name, age, and temperature were written down, Mandy and I were in charge of giving the worming medication. This was a challenge because the pills have to be chewed and do not have a pleasant taste whatsoever. Chad made us try one and I would have to agree—these pills taste like an extremely stale Flintstones vitamin. To help guide the kids through chewing the medicine, Mandy and I learned how to said “chew and swallow” in Creole. This helped some kids to not feel so lost in how we were helping them, but sometimes they just giggled at us because we totally have American accents when we try to speak Creole.
Making a trip to the pharmacy
            While Mandy continued helping Dr. Bosworth in giving the worming medicines and checking for other health symptoms, Chad and I hopped in the tap-tap and drove to another pharmacy to pick up more Albendazole (the worm medication) and a pregnancy test. This time, Chad made sure that I got to experience a “lower-status” pharmacy. As we pulled up to the building, I began having a completely different perspective on the pharmacy that was before my eyes. Compared to the one I saw yesterday—which had cool air flow, a radio playing, and everything typical drug store necessity—this pharmacy was barely the size of my dorm room back at Augie and we did our transaction on the outside porch rather than inside the building. As we waited for the pharmacist to tell us how much he had and the pricing, I started thinking about the “business” side of Haitian pharmacies. Back in the U.S., virtually all pharmacies have a computer-based system that has every single patient’s information on file such as their birthday, contact information, insurance provider, and previous prescriptions. Here in Haiti, while over-the-counter medicines are fairly easy to come by (provided that the particular pharmacy has what you are looking for in stock), I wonder how doctor prescriptions are handled or if there is a form of filing system to keep track of individuals.
Some of Taylor's "kids"
            When Chad and I arrived back at the school, Dr. Bosworth and Mandy were still hard at work in seeing each teacher and staff member. I used this opportunity to explore the classrooms a little more. I was told one of the teachers, Simon, that I was from Minnesota and he jokingly asked me if I was a fan of Kobe Bryant. Another teacher taught Taylor and me possessive pronouns in Creole—and I thought that learning Spanish verb conjugations were hard. To expand my Creole vocabulary even further, I learned that the word “belle” means beautiful because the teachers thought my hair was “very nice” looking. Then they asked if I was Japanese, which was funny because yesterday, one of Dr. Bosworth’s sons asked if my nationality was the same as the “Oppan Gangnam Style” guy. Just to clarify, I am not Japanese, but I am Korean—just like Psi who sings Gangnam Style.
I'm definitely not meant for sprinting
            Before we started packing up from the school, I got my cardio workout in for the day. The kids got me wrapped in a serious game of “Duck, Duck, Goose” but instead of chasing the kids around the circle, it was an all-out sprint for me around the school yard. It wipes me out quickly because I have not sprinted like that since high school cross country workouts.
            Once we left the school, we visited our tap-tap driver’s community and treated kids. This was one of the poorest places I have seen in the past couple days. There was garbage and goat poop everywhere and bed sheets were used as walls. We also visited another orphanage/school that was just as heartbreaking to be around. At both places, children would walk around with no shoes or pants and would have open sores all over their legs and feet.
Play time is always fun
            It was hard to be in these poorer communities, but it was even harder to treat some of the younger kids because they do not realize that the medicine we are giving them is going to make them better. These kids would cry, scream, and try to wriggle away from us and their mothers when we would try to give the crushed up version of the worming medication. In addition to communication barriers at the pharmacy, this is another crucial example of how we feel at a loss for words because we do not know how to communicate effectively with these people when giving treatments. We want to be able to explain how fighting the parasites will help decrease the severity of other symptoms, but do not always have the right words to provide this information efficiently. I think that is one of the greatest challenges of this trip so far—finding the right words to explain our story.

Monday, March 11, 2013

The Adventure Begins

Packing up medications for the day
After almost a day and a half of air travel, Mandy and I finally made it to Haiti to meet up with Dr. Annette Bosworth and her crew. During the flights, I could not help but wonder how useful we would be for the medical aspects of this trip or if we would actually use all the medications we packed earlier. Packing up the medications was truly a journey in itself because I have never encountered such a massive order all at once. It was a slow but steady process because we had to unpack the bulk shipments, assort the medicine by type, and pack everything in buckets, army bags, and boxes. As we sorted through the various medications, we saw many variations on a theme: basic health care. We mainly saw medicines for cholesterol, diabetes, and heart health as well as vitamins and a huge amount of various antibiotics. From here, we wondered what other serious health issues were problematic for Haitians. This was when Taylor, who has been in Haiti for over a month now, created the idea of fundraising for a worms vaccine because it affects numerous children and adults alike in varying degrees of severity. Before we left South Dakota, we were able to raise $1,830 which will enable us to provide 183 vaccines. We are hopeful that we can treat all 183 of those people before we leave at the end of the week and even more hopeful that we can continue to fundraise and provide more medical help for Haiti in the future.
Upon arrival to Haiti, we were both exhausted but relieved to see a few familiar faces at the airport, Chad and Taylor, to help us load up the four 50-lb bags of medications into the tap-tap. A tap-tap is basically our version of a taxi except you pile as many people, bags, or even animals as you can into the back (and on top) of this pick-up truck. Seeing these tap-taps and other vehicles driving around Haiti is unreal. I thought driving in rush hour around Sioux Falls was hectic, but it cannot even compare to the close-proximity, fast-paced driving down here. It feels like every driver is going 80 mph and coming within 2 inches of other vehicles and people.
While driving through Port-au-Prince, Taylor and Chad told us to look around and ask questions about anything and everything we saw. Something they pointed out right away were the pharmacies which are bright green buildings – I’ll talk more about my first visit to a Haitian pharmacy a little later in this post. Besides the assortment of colored buildings and street vendors, another thing I noticed was the drainage system which, right now, is basically cement ditches filled with garbage. When there is a tropical storm of some sort, these ditches fill up and carry the water away from the buildings into a drainage river—filled with garbage, sewages, and who knows what else.
My "shining" moment in taking blood pressure readings
After all of our travels and a full night of rest last night, we were able to go to a school today and connect with the teachers’ and other staff members’ basic health needs in hopes that we will be able to return later in the week to treat the children. Mandy and I helped check each person’s vitals—their blood pressure and temperature—so that Dr. Bosworth could have a general idea of where to start with every person’s treatment. This was a really neat experience because I had never actually taken a blood pressure reading before Mandy taught me how to use the stethoscope this morning. Mandy even joked around with me asking if I ever considered being a doctor instead of a pharmacist because I was pretty lucky in finding people’s pulses right away.
A typical Haitian pharmacy
Another awesome experience from today was when I got to go with Chad to a pharmacy to pick up some basic pain medications and worms vaccines. Chad said that this particular pharmacy was very impressive—it was one of the nicest ones he has ever been to. This pharmacy was probably no bigger than my living room back home. After working at Hy-Vee for the last two summers as a pharmacy technician, it was fun for me to see how this Haitian pharmacy was set up. Like many U.S. drug stores, this pharmacy had essentially everything you needed whether it was toothbrushes and mouthwash or ibuprofen and Tylenol. One thing Chad told me was that going to pharmacies in Haiti was like playing a guessing game because you never knew if they would have what you were looking for or even if they had enough of what you wanted. After picking out half of what we came looking for, we had to figure out prices. The Haiti economy is interesting because they use both U.S. dollars and Haitian dollars. This is where a translator comes in handy because, right now, the only words I understand in Creole (basically a French derivative) is “merci” which means thank you. While I am here, I hope that I can pick up on a few more words and be able to perhaps have a small, broken-Creole conversation at a pharmacy.
I look forward to the rest of my stay here in Haiti and cannot wait to step outside the box even more in these hands-on medical experiences.