Global Health Fellows Blog
Below are earlier entries of their blog:
5:09 pm est
After reviewing a record-breaking 138 applications,
we are excited to introduce Anand Habib and Saskia Guerrier, who will be taking our places in Thomassique this June!
Anand is a senior at Stanford, studying biology and writing an honors thesis in International Securities Studies
. He is originally from Houston, Texas, and aspires to become an infectious disease doctor working in the developing world.
He has extensive international health experience, most recently working with community health workers in the rural Guatemalan
highlands to implement a survey regarding conceptions of prenatal care. He also partook in a service-learning trip studying
social determinants of health in Oaxaca Mexico, and spent a summer devising and teaching an interactive health curriculum
in India through Project Dosti
He has also pursued his interest in health education domestically, working in schools and at the Boys
and Girls Club. At Stanford, he is a Director for the HIV/AIDS fundraiser Stanford Dance Marathon
. He has also worked to improve chronic disease management for local underserved populations at Mayview Community Health Clinic
through the Stanford Patient Advocacy Program
. He was a Truman Scholarship Finalist, serves on the Haas Center for Public Service National Advisory Board
, and has been recognized at Stanford for his academic excellence and writing abilities.
is in her final year at Bryn Mawr, where she is majoring in Anthropology with a minor in Africana Studies. She lived in Gonaives,
Haiti until moving to the United States at the age of 10. She plans to ultimately pursue graduate studies in global health.
Junior year, Saskia spent a semester in St. Louis, Senegal, where she studied and also volunteered at a maternity and
child health clinic. She also gained many insights into global health issues as an intern at the Office of the Global AIDS Coordinator
Domestically, she has engaged in health issues affecting underserved communities by working at
a health insurance company serving low income residents of Massachusetts. She interns at the Strawberry Mansion HIV/AIDS Clinic,
and is working on a senior thesis based on fieldwork at this clinic. Saskia has been a leader in multiple projects regarding
social justice and education. She is an Executive Board Member in the Social Justice Partnership Program
, and served as a research assistant on several projects researching education and educational access. She is also a coordinator
of the Teaching and Learning Initiative
, which promotes collaboration and dialogue between professors and students. She is a Posse Foundation Leadership Scholar
Both Anand and Saskia have strong passions for global health, and
we can't wait to see what they accomplish next year!
5:08 pm est
After a brief visit home to see our families for
the holidays, we have arrived back at the clinic. We were greeted by a visiting team which included Julian Hertz, the original
Global Health Fellow! In our absence, the other NGO in Thomassique, World Vision, provided the clinic with several new nurses
for the cholera ward. The staff and Julian continued with prevention activities and delivered soap, water treatment tabs and
ORS to homes in the most affected areas. After peaking with around 50 patients in the cholera ward in late December, the numbers
have decreased substantially, and we now have around 15 patients.
Since arriving, we've jumped right
back into all our projects and responsibilities. To give you an idea of what our days are like here, we documented our activities
this Saturday (granted, it turned out to be slightly crazier weekend than usual...but not by much!). Enjoy!
5:07 pm est
Earlier this month, our original Klorfasil
Coordinator, Shelove Belizaire, had to head back to Port au Prince to begin studying economics at university. We are sad
to see her go, but are excited to introduce our new Coordinator, Beana Elma!
Beana was born
, approximately a 40+ minute drive or 2-4 hour walk from Thomassique, depending on the weather. She has lived there her entire
Family: She has 4 sisters and 6 brothers (one of which is Jean Reluse, our Bouloum CHW).
jobs: Most recently, Beana has been working as a seamstress. She also used to be a school teacher.
motivates her to do this work?: Beana hopes to "improve our health condition in the community." Additionally,
the income from the job will help her support her family members, many of whom suffer from serious health problems of their
We first got to know Beana through her role as the Vice President of the Bouloum Health Committee.
She immediately stood out based on her natural leadership and enthusiasm for improving health conditions in Bouloum. When
we needed a new Coordinator, we immediately thought of her. We worked with Shelove to interview Beana and several other candidates,
and Beana distinguished herself with her strong math skills, excellent public speaking ability, and dedication to working
on health issues in the community. Shelove provided Beana with an in-depth training that included how to prepare and sell
the buckets, give education sessions, and work with other Klorfasil employees such as those running the warehouse in Hinche.
In addition to selling and promoting the systems, Beana will be making a special effort to educate the community about hygiene
and sanitation topics, particularly in light of the cholera epidemic. She will also be managing our Bon Sel
project, which we hope to expand to reach more residents in and around Thomassique.
5:05 pm est Patient Report:
We have now seen approximately 150 cholera patients, and currently have 18 in the ward.
We reached a peak of patients early this week, with up to 40 or 45 patients in the ward at one time (note that the graph shows
date of admission through Thursday, and does not include patients currently in the ward; click on the image for better resolution).
The atmosphere at the clinic is significantly calmer than earlier this week, but it is highly likely that we will see a rise
in patient numbers again. The biggest problem continues to be that people in remote areas are not drinking ORS before and
during their journey to the clinic. For example, one pastor reported that 14 people died over the last few days in his community,
several of them on the way to the hospital. We are working with local pastors and other groups to spread the homemade ORS
recipe and educational messages far and wide. Theoretically, there is already a government-run health center in the hardest-hit
area (Bokbanik), but the information we are hearing about deaths suggests that it is not functioning. World Vision may have
a tent coming that could be used to open a treatment center there, but the problem would be staffing such a center.
The Thomassique Cholera Committee is becoming stronger every day, and we are increasingly
impressed and inspired by the level of community involvement. On Thursday, the committee selected Thomassique's Sanitation
Commissioner as its President, and a local pastor as its Vice President. The committee has been organized into sub-categories
including water, education, and churches, with each sub-category having an appointed leader directing larger numbers of participants.
On Friday, the committee went to the local market as a group, spreading messages about cholera prevention and treatment, and
inspecting the hygiene conditions of food vendors. Today, we attended a meeting with the Magistrate and 12 pastors that represent
a wide geographic area (pictured above). The pastors were equipped with messages to convey to church-goers each weekend, and
stacks of ORS recipes to distribute. They also discussed other issues surrounding cholera, such as how to dispel doubts and
rumors circulating about the disease.
We received 4000 packets of ORS and 1500 liters of Ringer's Lactate IV fluid on Friday, thanks
to the help of Fr. O'Hare and Tom Brock, two wonderful contacts we have right across the Dominican border. Thank you to everyone
who has donated to the clinic, we appreciate your support and are dedicated to maintaining an adequate stock of supplies at
all times. We have designated a room in the clinic as the 'Cholera Depot' and it now contains all of the supplies needed for
treatment, employee protection and cleaning. We have also been receiving materials from other local organizations, such as
the Red Cross and World Vision; in turn, World Vision has been distributing our soap and hygiene packs during their education
Election Tomorrow: An added level of anxiety, on top
of the cholera epidemic, stems from tomorrow's election. Today, swarms of people crowded around the mayor's office registering
to vote; tomorrow they will choose from the 18 candidates vying for President. Historically, Haitian elections have been marked
with fraud and violence, so we are all hoping that the selection of a new President can lead to renewed stability rather than
5:04 pm est
Cholera has now taken a firm grasp on Thomassique
and our clinic. We have seen over a hundred cholera patients, and have had twelve deaths.
It is hard to express
the conditions here, which is possibly why we have not been updating the blog (combined with the fact that we are beyond busy
handling this crisis). The scene in the cholera ward is unsettling: Cots fill the room, strewn with bodies showing varying
levels of alertness. Cholera is not a pretty disease, and the massive quantities of diarrhea and vomit mixed with Clorox give
the room a highly distinct and foul scent. On several occasions the ward has been at or above capacity, with two or three
children sharing a single bed, and hardly any space for nurses and doctors to move between the approximately thirty-five patients.
The sight of coffins and the sound of grieving families have become all too common.
The good news is that cholera
is not a particularly complicated disease to treat. As long as the patient is kept hydrated using Oral Rehydration Solution
(ORS) and/or IV fluids, they can typically recover. One of the bad pieces of news though (which contributes to the high death
rate) is that many of our patients are coming from great distances and are not beginning rehydration at home. For example,
the towns along the Artibonite River, such as Bokbanik and Nan Kwa, are a four-hour walk away; patients that manage to get
to the clinic without dying on the way are so weak by the time they arrive that recovery is very difficult. Therefore, along
with the importance of preventive precautions (treating water, washing hands, cooking food), a main educational message we
are promoting is to prepare and begin drinking ORS at home, using a simple recipe of sugar and salt that we distribute on
slips of paper.
Producing an effective cholera response is also influenced by the cultural beliefs and practices
that provide the backdrop for this epidemic. Voodoo, though not particularly visible on a daily basis, is an important part
of many people's belief systems. We do not purport to serve as experts on Voodoo, but we can relay to you some interesting
things that community members have told us over the last week: They explained how some Voodoo priests have been spreading
the idea that cholera is the result of a 'powder' (powders are a central component of Voodooism) and claiming that they can
cure the condition. Therefore, people seek care from Voodoo priests for cholera, rather than accessing the actual care they
need (rehydration). Many rumors have been circulating about a public incident in the market last week: In one version we have
heard, two men hired by a Voodoo priest 'infected' a woman with cholera using a powder, and the woman was subsequently 'cured'
by the Voodoo priest as a publicity stunt. However, several observers caught on to the plot, and the two men were attacked.
This is not a simple situation of Western medicine vs. Voodoo; how can the two become more compatible to improve health outcomes?
Another conception we have encountered is the frustrating belief that death from cholera (and other diseases) is simply
inevitable. Though it is true that some people cannot be saved, the vast majority of people should be able to survive cholera
if they receive proper treatment. We have even seen this attitude among some staff members at the clinic, who seem resigned
to the idea that many of their patients will die. Perhaps this conception is the result of experience; premature death is
a much more familiar aspect of life in Thomassique than in the United States. But should not all people, Haitians and Americans
alike, be able to expect life rather than death in largely-treatable cases like cholera? How can people gain the power and
voice to expect and demand quality living conditions and medical care?
In times like these, it is also important
to recognize the positive developments. One bright point is the newly formed Thomassique Cholera Committee, which brings together
Thomassique's leaders in health, education, religion (including Voodoo), sanitation, water, police and government (though
the local government is extremely evasive and goes to great lengths to avoid any involvement in cholera efforts) to address
the challenges facing the community. This committee had its second meeting yesterday and will meet again tomorrow. Though
we took the initial steps to form the committee, we are encouraged to see that the community itself is now taking more ownership
over this committee and working to find solutions to problems such as mass-purification of water and the burial of corpses.
One of our hopes for the committee is that collaboration with other organizations can support and expand our community education
activities. Education is an absolutely critical component of handling this epidemic and reducing deaths. In the clinic, we
provide detailed, one-on-one cholera education for the highly-susceptible families of patients, and our doctors continue to
reach large audience through churches and the radio, but the demands of patient care necessitate that we prioritize the essential
medical function of the clinic. Therefore, collaboration with other organizations is vital to mount a sufficiently aggressive
education campaign in areas such as the previously mentioned towns along the Artibonite.
As we sign off, we want
to highlight another bright aspect of the previous week, which was having Dr. Charlie Dyer at the clinic. It was wonderful
to have him here, and we want to thank him sincerely for providing his excellent medical skills and advice. We look forward
to the arrival of another team of American medical professionals on Monday.
Tuesday, November 16, 2010
5:03 pm est
Cholera has arrived in Thomassique, and we are currently
treating patients at the clinic. The first suspected cases came on Friday, and there has been a consistent flow ever since.
We are anticipating that cases will continue to rise. Although we do not have the laboratory capacity to confirm cholera,
the patients' symtoms, including 'rice water stool', clearly mark their illness as cholera. At the moment, we have 17 patients
in the cholera ward, and in total we have had 24 suspected cases. Sadly, 2 patients have died at the clinic, and we have heard
word of others dying in their homes. Cholera is a highly treatable disease if people take quick action, so one of the key
messages we are now promoting is to begin giving Oral Rehydration Solution (ORS) immediately when someone begins having diarrhea
or vomiting, and to bring him or her directly to the clinic. It is crucial that rehydration begins immediately, but we cannot
distribute ORS to every home, so we are encouraging people to create the solution themselves at home using a simple recipe
of water, sugar and salt.
The clinic staff has been working non-stop. If you or someone you know is
a medical professional interested in volunteering at the clinic during this crisis, please contact Dr. Kenneth Kornetsy, email@example.com.
Our two service year doctors finish their term on the 22nd, leaving Dr. Casseus as the sole doctor; we are already feeling
under-staffed, so this additional loss is very concerning.
We have separated off the normal clinic from the new wing extension, designating the area as the cholera ward (pictured
at right; in the last couple of hours since we took this picture, the central area has been filled with more cots to accomodate
patients arriving tonight). The extension is not quite finished (it has no electricity, running water, or room dividers),
but is a good space for cholera treatment. We are working to maintain a tight quarantine on this space to avoid contaminating
the rest of the clinic or staff house and have hired additional cleaning staff. Normal consultations are closed, but we continue
to take emergencies and maternity consultations.
There is a rotating schedule of nurses and doctors
attending to the patients at all hours. Most cases of cholera can be treated solely with ORS, but the more severe cases also
require IV fluids, and occasionally antibiotics. We are providing food for the patients. Along with medical care, we are giving
preventive education, soap, water-purification packets, and instructions for preparing ORS to patients' families, because
they are at a high risk of contracting the disease. The administrative staff are helping with other efforts such as education
and record keeping, using a set of recently-developed cholera-specific charts and forms.
At the same time we treat patients at the clinic, it is crucial that we continue our prevention campaign. The cholera
forms track each patient's address and water source; we hope that the patterns we see emerging will help us identify contaminated
water sources and target our prevention campaigns. On Sunday, Dr. Hippolyte and Fidel made announcements in many local churches,
and yesterday Dr. Hippolyte and Emily appeared on the radio. Today we hosted the first meeting of the Thomassique Cholera
Committee (pictured at left), which we created to coordinate the efforts of our clinic, World Vision, government officials,
religious leaders, school directors, and other organizations working in Thomassique. For example, this collaboration allows
for supply exchange: We provided World Vision with ORS, and they gave us several boxes of water-purification packets (we are
still waiting on the Klorfasil systems to arrive). The Haitian Ministry of Health is also supporting us, and sent a car full
of cots, ORS, bleach and other supplies to the clinic this afternoon. The Community Health Workers continue to provide outreach
and education in their communities. Bouloum has seen a couple of cases, but Dahlegran, Barank, and Savann Plat have had no
One of the most troublesome problems facing us in this crisis is that we are still
without a good source of water. The pipe brining water to Thomassique was reportedly repaired yesterday (after nearly 2 weeks),
but we still do not have running water at the clinic or staff house. It is incredibly difficult to adequately clean a cholera
ward without sufficient water, so Brian has been traveling half an hour to Dahlegran each morning to collect several large
bottles full of water from their local water source. We sincerely hope the water will be back soon.
**To volunteer at the clinic during this crisis, please contact Dr. Kenneth Kornetsy, firstname.lastname@example.org.**
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