Global Health Fellows Blog
Below are earlier entries of their blog:
3:53 pm edt
Sept. 19, 2012
This week, we've been working
with MSPP (the Ministry of Public Health or Ministère de la Santé Publique et de la Population) and PSI to help distribute mosquito nets ("moustike") in Thomassique. According to the World Malaria Report 2011,
there were 216 million cases of malaria and an estimated 655,000 deaths throughout 2010. Studies have shown that insecticide-treated
nets (ITNs) can decrease clinical episodes of malaria by approximately 50%. These studies also estimate that ITNs reduce all-cause child mortality by 18%, meaning that 5.5 lives could be saved for every 1000 nets
that are distributed.
While the Americas region has seen
a 30% decrease in malaria since 2000, Haiti has not witnessed the same decrease. Accordingly, this year, PSI has been working with the Ministry of Public Health to ensure that every family has access
to a mosquito net.
Earlier this month, health workers began enrolling
individuals in the program in Thomassique, handing out yellow cards as vouchers for the nets. Even John and I received two
cards for mosquito nets! St. Joseph's Clinic also serves as a distribution point for Thomassique, so we will be storing
nets and giving them out to community members,
as they come to redeem their vouchers.
This morning, a large truck dropped off our first
batch of over 300 insecticide-treated nets. We look forward to receiving more nets from PSI/MSPP and distributing them within
Savane Platte Mobile Clinic
12:15 am edt
|Miss Anya, our community health worker in
Today, we (Dr. Pierre, the administrator Junior, a midwife Miss Wilna, and
the fellows) set up a mobile clinic in Savane Platte. Since it can be difficult for individuals in outlying communities to
access St. Joseph's Clinic due to the long distance and rugged geography, our clinic sends out a team to run weekly mobile
clinics in the outlying villages of Barank, Bouloume, Savane Platte, and Dahlegran.
Weather permitting, a doctor, a pharmacist, and a midwife or maternity nurse, head out to the surrounding villages
once a week to bridge the barriers that prevent people from getting healthcare. In doing so, they bring the services
of St. Joseph’s Clinic to these distant communities. Since walking to St. Joseph’s Clinic can take upwards of
four hours, many patients rely on these mobile clinics for medical treatment.
|Junior, our administrator, helps dole out
Mobile clinics take a lot of teamwork. Our community
health worker organizes volunteers from the local community health committee to help process patients and record vitals
in pre- consultation. The doctor then sees patients, while a maternity staff member provides prenatal and postnatal check-ups.
Meanwhile, Nicole (our pharmacist) or the fellows work to dispence medications to patients. Depending upon the need,
mobile clinics can run late into the afternoon. At Savane Platte, we finished with the mobile clinic around 2:00 pm and
saw about a hundred patients, including twenty maternity patients.
Savane Platte is also in the middle of constructing
their health center with funding from Medical Missionaries. Although it is a modest structure, this health center enables
the Community Health Committee to securely store Klorfasil buckets (water purification systems), Bon Sel (fortified salt),
and other medical supplies. We're also training our Community Health Workers to provide basic wound care and dispense basic
medications, such as Acetaminophen, Chloroquine, and hypertension drugs. With proper training, we believe our health workers
will be able to extend the medical services of Saint Joseph's clinic to Thomassique's outlying communities.
A Well-Traveled Ultrasound Machine
11:55 pm edt
|Carefully packing our new ultrasound machine|
a maternity program isn't easy work. This month, Medical Missionaries was named as the recipient of a
$100,000 grant from the JadeTree Foundation which will be used to fund three years of improvements to our Maternal and Infant
Care program here at Saint Joseph's Clinic. This grant will allow the expansion our community outreach
in Thomassique and the surrounding villages to work with Haitian traditional birth attendants, distribution of transportation
stipends that will allow pregnant women to afford a trip to the clinic for deliver, implementation of new education programs
for our maternal patients and women in the community, and provision of new medications and equipment for Saint Joseph’s
Clinic. Of course, this grant comes hand in hand with the generous donations from Medical Missionaries
supporters. One of the biggest improvements that we have seen so far has been an ultrasound machine that
just arrived this weekend, a $20,000 device that will allow early detection of high-risk pregnancies.
|The Pedro Santana border crossing (listed
left to right: DR, Haiti)|
This past weekend, we took a trip to Banica, a border town in the Dominican Republic and the
last stop for Medical Missionaries' sea containers full of much- needed supplies before they arrive in Thomassique.
Crossing the border, it’s hard not to reflect on the disparities between Hispaniola's two neighboring
nations. The forested hills of the Dominican Republic stand in stark contrast to those on
the Haitian side, where the lack of electricity coverage has led to a high demand for charcoal fuel, devasting the forests.
The paved roads on the Dominican side are another difference; while there has been recent progress in paving some
of the major highways that connect Haiti's biggest cities, the rest of the country's rural roads are rugged and unpaved.
Among other things, this makes transporting sensitive medical equipment a very tricky business.
Fortunately, through careful packing and cautious driving, our new ultrasound machine arrived in Thomassique in one
piece. This welcome addition makes Saint Joseph's Clinic the first health center in the Haiti's Centre
Province to offer ultrasounds, and we're excited for many more improvements to come!
A Warm Welcome
11:45 pm edt
the weekend in Port-au-Prince, we've been adjusting to life in Thomassique. So far, most of our time here has been spent
in a rigorous orientation program, visiting the community health committees in four surrounding villages, and being introduced
to the clinic staff and other NGO partners.
Last week, we were surprised with a party! Since my birthday (Danielle) fell awkwardly a week after I arrived in Haiti,
I was not expecting much besides a “Bon Fet” from my compatriots, especially given our busy orientation. Our
administrators went out of their way to make us all feel at home; they brought a cake back from Port-au-Prince, while the
midwives, Miss Wilna and Miss Fauna, cooked a delicious evening meal.
I was also introduced to the St. Joseph
Clinic’s tradition of being doused in birthday champagne, a celebratory practice. Following the meal, dancing, drinking,
and good times were had by all!
This week, we said goodbye to Anand and Saskia during another "surprise" evening party.
We wish them
the best as they continue their journeys in medicine and public health, and hope to continue their tradition of excellence
at the St. Joseph's Clinic. Saskia will be continuing her work at The AIDS Institute
in New York, while Anand will pursue a master’s degree in medical anthropology
at the University of Oxford.
(Photo: Danielle, Saskia,
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.**
10:24 pm est
Saturday, October 23, 2010
11:41 pm edt
Kontwol Kolera: Our Cholera Control Efforts
As of this morning,
an outbreak of cholera in the Artibonite region of Haiti has killed approximately 200 and hospitalized over 2600. Though we
are thankfully not seeing signs of an outbreak in Thomassique as of now, we are implementing several preventive measures to
buffer against a potential emergency here.
The key messages we want to convey are the importance
Using purified water. For this, we are encouraging people to purchase and
use our Klorfasil systems, which we have been selling for the last several months at the highly discounted price of $2.50/system
(actual value is $8.50/system). Klorfasil works by using a small quantity of granulated chlorine to treat water within 30
minutes. For people who cannot afford the Klorfaisl systems, we are encouraging the use of SODIS, a free purification technique
where water is placed in clear water bottles and treated by sunlight. We have a large collection of clear plastic bottles
available for distribution. Going along with this message is the importance of properly preparing food.
proper sanitation. The emphasis here is on hand washing, especially after using the bathroom and before cooking.
We have a large supply of hygiene packs which we are distributing widely. Each pack contains soap and a washcloth, and many
also contain items such as toothbrushes, toothpaste, and combs.
Responding to illness:
People showing signs of cholera should seek immediate medical care to be re-hydrated with Oral Rehydration Solution (ORS)
and possibly IV fluids. They should also take measures to avoid spreading it to others.
disseminating these key messages through a variety of avenues:
Radio: Clinic Director
Dr. Casseus will be appearing on the radio at 5pm to discuss the cholera outbreak. He will also appear on another station
Community Health Workers (CHW): We are having an emergency meeting
with our CHWs at 3pm this afternoon. They will be instructed to conduct hygiene information sessions in their communities,
as well as look out for and begin treating potential cholera cases using ORS. They will continue to promote the use of Klorfasil
systems or other treated water.
Education in the Clinic: With the help of our
midwife, Mis Ketna, we are creating signs conveying hygiene and sanitation messages to post around the clinic. We will also
hold education sessions about prevention each day for patients waiting to be seen.
and Churches: We are collaborating with pastors and school directors to provide educational information about cholera
prevention to church goers and school children. Several of the schools were already part of our hygiene program, in which
teachers were trained in hygiene techniques to teach their students. The churches and schools are also involved in the hygiene
In addition, we are preparing for the possibility of a cholera outbreak here
by preparing our supply of IV fluids and ORS. The department medical director is sending us 16,000 bags of ORS. In the case
that pre-made ORS runs out, it can also be made using a simple mixture of purified water, salt and sugar.
This cholera outbreak highlights major ongoing challenges facing Haiti: access to clean drinking water and effective
sanitation systems. According to a 2008 report by Partners in Health, approximately 70% of Haitians 'lack direct access to
potable water at all times.' Addressing these types of problems in the long term and preventing future outbreaks will require
major changes to the water and sanitation infrastructures.
12:53 pm edt
SATURDAY, OCTOBER 16, 2010
is an enormous problem in Haiti, where 46% of the total population is undernourished, and 17% of children under 5 are underweight. Overall, Haiti has a Global Hunger Index label of Alarming, as assigned by the International Food Policy Research Institute, and an estimated 2.3 million Haitians are food-insecure. In honor of World Food Day, we wanted to share what we've been doing at the clinic to combat the problem of malnutrition in Thomassique.
The first relevant item is our Medika Mamba program, which aims to bring severely undernourished children back to a healthy
weight. Medika Mamba is a peanut-based Ready-to-Use Therapeutic Food (RUFT), produced by the Cap Haitian-based organization Meds and Foods for Kids, with whom we partner for this program Along with ground peanuts, the mixture includes powdered milk, sugar, oil and vitamins
and minerals. Our Medika Mamba program is managed by Mis Solane, a Thomassique native; it was started in 2009 by Global Health Fellow Nick Cuneo.
To enter the program, malnourished children undergo an assessment
by Dr. Gibbs, one of our service year doctors who aspires to a specialty in pediatrics. Potential patients are referred to
her by other doctors in the clinic, our Ajan Sante (Community Health Worker), as well as Mis Solane herself, who conducts active patient searching in the community. Currently,
there are 14 children enrolled in our program, and treatment usually takes between 6-8 weeks. Once in the program, patients
see Mis Solane at the clinic each week to track their progress (measured by weight, brachial perimeter, height, and general
demeanor), and receive that week's allotment of Medika Mamba. The great thing about Medika Mamba is that the food requires
no refrigeration or preparation, and the treatment can occur in the patient's home. Mis Solane also provides education, hygiene
necessities (such as soap, toothbrushes, and toothpaste), and a free Klorfasil water purification system to each patient's family.
Once the child has recovered to a healthy weight, s/he
is released from the program. It's truly incredible to see what Medika Mamba can do, completely transforming a limp and nearly-lifeless
child into an energetic and sometimes even chubby one in a matter of weeks! Overall, the recovery rate of children in RUTF
programs is 85%, compared to 25-40% otherwise. About a month after a child is released, Mis Solane conducts a surprise visit
to his home, to check on his health and conduct a more general assessment of the living conditions (pictured). If the child
has relapsed to an unhealthy weight, he is re-admitted to the program. Mis Solane also looks to see if siblings of the patient
might need to enter the Medika Mamba program; in August and September 3 malnourished siblings were identified in this way
and entered into the program. For patients in the outlying areas where our Community Health Centers are located, the Ajan
Sante conduct the home visits.
Our second nutrition-related project is the School Lunch Program.
In contrast to Medika Mamba's focus on rescuing a select number of extremely malnourished children from severe danger, the
School Lunch Program aims to provide general nutritional and educational benefits to a great number of children. In this effort,
we partner with the Minnesota-based organization Feed My Starving Children (FMSC), who ship down sea containers full of highly nutritious and easy-to-prepare lunches. Once the lunches arrive in Thomassique, we distribute them to a variety of schools in downtown Thomassique and the outlying
towns (below are images from a recent delivery). The schools then take responsibility for preparing and dispersing the hot
meals each day to their students. Thanks to an extra shipment of food from FMSC this year, which will be arriving on Monday,
we were able to expand the program such that it now will provide lunch to over 3700 children for the entire school year; that's
more than 550,000 meals!
The benefits of this type of program are multiple, and extend beyond the overall
nutritional benefits. As the Haitian saying goes, sak vid pa kanpe;an empty bag doesn't stand up. In other words,
it's impossible to think or do anything when your stomach is growling! Having a nutrient-rich lunch helps students focus and
learn more in school. The School Lunch Program is extremely popular in Thomassique, and we frequently have local school directors
approach us asking us to be added to the program. Last Sunday, there was an especially nice moment as we delivered food to
the school in Dahlegran: Virtually the entire neighborhood came to help unload the food, including women in their Sunday-best
on their way back from church, and small children who marched to the depot with their future lunches balanced precariously
on their heads.
You can read more about these two programs and other health-related activities
that Medical Missionaries is doing in Thomassique on the Medical Missionaries website, www.medmissionaries.org/id67.html.
Emily A. Dansereau and Fidel A. Desir
Health Fellows | 2010-2011
St. Joseph's Clinic | Thomassique, Haiti
10:41 am edt
Bouloum CHC Opens!
Top: Ajan Sante Jean Reluse (far left in green) and the rest of the Bouloum Health
Committee at their new Community Health Center; Bottom Left: Bouloum residents celebrate at the opening; Bottom Right: Dr.
Cassesus addresses the crowd before the mobile clinic begins.
months of discussion, planning, and training, our fourth Community Health Center
(CHC) is finally open in the outlying village of Bouloum! The opening day started with a presentation by our Clinic Director,
Dr. Casseus, in which he explained the CHC's main function: to serve as a location where Bouloum residents can find basic
first aid, health education, and disease prevention resources (such as Bon Sel and Klorfasil). In honor of the opening, a
Klinik Mobil was held, where approximately 65 patients were seen, and a feast of delicious Haitian food then followed.
The opening at Bouloum was a particularly joyous occasion for several reasons. The first cause for celebration
is that Jean Reluse, who will serve as Bouloum's Community Health Worker, or 'Ajan Sante', is incredibly devoted to his role. Before training to become
an Ajan Sante, Jean Reluse had been Bouloum's school principal, and had no background in the health professions.
Motivated to learn everything he could for his new work, Jean Reluse showed admirable dedication throughout his 3 months of
training at the clinic and with Zanmi Lasante (Partners in Health). Even after the final patient left the clinic each day, he could be found sitting outside the clinic
guest house where he resided, diligently studying his Ajan Sante handbook in the dwindling daylight (as shown at
Another reason we are excited about CHC Bouloum is that the Bouloum Health Committee is extremely enthusiastic about their
involvement. Already, the committee has been very actively selling Klorfasil systems, and sold 90 systems in a month, before
the health center had even opened. At left, members of the Bouloum Health Committee attentively practice using the Klorfasil
Finally, we and the rest of the community celebrate the opening of CHC Bouloum because Bouloum is an especially
remote area that will greatly benefit from the presence of a CHC. The route to Bouloum is extremely long and rugged, even
when compared with Haiti's notoriously rough roads. This remoteness can be illustrated well by our personal experiences venturing
to Bouloum. During one visit in July our car became stuck in the mud for over 3 hours and ultimately had to be pulled out
by a pair of bulls (pictured above). Even in good weather, the drive takes at least 45 minutes. Needless to say, accessing
healthcare is a significant challenge for the residents of Bouloum. The demand for healthcare in this community was clear
when we held a Klinik Mobil (see below) there in June and saw over 110 patients in one day, far more than are seen at a typical
Klinik Mobil. Although the journey to Bouloum can be difficult, engaging with this highly motivated and deserving community
is certainly worth the trip.
7:28 am edt
we mentioned in our last post, access to medical care in the Thomassique region is severely impeded by the issue of transportation.
Most people in the region travel by foot or mule, and it takes many of them 2 to 4 hours to reach St. Joseph's Clinic when
sick. One of our solutions is the Community Health Center
(CHC) project, where people can get first aid and help with simple illnesses, but there are many patients who need to see
a fully trained doctor. For this reason, the physicians of St. Joseph's conduct regular Klinik
at various sites in the region. The establishment of the CHCs has been very helpful in facilitating these because
the Community Health Worker (CHW) can help locate and organize patients, and the health center is a perfect facility for the
consultations. Here's what happens at a Klinik Mobil
, demonstrated by a recent day
at our CHC in Dahlegran.
1. The CHW and members of the local Health Committee inform the community in advance that a Klinik
will be coming. There is usually great interest in these clinics, so patients gather outside the health center
to wait for our arrival. If at all possible, we try not to turn any patients away.
2. Our CHW (in Dahlegran, Mary Madeleine) intakes the patients, recording each patient's name, age, temperature and blood
pressure. On this day in Dahlegran we saw 47 patients. At other such Klinik Mobil
we have seen over 110 patients in a single day!
3. The patient is seen by a doctor (here is our Clinic Director, Dr. Casseus) in a separate room. The doctor prescribes medications
and provides medical advice. Sometimes patients have conditions that need further tests and attention, such as a woman seen
at Barank yesterday with advanced goiter. In those cases, the doctor refers the patient to seek additional care, either at
St. Joseph's or Zanmi Lasante's
hospital in Hinche.
4. Before leaving for a Klinik Mobil
, the doctor collects a box of commonly prescribed
medications. An auxiliary staff member from the clinic (at Dahlegran it was our wonderful lab tech, Elizabeth) and ourselves
staff the 'pharmacy'. We distribute and explain the doctor's prescriptions, and track the medications distributed.
Once all the patients have been seen, we pack everything up and get back in the clinic's Range Rover with our trusty
driver Philip. Half an hour to an hour later, depending on the site and the weather, we return to St. Joseph's and finalize
our record keeping.
For more information about our Community Health Centers, please visit the Medical Missionaries
Our First Month
10:52 pm edt
Bonjou tout moun and welcome to our blog!
It's hard to believe, but we have now been in Thomassique for a full month. After a whirlwind orientation from Katie and Kavita, we have quickly assumed our many roles as fellows
and already survived a few ti pwoblem along the way, including mechanical difficulties, illnesses, and embarrassing
Kreyol misunderstandings. For the next year, we'll use this blog to give updates about our work in the clinic and community,
for anyone that is interested! This post is admittedly overdue, but we promise to post more frequently in the future.
Our central goals this year
focus on improving St. Joseph's Clinic itself, so we'll begin with an update about the happenings in our klinik.
For those who don't know, St. Joseph's is a rural clinic that provides primary care, maternity services, lab tests, basic
radiology and emergency care to approximately 100,000 people in Thomassique and the surrounding areas.
We have quickly learned that supply management is a significant challenge at St. Joseph's. This is a common problem for clinics in the region,
and has been further complicated by the increased medical needs in post-earthquake Port au Prince. So, in an effort to improve
our oversight of medications, lab tests, and other supplies, much of our time has been spent organizing and inventorying items
in the clinic. After countless hours of moving, sorting and labeling, we finally have three sparkling rooms full of neatly
organized boxes: The medications depot (pictured at left, alphabetized and labeled with expiration dates), the orthopedics
depot and the storage room which once held the Tuberculosis program. The ER depot will also be completed soon, and after that
loom the surgical and pediatrics depots. Though it may not be glamorous work, knowing and tracking what we have in each of
these spaces is incredibly important for keeping the clinic consistently stocked. We've already found supplies that clinic
staff thought they lacked and have a better concept of what and how much to order in the future.
Another development at the clinic (which is probably more exciting to you than hearing about rooms full of boxes) is
the impending reinstatement of a Tuberculosis program! The government will be sending us a nurse specifically to run a TB
program starting next month, which we welcome enthusiastically.
There are also many promising advances being made outside the clinic. Most notably, three
of our new Community Health Centers (CHC- previously known as Satellite Health Centers) are now open in Savann Plat, Dahlegran and Barank. After trainings with
Zanmi Lasante and at St. Joseph's, our Community Health Workers (or Ajan Sante) Anya, Mary Madeline and Jude are each busy providing
first aid, essential medications, referrals and health education to 35-40 patients daily. Many of these patients (such as
those pictured above, waiting to see Jude at Barank) would otherwise be unable to access care due to their remote locations.
Additionally, we are incorporating our Bon Sel and Klorfasil projects into the health centers. Each Ajan Sante promotes these items to patients and community members, and is
responsible for conducting home-visits to ensure that the Klorfasil systems are being used properly.
We are continually inspired and impressed by the dedication of our Ajan Santes and Health Committees (groups of community
members that support and guide each CHC) to improving health in their communities. In fact, it was the Barank Health Committee
that first suggested the concept of a CHC and it is a testament to the hard work of many community members this idea has become
a reality. In the image to the left, our Klorfasil expert, Shelove, demonstrates how to use Klorfasil systems to the Bouloum
Health Committee (which will open a CHC in early August).
In all, one of the strongest impressions we have gained in our first month is that there is
no shortage of incredibly caring and passionate individuals in Thomassique working towards the same goals as us; the Health
Committees are only one example of this. We are thankful to the past fellows for cultivating relationships with some truly
inspiring organizations and leaders, and are excited to work with these extraordinary people in the coming year.
Thanks for reading; we'll be in touch again soon!
5:43 pm edt
Festive music emanated loudly from large speakers. Crowds of people mingled, greeting one another and chatting. The atmosphere
was vibrant and full of energy; this could easily have been a scene out of a wedding reception or town fair. Actually, this
was last Saturday’s mobile clinic for the physically disabled people of Thomassique, organized by a community-led organization
called ACAHT (Association pour la Canalisation d’aide aux Handicapés de Thomassique). Upon arriving at the event,
we realized that this was not merely a mobile clinic, but an opportunity for the community to come together and celebrate
the fact that much-needed services are now being provided for handicapped people in this area. The event was an embodiment
of all that ACAHT and other local community-led initiatives seek to do – bring people together to effect positive change
ACAHT is just one of many successful locally led initiatives in Thomassique. Here, we will highlight
the work of several other organizations with which we’ve worked this year. This is just a small sample of countless
community initiatives that exist here. ACOSAT
Within our first week in Haiti, we were
approached by Jocelia, a woman who runs an organization and school for orphans in Thomassique. The organization, called Association
Communautaire Orphelinat secours d'Enfant de Thomassique (ACOSAT), aims to provide services for guardian families taking care
of orphaned and abandoned children. While this is a perennial problem in the community, it has been a particularly pressing
need in the months following the earthquake. ACOSAT was one of the local organizations (along with ACAHT and the World Vision
Earthquake Relief Committee) that we partnered with to distribute the earthquake relief items that were sent to Thomassique
from the US in the months following the disaster.
An innovative thinker, Jocelia has also begun a program to
fund ACOSAT’s school by starting a business as a seamstress. She plans to teach young women in the school how to use
manually-powered sewing machines. They will make and sell uniforms, clothing, and decorative cloths. All profits will benefit
the organization and school. In an environment in which external funding is nearly impossible to come by, it is this kind
of entrepreneurial spirit that can sustain community initiatives such as ACOSAT. Lekòl Tèt
The lack of an adequate education system is a persisting problem in Thomassique. The government-run school has the capacity
to serve only a small fraction of children in the area. For the majority of children who cannot find seats in the government-run
school, private school is the only chance at an education. The cost of a private education – tuition fees, books, uniforms,
shoes - can be unmanageable, especially for families with multiple school-aged children. In response to this problem, there
are several locally run free or low-cost schools that have been introduced in Thomassique. We collaborate with several of
them for our School Lunch Program.
One of them, Tèt Ansanm, was started by Down Belizaire (our x-ray technician at St. Joseph’s Clinic) and his
friend Betony. This free school is open to Thomassique’s poorest children, and the teachers work on a volunteer basis.
Other free and low-cost schools in this area include Lekòl Fermi and Lekòl Pò
(the Poor House) is a home for the
aging and infirm of Thomassique. Managed by Pierre Louis, a local leader who also directs Lekòl Pò
v (the Poor School), Kay Pò
v exemplifies the social
services that are made available to those most in need – not by any governmental or international aid program, but by
a neighborhood coming together to support its residents. Association Femmes de Thomassique (AFDT)
It seems that we are constantly learning of more community initiatives in Thomassique. Just last week, we attended
a meeting with the Association Femmes de Thomassique (AFDT), an organization dedicated to the empowerment and mobilization
of women as key players in development work. We met with the committee of over 50 women from Thomassique and discussed their
needs and ambitions. One of their goals is to begin a loan program for women, using pooled funds to support entrepreneurial
ventures. They also expressed interest in collaborating with the clinic to address issues of women’s health in Thomassique.
We plan to collaborate with AFDT as we look to expand the outreach services of our maternity department. Furthermore, the
board members of AFDT expressed interest in selling Bon Sel
as a way of promoting good health practices and fundraising for their organization. AFDT’s salt sales began last week.
The presence of multitudinous community-led initiatives in Thomassique was a surprise to us when we first arrived
here. Not knowing much about the area, we had originally anticipated that community-led initiatives would require a certain
base level of material resources that were lacking in Thomassique. We were impressed to find that, even with extremely limited
resources, several programs have been implemented. This is not to say that resources are not needed. Indeed, money is the
limiting factor in every one of these programs. But we were surprised and impressed by the fact that community collaborations
such as these exist even in the absence of material resources; such initiatives are fueled by the resourcefulness, determination,
and civic-mindedness of the people of Thomassique.
This week marks our one-year anniversary at St. Joseph’s
Clinic. One year ago, our friend Rigot Thomas asked us a question that has resonated with us ever since: kijan w wè Ayiti?
How do you see Haiti? The answer is complicated, to say the least. Every day in Thomassique,
we witness the effects of global injustice: hunger, preventable diseases, lack of access to clean drinking water, and abject
poverty. But it is unfair and inaccurate to reduce this country to a poverty-stricken, victimized nation. The people of Haiti
are not passive recipients of misfortune or aid; they are active and invaluable players in development work. In the face of
a harsh reality, it is they who best understand the needs of this country. Our work in Thomassique this year would not have
been possible or effective without our local partnerships. We continue to be inspired and moved by the competency, compassion,
and undying commitment that these organizations have to this community.
5:42 pm edt
Imagine finding yourself ill and knowing that the closest health center is two to three hours away by foot. This is a reality
that the majority of our patients at St. Joseph's Clinic face whenever they seek care. We are centrally located in Thomassique,
but for our patients that live nan deyo
(in outlying zones), the clinic is far from accessible. If they get a cut
or have a cough, they must walk several hours to access medical care. Unfortunately, this means that many people do not seek
care until the last minute- when small cuts have become seriously infected, or minor coughs have progressed to pneumonia.
The severity of this issue was brought to our attention by our Salt Committee in Baranque (see previous posts
for more details on this project). As partners in improving health in their area, we asked the simple question: what does
your community need? They replied that one of their biggest concerns is not having medical personnel in their area- someone
to provide first aid, over the counter medicines, etc. So, we went back and spoke with some board members at Medical Missionaries
about how we can address this need.
Now that funding for this initiative has been secured, we
are ready to launch one of our most exciting projects: Satellite Health Centers (SHC). About a month ago, we held our first
Community Health Committee meeting in Savane Plate, an area about 45 minutes by car from our clinic, or at least a 2.5 hour
walk. Convened in the local school, the commitee was comprised of men and women, representing a range of ages and religious
denominations. They discussed the multitude of health-related problems in their community; they told us of neighbors who are
paralyzed with no access to wheelchairs, food insecurity leaving children hungry when they come to school, and of course,
the lack of primary care in their area. We assured them that we would offer our support in addressing the health problems
they identified, but also asked for their help in expanding some of our exisitng health programs- namely the salt and water
projects- to Savane Plate.
Since that first meeting, we have formed three other Community Health Committees in Dahlegran (pictured above), Baranque and
Bouloume- all areas with no other source of healthcare. In addition, we asked the committees to nominate individuals from
their communities to act as ajen sante
(Health Workers). After an interview process, one individual from each of
the four communities was selected to be the Community Health Worker for their hometown. Their duties will include providing
primary care, referrals to our clinic and assisting us in introducing health projects into these areas (see the newly set
up SHC in Savane Plate to the right). We hope that the SHCs will also be a vehicle for introducing future community health
projects to populations nan deyo
. We have already started Bon Sel Dayiti
sales and introduced Klorfasil
into the local school in Savane Plate.
By the end of this month, our Community Health Workers will have
completed their training at the Zanmi Lasante
(Partners in Health) Center in Hinche, and the SHCs will be prepared to open their doors to patients in their communities.
We will keep you updated on this exciting project as it develops!
Tet Ansanm Video
5:34 pm edt
Tet Ansanm is a Haitian Creole phrase meaning "heads together." This phrase describes how people
in Haiti approach the momentous task of improving their lives. Change happens when groups of people work together, when we
put our heads together. We made this movie to be about St. Joseph's Clinic, but it is also about how the community views the
work done by the clinic, how they work with us and how we hope to continue making change in Thomassique.
To view this
video full screen, you can find it here.
Wednesday, March 17, 2010
5:31 pm edt
For years now, our doctors have dealt with diseases caused by our patients using poor quality water
in their homes. These diseases disproportionately affect the most vulnerable population- particularly children under five
years old (see previous post on the Water Crisis
). This fact has led us to look for useful interventions
that can improve access to treated water in Thomassique- and hopefully reduce the incidence of disease and number of preventable
deaths that we see at the clinic every day.
is a simple, point-of-use intervention that uses granulated chlorine to treat water at home. Itwas initially introduced in
Thomassique last year, as part of the water study conducted by Rita Baumgartner, '08-'09 Global Health Fellow (see previous
posts on the Water Study
and Boutey Soley
). While Rita found that the price of Klorfasil would be prohibitive for many families, the households that were provided
with the system used it effectively and the incidence of diarrhea among young children decreased during the study. A benefit
of this system is that it is very easy to use. Simply fill the provided bucket with water, put in a small dose of granulated
chlorine, and in thirty minutes the water is fully treated. The dose of granulated chlorine used in the Klorfasil system is
controlled by a custom-designed dispenser head, which ejects a precise quantity of chlorine each time the head is turned.
One additional benefit of the system is that the presence of chlorine in the water prevents recontamination after treatment.
The Klorfasil promotion model is also very innovative. It has incorporated social marketing techniques to advertise-
providing a Klorfasil plaque for all participants to display outside their homes. This simple strategy builds social pressure
for everyone to start treating their water within a community- Don't be the last one to get Klorfasil! In addition,
the founder, Jon Steele, hopes for Klorfasil to eventually be the first home water treatment system that is self-sustaining-
run like a profitable business so that it doesn't constantly need subsidies from grants and donations. On the other hand,
purchasing Klorfasil is not simply a commercial transaction; it is an opportunity to encourage good sanitation practices and
raise awareness about the connection between untreated water and disease. Each family not only receives a water treatment
system, but also enrolls in the Klorfasil program that includes a full education session and regular follow-up home visits
to ensure proper use of the system.
For the last two years, Klorfasil has been sold in Hinche (a larger town
about two hours away)with great success. Not only has the Hinche program reached several thousand households, but the follow-up
data have demonstrated that families are using the systems properly and consistently. Since then, Klorfasil executives have
been looking to expand to a wider region. Impressed by the proven effectiveness of Klorfasil, Medical Missionaries
board member Peter Dirr, procured funding to launch this program in Thomassique. The funding is necessary to offset the cost
of the Klorfasil system from US $8.50 to the more affordable US $2.50. In the next nine months, we hope to sell over 3500
Klorfasil systems in Thomassique- targeting vulnerable patients at our clinic and parents of young children.
A few weeks ago, we hired our Klorfasil Coordinator, Shelove Belizaire (pictured on the left at our clinic), to begin implementing
this program in Thomassique. She finished her training in Hinche last week and is ready to start launching the project! This
week, we will be meeting with directors of several schools in Thomassique to give them the opportunity to participate in the
program by providing their schools with Klorfasil systems, free of charge. From there, we will begin selling the systems to
our patients and parents at the participating schools. This will ensure that those most vulnerable to water-borne illnesses
have access to treated water, and that the children of Thomassique will be able to find safe, clean drinking water both at
home and at school.
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