Rebuilding Haiti

Dave Campbell (far right) and his fellow travellers on the journey to Bouly, Haiti

Second-year Faculty of Medicine  student Dave Campbell is doing a six-week medical elective in Haiti.  He wanted to write a blog about his time spent in the wounded nation.  We were happy to offer him the forum; this is his story.

The last two weeks of my elective in Haiti I did a clinical observership with the Internal Medicine Department of the Hôpital Bon Sauveur de Cange (HBSC) – the original hospital operated by the Boston-based international NGO Partners-in-Health (PIH). Cange is a remote village in Haiti’s Central Plateau. Many of its residents were originally inhabitants of the fertile Peligre valley, home to some of the most fertile land in all of Haiti. In the 1960s the river was dammed to provide electricity to many of Port-au Prince’s rich and powerful. This displaced many thousands of people away from their fertile valley to the arid and desolate mountaintops – which formed the small township of Cange.

PIH was started by Dr. Paul Farmer when he was a medical student at Harvard Medical School. He had been coming to the area for many years and was touched by the plight of the peasants in the area and founded the small clinic that is now the HBSC. PIH was founded upon the notion of social justice and strives to provide a preferential option for the poor. This was initially focused on providing second-line drugs for resistant tuberculosis (TB) and antiretroviral agents for HIV – neither of which were traditionally offered to individuals in resource-poor settings. They have since transitioned to a more comprehensive model including offering services in primary care, medicine, surgery, women’s health and rehabilitation. PIH petitioned the WHO and drug companies to make this possible for their patients. PIH now operates 12 hospitals throughout Haiti’s central plateau; they also have operations in a dozen other countries in Central and South America, Africa and Central Asia.

Paul Farmer is also a medical anthropologist and I have been a fan of his work and writings for many years, since I began my studies in medical anthropology. It was a like a dream come true to be able to spend some time at the epicentre of PIH activities and to see their model. I was able to meet many wonderful physicians – both Haitian and expatriates whose dedication and commitment to the PIH model of equitable access of healthcare for the poor was truly inspiring.  Many of the patients we saw had come from Port-au-Prince (three hours away) or even further because the PIH facilities have the reputation of being among the best hospitals in the country and also the only hospitals that are truly free. Many patients seen in the outpatient clinic (which sees nearly 300 patients per day) had walked or come in on the backs of donkeys from the surrounding mountains – some of whom had been on foot for six or seven hours. There are many people who bring bed spreads and sprawl out on a piece of concrete on the grounds as they await the results of various lab tests before being diagnosed and given treatment for their conditions.

While the work PIH does in the plateau central is amazing and inspiring, being involved in medical care in such a setting was also very sobering. Only those with the severest conditions were admitted the 24-bed medicine ward. There were many patients with advanced stage TB and HIV as well as cancer and congestive heart failure. As a second-year medical student it was one of my first opportunities to have patients that I felt responsible for and who I got to follow as they progressed through their illness – including being present when many patients that I had become close to passed away.

I was invited to be part of a small group of PIH people involved with the construction of a dispensary in Bouly, a small mountain village. In order to maximize my involvement we decided to make a trip to the community so that I could meet local leaders who will be helping us with construction and operation. It was a seven hour hike from the Boucan Carre hospital – the nearest health facility, which is also the furthest point reachable by vehicle. We hiked up and down two mountains and across four rivers. It was very strenuous and I could not imagine having to do that in a time of health crisis. This community is very over represented in cases seen in the Boucan Carre hospital and we hope that the building of this dispensary which will be staffed by a local nurse and a part-time physician can reduce this incredibly high burden of advanced disease in this community.

We are hoping to have the construction completed by January 2011 and to open immediately.

For anyone who would like to learn more about the incredible work done by Paul Farmer and Partners-in-Health, I recommend reading Mountains Beyond Mountains by Tracy Kidder. For anyone interested in Critical Medical Anthropology I also recommend any of Paul Farmer’s works, but notably, Pathologies of Power.

Thanks to everyone who read my blog from my elective in Haiti.

Heavy rains make a bad situation worse

Second-year Faculty of Medicine  student Dave Campbell is doing a six-week medical elective in Haiti.  He wanted to write a blog about his time spent in the wounded nation.  We were happy to offer him the forum; this is his story.

Saturday was busy as we had a whole bunch of new patients come in from the Partners In Health facility in Cange and I was able to interview several of them.  Sunday afternoon I had visitors come from Handicap International in Port-au-Prince who wanted to see the operation here and what I do as an anthropologist.

I got back to the village just before the deluge arrived – there was a huge rainstorm, which is not uncommon for this time of year, but what is uncommon is how long it lasted. It poured for hours on end, the canals and even the major drainage river in the area overflowed. I tried to leave when it slowed up a little but everyone out in the streets told me to go back because I wouldn’t be able to cross the river since the bridges were washed out.

This morning on my way down to the clinic I was shocked at the destruction from the water. Many houses beside the river were washed right out and the houses beside the canals were all flooded.

Many people lost their goats, cows and chickens – which is tragic for these people since in many cases, these animals are the biggest investment they will make in their lives. As destructive as the rain was here in Deschapelles, I sure hope that Port-au-Prince didn’t get it this badly because it would be absolutely devastating, particularly for the many hundreds of thousands living in tents and makeshift tents made of bedsheets, still scattered throughout the city.

Monday is our big discharge/intake day for patients from Port-au-Prince.

Seeing patients come and go so frequently is definitely the worst part of this job! It is always so sad to see many of my friends leave – people that I have come to know really well over the past couple of weeks. It is particularly hard because of my internal conflict of being sad to see them go, but being elated for them for their progress on their new limb and for being able to go home to their new lives.

Five patients went home today, the smallest discharge group that we’ve had since I’ve been here, and they were all excited to show their kids and families their new limbs and to experience a life where they don’t have to hobble through the rough streets on crutches.

I had an interview this morning with a woman named Michelle (pseudonym) and it was a great experience. She is a 40-year-old lady from the mountains who is a bilateral amputee from poor control of her type 2 diabetes. She has such poor control of her blood sugars largely because it costs 30 Haitian dollars OR $4 U.S. each time she wants to get her sugars checked at the hospital or dispensaries. That’s quite a steep price in a place where the average income is $1 U.S. a day, so she struggles to check her sugars even on a monthly basis, and prays everyday that someone will give her a blood glucose monitor. Not to mention the costs of her oral hypoglycemic medications, and the fact that it is pretty difficult to make lifestyle changes in a place where the only affordable foods are very high in sugars and starches and it’s tough to get a lot of exercise when you’re a bilateral amputee.

The generalization of mountain-dwellers is that they are uneducated and therefore unintelligent. My interview with this woman was a great example of someone who was completely uneducated but far from being unintelligent. She had many very insightful things to say about being disabled in Haiti and was very astute in talking about the perceptions of people like her by the rich and powerful in the country. She also had a lot of great suggestions for how amputees and other disabled persons could be better cared for in the country.

Unfortunately due to a non-healing wound on her stump, thanks to her diabetes, she was sent home without being able to be fitted for her prosthetic limbs and told to return in several weeks if it heals which is easier said than done when paying the money to return is a costly endeavour.

So today has been another day full of tragedy for some and joy and excitement for others, which seems to be quite typical here in the L’Artibonite.