Dear Family and Friends:
Jim said at one point the woman grabbed the handles on
both sides and it seemed as if she lifted herself up out of the portable
dentist’s chair a few inches so that her back was as straight as a board. Jim said he could see the pain reflected in
her eyes, but she didn’t make a sound.
This Haitian woman had come to the mobile clinic at the
village of Massanba with four teeth broken off half way to the gum line. Dr Bastien, a Haitian dentist, had to cut
into the gums before he could extract the broken teeth. In the States, I would expect most patients
would be knocked out by general anesthesia before the gum cutting and
extractions by an oral surgeon. Dr.
Bastien had administered a heavy dose of xylocaine, Novocain or an equivalent,
but the patient was awake for the entire procedure.
To me, this woman is but one example of the amazing
stoicism and heart of the many good people of Haiti who have faced obstacle
after obstacle in their lives. At
Massanba, the mobile clinic team brought some light and relief to the many who
came to the clinic.
Infants speak a universal language when being examined
by a nurse or doctor – they often cry or in some instances scream when their
ears are scoped, or they otherwise are probed as part of a necessary
examination. Haitian babies and infants
are no different. But other than
“pitit”, the patients at Massanba I observed kept to themselves any audible
measure of the magnitude of their pain and suffering.
At the mobile clinic in Massanba, Dr. Bastien extracted
17 teeth from 11 patients. Even though I
was often around the corner in another room, no more than 40 feet or so from
Dr. Bastien, I never heard a cry or moan
from any of the patients in the chair.
Dr. Bastien, who has a dental clinic just one block
from L’Hopital Sainte Croix, was the only member of the mobile clinic team that
was not from the United States. All but
one of the members who flew into Port-au-Prince on June 11 were from the
Atlanta area. I think the other member
was from North Carolina.
Because construction continues at the HSC Guesthouse,
limiting the number of guests beds available here to the group of
undergraduates from Duke University staying with us, the sixteen members of the
Georgia group stayed at Residence Filariose operated by the University of Notre
Dame. It is located in Belval, a Leogane
neighborhood about 1 ½ miles from the hospital.
But HSC vehicles were used to transport the group to
the four days of mobile clinics from Monday, June 13, through Thursday, June
16. We also made all arrangements for eight translators to accompany the team
to assist in communications between the Haitian patients and the American team
members.
I had the opportunity to spend the entire day last
Monday with the team at the mobile clinic in Massanba, and also to travel with
one of the drivers for the end of the day pick-up of the team in the village of
Belle’air two days later.
In Massanba, an elderly couple graciously offered the
outside and first floor level of their beautiful two story house for the clinic
site. The house was on a hill above
other more modest wood and metal houses, and in many instances, shacks, in
lower farm land and stands of banana trees.
The “temporary clinic” house was painted a bright blue with white
trim. I’m still trying to figure out how
all of the concrete for this two story edifice and the substantial concrete
driveway and parking area adjoining the house was brought into the construction
site.
Unfortunately, I had not expected to make the trip to
Massanba and didn’t bring a camera with me, so I can’t share with you any
photographs of the four wheel drive vehicles traveling up the stream, the
“clinic house”, the team setting up all of the tarps for shade outside where
most of the patients and team members would be stationed, or the team in
action.
The team members from the States were a combination of
medical professionals and those without a medical background. The team leader, Priscilla, is a Certified
Family Nurse Practitioner. She is a take
charge and get it done type, who has been to Haiti many times with mobile
clinic teams. She runs a tight
ship. I can say that, in respectful
terms, from personal experience last week.
Priscilla’s husband, Ken, an engineer, provided
oversight for site set-up and assisted other non-medical team members in the
flow of patients from Point A to Point B so to speak. Other non-medical members pitched in as
needed to assist in the smooth operation of the clinic, so that the medical
professionals could focus on what they do best – helping the sick. Jim, a roofing contractor in the States,
acted as Dr. Bastien’s assistant.
Most of the medical professionals were nurses,
including pediatric and general medicine nurses, some with neonatal ICU
experience. The group also had a
pharmacist, Mike, who is Jim’s brother.
Mike was assisted by Briana, who is proficient in reading prescriptions,
and is quite knowledgeable about the various prescription and non-prescription
drugs that were on hand for dispensing to the patients. Briana was another one of the team members
who had been to Haiti with other mobile clinic teams.
The translators working this past week with this group
have been with many medical clinic groups from the United States. Last week’s group was given high praise by
several of the translators, who remarked that this group not only had a well
organized operation, but that all of the team members brought to the clinics
that invaluable combination of superior professionalism and sincere compassion
for their patients.
At the end of the week, I was advised by Priscilla that
in four days of mobile clinics they had seen more than 500 patients. The dentist performed extractions on more
than 40 patients.
I’m pretty sure the mobile clinic process in Massanba was generally the same for all four days. The first wave of patients assembled as a group around the lead translator, Peter, who held up the initial intake form and explained how it needed to be filled out before the patient could go to the next stage – “triage”. At triage, the intake form was reviewed by a team member, preliminary questions were asked, and vital signs, such as blood pressure and pulse, were taken.
New groups of patients arrived at the clinic throughout
the day. A translator assisted in having the patient describe
the reason for coming to the clinic.
After triage, patients were sent to a medical professional who conducted
a more detailed medical assessment specific to the reported ailment(s) or
condition(s), again with the assistance of a translator. Most often a medication was prescribed; in
many instances multiple medications.
After
the assessment and diagnosis stage, many patients who were to receive
medications were shown to the bench in a hallway on the first floor, to wait in
line for Mike and Briana to review the prescriptions sheet and gather the
prescribed medications. To ensure that
each patient fully understood how to use their medications, including when and
how often to take pills, or how to apply an ointment, each patient would meet
with “Mario”, the oldest of the eight translators (in picture at left). Mario celebrated his 58th birthday
while Jeanne was visiting Leogane a few weeks ago.
After watching Mario in action for several hours in the
pharmacy, I understood why a number of months ago Priscilla made a special
request that Mario be one of the translators.
Before Mario handed medications to a patient, he assumed a tone and
demeanor that was one-half Marcus Welby and one-half sage Haitian neighbor,
father or grandfather, depending on the gender and age of the patient. Even though I understood little of his Kreyol
instructions, I could tell Mario took all the time necessary to make sure each
patient fully understood his use instructions.
He spiced up his directions from time to time with a little humor, most
often for children and young adults.
In certain instances, medical treatment was given by
the consulting medical professional before the pharmacy stage. On several occasions, I watched the NICU
nurse administer a vaporizer treatment to a “pitit”, while the child’s mother
held the infant in her lap. The group
had come prepared with an ingenious “vaporizer pump system”, which is my fancy
way of saying that some of the non-medical team members – I think under the
direction of John who I think may have “invented the pump system” at a previous
clinic in Haiti - hand operated the tire pump to have the therapeutic vapor
come out of the plastic mouthpiece for insertion into the infant’s mouth or to
dispense vapors near the mouth and nose.
This vaporizer system is but one example of the
resourcefulness exhibited by the mobile clinic team during its four days in the
field.
Their day didn’t end with the trip back to
Leogane. The team spent most of the
evening preparing supplies, instruments, and prescription carrying cases for
the next day’s clinic. I hope they all
at least had time for a Prestige or Coke after dinner.
At
the end of the day, more than 140 patients had been seen at the Massanba
clinic. There is no telling how many
people had received relief from a condition that would have been left untreated
had a mobile clinic not come to Massanba that day, to Petit Harpont on Tuesday,
Belle’air on Wednesday, and Grande Savane on Thursday.
Not all patients however could be treated at the
clinics. One of the medical team
members mentioned how difficult it was
to diagnosis a condition that required more intensive medical intervention,
such as children who needed lifesaving surgery for a heart defect, or the eight
year old boy whose preliminary assessment was Type I diabetes. All such patients were referred to a medical
facility where hopefully they would receive necessary care.
Usually, the drivers of the transport vehicles remain
at a mobile clinic site the entire day.
This is done in part to allow for a quick exit from a village when heavy
rains start and the outgoing road becomes flooded, preventing a scheduled
return to Leogane. Last Wednesday,
however, one of the three vehicles was needed in Leogane at mid-day, which gave
me the opportunity to take the return trip to Belle’air at 3 p.m. The drive into the high mountains, half way
between Leogane and Jacmel, lasted almost an hour. This time I had my camera
with me.
Belle’air is about twenty-five miles from Leogane. The main highway from Leogane and Jacmel is
totally paved, and there are many large trucks on the highway hauling a variety
of building materials. Large passenger
buses and tap-taps make day trips back and forth on this main road.
Once off this highway however travel was on a narrow
and winding dirt road, which required three four-wheel drive vehicles. The lush vegetation, and the modest houses,
huts and shacks dotting the mountainside, announce the transition to a very
different way of life for the people who look down into the valley of the much
more “urban” city of Leogane.
The site of the Belle’air mobile clinic was quite
different from the modern two story home in Massanba. In Massanba, Dr. Bastien’s “office” was on
concrete porch protected from the sun.
In Belle’air, Dr. Bastien’s patients sat in the brown portable dental
chair under a tree and tarp alongside of the dirt road, about 30 yards from the
main clinic area at a modest wooden house.
In Massanba, the pharmacy was indoors, as was the
hallway waiting area. In Bell’air,
medications were assembled in a modest hut, and then dispensed just outside the
door on a wooden table of sorts. In Massanba,
patients sat on a bench waiting for Mario, and remained seated to receive his
instructions. In Bell’air, they stood
outside across the table from Mario.
I’m attaching several photographs taken at the mobile
clinic in Belle’air. I’ll also forward
to you by separate email photographs of the mountain region around Belle’air
and lower valley areas outside of Leogane the city. While the clinic setting in Belle’air was more spartan
than Massanba, the care in Bell’air was of course as excellent as in Massanba.
I didn’t travel with the mobile clinic team on their last trip, but I sure heard about the return trip on Thursday; about how one of the HSC drivers, Mr. Guey, kept the Nissan pick-up from rolling off a cliff. I first heard about this while I was on a moto, on my way to Belval to check with Priscilla about how the day went in Grande Savane. About 1/3 of a mile from Residence Filariose, Dr. Bastien flagged me down and told me that he and others in the pick-up had barely avoided a serious accident. He didn’t describe what had happened.
At Residence Filariose, I spoke to a few members of the
team who described how Mr. Guey remained cool and collected as the Nissan came
around a corner in the dirt road, and somehow started to drift backwards toward
the cliff. There were several people
riding in the back of the pick-up, and others in the cab with Mr. Guey.
At the end of the day on Thursday, the team gave me the
customary tips for the HSC drivers. But
Priscilla also gave me an additional, special tip for Mr. Guey to thank him for
saving members of her group from what could have been a fatal accident but for
Mr. Guey’s quick reactions and skilled driving.
As I reported to Priscilla in an email the next day
(with a request she distribute it to all team members), Friday morning I ran
into Mr. Guey sitting alone out back of the hospital. I sat down next to him, handed him the
special tip, and said: “Gwoup klinik la vle ou fe yon vwayaj espesyal paske ou
sove yo de yon aksidan ye.” He got a nice smile on his face – which is history
making in itself – a little gleam in his eye, and replied, “Thank you.”
Thanks to the online English to Haitian Creole “Bing
Translator” I have been using the last 2 ½ months, I think (but the Bing
translator does make mistakes from time to time) I had delivered this message: “The clinic group wanted to give you a special tip for
saving them from an accident yesterday.”
When I arrived in Port-au-Prince on March 30, 2011, I
was greeted in the airport parking lot by Bob and Robin Sloane, the Guesthouse
Managers I would follow. Mr. Guey was
the driver who drove us back to Leogane.
He didn’t say anything the next two hours. Regardless of the traffic conditions, he
never changed the expression on his face.
He was all business.
I’m glad for many people that last Thursday Mr. Guey
again was his consummate serious self, and all business. He has helped ensure that many good people in
last week’s mobile team will be back again to help many good people in Haiti.
I hope this note finds you and your loved ones in good
health and spirits.
David
20 June 2011
20 June 2011
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