Haiti 2010

Wear a hat and protective clothes when walking thru the camp for home visits, the other physicians advised, to protect against the sun, nails, sheet metal and steep paths. Today was my first to work at Terrain Acra. I had treated people for arthritis, anxiety, diarrhea, colds, hypertension, at the tent clinic in the morning. The temperature there was 104 degrees F. I had eaten nuts and dried fruit for lunch and now was climbing the hill with a nurse, translator and the physician who was showing me the approach to home visits for patients who are unable to walk or have special problems. The gravel path was steep and busy with people. The first family, a mother, two year old and eight month old all had tuberculosis and were ready to start a four drug treatment and we were going there to explain the program and set up daily visits by an ARC nurse to observe the ingestion of the meds and check on the status of the patients. Directly observed therapies (DOTS) is known to public health workers as a successful method of treating serious chronic diseases. DOTS was started by an ARC medical team at the refugee camps on the Thai border in the 1970’s.

We greeted the mother and entered her tent home thru a plastic flap. The ceiling and walls were plastic and the plastic floor sloped downhill about 20 degrees. One bare mattress lay on the floor. The toddler hid behind mom while the malnourished eight month old sat quietly. Clothes hung from a line and clean dishes were stacked in the corner. Yes, the mother understood the importance of taking the meds daily and that a cure is possible. Their HIV tests have not been reported yet. The father, who was away, working, had not been evaluated for either disease but would go to another clinic down town for an evaluation. Mother’s breast milk was drying up and the family was short of food and couldn’t afford formula. We recommended a screening program which gives advice about feeding and supplies food supplements, but not formula. ARC has no funding for food or malnutrition programs in Haiti. Programs that do exist are in the process of closing and have little to distribute. We told the mother that we would do our best to help and asked her to come to our clinic in three days.

A few days later, a nurse, translator and I visited a 64 year old who had been injured 15 years ago and was paralyzed below the waist. To reach the house we had to squeeze thru a narrow space between metal huts taking care not to snag our clothing or my backpack where I carried exam equipment, books and water. Two children giggled and ran ahead to notify the extended family of eight people. On entering the house we met the patient’s brother who was painting a geometric style urban landscape titled “trembelement de terre” as the quake is known there. He had sold one such painting and hoped to sell more. The house had two large rooms and the roof was high enough to stand. The roof was made of boards, sheetrock and paintings supported by 2x2 and 2x4 boards, all covered by blue plastic. The plastic had leaked during the rain two days ago. As the floor was dirt, the patient’s wife offered a bed for my backpack and a chair to sit on.

The Patient noted his urine, which drained from a catheter and had a strong smell. The catheter had not been changed in many months. He requested vitamins for strength and a wheelchair to replace the one that was broken. He was alert, smiled and answered detailed questions. His arms and trunk were thin, ribs visible easily from across the room. His hips, legs and feet were rigid. Turning him to his side to examine his back was like lifting a plank. His back and sacrum were scarred from previous skin ulcers, though he had none then. His legs and feet were covered with dry scales of skin. Where the brown scales had peeled the skin was pink.

I complimented them for doing good skin care and encouraged him to roll from side to side regularly each day and to use moisturizing creams, which were probably too expensive for them and not available in our clinic pharmacy. I wrote a prescription for an antibiotic for a urinary infection and vitamins, both of which were in stock at ARC’s pharmacy. No wheel chairs were available, but some NGO’s are starting rehabilitation programs and he might qualify in the future.

One week later, after obtaining a new catheter, we returned and replaced the old one. He was happy and appreciative. One week later he had a fever, diarrhea and tiredness. One other family member had similar symptoms. He was not dehydrated and his abdomen was soft and not tender. I prescribed clear liquids, carbohydrates and other meds and promised to return in a day or two. He requested a new tarp for the roof because his bed had been dripped on recently. I knew there were many people who needed new tarps, that the rainy and hurricane seasons would start soon and that ARC and other agencies had only a small number of tarps, so I told him I would look into the issue and get back soon.

ARC Haiti has coordination meetings five nights per week at the end of the day, usually lasting one hour, where information is exchanged and intra disciplinary issues are discussed. Though sometimes tiring and overly detailed, these meetings were very helpful in understanding how a displaced persons camp is organized and managed. It was to this group that I brought the request for extra food for the first family and a tarp for the paralyzed patient. The shelter coordinator had some tarps and the camp manager agreed with the country director to make a special provision of this supply due to extraordinary medical conditions. Likewise the group agreed to provide some food supplies for the malnourished infant and her family.

The infant with TB soon developed pneumonia so an ARC driver, mom, infant and I went to a close by hospital. However it had no inpatient facilities. Lacking a translator and speaking limited French made communication difficult, but we were directed to another hospital on the edge of town, which accepted the child. How the mother would get home and who would care for the other child were unknowns. I left her my phone number. The next morning at 4:48 am my phone rang, but I couldn’t pick up before it stopped ringing. After another ring I answered but the caller spoke Creole and I none, so we hung up. I was sure the voice was that of the mother and there must be some problem. No more sleep that night. The next morning my translator called the number that had called me earlier, but it was not our patient, rather someone who had called the wrong number. We were all happy the following day that the baby and mother were back, improved, eating more. The mother thanked us for ARC’s assistance.

Our last visit to the paralyzed 64 yr old found him improved and in good spirits. He thanked us for the tarp and asked if we might know of any jobs for his relatives. I told him that ARC does hire people for various activities and they could apply at the office or thru the camp zone representatives. I explained that I was returning home but other ARC personnel would be available for home visits if he should need help.

Providing health care always allows detailed information about people’s lives. Because of the home visits, I obtained an unusual, though brief, view of two family’s problems and struggles. Though the issues were more extreme than most families, the issues described above are shared by most of the people I worked with in Haiti. Seeing the nature and extent of people’s problems causes me to strongly support groups that work with the Haitian people to solve their problems.

Many government and aid groups such as ARC, have plans to build housing, provide health care and educational assistance, repair infrastructure and provide jobs in the next months and years. ARC is expanding camp management to additional camps, planning to build 2500 transitional houses beginning June 2010 and is currently improving its scope and depth of health care. With good planning, hard work and funding from many people, the hemi paretic man will have a dry bed and a wheelchair and the family with tuberculosis and the malnourished child will regain health, the children will be educated and the adults employed.