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Traveling to Haiti in December 2009, weeks before the earthquake, exposed me to healthcare in a low-resource area.

Hospitals ran without support staff and with only the most fundamental of supplies. I saw fractures being set without pain medication and sometimes without even an x-ray. Why? The answer is simply that the patients couldn’t afford it.

One woman came in with symptoms of congestive heart failure. She was short of breath and had significant swelling and pain in her legs. A resident doctor on duty evaluated her for free, a service provided by the state. But the healthcare coverage stopped there unless the woman or her family had the means to buy the treatment right there on the spot.

In this case they did. A family member went to buy diuretics, a needle, a syringe, gloves, gauze, and tape from the pharmacy across the street. They came back with the supplies in a brown paper bag, and the doctor administered the medications. This bare-bones supply system of sorts was commonplace at many hospitals across Haiti.

 

There are an estimated 25 physicians and 11 nurses for every 100,000 Haitians. This makes them a valuable asset to the country. (By comparison, its neighbor the Dominican Republic has more than 185 physicians and 180 nurses for every 100,000 residents, according to the World Health Organization).

When the magnitude of “something vs. nothing” is so powerful, their every act of care makes a great difference. In the days following the earthquake in January 2010, knowing that these strong and dedicated Haitian doctors were on the ground working hard as they always did was a central part of me personally coping with the tragedy.

Returning to Haiti two years later (over the recent winter break) showed me once again the effects of chronic endemic poverty. The common pediatric illnesses requiring hospitalization included malnutrition to the point of kwashiorkor, and gastroenteritis to the point of severe dehydration. In the outpatient setting, it was again and again cases of abdominal parasites and ringworm.

Parents often said they couldn’t afford to buy treated water or age-appropriate formula. Across the board, healthy children were still under-weight and under-height compared to international norms, stunted by their living situations.

During the most recent trip, we were fortunate to shadow and precept at St. Nicholas, a hospital in financial partnership with Partners in Health. They had many basic medical supplies and medicines in stock, free for patients. This made a world of difference.

 

One evening our group met at the home of Dr. Kerling Israel, a young Haitian physician who has trained both in her home country as well as in the U.S. and now works for Partners in Health in Saint Marc. We asked her what she felt Haiti’s health system needed most.

She answered thoughtfully and carefully: two things.

The first, she said, was medical supplies; the plastics, the instruments, the medicines that are simply nowhere to be found. The second is investment in sustainable operations. One example is her current work to build permanent partnerships between Family Practice Residency programs in the U.S. and the Residency training programs in Haiti. This exchange of faculty and residents benefits all involved and strengthens the future health infrastructure.

I witnessed the effects of chronic endemic poverty both before and after the earthquake, and the subsequent international aid response. In most ways not much has changed, but at least we’re getting closer to understanding and solving the long-term solutions. Many people, inside Haiti and out, are taking the first steps to raise the standard of care where it is needed most.

 

Our last day in Haiti was spent at a small beach near the city.

And yes, we did play beach volleyball with the Argentinian UN soldiers.

We took a road trip through Haiti’s mountains to visit the Citadel.  It was a 7-km hike up into the mountains to visit the largest fortress in the Americas.  Built in the nations infancy to defend against the possible return of the French, this mountain fortress with cannons and a self-sufficient water supply, never saw a battle but served it’s purpose in uniting Haiti’s kingdoms.

To say the least, the mountains were beautiful and the sweat it took to hike up to the mountain top was all worth it.

We visited an orphanage on the weekend. To get there it was an hour long drive on a dirt
road up into the mountain hillside plantation area surrounding the city
of Saint Marc. The road was rough and had deep ruts that were best passable by dirt bikes.

There were 15 boys and 11 girls cared for by one mother from the village
who cooks for them when they have food. Unlike many orphanages in Haiti which are run as businesses linked to lucrative donations from the western world.  This orphanage was stand-alone and not standing on much if anything at all.  We knew of it through one of the Haitian doctors who has volunteered there in the past providing care for the kids.  Food comes on a time-to-time basis whenever there are donations. They had not eaten that day and they had no food stored.

Rather than give money, we sent one Jeep  back to the city to get a filling
hot meal of rice, white beans, and a sauce with meat. It’s a
traditional Haitian meal commonly served at holidays and Easter. We
also had cake and soda for everyone.

The orphans, aged 5 to 17, were very polite and patient and there was
enough for seconds for most. After dinner we gave them the gifts of new clothes that were donated. The girls especially liked their outfits and you should have seen the look on the boys faces when they received their new nike sneakers.

Thank you so much for your generosity. The clothes and the monies that
went to their new years eve meal were much appreciated and made their
day special. It was our honor to distribute them on your behalf.

It was easily the most memorable day of our trip.

The first couple days back in Haiti were spent returning to some of the same small towns we visited 2-years ago for mobile clinics.  The buildings and people were the same, but I/we felt much more prepared this time. (thank you 2 additional years of medical school)

Our pharmamentarium had one main drug per class (albendazole, amoxicilin, metro, cipro, enalapril, hctz, metformin, asprin, tylenol, ibuprofen, iron, and good old multivitamins) so determining the diagnosis and treatment was ‘simpler’ than you’d think.

One of the days I was even to run a pediatric station more or less by myself with the help of a translator from Creole to French/English.   Most of the care provided at the mobile clinics was on the adult end of the spectrum with organized focuses on diabetes, hypertension, along with any-old medical complaint that people walked in with.

Halfway through interview season I took a 3-day sidetrack from common amenities to camp in the New River Gorge.  I’ve wanted to see this area for many years now after hearing randomly of their Bridge Day.

Sure, it was December but “the new” didn’t disappoint and I’m still not over my fascination of the size and magnitude of the bridge which connected ridge-top to ridge-top bypassing a yesteryears 1-hr drive down switchbacks and back up to cross the river gorge.

Even if it drained the bank account and maxed out my credit, traveling across the country to different pediatric residency programs was a blast.  Outside of the formal introductions to each respective program, I had many conversations and new perspectives to pediatrics, global health, and infectious disease to ponder.

Come March 16th and I’ll know where I’m matched to!  With many great programs/places/people at towards the top of my list, I’ll be glad and content to go just about anywhere.

Completing some of my clerkships up in Saranac on a Rural-Med tract was the highlight of my clinical years.  It was a turning point of sorts, and allowed me to experience living and working in a close-knit and honest small town, not to mention the great views and ease of getting out for a walk, hike, or canoe.

Many thanks to the staff and physicians at AMC.  It was an honor to work there for 3-months and I hope it showed.

It’s a few days out and I’m still feeling the sorry soreness from the last-minute weekend decision to run in the 4-mile shamrock.  With the memory of the Chicago polar bear dip still fresh and stinging, it’s difficult to come up with any good excuses to sit at home and be comfortable instead of taking on irrational feats.

With spring in the logical future, 2,700 were also itching for warm weather and ran through the Irish neighborhood to give St Patty’s day a warm-up. The bands rocked out at the neighborhood pubs and porches, giving us turn by turn motivation to keep on running.