2017 Buffalo Medical Mission (Part 1)
Dear Family and Friends,
With a little help and a lot of luck we made it to Haiti!
Today started off with a 3 hour delay of our flight from Buffalo to Atlanta due to inclement weather conditions in Atlanta earlier in the week. Thanks to a lot of help and coordination between Lisa (our fearless leader), the all-star team flying Delta and the rest of our volunteers we made our connection! The flights went smoothly and we landed in Port Au Prince on time.
From the airport we met with Pierre Louie. He and his friends helped us navigate the bumpy 5-hour scenic tour to Fontaine safely! With no shortage of baby goats, motorcycles and a muddy river it was certainly a wild ride.
Upon arrival, we were greeted by the warm hearts of the people of Fontaine - not to mention a very satisfying warm meal.
Heading in for the night we are all very excited to start clinic tomorrow!
Thank you for your support and look for tomorrow night's update!
I am an inexperienced first year medical student writing the journal for our first day of clinic. As many of you reading this know, we are giving medical care to the poorest people in the western hemisphere. Typical western concepts of patient care might not be feasible or beneficial here in Fontaine. Personally, this way of thinking has been a steep learning curve. On the bright side however, while using translators for each interview, I have picked up a few new words. Duele, means pain-if the word is misspelled my apologies. I bring up Duele because I have heard it spoken so many times today. But I was particularly moved by a patient who came to us with abdominal duele.
Now don't lose me, I am going to quickly switch gears but promise there is a reason why I was so struck by abdominal duele. We saw a huge number of people between the 18 of us here and there were numerous different diseases that we treated-but I use that word treat loosely both as a first year and as a visitor in this beautiful land. At the end of the day, we had exhausted our translators, and ourselves. We had gotten up at 6 am and finished 13 hours later around 6 pm. Once we were done, our team of 18 went to the roof to discuss the operations of the clinic, to reflect and improve.
But just before that two other medical students and I decided to walk around the village. I saw, shack after shack-homes that would be condemned in the US-gut wrenching poverty but people with eyes full of hope and hearts of hospitality. We inevitably got lost for a few minutes but some kind Haitians redirected us back to the school. Once we had meandered our way to the rooftop, we were ridiculed for forgetting our chairs and being late. Nevertheless, we sat down as our trip leaders brought up the topic of abdominal pain.
I learned that, in Haiti, abdominal pain is a common complaint. In the US when a patient comes to us because they have a burning feeling in their stomach after or before a meal, which is worse after laying down, worse with acidic foods, and there is no overt history of stomach bleeding, inability to swallow, etc., we are trained to put gastroesophageal reflux disease (GERD), high on our differential diagnosis. The causes of GERD can be NSAID use, H. Pylori infection, a virus, or even hypersecretory disorders. However, many of these typical diagnostic thought processes are informed by the culture, and the population you treat. I say all this because abdominal pain caused by GERD is often very treatable in the US, for many reasons: (1) we speak our patient's language, (2) we can follow up with the patient, (3) we can get them further treatment. In Haiti, however, we barely have any of those, our patients barely see physicians-due to poor resource availability, therefore, they tend to have a worse development of the disease. As doctors, we aim to do no harm. Yet if we give treatment for suspected GERD in Haiti we may do harm by desensitizing a patient to a drug, and even making them susceptible to other illnesses. We must think backwards because of the debilitating effects of poverty. Little access to follow up care and poor baseline healthcare hygiene education, etc., inform how we should proceed with treatments.
Now, back to the clinic, I saw a patient I will call "Joseph." He was 12 years old, cachectic, losing weight, feverish, itchy, because of a rash, and experiencing abdominal pain and diffuse lymphadenopathy. But he was quiet and calm-almost stoic. His main reason for coming in was the rash and abdominal pain with accompanying weight loss. During my interview I asked if he had a normal appetite, or simply not enough to eat. I will never forget the look I got from the translator. With a mix of "obviously" and "sorrow," he patiently asked my question and reported that Joseph was losing his appetite. Towards the end of the encounter my impression was a lack of helpfulness. I suspected that the kid has an oncologic process which are causing his symptoms. If that is the case, treatment of his disease could cost him more than a sector of the village combined. With little to no income, even for food, he is not going to get better. So, how do we cope. We can come back to the US, but he cannot. As we sat on the rooftop people spoke of abdominal pain often being related to simply a lack of food, or inadequate knowledge of how to space their meals which leads to GERD: I thought about the level of resource deprivation that renders many poor mothers incapable of feeding their children. Today we worked and it felt insurmountable-from systemic inadequacies to individual diseases the need is great.
Joseph was given Tylenol to help alleviate his fever, and we advised his mother when to seek more medical care, holding out the hope that his condition is not oncologic in nature. Through this exhausting day, I cannot help but think that whether we are prescribing medications or suturing a wound, we are treating an immediate problem and have the privilege of leaving at the end of the week, while they cannot. I have learned so much in 24 hours, all from my ivory tower, and I am humbled by the Haitian tenacity. Just to drive that point home, Haitian translators drive along the bumpiest roads I have ever ridden on. It feels like hundreds of mini car accidents that never end and leave your whole body vibrating when you step out. They drive along this road to translate for the impoverished village of Fontaine, taking off from work to try helping us provide care. They have an insatiable drive and must be motivated by love. As for me, it is becoming crystal clear, "where there is love of medicine, there is love of people."
Joe and the Haiti team
Today was our third full day in Haiti and our third clinic day. We have been having some trouble with the internet for the past few days so we apologize that these emails have not been as regular as they were promised, but that is sometimes the way technology works here. After two days of clinic in Fontaine, today we traveled to another village for clinic and will be back at Fontaine tomorrow. On our third day of clinic we are getting the hang of things but the never ending surprises here continue to humble us. We have met incredibly tough and strong willed people ranging from one month old babies to 96-year-old women. The clinic pharmacy today had some extra visitors-chickens that roamed in and out while prescriptions were being filled, and we had to take a short motorcycle ride through the village to use the bathroom during the day. Other than these minor details, we have much in common with the people and communities here. We are all learning so much-expanding our medical knowledge and cultural knowledge with the help of our Haitian friends. We ended our evening today with a delicious dinner of chicken, rice and beans, and avocado and a group meeting on the roof where we reflected on the day and discussed some of the clinical scenarios we encountered. We are looking forward to another full day of clinic tomorrow in Fontaine. Tomorrow should be a packed day because a few of us have planned to do a home visit for an elderly woman with rheumatoid arthritis to give her a steroid injection in her knee, and a few others have planned a hike up Mont Pignon which is a tall mountain visible from St. Gabriel's. We miss everyone in the US and remember, if you don't hear from us because of internet trouble we are still doing just fine!
Caroline Brotzki and the rest of the Haiti crew