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Cherlie and I had a short break at the beginning of April when we went up to Milwaukee for our 6th annual Hope for Haiti fund-raising banquet. It was a wonderful event and we were able to see a lot of former acquaintances, medical colleagues, Haiti visitors and meet some wonderful new friends. Now, we’re back at work again in the clinic and we certainly are enjoying being in the new clinic building. Our patients really enjoy it too and every day we hear expressions of their appreciation for providing them with such a beautiful place in which to receive care.

As we all know, it’s not the beauty of the surroundings that determines whether someone will get better or not when they’re ill, it’s the quality of care they receive. But, the cleanliness, organization and physical appeal are a reflection of the respect we have for our patients, and that is also reflected in the care we give them. We feel that as followers of Jesus Christ we are called to a higher level of excellence in all that we do in life and our careers and professions are certainly the most obvious places to witness that excellence.

Patients waiting on the porch of our new clinic as Cherlie talks with them

Patients waiting on the porch of our new clinic as Cherlie talks with them

Dr. Wolf examining a patient in the new clinic

Dr. Wolf examining a patient in the new clinic

CONSTRUCTION UPDATE

The workmen have been hard at work the past month doing the final stucco work inside and outside the second floor residence quarters that is on top of the pharmacy and lab building. They have made very rapid progress and the building feels like it is in the final stages of construction. We are extremely grateful for all of the financial donations that have made this construction possible. Thank you!

Masons putting on final stucco layer on second floor residence on top of the pharmacy and lab building

Masons putting on final stucco layer on second floor residence on top of the pharmacy and lab building

ANOTHER VISIT FROM JOHNS HOPKINS NURSING STUDENTS AND FACULTY

We were happy to host another group of nursing students and faculty member Grace Murphy this past week from Johns Hopkins School of Nursing (JHSON). We are involved in an ongoing water and sanitation community development project with them and we made good progress during the week. Three of the days were spent holding community education sessions in communities near our clinic that are not directly involved in the water and sanitation project.

JHSON students and their translator provide community education in a local church near the clinic

JHSON students and their translator provide community education in a local church near the clinic

JHSON students and faculty demonstrate hand washing technique to local community members

JHSON students and faculty demonstrate hand washing technique to local community members

While part of the group of students was out in the local communities, the rest were assisting Cherlie and myself in our clinic. One of the highlights for our patients was that they received education from the students while waiting for their consultations.

 JHSON students teach patients as they wait for consultations in the clinic

JHSON students teach patients as they wait for consultations in the clinic

Two days were spent holding a continuing education session for the 12 promoters who were trained in September 2013 to do community education. These promoters have been very active in their communities teaching people about how diseases can be spread by contaminated water, the importance of treating drinking water, personal hygiene and hand-washing and proper storage of treated water.

JHSON students teaching water and sanitation promoters in a continuing education session

JHSON students teaching water and sanitation promoters in a continuing education session

Promoters (note the t-shirts they were given after their training last September) listen to the lessons and follow in their notebooks

Promoters (note the t-shirts they were given after their training last September) listen to the lessons and follow in their notebooks

Of course, teaching wouldn’t be complete without having the promoters teach new material to one another. This helps reinforce the teaching points and allows them to give feedback to one another regarding the effectiveness of their teaching.

One of the promoters teaches new material to the other promoters under the watchful eyes of the JHSON students

One of the promoters teaches new material to the other promoters under the watchful eyes of the JHSON students

A new twist to the educational sessions was having the promoters participate in playing “comparison” games with pictures demonstrating good and bad hygiene practices. They loved the games and feel that they will help them in their community education activities.

Promoters learning to play the “comparison” game with hygiene pictures

Promoters learning to play the “comparison” game with hygiene pictures

At the end of the week, promoters and students posed in front of the clinic, giving the “clean hands” sign.

Promoters and JHSON students giving the “clean hands” sign

Promoters and JHSON students giving the “clean hands” sign

When visitors stay with us at our home in Jérémie, we like to show them the town and have them experience some of the activities. This group of students was able to participate in Haitian Flag Day celebrations in Jérémie on May 18th.

Haitian school students in colorful uniforms celebrating Flag Day in Jérémie on May 18th

Haitian school students in colorful uniforms celebrating Flag Day in Jérémie on May 18th

JHSON students and faculty at the Jérémie soccer stadium observing Flag Day festivities

JHSON students and faculty at the Jérémie soccer stadium observing Flag Day festivities

Another highlight of the students’ visit was that they brought several duffel bags full of used tennis shoes to us. We’ve had a wonderful time distributing them to needy patients in the clinic. They are thrilled with the gifts and we feel blessed by the givers! Thanks to all who contributed to this effort!

Cherlie helping a patient try on his new tennis shoes in clinic

Cherlie helping a patient try on his new tennis shoes in clinic

New tennis shoes bring a smile to the face of this little patient and his mother

New tennis shoes bring a smile to the face of this little patient and his mother

 

 

 

 

 

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By Dr. Katie Wolf

Okay, everybody, sing to the tune of “Row, Row, Row Your Boat”:

Lave, lave, lave men nou                      Wash, wash, wash your hands

Lave men nou chak jou.                       Wash your hands each day

Avan w manje, apre w twalet,             Before you eat, after you use the toilet

E nou va gen santé.                               And you will have good health.

This is one of the songs that the Johns Hopkins School of Nursing (JHSON) students taught our 12 Community Water Promoters at the three-day training program we held for them this past week.  The training session was part of a new water and sanitation development project that we’ve started in six of the communities around the clinic site.  These six communities were chosen because they showed that they had good leadership and did well with a seed project we have been doing with them over the past few years.  Each of the six communities chose two people for us to train as community promoters.  These promoters are charged with the task of changing their communities for health!  This is, of course, not a small task.  But, we are asking them to go around their communities with the message of clean water, good hygiene and sanitation, and hopefully, in time, attitudes and behaviors will change.

With funding from the Fox Cities Morning Rotary Club in Wisconsin and partnership with the Johns Hopkins School of Nursing, we began this project last spring with an initial assessment in the six communities to evaluate their present practices with regard to water treatment, water storage and basic hygiene and sanitation.  This assessment was conducted by our Community Coordinator, Gemi Baptiste and students and faculty from JHSON.  After this assessment, Gemi met with leaders and members of the communities and each community chose two people to become Community Promoters.

Community meeting to choose two promoters for training

Community meeting to choose two promoters for training

Promoters who were chosen by community leaders and members

Promoters who were chosen by community leaders and members

In September when the school semester began, the Johns Hopkins students and faculty began work on the curriculum to be presented at the training session.  With input from us here in Haiti, and with teaching materials gathered from various organizations and institutions, they had a good start to their teaching plans when they got down here.  We used the weekend to work out some of the final details and plan the upcoming week’s schedule.

The students were accompanied by two faculty members, Kevin Ousman and Grace Murphy.  They did a wonderful job of keeping the students focused and productive, but relaxed and able to have fun.

Faculty members from the Johns Hopkins School of Nursing – Kevin Ousman and Grace Murphy

Faculty members from the Johns Hopkins School of Nursing – Kevin Ousman and Grace Murphy

On Monday and Tuesday, the students had a chance to help Cherlie and me in the clinic as we consulted on our patients.

Students doing patient education with the help of a translator

Students doing patient education with the help of a translator

Emily Devan uses a Doppler to check for fetal heart tones on a pregnant patient

Emily Devan uses a Doppler to check for fetal heart tones on a pregnant patient

Megan Armbraster lets a little patient hear his own heart sounds!

Megan Armbraster lets a little patient hear his own heart sounds!

Wednesday marked the first day of the Promoter Training sessions.  All twelve promoters were very prompt in arriving and attentive to the teaching for the day.  The main objective of the first session was to present basic information about germs and how they spread and cause disease.  The students were very creative in demonstrating their major teaching points!

Students who taught the first day’s sessions – Nicolette, Caitlin and Amy

Students who taught the first day’s sessions – Nicolette, Caitlin and Amy

Everyone gets a chance to wash glitter off their hands.

Everyone gets a chance to wash glitter off their hands.

A major area of emphasis was cholera, which is resurgent again in the area around our clinic site, due to recent frequent rains.

Cholera teaching aid put out by the Haitian Department of Public Health

Cholera teaching aid put out by the Haitian Department of Public Health

Cherlie giving the promoters important information on cholera and how to prevent it.  She does similar teaching in the clinic each day.

Cherlie giving the promoters important information on cholera and how to prevent it. She does similar teaching in the clinic each day.

Thursday was a day for hands-on activities for the promoters.  They learned how to properly wash their hands with soap and how to make a “tippy tap” to pour water onto their hands from a gallon container without touching the container.  Everyone enjoyed the practical learning that day.

Making a “tippy-tap” in small groups

Making a “tippy-tap” in small groups

The promoters also practiced making oral rehydration fluid, as they would at home, to treat diarrhea and dehydration.

The promoters also practiced making oral rehydration fluid, as they would at home, to treat diarrhea and dehydration.

Friday, the third day of the training session, was spent reviewing all the previous information and practicing using some of the visual aids that the students had organized in a notebook for the promoters.  Each promoter had the chance to present a topic using a large poster, just as they will in the future when they present information to their fellow community members.

Using a poster to discuss important teaching points.

Using a poster to discuss important teaching points.

The high point of the day, though, was the giving of gifts, including T-shirts with the clinic logo, white caps, bright green bags to carry their notebooks and personal hygiene kits.

Promoters receiving their bag of gifts

Promoters receiving their bag of gifts

Promoters with Cherlie and Katie and their T-shirts

Promoters with Cherlie and Katie and their T-shirts

We want to thank the various Rotary Clubs in Wisconsin who have contributed to this water and sanitation project, the Johns Hopkins School of Nursing students and faculty who made the teaching sessions so informative and enjoyable and the businesses and organizations who helped the students bring down the T-shirts and gifts that were so special for the promoters.  A special thanks to all who prayed for our success and safety during the week!

The cholera epidemic has now reached Port-au-Prince, according to Haitian government health officials.  Over 70 cases have been identified in people who live in Port-au-Prince, but contracted the disease while visiting outside the capital.  Several cases have been reported in patients who have not left the capital city, which means that it was acquired there, rather than in the area where the epidemic began.  This is a serious development, because it means that the bacteria causing cholera is now in Port-au-Prince itself.  Officials are setting up cholera centers throughout the city and clinics and hospitals are gearing up to handle the epidemic.  Flooding from the recent hurricane, Tomas, will only add to the risk of spread of the disease.

At this time, there are no reported cases of cholera in the Grand’Anse department where we are located.  We’re taking the epidemic seriously, however, and are augmenting our own stock of antibiotics, oral rehydration packets and IV fluids in preparation.  Each time we go up to our clinic, we do health teaching with our patients, instructing them to be careful about the water they drink and to practice good hygiene and hand-washing.  We also have several hundred “hygiene kits” that we will distribute in our area, if needed.  We appreciate your prayers as we attempt to deal with this new crisis.

I’m sure you are all aware from the news channels that there has been an outbreak of cholera in Haiti.  Cholera is a very deadly disease, causing severe diarrhea that leads quickly to dehydration and death.  This is the first time it has been reported in Haiti and is a very serious situation on top of all the other problems here related to the January earthquake.  It was first reported on October 20th in the town of St. Marc, which is located north of Port-au-Prince.  Since then, cases have been reported in the Artibonite, Central and North departments of the country (Haiti is divided into 10 departments, which are like states.  The department Jeremie is in is called the Grand’Anse).  Between October 20 and 27th, the Haitian Ministry of Health has reported 4649 confirmed cases of the disease and 305 deaths.

The Haitian government, UN, and other non-profit organizations already working in Haiti after the earthquake have now begun to respond to this new crisis.  Cholera treatment centers are being set up in affected areas, and water purification tablets and oral rehydration salts are being distributed, especially in camps where IDP’s (internally displaced persons) are living.  In addition, many organizations are mobilizing community health workers and other personnel to do community education and teach about prevention, especially emphasizing water purification and hand washing.

On Friday, October 29th, there were reports of demonstrations against Nepal UN forces who are stationed at a base near the Artibonite River.  Many feel that the Nepal soldiers are responsible for bringing the disease, which is endemic in their country, to Haiti, contaminating the Artibonite River, leading to spread of the disease.

Thus far, no cases have been reported in the Grand’Anse department and Jeremie.  We have been spending time during each of our clinic sessions, though, discussing the outbreak and teaching our patients basic prevention techniques.  We receive reports from the UN every 1-2 days and are keeping up with the progress being made in containing the outbreak.  Everyone here is hoping that the disease can be prevented from reaching Port-au-Prince, in which case, it would likely spread to the entire rest of the country.

We will keep you updated from time to time on this blog.  Please continue to pray for this country and its people.

Clarice sat in her chair on the side of the desk in my examination room, looking intently at the little test cartridge.  I was talking to her as the HIV rapid test result was developing.  I realized she probably wasn’t hearing much of what I said – she was concentrating on the test cartridge.  I think she already knew the result – most of our HIV positive patients have been tested before and come to us to confirm their fears.  “The test is positive,” I told Clarice.  “That means that you have the HIV germ in your blood.”  I watched her face as I gave her the bad news.  Her head jerked back as if she had been struck.  “It’s positive?” she asked.  “I don’t know how that could have happened.”  As it turned out both she, 52 years of age, and her 69 year old husband were HIV positive.  They had nine children together, and both denied having sexual partners outside their marriage.  We suspected that wasn’t quite the truth, but we’ll probably never know.

Fortunately for Clarice and her husband, there is a very comprehensive HIV treatment program here in Jérémie, funded by PEPFAR funds (President’s Emergency Plan for AIDS Relief).  Testing, consultation, medications and hospitalization are all free, and the program gives nutritional support and money for transportation when funds are available.  We have diagnosed and referred several patients to the program already, but we continue to follow them in our clinic for other medical problems.  They like the fact that they can continue to see us and stay in contact with “their clinic”.

Each Friday morning I make rounds at the government hospital in Jérémie with the physicians who are responsible for the HIV program.  They work at the hospital as hospitalists, responsible for all the patients admitted to the medical service, both those who are HIV positive and those who are not.  Rounding with them gives me a chance to get better acquainted with the way the hospital functions, allows me to act as a mentor to the younger physicians and gives me experience with the HIV program itself.  In our clinic in Gatineau, we offer testing to all our adult patients and find that most are very receptive to being tested.  We hope to be able to detect many who are in the early stages of the disease, so they can be enrolled in the HIV program and begin treatment when necessary; people like Clarice and her husband.

Our overarching goal at Friends for Health in Haiti is to improve the health and change the lives and hearts of the people of Haiti. We desire to do this by providing integrated health care to patients of all ages, in a nurturing, Christian environment. We feel that it is important to maintain dignity while providing charitable care, instill a sense of responsibility, rather than contribute to dependency and strive for long-term sustainability by keeping our administrative processes simple and making wise use of limited resources.

Our developing model of care involves the following key concepts:

  • Care for patients of all ages each day
  • Point of care education using “teachable moments” during acute illness
  • Services directed to areas of greatest need (epidemiologically directed services)
  • Best practices incorporated into clinical guidelines for care
  • Empowerment of communities through participation in decision-making and responsibility for some of the costs of care
  • Nurturing, respectful, compassionate environment
  • Development of relationships as a priority: clinic staff relationships with the surrounding communities, local churches and religious leaders and the government sector, community members’ relationships with one another, especially the vulnerable, malnourished, elderly, and homeless
  • Teaching and mentoring of Haitian counterparts
  • Collaboration with and integration into the public health care system, including provision of immunizations, tuberculosis treatment, HIV testing and treatment, community education activities, and capacity building at the local government hospital in Jeremie
  • Integration of Christian witness with demonstration of strong moral and ethical principles in daily life and practice
  • Integration of traditional healers into the formal health sector

We invite you to share your ideas with us as we continue to develop this innovative model of care.

This afternoon we took another pediatric patient to the general hospital in Jérémie. We had seen him, a three-year old boy, last Thursday with fever and malaria. Since his father died and his mother lives in Port-au-Prince, he lives with his grandmother in a community near the clinic. We told the grandmother that if he wasn’t doing well over the weekend to take him down to Jérémie to the hospital. As it turned out, his fever came down but he developed diarrhea and wouldn’t eat. She gave him some juice, but other women in the community unfortunately advised her against giving him water, saying that it would somehow make him weaker. She was sitting there on the bench outside the clinic when we arrived this morning. It was obvious that the child was severely dehydrated, his little eyes sunken and his cries weak. We suggested that she take him down to the hospital right away, but she shook her head and said that was impossible. She didn’t know where to go, had no one to help her and had no money. So, we had her give him oral rehydration fluid all day there in the clinic, hoping that we could stabilize him enough to send him home. But, as we neared the end of the patient consultations, he had not improved and we knew that if we sent her home with him he would probably die during the night. So, the back of our pick-up truck became an ambulance once again, as we took the child and his grandma down the mountain to the hospital.

When we got there, I told the nurse on the pediatric ward the child’s history. She took some notes and sent someone off to get the doctor on call. She left the child lying on the examination table, and went off to take care of her other duties. My thoughts flashed back to the Emergency Departments where I used to work in Wisconsin. “Isn’t severe dehydration an emergency?” I thought. “Where is all the activity – drawing blood, starting an IV, nurse at his side, doctor in the room immediately?” Then, I realized with all too much clarity, that this, indeed, wasn’t Wisconsin, and in the nurse’s mind, this “emergency” could wait a few more minutes. Cherlie and I, however, were getting increasingly uncomfortable, so I finally suggested that I go to the pharmacy to buy a bottle of IV solution for the child (patient’s families generally have to buy all medications, needles, IV solutions and supplies for the patients before they are given any care). I figured this was a good way to get the ball rolling without being offensive. So, I bought the IV solution, but the pharmacy didn’t have the right size IV needle. The nurse said she would “lend” one from their supply, and began gathering gauze, alcohol, tape, tourniquet, etc. to prepare to start the IV. Finally, after another 30 minutes, the IV was in the young boy’s arm and the IV solution was running. I breathed a silent prayer of gratitude. Shortly thereafter, the on-call doctor came in and I again related the child’s history. He turned to write his admitting note and orders and it was obvious my presence there was no longer needed. So, we left some money with the grandmother, said we’d check on the child tomorrow and went on home.

As I sit here thinking about and praying for the little boy, I also think and pray about our clinic and the potential we have to impact lives such as this. Had the grandmother and her neighbors been more knowledgeable about childhood diarrhea and the importance of the use of oral rehydration solution, the child’s dehydration might have been treated sooner and been less severe. That’s why community education and health teaching is so important. And, if we had a clinic building and living quarters built there in Gatineau, we would be able to offer medical care daily, so the grandmother could have brought him back for re-evaluation sooner. And, if we had our clinic functioning and fully staffed for emergencies, we would be able to give him IV fluids during the day and keep him overnight, if necessary, rather than taking him to the local hospital, where emergencies aren’t urgencies and very little care is given without money available first.

As you think about this little boy, please pray with us that the “if only’s” will someday become reality.

Greetings once again from Jeremie, Haiti! As I mentioned in a previous blog, Cherlie Severe and I recently spent a few weeks in the US, attending conferences, visiting family and taking care of business related to our Haiti ministry. The first conference we attended was the annual conference for Christian Connections for International Health. This is a wonderful organization which seeks to provide resources and networking information for faith-based organizations working in global health. There were about 125 attendees at the conference, which was held at a retreat center near Fredrick, Maryland. The conference sessions and small group activities allowed us to learn some valuable information and develop relationships with others involved in community-based work like ours. If you’re interested in more information on CCIH, I encourage you to visit their website (www.ccih.org).

The second conference, which was held in Washington, DC was the annual conference for the Global Health Council and had around 2200 attendees from over a hundred different countries! It was a whirlwind week of panel discussions, lectures and small group sessions, but allowed us to hear first hand about the most up-to-date activities in the field of global health all around the world. And, it provided us with many valuable contacts for the future. Their website is www.globalhealth.org if you’re interested.

Today, Thursday, we were able to successfully make it up to our clinic in Gatineau without running into any problems or disturbances.  There were about 6-8 places along the road coming out of town where there was black dust on the road and burned steel wires from tires which had been burned there earlier in the week.  These were obviously areas where roadblocks had been created with burning tires and debris, keeping traffic from passing to and from town.  Roadblocks are a common form of demonstration here during periods of political unrest, and something that we’ve seen often over the years.  We’re hoping we won’t see more in the future!

It appears, from reports we’ve gotten from Port-au-Prince, that the demonstrations and violence there has abated as well.  All of this has been due to the rising price of goods and increasing hunger and poverty in the country.  There have been a number of news reports lately about Haitians making and eating mud pies, due to lack of food.  While that hasn’t been typical in our area of the country, there has definitely been a worsening of the economic situation in the country as a whole and an increase in the level of hunger and poverty in the communities around our clinic site.  Every day we hear stories about the scarcity of food, due to poor crops and high prices for seeds, and we often truly wonder how these country people are able to live each day.

With poor nutrition comes worsened health, making people more vulnerable to infections and illness.  We’re seeing increasing numbers of patients in our clinic with high fevers, pneumonia, malaria and typhoid fever and several patients with suspected tuberculosis.  We give vitamins and worm medicine to nearly everyone, to help improve their resistance to infection and fight their illnesses.  We’ve received donations of infant formula and milk, which we give out to our pediatric patients’ mothers.  But, our greatest need at this time is to receive enough funds to be able to begin construction of our clinic facility and living quarters, so that we can live in Gatineau fulltime, provide medical services on a daily basis and begin to help improve the economic status of our neighbors.  We appreciate your continued prayers and would be grateful for any financial support you are able to give us during this difficult time in Haiti.

Medical personnel sometimes wonder what is the difference between medicine and public health? Or, as I like to phrase the question, what is the difference between the medical model of care and the public health model?

  • Physicians are trained according to the medical model, which basically involves looking at an ill patient and deciding how best  to treat their illness, no matter how many resources are required.
  • The public health model looks at populations of ill people, trying to figure out what could have prevented the illness in the first place and improve the health not only of that individual, but of the whole population of which he or she is a part. Another important aspect of the public health model has to do with using limited resources in a way that will help the most numbers of people (this involves cost effectiveness and efficiency) and be equitable to all.

In our work in Haiti, we are operating with both models. We place priority on the public health model, as we care for individual ill patients. We try to prevent similar illnesses in the future, make sure that all people have access to basic medical treatment, and use our resources in the most effective and efficient manner. Our goal is to improve health in entire communities, establishing a model of care that can be replicated elsewhere. Meeting this goal begins with improving access to primary care of illnesses, so that minor illnesses can be treated promptly, thus preventing more serious complications from developing. There are many things that prevent people from getting the medical help they need in Haiti. These include distance (usually people have to travel on foot and the country is very mountainous), expense, fear of doctors and hospitals, and personal beliefs about health and disease. Many times, even when a patient is able to get to a local clinic or dispensary, they don’t find the medications they need, or the staff is not trained adequately totreat their illness. That’s why we place special emphasis on having an adequate supply of essential medications and in providing the highest quality care possible. In future newsletters we will discuss further plans we have for meeting the health care needs of the communities we serve.

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