Thursday was Dianna’s birthday (one of our translators for the gyn shack…a pretty impressive one too! She would take time to explain what a pap smear was and why it was important. She started nursing school last year. When I asked Joel if that was from her experience working with us over the past 5 yrs, he said, “Absolutely! She used to want to be a construction worker!”) So Carol (the pediatrician) decided she wanted to throw a party for her. We were on it! Doctor Susan (the gynecologist), myself and Joel jumped in the back of Dr. Gousse’s pick up while Carol and Osmain sat in the car (it sounded like a good idea at first…until my newly “washed” hair became caked in Mussotte dust.) So lets talk about the roads in Mussotte. Imagine an English Muffin spray painted orangey-red and cut in a rectangle. Now take out pieces of the muffin to make some holes and put those pieces on other parts of the muffin to look like rocks. Now make it on a slope in a surreptitious direction. Now plant lots of trees on the sides and place chickens, goats, dogs and cows along the road. That’s the Mussotte road! We went all the way to Miraguan (the nearest city and nearest hospital) which took about 35 minutes as we dodged the holes and the rocks and the various farm animals. Now imagine being in the back of a pick up truck! As I nauseously entered the little store…we found a cake, birthday party gear (hats/plates/napkins), ice cream, candles and a large bottle of Crema (kinda like Baileys Irish Cream…but with Rum). Joel was able to get Dianna out of the house as we set up our party. He brought her back and she was indeed surprised. We played music and danced and partied in our rural village of Haiti.
Saturday was surprisingly not as crazy as anticipated. We were done with the medicine patients by 3pm with hema-cues and ISTATs to spare! However, every day was crazy for the Gyn Shack. Around noon, Dr. Susan made an announcement that she would not be taking any more gyn referrals as they already had 50 signed up by then. Triage wassending all women to the gyn shack where they would get the “Pap Talk” from Dianna and thus decide if they wanted it. Many women from last year came back and so if they had normal paps, they didn’t need another one. Occasionally I would see a 70 year old have the gyn station circled and I would redirect them to the adult station. They don’t need a pap! They saw about 200 women and did over 150 paps and about 6 cryos total for the whole week. We had several people come back for blood pressure follow-ups or lab testing. Sam precepted with me about a patient she was concerned about. Thepatient had a hard mass on the right side of her face. With so many patients that the students see, one of the skills we want them to master is who is really sick and who’s not. So with this one, we spent more time getting a better history…no nausea or vomiting or diarrhea. She had it for 6 months. We did a through oral physical exam…just the hard mass. I called Dr. Gousse who had just left to return to Port-au-Prince. At first I couldn’t get a signal, so I asked the pastor in French if I could use his phone. He took my hand and escorted me to a corner of the church and viola….I had service (just in that spot!). Dr. Gousse notified me that Hope Hospital would be having visiting Oral Surgeons in November. So on an official “Hope Hospital” prescription paper I wrote for her to show up for consultation with the oral surgeons. I made sure she had the means to get there and a place to stay. Hope that works!
Near the end of the day, a man showed up showing us pictures of a friend. His back looked like it had hypo-pigmented splotches…kind of likevitiligo. He would walk us to his house. With some back and forth, Joel figured that it would be pretty far to walk, so we waited for Dr. Goulos to come home. So around 4 pm we piled in his SUV and ventured to his house. Now remember the roads? Now cut a piece of the muffin to the size of a strand of fettuccini and make it more squiggly…keep the holes and rocks and cows and goats and dogs though. It took about 20 minutes to drive maybe 3 miles! We were definitely in the jungle! When we met the man with the skin problem, we all just looked at him quietly. None of us had ever seen anything like it. He just wore boxer shorts and covered his torso with a quilt that went over his shoulders. His entire body was like elephant skin covered in blisters and ulcers. Tiny gnats flew around him as a continuousfilm of activity. He looked very skinny and very miserable, yet very stoic and humble. We decided to take the fettuccini road back to the house where all our meds and supplies were by then and return to take some biopsies. We gave him two jugs of silvadene cream, which we use for burns but should help with the ulcers. We brought him the rest of the indomethacin (family of ibuprofen for pain) and the rest of our antihistamines, which should help with the itch and sleep. We used lidocaine and a scalpel to make a few holes in his skin and put them in the pap bottles for the pathologist to read back in the states (along with the paps). Carol was curious and came with us and helped. Elaine, Joel and Goulos also went. We did an HIV and Syphilis test on him which both were negative. I asked Goulos to check in on him and he said he would. Weirdly, the wife said they took him to a “Dermatology Hospital” and had no answers for him. I have a hard time understanding that. Maybe they couldn’t afford the testing and treatment. Anyhoo…I hope the meds we left him will allow for some comfort. It’s patients like him that make me feel impotent at times.
Luckily, we didn’t see too much tragedy. Joel commented that he thought the community was healthier than usual. We saw over 700 patients in 5 days! We did get to see the satellite clinic in Mussotte where one can go for vaccines and TB testing, but the woman there wasn’t very welcoming and didn’t really want to show us around or talk to us. Goulos thought it was because when he had his clinic, she felt he was taking patients away from her. Oy vey! Samantha was keeping track of the kids who were vaccinated. Most kids had vaccines but theparents didn’t know which ones except for BCG (the TB vaccine) and some mentioned polio. They didn’t know if they were completed though and ironically…most went to the hospital (braving the rusty-English Muffin-holey –rocky- farm animalie roads!)to get the vaccines and not at the local clinic (probably because the lady is so mean!).
So last year, we were excited to see that the Fan Fan brothers had started a clinic at the church and that they were staffing it 5 days a week between the two of them, but alas, this year, the clinic had closed. They weren’t able to sustain it, since they had no funding. Elaine and I were peppering Goulos with questions as we drove back and forth to the skinman’s house. “How much does it cost to run the clinic?” Answer :$1500 per month; “How much does is cost to run it 2 days a week?” Answer $600 per month. Elaine and I were, as usual, on the same page. That’s doable! Joel continued to talk to Goulos and by the end of our driving back and forth, Goulos agreed to reopen the clinic and Joel would help withthe business plan. His plan is to ask every household to donate $25 per year like an insurance plan. Some can pay the full amount, some might just pay half and some won’t be able to pay at all, but it will allow for the clinic to be sustainable. Elaine had already looked into a grant to support a Community Health Worker, but we hadn’t settled on what the worker would focus on. In our discussions with Goulos, we decided that a pregnancy advocate would be the ideal beginning. Goulos and the doctor in Paillant confirmed that even though prenatal care and deliveries are free, the people don’t routinely come to the clinic nor choose to deliver there. It’s part of the culture to not trust hospitals (and the roads are also a real barrier…imagine that!) So having someone doing prenatal checks in the home would be a start. We decided to not rely on the designated Ministry of Health Community Health Care workers. Our Community Health Care Worker would be supervised by the Fan Fans out of the clinic that we will help support. Elaine and I had plenty of time to strategize, prioritize and recreate our purpose in Haiti (while resorting 2 days at the beach!) We continue to be dedicated to students early in their careers in order to give them an experience that will shift their career trajectory toward one that includes poverty medicine. We’ve adopted Mussotte as our community of choice to work with. I had a discussion with my son Joel that it’s time for him to take on more of a leadership role with H.E.A.L and we discussed what that would look like. He has agreed to be the lead operator for the clinic in Mussotte as far as coming up with a business plan, who to hire, how much to buy, and keeping in close contact with the Fan Fans. He ultimately wants to create an EMS system in Haiti (aka 911) ,which they don’t have and I think this would be a good beginning project for him. “But the most we can do for Mussotte,” I told Joel, “we have to get the roads paved!” I told him he’s in charge of that, too!
When I was checking in at the airport to fly home, by suitcase weighed 53.5 pounds. The Jet Blue guy said, “That’s ok. You’re my mama. I take care of you.” I thought, ok, I can take on being Haiti’s mama (or big sister, maybe) LOL!
For those that wanna join in the sisterhood (or brotherhood) we’re looking for people to be on our Board to help w fundraising, treasury and all around support. We want to play a bigger game. We would like to reach out to philanthropists, universities, companies etc so that we can sustain our impact in the world and with students. Let us know if you feeling pulled to be a part of our leadership team! Also, let me know if you would like to continue to help support the clinic in Mussotte on a more long-term basis. We couldn’t do any of this without all of you and so I am incredibly grateful for everyone’s perpetual generosity!
Hugs! Dokta Susan P