Summer in Haiti

By: Warda Zaman, OMS-II & Yuliana De los Santos, OMS-II

Contributors: Elizabeth Barr, OMS-II, Iwona Dziewa, OMS-II, Bhuma Krishnamachari, PhD, Bill Blazey, DO

Team Haiti using OMM on a patient, assessing and establishing pain scale in Creole when needed

We are not going to tell you how the 7.0-magnitude earthquake, one of the worst disasters faced in human history caused the death of about 222,000 and caused dreadful injury to more than 300,000 people.  This is an underestimated number if you consider the long-term post-psychological trauma faced by several survivors. Nine months later, a cholera epidemic struck Haiti, the first time in over a century. We are sure you have heard all about it in the news and may have donated the $10 to yélehaiti. Volunteers have come and gone (and continue to go as exemplified by yours truly) to provide medical care, working tirelessly under extreme conditions with no electricity and limited resources. Predictably, the situation is worsened by damaged infrastructure and communication systems.                   

We are also not going to share with you, how despite more than $2 billion in foreign aid, Port-au-Prince still has leveled buildings, and structures littered with rubble, including its National Palace.  More than 550,000 people are still in encampments clustered around the capital, living in conditions that are unfit for habitation. This is the scene our team of five NYCOM first-year medical students supervised by William Blazey, D.O. and Bhuma Krishnamachari, Ph.D., landed in Port-au-Prince after a quick 3.5-hour flight from JFK to see.

But we are going to share with you how when we landed in this beautiful country, we were greeted with a hug and smile by our host, Pastor RoRo, a Haitian-American who supervises the four Haitian Christian Outreach (HCO) mission camps throughout Haiti. How during the 47-mile drive that took 5 hours across rough roads and construction to our final destination- Peredo Community Hospital, we received a crash course on Haitian culture and language by Carey and Mike, a couple from Indiana who had been volunteering with HCO for over a month.  Although the long ride was bumpy and tiring, the breathtaking views of the mountains and the Caribbean Sea were enough to dissipate the exhaustion.

Team Haiti helping in closing the wounds of a lady attacked by machete

The Hospital Communautaire de Peredo- Peredo Community Hospital is located at a camp site along with the guest dorms which allowed us to become familiar with the clinic from our first day. Carey, along with Ally and Allison – two summer interns who were a great help in adapting to the living and social conditions of the camp site, had cleaned the clinic, organized the pharmacy, and started seeing patients a month before we arrived. Due to the existence of the Community Hospital, the locals do not have to travel more than an hour and half to a Cuban hospital in Caye-Jacmel, but can save that trip for dire emergencies.

Once they heard that a medical team (word spread that there were six “doctors” at the clinic) arrived, they began lining up starting at 6am and kept on coming until late-afternoon; traveling from near and far. We, medical students, worked in teams of two with Dr. Blazey swinging by to confirm our findings, make a diagnosis and prescribe any medication as necessary. Our days consisted of working in the Hospital from morning until early afternoon, spending afternoons participating in cultural activities and evenings reviewing the day’s work and engaging in structured educational discussions.  The discussion sessions, led by each student member of the team and facilitated by Dr. Blazey, were designed to educate the team about different disease pathologies in the context of Haiti.

Yuliana, part of Team Haiti, treating with OMM

We saw familiar diseases like heart diseases, gastrointestinal diseases and diabetes, but then we also saw diseases created by the results of poverty and injustice like malaria, typhoid, skin and soft tissue infections, easily preventable in resource-rich countries but commonplace in Haiti.  We saw many cases of tinea capitis, recurrent fungal infections, several upper respiratory infections in children, most of who were malnourished, and even some sexually transmitted diseases. We saw more than 350 patients at the clinic in 7 days, not counting follow-up visits, of which there were many.

What alarmed us the most was a case of a woman brought in after being attacked with a machete.  We were told that she was a homeless lady who was mentally ill.  We were not able to confirm why she was attacked but she had multiples open-wounds including a large one on her right leg, a left pinky finger hanging off her hand and a wound right above her right eye.  She was so strong that it required the whole medical team to hold her down while Dr. Blazey stitched her wounds (he managed with 7 stiches versus what would be 14 stitches here in the US).  That same morning we experienced the difficulty of managing chronic disease in a resource-poor country.  We saw a diabetic patient whose blood sugar was so high, she was close to a diabetic coma.  We stabilized her to the best of our abilities, and sent her to the hospital in Caye-Jacmel. Needless to say, that was an interesting and busy morning.

We also want to share with you that our time at the Peredo Community Hospital was a very rewarding one.  Living in the countryside for 10 days allowed us to appreciate how beautiful the land and the people of Haiti really are.  We all felt so privileged to be able to help the people of Peredo and meet the wonderful volunteers that spent their time at the camp site.  While we were at the HCO mission camp, we had the pleasure of befriending a group of volunteers from Ohio who were of great help to us in our work at the clinic.  It was truly wonderful to be surrounded by people who wanted to help others without expecting anything in return.  This trip was a life-changing experience that we will always cherish.

Team Haiti at the Peredo Community Hospital

It’s Impossible to Say “No” to an Abuela

By: Sarah Ng, OMS-II

This past July, a team of NYCOM and NYIT students and faculty travelled to El Salvador to participate in fieldwork as part of the Center for Global Health Program. The team was led by Dr. Zehra Ahmed, Dr. Michael Passafaro, and Dr. Deborah Lardner, and included Hau Chieng (’15), Ryan Denley (’15), Dane Masuda (P.A. ’14), Michael Nickas (’15), Sarah Ng (’15), Jasmine Beria (’14 Academic Scholar), and Jon Giordiano (’14 Academic Scholar).  During our three weeks there, we were able to shadow doctors and health promoters, successfully carry out a clinical study on Chagas disease, run health fairs for students of all ages, practice new clinical skills, enjoy breathtaking scenery, learn about a new culture and history, and much more!  Each of us took turns blogging about our experiences while we were in El Salvador, which was posted on the NYIT homepage during our time there. (http://www.nyit.edu/global_health/el_salvador_2012/)  We thought we would share a few excepts and photos from the blog here.

Today was an extremely full day. We woke up at 5:30 a.m. so that we could head over to the community of Los Cimientos, which was a three to four-hour drive – you lose track of time on these types of trips. We spent the first hour in our regular blue van, but the majority of the time, we sat in the back of a mid-size Toyota pickup truck. We had to travel up to the top of the mountain to reach the community. Even though the seating was uncomfortable for most of us, the sights never got old. We passed children playing soccer, dogs laying in the middle of the road, cows herded up the mountain, farmers taking work breaks in the shade, and beautiful, cloud-perched mountains sitting in the distance.

In the span of fifteen patients, we paid witness to a sixteen-year-old discovering she was pregnant for the first time, a woman who lost her pregnancy while recovering from toxoplasmosis — a rare disease in the United States, but more common in Central America,  a five-day-old baby boy who was extremely good-tempered despite his abdominal hernia, a slew of complicated and uncomplicated upper respiratory infections in children—a major concern in this region, and an elderly man with multiple chronic illnesses driving him into frailty.

Helen, the local Peace Corps worker, was able to organize a Pap smear clinic for us in the morning. The women in El Salvador tend to be nervous and embarrassed about the procedure—not unlike us. However, as a result, they will rarely volunteer for the test; we learned that last year, during an attempt to run a similar clinic, only a couple of women were willing to receive one.

This year, it so happened that a non-profit organization donated 25 solar lamps to the community. Helen was unsure of how she would distribute this finite and popular resource, but then she had an idea: she could offer a solar lamp to each woman who agreed to receive a Pap smear exam. And so, 25 lucky women left the clinic with both an environmentally-friendly light source as well as a helpful preventative measure for cervical cancer!

Dr. Ahmed, Michael, Helen—the Peace Corps volunteer that we met in Los Cimientos— and I followed médico promotor Marvin and his colleague to a local school where they spoke to a class of ninth graders about Chagas prevention. The presentation was remarkable, as it precisely tackled all the critical points about the disease. It also motivated the children to participate and ask questions. At the end of the session, Dr. Ahmed  gave the students a quick lesson on the purpose of our using an EKG in our Chagas study, and also on how to obtain an EKG exam for themselves. She thanked the class for having us.

Our last visit today took our group up a mountainside to visit the lone house on that particular trail.  I can’t even talk about the scary and steep drop-offs or the number of times I slipped or sunk into the mud because I know doing so will only upset me, but we’d heard the old abeula we were visiting was capable of making the trip without any difficulty at all.

On arrival, to my sight and to anyone else’s who’d graced that mountain home today, I saw an alert woman working hard by her indoor wood-burning stove.

After I asked her permission, she allowed me to take a picture of her methodically rolling out tortillas.  She was a very generous host to Dane, Sarah, and me, and happy to have us in her home.  She insisted on serving us some of her food.

Obviously, it’s impossible to say ‘no’ to an abeula.

We ate our tortillas with beans and some cheese taken from a bowl of mountain water.  It was delicious and we left nothing behind.

After assessing her normal blood pressure and asking some basic health questions, we checked her water basin—or pila—for contamination and left her home with a smile and an embrace.

Today was a big day for the five of us who are now second-year students, both D.O. and P.A. alike. We ran a health fair for a school in Yamabal; the fair has been over a month in the making. With the coordination of Peace Corps volunteers Alex and Elsa—Alex teaches at a local elementary school—we educated 40 fifth and sixth graders on nutrition, exercise, the lungs, the heart, and oral hygiene.

…To give the children some perspective on what happens when a person develops high blood pressure, he organized a “human” blood vessel, where NYIT students and faculty served the roles of vessel walls and children played the roles of red blood cells.  NYIT members stood opposite each other an arm’s length away from their neighbors– fortifying vessel walls just wide enough to let our eager red blood cells pass through two-by-two.  We asked the children to repeat the trip, but this time the NYIT members bottlenecked the end of the vessel to simulate a narrowing of the arteries and an increase in blood pressure.  Then, the illustrious Dr. Lardner played the role of a lifetime as arterial plaque impeding our red blood cells’ clear passage through the vessel.

…The constant integration of new lessons with ones we discussed earlier in the day was central to the success of our health fair. Teaching the interconnectedness of healthy choices and their effects on all the systems of the body was our primary objective. The enthusiasm and energy these young children exhibited for nearly three hours can only be a sign that today’s health fair will have a positive impact on their lives. This day showed me that even with obstacles like a language barrier, the right attitude and preparation will lead children to pay attention to your every move and learn from you–even if your Spanish sounds a little funny.

Before I go into anything else, let me be the first to tell everyone that we reached our goal of 300 patients today! Some of us thought it would take two full weeks, while others thought getting 300 patients in our three weeks here was going to be too tall a task; no one anticipated that we would be able to complete electrocardiograms (EKG’s) and venous blood draws on 308 locals in just three days.

So congratulations are in order for Jasmine and Dr. Passafaro, as well as for everyone else who helped them along the way.  This study has been more than half a year in the making. We believe it is going to be a significant stepping-stone in the screening for Chagas, no matter which way the results fall.

I hope you two remember us little guys on your way to stardom.

Learning Cultural Competence Through Service

By: Mark Yassa, OMS-II

Global Health is a topic discussed quite often in medicine today. Even here at NYCOM there is an entire organization, GHO, dedicated to teach students more about multicultural competence. What does the term multicultural competence really mean and why is it so important? Most medical schools now hold lectures discussing topics like global health and global awareness, but does just listening to information presented in a lecture format truly aid in understanding the culture of our patients?  Many, including myself, feel that the best way to truly understand culture is to experience it. It is active learning at its finest. This is why this past summer two other NYCOM students and I decided to take part in a medical mission trip to Nicaragua for 15 days through International Service Learning.
Me and a Pediatric Patient            Choosing Nicaragua was an easy decision for me for two main reasons. First, it is the second poorest country in the western hemisphere, so I felt that my presence there, however short, would be of more benefit to the people there than somewhere else. The other main motivating factor to go to Nicaragua was that it was a great chance to increase my proficiency in Spanish. This was beneficial because Spanish is the second most spoken language in New York City, where I ultimately wish to end up practicing. These factors combined with my personal interest in Latin American culture made Nicaragua my destination of choice.
While there, my peers and I gained a wealth of experience. Aside from the three of us from NYCOM, there were another ten pre-medicine Becky With A Newebornundergraduate students with us. It was great to be with such a dynamic group made up of eager, curious, and enthusiastic students. We assisted in the management of two temporary clinics during our stay, one in an orphanage in a very small village called Los Angeles and another that was run out of a church in Managua, the country’s capital. The orphanage was a great experience for me personally, and much to my surprise spiked my interest in dealing with pediatric patients. I also know that some of my peers got to witness a live birth while they were shadowing the program coordinator at the local hospital, which was of special interest to a few of the students  who may have a future in obstetrics and gynecology.

While we were in the clinic we were paired with translators to assist us during history taking, which was mostly done without supervision of the Katrina Auscultating Heart Soundslocal physicians so it was important to be efficient since there was a large amount of patients to see. While we were taking these histories I became aware that if I was back in the United States, I would most likely be asking much different questions. The factors that were directing my questions came from the bits of knowledge I gained about the culture when I arrived there a few days earlier. I arrived in Nicaragua a few days before the beginning of the program, so I had a chance to experience a little of the culture before the program began. I learned as much as I could by chatting with the locals that spoke English and other Americans who had been in the country for an extended period of time, educated me on many of the other social issues that I was unaware of.
Through talking to a female college student that had just finished studying in Managua for a semester I learned more about the “machismo” attitude that is prevalent in many areas of Latin America. In a nutshell, it is the attitude of masculinity being greater than femininity. This is coupled with the general acceptance of males in the society having multiple sexual partners outside of their marriage. Now, the point of this information isn’t to discuss morality or form judgments about the culture, it is just information. In fact as future physicians we should avoid alienating a patient by counter-transference of our feelings, since this could affect patient compliance to treatments or suggested lifestyle modifications. Cultural information like this has investigative importance during history taking and narrowing down differentials. In this specific example, we all knew that it was important to thoroughly investigate a patient’s sexual history if the he or she presented with any type of genitourinary problems. The cultural knowledge we gained helped us correctly diagnose several patients with bacterial kidney infections.

This is just one example of how knowledge about culture will benefit us in our careers. Benefit would also arise from knowing more about their diet, environmental exposures, home and family life or any other aspect of culture. Gaining multicultural competence is a challenge that all medical personnel will face. The moral of the story here is to attempt to learn as much as possible about our patient’s cultures. With New York City and surrounding areas being home to over 800 spoken languages, the most linguistically diverse city in the world, it is a fair bet that we will have many opportunities to learn about these cultures. The more we learn about the cultures of the communities we treat, the better we will be able to serve them.

Ghana is Rich

By: Neha James, OMS-II

The roads in Ghana are red.  They are made of rich red clay that melts in the heavy rains and powders in the dry heat.   The roads are cracked and uneven, full of potholes threatening to sprain an unsuspecting ankle.  When the sun is at its hottest, all of the roads are uphill and unforgiving.  Despite this, the roads in Ghana are beautiful.  They lead you to spectacular views and exciting discoveries.  When the moon is high, the roads turn blackish purple and come alive with crickets and grasshoppers and elephant grass swaying in the breeze.  The roads in Ghana are just as breathtaking as the rest of the landscape, as the vibrant fabrics, as the faces and smiles and hearts of the people.

My first view of that stunning red clay was from the window of our airplane.  We arrived in the Kotoka International Airport in Accra, the capital of Ghana after a 17 hour plane ride.  From there, it took a day’s journey by bus to bring us to the Jesse Rohde Foundation in the village of Oworobong in the rural Kwahu East District.  I remember sitting on the bus and wondering what I had gotten myself into as I watched dusty, bustling city streets slowly give way to intimidatingly thick vegetation.  Night fell and brought with it a crushing darkness interrupted only by our headlights.  Africa is advertised on television as a wild and downhearted place, both violent and destitute.  As the branches scraped along our windows and the road grew increasingly bumpy and narrow, I began to feel overwhelmed by that wildness.  I began to second-guess my decision.  I enrolled in the Global Health course because I sincerely believe that we all have a responsibility to expose ourselves to the world and do what we can to help.  I wanted to break out of my comfort zone and throw aside my sheltered life.  I hoped in my naivete to make a difference in Ghana, but the truth is that Ghana made a difference in me.

Over the three weeks I spent in Ghana, I helped my team to complete nutrition surveys in local schools, performed puppet shows to promote malaria prevention habits, and shadowed medical staff in neighboring hospitals and clinics.  I wrapped a long measuring tape around unbelievably skinny arms to collect left arm circumference data.  I listened to children as young as five years old tell me they’ve only eaten one meal in the past 24 hours.  I checked and rechecked the scale, unable to accept that the ten year old in front of me could only weigh 38 lbs.  I watched doctors prescribe antimalarial medications without performing a physical or waiting for blood results or explaining potential side effects.  We were taught about the differences in medical practice and quality of life during our Global Health course, but witnessing them for ourselves was staggering.  I would be lying if I said that these things don’t weigh on the soul, especially now that we are home in the U.S. with so many resources available to us.  I would also be lying if I said that this is the image I have now of Ghana, an image of poverty and inadequacy.

Ghana is rich.  While it lacks greatly in medical care and educational opportunities, Ghana is wealthy in hospitality and love.  Everywhere we went, people greeted us with shouts of “Akwaaba, you are welcome!”  They were all eager to meet us, learn from us, and help us.  The children fought excitedly to hold our hands or to pump water as we washed our hair.  Women set aside their chores and even the babies on their backs to take our laundry.  Men holding machetes sharp enough to slice through foliage in a single swipe smiled broadly and posed for the camera.  Ghana is rich in ways that America is poor.  In rural Ghana, there is no obsession with accumulating wealth or status or power.  The people are curious and playful, but never envious or greedy.  They stop us on the roadside not to ask for donations but to ask us how we are enjoying their home.  We see everything they lack due to all the comforts that cushion us here in the Western world, but it is impossible to feel pity for the young girl who is balancing a bucket of your bath water on her head because you cannot carry it yourself.  Even the small children, in their broken shoes and torn clothing, with their thin limbs covered in mosquito bites scratched open, smile and play and laugh as joyfully as children should.

Now, I am once again consumed by the chaos of American life.  The chaos in Ghana is that of children clinging to your arms and dust flying up your nose and goats walking in on you as you shower.  The chaos here is the feeling of never having enough time, energy, or money to attain something as simple and free as happiness.  Leaving Oworobong was harder than I could predict.  In those short three weeks, I truly came to call the village my home.  I discovered that one can prepare a proper morning routine with just 500 mL of water, that there are many more hours in the day if you take television and computers out of the equation, that the number of stars in the sky is far greater than I ever imagined.  I witnessed my first vaginal delivery and my first Cesarean.  I acted as a scribe at Tafo Maternity Clinic’s outpatient center and went on rounds with the attending at Hawa Memorial Saviour Hospital in Osiem.  Ghana provided me with a new understanding of health, poverty, and life.  I feel so thankful to the country and so indebted to the world.  It’s hard to sit still when you think of all that needs to be done, and even three weeks’ worth of experience, leaves me feeling like I haven’t done anything at all.  In the end, I believe that’s the whole point–never feel like you’ve done enough and always strive to do more for your community and for the global community.

I left Ghana with more of everything.

I am forever grateful.