Global Health Fellows Blog
Share in the adventures of Medical Missionaries' Global Health Fellows
by keeping up-to-date with their work via our blog! The people of Thomassique, Haiti, are greatly benefitting from
the work of our fellows!
Our First Month
10:52 pm edt
Bonjou tout moun and welcome to our blog!
It's hard to believe, but we have now been in Thomassique for a full month. After a whirlwind orientation from Katie and Kavita, we have quickly assumed our many roles as fellows
and already survived a few ti pwoblem along the way, including mechanical difficulties, illnesses, and embarrassing
Kreyol misunderstandings. For the next year, we'll use this blog to give updates about our work in the clinic and community,
for anyone that is interested! This post is admittedly overdue, but we promise to post more frequently in the future.
Our central goals this year
focus on improving St. Joseph's Clinic itself, so we'll begin with an update about the happenings in our klinik.
For those who don't know, St. Joseph's is a rural clinic that provides primary care, maternity services, lab tests, basic
radiology and emergency care to approximately 100,000 people in Thomassique and the surrounding areas.
We have quickly learned that supply management is a significant challenge at St. Joseph's. This is a common problem for clinics in the region,
and has been further complicated by the increased medical needs in post-earthquake Port au Prince. So, in an effort to improve
our oversight of medications, lab tests, and other supplies, much of our time has been spent organizing and inventorying items
in the clinic. After countless hours of moving, sorting and labeling, we finally have three sparkling rooms full of neatly
organized boxes: The medications depot (pictured at left, alphabetized and labeled with expiration dates), the orthopedics
depot and the storage room which once held the Tuberculosis program. The ER depot will also be completed soon, and after that
loom the surgical and pediatrics depots. Though it may not be glamorous work, knowing and tracking what we have in each of
these spaces is incredibly important for keeping the clinic consistently stocked. We've already found supplies that clinic
staff thought they lacked and have a better concept of what and how much to order in the future.
Another development at the clinic (which is probably more exciting to you than hearing about rooms full of boxes) is
the impending reinstatement of a Tuberculosis program! The government will be sending us a nurse specifically to run a TB
program starting next month, which we welcome enthusiastically.
There are also many promising advances being made outside the clinic. Most notably, three
of our new Community Health Centers (CHC- previously known as Satellite Health Centers) are now open in Savann Plat, Dahlegran and Barank. After trainings with
Zanmi Lasante and at St. Joseph's, our Community Health Workers (or Ajan Sante) Anya, Mary Madeline and Jude are each busy providing
first aid, essential medications, referrals and health education to 35-40 patients daily. Many of these patients (such as
those pictured above, waiting to see Jude at Barank) would otherwise be unable to access care due to their remote locations.
Additionally, we are incorporating our Bon Sel and Klorfasil projects into the health centers. Each Ajan Sante promotes these items to patients and community members, and is
responsible for conducting home-visits to ensure that the Klorfasil systems are being used properly.
We are continually inspired and impressed by the dedication of our Ajan Santes and Health Committees (groups of community
members that support and guide each CHC) to improving health in their communities. In fact, it was the Barank Health Committee
that first suggested the concept of a CHC and it is a testament to the hard work of many community members this idea has become
a reality. In the image to the left, our Klorfasil expert, Shelove, demonstrates how to use Klorfasil systems to the Bouloum
Health Committee (which will open a CHC in early August).
In all, one of the strongest impressions we have gained in our first month is that there is
no shortage of incredibly caring and passionate individuals in Thomassique working towards the same goals as us; the Health
Committees are only one example of this. We are thankful to the past fellows for cultivating relationships with some truly
inspiring organizations and leaders, and are excited to work with these extraordinary people in the coming year.
Thanks for reading; we'll be in touch again soon!
5:43 pm edt
Festive music emanated loudly from large speakers. Crowds of people mingled, greeting one another and chatting. The atmosphere
was vibrant and full of energy; this could easily have been a scene out of a wedding reception or town fair. Actually, this
was last Saturday’s mobile clinic for the physically disabled people of Thomassique, organized by a community-led organization
called ACAHT (Association pour la Canalisation d’aide aux Handicapés de Thomassique). Upon arriving at the event,
we realized that this was not merely a mobile clinic, but an opportunity for the community to come together and celebrate
the fact that much-needed services are now being provided for handicapped people in this area. The event was an embodiment
of all that ACAHT and other local community-led initiatives seek to do – bring people together to effect positive change
ACAHT is just one of many successful locally led initiatives in Thomassique. Here, we will highlight
the work of several other organizations with which we’ve worked this year. This is just a small sample of countless
community initiatives that exist here. ACOSAT
Within our first week in Haiti, we were
approached by Jocelia, a woman who runs an organization and school for orphans in Thomassique. The organization, called Association
Communautaire Orphelinat secours d'Enfant de Thomassique (ACOSAT), aims to provide services for guardian families taking care
of orphaned and abandoned children. While this is a perennial problem in the community, it has been a particularly pressing
need in the months following the earthquake. ACOSAT was one of the local organizations (along with ACAHT and the World Vision
Earthquake Relief Committee) that we partnered with to distribute the earthquake relief items that were sent to Thomassique
from the US in the months following the disaster.
An innovative thinker, Jocelia has also begun a program to
fund ACOSAT’s school by starting a business as a seamstress. She plans to teach young women in the school how to use
manually-powered sewing machines. They will make and sell uniforms, clothing, and decorative cloths. All profits will benefit
the organization and school. In an environment in which external funding is nearly impossible to come by, it is this kind
of entrepreneurial spirit that can sustain community initiatives such as ACOSAT. Lekòl Tèt
The lack of an adequate education system is a persisting problem in Thomassique. The government-run school has the capacity
to serve only a small fraction of children in the area. For the majority of children who cannot find seats in the government-run
school, private school is the only chance at an education. The cost of a private education – tuition fees, books, uniforms,
shoes - can be unmanageable, especially for families with multiple school-aged children. In response to this problem, there
are several locally run free or low-cost schools that have been introduced in Thomassique. We collaborate with several of
them for our School Lunch Program.
One of them, Tèt Ansanm, was started by Down Belizaire (our x-ray technician at St. Joseph’s Clinic) and his
friend Betony. This free school is open to Thomassique’s poorest children, and the teachers work on a volunteer basis.
Other free and low-cost schools in this area include Lekòl Fermi and Lekòl Pò
(the Poor House) is a home for the
aging and infirm of Thomassique. Managed by Pierre Louis, a local leader who also directs Lekòl Pò
v (the Poor School), Kay Pò
v exemplifies the social
services that are made available to those most in need – not by any governmental or international aid program, but by
a neighborhood coming together to support its residents. Association Femmes de Thomassique (AFDT)
It seems that we are constantly learning of more community initiatives in Thomassique. Just last week, we attended
a meeting with the Association Femmes de Thomassique (AFDT), an organization dedicated to the empowerment and mobilization
of women as key players in development work. We met with the committee of over 50 women from Thomassique and discussed their
needs and ambitions. One of their goals is to begin a loan program for women, using pooled funds to support entrepreneurial
ventures. They also expressed interest in collaborating with the clinic to address issues of women’s health in Thomassique.
We plan to collaborate with AFDT as we look to expand the outreach services of our maternity department. Furthermore, the
board members of AFDT expressed interest in selling Bon Sel
as a way of promoting good health practices and fundraising for their organization. AFDT’s salt sales began last week.
The presence of multitudinous community-led initiatives in Thomassique was a surprise to us when we first arrived
here. Not knowing much about the area, we had originally anticipated that community-led initiatives would require a certain
base level of material resources that were lacking in Thomassique. We were impressed to find that, even with extremely limited
resources, several programs have been implemented. This is not to say that resources are not needed. Indeed, money is the
limiting factor in every one of these programs. But we were surprised and impressed by the fact that community collaborations
such as these exist even in the absence of material resources; such initiatives are fueled by the resourcefulness, determination,
and civic-mindedness of the people of Thomassique.
This week marks our one-year anniversary at St. Joseph’s
Clinic. One year ago, our friend Rigot Thomas asked us a question that has resonated with us ever since: kijan w wè Ayiti?
How do you see Haiti? The answer is complicated, to say the least. Every day in Thomassique,
we witness the effects of global injustice: hunger, preventable diseases, lack of access to clean drinking water, and abject
poverty. But it is unfair and inaccurate to reduce this country to a poverty-stricken, victimized nation. The people of Haiti
are not passive recipients of misfortune or aid; they are active and invaluable players in development work. In the face of
a harsh reality, it is they who best understand the needs of this country. Our work in Thomassique this year would not have
been possible or effective without our local partnerships. We continue to be inspired and moved by the competency, compassion,
and undying commitment that these organizations have to this community.
5:42 pm edt
Imagine finding yourself ill and knowing that the closest health center is two to three hours away by foot. This is a reality
that the majority of our patients at St. Joseph's Clinic face whenever they seek care. We are centrally located in Thomassique,
but for our patients that live nan deyo
(in outlying zones), the clinic is far from accessible. If they get a cut
or have a cough, they must walk several hours to access medical care. Unfortunately, this means that many people do not seek
care until the last minute- when small cuts have become seriously infected, or minor coughs have progressed to pneumonia.
The severity of this issue was brought to our attention by our Salt Committee in Baranque (see previous posts
for more details on this project). As partners in improving health in their area, we asked the simple question: what does
your community need? They replied that one of their biggest concerns is not having medical personnel in their area- someone
to provide first aid, over the counter medicines, etc. So, we went back and spoke with some board members at Medical Missionaries
about how we can address this need.
Now that funding for this initiative has been secured, we
are ready to launch one of our most exciting projects: Satellite Health Centers (SHC). About a month ago, we held our first
Community Health Committee meeting in Savane Plate, an area about 45 minutes by car from our clinic, or at least a 2.5 hour
walk. Convened in the local school, the commitee was comprised of men and women, representing a range of ages and religious
denominations. They discussed the multitude of health-related problems in their community; they told us of neighbors who are
paralyzed with no access to wheelchairs, food insecurity leaving children hungry when they come to school, and of course,
the lack of primary care in their area. We assured them that we would offer our support in addressing the health problems
they identified, but also asked for their help in expanding some of our exisitng health programs- namely the salt and water
projects- to Savane Plate.
Since that first meeting, we have formed three other Community Health Committees in Dahlegran (pictured above), Baranque and
Bouloume- all areas with no other source of healthcare. In addition, we asked the committees to nominate individuals from
their communities to act as ajen sante
(Health Workers). After an interview process, one individual from each of
the four communities was selected to be the Community Health Worker for their hometown. Their duties will include providing
primary care, referrals to our clinic and assisting us in introducing health projects into these areas (see the newly set
up SHC in Savane Plate to the right). We hope that the SHCs will also be a vehicle for introducing future community health
projects to populations nan deyo
. We have already started Bon Sel Dayiti
sales and introduced Klorfasil
into the local school in Savane Plate.
By the end of this month, our Community Health Workers will have
completed their training at the Zanmi Lasante
(Partners in Health) Center in Hinche, and the SHCs will be prepared to open their doors to patients in their communities.
We will keep you updated on this exciting project as it develops!
Tet Ansanm Video
5:34 pm edt
Tet Ansanm is a Haitian Creole phrase meaning "heads together." This phrase describes how people
in Haiti approach the momentous task of improving their lives. Change happens when groups of people work together, when we
put our heads together. We made this movie to be about St. Joseph's Clinic, but it is also about how the community views the
work done by the clinic, how they work with us and how we hope to continue making change in Thomassique.
To view this
video full screen, you can find it here.
Wednesday, March 17, 2010
5:31 pm edt
For years now, our doctors have dealt with diseases caused by our patients using poor quality water
in their homes. These diseases disproportionately affect the most vulnerable population- particularly children under five
years old (see previous post on the Water Crisis
). This fact has led us to look for useful interventions
that can improve access to treated water in Thomassique- and hopefully reduce the incidence of disease and number of preventable
deaths that we see at the clinic every day.
is a simple, point-of-use intervention that uses granulated chlorine to treat water at home. Itwas initially introduced in
Thomassique last year, as part of the water study conducted by Rita Baumgartner, '08-'09 Global Health Fellow (see previous
posts on the Water Study
and Boutey Soley
). While Rita found that the price of Klorfasil would be prohibitive for many families, the households that were provided
with the system used it effectively and the incidence of diarrhea among young children decreased during the study. A benefit
of this system is that it is very easy to use. Simply fill the provided bucket with water, put in a small dose of granulated
chlorine, and in thirty minutes the water is fully treated. The dose of granulated chlorine used in the Klorfasil system is
controlled by a custom-designed dispenser head, which ejects a precise quantity of chlorine each time the head is turned.
One additional benefit of the system is that the presence of chlorine in the water prevents recontamination after treatment.
The Klorfasil promotion model is also very innovative. It has incorporated social marketing techniques to advertise-
providing a Klorfasil plaque for all participants to display outside their homes. This simple strategy builds social pressure
for everyone to start treating their water within a community- Don't be the last one to get Klorfasil! In addition,
the founder, Jon Steele, hopes for Klorfasil to eventually be the first home water treatment system that is self-sustaining-
run like a profitable business so that it doesn't constantly need subsidies from grants and donations. On the other hand,
purchasing Klorfasil is not simply a commercial transaction; it is an opportunity to encourage good sanitation practices and
raise awareness about the connection between untreated water and disease. Each family not only receives a water treatment
system, but also enrolls in the Klorfasil program that includes a full education session and regular follow-up home visits
to ensure proper use of the system.
For the last two years, Klorfasil has been sold in Hinche (a larger town
about two hours away)with great success. Not only has the Hinche program reached several thousand households, but the follow-up
data have demonstrated that families are using the systems properly and consistently. Since then, Klorfasil executives have
been looking to expand to a wider region. Impressed by the proven effectiveness of Klorfasil, Medical Missionaries
board member Peter Dirr, procured funding to launch this program in Thomassique. The funding is necessary to offset the cost
of the Klorfasil system from US $8.50 to the more affordable US $2.50. In the next nine months, we hope to sell over 3500
Klorfasil systems in Thomassique- targeting vulnerable patients at our clinic and parents of young children.
A few weeks ago, we hired our Klorfasil Coordinator, Shelove Belizaire (pictured on the left at our clinic), to begin implementing
this program in Thomassique. She finished her training in Hinche last week and is ready to start launching the project! This
week, we will be meeting with directors of several schools in Thomassique to give them the opportunity to participate in the
program by providing their schools with Klorfasil systems, free of charge. From there, we will begin selling the systems to
our patients and parents at the participating schools. This will ensure that those most vulnerable to water-borne illnesses
have access to treated water, and that the children of Thomassique will be able to find safe, clean drinking water both at
home and at school.
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