Anand is a senior at Stanford, studying biology and writing an honors thesis in International Securities Studies. He is originally from Houston, Texas, and aspires to become an infectious disease doctor working in the developing world. He has extensive international health experience, most recently working with community health workers in the rural Guatemalan highlands to implement a survey regarding conceptions of prenatal care. He also partook in a service-learning trip studying social determinants of health in Oaxaca Mexico, and spent a summer devising and teaching an interactive health curriculum in India through Project Dosti.

Patient Report: We have now seen approximately 150 cholera patients, and currently have 18 in the ward. We reached a peak of patients early this week, with up to 40 or 45 patients in the ward at one time (note that the graph shows date of admission through Thursday, and does not include patients currently in the ward; click on the image for better resolution). The atmosphere at the clinic is significantly calmer than earlier this week, but it is highly likely that we will see a rise in patient numbers again. The biggest problem continues to be that people in remote areas are not drinking ORS before and during their journey to the clinic. For example, one pastor reported that 14 people died over the last few days in his community, several of them on the way to the hospital. We are working with local pastors and other groups to spread the homemade ORS recipe and educational messages far and wide. Theoretically, there is already a government-run health center in the hardest-hit area (Bokbanik), but the information we are hearing about deaths suggests that it is not functioning. World Vision may have a tent coming that could be used to open a treatment center there, but the problem would be staffing such a center.

Supplies: We received 4000 packets of ORS and 1500 liters of Ringer's Lactate IV fluid on Friday, thanks to the help of Fr. O'Hare and Tom Brock, two wonderful contacts we have right across the Dominican border. Thank you to everyone who has donated to the clinic, we appreciate your support and are dedicated to maintaining an adequate stock of supplies at all times. We have designated a room in the clinic as the 'Cholera Depot' and it now contains all of the supplies needed for treatment, employee protection and cleaning. We have also been receiving materials from other local organizations, such as the Red Cross and World Vision; in turn, World Vision has been distributing our soap and hygiene packs during their education sessions.

Cholera has now taken a firm grasp on Thomassique and our clinic. We have seen over a hundred cholera patients, and have had twelve deaths.

It is hard to express the conditions here, which is possibly why we have not been updating the blog (combined with the fact that we are beyond busy handling this crisis). The scene in the cholera ward is unsettling: Cots fill the room, strewn with bodies showing varying levels of alertness. Cholera is not a pretty disease, and the massive quantities of diarrhea and vomit mixed with Clorox give the room a highly distinct and foul scent. On several occasions the ward has been at or above capacity, with two or three children sharing a single bed, and hardly any space for nurses and doctors to move between the approximately thirty-five patients. The sight of coffins and the sound of grieving families have become all too common.

The good news is that cholera is not a particularly complicated disease to treat. As long as the patient is kept hydrated using Oral Rehydration Solution (ORS) and/or IV fluids, they can typically recover. One of the bad pieces of news though (which contributes to the high death rate) is that many of our patients are coming from great distances and are not beginning rehydration at home. For example, the towns along the Artibonite River, such as Bokbanik and Nan Kwa, are a four-hour walk away; patients that manage to get to the clinic without dying on the way are so weak by the time they arrive that recovery is very difficult. Therefore, along with the importance of preventive precautions (treating water, washing hands, cooking food), a main educational message we are promoting is to prepare and begin drinking ORS at home, using a simple recipe of sugar and salt that we distribute on slips of paper.

Producing an effective cholera response is also influenced by the cultural beliefs and practices that provide the backdrop for this epidemic. Voodoo, though not particularly visible on a daily basis, is an important part of many people's belief systems. We do not purport to serve as experts on Voodoo, but we can relay to you some interesting things that community members have told us over the last week: They explained how some Voodoo priests have been spreading the idea that cholera is the result of a 'powder' (powders are a central component of Voodooism) and claiming that they can cure the condition. Therefore, people seek care from Voodoo priests for cholera, rather than accessing the actual care they need (rehydration). Many rumors have been circulating about a public incident in the market last week: In one version we have heard, two men hired by a Voodoo priest 'infected' a woman with cholera using a powder, and the woman was subsequently 'cured' by the Voodoo priest as a publicity stunt. However, several observers caught on to the plot, and the two men were attacked. This is not a simple situation of Western medicine vs. Voodoo; how can the two become more compatible to improve health outcomes?

Another conception we have encountered is the frustrating belief that death from cholera (and other diseases) is simply inevitable. Though it is true that some people cannot be saved, the vast majority of people should be able to survive cholera if they receive proper treatment. We have even seen this attitude among some staff members at the clinic, who seem resigned to the idea that many of their patients will die. Perhaps this conception is the result of experience; premature death is a much more familiar aspect of life in Thomassique than in the United States. But should not all people, Haitians and Americans alike, be able to expect life rather than death in largely-treatable cases like cholera? How can people gain the power and voice to expect and demand quality living conditions and medical care?

In times like these, it is also important to recognize the positive developments. One bright point is the newly formed Thomassique Cholera Committee, which brings together Thomassique's leaders in health, education, religion (including Voodoo), sanitation, water, police and government (though the local government is extremely evasive and goes to great lengths to avoid any involvement in cholera efforts) to address the challenges facing the community. This committee had its second meeting yesterday and will meet again tomorrow. Though we took the initial steps to form the committee, we are encouraged to see that the community itself is now taking more ownership over this committee and working to find solutions to problems such as mass-purification of water and the burial of corpses. One of our hopes for the committee is that collaboration with other organizations can support and expand our community education activities. Education is an absolutely critical component of handling this epidemic and reducing deaths. In the clinic, we provide detailed, one-on-one cholera education for the highly-susceptible families of patients, and our doctors continue to reach large audience through churches and the radio, but the demands of patient care necessitate that we prioritize the essential medical function of the clinic. Therefore, collaboration with other organizations is vital to mount a sufficiently aggressive education campaign in areas such as the previously mentioned towns along the Artibonite.

As we sign off, we want to highlight another bright aspect of the previous week, which was having Dr. Charlie Dyer at the clinic. It was wonderful to have him here, and we want to thank him sincerely for providing his excellent medical skills and advice. We look forward to the arrival of another team of American medical professionals on Monday.

 

As we mentioned in our last post, access to medical care in the Thomassique region is severely impeded by the issue of transportation. Most people in the region travel by foot or mule, and it takes many of them 2 to 4 hours to reach St. Joseph's Clinic when sick. One of our solutions is the Community Health Center (CHC) project, where people can get first aid and help with simple illnesses, but there are many patients who need to see a fully trained doctor. For this reason, the physicians of St. Joseph's conduct regular Klinik Mobil at various sites in the region. The establishment of the CHCs has been very helpful in facilitating these because the Community Health Worker (CHW) can help locate and organize patients, and the health center is a perfect facility for the consultations. Here's what happens at a Klinik Mobil, demonstrated by a recent day at our CHC in Dahlegran.

1. The CHW and members of the local Health Committee inform the community in advance that a Klinik Mobil will be coming. There is usually great interest in these clinics, so patients gather outside the health center to wait for our arrival. If at all possible, we try not to turn any patients away.


2. Our CHW (in Dahlegran, Mary Madeleine) intakes the patients, recording each patient's name, age, temperature and blood pressure. On this day in Dahlegran we saw 47 patients. At other such Klinik Mobil, we have seen over 110 patients in a single day!



3. The patient is seen by a doctor (here is our Clinic Director, Dr. Casseus) in a separate room. The doctor prescribes medications and provides medical advice. Sometimes patients have conditions that need further tests and attention, such as a woman seen at Barank yesterday with advanced goiter. In those cases, the doctor refers the patient to seek additional care, either at St. Joseph's or Zanmi Lasante's hospital in Hinche.

4. Before leaving for a Klinik Mobil, the doctor collects a box of commonly prescribed medications. An auxiliary staff member from the clinic (at Dahlegran it was our wonderful lab tech, Elizabeth) and ourselves staff the 'pharmacy'. We distribute and explain the doctor's prescriptions, and track the medications distributed.


Once all the patients have been seen, we pack everything up and get back in the clinic's Range Rover with our trusty driver Philip. Half an hour to an hour later, depending on the site and the weather, we return to St. Joseph's and finalize our record keeping.

For more information about our Community Health Centers, please visit the Medical Missionaries website (www.medmissionaries.org).

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.

Clinic Updates

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.

Community Health Centers

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).

Looking Forward

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!

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 in Thomassique.

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 Ansanm
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 Pòv.

Kay Pòv
Kay Pòv (the Poor House) is a home for the aging and infirm of Thomassique. Managed by Pierre Louis, a local leader who also directs Lekòl Pòv (the Poor School), Kay Pòv 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.

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.

Last week, a team of seventeen surgeons and nurses arrived at St. Joseph’s Clinic for the annual surgical visit. After months of planning, the team came prepared with the supplies and know-how to work through an intense week of operations. Before their arrival, we rearranged the clinic, organized supplies, cleaned the floors and walls, and prepared the operating rooms and inpatient rooms. Over the past year, the doctors at St. Joseph’s had been collecting the names of patients in need of surgeries, and those patients were tracked down and told to come into the clinic upon the surgeons’ arrival.

The team – consisting of two orthopedic surgeons, an OB/GYN, two general surgeons, a urologist, an anesthesiologist, six nurses, three scrub nurses, and a nurse anesthetist – got straight to work…and didn’t stop until the end of the week. In just four and a half days, the team completed 85 surgeries and over 100 surgical consultations! The surgeries performed included prostatectomies, hernia and hydrocele repairs, exploratory laparotomies, circumcisions, clubfoot repairs, a leg amputation, and numerous minor operations (see chart below for a breakdown of the surgeries performed). While some patients were victims of last month's earthquake, many were residents of Thomassique with persisting health problems.

The surgical visit was an incredible experience for both of us, in part because we played a very active role in the goings on of the week. For example, we devised a patient identification and record keeping system for the surgical cases, by which patients were tracked following their operations. Post-surgery, they can now receive appropriate follow-up care here at the clinic because we can easily find their records.

Each day during the week of the surgical visit, one of us worked in triage (where we translated for surgical consultations and managed the record keeping system), and the other scrubbed into surgeries. Scrubbing in was unimaginably exciting – not only did we observe the surgeries, but we were able to participate by holding retractors, using the Bovie to cut and cauterize tissue, putting in sutures, and assisting the surgeons in any other way possible (see photo). We also learned about spinal anesthesia, how to put in an IV, and how to insert a foley catheter. The week left us with a renewed enthusiasm for clinical medicine. The clinical skill set, dedication, and compassion that the team brought to their work was inspirational, and we hope to emulate their approach in our own careers.

Since the team’s departure on Friday, we have been reflecting on the impact that this year’s surgical visit has had. In just a few days, 85 lives were dramatically improved. It was refreshing to experience the immediate and tangible changes that result from a medical trip such as this. In many of our other projects, we find ourselves working on larger systemic problems at a community level. While these endeavors are essential for addressing chronic problems, it is often difficult to gauge what kind of an impact we are having, or how much time it will take to make a difference. This week gave us a chance to experience another approach to global health, where impact is as immediate and palpable as the lengthening of a tendon or the excision of an infected scar. In all, though, both of these efforts are two sides of the same coin. It is by integrating these individualized and community-based approaches – by addressing both the immediate needs and the systemic roots of disease – that we can begin to make real and lasting improvements to health in Thomassique.

After carefully reviewing over 130 applications, we are pleased to introduce the 2010-2011 Global Health Fellows!

Emily Dansereau is originally from Seattle, WA and is currently a senior at Stanford. While there, Emily has excelled academically and was elected to Phi Beta Kappa as a junior. She studied Human Biology and has been involved in a number of extra-curricular activities that have exposed her to the underlying issues that affect health. She did significant hands-on work with under-served communities in East Palo Alto through East Palo Alto Tennis and Tutoring as well as Stanford's Patient Advocacy Program at a local clinic.

In the summer of 2008, Emily was awarded a competitive grant from Stanford to travel to Cochabamba, Bolivia. While there, she worked in a rural health clinic doing a variety of activities. During that time she also implemented a program designed to teach children about dental hygiene and secured funding to provide tooth brushing kits to children in local schools as well as those that come to the clinic.

Fidel Desir was born in the Dominican Republic, but was raised in Puerto Rico. He is a senior at Washington University in St. Louis. As an Annika Rodriguez Scholar, Fidel has demonstrated academic excellence, dedication to medicine, and a commitment to working with under-served populations. During the summer of 2008, Fidel and another scholar received the highly-selective Davis Projects for Peace grant to conduct an eight-week HIV prevention project at a maternity center in the Dominican Republic. For this project, Fidel led seminars about HIV/AIDS, targeted towards women.

In addition to international work, Fidel has made it a priority to work with under-served populations in the US. He is the co-Director of College Connections, a service program that prepares low-income students from St. Louis high schools to get into and succeed in college.

Beginning in June, Emily and Fidel will be taking our places here in Thomassique. Both of these individuals have great enthusiasm for the program, for global health and for addressing health disparities worldwide. We look forward to seeing how they grow and what they accomplish in the next year!

Everyone here in Thomassique has been working furiously over the last week in response to the devastating earthquake of Jan. 12th. The brunt of the 7.0 earthquake was felt in Port-au-Prince, where many of our staff have family and friends. Luckily, though we felt the earthquake in Thomassique, no one was hurt and nothing was damaged at the clinic. We have been very fortunate all around as our staff members' families were also largely spared from death or injury.

Many of our community health projects are now on hold as we make plans to mount an effective response and offer relief to those who need it most in the wake of this catastrophe. While we expect that the effects of this earthquake will reverberate within our community for years to come, the immediate need is monumental. Tomorrow, a team of 16 people (including 6 doctors and 2 orthopedic surgeons) from the US will be coming into Thomassique to perform operations and emergency procedures for victims of the quake both here at the clinic and at facilities in nearby Hinche. After they leave, another team of surgeons and nurses will be arriving on their heels to continue in the relief effort.

Last Tuesday morning, we awoke as usual, ready for a busy day of work. We were surprised to find, however, that this particular morning was far from typical: there would be no face washing, no showering, and (much to our dismay) no breakfast. As it turned out, a pipe near the water source (at the river about fifteen miles away) had broken, and thus all of Thomassique was without water. As the day wore on, we realized how dependent we are on having water – there was no way to do our laundry, no flushing toilets, and (much to our dismay again!) no lunch. Luckily, we had a container of drinking water to get by on, so we avoided dehydration. Eventually our amazing cook, Mme. Gilbert, thought of innovative ways to prepare food without water so that we wouldn’t go hungry. Still, we were struck by how drastically our lives were changed in the absence of water.

Water seems to have been a theme in our lives as of late: our waterless day was the culmination of a month when we had a broken UV water filter and two broken water pumps. While water crises have just recently descended upon our personal lives, Thomassique’s serious water crisis – a lack of access to potable water - has been a major focus of our community health projects for quite some time (check out previous posts on Boutey Soley, the Water Study, and the Water Crisis).

Recently, we have been discussing how best to direct the future of the Water Project. One of our main goals – both with the Water Project, as well as with our salt and malnutrition projects – is to integrate the education program into the daily clinic routine. While outreach and community education remain crucial components of this project, it is important that all of our patients, too, are well acquainted with methods of water treatment. Therefore, we are encouraging the health care professionals at the clinic to give brief education sessions that focus on point-of-use water treatment methods (namely solar disinfection), especially targeting expectant mothers and patients with diarrheal diseases.

A major appeal of the Boutey Soley system is its suitability for a resource-poor setting; it only requires clear plastic bottles and sunlight. There is no shortage of sunlight in Thomassique, but we’ve found that procuring the plastic bottles presents a barrier to many families in the community. To address this, we have partnered with Jasmine Carver, a Peace Corps volunteer who is working on environmental issues in Pedro Santana, a border town in the Dominican Republic. Jasmine has been working to start a recycling program in Pedro Santana, and she’s agreed to help us collect clear plastic bottles. We got our first batch of bottles a few weeks ago, and we’re hoping that as Jasmine’s recycling program continues to expand, we’ll get enough bottles to meet the need in Thomassique.

While point-of-use interventions are effective immediate strategies for decontamination of water, they do not guarantee access to water in the first place. Currently, almost all water sources in this region are contaminated. Mack Leazer, a Virginia-based well driller and friend of Medical Missionaries, is exploring the possibility of increasing access to drinking water by drilling wells in this area to provide people with improved access to safe drinking water. During a visit to Thomassique in November, Mack learned of wells that have been drilled in the area by World Vision, with limited success. Those wells have been drilled in conjunction with a US-based NGO, Haiti Outreach. Mack has been in contact with Haiti Outreach in order to explore ways in which Medical Missionaries can collaborate with their organization to improve access to potable water for the people of Thomassique and its outlying villages.

If there is anything that we’ve learned about water in the past week, it’s that its effects are pervasive. We have long known that inadequate infrastructure in Thomassique results in an increased incidence of dehydration and diarrheal diseases. We have witnessed the effects of this serious problem in hindering access to food and drinking water for the people in this region. Though normally, St. Joseph’s Clinic is equipped to maintain a steady supply of water, we too are affected by this reality from time to time. Our experiences over the last month have brought home for us the significance of this particular community health project as well as our own dependency on having a supply of clean water—and just how harsh it can be when all of a sudden the fragile system in Thomassique breaks down.