The Paradoxes of Haiti

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My first week back after a medical mission trip to Haiti presents many difficulties – some physical (I won’t expand on the topic of GI issues after eating rice, beans and potatoes every day for a week) but most psychological. At 10 am on Sunday I was enjoying the feel of sand between my toes and salt water on my ankles as I walked down the beach, knowing that 12 hours later I would be arriving to Minnesota and freezing temps. That is the uncomplicated part of the transition. The psychological transition is still a part that I struggle with and sometimes do better than other times. Following are just a few of the thoughts that have created a wrestling match in my head this week.

  1. We were able to prevent a woman from dying due to a bad infection in her foot by amputating her lower leg. She has very poorly controlled diabetes due to poverty, low IQ, and lack of resources for adequate administration of insulin. One of the last patients  I saw before I left for Haiti also has poorly controlled diabetes – due to lack of motivation to check her blood sugars and take medication, both of which are provided thru her insurance.
  2. Maternity was very busy the week we were in Haiti and our nursing volunteers spent many hours working with Haitian staff to improve breast-feeding and care of patients in labor. It is much easier to teach the mechanics of nursing care than it is to teach respectful care. Slapping and yelling at patients during labor is all too commonplace.
  3. Cervical cancer continues to be a preventable disease that kills all to many mothers, disrupting their families. We screened 67 patients for cervical cancer, treated 10 pre-cancerous lesions and diagnosed 1 locally advanced cancer that is untreatable and will be the cause of death in this woman within the next year. A combination of low-cost screening and vaccination with Gardasil has the potential to completely eliminate this cancer throughout the world. Due to unfounded fears of vaccines in this country, only 40% of young girls and boys are vaccinated with Gardasil.
  4. Motorcycles are the primary mode of transportation in Haiti. We treated 3 victims of moto accidents, one a  16-year-old girl who will have permanent scarring on her leg that impedes her ability to walk in the future. Once their wounds were cleaned, stitched and dressed, we sent them home on a motorcycle
  5. Most of the hysterectomies that we perform are due to fibroids (benign tumors of the uterus) and heavy menses. One of the patients that we saw was 41 years old and had not been able to conceive a pregnancy. She was severely anemic but her husband decided that they would pray to God for a miracle child rather than allowing her to have surgery. Another woman looked 8 months pregnant due to her enlarged uterus and her hemoglobin was 3 (normal is 12-15). She was in danger of bleeding to death with her next period. In the US, she would have received 4 units of blood before surgery. She received one unit of blood that was donated by a relative and infused during her surgery. She was also unhappy as she has only one child.
  6. A young man presented to clinic with a large abscess on his arm. His HIV test was positive, as was his syphilis test. He did not believe the results and declined government-funded HIV meds or antibiotics. We could not operate on him as he was at high risk of complications with active HIV.

When co-workers see me this week they often ask, “How was Haiti?”. Trying to find the words to describe the above and more can be difficult, if not impossible,  in a few minute passing conversation.  Do others really want to hear the confusion in my head or do they want to hear that we performed 49 surgeries, 67 cervical cancer screenings and 104 dental exams?  To say “Great job and thank you for what you do” and then move on. But what we do in one week is not enough. And that is the Paradox of Haiti.

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on Christianity and mission work

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I consider myself Christian – I attend church on Sundays, have taught Sunday School and assisted with youth groups, traveled on youth mission trips. I also question many of the tenants of mainstream Christianity and try to work within my faith community for change. During my trips to  the developing world, I have participated in Baptist, Methodist and Catholic church services. The hospital we serve in Haiti started as a Baptist mission outpost. I have worked alongside atheists, evangelicals and Muslims.  All of this is to say that I have seen both the up and down sides of Christianity abroad.

As American Christians, we are often drawn to stories that purport to show the changes that teams of missionaries can make in impoverished nations and how the populace of the developing world welcomes these individuals with welcoming arms.

Now consider the following scenario. A devoutly Christian couple in Western Africa consider themselves very fortunate – they are healthy and have good jobs, are able to afford to send their three children to good schools and have a strong religious community. Recently they have become concerned about stories that they have heard about America – broken families resulting in children growing up in poverty, senseless gun deaths due to young men’s lack of connection to their communities, lack of medical care in sparsely populated areas. Both of the Africans are trained in medicine – a doctor and a nurse. With the financial and prayer support of their religious community, they uproot their family and move to a remote community in the western US. The family finds many of the foods and traditions of this new land to be foreign and write about them in a blog that they share with the community in Africa. Efforts are directed to building a school so that area children don’t have to travel so far for school and so that they can “save” the souls of the children by teaching them African Christianity. Future plans are to add a medical clinic to serve the needs of adults while spreading the African gospel. Youth mission teams are being formed in their home church so that youth can travel to this remote, foreign area of American to help with summer camps. All of these endeavors are meant to bring the community in America closer to the African way of life, thus solving all of their problems.

Does this story sound too familiar? It might be extreme to grab your attention, but is it so far from the truth? Following are just three examples of similar examples that I witnessed on my recent trip to Haiti.

  1. I was asked by a Haitian Catholic priest to vouch for his work as he was applying for a grant thru the Koch foundation. I have worked with him closely in our microfinance program and he is an extraordinary person that has been very responsible with finances. I contacted the Koch foundation and was informed that I was not able to testify to this man’s extraordinary work as I was not a person of the Catholic faith.
  2. The hospital in Haiti where we work is in desperate need of new operating room tables. I contacted a mission organization that acts as a clearinghouse for medical equipment. In order to be a member of their on-line community, I was asked to sign a form declaring my faith and stating that I believed that Jesus was the one true and only savior.
  3. One of the surgical members of our recent trip was familiar with a mission hospital in Africa that was in need of surgeons to teach local physicians. I checked out the website and found lovely pictures of the surrounding countryside, medical facilities and new solar panels. But other parts of this mission project were disturbing to me. The hospital was intentionally established in a part of the country that was “99.99% Muslim”. Christianity was taught to post-op patients and a separate building housed those Africans who had converted to Christianity and were ostracized from their Muslim families. I had the option to purchase a book that had recently been written about establishing missions to convert natives from the Islamic faith to Christianity.

Thankfully, I have witnessed far more examples of Christianity done right. Many of the American volunteers that I have worked with in Haiti are called to do good thru their Christian faith – and that is what they do when serving, regardless of the faith of those who they serve. If it were not for Baptist mission work abroad, Dr Hodges would never have traveled to Haiti after WWII and established Hospital Bon Samaritian, currently the main employer in Limbe (population 75,000) and source of clean water for the town. Fr Charles, in a remote mountain village, is working to build a hospital, has opened 6 schools and brings the outside world to illiterate citizens each Sunday.

It is complicated. I have more questions than answers after 10 years of working in Haiti. But maybe questioning is the first step in getting the answer right.

 

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Teaching cervical cancer screening in Kenya

Re-entry from Haiti to American Healthcare

Our January 2016 medical mission trip marked the 10th anniversary of my first trip to Haiti. During those first few years it was always a culture shock as I entered Haiti and dealt with the cacophony of noise, the smells of burning garbage and rotting fruit and the difference in hospital resources. More recently, I have found it easier to slip into my role as a temporary physician in Haiti and harder to re-enter the physical and psychological world of American healthcare. As pictures are often louder than words, I will use them to illustrate the differences between the two healthcare systems.

Providing health care in Haiti, though limited in scope, is sorely appreciated by the people who often wait months to collect enough funds to afford a surgery and then for a surgical team to arrive. They arrive on the designated day of surgery waiting in line to be examined by the “blanc” doctors and then waiting some more for their surgery. 190

While we are busy in the operating room performing the surgery, the family is busy preparing the patients room for their arrival immediately after surgery. The family is responsible for providing sheets and pillows, food and a bedpan as the hospital does not have adequate bathroom facilities for patients and their families.

As there are few nurses available, families often sleep on the floor by the patients bed so that they can be available to help with feeding and getting the patient out of bed.

Most American patients expect a private room and bathroom when in the hospital.  Our post -op rooms have 3 narrowly spaced beds and are filled on a first come, first serve basis. This means that there could be both men and women in the same room as well as multiple family members. The wall sockets are usually stacked with cell phone chargers.

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Although this may look chaotic, there is a semblance of order that runs throughout our day. Potential surgical patients are screened in the morning with surgeries starting around 10 am and lasting until 5-6 pm. Emergencies are triaged as they are sent from clinic and when one of the surgeons is between cases. We make surgical rounds in the early morning and again after dinner, doling out pain medications and encouraging patients to eat and walk. Haiti has no electronic medical record. While I am sure that some American doctors would whoop with glee at this announcement, it is beyond irritating to write the same operative note three times in three different places while trying to gather patient clipboards from the nurses station and around the ward.

Privacy in the US medical system is a sacred law known as HIPPA and one that has serious consequences if violated. Privacy in Haiti can be difficult when rounds are made in a three bed ward with family members of each patient listening in to our conversations. That doesn’t include the numerous visitors in the courtyard that can look in thru the open air windows.

By the end of a 5 day surgical week, we have usually performed 40-50 operations.  Some of these surgeries are lifesaving, while the majority improve quality of life. Our complications are no greater than in the US and outcomes just as favorable. We use far less resources with only minimal lab tests available and no blood bank. I am exhausted, my feet ache from standing on the concrete floors and my back is sore from the uncomfortable beds. And yet, the satisfaction and feeling my heart full is so much more than I feel at the end of a week of work in the US.

Now I find re-entry into the hospitals of the US more disturbing than my week in Haiti. The amount of waste that occurs on a daily basis with medical equipment in this country is mind boggling and one of which we should be ashamed. Surgeons demanding expensive instruments and multiple suture choices are difficult to listen to.  Most patients are appreciative of the care they receive, but wouldn’t be able to grasp wait times and lack of access to healthcare that is present in the developing world. Thankfully, the end of each Haiti trip brings with it plans and ideas for the next trip.

 

Domestic Violence for one woman in Haiti

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In recent reports, 30% of Haitian women have suffered acts of violence from partners or husbands. A third of surveyed Haitian women believe that a man may sometimes have the right to beat his spouse. Add to this that the Haitian justice system often victimizes the woman and rarely are charges brought forward. Unfortunately, these are not statements that are unique to Haiti; they are true for many developing world nations where women are often treated as second class citizens. Being an eyewitness to this reality for one woman during our most recent medical mission trip is much more moving than all the previous articles or books that I have read.
Unbeknown to the medical team, the woman had arrived at the hospital the night before after having suffered a stab wound in the back from her husband during a fight. Some family versions of the fight stated that she had started it by cutting her husband’s ear with a kitchen knife. The x-ray machine at our hospital was down due to remodeling, so the woman was sent across town to another hospital. She returned the following afternoon, in severe pain and with very labored breathing. I was flagged down by one of the Haitian family practice docs as we were packing our supplies for departure the next morning. Word of caution – If the American gynecologist can tell that something is wrong on your chest x-ray, you are probably in urgent need of medical attention as the last time I formally read a chest x-ray was 24 years ago. Her x-ray was significant for a collapsed lung on her left side and a fracture of her collarbone, caused by the knife wound in the back. She was fortunate to still be breathing but was at imminent risk of her heart shifting due to the collapsed lung. The team halted our packing duties and immediately shifted to duty mode. A few people were sent in search of a chest tube and vacuum device while others got the patient comfortable on the OR table. Events like this always make be proud to be part of a fabulous team – no job is too humble (ie searching among dusty shelves in a dark room with a flashlight for a chest tube) and individuals get comfortable dealing with tasks outside their specific expertise (ie gynecologist reading chest x-ray, dentist reading instructions on vacuum device and filling channels with water). Within an hour, the patient was breathing more comfortably and settled in her room, with strict instructions to her father to get help if the pump quit working. When the pump burnt out 11 hours later, he dutifully notified us and we substituted another pump. Two days later the chest tube was removed and the patient was discharged home – with her husband at her side. I am sure there was community discussion about her blame in the matter by starting the fight and at no time did she ask to press charges.
Studies have shown that domestic violence sharply decreases when the female partner is seen as a contributing financial partner to the household. If our patient had a small business and was increasing the family’s financial stability, her husband may have thought twice about wounding her with a knife, as it would impact her ability to work. Helping Haiti Work, a microloan program that my husband and I established in 2012, is attempting to right some of these imbalances for the women of Haiti. In my discussions with the loan recipients they have expressed that some of the indirect advantages of the program is that they are generally treated better by their spouses and the community, as operating a business brings them more authority. Trying to change cultural norms around domestic violence can take an extended time. Maybe we need to also look at short term empowerment of women so that they can influence the longstanding cultural norms.
Our fundraising for this program in 2014 will generate 40 new loans of $200 each for women on the waiting list. More women continue to wait. Please consider Helping Haiti Work in your end of year donations