A Hospital in the Mountains

Today was our last full day in Haiti and we spent most of it visiting Partners in Health's newest hospital in Mirebalais, an hour-long bus ride from the orphanage where we've been staying.
Before it was built 2 years ago, anyone who lived in the mountains had to travel hours to reach the PIH hospital in Port-au-Prince.
Last year, we visited the hospital after it had just opened. It was a beautiful, but almost empty building, save for a few people waiting to be seen in their outpatient clinic. When I was asked what I thought of the hospital, I remember answering that I wanted to wait and see what would happen first. Would there be sufficient staffing and need to make it a full-fledged hospital or would it remain a nice, but underutilized facility?
I'm happy to report that it has come a long way in the past year. The inpatient units are mostly full and the outpatient clinics see 700+ patients a day. They have a large pharmacy, a CT scanner, a teleradiology program, residency training programs in internal medicine, surgery and OB/Gyn and they even have a physiatrist (rehabilitation medicine physician) on staff !
On the Rehab front, they have a small inpatient unit with adjacent gym located on one of the wards, but noting an increase in trauma patients, the unit will increase in size to 10 beds and will move to a brand new building currently being built on the hospital grounds (see the photos of the current program and it's future home below).

I plan to get in touch with their current rehab doctor to discuss possible collaborations between them and the department of PM&R at UNC (some telemedicine educational programs? A future resident elective? We'll see.)
We celebrated the end of our trip with dinner at Pizza Amour, a restaurant run out of the home of some ex-pats that has the best pizza in Port-au-Prince.
Now it's time to pack up for our return flight tomorrow morning.
Bonswa !

Meeting from Afar, Now and in the Future

Had a nice event at the orphanage today.

One of the students used Skype on her laptop to connect with her mother's 5th grade class in New York. The elementary school children had just completed a section on Haiti and now had the chance to connect with, and ask questions of, the children of Zanmi Beni. (See first  2 photos below)

At a briefing we had earlier today at the US Embassy, we were told that approximately 20% of Haitians had some access to the internet and here at Zanmi Beni Orphanage, they have a wireless router (that I'm currently using to upload this blog post) which provides slow but steady internet access.

Unfortunately, while it's fast enough to surf the net and watch some videos, it's not fast enough to allow for real-time bidirectional video-conferencing. The images on today's skype session were jumpy and out of focus. Good enough for the children to see pictures of one another and talk to each other, but not good enough to provide educational programs or telemedicine consultations.

As part of a Google Grant to the NC Children's Hospital, we brought a new iPad with us to present to the staff at Zanmi Beni with plans to use it for future telemedicine consultations. Their current bandwidth won't allow for this, at least not yet.

We still gave them the iPad, along with instructions for its use, and told them that we hope the future will bring faster internet connections that will allow us to videoconference with each other.

Tomorrow, we'll visit their hospital in Mirebalais (which already uses telemedicine in its daily practice ) then have a pizza party to finish off our last night here in Haiti.

The Tin Works

Today was spent completing the repairs to the PT gym in the morning. With new screens in place and newly painted walls, the gym looked much better and brighter.

Our reward for such good work? A trip to the local Tinworks shop where metal is hammered, cut and shaped into wonderful artwork.

We also received the good news that we will get to visit the US Embassy tomorrow after all and will receive a briefing on their work in Haiti (thank you to the offices of Senator Kay Hagan and Congressman David Price).

It's hard to believe that our trip is nearing its end! On Saturday we're scheduled to visit PIH's hospital in Mirebalais and then we return to the States on Sunday.
We've still got some work to do (like make a list of equipment needs for future donations) but I'm happy with what we've accomplished thus far.

Bonswa !

Feeding a Fragile Little Girl

So many stories to tell from today's activity

- the trip to Haiti's version of Home Depot (where they sell Gatorade)
- the talk I gave to the women who feed the more severely disabled children
- repairing the broken screens in the PT gym (Dr Sanford received many kudos for his good work)
- painting the PT gym walls
- trying to get help to schedule a visit to the US Embassy (a Shout out to the offices of Senator Kay Hagan and Congressman David Price for their quick responses and offers to help)

But the encounter from today that will long stick in my mind is the request for me and Beth (our PT) to take a look at a little girl who is felt to be so fragile that the caregivers at the orphanage keep her inside the dormitory area to avoid her getting injured or catching a cold.

Angelique came to them 3 years ago. She has hydrocephalus, severe intellectual disability,  minimal vision, severe cerebral palsy, scoliosis, torticollis, and contractures. She also has profound feeding difficulties for which she needs to be spoon fed a puréed diet so slowly that it is agonizing to watch .
As she coughed and sputtered through a few spoonfuls, we were told that it typically takes her 90 minutes to finish (or not even finish) her plate.

We made some suggestions about trunk and head support,but I'm not sure it's going to be possible for them to enact them. Instead, we offered to see if we might be able to find a suction machine back in the States that we could send them to help her when she aspirates (which, I think is often). Frankly, it was the low point of my day - a frustrating situation with no sufficient solution. Back in the US, this girl would have had many more medical interventions - a feeding tube, surgery on her back and joints- but, when I'm honest with myself, I'm not so sure that her quality of life would have been any better.

Like all of the  orphans, she gets a good deal of love and attention from the staff at Zanmi Beni. And after all, medical care is not an end in and of itself. It's used to prolong and enhance someone's life. This fragile little girl will likely not live much longer, but I do get some comfort in knowing that she is cared for and loved and in the end, isn't that what truly feeds us?

In the gym... And the pool

We continued our stay at Zanmi Beni orphanage with time spent in the gym and, later in the day, in the pool!

In the morning, we returned to the PT gym,which is a semi-screened in addition to the back of the main building. It should be a fully-screened addition, but over the years, the wear and tear from use (and children) has led to multiple holes and tears in the screens. Enter Dr Timothy Sanford, a.k.a. The Handyman who made a trip to the local hardware store and returned with tools and supplies to begin repairing the screens.

Meanwhile, Beth Leiro continued to work on positioning devices and wheelchair seating systems. This time, she was joined by a group from the Afya Foundation, a New York based organization that "support(s) ongoing health initiatives in Africa and the Caribbean by supplying critically needed surplus medical supplies, hospital equipment and humanitarian provisions by collecting unwanted supplies from the healthcare, corporate and private communities and sending them abroad."

Later in the day, several children from the orphanage got a treat when a group of high school students played with them in Zanmi Beni's outdoor pool. Everyone enjoyed the break from the heat and some of the high schoolers might have been inspired to become aquatic therapists one day.

Tomorrow, we hope to finish repairing the screens, adapt some more equipment, and possibly paint the PT gym.

For tonight,
I'll say
Bonswa

A Full Day

Today was our first full day in Haiti and it was a very full one indeed.
We awoke to the sounds of children playing outside at 6 am as they waited for their school bus.

After breakfast, we approached a group of children in wheelchairs and their caregivers and used bubble blowing to break the ice and get to know their names.

We took notes about which children might benefit from adjustments to their positioning systems and made plans to get this done later in the week.

Soon afterwards, we gathered in the Physical Therapy gym and presented their staff with a blue feeder seat that we had brought with us from the States. As soon as they saw it, the Zanmi Beni staff told us that it would be perfect for one of the children and before I knew it, Beth Leiro, the physical therapist on our trip and Tim Sanford, our resident physician, sprang into action. Working alongside the Zanmi Beni staff, they molded the seat to fit into the boy's current wheelchair, replaced the straps to better fit him, and raised the foot rests to better suit him. He looked great !

There are still several other children who need seating modifications (replacing some straps here, raising foot plates there) and we look forward to doing what we can to help while we're here.

Later, we helped feed the children lunch (more on that in a future post ) and worked with some of the younger children to make necklaces and bracelets with beads.

This afternoon's  activities were curtailed by a sudden storm that quickly turned the playground to mud (but the able bodied teenagers didn't let that stop them from playing soccer/football in the rain).

I'm already tired just recounting the days activities and it's not yet dinner!

(Much) more to come.

Bonswa !

Arriving in Haiti

Following a few hours of travel (RDU to Miami international , Miami to Port au Prince) and waiting in a long, slow line at immigration, we exited port au Prince airport, loaded our luggage onto the back of a truck and rode a bus through the streets of the city to the Zanmi Beni orphanage.
The roads alternated between paved and potholed, with no center line and no sidewalks. This left navigation up to the whims of every driver on the road and led to  some creative maneuvers. Tap taps, motorcycles, cars, pedestrians and goats all shared the road.

When we arrived at the orphanage, the children (some in wheelchairs and others running about) stopped playing on the playground and came over to greet us.

I spotted a couple of the girls I remembered from last year and went over to say "hi". To my surprise, they smiled and hugged me as if I had never left. We played games and toured the grounds for a few hours before a delicious meal was prepared for dinner.

After dinner and a discussion about plans for tomorrow,most of us went straight to bed, knowing that we'll likely be awakened at 5 AM by the sounds of children asking us to come outside to play.

Better get some sleep!

Back to Haiti !

It's a beautiful day in North Carolina. Little humidity (hard to believe, I know) and highs in the low 70's.
Right now, it's in the mid-80s in Port-au-Prince Haiti with high humidity and thunderstorms expected every day of the week for the next week.
I can't wait to get there.
Tomorrow morning, I'll be flying back to Haiti, back to Zanmi Beni Orphanage and back to the children and caregivers I met last year on my first trip there.
This year I'm lucky to be traveling along with Tim Sanford, a resident in Physical Medicine and Rehabilitation at UNC (where I practice) and Beth Leiro, a friend and pediatric physical therapist from Chapel Hill.




Thanks to generous donations from our supporters, the three of us will be spending the next week working with disabled children and their caregivers at Zanmi Beni. Thanks to a Google grant through the NC Children's Hospital, we're also bringing a new iPad to donate to the orphanage so we can meet with them via videoconferencing (FaceTime anyone?) throughout the year as needed.

I've  got lots of things planned, but first, I've got to finish spraying my clothes with Permethrin (to cut down on my chance of being bitten by mosquitoes ).



Tomorrow, we catch an early flight to Miami and then connect on to Port-au-Prince.
I'll be updating this blog each day to share our experiences and lessons learned.

Bonswa !