Monday, April 14, 2014

GUEST BLOGGER - COLE BOYLE

We're doing a series of guest bloggers who joined Columbus Medical Mission Team this year.  The first is Cole Boyle, a student working on his Masters in Public Health at UNMC.  He has an undergraduate degree from UNL and will graduate in August with his MPH.

Haiti---from a public health perspective

My first trip to Haiti was a humbling and eye-opening experience. This was my first trip to any third world country, so I had no idea what to expect. Before leaving, I knew that was a very poor country with a tumultuous history, but I didn’t fully comprehend just how poor Haiti was until I actually witnessed it myself. The abject poverty that I witnessed for the first time on the ride from the Port au Prince airport to Pierre Payen was overwhelming. During the long, uncomfortable ride to the place I would be calling home for the next week, I couldn’t help but ask myself what I had gotten myself into. I was tired, hot, sad, and didn’t know how the vehicle I was on was going to make it on the narrow, crowded highway in one piece. I was definitely out of my comfort zone.
View out the front of our truck.


Our Paddywagon ride to Pierre Payen.

The baggage truck with the rest of our team. 

Streets in Port au Prince.

Market along the road. 

 These feelings changed over the next few days of working in the clinic and experiencing the people and the culture of Haiti. I utilized my prior experience as a pharmacy technician and spent most of my time working with Sandy, a wonderful pharmacist from New Hampshire. We unpacked the drugs the teams had brought and reorganized things so that, by the end of the week, our little pharmacy went from a state of disarray to one that was organized and functional. 
Pharmacy & equipment.


Cole & Sandy, the Pharmacist. 
I also had a chance to witness how each patient at the community clinic was tested for HIV and syphilis, and I served as Chris’s “test dummy” for his EKG machine demonstration to the Haitian nursing students.

One of the seminars. 
While working in the clinic, it was interesting to see how well our team worked together and with the Haitian staff and translators to deliver the best care we could with the resources we had. In the U.S., different health care teams don’t really have a chance to interact in our fragmented, complex systems. Working in a much more simplified health care system than the one I am used to in the U.S. made me ponder about how all of our regulations, insurance bureaucracies, and technologies influence health care (for better and for worse).

Kelsey and Dr. Mark Carlson.
As a public health student, I was shocked with the country’s complete lack of a public health infrastructure. During my short time in a small section of Haiti, I witnessed issues with sanitation, access to clean drinking water, food insecurity, and an absence of public safety rules and regulations. The public health problems in Haiti are immense and complex; however, I did see some impressive public health success stories. One of these was at OSAPO. The OSAPO clinic is located in a remote area up in the hillside, where the people are even poorer and even further removed from basic services and access to health care. Not only does OSAPO offer a clinic with some state-of-the-art medical facilities, it offers a holistic approach to health care with health and nutrition education, latrines, and wells for access to clean drinking water. The public health prevention efforts at OSAPO have demonstrated a remarkable and significant decrease in cholera and malnutrition prevalence in the people it serves. In addition, the clinics we worked at in Pierre Payen had well implemented HIV testing programs, which offered access to HIV meds and counseling for those testing positive.

OSAPO.  A shining example of a global health initiative.
Not only health care, but nutrition, farming and education are all part of the project. 

The new maternity ward at OSAPO.

The delivery room at OSAPO.
  My short time in Haiti was an unforgettable learning experience. I am thankful for all the things that I have in the U.S., but there is something that can be learned from a simpler way of life. How is it that, in a country with nothing, people still manage to get by and be happy? In the U.S., the CDC estimated that 1 in 10 adults are depressed; however, conversations with the primary care practitioners on our team indicated that only 1 or 2 out of the hundreds of Haitians we saw during the week reported feeling down or depressed. I’m still overwhelmed by the poverty and the complex, never ending problems in Haiti, but I left the country with a greater appreciation for the resilience of the Haitian people.

I would like to thank the Columbus Medical Mission for the opportunity to have this experience and for being able to get to know some of the most altruistic, sincere people I’ve ever met. I look forward to returning to Haiti someday soon!

Cole Boyle
 




Thursday, April 10, 2014

LAST NIGHT IN HAITI

It was our last day and night here.  Surgery went well and was cut short by a baby to sick to have surgery and one no show.  It didn't break my heart totally since we've put in such long days and I was giving a talk to the nurses this afternoon.  There were 45 in attendance.  I gave a basic ENT talk.  They served lunch, we had handouts and a slideshow (translated into French).  Dr. Jovin, the ENT from Port translated for me and I was allowed to present our $4000 worth of nursing books to be placed in the library.  They want to be careful that the books don't disappear.  I had to admit to Joe that I secretly gave one to a nursing student who was the granddaughter of my mastoidectomy patient.  Joe was fine with that.  The nurses were like sponges paying attention to everything I presented and trying to get the best copy of the handout.
Educational seminar.

Dr. Jovin, ENT, Dr. Louve (sp?) director of education and Dr. Novotny presenting the books. 
Surgery went well.  Laci got to help with anesthesia for awhile.
Laci doing anesthesia.
We gave some equipment to the hospital and to Dr. Jovin.  Much of it was donated by a Medial Equipment company.  Dr. Jovin gave me a plate with the Cetidel.
Dr. Novotny with Dr. Jovin with a sign of Thank You to Mobile Instruments who donated the equipment. 

The cleft that canceled because her lungs weren't good enough. 
We ended the day by going to the ocean and having a foot washing and then discussion of the trip.  We took photos, but mine didn't turn out, so I'll have to post another time. We'll be up by 5 am and on the truck by 5:30 so it will be a long day coming home.  Port, Ft. Lauderdale, Dallas, Omaha.  Home by nightfall. 
All in all it was a very good trip.  There were the usual frustrations that go along with something totally outside your comfort zone.  Then add the heat and long hours, but also the rewards of the people we met, people we helped and some who we couldn't help.  There are some amazing things going on down here and it is a beautiful country.  We had chances to see the area and the ocean and get to know a lot of other mission workers.  Many of these leave us feeling totally inadequate in comparison to the huge commitment made by them, but we've done the best we could.  Signing off for now.  Homebound tomorrow.

Wednesday, April 9, 2014

WEDNESDAY IN PIERRE PAYEN

I should post some pictures of the folks working with our team.  This morning surgery got delayed because our asthmatic girl ended up on a ventilator (that is Dr. Leach hand ventilating her all night long).  I got a chance to sleep, but many of the team were over at the hospital through the night with all the action.  In the end they transported her in the van to Port au Prince.  The ambulance was broken down. That left us with only one anesthesia person, Les, so our surgery was down by 1/2 till noon.  We turned away some who were there counting on surgery.  The schedule is in a state of flux continuously, to say the least.

We're going to try for the OWH with this picture at the entrance to the Hospital.  This is just across the highway from our living quarters.

Laci and Vanessa.  Admittedly they have been stuck in the OR all day every day and sometimes into the evening.  Give them super credit when they get home PLEASE!!!

Dr. Roger Evans, Urology and Dr. Nila Novotny, ENT

Kelsey, Dr. Leach and Dr. Miller watching after our asthmatic just before we transported her out. 

The OR crew. Vanessa, (OR nurse) Simeon (translator), Sam (OR nurse), Les (anesthesia), Dr. Evans, Urology.

Vanessa and Dr. Evans with the patient.
I had no idea there were so many jaw tumors in Haiti.  I'll include a couple of them. 

These don't even scratch the surface of the unusual diseases we've seen on this trip.  Kelsey spent much of the night with the asthmatic and said it was a relief to assist in a hysterectomy so she could just do the work and not have to be so serious. Molly got named as a godmother for a new baby! 


Tuesday, April 8, 2014

HAITI - MONDAY AND TUESDAY

Somehow it seems like we've been here a week already.  We lost internet last night and this might not last long so I will be brief.  I did a cleft yesterday and 2 more gigantic thyroids.  Today was ear surgery. There were some misc. tonsils, tubes, etc. My last ear case didn't show up, so who knows what is with that.  We had 5 fetal demise yesterday and one live birth today so we aren't quite batting 1,000.  Fetal mortality is high, but I don't really know much about that.  There is talk of fixing the AC in the larger OR, so I'm optimistic about that. Sweat was dripping down to my waist when I took off my surgical gown yesterday and today. I'll throw in a few pictures, then sign off to go up and sit on the roof.  Everyone has found a niche.  There are frustrations and rewards everywhere.  Clinic is VERY busy and the hospital is VERY busy with us here.  Our seminar brought around 60 yesterday and 70 today, I think inspired by our desire to teach the nurses.
Sweating during surgery.  

Cleft before.

Cleft after repair.
We hiked up the nearby mountain after we finished surgery.  It's not a very big mountain, but you can see the ocean and coastline.  It's got a very nice breeze so calms down the heat nicely.  Beautiful view.

Kate, Linda and Mark on our walk up the mountain.

Kevin and Kim Harm

Linda Carlson showing her pictures to the kids who followed us up the mountain.

John D. with his new friend.

John, Kevin, Cole, Kim, John D. and friend before our little hike.
There don't seem to be many misquitos, but I wake up with bites every day.

Sunday, April 6, 2014

SUNDAY, DAY OF REST?

Today we had no scheduled clinic, but the Primary Care saw patients anyway.  Urology and ENT did surgery.  We have 2 OR's, one small and one larger.  I have to say this is more organized than any mission I've done (save Guatemala where the whole hospital was in a big truck).  Since there was no GYN surgery, Dr. Julie (Bleyenberg) assisted me with the thyroid.  This had been there for an indefinite length of time.  The lady said she was 50, but I'm not sure she really knew.  Most people are born at home and have not birth certificate, so it's not uncommon to pick your age and birthday.
We first did a tonsil which went off without a hitch.  Not even 2 drops of blood and the child went home before I finished with the thyroid.
The tonsil starting.

The thyroid was massive and took 4 hours, so while we were finishing surgery, the rest of the team went to OSAPO, which is a very progressive health care and teaching facility. 
Pre op thyroid, 50 year old.
Tumor is OUT! 
A very good day.  I'll post more about OSAPA later, it's an example of Global Public Health program.




Saturday, April 5, 2014

HAITI CLINIC DAY 1, UNSCHEDULED

Today was a day to see just a few patients.  We weren't really advertised to be here seeing patients in regular clinic so we only saw 75 people.  I personally just saw 15.  A couple of them were sent up from Port au Prince, I think by the ENT there who I am supposed to work with next week.  They both had bad ears. One was a large perforation which I'm very afraid won't heal since it's so large.  The other is a child with an ear canal closed up.  Mom swears it was normal at birth, but closed up at age 2 mo and has drained ever since.  I'm waiting till the radiologist gets here tomorrow to look at the CT scan they brought with them before I decide what to do.  I saw nasal polyps eroding into the eye and a tumor the size of 1/2 a soccer ball on the side of the face.  Given the fact that it was at least partially removed 3 years ago and I saw a picture of it, and the fact that his jaw bone is eaten away, and the fact that he is HIV positive, I don't think there is much I can do for him.  I took a needle biopsy so we'll see what our lab has to say about it.  There was a leg with a 2 year old machetti wound that needs amputation.  None of that "worried well" stuff we see back home. You know, "just wanted to be reassured I didn't have cancer", type patient.  The limited X-ray capability and lab force all of us to use our clinical judgement.  Cole was afraid he wouldn't have anything to do, but is working in pharmacy and will work with HIV testing starting Monday.  John D. is go-fer extraordinaire and worked non-stop all day.  We've got the Family Medicine clinic fully staffed, admitted some CHF today and the Urologist and OB/GYN running nonstop all day.  There's a limit to how much I can load on this internet, so I'll try to post some pictures.
It didn't load them all, but this is fairly good.  NN
Mary, Namdar, Kate, Wendie and Melinda.  Pre and Post op nurses.
Line at the registration table.  Crowds were very well behaved.  Lined up and waited patiently.  They let in about 20 at a time so as not to clog the hallways.



Outside the front entrance to the hospital.  Patients being patient.


John and his totes full of supplies.  He never stops working.

Laci, John and Linda.  Laci is working in surgery and helped get stuff we needed for clinic.  Linda is the ENT clinic nurse. 

More equipment in the corner of the ENT exam room.

Here with the microscope John was able to mount on the exam bed.

This guy got in a fight with his uncle 8 days ago and his uncle bit him.

I got him patched up, but told him not to eat a Big Mac for a couple weeks so it won't break open.

Friday, April 4, 2014

PIERRE PAYEN APRIL 4, 2014

We started very early this morning shivering in the snow as we wiped it off the suburban and made our way to the airport.  We were there by 4 am, so started out tired.  Flights weren't exactly on time, but we all made it to Port au Prince on the same plane in the end.  The airport was chaotic as expected and poor John, who was looking after our hospital equipment like a hawk, got pulled into customs where they opened at least 20 totes and suitcases.  It all passed inspection and we proceeded to pile the suitcases in a truck along with some of the team.  The rest of the team got another truck and a few lucky folks got the van.
Most of the group leaving from Omaha.

Port au Prince

The "Paddywagon".  Just new last Novermber.  We rode on benches along the sides and had our carry ons with us. 

Loading the equipment truck.

Our surgical equipment trucks. 

Loading the equipment.

Waiting to load in the airport parking lot.

Back of the "Paddywagon".  Laci, Mary, Mark (Audiologist), Cole, Kelsey, Molly L to R.
Rt side Lt to Rt. Kate, John, Kevin, Kim, Wendie, Megan, Cambra (?) and Vanessa.  The empty spot was for Novotny's

We had riders in the equipment truck.  They had the best breeze. 
We drove north along the ocean for about 1 1/2 hours or so and pulled up at Pierre Payen about dark.  No more pictures today.  We ate a good supper, spaghetti, salad, bread, Hershey's chocolate for dessert (there goes my diet).  Then we unloaded all the totes.  We'll unpack after breakfast in the morning.  We all go tour work assignments and looked around the hospital.  Overall a good day with no real problems.