Letter to the Guest EditorGuest Editor, Jorge L. Gamba, M.D.
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| Many local groups and community organizations are involved in medical humanitarian missions overseas. The most successful
regional organizations appear to be committed to long-term improvement in health care by providing education and training to the local personnel as
well as focusing on improving regional infrastructure in one locale. This frequently includes development and maintenance of
hospitals/clinics, improvement in nutrition, sanitation, and delivery of essential medical goods.
Several physicians of the DCMS have volunteered their
services in Haiti with the St. Boniface-Haiti Foundation, devoted to improving health care in a small community in rural Haiti. I recently
asked one of the surgeons to describe his experiences in Haiti upon his return. This is his response.
Dear Jorge, You indicated an interest in hearing more about how the medical mission in Haiti might be helped. We are primarily looking for two things: medical and nursing volunteers who will go work in Haiti for a brief time and organizations to which we can apply for financial support. Our effort includes both formal grant applications with organized facts and figures and more ad hoc appeals to community groups using a slide show accompanied with facts and anecdotes. Haiti is impoverished to a degree hard to comprehend. Most (85%) have no job and subsist in a hand-to-mouth barter economy. Port-au-Prince is a sprawling and heavily congested city which is largely a slum. The worst parts defy description. Above the city in the overlooking hills are scattered the walled and guarded compounds of a very few wealthy inhabitants who seem to isolate themselves completely from the people at large. It is generally peaceful, but political disturbances are not rare, and I think many of the urban young seem sullen and discontented. The few "modern" stores and businesses will have armed guards at the door or circulating inside to ward off gangs of bandits or kidnappers. Port-au-Prince General Hospital is medireview. It is not uncommon to have two to a bed. Families must bring in the food for the patients and also buy and bring in medicines, IV supplies, etc. If they can't afford to go buy it, they do not get treatment. The countryside is more relaxed but far from bucolic. Many seem to have a small plot for some food production, but malnutrition is very real. The land above the coastal plain is largely stripped of significant timber and the topsoil has long been washed away. Our mission is in Fond-des-Blancs, a village in the low mountains about 65 miles from Port-au-Prince. It is supported by the St Boniface-Haiti Foundation (of which I will say more later). The roads are such that it is about a five hour trip from the airport in the Land Cruiser (actually an improvement over the past). In addition to the little hospital, there are churches, a morgue, a few primitive shops, an open stall market area, and small dwellings (one or two room cinder block with a separate cooking fire area, but also many banana leaf thatched huts with dirt floors. Many people come in from the surrounding hills on foot or donkey to the market or to visit the hospital. There are few jobs. They live through subsistence farming - a garden, a pig or goat, some chickens, mangoes, and a couple of acres of maize. There seem to be no government services. There is no electricity. Water is from the river, cisterns, and a few hand-pumped wells. The village priest seems to be the organizing element for most "civic" initiatives including an elementary school. The St Boniface-Haiti Foundation also supports a house in Port-au-Prince with an adult supervisor for a handful of boys from the village to allow them to attend high school there. The hospital is small and painfully ill-equipped. It operates with solar panels, batteries, and a generator. There is an outpatient clinic area where adults and children see the two Haitian physicians employed by the mission. There is no x-ray, minimal lab (hemoglobin and white blood cell count, I think), and a limited pharmacy stocked with donated drugs the U.S. volunteers bring in their suitcases. There are about twenty-five in-patient beds. Last month, a typhoid epidemic filled it to overflowing. Babies are delivered there, unless a C-section is required, in which case the mother in labor is taken in the back of a pickup truck over the dirt track to a slightly larger facility in Les Cayes two hours away. Malnutrition is the standard. Infant mortality in the country is sixty percent. Neglected medical conditions, which in the States would have been easily treated in their early stages, progress to grotesque extremes causing great suffering and even death. I cannot exaggerate this latter point, and it is because of this that a surgical program of modest scope has so much to offer. The new OR adjoins a new nutrition center where mothers are instructed in how to feed their children using supplies mostly from Food for the Poor kept in a new, large rat-proof storage room. The outlay for operating the hospital is supplied by the St. Boniface-Haiti Foundation. This covers salaries of the nurses, doctors, a part-time dentist, and little else. Logistical support is weak. The St Boniface-Haiti Foundation is almost smaller than its name- in reality a literal handful of very middle class people from St Boniface Parish in Quincy, Massachusetts, a priest, a couple of doctors, a hospital administrator (Jack Logue) and his wife (Sandy, a nurse) who organize the volunteer groups and individuals with both medical/nursing and strictly lay backgrounds who come down to work a week or two. It grew from a portion of the proceeds generated by a "march against hunger" by the women of St Boniface Parish in 1983. It was put together piecemeal and has a precariously small support base. The flow of money is tenuous and there are no "deep pockets." Most medical supplies are donated through solicitations by the mission volunteers. Expenses are growing and very basic equipment and medications need to be purchased to allow a more acceptable standard of care. Beyond this, it is possible as age overtakes the small central core of volunteers, the whole thing may collapse ending medical care in Fond-des-Blancs. It is recognized that somewhere, a white knight or two has to be found, and we are trying. If any interest can be generated with potential sources of support, give me instructions and we will provide whatever information needed to support a request for money, specific medical supplies, and/or volunteer medical personnel. Thanks for asking, Ken The St. Boniface-Haiti Foundation is a not for profit organization whose web site is www@Haitihealth.org. The next trip to Haiti is October 10th and will include a surgical team directed by Dr. Ken Koster accompanied by nurses and other personnel from Baptist and St. Vincents Medical Center. Surgeons and anesthesiologists are in particular demand. Mr. Jack Logue (VP, St. Vincents Medical Center), is the local coordinator for the Foundation. He can be contacted at 904-308-8446. January, 2002/ Jacksonville MedicineWhat's New
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