Hi all!
A few weeks ago, BHI partnered with International Planned Parenthood’s Haitian member organization, ProFamil, to teach their physicians, nurses and health promoters about cervical cancer screening with Visual Inspection with Acetic Acid followed by cryotherapy treatment.
Dr. Rachel Masch, BHI board member and Professor at Beth Israel Medical Center, lead the effort and will be returning in August with a team of gynecologists to conduct the clinical training during which we expect to screening about 500 Haitian women. Please enjoy Rachel’s daily blog from the recent trip. If you have any questions or would like to get involved in this project, please contact me at lditzian@basichealth.org.
Thanks!
Lauren
Program Manager, Basic Health International
June 5, 2011, Sunday
After a two hour delay at Kennedy we actually arrived in Port-Au-Prince (PAP) only 1 hour late. Our bags came off the plane and we were able to retrieve them and I had no trouble at customs despite the two “pelvises ” I had in my suitcase (Pelvic models used for clinical training). We were mobbed by guys wanting to help with our luggage on the way out; and we were “helped” with our luggage cart down the long covered walk to the parking lot. There is now restricted public access to the airport exit – it used to be that anyone could come right up to the exit doors- but now they have made an ~1000 foot walkway to keep people away (not sure if it is because of looting or crowd control . . .?). The man from ProFamil (Alix) was just outside the gate and we were whisked into a car after Sophie, my resident at Beth Israel, met some of her cousins. We were driven through PAP and then up the hill to Petion Ville – an area unaffected by the quake. Parts of PAP are still a mess, but not as bad as I expected – perhaps we did not drive by the worst parts.
We are staying at a B&B, “Hotel Morgan,” which is actually the home of a Canadian man (Morgan) and his Haitian wife, Carol. Sophie and I were regaled with stories from Morgan – the namesake of the place. He is quite a colorful character. Irish by birth, spent time in the states, back to Ireland and then to Haiti 30 years ago where he has stayed. He is extremely kind, as is his Haitian wife, who seems to really be in the know about all things Haitian. A young Haitian internal medicine physician, Sybil, was visiting with them when we arrived and we quickly recruited her to help us with the health promoter educational sessions. She is enthusiastic and equally as important, fluent in French, Creole, Spanish and English. BONUS!!
It is nice to have Sophie here since she speaks the local language and has a sense about the customs. The heat is not terrible, it rains only intermittently and I’m using a lot of bug spray.
June 6, 2011, Monday
Sophie and I spent most of last evening/night preparing for the session today. I had asked to leave early in the morning to arrive at the office of ProFamil with some time to spare, but we were picked up at ~8:10 AM, then wound our way down the hill, through Port-Au-Prince (PAP) to pick up Sybil (the young Haitian MD who agreed to help us out) and then Tania, a Program Officer for IPPF/WHR. We encountered several INCREDIBLE “blockus” (Kreyol for traffic jams) all over town. Add that to the fact that the “roads” here are no joke – many of them would be better described as large water/mud filled holes surrounded by some dirt and/or occasionally concrete. So, a bit like Gilligan’s trip was supposed to be – we had almost a 3 hour tour of PAP this morning (okay- maybe more like 2) and covered a distance of only ~5-7 miles. We were supposed to start our course at 9 AM and didn’t actually arrive at the building until 10 AM. We then met with the Medical Director of ProFamil, Dr. Michaud, and one of the other docs, Dr. Tassy. We spoke to them for several minutes, and prepared some of the handouts, etc, so that by the time we walked into the classroom it was 10:30. The 11 health promoters had been there since 8 AM!!
The day, however, went really well. The participants were actively engaged and asked some really great questions. We had formulated a few different games for them to play and we were amazed at how competitive they became (Myths & Facts about STDs/HPV and then a rendition of Jeopardy), I think the real competition started after we told them about the prizes. And shockingly, the most desired prize? Not the purell, or the gum, or the notebooks or the flashlights, but the CONDOMS!! One woman actually came up to me at the end and asked if she could get some too, even though she didn’t win. How can you say no to that?? There were moments when I thought a fight might break out. Well, not really, but they took the games very seriously! At one point Sybil had to admonish them and remind them that the point was really to learn, and that they should stop being so competitive. But it was good energy and very spirited!
Among us we were able to have our language understood. I muddled through with my French, Sophie was able to translate a lot of the medical information into a workable Kreyol, and Sybil was really the glue that kept it all together. Having a bright, engaged, enthusiastic and multi-lingual local physician helping us was really amazing. Sometimes it is better to be lucky than good!!
We were able to return to the guest house just before the pouring rain came with its jagged lightening and raucous thunder. It has stormed like this every night for several weeks, apparently. I have always loved a good thunderstorm, especially when it brings the heat down and the cool breezes up. But being here I am reminded that there are THOUSANDS of people all over PAP that are living in tents, on swaths of dirt and mud, that also have to endure these rains. It is sobering.
June 7, 2011, Tuesday
Shortly after I sent off the e-mail yesterday the lights flickered on and off for 5 mins and then our electricity went completely out. A generator was plugged in almost immediately and we were back in business, hardly a moment of inconvenience. That would be life on the hill. Several minutes later Morgan came downstairs to say that the deluge had caused a bridge to collapse in Petion Ville (just nearby), there was flooding in the tent cities and several people had been either drowned or washed away. There was no electricity in the city and the rain continued to soak the already saturated land. There seem to be no breaks here.
I am writing this from the front seat of our jeep. We have been stuck on a hill for ~30 minutes; there is some tremendous “blockus” that has stopped all traffic. In some ways it is a welcome relief from all of the bouncing about. We commute 4-5 hours/day, and the round trip is really only ~10 miles.
Because of the rains last night it took another 2+ hours to get to ProFamil this morning. Once again we did not leave until ~8:10 AM, and then we had to drop off medicines for Sophie’s uncle, pick up Tania in BelVil and then Sybil in Frere. None of it is very far, but the roads are impassable, and even the ones that are deemed “passable” are extremely hard to navigate. It’s as if we are constantly on back roads, except with thousands of people and goats, and motorcycles and garbage and other cars everywhere. How is it possible? The horn is used liberally- to warn others as we turn a blind curve, to pass people on the left into the oncoming traffic, to tell pedestrians to get further to the side of the road, further into the ditch. But Alix, the driver, has been incredible. We almost got stuck up a muddy hill, but after putting the jeep into low gear, spinning out the wheels and gunning the engine he was able to conquer it on the third or fourth time.
And yet, one can appreciate how beautiful it could be. The mountains surrounding the city are lovely, and the way the clouds hang low over them every morning is somewhat magical. But where do you start? Corrupt politics, misguided international intervention, Nepalese UN workers dumping shit into the rivers and causing an overwhelming cholera outbreak, disease incidences beyond mention, educational systems in shambles – how to establish the priority? And yet- the people are hard-working, and motivated and SMART. There must be a way.
Today was the last day of our health promoter training. We recapped yesterday’s teaching points and then did some role-playing. They were amazing. They all took it really seriously and devised little skits. I, of course, missed the nuances, but Sybil said they really captured the different kinds of attitudes/people in the communities. I was impressed. They had really gotten it.
Well, it is6:25 PM. We left ProFamil at4:20. And we are not back yet. I am passing one of the many tent cities in this city. What do they do in the dark and the rain? Where is their sanitation? How do they eat? And one of the mayors’ responses was to force them off the public land and out of their tents, but he gave them no alternatives for housing. Where are they supposed to go?
I can tell that we’re almost back at the guest house because the road has gotten infinitely better. The new president, Mr. Martelly (a famous Haitian vocalist in a popular band), had a road fixed that was right near his house. It was done really quickly, apparently. My suggestion was that the president be forced to move every two months.
June 8, 2011, Wednesday
I have just finished the MD/RN training. The doctors and nurses were more sedate than the health promoters but I think they liked the course. They also seemed eager to get it going.
After the thunderstorm the other night, we were told that the deluge had caused a bridge to collapse just near where we were and the floods had caused several deaths (I think the total ended up being 11). The thought of all that water in the tent cities is unfathomable. It seems that it is hard for anyone to catch a break here. But tonight Dr. Compas took us out for dinner and drinks and it was as if we were in a totally different city. People were relaxing, out to dinner, drinking, music playing . . . We then went to a place called “the View,” a roof top bar that is really nice by any standards. Next stop: to drop something off at the Hotel Karibe, (where we were going to stay but it was full), and it seemed like we were somewhere inMiami. While hanging out in the lobby we met the new President of Haiti’s campaign manager- he works for a company that goes around the world managing campaigns. They have projects inMexico,Africa, other Latin American countries . . . FASCINATING! We also met a MIT grad who works with the Clinton-Bush Relief Fund and a member of Union 1199 (the big health care union in NYC) that were interested in collaboration. I am amazed at all these smart, motivated people. It seems impossible that this place continues to be such an incredible mess.
June 9, 2011, Thursday
So the official course is now completed. It is hard to try and think and speak in French – unfortunately it is not yet intuitive and takes a lot of energy. Not quite as much as bouncing around for 2.5 hours to get 5 miles, however, but at least I have motorized transportation! Walking these hills would be no joke.
I think the course went over well, although I’ve decided we need native MDs to help us out with explanations. The young MD who was with us on Mon and Tues really took initiative and was integral to the health promoter’s understanding of the material. We had Dr. Compas with us yesterday for 2 hours and he was a great asset also.
Our last working day inHaiticonsisted of mostly being in the car. Dr. Compas was going to pick us up at 9 AM so we could avoid the trip to Belvil to pick up Tania, and have a hope of getting to ProFamil by 10 AM. I asked Carol to call Alix at 7:30 AM to tell him not to come and get us and then I went to use the computer for ~1 hour. Apparently, she couldn’t get through to him and he came anyway. He said that he was not authorized to let us go with anyone else . . . So, we left at ~9:15-9:30 and it was yet another 2 hour 15 minute trip to go the ~5 miles to the office. What a mess!! We did get some work done in the car, however, once we picked up Tania. I think next time we will stay at the Karibe since it is more central.
We picked up Dr. Tassy from the office at ~11 AM and then were back into the car to go to the MLK ProFamil clinic downtown. That took ~1 hour. The clinic layout seems fine. The previous clinic was destroyed in the “tremblement du terre,” and this new one is a pre-fabricated structure that was put up in ~5 days. It has 2 exam rooms and 2 consult rooms (which will become exam rooms for our training). There is enough space for at least 3 people plus the patient. They also have a youth center – a nice separate space that we can use for registration and/or to have the gowned women wait for their screening. And then there is a whole back area where we can set up chairs and do some exit interviews/surveys. It will be hot, but fine. We also met another doctor who wasn’t at the training the day before. He had too many patients and couldn’t break away, apparently. He didn’t seem phased when I told him he’d have to take a test. I took a lot of pictures at the clinic, but also in the truck – most of my pictures have the windshield wiper of our jeep as a bottom frame. I spent A LOT of time in transit. But I got quite the tour of the city. On our way back from the MLK clinic we stopped at the presidential palace and the epicenter of the quake – really incredible to witness the devastation, which is hugely apparent even after 1.5 years.
We went back to the main office of ProFamil to discuss how to roll out this program and establish “next steps.” There is no named Minister of Health, yet, and the Executive Director of ProFamil has a lot of contacts in the ministry. I think this may be a real opportunity to shape the cervical cancer screening and treatment guidelines in this country.
The meeting went well. We discussed the age at which we would screen: 30-59 and what we would do with those women who came who were younger than 30. We also discussed what we would do with those women with frank cancer. It’s a real problem, because there is nowhere for them to get chemo or radiation. The surgery could probably be done in l’hôpital général, but not by trained oncologists. What to do with them? Very few of them will be able to afford the adjuvant treatment. And, apparently they have to pay for EVERYTHING, including the tubes that are used to collect their blood. No wonder no one gets any care. Food for the family or a pap smear for me? Not a hard choice.
Dr. Compas came to pick us up at ~3:30 PM and took us downtown for some delicious Creole food. Griot de porc (fried) with riz au pis vert; lambi (conch) with a delicious sauce, beef soup. All delicious. And we were hungry, since we hadn’t eaten since ~7:30 AM, and it was cornflakes! We split a bottle of wine among the 3 of us, which had the effect of making me VERY sleepy.
Tatiana, a professor in urban planning atColumbiaUniversityin NYC, came by the restaurant to say hi. She’s fascinating – and a fellow Brunonian. She has been living inHaitifor ~1.5 years. She came for a sabbatical year to write a book, but was thwarted by the earthquake. She travels back to the NYC area every 7-8 weeks to teach a module for a few days and then returns toHaiti. She is smart, articulate and passionate. With all these incredibly bright and motivated people, why can’t anything get done???
We dropped her off at a friend’s house and then went back to “Hotel Morgan.” The plan was to go see Ram – a popular Haitian band that combines Kanpa, folklore and rock – but they didn’t start until 11 PM. We relaxed for a bit and then went to pick up Tatiana at a restaurant down town. She was with a colleague Greg, who lives inAtlantaand is also an urban planner. He was in PAP doing a project with OXFAM. Greg told us about his “bus-jacking” incident on I95S going from NYC toBaltimoreon theChinatownbus. Crazy things happen every where, not just inHaiti.
Ram plays every Thursday at the Hotel Oluffson – the old presidential palace, according to Morgan. It looks veryNew Orleans– with interior balconies and a large courtyard. We walked up some elegant marble stairs that split off to either side and into what I assume used to be the lobby. There were MOBS of people. We all started dancing and were soaked with sweat within minutes, but it felt so good to MOVE. One of the women who worked there became “possessed,” and trance-like. I thought at first she was having a seizure, but then noted that Dr. Compas was not worried, nor doing anything, so I figured she would be fine. The music was really amazing and everyone was incredibly uninhibited. The band ended at ~1:30 AM – much earlier than I had expected, but apparently they had started at 9 PM, not 11. We were home and in bed by 2 AM.
Haitiis an incredible place. The landscape is beautiful, the people engaged and eager, the music and food fantastic. And yet it is a place with no rules and seemingly little accountability. It is a place that has suffered from misguided foreign intervention, corrupt local politics and natural disasters which they have no infrastructure capacity to handle.
But I was so impressed with the health care workers with whom I met, and with so many of the other folks with whom I crossed paths: they seemed smart, savvy and really enthusiastic. With the election of the new President, I think there is a real sense of hope that things can change. But it’s so hard to know where to start. Although cervical cancer screening and prevention seems lower down on the priority list, I think that doing something positive and helping people to get and stay healthy is an important part of healing the country as a whole. And if we all do our parts, perhaps change can really happen. Like always, we will have to wait and see. But I’m excited at the opportunity and hopeful that it can happen.
Tags: cervical cancer, Haiti, masch, pap smear, profamil, rachel, sophie
