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August 2003 Health News This Month

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Posted August 12, 2003
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Healing hands in Haiti: With the nation's economy in shambles, a medical mission from Miami brings critical care
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HELPING RURAL POOR: Vicki Viveros, 23, a University of Miami medical student, checks a Haitian woman's blood pressure at a temporary clinic in Savanette. MARICE COHN BAND/HERALD STAFF

By ELINOR J. BRECHER, Miami Herald Staff Writer 

THOMONDE, Haiti - It's the last morning in rural Haiti for medical students who came to treat some of the poorest people in the hemisphere's poorest country, an experience tailored to touch their hearts as much as to test their skills.

''I'm sure each of you had your hearts broken by the orange hair and big bellies,'' says Dr. Barth Green, head of the neurological surgery department at the University of Miami School of Medicine and one of their mentors.

The students had seen dozens of malnourished children: Here in the Central Plateau, balanced diets are as rare as electricity, indoor plumbing and paved roads. The students had come with Project Medishare, the medical mission that Green and UM colleagues Dr. Arthur Fournier and Dr. Michel Dodard founded in 1994.

Since then, Medishare has reopened a long-shuttered government clinic in Thomonde, trained about 40 local health agents, established a medical residency program for Haitian doctors, and hosted diagnostic clinics called community health fairs three times a year.

With the island nation's economy in shambles, the Haitian government is hard-pressed to provide social services anywhere, but especially in regions isolated by roads that consist of craters connected by ruts.

Foreign medical missions have tried to fill the gaps, with mixed success.

Dr. Paul Farmer, a Harvard University medical educator who runs the Central Plateau's only full-service hospital, says Project Medishare has become ``a major force for good throughout central Haiti.''

Farmer, in an e-mail, noted that most medical missions ``focus on the short-term [and] when visitors leave, so does the project . . . That changed when Medishare developed a full-time presence here.''

That presence depends on the students.

''Many young people ask me about going into medicine,'' Green, 58, tells them. ``For the last 10 years, they've been asking about quality of life: how to work the least amount of hours and make the most money. When we think about quality of life, it should be about how to bestow it on people who don't have it.''

Few people have less of it than those who show up at the health fairs here complaining about conditions that, in the United States, would be managed by an appointment with the family doctor and a trip to the drug store: rashes, bacterial infections, vitamin deficiencies, parasites.

But in rural Haiti, routine maladies can stunt, cripple and kill. Conditions stun even those with experience in the developing world.

Haiti has the Western Hemisphere's highest infant mortality rate (nearly 94 of every 1,000 babies die before their first birthday), the lowest life expectancy (about 49 years is the average), and fewer than two doctors per 10,000 citizens.

''I thought it would be similar to India,'' says UM student and Michigan native Reshma Shah, who has visited relatives in and around Bombay. ``India at least has infrastructure. Here, if it doesn't rain, they don't have water.''

For the first time in years, however, there's hope: $146 million in international aid for health and infrastructure projects, which the United States and others have blocked for political reasons, is on the way.

In South Florida, the plight of people in this destitute corner of Haiti demands attention for practical as well as humanitarian reasons, says Marie Chery, Medishare's Haitian-born executive director. The longtime UM AIDS researcher and registered nurse recently relocated to Thomonde, a dirt-road town of 39,000, 31 miles northeast of Port-au-Prince, the capital, near the border with the Dominican Republic.

Considering the number of Haitian immigrants who end up at Jackson Memorial Hospital, treated at taxpayer expense for big-ticket ailments such as AIDS and tuberculosis, ''it's in South Florida's best interest to try to assist [in Haiti] any way they can,'' Chery said. ``When people come [to Miami] on a boat, it's not only for political and economic reasons, it's for access to health care.''

The medical students in Thomonde this summer -- most entering second year -- included 14 from UM, three from Northwestern University and two from George Washington University. Eight volunteer physicians also were present, with Chery supervising them.

Each day, they split into two groups to hold health fairs. In four days, they saw more than 1,200 patients.


After bone-jarring ride, students reach remote town

The first day, a small caravan of 4x4s heads to a school in Savanette: a collection of tin-roofed block buildings without lights or bathrooms. Driving less than five miles takes a bone-jarring hour.

The previous evening, the students got some advice from Dr. Glenn Geelhoed, a George Washington University tropical medicine specialist who has led dozens of medical missions to Asia and Africa: Practicing medicine in the Third World requires ``an infinite threshold for frustration.''

The routine is the same at every health fair: Students check height, weight and blood pressure, jot the information on a registration slip -- a rudimentary medical chart -- and send patients to the appropriate line: pediatrics, OB-GYN/prenantal care, general complaints.

This day, Dr. Arturo Brito, a pediatrician who runs UM's Pediatric Mobile Clinic, is seeing children.

He tells UM student Vicki Viveros, 23, to hold Stanley Sama, 1. The baby has had a cough and fever and Brito, 41, knows he'll throw a tantrum when the exam begins.

''Tell the mommy it's OK if he cries,'' he says to Allyson Webb, a Peace Corps volunteer who's translating. Stanley writhes and shrieks.

The 26-year-old mother has three other children.

''Tell her that the longer she breast feeds, the better,'' Brito instructs Webb.

Barth Green sets up at a wooden table in a corner. He's expecting what he always sees here: malaria, typhoid, HIV complications, an epidemic of hypertension and GERD (gastroesophageal reflux disease).

The latter two, explains Green, best known as president of The Miami Project to Cure Paralysis, owes to stress and diet.

``Before they sit down, I've diagnosed them.''

At day's end, the group has seen 204 patients, then joins the other group for dinner at the guest house.

''From now on, you are clinicians,'' Geelhoed tells them. ``The number one thing you did today was pass along hope.''

At dawn the second day, Reshma Shah and classmates Hermena Cerphy and Jenny Duret, the trip's student coordinators, are organizing the day's pharmaceuticals. It's their second mission.

Medishare brings South Florida's future physicians here to learn about a culture that will produce many of their Miami patients. But it also cultivates Haitian-American medical students like Cerphy and Duret hoping they'll ''become the most important advocates for their homeland,'' Green says.

''I always wanted to be a doctor because of the way things are here,'' says Cerphy, 23, who was born in Port-au-Prince and has lived in South Florida since 1991. ``Now I've come back in a position to make a difference. I see it as my duty.''

Cerphy and Geelhoed set up a makeshift OB-GYN department at a farm house near the village of Saladere. In the cave-like dimness -- with two bat-eared mongrels snoozing in the corners -- Cerphy probes the swollen belly of a woman who thinks she's two months pregnant.

Odilene St. Louis also thinks she's in her early 20s, but she isn't sure.

What she does know is that she has miscarried four fetuses, twice the number of her live births.

Cerphy is too busy to notice the mind-bending irony of the shack's decor: walls papered with ads for the developed world's unattainable luxuries, ripped from English and Spanish-language magazines: Yves St. Laurent couture. York air conditioners. Zoloft.

Cerphy performs nearly 30 pelvic exams and instructs patients in the use of self-administered PAP smear/sexually transmitted disease detection kits. In a month or so, a Medishare-trained health agent will bring the results. If a patient needs follow-up care, the health agent will refer her to the Thomonde clinic or Paul Farmer's Zanmi Lasante (Partners in Health) hospital.

This might not seem like a health-care revolution, but follow-up amounts to exactly that in rural Haiti.

''We're two hours by plane from Miami and no one seems to notice,'' says Jeremy Green, 24, Barth Green's son and a Northwestern student, manning the pediatrics department under a mango tree at the farm. ``These people did nothing to deserve this.''

On the third day, Womiel Seran enters the world about 1 a.m. in Thomonde, apparently healthy despite his mother's high-risk pregnancy.

Elvan Seran, 17, was eclamptic: She suffered pregnancy-induced hypertension that caused her to have a seizure and could have killed both mother and child.

Womiel and his mother survived because Elvan Seran's relatives got her to Thomonde's clinic: an un-air conditioned cinder block structure open 24/7, with a dispensary, a five-bed day hospital and a pharmacy.

Families cook patients' meals over a charcoal fire in a courtyard and hand-fan the flies away.

The Ministry of Health closed the clinic in the mid-1990s. After that, pregnant women and newborns began to die at an alarming rate, according to former Mayor Delva Jean Souverne. Medishare expanded and reopened it last year with the ministry's approval.

When Medishare showed up in Thomonde, says Souverne, ``it was like God comes down here. They help so many people.''

Wednesday afternoon, the health-fair crowd outside a defunct government clinic in the town of Casse seems dangerously unruly. The rear surges forward, jamming those in front against a set of wrought-iron gates.

Fournier, UM's associate dean for community health affairs and vice chairman of the family medicine department, has seen it many times: desperate people so frantic for help that they nearly kill each other trying to get it.

He resorts to a proven crowd-control measure: screaming. ''Mes amis [my friends]!'' he thunders in Creole. ``Silence! Take pride in the fact you are Haitian . . . ! You have a lot of health problems, but if you don't control yourselves, we are never coming back!''

''That was theater,'' confides Fournier, 55.

It works. People back off and form something of a line.


Program lets family receive its daily medication

Thursday morning, health agent Iphonea Vincent visits one of her client families. Their home: a two-room shack with grimy corn-stalk sleeping pallets and piles of ragged clothes.

Vincent, 34, brings medication to the family as part of a Medishare program called ''direct observe therapy,'' which ensures that patients unfamiliar with pills get the right doses at the right times, and that they don't sell their medications.

Axilien St. Louis, Charitable Milien and their six children all have tuberculosis. Milien, in her mid-30s, contracted TB, then infected the rest of the family.

Axilien St. Louis is now strong enough to hoe his corn. Odilence, 14, Hifonise, 10, Ginel, 8, and Itenni, 7, have returned to school. The 3-year-old twins, Woni and Wonal, have gained weight.

Medishare has trained 37 health agents. A grant from the Miami-based Green Family Foundation -- no relation to Barth Green -- will nearly double the number (and provide the agents badly needed transportation: five donkeys).

Vincent took charge of the family last November. She often brings something to eat because the medication must be taken with food and there isn't any. Before Vincent came, the family had spent all its money on ''witch doctors,'' explains Peace Corps volunteer Lorelei O'Hagen.

She glances around the shack and whispers that the family is ``at the bottom of the [economic] ladder.''

They still believe in spiritual healing, she adds, ``but they know that Medishare helps.''

Reprinted from The Miami Herald of August 10, 2003.                                                                                       , the scholarly journal of democracy and human rights
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