"So what is it you do in Haiti, exactly??!" Part 2: Medical Consulting

WARNING:  This is not one of my typical, easy and fun to read, Miss Moses Lake posts.  Enjoy or skip on to the next as you like!!  :D

If I am trying to make what I do sound really exciting, I will tell you "I do independent medical consulting for clinics in Haiti!!"  But I mean, really!?!  What does that mean??  In reality, not much.  :)   But here are some of the basics in a bite-size portion.   

In a nut shell: I combine my experience in Haiti with my growing medical knowledge and connections (the Clinton Global Initiative, contacts in Haiti, and friends that run medical clinics), and upon request, help various short term medical mission teams in Haiti transition their care to a more sustainable, culturally-sensitive, and continuity-based practice. 

 

After the earthquake, we saw a lot of crush injuries, and similar ailments.

I am extremely blessed to have been given such a unique set of experiences within Haiti.  My first trip to Haiti was prior to the earthquake, when few knew of Haiti (multiple individuals asked if Haiti was in Africa when I mentioned going) and when walking through Port au Prince, Caucasians were so seldom seen that Haitians would come outside to point and take pictures of my team.  With so little outside help (as illustrated by the rare Caucasian sighting), I was privileged to see what the Haitian healthcare system looked like on its own, and how a visiting mobile clinic functions.  After the earthquake, I was able to travel back to Port au Prince when the massive influx of emergency healthcare was present, and I have watched as Port au Prince (and the greater Haiti) has gone through massive transitions (Cholera epidemic included!) in the three years since the earthquake - not all in positive ways.

 Much of the medical care in Haiti is now provided by short term medical teams, usually run by Haitian individuals (or similar) with no medical background, and staffed by American and European medical professionals with little or no experience with the Haitian culture.  These teams often are in country for 1-2 weeks, and a new set of team members come every additional trip (usually only a few trips a year for such an organization).  While these groups provide an incredible experience for the team members, and often bring many smiles to the faces of the Haitians they serve, with time I began to question the true impact these teams were having (or not having) on the long-term health and potential of the people they serve.  And I realized how much additional good could be done with some simple, mindful adjustments.

 To illustrate the point, the one thing I have devoted my time to more than any other, is the creation and implementation of patient record systems.  Many of the groups I work with do not keep any record of a patient and the care provided from one visit to the next.  So while a patient may walk away with a 14 day supply of antibiotics to cure an infection, when/if a team comes back several months later and the infection is not gone, there is no record of what antibiotic was tried previously (and the patient has no idea; "it was a white pill!"), and so the same antibiotic will likely be given once again, and once again it will not cure the infection.  Similarly, one blood pressure reading can tell you little, but several blood pressure readings over time can tell you a great deal!  But if you are not keeping track from visit to visit, it does little good to take blood pressures at all!  So why are these teams not keeping patient records?

A medical clinic's "patient notes" prior to my work with them: wadded up pieces of paper stuffed into gallon sized plastic bags, and later thrown away.

The same medical clinic's patient record system after Emily Fry and I worked on its implementation.  Patient files are separated first by village, and then by last name.

I argue this break in system is because the Haitian directors with no medical background do not fully understand these principles (as you wouldn't expect any non-medically trained individual to fully understand!), and because the medical professionals who come and go do not recognize how little continuity is being applied from their visit to the next medical team's visit.  So, while I am far from the most qualified person for such work, I have decided to use my experience in Haiti and growing medical knowledge to act as a sort of "Bridge Figure" between these two: the Directors of the Clinic with no medical knowledge (usually Haitian), and the Medical Volunteers.

 I call it "consulting" to make it sound fancy, but really all I do is explain to the directors the importance of patient records, help in the implementing of patient record systems when appropriate, and speak for the need to think about medical care in long-term, continuity-based ways: "Hey, what about returning to the same village every two months, and providing 60 day supplies of medications when we go....that way we can actually treat chronic medical problems in a proficient, life-changing way?  And we can track progress in our notes!"  It truly is unexciting work in many ways.  But I believe this is how I can make the greatest difference in the lives of the Haitian people, long-term, given the unique set of experiences and knowledge God has given me.

Working with a clinic in rural Haiti on the use of their new patient record system (note clipboards in providers' hands).

I also speak to the medical volunteers, new to Haiti, about the fact that first world medicine cannot  simply be applied to a third world setting with no fault!  In one sad illustration, a five year old Haitian boy had hydrocephalus: "water brain", treated in the United States with the placement of a shunt shortly after birth.  If not treated, it leads to severe mental retardation.  A neurosurgical team traveled to Haiti, found this 5 year old boy, and performed a "miracle surgery" of a shunt placement....and then left back to the United States.  Three weeks later, this boy was dead.  Why?!  Because the application of healthcare that works in one corner of the world, does not always work in another!  In this case, there was increased bacterial risk in Haiti, the mother did not understand the warning signs to look for, and the mother did not have access to follow up care.  While this is a large example, similar principles exist in the every day primary care clinic as well.

 Please understand that I write all this with love.  I understand that many of my readers may put their heart and soul into providing care for those in need.  I do not aim to undermine such efforts, here in my writing or in the work I do, but simply to suggest that each of us individually, and as teams, need to pull back and re-evaluate the true impact outside aid is having on a nation we love. 

Also, please note that what is written here is extraordinarily watered down.  I have much additional experience and insight (from experiences in Haiti and working with outside groups, like the Clinton Global Initiative), and there is much more to what I do (teaching healthcare classes, hands-on healthcare providing, consulting with Electronic Health Record suppliers, etc.), and if you ever want to sit down and have a meaningful discussion, I would be more than happy to!

At the Clinton Global Initiative - U 2012

If you would like a bit more colorful description, with some fun background, here is a magazine article written on my background and work in Haiti, published a year ago.

Teaching a class on Cholera Prevention and Treatment.  One of several other things I have aided in.

Romans 12:5-8   We have different gifts, according to the grace given us. If a man's gift is prophesying, let him use it in proportion to his faith. If it is serving, let him serve; if it is teaching, let him teach; if it is encouraging, let him encourage; if it is contributing to the needs of others, let him give generously; if it is leadership, let him govern diligently; if it is showing mercy, let him do it cheerfully

Colossians 3:23    Whatever you do, work at it with all your heart...