Haiti's fair share

by Rhonda Mullen      Photos by Chris Lowell and Nick Vitone

What Emory Medishare is doing to help build health care infrastructure for the poorest country in the Western hemisphere.

The 65-year-old man had been bed-bound with a catheter for 10 years. He felt less than a man, much less the head of his family. He had never been able to play with his grandchildren. Then a team of surgeons and medical students from Emory Medishare entered the picture. The man had the surgery that corrected his urologic problem, and he was returned to health and his rightful place in his family.

Emory Medishare is a branch of the nonprofit organization, Project Medishare, which advances community health and development in Haiti. Emory’s partnership began in 2008 with the first medical trip of six Emory medical students and faculty to Haiti. Since then, Emory teams have grown in number, with 10 core faculty and 40 medical students traveling to Haiti several times a year to offer primary care clinics and surgical services. Recently, they’ve added an OB/gyn arm and a research component to their efforts.

On the primary care trip each November, Emory volunteers typically see 400 to 500 patients of all ages over the course of a week, treating prevalent diseases such as malaria, hypertension, skin infections, and gastrointestinal disorders. During a surgical trip each July, Emory surgeons perform procedures that are unavailable in Haiti—which has only one urologic surgeon for its 9 million people.

When the students see what can be done, when they experience stories like that of the grandfather, they are fired up, says Emory urologist Viraj Master, who has participated in the trips. 

Coordinating efforts

Emory Medishare teams work in Haiti’s central plateau

Emory Medishare teams work in Haiti’s central plateau, where patients are among the most underserved in the world, with people lacking basic resources that many Westerners take for granted.

“One of the greatest pitfalls of our work is fragmentation,” says Ira Leeds, a second-year student who organized a surgical trip this summer. “We are there for a short, focused time, so in the grand scheme of things, what good does that do? What we are building toward is a synergistic whole, something that’s greater than the sum of the parts.”

The school’s collaboration with the parent organization is vital to sustaining any gains made in Haiti. For example,Emory’s team relies on Project Medishare to protect the expensive surgical equipment they leave behind so it will be available for the next visit.

Beyond that, “we’re not just parachuting in and then leaving,” Leeds says. “We’re building an infrastructure for the long-term.” For example the students have launched a capital campaign, Project Casse, to transform a dispensary into a fully functional year-round primary care center. In a second phase, the campaign will build a maternal health center to reduce maternal and infant mortality, and a third phase will build a physician’s residence to allow for 24-hour access to medical personnel.

The situation on the ground

The efforts of Emory Medishare began before the earthquake and will continue after its impact has passed. “Haiti’s problems did not start with the earthquake,” says Leeds. “Haiti has been the target of 200 years of exploitation and neglect that have led to a country with grossly inadequate social services for good health and a decent quality of life. Even before the earthquake, one in five children in the central plateau there did not live to see their fifth birthday.”

The Emory teams work in one of the poorest areas in all of Haiti, in Thomonde in the central plateau. The population there is one of the most underserved in the world, with people lacking basic resources that Westerners often take for granted.
While Thomonde was not near the epicenter of the earthquake, immigration in the months after the quake has doubled its rural population.

The Emory surgical volunteers also work in nearby Hinche, a relatively urban town of 50,000, which pulls another 500,000 people from the surrounding area for specialized health care. While operating conditions are better in Hinche, they remain rudimentary by most standards.

On his first trip to Haiti, Master and his colleagues worked without electricity, relying on camping headlights when daylight started to fade. No electricity also meant that anesthesia requiring electronic delivery was out of the question. The surgeons instead relied on spinal anesthesia, working against the clock before it wore off in 2-1/2 hours.
Equipment was a problem too. The students had raised enough money for travel and supplies, allocating funds carefully and bringing only enough suture lines to supplement what the local hospital could supply. However, when they arrived, they learned that there was no suturing material and were forced to adapt their procedures to use no more than three sutures per patient.

A measured response

Leeds, who has participated in both the surgical and medical trips, says that Emory Medishare has made intentional efforts to better coordinate efforts in Haiti to have a bigger impact. One example is a research intervention that has both primary care and OB/gyn components, which the students will begin in November, to see if they can lower high blood pressure in pregnant women. Follow-up is planned for April 2011.

Another project, funded by Emory’s Global Health Institute, is allowing students to study mental health in Haiti. “It gives us an opportunity to unpack what we’ve noticed on trips of an often undiagnosed and under-discussed issue of mild to moderate mood disorders in Haiti,” says Leeds. “For example, there is no word in Kreyol for depression. If we ask a potentially depressed person, ‘Are you sad?,’ they say, ‘No.’ If we ask what their day is like, they say, ‘I just sit around and do nothing.’ We suspect depression, but we have no clear way of diagnosing it in a foreign cultural context.” Students hope to be able to provide data and recommendations about how better to address the problem at the conclusion of the study.

Having a measured response is important to the Emory volunteers so they can find the best way to deliver health care to the Haitians. “How we help is important,” says Leeds. “The systemic underpinnings in the country, not the earthquake, created the current problems. The real way to rebuild is to put in place the infrastructure that wasn’t there.”


For a good cause

Emory medical students are exploring every angle to raise funds for the capital campaign for Haiti, from traditional bake sales to auctions where faculty members have offered themselves for kayaking in North Georgia or hosting a badminton tournament. To make a donation to Project Casse, contact Ira Leeds at ileeds@emory.edu. The photos in this article are also on sale, with all of the proceeds benefiting Project Medishare. For more info, contact Jackson Fine Art at 404-233-3739, www.jacksonfineart.com


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