By Dr. Jill Ratner

Four months after Dr. Michael Shaw returned from his first trip to Haiti and his first experience delivering health care in a resource limited country, we sat down to talk. Even though Dr. Shaw is a seasoned Obstetrician/Gynecologist and has done extensive volunteer work with Planned Parenthood, he admitted that nothing had prepared him for what he saw in Haiti. And as with many of our volunteers, sometimes you need some time to process the experience.

He spent his week working in the clinic at Open Door Ministry alongside trip leader and pediatrician, Dr. Allison Platt, and then focusing on his core mission: teaching life saving colposcopy and cervical cancer screening at the Justinien Hospital, the main teaching hospital in Cap Haitien. To do this he would conduct training classes and make rounds on patients with Ob/Gyn Attending, Dr. LeConte and his house staff.

Cervical Cancer is the leading cause of cancer death for women in Haiti and it strikes them in their 30’s and 40’s.

This program was first brought to Cap Haitien by another Hands Up for Haiti volunteer, Dr. Sue Malley who managed to get the first cryoprecipitate machine and screening done two years ago. (link to previous blog)

“There is no comparison with working in a clinic or office in the United States and the conditions in which you see patients in Haiti- the heat, the lack of equipment, nothing is clean despite all efforts- you can’t be ready for that”.  Despite that, he commented that the cases he saw in the hospital were extremely well managed, and the outcomes were going to be good. The patients were suffering from complicated medical problems such as uterine perforation after an abortion and severe pre-eclampsia of pregnancy. Despite the environment of crowding,  lack of basic hygiene control, and incessant flies in the hospital, patients were receiving good care.

Dr. Shaw felt that cervical cancer screening with colposcopy and “see and treat” protocol was definitely the “way to go” in this setting, especially since obtaining routine Pap smears is not possible for the millions of women at risk.  He felt that there were women with pre -cancerous or cancerous lesions that he treated and he was sure that they will have good outcomes because of this.  “The equipment is old, difficult to focus and needs upgrading”. One of Dr. Shaw’s goals will be to try to obtain a new culposcope and cryoprecipitate machine for the program.

Although Dr. Shaw recognized that doctors were trying their best to deliver good care, he did feel there was much need for increased sensitivity to the rights of patients for respect and privacy even in this setting. It is a different culture and “The lack of drapes during exams, the lack of privacy was really hard for me to see.”

As far as Hands Up for Haiti was concerned, Dr. Shaw had nothing but superlatives. “I always felt safe and the trip leader was “tremendous”. “From the moment I stepped off the plane, until returning home, our Haitian team was always there and escorting us through sometimes tricky situations”.

As for most of our medical volunteers, the first trip is always the hardest. “It was difficult being without the support of my family and other Ob-GYN colleagues. I am not ready to go back…..yet. When I do go back, I think the way to go will be with an experienced operating nurse, and maybe even an anesthesiologist. I would be willing to continue to work on the cervical cancer screening and on the operating room protocols and techniques with the Haitian doctors and nurses.”

There were bright moments as well. “One of the highlights of the trip for me was watching Allison treat the children from the orphanage. The children were so grateful for the attention and care. It was emotional and heartbreaking all at the same time”.

In the meantime, Dr. Shaw is continuing to support Hands Up for Haiti and its work, and will be actively seeking improved equipment that will make treatment options even better.

By Erica Bromberg

I recently returned from my third trip to Haiti. This time, I went on a pediatric mission. There were 14 people on the trip and the group consisted of students, pediatricians, nurse practitioners, nurses, nutritionists, social workers, and a professional photographer. As with my previous two trips, this mission was nothing short of amazing. This was my first trip without my mom, but our team leader was my childhood pediatrician and Hands Up For Haiti’s president, Jill Ratner. Jill was an unbelievable team leader. There were quite a few “young” people on this trip – Jenna, a sophomore at Cornell, Chava, a nursing student at Pace who is my age, and Pete and Pat, two social workers. Not to mention the amazing Haitian translators we work with every trip. I was so excited to see them again. The pediatric mission was great for me to learn about basic medicine. I will never forget what Albendazole is used to treat! (worms).

Upon arriving in Port au Prince last Sunday, we were informed that not all of our luggage, mine included, would be able to continue with us to Cap Haitian that evening and would be sent out on the first flight the next morning. I then saw that my suitcase had been locked with the spare lock I had on one of the zippers (and I did not have the key with me!). Fortunately, we were able to take all of the luggage with us and upon arriving at Open Door we were able to break the lock open. We spent the evening setting up our bug netting and we ate Ma Pas’s amazing home cooked dinner.

Day 1

We were spending the first few days seeing patients in the clinic at Open Door. The first morning we were awakened by the usual roosters at 4am. We started clinic around 8:30am and worked until the early afternoon. I helped the doctors with scribing, getting medications from the different rooms, and I got to rub Permethrin cream on a baby with scabies – my first time administering treatment to a patient by myself!

The worst case of the day was a two year old with a rectal prolapse that was so bad she couldn’t sit down. I will spare the details. The child was in such hysterics our only solution was to temporarily tape her rear end closed and advise that she returns to the clinic in two days if it does not improve. Another baby had a face covered in impetigo. In addition to medical treatment for the infection, the nebulizer was used to soothe his face as temporary relief. The team was excited to see the baby the next day and how much his face had already improved!

After clinic we went over to the orphanage. We saw the kids playing on the swingset. As usual, they were craving attention and would not let go of our hands. After the orphanage we walked down the road to see a well that had been built. A 12 year old Haitian boy walked with me the entire time, chatting in English. He told me he loved me and also asked for money to keep going to school. I told him I did not have money on me but that he should stay in school as long as he could and how important it is that he gets an education.

On Tuesday the team split up – half of us went to do outreach in a local village and the other half stayed at Open Door clinic. Outreach was performed in a local church. There was nothing in the church except for a few tables and chairs. We made do with what we had and set up different “office stations” for the doctors to work. We examined 45 patients in total. I saw a young girl with tinea on her scalp. It had caused a large bump on her head. A young boy had an accident with a machete about two weeks ago. The tip of his finger, which was falling off, had been stitched up about two weeks ago, but the stitches were all frayed and infected and his finger was gangrene. We attempted to clean the finger and put some gauze over it, but the baby needed to go to the hospital immediately to have part of his finger removed.  The patient who had the largest impact on me was an 18 month old who was so malnourished he was about the size of a six month old. The mother said he was enrolled in medika mamba, the local malnutrition program (mamba is peanut butter in Creole), and not gaining any weight from it. It was clear to us that the mother had some issues of her own. She seemed unresponsive to our comments and suggestions and very removed from the situation. The nutritionists tried to speak with her one on one to get the message through to the mother that her child would die if he did not gain weight. We gave the mother money to take a tap tap to the hospital and told her that we were going to check on her the next day to confirm that she went to the hospital. We later learned that she did not go to the hospital, as she believed she did not have enough money to then take a tap tap home from the hospital. The whole situation was very saddening.

In the afternoon, we walked up Prayer Mountain. The view was gorgeous and it felt great to be walking around outside. We were joined by some of the village children. That night, the boys (Samson, Guindy, Sonel and Peterson) took us over to the church and played music for us. We danced around and formed a big conga line.

Wednesday the team switched roles from the previous day, so I spent our third day in the clinic at Open Door. I worked in triage, helping to weigh and measure the kids. The biggest case of the day was putting sutures in the forehead of a girl who was accidentally hit by a rock. She was very scared at the sight of her blood and screaming uncontrollably. It didn’t help that we did not have the right size needle.

I gave a community lecture on why babies are born with birth defects. There are many myths and superstitions in Haiti so my goal was to dispel the myths. I spoke about a few different syndromes, gave advice on nutrition for the mother while pregnant and the consequences of drinking or smoking while pregnant. I did not receive many questions from the attendees, but I was glad when a mother said she was planning on getting pregnant again and happy to have this new information.

Thursday morning we packed up our bags, as we were staying at a hotel in Cap Haitien the rest of the trip. Half of the team went to Grand Riviere while the other half went to Limonade. I was part of the group traveling to Grand Riviere, however we never ended up in Grand Riviere – over halfway through our tap tap ride we were stopped by a roadblock. People had placed tree trunks in the middle of the road as a protest to get the government’s attention. They wanted the roads to be fixed. We were able to get through the first roadblock, but we were stopped about five minutes later and had to turn around. We couldn’t return via the road we had come from, so we had to find an alternate route and ended up driving through rivers and streams. It was quite the adventure.

We joined the rest of the team in Limonade. 60 patients were seen in total, only about two of whom were healthy. The most malnourished children were seen here out of any other clinic day on the trip. I assisted Lauren, a Pediatric Nurse Practitioner, with getting medications for patients. We saw a three year old who was so malnourished he weight 13 lbs and was the size of a two month old baby. He couldn’t walk and his cry was so weak it was barely audible.

The malnourished three year old and his 19 year old mother:

On Friday I went to Shada with half of the team and the other half went to Labadee. Shada is one of the poorest slums in Cap Haitien. The houses look like shells of concrete and there is trash everywhere. I was looking forward to working in the clinic at Shada, as I had never been there before. The clinic was extremely small but we worked very efficiently. Much to my surprise, we barely saw any malnourished children. Many of the children were already enrolled in a malnutrition program. Most patients had UTI’s, scabies, or other infections requiring antibiotics. One 16 year old boy, who showed up to the clinic alone, was extremely thin and had very concentrated urine. It was unclear whether he had typhoid.

After clinic, we walked down the street to the local market. It had tons of paintings, sculptures, bracelets, wooden bowls, etc. I definitely could have found something to buy, but the shop owners were very relentless and intimidating and I was not up for bargaining. Friday afternoon we went to a healthcare networking event at a nearby hotel. The hotel sat atop a mountain and we had a gorgeous view of Cap Haitien. That evening we had dinner as a team at another nearby hotel, Cristophe.

Our last morning in Haiti most of the team went on a site visit to a Hatian woman’s home. We originally planned on having working sessions and discussions with the children, but due to miscommunications none of the children were there that day so the team went to scope out the space for future visits. The woman’s main mission is to “evangelize” the children in Haiti. The team saw the program brochure before traveling to her home and it was very religion oriented. However, upon visiting the gorgeous home and speaking with the woman, the team realized the main mission of the program was to promote education among the children. It was definitely a worthwhile site visit and the group would love to work with the children on future trips.

Instead of going on the site visit, Chava, Jenna and I accompanied Samson on a ride back to Open Door. We walked across the street to Deula’s home and Samson had a man climb a tree and cut down coconuts for us! We drank the coconut water. On the way back to Cap Haitien Chava went on a short motorcycle ride with Samson.

By Jill Ratner

Every team that has gone to Haiti has witnessed that so much of the disease that we treat would be prevented by basic services that are so available in the developed world that we take them for granted.  Availability of clean water is just something that people in Haiti, like most of the population of the world, do not have access to on an every day basis.  The consequence is living on the edge of dehydration constantly, drinking sugary drinks since water is not clean, bathing in areas where animals and humans may dispose of waste and garbage and using water sources that are riddled with bacteria and parasites. Children are particularly vulnerable to these plagues that rob them of good health, ability to grow into robust adults, and interfere with intellectual growth.

When Doctor Eugene Maklin sent us an email with a list of locations he and Dr. Jasmin, the Minister of Health had identified as communities in dire need of community wells, Hands Up for Haiti saw this as an opportunity to support this effort and in a concrete way, improve water access to communities where we work and support health care. Although we are not engineers, we recognize that water is essential to good health, and thus, the ability to collaborate with this effort was the kind of investment that would give a great return in terms of decreasing illness.

Each well serves between 2000-5000 people. In the spring of 2013 we were able to finance a well in the community of Labeline, near Limonade and Bwa de Lance.  This winter we are coordinating with the Northeast Rotary Club to finance the building of a second well.

Each well serves families that previously had to walk May miles for clean water. Each well is a guarantee of healthier children, and families whose lives are made easier and safer through access to clean water.

By Mary Ann LoFrumento MD

We all wish for happy endings in our stories and in our lives. But life in a slum like Shada is as far from a fairy tale as possible.

Returning to our clinic in the midst of Cap Haitien’s worst slum, I found myself feeling cautiously optimistic. I was immediately surrounded by a familiar group of children who wanted to pose for photos and who always asked for something to eat, hoping the visiting “blan” would have brought some treats for them. Hard to explain that our reason for visiting was to help support this small clinic, a medical oasis in the midst of so much poverty and neglect, solely supported by Hands Up for Haiti. But when you are small and hungry, larger concepts like access to health care, are beyond your grasp.

Madame Bwa, our community leader and midwife, greeted me with her warm and welcoming hug. Miguel Ange, so proud of this clinic, grasped my hand and shook it firmly. “Bon jou, Dokte Mary Ann.” I was joined by my partner and President of Hands Up for Haiti, Dr. Jill Ratner and our Treasurer, LaMar Parkins, on his first trip to Haiti. There were no patients to be seen this morning as we had scheduled a meeting to discuss the challenges of the clinic and to deliver a donated electronic scale for our malnutrition program.

There was a young woman sitting on the bench inside. She looked familiar, but I could not place her right away. Then Miguel Ange told me who she was “Remember the baby we brought to the hospital? This is the mother.” “Oh, of course”. I said, remembering now her face from the photos. My heart soared as I went to greet her, expecting the baby would be here as well. A true testament to our success and our heroic efforts, I thought, my optimism and belief in our mission rising. But this young woman was sitting alone and quickly I realized the reality.

“The baby?” I asked her. She shook her head. The baby had died six days after we took him to the hospital. I felt a sadness begin to take hold inside me and well up behind my eyes. To help halt my feelings of grief, I reached for the familiar medical shield, the doctor in me wanted to know what had happened. But this young mother did not know, “There was something wrong inside” was all she was told. And there was infection. I remembered the thin, weak body of her child. The poor respirations, the faint pulse, the liver edge that I felt way below where it should have been. But I had truly had hope that once in the hospital, the baby would have survived.

Miguel Ange had never answered my emails about the baby. But he knew I had wanted to know. So he reached out through Madame Bwa.  Despite sharing this sad news, the young woman was happy to see me and embraced me warmly. She said, “Mesi”, thank you in Creole. She was grateful that we had taken the baby to the hospital and paid for his care. With our translator, Tiroro, who had been the driver that day rushing through the busy streets to eh hospital, we sat down to talk. I realized how young she was, barely out of her teens. She said she did not want any more children. I said I hoped that she would have another baby and it would be healthy. I also told her what I believed: if the baby had been in a hospital in the US, the baby might still have died. Sometimes, there is nothing that can be done and babies die here too. She looked up and hugged me when I said that.

Do I know for sure that there was nothing that could have been done? No. But it felt good to say it. We also told her that it was nothing that she did wrong. I didn’t ask, but sometimes beliefs in curses from voodoo practitioners can weigh heavily on a mother who has lost a child. I wanted to take away her pain and guilt.  It was all I had to offer.

I was trying hard not to fall apart. But inside I was really hurting. I felt my eyes begin to tear, but I held back from my own outpouring of frustration and sadness. I had really wanted a happy ending to this story. I had imagined that we could go back and take more photos of the child recovered from his illness thanks to our heroic efforts. I was humbled and reminded that this is real life, real pain. This was her story not mine.

And then I remembered the photos I took that day. They were still on my iPad which was in my bag. I asked her if she had any photos of her child. She said no. I asked if she wanted to see the ones I had taken that day. I found the photo of her baby I had taken in the clinic. It was for teaching purposes. To take home and maybe analyze with our doctors here He was lying on the table, but he was looking up at the camera. She had no photos of this child. She began to cry when she saw it. I said, I would print a copy and bring it with me when I returned the following month. She said she would really like that. We held hands, we hugged, and I asked if she could come back to see me in November when I returned with my team.

There is no happily ever after in Shada, but there is humanity. I’ll be back in a few weeks. There will be more sick babies to see, more malnourished children asking for food outside. I would like to see this young woman again. I would like to know that she continues on in her life. I would like to give her that photo, the only one she will have of her baby. Maybe that is what I have to leave behind. It is easy to be a hero, or pretend to be one. It is a lot harder to be a simple doctor who has lost a patient, but can be there in the family’s pain.

This story is dedicated to the memory of this child and the other children in Shada who have died this past year.

By Mary Ann LoFrumento

This was not my first time in Shada. For the past three years, I visited every six months. This trip, we came to hold classes on breastfeeding, childbirth and nutrition. We hadn’t planned to see patients until the next day.

The Clinic de Communitaire de Shada, supported by donations from Hands Up for Haiti, was filled with curious pregnant women and mothers of new babies. They sat packed in one small room that doubles as a waiting area and triage and clinic space when our teams are there.

I was helping nurse Judy McAvoy with breastfeeding consultations in the small back office of the clinic. “Dokte Mary Ann,” I heard my name called by one of the translators. Madame Bwa, the local midwife and community leader, had a sick baby for me to see. The baby was brought in by his mother and placed on the table scale.

Wasted, severely malnourished, dehydrated and in heart failure, the baby did not respond to my vigorous touching and prodding. Sad, lethargic eyes stared at me as I examined him. It was hard to determine the age by exam, but the mother said he was about 11 months old. She’d breastfed him for the first 9 months and then she had to go away, and left him with the father. She thought they tried to give him milk but he vomited it and so they stopped. She didn’t know what they tried to feed him. Only that she returned after two months and found him so weak he couldn’t drink or eat.

I placed my hand on his belly and felt his liver edge. It was several centimeters below the rib cage, a sure sign of congestive heart failure. His pulse was very slow and weak. As I checked his vitals and watched his pale face, my brain tried to diagnose the problem. Was the baby anemic and therefore the heart was working harder to pump adequate oxygenated blood, forcing the heart into failure? Or was there a birth defect in the heart weakening the child who then did not have the energy to eat?

Never had I felt so useless as a physician. I frantically asked if anyone had Gatorade. Perhaps we could put a tube into his belly and get him some hydration. No one had a drink and, in fact, we didn’t even have a tube. In the US, this baby would have received an emergency IV and been pumped with life-saving fluids. An X-ray would have been done to determine if there was any pneumonia or congestive heart failure. Blood work would tell us the state of his electrolytes and if he was anemic.

We had nothing to help this poor infant. I turned to the translator and said, “The baby has to go to the hospital. We can’t do anything here.” I was told the mother had no money for transportation and no money to pay for any care at the hospital. Even public hospitals require patients to pay, even in emergencies. “If the baby does not get to a hospital, the baby will die.”

Last year, Hands Up for Haiti was fortunate to have a small SUV donated for our teams in Haiti.  It is how we move from one place to the next and also how our in-country team carries supplies back and forth from our storage area. Tiroro, our in-country team coordinator and driver, immediately got the car and we drove mother and baby through the congested streets of Cap Haitien. Tiroro turned our car into an ambulance, with continuous horn to get people and motos and tap taps out of the way. It probably took only 15 minutes, but it seemed like an eternity. I tried to reassure this young mother, but her look of blank resignation told me she knew that the baby might die.

We arrived at Justinien Hospital where Hands Up for Haiti has established excellent working arrangements for the teaching of neonatologists, urologists, opthalmalogists, and obstetricians. These connections paid off immediately as we ran into one of the doctors we knew. He called for the Pediatric doctor and the baby was carried in. We also provided the mother with some funds to pay the expenses.

It was just one baby. One life. We were there. How could we ignore the situation? It must happen every day. Many mothers, like this one, have no resources. Often they wait too long and then it is too late to get help for a sick baby.

The situation has haunted me since my return. A heroic moment for our team, but not enough to turn the tide.

We must work harder to create a more sustainable health system for the people of Haiti. Sanitation, clean water, and food security remain major problems in Shada and many areas of northern Haiti where we work. Access to education and healthcare is still a challenge for the majority of the population.

Our commitment to the people of Haiti has not lessened. Hands Up for Haiti has worked to renovate facilities and upgrade the medical services provided to the people. Training Madame Bwa and her assistants in Helping Babies Breathe has helped newborn babies in that important first moment of life. Every mother we give a birthing kit to and educate about childbirth may help save her life and her newborn. Every mother we educate about the importance of breastfeeding throughout the first year of life will help prevent another baby from becoming so ill. And our ongoing support for programs such as the Medika Mumba Malnutrition Program at Shada helps ensure that these babies do not get to a critical state.

This infant survived for today. But as with everything in Haiti, there are no guarantees for the future. It is easy to get discouraged, but we are committed to continuing our efforts to make a difference in the lives of the children who live in Shada and the surrounding neighborhoods.

By Katie Lynn RN. With contributions by Barbara Rome RN, Andrea Feddes, RN, and Kristen Ward RN, editorial assistance by Mary Ann LoFrumento MD.

My name is Katie Lynn and I’m an ICU nurse in Mount Kisco, NY. Working in a resource limited country was something I had wanted to do from the time I was in nursing school. I envisioned myself in a remote village, surrounded by children. In November 2010, I got my chance to do just that with Hands Up for Haiti.  Although I have been a part of several missions in the past, this was my first experience leading a team.

After months of intense planning and preparation, and help from two members of the team who had been leaders in the past, I was still anxious that things would fall apart. We were a team of eight nurses and one pediatrician. The focus of the mission was education: childbirth, breastfeeding, infant resuscitation, developmental disabilities, sexual education, and prevention of relationship violence. It was a wide range of topics and every member had to prepare in advance for these sessions.

Right from the beginning I realized the immense responsibility of this role and the stress that goes with it. Having the flights booked was one thing, making sure everyone got on the plane was another story; making plans for our teaching sessions at the various clinics and hospitals seemed straightforward but getting everyone to where they needed to be at the right time was the challenge. Being a team leader meant saying “Ok, it’s time to go”, instead of being the one saying “When are we leaving?” This was a whole new side of being on a mission and a steep learning curve.

I worried for our safety as well, since we would be tackling sexual assault head on and this could put members of our team in danger. Seventy percent of women in Haiti will experience some type of violence in their lifetime and sexual assault is unfortunately too common and often “accepted” as part of a culture. How would we, a group of women, spread the message in Haiti that rape is wrong and it is a crime.

One of the nurses on this mission was Barbara Rome, teaches at CUNY College and is a Sexual Assault Nurse Examiner (SANE) in New York City. She is a specially trained nurse called in to collect evidence from rape victims and provide support. In this roll she’s also done education with teenagers. Barbara shared, “Violence against women is pervasive, takes many forms and is a global issue. My goal during this mission, was to offer my expertise to young girls and women in Haiti. Preparing my presentations on Sexual Assault and Domestic Violence I wanted to let the women of Haiti know that they are not alone, and that there are services and people available to help.” Barbara was equally unsure about how this message would be received by the community and also concerned that the language barrier and use of translators would affect the ability to communicate affectively.

Another important part of our team were four young nurses from Ontario, Canada, Krsiten Ward, Katrina Bates, Andrea Feddes, and Hope Anne Bechard.  In June of 2012, they traveled to Haiti with us and were struck by the complacency that seemed to surround the issue of sexual assault. Their energy and my realization that more needed to be done were the impetus to return on a solely educational mission. Three of them had graduated from nursing school a few weeks prior and were eager to return to Haiti, working on what they would teach while at the same time finishing up their studies.

Kristen Ward, one of the nurses said, “When coming home last year, I felt as if we barely accomplished anything.  I returned this June with such mixed feelings, but very hopeful that we would accomplish more.”  It was the same for the others, who had been so shocked by the stories they heard a year ago and determined to make a difference.

Before we started we all wondered out loud and to ourselves, “Would they listen to what we had to say?” The answer we found is YES, they will listen. But we needed a little help from our Haitian colleagues.

A contact was made with an amazing Haitian woman, Elvire Eugene, the V-day International representative in Haiti. V-Day is a global activist movement to end violence against women and girls. In Haiti, she runs a powerful organization, Association Femmes Soleil d’ Haiti known as AFASDA. Elvire and her colleagues have already begun to address this topic. The mission of AFASDA is:  to work with women and help them to make actions for a more equitable society through their active participation. Our team met with Elvire before we began our work and learned how we can be culturally sensitive when teaching this topic. For Barbara Rome, meeting Elvire was the highlight of her week as they compared stories and compared their work in two countries.

The very next day our team began our work. We were headed to Shada, the slum area of Cap Haitien, where Hands Up for Haiti has been working for the past three years to establish a clinic to serve the mothers and children. The community health worker Madame Bwa arranged for two of our young nurses to address a group of teenagers. They spoke in an outdoor area because the group was so large. It was supposed to be all girls but curious boys appeared and sat around the perimeter . Edia, our translator was a powerful voice to help the nurses talk about puberty, sexual health and then try to approach the topic of sexual assault.

From Andrea Feddes, one of our nurses, “Teaching girls with boys surrounding us was somewhat difficult at times, especially when we got to the section on preventing violence in relationships. We found that when talking about puberty and sex education both the girls and boys were very interested and engaged in conversation with lots of questions. One of the boys even explained to the girls what we had just said and he explained perfectly. But when we began speaking about sexual abuse things got pretty heated. “

“By this point in the discussion there were lots of people around, which included a good mix of men, women, girls and boys. I won’t forget some of the things this one gentleman was saying to us, and our translator. He kept shouting that we weren’t allowed to tell the women that they have rights because they don’t. At one point we were being shouted at and called names. Being in Haiti doesn’t scare me and I’ve never once felt unsafe or uneasy, but with teaching these difficult subjects in a country where women don’t have rights, and are abused, it was a little scary, especially in Shada where education is so limited.”

The nurses got a second chance to teach these topics, this time at Open Door in the more rural area of Bois de Lance. It was market day and the street was filled with young girls. We invited them in for an impromptu class, using older girls to bring younger girls. Suddenly we had a captive audience of girls eager to hear the messages the nurses were teaching. By keeping the group all girls, it was much easier to focus on important topics and give the girls the freedom to ask questions. Everyone breathed easier as the team found a way to educate and empower these young girls.

Meanwhile, Barbara Rome continued her work to educate Haitian nurses on caring for victims of sexual assault.  She led the team on a visit to Hospital Fort St-Michel and met with nurses and nursing students about what they might see in a rape victim and how to care for them. Her expertise was evident as she encouraged compassionate care for women that would help them medically and protect them from future violence.

What we found everywhere we went was that women are afraid to report the rape for fear of retribution from the attacker. They also won’t seek treatment for fear they’ll have to report the rape, increasing the risk the woman will become pregnant or contract an STI. In the U.S. women are offered Plan B (where it is legal) and given antibiotics to prevent disease. We hope to help AFASDA develop a program so that women can at least receive treatment without having to report the rape. We also learned that, while domestic violence is illegal in Haiti, the law stops where a marriage begins. Married women have no protection under the law.

Elvire also invited our team to speak at one of her offices near Cap Haitien. About 30 people, mostly teenage girls came and listened, We emphasized that if a man respects you, he won’t put his hands on you and that the girls deserve to be respected. Barbara Rome, “I was amazed at the reception by both the young girls and women. They were attentive, engaged and interested in my presentation”.

One of the most emotional moments of our trip was when of our own translators shared her story with the young women. She spoke of how was beaten and abused for 10 years before she could escape. Afterwards, with our encouragement, the translator exchanged contact information with an AFASDA worker so that her story can help to foster change.

By the end of our week, we were all exhausted, but also very encouraged. Barbara commented, “This trip has made me realize what is needed and how I can help to decrease the incidence of violence. My vision for the future is to help educate the nurses in Cap Haitain on the care of the sexual assault victim, hoping to eventual train nurses to become SANE nurses. “ The young nurses felt that they had accomplished their goal of returning to Haiti with a well organized approach to educating and empowering the young women they met. Perhaps Andrea, our young nurse from Canada, summed it up best, “Nelson Mandela says ‘Education is the most powerful weapon that you can use to change the world.’ This quote speaks volumes to what this trip was all about and what we are trying to do in Shada and the rest of Northern Haiti. My theory is if we can get through to just one person and if that person gets through to others than we have made a difference.”

For me, being the leader of this trip turned out to be a wonderful experience. Like describing a sunset, I cannot fully express how amazing it was to make these connections, to know that we’re doing the right thing, that the women (and some of the men) of Haiti want help to change the culture which is too accepting of relationship violence and sexual assault. It’s enough to keep pushing forward, in hopes that one day rape will be treated in Haiti and the rest of the developing world as the unacceptable crime it is.

I have just returned from my 7th trip to Northern Haiti in the last 3 ½ years and it was, once again, an amazing experience. My name is Judy McAvoy and I am a registered nurse and certified lactation consultant and childbirth educator.  I am also one of the original members of Hands Up For Haiti, having first traveled to Haiti in March 2010 with Dr.Jill Ratner, on my first medical mission into a third world country. What could have been a one -time experience has turned into a lifelong commitment.

The notion of participating in a medical mission had been a yearning of mine since high school- but as fate would have it- life happens and personal dreams and desires often get pushed to the back burner. That is not to say my life has been a disappointment by any means- quite the contrary. I have found a career that I love, a family I adore and have had the good fortune to enjoy all this in relative comfort. My husband, Jim and I, have worked hard for the past 40 years together- raising three children-now all young adults- of whom we could not be prouder. We have provided them with a stable, loving and supportive home base, a good education, and they have all set off on their own varied paths in life. Once again after all the years of never having a minutes’ peace or quiet, we were left as a couple!

So it was with a sense of selfishness (since I was now asking to have something that I actually wanted) that I approached my family to elicit their feelings about my possible opportunity to travel to Haiti after the earthquake in January 2010. I felt I needed to do something to help the desperate people who were suffering so –but I did not know exactly WHAT I could do. It was with my family’s blessing and support that I joined Dr. Ratner on this enormous undertaking.

We had no idea what we were in for when we set off- but what we thought we were bringing and giving to the people of Haiti has come back to us a million-fold. Never in my wildest dreams did I envision being so absorbed and obsessed with what I initially thought to be a simple trip to help out after this crisis. As it turned out, we fell in love. We fell in love with the people and with the country. We were welcomed so warmly and appreciated and thanked repeatedly for our meager efforts to ease their discomfort- if only for a brief time- and for showing them that we really cared. After an eye-opening, whirlwind of a week, as we were preparing to leave, we were asked not “if” we would be coming back, but “WHEN” we would be coming back…That sealed it- we KNEW we would have to return. And return we have- numerous times now –and with numerous people of varied backgrounds, talents and skill-sets.

The focus of most of the previous trips I’ve been fortunate to be a part of has been medical. Doctors would work in various clinics and nurses would be supporting this effort.  This last trip, however, was primarily a nursing focus with eight nurses taking the lead in the planning of this educational mission and one doctor along for support.

My role was to educate both nurses and mothers. We taught student nurses at Haiti Hospital Appeal about infant resuscitation, routine newborn care, and the importance of initiating early and prolonged breastfeeding.

We taught caregivers at The Maison de Benediction- a respite center for children with special needs- about the illnesses and conditions of the children in their care.

In the slum area of Shada, we taught childbirth education to pregnant women. Even women who had a baby already seemed to be in need of this basic information about what happens during the delivery. We distributed birthing preparation kits to each woman. These kits, which contained blankets, a safe blade and strings to cut and tie the umbilical cord, and a first outfit and hat for the baby were prepared by a Girl Scout troop from Pawling NY.

Equally well attended was a class on breastfeeding to young pregnant women, and new moms with their babies. Breastfeeding a baby for at least the first year is life saving for these babies and the best way to prevent malnutrition. After speaking to this packed group for almost two hours, I was also able to provide one on one counseling to moms who were having breastfeeding problems. The biggest misconceptions about breastfeeding seemed to be that the early milk or colostrum was not good for the baby. And mothers would sometimes wait one to two days before breastfeeding the “real” milk. It took some convincing to let them know how important that early milk is. Another belief is that what a mother drinks, such as alcohol, does not affect the baby. These new moms had so many questions, I could have talked even longer.

This proved to be an extremely satisfying mission for me as I felt I had a direct impact on many of these moms and babies this time. As always at the conclusion of our missions, it becomes clear there is still so much more to do- which is why we continue to return. I am confident we will have a repeat “nursing” mission trip to pick up where we left off. I am anxiously anticipating the planning for the next one. Thank you to all who made this trip so memorable for me.

By Erica Bromberg

I returned from my second mission to Haiti this past weekend and it was just as good as the first trip, if not better. This trip was very different for a few reasons. First, there were twelve of us, making the group a lot larger than the December mission. We also had many more guys (great for travel purposes in terms of carrying and lifting bags and staying safe, not so great when the guys claimed the larger room for sleeping accommodations at Open Door!). Second, my Dad came on this trip, spearheading Hands Up for Haiti’s Urology team.  Lastly, the group performed both ophthalmology and urology surgeries, which I was able to observe.

Although there was only one other person under the age of 30 (I think it would be safe to say 40 or even 50…), I enjoyed working with every person on the team. As with the December trip, my mom was the trip organizer and leader. Mom did not stop thinking, organizing, teaching, leading, and caring for patients all week; she truly was an amazing leader.

Mitch, Mom’s co-leader and Dad’s “twin”, returned on this trip as well. This time I was able to observe a few of the eye operations Mitch performed.

After Dad saw how much I enjoyed my first trip, he decided to join us on this mission, in essence forming the organization’s urology team.

Dad was accompanied by Joanne, an [amazing] RN who works with Dad at home. Joanne helped Dad examine patients at the clinic by checking blood pressures, collecting urine samples, etc., and she assisted Dad and the Haitian surgeons in the OR at Justinien Hospital.

John, an ophthalmologist whom we have known since we moved to Armonk twenty one years ago, joined my mom and Mitch as the third ophthalmologist on the trip. I was also able to observe John perform surgeries.

Michael is an OD (optometrist) in Westchester who joined the eye team on this mission, doing complete eye examinations as well as teaching the optometrists at the clinic in Cap Haitian.

Wendy, an ophthalmic technician, was a crucial member of the team, performing auto-refractions on every single patient as well as assisting with other eye exam procedures.

Charlotte, an OR nurse, performed vision exams at the clinic and assisted the eye surgeons in the OR at Vision Plus Clinique.

Charlotte’s husband, Dwight, was a key member of the team, registering patients at the Open Door clinic and documenting our trip through photographs.

Mike, a pre-med post-bac student at Columbia, came on the trip with the same intentions as me – to learn as much as possible. It was great having another pre-med student on the trip (and someone relatively close to my age!).

Lastly, Geral (also known as Jean), returned to his birthplace of Haiti for the first time in thirty years. Not only was it great having a member of the team who could speak Creole, but Geral is possibly one of the friendliest people I have ever met. Geral works for Propper Manufacturing and came on the mission to repair instruments as well as teach the Haitians how to do so.

Upon returning to Open Door where we were staying for the first few days, I had the sensation one feels when returning home after being away for a long time. This feeling was pleasantly surprising, as it confirmed that I was excited to be doing another medical mission. I also noticed some progress. The clinic had the beginnings of a second story and there was an additional building in front of the school.

Day Three

We spent Tuesday morning at the clinic again.

Geral and Dwight registering patients:

Mitch examining a patient at the slit lamp:

John prescribing glasses:

Mom and John performing exams:

Charlotte checking visions:

Me and Mike with our stickered friend:

In the afternoon, Mike, Dad, Joanne and I drove into Cap Haitien to begin working at Justinien Hospital. We met Dr. Desir, the head urologist at the hospital with whom we would be working all week. The company Karl Storz donated a lot of instruments for us to bring to Haiti so we gave those to Dr. Desir first thing. He was so appreciative.

Next we got a tour of the hospital. In the recovery rooms were rows of beds with people, windows were open and flies were all over the patients, nurses were dressed in white caps and stockings, and there were bathing bins next to each bed. There was no air conditioning except for in the two operating rooms. We saw a few mice running the length of the hall outside of the OR… It was truly medicine from the 1920’s. After operations, patients are wheeled from the OR, outside, and up the street to the recovery room. This happens rain or shine.

Patient being taken to the OR

Operating room entrance

Scrub station (no running water)

Operating room

Dad and Joanne at the urology entrance

The urology section of the hospital

Day Four

Mike and I spent Wednesday with Dad and Joanne at the hospital. We watched a cystoscope in the morning (looking inside the urethra and bladder with a probe) and then observed three operations – two supra-pubic prostatectomies and a hydrocelectomy. Dr. Desir and Dad let us all peek inside to see where the bladder was cut open. The only complication of the surgery was when the peritoneum was accidentally cut into when opening the bladder, and as a result part of the intestine started poking through. Apparently this is very common since the peritoneum is so thin. The craziest part of the surgery was the contraption that was set up at the end in order to keep pressure on the cavity where the prostate once was. A catheter with a balloon was inserted into the patient and a rope leading down the patient’s leg to his foot was tied to the end of the catheter in order to create a stirrup. Talk about primitive medicine! The third operation (hydrocelectomy) was the most “fun” to watch. The scrotum was cut open and 2,500 mL of fluid was drained from one side of the hydrocele and 500 mL from the other side. Each surgery took about an hour and a half.

Dr. Desir and Dad

Joanne, Dad and Dr. Desir

Dr. Desir digging for the prostate!

Joanne and Dad showing me the bladder during surgery

Me, Dr. Desir, Joanne and Dad

Translator Guindy spent the day with us and it was perfect for him because he wants to work in the medical field. It was his first time seeing surgery and he had a blast.

Day Five
Thursday I spent the day with the eye team at the clinic. We saw a lot of pathology as usual. Sandra’s cousin came in to have her eyes checked – she is completely blind in one eye and has nodules on the other eye. A doctor told her to have surgery in the Dominican Republic to fix the blind eye, which would have been a complete waste of time and money. A fifteen month old baby had crossing eyes but both were functioning separately (called alternating esotropia), which is a good sign. This means that the brain is still using both eyes so if we can get a pediatric surgeon to come on the next trip they will be able to operate on the baby.

Vision Plus Clinique

Teaching moment

Mom examining a patient

Baby loving the light (until it was in his eyes)

Mom examining the baby with alternating esotropia

Charlotte and a patient

Michael examining a patient with translator Sandra

I watched a few phacoemulsifications (cataract surgeries) in the afternoon. I had never seen eye surgery before and it was fascinating. I couldn’t believe that the patient was not sedated during surgery, only the eye was numbed. The surgeries took close to an hour each, but at home Mitch and John are able to do them in about half hour or less. These took more time because the Hatian doctor is relatively new at performing the procedure and Mitch and John did a lot of teaching. Mike and I were allowed to look into the oculars of the microscope from time to time to see what was being done.

The eye surgeons and nurses in the OR at the eye clinic

Mitch and the Haitian doctor performing cataract surgery

Wendy checking a patient’s vision

Michael teaching the Haitian optometrist

Charlotte in the OR

Geral spent each day at the clinic teaching Tiroro how to fix machines, since Tiroro hopes to come to the US and go to school to be a mechanic. Geral became a hero when the machine used for performing eye surgery broke and having never seen the machine he was still able to open it up and completely fix it.

Geral and Tiroro

Geral fixing things!

Day Six
I spent the morning of our last day with the urology team and the afternoon with the eye team. I observed a few more surgeries more surgeries and while with the urology team I saw bladder tumors being removed.The last night we had the usual big dinner back at the hotel with all of the translators and the Haitian doctors. I was sad to part with the Haitian doctors and translators; I felt as if they had become my friends. I really hope to return on the next mission.

By Warren Bromberg

The urology team is pleased to report a successful inaugural HUFH mission.  Warren Bromberg, MD and Joanne Hall, RN saw 55 patients in two days at Open Door, several of whom required urgent critical intervention.  Men were seen with urinary retention and obstructive uropathy, massive hydroceles, kidney stones, testicular cancer, hematuria, urethral stricture disease, infections, hernias, and severe hypertension.  Much needed medicines were administered for infections (ciprofloxicin or doxycycline) and hypertension and referrals to the Open Door primary care physicians or to a surgeon or urologist at Justinien Hospital were established.  The primary care physicians joined us for a number of instructional patient visits and were most appreciative.

One of the highlights of the Open Door mission proved to be the community educational event attended by about 40 people of all ages.  Joanne and Warren were joined by Jean Moise, a US engineer with Haitian roots, who served as the translator.  For nearly 2 hours this lively interactive session covered topics in urology such as anatomy, urinary infections, sexual function and disease prevention, contraception, kidney stones, pubertal issues, and the importance of checking blood pressure, and dispelled many unhealthy myths.  The session would have continued well into the night were it not for the dinner bell!

Prior to the mission Dr. Bromberg contacted Dr. Jory Desir, the director of urology at Justinien Hospital, to establish a working relationship and assess what he needed most.  The urology team worked with Dr. Desir in his public clinic consulting on difficult cases, assisting with procedures, participating in resident conferences, making pre- and post-operative rounds, and performing ultrasound studies.  At the hospital, the urology team participated in a multitude of surgeries including open prostatectomies, orchiectomies, transurethral prostatectomies and bladder tumor resections, supra pubic cystotomies, hydrocelectomies, urethral reconstruction, drainage of an abscess, and cystoscopies. Dr. Desir proved to be a caring, dedicated, and talented urologist so a collaborative relationship was readily established.  The urology team provided much needed donated endoscopic equipment and Dr. Desir was eager to hone his endoscopic skills.  Joanne shared her nearly 4 decades of nursing expertise with the clinic and OR staff and helped to organize the department on many levels.   The team left a trove of donated educational videos since travel to conferences is financially prohibitive for the Haitian doctors.

Erica Bromberg and Michael Boyajian, pre-med post-baccalaureate students, joined this mission and proved to be invaluable and tireless assistants in the clinic and in the OR.  Not only were they immersed in the direct delivery of health care but the mission solidified their interest in becoming doctors.

By Beth Bromberg

The eye team and urology team spent the beginning of our week at Open Door. We saw 185 patients over the two days. The ophthalmology cases seen were extensive, including presbyopia, myopia, glaucoma, severe endstage glaucoma, cataracts, hereditary diseases causing blindness, corneal scarring causing blindness, alternating exotropia, infectious retinopathy, Coats’ disease, pseudotumor cerebri, synchesis scintillans with a secluded pupil and traumatic cataract, diabetic retinopathy (this patient had no known history of diabetes and was diagnosed  by checking the urine for glucose – suggested by pre-medical student Michael Boyajian!), traumatic injuries, entropion from trauma, and trachoma in an 11 year old girl.

Each team member possessed a crucial role. Dwight Willman and Jean Moise registered patients and Wendy Hollis performed autorefractions with a donated autorefractor, which is now permanently at Open Door. Erica Bromberg checked visual acuities and assisted in both the eye rooms and urology room. Michael Boyajian also assisted all doctors as needed in all rooms. They both helped with record keeping and learned how to check blood pressures. Michael Yellen, OD, John Ettenson, MD, Mitchell Stein, MD and Beth Bromberg, MD evaluated the eye patients, started treatment for disease where appropriate and referred patients to the Vision Plus Eye Clinique in Cap Haitien for further evaluation and treatment.

In Cap Haitien, the eye team worked with the Haitian ophthalmologists at the new Vision Plus Clinique. It is a freestanding clinic with eye exam lanes, an operating room and an optical shop. It services both public and private patients. We worked in both the public and private clinics examining preoperative patients for cataract surgery, postoperative glaucoma and cataract patients, and consultations requested by the local ophthalmologists. These consultations included patients with congenital cataract, congenital nystagmus with bilateral amblyopia, strabismus, orbital tumor, exophthalmos, Horner’s syndrome, decreased vision secondary to previous traumatic choroidal rupture, central retinal vein occlusion, proliferative diabetic retinopathy, uveitis, papillitis with associated retinopathy, toxoplasmosis, glaucoma at all stages of disease (early to end stage), congenital nasolacrimal duct obstruction, cataracts (both visually significant and mild). Twelve cataract surgeries were performed, teaching and assisting the Haitian ophthalmologists in performiing phacoemulsification. Charlotte Willman, RN taught the Haitian nurses how to set up the machine and instruments for phacoemulsification as well as how to clean and sterilize between cases. Wendy and Michael provided hands-on teaching to the Haitian optometrist and evaluated patients with the ophthalmologists. Erica and Michael B. observed in both the clinic and OR and assisted the doctors. Over the three days in the eye clinic we saw approximately 100 to 120 patients and dispensed medications to treat the appropriate diseases. The remaining medications were left with the Haitian doctors to continue ongoing treatment and treat future patients. Jean Moise, the engineer from Propper manufacturing, inventoried all the equipment in the eye clinic, instructed a local mechanic on repairs, repaired many of the defective equipment and repaired the new phacoemulsification machine when it broke down at the beginning of a surgical case.

Our two ophthalmic surgeons, John and Mitch, worked in the operating room at the IEF clinic in Cap Haitien with Haitien ophthalmologists Pierre Dupuy, Jr. and Marie Carmelle Guerrier.  Late last year Alcon donated a machine for the OR which would allow them to perform phacoemulsification, the newest technique for cataract surgery.  At that time Drs. Dupuy and Guerrier asked us to teach them the technique during our current visit.  In the interim another American doctor had worked with them in the OR.

Mitch first held a session to review the steps of the procedure, and then for three days John and Mitch sat in and assisted Dr. Dupuy as he operated, teaching as they went along.  A total of 12 cases were done over the course of three afternoons.   Dr. Dupuy is an excellent technical surgeon and had a basic working knowledge of the steps of the procedure.  Drs. Ettenson and Stein spent a lot of time helping him perform the steps in ways that both made the procedure easier for him and decreased the risk of surgical complications.  During the course of the week Dr. Dupuy made significant progress, doing 10 cases start-to-finish.  We encouraged him to continue to do the procedure on his own but to select patients whose cataracts are not very advanced and therefore easier to remove via this technique.   We plan to continue this training with them during our next visit.

The eye team made great strides in helping the Haitian ophthalmologists in their quest for creating sustainable eye care in the north. There is much work to be done, but we are making good progress.