Children in orange and plaid school uniforms with hair neatly parted in matching bows shout “blanc, blanc,” and wave at our rickety van as we pass. Palm trees grow at the road side along with banana trees and rows of cactus bushes displaying that afternoon’s clean laundry. Locals push wheelbarrows full of coconuts or steer their donkeys carrying lumber. Goats and chickens mill around in vast green fields leading up to lush mountains.
In February 2017, I had the opportunity to travel to Haiti with a team of pediatric residents from Alfred I. DuPont Hospital for Children to provide medical care for children in partnership with the organization Hands up for Haiti (HUFH). HUFH is a medical humanitarian organization working to create a sustainable health care system in northern Haiti through building partnerships with local community and medical leaders, and visiting medical teams. With programs in maternal child health, malnutrition treatment and prevention, and clean water and pollution initiatives, among others, local teams and visiting providers collaborate to deliver care and support communities in remote areas
Based in the rural sea-side fishing village of Bod Me Limbe, each day we travel to surrounding schools, churches, clinics, and even living rooms, to provide pediatric care to children. We pass taxi pickup trucks brightly painted with religious slogans like “c’est mon destin” (“this is my destiny”) and motorbikes overflowing with 5-6 children each, shuttling them to and from school.
At our work sites, children gather outside on benches and wait first-come, first-serve to be seen. We unpack our traveling pharmacy of antibiotic, antiparasitic and antifungal medications for diagnoses ranging from skin infections (mostly tinea and scabies) to gastroenteritis, rheumatic fever, headaches and skin burns.
Children with pneumonia and ear infections get standard dose antibiotics without concern for antibiotic resistance, and all kids are given hand-prepared baggies of multivitamins. Suspecting hepatitis and heavily reliant on my physical exam, without ready access to imaging or laboratory tests, I prop children across their mothers’ laps to palpate for hepatosplenomegaly. I treat empirically for malaria in a little boy with fever, body aches, scleral icterus, hematuria, decreased appetite, and hepatosplenomegaly. I see my first case of chicken pox (since I don’t remember much about my own personal itchy experience at age 4).
Children with bloated distended abdomens, vague generalized abdominal pain, and decreased appetite get deworming medication. So much of the illnesses Haitian children face are related to poor water sanitation, with 1 out of 10 Haitians lacking access to a clean water source and 1 out of 3 lacking access to a proper toilet. 1 out of 9 Haitian children die before the age of 5, with almost 20% of the deaths related to illnesses caused by unclean water.
Through translators, we counsel families about purifying water through boiling, chlorination tabs or iodination. We discuss dental hygiene, swimming safety, fire safety, breast feeding, nutrition, and guidance about when to seek higher levels of medical care. We coordinate a sexual education program for local teenagers, providing counseling about pregnancy and sexually transmitted infections – answering many questions about HIV and, yes, you can get pregnant even if you have sex in the ocean. I check weight-for-height z-scores and refer children to the HUFH malnutrition program through which children receive Medika mamba, a peanut-based ready-to-use therapeutic food distributed worldwide to treat pediatric malnutrition.
Millions of children around the world do not reach their developmental potential because of the influence that chronic poverty, poor health, and inadequate nutrition have on early childhood development. Children in Haiti are faced with a disproportionately high number of risk factors that predispose them to neurodevelopmental disability, including neonatal infections, malnutrition, malaria, anemia, and other social determinants of health.
As part of my work in Haiti I pilot a developmental assessment tool designed specifically for the local Haitian pediatric population. This developmental project will be an ongoing partnership with HUFH, as we work together to create an appropriate measure that could one day be used as a screening tool for high risk children who need additional support to reach their full developmental potential.
Through the HUFH global health elective, you not only have the opportunity to work closely in partnership with the local Haitian medical team, but you are granted a unique integrative cultural experience as well. After work each day, we return to the village to play clapping games and Frisbee with the eagerly awaiting local kids. We attend a voodoo dance party, a celebratory wake in honor of a recently deceased village elder, practice Creole with the locals, and watch from the shore as teenage boys cast their fishing nets off the sides of their boats to catch that night’s dinner. In the evenings we discuss ethics, barriers to care, quality improvement efforts, and review nutrition and infectious disease medical curricula.
A key part of the HUFH mission is to train a future generation of doctors and nurses to deliver effective health care in a country with limited resources. My work in Haiti was not my first exposure to health care in an underserved area – with a specific interest in global health, and previous experiences in Haiti, Uganda and Ghana, I am dedicated to working with others to improve the access and quality of pediatric care around the world; such a goal can only be achieved through partnership with local communities.
Through global health I have developed an increased awareness for health care inequity and the social determinants of health; with each experience I gain valuable skills in the clinical art of medicine, preventative care, public health, research and education. I look forward to collaborating with HUFH throughout my career as the Haiti developmental assessment project evolves and as we work to inspire others to broaden their impact to the global community.
Tamar Goldberg, MD is a second year pediatric resident at Alfred I. DuPont Hospital for Children. She will be starting her subspecialty training in pediatric neurology and neurodevelopmental disorders at Boston Children’s Hospital in July 2017.