March 19, 2014

Blogging around the World: Terrie Ahn in Haiti, part one

This is part one of two. Click here for part two.

Sunday, March 16

Greetings from Haiti. Our team this year consists of 12 second-year medical students, one fourth-year pharmacy student, two pharmacists and four physicians (Dr. Diane Levine; Dr. Donald Levine, Dr. Jeffrey Vanlaere and Dr. Aimee Tow). Our team also includes Max Bond, a medical student in his last year at the University Notre Dame D'Haiti.

After a long overnight layover in Florida, and a bumpy two-hour ride up the mountain, we safely arrived (with all drugs and supplies through customs) at our guesthouse and clinic location in Morne.

It was a rocky road up the mountain (especially for those prone to motion sickness), but a beautiful and scenic view was waiting for us at the top. The guesthouse is run by Father Roosevelt, a pastor of the local church where we are running clinic. He also is a well-respected leader within the community.

On our first day, we settled in, got a tour of the area and set up our triage area, patient rooms and pharmacy. The clinic is conveniently equipped with donated patient beds for physical exams.
One of the most unique aspects of our trip is that we are returning just two weeks after the first-year medical students came in February (click here to read first-year student Patrick Wloszczynski's Haiti blog). This has never been logistically possible before, but it serves as a stepping stone toward the World Health Student Organization's ultimate goal of providing sustainable health care to our patients. The opportunity to follow up on patients seen just two weeks ago serves as a great resource for us to learn how to better provide reasonable and sustainable treatment (perhaps through medications, patient education, etc.) The M1 Haiti team advised specific patients to return to seek care by the M2 team. Each patient also was given his or her own health care booklet that included personal health information such as diagnoses, medications and vital signs on visits. When these patients return, we will be able to see how they have progressed, as well as document changes in their care. We hope they will continue to bring these booklets to their future medical visits.

We have now completed two days of clinic. With almost two years of medical school under our belts, but with very little patient interaction, many of us are quickly realizing the difficulty between academic medical learning and actually putting clinical medicine and physical diagnosis into a real-life setting. One patient interaction involves taking a complete, yet focused history, physical examination and differential diagnosis. And although we have learned a lot of pathophysiology, I am quickly experiencing challenges to thinking of the human body as a whole instead of just individualized organ systems. It will be interesting to see how we improve over the next few days. More updates to come soon.

Tuesday, March 18

Today was our third day of clinic and so far, the busiest. The doctors have been very patient in guiding us through various physical exams and physical diagnosis. We are gaining a lot of experience and practice with auscultation techniques, use of our stethoscopes, ophthalmoscopes, otoscopes, as well as with pelvic and rectal exams.

It is amazing to see how much information we can gain about a patient by simply taking a thorough history, observing with our eyes and feeling with our hands. Although being in Haiti makes me appreciate the health care that is available to us in the States, it also makes me step back and think about how easily it is taken for granted and how often we forget to just take a step back, listen and observe. As medical students and physicians who work in a country where tests, scans and biopsies are readily available at our convenience, I imagine it'd be so easy to fall into the constant habit of depending on technology and machinery to make a diagnoses - when really, the answer could have been found simply by listening, observing and conducting a thorough physical exam on the patient.

Today, in particular, we seemed to have a lot of patients needing emergent care. With patients standing in line for hours outside in the sizzling 97 degree heat, one can only imagine the dehydration and heat exhaustion that patients experience. Allison Pianosi aided our team of doctors in taking care of a female patient who fainted while standing in line for the clinic. They immediately started her on IV saline and monitored her progression there afterward. We sent four patients to the hospital with suspicions of malaria, metastatic cancer, perirectal abscess and acute gallbladder infection. Mike Oom and Priyanka Singh have worked tirelessly for the past two days running around Port-au-Prince to take care of these patients. Sadly, in Haiti, complete medical care isn't always given in a single location. Patients run from location A for a CT scan across town to location B for an X-ray, back to the hospital to complete the diagnosis and receive treatment. This doesn't guarantee that the equipment is correctly functioning and/or readily available, and no diagnostic procedure and/or treatment is done without payment up front. Compounding the problem is transportation to the hospital from our rural location in Mourn and how to pay for it. Thus, good health care here in Haiti is a luxury provided only to those who can afford it - even in emergency situations.

After a long and hot day, we served more than 120 patients. It was the most successful clinic day yet, and felt like the team had finally found its groove. In addition to treatment, another major focus of the care we provide is prevention. In group seminars, we educated waiting patients on safe sex practices, salt retention for blood pressure control, the importance of hydration and clean water sources, etc. Amy Li and Jacqueline Brand prepared patient education pamphlets on these topics and more, fully translated into Haitian Creole, so that patients can reference the material at home.

Wednesday, March 19

This is a guest post written by Shannon Priest, a fourth-year student at Wayne State University's College of Pharmacy and Health Sciences.

Our fifth day in Haiti is coming to an end and we'd like to provide some updates on how the tail end of our trip is unfolding. It was another action-packed day at clinic, with an interesting variety of patients, chief complaints and obstacles. Our fourth doctor, Dr. Max Bond, was unavailable to see patients today, meaning we've just as many patient needs to try to fulfill but one less valuable resource with which to do it. The stretch of long and demanding shifts has left all of us a bit exhausted. Nonetheless, the group has worked really hard and come together to overcome the unique challenges the day has posed, ultimately resulting in about 80 Haitian patients being examined, counseled and treated as necessary.

The patients we were able to help today may have been the most seriously ill yet. Many had the aches and pains typical of aging or bearing long hours of hard work, GERD symptoms that afflict so many and dehydration or infections so common throughout the country. However, a subset of patients, perhaps more so than we've seen on other clinic days, were facing end-of-life or tragic illnesses and conditions. Kim, the president of Rays of Hope and coordinator of our trip, was able to share words of empathy and compassion, providing hope to a woman who seemed to have cancer that had presumably been progressing for some time. Dr. Amie comforted the mother of a month-old baby with yellow fever who is not likely to recover to any appreciable extent and we made an extensive effort to obtain medication for a man who has BPH, progressive glaucoma and severe disfigurement of one of his arms due to an old fracture that was never medically addressed. While it was at times emotionally taxing to feel that we couldn't provide the type of care they could have accessed in the United States, we took some solace in knowing that we may have been the only ones to truly listen to their stories and do all that we could to help.

Mr. and Mrs. Dr. Levine have an early flight to catch tomorrow and during our nightly debriefing we were able to provide them with a group thank you and express how much their involvement in the trip helped to make for an enjoyable and educational experience. Conversely, both doctors expressed their satisfaction with the trip and commended all of us on how far we had come as a group in terms of providing patient care. While the tone of the evening may have been sentimental for the most part, the group rarely misses an opportunity for humor. Dr. Don Levine made fun of Jennie one last time before departing, and the pharmacists, in turn, presented him with the long-awaited hot fudge sundae he had been requesting since the first day of clinic (fashioned, of course, from a brown paper bag, napkins, a lollipop and colorful calcium carbonate chews).

The general consensus is that the entire experience is moving by much too fast and we are doing all we can to savor the last few days we have together in Haiti.

Terrie Ahn is a Wayne State University School of Medicine second-year medical student volunteering in Haiti through March 22 with the school's student-run World Health Student Organization. WHSO's medical mission trips are funded by donations. To donate, visit