Trip Report Dr Eric Jerome • August 2010

AMHE Relief Mission Report
Jeremie Mission.
Eric L. Jerome, MD FACP, Relief Coordinator

Indeed, we landed in the Haitian capital on the 19th of August 2010, Dr Monique Rousseau, Dr Jean J Janvier , Dr Eric Jerome . The other group composed of Dr Ducarmel Augustin, Dr Jean Claude Tabuteau Dr Nicole Michael and others arrived from Miami.

In Port-au-Prince, it was essential to visit HUEH, the hub of our involvement in Haiti. The TB tents house close to 55 patients receiving anti TB treatment. According to Dr Megan Coffey the physician in charge since the earthquake of the 12 of January 2010, a great number of people with TB have been presenting to the ED of the HUEH and those tents are necessary to take care of them. They are discharged when the sputum becomes negative but they return for follow up to receive medications. Sputum tests are performed by Gieskhio free of charge. The nursing staff which is incredibly dedicated has been provided by the HUEH. Medications and nutritional supplements are given by diverse groups. These efforts need to be encouraged since they allowed this health issue to be addressed. Tuberculosis remains an endemic problem in Haiti. Each case we treat decreases the level of contamination.  Lodging and transportation of Dr Coffey are assured by AMHE Medical Relief mission after the departure of IMC from HUEH last June.

Since the main purpose of our trip was the south of Haiti, we departed for that region on the 20th.
We arrived in Jeremie by car in the early hours of the morning on August 21sh 2010. From Port-au-Prince to Cayes, the ride turned out not to be difficult. However, crossing the mountains of the “Massif de la Hotte”, with highest peak of 7700 feet miles away,   appeared very scary at night. The roads were being made larger since the cliffs were so deep. The stars with shining light in a dark sky became our GPS system. We were certain we were going north. We reached and crossed the Grand Anse Valley irrigated   by four rivers just around 3:00am.

After some rest at the Hotel “Le Bontemps” located on Emile Roumer avenue in Jeremie, we joined Dr Jean Claude Tabuteau group at St Antoine Parish near the Voldroque river with its blue green and limpid waters. The vegetations stood impressively majestic. On Dumarsais Estime bridge(1950) a smaller version of the Brooklyn bridge a thrill went down my spine with so much history around us, familial and political intertwined.  We traveled behind the church where many physicians have already started to work. We were divided into specialty groups including Pediatrics, Medicine, Surgery, Ophthalmology and Women Health. A large crowd with many children was patiently waiting to be seen.

The pediatric group with Dr Nicole Michael and ophthalmology were actually very busy. The surgeon performed Incision and Drainage on a neck abscess on a child. Cases of asthma, STDs, accelerated hypertension were found, treated and referred to the Main Hospital in Jeremie for Tuesday since we were going to be there. Medications we brought were provided to the patients.

We went back to our cozy Hotel one block from the Main hospital in Jeremie. And then we traveled to Gebeau  to attend  the theater. It was an Interesting play permeated with violence that concluded with the victory of Good over Evil. A city with theater in the middle of so much poverty indicates a sense of hope. And we were so glad AMHE physicians came to Jeremie to care for patients in need of doctors.
On Sunday we rested while another group with Dr Monique Rousseau , visited the city of Abricots. In the evening we went to the main Hospital (St Antoine).We met with the nursing staff doing the night shift, caring for the women and men pavilion. Pediatrics and Ob-gyn occupied other buildings.

Next day we met with the Chief Medical Doctor in his office Dr Jean Marie Duvilaire, hired less than a few months ago. He gave us an overview of medical services in the Hospital, one Medical Doctor, one OBGYN working for the past twenty years, one pediatrician, and two residents. No surgery was being performed. We met one representative from CDC and one from Gieskio collecting statistics and providing Anti HIV medications and care.

We spent the afternoon making clinical rounds with the medical doctor. Cases of stroke, ascites, pneumonia, sickle cell, heat exhaustion, malignancy were discussed. The lab was not adequate. There was no EKG machine. Pharmacy was nearly empty. Ultrasonography is done in private with poor interpretation. Delivery of health services was inadequate, without the basic settings.
Later we responded to Mr. Daniel Etienne invitation for a get together in the city of Roseaux, where we met many friends of grammar school (Frères de Instruction Chretienne). That School was closed to my consternation. We thank Daniel for a great reception.

On Tuesday the 24th we worked at the Main Hospital clinic. The four of us occupied different rooms. We actually brought back two mothers with their infant leaving the hospital and cursing because they were refused registration. A woman from Previle traveled 15 kilometers to seek medical care at the main Hospital. She had Asthma with bad wheezes. We have to go back to the hotel and provide her the proventil and the steroid pump. Pharmacy did not have such medications. People were grateful since the number of patients exceeded the number of available doctors. We filled the gap for one day. Lack of Physicians was blatant. Haiti is graduating 300 physicians a year when 700 are needed for a population of close to ten millions.

On Wednesday we traveled to Carrefour Sanon eight kilometers from the city of Jeremie for a clinic under the bananas trees. Sixty to seventy people were waiting. Greeted by smiling children we were more than happy to work on St Louis day the 25th of August 2010. Dental problems and eye ailments were found in need of immediate attention.

The next day we traveled back to Port-au-Prince. We again enjoyed the green mountains of the Grand Anse and the valley filled with palms, mangoes and bananas trees. According to one engineer the panoramic road from Cayes to Jeremie should be finished at the end of 2011. Heavy construction material and men at work along the roads are proof of the seriousness of the time outlined.
We were tired out but happy for this wonderful journey to the city of Poets. This Mission represents a fact finding activity for better planning. We ask the membership to be ready for calls to action.
AMHE Medical Relief Mission has sent his members to Jacmel, Cap Haitien and Jeremie.AMHE  is therefore looking at  decentralization of its activities. Dr Paul Nacier in his July 2010 presentation in Montebello Canada has clearly stated the new vision.

This program of the Association of Haitian Physicians Abroad that really started 7 years ago has significantly matured to keep rock solid the involvement of this organization in Haiti. The group really believed in capacity building in the development of Haiti and health is the great guarantor of a sound work force. AMHE has been a strong partner of the Ministry of Health even before they signed a contract in 2007. And the relationship has been stronger since the earthquake. Look at the nude facts, assess the problems, propose   and insure a cure, should be our modus operandi.

Hope the membership continues to support such a great movement. The gorgeous land of Haiti needs to become a pride again with Haitians Helping Haitians.

Eric L. Jerome, MD FACP, Relief coordinator

OBGYN rotation at HUEH
Dr Sophia Lubin second tour of Duty

I had a great trip.  I was able to do my presentation which was much appreciated.  I spent a lot of time with the residents discussing clinical practice differences as well as assisting with some of the work including some gynecologic cases and c-sections. I’m glad I had a chance to return and see that they are functioning a lot better than when I left in February.  They are no longer in the tents and the operating room is functional for all kinds of cases.  It was also very good to meet Dr. Viala.
By the way I gave the endoscopy materials to Dr. Lassegue.
Dr Lubin