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Tuesday Nov 02, 2010

El Dia de los Muertos

Again today, our group divides up tasks and sites. As it happens, I'm the lone Philadelphian assigned to ride into two bateyes with Dr. Dorka Carrasco, an internist from the Centro de Salud Divina Providencia, and her team of two nurses and a trusty driver. This foursome visits, on average, two bateyes per day, seeing sick patients and providing anti-parasite medications to the healthy ones. 

On the way out, Dr. Dorka tells me about a patient she saw two weeks ago in one of the bateyes we're visiting today, a three-year-old girl with a loud heart murmur and a swollen right lower leg. Even with my broken Spanish, it feels similar to conversations I have with my colleagues back home almost every day, working through the particulars of a case and discussing the right approach to a work-up.

The bateyes feel familiar as well: structures ranging from improvised homes made of scrap wood and corrugated tin to freshly painted concrete community buildings; muddy roads in which the children walk barefoot, only sometimes hopping away to dodge a pile of goat feces; lush trees and bushes whose branches hang low with the weight of fruits and flowers. In the first batey, we set up our clinic in the one and only schoolroom; in the second, we arrive in the church and are greeted by a dozen families patiently waiting for us in wooden pews. The chief complaints, as always, range from the ubiquitous "gripe," or upper respiratory infection, to less straightforward ones like the boy with a month of hoarseness and Dorka's patient with the murmur and swollen leg. We work fairly quickly, Dorka's team being a smooth operation, and see some thirtyish patients in all -- a light-to-medium batey day.

As we wrap up our consultations and start packing up our equipment at the end of the day, a little boy who looks about a year old catches my eye. Toddling along the pews while Dorka finishes taking his mother's blood pressure, he's bright-eyed and plump, with a smile that won't quit. "Que precioso," I can't help saying to his mother, and everyone hears me. Dorka, the nurses, the mother, and the batey's health promoter all nod as though this little guy is obviously something special and I'm just catching on. Breastfed, they tell me, all of them smiling with obvious collective pride.

Back at home with our evening plans (baseball game in San Pedro de Macoris) thwarted by threatening clouds, a few of us take a walk to the cemetery in Consuelo, where we run into one familiar face after another. Today is el Dia de los Muertes, the Day of the Dead, a Latin American holiday on which families pray for and honor their loved ones who've passed away. It seems that the whole town has turned out. Families buy bouquets of flowers, little white votives, and bags of oranges from vendors at the entrance of the cemetery, and the place is alive with conversation (and the roar of the occasional motorcycle speeding along the rows). Another delicious Martina meal, a meeting to debrief about the day's experiences and to plan the week ahead, and a kitchen dance party (now heading into its second hour as I begin writing this) follow. 

Tomorrow is a big day: for probably the only time during this trip, all of us are heading to the bateyes. We've packed our bags with otoscope tips, tongue depressors, and alcohol wipes. We're bringing our charla flip-books with us in hopes of stealing a moment for an impromptu lesson on parasites or handwashing. If the weather holds out, we'll be all set.

Posted at 11:54PM Nov 02, 2010 by Pamela Mazzeo MD in Health  |  Comments[2]

Monday Nov 01, 2010

A Return to Barrio Filieu

Today is our first work day! Off to Barrio Filieu, close to the clinic and to our neighborhood, to embark on a campaign of de-worming and education.

Several hundred people live here, among them many children under 5 years old, who are eligible to receive free health care at Ninos Primeros en Salud (NPS), the pediatric arm of the Centro de Salud Divina Providencia, the clinic with which CHOP is partnered (and yes, you read that right: Kids First Consuelo!). Routine well care here involves the same important basics as at any pediatric practice back home: plotting heights and weights on growth charts, age-appropriate anticipatory guidance, vaccines -- with a nearly incredible ninety-eight percent vaccine compliance rate for NPS kids under 5 in a recent review. The NPS staff also carries out malnutrition surveillance and twice-yearly doses of antihelminthic (de-worming) medications. 
 
Unfortunately, the program can't yet support regular clinic visits for children older than 5 years. Those children do receive de-worming medications twice a year like their younger counterparts, though, and that is part of what we're here to do today. We divide into three groups. The first, including the NPS nurse Ramona, CHOP Global Health fellow Lara Antkowiak, and three of our team members, goes from door to door along the muddy and narrow roads of the barrio.  This group issues chewable albendazole tablets for children ages 5 through 18 years, as well as for any adults in the home who are involved with food preparation. The rest of us divide into pairs, and at intervals of every two to three homes, we deliver "charlas," little instructional chats about intestinal parasites, to whatever residents we can round up. 
 
A lot of the information in our talk, to my surprise, is not really new to the barrio residents. When we ask them what they know about parasitic infections, they rattle off symptoms and signs: diarrhea, anemia, loss of appetite. They know parasites come from the soil and from "agua sucio." Most of the time, they know a handful of ways to prevent infection: trying (ha!) not to let children eat dirt, cooking with clean water. We correct a few misconceptions (with some regret, we have to inform them that sweets do not cause tapeworms), and unfortunately I think we turn a few families off spaghetti for good with some particularly memorable photos. We list the occasions on which it's critical to wash one's hands with clean soap and water (before cooking and eating, after using the toilet or latrine, etc). Our audience nods, asks appropriate questions, knows that "clean" water is that which has been boiled for several minutes or disinfected with a few drops of bleach (that's after it's been carried home in a big jug from the community tap, of course).
 
On the way back to our house, I can't help worrying about how huge a task it must be to stay vigilant about hand hygiene and food preparation (just for starters) when purified water is such a chore to obtain. I'm a bit embarrassed to admit this, but even in clean and beautiful Casa Roja for two weeks, it's all I can do (er, and maybe a bit more at times) to remember to bring bottled water into the bathroom with me when I brush my teeth.  And here we're asking an entire community of people to change the way they live every day, forever.  Or at least until the water supply is more reliably safe and accessible.
 
But there's no doubt that some of them are doing it. The great majority of our charla audiences today were easy to recruit, interested in what we had to say, eager to participate, and grateful for the teaching. A number of families rattled off the answers to our questions with such impressive speed that we joked that they could give the charla themselves. We suspect that the repetition of this message and the attention of the NPS staff are really helping it sink in. 
 
Time and data will tell...but we're hopeful.

Posted at 11:31PM Nov 01, 2010 by Pamela Mazzeo MD in Health  |  Comments[0]

Saturday Oct 30, 2010

Hope heads out for another field trip!

I got caught in a wind tunnel crossing University Avenue yesterday, running back to Epic training in Colket after a mid-morning caffeine fix in Abramson. My hair and scarf whipping in a gust, leaves and construction grit swirling above the pavement, coffee cooling too quickly in my to-go cup...it seemed almost unimaginable that in 36 brisk little hours I'd be shrugging off my cardigan in balmy Santo Domingo.


But here I sit under a circling ceiling fan, mosquitoes buzzing outside the window screen! Along with my teammates, a group of eight other CHOP doctors and nurses, I'm settling into Casa Roja. This is our home for the next two weeks, in the town of Consuelo, midway along the eastern half of the Caribbean coast of the Dominican Republic. It's my second trip here with a CHOP Global Health team, and I've come back because I couldn't pass up the chance to be part of the evolving relationship between CHOP and our partners here.  

When I was here in June of 2009, as a second-year resident in pediatrics, we spent just about every day riding into Consuelo's bateyes (communities clustered around the Dominican sugar cane fields, populated by migrant workers and their families) and staffing mobile pediatric clinics. The days were long and the work was intense, and I inevitably came home with my skirt smeared in a sticky mixture of albendazole and Gatorade...but the experience of working in the bateyes was unforgettable. Certainly, some of the poverty we saw was striking and the disadvantage hard to take in. In the end, though, I think I was more impressed by the fierceness with which the doctors and community leaders of Consuelo approached the task of caring for their fellow townspeople. Since then, a number of CHOP and other groups have come through Casa Roja to help support the Consuelo team in their mission. CHOP has established a Global Health Fellowship, with one fellow based full-time in Consuelo and working with our colleagues here in the Centro de Salud Divina Providencia. The batey outreach program is thriving.  

Now, our focus will be different. Instead of hauling huge Tupperwares full of amoxicillin and permethrin to and from the bateyes every day, on this trip, we'll be spending more time in the barrios here in town. We've prepared talks on basic but critically important topics like handwashing, vaccine-preventable illnesses, and breastfeeding, and we'll be doing educational outreach as much as medical. I love this new emphasis, because it reflects what I think of as a central mission in pediatrics: empowering families to help their children achieve their highest potential.

There'll be a lot more to say about that later. For now, I'm loving the breeze from the fan and the sounds of salsa horns drifting in from the bar down the block. It's Saturday night in Consuelo. We're too travel-worn to do much more than blog and surf Weather.com right now (Hurricane Tomas, feel free to take a sharp right anytime!), but it's nice to know that, a few streets over, music is pouring out of a storefront bar, and a mama is standing on her porch holding her baby and dancing in place with a huge smile. 

Posted at 10:54PM Oct 30, 2010 by Pamela Mazzeo MD in Health  |  Comments[4]

Tuesday Feb 09, 2010

Global Health Team Prepares to Depart Haiti

Final thoughts sent back from a few team members as they prepare to depart Haiti on Wednesday morning on a plane provided by Partners In Health:

We all leave here wanting to do so much more. The Haitian people have taught us more than we could ever have taught them in the context of this natural disaster. Hopefully, this will be an ongoing initiative to assist the Haitians toward a stronger health care system overall.

The experiences we bring back to CHOP will be diverse yet tied together with a common thread. The pain and suffering is crushing... the strength and resilient nature of these people inspiring.

 Many of our nights were in the "ICU" tent taking care of families who now have come to know our faces and names. These families are dedicated to the care of their loved ones, standing by to provide drinking water or assist with other personal needs. They sit vigil 24 hours a day, sleeping on cardboard boxes under the hospital cots at night -- even the patient's children.

 Each night we bring water and energy bars from our camp to hand out to these families as there is no other food or drink available during overnight hours. By the end of the week, they would anticipate our needs as well, and jump to assist us whenever they were able.

 They often sit and chant prayers. We've been told by our interpreter, Charles, they include us in many blessings for the kind care we give their loved ones. They have such resolve and clarity to what their reality is, and showed grace and patience as we adapted.

 Death happens here. The resources are minimal. Antibiotics are in abundance, but suction and ventilators are not. There are no monitors, no 24-hour labs, no replacement linens or hoppers to empty waste. It helps us understand what the effect of inadequate infrastructures has on a community.

 We all look forward to returning to our families stronger, humbled and eternally grateful for the opportunity we've had here. Haiti is far from what we expected. It is profoundly richer.

 

Posted at 08:36PM Feb 09, 2010 by Juliann Walsh in Health  |  Comments[6]

Monday Feb 08, 2010

Midnight Snacks

The Global Health medical team completed its first week treating patients in Haiti. They are staying north of Port-au-Prince in a tent compound established by the aid group Partners In Health and have access to fresh drinking water, showers and two MREs (Meals Ready To Eat) per day.  Some team members developed a bartering system with military personnel to exchange their Power Bars with MREs of spicy chicken in a bag.

“MREs (Meals Ready to Eat) are delicious in the middle of the night,” explains Global Health volunteer Warren Frankenberger, a nurse in CHOP’s emergency department.

Resources, not just food for the medical workers, are scarce everywhere in Haiti. The team rushes blood back to a makeshift Red Cross area in hopes of salvaging a unit of O-positive blood, and shuttles oxygen tanks from tent to tent, hoping they don’t run out. They are conserving glucose strips for those who “really” need it, and there is one ventilator operating in the entire hospital compound.

“This is triage at its core,” observes Frankenberger.

A great struggle for the team is witnessing the end of life that could be prevented in better circumstances, and balancing that with their ability to relieve suffering which they are doing continuously.  In these difficult times, our CHOP volunteers stand side by side with the families, other doctors, military paramedics and nurses from several different countries, their heads bowed while a someone says a prayer and they share in this experience of humanity.

 

Posted at 03:34PM Feb 08, 2010 by Juliann Walsh in Health  |  Comments[2]

Friday Feb 05, 2010

Four Deliveries in One Hour


Four deliveries in one hour! The Global Health team working at the University Hospital (HUEH) delivered four babies in under an hour last night, giving some of CHOP’s pediatric nurses a crash course in midwifery. By morning all four babies were doing well and our team was sleeping off the adventure, according to Global Health volunteer Warren Frankenberger, a nurse in CHOP’s emergency department.

Earlier in the week, team leader Fred Henretig, M.D., met up with a group of Swiss pediatricians already stationed at the hospital. The Swiss team was thrilled to learn other pediatricians had arrived at the hospital to help care for the children.  Dr. Henretig set out immediately to establish a schedule of rotations and transition of care between teams.  One goal is to maintain a 24-hour staffing system to keep in place after the CHOP team returns to the U.S. next week.

There are medical volunteers working at the hospital from all over the world. A group of Haitian-American nurses tracked down the Global Health team to express gratitude for their presence at the hospital and to offer assistance.  The nursing needs in Port-au-Prince continue to be huge in all areas of care. In fact, several CHOP nurses are working hard to support the medical and intensive care wards, where nursing coverage is very short.  They are assiting with procedures and care for some of the sickest patients in the hospital.

Yesterday afternoon, a few Global Health team members went on "rounds" to receive reports on many of the children.  The pediatric ward is in four tents, each with about 20 to 25 children. Much of what the group sees and treats is completely preventable in the US, such as blood and wound infections, dehydration and post operative care. However, the required equipment remains scarce: there are no working ventilators and very limited oxygen. There are many cases where the physicians have had to take extreme life saving measures with a lack of lighting and medical tools.

Back at home, Global Health representatives are preparing for the team’s return on Feb. 10. And, they have also arranged a brief prayer service for Haiti and our Disaster Response Team in the Schlimm Center for Prayer and Reflection on Monday, February 8, at 12:10 p.m. The Center is located on the 1st floor of the Main Hospital, near the gift shop. All are welcome to attend.

Posted at 05:04PM Feb 05, 2010 by Juliann Walsh in Health  |  Comments[4]

Wednesday Feb 03, 2010

Day 2: What Haiti Looks Like Today

The Global Health Haiti Disaster Response Team arrived in Port-au-Prince on Monday, Feb. 1,  and spent their first day working at the University Hospital. Rakesh Mistry, M.D. and Warren Frankenberger, R.N., two team members from CHOP’s Emergency Department, reached out last night to Global Health Director Rodney Finalle with reports from the ground. The following summarizes what they are seeing:

The 12-member team -- four pediatric emergency physicians, a general ED physician, and seven pediatric nurses from the ED, ICU, and transport teams -- are staying in a tent camp on a concrete basketball court of a community center. Others staying at the compound are volunteer physicians and nurses sponsored by the aid group Partners In Health. The camp is about 30 minutes north of Port-au-Prince.

The damage inflicted by the Jan. 12 earthquake on the country of Haiti, and its people, is readily evident in the destruction seen while driving south to the University Hospital (HUEH), with rubble from collapsed buildings extending into the streets and highways, according to Rakesh Mistry, M.D., a doctor in CHOP’s Emergency Department and member of the Global Health team in Haiti. 

 Many Haitians attempt to restore a sense of normalcy and people walk the streets as they head off to work. Traffic is heavy. However, entering HUEH yields a quick reminder of the earthquake’s force.  The nursing school building in the center of campus is a pile of stone, with known casualties still in the rubble. Several buildings are structurally unsound, forcing nearly all patient care to military and Red Cross tents throughout the hospital grounds. Hundreds of men, women, and children line up to receive care in a setting similar to a MASH unit.

 “During our first shift, we moved from tent to tent, looking in on sleeping, and sometimes crying, children,” recounts Warren Frankenberger, a registered nurse in CHOP’s emergency department. “Often, a mom sleeping on the floor beside her child would grab me, plead to me in either French or Creole, to see her child. A perfect stranger with a stethoscope around his neck and a head lamp on becomes someone she immediately looks to for care of her very own child.”

Fortunately, much of the disaster-related injuries have been addressed yielding to the need for post-operative and ongoing medical care. So many children are injured with fractures and amputations. The medical need is great and the resources are minimal or makeshift.

“The pediatric ward remains full of severe orthopedic injuries -- I have seen as many femur fractures as I usually see in two years -- with amputees and complex hand injuries mixed among the patients,” Dr. Mistry said.

As Haiti emerges from the quake-related injuries, the medical needs have shifted towards care of the usual patients that present to the general hospital. Volunteers from several countries now participate in the care of more typical pediatric illnesses, such as pneumonia, meningitis, asthma, and diabetes. 

“We continued to move from tent to tent, using our headlights and flashlights to see what is needed,” Frankenberger said. “A humble look at what nursing may have looked like a long time ago; but, here in Haiti it is what nursing looks like today.”

“It has been only 30 hours, and just our second night in Haiti, but we have learned much,” Dr. Mistry said.

Learn how you can support CHOP’s Global Health Haiti Disaster Response team.

 

 

Posted at 04:39PM Feb 03, 2010 by Juliann Walsh in Health  |  Comments[14]

Tuesday Feb 02, 2010

Global Health Team Arrives in Haiti

 

CHOP team in Haiti

 

The Global Health Haiti Disaster Response team receives instructions from Tony Rich, manager of emergency preparedness, during final orientation at the Incident Command Center at Children’s Hospital before departing for Haiti. The members are Team Leader Fred Henretig, M.D.; Rakesh Mistry, M.D. ; David Chao, M.D.; Neil Uspal, M.D.; Brian Barnett, R.N.; Marcia Carter, R.N .; Warren Frankenberger, R.N.; Diane Gardella, R.N.; Wendy Hemme, R.N.; John Kimbrough, R.N.; Kathleen O’Conner, N.P.; Steve Larson, M.D . (HUP Emergency Medicine)

After snow delayed flights Saturday, the Global Health Haiti Disaster Response medical team made it safely to Port-au-Prince yesterday and established a home base camp at a facility operated by Partners In Health. Their living conditions for the 10-day trip are simple, and include three tents, two meals per day, clean drinking water and showers.  The compound is secure and safe, but very noisy due to constant military jets flying over, according to team leader Fred Henretig, M.D.

The CHOP team made an initial assessment at the hospital when they arrived and noted that the pediatric unit is large, and the care is fragmented , but the team just arrived and will have a better sense of the clinical needs today. The CHOP team is going to begin by covering the night pediatric shifts at the University Hospital. On the first night, six team members worked in the pediatric ward, a unit with about 80 to 90 young patients.   For the moment, daytime pediatric shifts are handled by a Swiss medical team. There are several international medical teams working at the hospital, speaking many different languages.

The team plans to return to the U.S. Feb. 10.

Posted at 04:56PM Feb 02, 2010 by Juliann Walsh in Health  |  Comments[5]

Saturday Nov 21, 2009

A Labor of Love: Therapists Exchange Ideas - A Guest Blog Entry

Guest blogger Carla Campbell, M.D., M.S., recounts the team's visit to a Dominican orphanage.[Read More]

Posted at 01:03PM Nov 21, 2009 by Linda Lightner in Health  |  Comments[23]

Friday Nov 13, 2009

Reflections - A guest blog entry

As the Global Health Team prepares to depart the Dominican Republic, Melinda Jones Daniels looks back on her stay.[Read More]

Posted at 11:16PM Nov 13, 2009 by Linda Lightner in General  |  Comments[19]

If You Build It, They Will Thrive

The varied fabric of batey life reveals itself during a walk through Consuelito. Join us.[Read More]

Posted at 02:20PM Nov 13, 2009 by Linda Lightner in Health  |  Comments[0]

Thursday Nov 12, 2009

Quince anos tenia Martina - Another guest blog entry!

Pediatrician Carla Campbell, M.D., M.S. introduces Martina, the woman who keeps the team well-fed and contented.[Read More]

Posted at 05:19PM Nov 12, 2009 by Brian Pomeroy in Health  |  Comments[8]

Wednesday Nov 11, 2009

It Takes a Village to Raise a Village

What happens during the 99 percent of the time visiting health teams are not in the bateys can make all the difference in children's health.[Read More]

Posted at 02:56PM Nov 11, 2009 by Linda Lightner in Health  |  Comments[5]

Monday Nov 09, 2009

Bienvenidos a Barrio Feliu - A guest blog entry!

Pediatrician Mary Fabio, M.D., shares her impressions as the team visits one of Consuelo's barrios.[Read More]

Posted at 08:52PM Nov 09, 2009 by Linda Lightner in Health  |  Comments[13]

New Beginnings in the Oldest Church

A day off presents opportunities for learning and leisure.[Read More]

Posted at 05:46PM Nov 09, 2009 by Linda Lightner in General  |  Comments[0]

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