Even though the disaster in Haiti is weighing heavily on my mind and work, I still want to post this article about last week’s medical trip, which I wrote before the earthquake occurred. I hope it’s a good reminder that there is much to be hopeful for.

There have been many times over the last several months when I’ve been struck with the sudden and exciting feeling that I am part of a movement. For all the times when I feel like I am fighting against the tide to do what I believe to be right, these moments when I feel carried by the swells of support and energy and understanding around me are that much more amazing. The team that made up last week’s medical service trip brought basically an entire week filled with that sense of potential, and I could not be more grateful and honored to have gotten to share in it. We have a lot of work ahead of us.

One thing that struck me during the many conversations I heard and particpated in over the course of the week was the degree of critical thought and reflection everyone was engaged in. The Quinnipiac Physician Assistant group, led by Zinny, Diana, and Christina, and the Tufts Community Health group, led by Raquel, each brought different perspectives and backgrounds with which to guide their understanding of the work they were about to begin, and the context they were about to enter into. Three medical students from UConn, two jacks-of-all-trades volunteers, four doctors, and one nurse practitioner added to the mix. That everyone came together to discuss not only their impressions of the communities and people – the types of illnesses seen, the general condition of the homes and streets, the incongruousness of poverty and smiling children (and with that, the recognition of our own assumptions and preconceptions about how people interpret their own reality) – but also to discuss the structural and societal factors lying under the surface, and how HHI could play a role at this deeper level, was a real testament to their dedication and motivation. I am so taken with how articulate, insightful, and action-oriented they all are.

It was especially wonderful to have three other HHI board members here. We had some very long and significant discussions, along with “business meetings” with several partner organizations, and I am so glad we had the opportunity to do so. Even though we had to steal Craig, Monica, and Brad from their relaxation time on the beach (and perhaps cut into their sleep time as well), I think it was well worth it for HHI given how productive a week it ended up being. As great as the internet is, there is no replacement for good face-to-face discussion.

In terms of the clinic days themselves…

The Tufts team implemented – to great anticipation – the project they had created over the course of the fall semester. The project had three main components:

• Each patient was photographed and given a coded number corresponding to his or her medical consultation form. The plan is to build this out into a records system for tracking patients over time.
• The labels we use to dispense medications were improved upon by adding a diagram of the human body. By highlighting the part of the body that the medication is intended to treat (for example, ibuprofen for a patient with muscle pain in his back), the new labeling system educates the patient and also helps to avoid confusion for those who are illiterate.
• A random sample of patients were interviewed post-clinic to gather their feedback on the care provided, and also to gauge their understanding of the diagnoses and prescriptions they were given.

These changes together represent a major step toward increasing the sustainability of HHI’s medical work in the region, and also toward improving the quality of care we are able to provide our patients.

Our cooperadores were also closely involved in the clinics, and I have high hopes for the role they will play in the future. They were instrumental in organizing the crowd and keeping us within the boundaries of organized chaos, and I think they really appreciated getting to meet the Board doctors and the trip members. I really want the cooperadores to feel like they, too, are part of an organization and a movement, and that they have a voice in the direction and steps we take. They are as big a part of HHI as any of us.

During the course of the week, over six hundred patients in five different communities visited our clinics. Fifty patients were referred for follow-up care. Of these:

• Twenty were started on medication for hypertension, and received a referral to have their blood pressure checked in one month with one of the local doctors we have developed partnerships with. These patients will be provided refills on their medications free of charge through each of the HHI medical service trips. However, the formulary we followed took into account the most readily available and least expensive hypertension meds in-country, so that local doctors will be familiar and patients can access them regardless.
• Eleven received referrals for dental care through our partnership with the Seguro Social hospital in Montellano. Referred patients will be charged half-price for services, and HHI will pay the other half. (For reference, a tooth extraction costs 200 pesos, or about US$6.) We have also added the incentive of receiving a dental hygiene kit, thanks to the donations of toothbrushes and toothpaste that HHI has received, if patients visit the dentist through this program.
• Eight were referred to a primary care doctor for follow-up on an illness that was treated by the HHI doctors, such as pneumonia or a skin infection.
• Five received referrals for further diagnostic testing, such as blood tests or x-rays, through a primary care doctor.
• Six were referred for specialist care, including urology consults, opthamology consults, and hernia surgeries.
• One was referred for pre-natal care.

Over the next few weeks, we will be following up with these patients to ensure the referrals are seen through, and to see how HHI can provide further support.

Until next time,

Laura

The following is from an email we sent out to family and friends today:

As you have undoubtedly heard by this time, there was a 7.0 magnitude earthquake that hit outside Port-au-Prince, Haiti last Tuesday.  The quake has caused widespread destruction, with an estimated 3 million people affected.  Currently, some of our friends and most of the doctors with whom we are collaborating have left to assist the relief efforts in Haiti.

Many of the communities we are working with here in the Dominican Republic are of Haitian descent.  Almost everybody we know knows somebody that was affected, and there are many that simply do not know if their families or friends are okay, since lines of communication into Haiti are almost entirely down.

We have been struggling to find the best way in which we can be of assistance, both as individuals and as members of Health Horizons International, which as you know is our young not-for-profit organization working to positively affect community health in this area.

Firstly, we plan to discuss with our cooperadores de salud (community health workers) the capacities and capabilities that they and their communities have to offer.  We will be meeting with them tomorrow to see what they have heard and learned in their homes, what has been done so far on the individual and neighborhood level, and if there has been any kind of organizing in their own communities that we can all support.

Secondly, we have been doing our own research, both on the ground and on the internet, to find out how we can best help address the most pressing needs of relief organizations working to provide medical aid, food, clean water, shelter, and other necessities to the victims of this tragedy.  As we work to leverage our own time and resources here in the Dominican Republic, we want to share with you ways that you can help the cause from wherever you may be.

The Center for International Disaster Information makes it clear that monetary contributions to established relief agencies are the most useful response to disasters like this one.  Financial contributions allow professional relief organizations to purchase exactly what is most urgently needed by disaster victims and to pay for the transportation necessary to distribute those supplies.  We recommend donating to any of the following organizations that have well-established modes of access and intervention to Haiti, and/or have physical bases in Haiti:

1. The Red Cross
2. Partners In Health
3. CARE
4. Doctors Without Borders

InterAction has a listing of many other organizations in need of donations, so please feel free to do your own research.

We also urge you to stay informed of the changing situation and needs in Haiti.  Organizations that have the capacity to accept materials shipped from abroad, and to transport and distribute them in Haiti, will hopefully make those needs known.  Especially where the infrastructure to deliver aid is already strained, it is important to confirm that donations can be managed.  According to the CIDI, this is also a reason why volunteer opportunities for disaster relief are limited. Another person without the necessary technical skills and experience can actually be a burden to the effort.

We felt the tremors from where we live on the north coast of the Dominican Republic.  Considering Puerto Plata is about 140 miles away, we can only imagine how significant the damage was in Port-au-Prince.  Being so close, physically and emotionally, to one of the worst natural disasters to happen in 200 years on this island, we feel compelled to do something, and encourage you to join us.  The most important thing is to understand the gravity of the situation, to care, and to act, even if that action is simply staying informed and engaged.  We will keep you updated on the efforts on our individual as well as HHI’s part.  Thank you for your support – it is greatly needed and appreciated.

Please take care of yourselves and of each other,

Angi and Laura

The incredible tragedy of yesterday’s earthquake in Haiti has been in our minds and hearts all day.  There were tremors all the way up here on the north coast of the Dominican Republic, but this side of the island was for the most part unaffected.  There has already been a great deal of discussion among the doctors and international volunteers that we know here about how to best help in the humanitarian catastrophe around Port-au-Prince.  Angi and I hope to stay updated as relief efforts are organized, and see how we can be involved.  So many of the people we work with have family and friends in Haiti, and we know that the effects of this earthquake will be felt in their lives forever.  But in the days, weeks, and months ahead, we hope the international outpouring of support for the victims of this disaster, and for the country of Haiti as a whole, will be directed to quickly and effectively stem any further destruction, and to build anew.

Thanks to everyone who has emailed and called expressing their concern for Angi and me personally — we are both safe and sound — and we’ll for sure be in touch about any relief we’re involved in and any news we hear.

~Laura