As it is with most international missions, the day was full of several seen and unforeseen challenges. Those challenges were met with fierce determination, teamwork, collaboration, and understanding – and this was accomplished even before the ice breakers and laughs later that evening! The first day of clinic was as equally rewarding as it was challenging, and it became evident during the group reflection. From the beginning of the day there was a sense of trust and reliability with one another – providers were consulting one another, poking their heads to ask questions through the curtains that separated each room. There was also a focus on providing culturally appropriate care – many of the group members were familiar with the Haitian culture and were excellent resources for many things. The added layer to providing appropriate care was the acknowledgement of the limited physical resources that were available in the community and being creative with the plans for care. Many of us had to alter the treatments, education, and reassurance given to patients, but it was done in a collaborative manner. We did our best to empower, to make meaningful contributions, and assess the biggest needs.
I grudgingly woke up to the Song of the Rooster, and felt a wave of excitement as I realized that the first day of clinics was finally here. After a minor mishap with the water system, we were all packed up and ready to head to the clinic.
We pulled up to the clinic to find a line already forming, with many Haitians young and old eagerly awaiting to be seen. I later found out that many of these people traveled far and wide, and were waiting since 5 am that day, just to make sure to get a spot in line. After a quick meeting and set up of the clinic, our team manned their stations, and we opened our clinic doors.
We had three main departments set up: OB/GYN, General Medicine (w/ a subdivision of Peds) and Dentistry. Due to limited amount of resources, our clients could only pick one department to be seen in, and this was distinguished by the color of the cards they were given while in line. Pink for OB/GYN, Blue for Dentistry and Orange for General Medicine.
I was assigned to Pharmacy, with 3 other members of our team, including our licensed Pharmacist. And quite frankly, being in Pharmacy was like being in a zoo. Being that it was day one of our clinic, a lot of things were trial and error that day. We realized what worked, what didn’t work, which medications were a high demand based on common diagnoses, and how important it was to explain the medicine dosages, and the importance of being compliant with the meds to each patient with a script Rx.
Throughout the day, I admit that I sneaked away to expose myself to the other rooms and departments, when Pharmacy wasn’t so packed. I watched in awe as Dr. M. Jean explained to me the steps he takes in cleaning and extracting a patient’s teeth. I observed in amazement as Dr. Ceus conducted a joint aspiration procedure on a young girl’s knees. I poked my head in the pediatrics room as our nurse practitioner, Andrea explained to a parent the instructions for a medicine she was prescribing to a child. I peeked into the waiting room as Cassandra, our C.A.O directed patients to the correct places to sit, and when to get up to see a provider.
We spent all of 10 hours at the clinic that day, and it honestly felt like 3 days had gone by. But as mentioned before, our unspoken motto for this trip seemed to be “work hard, play hard”. We boarded the yellow limo back to our guest house, gratefully scarfing down the delicious meal prepared for us, and although the day way long and tiring, we had enough energy to conduct a surprise birthday party for one of our team members, Shirley. She was serenaded by our local dentist, Dr. C. Jean, who surprised us all with a lovely singing voice as he sang her a Happy Birthday in both English and French.
We reflected on the day, as we munched on our slices of Haitian cake, and as our team leaders Mitzy and Sasha delegated the team meeting for the night. Our meeting ended on a lighter note, as we began an icebreaker. We were instructed to partner up with someone we didn’t get a chance to interact with much (my partner was Stevenson), and to share some fast facts with each other. Then, we played Birdie and Perch, and although Stevenson and I were knocked out early in the game, we cheered on as the final two teams perched their way through victory. Finally, we played a game called Mafia, which is better explained in person. This night of teambuilding really brought us closer as a family, kept us laughing with and learning about each other, and eased our minds from the rough day we had.
Day Three was won and done.
Be on the bus at 7am and be ready to see patients! That was the repeated message from the night’s previous meeting. All of that went out the window as the day got off to an unexpected start. No running water. Confused faces drizzled in the living room trying to figure out what’s going on. The native Haitians on the trip quickly adjusted by getting buckets and filling it with water from the pipe outside to go shower. In addition to that, the breakfast we were expecting at 6:30 am before our scheduled departure was nowhere to be found when we finally left at 7:50. Our bubbling excitement would have to fuel us through the early morning of seeing patients on an empty stomach.
A crowd of patients crept into view as the yellow bus pulled up to the courtyard of the technical school where clinic will be set up. From our experience on previous trips, we know there were probably individuals who journeyed from the countryside the previous day and slept on the streets to be early in line. Everyone was aware of the meticulous plan and their expected roles from the patient flow to discharging from the pharmacy.
The day was off to a rough start. Our careful preregistration strategy did not work as expected. Preregistered numbers were handed out in advance to ease the flow of the initial influx of patients waiting in the courtyard to be seen early in the morning. Half of the slots were given out with the other half saved for walk-ins. The morning was mostly spent triaging walk-ins because those with registered numbers did not feel the need to wait in line early and preferred to leisurely walk in to be seen right away later in the day.
The flow incorporated four volunteers in intake/vitals; one volunteer doing flow and directing patients from the waiting room to the appropriate clinic room; three dentists and an assistant in the dental clinic; an ob/gyn, an assistant, an observer and a lab specialist for analyzing wet prep slides; a pharmacist and three to four assistants in the pharmacy; and everyone else in general clinic rooms including the sport medicine fellow and the pediatric nurse practitioner.
This year we incorporated a mandatory women’s health education session prior to being seen in clinic. The women all eagerly lined up to file into the education room to learn about hygienic practices, self-breast examination through a model, managing menstruation and menopause. The sessions were such a big hit that a body guard had to be assigned to the doorway to regulate and prevent women on the outside from stampeding into the doorway of the education room.
Patients were sent to either dental, ob/gyn, or general clinic based on their pre-registration card. Everyone got into a rhythm and patients were seen quickly. By the time lunch came at 1PM no one wanted to take a break but had to provide themselves some type of sustenance since skipping breakfast. Handful of volunteers would stop by a secluded room to consume a sandwich in a hurry before returning to their station.
The day flew by. No one kept track of the time. 2PM came and the group had to split up; two volunteers went to the business workshop, the ob/gyn, one of the co-founders and another volunteer headed out to the Widwive training session.
This year, a business workshop was incorporated with the help of the KORE’s chief creative officer, marketing professional, and small business owner, Sony Laventure. He would lead workshops from 2-5PM teaching local business owners and entrepreneurs how to develop a business plan, formulate a marketing strategy and execute their plan to grow their business.
Today, the midwives training group would go make an initial assessment before diving into hands-on interactive sessions with the birthing simulator purchased. The meeting with the midwives at the local clinic did not go as anticipated. A curriculum was formulated for normal vaginal delivery and managing post-partum hemorrhage. But based on the meeting with the clinic staffed midwives, the knowledge imparted would not be useful due to lack of basic resources. The clinic was understaffed and underequipped. Patients had to be written a prescription for gloves before they can be evaluated in proper sterilized technique because the clinic could not afford basic rudimentary supplies. There was one blood pressure cuff shared by the entire staff at the clinic. A bulb syringe for the neonate and an ultrasound machine were extravagance they could not afford. In the discussion later that day, the ob/gyn expressed being disheartened by the harsh reality of medicine in St. Michel. The plan to hold several hands-on education sessions for the midwives had to be scrapped and re-evaluated for another trip.
The day ended on a favorable note. The team celebrated the birthday of one of the volunteers who is of Haitian-descent but visiting Haiti for the first time in her life. She exudes an altruistic energy. She was the lone assistant for the three dentists that day and they all had nothing but rave reviews for her persona and ability despite not having any medical or dental training.
After the birthday celebration, some scattered to bed to recuperate but most stayed behind for an ice breaker and a game of mafia. It was a good day. Time to refuel for tomorrow.