April 6, 2011

We had the EASIEST commute today to the commune of DeBoucher… and by sunset, we have served to date over 300 patients this week.

Today our team set up in a nice house, with two medical stations and one dental station in the living room and dining room area, and the pharmacy out on the covered but cooler porch. First, a few observations on our mobile medical clinics:

A. The Haitian colleagues on our team have vastly improved our effectiveness, efficiency and reach. We hired a Haitian doctor and nurse before we arrived and a Haitian dentist on arrival to supplement the efforts of the Epiphany 5. We also engaged five young translators who have bridged the language gap, but are also very eager and helpful in moving our hundreds of pounds of medications each day, counting pills, assisting with intake and advising patients on treatment instructions.

B.Our physician, Dr. Alex LeBrun, came out from PAP and stays with us at l’Hopital Ste Croix (HSC). We do consults in the field and compare notes over the dinner table in a mélange of French, English and Creole. He has taught us a great deal about tropical medicine.

C.Our dentist, Dr. Emmanuel Bastien, has proved a real hero as perhaps 20% of our patients come with painful dental problems. He does yeoman’s duty with tooth extractions. Typical Rx was Ibuprofen for the pain and Amoxicillin to control infection. As David Paige, the manager at HSC, observed: a dentist provides immediate relief to people in pain.

D. Our nurse, Rosaline Telfort, is immensely efficient in triage. A woman of few words, she shows compassion as well as speed in assessing patients.

E. Our PoE nurse, Susan Almquist, also worked in triage but became a star in the pharmacy, especially as queen of pediatric suspensions. She explained how pain killer or antibiotics are best delivered to pediatric patients. Whether working in triage or the pharmacy, Susan, Mary, John and Nick have become more closely engaged with patients and received many expressions of gratitude.

F.iPhone on scene: here we were on ‘the dark side of the moon’ for cell phone bars, but Linda added ePocrates as a PDR on a PDA (with help from our son Alex) on the advice of Dr Emily Hitron, a Haiti veteran from Needham. Linda found that program highly effective for prescribing med dosages for infants and kids, since she usually cares for adults in Boston.

G. We typically carry four large suitcases of medications to each clinic. Deciding which medications to include and making certain that we have enough medications is the daily dilemma. Linda created the Formulary, the menu of drugs for the pharmacy, and filled it with an order from Blessings International and all the great donations. We carried the medications to Haiti in 10 suitcases, each weighing nearly 50 lbs.

H.Pharmacy operations: filling the RX proved to be the bottleneck and by Day 3 we had more pre-packaged RXs, a better alpha storage of our formulary, and we had a better industrial system for picking and packing orders. A typical Rx for each per person has vitamins, Tylenol or Advil, and two items for a specific problem. Several Rx had as many as 6 or 7 items. John, Mary, Nick and Susan work the apotheke – and have a new respect for the profession! By Day 3 we used bins for each order and specialization to speed up delivery.

The climate with 90 degree heat gives ‘sweat equity’ a new dimension for working or just standing, sitting in line. And we were just trying to ensure the right…

-Medication
-Dosage
-Form (pill or suspension)
-Count

One comment on what is valued here: our empty large pill containers are prized for storage of salt, sugar or other items at home. At one clinic a mom was as thrilled with a set of our big Vitamin bottles with screw tops as with fine china.

EN FIN: With Mickey as Haiti’s new president, everyone seems more optimistic today.

SUMMARY: we do think we are leaving this a healthier place and felt the warmth of the Haitian people today


-Nick & Linda