Preparing to Go – Some Resources

It’s hard to believe that we are leaving for Honduras again in just two and a half short weeks – amazing!  I truly can’t wait to be back on the ground and spending time with our friends and well, family there.  As I prepare for another trip, I wanted to address one of the most common questions asked from team members and potential team members who are considering a trip with us.  That is “how can I prepare for this trip?”  One of the most common concerns we hear is people afraid they will be unable to practice medicine in a third world country.

First, common things are common.  Flashback to PA/nursing/medical school, right?  But, it’s true!  Just like upper respiratory infections, gastroenteritis, acid reflux, high blood pressure, diabetes and so on are common here, they are common other places as well.  Surely we all know how to manage those things!  While the resources available to us may be slightly different from place to place…okay, maybe really different…the basic principles of management are the same.  We all know how to treat the symptoms of an upper respiratory infection (aka cold).

Second, there are a TON of resources available if you just know where to look.  My absolute favorite book to bring when I travel on mission trips is Handbook of Medicine in Developing Countries.  This is my go-to when I’m stuck.  I think it’s an amazing resource that has a lot of information packed into one manual.  And, it’s available as an e-book so you can just download and go!  Here’s a link to Amazon if you’re interested: https://www.amazon.com/Handbook-Medicine-Developing-Countries-Dennis-ebook/dp/B00P02PHV0/ref=sr_1_1?ie=UTF8&qid=1467826196&sr=8-1&keywords=handbook+of+medicine+in+developing+countries.  (Don’t forget to shop using Amazon Smile and support Impact!).

Another great resource is the World Health Organization (WHO).  They release all kinds of guidelines for various conditions on a regular basis.  Whether you’re interested in child health, communicable diseases, HIV/AIDS or something else, there’s something for everyone.  Here’s a link to their main guidelines page: http://www.who.int/publications/guidelines/en/.  Take some time to explore and see what might help you in the future!

Lastly, one of my other favorite resources is the Institute for International Medicine (INMED) out of Kansas City, MO.  I have had the privilege of attending their Exploring Medical Missions Conference for the past four years and have taken some of their online courses in the past.  In fact, I’m super excited to tell you all that I have enrolled in their 10 week International Medicine and Public Health hybrid course this fall.  They always have SO much good information in their courses and I’m sure this one will be no different.  So check out their website if you have a few minutes: http://www.inmed.us/.  If you have a few more minutes, check out this TED talk by their founder, Nicholas Comninellis: https://www.youtube.com/watch?v=jkkNo_upwZA.  Well worth fifteen minutes of your time.

So, those are some of my favorite resources.  What are you favorites?  Feel free to share so we can all find them!  Well, I’m off to pack some supply bags for our upcoming trip.  Be blessed my friends!!IMG_4133

Mother’s Day

Tonight I’m sitting on my couch pondering as another Mother’s Day comes to a close.  As many of you may know, my husband and I adopted our son from Ethiopia last year and brought him home in April 2015.  This day is one of many emotions for me.  I’ve always had a mother’s heart.  Being the oldest of six, I kind of fell into the mother role as I helped my momma over the years.  I learned to change diapers, rock babies to sleep and watch over the littles from a young age.  It was just natural for me.  When I hit adulthood and found out I may not be able to have biological children, it was quite a blow.  I always thought I was destined to be a momma.  Ultimately my path led to adoption and to my son.  So here we are – second mother’s day as an “official” mom.  I am overjoyed to finally by a mother but I mourn the losses that brought my son to me.

In some ways, this day is a reminder of the pain that so many women face today.  There are women, like me, who cannot have biological children and mourn that loss.  There are women who birthed children but lost them – to death, to drugs, to disease, to so many other things.  For whatever reason, those children are no longer in their lives.  There are women who bore children but had to give them up for some reason.  There are many who have lost their mothers.  This day can be a day full of pain for so many.  For all of you, I am praying.  Praying for God to ease your pain, wipe your tears, and soothe your broken heart.

But this day also motivates me.  While I cannot prevent all of the losses I just listed, there are some we can avert.  Each trip we take to provide medical care in under-served areas makes a difference – many deaths are related to preventable disease.  Each course of antibiotics, each life-saving medication helps one more momma keep her child or one more child keep their momma.  Each child our family sponsors is one more child who can stay with their family, who can remain healthy and vibrant.  Each time I can send a check from Impact to our Haiti project for salaries, I know we are helping a woman with a job so that she can provide for her family.  Yes, the need can be overwhelming.  But if we let the need overwhelm us, we are temped to sit and throw up our hands in defeat.  We have a choice to make.  I choose to make a difference.  It may seem small and insignificant.  But, if we each choose to make a difference, what seems small and insignificant becomes huge and world-changing as we join together.  So on this Mother’s day, what will you choose?  Won’t you join me on this journey of making a difference?

Happy Mother’s Day!

Jackie

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From a PA Student’s Perspective

By Julie Lewis – Team Member on a Trip to Haiti in Jan 2013

Sitting on the plane, filling out customs sheets, Jackie, our leader, warned us — do not let the Haitians take your bags.We finally arrived in Haiti to an airport half-open to the outside, like a big patio. From the arrival gate, I could actually see the heat, and also the men in red shirts waiting to “help” with our bags. As the rest of the Global Vision Citadelle Ministries (GVCM) team pulled bags from the conveyor belt, I guarded the stack of bags shaking my head no to every person offering assistance, eventually sitting on the pile to ward them off. Half filled with our belongings, half filled with medical supplies, the contents were too important to leave in the hands of anyone we did not know. We were spending a week at the GVCM clinic, offering health care for less than $1 per family to an impoverished population, and living within the orphanage walls.

Trudging through the chaotic parking lot, swimming through the heat and with men in red shirts asking to help us with our bags, we piled the luggage into an open-bed truck, lined with wooden 2x4s for seats, called a Tap-Tap, and took off. We traveled 2 hours up the mountain, passing a sea of tents – towels, sheets, and even Twister boards served as front doors and roofs. We passed new looking, government-built homes. We watched children walk alone down the road, women carry laundry baskets on their heads, and wild animals run into the road.We arrived at the GVCM orphanage, stopping at the freshly painted gate and waiting for the armed guards to let us into the compound. Shown to our eight-person bunkrooms by Markus, one of the orphanage staff, we were pleasantly surprised to see an air conditioner on the wall. We later found out that the orphanage tries to make accommodations for their American volunteers to the best of their ability.The orphanage houses 75 children, nearly a quarter of which are deaf, but they are not all orphans. The orphanage also offers education to the deaf. The other children were either abandoned at the gates or brought in by families who could no longer care for them. As we toured the facility we saw all 75 children scattered around the campus playing basketball, soccer, and tag. That evening, I wandered into a small room that the door had been shut the whole day. I saw five young infants who quickly became my line of focus, especially 7-month-old Jaclyn. Jaclyn was brought to the orphanage because her family was unable to care for her. At first, I was told, she could barely hold up her head and would get sick when she ate a full bottle, because her body was not used to the large amount of formula. When I met Jaclyn, she was starting to drink a full bottle, but her legs were still bowed and her muscles atrophied from malnutrition. She was unable to bear weight on her legs even with extra support. She was only 11 pounds, which was a 2 pound increase since her arrival at the orphanage. She still wore a smile all of the time. My most vivid memories from my trip to Haiti are the nights I rocked Jaclyn to sleep in my arms and felt the rise and fall of her tiny chest in my arms as I held her tight against my chest. It was soothing to know she was safe and she had overcome her previous life.

As we walked about the gated complex watching the children play with torn garbage bags as kites and kick rocks as soccer balls, I saw a guarded boy with scars lining his left eyebrow and down his arms. I immediately remembered the story that brought me to Haiti. Told to me by Jackie Lageman Borst, PA-C, medical director of GVCM Haitian Clinic, Miguel was a 9- or 10-year-old boy who was trapped between the Haitian and Dominican border. The two countries are constantly in disagreement and Miguel was trapped. He was beaten mercilessly with a machete. When found, he was taken to the GVCM clinic where Jackie was working and his life was saved. I now had the chance to meet the young man that changed my life. He did not know that he did. But he was the reason I was in Haiti and able to be a part of the wonderful work. I approached him and stuck my hand in the arm slowly. His flinched a small bit, and stuck his hand in the air and gave me a high-five. I had tears in my eyes for the young man’s smile that brought me so much joy.

Sunday morning, we woke up early and ate breakfast prepared by the Haitian women: eggs, French toast, pancakes, bananas and Nutella. We played soccer with the children while waiting for the church services to begin. We saw a large group of people moving in our direction yelling “JACKIE, JACKIE!” An elderly woman was being carried over a mans shoulder. The children dispersed and told the Americans, “We need Jackie. Jackie! Jackie!” Jackie and the Physician Assistant students quickly assessed the women using a translator. It was quickly determined the elderly women was most likely passing a kidney stone. We treated her with pain medication that we had brought with us.

We arrived at a gate that opened to a small property surrounded by trees. We entered to find the small clinic that was a small brick building with bars that lined the front. It was filled with exam tables, bandaging supplies, Obstetric kit, (all of us praying that it would not need to be used this week), and the pharmacy. The pharmacy contains mostly medications that are over the counter in the United States such as Tylenol, Acetaminophen, NSAIDs, children fever reducer, Pedialyte, and some prescriptions such as ranitidine, omeprazole, anti-hypertensives, and metformin.

In the United States, patients at urgent care or emergency departments are seen within hours. Haitians do not receive health care. It is unknown the next time they will see a provider. Haitians walk miles and hours to reach a clinic, and then often wait all day to be seen. We had numerous translators and volunteers from the orphanage to help us organize the crowd, a triage area, multiple exam stations, and a pharmacy. In one day we saw over 120 patients, using headlamps after dark to be able to read and examine patients. Even then, patients who had waited 8 or more hours still sat hoping to be seen by providers.

The next day there was already, all the way to the gate, people pushing to be in front and calling out to any American, “Doctor,” and pointing to the body part that caused them pain. One man presented to the clinic with a swollen eye. He said he was shot about two months ago and a piece of shrapnel was wedged in his eye. Luckily, we had an ophthalmologist on the trip, and he was able to successfully remove the foreign body. Without the GVCM clinic, this man may have waited another two months or more before receiving removing the foreign body.

A young girl probably about eight years old presented for an eye swelling. Her eye had been swollen for about three days and continuously grew in size. Upon presentation, we knew immediately she had periorbital cellulitis, which can result in fatality if untreated. We treated her with IV antibiotics. Wiping the dirt off her skin and then cleaning the site with alcohol pads, I wondering to myself how long she had to walk to get to this clinic. Even placing the IV in her was difficult due to the dehydration. The IV was held up on the wall of the clinic by a nail sticking out of the wall. The daughter and her mother sat at the clinic all day waiting for eight hours until the second dose of IV antibiotics could be given. After a long day in the clinic, the swelling had slightly improved and the patient was sent home on oral antibiotics. Without the GVCM clinic, the innocent child would have presented to the emergency department of Haiti, which does not guarantee to receive medical attention. As I am told, many patients pass away in the waiting room, waiting to be seen by the doctor. They wait for days for life threatening conditions. The GVCM clinic gives patients a fighting chance.

A two-month-old female presented in the arms of her mother. The mother noticed she is not gaining weight as her other children have, and she is having a difficult time feeding. The infant is slightly small for her age but appears smiley, well hydrated, and nourished. Upon examination, the family practice physician finds that the female is tongue-tied. The procedure to correct this is a frenotomy, which means cutting the sublingual frenulum. Local anesthesia and post-resection suturing would be used in the United States; however, in Haiti, this was not available. The physician was able snip the frenulum and control the bleeding and pain within minutes. Post-procedure, the infant was immediately able to feed properly. It was amazing to see the joy in the mother’s eyes, seeing her daughter fed without a struggle.

“Who is next?” I called. As I look it is a 5-year-old girl with her mother. She has her hand on her abdomen as she grimaces. I ask, “How can I help you today?” The young girl said that she was hungry. I was on strict orders not to give out food to the Haitians due to the implications to follow. Her belly was obtunded and as I listened, I heard the grumbles inside. I took the young girl and the mother to the back of the clinic away from the Haitian population and gave them both a protein bar. The young girl’s face lit up and she quickly ate the granola bar switching off bites with her mother. She held my hand as we walked back to the front of the clinic and I had tears in my eyes because I knew this child does not know the next time she will have a meal.

We finished the patients for the day and I looked up at the sky. The stars filled the sky – so many and so bright. It was like nothing I had ever seen before. There was no background noise. The night was silent and the stars reminded me all the patients I had seen during the day. The smiling faces that left the clinic, because they were able to help ease their pains for at least one day.

Getting back the New York City airport I was shocked seeing the big lights and towers after coming from complete poverty. There were restaurants that surrounded the airport everywhere. You could get anything you ever imagined as opposed to giving starving children part of your lunch because they needed it more than you did. Outside the airport, in the relative order and absence of men in red shirts, taxis were lined up waiting for visitors. I was back in the United States, leaving behind Miguel, Jacyln, and the 800 patients who found care at the GVCM. Left with memories of those smiling faces, I go through my day with a new outlook on life, a positive feeling, and a new sense for our quality of life.

Editor’s Note: Julie has since completed PA school and is a practicing PA-C hoping to return to Haiti in 2014.

Transition

A week ago, I returned from my twelfth trip to Haiti. One would think that it would be easier to transition back after so many times, that it would be “old hat” so to speak. But, for some reason, this trip has been harder than usual. It’s a week later and I am long to be back with the Haitian people who I love.

I think the starkest contrast is at work. In the U.S., I work in a primary care walk-in clinic which is very similar to the clinic we work at in Haiti. Two weeks ago, in Haiti, I rationed the use of my otoscope (to look in ears) because the battery only lasts so long and electricity is unreliable to recharge it. I made do removing a foreign body from an eye when I couldn’t find a sterile cotton swab to do the job. I often walked into the pharmacy to see what we had on the shelves to determine what I could prescribe for various ailments. Last week, back in the U.S., I had everything at my fingertips. I opened cabinets that were fully stocked for whatever situation might arise. My otoscope was not only reliably powered but high definition! My biggest worry with prescribing antibiotics was what pharmacy the patient wanted their script electronically sent to – I had my choice of medications. How does one reconcile these two work environments?

Don’t get me wrong – I love my job here in the U.S. But somehow I find myself longing for places like Haiti. Places where I see my patients in churches with the rain pounding so hard on the tin roof that I have to shout to be heard. Places where I smack the mosquitoes away as I try to listen to someone’s heart. Places where children smile at the white lady who keeps coming back to see them. Places where a touch, a kind word, a smile makes all the difference in the world. Places where medicine seems so much simpler and I have to dust off my clinical exam skills because it’s all I have to make a diagnosis.

As I sit here tonight, I’m reminded to take what I’ve experienced and learn from it. I cannot reconcile these worlds. I don’t understand why people are born into such contrasting environments. But I can do my part to make a difference. I can be grateful for every opportunity to go to places like Haiti. My life has been changed by these trips. I no longer take things like toilet paper or clean water for granted. I smile a little more often as I’m reminded what a difference that makes no matter where one is. I sit here tonight longing to be back on the mission field. But, instead of moping around, I will use this longing to motivate me to make the next trip even better, to provide more care, to touch more lives, to push the limits of what we’ve accomplished thus far and continue moving forward. Recently I ran across a quote by William Borden that I really liked and which I will leave you with tonight – “No reserves. No retreats. No regrets.”

Till next time,
Jackie