Lespwa Lavi held its first mobile medical clinic in February, 2019

As I watched the line getting longer and longer, extending past the enormous mango tree, I re-counted the bags of doxycycline and amoxicillin. “We’re not going to have enough…” I whispered.

I’m no stranger to medical missions. As a pre-med student, I spent a couple weeks in Ecuador conducting mobile clinics, then two months in Ghana where I spent quite a bit of time in the hospital – both as a patient and student! When I was in my master’s program, I traveled to Haiti in 2010 and toured the temporary hospitals set up after the earthquake. After I began practicing medicine as a physician assistant, I longed to go back to the third world. When the opportunity arose to start a mobile clinic in Verrettes, I partnered with Lespwa Lavi vice president, Dr. Kadon Hintz, who practices emergency medicine in Bismarck, ND and Dr. Maria Dwyer, a dentist and Lespwa Lavi board member.

We prepared for the trip for months. We met with other medical teams who had done mobile clinics in Titanyen, two hours south of Verrettes, and used their data to determine how much medicine we needed to bring. We knew that the only primary care clinic in the region had been closed for over a year, so we were expecting a crowd, but we thought we were prepared. Our past experiences had been similar to that of our colleagues in Titanyen – many people just come to the clinic for a check up or minor issues.

After safely making it through customs with our suitcases of medication and supplies, we arrived in Verrettes and met the Haitian nurses and translators who would be working with us. We were also lucky enough to have two medical students from Port-au-Prince join us! On the first day of the clinic, we carefully measured out bags of antibiotics, Tylenol, Pepcid, blood pressure medications, and hundreds of bags of vitamins. Once we arrived at the open-air school where we would be seeing patients, there was already a line. My husband gathered the people under a sweeping giant tree and shared his testimony while they waited for us to set up. The pastors of the Lespwa Lavi church arrived and began teaching and praying with the crowd.

Finally, we opened the gate and the first press of people met with the triage nurse who checked their vital signs. Everyone wanted to see the dentist. Dr. Dwyer found she was unprepared for the amount of dental decay she would encounter, and she was kept busy. The first patient I saw was a man in his 50’s who volunteered with Lespwa Lavi. He described classic symptoms of angina (heart attack) and his blood pressure was over 200 systolic. Thankfully he was asymptomatic at the moment, because my ER provider brain was freaking out a bit. His daughter was one of the nurses working with us, and assured us he could get some cardiac care in Deschappelles, a nearby town which is home to Hopital Albert Schweitzer, one of the top hospitals in Haiti. It is still about a 90 minute walk, which was not what I wanted for my angina patient. We got him started on a blood pressure medicine and aspirin and arranged to have him follow up with the hospital.

A sweet little boy with an ear infection.

After Dr. Hintz and I had seen about 70 patients, we realized that we were almost out of medication. Medication that was supposed to last two more days! We couldn’t ration it, we were seeing patients with legitimate complaints. Bacterial infections were rampant. Finally, at the end of the clinic, the children were allowed in. We only saw a few that day since we had been so busy. I was struck by their common complaint – they all had a stomachache. When the first child I spoke to complained of this, I started asking her questions through the translator, just as I would in the US. Was she nauseated, constipated, having fever, burning when she pees, on her period, etc. I couldn’t get anywhere, and the translator interrupted me. He said, “Ask her if it goes away when she eats.” I did, and she replied “Oui.” The translator said, “She’s just hungry.” We found the exact same problem in child after child. They did not even realize they weren’t getting enough food. But it hurts when a piece of bread in the morning is all you have. That afternoon, I saw my first glimpse of life-threatening malnutrition in a 14 year old girl who had been adopted by a woman in the community. She had kwashiorkor, which is protein malnutrition in children, evidenced by her sparse reddish hair, muscle wasting, and edema, or swelling of the legs. Her adoptive mother told me she could not go to school because she was too tired. I called our director, Duvelsaint, over and he took the child’s information. She is now enrolled in our nutrition program.

Another patient from that first day stands out. In fact, I haven’t stopped thinking about her for the past 7 months. She was a 46 year old mother with breast cancer, accompanied by her two sons. She knew she had a breast mass. She had gone for an ultrasound somewhere and she was told she needed surgery. In Haiti, there is no such thing as health insurance. The hospital in Deschappelles could remove the mass and treat the cancer, but she needed to pay for it up front and have a family member donate blood for her. She did not have the money, and came to us hoping “for a medicine” to cure her cancer. Again, we took her information in the hopes that we could find a donor to pay for her surgery, however she was lost to follow up and we have not been able to track her down.

At the end of that first grueling day, we had only a few bottles of Tylenol and some Ciprofloxacin left. We were supposed to see 80 patients, but ended up seeing roughly 110. The following morning we had another clinic scheduled in Marin, a suburb of Verrettes. We stopped at the “pharmacy” in Verrettes hoping to purchase some more medication. The “pharmacist” – I use that term loosely – did have some amoxicillin, Tylenol and metronidazole, but he wanted to charge us 8 times what we would pay in the United States. We turned him down. But we already had dozens of patients waiting for us at an abandoned clinic building in Marin. We held a quick meeting with our director. One of our translators and the pastor volunteered to drive an hour to St. Marc, a larger city, and buy some medication. In the meantime, we would write prescriptions and the patients could pick up the medicine tomorrow. Except we did not really know what was available in St. Marc, so our prescriptions would be a rough guess!

The bare shelves at the abandoned clinic building in Marin.

Many patients stand out from the second clinic day. An elderly women who did not know her age, but estimated at least 90, who could not walk and was carried in by a stranger. All her family was dead and only the pastor of the local church was helping her. She had so much pain. We gave her Tylenol, which she had never taken. A young women, pregnant for the first time, in her third trimester. She had not seen a doctor and wanted to know if everything was normal. The baby had a great heartbeat and mother felt well, so we gave her some prenatal vitamins and counseling on what to expect. We drained some abscesses and put in a couple stitches. The patient load was capped at 80 people that day and many were turned away. In the evening, our heroes arrived with boxes of medication from St. Marc. They were able to purchase everything we needed! It truly felt like a miracle after our experience with the Verrettes pharmacy.

The author examining twin girls with fever.

Day 3….which actually turned into Day 4 because there were so many people….was my favorite. We wanted to do a clinic on the land where Lespwa Lavi Academy is going to be built. It is a little way out of town, so the people who live around there are farmers or peasants, the poorest of the poor. We planned to hold the clinic in the makeshift church “building” which had been erected out of sticks and mud on the property. When we arrived, the structure had been transformed. The church volunteers had collected tables, chairs, and curtains and transformed the little building into a functional clinic. It was so considerate and well done that it just brought me to tears. Dr. Hintz and I sat in the 95 degree heat seeing patient after patient, listening to Pastor Dony pray with the crowd and in his soft, gently way, share scripture with them.

The church building on Lespwa Lavi land where Day 3 & 4 clinics were held

At one point, the medical student who was triaging, brought a young pregnant lady to me because he was concerned she was in pre-term labor. This was her second child. She told me she had seen a nurse, but she really had no prenatal care by our standards. She was unsure of her dates of pregnancy, she thought 20 weeks, but looked to be between 24-28 weeks. I knew Hopital Albert Schweitzer recently opened a NICU, but I doubted their facility could handle a 28 week baby. I took her history and we checked her urine for infection and protein, a sign of pre-eclampsia. We had no way of doing a proper pelvic exam, but I was able to monitor the baby’s heart beat for about 20 minutes. During that time, I literally kept my hands on her belly feeling for contractions. She had none. At the end of the visit, I advised her to go to the hospital right away if the pain came back. I put her on bedrest – or I tried anyway. I told her that is what would be best, but we both laughed. Bedrest is impossible for women in Haiti. Her toddler would starve and they would have no clean water if she did not walk over a mile to the well every day. In the end, we agreed that she would drink plenty of water and lay down as often as possible.

One of the last patients I saw brought out every emotion I had felt on the trip thus far. A little four year old girl, who looked like she was two, came to my little makeshift office by herself. She was crying and again complained of a stomachache, like every other child I had met in the clinic. She also had multiple skin infections on her buttocks, evidently from poor hygiene. I called over to triage and they found the woman who had brought the girl. She was not related to her. The child was a “restavek”, a household slave. The woman told me the girl’s mother could not care for her, so she did. I explained that she needed antibiotics and food. Then the woman told me she did not really have her living with her, but she would tell the people who did. I was not confident about that, so I pulled one of our pastors into the situation. He knew the girl and assured me he would keep an eye on things and find out what was going on. Since she was not old enough for school, she could not be enrolled in Lespwa Lavi, but we invited her to our feeding program that evening and gave her the antibiotics she needed.

A little girl who lives near the Academy property.

Lespwa Lavi’s goal is not to put a band-aid on the enormous gaping wound that is healthcare in Haiti. With the help of our partners, we will soon re-open the abandoned clinic in Marin, providing consistent primary care to that community. So the little elderly woman can get a refill of her Tylenol, the pregnant patients can have care and monitoring, and the little children can be vaccinated. More is needed. Verrettes has over 60,000 people, so a little 3 room clinic won’t quite cover it. That is why we have designed a partner clinic to be built on our campus in Verrettes. It’s a blessing to be able to partner with Hopital Albert Schweitzer and have a place to refer patients who need more advanced interventions, but the lack of healthcare in Verrettes and Marin far surpassed our expectations. According to the WHO, only 8% of Haitians have acceptable access to primary care, and after this trip, I would lower that to 0% in Verrettes. Let’s change that. Would you consider partnering with us to bring Hope to Verrettes?

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