The 2nd annual DISH international medical service was implemented in Dame-Marie, Haiti, from May 23-27, 2013.
A total of 42 licensed healthcare professionals participated in the mission:
23 providers including doctors, nurses, and pharmacists from Florida traveled to Port-au-Prince (PAP). They were joined at the airport by 14 doctors and supporting staff from Haiti. After 3 hours at the airport of PAP waiting for clearance where all the medications and supplies were checked for valid expiration date, the team combined in a 4-car convoy including 2 buses provided by the Haitian Ministry of Health (MSPP). They headed straight from the PAP airport to Dame-Marie, a village in the southwestern most part of Haiti, located 204 miles (329km) from PAP. 5 doctors from Hopital de Dame-Marie including the medical director joined the mission and worked side by side with DISH during the 3 days of service.
The estimated cost for each participant who traveled from Miami to Haiti for the mission was about $ 1,250, which included airplane tickets, transportation in Haiti, and room & board. Each mission participant from the US paid his or her own travel fees. The 2 buses with drivers and two officers provided by the Haitian MSPP helped significantly defray some of the transportation costs from PAP to Dame-Marie. In addition, we still had to rent 3 smaller vehicles with drivers and we added 5 security officers.
The medical mission’s 4 core components:
- The medical component included 3 clinics on 3 different sites
- The surgical component
- The pharmacy
- The HIV screening and preventive program in collaboration with Volontariat pour le development d’Haiti (VDH).
Final count of collected and documented medical files revealed that nearly 2,000 pre-registered patients were seen and treated in 3 different sites.
1. The hospital
2. The centre paroissiale
3. The dispensary
Pre-registered patients were assigned to a center based on severity/acuity of the medical condition. More severe cases were referred to hospital, and less severe cases to dispensary and centre paroissiale.
Medical encounters files were collected and counted on daily basis from each site. All collected files to be scanned and electronic copies to be given to the Host hospital. Files are being reviewed for specific cases that need close follow-up at the hospital.
Most medical cases seen were joint pain (Rheumatoid Arthritis, Osteoarthritis), Hypertension, diabetes, gastritis, malnutrition, vaginal infections, sinusitis, rashes.
Surgical components: treatment and referral
Two leading american board-certified surgeons carried out the surgical part of the mission. Dr. Joel Levin is a renowned plastic surgeon with decades of experience, and Dr. Romane Joseph is a distinguished general surgeon; both are based in Miami.
18 surgical cases were performed. Adequate prophylactic antibiotics regimen and pain management were provided upon discharge. Follow-up of wound care and suture removal will continue at the hospital in Dame-Marie.
15 more complex cases selected for referral to Baptist surgical mission in Croix-des Bouquets in August 2013 for surgical intervention. This program will initiate a DISH-Baptist partnership in terms of complex surgical patients’ referral. The program will provide free transportation and room and board to surgical patients for more advanced surgical care.
Most cases seen were benign debilitating mass, lipomas, keloids, hernias, chronic wounds, burns.
Of note, there were 2 cases of true hermaphroditism with both genitalia. One of them is in the process of choosing to be treated to suppress one sexual appearance for another. These 2 cases are being referred to the Baptist program surgical group. DISH is writing a case report about one of the cases, a 15-year-old with both sexes’ physical appearance including both genitalia who is terrified from daily bullying at school. That individual who has been having his/her menses exhibits full breast development, both sexual appearances, a right descended testicle and a mixed-picture genitalia apparatus. He/she wants to be operated upon and to be treated to become a man. He/she added he/she will take away his/her own life if it does not happen.
- Estimated cost of medicines and supplies provided was approximately valued at over $50,000.
- Pharmacy was held at centre paroissiale
- More than 5,000 prescriptions were filled in 3 days
- The pharmacy was significant and pertinent. We had a large stock of meds carefully picked from the listed of pre-registered patients and statistics of diagnoses. 3 American board-certified pharmacists supervised the delivery of medicines based on American medication delivery standard, especially for prescribed (non-over-the-counter) medications.
- Medicines purchased from Mercy wholesale providers & from Johnson & Johnson.
- Medicine purchased within days prior to mission with maximum expiration date, sometimes up to 2016.
- About 40 duffel bags of medicines and supplies transported to Dame-Marie.
- 32 bags distributed
6 left over bags of medicines and 2 bags of supplies delivered to the city’s mayors, the mission coordinator in Haiti, to be shared between the hospital and the dispensary. These medications and supplies are to be delivered to the population according to local protocol of distribution of donated medicines and supplies, to be given free of charge to needed patients.
The pharmacy was the point of focus as all patients with prescriptions had to go to the pharmacy for medication dispensing. At times, the wait time was significant because of the high number of patients to be served in a short period of time. However, we were able to dispense the majority of our medications prescribed. A backup plan to honor unfilled prescriptions is being implemented by our coordinators in Dame-Marie.
The HIV prevention and screening program with VDH
In collaboration with the Haitian based nonprofit organization Volontariat pour le Development d Haiti, DISH implemented the HIV/AIDS prevention and screening program. VDH officers traveled to Dame-Marie with DISH to implement the program. Hundreds rapid HIV tests donated to DISH for the mission were utilized for patient screening. Hundreds of condoms were given by DISH to patients after counseling through VDH officers. The HIV program was advertised at the clinic sites and on the radio. DISH mission providers referred patients for testing based on their clinical judgment. Many patients were tested. Positive cases will be confirmed with additional confirmatory test and will follow up by VDH for treatment referral. DISH will obtain a list of confirmed positive cases and will contribute in referring them in specialized center for management.
The DISH-VDH cooperation is a continuity of a prior cooperation in 2012 where the two organizations co-hosted a successful continuing medical education seminar at the hotel Karibe in PAP, Haiti, with the participation of 90 doctors and 20 other allied health professionals. This year the focus was public HIV prevention awareness and screening free of charge in Dame-Marie, Haiti.
The patients we served
2052 patients were pre-registered by DISH mission coordinator Mr. Gilbert Jean over 1 month (March 2013). They were recruited from all over the regions. Announcements were made through local radios, churches, community leaders stations, schools. Patients showed up. Not only the pre-registered patients but also their friends and family members.
Many patients came from surrounding rural areas walking miles of distance, sometimes on horseback or by boat. Some of them were wearing Sunday’s clothes, some came as they were. But all of them were eager to be seen. “I have never seen so many young men willing to have a physical exam” said a DISH mission physician. It was a very friendly, enduring and dignified crowd who answered to a call of trust. One elderly woman stated: “ I came riding a mule to confirm with my own eyes that free medical attention and medications were indeed being given for 3 days. I have never seen that before in my life time” and tears were pouring down her face.
DISH Mission 2013: Cooperation & Success
The DISH 2013 medical mission in Dame-Marie has been an exemplary success. It was an ambitious, original and needed project. The following areas of cooperation illustrate the magnitude of the experience, its successes, the lessons learned and challenges.
Cooperation DISH-Haitian resources
1. Hiring and working with Haitian doctors: 14 doctors and one nurse practitioner from PAP were selected & recruited from an ad published by DISH in the Haitian newspaper Le Nouvelliste. We did receive up to 70 applications from Haitian doctors to participate in the mission. In addition, we also hired 5 doctors from the Hôpital de Dame-Marie.
This model of cooperation in medicine was pertinent. We allowed Haitian doctors to participate in the care of their citizens. They know the language and the culture and the most common clinical conditions. We created for them an opportunity to work and to know our organization, and to share professional experiences. We allowed them to better know their country. All of them admitted that it was the first time they visited the southwest of Haiti and visited an area that required more than 20 hours of travel by car back and forth. We created for them a temporary job opportunity. Each Haitian participant was provided with free transportation, room, board and $US 350 stipends.
Working with Haitian providers was one of the greatest strengths of the mission implementation. This is a model that other international organizations working in Haiti or other countries should consider. It can be implemented not only in health but also in education, agriculture, engineering, etc. Instead of coming to the country with the so-called “expertise from abroad,” it is an investment to work with skilled local professionals. We empower them in many ways including in networking for their professional growth. We increase the chance of adequate follow-up for the people or the project we serve. We create jobs by recruiting locals to join us. Moreover, we establish an automatic membership of professionals based on a common experience to ensure the successful realization of future project/mission.
2. Cooperation with the Haitian government and the Haitian ministry of Health (Ministère de la Santé et de la Population) MSPP
We are thankful for the collaboration of:
- The Haitian government and especially the MSPP: they provided us with 2 buses in good condition with full gas, 2 drivers, and 2 security officers.
- The minister of foreign affairs, especially the Haitian consulate of Chicago who for the second time authorized Madame Gertrude Beauboeuf as special envoy to travel with the DISH mission.
- The above represented very substantial technical support and we salute the trust and cooperation of the Haitian government in our effort.
3. Cooperation with l‘Hopital de Dame-Marie
The cooperation with the local hospital, including utilization of the OR, the clinic site and 5 doctors from the hospital, showed complete cooperation with the mission. We wanted to do the mission in cooperation with the main entity serving the community, l’Hopital de la Communauté Dame-Marienne. Because of this successful cooperation, we facilitated follow-ups at the hospital for the patients we served, especially the surgical patients. We also aim to stay in close contact with the hospital to follow up and find out about the outcome of certain cases and how we can contribute in their care. We have also made a list of items, equipment that the hospital needs, and will try to see how we can contribute in helping them acquire some of these items. A partial list of needed equipment includes an ultrasound machine, an EKG machine, a copy machine, computers, a basic lab mobile unit for blood count, chemistry count, urine analysis, pediatric beds, cribs, etc.
Mission donations & acknowledgments
We received a sizable donation of our medications from the CEO of sister Emmanuel Hospital, Dr. Shed Boren and CNO Dr. Bev Allen. Mission participants provided a significant amount of medications and supplies.
Financial donations were received from the following DISH mission supporters : Dr. Manual Mayor, Dr. Fred Grynberg , Ms. Karen Levin, Ms. Amy Anderson , Dr. Joseph Thevenin, Dr. Salah Amer.
A special recognition and gratitude to St. Jude representative Mr. Scott M. Mathison for sponsoring the multiple work dinner meetings at Soyka in preparation for this mission.
We thank all DISH mission participants from the USA and Haiti. Special thanks to the Dame-Marie Hospital executive director Mr. Pierre Antoine, and the medical director Dr. Pierre Robert Azor. We would also like to thank our Haiti and USA based coordinators Mr. & Mrs. Gilbert Jean, and Ms. Agnès Bonduel respectively.
Kansky J. DeLisma, MD, MPH
Photos and illustrations by Jean-Pierre Dodel (firstname.lastname@example.org).
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