by Jonathan LaMare

This past week was particularly eventful here at Be Like Brit in Haiti, in that Cherylann and Bernie were here for much of it, along with our Global Pediatric Health Fellows from UMASS Medical! We celebrated a first of sorts in regards to our medical clinic! While we have always tried to share our resources with our community and open our doors to those in need whom we believe we can effectively help, thanks to the collaboration between BLB and UMASS Medical, we were able to run our first Pediatric Clinic right here in our own space! While this was a "pilot" of sorts, it gave us great insights and perspective for great things we hope to come!!!

We were able to see more than 50 children in our clinic over the course of two days, and are very happy that our own nurse, Madona, was on hand to translate for the UMASS doctors, as well as to augment her own capacity and skills. Madona is a great resource, too, in that she has unique understanding of cultural beliefs and other dynamics around thoughts of illness, hygiene, and more! We love how these collaborations create a great opportunity for us to work together and learn from each other! Our most successful case from this two-day clinic is a young child with a serious hernia has been successfully referred to treatment with one of our medical resources in Haiti, and will have corrective surgery at almost no cost! How wonderful!!!

Dr. Michael Taylor of the Fellowship had a few things to reflect on in regards to the experience here in Haiti over the last 10 days! Here's what he had to say:

"It was a pleasure to take my second trip to BeLikeBrit orphanage on behalf of UMASS Medical School this past week. The residents and I had a fantastic trip. The highlight for me was working with the residents as well as the caregivers on hygiene education. The topics were varied. We met with the male and female caregivers separately and encouraged them to ask any questions that they had about good hygiene in general and some of the more sensitive topics related to bodily hygiene more specifically. We then focused the discussion on expected bodily changes and changing hygiene demands in adolescents. The caregivers were very engaged in the topics and asked numerous questions. It was clear that they were already familiar with most of the topics discussed but they appreciated the open forum to be able to ask questions and bring up specific scenarios that they had faced with the children. I then asked if they would be willing to pass on what they had learned to the children in a teaching role and they were very excited by the idea. During the second session they took on the responsibility of teaching and I was impressed by their ability to engage the children with questions and examples. It was clear that as they taught the children that they were becoming increasingly more comfortable with the subject matter. At the end of the session the caregivers were beaming, filled with pride over what they had learned and in their ability as teachers to pass it on to the children. The entire exercise was exhilarating, and rewarding in a way that reinforced for me my ongoing desire to engage in health education in culturally appropriate ways. Thank you BLB for an excellent trip, we look forward to joining you again soon!"

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 Doctors Anna B. and Anna C. reflected, too! Here's what Anna C. had to say!

I came to Haiti as a novice global health traveler. I didn’t know what to expect, but all I knew was that I wanted to experience something different than what I had been exposed to in the US, and I wanted to make some kind of meaningful contribution to the kids in Haiti. I was so grateful for what UMass had provided me with my medical education and training, and even more grateful for this opportunity to experience medicine outside our borders. I am lucky that coming to BLB would be my first experience, because I got not only the global health experience, but I got to experience how awesome BLB is, and appreciate the Haitian culture.

From this experience, I would have never learned how fascinating ear exams could be! In the clinic, I am so thankful to have had the support of Anna and Mike while we saw both the BLB kids and kids in the surrounding community. I thought that coming to Haiti would mean having a completely different list of differential diagnosis and dusting up on strange, “zebra” diagnoses. Turns out, viral infections exist in Haiti too! But I also did get a nice refresher on infectious diseases and fungal infections that are less common back home. I also knew that resources would be scarce in Haiti, and a number of times, we had to be a little creative with treatment plans. Other times, there would be little that we could do, mostly owing to the weak public health infrastructure (which was always a subject of heated discussion among the three of us). Nutrition programs and access to medical facilities were two of the largest barriers that I experienced while taking care of patients here. As a physician, it’s difficult to feel ineffective because of barriers that we have no influence or control over. Back home, there’s always a consultant, always a program we can refer kids to. In Haiti, this is extremely rare. Even programs that are available have their own shortage of resources, and access is still the most common barrier. We always put our best foot forward though, and provided the best care we could offer. Even though we had a short stay in Haiti, I felt overall that we were able to provide many with care that they would have otherwise not received. At the same time though, I hope I can do more to have a more long lasting impact on the health of these kids.

The kids here are so much fun, and welcomed us with so much love, smiles, and hugs that I was nearly brought to tears. They are kids just like other kids. Seeing them in the clinic didn’t even feel like work! As I see them today, it’s difficult for me to think that they had difficult beginnings because now they are growing and eating well, and treat each other like brothers and sisters. The staff here is also incredibly committed to the children, treating them like their own. We had the opportunity to work with the staff in doing some personal hygiene teaching for the children, which was an enriching and engaging experience for everyone.

I also got to learn so much about Haiti from everyone here! All the groups we worked with were so welcoming of us and allowed us to be a part of their community. I enjoyed every sit down dinner conversation, the tour of Grand Goave, our hike around the orphanage, and especially the trip to the market to get the pig leg (to practice suturing)! From meeting patients, to attending church, and having brief interactions with people in town, I have so much admiration for the Haitian people for their resilience despite the poverty that surrounds them. Every day, they continue to use their faith, personal strength, and willpower to continue supporting their families. They find hope and happiness in their daily interactions rather than their material belongings. To see what we saw in Haiti was such a huge change from what I had seen at home.

On our last day in Haiti, some of the children did not have school, and so the morning was more energized than most. We were wrapping up the last our of wellness checks, and as I got to learn a little bit about each child - their favorite food, best friend, favorite activity at BLB - I realized that I was what everyone else at BLB was: attached. They knew as complete strangers, and would come to us knowing that we could take care of them. I loved the dancing, birthday parties, and games they got us to play. When we met Cherylann, she told us that once we become a part of BLB, we never leave. I think she’s right. I can’t wait to come back. Even with all the mosquitos (12 bites in 10 days).

And from Anna B:

The saying we were quickly introduced to on our arrival, was “It’s Haiti.” This is often said with half a smile and a shrug of the shoulders to indicate a mixture of resignation and forbearance for the unpredictability of schedules and the limitation of resources. Throughout my two weeks here in Grand Goave, working at Be Like Brit and in the surrounding community, I found myself both charmed and at times, frustrated with this mantra. After-all, I’ve been trained as a physician, which, at least in the USA, involves being imprinted with a belief in regimentation and using our vast resources to get to the bottom of what is wrong with a patient. We (and our patients) love answers! Here, I discovered, I had to find my reward not in being a diagnositician but in being a care taker and an educator.

Often this meant providing treatment for symptoms that I might have wanted to test for further in the US before treating.   We provided reassurance and held off on antibiotics for a two year old boy with a history of cough, fever, and crackles on lung exam, whom I might have sent for chest xray back home. Here there was no xray easily available, so instead, we thought about his nutritional status and whether he was at risk for a serious infection. Given that he was well-appearing and a healthy weight, we felt safe attributing his symptoms to a virus. A 5 year old boy was brought in by his mother from the community with bloody diarrhea, a complaint that would have doubtlessly led to blood and stool testing in the US. Instead we thought about what would be the most likely cause, and empirically treated.

Another way I had to give up some of my routines was in the history taking. Histories were often muddled by the need for translation and cultural differences. For example, I found that our Haitian patients often were surprised and perhaps a little exasperated by our persistent questions about the number of times something had occurred; i.e. how many times they had had diarrhea, or how many wet diapers their infant had had (a moot question in most cases since hardly any of the infants wore diapers.). Fevers were always tactile since no families had thermometers. The duration of a symptom was often nebulous. I learned not to be come obsessed with numbers but to focus on how my patient felt and how they looked, and treat as best I could with what we had.

Treating with what we had meant improvising in ways I never had at home. A 3 month old and her older sister came in with impetigo during one of the community clinics we offered for the employees of Be Like Brit. Our first choice antibiotic that we would have used in the US was not available in the modest pharmacy of donated medications. We found an alternative for the older sister but struggled with what we could give the infant. The pills we had available (adult doses) would have needed to be cut in to fourths to make it the appropriate dose for the infant’s weight. We ultimately settled on an antibiotic that was not ideal but we felt was better than nothing. We asked their mother to return the next week to make sure that the lesions were healing. I thought of the mother who had come in earlier that day with her male infant adorned in frilly yellow dress—when asked, mom had said that she had expected a girl and when her baby boy had been born these were the only clothes she had for him. In Haiti, there wasn’t always the perfect fit, but this did not stop anyone from carrying on with exuberance and determination.

The last two weeks have been pushed me out of both my personal and professional comfort zone. Without the weighty, complicated trappings of American medicine, I’ve found myself connecting with the children I’ve seen and the parents I’ve counseled in ways I don’t have time or energy for in the US. And as the children of Be Like Brit often say, “It was good.”

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Yesterday we welcomed to Haiti our newest group of Britsionarys, who have yet to come up with their Team name! We're thrilled to have Leslie, Cindy, Lauren, and Leenie back as returning - with Leenie at the helm of the week - and a great group of new Britsionarys along with them! It is sure to be an exciting week as we build a home for the family of one of our children - another commitment to not only the children of Haiti, but to our friends and our neighbors, too!

We know it will be another great week, and October is going to be a VERY busy month for us! Be sure to keep up on all of the things which will be happening here! We thank you for helping us help the children of Haiti at Be Like Brit!!!