Monday, March 5, 2012

Elections & Cholera

Elections & Cholera - Haiti Nov 2010

Ile a Vache, Sunday November 29, 2010
We arrived in Port Au Prince (PAP) on Saturday morning, the day before the presidential elections. Didier, from Port Morgan Hotel, had arranged for secured transport between the international and domestic airports, and then for air transport to Les Cayes. We arrived at Ile a Vache without any problems and in a record time.
The island is tranquil as always. There is no cholera that we heard of here. On Sunday we went to see people vote at the Trou Milieu National school and at Madam Bernard's, two of the 3 polling stations in the island. The Minustah (UN forces in Haiti) was guarding the process and the turn out was massive. People were resigned to the long lines and waiting times of more than 3 hours. As the day progressed so did the frustration of the process. We guessed that not everyone in line would be able to vote by the time that the poles were to close at 4 pm.
We have been asking people about the elections and their candidates; the little information we have gathered indicates that the current government's candidate is not the people's choice. There is unrest and frustration in PAP, but the island is tranquil the day after. 
Today we are going to work at the clinic and we will talk to the staff to see how we get organized for next year. We need to set up a different system to dispense medicines at the clinic. 
Tuesday, December,1
Monday was a busy day at clinic, a lot of children, some of them few days old. While Javier visits the patients I work organizing files for the clinic. We prepare a spread sheet with a list of all the medicines that have bought from July. The increased number of patients and the total gratuity is proving to be very onerous. We are spending an average of $950 US per month in medicines. We have a meeting with the clinic staff to decide how to proceed for next year. We will let people know that starting in January we will charge 50 Gourdes per visit including medicines, a little over $1 US. Also if people bring a bottle, or a flask from previous visits, to dispense the liquid medicines we will charge only 40 Gourdes. Currently we are spending $50 US a month in flasks.
We also decide to increase the clinic staff monthly salaries. Surzie's will rise to $175, Zet's to $100, Salnav's to $70 and Marie's to $50. To compensate Zurzie and Zet for the extra work of the last few months we will give them an extra pay in December. We also discuss an incentive system to pay them extra money based on the number of  patients they visit.
Wednesday, December 1
On Tuesday we had 62 patients. Plenty of malaria. Salnav, the clinic's security employee, brings his 7 year old. He has been having large amounts of blood in his urine for a month. He was taken to the hospital in Les Cayes and they gave him antibiotics, with no results. Javier is afraid it might be a tumor in the kidney. Dr. Carme Guillen from Barcelona has called some friends in PAP and she has arranged for the kid to be seen at a hospital in PAP.
Our friends Javier Raventos and Montse Andres arrive in Ile A Vache from Barcelona via Miami.
Today the clinic gets 53 patients. We call a meeting at the school with the teachers, parent's committee and administrators. The meeting does not go well. The administrators resent the control we want to establish through the parents. Nevertheless we pay the teachers their salary for November through the parents committee.
Thursday, December 2
We go to Les Cayes to buy medicines and to meet with the director of the General Hospital. There is potential for medical students and residents from Miami to cooperate. We have already discussed this possibility with the Faculty of FIU Medical School in Miami. We also check on the status of the materials for the Solar and Eolic energy system for the clinic as well as the fridge for the vaccines.
The World Health Organization has sent a team to deal with cholera in Les Cayes. They have already treated 187 confirmed cases. They have 37 separate beds ready to go and treat malaria cases. They go to the houses that might have been in contact and decontaminate them. We will participate in a prevention program with this group. They will coordinate with Surzie a prevention and informative campaign from the clinic. The instructions for the clinic staff in case of cholera cases in the island is to send those patients immediately to the treatment center at Hospital General in Les Cayes.
Friday, December 3
Another busy day at the clinic. One of the patients is a case we saw in July. Javier suspected lung cancer at the time and we gave the patient money to go for an Xray to Les Cayes. She comes today with the Xray results, she is so frail. Diagnostic is confirmed and there is nothing we can do. We give her cortisone to make her feel better, that's all. 
We give money and instructions to Salnav to take his son to the hospital in PAP for an appointment Monday morning. The lab tests that Javier ordered for him at Cayes show that he is acutely anemic and  needs a transfusion.
At the hotel we meet a couple of doctors from Doctors Without Borders resting from their work at Les Cayes. They are setting up clinics in Les Cayes to treat the cholera. They sound quite grim.
The situation at the school remains difficult. We will have to wait to see how things evolve but we are confident that we are on the right path and there is a plan in place.