Association of Haitian Physicians Abroad (AMHE),
NJ Chapter

Post Earthquake Relief
Trip to Haiti with Caribbean Medical Mission

On June 6, 2010, a group of volunteers including physicians, nurses, medical students and others under the banner of the Caribbean Medical Mission (CMM) went to Haiti to offer free medical care.
CMM is a sister medical society made up of primarily English speaking individuals that have for motto “to serve the needy.” It has been in existence for over 12 years and each year, it conducts free clinic in at least one Caribbean island. This year was the turn for Haiti.
Under the guidance of Dr. Reynald Altema who holds a dual membership in both CMM and the Association of Haitians Physicians Abroad (AMHE), a team was assembled. There were 3 primary care physicians, 2 pediatricians, 2 ophthalmologists, 6 RN's, 2 medical students, and 3 other volunteers.   Two of the physicians were members of AMHE (1 primary care and 1 pediatrician).   Five of the 6 RN's as well as both medical students were creole speaking.   Our efforts were concentrated in 2 areas: Cazale and Arcahaie.

Cazale. It is a small hamlet East of Cabaret off Route Nationale #1.   Cazale is peopled primarily by farmers and peasants.  A small private clinic serves this town, but often time patients can't afford the modest fees being charged.  Monday and Tuesday were spent there. An outdoor clinic was set up in an idyllic spot: under large mango trees, next to the Torcelles river. Each day about 250 people were seen.   The most frequent illness seen in adults was of gastro-intestinal nature-overwhelmingly reflux esophagitis-, in both sexes. In women, young or old, nonspecific vaginitis was a common diagnosis. Some cases of malaria were seen. Interestingly, few cases of diabetes or hypertension were recorded. Dermatitis (fungal, bacterial, allergic) was also a common finding. Obesity was not seen; people there walk a lot since they don't have cars and they are thin.
The river that runs nearby is both a blessing and a curse for the population. According to the locals, the Torcelles river which flows from the mountains, frequently overflows its banks when it rains upstream and was the main culprit in the flood that ravaged the area a few years ago following the hurricanes. It is not systematically used for irrigation. The river is used for numerous purposes by the residents in the area: for drinking (no standard purification process), bathing, laundry etc. It is suspected that the high coliform count helps to explain the frequent cases of dermatoses and vaginitides (seen even in virgins). Curiously though, diarrhea was not commonly seen in the adult population.
A good public health project would be the establishment of potable water and drainage of stagnant marsh to reduce the rate of malaria.  A formal irrigation system would also boost agricultural production in the area.

Arcahaie. It is a seaside town, famous for being the city of the creation of the Haitian flag.  Wednesday and Thursday were spent there.  On the first day, about 300 people were seen and over 500 people showed up the second day (lining up to wait as early as 5:30 in the morning). It has a public clinic that is poorly equipped and since it was being repaired, we also ended up seeing patients in an outdoor setting. More cases of hypertension and diabetes were seen in Arcahaie. Vaginitis, reflux esophagitis were also common findings. Quite a few cases of filariasis were noted and several people with elephantiasis were seen (one case was a young man in his twenties).   The range of locally available tests was noticeably very limited; ultrasound, EKG, GI series, etc were not being offered; patients have to go to Port-au-Prince. This public clinic is the only one available for a wide swath and it is not adequately endowed to take care of such a large population.

At both places, the ophthalmologists were swamped because they were offering free glasses and lots of medications for glaucoma. Any casual observer will readily notice the woeful state of the health care system. Malaria, a totally preventable disease is endemic. Arcahaie is strategically located about 1.5 miles from route Nationale #1. This busy highway is the site of many accidents and casualties every year. Therefore, it would be of vital importance that a trauma center be established at Arcahaie. The existing public health facility should be modernized and turned into a comprehensive health care facility to serve the large swath of this valley. This should be part and parcel of nation building.

By Dr Reynald Altema. Internist.

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