Opening Healing and Hope for Colminy Malnutrition Treatement Clinic

Since my arrival there have been both problems and progress. I’ll start with the problems.

For one, it took forever to get here. Pilots on the plane we’d boarded in Miami noticed a potential mechanical problem. So we sat on the tarmac for 2 hours while they figured out what to do. Finally they announced we were to change planes. So, we all off-loaded, dashed through the airport to a distant terminal, only to wait for another hour.

Naturally we arrived in PAP quite late. Rick and others (who had arrived early morning) were anxiously waiting as it would soon grow dark and they were aware of problems on the only road ahead.

A bridge was out! The story goes that a fellow intentionally removed it’s bolts to sell for, obviously, a tiny fraction of the cost of the bridge and at great risk and inconvenience to traffic.

To make matters worse, they’d had a torrential rainfall which clogged a rugged by-pass with pools of water and slick mud. As we maneuvered around the bridge a bulldozer was pushing a bus through the muck with other buses and semis lined up on either side.

Several young Haitian men stood in the sludge. They were boosting vehicles in an effort to keep them moving forward. When it finally became our turn Rick yelled at us for single dollars to tip these soggy guys. I’d brought 50. He grabbed about ten, then practically threw them, one by one, out the window as we passed …all while maneuvering our truck as the wheels sloshed and spun through the soup.

Hurray! We’d made it!

That is until we came upon a traffic jam composed mostly of semis. “A riot ahead,” we were told. A fellow had been arrested and his buddies were rioting to set him free. (A strange system of justice, I’d say.) But it worked! After about an hour the guy was set free and we were on our way again.

Meanwhile Rick had been noticeably worried. (Actually, that’s a massive under statement!) He’d spent the entire time in desperate audible prayer.

Admittedly it didn’t look particularly bad to me. Just annoying. But in fairness to Rick, mobs of angry Haitians are frequently known to block busy roadways with tires then torching them. Or worse, torching innocents as their slowed vehicles pass through. Fortunately, we saw none of this.

From having gotten up at 3:30 that morning we actually arrived at Destiny Village (DV) very late. We were all too exhausted for dinner and headed straight to bed.

And so ended Day One. (That was NOT a promising start!)

Fortunately the other days have been better though I’m still battling the problem of getting transportation, accomplished once by grabbing my first moto ride (a Haitian motorcycle taxi). But that won’t work when I have to haul loads of gear to Colminy.

Yet, so far, I’m still on schedule to accomplish all I intended for this trip.

On Day 2 I made contact with the nurse Andre had hired. She hopped a moto  and came to DV. First impressions, I liked her very much and learned that she’d only met Andre once. He hired her but gave her no indication about what her salary would be. She seemed very satisfied with the much lower rate I offered her. Through a DV kid translator I explained as much as I could about the position, then made arrangements for more extensive training.

 

I was only able to get a few things done over the weekend and Monday — mostly helping out in little ways around DV.  Too much clinic to do, but without transportation, no way to get it done.

On Tuesday I joined the nurse’s training with HHC’S nurse. Actually, it was observing a well established malnutrition clinic in action. All in Creole, of course. Some of these kids (mostly babies) were worse off than those I’d seen on my trip to Cap Haitian. Our nurse got some hands-on experience.

Afterwards I spoke with one of the office personnel. She speaks English very well. This organization is amazing — full service clinic, malnutrition clinic, orphanage and school (in English, no less). At any rate they are bending over backwards to help us. Tomorrow they are sending their supervising malnutrition nurse to assist our nurse on her first day. They’ll also let us piggy-back our Media Mamba orders onto theirs so that we don’t have to drive so far to pick ours up. (That was a bear!) They also volunteered to be an on-going info resource for us about operations. “Got a question? Ask them!) Great! All greatly needed and appreciated.

Things never go as expected in Haiti. Wednesday we were to set up our clinic and do a practice run. We get to our borrowed church/school early — but we wouldn’t be getting in. Bees had taken up residence yesterday and the exterminator hadn’t arrived yet.

Even so, we made use of the time. The nurse, pastor and English-Creole speaking driver conducted lengthy interviews with multiple residents — acquiring useful data for when applying for grants.

Thursday was both set up, practice and real deal all in one. Good thing we had a highly experienced nurse with us!

My driver picked me up from DV at 6:15 am on this, the clinic’s launch day. We stopped on the main road to pick up Joanne, the experienced malnutrition nurse from Montrouis who had trained HHC’s nurse.  But she hadn’t arrived.

By 6:30 I was getting nervous and almost took off without her. Since the bees had prevented us from setting up, I felt we needed to get to Colminy extra early. My Haitian driver warned me, “You’ll be sorry. You’re going to need her!” She finally showed at 6:45 (there’d been some trouble with her tap-tap, a common way the public travels in Haiti, along with motos). My driver was right! I am soooo glad we waited.

Even after picking up Natacha (HHC’s nurse) from St. Marc, we made it in time to open at 8 am as promised. However, many patients had arrived before us. This was going to be a very busy day!

Attached shows the group we found waiting. Many others arrived over the next hour or so, but the newbies filled in an area behind me so I never could get a single pic of everyone. And of course, some left as others came.  Everyone sat on benches watching the nurses work with those ahead of them.

Unfortunately, we had no way of knowing who’d come first. Or second. Or third. After awhile, I thought they were going to burst into a full-fledged riot. Waiting mommies were getting angry that those who’d come later were getting seen first. Could be, but we couldn’t know!

My driver and the pastor (whose church/school we were using) stepped up for crowd control. I’d brought masking tape to anchor a yardstick to the wall for measuring. They grabbed the roll and a marker. Writing numbers on the tape, they tore each off and stuck it on a parent’s shirt.

One young mother shook both fists and screamed that she’d come before #6. Others joined in, claiming their arrival before or #24 or #43, or… Whatever! In spite of not knowing the correct order, my driver stuck to his guns. He stopped at #50, announcing that that was the last number that would be seen “this day.” Eventually, most of the others stormed out and things settled down. Meanwhile the nurses and their two hired helpers had continued on course.

(I left the tape and marker with the pastor. He said he’d be their early each week and start the numbering as soon as the first parent arrived. Hereafter, that problem forever solved.)

The only other potential risk was the bees. Although no longer inside, what seemed like thousands were swarming vigorously outside around two opened doors. Fortunately, there was a third door where folks could still come and go without much risk. To my knowledge, no one got stung.

Please note some of the signs of malnutrition — extreme thinness or puffiness, distended bellies, rusty-blondish hair, pedal edema (swollen feet), listlessness, etc. Some of this is quite visible among some the kids here; others not so much.

This clinic and Medika Mamba (the “solution”) is specifically designed for kids aged 6 to 59 months. That’s when acute and chronic malnutrition poses the most deleterious long-term threat.

The last image show the backs of the last mommies standing around the 2 nurses while they explain their responsibilities in administering 1-4 sachets of Medika Mamba (the exact number identified by the nurse) daily to their malnourished child — and nothing else except water. Only nursing mothers are to violate that, as they ARE to continue nursing along with the MM.

Each sachet of MM contains 500 calories, plus all the essential protein, fats, vitamins and minerals that the child needs. Children admitted to the program were also given a deworming pill and a round of Amoxicillin.

These pictures show the crowd.

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The woman in the blue top is Natacha, HHC’s permanent nurse. The woman behind her and to the left is Joanne, the temporary nurse from Canaan Christian Community in Montrouis. (The one we waited for on Pierre Payen’s main road.) The woman in the knit (or is that crocheted) hat and the one next to her in plaid are the two hired helpers from Colminy.

 

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The woman seated behind the supply table brought our first patients. She has 7 children under 5! How? …I’ve been wondering! Since none appear to be twins or more, I’m thinking she took some in when another mother passed away or became too sick to care for them. But I can’t say for sure. All I can say is that some are malnourished and their assessments took a long time.

 

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A better view of the same mother, assisting one of her malnourished kids to have her photo taken along with her identifying number — #1.

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Natacha ready to take the girl’s photo. Unfortunately, she was having trouble with the used camera we supplied for her. (After clinic I bought her a new one is Saint-Marc.)

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Natacha straightening out a baby for measurement. This little girl is still to young to stand on her own.

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Joanne leaning over a standing child while reading his measurement under the clip board she’s placed flat on top of his head.

 

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Here’s a dad supporting his son as Joanne uses a MUAC (mid-upper arm circumference) bracelet. This is one measurement tool used to identify if the child is truly malnourished.

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Measuring a non-standing baby.

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Obviously, some children don’t like getting measured. These kids have rarely (if ever) been examined by a nurse or doctor. For sure they’re not being hurt. But I think many, like this one, were truly scared.

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Johane starting a child on a sachet of MM. She did this at the end of each malnourished child’s assessment.

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And, of course, some kids don’t mind getting measured — especially the older ones. Unfortunately, we didn’t have a measuring stick longer than 36 inches. So we used tape to ID the top of 36 inches, then placed the stick from there up. Do the math, and you know her height. (Of course, they used centimeters instead of inches).

Funny, it seems like more pics were taken of our temporary nurse (Joanne) instead of our permanent one (Natacha). No real reason. But, in case you’re wondering… yes, Natacha worked equally hard. I thought she did a great job! Joanne agrees!

As mentioned earlier, most (if not all) of the kids we examined have never had any sort of physical before. So, especially the youngest ones, seemed terrified of everything done with them. …the worst seemed to be the hanging baby scale. Sometimes they’d stiffen, throwing their heads back. Whenever that happened, the sling seat tipped backwards and I feared they’d fall to the concrete floor.  I’m thinking I may want to get a typical tabletop baby scale instead.

(We also had a standard digital standing scale for those who could and would stand still. However, I don’t have any pics of those as that scale was positioned in a dark corner behind a table.)

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As you can see, images of that “scary” hanging scale are the first ones here.

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An “older kid” being positioned for his “before photo” in front of the crowd. Nudity is so common here, that no one considers a need for privacy — not the patient, the staff or what had become “the audience.” Admittedly, this cultural difference makes me a bit queasy. Even in nurse’s training the “necessity of privacy” was stressed.

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If you haven’t noticed before, some of these kids had very blond hair; almost all had tinges on their fringes. Eventually, as the child’s malnutrition worsens, they’ll also loose skin pigmentation. A few of Thursday’s patients were somewhat lighter than usual for Haiti. One’s coloring was a bit splotchy. But I didn’t see any who were significantly light. (A couple of these pics may be repeats to emphasize the blondness.)

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No one ever told me that malnourished kids are at high risk for umbilical hernias. But it makes such sense it should have been obvious. Protein-starved bodies are designed to rob protein from the least necessary muscles for use by those essential for life. Therefore, abs are weakened as they forfeit protein to the heart and thoracic muscles (controlling the lungs). Weakened abs create a perfect environment for hernias to form and protrude.

Probably half of the kids we saw exhibited some degree of herniation. As long as the hernias remain small, they aren’t likely to cause problems other than looking awkward. No action required.

These first 6 images illustrate these children’s budding hernias.

But so far, so good. Even so I was concerned enough to stop by the NGO hospital in Pierre Payen to inquire about it. They can repair it, but an American surgeon won’t be available until November. (When we just happen to have planned on returning.) When I asked how much, they replied, “Is she Haitian?” Since she is, the price is “10,000 Haitian gourdes.” Wow! Ten thousand gourdes — less than $200 US. Definitely doable! (BTW: there’s no comparison between this hospital and “Stanley’s” across the street. Designed by an American doctor, this one is sooooo much better.)

Now my questions are — Can she wait? Must she wait? Malnutrition alone creates huge risks. Is surgery too risky in her current state? However, if her nutritional status improves (as it should on the MM program), are we increasing the risk of strangulation by providing the protein that will strengthen her abs?

We need a physician’s assessment!

The exceptions are if parents don’t follow instructions, evidenced by the child not gaining weight. Children ALWAYS gain weight on the MM provided unless he/she has an underlying medical condition (usually TB or HIV). But not gaining usually means the parent is sharing or selling the MM instead of using it exclusively for the patient.

Therefore, if a child hasn’t gained weight by this Thursday, the parent will be warned. If he/she returns the following week without improvement, the child is removed from the program. HHC will provide a referral and funds for a moto or tap-tap ride to the nearest quality hospital. No cost is required for malnourished kids to be tested and treated.

For lack of time, at least half of last week’s patients were turned away. Those admitted will be reassessed and given more sachets this week. Newbies will get an initial assessment and, without a doubt, more will be added to the program.

HHC’s launch happened on schedule. And by the time we left, the bees had created an impressive hive on one door. But at least they’d stopped swarming.

Friday, was my last day in Haiti. I’d done all I’d intended except one — open a bank account in which HHC can deposit funds from the US and another can withdraw them for operational expenses. When I came, I had no clue Who that should be. Fortunately, by Friday I knew — it would be Pastor Marc.

He’s highly respected among his peers and the community he serves. Tears welled in his eyes when I’d confirmed that we’d be opening, as planned, on May 5th. (He hadn’t been pleased with Andre’s performance either.) So on this day he willingly met me at the “American bank” in St. Marc where we opened a joint account.

Pastor Marc will also provide the clinic’s oversight, pay the staff monthly, and pick up water and the MM as needed. He’s asking no payment for himself, but I’m determined to give it. How much? …another No Clue! I’ve yet to figure that out.

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Far beyond awkward, the baby in the next two images demonstrates one large enough for internal body organs (most likely the small intestine) to push through and get trapped — stopping the flow of blood — Strangulation. Excruciating pain! Life threatening!

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This is a poster of faces — all first kids admitted to HHC’s malnutrition program. (Actually, full-body images were taken.) Most, if not all, will continue on it ’til returned to health. This usually takes 8 – 12 weeks, using a full box of Medika Mamba plus or minus a few sachets. Once done, we should get “after images.” (Hopefully, by then they won’t be scared of the simple physical exam.)


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