April 2012 Mission: HAM founder and medical director, Dr. Tracee Laing, and operations director and board member, Paul Hammond, arrived in Haiti on Easter Sunday, April 8th. They are to spend three weeks working with HAM's Haitian staff at the Centre de Santé clinic in Dumay and will be joined for part of the time by documentary film makers, Jeff Hammond and Doriana Westerman of Global Eyes Media and Sun and Life Photography, long time HAM volunteer, supporter and translator/interpreter extraordinaire, Evelyne Poelzing, and Dr. Jim Naprawa, a first time volunteer with HAM. As usual, the team will be posting from Haiti on a daily basis, which you can read below.
Sunday, April 8th: We, Dr. Tracee and Paul, arrived in Port-au-Prince a bit after 4:00pm, only slightly delayed at the Miami Airport, a typical situation for flights to and from Haiti. We boarded the plane and were ready to go when over the speaker it was announced that "someone in the front of the plane had a maintenance issue
that needed to be resolved before we could take off." These were confusing words, and the resolution took about 30 minutes, after which there was a problem with getting the jetway detached from the jet. But, we eventually took off on an otherwise uneventful flight, arriving in tact with all their luggage arriving as well, better luck than the January team. Charles met us and was accompanied by our new driver, Reginal, and translator Marvel. Tonight we will stay at Carolyn's and are off to the clinic early tomorrow morning. We haven't been here for almost six months, so the homecoming with Charles and Carolyn felt especially sweet.
Monday, April 9th: Communication always seems to be one of the biggest challenges in Haiti. We were told the  time getting off the plane yesterday and it was an hour earlier, which is consistent with our previous experience that Haiti doesn't follow day light savings time. So, we told Charles and the crew to pick us up at 7am at Carolyn's today to leave for the clinic. Our alarm went off at 6 as planned, but 10 minutes later Charles called saying he was out in front, that it was 7:10am! So now it seems Haiti does follow day light savings time, thanks to the new president. Nothing like starting out the day an hour behind. We departed 20 minutes later, Tracee no better for the lack of her morning coffee. Our drive to the clinic was quicker than usual as there was no school today, with people still in the celebratory mood after the Easter Holiday. In the six-months it's been since we were last here, I noticed several new buildings and businesses have sprung up along our route to the clinic. Oddly, these appear to mostly be beauty salons, gas stations, and night clubs. Is this the stuff of recovery? One marked change was that when we crossed the River Grise, there was hardly any water, especially given it rained very hard last night. It seems the construction industry has found a major source of open-pit sand and gravel mining in the river bed (see picture on right), re-routing the water into agricultural viaducts. While it makes for an easy river crossing, it's hard to imagine it's not an environmental disaster in the waiting.
 Arriving at the clinic was the usual chaos of fond greetings from the staff and the mad rush of unpacking the meds and having the pharmacy staff update their inventory, while patients are waiting to be seen. Fortunately, we had three doctors seeing patients today, with Tracee and Dr. Cater seeing regular patients and Dr. Jacques doing surgery consults. At left, Tracee and the girls mother were working  hard to get the girl to smile, with Dr. Cater in the background, but despite her fancy hairdo, she just wouldn't cooperate. Additionally, Tracee saw a patient with an unusual tumor on her hand, pictured right, who she was able to refer to Dr. Jacques just down the hall. While the doctors saw patients, Paul, Charles and Reginal headed back to Port-au-Prince to do some errands, including the grocery shopping for the week.
The afternoon was spent in meeting prioritizing projects and tasks for this trip, and then with the mundane job of "setting up camp". Because the volunteer quarters at the clinic are only used when volunteer teams from the US are staying there, there are always a lot of chores in setting up the facilities upon arrival, and packing everything up for departure. Bedding has to be pulled out and set up, along with mosquito netting, all the dishes, pots and pans and kitchen ware have to be washed and set up, and rain protection requires assembly. As the sleeping quarters are a sleeping porch open to the elements on three sides (see picture below), and it is the rainy season with heavy rains and winds arriving every evening, we need to install tarps all along the parameter that can be unfurled in the evening when the rain begins. By the time we had gotten everything set up, and cooked and eaten dinner, everyone was pretty worn out. Hopefully we'll all sleep well tonight, lulled by the sound of the rain pelting the tin roof above our heads.
A shot of the back-side of the Centre de Santé, where the volunteer sleeping porch is located. You can see a bit of the solar panel array on the right side of the roof, and the empty water tank on the left side of the roof. We're looking to drill a new water well to fill it daily within the clinic property, more on that in the coming days. In the foreground you can see the start of Tracee's garden, now encompassed by a goat-resistant fence. In the bottom right corner you can see the avocado tree that Carolyn started from a seed for us at her place.
Tuesday, April 10th: It was a wet night, with rain falling steadily for several hours, though we woke early to a clear morning, hot sun and cocks-a-crowing. Paul, Charles, Wilberne, the clinic administrator, and Reginal headed to Port-au-Prince to deal with bank issues and try to find a water well drilling contractor. It took all day! The trip was mostly successful, though it looks like there is a backlog of water wells to be drilled and the waiting list is six to eight months.
Meanwhile, Dr Tracee, Dr. Verdieu, and Dr. Dezard were seeing patients in the clinic in Dumay. On the right is Kingston, who fell and cut his rt. eyelid a week ago, but was
seen for persistent fevers. Dr. Tracee took his picture just because she thought he was
adorable.
This
is Castomalie on the left, who greeted Dr. Tracee today with a booming
"Bonjou Blanc!". Mom seemed a bit embarrassed, but it made everyone
laugh.
Translator, Marvel, and community health worker, Junior, on right, walking with Dr. Tracee to a house call in Dumay. They  were concerned about a new mother who delivered a healthy baby one month ago, but they were told by the aunt, who brought the baby to the clinic for his first check-up, that mom was too ill with fever and abdominal pain to come to the clinic herself. After a one hour walk, they arrived at mom's home to find aunty looking a bit embarrassed, and mom walking around the house doing chores. Mom did have a tender abdomen, so she did need some attention, but she did appear to be fully able to come to the clinic herself. Nonetheless, it was a productive trip. It was a nice afternoon for a walk, and we had 2 hours to discuss the issue of home bound ill patients in the Dumay area. We decided we would try to see 2 or 3 truly home bound patients at the end of each clinic. Junior agreed to put together a list of home bound patients so we could walk to a different area each day. Getting out to individual households also helps us to better understand the needs of the community.
 
Dr. Tracee doing a little first aid from the back steps of
the sleeping porch for a
young girl who lacerated her hand while cutting open a mango after
clinic hours.
 Wednesday, April 11th: This is Myrthachi, left, who came to the clinic with
her dad (he looks intimidating, but was only trying to see what was
going on outside the window - he laughed hard when he saw his picture).
Myrthachi cut her foot, then walked through the mud last night. Happily,
she has had all her childhood vaccines, so she didn't need a tetnus
shot.
61 y/o Juslene, right, was seen today in the clinic.
She lived in Dumay until the age of 52, when she moved to the USA. She
was in Haiti visiting family and prefers to see the Dr. when in Haiti,
because this is where she can afford healthcare. Dr. visits are out of
reach for her in the USA.
 Many of you will recognize our patient Donald, left,
who walked around with a compound tibial fracture for 3 months until we
arranged to have limb saving surgery per Dr. Beauvoir, an amazing
Haitian orthopedic surgeon. He is sitting next to his grandmother. Our
first official home bound clinic patient.
Life going on outside the home of our second home bound patient, right; Grandma Lucia.
Several great grandchildren of our second home bound patient, below.
 Left is a grandmother lost the use of her legs
shortly after the 2010 earthquake. She is permanently in this position
due to painful pressure ulcers on her back and buttocks. Her
granddaughter cares for her, but hasn't had the supplies needed to
changes dressings on the wounds for 3 months. We were able to supply
Grandma Adanlie with what she needs to stay clean and be more
comfortable.
Thursday, April 12th: Sorry, we have no photos from today and will have to make do with a brief summary of events. There were less patients for the doctors to see, as it was market day when much of the community goes to market to sell or buy. Paul met with
a Mennonite group, Blue Ridge, that drill water wells who might be able to squeeze us into their schedule, not least because we can pay them the deposit immediately. We are trying to get the details sorted out so we can sign a contract and pay the deposit within the next few days. We left the clinic in the early afternoon for the airport to pick up Jeff and Dori, the film makers who will be making a documentary about the Centre de Santé. Traffic was especially bad and the airport was more chaotic than usual because Mexican President Calderone was flying in and out of Port-au-Prince for some official meetings. Jeff and Dori eventually made their way to us safely and the team headed up to Carolyn's house where we were staying the night. We had a fun evening meeting up with an old friend of Paul's, an AP journalist named Martha Mendoza who just happened to be in Haiti working on some stories.
Friday, April 13th: Right, these brothers came to see Dr. Tracee this morning. Obviously, he loves his little brother.
Another pair of brothers, above...Mom said she was hoping for a girl the second time around!
We
reconnected with AUMOHD today, right. The Haitian Human Rights group that
helped organize the Dumay community when there were so many kidnappings
in the Croix-des-Bouquets zone.
Above, Jeff
Hammond and Dori Westerman started working with Evelyne Poelzing on
their documentary today, interviewing several employees of the clinic.
When done, we hope to have a 12 minute video to show people who want to
learn more about the clinic and the Dumay community. Here, they are
interviewing our Medical Director, Dr. Jacques.
Saturday, April 14th: The team went out at the clinic again today to work on the documentary. Unfortunately the rains have been extensive enough that the river had risen too much for us to drive through. So we had to take the long route around and it took over two hours just to get there. Upon our arrival, we found the cholera clinic bursting at the seams with 27 patients, up from 13 yesterday. As we have feared, the start of the rainy season has caused a jump in cholera cases, however we have never seen such a crush as there was today. Dr. Jacques had been in contact with the Ministry of Health begging for assistance and they eventually sent an ambulance to take four of the
most serious cases downtown to the hospital, but by late afternoon we still had over 30 cases at the clinic.
Left, we ran out of beds and had patients hooked to IV's 
everywhere. Right, Dori taking pictures inside the overflowing tent in the cholera clinic.
Left, Evelyne, Jeff and Dori setting up on location for interview with Donald and Magali at their home in Dumay.
A nearby goat was jealous of not being interviewed  and was bleating loudly and interrupted our work briefly.
Monday, April 16th: There has been an explosion of cholera in our area. Before last Friday,
we had an average of 7 cholera  patients a day. By the time we left the
clinic on Friday afternoon there were 13, and upon our return Saturday
morning we were up to 30. Dr. Jacques was on the phone with the Haitian
Ministry of Health (MSPP) and members of the Health Cluster at this
point requesting help, as w e were
running out of space, supplies and staff. We had pulled in as many
additional staff as we could on Saturday, but it was obvious we weren’t
going to be able to keep up without additional resources of all types. Above, meeting with MSF and MSPP in Dumay to discuss the huge increase in Cholera patients.
There were over 40 patients in the cholera clinic when we arrived this
morning at 8:30. Below, a family  member helping out her sick relative. Fortunately, the MSPP had responded and removed 15
patients to transport to the hospital by mid-day. In the late morning, a
large delegation arrived from the MSPP led by the director of cholera
response for the Quest region, to evaluate the situation for themselves
and develop a plan. MSF also sent a team to assess the situation and
offer help if needed. Apparently, our area has become the hotspot for
cholera in the entire Quest region, which includes Port-au-Prince, and
this group is now searching for the source of the local outbreak. They
also agreed to supplement our staff with additional nurses from the
city. They got us a couple of tents and some more cots, but the tents
have not been put up yet due to the ground needing to be prepared. By
the end of the day we were back up to 48 pt’s. Our previous maximum was 
in the low 20’s and with only 22 beds, we were way beyond capacity this
AM. There is nothing to protect the cholera patients from the rain
tonight, and luckily it doesn’t look like rain. Tomorrow, the tents will be up. Left, starting IV's in the open air.
Right, hydrating with IV bags hanging in the tree.
Below, chilling while getting IV fluids.
All photos in today's post courtesy of Jeff & Dori.Visit their website at Global Eyes Media.
Laura Wright, from First Presbyterian Church Richmond,
came to evaluate our clinic site as a possible location for their Living
Waters clean drinking water project. Let’s hope they choose our clinic -
I can’t imagine a location more in need of clean water right now! We
feel very lucky to have run into Laura at St. Joe’s this weekend. Right, Laura Wright with Paul assessing the clinic property for the living waters project.
Tuesday, April 17th: Dumay has become the cholera hotspot of the entire Quest region. We were up to 75 patients in the morning, losing our third patient since Saturday. Our staff was overwhelmed. When the ambulance arrived to pick up the body and a few of the most seriously ill patients by late morning, tensions among patients within the cholera clinic were at the breaking point. About noon, the Ministry of Health (MSPP) and ALIMA (the Alliance for International
International Medical Action) arrived and began a plan of action. ALIMA would set up the tents we had received from UNICEF and fully equip them, segregate the cholera area into zones isolating the more serious patients, dig drainage around the area, and install new containment fences. The MSPP would provide 10 nurses and two doctors by the evening to help set up, organize and relocate the patients into the new tents. It was a wonderful thing, to be able to call our partners for help and have them come running, or as Paul referred to it, "they've
sent in the Cavalry"! It was a chaotic but amazing day, with crews working around the clock to make everything happen. By midnight the tents were set up and equipped for 50 patients. Below are some photos from today, mostly shot by Jeff and Dori.
 A crowd forms as the body is loaded into an ambulance.
Crew hired by ALIMA prepares the ground for tent construction.
Dr. Tracee, flanked by Marvel and Junior on route for afternoon house calls.
Dr. Tracee and her crew talking with immobile patient, Irassaint Louis, who lives alone in the adjacent house.
Messuear Louis having blood pressure taken by Dr. Tracee. His heart was very strong.
Adding to the chaos of the day, a swarm of bees ascended upon a plant in the garden behind the volunteer sleeping porch. Accidentally disturbed, they were a frightening sight when airborne.
The crew raising one of the tents.
Crew working through the night to complete set-up of the
revamped cholera clinic with a much higher capacity.
Wednesday, April 18th: After the chaos of the past few day's cholera crisis, today was a welcome relief of orderly operations and positive surprises. By sunrise, all the cholera patients had been moved to their correct locations and the crew began the trenching and fencing work. The idea was to create a system of internal fencing within the cholera clinic that would force people inside to disinfect their feet and hands whenever entering or leaving, all in an attempt to contain any infection from spreading outside the cholera clinic area. The chaos of the previous day had dissipated and there was order and calm around both clinics throughout the day. The number of cholera patients dropped to around 50 by day's end.
Just yesterday, we signed the contract for the water well to be drilled and were added to the waiting list for the  drilling schedule. So it was a big surprise when Mike called from Blue Ridge to say he was on his way to drilling the well this morning. They spent the entire day here drilling down to 220 feet through limestone, and found water, just not quite enough. Blue Ridge will return tomorrow morning and continue drilling to about 300 feet and then insert the 6" casing and clean and cap the well. This all terrific news, though we do not yet have the water pump that will run off of solar power, so once the well is complete, it will be capped to wait for Keith Hare and the pump team to travel down here for that installation. With some luck, we'll have running water at both clinics by the end of the summer. Then we'll hope that we can craft a partnership with Living Waters for the World and First Presbyterian Church Richmond to install a filtration system to support the entire clinic. Our fingers are crossed!
Pictures of the Blue Ridge drilling crew in operation.
Thursday, April 19, 2012: Today Blue Ridge Christian Homes completed digging the well. It is now
capped and waiting for the pump. After 3 nights with no rain, the
cholera cases have dropped to 19 by the end of the day, but the facility is up and running, and an
ALIMA team is in Campeche Dumay to educate the people on avoiding
cholera. We continue to see patients in the clinic and go to homes to
see those who are not mobile. Dori and Jeff continue to work on their
film documenting everything that is going on this week. Evelyne Poelzing, our friend and amazing interpreter and translator who has been indispensable to the interview portion documentary, left the team this afternoon to head home to Florida. She worked tirelessly while here and we shall miss her terribly.
The new cholera tent up and running next to the sleeping porch.
Disinfecting the entrance and exit lanes for the cholera clinic
Cleaning up in the cholera tent
Hand washing
9 day old twins brought to the clinic by mom who is sporting a black velvet hat with purple feathers
We passed a voodoo Dr's house while out on
house calls. I guess the trinkets in the tree represent spells, contain
potions, and trap diseases he extracted from his patients. If you don't
pay your bill, he gives your disease back to you.
Friday, April 20: After several days of intense activity, today was a welcome relief of the semi-calm of "normal" operations. Dr. Jacques has been away from the clinic all week in Pinion being trained in Laparoscopic surgery and he missed the cholera crisis. We've been on the phone updating him, but it's really been up the Dr. Tracee to coordinate with the MSPP, ALIMA and other NGO's during the crisis. Today she met again with the MSSP and ALIMA to review the plan of action and staffing for the weekend and next week. The numbers continued to fall today and we are all hoping the worst is over, but local staff and community education continues to be of utmost importance to help guard against another crisis. The well drilling was completed yesterday, so now we wait for Keith Hare and his crew to come sometime hopefully this summer to install the solar pump. Below are a few photos from the past couple of days.
Right, what Blue Ridge left us upon drilling a 300 foot deep well.
Dr. Tracee reviewing map of cholera treatment centers in Quest with Dr. Melody and Dr. Richard of ALIMA.
Dr. Tracee talking with patient during one of her afternoon home visits.
Jeff shooting a photo of Dr. Tracee doing home visits.
Inside the new cholera clinic tent.
Saturday, April 21: We had a fun and differently paced day, buying art for the upcoming Art For The Heart auctions later this year in California, Washington and North Carolina. We visited the metal art workshops in Croix des Bouquet and the artists cooperative in downtown Port-au-Prince looking for wonderful pieces to share with our supporters. Below are a few photos, mostly taken by Jeff and Dori.
Speaking of Jeff and Dori...
Serge Jolimeau's metal art shop in Croix des Bouquet
First step, pounding the metal drum flat...
...then the design is drawn onto the metal in chalk
And the cutting out of the design
Skipping to the part where the art has been picked, purchased, packed and ready to bring home for our 2012 art shows in Ojai, Asheville, Seattle, and Santa Cruz
Driving by the remnants of the Presidential Palace in downtown Port-au-Prince
Sunday, April 22nd: After staying the night at Carolyn's, we headed to St. Joseph's Home for Street boys, to record some Haitian drumming for the documentary. St. Joseph's uses the arts to help empower the boys who live there to find passion and believe in themselves. There are several drummers who play with the Resurrection Dance Company, an internationally touring dance company made up of boys from St. Joseph's. After the recording session, we went to the airport to pick up Dr. Jim, emergency pediatrics doctor who works at Nationwide Children's Hospital in Columbus who will be working with our team for the first time. Dr. Jim arrived on schedule, but unfortunately his checked luggage did not. Then it was back to the Dumay clinic. Upon arrival we met ALIMA's project manager for Haiti, Niger and Chad who had just arrived in Haiti to check things out. During our discussion he mentioned that his team was investigating what they thought might be the source of the recent cholera outbreak in the area, the water source for the Campeche Dumay. Dr. Tracee wanted to visit this water source to check it out, so some off the team headed out on a hike to see for themselves. We were led to what we were told was the "source", a spring head near the mountains, that was contained withing a cement building with the door locked. After some discussion, we discovered that water was piped from this "source" to a different "source" within Campeche. Another hike took us to a PVC pipe within the community of Campeche that was continuously spouting water. There we witnessed some young men drinking directly from the pipe and explained to all the need to chlorinate the water before drinking.
Jeff and Walnes sharing the Djimbe drum at the start of the recording session
Second drummer, Patrick,going jungle for us
Tracee, Charles and Clairdume checking out the locked up "source" of the "source"
Monday, April 23rd: It was Dr. Jim's first day working at the clinic, and he was put to good use. He saw many children, being a pediatrician, and doubled as the anesthesiologist for Dr. Jacques, who preformed 3 surgeries today. We all spent the day working at the clinic, except Charles and Reginal who returned to the airport to retrieve Dr. Jim's lost missing baggage from yesterday's flight. The minimal traveling today was fortunate as it began raining about 4pm and there were reports of manifestations in downtown Port-au-Prince, something we have to stay away from. This situation caused Jeff to muse, "It's harder to burn a tire in the rain". A few of Jeff & Dori's photo's from today are right and below.
Dr. Jim in his role as pediatrician
A definite candidate for surgery
Dr. Jacques, Nurse Carmel and Dr. Jim during surgery
After surgery...a big improvement
Tuesday, April 24: We headed into Port-au-Prince early today to get Dr. Jim and Dr. Tracee to St. Damien's Hospital, an amazing children's hospital that is committed to serving the poorest children in Haiti. While the doctors toured, Jeff and Dori were taken to Carolyn's so they could spend the day editing the their film and packing, as they leave Haiti tomorrow. The afternoon was suppose to be spent at Dr. Joey's clinic in Del Mas, but due to a mix-up, they didn't have patients lines up to see us.
Phadoul
took us on a very honest and complete tour of St. Damien's Hospital
today. They are doing amazing things for those with the greatest need! Marvel, Dr. Jim and Phadoul looking sharp!
One of 4 impressive operating rooms at St. Damien's
Working on the video and keeping folks back home up to date .... Jim is studying the history of Haiti.
Wednesday, April 25th:
We departed early from Carolyn's to drop Jeff & Dori off at the airport on the way to the clinic. It has rained steadily and this road was flooded.
We
finally made it through the floods to encounter tires burning and a
"manifestation", so we had to turn around and a 1 1/2 hour trip turned
into a 3 1/2 hour trip to the clinic. We decided we would just stay in
Dumay to work the rest of the week.
A young lady seen today in the clinic - love the hat! Dr. Jacques and Jim worked in surgery while
Dr. Tracee saw patients.
The Dumay team working with the Haitian government on their new vaccine promotion program.
Surgery - a young woman with large tumor on her hand, removed by Dr. Jacques.
86 year old Mdm Heleine with Dr. Jim in her home.
Three beautiful girls playing outside a home bound patients home
Marvel and Junior trekking with Dr. Jim through the mud on a house call.
Kids playing outside of one of our home bound patients homes.
Stalwart HAM employee Junior with his wife and sons: Kendell and Christopher.
Thursday, April 26th: Tomorrow is our last day to work in Dumay. We are happy to report that
the numbers of cholera patients have dropped significantly. Today, we
have only 10 patients admitted on IV fluids.
We have spent a lot of
time with staff this week, and feel we have been able, through their
suggestions and concerns, to make some changes to improve patient care
and staff efficiency. It all costs money, so we will head home on
Saturday to work on that end.
A boy with a bad case of impetigo treated in the clinic today.
Bruno Josnell holding some of his artwork today.
We decided we needed a little more art for this years upcoming art auctions.
Friday, April 27th: Our final day of the mission was a busy one with many patients for Dr. Tracee and Dr. Jim to see, a surgery for Dr. Jacques and Dr. Jim, many meetings with various partner organizations and staff, and packing and closing up the volunteer quarters until the next mission in late July. It has been a very busy and productive mission, and we depart leaving the cholera clinic expanded to over 70 beds, and new water well drilled and cased to supply both the Centre de Sante and the Cholera Clinic as soon as the new pump is installed this summer, we are poised to begin our clean water project by the end of May, and we have art purchased for several upcoming auctions. Additionally, the relationships we have worked hard to develop with our partner organizations proved to be of great importance in our time of need. We now return to Ohio with much work to accomplish, not the least of which is the task of raising the funds to required to keep our Haiti projects operating through the year and well into the future.
 A young patient seen in the clinic on Friday.
Dr. Tracee making a couple of patients smile
Dr. Jim looking happier than his patient
An important meeting of HAM, OXFAM, DINEPA (the Haitian governmental department responsible for water and sanitation), and ALIMA discussing our partnership for educating the Dumay community about the importance of hygiene and clean water, and to provide access to clean water to the community.
The new cholera tent adding 50 beds and a new fence to help quarantine the cholera area
Junior, Marvel and Dr. Jim en route for a followup home visit a severely anemic home-bound patient
HAM staff meeting at the end of the day
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