Dr. Tracee Laing’s Reflects on Dr. Paul Farmer’s Passing

Dr. Paul Farmer passed away unexpectedly in his sleep on Monday, Feb. 21st. at the age of 62. Many of you who follow Healing Art Missions (HAM) or international public health news, may recognize the name. In 2003, the author Tracy Kidder wrote Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World, which describes Farmer's work in Haiti, Peru, and Russia and brought Dr. Farmer’s extraordinary vision to the world. I had been working in Haiti for several years when the book was published and previously had the great fortune of meeting Dr. Farmer and learning about he and his Partners In Health (PIH) cofounders unique vision. Their community-based treatment strategies delivered high-quality health care in resource-poor settings in the U.S. and abroad. Dr. Farmer’s vision and determination were a great influence as we developed HAM’s work model.

Dr. Paul Farmer at work (credit below)

In HAM’s younger days of the early 2000’s, when we were attempting to figure out how to deliver primary health care in rural Haiti, I reached out to Paul Farmer via email. He wrote back! He connected me to the PIH sister organization, Zanmi Lasante and their team in Haiti. Loune Viaud (ED of ZL) picked me up on a street in Croix-des-Bouquets and drove me way up into the Central Plateau, to Zanmi Lasante hospital in Cange. I will never forget her chastising me on the trip up for my inability to converse with her in Kreyol. Luckily everyone there was fluent in English. I toured the facility, went on rounds with the doctors, and followed accompagnateurs into the countryside, to visit HIV and TB patients making sure they had all they needed to take their daily medications. I was fed and given a place to sleep. 

Treking supplies through the mountains to the Healing Art Missions clinic in Demier.

The entire trip was about what they could do for me, and thereby HAM and the people of Dumay. In those days I was training to run the Columbus Marathon, so I was in pretty good shape, or so I thought. During the ride up the mountain to the hospital and back, I got terrible motion sickness and had to stop to vomit at least once. Hiking with the accompagnateurs visiting patients left me breathless, sweaty and exhausted. At one point we stopped and a woman ran out of her mud and stick home with a plastic chair for me to sit in. I had a lot to learn. 

Around 2004, I attended a medical conference at the Montana Hotel in Port-au-Prince, long before it’s tragic collapse during the 2010 earthquake. The keynote speaker was Dr. Paul Farmer. He was encouraging Direct Observation Therapy, DOT, for infectious diseases requiring long term care like Tuberculosis and Aids. I cannot remember the exact quote, but he said something along the lines of: we all need to be working to offer the same level of care in Haiti that we can access in the USA. He continued, saying we should be offering comprehensive care for infectious diseases, including TB and HIV. If we aren’t, we should stop patting ourselves on the back and we should work harder. As conference attendees bellied up to the bar that evening, many were angry. “How dare he say that about us!” Personally, I was sobered by the talk; Paul Farmer was absolutely right. That may be the origin of one of my favorite sayings, “if you’re not making someone angry, you’re not accomplishing anything.” 

 HAM started working on our HIV/TB program that year, with a great deal of help from Zanmi Lasante and Paul Farmer, who connected HAM to sources for medical supplies and the people needed to get supplies through Haitian customs. We sent teams of HAM employees up to Cange for training, and they sent education materials, for patients and staff, to us. HAM staff members stood on a street corner in Croix-des-Bouquets and handed off blood samples of HIV patients to Doctors traveling to Cange so they could run tests needed to evaluate whether or not the HIV medications were working. PIH/Zanmi Lasante and Paul Farmer did all they could to help HAM succeed at bringing comprehensive care to our community in Haiti. 

 I personally, and HAM organizationally, have been significantly aided and influenced by Paul Farmer’s philosophy, words and actions, and for that, we are forever grateful. 

 “The idea that some lives matter less is the root of all that is wrong with the world.”- Dr. Paul Farmer.   

Dr. Tracee Laing 
Founding Director, Healing Art Missions 

(1) Photo of Paul Farmer is from Wikipedia and stated it must be attributed to the Author : By User: Cjmadson - https://en.wikipedia.org/wiki/File:PEF-with-mom-and-baby---Quy-Ton-12-2003_1-1-310.jpg, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=32838166

HAM’s Haitian Staff Working to Make a Difference

February 7, 2022 was supposed to be the last day of the Jovenel Moïse presidency. Without a president, the acting head of state is Prime Minister Ariel Henry, who was appointed by president Moïse shortly before the president was assassinated. Henry, who was not elected and has been implicated in Moïse’ death, has stated “our institutions are completely dysfunctional…elections are the only way forward.” Yet, Haiti has no constitutional leader and there are no elections scheduled. The Dominican Republic has begun building a border wall along almost half of the 244-mile land boundary it shares with Haiti, to stop irregular migration and the smuggling of goods, weapons and drugs. These are some of the past month’s headlines from Haiti. 

Having spent the past 24 years collaborating with rural Haitian communities to provide the necessary resources and funding to fight the conditions of structural poverty, we at Healing Art Missions (HAM) know the Haitian population as warm, hardworking, and desperate for the opportunity to improve the quality of life for themselves and their families.  

It’s true that life in Haiti is extremely hard in this moment of a failed government, corruption, growing economic instability, and the lack of security in most any form. The Dumay community of approximately 20,000 people, the primary populations HAM serves and where HAM’s Primary Care Health Clinic is located, has been controlled by gangs for the past year. Gangs control the surrounding communities including the closest major city Croix-des-Bouquet and into Port-au-Prince. Travel from Port-au-Prince to Dumay, a commute many of our doctors and specialists are required to travel to and from work, involves passing through zones where different gangs compete and where gun battles often break out. Dr. Jacques, HAM’s Haitian director, has successfully negotiated with the gang leaders who control the areas including and surrounding Dumay, to allow the HAM Clinic to continue operating. Over the next few months, we are going to introduce you to some of HAM’s newly hired, courageous health care workers at the Dumay clinic. This month we feature Dr. Thelusma, our new Ophthalmologist, charged with running the eye clinic in Dumay.   

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Dr. Machnally Thelusma at work in Healing Art Missions’ Dumay eye clinic.

Dr. Machnally Thelusma lives in Port-au-Prince and currently works in Dumay two days a month. She is a 2019 graduate of the Haiti State Medical School, and a PGY2 Resident in Ophthalmology at Hopital de l’Universite d’Etat d’Haiti (HUEH). When asked why she chose her field of medicine, she said, ”I’ve always wanted to work in a specialty that allowed me to help a lot of people in Haiti, and I think ophthalmology is one of them because we have only a few ophthalmologists here in comparison to other specialties. We have a lot of people with eye disease in Haiti. For me, helping those people, will make a great difference in their lives.”  Doctor Thelusma added, “It’s a privilege to work at Healing Art Missions, the only hospital in the area with eye care services.  It allows me to do what I love for the people who need it the most.” 

We are grateful to have Dr. Thelusma on our HAM team! 

Earthquake Response Reveals Need for Additional Action

2022 in Haiti began with two moderate Earthquakes on January 24th in the Nippes region, magnitude 5.4 and 5.6, followed by several aftershocks felt all across the country. So far there have officially been 2 deaths and 45 injuries, along with 800 houses destroyed. Our contacts in Haiti tell us there is a great deal of panic in the population triggered by a collective PTSD with roots in both the 7.2 magnitude earthquake in Nippes last August, and the lingering memory of the horrific 2010 earthquake centered in Leogan.  

Dr. Sylverain draining a knee infusion following a mototaxi injury.

While it is fortunate the destruction from these recent tremors was moderate, it has once again exposed significant limitations in the medical capabilities of hospitals in the Nippes region of Haiti. While there are hospitals staffed with nurses and support staff, there is an almost total absence of surgical and traumatic care in the southern region of Haiti. Prior to last August’s major earthquake that damaged or destroyed many of the roads and bridges in the south, patients requiring major surgery were transported by car to Port-au-Prince (PaP) hospitals, where 90% of hospitals and the medical professionals are located. Immediately following the August earthquake, the first load of patients being taken from the affected area to PaP via ambulance was kidnapped by gangsters that control areas between Nippes and PaP. While these patients were later released, it became clear that transporting patients from the affected area to the capitol for surgeries was not a workable solution.    

If you’ve followed this Blog, you already know how Healing Art Missions (HAM) mounted a successful surgical response to the August disaster, by flying teams of orthopaedic and general surgeons, anesthesiologist and nurses to the affected region. Organized and led by HAM’s medical director Dr. Jacques, they operated in existing hospitals facilities, working with the hospitals support staff. Our original plan was to maintain a weekly surgical presence in the southern region for three months to perform major surgeries, as well as maintain post-surgical care related to earthquake injuries. However, as the number of earthquake related surgeries decreased, Dr. Jacques noticed the number of patients in need of surgical care remained constant. Patients could no-longer travel the gang-controlled roads to PaP to receive health or surgical care and were now relying on local surgeries provided by HAM’s team.  

The reality is, the Department of Nippes is among the poorest regions in Haitian, in a country where the majority of the population lives in extreme poverty with less than 2 us dollars per day. Add to that the natural disasters affecting the region, including Hurricane Mathew in 2016 and the August 14th earthquake, the health crisis of covid-19, the gang control of PaP and surrounding areas, and the escalating inflation rate; together, they make access to healthcare even more difficult in Nippes than in most all of Haiti. 

Dr. Jacques working with a resident in Dumay.

HAM sees the great need in Southern Haiti for accessible and affordable surgical care. We have earned a positive reputation in the Haitian medical community as a result of 23 years of delivering quality community healthcare and our successful response to last August’s earthquake. We have earned the trust of the Nippes Ministry of Health, Hospital health officials, and even Voodoo practitioners, setting the stage for HAM to partner with the local healthcare system to make affordable surgical and orthopaedic care available in Nippes. As such, Dr. Jacques is working to create a new plan to continue to send surgeons to Nippes to work with local staff nurses, nurse anaesthetists, and surgical techs, each week. Creation of this new program will require additional financial resources. We are not sure when exactly we will be able to fully realize the plan; however, true to our mission and our history, HAM will work to provide this resource to the people of Nippes.  

Looking at the New Year Ahead, by Dr. Jean Fritz Jacques

Dear Collaborators, 

2021 has been difficult and challenging for many people around the world. Many goals have been dropped or quarantined, and many dreams broken by the global health crisis of Covid-19. The Coronavirus pandemic has shown us a new world; one where the status quo no longer exists. 

Dr. Jacques and Healing Art Missions team inventorying and distributing medical supplies.

As Achim Steiner, Administrator of the United Nations Development Programme, stated, “The world has seen many crises over the past 30 years, including the global financial of 2007-09. Each has hit human development hard but, overall, development gains accrued globally year-on-year. Covid-19, with its triple hit to health, education and income may change this trend.” 

In Haiti, the increase in kidnapping targeting in particular medical professionals, general insecurity, the low rate of anti-covid vaccination (0.63% of the population according to Ministry of Health), the gangsterization of neighborhoods given access to basic services, and the inflation rate at 26.3% complicate the daily life of Haitians even more. 

Attending the injured, part of the response effort to the earthquakes.

At Healing Art Missions, we can say we are lucky and God has protected us so far from the tragic consequences of Covid-19 and the waves of kidnappings and insecurity in Haiti and perhaps our positive impacts, our reputation, our attitude towards others and above all our way of treating our beneficiaries have served as a protective shield for our staff. In fact OUR model has been very popular and appreciated in the medical response to the recent earthquake in Les Cayes and the Nippes. 

On my own behalf and on behalf of all the members of the Healing Art Missions family, I thank you very much for your continued support to the Haitian people. 

My wishes for 2022 are to continue to work together and as a team to positively impact the world and support people in great need in Haiti.

Dr Jean Fritz Jacques, MD, MBA, CEO Medical Director, HAM

Gazing Forward

As we shift from 2021 to the new year, I want to thank all our supporters, Haitian staff, and the Haitian communities with whom HAM works for, together, overcoming the challenges we faced in Haiti over past year. It was an impressive feat to keep Healing Art Missions healthcare, clean water, and education programs operating, and in some cases expanding, despite many obstacles. 

Click on the right of the image to see a images of a few key moments for HAM in 2021

In addition to our ongoing programs, HAM responded to the August 14th a 7.2 magnitude earthquake on Haiti’s south-west peninsula with the help of a grant from Together Rising.   Dr. Jacques partnered with Haitian colleagues (general surgeons, orthopedic specialists, various professionals, and medical institutions near the epicenter) to mount an immediate medical response, performing over 152 surgical procedures in six weeks and continuing with post-op care through November. This project was a perfect example of HAM’s philosophy of providing resources to our Haitian partners and allowing them to plan and manage the solutions; who better to access local resources, utilize the strengths of available professionals, and be sensitive to the customs of the communities they are serving. 

Now that it is January 1, 2022, we must fully turn our focus to what is ahead for the Haitian people.  Our U.S. leadership team must work to strengthen the HAM organization, while continuing to raise the necessary funds and provide accountability and transparency, to meet the needs of our partner communities in Haiti. We plan to hire a paid Executive Director sometime in 2022 to take over the day-to-day administrative and fundraising duties from myself, Founding Director Dr. Tracee Laing, and Director of Operations, Paul Hammond, both of us volunteers. Please note that both myself and Paul will remain on HAM’s Board of Governance as long as we are able. 

The challenging question we face as we move forward into the new year, is a question to which no one truly knows the answer. What will 2022 bring to Haiti? Will it bring deepening socio-political instability, opposing gangs controlling more and more communities, ongoing violence in the streets and more kidnappings? While it is impossible to see forward through the fog of Haiti’s current status, I remain optimistic beyond just hope. Such optimism comes from seeing what HAM’s Haitian staff have accomplished over the years, from the successful earthquake response Dr. Jacques and his medical colleagues mounted, and from knowing the determination and will of the Haitians we work with as they address the needs of their own communities. And last but not least, optimism from the ongoing support HAM continues to receive from all of our partners and donors who continue to step up when most needed. 

Stepping into a new year of unknowns is so much less daunting when one is surrounded by so many others who share and support one’s belief that change can happen. Thank you all!

Wishing you a happy and healthy 2022!

Dr. Tracee Laing, Founding Director

2021 End of the Year Letter and Report

Dear Friends,

I haven’t set foot on Haitian soil in 22 months. Having traveled to Haiti four times annually for over twenty years, I find this hiatus since January 2020 personally difficult. Besides missing Haitian friends and coworkers, I haven’t been able to work at the Dumay Clinic, or to visit the Charles Salomon School or Demier to show support for our communities and for the Healing Art Missions (HAM) staff. The reasons for my absence are twofold: the Covid-19 pandemic and escalating sociopolitical violence that would put me and others - including staff - at risk of kidnapping and assault.

For Haitians, the year has been worse than usual. A 7.2 magnitude earthquake on August 14th left an estimated 2,200 people dead and 12,000 injured, with many more missing; a tropical storm followed, triggering flooding and landslides. Just a month earlier, on July 7th, the assassination of President Jovenel Moïse released a shockwave of sociopolitical chaos and surging kidnappings, with a reported 117 people taken hostage in September alone, up from 31 in July. That’s the tip of the iceberg, since many kidnappings go unreported. U.S. news media finally awakened to the violence in Haiti only last month when 17 missionaries, most from here in Ohio, were kidnapped. In reality, kidnapping and bloodshed happen daily to Haitians all over the country.

And yet I remain optimistic about HAM’s work in Haiti. Despite these challenges, our Haitian staff labor tirelessly to run HAM’s programs, providing communities with healthcare, education, clean water and employment. Over the past year and a half, our staff, under the dedicated leadership of Haitian Director, Dr. Jacques, have proven they don’t need the U.S. leadership team in Haiti to succeed. In fact, in our absence, staff have overseen the construction of new facilities at the Dumay Clinic to support our growing safe birthing program, and the number of surgeries at the clinic has increased substantially. Because Dr. Jacques has begun training University Hospital surgical residents in Dumay, they and their patients can use HAM’s operating room and its reliable solar power (at a time when fuel to generate electricity is extremely scarce), simultaneously avoiding the most violent areas of downtown Port-au-Prince. In addition, HAM has organized a robust response to the August 14th earthquake. We obtained a large grant to fund salaries and supplies and deployed an all Haitian staff of orthopedic surgery, wound care, and safe birthing teams to cities closest to the epicenter - all spearheaded by Dr. Jacques. We’ve built on knowledge gained after the 2010 earthquake, hiring Haitian medical professionals to design and carry out the disaster response.

In the U.S., our leadership team remains in constant touch with Haitian staff via email, WhatsApp, and ZOOM. It’s essential we stay on top of changes on the ground, maintaining both programmatic transparency and financial accountability and ensuring our staff has resources to serve their communities. This program expansion requires increased revenue. A year ago, we hired a part time grant writer and already have successfully garnered foundation support, as the Expense and Income graphs in the accompanying Annual Report demonstrate. Such funding has been crucial to our expansive earthquake response.

The challenges facing the Haitian people mount daily, making it more important than ever to support those on the ground laboring to provide health care, education and clean water in the communities HAM serves. We are honored to partner with HAM’s dedicated Haitian staff as they persevere. I hope you’ll read the accompanying report and join with me and others in HAM’s family, renewing our commitment to the Haitian people.

Most sincerely yours,

Tracee Laing, M.D. Founding Director

We encourage you to download and read about HAM’s accomplishments and challenges this past year.

HAITI IS NOW THE KIDNAPPING CAPITAL OF THE WORLD

No doubt you have heard about the recent kidnapping of 17 Christian missionaries in Haiti, all of whom as of this writing are still being held in captivity for ransom by 400 Mawozo, one of Haiti’s largest gangs. Sixteen Americans, including children, and one Canadian were taken in Croix-des-Bouquet on their way from the orphanage they were visiting to the airport. Many of the missionaries were from Ohio, and Healing Art Missions’ Dumay clinic is just five miles from Croix-des-Bouquet. This recent act of violence hits close to home for us in the U.S. and Haiti. But if we take a step back and look at this horrific incident within the larger sociopolitical environment in Haiti, it can help provide some much-needed context.

According to the Center for Analysis and Research in Human Rights in Port-au-Prince, there were at least 395 kidnappings in the first six months of 2021, up from 88 during the first six months of 2020. Following the assassination of Haiti’s president, Jovenel Moïse in July, kidnappings jumped to 73 in August and 117 in September. These numbers are likely well undercounted as many gangs are simply paid off and their crime not reported. But almost all the victims have been Haitian citizens, and a few Haitian-Americans, until the 17 missionaries were abducted on October 16th. Furthermore, Haitians being kidnapped are not just the wealthy or from the professional class, but include Haitians barely surviving these turbulent times. Haiti is now the kidnapping capitol of the world.

The fact is, daily life in Haiti includes the fear of being in the wrong place at the wrong time. Gangs rule much of the capital, Port-au-Prince, and have been expanding their control to surrounding areas and other large cities. On top of the Gang threats, the Haitian population must contend with the daily anxiety of Covid, with < 1% who have received at least one shot, fallout from the recent earthquake, increasing food insecurity, and gas shortages. Businesses and hospitals are closing, leading to layoffs and lack of healthcare, because of the lack of fuel for the generators needed since the national electric grid rarely functions. Fortunately for the community of Dumay, Dr Jacques was able to obtain COVID vaccines for the entire staff in August, and the clinic runs off of solar power, not a generator.  

It is important to note that under presidents Obama, Trump and now Biden, the U.S. State Department firmly supported the election and governance of both Haitian carnival singer Michel Martelly and his political protegee Jovenel Moïse over the past decade. Both were elected with less than 20% of the electorate voting in heavily contested elections, and there has since been definitive proof of extreme corruption during their administrations while ever increasing lawlessness and gang violence dominated the streets. Yet the U.S. Government chose to fully support these leaders, that is until Moïse was assassinated. 

And we shouldn’t forget that over the past few months, the U.S. Government has sent thousands of Haitian migrants trying to escape the poverty and violence of their own country, back to Port-au-Prince and potentially into the hands of the gangs. 

In contrast to long failed US policies toward Haiti, is the grass roots Commission for a Haitian Solution to the Crisis. It was formed before the assassination of President Moise, to move Haiti toward Democratic elections and an honest government.  The solution for Haiti’s problems can and should come from Haiti people, with all of our support. 

Partners Make the Difference

Given the 24/7, rapidly changing news cycle, it’s easy to forget that less than two months ago a 7.2 earthquake hit the southwest peninsula of Haiti, followed two days later by a direct hit from Tropical Depression Grace. Grace exacerbated the earthquake calamity by dumping more than 5 inches of rain causing flooding and landslides. More recent Haitian news headlines have been filled with the political fallout from the assassination of President Jovenel Moïse and the fact that gangs are now controlling much of Port-au-Prince and other major cities across Haiti. 

HAM’S Pharmacy Technician, Darlene Marie, Joseph, with her newborn son recently delivered at HAM’s Safe Birthing Center

Unlike the 2010 earthquake that damaged much of Port-au-Prince, killed hundreds of thousands of Haitians, and brought a flood of international volunteers and NGO’s into the country, the August 14th earthquake attracted little international involvement. Fortunately, several official Haitian NGO’s such as Healing Art Missions (HAM), who’ve worked on the ground providing medical services since long before the 2010 earthquake, learned many lessons from the 2010 response.  Dr. Jacques, medical director/CEO HAM Haiti, used his experience from the response to the 2010 earthquake, his connections to the PaP medical community, and personal knowledge of the remote location of the 2021 earthquake to quickly assess the situation. He understood the severe surgical and medical supply limitations of the hospitals in the devastated areas and that the quickest response to address complicated fractures and crush injuries would come from Haitian surgical specialists, many of whom reside in the Port-au-Prince area. If you’ve been following HAM’s Newsletters you know that HAM, through Dr. Jacques leadership, assembled and organized specialist surgical teams, and negotiated with the government and public and private hospitals. HAM’s teams were among the first NGO’s to reach Les Cayes, the largest city close to the epicenter.

Direct Relief-provided midwife kits arrive at Maison de Naissance in the days following the earthquake the rattled southwestern Haiti in August. (Courtesy photo)

An important but less visible factor in the success of NGO’s, like HAM, who believe the Haitian medical community should always take the lead in the public health arena, is the web of partnerships that have been established over the years. A perfect example of such a partnership connects HAM to a California based NGO, Direct Relief International (DRI) who supply donated medicines and medical supplies to established NGO’s working on the ground delivering medical services. This partnership began following the 2010 earthquake with DRI supplying HAM’s Dumay Primary Clinic with hundreds of thousands of dollars of medicine and medical supplies and equipment over the years. Just within the past few months we received a significant delivery of birth assistance kits for Midwives to use in support of our Safe Birthing Program. 

A few days ago DRI published a news piece on their site titled Haiti Earthquake Disrupts Access to Maternal Health Care, which talks about their partnership with another NGO, Maison de Naissance (MN), which was heavily damaged by the August 14th earthquake. MN a modern, culturally appropriate maternal center, established in 2004 and sponsored by Global Birthing Home Foundation which provides accessible and affordable maternity care in the La Cayes area. The article speaks to the importance of accessible healthcare as well as the realities and challenges of providing such services as birth deliveries in an earthquake affected area. It also demonstrates the importance of partnerships between local NGO’s delivering health care services, and international NGO’s who can provide relatively quick access to medical supply resources. In this particular case, DRI also provided direct financial support to help rebuild severally damaged facilities. 

Direct Relief International has also provided HAM’s Safe Birthing Program with midwife kits.

Healing art Missions also responded to the urgent need for maternal care. While Dr. Jacques was assessing the medical needs of the Haitian population most affected by the earthquake, he noticed a severe shortage of midwives at the Hôpital Sainte Thérèse de Miragoâne. The city of Miragoâne is located on the north side of the peninsula, and St. Thérèse is one of the hospitals where Dr. Jacques negotiated for placement of HAM’s surgical teams. After checking the current work schedule of the four midwives working at the Dumay Safe Birthing Program, Dr. Jacques realized he could adjust the schedule so that one of the midwives, Joel, would be able to work for two months at Hôpital Sainte Thérèse de Miragoâne to help ease that burden. Fortunately, in La Cayes, on the south of the peninsula, MN remained operational despite damage to their facility, making sure supervised births were able to continue in that area.

HAM’s Board of Directors in the U.S. are extremely proud of our Haitian staff, under the leadership of Dr. Jacques, as well as all members of the medical teams put together to respond to the earthquake. These dedicated, hardworking Haitian professionals, along with so many others working with NGO’s responding to the many current medical needs in Haiti, have been responsible for mounting an effective response to a natural disaster within their own borders. As we at HAM have said many times before, the best thing international aid groups can do for Haitians is provide the necessary resources to address their own challenges. 

A Visit with Vodou Priest, Dok La

While Dr. Jacques was in Les Cayes last week, he had heard from locals there that many people had been visiting a Vodou Priest, Dok La, in the community of Arnaud in the Nippes region. While the radio and social media in Haiti are reporting that a Senator from that area had helped hospitalize about 15 patients, including an 18 months old child, most of whom had fractures requiring surgery and orthopedics, in reality many of these same people were visiting and confiding in Dok La of their own accord. Dr. Jacques decided it was time to pay a visit to Dok La. 

Dok La and Dr. Jacques in Arnaud

Dok La is 76 years old with more than 35 years’ experience in the profession. He is considered as a legacy for his family, an icon for the area with people coming from various regions of Haiti, including big cities like Cap Haitien, Jeremie, and Les Cayes, and even from the diaspora living outside of Haiti. All different levels of social classes come to regular clinic in his home. His fees are relatively high running 7500 Gourdes, the equivalent to roughly $77.32 USD per consultation, while the HAM clinic in Dumay charges 100 Gourds per visit, the equivalent of just under a dollar USD. Dok La treats his clients for, among many things, fractures, abscesses, hematomas, and mastitis in breastfeeding women.

Vodou has a long and important role in Haiti’s history. According to Wikipedia, “Haitian Vodou is an African diasporic religion that developed in Haiti between the 16th and 19th centuries. It arose through a process of syncretism between several traditional religions of West and Central Africa and the Roman Catholic form of Christianity. There is no central authority in control of the religion and much diversity exists among practitioners. Vodou has faced much criticism through its history, having repeatedly been described as one of the world's most misunderstood religions.”

Assessing Dok La’s patients

Having lived his entire life in Haiti, and growing up in the Nippes region, Dr. Jacques understands the power of a Vodou priest in Haitian communities. His recent visit with Dok La confirmed the outsized leadership role such priests can play in the medical response to earthquakes within communities where such beliefs can cause alienation from medical doctors. Understanding this culture, Dr. Jacques carefully negotiated with Dok La to authorize HAM’s team to approach the patients he is treating for severe injuries from the earthquake to return to the hospital for treatment if the patients choose to go as he does not hold anyone by force. If the patients want hospital treatment, and Doc La respects his agreement, he will be able to accompany the team to come to see the treatments that are being performed at the Sainte Therese Hospital.

This process of working with local communities in the way Dr. Jacques is working with Dok La in Arnaud may seem frustrating, as it was in this case. However, this process is extremely important, as stated HAM’s vision, to collaborate with rural Haiti to help them lift their communities out of the cycle of poverty. This vision, coupled with the HAM’s values of our commitment to fostering the dignity of the individual and respecting the ways of the community, is what sets this organization apart from the majority of our peers. 

Dr. Jacques evaluation Dok La’s patient

GRASSROOTS NON-PROFIT ON THE FRONT LINES OF EARTHQUAKE RELIEF EFFORTS

A witness of assessment and importance of HAM medical response to
the earthquake.

Les Cayes, Haiti

On August 14th 2021 a 7.2 magnitude earthquake tore through infrastructure leaving countless individuals wounded, hospitals overwhelmed and thousands seeking medical care in Haiti. The earthquake has injured over 6,000 and taken the lives of almost 2,000 people with the death toll rising by the minute. Many structures have been destroyed leaving thousands homeless as a tropical storm battered the island just one day after the earthquake, causing landslides and flash flooding. The epicenter of the earthquake was out on the southern peninsula of Haiti where road access is difficult in the best of times, now exacerbated by tropical storm. Healing Art Mission’s (HAM), a nonprofit organization founded in 1998 and based in Granville, Ohio, was among the first NGO’s to reach Les Cayes, the largest city close to the epicenter, mobilizing a coordinated team made of surgeons, orthopedist, anesthesiologist, and wounds care specialist to cover the emergency, essential surgical care and trauma related to the victims of the earthquake there and those in the Nippes area. 

HAM’s primary projects in Haiti focus on the fundamental issues of community-based healthcare, education, clean water, and employment, hiring Haitians to run the operations with financial and material resources provided by the organization. Fortunately, HAM’s staff was uninjured and their facilities intact from the earthquake. HAM’s Medical Director, Dr. Jean Fritz Jacques, and the HAM Board of Directors, recognized the organization was in a unique strategic position to respond to the crisis. Adapting that same model, Dr. Jacques structured a fast and effective response plan to the earthquake that would empower local professionals and medical specialists to manage the medical response by providing them with critical resources. 

Notre Dames Hospital in Les Cayes.

The first step was to solicit a current assessment of the situation on the ground from the directors of General Hospital in Les Cayes and Hospital Notre Dame. To complete the assessment, Dr. Jacques also consulted with the frontline workers, the first group of residents from the Surgery Department of Haiti State University Hospital that had been sent to Les Cayes. 

With emergency funding provided by the Together Rising foundation within days of the Earthquake, and a current assessment, Dr. Jacques negotiated partnerships with the Haitian Association of Surgeons, the Surgery Department of Haiti State University Hospital, and the Haitian Ministry of Health (MSPP). These partners are providing trauma surgeons, orthopedists and anesthesiologists along with wound care experts, nurses and administration support, in an organized effort led by Dr. Jacques. Additional partners from the affected areas include the Nippes Healthcare Headquarters, and Sainte Therese Hospital of Miragoane, and General Hospital  and Hospital Notre Dame, both in Les Cayes.

Orthopedics specialist performed surgery with resident
doctors. This project in Les Cayes is a training one as well as
disaster response.

A major challenge in Haiti is that local and governmental Haitian organizations lack the resources to support any robust response required of such an emergency of this magnitude. Through the multiple partnerships Dr. Jacques has negotiated and the initial funding from Together Rising to pay the Haitian medical teams and purchase any available medical supplies, HAM has helped mount a significant response to the Earthquake. 

Since August 14th, in addition to the initial patient load directly following the earthquake, many additional patients have presented at the intervention sites with neglected fractures handled by local voodoo priests. Others had neglected fractures because they could not afford the costs of the procedure. Additional patients arrived well after with all sorts of fracture complications because of non-standardized care related to the trauma provided by non-specialist. It is necessary to identify and treat such vital threats especially open fractures, closed fractures with compartment syndrome, infected wounds with necrotizing fasciitis.

Memorandum of understanding with institutions with Dr Viard PDG of
Notre Dames Hospital in Les Cayes.

As of August 25th, the team has performed the following procedures: 

• 21 fractures of the upper limbs

• 41 fractures of the lower limbs

• 10 ulcerative necrotic wounds

• 40 cases requiring cleaning and sutures only

• 16 wound dressings

• 15 wound care

• 6 other

* NOTE: there were other cases treated outside of these institutions, as well as in Hospital Immaculee Conception des Cayes not counted in the above.