To gain an objective, patient-centered perspective on our medical services the Lamp conducted a survey of 100 patients.  We were interested in determining patient satisfaction with our Health Center, identifying strengths and weaknesses of our services and answering some specific questions on patient needs.  The survey was conducted by Dr. Isemonde Joseph, a visiting doctor who had herself grown up in Cité Soleil, and is fluent in Haitian Kreyol.  Dr. Joseph volunteered her services at the Lamp clinic for a full two months in late 2017 and conducted the survey at that time.

The survey respondents included 40 women – 20 of whom were pregnant – 40 children and 20 men; this is approximately the normal patient mix at the Lamp Health Center.

There were many gratifying results but also some that we are already working to improve

A striking outcome of the survey was the way in which it emphasized the economic hardships faced by our patients.  This came out most clearly when respondents were asked if they were satisfied with the outcome of their last visit to the Lamp, based upon the successful resolution of the particular health issue that brought them to the Health Center.  Seventy-eight percent (78%) said yes to this question, but 22% said no.  Upon further questioning it was discovered that every person in that group was prescribed a medicine or test that needed to be purchased outside of the Lamp.  Each of those respondents stated that they did not have the funds to afford this, or that it had been extremely onerous for them.  One woman, for example, said that she was forced to sell her sheets to buy the needed medication.

This is a distressing finding because it indicates that the Lamp is not only the primary care center for many people, it is the only care center that they can afford.  As a primary health care center we must refer some patients to higher level care and also prescribe some medicines that we are not able to provide.  We are committed to providing a lengthy list of essential medicines and tests and we purchase those supplies that we cannot get through pharmaceutical donation.  But our lists cannot cover every medical need.  The survey highlights the fact that many referrals are not pursued due to economic incapacity.  We must strive to expand our list of available medication.  But it also makes very clear that the medicines we provide are of critical importance to the well-being of our patients.

Note that during the last two years we have provided, through the clinic, an average of more than $1M worth of medicine per year.

Some other key findings are presented below.  Patients were asked to name three things (or less) that they appreciated about the Health Center and three things that they did not appreciate.  This was an open-ended question – the respondents were not prompted.

These are very gratifying results.  Note for example that “good quality care” and “exceptional doctors and nurses” were mentioned many more times than “low cost” — even though it is clear that “low cost” is critical to every respondent.  The quality of our staff and our services has not gone unnoticed.   Other positives that were mentioned included the health education sessions that are held each morning and the peaceful atmosphere within the clinic.

On the other side of the ledger one issue stood far above the rest: 27 people mentioned that they did not appreciate coming so early in the morning to get their ticket to see the doctor.  We operate – barring emergency needs – on a first-come first-served basis.  Given the intense demand for our services this is a difficult problem to solve, but we are working to reduce the stress on our patients as much as possible.

Forty-eight percent (48%) of respondents said they did not have any complaints.

Two questions focused on the ability of our staff to communicate well with the patients.  Many of our patients have limited education, making oral communication extremely important.  All respondents (100%) stated that medicine regimens were well explained by the nurses, and diagnoses were well explained by the doctors. 

Women’s Health

Dr. Joseph at the women’s clinic

We took the opportunity, in the survey, to ask some questions that were relevant to our women’s health program, including our plans to begin a birth assistant training program.

Seventy-one percent of respondents said that the last child in their family was born at home.  Of these births only one (1) was attended by a trained birth assistant.  The number is in line with our expectations, but it is good to have objective data to confirm our understanding.  We have heard many sad stories of the deaths of mothers and infants due to complications or due, more simply, to lack of sterile tools, hygiene, or relevant knowledge.  The survey allows us to move forward with our program of birth assistant training with a new sense of urgency.

The survey also asked whether the respondent would prefer the birth to be at home or in a hospital.  A fairly high percentage (29%) stated that they would prefer to have the delivery at home.  However, when queried further, it became evident that this preference was predicated on the cost of a hospital delivery.  Almost two-thirds of those who preferred a home birth did so because of the low cost.  The remaining persons, however, (9% of the total) stated that they preferred home births because they could access family helpers, they wanted to be cared for by family members, and/or they disliked the unfamiliar and impersonal hospital setting.

Conclusion

Overall, the survey provided a good snapshot of patient opinions and concerns.  We are affirmed in the knowledge that the community holds the Lamp Health Center in high regard and that patients are, in general, very satisfied with the quality of care they receive.  We will continue our efforts to improve our services, so that – when this survey is repeated next year – the results will reflect these improvements.

by Lamp Medical Director Barrere Hyppolite, MD

This is the story about a one year old boy named Dieujackson Bernard.  His mother, Antonine, a struggling single mother to 6 children, brought him to the clinic because he was so severely sick. From the moment I saw her I was a little bit horrified to see this child like this and I told her, “Miss, have you never been to a hospital? Have you never given him oral rehydration salts?”   Her answer was filled with sadness and guilt that she could not do more. Dieujackson was suffering from a severe case of dehydration caused by acute gastroenteritis (a bacterial infection of the intestines).

Normally, I refer this patient to a hospital for rehydration through intravenous lines. When I told her this she literally melted in tears saying, “Doctor, I can’t go because financially I can’t. I have 6 children without a father.” I felt stunned, sad, and angry because this mother was having to watch her child dying slowly in her arms. This is a situation that can be the daily struggle of some Haitian mothers.  I was angry because I felt I was in front of a situation of despair. I nearly cried – it is unacceptable!  So I reassured her saying, “Okay Miss we will proceed together and you can calm down.  You must scrupulously follow my instructions and my medical orders!  We will try to rehydrate him by mouth with oral rehydration salts.  You must completely eliminate fatty meals and give the appropriate antibiotics available at the pharmacy of our clinic. The mother replied, “Yes doctor, I will.  You can count on me!”

Every 2 days she had an appointment with me. Before the weekend I saw her again and observed that she was courageously following my recommendations. But then at the beginning of the following week, she did not come to the clinic. I felt a little bit anxious and again angry because financially she probably was having trouble reaching the clinic or something else. But on Wednesday (6 days later), she entered into my office bearing a child in the same clothes but looking totally different. I have to admit I didn’t recognize her or even the child in her arms.  She began the conversation like this, “Doctor this is Dieujackson, you understand? (in Creole “se Dieujackson wi“), the child who was nearly dying last week”.  And I was totally surprised by the radical change. I just said in Creole, “Rete mwen sezi” (I am stunned!).  I felt total joy and amazement to be a part of this miracle! She was so happy and grateful for the care, attention and patience she received at the Lamp clinic!

Dieujackson — recovered

A great man has said, “The greatest gift you can give to a person is the gift of attention.” After her departure with the child, my day felt really blessed and proudly I said to myself, “This is LAMP, you understand!” (in Creole “Se sa ki LAMP la wi “). Every day, from Monday to Friday, we do our best to achieve miracles or at least to give support and put a smile on a patient’s face.  This is the greatest gift we can give to our community of Cité Soleil, to our little sisters and brothers!

On January 12, 2010 the earthquake struck that was to have such a profound impact on life in Haiti.  Haiti is a country with one major city, the capital Port-au-Prince, the home to almost all of its hospitals, universities, government buildings, and larger businesses.  The epicenter of the earthquake was near enough that Port-au-Prince was left in ruins.  More than 200,000 people were killed and more than two million were left homeless.

Reconstruction has occurred in many ways since that critical day but eight years later the country has not “recovered”.  The concept of recovery is itself unhelpful for understanding the situation.  Haiti was, before the earthquake, the most impoverished country in the hemisphere.   Then the earthquake destroyed a terrific quantity of already minimal assets.  Unlike the United States, where recovery can occur through the reallocation of existing resources, in Haiti these resources are not available.

It is true that substantial international aid was directed toward Haiti through agencies such as USAID and the Red Cross.  Money sent to smaller nonprofits (such as the Lamp!) enabled them to provide effective direct assistance but some of the larger agencies failed to utilize the money effectively.  It is also true, however, that international aid was always only one facet of the solution.  Hundreds of thousands of individuals and businesses needed to rebuild their personal and commercial lives and they have been doing this, with or without assistance.

Currently, the previous “business district” of Port-au-Prince remains a no-man’s land of damaged and abandoned buildings.  But much construction has gone forward.  Hospitals and schools have been repaired and many new government buildings will soon open their doors.  Although few permanent homes for earthquake victims were ever built, new programs have assisted families to find their own housing and this has meant that the “tent cities” of displaced people have disappeared.  There is a beautiful new hospital to the north of the city.

The news, in other words, is mixed.  Haiti remains a nation of limited resources.  A new building for the Ministry of Health will not change the fact that government spending on health remains a meager $13 per person per year.

The earthquake was simply a tragedy; many Haitians are still struggling to meet basic needs and this means that our work, as concerned members of the same human family, must continue.

Former downtown district

Upper portion of Port-au-Prince today

Dear Friends –

I have been lucky enough to have met a local resident in Cité Soleil in the past few years with whom I have become friends. Alfred lives in the Bwa Nèf section, not far from the Lamp Health Center. A few years ago while living in another part of Haiti, his wife died. “Li te gen fyèv, le sa a mouri,” he recounted sadly to me one afternoon, describing the febrile illness that would take her. At the time she had no access to a doctor or medication.

Alfred is constantly smiling. He lives with this two children in a home constructed of wood cross beams, corrugated tin and rust on the outside, but love and patience and kindness on the inside.

Alfred earns a living by making wood burning stoves for cooking. He has a small workshop next to his home. If you visit, you know he’s there because you can hear the tink, tink, tink of his hammer and awl, pounding the sheets of metal from discarded barrels into rounded forms that will eventually form the finished product. I like to visit Alfred, to sit with him and chat about our families, and admire his craftsmanship. Despite his limited means, he continually and consistently shares what he has, dealing artfully with life’s challenges, and transforming others’ lives in the process.

And so it’s plain to see that sharing forms the cornerstone of this relationship, like sharing forms the cornerstone of any meaningful interaction. Sometimes sharing can be challenging to say the least. But consistent sharing, with vision and organization invariably leads to positive change. This notion is key to understanding why Lamp has been successful.

Lamp for Haiti is the result of a sharing vision in which you have decided to participate. I am guessing that your choice to continue on this journey has been edifying in ways you might not have initially expected. But because of your willful participation Alfred and thousands like him have a health center nearby where children living on the fringe of the economic fringe, are receiving quality health care.

Lamp has made great progress this past year because of an unwavering belief that when we pursue a noble goal — like providing quality healthcare for a community in dire need — and when we do so in an organized fashion with vision and commitment, positive change will invariably come. Maternal-child health, child nutrition, organized electronic records, ultrasound and x-ray. All these were thought impossible. A sharing spirit has made them a reality.

It’s good to have family with which to share at this time of year. Lamp’s efforts are reaching others effectively because of our commitment to this concept. We are helping to transform lives, and in so doing our own lives are changed too. Thanks again for being a part of this worthwhile project.

All the best to you and your own family this season and in the coming year,

James Morgan MD
Founder and Chair of the Board
jmorgan@lampforhaiti.org

We do need your continued commitment!

To make a year-end donation, click on the yellow Donate button
or send your check to Lamp for Haiti, P.O. Box 39703, Philadelphia, PA 19106

Thank You!

The Women’s Health Clinic is one of the Lamp’s most valuable programs. In the past, women in this low-income community did not have an option for affordable care, so that prenatal check-ups, for example, were virtually unheard of. The majority of women also gave birth at home, in highly unhygienic conditions, due to the costs of delivery at a hospital. Complications in delivery resulted in many deaths. In Haiti, in general, 1 in 83 mothers die in childbirth (lifetime) and this number is higher in low income areas such as Cité Soleil.
The Lamp recognized immediately that services for women were a critical need, so that the Women’s Health Clinic has been a feature of the Lamp’s services since its earliest days. But the Women’s Clinic has grown dramatically over time. We expect to provide at least 450 mothers-to-be (and new mothers!) with regular check-ups in 2018.
Lamp services have also increased over time. This year we added ultrasound capability and also decided to include both delivery kits and infant kits in our regular service package. The kits have proven to be more than popular. They a great way to encourage expectant mothers to come in for regular check-ups since we only give kits to those that have come at least three times.
The area remains one of extreme poverty and many births still take place in homes, but the Lamp’s Women’s Clinic has become a well-loved community institution where women can expect to find professional care and genuine concern for their families’ health.
In 2018 we will be initiating a training program for community birth assistants, to reduce the risks of home births. Please stay tuned!

A satisfied doctor (and mom!)

An expectant mom visits the clinic

Dr. Severe examines a patient

A major building project was completed this quarter, namely a 150 yard drainage canal that will drain mosquito infested standing water and reduce flooding in the neighborhood adjacent to the Lamp for Haiti Health Center.  The project will have tremendous benefits for all of the families along its path.  Even more importantly, perhaps, the canal was built entirely with local labor.  As of August 30^th, the Lamp has spent approximately $17,000 on labor costs alone, here in Bwa Nèf, in 2017.  This is an enormous infusion of earnings for the community.  Projects have included the canal, a “peace garden” adjacent to the clinic, and renovations of the public toilets and the main clinic building.  For a massively underemployed population, this is one of the most significant side benefits of having the Lamp health center in the midst of the community.  The dual impact of these projects mean that this is money doubly well spent.  The Lamp is building community in more ways than one.

For other stories from the latest newsletter, click here!

In Bwa Nèf, home of the Lamp Health Center, malnutrition is a serious and ever-present threat to child health and long term development.  The Lamp’s child nutrition program provides peanut-butter based therapeutic foods and other health services to severely malnourished children aged 6 months to five years old.

In the past, severely malnourished children who came to the clinic were placed into the nutrition program by the attending doctor, and the Lamp also conducted assessments in local schools.

But this year the number of children in the program has exploded to more than four times the level of previous years.  One hundred and thirty five children were added to the program in the last six months alone.  The reason for this is simple: this year marked the first time in which the Lamp has employed Community Health Workers to visit each home in the surrounding community.  The CHWs, who make health needs assessments for each family, ended up discovering a great many children who were suffering from malnutrition.  This was heartbreaking in one sense, but worth celebrating in another because, right now, about 40 of those children are back to a healthy weight and the others are steadily putting on the pounds.

The combination of outreach, through the CHW program, and child nutrition services have resulted in an incalculable benefit to the community.

The program costs the Lamp approximately $75 per child.  If any reader would like to consider organizing a fundraiser for this program, please contact the Lamp at admin@lampforhaiti.org or call at (267) 499-0516!

Richanda at start of program

Richanda half-way through program

Receiving packets of therapeutic food

Ms Alissage, the nurse that manages the child nutrition program