Reflections from Dr. Morgan at the Clinic

I am happy to be back “home” at Lamp, after we had canceled our three most recent trips due to street protests and insecurity.

Our day started in the usual way, with our driver Anglanes arriving at my apartment with a warm smile, welcoming me back to his country. But that smile faded quickly, as he told me about “blokis” or street barricades that he had to avert to get to work. There is a massive demonstration planned for this Friday, to protest the current president and force him from office, and sometimes things start to heat up a bit in advance of the main event. Vit vit, he said as he hurried me into the van and off we went, doors locked.

On the way I chatted with Dr. Hyppolite and the nurses and our newest lab tech, Miss Blais.  As we approach the outskirts of Cite Soleil, like he does every day, Dr H. hangs his stethoscope around his thick neck, and it makes both ends of the instrument sort of stick out so one has the sense that it will fall off . He wears it this way, I ‘ve come to learn, deliberately. He wants people to know that if they plan to hold up the vehicle,  they may ultimately be harming themselves or people they care about if the doctor can’t get into work. Thus far, it’s been quite effective.

During my morning meeting with Dr. Hyppolite, we talk about the gangs in the area, and how their presence impacts our staff. Then we talk about medications, and he tells me how we need to deepen our reserve as the needs are growing at Lamp. “It’s a great need, Dr. Jim”. Next we discuss how he wants to take the exam for ACLS (Advanced Cardiac Life Support) as he has taken the course online because it’s not available in Haiti. He has studied it over multiple times and is sure that he can pass it, but he cannot find a way to take it, and can I help him? After telling me about his ultrasound skills that are growing, but which are still not good enough because of limited opportunity to get more training, our conversation comes back to the community, and that despite the troubles and the gangs and the ubiquitous trash and lack of electricity  and poor sanitation… despite these things, he is committed to Lamp, and Lamp is committed to the zone.

As I sit down at my desk, readying for the patients, I feel that I’ve just conversed with one of the most committed doctors I’ve ever known, and I feel privileged to call him colleague and friend.

One of my first patients of the day was Lourdy, about 40 years old with a cough for the past month. She had been to see a doctor at the general hospital about one month ago, and they suggested some medication, but she hasn’t the money and could not afford to buy it. She has asthma, and we were able to give her some medication which will control her symptoms.  She thanked me as she left, and   wished me a good day, smiling and coughing as she did.

There were multiple patients like Lourdy, facing challenges like will I be able to eat tomorrow?, and how will I access medication?   Clearly these are problems not unique to the slums of Cite Soleil, but they are indeed acute here.  But what’s even more clear to me is that committed people, like you who would take the time to read this, or Dr. Hyppolite, who is living this, together play a vital role for this place.  We are having a positive impact.

– Jim (via email from Haiti)

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Update: The Lamp Health Center has reopened

LATEST UPDATE:
We are happy to share that conditions have calmed just enough that the Lamp Health Center was able to be reopened in Cite Soleil on Thursday, Feb. 21st and remains in operation today. Below is a message from our In-country Medical Director, Dr. Hyppolite.
“Thursday’s reopening was like a breath of oxygen for the people of the area and also for other neighborhoods! Everyone in the community was waiting anxiously for our return. We are very grateful to our Lord that we have reached safely to our clinic and could enjoy a productive day without any incident. We hope conditions will allow us to continue. Today all of Lamp’s services were fully functioning and our full staff was present. Among the patients I saw today was a man with high blood pressure and cardiac problems.  Lamp has been treating him for almost one year.  Because of the lockdown situation in the streets he was unable to get for medical care and needed medicines, even though he was not feeling well over the last two weeks.  He was desperately awaiting the reopening of Lamp. Today he was joyful to learn the clinic was reopened and came because he was feeling very bad with a lot of pain on his thorax (chest). When we examined him, we found his blood pressure was 180/110 and he was out of breath and uncomfortable.  Fortunately, Lamp can help him address this problem and he is already feeling better. 
Dr. Vilpigue sees pediatric patients.
The cardiac patient Dr. Hyppolite treated.
The busy waiting area of the Women’s Clinic
Taking care of life and giving patients back their smiles is something precious and shows us what we do in this neighborhood is the right thing and life-changing.  We saw many patients today and it was a good day for us all.”    Sincerely yours, Barrere Hyppolite MD
The risk of renewed civil unrest remains high and thus Lamp will continue to evaluate conditions on a daily basis.  Be assured that we are doing all we can and that our patients appreciate it more than ever.
We thank you for your support in these tough times,
Jim Morgan, MD
Board Chair, Lamp for Haiti
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Update on operations due to unrest in Haiti

Dear Friends of Lamp for Haiti:

Some of you have undoubtedly heard about the civil unrest that has been percolating in Haiti over the past few months, which has now accelerated these past 10 days . The origin of the current unrest is, as is often the case, complicated. Suffice it to say, the poor are often caught in the middle of the crossfire and our goal at Lamp is to not lose sight of our mission.

I am writing today to give an update on our facility, our staff, our patients, and ultimately our mission.

I’ll start with the last point, because our mission has not changed. Our mission statement, found on our website, speaks to our commitment to engage the local community, and to improve lives of those living on the margin.  As always, our mission is our guiding light and we will hold steadfast.

Regarding the work, however, we have had to suspend our operations in Haiti this past week, as it is too unsafe to travel around in Port-au-Prince, even inside a vehicle. Reports of harm to both persons and property are real, and we just cannot take that chance with our staff.

As of now our Lamp staff and community, and our facility, all are safe and accounted for. To be clear, the majority of the protests are occurring within the larger urban areas. Hospitals have been closed, roads blockaded, and supplies have become scarce. The Lamp Health Center in Cité Soleil has been closed for the past week. We are not certain when things will normalize enough that we’ll be able to safely get staff and supplies back to our facility, though we hope that it’s soon. We will play it safe in the meantime.

Our community of Cité Soleil, which is situated on the edge of Port-au-Prince, is presently not the center of demonstrations, though supplies into and out of the zone have been limited. Should the protests persist more than another week or so, the challenge we will face will be in getting even basic necessities like food and water into our community, as it will require passing through areas where protests are currently underway.

Let’s hope that a resolution arrives early this week, allowing our staff to get back to work, and allowing us all to continue to work towards our mission. We are monitoring the situation closely.

We will continue to keep you abreast of significant changes. Thank you again for your solidarity and support of our friends in Haiti, and of Lamp for Haiti’s mission.

Sincerely,

James Morgan, MD

Board President

 

 

Other sources for information:

-Miami Herald –  https://www.miamiherald.com/news/nation-world/world/americas/haiti/

-AP News  https://www.apnews.com/Haiti

-CNN https://www.cnn.com/2019/02/17/americas/haiti-protests-state-university-hospital-intl/index.html

-NPR news  https://www.npr.org/2019/02/15/695095120/do-not-travel-to-haiti-u-s-tells-citizens-citing-violent-unrest

 

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Nine Years Later

Nine years ago today, at 4:53 pm, a 7.0 magnitude earthquake struck Haiti. With that event, came abrupt devastation and loss of life and suffering.  Accurate counts are hard to come by, but suffice it to say many died, many became amputees, many lost a home.

None of us have given up.

I recall in the aftermath of the tranbleman tè a physical fear that we might not be able to access food or water, and feeling constantly parched. I recall the smells permeating around the city, as bodies began to decay under the rubble. I recall the exhaustion of the seeming never-ending line of patients to be yet seen.  But in particular, I recall one young man whom I was helping to care for. He was about 25, and he had been working in a local business when the building collapsed suddenly. He lay on a thin mattress on the tile floor before me, his left arm crushed. The once sturdy radius and ulna of his forearm were quite literally ground into a sand-like state; the swollen, red soft tissue of the arm belied an insidious growing infection. We gave him fluids and antibiotics and pain medication, and we prepped him for surgery to have an amputation.

And I sat down with him and we talked. “You have to save me”, because, you see, he had a fiancée, and was to be married in a few months. Also, he had a job, and his mother was counting on him to provide for the family. “So you have to save me.” He asked me about my family, and wanted to know what brought me to his country. He had so much pain, he said, but the medicine helped.

I saw many patients that night, stopping to check in on my friend several times before my relief arrived. I tried to reassure him that the surgeons were working as fast as possible. I examined his swollen arm and noted his growing fatigue, and said goodbye one last time.

The next day, I found out my friend died. I wept for him then, knowing that my tears were but a few drops in the sea of tears, and I went back to work.   As we all know now he was one of many who would perish, and yet he left behind people who would not allow their lives to be defined or confined by this tragedy. People like you who would continue to stay engaged in life, and try to make it a little bit brighter.

There exists in certain parlance a simple notion of see, judge, act. We keep our eyes open to the world around us.  Should a certain condition arise, the see-judge-act model suggests we follow observation with deliberation. Is this situation normal? Can I, ought I, involve myself? Finally comes agency. Agency involves risk taking, and engagement.

Today we have an opportunity to recall in solidarity the pain of the 2010 earthquake. But with agency, with organization, with great hope let’s continue to engage the personhood of one another.

Warmly sent, on this cold January day-

Jim

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Accompaniment (Part 2)

This morning, I accompanied our accompagnateurs, or Community Health Workers, Damas and Miss Salita, and together we walked around the Bwa Nef neighborhood. The role of the CHW is essentially twofold – identifying sick patients who have not been evaluated for a medical problem, as well as following up on those who are already receiving treatment.
Today we passed Wobé, a 2 year old boy who had been unable to walk due to generalized weakness. Earlier this year, our CHWs had identified him while making their rounds in the community and suggested to the mother that Lamp’s child nutrition program could help. She took their advice, and came to our health center to enroll.  Today, having completed  treatment in the  “Medika Mamba” program,  Wobé is a happy 2 year old boy, walking independently alongside his mother.  Seeing this little boy improve, and too, bearing witness to his mother’s proud countenance, was a sublime experience I won’t forget.
And while the specifics of our CHW work are clear, the unwritten concepts that they manifest are even more striking.
In our last newsletter, executive director Henry Reimer wrote about the notion of accompaniment.  Henry described not only the importance of physically walking alongside our brothers and sisters (and two-year olds!) in Cite Soleil, to and from Lamp Health Center, but also the fruits of that accompaniment.
When we accompany another person, it’s hard work. (Today, where it’s about 90 degrees in the shade, our women’s health program alone saw 39 pregnant women. The medical team saw about another 40 general medical patients.)
The fuel for such work lies at the nexus of a firmly held belief in the organization’s mission,  a well-honed, specific skill set, and of course, persistence.
Accompaniment requires active recognition that the ego is always waiting to take center stage if we let it, and so we need to consistently keep the mission in our sight.  Genuine accompaniment requires an ability and willingness to collaborate, and to remain open to new ideas.
Accompaniment requires pressing on, when curveballs – or bullets, or lack of food, or hurricanes – come our way.
Finally, accompaniment involves a posture of vulnerability.  When one assumes such a posture, it invites risk, but certainly through risk great advances can come.  Accompaniment is real life.
I think a good example of accompaniment can be found in a  marriage, where two people commit to one another for the duration.  The marriage vows don’t qualify that commitment but instead they essentially say “I will stick with you and I invite to to stick with me. I don’t know how we’ll navigate through the hard times, but if we stay committed to the relationship I think we can make it work.”
All of us who choose to stay committed to Lamp’s mission do so with because of an inherent optimism and desire to accompany one another.  Wobé’s progress is indicative of the fruits of such a commitment. I thank you for accompanying the stranger, and for your continued support of this work.
Jim
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A story of accompaniment

Many stories at the Lamp make reference to dire threats to health and challenging medical treatment.  This one is about something much simpler.  Ms. Plaisirmon had already had two children when she enrolled in the prenatal care program at the Lamp.  She received a battery of tests and then came regularly to the clinic for the next eight months.  Her health was generally good – she was treated for an infection and mild anemia – and so was that of the baby.  Lamp Community Health Workers (CHWs) came to her home several times to check in on her.  She got an ultrasound and took her prenatal vitamins as prescribed.  She received a delivery kit and an infant kit.  When it came time to deliver, one of the CHWs went with her to the hospital to make sure that she had the support she needed.  In the photo, she is back at home with her new baby boy (dressed in clothes from the infant kit).  Her gratitude is boundless; she recalls the struggles — physical, financial and emotional — she had with her first two deliveries; she sends message after message to Lamp staff, thanking them for their accompaniment.

The idea of accompaniment is one that Dr. Paul Farmer made central to all of his medical theory.  (Dr. Farmer is the founder of Haiti’s best large-scale health organization Partners in Health and was a crucial inspiration for the Lamp in its early days.)  Health is best served, he felt, when the medical profession considers the whole complex of factors that cause ill health.  In low income settings this means that one must accompany each patient, continually overcoming those factors that may block the path to good health.  Ms. Plaisirmon’s story is an ordinary one, but it is an important one for the Lamp.  It is a sign that we are on the right path.

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Making a Difference — Through Basketball

By Tobias Baer

You can choose to ignore the troubles in the world or you can do something about it. In 2015, when I was eleven, I had the opportunity to meet Lamp for Haiti co-founder Dr. James Morgan, who has worked to help people in one of the poorest parts in Haiti, Cité Soleil. Lamp for Haiti provides basic health care treatment to the people in Cité Soleil with experienced doctors that give examinations, treatments, and medicine.

I wanted to find a way to help support this cause, which provides so much for people with so little.

To do this, I came up with and planned a fundraiser based on one of my favorite activities — basketball. I love playing and watching basketball, and knew other people do, too. The first Hoops for Haiti, which is a 3-on-3 basketball tournament, took place in 2016 in Montclair, NJ. Then, I organized  a second tournament in 2017. In total, we’ve raised over $10,000 for an incredible cause, and brought together dozens of players and lots of sponsors.

This year, I’m hoping we raise at least $6,000 — and you can help fulfill this goal.  So please, consider donating to Hoops for Haiti to help support thousands of people in one of the poorest countries of the world. If you would like to help fund Hoops for Haiti, you can participate in the 3-on-3 tournament on May 12, or you can donate money at the Hoops for Haiti section of the Lamp for Haiti website. Together we can make a difference, so please consider donating to Hoops for Haiti.

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Spring message from Dr. James Morgan

— Jim is the Founder, Medical Director and and Board President of the Lamp —

Dear friends,

Last week, as winter was heaving one last storm on the region, I trekked into New York City to attend a cutting-edge medical conference at Columbia University.  I learned of high tech therapies that several years ago were considered definitely-out-of-the-question, but that now – in no small part due to a stalwart group’s vision, creativity, and refusal to accept that the future must mirror the past – are having real and dramatic consequences, and lives are being made whole.

It so happened that on that same chilly March day, between speakers, I dialed into our weekly Lamp strategic planning conference call.  On that call we discussed nutrition supplementation or malnourished infants and children. We spoke about the major repair our only vehicle is presently undergoing.  Our larger van was recently stolen, and we spoke about the urgent need to replace it.  We discussed the EKG system that helps us to diagnose cardiac problems and to inform the use of appropriate medications and its need to be upgraded soon.

In short, we spoke about lives being made whole.

I hung up the phone and went back into my lecture, now more aware than ever of the almost schizophrenic situation I found myself in one more time.  After over 15 years of straddling the worlds of Haiti and the US, I still haven’t found an on/off switch for my brain.  The differences in available resources are just too great.  Without that switch, my eyes still tear, and my throat still tightens when I am faced with such starkly contrasting circumstances.

There was a time in my life when thinking about such a contrast — the affluent/ organized world and the poor/ often disorganized world — was paralyzing for me.  But people grow, myself included.

Now I let such stark contrast inspire me, and I hope that you do too.  I’m Inspired and energized because I know what together we have accomplished already. For example, we have electronic health records and digital x-rays in a neighborhood with virtually no electricity. We provide an oasis of security and health in an area where the police won’t tread.

And while our work is a lot less high tech than those I learned of at Columbia University, the lives we are making whole are no less human, the families remaining intact are no less loving, the mosaic of creativity is no less beautiful.

I hope that you will consider making a contribution to our Spring Drive this year. Let yourself be inspired by the real accomplishments we’ve already made, and those yet to come.

My best to you and your families at this lovely season of year!

James Morgan, MD

Medical Director/Board President

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Patient Survey at the Lamp Health Center

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.

Appreciate  
Good quality of care 98 %
Exceptional doctors and nurses 73%
Low cost 31%
Good service 22%
Free medicines 19%
Clean clinic 17%
Free lab testing 16%
Close to home 13%
Staff is respectful to patients 12%

 

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.

Do Not Appreciate  
Must stand in line for an appointment card too early in the morning 27 %
Sometimes need to buy medicine 9%
Problems with individual staff members 7%
 
No complaints 48%

 

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.

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A good day at the clinic – one story

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 recovery

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!

 

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