A Quest for Haiti: Reflections on a Year in Haiti: Malnutrition and Miracles

As surprising at it seems to those of you who know my reaction to anything medical, one of the most interesting and exciting things I have done here has been working with the handful of medical teams that have come to Gros Morne. It has been a fascinating way to learn more about the daily struggles Haitians live with and how, despite the many efforts put into healthcare in Haiti, medical attention is still not accessible to many people.

Early in the new year, a team of pediatric medical students from Johns Hopkins came to provide a mobile clinic. They performed regular check-ups for all kids aged new-born to 17 in some of the areas in and around Gros Morne. One of the main goals of the clinic was to identify children in need of umbilical hernia surgeries, circumcisions and general pediatric surgeries. The team of students and surgeons was headed by Dr. Sr. Karen (a Sister of Mercy), who is just an incredible lady.

Here's a little kid with a pretty large hernia.
They are measured by how many fingers you can
fit into the hole. For example, it may be
a "two finger" hernia, which means that it's relatively
small. A grown man could fit four
fingers into this baby's hernia.
(Beth took this photo.)

For this team, we did some of the pre-organizing - making sure they had tables and benches and coordinating with a local priest/village leader that we could use their space. Then the three of us, (Beth, Frankie and I), translated during the consultations. We saw many of the same things that we had seen in other clinics -- fevers, colds, coughs, stomach pain, etc. In addition to this, we identified several children that were referred to the free malnutrition clinic at the hospital. Many children had varying degrees of umbilical hernias. I had never seen one until I came here and now I see them everywhere. It looks like a child has a small (or large) bubble in their belly button. There is a ring of muscle and tissue around where the umbilical cord enters the fetus that usually closes before a baby is born. But occasionally, this ring doesn't close and it creates a weak spot/hole in the abdomen. Intestine, fat or fluid can push into this weak spot causing a bulge. Sometimes the hernia corrects itself, but if it doesn't by the time a child turns 4 or 5, an operation is needed to correct it. If left untreated in girls, it can cause complications during pregnancy. While the pediatricians were here, they saw a little over 300 children and performed 17 surgeries.

We did have several interesting and heartbreaking cases, all on the last day. Immediately after we had arrived at the site and surveyed the children that were waiting to be seen, Dr. Sr. Karen told Beth and I that one of the little girls there was going to die. This particular little girl looked like she was about 6 years old, but she was actually 8 or 9. Her legs, arms and face were all swollen. Her hair was clumpy and she had dark spots all over her face. The skin on her legs and feet looked like it was peeling off leaving open sores. She said that the girl was suffering from Kwashiorkor, a type of severe acute malnutrition caused from lack of protein in the diet, although in some cases, it may be caused by an underlying disorder that makes it difficult for cells to absorb the protein.

(Zaas' photo)

I did some research on Kwashiorkor. According to UNICEF, this little girl was probably suffering from severe Kwashiorkor. Instead of the typical malnutrition you think of, where a child is literally skin and bones, children with Kwashiorkor are characterized by edema (accumulation of fluid in tissue) which can result in heart and kidney failure. It was suspected that this little girl was so far along in the disease that her organs were already starting to shut down. She had "severe edema" – her feet, legs and arms were swollen and swelling was beginning in her face. Another sign of Kwashiorkor is dermatosis -- patches of lighter or darker skin and peeling of skin. This little girl's skin was discolored, had many patches of peeling/flaking skin on her feet and legs exposing raw skin. Because of all of this, it put her in the "severe" category.

Dr. Sr. Karen told Beth and I not to tell the students what the girl had because she knew that they had never seen anything like it, (it is uncommon in the States), and she wanted them to try and deduce, based on the symptoms, to guess. One of the coolest parts of working with students was that they too were in the learning process and were so willing to explain different things to us, what the causes were and why it was treated a certain way. I never thought I would enjoy learning about medicine so much - but I guess I have to add it to the list of things I never thought I would like or do since coming to Haiti!

Dr. Sr. Karen said that this little girl needed to be treated immediately and even with treatment, it was likely that she was going to die. I helped her and one of the residents translate while they asked the father basic questions, told him how serious the situation was and how a car was coming to bring them to the hospital. The little girl was eventually transported to the State hospital in St. Marc. This was an incredible surreal experience. Here was a little girl, right in front me, that was going to die because her parents couldn't afford to take her to the hospital when she first started getting sick. It was hard to know what to feel. Part of me was horrified that death was so near, part of me was terribly sad because this little girl was suffering so much, and part of me was reminded that this is what life is like in Haiti.

(Zaas took this one.)

There were two other interesting children who came into the clinic that will actually lead to another post, but I'll introduce them now. One was a little boy, about 5 years old, who came in with osteomyelitis, a bone infection. He actually came to be seen by the student I was translating for and it looked like he had a hole in his shin and pus was sort of oozing out of it. He could barely walk and hobbled around on tiptoe. He looked so sad and scared and when his mom found out how severe it was, she was terrified. He was given specific antibiotics and was instructed to return in 3 weeks when Dr. Sr. Karen returned with more medication. Karen stressed how important it was to take the medicine because if he didn't take them, he was at an even greater risk of losing his leg.

The other young man who came in, who's story will continue later, came in with an elbow that didn't work. He had broken his elbow in November, nothing was ever done about it and now his arm just hung uselessly at his side.

Our first adventure!! Climbing Stellenbosh Mountain in
Stellenbosch, South Africa, January 2013.

One of the coolest parts of this particular team, was that one of my friends I met studying abroad was able to hook on to the pediatric team's transportation and come visit. He was on his way home from Ecuador, found a cheap ticket to PAP and thought he would "stop by." He too was an International Relations major (at Ohio State) and is interested in community development/non-profit work. It was so fun to have Zaas come and see what we were doing here. There is really only so much that I can share via the written word and images. But to really be here, take in the sounds, the smells and the sites all at the same time is something totally different. I was happy that I was able to share some of the experience with him. He was put to work as soon as he got here, trying to keep children and their parents in line while waiting to see the doctor, giving every kid worm medicine and fluoride and snapping wonderful photos -- all without speaking any Creole.

Another adventure - two years later, almost exactly.

It has been such a privilege to work with teams like the one from Johns Hopkins. I know I take my good health (knock on wood), health insurance and doctor/nurse friends for granted. In other areas of work here, we see the daily struggle with education, drought, poor soil quality and lack of infrastructure. But these opportunities have given us a close-up picture of what children and adults of Haiti suffer, the difficult choices they face between health care and feeding their family and how poverty truly impacts all areas of life. I know I cannot thank the various groups that have come not only for the care they are providing the people here, but for allowing me to be a part of it.

Update as of April 2015:
Since the little girl with Kwashiorkor was diagnosed, she was sent from our hospital to the larger one in St. Marc. There, she was slowly introduced to food, beginning to increase calories (carbohydrates, sugars and fats) and then protein. We heard only a little news while she was in St. Marc, basically that she had good and bad days. But a few weeks ago, Sr. Jackie told us that the mother had approached her in church and told her that the little girl was home and feeling much better. We're not sure what the long term ramifications are, but it's a miracle that she's still alive!!

Some more of Zaas' photography!