TRAVELER'S THOUGHTS - St. Vincent's Pharmacy

The Pharmacy. This is where Dr. Eric spent the bulk of his time at St Vincent’s. For such a small room (9 by 15 feet), its significance is great.

This tiny room sits down a long hallway at the end of the clinic building. It is little more than a large closet and boasts a single widow on its outer wall for light, air, and dispensing medications, a true walk-up pharmacy.

Dr. Eric doing a test drive of the walk up window

Upon first inspection, there was little room to move around. Boxes were stacked haphazardly, obstructing access to the window and part of the shelving, which spanned the right wall of this narrow space. Eric’s task was to get an understanding of the pharmacy: what medications are here, what else needs to be here to provide well-rounded care, what things are missing to be able to administer certain drugs, etc.

Given the small footprint of the room, we all expected it to be a rather simple task. We were shocked that he (and an assistant) spent nearly 12 hours in this tiny space, working his way through every bottle of antibiotics and every dose of drugs. While it wasn't complicated, it was surprisingly slow and cumbersome. Add to that the hours that Dr. Eric worked on the spreadsheet every evening and one begins to see how critical this room truly is.

Following a general review of the pharmacy, we got down to the nitty gritty. We pulled out case after case of donated pharmaceuticals and began trudging down the long road to organization. Cases were brought out into the hallway and like items were gathered into logical categories. The volume of medications and supplements present in this little room was amazing.

After identifying the contents of each box, they were restacked in some semblance of order against the wall: supplements to the right, antibiotics in the middle and analgesics toward the door, all labels facing forward. Any box that was not labeled received a hand-written label so it would be very evident what was in each box. We attempted to mirror the shelves of open inventory with cases of the same medications on the opposing wall to efficiently facilitate re-stocking.

Hard at work!

Then came the “fun” part: a full and detailed inventory. We looked in every case, documented every medicine by name, strength and administration route. We reviewed and charted all expiration dates. All data was entered into a spreadsheet. Next, we attacked the open inventory and the boxes containing various donations, some quite puzzling! Many of the donations were handfulls of this and bags of that which Eric sorted into useful organized collections. At least now all of the dressings were in one spot; all syringes and needles in another, and so on.

A number of things were surprising and sometimes frustrating. It was great to see that open shelves were stocked and labeled. However, if the same time were spent organizing and shelving items as they came in instead of simply piling boxes in the room, much time could be saved avoiding large, complicated inventories.

Mountains beyond mountains of antibiotics

During our inventory, we were absolutely shocked at the volume of certain medications. At first evaluation we miscalculated thinking that there were more than a half million 500mg Ampicillin tablets. A review of the math showed there were roughly only fifty thousand tablets (only 50,000?!!!). In addition there were 5 cases of ciprofloxacin (another 50 thousand plus doses) which has guarded use in a pediatric population. Thre were also tens of thousands of doses of other antibiotics. Dr. Eric worries that there is simply no way that even a fraction of these effective and valuable medications can be used before they expire. We are hopeful that a portion of these medications can be donated to other places that need them to further benefit the Haitian people.

We discoverd case after case of English cod liver oil. Boxes and boxes of liquid B vitamins. Canister upon canister of chocolate protein powder in cans beginning to rust.

What began as a simple inventory turned into a much larger, more meaningful goal: to generate a system that would more efficiently document what the clinic has in stock. An online system that can be accessed by medical teams in Haiti and the States to determine what the needs of the pharmacy are at all times, thus allowing donors to more effectively allocate their money and cargo space to necessary supplies.

It is our goal to help St. Vincent’s utilize their wonderful pharmacy to its fullest capacity, efficiently and effectively serving as many people as possible.

TRAVELER'S THOUGHTS - St. Vincent's Clinic

Dr. Eric with a representative of the Japanese NGO

that built St. Vincent's temporary clinic

Observations and thoughts from a Critical Care House Physician

(While we usually write our posts from the perspective of our group as a whole, this one was written by our doctor, Eric. We felt it was best to keep this in his voice, since he is the medical professional and has the knowledge and background to comment on the clinic and medical facilities at St. Vincent’s.)

At first glance, the clinic building itself impressed me. It is a very simple, versatile structure that could be adapted to many purposes as the needs of St. Vincent’s change over time. (I wonder how hard these buildings get used during normal years, but would suspect this facility should last as long or longer than most other temporary structures. I wonder how the roof will fare during hurricane season. Tom, no doubt, would have a better understanding of this.)

It was refreshing to see that each clinic room had a window that opens into the hall and to the outside, allowing some natural light and a bit of ventilation. All rooms had electric lights and fans overhead as well as more electrical outlets than expected. In addition, there was a toilet and sink with running water at the end of the hall. Considering the destruction of the much of the city's infrastructure, this was an unexpected bonus.

It is hard to say how these rooms could be best utilized. Without having seen the clinic in operation, I suspect it functions reasonably well. Each clinic room is basically a blank slate at present. Most had some type of simple furniture, depending on the nature of the clinic being held; however, other furniture and equipment would improve how well each clinic operates.

The Club Foot Room

Take for instance the Club Foot Room (which might be more appropriately labeled the Cast Room). It is perfectly functional with minimal furnishings: a table, 2 chairs and a bucket of water for dipping the casting fabric. Couple these simple items with skilled hands to apply the cast and the clinic can serve its’ purpose. Small additions like a lockable cabinet or cart to hold the various casting materials (i.e. soft wraps, pads, cast cutter and cast removal pry tool) would make the room more efficient. None of these items were in the room, so I suspect they are stored somewhere else or are brought in each time a medical team arrives. The addition of an adjustable height stool for the technician applying the cast would also be beneficial.

There are similar needs in all the rooms. Most have a place for patients to sit or lie and a place for the physician to sit. However, there was not a dedicated place for general examinations and few privacy barriers for disrobing. There appeared to be no easy setup for iodine, bandages, suture and gauze to treat common cuts and scrapes. Again, small additions like shelves or cabinets could benefit the clinic doctors seeing patients at St. Vincent’s.

I did not get a sense as to how the medical charts and records were or should be handled. There was no initial receiving desk or charting area. There was no dedicated space for medical records.

While there is an interior hallway with a row of chairs for those waiting to be seen, space is tight. A busy clinic day could easily overwhelm the limited interior seating. Also, I doubt if a wheelchair could make it down the hallway with these chairs in place. (I wonder if a fixed rood over the part of the courtyard adjacent to the clinics main door could cover a temporary receiving desk/table and become an additional waiting area protected from the hot Haitian sun.)

The Eye Clinic

The room that was my biggest mystery was the Eye Clinic. I am not sure if any of the equipment was functioning. The opthalmoscope was plugged in but would not turn on. The large box of interchangeable glass lenses (that help determine what correction is needed) were a jumbled pile in a closed case. I could not ascertain whether either of the eye care machines in the exam room worked. The vision charts were on the floor partially behind the exam table and did not seem accessible for use. There were multiple boxes of eyeglasses with their corrections written on the front of the wrapping of each pair. I suspect this room likely has the greatest need for technological improvement.

One of the brace crafters (left), Dr. Eric (center) and

Mr. Alexis (Headmaster at St. Vincent's school)

The brace shop, which will soon move to another location and be replaced by a dental clinic and expanded pharmacy, was fascinating. The craftsmen’s ability to manufacture braces with the limited equipment that survived the quake was impressive to say the least. The men, (I believe most or all of which are hearing impaired), are presently limited to one working drill press, a grinder, and a manual metal cutting tool (similar to a large paper cutter). With these and other simple hand tools and well-worn anvils, they are able to produce leg braces and prosthesis for lower extremities. I get the feeling that the manufacture of prosthesis are limited by the shop’s access to martificial feet and the high quality metal spacers that connect the prosthetic foot with the stump cover.

One of St. Vincent's custom prosthesis

One of the workers showing off his leg

The prosthesis they showed us were tremendous! Each was skillfully made and quite impressive.

Dr. Eric learning how the braces are made

The men also make external metal braces that attach with leather straps to thigh and calf. Each brace is made from long metal pieces with hinge pins crafted from cut nails formed into rivets. Their resourcefulness was indeed impressive. (The repurposing and recycling movement has been well-embraced in this shop!)

The oven

Unfortunately, they are no longer able to make synthetic braces and prosthetics due to the lack of sufficient electrical power. The industrial oven needed to manipulate and cure the synthetics sits empty because it requires 220 current that is not available at the temporary clinic. Hopefully there will be a large enough generator to power the oven at the permanent location. Otherwise, a very useful piece of equipment will continue to sit and gather dust.

When the brace shop moves to its permanent location, quite a bit of space will be available in the clinic. A portion of this space is allocated for a dental clinic while the rest will allow the pharmacy to be expanded.

We came across no dental equipment that had been salvaged from the previous location. I failed to ask Father Saldoni if any had been recovered.

In the expanded pharmacy, I envision sturdy open shelves for the larger cases of donated meds, a compounding area (covered lab bench), a records table/cabinet, hopefully a rework of the present shelves which house the easily accessible meds, and cabinets for the more fragile meds (injectable) could fit in this larger space. Hopefully this vision for a more efficient use of space will be taken into consideration.

While my observations about the clinic may seem negative, they are not. I am impressed that there is a clinic; that there are multiple exam rooms, that there is a functioning restroom. It was very clean, well maintained and fairly well lit. Each exam room could function if staffed with skilled professionals. However, there are definitely improvements that could be made to make the spaces function better until the permanent facility is built.

Thoughts from The Red Thread Promise: We wonder when building of the permanent structure on St. Vincent's larger property (the one destroyed in the quake) will commence. To our knowledge, the Haitian government is still in the process of creating it’s first set of building codes, something that has not existed to date. Until those codes are complete and published, no new construction can begin. The good news is that the architectural plans are being developed as we speak. In fact, Tom, from The Red Thread’s team, is working with St. Vincent’s Haitian and American architects to maximize the potential for the new facility.

St. Vincent's

Take a quick virtual tour of St. Vincent's from the perspective of our youngest team member, Hana. In it you'll see part of the grounds and classrooms for the blind, deaf and children with other physical handicaps.

Dianna's new wheelchair

Here is Dianna on the day she received her wheelchair from The Red Thread Promise, February 8, 2011.

Her old chair was tattered and worn and much too large for her. It had wheels meant for smooth hospital corridors, a far cry from the bumpy streets and rough terrain of Haiti. The new one is the smallest child-size that we could have manufactured, with large all-terrain wheels specially designed for uneven surfaces. She is able to wheel herself freely through the corridor, something she could not do with her old chair. It's bright red cushions attract the attention of everyone at St. Vincent's, but the smile on this angel's face says it all!

We look forward to delivering many, many more quality wheelchairs to St. Vincent's and others in need of mobility throughout this small Caribbean country that holds a special place in our hearts.

TRAVELER'S LOG - Epiphanie & Holy Trinity

Epiphanie Episcopal Church, Port-au-Prince, Haiti

The team had a great experience at Epiphanie Episcopal on Sunday morning during our last full day in Haiti. Due to our dependence on drivers and the unpredictable Haitian traffic (forcing us to muster our patience), we arrived about half way through the service. Despite our tardiness, we were able to enjoy everything, even though our understanding was limited. (The Creole CDs that some of us are using were helpful, but we’ve got a long way to go!)

They provided us with a Book of Common Prayer that paralleled the French with English that was extremely helpful. And a young woman in front of us was kind enough to us find the passages in the book and kept us on track during the service. (Merci, mademoiselle in the red & white skirt!)

Unfortunately, Fr. Sadoni did not deliver the sermon that day as it was an opportunity for one of the lay leaders to give the message. He was a very passionate speaker and the crowd at the church hung on his every word.

Epiphanie's sanctuary

Following the service, we looked around for the St. Vincent’s children. When we didn’t see them, we asked Fr. Sadoni about them and he shared that the kids worship at Holy Trinity, the cathedral for the Episcopal Diocese of Haiti, where there is a mass specifically for children.

Four days earlier, we were able to visit Holy Trinity’s temporary school and see the remains of the cathedral. It is within walking distance of St. Vincent’s, so we took off on foot, led by John Robert, our English-speaking guide from St. Vincent’s.

What a spectacle we must have been, strolling through downtown Port-au-Prince like the rats following the Pied Piper of Hamelin! For many of us, it was our first time actually walking the streets among the chaos and busyness of the nation’s capital. It was very different from our normal vantage point as passengers of various vehicles. In some ways, it was terrifying due to the extensive media coverage of the riots and unrest from weeks prior, the footage still fresh in our minds. Yet, in the same breath, it was exhilarating to be a part of the pulse of the city, brushing shoulders with street vendors and buyers, stepping onto rubble-strewn walkways and over heaps of trash.

Holy Trinity Cathedral exterior prior to and post January 12, 2010

(photo credits: Poverty Initiative & Alec Bersch)

When we arrived at the Holy Trinity School, we came into the courtyard and looked around, amazed at the concrete jungle surrounding us. In the heart of the city, this same property had once housed an amazing cathedral, rich in history and well-known for it’s murals and cultural heritage, and a large school with enrollment of over 1,200 students. Now, it is a maze of small crowded classrooms on the ground level filled with teachers and administrators doing the best they can to educate the children with very minimal resources.

By the time we visited, little remained of the original structure. Thanks to the internet, we are able to catch a brief glimpse of the “before” and the “after” (prior to the clearing of the site.)

(photo credits: Episcopal Café & Smithsonian)

Most of the murals were completed in the 1950s and were painted by some of Haiti’s most renowned artists.

The mural pictured above depicts the baptism of Jesus’ baptism. After January 12, only portions of the mural remain. Great care has been taken to preserve the remaining murals as the rest of the building is demolished.

The Rev. Fernande Sanon Pierre Louis

As we walked the grounds, we were greeted warmly by The Rev. Fernande Sanon Pierre Louis, Haiti’s only female priest and the principal of Holy Trinity School. She was kind enough to give us a tour of the temporary facility during which she shared her account of the earthquake and following weeks.

She is an extremely passionate woman who cares deeply about the 1,000+ students still at Holy Trinity. Her animated account of the earthquake and aftermath was absolutely heartbreaking. How it must have hurt for her to recount her story to us, unannounced strangers who showed up one Wednesday afternoon. Rev. Louis teared up frequently during the story as did many of us. (Read her full account on the The Episcopal Diocese of Maine’s website.)

As Rev. Louis showed us around the campus, she shared her frustration about the state of the temporary school. While she is appreciative of the structures, the rebuilding of the school was done while she was recovering and without her input. The arrangement of the classrooms is not conducive to learning since classes are so close together with short walls causing the sound to bleed from room to room. (We can only imagine how loud it must be when school is in session with 1,000 students!)

Her deepest concern was how this would affect the children’s learning and performance that was a great success prior to the earthquake. She spoke with such pride about how Holy Trinity was able to add academic grade levels each school year before 2010. The children passed the national tests with flying colors and it is clearly her goal to return the level of learning to what it once was.

We share this passionate woman’s desire for children to have the best opportunities in life. We have no doubt that Rev. Louis will find a way to give those opportunities to each and every one of the students of Holy Trinity. Likewise, we will work together for the health and well-being of the children of St. Vincent’s.

TRAVELER'S THOUGHTS: JoJo's artwork

After posting about JoJo and his artwork, several people have contacted us about purchasing his paintings to support St. Vincent’s. Unfortunately, we were not able to see JoJo again after our last post and were unable to fill any requests during this trip. However, if you are interested in purchasing any of his artwork, please contact Kathy@redthreadpromise.org to make arrangements. Some of our team members will be back at St. Vincent’s with a medical team March 15 – 19th, 2011 and would be happy to purchase a painting for you.

In the meantime, we thought we’d share the ones that we purchased. Each is beautiful and has a completely different feeling. But more important than the art is the very talented man behind it. He has overcome obstacles in life that most would consider impossible. He is making his dream come true as an artist and has a passion for helping those who have helped him: the staff and children of St. Vincent’s.

Detail of painting above

We are hoping that in some small way, we can help JoJo fulfill his dream of creating a gallery:

• one where the artwork of the children is sold locally and internationally to increase funding and awareness for St. Vincent’s
• one that would give other children with disabilities the opportunity to find a trade that will allow them to become independent as adults
• one that would have a glass wall in the front so Haitians could see the children creating their masterpieces, making a living for themselves
• one that will be the catalyst that changes his countrymen’s view of the disabled, finally recognizing them as productive human beings.

When I work with the blind, I am their eyes; they are my feet

When the deaf help me, I am their ears; they are my hands

When I embrace the mute, I am their voice; they are my limbs.

~ Joseph John Paul “JoJo”

TRAVELER'S LOG - Rivers of Hope visit

Going to the orphanage is always a treat! Most of the kids were running around, laughing and having fun with us. We held babies, played with toddlers and wrestled with kids. We even had the opportunity to help feed the youngest ones lunch! We "ooh'd" and "aah'd" over everyone and were sad that our visit was so short.

Right now, there are 15 children at Rivers of Hope. Four are available for adoption. Please contact us if you or anyone you know has any interest and we will put you in contact with the right people. These beautiful children need homes!

Here are just a few of the pics that we took. First are individual shots, followed by group shots and us having fun with the kids!