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28687: Hermantin(News)Group's trip a rewarding venture (fwd)

From: leonie hermantin <lhermantin@hotmail.com>

Posted on Sun, Jul. 23, 2006

Group's trip a rewarding venture

For The Miami Herald

Miami Herald writer Jenny Jacobs recently traveled to Haiti to follow a group of University of Miami medical students volunteering with a Miami-based nonprofit.

Jedlyn Pierrilus left Haiti at age 8 after a family friend was shot in a botched robbery at her home. She returned last month for the first time as an adult to use her medical training and Creole language skills to help treat patients in the country's Central Plateau.

She and seven other University of Miami medical students spent six days in Haiti with Miami-based Project Medishare for Haiti, which aims to boost the country's healthcare infrastructure. They left behind the high-tech equipment they're used to at Jackson Memorial Hospital and used basic tools to treat ailments they had only learned about but not seen: malnutrition, dehydration and the skin condition scabies.

''You read about these things but seeing them is completely different,'' said Shaun Patel, who is entering his fourth year of medical school at UM and used his two-week vacation to travel to the Caribbean nation, the poorest in the Western Hemisphere.

One participant, Dr. A.J. Khaw, even missed his residency graduation to volunteer with Project Medishare, which operates rural clinics and sends volunteer crews to Haiti year-round.

After arriving last month in Thomonde, about a four-hour drive from Port-au-Prince, the students set up clinics in nearby towns.

By 10 a.m. on the first day of clinics in the town of Casse, 173 people had lined up outside to receive healthcare when the students and doctors arrived. When the students entered the one-story clinic owned by the Haitian Ministry of Health, the Medishare staff already had divided the enclave into three stations. ''General Consultations,'' ''OB/GYN'' and ''Pediatrics'' were written in black marker on the clinic's several doors.

Students scrambled to get organized. A vital sign station needed to be set up, someone with a knowledge of Creole was needed to take the histories and a doctor somehow needed to see each patient before the day was up to write prescriptions.

By 11 a.m. the Creole speakers in the group were helping the doctors figure out the patient's symptoms and complaints. That day in Casse, 80 percent of the children the students and doctors saw were suffering from malnutrition.

''Malnutrition was so common and it's something that's a vicious cycle because the people are so limited. That's why there's a need for total community development. They need clean water and a means to get nutrition,'' Pierrilus said. The conditions they have are totally manageable but it's a vicious cycle if the community issues are not addressed such as having clean water.''

Without the conveniences of modern technology, doctors had to rely on the basics -- their hands and patient descriptions of their ailments.

That is where Pierrilus jumped in -- knocking down the language barrier. She said that this was her most important role in Haiti, one that helped save a life at a clinic in Caye Epin, a town about an hour away from Thomonde.

When a 32-year-old woman walked into the makeshift clinic in school room owned by another international nonprofit, Partners in Health, Pierrilus noticed she was extremely short of breath.

She took the woman's blood pressure three times because it was so high.

''Being a first-year medical student, we are taught the normal range of blood pressure, I couldn't seem to understand the numbers I was getting,'' said Pierrilus.

Pierrilus also noticed the woman's arms and legs were swollen with an excessive amount of fluid. A stethoscope detected a heart murmur.

``The minute I took her history I knew she had a severe condition,''

After one of the doctors examined her, he confirmed that she had postpartum dilated cardiomyopathy. That meant her heart was enlarged after she gave birth to a child she lost, and could not pump efficiently. Her heart valves were disrupted by the dilation and produced a back flow of blood, eliciting the murmurs.

Pierrilus recalled the woman's reaction to the news.

'She looked at me with still eyes after hearing my explanation of her condition and the urgent recommendation for her to go to the hospital. . . . She said I'd rather not tell anyone. `Do I need to go home?' I said, yes, so you can at least tell someone that you will be away and so you can get some clothing.''

The women left and returned with a small bag. Two hours later, she was en route to the hospital.

Pierrilus learned some important lessons that day that will stick with her, she said. ''Doubt for me actually worked out because if I had actually passed that patient up, God only knows. It was important for me to take my time because of my uncertainty,'' she said.

Serving a population in a country where high-tech tools are rare also taught the doctors-to-be a few more lessons.

The phrase, ''I wish I had a chest x-ray,'' was commonly heard throughout the trip.

''Across the board, when people said they had trouble breathing, in the states, you would use a chest x-ray. But here, you rely on other things -- like auscultation, or listening with a stethoscope,'' said Michael Ricafort who is going into his second year of medical school at UM.

Even simple objects like cola bottles proved to be important tools. When 2-year-old Pierre Nophelia's mother carried his limp body into the clinic at Casse, Pooja Doshi, a 21-year-old second-year medical student, immediately started taking his vital sings. Pierrilus spoke to his mother in Creole.

The little boy had not been eating and had had diarrhea for the past few days.

''Who has a water bottle?'' shouted Dr. Arthur Fournier, co-founder of Project Medishare.

One student came up with an empty cola bottle and filled it with his clean bottled water. A student quickly stirred a sugar mixture into the bottle and Doshi and another volunteer gave the child oral rehydration therapy through a syringe.

''Once we gave him a little bit of oral rehydration he literally made a complete 180 -- his eyes opened up and he started moving around. Though it didn't take much on our part, it was really rewarding to know that we potentially saved this child's life -- and made his mother happy,'' Doshi said.

Pierre's mother was given several packets of the mixture -- and the bottle -- to use over the next few days.

Dr. Nathalie Dauphin-McKenzie, born in Haiti but moved to the United States in the fourth grade, is a fourth-year resident in OB/GYN at Jackson Memorial.

''The older professors always taught us we don't need technology. In OB/GYN, we were taught that our hands are our ultra-sounds and the reality is, you don't need technology a lot of the time,'' Dauphin-McKenzie said. ``It's like being able to multiply without a calculator. We can do it, we just don't because it [technology] is there.''

''Being in a place like this, you realize you can diagnose certain pathologies without existing technology, and that's really gratifying,'' Dauphin-McKenzie said. ``You feel like a real doctor.''