Healing in Haiti

Monday, June 6, 2016

Rush marks sixth year of relief work with new building

By Kevin McKeough

When Stephanie Wang, MD, first saw the Haitian tent city named Jerusalem, she thought the situation was hopeless.

“It was so devastated and so hard to get around, I thought there was no way anything could happen there,” she recalls of the sprawling camp, which arose after a massive earthquake on Jan. 12, 2010, devastated Port-au-Prince, Haiti’s capital, and the surrounding area.

Despite her doubts, Wang and the Rush volunteer teams she leads have returned to Jerusalem nearly 20 times over the past five years to provide volunteer medical care. Originally working out of a tent, then under a concrete canopy, the relief effort marked a milestone in May with the completion of a building housing the volunteers’ clinic.

The teams first began traveling to Haiti less than two weeks after the earthquake, which killed more than 300,000 people. In addition to providing medical care that remains in desperately short supply, they’re training community members to be health workers and establishing a program to provide Jerusalem with clean water.

The ongoing effort also further develops the capabilities of Rush clinicians and provides a highly sought after educational opportunity for Rush University students. “It’s a gift to those of us who get to go down there,” says David Ansell, MD, senior vice president of system integration at Rush, who was part of the first medical relief mission and has taken part in four others. “We gain far more from the experience than the people there.”

Fast responder

Wang was in a unique position to help when the earthquake struck. Since 2005, she has organized and led physicians and students at Rush on volunteer medical missions to the Dominican Republic, which shares a border with Haiti on the Caribbean island of Hispaniola.

Her relationships in the Dominican Republic enabled her team to get to Haiti when others couldn’t, because the earthquake had left the airport in Port-au-Prince inoperable. “We had the contacts and the knowledge of the terrain and the means to maneuver,” she says.

On Jan. 25, the team of 19 Rush volunteers, which included nurses, vascular and orthopedic surgeons, anesthesiologists, and critical care and internal medicine specialists — flew into Santo Domingo, the Dominican capital, then traveled by truck and bus over dirt roads for 10 hours to reach Port-au-Prince.

“There was no gas, and the roads were impassible because of debris and people who had lost their homes sleeping in them,” Wang recalls. “The health system was nonexistent. The nursing school (in Port-au-Prince) collapsed and killed many of the nursing staff, and the physician staff who survived mostly were taking care of their own family and friends.”

During their 10-day stay, the team treated more than a thousand patients suffering from fractures, wounds, infections, and even heart and kidney failure. Physicians on the team also performed approximately 50 surgeries and organized an intensive care unit in the tent hospital on the grounds of General Hospital, Port-au-Prince’s main hospital.

“We wanted to make sure that future teams coming to Haiti would have better conditions than what we found when we got there,” Wang says. “On a personal level, it was so hard to walk away, but how can you continue to help when you have no infrastructure?”

‘It’s like the other side of the moon’

Wang and her Rush colleagues decided to try anyway. Over the next year, additional primary care teams traveled to Haiti to look for a place where Rush could maintain a long-term presence and help the community develop its health care capabilities.

They considered Jerusalem, located an hour’s rough drive northeast of Port-au-Prince, at the invitation of community leaders. When it became clear that the tent city, which was supposed to have been a temporary settlement, had turned into a permanent community, the Rush team decided to focus its efforts there.

Home to hundreds of thousands of Haitians left homeless by the earthquake (an exact count isn’t available), Jerusalem began with tents, which begat shanties and dirt roads. Although the Haitian government has designated it a permanent settlement, the makeshift city has no running water, sanitation, schools or services.

“It’s like the other side of the moon, but the people are warm and kind, even though they have nothing, and they’re suffering,” Ansell says.

“It’s a testament to the resilience of the Haitian people that somehow, they’re surviving,” Wang observes.

Providing reliability and continuity

Since 2011, teams of 10 to 12 Rush volunteers — including staff doctors, nurses, residents, fellows, students, and other health care professionals — have traveled to Jerusalem every three months to provide ongoing primary care in the community. Jennifer Towbin, MD, an internal medicine physician at Rush, assists Wang in administering the trips and often joins in them.

Rush staff members pay their own way on the trips, which cost about $1000, plus airfare. Students receive scholarships from Rush University’s Office of Global Health and from proceeds from an annual fundraising event but pay a portion of their own costs. In spite of the cost and sacrifices to participate, there is a waiting list to make the trip.

During their weeklong stay, each team sees about 500 patients for everything from acute care of infections and tropical diseases to chronic illness such as diabetes and hypertension.

“One of our big focuses has been on continuity management of chronic diseases,” Wang says. “It’s very challenging in a developing world environment where people are struggling to survive to help them prioritize treatment of chronic illnesses, particularly when they don’t have symptoms.”

To address the challenge, the team provides patients with free medications to span the gap between the trips. They also have hired a local physician who sees patients once a month in follow-up and assists them in tapping into secondary and tertiary care services.

The reliability of the Rush volunteers has led to between 30 and 40 percent of patients returning for follow up treatment, a relatively high rate given the conditions. “When we say we’re going to be there, we’re there. When we say we’ll bring medications, we do,” says Babs Waldman, MD, an internist who is medical director of the Community Health Clinic in Chicago. Waldman has been a volunteer with the Rush teams over the past four years and has been a leader in establishing community development programs in Jerusalem.

Amidst the chaos of Jerusalem, this kind of ongoing care can be lifesaving. For example, Waldman remembers an early patient who had suffered a stroke shortly before he first sought care from the Rush team.

“He comes every time we’re there, he has perfect blood pressure, he really has improved,” Waldman says. “I don’t know what would have happened to him otherwise.”

Building capacity in place of chaos

The opening of the new clinic building, made possible with funding from the Chauncey and Marion D. McCormick Family Foundation in Chicago, provides a tangible sign of Rush’s commitment to its efforts in Jerusalem. Equipped with five exam rooms, it will allow the volunteers to improve the quality of their services, and it includes space to expand the clinic’s lab, pharmacy and dental services.  

The new facility also has enabled the volunteers to switch from paper charting of patient visits to an electronic medical record system, which will allow for more thorough and accurate monitoring of patients’ health. “It seems crazy, because we’re in a place with no water and no public electricity,” Wang says.

In another sign of progress, by June the team will have finished training five people in Jerusalem to be community health workers. The clinic hopes to hire them then to provide services such as public health education, improving medication adherence, and assisting with accessing other services

Rush volunteers also are addressing Jerusalem’s lack of clean water, which currently is trucked into the camp. (The new clinic building has the area’s only functioning toilet.) They paid for a geophysical study to locate water underground in Jerusalem and hired contractors to dig a well.

“We now have the deepest well and the only clean water source in the entire area,” Waldman says. Replicating a program that Wang launched in the Dominican Republic, members of the community will sell bottled water from the well, providing both water and employment. A small portion of the proceeds will support the clinic as well.

Affirming a commitment to global health

Ansell, who oversees Rush’s community service programs, says the volunteers’ experience in Haiti gives the volunteers insights they can apply in Chicago. “It provides a deep understanding of how to approach a community,” he says.

“We can’t come in riding on a white horse. We have to come in very humbly, with the idea that if we’re going to commit, we’re going to commit over time.”

The trips also serve an educational purpose, providing Rush residents and students from all the University’s colleges with an exposure to tropical medicine and the broader issue of global health disparities. “Learning to provide care as part of interdisciplinary team in an extreme environment makes you more prepared to be a better practitioner,” says Susanna Chubinskaya, PhD, associate provost, Office of Faculty Affairs, which includes the Office of Global Health.

Until recently, Wang had been volunteering most of the time she spent on the Haiti and Dominican Republic missions while also juggling multiple responsibilities at Rush — she’s a physician and medical director at Rush University Internists, a primary care practice, and assistant program director of Rush’s residency program in internal medicine. Earlier this year, she was appointed director of the Office of Global Health, making her relief work part of her official Rush duties (to make room for it, she’ll give up her medical director role).

“Putting someone like Stephanie in charge really indicates Rush’s commitment to our global health program and understanding the academic and service mission of global health,” Chubinskaya says. That commitment also is evident in a global health elective course for fourth-year medical students and a global health internal medicine residency/fellowship track.

Making progress ‘one patient at a time’

Wang plans to take an inventory of global health activities at Rush — which also include endeavors such as an annual global health symposium and a trip to Belize that nursing, allied health, and graduate research students make each year to provide care and build a home — and increase measurement and evaluation of the outcomes of such efforts. She also hopes to increase global health training opportunities for students from all colleges and medical residents and fellows.

Of course, she also will continue leading the work in Jerusalem, with the ultimate goal of putting Rush out of business there. “Systems change is crucial. We’re trying to find a way for the health system there to stand on its own two feet,” she says.

“But we don’t want to ignore the needs of patients today and focus exclusively on strengthening systems to take care of patients in the future. We’re fortunate to have great local partners helping us strike this balance. In the meantime, we just have to measure our progress one patient at a time.” 

Photograph by Annie Grossinger. Used by permission.