Recommended Vaccines Before You Depart For Haiti

A number of vaccines, noted below, are recommended for travelers to Haiti by the Centers for Disease Control and Prevention. See your doctor before you travel to make sure you have had all necessary vaccines.

• Routine: Be sure that you are up to date on vaccines such as measles/mumps/rubella (MMR), diphtheria/pertussis/tetanus (DPT), polio, seasonal and 2009 H1N1 flu, and varicella as appropriate for your age. This will protect you and also the people you are going to help.
  
  • Measles has been eliminated from Haiti, but there is a risk of a measles outbreak if someone who has measles travels to Haiti. Therefore, it is very important that you are protected against measles. If you are protected against measles, this ensures that you will not be able to spread the disease in Haiti. Make sure that you have evidence of measles immunity through one of the following ways:
    
    1. evidence of measles vaccination (2 doses), OR
    2. laboratory evidence of immunity or confirmation of disease, OR
    3. having been born before January 1, 1957, as evidence of acquired infection.
    If you are not protected against measles through one of these ways, CDC recommends that you get the MMR vaccine before traveling to Haiti.
  • A current tetanus shot is also very important.
• Hepatitis A or immune globulin (IG): Even if your departure is imminent, one dose of hepatitis A vaccine provides adequate short-term protection for healthy people. For long term protection, a second dose is required 6–18 months after the first dose, depending on the brand of vaccine used.
• Typhoid: There are two vaccines available for typhoid prevention. The injectable vaccine may be preferable to the oral vaccine in cases where travel is imminent. The oral vaccine requires refrigeration and 4 tablets taken every other day over one week.
• Hepatitis B: If your departure is imminent, the first in a three-dose series (day 0, 1 month and 6 months) may provide some protection. An accelerated dosing schedule may be used (doses at days 0, 7, and at 21–30 days with a booster at 12 months).
• Rabies: If your activities in Haiti will bring you into contact with animals such as dogs, cats, bats, mongooses or other carnivores, you should consider pre-exposure rabies vaccination, which is a three-shot series (days 0, 7, and 21 or 28) given before travel. Even if you receive pre-exposure vaccination, you will still need immediate medical treatment if you are bitten or scratched by an animal. (See the Animals section for more information.)
• The vaccine recommendations on this page are based on diseases previously observed in Haiti and the possibility for outbreaks in the aftermath of the earthquake. At this time, vaccines for diseases such cholera and meningitis are not recommended and polio booster vaccination for individuals already fully vaccinated against polio is not recommended.

Haiti's Current Medical Crisis

More than three months after Haiti's earthquake, the country remains in a desperate medical crisis. Dr. Jon LaPook reports on the life-or-death dilemmas facing doctors there.

CDC Warns Haiti Relief Workers To Watch For Signs Of Dengue Fever

The Centers for Disease Control and Prevention are warning people who helped with earthquake relief in Haiti to be on the lookout for Dengue fever. 

Dengue fever is characterized by high fever plus two or more of the following: headache, retro-orbital pain, joint pain, muscle or bone pain, rash, mild hemorrhagic manifestations (e.g., nose or gum bleed, petechiae, or easy bruising), and leukopenia.

The incubation for the virus ranges from three to 14 days but is typically about one week; therefore, illness may occur while the workers are stationed in Haiti or after they return to the US. Most dengue fever cases can be treated with bed rest, acetaminophen, and oral fluids.

A small proportion of patients develop dengue hemorrhagic fever (DHF). In those cases, patients have a resolving fever or a recent history of fever lasting two to seven days, any hemorrhagic manifestation, thrombocytopenia (platelet count <100,000/mm3), and abnormal vascular permeability evidenced by hemoconcentration, hypoalbuminemia, or abdominal or pleural effusions. DHF can result in circulatory instability or shock, and the risk for these complications may be increased among persons with prior dengue infection. Adequate management of DHF patients generally requires timely hospitalization and judicious administration of intravascular fluids and close monitoring of vital signs and hemodynamic status. 

The 7.0 magnitude earthquake that struck just outside Port au Prince on January 12, 2010, caused extensive damage to homes and utilities and left many residents without proper shelter or access to important services such as electricity and water. Exposure to the elements and increased opportunities for mosquito breeding site proliferation have likely increased the risk of disease spreading, such as dengue.

Since dengue is endemic in Haiti and relief workers responding to previous disasters in Haiti reported high rates of dengue infection, the CDC Dengue Branch is warning physicians to evaluate travelers returning with a febrile illness (or a recent history of febrile illness) from Haiti and report cases of suspected dengue to either their local health department or CDC.

If you have questions, call the CDC's at 800-CDC-INFO (800-232-4636).

Trip Report From Kaye Whitney, PT

The following report is from Kaye Whitney, a Physical Therapist from Sonora, California who spent 2 weeks volunteering at Hopital Adventiste d'Haiti.  Kaye also provided all of the images published in this post.  Hopefully, there are other therapists out there who are willing to emulate her service and join the swelling ranks of HAH therapy volunteer alumni.

I have recently returned from 2 weeks at Hopital Adventiste d'Haiti.  What an experience!  When I first got there I was overwhelmed by the destruction and poverty that I saw. The most scary thing was the airport process, coming and going. Talk to anyone and you will be treated to various airport adventures. I was traveling alone and was very cautious about not letting my bags leave my hands. My driver, Richard, took very good care of me. I came and went without incident. 

At first all I saw was the chaos of the earthquake and dirt and poverty and hunger. The longer I was there I only saw hope, courage, friends and fellowship. There was an organization and rhythm to the chaos. It worked on so many levels. It is so different than US standards but are we the standard? I think not.  Dr Scott Nelson, each morning would remind us of the work that needed to be done that day but that relationships were so much more important. I agree. 

Those relationships didnʼt start developing for me until I began to use Creole in my fractured form. I found the interpreters helpful and the patients loved helping me get my words correct. I had more cooperation from the nurses and family members. Even strangers in the halls and stairwells became friendly when I just said “bonjour.” Donʼt try smiling as we do here in USA. It doesnʼt work, except with kids. I learned enough PT Creole that even a interpreter told me to stay a little longer and I wouldnʼt even need an interpreter.

My jobs were many. I came to do Physical Therapy which I did in the hospital and in the tents on the hospital grounds. I also spent time in the stock room, kitchen clean up, ortho rounds, ortho clinic, and meal distributions. Long days.  The hospital has coordinated with Handicap International/Christian Blind Mission, to aid in PT care. They work at the hospital and tents from 10-4 PM each day. They connect the patients with the outlying PT clinics (antennas). There are 9 of them. They also bring their own interpreters and 2 Haitian trained assistants. 

HI/CBM has difficulty working in the hospital because of their limited hours so my presence was important for hospital care and ortho clinic and rounds.  Hospital PT care is the same world over, the injuries are different. 

PTʼs get patients moving, prevent contractures, encourage and motivate. We educate family and provide improved quality of life.  A sample of patients included burns, bilateral hip disarticulation, arthrogropyosis,  multiples of fractures treated with external fixators, brachial plexus palsy, amputees, contractures for many reasons, hip hemiarthroplasty, and foot drop. 

Patients get Tylenol and ibuprofen for pain and many needed a tent to leave the hospital.  The organizer in me was happy to help with a systematic numbering of the patients beds and developing a short PT checklist page for the charts. By working in the stock room and ortho clinic I knew where to go for crutches and braces. PT there could use more theraband, walkers and pediatric walkers/crutches. Other items were plenteous.  Did I make a difference? I did to my patients and I did to myself. One lady wrote me a letter of thanks which I will cherish all of my days. I promised to see her in heaven. I see the world through different eyes now. I am going back.

What I loved-Haitian friends, helping people, sharing food, warm weather, beautiful Haitian singing, cold showers, volunteer comraderee, and a hope in a better future here and heaven.  What I didnʼt love...sweating constantly, seeing poverty and hungry people and living conditions that were poor long before the earthquake.  Please find time in your schedule to contribute to this country and organization.  Two weeks is best and going through LLU Global Health Institute is good as they handle the details of the trip so nicely.

Facility Improvements

The post below was authored by Scott Nelson, MD, Director of Orthopaedic Surgery at Hopital Adventiste d'Haiti.  Hopefully this will give donors an idea where their hard earned dollars are being spent.  

However, it goes without saying that the needs are great and more funding is needed to further renovate this facility.  Please consider donating to the project here.

This post also demonstrates the need for qualified nonmedical volunteers.  Please contact LLU Global Health to determine if HAH could use your services.

Volunteers donated US $1 bills to each of the young boys who filled a trash bag with the loose trash that was strewn around the campus. As the donations begin to run out before all the trash was collected the participants were glad to pick up 2 bags per dollar. Our campus is now clean.

Rooms in the southwest wing were never finished after the initial construction phase 5 years ago.

Plumbing fixtures and painting was completed by Dr Peter Nelson and Arpad Soo from San Luis Obispo, CA. The rooms are now ready for patients. We thank the generous donors of Amistad International for the plumbing hardware that was purchased locally as well as in the US.

One of the biggest challenges in preparing these rooms was fixing the sewer system which had been plumbed to drain the toilets onto the front lawn. Arpad, Jerry and crew worked day and night digging trenches around the raw sewage and placing the appropriate drain pipes. 

Another peculiarity is why the toilet inflow was plumbed into the hot water pipes. Thank you to the expertise of our plumbing crew and their hard work most of these problems are now resolved.

Arpad worked most nights until after midnight repairing leaks and faucets around the hospital. 

This very important sink in which we scrub our hands before surgery now has new foot pedals thanks to a donation from Ferguson Enterprises in Santa Maria, CA. It is important to use high quality materials as the elements are intense and these sinks sustain a high volume of use.

Liz Dickinson, RN, Vice President of Nursing at Loma Linda University Medical Center transformed our operating room with her friend Sylvia. We thank LLUMC and Liz for her hard work and the amazing improvements that were made.

Before this past week, there were still cupboards stuffed with instruments from years past. Liz, Sylvia, and the Haitian nurses sorted through all of them.

Some sterile packaging of unused instruments dated back to 1952.

The "before" shot below of the central sterilization area.

The "after" shot below. The newly painted cupboards are awaiting placement of well organized instruments.

New shelving was placed in the sterilization area after relocating the decontamination sink to a separate room.

In spite of our very low infection rate, measures are being taken to continue to make safety improvements for our OR. This decontamination sink had its faucets and drains replaced this week and it was placed in the decontamination room where instruments will be scrubbed prior to bringing them into the sterilization area for final wrapping.

Peter Nelson, DDS (on the right below) poses with Kyle Fiess of Maranatha. He used this hammer drill to make approximately 60 holes in the 10 inch walls of the southeast wing through which the entire plumbing system will be replaced. Prior to the earthquake the low pressure partially functioning water system delivered water to various plumbing fixtures, many of which were in disrepair. With the installation of a high volume inflow system and increased water pressure many leaks became apparent. This was causing a loss of approximately 7000 gallons of water per day into the walls, foundation, and electrical system of the hospital. 

No Words Can Describe What Happened That Day

Partners In Health physicians David Walton and Evan Lyon share photos and stories collected in the first few days following the devastating earthquake in Haiti.

Click here to watch the video.

World Malaria Day

The commemoration of World Malaria Day today is of the utmost importance this year. Recent reviews of progress made towards eradication reveal the tragic toll malaria still takes on many developing countries. Despite improvements in treatments and diagnostics, malaria continues to kill almost one million people every year.  The fact that quick, effective diagnosis and treatment is now possible makes the continuing tragedy of malaria in the developing world all the more unacceptable.

Already at high risk for malaria, Haiti faces an even greater likelihood that the disease will spread after the January 12 quake because of overcrowding in the displacement camps, inadequate shelter and sanitation, overburdened medical facilities, and ruptured sewer systems all of which provide favourable conditions for the breeding of malaria vectors.

Learn some quick facts about malaria here and tips for malaria prophylaxis here.

Jordan Owen, EMT-P Trip Report

The following trip report was written by Jordan Owen, a Captain, EMT-P in the Bass Lake, California Fire Department.  Jordan and his team were with us during our visit in March and we all greatly appreciated the care they gave our patients.

A close friend of mine went to Port-au-Prince shortly after the Quake. He went with Firefighters for Christ. Upon his return he and I spoke about his experience and I could see a "Change" in him. Little did I know, I was in for a "Change" myself. Brian had met several American relief workers while in Haiti. I expressed to him how eager I was to volunteer as well. Brian emailed a few folks and had included me in the email along with a brief introduction. I then emailed the contacts, one of which was BCFS (Baptist Child and Family Services). I expressed my desire to help out any way possible and listed my qualifications. I have been a Paramedic for 18 years and Fire Captain in Bass Lake, CA. I also have Incident Management training and experience. 

Within 8 hours I had a phone call and with in 72 hours I had a confirmed plane ticket to PaP! I had just 10 days from the initial email to departure. WOW! There was a lot to get prepared for. My wife and I are avid campers and wilderness people so I already had the essential tools and equipment to "Rough It". I did however purchase a Steripen to ensure clean water beyond that of a traditional pump. I checked the weather and knew that it would be Hot and very humid so a sleeping pad and sheet were all I needed to pack for sleep. I included a variety of high protein snacks and several packets of electrolyte replacement powders. And as a special treat, my wife included some Starbucks instant coffee packs with creamers. This turned out to be wonderful! I met my team in Miami and we flew to PaP together. 

The flight was that of a conventional American flight but the baggage claim, WOW! You have to really be aggressive for this one! Anyone that has done it will tell you it is a cross between Hide and Seek and a Rugby match. This was the first experience to say, Hello Haiti! Once we pushed and shoved our way to our awaiting bus the ride to Hopital Adventiste was amazing. The pictures and videos I had seen don't compare to the real thing. This really induced the gravity of the quake for me and was just the beginning of a roller coaster ride of emotional responses. En route to the hospital I had expressed my willingness to do whatever was needed to our team medical officer, Dr David Marks. I wanted to be his right hand man. I was in Haiti to do and see and help as much as I could in 7 days. I wanted to be effective. 

 The minute we walked through the door we at HAH we were summoned to help with an emergency c-section and assist in the care of the 30 week old micro preemie. Dr Marks asked if I was ready and I gave him an eager affirmative! From that point on we didn't sit in one spot for 7 days. We were responsible for the ER night shift initially but this carried into day shift and so on. We were called at all hours of the day and night to participate in both stat and non-stat assessments and treatments.

 Throughout the week I introduced myself to various people and met the Orthopedics Team from LLU. I had asked if I could watch some surgeries and the team invited me in. I asked many questions and valued my time with the team as priceless! The technical information and relationships were amazing. If I had it to do over again the idea of becoming an Orthopedic Surgeon would satisfy my boyish love for Tinker toys and Erector sets. 

My experience in Haiti is a life-changing event. I witnessed a group of people that have nothing, No money, No home, some have no family, but they still have God! The faith these people had in God made me feel as though I had none. It was inspiring. Throughout the week they helped me. The team dynamics and cohesive relationships between volunteers, interpreters and rescuers were unparalleled. Somehow in Haiti, God’s voice was clearly heard for me and without the distractions and luxuries of home, His Light was evident.

Returning home. The trip back seemed as short as the anticipated flight going to Haiti. It was great to see my wife and daughter. I was enjoying the “Buzz” of helping others and hearing God so clear. The following day I was trying to organize my pictures and emails and just get back into my daily routine. I paused for a moment and as I sat there I started to cry. I looked around my home and thought how could I be so selfish and take you for granted God, why do I have all these things but have little faith in you?

Haiti for me was and adventure of both culture and faith. We were healed in the process of helping others. The volunteers helping in Haiti will always carry away more than imagined. God is affirming the Haitians faith through our volunteer efforts. God bless them and keep them.

Report From Pediatric Orthopaedic Society

A report, sponsored by the Pediatric Orthopaedic Society of North America, assessing the effects and needs in Haiti after the Big Quake can be accessed here.

A direct quote from the report referencing the orthopaedic work to date at the Hopital Adventiste d'Haiti states: "In summary, this was the best equipped and adminstratively managed hospital among those we visited."

Things To Bring #14 - Fanny Pack

According to Wikipedia, fanny packs are considered unfashionable by most people and invoke the stereotypical visual of a displaced tourist known around the world. While I am NOT advocating a return to the 70s, wearing a fanny pack, or something similar, is a reasonable option to keep track of personal items while working in the ER, OR, wards, or clinic at Hopital Adventiste d'Haiti.

In mine I kept my passport, wallet, scissors, hand sanitizer, small camera, pen and pad, headlamp, and spare examining gloves.   In spite of the fact that I took heat from the residents for wearing one, I figure that if it's good enough for the Hulk, it's good enough for me.

Another option is a small backpack however that brings with it accessibility issues and I'm sure that I'd leave mine lying around someplace after I had taken it off.  Your mileage may vary.

Orthopaedic Aid For Leogane, Haiti

A stark reminder of what early conditions were like at Leogane, close to the epicenter, just a few kilometers from Hopital Adventiste d'Haiti.

Singing Rooster Coffee

Singing  Rooster's  Haitian Mountain Bleu coffee  comes from the same plant & is grown in the same region as the wildly successful Jamaican Blue - but at a fraction of the price. 100% of Singing Rooster's proceeds go BACK to Haiti; their goal is to build economic infrastructures based, in part, on coffee growing, production and exportation.

I can't imagine a better scenario than drinking a cup of Singing Rooster Coffee while planning your next volunteer trip to Hopital Adventiste d'Haiti. Build an economy. Pass it on.

Haiti - A Story Much Deeper Than Its Cover

The following trip report was written by Peter Elsissy, a senior Orthopaedic Surgery Resident at Loma Linda University.  After graduation, Pete will be moving on to Arizona with his wife Laura for a Total Joint Fellowship.  The Elsissys spent the last two weeks of March volunteering at Hopital Adventiste d'Haiti.  Pictured below is Pete with one of the translators in the operating room.

Being my first mission trip, I didn’t quite know what to expect as we arrived in Haiti. What I now realize is that I got way more than I ever could have expected from this trip—a tremendous change in perspective. The emotions experienced ranged from joy, excitement and accomplishment, to sadness, fear, and a sense of helplessness. It was a very dynamic experience that is still difficult to wrap my mind around. There were many surprises along the way. The first of which happened before we even got there. For some reason, I imagined that we would be traveling from our connection city of Miami to Port au Prince in some tiny prop jet that held about 30 people. That was the complete opposite of the completely filled (all but one seat open) 767 jumbo jet that took us in to Haiti. There were a tremendous number of volunteers. One group that stands out in my mind was a team of helpers that wore shirts with the words “You Need Haiti” written in large red letters across the back. I recall lightly joking about the shirts with a few people on the plane only to later realize that the slogan was right on the money.

The country looks deceivingly “normal” from the air. It took less than five minutes to realize that “normal” means something totally different there. For starters, the “baggage claim” at the airport consisted of a large room where luggage from all arriving flights was simply thrown into a large pile for crowds of people to rummage through praying that no one had stolen their bags. Thankfully, all our bags arrived safely and were claimed appropriately. Upon exiting the baggage claim, we saw the “red fence” that LLU global rightly warned us not to cross until our ride was clearly visible. For on the other side of the fence was chaos.

Once we finally saw our ride, we built the courage to exit the airport only to be met by a barrage of people trying to “help” with our bags for tips. Help by their definition consisted of any hand that touched one or more of your bags. Not surprisingly, the short walk from the fence to our car cost the group an excess of fifty dollars.

The ride to the hospital showed a scene of complete chaos and devastation. Thousands of people in the streets surrounded by nothing but rubble, trash and make-shift shelter. It was a difficult thing to witness. Pancaked buildings, tent cities, and stray animals with people trying to find or make anything of some value. The destruction cannot be put into words and is far worse than seen on TV.

About an hour later, we arrived at Hopital Adventiste  d’Haiti (HAH) in Carrefour. Interestingly, HAH is the closest standing hospital to the epicenter.

We received a warm welcome by Dr. Scott Nelson and the rest of the team. The building was surprisingly undamaged and compared to the scene on the drive was actually calm and peaceful. We were taken to our sleeping area which consisted of an open air loft with army cots and mosquito nets. The cots were surprisingly comfortable and the nets are a must as the mosquitoes are fierce. The weather—hot and humid always. 

A brief tour of the facilities immediately made you realize how much pathology we were in for. There were patients EVERYWHERE. A trip to the OR brought a welcoming calm as we entered an air-conditioned arena that was the first familiar place to see. We finished a few quick I&D’s then headed up for some vegan dinner by the Supreme Masters of Ching Hai International. It was surprisingly tasty. Their ministry of cooking for the needy was greatly appreciated by patients and workers alike. We headed to bed early that first night for some needed rest.

Over the next 10 days we slowly adapted to life at the hospital. After the first few days, things got fairly routine and somewhat comfortable in a way. We woke up each day around 6 am. Breakfast (usually a Power Bar) and coffee, followed by rounds and morning report/worship at 7:30. The residents then headed to the OR (naturally) while the attendings headed to clinic. The operative experience was tremendous. 

We did 64 cases in 9 days. The case load ran from infections, to fractures, and several tumors. Our team performed 3 major amputations consisting of two AKA’s and one hip disarticulation. Unlike the usual 4 week old fracture we are used to at the county hospital back home, most fractures we treated in Haiti were about 10 weeks old. We treated the usual mix of a few ankle fractures, two humerus nonunions, a few forearm fractures, a hip fracture, a tibia fracture, a femur fracture and tons of osteo/infected nonunions. 

The incidence of tumors was surprising. We treated multiple soft tissue sarcomas, a few lipomas, and an osteoscarcoma. We had one case of necrotizing fasciitis that required an above knee amputation and sadly ended with the patient passing away less than 24 hours later. 

One unique experience was placing Taylor spatial frames for fracture and deformity correction. In our first 2 days we placed three frames on two patients, a surgery that I have only done once in my 5 years of training in the states.  These experiences surpassed my expectations and made a tremendous impact on the lives of people with serious orthopedic problems.

As for the patients--- they were wonderful. It was amazing to see how thankful people with so little could be. They were quick to smile, always grateful and rarely complained, even after major operations.

This grateful attitude only fueled a desire to work harder and do more for these patients in need. Despite working long days, it’s easy to feel that you didn’t do enough. How people with nothing could have such a great faith in God and show gratitude in such a desperate situation says a lot about their spirit. It also quickly reminded me of how many blessings we have that are taken for granted so easily. It is difficult to be home again. Our house feels bigger than ever before and our decorations and flat screen TV seem all of a sudden a bit vain. I keep asking God what I did to deserve these blessings while so many others with a faith equal or greater to mine have nothing. It’s beyond my understanding. That said, it’s comforting to know that God is just and has a perfect plan for His people. He did state that “Blessed are the meek, for they shall inherit the earth,” and “many who are first will be last and the last will be first” [Matt 5:5 and 19:30]. It seems that we have a lot to learn from the people of Haiti. The volunteers with the goofy shirts were absolutely right. I did need Haiti.