PROJECT MEDISHARE TRAVEL PLANNING This is probably going to be most helpful for the people who are going to Haiti (or out of t

In a message dated 5/30/2003 1:37:10 PM Eastern Standard Time, msdgwg@gwumc.edu writes:

My neighbor has Haiti on his State Department beat, and advises that the following two contact points can be used for any emergency. the RSO (Regional Security officer) of the Haiti beat is Jack Arnett, and his phone number is 509/222-0200 (the US Embassy) and the "Post One" phone Number is 509/221-3540. This is in the event that any parent of any student, for example, needed to reach us, in an emergency that would qualify for them to find us.

Thanks Dr. Geelhoed - we have those on file. Also we have a phone at our guest house which works during the day from 8-4 -- The students should have sent you a document with the info included but the number is 011-509-276-9164 - Thanks. Ellen

This physicians’ guide is intended for doctors who are going to Haiti (or out of the country for that matter) for the first time. For those of you who have been before, this should serve as a good reminder of the preparation involved before departing. Please remember that the itineraries are tentative and plans may change once you arrive, so be prepared for just about anything, and be flexible!!! Project Medishare staff will be on hand to assist in resolving unforeseen problems.

Flight times and team itineraries - You will be departing on Sunday, June 8th from Miami International Airport on American Airlines. All of the departing flights are morning flights and in the past teams have had to arrive at the airport two hours before departure. A list of who is on what flights is at the end of this packet.

Weather this time of year - According to the weather projection for the next week in Port-au-Prince, Haiti, the highs are around 87°, and the lows are around 73°. The weather is partly cloudy with 20% chance of rain- this could change in the next week, so bring rain gear just in case! If you visit locations higher than the capital (such as Thomonde or Kershoff), be prepared for cooler nights. You can check online at http://www.weather.com to continue to get more up-to-date info.

Malaria prophylaxis - We will give you all the chloroquine you will need for your trip. Take your first dose (three 150 mg tablets) of Chloroquine one week before you leave (June 1st). Take your second dose on your first day in Haiti (8th). Take your next two doses on the same day of the following two weeks (June 15^th and 22nd), for a total of four doses. Chloroquine should be taken on a full stomach to minimize nausea. Chloroquine resistant strains have been reported in all endemic areas across the world except North America north and west of the Panama Canal. There has never been a problem with Chloroquine resistance in Haiti. Therefore, Chloroquine should be sufficient prophylaxis against Plasmodium falciparum, P. malariae and P. vivax, species. SIDE EFFECTS of Chloroquine include headache, gastrointestinal problems, itching, fatigue, loss of appetite, and blurring of vision, although these are uncommon. Chloroquine is contraindicated in people with porphyria and psoriasis. It should be used with caution in people with liver disease and alcoholics. In addition, antacids and antidiarrheal agents can interfere with absorption of Chloroquine. So, for four hours before or after taking Chloroquine, do not take kaolin, calcium carbonate, magnesium trisilicate, etc. Safety of Chloroquine with pregnancy has not been confirmed, however, no teratogenic effects have been reported and the World Health Organization feels that the benefits of Chloroquine prophylaxis outweigh any potential risks. Please let us know if you have any questions or are affected by any of the above. If you have a reaction to Chloroquine, your malaria prophylaxis will be changed accordingly. That is the official medical information. Based on reports from Medishare “veterans” who have taken Chloroquine, many have experienced strange dreams and a sense of being "high" (especially if you accidentally take too many pills - don't do this please!!!) For more information on malaria or Chloroquine, please visit the CDC's travel website (www.cdc.gov/travel/caribean/htm and yes, it only has one "b"). Go to "Diseases" and look up Malaria. All the information in this pamphlet, plus much more, is there.

Vaccinations- Everyone should be up to date on tetanus, diphtheria, measles and Hepatitis B. In addition, Hepatitis A and Typhoid vaccinations are recommended by the CDC before traveling to Haiti. Dr. Fournier does not recommend Typhoid because it is a very painful shot, will make you sick for a while after it is administered, and we have effective antibiotics in the unlikely event you develop this illness. Please talk to him or your doctor for more information.

Packing Medicines and Supplies Packing list - This list is pretty comprehensive. You really don't need to bring a lot of stuff. Each person gets one personal bag, preferably a medium-sized duffel bag. Also, keep in mind that your bag will very likely get tossed around and dirty! Most people in the past have checked one large backpack. You can also bring a small carry-on. Each person will be responsible for one bag of meds and supplies. We will work out the details after all the drugs/supplies are packed.

PASSPORT (everyone should have one by now). All passports must be valid for at least 6 months following the trip (VERY IMPORTANT). If you suddenly realize that your passport is not valid, you can expedite a new one in 5 days time for $100. Contact Ellen Powers IMMEDIATELY if you think this is going to be a problem. Please make two photocopies of your passport (in addition to the one you’re making for the paperwork you give to Evelyn). Leave one at home with someone who can always be reached (your emergency contact) and bring the other one with you to leave in the hotel/orphanage/wherever you stay. You should carry your real one with you at all times.

- Spending money approximately $20 to $50, depending on how much art, souvenirs, and beer you plan to buy

- Clothes To Sleep In (long pants and a long-sleeved shirt are suggested to minimize bug bites)

- Anorak or lightweight jacket (a sweatshirt is probably more than sufficient for summer - depending on how cold you normally get). You may also want to bring a poncho in case of rain.

- TOWEL, hand towel, toothbrush, toothpaste, PERSONAL TOILETRIES (feminine hygiene products, deodorant, shaving gear, etc.), shampoo, soap (liquid soap and a sponge are often easier to use with limited water), shower shoes and TOILET PAPER (1 or 2 rolls - you will definitely find use for it).

Do not bring anything that requires electricity (i.e. an electric razor), because there probably will not be a power source available.

- HAND SANITIZER (keep a small bottle with you in your hip pack and use it in between every patient; soap and water are not always accessible). This is VERY important.

- SLEEPING BAG and/or blanket and a small pillow (our predecessors have used pillows from the airplane at their own risk).

- CANTEEN or WATER BOTTLE. Bring several bottles of water (1-2 L). Water should be provided at the sites, but it's good to have your own just in case.

- INSECT REPELLENT (the CDC recommends a repellent that contains 30-35% DEET), mosquito coils and/or citronella candles. Also, some cortisone cream or other anti-itch remedy for the inevitable bug bites. The really strong repellent can usually be found at any outdoors or fishing store and probably at Target or Walmart.

- SNACKS (power bars, dried fruit, granola bars). Lunch can be a very uncertain meal.

- INSTRUMENTS (stethoscope, blood pressure cuff, ophthalmoscope/otoscope-if you really want to, reflex hammer, penlight). CHARGE your handle before you leave (you will not be able to charge it once you are in Haiti), bring extra batteries and label everything. Matt Bitner (MS3) has an engraver - see him if you are interested.

- JOURNAL and BOOK. You might want to take a book along to read on the airplane. We also recommend daily journal entries to preserve the experiences of each day.

- PRESCRIPTION MEDICATIONS - be sure to bring enough to last the whole trip. It's probably also a good idea to have a stash of anti-diarrhea (Lomotil is suggested), anti-nausea, anti-motion sickness, and/or anti-histamine medicines if you are worried about any GI or allergy problems while on the trip. The roads are very rough and sometimes even the sturdy get a little queasy. It has been recommended by many predecessors to take a Dramamine or scopolamine every morning, just in case!

- CONTACTS AND SOLUTION and/or EYEGLASSES. If you wear disposables, bring an extra pair of lenses with you. If you are blind without your glasses and prone to lose them, bring an extra pair. DO NOT bring jewelry and/or other valuables.

- FLIP-FLOPS, FLIP-FLOPS, FLIP-FLOPS! BRING TWO PAIRS, one for outdoor, one for indoor! You will NOT want to be walking around or even take a shower barefoot. Bring at least one pair of flip-flops that you don’t mind losing or throwing away at the end of your trip (you will probably never want to see them again).

HIP PACK OR SOMETHING ELSE TO KEEP YOUR VALUABLES IN that you can take with you at all times.

Please remember that space is limited, both in the trucks we use to get to Thomonde and in our guesthouse. If your suitcase is bigger than you, we may have to choose between the two of you for space in the truck. Just kidding, but please make it easier on everyone by packing as lightly as possible.

For more information- The web address for the CDC is www.cdc.gov/travel/caribean.htm (That's not a spelling error, the site address has only one "b" in it.) For passport and other travel information www.travel.state.gov

Your role as teacher. Project Medishare is dependent on the dedication of it’s students and the physicians who supervise them. Expect to see large numbers of patients every day, so it is important to keep an eye out for productivity. The emphasis is on screening and prevention – Try not to get caught up in treating every complaint or identifying problems you can’t treat. Every evening review the events of the day with the students and adjust your plan for the next day; highlighting what you did well and what needs improvement. Keep in mind that the example you set as a role model is as important as the factual knowledge you convey. Do not be afraid to confess you ignorance or seek consultation with your peers or Haitian colleagues, strive for cultural competency: rural Haitians will not be on the same page with your western model of disease and may explain their problems in a totally different context than you are used to. Keep in mind, though, that there are some individuals (not many but ..) that are there because the foreign doctor is in town and they may not necessarily be ill. Do not feel obliged to give everyone medication but of course multivitamins and pre-natal are always good to give. Not everyone needs medicine so let them know that and make sure to complement them for “taking such good care of themselves and/or their children” and “keep up the good work” etc… Be careful not to shame them or blame them, or pontificate in English without explaining to the patient in Creole what you are doing and why you are doing it. Do not take pictures without the subject’s permission. Finally, take advantage of “teachable moments” – if a patient presents with a classical clinical presentation make sure it’s discussed with everyone, not just the students who find it. But to be culturally sensitive and not scare and/or overwhelm the patient only have 2 to 3 students at a time review a case. Our students are first and second years, so be patient with them – they will not have the clinical acumen of more advanced students and you may have to explain things they’ve not yet had in class.

What to expect in terms of diseases: The diseases you will see are largely the result of poverty and lack of access to health care. Among children, protein malnutrition, usually accompanied by anemia and roundworm infection is quite common and easily diagnosable. Skin diseases include “pias” (ringworm) “bouton” (impetigo) and “gratelle” (scabies). Infectious diseases are common and usually diagnosed by symptom complexes. For example:

You may also encounter variations on the themes of all classic diseases – scrofula and POH’s disease in children rather than pulmonary T.B., elephantiasis presenting as hydrocoele, congenital rubella and syphilis syndromes.

Lack of access to care means you’ll find lots of previously undiagnosed benign and malignant tumors, also hernias, a big problem in pregnancy is anemia – we frequently encounter hemoglobins in the 4-6 range.

Medicines – The students do a pretty good job of gathering meds before we leave, but we never have enough antibiotics, anti-fungals, anti-scabetics, anti-helminthics, pain relievers or prenatal vitamins. We also can get medicines from the pharmacy at Thomonde, but if we do, we should compensate them for the cost. Medicines for T.B. or HIV will be provided through Zanmi Lasante and the Community Health Agent program.

Referrals – In addition to the trips with our volunteers, Medishare supports the clinic in Thomonde and a community health program. Therefore if you have a patient which you feel needs follow-up care (including TB and HIV), put them on the list noting their name, what area they are from, and reason for follow-up and at the end of each day forward the information to Ellen Powers who will make sure that the community health agent and/or doctors from our clinic receive the information.