Newsletter of the Hôpital Albert Schweitzer
Alumni Association
Dues!
HAART Pilot Program—HIV
Antiretroviral Therapy
Greening the Artibonite
by Ian Rawson
Solar Fridges for Gabriel and
Terre Nette Dispensaries
HAS Links with USAID
Infant Nutrition Program
Alumni Association Supports
Addison Vestal Medical Library
Alumnus Profile: Sonny Miller
Reunion Updates
Annual dues are $35 and go to keeping us connected, planning reunions, and supporting the HAS medical library, among other things. Please send your check, payable to the HAS North American Alumni Association, to: HAS Alumni Association, c/o Dr. John Judson, 512 Bridgeville Drive, Lemoyne, PA 17043. Make John’s day!
Co-editors Gwen Bergner and Patti Marxsen invite your comments and suggestions for future newsletters. To contact them, please email Rona Watts at alumni@hashaiti.org . You can read back issues of Sak Pase? on the Alumni Page of the HAS website at www.hashaiti.org, located in the Who We Are section. Share the news of HAS with friends and associates.
Marin,* a 22-year-old man who had worked as a teacher while pursuing a university-level degree in information sciences, had been preparing his funeral when he enrolled in HAS's new HAART (Highly Active Antiretroviral Therapy) program to provide antiretroviral therapy to people infected with HIV. Now he's gained weight and hopes to finish his education and find a job in the field for which he's trained.
Marin is just one success story that Dr. Roseline Bazile of Community Health happily recounts in discussing the HAART pilot program that began in October 2004. With the HAART program, which is supported by the Global Fund, HAS joins other organizations working in Haiti to provide antiretroviral medicines (ARVs). Haiti is the Caribbean country hardest hit by the AIDS epidemic according to the latest UNAIDS report. Although infection rates vary across the country, about five percent of the HAS district population is infected with HIV (approximately 6,000 individuals).
Despite this large number of infected people, the pilot program necessarily started small, enrolling 24 patients from Liancourt and Deschapelles. A selection committee composed of the hospital chaplain, medical director, head nurse of the medicine ward, the HIV/AIDS program director, and the director of community health determines their eligibility based on social and medical criteria that follow WHO guidelines. The program has enrolled an additional 20 patients each quarter and, as of May 2005, counted 84 participants.
In addition to providing medical tests, examinations, and counseling, the program delivers extensive training in the treatment regimen for the patient, an accompagnateur or support person, and family members. Patients also receive food supplements from Save the Children’s food security program.
One of the project’s goals was to estimate the cost of antiretroviral treatment. According to data collected so far, the total cost of treating twenty patients for three months is about $3,184 US, which averages out to $637 per patient per year. However, the program’s directors anticipate that this cost will rise since it does not include all costs for lab tests, drugs for opportunistic infections, staffing, and administration.
Though it’s necessary to assess treatment costs, Dr. Bazile considers each patient individually and with great compassion. She becomes animated describing how Terlaine, a 24-year-old LPN, was so physically weak and emotionally dejected at the outset of treatment that her parents had to bring her for treatment. “Now she comes by herself and says she loves life,” Dr. Bazile enthuses. Terlaine and Marin shore up each other’s spirits in a support group for HAART participants.
Because of individuals like Marin and Terlaine, both of whom had promising and productive futures before being incapacitated by HIV/AIDS, Dr. Bazile emphasizes how important the HAART program is for a poor country that cannot afford to lose its young people, perhaps its most precious resource. Marin serves as a success story of the treatment program but also of the devastating and uncounted costs of untreated HIV/AIDS. Before enrolling in the HAART program, Marin lost his teaching job due to illness; then his parents paid a significant amount of money to a houngan (voudou priest) in hopes of saving his life; now they cannot afford to finance his education. It is a travesty—on both an individual and national level—that this man of intelligence, education, and motivation now complains of boredom.
HAS is currently searching and applying for further grants to expand HIV prevention and treatment in conjunction with the Women’s Health Program, focusing on issues involved in prenatal care and family planning. In this way, Community Health integrates Global Fund programs (HIV/AIDS, malaria, and TB), which are directed by Dr. Bazile, into already established HAS program activities. Drs. Bazile and Rikerdy Frederic, Director of Community Health, work with Chief of Medicine Dr. Bob Carraway and Co-Directors of Nursing Nordine Mondesir and Chantal LaRouche and their team members to run the HAART program.
Despite working with the disheartening and long-term problem of HIV/AIDS, Dr. Bazile maintains her wholehearted belief in the HAART program. “The country needs help; the patients need help,” she states firmly.
* Names of program participants have been changed to protect confidentiality.
** For this article, the editors are indebted to a report on the HAART program written by Dr. Roseline Bazile and Debbie Berquist Jules.
Editors:
Gwen Bergner
Patti Marxsen
alumni@hashaiti.org
Chris Snavely led a small group of visitors through the Verettes market, stopping at small piles of wood charcoal, the basic cooking fuel for Haitian families. “This is why we're here, folks,” Chris said. “They're cutting the trees faster than they can be grown here, and we need to get more trees on the mountains.”
As chairman of Snavely Forest Products, this Pittsburgh businessman, knows trees. After all, he’s spent a professional lifetime buying them, processing them into lumber, and selling them to retail outlets. More recently, Snavely has been involved in planting trees in this hemisphere to ensure a steady flow of raw materials for his processing plants. He has seen first-hand how strategic planting improves the ecology of underdeveloped areas. On this, his first trip to Haiti, Snavely wanted to see how strategic planting could work in Haiti and to show a group of Pittsburgh visitors how commercial forestry could help address malnutrition.
High in the mountain community of Bastien, Snavely looked out over a deforested landscape, the limestone rocks visible under a shallow layer of soil in which scattered plants of corn and beans held a tenuous grip. “The next time it rains, even this soil will probably be gone,” Snavely observed. “The only way to make a long-term change is to address the entire watershed and plant so many trees that soil can accumulate.”
Back at HAS, Snavely held a shriveled cluster of roots in his hand. “This is, or will be, a Pauwlonia tree,” he said to a group of local farmers as Herbe Cleophat, the director of HAS Community Development services, translated. “In seven years it will grow to over 30 feet, and it can be cut down for lumber, so you will have a cash crop. In the meantime, it will help to hold the soil on the hillsides.” The farmers listened intently as Cleophat explained that 200 trees donated by Snavely would be planted in a plantation on the hospital’s farm in Drouin, and approximately 50 would be planted on the hospital property, and the remainder would be distributed to individual farmers. In this way, it will be possible to assess how the trees perform in a variety of ecological conditions. “After the first year of growth, we will cut the tree back, and a number of sprouts will emerge,” Snavely explained. “Then we cut all but the strongest sprout, and plant the others in the small bags. The ones which start off strong will be distributed, and we will have a second generation of trees. That way this small group of trees will eventually become a group of forests. If they are spread around the valley, we will get a start on preserving the watershed. Water will be retained and crop production will increase.”
At dinner with the visiting team the night before returning to Pittsburgh, Snavely responded to appreciation shown by the HAS management team by expressing his thanks for the opportunity to help out. “It’s not often that you get the chance to do a lot of good with a pretty simple idea and a few trees,” he said. “I’ll be back soon to see the results here, and maybe bring a few more trees.”
Chris Snavely and his friends in the US lumber industry have established a Watershed Management Fund at HAS to finance the expansion of this initial effort into a broader campaign to reforest the Artibonite Valley. Contributions may be directed to HAS and designated for the Watershed Management Fund.
—Ian Rawson
Ranging from the fertile Artibonite Valley into the surrounding mountain communities, the varying terrain of the HAS district poses a challenge to medical infrastructure and technology. Two of the district's most remote and difficult-to-reach dispensaries, those in Gabriel and Terre Nette, posed such a challenge. Unreachable by automobile, these mountain dispensaries had conventional, gas-powered refrigerators, which weren't running because no one could carry replacement gas tanks up the mountainous footpaths. Refrigerators are crucial, of course, for storing vaccines and medications. Solar-power refrigerators seemed to be the answer to local conditions, but how to get the technology in place?
Raphaela and Rolf Maibach, founders of the Swiss Bundner Partnerschaft that contributes to HAS through fundraising and recruiting medical staff, directed the effort to bring solar fridges to these communities. Funded by the Swiss Rotary Club Flims-Laax and Rotary International in coordination with Haiti 's Rotary Club St. Marc, the project took a full year to prepare. Engineer Albin Graf designed the plan, and Rolf and Raphaela led the way from initial coordinating to final implementation. Hertha Isaac in the Sarasota office helped procure the necessary equipment: refrigerators that met WHO specifications for underdeveloped, tropical countries; solar panels for the dispensary roofs; battery-operated cooling boxes; plus miscellaneous tools and hardware.
In May, Dr. Colette Vilgrain and sociologist Régine Alexandre traveled from Port au Prince to Deschapelles to test educational materials on infant nutrition with HAS health care workers and HIV positive mothers from the community. HAS serves as one of several test sites in Haiti for a USAID program aimed at educating HIV positive mothers about how to feed their infant children so as to minimize risk of HIV transmission. Although it is standard policy in developed countries to advise HIV positive mothers not to breastfeed their infants, this policy cannot be followed strictly in the developing world.
Many mothers simply cannot afford formula as a substitute for breast milk. In Haiti , a month's supply of formula costs about $56, a prohibitive expense for a population living on about a dollar a day. Even if mothers manage to obtain formula, they often do not have access to clean water for mixing it. Babies can sicken from formula made with unclean water, weakening their immune systems and rendering them more susceptible to contracting HIV from breast milk when mothers can't afford to continue with formula. Although there is some risk of HIV transmission with breastfeeding, mother's milk actually protects the baby's digestive tract and lowers susceptibility to HIV. Therefore, WHO guidelines and USAID policy advise mothers either to breastfeed or give formula exclusively for the child's first six months. After six months, mothers inevitably introduce other liquids to the baby's diet, thereby increasing the child's susceptibility to HIV, and so mothers should stop breastfeeding then.
USAID is developing print materials to educate mothers about making the choice between breastfeeding and formula. These brochures also explain sanitary practices for mixing formula and breastfeeding techniques for minimizing HIV transmission. For example, drawings show that nursing mothers should hold babies so that the entire aureole is in the baby's mouth, thereby reducing the chance that the baby's teeth could cut the mother's nipple and expose the baby to the mother's blood. Developed by USAID in Africa and now intended for the generally impoverished and usually illiterate Haitian population, these materials are still undergoing revision to ensure their clarity and appropriateness for conditions in Haiti . Dr. Vilgrain and Ms. Alexandre asked the two HAS focus groups, nurses and mothers, to give feedback on the materials and make suggestions for revision.
Efforts to convince mothers to follow these infant nutrition guidelines need to take into account local cultural as well as economic factors. Typically, Haitian mothers do not breastfeed exclusively in the first six months due to both traditional and contemporary cultural factors. Traditionally, mothers feed two- to three-day-old infants a tea called “lok” that is made of the herbs basil and corossol mixed with oil and which, they believe, helps the baby eliminate the meconium. Less traditionally, mothers will give their babies formula if they can because they believe it is better than mother's milk since it is expensive and since American children, whom they believe are given formula, are relatively healthier. It might seem that the optimal course of action to avoid HIV transmission would be to provide HIV positive mothers with formula at no cost, but even this plan poses a cultural challenge since others in the community would see the mothers receiving the formula and identify them as HIV positive, which would lead to stigmatization.
Dr. Vilgrain, who spoke with the mothers, was struck by how competent and committed they were to ensuring their families' health. “They are all hard-working market women, and they are intelligent, psychologically sophisticated, and really energetic,” she marveled. At the same time, she was saddened that these smart and capable women were HIV positive and that this status would likely sap their energies which could better go to contributing to their families and community. On a more positive note, Dr. Vilgrain reported that the women from HAS's district “are much more open and communicative than those I interviewed in Port-au-Prince , and they all expressed gratitude for support they've received from HAS, which helps them face the difficulties of life with HIV, including stigmatization. These women really make a heroic effort to survive and thrive amid the momentous difficulties of life as market women in Haiti .”
In the last few years, the Alumni Association made a long-term commitment to support the Addison Vestal Medical Library at HAS. We count on the medical director to assess the library's needs and to request funds from the Alumni Association. This year the Alumni Association donated $1,500 for library purchases. In the following note, Medical Director Bob Carraway reports on how HAS plans to use those funds:
We did a survey a couple of months ago with the staff. They indicated which journals were most important to them, and we learned that the staff uses either the standard textbooks or the Internet for the bulk of their research.
Hence we are planning to:
1. Limit subscriptions to frequently used journals.
2. Purchase a new standard textbook for each major specialty.
3. Obtain a computer that will be dedicated to medical research only (we already have most of the hardware in house).
4. Consider getting other general medical resources on CD such as "Up to Date."
5. Thin and remove many journals and texts that are outdated and/or available on the Internet (this is partially completed).
6. Depend upon donated journals and textbooks that are so helpful (Dr. Charlie Bales sends his New England Journal of Medicine to us regularly).
7. Move the Albert Schweitzer collection to the climate-controlled medical library to improve access and preservation.
Bob welcomes other ideas on how to improve this valuable facility. He can be reached at info@hashaiti.org .
Dr. Henry K. “Sonny” Miller has one of the longest associations with HAS of anyone alive today.* He was a charter member of the Grant Foundation Board that Dr. William Larimer Mellon founded in 1953 while he was a medical student at Tulane University in New Orleans and HAS was barely more than a gleam in the Mellons' eyes. Larry and Gwen Mellon and Sonny and his wife Katie Miller became close friends while planning the hospital that opened its doors in 1956.
Sonny grew up in Shreveport , Louisiana , the son of a well to do businessman. But Sonny didn't want to join his father's business; he had wanted to be a doctor since he was a small boy. He graduated from Tulane Medical School in 1945, after which he was drafted into the US Army and stationed in Japan . The Japanese tour of duty proved serendipitous in regard to Sonny's future association with HAS.
Upon his return from Japan , Sonny accepted a residency in gynecology/obstetrics at Tulane. Larry Mellon was one of his students. Rumors swirled around the hospital about Larry Mellon—about his background, his age, his wealth. People spoke of the Mellons' beautiful house on North Line Street —not a usual medical student neighborhood. One morning at the hospital Sonny asked Larry if he knew of a foundation that might help him bring a shoeshine boy he had befriended in Japan to the United States . Sonny had helped the young man, Takesh, get a scholarship at LSU, but he needed an additional $3,000 for airfare. Larry told Sonny about a foundation in New York and suggested that Sonny call the next day. When Sonny did, they said, “No problem, we will send you what you need.” Sonny was amazed at how easy it had been. Only much later did he learn indirectly that Larry had footed the bill. Takesh went on to become a prominent educator in Japan .
Larry was so impressed with Sonny's commitment to help Takesh that he invited him to join the brand new Grant Foundation Board. By this time, both Larry and Gwen Mellon had become friends with Sonny and his wife Katie Miller. The two couples became even closer as they pored over hospital plans.
Sonny remained on the Grant Foundation Board for more than 40 years, becoming an Emeritus member in 1996. During those 40 plus years, he never missed a Board meeting and served as a trusted friend and advisor to the Mellons. The Millers have also been staunch financial contributors to HAS over the years.
Sonny's trips to Deschapelles, often with Katie, to attend board meetings and perform gynecological surgery were marked by his warmth and generosity. Sonny's house companions enjoyed the grits and bacon that he brought and personally cooked for them. Children and vendors delighted in seeing him and congregated at his house knowing full well that Sonny's compassionate heart would not allow him to obey the prohibition against informal street business. Sonny made friends in Port au Prince as well. He was a loyal guest of the Oloffson Hotel and a friend to one taxi driver's family for decades. Sonny collected Haitian art and built what must be one of the finest collections in North America —now willed to a college in Louisiana .
Sonny lost his beloved Katie some years ago. Despite this loss and the challenges of age, Sonny's interest in HAS is undiminished. He still enjoys reading HAS reports and keeping up on the business of the board. He stays in touch with HAS friends and colleagues. When both the hospital's x-ray machines broke recently, Sonny said, “How can you run a hospital without x-rays?” and promptly stepped up with a generous donation to get them working again.
As the only hospital in Haiti that has not closed its doors since they opened, HAS owes its survival to unsung heroes like Sonny. As HAS ages, we are thankful for its longevity but mindful of how easily institutional history is lost and the contributions of fine individuals forgotten. We honor and remember Sonny's work, wisdom, and kindness, which have inspired those who came after.
For some facts in this article, the editors are indebted to an unpublished memoir written by Dr. Miller.
The European Alumni Association Reunion will be held in Morschach, Switzerland from Friday, June 30 to Sunday, July 2, 2006 . Morschach is near Brunnen which is, in turn, near Luzern. Post-reunion activities will be planned for those who wish to extend their stay past July 2. A tentative program and a registration form may be found on the HAS website at www.hashaiti.org or contact Dr. Elvira Ghioldi at europeanalumni@hashaiti.org .
The North American Alumni Association is planning their next reunion for 2007, time and place still to be determined.
Please forward this e-newsletter to HAS friends and other alumni who might not be on our mailing list. Your assistance is very much appreciated.
HOW TO GET ON THE LIST
If you, or anyone you know, would like to be on the email list to receive future issues of Sak Pase?, please send your email address to Rona Watts at the HAS Office in Pittsburgh at alumni@hashaiti.org .
HOW TO GET OFF THE LIST
If you do not want to receive future newsletters, please reply to this message with “REMOVE” as the subject line.
Visit www.hashaiti.org to stay informed on other aspects of the hospital's
work.