I was honored and quite surprised as I never saw him express much interest in my work. When I returned from my recent mission to Haiti I saw a large wrinkled up manila envelope sitting on the kitchen counter. I was busy unpacking and noticed the envelope still sitting there untouched. Finally, I asked what it was and he said it was just something for me from his teacher. Opening it I found it was full of money, mostly coins and wrinkled up bills. It added up to $106 and change. There was also a note from his teacher saying “you are raising a fine young man.” I was so moved by the generosity of his classmates and the actions of my son. I wondered what he had said to inspire his class. He is a young man of few words and he said “I just told them what you did”.

Of all the accolades and awards that I have received, this is the most moving one. There is nothing more rewarding than watching your children grow into fine young adults and learning from your example. Your children are observing everything you do good or bad so this is a valuable lesson in mindfulness.

In March of 2011 she went back to Haiti for another medical mission, while there she visited the ‘Amputee Soccer Team’ that she had adopted the first time she was in Haiti. The soccer team is made of of young men who lost limbs during the earthquake.

Dr. Dhanda is extremely devoted to her mission and gives her all to help those who are in need. Her next mission will be to Nepal in 2012. She is truly an angel of mercy who spreads love and caring wherever she goes.”

– Stars of Lake County, 2012

• It is probably one of the most difficult things you will ever do mentally, emotionally and physically. The hours are excruciatingly long and the emotional toll can be unrelenting.

• It is an emotional roller coaster. One moment you will feel joy and satisfaction because over having made a significant difference in someone’s life and the next moment you may witness the sorrow of a tragic loss of life.

• You will be continually confronted with the challenge of giving adequate and meaningful health care under difficult circumstances.

• You will meet like minded volunteers and create life time bonds with wonderful, giving people.

• Working in a resource poor environment you must be creative and invent solutions for problems.

• Be prepared to teach so that you will leave something behind that is long-lasting.

• Be prepared and open to learning. You cannot help but come back changed for the better.

• Communication is challenging due to language and cultural differences.

• Cultural sensitivity is particularly relevant to maternity care. It is important to incorporate those traditions that will strengthen family ties and provide a support system for the woman and her baby.

• It is an adventure but it is not a vacation. The accommodations are usually spartan but luxurious compared to what the local people live in all the time. The food will sustain you and you may learn about hunger. For me weight loss is a good thing.

• It is not uncommon for volunteers to experience profound reactions when arriving home, such as—guilt, sadness, anxiety, and depression.

• Coming home is difficult because your friends and family may not really relate to what you have been through unless they have had a similar experience. Keeping in contact with other volunteers is helpful.

• You may be struck by our shameful waste and abundance. How can we have so much while others have nothing?

• It is life changing as you will never look at things the same way again.

• This experience is rewarding beyond measure.

• You may come away, as I did, with a renewed belief in what humans are able to accomplish when we all work together for a common purpose.

• Mission work is definitely not for everyone.

I invite other volunteers to share their views and comments here.

I am an OB/GYN physician who practices medicine in rural Northern California. I recently returned from my second volunteer medical mission to Haiti where I worked excruciatingly long hours performing surgeries and providing other medical care for women. I want to tell you just one of the powerful stories that has occupied my heart and mind.

Let me provide the setting. The two-bed emergency department was noisy and crowded. It adjoined the ten-bed medical/surgical department and the four-bed ICU, without much separation. There were too many patients and not enough beds. Some patients were sitting in chairs between the gurneys and others were lined up outside the hospital with their chief complaint and vital signs taped to them on a piece of paper, but that is a story for another day.

I asked the translator to bring a screen for some privacy while I found a paper gown to use as a sheet to cover Sarah. In past missions, I have found it easier to perform an ultrasound than to ask a lot of questions to try to determine a woman’s last menstrual period. The translator explained to Sarah what I am doing as I performed an ultrasound with a scanner that was not designed for obstetrics–but it is all we had (and it is more than we had on my last mission here). She was about 14 weeks pregnant, but there were no fetal heart tones I expected to see on ultrasound.

I asked her questions, through the interpreter. “When did the bleeding begin?” “When did the pain start?” The story kept changing and the answers were conflicting. A Haitian surgeon tried to help. He told me she said she had had a D & C elsewhere and subsequently developed pain and bleeding.

I have been taking care of women for many years and I follow my instincts. I told the medical student who had been shadowing me that I was suspicious that something was missing in Sarah’s story. I asked the translator to translate my words exactly, “What did you put up inside your vagina?” Finally, the truth. She had inserted a medication called Cytotec and taken some orally as well.

Port-au-Prince Market

I ordered medication for Sarah to help with the pain of her contractions. She needed a bed. I checked the isolation room. As I looked in, I remembered the 24 year old young man who lay dying of AIDS, yearning to see his mother, who never came. I shook my head to clear it. The bed in the isolation room was empty, so I arranged for Sarah to be placed in there.

I did not want Sarah to be left alone. The nurses were too busy to leave the Emergency Department, so I assigned the bright young Haitian medical student the task of monitoring this scared teenager. Luckily, the student also spoke English, so I gave her very specific instructions to check Sarah’s vital signs, time her contractions, and call for help if there was heavy vaginal bleeding.

Two young men were now at Sarah’s bedside. I could not tell who was the partner and who was the “cousin,” so I let them both stay in the room.

The teenager labored while I cared for other patients, checked on her intermittently, and gave her more pain medication. She delivered the gestational sac intact and the family wanted to see it. After some questioning, they were satisfied that she was no longer pregnant. It was 11:00 p.m. and even though we needed the bed, it was unsafe for the Sarah to go home through the streets of Port-au-Prince.

The following morning, I found a “fatherly” translator and asked him to talk to the two young men about using condoms for birth control. I counseled Sarah about caring for herself during her recovery. She had been through a lot and definitely did not want to repeat the experience. I told her to say “NO!” if her partner does not use a condom. They were all laughing now at my emphatic gesturing. In the previous four days, I had done three emergency D & C’s on young women for incomplete abortions. Unlike Sarah, these women were hemorrhaging. I wondered how many of these had been self-induced.

There is little or no access to birth control in Haiti and a lack of education for young people. There is so much need. I have done a lot, but it is not enough. I return to my home in California with renewed conviction in what people are able to accomplish when we work together for a common purpose. I am determined to raise the funds that will enable me to go on my next medical mission. Don’t underestimate the things that we can do.

I would encourage all healthcare professionals to consider donating some of your time to this worthy cause. You will come back challenged and fulfilled and your services will be greatly appreciated. I met many wonderful, giving volunteers from all over the world including the twin Bitar surgeons while working at Hospital Bernard Mevs/Project Medishare in Haiti. Following is a letter of appreciation I recently received.

Dear Volunteers,

As you are settling back into your life back at home, we would like to express how much we appreciate your coming to Hospital Bernard Mevs/Project Medishare. We realize the work here is challenging and sometimes frustrating, and we hope that you realize how much we truly value your help. Since the earthquake on January 12, 2010, Project Medishare has treated over 180,000 Haitians in need. This could not have been possible without volunteers like you who have given your time, skills, and money. You have helped many more than the handful of people that came to the hospital during your volunteer tour. Equally important, the assistance and knowledge that you have imparted to the nurses, translators and other local staff will allow them to continue in your footsteps long after your stay with us.

Hospital Bernard Mevs/Project Medishare has made some remarkable advances since the merging of the two organizations in June. Now, we have the Spinal Cord/Rehab unit fully staffed by only local Haitian nurses who are able to provide all nursing care independently. The nurses who staff the ICU are learning to be able to negotiate ventilators and other aspects of critical care nursing of which they had never had previous exposure. These nurses continue to be eager to learn to be independent in one of the most challenging aspects of nursing care. We have a pediatric unit in which nurses and interpreters are learning to manage complex patients including ventilated and cardiac patients as well as premature babies in the only PICU in the country. For Haiti, these advances are a giant leap in the realm of medical care and are due in a large part to you and the other volunteers who have given your time and patience.

We hope very much that you return to Hospital Bernard Mevs/Project Medishare as we continue to help the people of Haiti. We are working everyday to improve our hospital and build sustainability, and your assistance with this process is invaluable.

Thank you again and please keep in touch.

Sincerely,

Dr. Marlon Bitar and Dr. Jerry Bitar
Directors of Hospital Bernard Mevs/Project Medishare

Many of the problems faced by volunteers in developing countries are complex and vast. There aren’t enough resources available. Poverty is overwhelming. Education is lacking. Clean water can be difficult to find and malnutrition makes medical care even more challenging. It is almost too much to bear to see a mother die in childbirth of something that is preventable. How do you send a child back to the same environment they came from knowing they may become sick again?

Many times, though, we have an opportunity to touch lives in a very lasting way. So many people suffer from lack of access to the most basic medical care, which really does mean the difference between life and death. Partnering with local healthcare providers and sharing your knowledge leaves behind something that is everlasting. And that’s just the beginning of the difference our volunteers can make.

I am always humbled by the kindness shown to the volunteers. People who have nothing go out of their way to make sure that we are as comfortable as possible, and they are genuinely grateful for our presence. The Haitian staff expressed gratitude to our volunteer team for choosing to stay at the hospital during the turmoil and danger caused by the election. How must it be to know that strangers cared enough about you to fly across the world to care for you? On a very basic, human level, volunteers change lives simply by reaching out.

When you care enough about strangers to leave your family, friends and comforts behind to make a difference in their lives, something happens inside of you. You discover that the secret to happiness is not in what you have, it’s in what you give away. Yes you will absolutely make a difference; perhaps more in yourself than the people you came to help.

“Well, here I am on day 5, a little more than half way thru my stay here in Port Au Prince. As soon as I got here, I recognized the smell and the feel in the air instantly. The volume of the environment in Haiti has only one level and that is “yell”. I am not used to all of the yelling, everybody yells when they are talking or fighting, it is all the same volume regardless. The hospital is as busy and chaotic as ever. Our first day here Saturday, was one code blue after another, besides my own sick ICU patients, you float to the ER (next little room over) and help as needed. I was a little shell shocked the first several hours.

At the end of day two, we were preparing to go to the UN for dinner and I got pulled outside to Triage. There I found a 15 yr old boy with a gunshot wound in his abdomen and out his back laying cold and clammy on a stretcher with no one doing anything. Eileen Miller (my good friend and a nurse anesthetist) was with me (thank you God) so we started 2 lines, poured iv fluids in, screamed for help. The poor boy was at a soccer game when at the end of the game someone opened fire in the stands and he was shot. I had to cut off his really nice soccer jersey, it was probably his prized possession. We were overflowing with patients, so unfortunately after we got a breathing tube in him, we had to transfer him to the “General Hospital” here in Port Au Prince because they could take him. The surgeon there agreed to do his surgery only after our group came back to our hospital and brought a list of supplies to him, kind of a trade I guess. I pray he lived, but I haven’t been able to find out just yet. On Monday night after our shift we were planning to get dinner at the UN when a 4 yr old boy “Addison” was brought in the ER with approx. 30% burns on his body. Apparently his parents were trying to fill a lit Kerosene lamp in their tent house when the kerosene splashed out and down the entire front of this kid and he lit on fire. No dinner again, thank God again that Eileen was with me, we both worked in the Burn ICU at Harborview together for years. We started an iv, lots of fluids, lots of drugs to knock him out and debrided his sweet little body. Got him all gooped up is Silvadene burn cream and wrapped him in gauze like a mummy. He had a good amount of 3rd degree burns and will need several surgeries. So we kept him overnight and transported him in the morning to one of the Doctors without borders/France hospitals that has a burn unit. I have been praying for Addison as well.

Yesterday in the ICU it was calm in the morning, we are seeing a lot of progress with one of my patients. She is a 21 year old who was 33 wks pregnant and got in a care accident. She sustained a head injury and a big lac to her head. She ended up getting tetanus and was very sick in the ICU. They did a c-section and the baby died a few days later. She (the patient) was also diagnosed with HIV while she was here when one of our staff got stuck with a needle from the patient,,,,:( Anyways, she has been off the ventilator now for 2 days, she still has her tracheostomy, but is doing better everyday. Her muscle tone had relaxed enough that yesterday we were able to stand her by her stretcher and put her in a chair for awhile. I gave her my Mp3 player yesterday and she thinks she has died and gone to heaven. When we try to move it to do something, she grabs it like we are going to steal it!!! Anyways, gotta run, my shift starts in 2 minutes. This place is beautiful and horrific all at the same time, amazing huh?”

God bless,
Terri

A white-water-rafting ride is exciting, thrilling, scary, and can be dangerous if certain guidelines are not followed.  Understanding the guidelines of securing a relief site is not always easy or transparent. This part of the experience is a bit like entering the raft.  Participants thought they knew what they were getting into, but could not anticipate every surprise curve, twist, or turn they encountered. Despite having a plan, one may encounter turbulence, rocks, or rapids.  Fortunately, there are helpful tools such as paddles, helmets, and life jackets keeping one safe.  Nevertheless, there are many surprises along the way.  One may even be thrown overboard.  One must not panic then but let the experience take over.  Like the river rapids, no two rivers or experiences are exactly the same. While there are similar aspects, the experience changes depending on the people in the raft, the weather, or the river itself.

Just as the white-water-rafting ride is done, the participants are surprised by the challenges of getting off of the raft as they return to their everyday lives back home.  Returning home is also much like a river. The river may appear to be the same, yet different water now flows along the river banks. Once the participants return, they realize home has changed as has their point of view and the world around them. Gazing at the river with a new set of lenses, the river no longer seems the same. A sense of tension is felt as others are unaware of the changes that have occurred in the participants’ absence. One’s personal and professional identities are questioned and redefined.  At times participants felt isolated upon their return because this new viewpoint allowed them to reexamine their purpose as a professional. Acting as an educator of others in Haiti provided a new purpose and was a way of building sustainability. Compared to work back home, the need in Haiti for services seemed to take on a more urgent meaning and importance for our participants.  In Haiti, the participants were able to experience a wider scope of practice compared to back home, creating a sense of frustration at times.  Although there was difficulty returning to their role as a PT, all participants were able to articulate a deeper understanding and meaning of social responsibility.

Sue Klappa PT, PhD, Erin Faanes, Andrea Guggenbuehl, Ellie Johnston, Katie Larsen, and Crystal Stien

As Dr. Paula knows, Haitians are smart.  In my eyes, Haitians exercise an ingenuity that we in monetarily richer nations, to our detriment, have forgotten.  Most poignantly I think back to a Haitian man peddling wares along the side of the road in Port-au-Prince.  He had a small block of iron, surely pulled from the rubble, in which he had built a fire.  He had placed that hot iron inside a ripped car tire in order to plastic weld the tire back together.  This is one way he made money to survive.

So often we in America judge cost versus the time allotted in our busy schedules, and often would probably just buy brand new tires.  Haitians, without money, must overcome seemingly insurmountable obstacles with nothing.  How much money would you pay for new car tires?  The few Haitians with the luxury of having a job, a good middle class job, would not make that amount of money in a month.  This is why I spent my money to provide medical care to the most vulnerable alongside Dr. Paula.

Despite all the Haitian people’s ingenuity they need our assistance.  Many in Port-au-Prince still live in shacks made from the same UN tarps handed out after the earthquake more than a year and a half ago.  More than money they need technical skills and training like those Dr. Paula provides.  To only give money and not development, is in effect, like putting gas in their car, but not showing them how to drive.

Dr. Paula, like me, felt a calling to make a lasting impact in Haiti and to improve Haiti’s health infrastructure.  This is why she goes on medical missions.  But unfortunately, also like me, she has no multinational organizations funding her trips or stocking her supplies.  There are no outside sources of supplies in Haiti, no running to the store or having a rep bring over another surgical instrument you need while you are there.  The facilities have dwindling supplies but luckily are staffed with very competent people.  Dr. Paula came as prepared as she could with as much of her own equipment as she could bring and subsequently donate.

She told me about bringing a really nice collapsible retractor for the OB/GYN surgeries in which she specializes.  Upon arrival she had been informed that the only working sterilizer at the hospital was too small to fit this mid-sized instrument.  She connected me with a surgery technician that led me to a back room in the OR where the large nonfunctional sterilizer was located.  I asked him if he knew Dr. Paula and he grinned and talked fondly of how he knew from her previous trips and spoke about how much he liked and admired her as a surgeon.

Soon patient after patient would arrive with the same story of unsuccessful self-induced partial abortions performed by ingestion of local voodoo practitioners’ concoctions.  Her surgeries saved their lives daily.  When the power went out during surgery she worked under flashlight.  As the only surgeon on staff at night she was always around when the other physicians needed her like one night when she taught the ER personnel how to do a figure eight tie off of a blood vessel that refused to stop hemorrhaging even after cauterization.  By the end of her time at Bernard Mevs she had performed multitudes of operations, been integral in the ER, and even delivered a couple babies along the way.  Not bad, but she still had more to give.

In time Dr. Paula got the assistance of her retractor, and the Haitian people got the benefit of her surgical skills and teaching.  They also got something I’m sure none of them were expecting, a strong dose of her kindness.

She went out of her way for those around her.  One Haitian staff member was pleading for any help to get additional education in physical therapy here in America.  Dr. Paula spent hours giving him guidance and feedback, and went so far as to produce a video for him to use in connecting with schools.  She was a mentor and friend to so many in Haiti, including myself.

She always seemed to have a smile, always engaged, always admirable.  I could tell by seeing her interact with locals that they were fond of her, always remembering her by name.  Her many friends in Haiti, as I’m sure she must have in her hometown, remember her nice deeds.  I remember laughing over family stories.

So please, however you can, help Dr. Paula on her mission of kindness and giving around the world.

by  H. Paul Goodell