Six Student Pharmacists Reflect On Global Health Experience In Haiti
Six Duquesne student pharmacists participated last month in a hands-on experience in global health in Cap Haitien, Haiti. Through a partnership with The Espwa Foundation, a non-profit organization with a sustainable and empowering mission dedicated to serving individuals in Cap Haitien, the students were given the opportunity to learn about the culture and delivery of healthcare in Haiti.
Assistant Professors Dr. Jordan Covvey and Dr. Kevin Tidgewell co-organized and led the Spring Break-Away trip, which was associated with the Perspectives in Global Health elective course in the School of Pharmacy. The trip included four PY3 students, Briana Schreckengost, Tom Handerhan, Kelly Mazzei, and Tess Calcagno, and two PY2 students, Allison Kachel and Nathan Gartland, as well as Espwa's Executive Director, Christopher Pfeiffer. The elective course additionally includes Associate Professors Dr. Anthony Guarascio and Dr. Lauren O'Donnell as instructors, and exposes students to a landscape of global health topics, including infectious disease, culture and ethics, international drug discovery, poverty and international aid.
According to Covvey, students participated in a variety of activities during the trip. They met with two local physicians, Dr. Rodlin [RoRo] Paul and Dr. Eugene Maklin, and engaged directly with them in St. Anthony's Medical Clinic over three days. Activities at the clinic included organization and inventory of pharmacy and laboratory supplies, shadowing of the doctors during the patient care process, working with the nurse for pharmacy dispensing and counseling, blood pressure measurements during triage and creation of a new clinic intake form (in Haitian Creole). Students also visited and toured other local healthcare facilities and efforts, including the New Hope Hospital in Plaine-du-Nord, the Hope Health Action (HHA) Hospital and Community Hospital Idadee (CHIDA) facilities in Cap Haitien, the natural medicines clinic at the EBAC orphanage, and the Cap Haitien Health Network depot.
"Students also engaged in a number of cultural experiences during the trip, including a visit with Espwa's Peace and Joy children, a visit to Friendship Island with the Haitian Creole Tour, touring of Cap Haitien city sites and the tourist market, and eating plenty of ‘poulet in sauce.'," said Covvey.
"Understanding that this was the first trip of its kind from Duquesne University, I went to Haiti with few expectations and an open mind," said Kachel. "This trip served to function as an initial needs assessment for St. Anthony's Clinic in Cap Haitian, Haiti. The Haitian doctors we worked with explained to us about the prevalent disease states in their patient population, as well as the medications they most frequently use. Just a few of the common disease states we encountered included typhoid, diabetes, roundworms, and ear infections. A really meaningful part about this trip was that we were able to take the Haitian doctor's hopes and plans for the clinic into consideration when debriefing our final needs assessment. I am ecstatic see this project flourish in the continuing years with the support of the Duquesne University community!"
"This was my first cross cultural immersion experience and I am so grateful to have had the opportunity. It has changed my life in so many ways," said Mazzei. She added that Haiti is one of the poorest countries in the Western Hemisphere, which is evident when driving through the streets that are filled with trash, a central well for water, and a lack of healthcare access.
"We spent a lot of time seeing the health care system in Haiti at different levels, and what struck me most was the lack of ability to purchase medications and supplies for the St. Anthony's clinic. This clinic relies on infrequent donations of soon to be or already expired medications from the United States or the Dominican Republic. When the pharmacy did not have a medication prescribed, the patient had to go on the streets to find it, and almost always, could not afford it if they found it. This is so different from the United States and our overprescribing, overstocking, and medication ordering system."
Calcagno agreed, adding, "It was eye opening to see the variation between Haitian healthcare and healthcare in the US. I expected not to see state-of-the-art hospitals in Haiti due to known economic restraints. However, what surprised me the most is that St. Anthony's clinic really only had medications to treat a select few disease states which commonly inflict Haitian patients. Here, we can treat thousands of disease states which Haitians may have never heard of."
"I found the experience to be very enlightening," said Gartland. "Having seen Haitian healthcare first hand, I now have a new appreciation for our own healthcare system. Access to medications and adequate treatment is a luxury in the United States and is something we often overlook. One of the major complications we encountered at the clinic was the lack of appropriate therapeutics. Some of the clinics only receive ‘new' medication shipments every three months, which are often loaded with expired drugs. Establishing a fund or monthly budget to purchase necessary agents would improve overall patient outcomes and access."
"We were invited to utilize our clinical knowledge and training to optimize the workflow of St. Anthony's Medical Clinic," Gartland added. "We established connections with the local physicians, interacted with patients despite the language barrier, and had some free time to entertain the local children. This experience has allowed for me to grow personally, and I look forward to our continued partnership with St. Anthony's Medical Center and Duquesne's involvement in Cap Haitien."
St Anthony's Medical Clinic provides important primary care services to a needy area in Cap Haitien. At the current time, the clinic provides free medical services two days per week to the surrounding community, with limited supplies and medications available. During the time spent in the clinic, a variety of important medical conditions were seen and treated. According to Handerhan, "The medical staff works wonders with what they have, but their entire pharmacy fits in one cabinet. This one cabinet serves hundreds of patients."
"We are hopeful to secure long-term donations from the Duquesne network of students, faculty, staff and alumni to allow for ongoing sponsorship of the clinic, including physicians, nurses and support staff," said Covvey. "As little as $4000 could provide a year's worth of funding for the clinic and dramatically change the health of an entire community."
Schreckengost said that she traveled to Haiti with a goal to learn more about healthcare in an underdeveloped area, and particularly how this translated in the pediatric population. "Children in Haiti have a spirit about them that is unlike anything I've ever seen, but medical care for them is limited," she said. "We saw a lot of cases where families either could not afford medications or where pediatric formulations were unavailable for common conditions like flu, rashes and coughs. The most inspiring pediatric care I experienced was at HHA. There are some amazing changes being made to impact children with disabilities, who previously have been stigmatized and pushed aside. HHA strives to treat children with disabilities as people and give families the opportunity to love and care for their children in ways they previously could not. I loved seeing Haiti trying to make a change to be inclusive for everyone and eliminate the stigma associated with children who have disabilities. Pediatric care is a passion for me and I was very surprised by the positives and negatives associated with it."
The students all agree that the people of Haiti have left an impression on them that will last a lifetime. "A powerful thing about Haiti is the ability of those we met to smile," said Mazzei. "These people live in poverty and have essentially nothing, but adults and children were happy to see us, happy for our help, and wanted to know when we were coming back! This trip put into perspective the blessings I have been given in the United States, like the choice to go to school and become educated, having access food and clean running water, and receiving quality medical care, and reinforced that we all have a reason to smile and appreciate what we have a little more."
Tidgewell added, "It's humbling to realize all the things that we take for granted and the ways in which we can help, both locally and abroad, with simple gestures. This is one of the reasons why we thought it was so important to rally the Duquesne Pharmacy alumni community to take on the challenge of raising money to fund and support the St. Anthony's Clinic Pharmacy. Dean Bricker is famous for his line that ‘No-one cares how much you know, until they know how much you care,'' and the spirit of service shown by these student pharmacists is one of those things that sets apart a Duquesne pharmacist."
Covvey and Tidgewell are embarking on a longitudinal effort within the Duquesne community to sponsor the clinic and its mission. For those interested in contributing to this important endeavor in collaboration with Duquesne, donations can be made directly through the Espwa Foundation, a 501(c)(3) non-profit, at https://espwafoundation.z2systems.com/DuquesnePharmacy2018.
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