Advice for Haiti Medical Mission Teams as of 2/13/10
Our medical mission team of 3 doctors, 2 nurses, and 3 lay people just returned from a 1 week
medical mission trip to Port-au-Prince, with ground support by Craig Miller of Thirst No More
(www.thirstnomore.org). The following information should prepare similar groups over the next
few weeks, if each subsequent group will update the medical supply list. Our team visited 5
different sites on 5 consecutive days from 2/6/10 through 2/10/10. I don’t know each of the
locations, but our clinics included a street setup near a collapsed building, an orphanage, a
medical clinic by an orphanage in Carrefour, the El Shaddai Children’s home in Dessources,
Croix des Bouquets, and finally at the seminary of the Church of God where our supplies were
located. We also delivered medical supplies to the UN compound tent hospital and food to the
orphanage in Cabaret run by Pastor Pierre Prinvil.
Some of the greatest medical need certainly is inside the most crowded of the tent cities in the
downtown area of Port-au-Prince. However, we did not have what I considered adequate
security or supplies for such a venture. Food and water are being delivered to these areas by the
US military prompting long lines but orderly distribution is available with this type of support. I
am proud to see what the United States is doing in regard to humanitarian assistance there as I
saw hundreds of people leaving these distribution points with 50 pound bags of rice labeled
“USAID” on their heads.
As noted above, our physicians provided medical care in more of the outlying areas where
population density was somewhat less and security was less important. Each doctor saw about
50 patients each per day, so that we treated over 700 people (and one goat!) during our trip. The
following list contains the characteristics of the patients we saw.
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Headaches – we assumed this is due to dehydration or stress, and treated with Tylenol or
ibuprofen.
Fever – many people complained of fever, but on further questioning, most of these
symptoms seemed to be noninfectious, as best as we could determine. Obviously malaria
is a risk in that area, but we only treated 1-2 people for malaria.
Dizziness - ?dehydration
Abdominal pain – worms vs. H pylori vs. GERD, uncertain cause. We commonly used
omeprazole or ranitidine. Vermox was used frequently and may have been useful to use
on every patient. We didn’t use peptobismol, but that might be another option.
Vaginal infections – it seemed that all the women had vaginal discharges and it was
difficult determining whether these were STD’s or bacterial vaginosis or yeast. We
treated most with diflucan, some with metronidazole, and some with topical medications,
but the medical provider should determine some way to quickly come to a plan for each of
these patients.
“Grippe” – URI, possibly due to the rubble dust and trash and smoke and tent living,
nearly everyone has URI symptoms which can be treated with cetirizine (Zyrtec),
loratadine (Claritin) or Benadryl.
Cough – related to above, only a few had actual wheezing though.
Rashes – we used a lot of hydrocortisone and antifungal creams
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Wounds – there continue to be wounds that go days without being dressed and these
people show up in clinic to have their wounds cleaned and redressed, but there were only
5-10 per day.
No appetite - ?worms
Insomnia – probably related to stress, Benadryl was a good solution
Diarrhea - ?worms vs. viral infections. We have lots of loperamide there but didn’t use
that much of it.
Vomiting – there was a little vomiting, but not that much
Eye pain – this is a very common complaint, possibly due to irritation from air pollution as
noted above. Consider taking lots of visine type eyedrops, or possibly acular, optivar, or
naphcon.
HTN – we didn’t do bp checks on everyone, but we did detect a significant amount of HTN
on those we checked. I would recommend doing bp checks on all adults coming in to clinic,
possibly using an automated cuff with various sizes of cuffs. Regarding treatment, we
used captopril, but in retrospect, I think it would be better if you would bring in a lot of
norvasc, which would likely be more effective for that population and wouldn’t risk renal
problems if they were to get dehydrated. There is some hydrochlorothiazide and lasix
there also, but you might consider taking in some beta blockers too.
Palpitations – several people had these symptoms, possibly stress related. Metoprolol or
propranolol might have been a good option, but we didn’t have those.
Diabetes – many have diabetes. There are glucometers there but you will need to take in
the specific test strips listed below for the glucometers we have. Metformin and glipizide
are available there at this time.
Below is a list of items that are well supplied. DO NOT BRING THESE SUPPLIES (at least as
of 2/13/10)
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Biaxin in any form
Any IV fluid
Thermometers
Lidocaine, with and without epi
Oral rehydration salts
Neosporin
Rocephin (ceftriaxone)
Betadyne
Rubbing alcohol
Hydrogen peroxide
Bandaids
7 or 6 ½ sterile gloves
Bactrim suspension
Nonsterile gloves
Tongue blades
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Alcohol prep pads
Clindamycin
Sutures
Doxycycline
Ciprofloxacin
Moxatag (sustained released amoxicillin)
Narcotics or any controlled substance (unless you dispose of it at the end of your trip)
Benzonatate (Tessalon)
Saline for wound cleaning
Loperamide
Salbutamol inhalers
Beclomethasone inhalers
Glucometers
Sterile 4x4’s
Sterile gauze such as kling or kerlex
Scalpels
Needles
Syringes
Amoxicillin 250mg chewtabs
IV tubing
Medicine bottles (6oz amber bottles)
Malaria testing kits
Now to the list of things that you should BRING.
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Sharpies – red and black
Well built plastic crates
Trash bags
Lots of medication baggies (with picture instructions as available from Blessings.org)
Lots of adult vitamins (give to everyone)
Lots of children’s vitamins, including chewable and prepackaged liquid vitamins
Chloroquine
Lots of omeprazole or ranitidine
Eyedrops for general discomfort (visine, naphcon)
Lots of hydrocortisone cream
Lots of mebendazole (vermox)
Lots of elimite (permethrin) cream
Ivermectin for scabies (2 tablets at one time treats scabies in older teenagers and adults)
Albuterol inhalers
20-30 aerochambers with pediatric masks
20-30 aerochambers
Lots of Benadryl
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Lots of cetirizine or loratidine
Norvasc (2000-3000 tablets if possible)
Beta blocker of your choice (metoprolol)
Children’s Tylenol (chewable and prepackaged liquid)
Glucometer strips for Infacare Prestige IQ glucometer
Automated BP cuff with regular and large cuffs, with batteries – possibly 2 of these
Hand wipes
Hand soap
Hand sanitizer
Amoxicillin 500 mg tab – 5000 tablets
Ibuprofen or naproxen – 10,000 tablets
Some sulindac or clinoril
2 arm slings of each size
2 wrist braces of each size
2 ankle braces of each size
20 disposable sterile suture sets
Some type of plastic container for nonsterile 4x4’s after the paper wrapper has been
opened, like a Tupperware breadbox
Chewable cetirizine – 5 mg, you could probably use 2000 of these if possible
Toys and candy for children (and adults)
Stool softener
D50W – 1-2 amps
Non-electric cast cutter to remove casts
Valproic acid (especially for Deborah – the niece of interpreter Meliane)
Urine cups (these seem more useful for delivery of liquid medications through syringes
than the amber medicine bottles)
You should consider developing an EMERGENCY BAG, to be carried by one person. We found
ourselves walking to surrounding areas in poorly lit conditions and we could have used this type
of kit. It should contain the following items:
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Gloves
Scissors
Tape
Chucks
IV start kit
D50W
1:1000 epi
High flow pressure tubing (no filter)
Tourniquet
18, 20, 22 gauge angiocaths – 2-3 of each
Butterfly IV needle
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TNG
Flashlight/headlight
Stethoscope
BP cuff
Nonsterile gauze
Mask
Resuscitation mask
IV – saline – one liter and 500 ml
Glucometer
Baby wipes
Hand sanitizer
Trash bag
Oral airways – several sizes
Various syringes and needles
NG tube and 60 cc piston syringe (for suction)
11 blade scalpel
Possibly lorazepam (there is already some in the supplies if you can find it)
Other ideas for your group
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Consider giving vermox 1 bid x 3 days and one month of vitamins to everyone, and you
would benefit by having these prepackaged prior to your trip and labeled in the picture
instruction type baggies provided by Blessings.org.
TENTS ARE BETTER THAN GOLD. Consider taking 10-20 tents with you to give to your
interpreters, pastors, drivers, and their families.
The UN compound tent hospital will run blood tests for you if you take the blood to them
(special tube for their I-stat) and wait there for quick results. They can do cbc, Na, K,
glucose right now, but may get more testing capability later.
Some medical personnel may want to volunteer in the UN compound tent hospital on the
airport grounds. The nurses from Tulsa were very fulfilled with their work there.
From a financial standpoint, be prepared to pay $300 per day to Thirst No More for
transportation and interpreters while in Haiti. Pay $500-750 for bus from Santo Domingo
to Haiti each way if you can’t fly in to Port-au-Prince. $100 each way for liaison in Santo
Domingo.
Be aware of international calling rates while in Dominican Republic - $20 per MB data (a
website page might cost up to $100) and $2 per minute talk time. Texts are $0.50 a piece.
In Haiti, through the end of February, AT&T has waived fees for international data and
phone, but I haven’t confirmed that on my bill yet. An iPhone generally works quite well
in all locations in Haiti, and texts or emails are better ways to communicate than phone
calls.
Generally, when bringing medications, it’s better to bring meds in bulk rather than
bringing in individual donated samples which are hard to organize.
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Don’t underestimate the importance of organization of medications and supplies. One of
the most frustrating parts of our trip was the inability to find medications that we knew
we brought, but we just couldn’t find them. I would suggest immediately taking the
supplies and medications that are available and arranging them in the rent house on
shelves, then adding your supplies to them, then stocking adequate supplies in your crates
to carry out to the field with you. At the end of each day, restock your crates from the
supplies.
Buy something with which to gift your interpreters. Tents would be the ultimate gifts. I
would really appreciate if someone would give a tent to Jack, one of the interpreters, so his
family would have a tent. I took extra tents, but by the time I was going to give it to him,
it was gone.
Consider leaving your clothes with the Haitians.
A blog is an excellent way to elicit prayers and communication with your church. You will
be so uplifted by their comments and prayers. Put plenty of pictures on the blog. Have
each person practice blogging from their cell phone or computer before you leave the
states. Someone will need to take along a laptop.
Other various items to take and consider
o Flip flops for showers
o Bug spray
o Sunscreen
o Camelbak backpack is best, because water is very important. Other people liked
fanny packs and small backpacks.
o Break for lunch (out of sight of patients) and bring extra food/MRE’s/water for your
interpreters.
o Hat
o Extra battery/power source for your phone
o Bar soap
o Camp towel
o Headlamp
Get your shots – up to date on tetanus, hep B, hep A, polio, MMR. Typhoid injection or
oral vaccine. Malaria medication for prevention.
Please try to discard the controlled medications in the pharmacy (hydrocodone, ketamine,
something else)
One of the most rewarding things our group did was to purchase several hundred pounds
of rice, along with beans, sugar, oil, water, and detergent for an orphanage in Cabaret at a
cost of around $1000.
Please utilize this list of “BRING” and “DO NOT BRING” and keep it up to date for the
next group coming in.
Please try to work toward continuity of care, where we are trying to minister to various
sites on an ongoing basis through the local churches. It is so helpful to be able to say to a
patient, “Come back in 1 week or 2 weeks when another doctor will be here and he can
recheck your ________”. This also allows us to not have to hand out so much medication at
one time, knowing someone else will be following us in a week.
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International dialing is awkward, but my iPhone was set to “international assist” and took
care of most of the calling. The Haitian phone numbers are usually 8 numbers that must
be preceded by 509. Occasionally one must add a “+” sign then 011 (the country code for
Haiti) to get a call through. Usually to call a US phone number in Haiti, one could dial +1
then the 10 digit number to connect. This also seems to be in flux in Haiti right now
though, so that is why texting and email seems to work better.
Useful contact information:
Craig Miller of Thirst No More – cell 512-983-2033, email craig@thirstnomore.org
Thirst No More – www.thirstnomore.org. This is an organization that deserves our financial
support, especially as they are seeking to purchase vehicles. Craig did an outstanding job in
supporting our group and they need financial support as they rent a house for continuing work in
Haiti and as they need to purchase 2 vehicles. I personally vouch for the integrity of their
Christian mission, purpose, and integrity.
John Caubble of First Baptist Church, Rogers, AR – cell 479-644-1117
Doug Porter – pastor in Georgia with numerous Haitian contacts (put us in touch with 2 of the
children’s homes) – cell 706-490-2479
Pastor Pierre Prinvil – cell phone is +50938070903 – runs children’s home in Cabaret where we
gave food.
Elizabeth Clacklin – cell +50938687140 or +01150939306717 – she runs the El Shaddai
Children’s home in Dessources in Croix des Bouquets. Donations to this excellent facility can be
made through the Christian Light Foundation, with information at
www.christianlightfoundation.com. We were EXTREMELY pleased with the work and ministry
in this facility and they deserve our support.
I hope this information is useful. Please call, text, or email me if I can be of help.
Jim Byrum MD
Cell 479-936-1021
Home 479-271-9431
Email jbyrum2001@gmail.com