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Haiti Progress: St. Marc Clinic Opens, ARVs for Patients Secured

By Charles King

February 16, 2010

There are two large providers of medical care to people living with AIDS/HIV in Haiti. Zanmi Lasante, otherwise known as Partners in Health, founded by Dr. Paul Farmer, operates through the central and border regions of the country. GHESKIO, founded by Dr. Jean Pape in affiliation with Cornell University, operates 28 clinics around the southern areas as well as in Port-au-Prince. These two organizations rightly deserve credit for their pioneering efforts to make ARVs available in Haiti.

Both groups have set up field hospitals and brought in hundreds of volunteers and are managing huge relief efforts. Both are overwhelmed. Establishing on-the-ground relationships with them is critical to our patients and to the success of the clinics.

After several attempts to arrange meetings, Dr. Patrice Severe, who oversees HIV care for GHESKIO, drops by the PHAP+ clinic on Friday afternoon. He is in a hurry. Patients with active and multi-drug resistant TB, many also living with HIV/AIDS, have been staying in open wards in the field hospital for lack of any other shelter. GHESKIO is managing a 6,000 person, spontaneous, refugee camp that has sprung up around its hospital.

Patrice is moving these patients and their families to a separate camp where the patients can be kept in isolation. There is already a great risk that a large number of people have been exposed over the last four weeks.

I explain the two clinics we are supporting in Port-au-Prince. "What do you need?" he asks. I explain that we have run low on antibiotics and that we are out of ARVs, and are in need of more volunteers. Patrice says, "At the hospital we have so many volunteers, 10 doctors where we just need one in some units. I will see if we can't get some of the Haitian doctors to come over and support you. And we can share some antibiotics and other medications. Let's do a list."

He is reluctant to give us ARVs, however. I explain the careful steps we have taken to verify people's regimens, our charting system and the use of short term directly observed therapy for people who indicated a lack of understanding about usage.

Patrice wants us to refer everyone who is HIV-positive to a GHESKIO clinic for lab work, which is fine since we don't have the ability to do confirmatory or CD4 tests in any case. GHESKIO will prescribe the ARVs but send the patients back to PHAP+ for follow-up and ongoing care. This concession reflects the fact that GHESKIO really is functioning well beyond its capacity. And it guarantees access to an ongoing supply of ARVs for PHAP+ patients.

Now if only we can strike a similar deal for the FEBS Clinic in St. Marc.

The FEBS Clinic finally opened this last Wednesday. John Roberts and Eleftheria Tsavoussis (known to us as "Lefty"), two nurse practitioners from Boston, and Rowan, one of the SOLO EMTs got it going with the help of a local pediatrician, Dr. Valerie. FEBS staff had already done a great job pre-registering patients. So the clinic opened with over 300 patients pre-registered.

Jobanny and I arrive at the clinic Friday evening just as the three volunteers are settling in around the table in the main room for a celebratory pre-dinner toast of Haitian rum. They are clearly exhausted but exhilarated with what they have done. In three short days, they have seen nearly 300 people with everything from serious earthquake injuries compounded by long hard rides on top of piled-high trucks leaving Port-au-Prince to hernias and abscesses.

FEBS staff have been everywhere -- managing paperwork, escorting folk to the hospital, stocking the pharmacy, and providing translation. Rowan has a generator working to supplement the sometimes feeble public utility, and, John brags, unlike the camp in Port-au-Prince, the toilet actually flushes ... you just have to fill up the tank with a fresh bucket of water each time.

Kenny comes by to meet with me, reporting on what has taken place today, and planning for meetings tomorrow at the local hospital. Later, he gives me a tour of the building. We talk about each space and exactly what modifications are needed to give the clinic true functionality. For example, We need more shelves, a refrigerator and a small desk for the pharmacist. And in the main room, two sets of partitions for semi-private consultation cubicles, with a second bathroom are needed.

John promises to make a list of equipment we should have on site. He also wants to work with us to introduce electronic medical records. The paper charts are already messy. Rowan is going to look at options for electricity. I promise to spring for a can of paint on my next trip. With a little loving attention, this could soon be the finest primary care clinic in Artibonit.

Jobanny and I spread out our bedrolls in the exam room. There are no screens on the window. Around 2:30 in the morning, we are both awakened. There are hymns still being sung at the church service down the street, but it is the mosquitoes that get us up. Groggily we douse ourselves with Deet spray. John told me they treated three people for malaria over the last couple of days.

The next morning, Kenny comes by at 8:30 sharp. I've already provided translation for two patients who came by for follow-up even though the clinic is closed. One young man is shown how to clean a large drained abscess on his cheek. An older woman, with both diabetes or "sik", and hypertension, brings back a lab report. Both her sugar and blood pressure are stable. She is given an appointment to return next Tuesday, when we will have a new team of nurse practitioners in from Washington, DC.

Kenny and I head over to the hospital, where we meet with Dr. Roosevelt Michel. He is the local coordinator with Zanmi Lasante. He tells us he has only been at this post for three weeks.

Read all of King's blog posts from Haiti

Please consider donating to Housing Works' relief efforts in Haiti. Every dollar makes a difference.

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Charles King Blogs From Haiti

Charles King

Charles King

Charles King is the president and CEO of Housing Works which has been providing services since 1990 to homeless men, women, and children living with HIV and AIDS in New York City and beyond. King is one of a handful of people living with HIV at the head of a major AIDS organization. He cofounded Housing Works with his life partner Keith Cylar. When Cylar passed away in 2004, King took the reins.

Born and raised in a small town in Texas, King attended Yale University's law school and divinity school and was ordained as a Baptist minister by an African-American church in New Haven, Connecticut. He conducts a weekly Bible study course at Housing Works' Keith D. Cylar House, where he lives in a small, book-lined studio. King also leads Housing Works' advocacy department and has been arrested dozens of times.

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Recent Posts:

March 2, 2010 - The UN Responds to Calls for Haiti AIDS Strategy, but Activists Are Skeptical

March 1, 2010 - UN and UNAIDS Must Address Needs of Haitians With HIV/AIDS

February 22, 2010 - A Slow Recovery in Haiti

February 16, 2010 - Haiti Progress: St. Marc Clinic Opens, ARVs for Patients Secured

February 14, 2010 - On Haiti Day of Prayer, Activists Discuss Long-Term Goals for HIV Clinics

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