Report 1

Reporter Madeleine Spence

Contact at destination Shawn Hodges. To organise, contact hbsfl@att.net

Year of visit 2019

Country Haiti

Region Limbe

Institution Hôpital Bon Samaritan

Department General Practice/Internal Medicine/Paediatrics

Work / Study undertaken

I spent 3 weeks as a volunteer at Hopital Bon Samaritan. I would spend some time in the hospital pharmacy each morning completing an inventory of the medication sold the previous day, and restocking. I then some time shadowing a doctor in the outpatient clinic, where patients of all ages presented with a huge variety of conditions, some requiring admission. I clerked patients with supervision and assisted in the small ED room next door, with suturing and dressing changes.

I also spent time with a doctor reviewing the medical inpatients, both adults and children. There is a maternity ward at the hospital, and I observed a delivery there. I was also able to spend some time in theatre.

Description of the service and department

Hopital Bon Samaritan is a non-profit organisation, receiving some local funding as well as financial and equipment donations. It was founded by an American Christian missionary in 1953, and although many of the volunteers tend to have a religious focus, this is not a requirement to volunteer.

Haitian doctors run a busy daily outpatient clinic, as well as medical and paediatric inpatient wards. There is a doctor on call 24/7. There is also an obstetrician at HBS, who could perform emergency and elective caesarean sections, as well as some general surgery. Most of the remaining surgical cases would be sent to Cap Haitien. Surgical teams, typically from the US, visit HBS annually and do elective cases; during my placement there was an orthopaedics team for a week.

Patients must pay for everything themselves – cannulas, fluids, catheters, etc. They pay per night stay. The nursing staff at the hospital is very minimal, and the patient’s family will stay at the hospital to look after their basic needs, such as bringing water and meals.

As well as the hospital, there is an orphanage on the same site, and the children are very friendly and keen to hang out!

Description of the destination

HBS is located in a town called Limbe, where there are also several other clinics and a government hospital, as well as schools, a few churches of different denominations, and a market twice a week. Limbe is in the North of Haiti, 18 miles from the city Cap Haitien.

Were the local people friendly? Yes, the Haitian staff were very friendly and welcoming, especially once I attempted some Creole!

Did you feel safe and if not why not? All the hospital buildings and accommodation are enclosed within a compound, so I felt completely safe within this. Volunteers are not allowed to leave the compound alone or after dark, as it is not safe to do so. Haiti is an unstable country, check the UK FCO page for updates, and stay in contact with HBS for information about what’s happening on the ground, as things can change quickly.

What did you do in your spare time? In the afternoons I spent time with the children from the orphanage, helping them with homework or doing arts and crafts. In the evenings we would play games or watch films. I visited the local market with other volunteers, and at the weekend there are trips organised to the beach and for hikes.

Is there anything that you would particularly recommend others to do? Bring plenty of books/things to do in spare time. WiFi is limited! I went to HBS on my own, and the other volunteers there were very supportive and I got a lot out of the experience. However, it was tough at times, and I unless you are used to solo travelling, it might be preferable to visit with a friend.

What time of the year were you there? What was the climate like? I was there in February. The weather was very warm, around 30 degrees, but not humid. It rained most days, bringing cooler weather. None of the hospital buildings have air conditioning, and I think by summertime the heat would be very difficult.

What was your accommodation like? I lived on the hospital site, in my own room with en suite bathroom.

Was it provided? Yes

How much did it cost? Accommodation and food were free.

Did you enjoy your visit? Yes, I learnt a lot and had some very memorable experiences.

Did you find it useful medically? If so, in what way?

Haiti was extremely useful medically, I went at the end of medical school after my finals and I felt it helped consolidate everything I’d learnt. The diagnostic tests available are very limited, for example doctors cannot order U&Es. X-rays are expensive, as are ECGs, which have to be done at another clinic in the town. This means that a lot of thought goes into the benefit of ordering tests. There is a much greater emphasis on physical examination, and doctors are very skilled at this. I examined a lot of patients and was able to elicit many clinical signs. There are lots of antenatal checks in the outpatient clinic, and my obstetric palpation skills improved. I saw presentations at much more advanced stages than in the UK, as well as things like kwashiorkor and typhoid fever.

Has it improved your French? The official language in Haiti is French; children learn it in school and doctors train in French; everything official is written in French. However, the spoken language is Haitian Creole. Some knowledge of French makes Creole easier to learn, since many words are derived from French. By the end of my placement I was able to ask patients basic questions, but it was sometimes difficult to follow the answers. I felt this language barrier did limit my interactions with patients. However, French was helpful, to communicate with the doctors, and some younger people do speak good French. If your intention is purely to improve your French, Haiti would not be the best destination, however if you are at all interested in linguistics, learning Creole is absolutely fascinating and I would really recommend Haiti from this point of view.

How has it increased your knowledge of French culture? I learnt about Haiti’s colonial past. I would recommend reading Dr. Paul Farmer’s ‘Mountains beyond Mountains’ to gain an understanding of the issues facing Haiti politically and economically.

If you went back would you do anything differently? Not much – I had a really wonderful experience. See above about going alone.

How did you get there? I flew via Florida, there are flights to Cap Haitien from Miami and Fort Lauderdale. A driver from the hospital met me at the airport in Cap Haitien. Although flights to the capital, Port au Prince, may be cheaper or more direct, HBS recommends volunteers do not do this, as the airport and roads around it are not safe.

What was the approximate total cost? I spent virtually nothing while I was there since bed and board are provided and opportunities to spend money are limited. I think I spent about $25 dollars on a meal out and weekend trips. The second part of my elective was in Cuba, which is less than 100 miles away, but the flight between them was £400 since you have to go via the Bahamas.

Is there any other information that you think may be useful? It might be worth finding out whether there will be any surgical teams visiting while you are there since this added a lot to the experience. The placement took about 6 weeks in total to organise.