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An ounce of prevention is worth a pound of cure. --Ben Franklin

Poem from Haiti

--by Sriram Shamasunder, Oct 22, 2014

Nobody should die from diseases we know how to treat. Currently in all areas of the world over 50,000 people die daily from diseases we can treat. One component of getting good care in very poor places is to have the human capacity and training to deliver good care.

Two UCSF Physicians have started a project called the HEAL initiative(www.healinitiative.org) that aims to address health workforce in resource poor communities. HEAL initiative works at sites domestically and internationally, from Navajo Nation in New Mexico to Liberia and Haiti and India to both improve the quality of care, support and train local health professionals.

The work that is about health care but is also beyond health care. It is about solidarity and justice. A simple home visit can shape the way anyone thinks about health. Last week, HEAL initiative founders accompanied some skilled community health workers at Zanmi Lasante in Haiti on home visits.

Zanmi Lasante, the sister health organization of Partners in Health in Haiti have been making patient home visits for decades. Patient home visits are deeply embedded in the philosophy of finding the most vulnerable patients and getting health care to them instead of waiting passively for sick people to come to the hospital.

This past week, we trekked up the mountain to reach a patient's house in rural Haiti. The community health workers sit with patients and discuss what ails them on many levels.

The travel can be arduous. The rivers become so swollen in the rainy season they are impassable. The stony mountains jab at our heels as we make our way up the hill. The heat blazes to leave soaked skin.

But it is this journey on foot that so much is revealed: the distance for a patient to the nearest hospital, and the fortitude required to walk that journey. What it might be like to cross a river barefoot with a two year old on your hip. When someone can't pay for medicines or health care, what other costs may be suffocating their budget?

On arrival to the house, the family structure is revealed, how many people are staying under one roof, what material makes up that roof, straw or tin or concrete? Does the patient own his/her own land? Are there crops rising up from the soil or is the land barren?

On one home visit we came across this grandmother inspired this poem. There was a simultaneous feeling that her needs are deep, and suffering immense. But also a hope.

Towards Flooding Homes with Dignity

In the mountains of Haiti looking out over the central plateau
the hills roll along like massive unripen green mangos scattered across as far as I can see

light falls at an angle
creates a color
I have never seen

an urgent rain scatters as fast as it came
ushers in it's place a sweet scent that I cannot name

the old woman in front of me
in rural Haiti
her daughter has left to Port au Prince to find work
leaving several young children behind

this grandmother cajoles the
emaciated land to cough up fruit and nuts that might feed three hungry bellies
a desperation easy to feel as
sticky midday Haitian heat against skin

her loneliness as obvious as any aching swollen joints
and probably pangs her more

why would I not spend the rest of my days
her wrinkled hand clasped in mine?
what solidarity other than this could be more important?
what task more important could beg me away?

what edifice could pretend to promise more purpose
for a longing human heart?

today I wish I was a tin roof
long and lean
without slits or holes
I would spread out over this small house

so rain does not fall through
like an unwelcome drunken guest
a wet collapse across the mud floor

but between the stuttering rain
if we listen

an army of skilled Haitian health workers gathers strength in the distance
nurses, accompanateurs, doctors, mental health workers

in every corner of the land
they gather
like a prayer as precious as health
like a clandestine blessing

in time
the Haitian health worker peace army
will spread out like a cool breeze
throughout the landscape

they will walk over the massive unripe mango like hills
to arrive
at the precipice of this old woman's house

to offer the clasp of a hand
and some fruit

cover her small plot of land
with the solidarity of the right to health

scatter seeds across soil that grow into
food to fill bellies

flood her home with
dignity

flood her home
with love

flood her home
with something other
than rain

In addition to a community heath model, Zanmi Lasante is training a generation of physicians and nurses in a new tertiary facility. There is a new generation of surgeons, and family medicine doctors, and advanced care nurses, and internists going through advanced training in large numbers for the fist time. This the Haiti health professional peace army that will lead for years to come. What makes this tertiary hospital important is that it is embedded in a community health model with accompanateurs as the cornerstone.

The community health model of Zanmi Lasante is a simple solidarity of sitting and listening in a patient's home, of seeking out the most vulnerable and sitting with them side by side. As we walk to their houses, we tie some of the most vulnerable into community clinics as well as a high quality tertiary facility with skilled Haitian health professionals. To witness this solidarity and movement towards health as a human right is to witness something precious becoming conferred as a right. It is changing the landscape in Haiti as slowly but as surely as the rain or the earthquake. The HEAL initiative aims to train a generation both domestically and internationally that might become skilled at flooding homes with dignity




Author: Sriram Shamasunder, MD (previously featured on DailyGood: "A Doctor-Poet's Birthday in Burundi") Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, e-mail: sshamasund (at) medicine.ucsf.edu . Open Access:  This  article is distributed  under the  terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. 


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