MUSC Infectious disease expert treats kids in Haiti

By Helen Adams

It’s a long way from the historic streets of Charleston to the unpaved roads of rural Haiti in more ways than one.  Not only is it a trip of more than a thousand miles; it is also a journey to a country trying to recover from years of government corruption, a devastating 2010 earthquake, a cholera epidemic, and poverty described by the U.S. government as the worst in the Western Hemisphere.

In June, a team of medical students, physicians and other health care providers from the Medical University of South Carolina (MUSC) made that journey on a volunteer mission to help people in central Haiti, about an hour and a half from the capital city of Port-au-Prince.  They were based in Thomonde, an agricultural community of just a few thousand residents who have beautiful views of green hills and grazing farm animals but don’t have easy access to health care.

International agencies, including the World Bank and World Health Organization, rank health care in Haiti as poor.  Fewer than half of the people there have the recommended immunizations, there are sanitation problems and people die from preventable diseases.

“We saw a lot of people who had problems that you don’t typically see in the US,” said Terry Dixon, MD, PhD.  Dixon, an MUSC pediatric infectious disease expert and assistant professor of pediatrics, served as a mentor for the students on the trip.

An example that stood out:  “We treated some kids who had chikungunya,” remarked Dixon.

Chikungunya has nothing to do with chickens.  It is a mosquito-borne virus whose name comes from an African word meaning “to become contorted.”  The term describes how the virus’s victims look as they deal with the severe joint pain it causes.  Since there is no medicine that specifically treats chikungunya, the MUSC team treated the children’s symptoms and made them as comfortable as possible while the virus ran its course.

Other ailments the MUSC team treated in Haiti were less exotic but surprising in their own way.

“We saw one teenager who had heartburn for eight months,” Dixon said.  “Here, I’d just go to the drugstore and get some Zantac and call it a day, but he didn’t have that.  You really felt for this guy to have that kind of pain for so long.”

The MUSC team helped hundreds of patients during its week-long stay in Haiti.  It was based in a clinic in Thomonde provided by the non-profit Project Medishare, and sent students and mentors out into even more rural areas each day to reach as many people in need as possible.  Three-quarters of the patients were children, according to Dixon.

Many of the people treating those patients were relatively young as well.  The MUSC group was organized not by a professor or a dean but by medical students with the group MUSC Service Learners International (SLI).  They wanted to learn what it was like to practice medicine away from the technology-filled facilities at MUSC.  In Haiti, expensive equipment was in short supply.  The students had to rely on what they’d learned about hands-on medicine.

Before the trip, “I underestimated and underappreciated” the importance of physical exam skills, said second-year medical student Melissa Hite.

She was not the only one. Dixon smiled, remembering how other students evolved during their time in Haiti, learning to listen closely to their patients and trust their own observations.

“A kid coming in with a cough, a fever, they perform an exam and find all the signs of pneumonia,” Dixon said.  “And we say, ‘This kid has pneumonia.  What do you want to do?’  They’re like, ‘Well, I’d like to get a chest x-ray.’  You’re like, ‘Why?  You already know the kid has pneumonia from your exam.’”

The pace was fast.  For example, Dixon estimates that he and another MUSC pediatrician on the trip treated more than 250 patients during their week in Haiti.  Back home in Charleston, they’d treat about 28 in the same timeframe.

By the end of their visit, the MUSC mentors and students were tired but exhilarated.

“These experiences do a lot to build character,” Dixon said.  “It’s great for the students because it reinforces why they’re going into the medical field.”

The trip served another purpose as well.  It allowed the students and their mentors to make use of MUSC’s Center for Global Health.  The Center helps the MUSC community find funding and other resources for volunteer work outside the US. Dixon received one of three newly established Faculty Mentorship grants the Center offers to travel on his most recent trip to Haiti.

“The mentorship grant was extremely important because it allowed me to travel to Haiti and provide guidance to our students,” said Dixon. “I was very grateful to receive the grant.”

The breadth of expertise and knowledge offered by SLI’s mentors gave students an opportunity to treat a large number of difficult cases with real-time, immediate feedback in an environment devoid of advance diagnostic technologies.

“Dr. Dixon is unique in that his specialty of pediatric infectious disease is very relevant to the population that we work with,” said Hite, “and his knowledge of disease is not only admirable but indispensable in our work.”

MUSC had the foresight to, in implementing its 2010-2015 Strategic Plan, include globalization among its four areas of emphasis.  The Haiti trip provided a good example of the reason for MUSC’s growing interest in global health.  The chikungunya virus that doctors and students encountered there recently appeared in South Carolina for the first time in a person who had recently returned from Haiti.  Dixon predicts more cases here in the future as mosquitoes carrying the virus move into the US, showing that health issues are not bound by borders.

Helen Adams is an intern in the Center for Global Health