Stichting Projecthulp Haïti

Maart 2008

Foto's februari 2008

Dia presentatie februari 2008.

Medical Clinic in the Haitian village of Prospere (John Ackerman)

Vitamine project support by Stichting Projecthulp Haïti

In 2005/2006 heeft projecthulp USD 6000 gegeven voor het Vitamine project voor de kliniek van John Ackerman . Voor dit bedrag zijn vitaminen preparaten gekocht in India (daar waren ze het goedkoopst) en velen, vooral kinderen en zwangere vrouwen hebben hier heel veel baat bij.

Reis februari 2008
Medio februari 2008 mocht ik Haïti bezoeken (vanwege een escortering voor WK) en tijdens dat verblijf ben ik in de gelegenheid geweest de kliniek te bezoeken.
Hieronder vindt u een verslag.

Dinsdagavond 12 februari 2008 werd ik gebeld door John Ackerman, hij zou mij de volgende morgen ophalen tussen 06:25 en 06:30 uur. Dat was typisch John.
Man van afspraken en daar was hij stipt op tijd de woensdagmorgen.
Op weg naar de kliniek werd een Haitiaanse verpleegster en een tandarts opgehaald. Men stond te wachten langs de weg. De tandarts achter in de bak van de truck.
Richting Dominicaanse grens, daar vlak bij gekomen gingen we van de begaande weg af naar het 'einde van de wereld' en toen nog een stukje verder.
Daar waar je het niet verwacht staat een klein kerkje op een 'stukje' berg, onder de kerk is een ruimte waar de kliniek gevestigd is. Een kale warme stoffige ruimte. Niet te vergelijken met onze polikliniek.

Met verbazing zag ik vele mensen wachten in hun mooiste kleren.
Er was een soort van wachtruimte gemaakt. John vertelde dat velen mensen uren (wel 8 tot 9 uur) moeten lopen en dan tegen de avond of in de nacht aankomen.
Om het wachten te veraangenamen is toen een wachthokje gebouwd.
De deur van de kliniek werd opengemaakt en wat je daar ziet is onbeschrijfelijk.
Oude onderzoekstafels, dozen vol medicijnen van alles en nog stond op de grond.
Een kliniek waar je in Nederland niet mee hoeft aan te komen.
Er is een kleine generator, voor de ventilatoren en voor de bloeddruk meter.
Een dopple-apparaat werd klaargelegd. Die wordt gebruikt voor het horen van de hartslag van de baby in de buik van de moeder.
De voorganger van de kerk (Pastor Francois) is "de boekhouder", samen met de Haitiaanse verpleegster wordt de 'intake' gedaan. De patiënten hebben zelf hun patiëntenkaart bij zich. Nieuwe patiënten krijgen er één van de verpleegster.
Men moet een klein beetje geld betalen (naar vermogen) in Gourdes, dat is het lokale geld, dat soms zo vies is, dat wij het niet durven aanpakken.
Ieder patiënt krijgt een volgnummer uitgereikt. Hiervoor worden oormerken van koeien gebruikt (dat is van plastic en gaat lang mee).

Bij de wachtend patiënten is een zogenaamd koopvrouwtje bezig eten te maken die zij verkoopt aan wachtende patiënten.

Inmiddels had John de kliniek in gereedheid gebracht. Twee teiltjes met drinkwater en een sterilisatiemiddel voor de broodnodige 'steriliteit' van handen en instrumenten.
En daar begint het spreekuur.

Aan de ene kan de Haitiaanse verpleegster die de routine controle uitvoert op de in verwachting zijnde patiënten.
Dopple apparaat, bloeddruk alles werd gecontroleerd, was het goed dan kreeg twee strips vitamine en één strip Aspirine.
Bij complicaties of vermoeden daarvan, wordt de patiënt door John onderzocht.
John zelf onderzoekt verder alle andere patiënten.
Het viel op John, die tijdens de rit een redelijk agressieve chauffeur bleek te zijn, veranderde zodra hij de rol van ´dokter´vervuld.
Met enorm geduld en aandacht spreekt hij met de patiënten, doet onderzoeken, stelt hen gerust. Wat had die man een enorme uitstraling.
Iedereen werd in zijn waarde gelaten.

Uiteraard werd aan mij per patiënt verteld wat er aan de hand is en welke de remedie hij ging toepassen.
Vaak wormkuren voor kinderen. Middel tegen schurft en bijna altijd werd dit vergezeld van een strip met vitamine.

Bij ernstige zaken kan John zelf niets doen en verwijst hij door naar het (Universiteits) ziekenhuis in Port au Prince.
Bij andere ziekenhuizen moet eerst betaald worden voordat je geholpen word en dat geld ook voor de meeste artsen in Port au Prince.
Geen geld, geen hulp.
Port au Prince ligt voor deze mensen heel erg ver weg en het reizen daar naar toe kost soms meer dan een dag.

Kinderen gaan vaak dood aan mazelen, voor ons onbegrijpelijk.
Veel mensen sterven nog aan TBC .
Ziekten die bij ons al 'geen ziekten' meer zijn, zijn levensbedreigend in Prospere.

Opvallend is het geduld van de patiënten. Loopt een spreekuur in Nederland uit dan zie je vaak boze gezichten in de wachtkamers, hier wacht men geduldig.

Tussendoor even bij de tandarts wezen kijken. Deze heeft een eigen praktijk in Port au Prince, komt eenmaal in de week en helpt hij de mensen in de wijde omgeving van Prospere.
De verrichtingen van de tandarts beperken zich tot het trekken en reinigen ( tandsteen e.d.).
Hij maakt zijn instrumenten schoon met een Dubro sopje. De instrumenten zijn flink in het sop gezet, daarna goed schoongespoeld met drinkwater (meegenomen uit Port au Prince).

Veel moeders komen met hun (kleine) kinderen. Die kinderen moeten vaak uren wachten.
Er is geen voorziening waar ze kunnen kruipen of spelen.
John vertelt dat er ongeveer 3000 USD nodig was om een soort van Crèche te bouwen en in te richten, (met een soort van vloerbedekking of zoiets en een dak tegen de zon en regen). Zodat de aller kleinste kunnen kruipen.
Voor de wat grotere kinderen wil hij wat speelgoed zoals een schommel en een wip aanschaffen. (Projecthulp heeft deze 3000 usd toegezegd.)

Laat in de middag als iedereen is behandeld gaan we moe en voldaan naar huis.
Op de terugweg zijn mensen bezig is bij het riviertje dat vanaf de bergen naar het vlakke land loopt.
De één doet de was, de ander wast zich zelf, weer een ander wast de groente en sommige drinken er uit en dat het gehele traject lang. Een wonderlijke ervaring.

Zo wordt je met de neus op de feiten gedrukt.
Geen dokter in de wijde omgeving, uitsluitend een verpleegkundige die met hart en ziel de mensen daar helpt, dit afgezet tegen onze eigen gezondheidszorg. Een groot verschil.
En wij vinden het in Nederland maar allemaal gewoon.

De mensen daar in Haïti ook. Ze weten niet beter.
Leven en Dood erg dicht bij elkaar.
Niets hebben en toch blij zijn.
Wachten op morgen iedere dag maar weer.

Hebt u vragen over dit project?
Dat kan mail naar info@projecthulp.nl of bel met 0598-614814

Wilt U financieel wat geven voor dit project, stort dan uw bijdrage op bankrekening 42.91.01.082 ten name van Projecthulp Haïti Veendam. Met vermelding van John Ackerman.

Via ons contact Evelien de Gier ontving Projecthulp Haïti een verzoek voor Vitamine, bestemd voor een kliniek net buiten de stad (richting Dominicaanse grens).
Deze kliniek valt onder verantwoordelijkheid John Ackerman (www.totheleastofthese.org), in samenwerking met Evelien en Kees de Gier zal projecthulp hieraan meewerken voor de eerste periode heeft Projecthulp Haïti $6000 overgemaakt, Evelien houdt in Haïti de vinger aan de pols.

Zie verder de informatie hieronder:

Uit het NCR Handelsblad:

Vitaminetekort catastrofe

Door onze redactie wetenschap

ROTTERDAM, 25 MAART. Naar schatting een derde van de wereldbevolking blijft achter in de intellectuele en lichamelijke ontwikkeling door een tekort aan vitaminen en mineralen. Dit schrijven UNICEF en de Micronutrient Initiative in een verslag over de voortgang van de strijd tegen deze 'verborgen honger'. De oplossing van dit probleem (verrijking van voedingsmiddelen en gerichte campagnes) is relatief goedkoop, aldus de organisaties, maar de voortgang lijdt onder een gebrek aan belangstelling van regeringen, media en publiek. In 2002 besloot de Algemene Vergadering van de VN dat het jodiumtekort in 2005 geheel opgelost zou moeten zijn, net als het tekort aan vitamine A in 2010.

De onderzoekers schatten dat alleen al jodiumtekort de intellectuele vermogens van de tachtig armste landen ter wereld met 10 tot 15 procent heeft verlaagd. In de industriële landen komen dit soort tekorten nauwelijks nog voor door verplichte verrijking van veelgebruikte voedingsmiddelen, zoals jodium in zout en (in de VS) foliumzuur in meel.
Dat extreme tekorten aan essentiële vitaminen en mineralen ernstige ziekten kunnen veroorzaken is bekend, maar pas de laatste tien jaar is het besef ontstaan dat ook geringere tekorten ernstige gevolgen hebben op de lange termijn. IJzertekort leidt bij 40 tot 60 procent van de jonge kinderen in de Derde Wereld tot een verzwakking van de intellectuele ontwikkeling. Jodiumtekort tijdens de zwangerschap leidt tot de geboorte van 18 miljoen baby's met een geestelijke achterstand (op een totaal van 129 miljoen geboortes per jaar). Een tekort aan vitamine A leidt tot verzwakking van het immuunsysteem bij 40 procent van de baby's en kleuters in de Derde Wereld, met dodelijke gevolgen bij 1 miljoen van hen. Gebrek aan foliumzuur leidt wereldwijd jaarlijks tot de geboorte van zo'n 250.000 baby's met ernstige afwijkingen.

In de zwaarst getroffen landen (Afghanistan, Mali) leidt alleen al het tekort aan deze voedingsmiddelen tot een 2 procent lager bruto nationaal product. In een nog relatief welvarend land als Turkije wordt het jaarlijkse verlies aan productiviteit geschat op 0,7 procent.
Verschillende tekorten doen zich vaak bij dezelfde kinderen en volwassenen voor. De helft van de kinderen met een vitamine- of mineraalgebrek lijdt onder meer dan één tekort.

Supplemental Vitamins for the Most Important times of Life

Overview

Pregnant women and young children will be able to supplement their often very poor diet with vitamins given to them at the 'To The Least of These' clinic. It is expected that through the taking of these high quality vitamins the pregnant women will be in a higher state of health when they deliver the baby. Thus, babies will be more viable at birth because their mothers took these vitamins during the antenatal period.

Young children under the age of 10 years old given vitamins during their childhood will also have a higher quality of health.

These people who will be given vitamins will be patients at the 'To The Least of These' clinic, which is located in Prospere, Haiti.
John Ackerman, an American Registered Nurse who has been doing medical clinics in Haiti for eighteen years, runs the clinic. Edin Francois, a Haitian Registered Nurse who has been working in the clinic for the past four years, assists him. The clinic is open three days a week and sees a wide variety of patients. Almost all the patients are from a very low socio-economic class. On the average clinic day the number of patients seen can vary greatly, from as few as twenty-five to as many as seventy.
Pregnant women make up approximately 20% of the patients. The percentage of children is much more varied, making up anywhere from 30-60% of the patients.

Background

Haiti is known throughout the world as 'the poorest country in the western hemisphere.' Not only is the average Haitian very poor by world standards, they are also less educated and are usually in a poorer state of health. The average Haitian lives only to age 56, as compared to the average of 74 for the United States. Contributing to this is their diet, which is very poor, not only because of economic problems but also because of their choices in foods. Although the great majority of Haitians are breast-fed they are weaned at a very early age. They are encouraged to eat a diet very high in processed sugar, salt, and large amounts of oil and fried foods. This sets many of them up for problems with hypertension, diabetes, and gastro-intestinal illnesses later in life. Although many children get enough quantity of food to eat, the quality of what they eat is very poor. This frequently causes vitamin deficiency. Thus, they develop many illnesses due to their weakened states. Some of the diseases to which they are prone are tuberculosis, lung and abdominal infections, and multiple skin funguses and infections.

I have observed that the average female who live in or near the village of Prospere gets pregnant with her first baby on or around her 20th birthday. She is usually a young lady who has grown up eating a poor diet and taking little care to get what she needs for her body to develop well, especially through the years when she is fertile and having babies. The practice of birth control, although somewhat common is not desired by most Haitians. Thus, the number of times a woman becomes pregnant varies widely. I have seen a few women who have had 20 babies, which means that they have probably been pregnant more than that since most do not even know when they have spontaneous abortions. I also recall a lady who had 12 delivered pregnancies but only one of the children lived more than a month after the birth. Without good nutrition during pregnancy and delivery many women decrease in body strength and health states with each pregnancy. Thus the baby is born in a diminished state and the mother’s demise comes earlier in life.

When the baby is born to a mother in a weakened state, that adds to the chance that the baby will be still born or very weak at birth. I have never had the personnel or time to personally do high quality research on the mortality rate of mothers and babies who come to the clinic.
From my simple observations I have concluded that when I began the clinics approximately 13 years ago a mother who delivered a baby would have a 20-25% chance of her child dying before age 5. I have noticed in recent years the numbers appear to be improving but I am still unable to report any numbers from any research studies. Mothers are still probably losing between 12-15% of their babies before age 5. This is far worse than the average rates in the rest of the world.

Goals and Objectives

Goal #1 – To Improve the health of pregnant women during their antenatal period.

Objective #1.1 – To provide all pregnant females who come to 'The Least of These' clinic with a high quality, iron rich prenatal vitamin for the entire time they are under the care of the clinic during their pregnancy.

Objective #1.2 – To alleviate problems of nausea while taking the prenatal vitamins by having antacids available for those who need them.

Goal #2 – To reduce the severity of malnutrition and the number of children who are malnourished.

Objective #2.1 – To encourage pregnant females who come to 'The Least of These' clinic to exclusively feed their babies breast milk until the babies are at least 6 months of age.

Objective #2.2 – To encourage pregnant females who come to 'The Least of These' clinic to breast-feed their baby as long as the baby will continue to take breast milk.

Objective #2.3 – To furnish children under the age of 10 who are seen at 'The Least of These' clinic a month’ s worth of vitamins to be taken on a daily basis. If the child appears to be anemic, vitamins with iron will be given.

Objective #2.4 – To observe for signs of worms, marasmus, and kwashiorkor and treat these nutrition problems appropriately.

Methods

Pregnant women will be encouraged to come to 'The Least of These' clinic at least once a month during their months of pregnancy. At their examination they will be checked for their general health status. The heart and lungs will be auscultated, eyes and throat will be examined, general skin condition will be evaluated, and their face and extremities will be observed for swelling. Abnormalities are noted. Any swelling is followed up with urine tests and blood pressure evaluation. Any patients who are observed to be in a state of pre-eclampsia are referred to the Chancerelles Hospital in Port-au-Prince where the patient is maintained or released back to our care after evaluation. General complaints are evaluated. The height of the fundus is measured and evaluated for fetal growth. A Doppler is used for the nurse and the patient to be able to hear the sound of the baby’s heart beat. Any problems are evaluated and treated appropriately, or they are referred to another health care facility. The patient is given a prenatal vitamin, acetaminophen for general aches and pains, and any additional medication and treatment that we believe to be needed.

Many children are seen at every clinic. Most are there because they have a cold, fever, or aren’t eating. We do a general physical on each child in order to come up with a diagnosis. We give instructions to the child’s parents or caregiver and any medication that may be needed. We plan to give each child over the of age 18 months daily multi-vitamins for one month or multi-vitamins with iron if the child appears anemic.

Babies under the age of 18 months would not be given vitamins unless the child appeared to be in a state of malnutrition. In malnutrition cases, liquid multi-vitamin drops would be given. If the baby appeared anemic, multi-vitamin drops with iron would be given. These babies would be followed by appointments until the condition is elevated.

When one of our prenatal patients gets closer to her time of delivery we begin to encourage the patient at each appointment that she is to give the baby nothing but breast milk from the time it is born until the baby is at lest 6 months old. We have been doing this for a number of years now and are observing much healthier babies.

Funding for this Project

'To the Least of These' clinics charge an initial charge of 20 Haitian dollars ($2.20 US) at the time of the patient’s initial visit. They are given an index card with their name, age, and date. This is their 'medical record' for which the patient is responsible. On subsequent visits to the clinic, if the patient returns with their 'dossier', they are charged 12 Haitian dollars ($1.30 US).

We have found the income from the clinic has been ample to pay for the wages of the nurse, a small stipend to one other worker who helps in patient control, and pays for all the medicine and equipment that we purchase and distribute at the clinic. Many of our medicines are furnished by a mission organization called 'Christian Aid Ministry' which makes it possible to keep our charges to patients low. John Ackerman is a missionary and is supported by a number of churches and individuals in the United States and Europe.

What we are requesting is additional funding so we will be able to fund the purchase of all prenatal vitamins, children’s chewable vitamins, children’s chewable vitamins with iron, baby vitamin drops, and baby vitamin drops with iron. Although we have been able to distribute some of these in the past, due to irregular contributions of these to our supply via Christian mission organizations, that supply is often less than dependable or not available at all. Their excessive cost makes it impossible for the clinic to purchase enough to treat the entire clinic population.

The costs for the following assessment are what I have found to be 'somewhere in the middle' of the price range.

The budget needed for this project is to fund approximately 900 months of prenatal vitamins, and approximately 1800 months of children’s and baby’s vitamins. The prenatal vitamins cost approximately $3.50 US for each month and the cost for each month of children’s and baby’s vitamins are approximately $1.50 US for each month.

Your consideration for this grant would be greatly appreciated.

Very Respectfully Submitted,
Because of Christ,
John Ackerman

Mail 8 september 2004:

My Dear Dutch Friends,

First of all I want to thank you for the grant you rewarded to “To the Least of These Ministries” for the distribution of vitamins to pregnant women and the children who are seen in our clinic. I trust and believe it will be a positive experience for both of us.

I want to bring you up to date on what we are doing with the $2000 US you have sent to us. I have deposited that check in our account here in Port-au-Prince.

We have purchased 288, 30 pill bottles of prenatal vitamins. By taking two pills out of each bottle, because we work on a 4 week basis instead of a 30 day one, we have approximately 308 months of these purchased for approximately $916. That is very expensive I realize but I know of no other place to get this quality of vitamins for any less a price. I believe this initial purchase will last us through sometime in December.

I also purchased 4 gallon of children’s vitamins which we repackaged into approximately 128 of distributable 4 ounce bottles. By repackaging them we saved approximately ¾ of the cost of purchasing the vitamins already pre-packaged. The total cost of these vitamins were approximately $105.00 total.

I also purchased 50 bottles of baby’s vitamin drops. Their cost was approximately $110.00 total.

Including the repackaging and transportation I have $679.00 left of the $2000. I believe the estimate that we have given will turn out to be close since I should have enough prenatal vitamins to cover 4 months. The rest of the $679 will probably be needed for additional children’s and baby’s vitamins before that 4 month period is finished.

Please, if you need more exact numbers let me know and I will be glad to work on them.

Please accept sincere appreciation for your help in this project. We trust it will make a very positive difference in many people’s lives.

Sincerely,
John Ackerman

Mail 3 juni 2005:

Dear Friends,

I am writing to let you know that all the funds that you have so graciously given (except for $30 which is still left in the account) have been used to purchase, package, and bottle vitamins for many babies, young children, and expectant mothers. I am unable to give you the exact number of pills, months of prenatal vitamins, or bottles of liquid vitamins given out at the clinic but it certainly seemed like a lot. Just as a little example of the numbers we have been dealing with; since January 2005 we have done more then 2700 patient consultations. Of these I would estimate that 35% were examinations of pregnant women. About 13% were young babies, and probably about 25% were young children through early teenagers. Most of these patients received vitamins along with other medicines for the treatment of their malady.

My only personal conflict would come when I was dealing with the very young babies. I have a very strong belief that one of the most prevalent reasons why the mortality rate here is so high is due to the fact that mothers of newborn babies attempt to almost immediately try to force the baby to eat food, drink cows milk, drink water, and get the baby off breast milk. These babies are often very small and have a difficult time thriving. For that reason I try to keep a standard in which a mother and baby that is seen at the clinic will exclusively breastfeed for seven months prior to including other liquids and food in the diet. This standard isn't kept by all my patients but the longer I push this idea, the more women I find following the recommendations. We are seeing healthier babies through this. So, the conflict comes when I see these babies less then 7 months old. In order to not go against the standard policy about exclusive breastfeeding I choose to not give vitamins simply in order to show my belief that breast milk is more important then early vitamins. If the baby is emaciated and having difficulty thriving I do overcome this though and do treat the sick baby with vitamins in addition other medicines to counteract the illness.

Of the $6000 that you have given toward the project all the funds have been used to purchase vitamins directly except for the $30 which is still in the account, $23 which went toward the work of one person and her transportation in order to collect examples of useable vitamins that we could evaluate for the program, and $200 for bottles that were use to dispense to the children.

Things I have learned:

1. Vitamins, especially prenatal vitamins are very expensive. I began in September of 2004 purchasing packaged "prenatal vitamins" but by the time December came I realized that it would be impossible for me to make it to the end financially if I continued to do this. At that point I changed to a bulk packaged high potency vitamin that contained an ample amount of iron and also folic acid. These were still expensive but the amount that I saved by going this route was enough to allow us to purchase enough vitamins that we now have enough to last us through the month of August.
2. I saw the need for a different type of High potency vitamin for babies and children that contained more iron in order to treat the occasional case of severe anemia. This purchase also helped to drop the amount of funds available for the prenatal and regular children's vitamins but I found it a very important addition to the vitamin arsenal.
3. There are very few dependable outlets for good vitamins in Haiti. In all our checking we found three or four pharmaceuticals that sold vitamins but they are mostly very undependable for having their products. The one we primarily used; 4-C is usually dependable but also relatively expensive.

Again I wish to thank you for allowing us at "To The Least of These Clinic" to use your funds in order to support the health of some of the people of Haiti. It has been an honor to be able to work with you and hope we can make a way in which this program can continue beyond the present year.

Very Sincerely Yours,
Because of Christ,
John Ackerman

Mail 7 september 2006:

Dear Friends,

I wanted to give you an update on the status and progress of the Vitamin Project that we have carried out at the To The Least of These Clinic in Haiti.

This year we have performed approximately 3800 exams and treatments of patients at the To the Least of These Clinic at Prospere. This number is again down slightly from the past two years due to longer periods of poor weather in the mountains which keep the persons who walk long distances from coming and our vehicle inaccessibility. Also the political insecurity has been an added problem which has kept people from coming to the clinic.

We continue to give many babies, most children, and all pregnant women vitamins at each visitation of the clinic. We feel that the vitamins for the pregnant women are extremely important and make a very large difference in the health of the baby and also the mother after the delivery.

At the beginning of this year we changed our choices in prenatal vitamins to simply a high Iron multi vitamin instead of the traditional prenatal vitamins which was given along with a folic acid tablet each day. Actually we are finding that the women prefer this since they find them easier to take and keep down due to a common acid reflux problem associated with the prenatal vitamins. We are seeing good results with this new regimen and do know it has lowered our costs to make it workable for the finances of the clinic.

Again, I wish to sincerely thank you for the money to do this project for this year. We still have $320 left in the vitamine account from this year.

We would appreciate your continuing to fund the vitamin program for the clinic. Whatever you can do would be appreciated. But if you plan to use these funds in a different direction then ours I simply wish again to thank you for your very significant contribution to the health care of a large part of our patient population for these past two years. You are appreciated.

Very Sincerely,
Because of Christ,
John Ackerman

John, Jodie, and Jessica Ackerman
To the Least of These Ministry Serving "the least" with medical care and education in Haiti in the spirit of Matthew 25:40
http://www.totheleastofthese.org/ Updated Sep. 4rd. (Check it out!)