Doctor reflects on experiences in Haiti

Rhonda PecoraroHearts Afire News

By Ed Scott

OUANAMINTHE, Haiti – As the medical team from Hearts Afire  made its way over the bridge that separates Haiti and the Dominican Republic on the island of Hispaniola, a lone man was seen bathing below in the Massacre River, where 17,000 to 30,000 Haitians reportedly were slaughtered in 1937 by the Dominican army under orders by former dictator Rafaél Trujillo. photo 3More than 75 years later, the terror is gone but poverty and hunger persist in Haiti, and the river now serves as a symbol for the work the mission team would be doing that week, as well as a reminder that the Haitian water supply is extremely poor. Two healthcare providers, three registered nurses and about a dozen non-medical volunteers representing Hearts Afire tended to 576 patients over 3 ½ days at the Hope for Haiti Children’s Center (an orphanage also known as Danita’s Children) during the week of July 14, 2013, in Ouanaminthe. “It was really outstanding,” said Daniel Kassicieh, D.O., a board-certified neurologist who has been practicing in Sarasota, Fla., since 1987. “The longer we were there the more efficient the whole patient triage and treatment system became.” Dr. Kassicieh worked side-by-side with Ken Cetin, PA-C, of Sarasota, who runs the Community Care Family Clinic in Arcadia, Fla. Patients were treated for a number of ailments, but there was a central theme. Approximately 75 percent of the adult patients they saw complained of “acid.” “Americans would know that to be heartburn but, unfortunately, ‘acid’ or ‘heartburn’ is epidemic in Haiti,” Dr. Kassicieh said. “The reason behind that is that they don’t have a clean water supply or sanitary dish washing.” As in other developing countries, Haiti’s water supply – its lakes, rivers and wells – contains H. pylori, bacteria that affects the lining of the stomach, and causes ulcers. It is spread through contaminated food and water. “It is well known in the United States. We can actually test for H. pylori, just with a simple blood test and then treat people for that,” he said. There is no point in giving Haitians the same treatment that Americans receive, Dr. Kassicieh said. The Haitian residents’ infections will come right back because they continue to utilize the contaminated water supply. “They don’t have dishwashers. That’s another big reason,” he said. “The dishwashers in the United States have high heat, and the detergents kill off the H. pylori. Dr. Kassicieh added that H. pylori is detected more often in rural areas of the United States than in urban areas. But in Haiti, “virtually 100 percent of the population, if we were able to test them for it, would come back positive.” Since it cannot be eradicated, Dr. Kassicieh said, the only thing one can do is to treat patients symptomatically for “acid” or “acid stomach.” “You ask them, ‘Do you have acid?’ and they will respond yes.” So common was the need for an H. pylori treatment that the Hearts Afire pharmacy ran out of Zantac and Prilosec acid blockers after just 2½ days. But the Sarasota, Fla.-based non-profit organization responded to this great need by purchasing 2,000 additional Ranatadine (Zantac) tablets on the evening before the final clinic day, at a neighborhood pharmacy in Dajabon, Dominican Republic, the border town where the team was spending nights in the Massacre Hotel. By the end of the final clinic day only a handful of Ranatadine tablets remained.  About three dozen volunteers who did not work with the medical team instead interacted with the orphans at Danita’s, as well as those in other nearby orphanages and residents of Bon Samaritan, an old folks’ home where, ironically, its staff was caring for twin babies who had been found in a roadside trash can. The group prayed with, played with and fed as many people as they could over four days in the Haitian border town. The team blessed the community in other ways. It gave away colored soccer balls with the John 3:16 message and seeds from Hope Seeds. Meanwhile, the Hearts Afire medical team, selected volunteers and the Danita’s orphanage staff worked together to serve the patients. “To be able to accomplish that kind of feat … is truly a miracle,” said Dr. Kassicieh, a native of California who is a member of a church in Sarasota. “It’s only by the grace of God and His blessings that we were able to do that. But it wasn’t just Dr. Ken and I. It was the entire team. It was the intake team, the triage team, the prayer team. The pharmacy team was phenomenal. They had to fill the thousands of prescriptions that Dr. Ken and I wrote for the patients. With the sparkling, new medical center at Danita’s not yet available for use, the volunteers found a very suitable replacement: four large classrooms facing each other diagonally on the first floor of a schoolhouse on the property. It was their first ever use of the facility. Hearts Afire paid $500 for fuel to run the electric generators in the building during the clinic days. School was out for the summer but the doctors definitely were in. The staff of Danita’s got word out about the team’s pending arrival in early July, and the community responded. After a three-hour run on Monday, July 15, during which 31 children and staff members from the orphanage were treated, Dr. Kassicieh and Cetin treated 108 people from the community on Tuesday, 182 on Wednesday and 255 on Thursday. The number of patients seen by the two medical providers that July week far exceeded any patient load Dr. Kassicieh had ever cared for. (Most American doctors see about 25 patients per day.) On the final clinic day, seeing 255 patients combined, “was the busiest day I’ve ever had, practicing medicine in 30 years,” he said. To any healthcare professional (doctors, nurses, pharmacists, EMTs, etc.) who may be contemplating going on a mission trip, Dr. Kassicieh says: “I would say do this for your own personal and spiritual fulfillment. Personally, professionally and spiritually, I felt so refreshed. It was joyful for me to do that.”  Prescription drugs, purchased from Blessings International of Broken Arrow, Okla., arrived with the Hearts Afire team in large bottles and boxes packed in about a half dozen old suitcases. In addition to one or two medications prescribed by Dr. Kassicieh or Cetin, each patient received a 30-day supply of vitamins (adult, child or pediatric). Each Haitian who entered the clinic – patients, translators and pastors alike – also received a dosage of Albendazole, a de-worming medication. Worms are another byproduct of the poor water quality in Haiti and elsewhere in the developing world. The workload and pace of activity was daunting, but not insurmountable. “To have to count that many pills, that’s huge,” said Dr. Kassicieh, who estimated that more than 30,000 tablets were dispensed overall. As with all Hearts Afire mission trips, all medicine that was not dispensed that week was left behind, in the care of orphanage staff. It was the third trip to Danita’s and fifth overall trip to Haiti for Ken Cetin, who served as medical director while a Pastor served as team leader. After the trip Cetin said he went to Haiti with three primary concerns: where the clinic would be located, its proximity to the pharmacy and “the amount and types of medicines we would need to bring down with us.” The first two concerns were alleviated when Dr. Kassicieh and Cetin toured the schoolhouse. The third concern went away when they located the pharmacy near the hotel in the D.R. “So as you can see everything worked out just as ‘I’ planned,” Cetin said. “No, it was the great ‘I am’ that laid the plans. That is why we were able to flow with efficiency unseen in the history of our (Hearts Afire) organization. I just had to get out of the way to let that happen.” It was the second trip to Haiti in as many years for Dr. Kassicieh, who said he decided to work there at the suggestion of Hearts Afire co-founder Dr. Vilma Vega, an infectious disease specialist. “With her encouragement, and Ken Cetin’s encouragement and, frankly, God spoke to me and said I should step out of my comfort zone and go take care of these people,” Dr. Kassicieh said on a hot July night in his room at the Massacre Hotel. “The Scripture says help the poor and needy. So that’s what I did.” After the final clinic day, Dr. Kassicieh shook hands with Danita’s Children founder Danita Estrella-Watts (see picture), and told her his 2012 trip was phenomenal but this year “exceeded phenomenal” as far as his personal and spiritual fulfillment. “If you want to step out in your field, and really understand what it is that you are doing and you want to see how medicine is carried out in other parts of the world … you will make a tremendous impact,” Dr. Kassicieh said, extending his message to healthcare professionals considering going on their first mission trips. “The short time you are here caring for these people and showing them love and consideration and treatment is beyond anything you have ever experienced. It is a life changing moment. You will be one of the most important things that have ever happened in their lives.”