1. Family Medicine Cares International AAFP Global Health Workshop October 2013
Mary Jo Welker, MD, FAAFP
AAFP Foundation President
Jane A. Weida, MD, FAAFP
AAFP Foundation Vice-President

2. Dr. Welker has reported no conflicts of interest
Dr. Weida has reported no conflicts of interest

3. Educational Objectives
At the end of this presentation, participants will be able to:
Identify the clinical opportunities for volunteer work in Haiti with Family Medicine Cares International and their partnership with Heart to Heart International
Describe the medical education system in Haiti, from medical school through Family Medicine residency plus the schools and programs that exist
Identify future opportunities for medical student education and residency education in Haiti as part of the project work

4. AAFP Foundation Mission Statement
The American Academy of Family Physicians Foundation
advances the values of Family Medicine
by promoting humanitarian, educational, and
scientific initiatives that improve
the health of all people.

5. The Heart of Family Medicine
The AAFP Foundation is a 501(c)3
Supports and/or runs 27 programs.
The work is made possible through the donations of family physicians, corporations and others who provide donations of time and money.
Family Medicine Cares International is the Signature International Humanitarian Program of the AAFP Foundation

7. On January 12, 2010…
At 4:53 pm, a 7.0 magnitude earthquake struck Haiti, the poorest country in the Western Hemisphere
The epicenter was near Leogane, 29 Km (18 miles) west of the capital of Port-au-Prince
100,000 people perished in the first 60 seconds

8. On January 12, 2010… Rescue efforts were hampered by
No electricity
No cell phone reception
No heavy equipment to free survivors
Poor infrastructure, poor roads, the airport was destroyed, etc.
Hospitals were quickly overwhelmed by the tremendous need

9. The Devastation At least 220,000 people lost their lives
250,000 residences and 30,000 commercial buildings collapsed or were severely damaged

10. Signature Humanitarian Program
That year, the Foundation began making plans for a new Signature International Humanitarian Program, having just completed plans for a Domestic Program
Haiti was chosen as the site
Great need – still coping with the aftermath of the earthquake
Close to home – easy to get to
Our members expressed interest in providing assistance to the people of Haiti
Partnership with Heart to Heart International on the ground

11. Family Medicine Cares International
Announced at the AAFP Annual Assembly in Philadelphia, October, 2012
Components: working to improve the quality of life and health of the people of Haiti
Family Medicine education and promoting Family Medicine in Haiti
Patient care – ongoing opportunities – provides sustainability
Children’s Projects
Medication airlift if possible (customs in Haiti is problematic)
Re-construction/public health project as needed and feasible

12. Family Medicine Cares International
Work is accomplished by:
Annual Delegation
Ongoing Efforts
Patient care
Orphanage support

13. Indicates Family Medicine Cares International locations

14. Annual Delegation Trip
The Annual Delegation trip is a one-week volunteer opportunity that includes both medical and non-medical individuals.
Inaugural Delegation
February 2-9, 2013
21 People – 13 physician members
Three Teams
Patient Care
Medical Education
Service
2014 Delegation: February 15-22

15. 2013 Delegation Team Members
Dr. Ainee Ahmed………………………………………………York, PA
Dr. Julie Anderson……………………...…………………St. Cloud, MN
Dr. Denis Chagnon…………………………..………....Lake Placid, NY
Brenda Cherpitel…………………………...………...Overland Park, KS
Dr. Anna Doubeni………………………….………...…Philadelphia, PA
Lori Foley……………………………………………….Kansas City, MO
Dr. Michelle Jones ……………………………………..Hampstead, NC
Dr. Laura Knobel………………………………………...….Walpole, MA
Dr. Evelyn Lewis&Clark……………………….……………Newnan, GA
Douglas MacLean…………………………………Westlake Village, CA
Haley Maclean…………………………………….Westlake Village, CA Taylor MacLean………………………………...…Westlake Village, CA Dr. William Markle……………………………………...……Clairton, PA Christen Moburg…………………………..…………….Georgetown, IN Dr. Jacobo Rivero………………………………...……………Zillah, WA Dr. Dave Smith………………………………………….Elkhart Lake, WI Karen Smith……………………………………………..Elkhart Lake, WI Dr. Kimberly Tjaden …………………………………….……Sartell, MN Dr. Jane Weida ………………………………………West Reading, PA Dr. Mary Jo Welker ………………………………………Columbus, OH Lloyd Welker………………………………………………Columbus, OH
This map displays the names and home states of our 2013 Delegation members.

16. 1st night at the Volunteer Center in Port-au-Prince.

17. Patient Care Team Treated More Than 600 Patients
2 weeks to 92 years
100 well-child visits at orphanage
Urban and Rural Locations
Port au Prince
Santo “Clinic in a Can”
Dufort Mobile Clinic
Place l’Or Mobile Clinic

18. Ongoing Volunteer Opportunities
Three to four volunteer physicians are needed each week throughout the year to provide ongoing patient care in community clinics in Haiti.
These volunteer physicians generally serve one-week deployments, working alongside Haitian nurses and medical personnel to deliver the quality care the local population so desperately needs.

19. Ongoing Volunteer Opportunities
Opportunities for practicing and resident physicians (with physician supervision)
Can volunteer for 1 week to months at a time
Costs are reasonable
All details are pre-arranged – translators, transportation, including to and from airport, safe food, housing, training manual for providing care in Haiti, etc.
Contact Foundation Staff Brenda Cherpitel (Director of Development)

20. Brenda Cherpitel
AAFP Foundation
x4452

21. Medical Education Team
Leadership “Traveling Squad”
Full Day Symposium on Cardiovascular Risk
Cap Haitien
Port au Prince
Met with Key Contacts in Haiti Health Care
Council of Deans (4 med schools)
Cap Haitien & Saint Marc Residency programs
MSPP
US Embassy
Over 70 residents, physicians and medical leaders participated in the symposium.
There is not any continuing medical education available in Haiti so our symposium featured topics requested by our Haitian colleagues and they were well received.

22. Family Medicine Symposia
Topics chosen by Cap Haitien residency director and our symposium planning team
Delivered in English, translated into French
Attended by residents, faculty, and practicing physicians

23. Symposium in Cap Haitien

24. Medical Training in Haiti
Primary and Secondary School – 14 years
No undergraduate education required
Medical school:
Classroom – 2 years
Externship rotations – years 3-5 in public med school(one in Haiti), years 3-6 in private schools (there are three in Haiti)
Internship – 1 year
Mandated social service – 1 year (for nurses too)

25. Residency Training
In addition to one-year internship, residency requires:
Family Medicine, pediatrics, IM – 2 more years
Ob-Gyn – 3 more years
General or orthopedic surgery – 4 more years

26. Medical Training in Haiti
Most primary care is delivered by generalists practitioners with no residency training
CME is limited and not required
There are few trained family physicians
Delivery of care is hampered by spotty electrical service, poverty, low physician salaries, rural locations of many patents and physicians, availability of meds, etc.

27. Residency Training
Residency in Cap Haitien – in existence for 12 years
Residency in Saint Marc – in existence for 2 years – no graduates yet
Residencies are in need of:
Medical equipment
Books and other training materials
Faculty development

28. Medical Education Team Meeting with Council of Deans
The Deans were supportive of concept of Family Medicine but generally not very familiar with the specialty
Little training in med school to familiarize students with Family Medicine
A future goal of FMCI is provide a short curriculum (perhaps 3 weeks) to the medical schools to let the students learn about the scope of Family Medicine

29. Medical Education Team Meeting with General Director and Academic Director of Health Ministry
They verbalized the need for Family Medicine in their country
They have limited resources to support the medical needs of the country
They have limited resources to support additional residency positions in the county
They would welcome our help in advancing Family Medicine

30. Medical Education Team Met with US Embassy Officials
Learned about the many challenges to providing quality medical care in Haiti
Future plans are to continue to meet with embassy leadership during every Delegation trip

31. Vo-Tech Scholarships “Agents of Peace”
Benefits inner city youth and young adults
Provides scholarships to complete vo-tech training in heavy equipment operation, plumbing, electrical, etc.
Jobs, hope, change
We attended their first graduation ceremony
Provided five scholarships for heavy equipment operation in February 2013.

32. Family Medicine Cares International Resident Scholarship
One scholarship for a Family Medicine resident to be part of the 2014 FMCI Delegation to Haiti (February 15-22, 2014).
Covers expenses for travel to Haiti & in-country, including housing and food.
Includes expenses for Scholarship recipient to present at the 2014 AAFP National Conference.
Maximum amount is up to $5,000.
Only Resident members of the AAFP are eligible to apply.
Application period: September 22 – November 1, 2013
Candidates must provide:
Delegation Application;
CV or Resume;
Letter of Intent; and
Letter from Residency Program Director
Scholarship funds are provided by the AAFP Foundation Board of Trustees to one deserving resident. The resident will have the choice of serving on the patient care team or the medical education team.
Applications will be available at

33. Service Team Painting Distributed vitamins to children (donated)
Orphanage
Exam rooms in Bel Air clinic
Distributed vitamins to children (donated)
Parties for children in orphanages
Feast (with a goat)
Small back-packs with treats
Party

34. Bel Air Clinic: Triage Area Renovation
A major challenge was the problem of privacy, security and cleanliness within the triage space.
The clinic is located on the balcony level of a large church which is an open cement block structure that allows excessive noise and dust from the streets below.
Bel Air Clinic: Pharmacy Renovation:
The clinic offers health care to approximately one hundred patients every day.
The lab patient waiting area was within the pharmacy area.
The pharmacy area was not secure.
Patient assistance at the lab was observed and heard by those waiting for lab work/results. The area was often over-crowded.

35. Delivery of Milk, Water and Protein
Rose Mina Orphanage
The orphanage provides a home to approximately 90 children ages 0-21.
Many of the children are abandoned or have one parent that cannot take care of them.
Some are tiny babies that have been left there by very young mothers who are unable to care for them.
Many of the children are barefoot and some without underwear or pants.
There are several disabled children.
All of the boys sleep upstairs (up a very dangerous metal staircase) with open access to the roof where all of the clothes are laid out to dry in the sun.
There are no railings to prevent children from falling off.
The 2013 Delegation painted the outside of the entire building, funded kitchen and bathroom improvements, provided vitamins for the kids, hosted a lunch and party for the children, and performed well-child exams.
Also, on a monthly basis funds are being provided to purchase milk, water, protein, and other health related needs.
Delivery of Milk, Water and Protein

36. Fondwa Orphanage and School
Fondwa is located in the mountainous region at the epicenter of the earthquake.
Both the school and orphanage were completely destroyed.
The school provides education to children ranging in age from 3 – 16.
The orphanage is home to children
ranging in age from 2 – 18.
The school, Fraternité Saint-Antoine, was founded in 1993 and provides education to children ranging in age from 3 to 16 (172 girls and 114 boys).
The orphanage, Notre dame de Fatima, was created by the Peasants Association of Fondwa in 1993 and is home to children ranging in age from 2 to 18 (40 girls and 20 boys).
The orphanage now consists of three temporary buildings—a sleeping quarters for the boys, one for the girls, and a tiny administrative building. The Foundation provided funds for a new kitchen (permanent) building.
The school operates in makeshift buildings just down the hill from the orphanage.

37. Ongoing Service Efforts
Provide high-fat powdered milk, clean water, and protein to the Rose Mina Orphanage
Investigating other orphanage needs
Looking into additional partners in Haiti for the service work

38. Next Steps/Dreams
Have started meeting with the other FM organizations to provide:
Expertise in areas such as curriculum and faculty development
Opportunity for more people to learn about FMCI
Support for residencies – equipment, training for residents as well as faculty

39. Next Steps/Dreams Exposure to Family Medicine in medical schools
Continuing medical education
Very preliminary work for perhaps a third Family Medicine residency in Les Cayes
Faculty
Expertise
$$ needed

40. Key Contacts Board of Trustees Officers: AAFP Foundation Staff:
Mary Jo Welker, MD, FAAFP, President
Jane Weida, MD, FAAFP, Vice President
Jason Marker, MD, FAAFP, Treasurer
AAFP Foundation Staff:
Craig Doane, Executive Director
Brenda Cherpitel, Director, Development
Lori Foley, Director, Strategic Partnerships

41. For more information or to obtain an application please contact:
Brenda Cherpitel
AAFP Foundation
x4452