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'For generations to come'

A University medical student wants to make a difference where medicine and human rights intersect

When fourth-year medical student Amanda Noska arrived in Haiti in January to study human rights, she found no shortage of issues to address. Noska was in Port-au-Prince for a public health fellowship to learn about the face of HIV and AIDS at a free clinic there.

But first, she couldn’t help but notice the widespread poverty. About 54 percent of Haiti’s people live on less than $1 a day, according to the United Nations Development Programme, and 78 percent live on less than $2 a day.

And she observed that most patients at the free clinic — in English, it’s called the Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO) — either had no income or lived on less than $20 per year.

Amanda Noska

The number of people living with HIV has steadily increased in Haiti since the mid-1990s, according to the World Health Organization, and an estimated 2.2 percent of Haitians ages 15-49 now have the virus.

Currently, Noska says, prostitution is on the rise, and sex workers are getting HIV faster than any other group in Haiti.

“Women are often resorting to prostitution to feed themselves and their children when they have no other options,” says Noska, who started her medical training at the University of Minnesota Medical School-Duluth Campus and is also completing a master’s degree in public health through the University’s combined M.D./M.P.H. program. “It’s very concerning because women have children, and children can be born with HIV/AIDS, and that can be detrimental for generations to come.”

With limited resources, it’s difficult for health-care workers in Haiti to rein in this devastating disease, Noska says. But she hopes that through a project she’s now completing for the clinic, she can bring them a step closer.

Finding a way out

Noska found a great resource at GHESKIO, a clinic funded by Haiti’s national government and the U.S. President’s Emergency Plan for AIDS Relief. The clinic also is designated a research institution by the National Institutes of Health and is affiliated with Cornell University in New York.

“I was delighted to find out that this top-notch HIV/AIDS clinic exists in Haiti,” she says.

Medical student Amanda Noska (left) and the doctors at GHESKIO, a free HIV/AIDS clinic in Haiti. (Photo: Amanda Noska)

The clinic offers free services such as HIV counseling, AIDS care, and management of other transmitted infections and distributes free antiretroviral therapy (ART). It also supports a nutrition program because it’s hard for ART to work if the patient is undernourished or starving.

In addition, the clinic has a counseling center for rape victims, a staff psychologist, an obstetrics clinic, a pediatrics clinic, an adolescent health program, and a dentist.

“The waiting rooms of GHESKIO are always at capacity with patients in need,” Noska says.

Because of the increasing rates of prostitution and sex workers with HIV, the clinic is launching a special service entirely devoted to reducing disease in this population, she says.

And to help solve the bigger-picture problem, it’s starting a microfinance program that provides small-businesstype loans to help sex workers find alternative ways to support themselves and their families.

“Women get [the loans] and then they start a business and pay them back as they go, essentially so that they can get out on their own, be independent, and have their own source of income — and stop the sex-working exchange,” Noska explains.

Changing reality

Through her fellowship at GHESKIO, Noska did whatever she felt she could do as a medical student. That involved filling out appointment cards, conducting physical exams at the clinics, and doing some laboratory work.

But she took another part of her work back to Minnesota. For her M.P.H. master’s project, Noska is analyzing data to help get the microfinance program up and running — and make it work.

The hillside of Port-au-Prince. (Photo: Amanda Noska)

Noska is looking for a correlation between the women’s annual income and prevalence of HIV. The idea, she says, is that GHESKIO could use the information to establish a baseline loan amount that accounts for the cost of living in Haiti while simultaneously assisting women with funding to establish alternative means of income.

For Noska, becoming a doctor isn’t only about treating disease; it’s also about helping people by acknowledging their reality.

“It’s hard to see people carried into a clinic and dying of AIDS and just unbelievably sick,” she says. “Even more than that, I think it is so painful to watch people emotionally beaten or emotionally void or just crushed by their circumstances.”

But Noska hopes that providing an opportunity to change those circumstances will improve Haitian women’s health, both physical and mental.

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