Reflections on Haiti

Introduction

In this first of a three-part series, members of the American Orthopaedic Foot and Ankle Society share their experiences as they worked with Health Volunteers Overseas to help victims of the earthquake in Haiti.

Like everyone else I was shocked on January 12, when the news poured across my television screen showing widespread devastation in Haiti following the earthquake near Port au Prince. I would have loved to have dropped everything and gone immediately to help, but I really didn’t know how.

My admiration for those who did get there in those early days was enormous. I followed the post-earthquake events with amazement and horror. I was spellbound by the heroic efforts of surgeons working day and night with minimal equipment in makeshift operating rooms, sleeping in tents, and trying desperately to help the masses of injured Haitians.

I could not believe the reports of equipment being stolen off the delivery trucks. I also heard many reports of surgeons, exhausted and depressed, discretely slipping back to the airport to come home, afraid that their departure would cause anger with the now-homeless Haitian community. I recognized that without a good plan, my arrival in Haiti amidst the chaos would be more hindrance than help. It was clear that to be effective as a volunteer in Haiti I would need to work through an established organization. I signed up with the American Academy of Orthopaedic Surgeons (AAOS) and Health Volunteers Overseas (HVO). I listened to others, learning where and how I might be able to do the most good, and I waited.

Following their arrival in Haiti, the volunteers were taken to the village in the back of this truck. Images: Thomas R

Help Haiti mission

Just weeks after the earthquake my friend and colleague, Tom Lee of Columbus, Ohio, told me of his plan to go to Haiti with a complete medical team. He shared his contact with me and I immediately went to work contacting the group organizer. Instead of Port au Prince, this organization was based in Pierre Payen, 60 km north. Several years ago, the Church of Christ established this mission site because it was located on the main highway halfway between Port au Prince and Cap-Haitien and because it had almost no access to medical care. Working with the Haitian government they built a small hospital with one operating room. Although it lacked much of the advanced medical equipment we enjoy in the United States, it was one of few facilities near Port au Prince with running water and electricity after the earthquake.

Ric Bonnell and his wife Wendy, veterans of the “Help Haiti” medical mission in Pierre Payen, organized a relief effort. Through word of mouth they recruited complete teams that included one or two orthopedic surgeons, an anesthesiologist, general surgeon, and nurse. I took Week 10 and began recruiting my team.

My team

My first volunteer was my circulating nurse at my hospital, the University of Arkansas Medical Sciences (UAMS), and she quickly recruited her best friend, who is a nurse with pediatric experience. I convinced my fellow to join me and our young cast technician begged to go. For the first 8 weeks after the earthquake the Pierre Payen teams flew in and out of Haiti by private jet. Despite multiple phone calls, I was unable to find a private corporation able to take us to Port au Prince because of their insurance liabilities. It appeared that our efforts to get there might flounder. When, 9 weeks after the earthquake, commercial flights resumed into Port au Prince we realized we could take a larger team. Our final team ended up with two orthopedic surgeons, two anesthesiologists, four nurses, a cast technician, physical therapist, and anesthesia technician.

Members of Ruth Thomas, MD’s, Pierre Payen medical team.

Six hospitals

Before the earthquake, Haiti’s population was estimated at 9 million: 3 million in Port au Prince. There were 11 hospitals in Port au Prince and 10 more outside the capital city. During the earthquake, over 250,000 Haitians were injured: 80% of these injuries were pelvic and lower extremity. By mid-March, only six hospitals were functioning in Haiti with only three C-arms and one microscope. Before the earthquake there were 41 orthopedic surgeons on the island; one was killed in the earthquake and another left the country. Of the remaining 39, only 19 were actively treating patients in late March when my team arrived. The university medical system in Port au Prince had literally collapsed.

Ten weeks after the earthquake, through the generosity of many individuals, the small hospital at Pierre Payen had the incredible distinction of owning a full-size C-arm and a mini C-arm, a complete inventory of orthopedic instruments, and a large collection of orthopedic implants. Of even more importance, an anesthesia machine had been provided which allowed general endotracheal anesthesia vastly increasing the types of injuries and illness that could be surgically addressed.

Just weeks before our arrival, WiFi Internet access was established for the first time at the mission dorm house across the highway from the hospital. Now patients with severe orthopedic problems were being sent to our facility from many of the makeshift tent hospitals in Port au Prince.

Working with the system

It was obvious that we were needed. We know that we contributed. But more importantly, we learned that to make permanent changes we would have to work within and parallel to Haiti’s existing health care network. In Pierre Payen that meant having patients check in through the Haitian clinic across the street from the hospital before being seen by us at the hospital. This worked for non-emergent cases, allowing the Haitian system to collect their fees and maintain ongoing serial records. When emergencies arrived on our doorstep and patients were whisked directly into surgery, the fee was never collected.

There have been complaints from some physicians in Haiti that our enormous onslaught of free medical care after the earthquake has seriously damaged their already-fragile health care system by eliminating the “fees” which helped to support it. We must respect their complaints and future relief efforts should be designed to work with the local system and not against it. To be successful we must develop trust between our volunteers and the Haitian medical system. The Haitian government will have to be transparent about available in-country facilities, equipment and supplies. The method of delivery must be scrutinized to reduce inefficiency and make sure that the resources we bring with us are appropriately delivered. Long-term goals must be established to ensure that the Haitian government does not become dependent on our help and that steps are taken to appropriately improve their health care system for the long term. And most importantly, we must not just do, we must teach. To do this effectively, the Haitian university system must be restored and our relief efforts should be funneled into their system as much as possible. This would allow us to share our knowledge with medical students, residents and established Haitian physicians.

Following the disaster, residents had to salvage whatever they could to survive.

Thousands lived in this tent city near Port au Prince.

Working together

We can also continue to work through the existing non-government organizations (NGOs) to provide medical care as we did in Pierre Payen, but again, we should try to teach and not just do by inviting students from the university system to work with us side-by-side.

Haiti is our neighbor. Americans have good hearts, and our supply of want-to-be volunteers is massive. We have the know-how and the ability to deliver. Still, without excellent organization of our efforts, and appropriate seeding of our wisdom, we will not change Haiti.

To do the most good, we must work together. I believe that the future of Haiti can be brighter if we find a way to unite our Herculean efforts under one centralized umbrella organization that can communicate with existing NGOs, the Haitian government and university system, and the many American physicians and health care workers that want to help Haitians to live a better life. We can do this, if we all try together to make it happen.

Reference:

haititeam10.blogspot.com

Ruth Thomas, MD, can be reached at ThomasRuthL@uams.edu

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