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Published: March 3rd 2018
On Feb 21 Jeremy drove me to the Halifax airport and an ungodly hour with two carry-on bags and two giant duffle bags crammed full of group medical supplies. I was starting the trip to Bernard-Mevs Hospital in Port-au-Prince with a group of healthcare workers from Halifax. We were all heading down together for a week under the support network of Team Broken Earth, which is a medical aid organization founded by orthopedic surgeon Dr. Andrew Furey out of St. John's Newfoundland. Dr. Furey originally began his medical aid work in Haiti during crisis relief after the deadly earthquake of 2010. Since then, Team Broken Earth has expanded and evolved to provide more ongoing care, infrastructure development, and health worker education. I really love this organization and I have been following them for some time, but I did not feel until recently that my skills were ready to be able to contribute in a meaningful way. My time has come now, though!
The trip was fairly uneventful. We had a pleasant route of Halifax->Montreal->PaP which meant no American customs (yes!). In Montreal we picked up Tigger, an anesthesiologist who was joining us from Vernon. He turns out to be an
incredibly fun, easy-going guy and immediately fit right in with our group. Justin, an emerg doc from Calgary and one of Daryl's best friends (my resident in Halifax), met up with us in Haiti. So, by the time we arrived at Bernard Mevs hospital we had our entire 16 member team in place. This included 2 anesthesiologists, 3 orthopedic surgeons/residents, 1 plastic surgeon, 4 OR nurses, 1 respiratory therapist, 3 ICU nurses, 1 emerg doc, and 1 internal medicine resident. A few other small teams of ER docs and pharmacists were already on site from other organizations.
I guess I shouldn't say the flight was entirely uneventful. About half way to PaP the call went out for a doctor on the plane. Needless to say, there were a few to choose from... Ian from anesthesia responded first and Tigger went to help, too. I popped my head round but they had everything in hand. I would rather have an anesthesiologist look after me for an in-flight cardiac issue than an orthopedic surgeon, anyway! Ian stayed with the patient all the way until we landed when an ambulance took over. Where did they go from there? No idea... they didn't
Xrays on site were digital, but sometimes patient came to us bearing gifts
come to our hospital anyway. There are not that many choices in Port-au-Prince, which is one reason why we are there.
On paper, the Bernard-Mevs sounds like a reasonable facility. It has 2 medical-surgical wards, some private rooms, and ICU, a peds ward, a PICU and a NICU, plus pediatric and general emergency. It is considered a (maybe "the") major trauma center. In reality, though, each of those areas are just a fairly small room with as many beds and equipment crammed in as can reasonably be accommodated. The entire footprint of the facility is equivalent to a small Canadian elementary school, and you must go outside through a courtyard to travel between areas. Nevertheless, I am certainly impressed with the infrastructure that they have. It is much better than what I was expecting. It is obvious that aid from organizations like Team Broken Earth and Project Medishare are being put to good use. They have clean, light, functional hospital beds on the wards (although they do not consistently have sheets for those beds). They have a few ventilators for both pediatrics and adults (which almost always function). They have digital xrays with an electronic storage system and even
Paperwork. So much paperwork.
a portable CT scanner in a large trailer, which is functional 90% of the time. But, the walls are still cracked, the power occasionally goes out, and mosquitos and flies are prominent. You never forget you are in a resource-limited setting. In fact, it is the consumables that really limit the care provided. Things like dressings and drugs may be available one day and not the next. Everything is reused as much as possible until it cannot function anymore. Perhaps Canadian healthcare could take a page out of their book...
On Wednesday evening after we arrived we settled in to our personal areas. We are all in rooms of 4 bunks. I am in a room with Monique (an RT who speaks acadian french), Daryl (an ortho R5), and Justin (the emerg doc from Calgary). We are a fun room. There are about 6 bathrooms with a toilette, sink, and shower each. The showers are... OK. No hot water, and some have little more than a trickle for water pressure. But there are flush toilettes so I am thanking my lucky stars on that front! We drink and brush our teeth from water from a communal water cooler which is supposed to be safe, but to be honest I am still treating each litre I get with my own water purification tablets (I have trust issues!). The OR team got to work unpacking and organizing the ~15 duffle bags of supples that we brought and sorting out what equipment was available. Team Broken Earth keeps their own orthopedic supplies down there, and those sets are locked away when we are not there. I know that sounds as bit protectionist, but it is the only way to ensure things are semi-complete and organized when a new team arrives so that we can get our best work done in the limited time we are there. As it is, the sets are still sparse. Most are missing clamps, some screwdrivers, proper selections of screws, etc. To operate in Haiti is to "make do." I had hoped that we would get in to the OR our first night, but it didn't work out.
The whole group packed into the back of a covered pickup truck to be driven out to a restaurant for dinner. It was sort of a Western-style fast food kind of place, and was fairly unremarkable. Our pizza order got lost and we waited politely FOREVER before making some inquiries and realized they had forgotten. Then by the time we got out of there our driver was no where to be found! This was when I realized we had a bit of a problem.... We had no way of contacting really anyone and it isn't like you can just flag down a taxi at night in Port-au-Prince. Fortunately, Justin had the presence of mind to pick up a local SIM card when he landed at the airport that afternoon so he was able to use his phone to call Stacey, the volunteer coordinator at the hospital, who contacted our driver and made him come back for us. Phew! No harm done, though. The night was warm and we were all well bug-sprayed, so it was fine to wait on the curb for our lift.
Today, Thursday, they organized an orthopedic and plastics clinic for us to see patients and arrange surgeries for the rest of our time here. As I had expected, things started slowly. Supposedly the residents and translators were going to arrive at 7:30 and clinic was going to start at 8am. Yah... that didn't happen. I think our first patient rolled in around 9:30 or 10 and another didn't come until half an hour after that. Eventually, though, things rolled along and when it was all said and done we had seen quite a few patients included many who needed surgery. Some of the patients were non-operative and just needed a cast change or reassurance. We saw a little boy with a limp who seemed to be getting better and likely had some transient synovitis which was starting to resolve. Another was an adorable 16 month old with intoeing, which is quite normal and should naturally improve as she gets older. Some, however, definitely needed our help. One woman was brought to us specifically to see Dr. Leblanc (Marty), our plastic surgeon. She was brought from 5 hours away in the mountains by the staff at a rural clinic out there. She was a young mother in her early 30's with a massive circumferential tumour around her thumb. We believe it is a giant cell tumour, which is a benign growth but had just gotten completely out of hand. It was literally like she had stuck her thumb inside a grapefruit and was carrying it around with her at all times. Needless to say, it had reached the point where she no longer had function of that hand. Marty said he would do his best to debulk the tumor and give her a functional hand back, but there was a chance that he make have to take the whole thumb. She was unconcerned and basically just said "do what you need to do!" That is the general attitude here - just do what you need to do and we will make it work.
We continued seeing consults and consenting people for surgery as needed. We had translators as well as Haitian orthopedic residents working with us. The residents were great because they were able to translate and we got to teach at the same time. It was a very effective partnership. Plus, they got to teach me about the many billion forms that each consult and surgical booking required! Interestingly, all surgical consents MUST be signed by the patient as well as a family member or close friend. I should mention that families are in important part of the care team in Haiti. They bring patients food and drink, they empty bedpans, they keep them calm, they hold emesis basins, they are fully involved. At night and during the day the hospital grounds are full of associated caregivers who sleep on chairs or on pieces of cardboard on the ground, ready to assist their loved ones as needed.
Around 2pm the local surgeons finished in the OR and we were able to get in to do the thumb case. We wanted to get the thumb done as soon as possible because we wanted to be able to do a wound check, especially if any kind of skin graft was required, prior to our departure in case any further intervention was required. There are currently just 2 functioning ORs, only one of which has fluoro (intra-operative xray). I got to assist Marty with the case and it was fascinating. The world of "hand" is an interesting one because both orthopedics and plastics train in that area, and sometimes it is as bit of a turf war as to who "owns" it at a hospital. In both Halifax and Calgary, most of the time plastics does work distal to the wrist so I don't have that much experience operating on fingers, but I am always interested to be involved. The plastics and orthopedic approaches are a bit different. I was concerned that the boney joints would not be stable while he was worried that taking too much skin would not allow sufficient venous drainage (I hadn't even considered that). When it was all said and done, the thumb looked much more functional. I hope she does great with it.
After the thumb we were able to quickly nail a femur fracture but we were not done in time to make it out with the group for dinner, so they brought us back some food. I scarfed it down and headed to bed. It was a long day! But I'm really happy with how we are settling in to the hospital.
Tot: 1.783s; Tpl: 0.042s; cc: 14; qc: 59; dbt: 0.0198s; 1; m:saturn w:www (220.127.116.11); sld: 2;
; mem: 1.4mb