Thursday, April 24, 2014
LETTER FROM CAP HAITIEN
Dr. Samuel Broaddus, director of the Division of Urology at Maine Medical Center, recently returned from a 10-day trip to Cap Haitien, Haiti, where he led a seven-person surgical team from Maine. He has been working with Portland-based Konbit Sante for years.
In Cap Haitien, Haiti’s second-largest city, Konbit Sante volunteers work at Justinian Hospital and at a community health clinic in one of the city’s poorest neighborhoods, Fort St. Michel. While Cap Haitien wasn’t damaged by the earthquake in January that destroyed Port-au-Prince 90 miles south, many wounded refugees have been arriving since the earthquake.
Excerpts from a recent letter are used with permission.
I have been traveling to Haiti for 16 years as a medical volunteer. This is my 12th trip and many colleagues from Maine have asked me, with each passing year, if things will ever get better here. After the earthquake, no one has asked me that question. Haiti is a country that defies easy answers.
We often use the phrase “It’s complicated” to describe many aspects of Haitian life.
As I write this, I am sitting in the operating room at Justinian Hospital in Cap Haitien, listening to a 6-year-old burn victim in the adjacent surgery ward screaming in pain as her dressings are changed without the benefit of pain medication. Why? There are not enough of these drugs to go around to all the patients who need them. We ration care and we ration medications. Earlier in the week at supper, a colleague leaving for her return trip back to the States gave me a plastic bag filled with narcotic pain medications. “Trust me,” she said, “you’ll need these” and in fact, two days later, I did.
A medical system that was barely able to provide even basic services has now been strained beyond anything I have ever experienced working here. Mainers should be proud of what Portland-based Konbit Sante has accomplished over the past nine years, and particularly what it has accomplished over the past month.
They have 26 Haitian employees here in Cap. They also have more than 70 Maine volunteers with a wide variety of skill sets, who have partnered with Haitian colleagues in a unique model helping to maintain a fragile system of health care delivery.
Konbit Sante will play an increasingly important long-term role in Cap Haitien because it is an organization built on friendships, professionalism and collaboration. I know all the Haitian surgeons at Justinian Hospital by name. I know their families. They know my family. Some have been my houseguests in Gorham. We respect one another.
It is this type of friendship that will ultimately make a difference in how Haitians view foreigners, outside the glare of international media spotlights, and ultimately how health care will be improved, one small step at a time in Haiti.
There is a Haitian saying, “Little by little, the bird makes its nest.” It is descriptive of how I believe life and health will be improved here.
The Justinian Hospital, the largest hospital in the north, is busier than on my last trip. The wards are very crowded, particularly the surgical wards, 20 patients tightly packed in large rooms with no privacy. The emergency ward remains hectic; I haven’t seen any ambulances, just private transports.
Many of the ward patients have severe orthopedic injuries or fractures, and some have significant postoperative wound infections following field surgery in Port-au-Prince.
Dr. Matt Camuso, our orthopedic surgeon, and his two assistants, Joanne LeBlanc, R.N., and Linda Ruterbories, A.N.P., have been partnering with the Haitian orthopedic surgeon Dr. Pierre Louis and have completed a number of complex orthopedic reconstructive surgeries. Matt brought a great deal of orthopedic surgical equipment donated by OA (Portland-based OA Centers for Orthopaedic Excellence) and MMC (Maine Medical Center) and has been integrating this into the OR inventory at Justinian.
He has been a perfect match for Dr. Pierre Louis; they both served as military surgeons. Matt’s personality is calm and reassuring, and I predict a long-term relationship. That is what we all need to be thinking about as we transition to the long haul of rehabilitation and reconstruction.
Our two wound-care nurses from MMC have been angels. March Truedsson and Marieta Atienza have been ministering to the worst of the infected wounds with enthusiasm, kindness and attentiveness. These are just awful wounds, probably among the worst of my 30-year career. This morning in “wound clinic” they saw 25 new patients.
As for me, I have spent time with the urology residents, interns and nurses trying to maintain some sense of normalcy.
Performing some urologic surgery, daily teaching rounds, instruction in ultrasound, and PowerPoint presentations about routine urological problems, I think there is something helpful to everyone’s morale with routines and schedules.
The 12-year-old boy with a big smile but the insensate, useless arm will haunt me for a long time. He is days or weeks away from an amputation at the shoulder. The pediatric ward at the Milot Hospital filled with children missing parts of arms and legs was hard for me to get my brain around; this must be what war is like: indiscriminate, brutal and without reason. I try not to think about the big picture too much.
I saw a woman who had lost one arm and severely injured her other arm. Matt reviewed her X-rays and we spent some time discussing her case with Dr. Bernard. When we left she said in broken English, “God bless you.”
We had done nothing but show her a little compassion.
There are thousands of Haitians who have undergone recent amputations just like these people. How do you begin to rehabilitate an entire segment of a society, particularly in a country like Haiti? I shouldn’t be asking so many questions when I know the answers involve suffering and loss on a biblical scale.
My biggest fear is that Haiti will fade from the world’s consciousness as it has done every time there has been a natural or political disaster in this country of more than 8 million people. This is just the beginning of an arduous road to recovery; Mainers need to understand that “earthquake relief” is very long-term; not a quick-fix “CNN moment.” It will be ongoing and difficult for years.
As a health care volunteer in Haiti, seeing the reality on the ground over the past 10 days, I am already discouraged about how long this recovery will take. It is all very personal for me; I have been on the verge of tears for days.
What Haiti needs most is a long-term commitment from the international community, and from people like you and me, that it will not be forgotten, and that this international response will be sustained for many years and decades to come.