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A Doctor Heads Home to Haiti FREE

Lionel J. Malebranche, MD
[+] Article, Author, and Disclosure Information

From Christiana Care Health System, Wilmington, Delaware.

Potential Conflicts of Interest: None disclosed. Form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0378.

Requests for Single Reprints: Lionel J. Malebranche, MD, Christiana Care Health Services, Department of Internal Medicine, 4755 Ogletown-Stanton Road, Newark, DE 19718.

Ann Intern Med. 2010;152(10):677-678. doi:10.7326/0003-4819-152-10-201005180-00211
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A second-year medical resident returned to Haiti, his native country, in the aftermath of the 12 January 2010 earthquake. He witnessed the total devastation of Port-au-Prince, the city of his birth, and great human suffering. He describes the emotional and logistical challenges of providing care to the wounded of this impoverished nation.

I was born in Port-au-Prince, Haiti, and spent my childhood in the neighborhood of Turgeau and Debussy. I went to school at Saint-Louis de Gonzague and completed my medical studies at the Faculté de Médecine et de Pharmacie de l'Université d'Etat d'Haiti. Although I had a very good life in Haiti, coping with the ever-present political unrest and riots took a toll on me. As a result, I, like many young Haitian professionals, left my country to seek stability elsewhere. I have been living in the United States, first as a permanent resident and now as a U.S. citizen, for the past 5 years. During this time I completed 1 year of general surgery training; I am now a second-year internal medicine resident. It was my surgical experience that was most useful several weeks ago, when I returned to Haiti to help in the aftermath of the earthquake that occurred on 12 January 2010.

When the news broke, I froze in front of the television screen. I was filled with worry about my extended family in Haiti. I knew full well the limited resources available to the people in this already fragile country, with the western hemisphere's most precarious economy. My wife was already in tears—there were rumors that the earthquake had struck one particular area in Peguy-Ville, a suburb of Petion-Ville where her mother lives. I frantically called, e-mailed, and text-messaged, but all communication routes were paralyzed.

I had to go to Haiti. As a medical resident, my contribution would certainly be limited, but I was convinced that I could find my extended family and bring some comfort and medical care to my people. My spouse, parents, friends, and coworkers feared for my safety but offered much-needed emotional and spiritual support.

My greatest challenge at that time became how to reach Haiti when all airports were closed. I tried to find a nongovernment organization (NGO) or other government relief team to serve as my umbrella, but these channels were saturated—it seemed the entire world had volunteered to help. My father and I decided to fly to the Dominican Republic and drive a rental car across the border into Haiti. I had no idea where I would work, but I was certain that I would find a place to provide assistance to the wounded. I was devastated when reports of border closure forced me to cancel my trip.

Luckily, a chain of professional contacts led me to Konbit Sante, an NGO based in Portland, Maine. I flew to the Dominican Republic with this organization. My next challenge was how to get to my family in Port-au-Prince. This time, a series of contacts through my church miraculously connected me to the Jehovah's Witness organization in the Dominican Republic that would pick me up at the airport in that country and bring me to Port-au-Prince.

After a warm welcome in the Dominican Republic airport, I and several Dominican Jehovah's Witness providers—a young doctor, 2 nurses, and our driver—began a long day of travel. We reached the Dominican–Haitian border around 10 p.m.

At the border, we met 2 buses filled with supplies. We were told that the convention hall of the Jehovah's Witnesses had been transformed into a hospital. Everyone wore masks to protect against the odor of dead bodies, and all eyes were highly alert. Ambulance buses went back and forth transporting patients to the hospital in Jimani, a small bordering Dominican town. Everybody was on the move. I was touched by the dedication of our Dominican neighbors to helping Haiti in this time of great need.

Once we identified ourselves as health care providers, we crossed the border without difficulty and reached the town of Santo in Haiti around 1 a.m. Scenes of shocking devastation lined the road. Hundreds of people slept on sheets on the grass in the courtyard of the Santo Assembly Hall. These people had lost their homes or were afraid to return to their homes as the aftershocks persisted and rose in magnitude. Thankfully, it was not raining.

The next day will stay with me forever. After morning prayers and breakfast, we convened to develop our strategy for the day and assign the tasks to the medical staff. Two additional physicians had joined our group. Before starting our work, we sensed that acute traumas would decline and that we would be dealing more with chronic issues. However, we treated about 75 acute patients that day, performing 15 to 20 minor and complex surgical procedures. We reduced more than a dozen fractures and attended to many more open fractures before transporting the patients to the Dominican Republic in our own vehicles. After 16 hours of nonstop work, we were exhausted and supplies were running short.

That day was also marked by the only death among my patients during my time in Haiti. A previously healthy 17-year-old male with no past medical history was found in the rubble of his house 3 days earlier. He suffered from quadriplegia from compression of his cervical spine. He wore a soft collar because no hard collars were available; we desperately tried to manufacture a makeshift hard collar. I began giving him steroids in an attempt to decrease edema and optimize spinal cord recovery. However, our only tools were steroids and our clinical acumen—we had no labs, no radiology, no pressors, and, most critically in this patient's case, no ventilators. Attempts to transfer him to a facility with these services were unsuccessful. I told his parents that his prognosis was very poor, but they held onto hope even as he progressed to respiratory decompensation and cardiac arrest within hours. I started chest compressions while his father gave him mouth-to-mouth breaths—blowing as if trying to breathe his own soul into his son. The son opened his eyes and smiled as life faded from his body. This death was inevitable, for we had no means of transitioning him to mechanical ventilation. With resources, we could have easily saved his life. I felt powerless.

Yet there was no time to mourn as more patients streamed in. Many had dirty wounds, either because they had been trapped under the rubble or because they had attempted some artisanal treatment, not knowing that medical care would be available. I saw more paraplegics in 1 week than I had seen during my entire training thus far. I saw more than 30 cases of osteomyelitis. We lavaged wounds and doled out broad-spectrum intravenous antibiotics. We lacked sufficient pain medications to alleviate patients' suffering, but we did what we could.

While only a second-year resident, I had the privilege to lead the medical team during my short stay. I worked on improving our efficiency. We conducted brief rounds every day and kept records on our patients. We also implemented a social service desk to provide assistance to those who needed food and shelter, not medical care. Many young people reported palpitations and anxiety since the quake hit. I was also anxious and having palpitations myself.

Another patient who will stay with me for a long time was a 39-year-old woman with diabetes and hypertension who presented with a large heart-shaped wound on her forehead; a long, deep laceration of her occipital scalp; and near-destruction of her left ear. She arrived 6 days after the event in moderate distress. When I undressed the forehead wound, which had been previously dressed by a nurse in her neighborhood, I uncovered hundreds of fly larvae nesting in the wound. I shivered and rushed her outside to avoid infesting the other patients. I flushed the worms from the tunnels they had created under her skin, administered intravenous antibiotics, and tried to keep her diabetes under control. It was gratifying to witness her improvement over the next 3 days.

In addition to the horror of individual patients' suffering, I witnessed the physical destruction of the city and a total inability of the government to meet its people's basic needs. Grateful that I found my family members alive, I was helpless to address their homelessness. I continue to pray for those who have lost their family members to this disaster. I am changed by having borne witness not only to human fragility but also to the ability to survive against all odds. The coordinated effort of the international community to help Haiti inspires me. My hope is that a stronger Haiti will emerge from this catastrophe.





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