Haiti Update
If anyone was possibly wondering, “Where in the world is Adam?” The answer is at the Hôpital Albert Schweitzer
(HAS) in Deschapelles, Haiti…and why Haiti? Well, about two weeks ago an email was forwarded to me that the
hospital was in desperate need of a surgeon to help out for a few weeks; and since I am not leaving for Ethiopia
until 13 August (the details of that will be in a future update), I figured I might as well head on down and check the
place out. I mean Haiti was always on my list of places to see.
So basically three days after getting the message I was on a non-stop flight from JFK to PAP (Port-au-Prince). I
was met by Debbie, the hospital director, and we drove four hours north of the capital to the central part of the
country. The hospital is located in the middle of Haiti, in the lush Artibonite Valley, about half way up the coast
from Port-au-Prince and midway between the Caribbean Sea and the Dominican Republic border. As an FYI, Haiti
makes up the western part of the island of Hispaniola.
As I am sure many of you know, Haiti has been and is a political and economic mess. I am not going to touch on
the politics as I basically don’t understand them myself. There were, however, elections in February and a new
president was elected, although it is as yet unclear whether he is doing much to stabilize and improve the country.
What I do know is that Haiti is one of the poorest countries in the world - ranking right up there with such exotic
travel destinations as Malawi and Sierra Leone. In terms of per capita GNP, Haiti’s is $390; sure that’s more than
double Malawi’s US$ 190, and Sierra Leone’s US$200, but compared to the United States at US$ 41,400, it’s
really really bad.
But here in Deschapelles things are a bit different. In fact, at times I don’t really feel that I am necessarily in Haiti
or even the Caribbean. We are isolated from much of the poverty on a rural campus of dirt roads, old stone and
concrete buildings, and guest houses that before the hospital was built belonged to the Standard Fruit Company.
HAS was opened in 1956 by Larimer Mellon and was modeled on the hospital founded by Albert Schweitzer in
Gabon, Africa. Larimer Mellon, of Gulf Oil and Mellon Bank lineage, ended up later in life attending Tulane
medical school. He and his wife, Gwenn, built the hospital using the Albert Schweitzer principle of, “Reverence for
Life.” For fifty years HAS has provided for the health of the roughly 300,000 persons living in the valley. There are
surgery, medicine, pediatrics and ob/gyn services, as well as seven dispensaries located throughout the district.
The hospital itself, although once bigger, now has 100 beds - one third of which are surgical, and employs a local
staff of approximately 700. Currently there is only one fulltime general surgeon, Dr. Chauvette Exe, a Hatian
doctor trained in Port-au-Prince and who has been at HAS for 23 years. He is a wonderful, reserved, and very
capable surgeon. In the past there have been American and European surgeons to help with the case load,
however, once I leave, Dr. Exe will be by himself.
What has been most amazing for me is that this is probably one of the best third world district hospitals I have ever
seen. Nurses actually care for patients and record vital signs and urine output on a regular basis; there are real
patient charts and medical records and the ability to track down old x-rays; and the operating room is stocked with
all kinds of sutures, self-retaining retractors, and even long tips for bovies; in addition to functioning lights, running
water, and air conditioning.
However, I don’t want to go too overboard. Remember, HAS is still a Haitian district hospital – it’s certainly far from
perfect. But the way the buildings were designed with central courtyards with stone fountains and teeming with fruit
trees; and rooms of two, four or six patients with glass louvered windows and screens to allow sunlight and cooling
breezes to enter makes for a very pleasant facility.
As for the caseload, since I arrived we have had two mass casualty situations. The first was on my second day
when 12 patients presented after the truck they were riding in drove off the road. One older man arrived in a coma
(GCS 3) and died the next morning, another had a traumatic above knee amputation; others had an open elbow
fracture, some severe scalp and facial lacerations, and a bunch of bumps and scrapes. Two days later 20
patients presented at once secondary to a mini-bus crash. Again there were many fractures and lacerations, but
fortunately no other serious injuries. I was told, however, that a number of victims died at the scene.
What was fascinating to observe was the system that they have developed here to take care of large numbers of
casualties presenting at the same time - something which happens about once a week. Before any doctor arrives
in the emergency room area, the staff is trained to give each patient a number in the order of their arrival and
write that number on a piece of tape that is affixed to the patient’s forehead. They then insert IV lines, apply
pressure dressings to bleeding wounds, expose the patients, take vital signs, and prepare patient charts. By the
time this is done a physician or surgeon has usually arrived and can deal with the issue of formal triage in terms of
deciding the order in which treatment will occur. By also having the patients numbered it is easy to do follow up
once they are sent to the wards or OR or x-ray. For example, it is much easier to keep tract of patient #1, #2, etc.,
instead of “the femur fracture” or “the scalp laceration lady.” I certainly would recommend this system for any
developing country district hospital. I will certainly introduce it to places I visit in the future; and we are in the
process of writing up this method to present at an up-coming trauma conference.
In addition to the trauma cases, I did a below knee amputation on a diabetic woman with a gangrenous lower
extremity; diabetes and high blood pressure are very common here. The biggest case so far was an abdominal
perineal resection for a very low rectal cancer. Exe and I operated together and all went very well.
Other elective cases have ranged from prostatectomies, circumcisions, hernias and hydroceles, breast biopsies,
to skin grafts, and the excision of various masses including the largest hemangioma on a guy’s back that I have
ever seen. (It measured about 8 x 14 cm).
I was also planning to help Exe do a colonoscopy as he isn’t comfortable doing them, but the patient we had
scheduled never showed up. It is, however, really nice that they have so much equipment including endoscopes
and colonoscopes. In addition to the general surgery there are also plenty of orthopedic cases. They put in plates
and rods, although I personally don’t feel comfortable doing these types of cases. I’ve been told that they have
had a very good success rate and very few complications.
This weekend I am on call which will enable Exe to travel to Port-au-Prince to visit his family. I’m hoping things will
remain quiet, but it will be interesting to see what happens. Luckily, even though I don’t speak Kriole (the local
language) many staff members speak English and my basic French is rapidly improving.
As for the living situation, I must admit it’s fairly comfortable. I have my own room in the guest house. There are
cooks who provide us with three meals a day, and maids to do laundry and clean. Sure there is only running water
two hours a day, from 6 am to 7 am and from 6 pm to 7 pm, but there is electricity all the time. A real swimming
pool, left over from the Standard Fruit Company days, is also very nice after a long day in the OR. Basically life isn’
t too bad.
I really haven’t seen much outside of the hospital campus, although last Sunday I did go with one of the American
pediatricians and his wife to the nearby village of Verrette. We went with one of the local hospital employees and
attended a cockfight – these aren’t the kind where they use razor blades so it was not to the death and there was
no blood, but it is one of the few forms of entertainment and the local folks really got into it, cheering on their
favorites and making wagers all around. Afterward we saw some dancing that was part of a voodoo ceremony; it
was interesting, but to my untrained eye seemed merely like a bunch of guys banging on drums and a bunch of
women dancing in circles, but hey, what do I know?