Journal From Haiti: An Internist's Experience in
By Howard W. Newell, MD, FACP
When choosing a specialty to pursue as a medical student, I selected internal medicine because of the diverse problems I would see and the interaction I would have with a variety of people. Indeed, I experience this each day as a practicing internist in North Carolina, where I also work weekly at a wound care center. Because of my background and interests, I had considered medical mission work in the past, and in January, I felt a strong desire to help those in need when the earthquake devastated Haiti. My training in wound care management seemed like it would be especially beneficial to those injured there, so I contacted a physician near my hometown who was organizing a medical mission to Haiti. He had many mission trips to his credit in South and Central America and Central Africa. He was well organized, and I readily agreed to participate. A hospital, pharmacy, orthopedic clinic, and school from our local area donated medication, DME, and other supplies and money to support our trip. Our medical director contacted other national and local charities that also made donations.
Our group consisted of 34 people from varied backgrounds. Four physicians - one internist, one pediatrician, one family medicine doctor, one emergency room physician - and two physician assistants were the providers. Accompanying us were three pharmacists and several nurses and personnel who had experience in chronic care facilities and health departments. Our supplies were shipped in the planes that took us there. Several of us were fortunate enough to fly on private planes donated by two local businessmen, and we arrived in Port-au-Prince on February 20 to set up our clinic in an abandoned school house. Others flew commercial to Santo Domingo and traveled eight hours by bus through the mountains to reach our clinic on February 21.
The facility had been used by the international branch of our medical director's church, and the accommodations were much better than anyone in our group had expected. We actually had running (cold) water, filtered water to drink, and partly working toilet and shower facilities. (This was far better than the situation for our patients, who shared bath water and thereby transmitted some diseases among each other.) We slept on cots inside the school, which had been inspected by contractors and deemed safe. However, our Haitian translators and other locals slept outside on the ground. They would not sleep inside, and their reasoning was more evident when tremors shook the building two nights in a row - once tossing me up on the cot. The first day after our arrival, we toured the area outside of our camp. The devastation was massive and difficult to comprehend. Chickens, pigs, goats, and dogs roamed the neighborhood. Still, many children were playing in the streets, and in one field, some youths had organized a soccer game.
While I speak some French, the Creole language was somewhat different, though I was able to learn several phrases to communicate on my own. However, all of the instructions and pharmaceuticals given there were provided with clear instructions from one of the several translators with us. Three of our translators were medical students from Haiti. Unfortunately, they now have no medical school in which to finish their training. One student, Gail, stated that most of the physicians who taught at the school had died in the quake. She felt great concern for the fate of her people after those of us providing care left.
Contrary to my anticipation, I provided very little wound care while in Haiti, as our group included a wound care nurse who works for a home health agency. My time was spent treating hypertension, diabetes, splinting fractures, and treating Malaria, among other infections. Most everyone there was suffering post traumatic stress from the quake, and many experienced stomach aches, headaches, and sleeplessness. When I asked patients what they had been eating, some would not tell me. However, they did state that their drinking water just after the quake was not always safe or treated and very dirty. Many people had diarrhea, and others could not access clinics to fill their regular medications.
We spent a day at a tent city, and there one of our translators found alive his brother whom he had not seen since the quake. During this day, our group treated a range of patients and problems. Our pediatrician cared for a one-day old baby with an infected umbilical cord. One infant had been abandoned, and one of our nurses instructed a surrogate caregiver on how to feed and care for the child. My colleagues and I treated an adolescent who had not received care for a foot wound and developed osteomyelitis. We discussed treatment options available and transferred her to a hospital in town where, we later learned, she had an amputation of her lower leg.
On another day, we went into a mountain region and provided care to a large group of patients who had not received health care for a long time. Throughout our journey, we met local survivors who shared their stories with us. One man we met told of how his wife was lying on the bed with their three children while he sat in a chair nearby. The quake struck and within a few minutes, she was dead, while the children and he had survived. Every day he goes back to his "home" to honor her memory. Indeed, the strength of the Haitians was astounding. People were sleeping on the ground and used tents or tarps to cover their living areas. Many were reclaiming the metal from the concrete that had been the roofs of their houses to sell for recycling. At one house, the walls had collapsed, likely due to poor mortar, and the blocks from these fallen walls became a makeshift pen for the family live stock that survived. One family slept at the still-standing metal gate to our camp.
We toured downtown Port-au-Prince where the National Palace, Legislative, and Justice buildings once stood. The military presence was evident throughout to keep order. A missionary traveling with us told of how bodies had lined those streets during the few days after the quake - a month after the quake, however, markets had replaced bodies. Vendors were now selling food, trinkets, various hardware, and wooden poles to support tarps for walls and roofs. Large trucks were traveling the streets transporting water to the tent camps, which were too numerous to count and too large to comprehend. Signs posted in the tent camps reminded people to wash and use good hygiene.
The Haitian people expressed an unreal amount of appreciation toward us, and I think everyone in our group had difficulty leaving, knowing so much more work was left to be done (or not) by others. I will never forget the experience, and not only because of the help that we provided. It was extraordinary to witness how people live, survive, and carry on in the face of abject poverty and devastation in one of the poorest countries in the world - when we are so blessed. One of the last acts of thanks was when a translator stated that he would see us again - not in this life, but in the life hereafter. To me, this powerful statement was the epitome of their faith and gratitude.
Here are some pictures from this experience:
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