Maddie Barbe & Stephanie Golding
It was the morning of June 27, 2017 when we grabbed our bags and started our journey to Port-Au-Prince, Haiti. We landed in Port-au-Prince, and even just in the airport, the cultural difference in Haiti was evident. While waiting for our bags, we noticed that Haitians have less value for personal space and had no problem interacting closely with those who surround them. While Americans would distantly wait their turn to pick up their bags, Haitians were quick to push strangers aside to get to their luggage. Overwhelmed in the small airport, we were then taken to Hopital Bernard Mevs, the hospital where we would be staying for the week and spending the majority of our time working. The next morning, we met Dr. Ryan Fitzgerald, DPM, a podiatrist on FootAid’s Mission Response Team that we would be helping bring much needed foot care to the area.
Haiti, a small country in the Caribbean that shares an island with the Dominican Republic, was hit by a 7.0 magnitude earthquake in January of 2010. Included in the major demolition of the country was the destruction of 50 health centers, part of Haiti’s main teaching hospital, and the country’s Ministry of Health. In the aftermath of the earthquake, United Nations sent aid and established a base in Port-Au-Prince. Despite an attempt to help, the UN peacekeepers played a significant role in the initial outbreak of what became a deadly cholera epidemic in Haiti. The week we were there, the UN troops were withdrawing from Haiti. Today, Haitians continue to struggle, with 59% of the population living on less than two US dollars per day (World Bank 2012). According to the United States Agency for International Development in March 2017, about 40% of Haitians lack access to essential health services. Seven and a half years after the earthquake, Haiti is still recovering.
When we got off of the plane and were driving around Haiti, we noticed how hilly and uneven the roads and sidewalks were. There are lots of stairs and the streets are filled with people selling different things, rubble from the surrounding buildings, and piles of trash. For anyone with a foot pathology that affects their ability to walk, it would be necessary to rely on others to help them get around the city. When talking to a volunteer emergency department doctor, he told us that it is not uncommon for patients who require that much help to be abandoned by their families at the hospital. The families drop them off and never come back to pick them up because they can no longer handle the burden of their debilitated family member.
Our first day in Port-Au-Prince, we went to a clinic run by FHADIMAC, an organization that, through the work of volunteer Haitian and foreign doctors, helps people with diabetes and hypertension. The clinic was set up with one building used to treat relatively less severe diabetic patients and a second building, which resembled a shipping container, used to treat more severe wounds and infections. We saw several patients, many with ailments similar to those we had seen during our time shadowing in the United States. Things would get much gorier later in the week. A few patients we treated at FHADIMAC needed surgery so we started creating a surgery schedule for later in the week.
Our afternoon at FHADIMAC ended early, so we got a chance to visit the Haitian National Pantheon Museum at the urging of some of the FHADIMAC staff. The museum was incredible and had many historical artifacts from the time of colonization (including the anchor from Columbus’ ship the Santa Maria). Our guide gave us a taste of the rich history of Haiti, and we learned about the heroes who successfully rebelled against Napoleon’s army to free themselves and others from slavery.
The other days were spent at Hopital Bernard Mevs, a hospital in Port-Au-Prince that is associated with the organization Project Medishare. We mainly worked in the wound care center of the hospital with Dr. Adler Francius, a general surgeon from Haiti specializing in wound care. We assisted Dr. Fitzgerald in wound care, amputation of digits, melanoma removal, treatment of a gas gangrene infection, and correction of a congenitally deformed second toe. Amazingly, these patients underwent surgical procedures in the office, some with local anesthesia and some without receiving any anesthesia. Most of the patients would watch us perform the procedures on them, sitting up with their eyes glued to what we were doing. They watched their toes being removed, their wounds being debrided, and their abscesses being drained. None of the patients ever complained, and only a few made facial expressions that indicated they were pain. We were surprised and amazed by how resilient these patients were. Performing surgery in the clinic was somewhat frustrating at times because we did not always have the preferred tools available, but the wound care nurses made things as seamless as possible. Some of the nurses spoke both English and French and were therefore very helpful for communicating with patients. Even with their help, sometimes they could not understand our English (they said we spoke very fast!), and it seemed that some things got lost in translation.
Caption: Large wound seen in wound care center when power was out (Left Image); Before and after treating congenitally deformed second toe (Center & Right Images)
Every afternoon, the power would go off, leaving us in the dark with patients, so we tried to get an early start in the mornings. This wasn’t difficult since we stayed across the street in the dorms of Hopital Bernard Mevs. We also had a friendly rooster outside our window, who made a few 5 am wake up calls. There were a few other volunteers, including doctors, nurses and other healthcare professionals staying for a few weeks at a time. We went to dinner at the now closed UN Base every night. It was a very unique experience with tasty food, which we washed down every night with a Prestige (the Haitian beer of choice).
Our final day in Haiti, we brought three patients we had seen earlier in the week to the operating room in Hopital Saint Louis, another hospital in Port-Au-Prince. The surgeries were a melanoma removal, a transmetatarsal amputation, and a diabetic ulcer procedure. The OR here was similar to an OR in the US, except it lacked some of the proper surgical instruments needed for the procedures Dr. Fitzgerald would be performing. The afternoon prior to our day in the OR, Dr. Fitzgerald and Dr. Francius went through a large pile of surgical instruments, where Dr. Fitzgerald picked out what he thought we would need in the OR. Dr. Francius made sure to bring those instruments with him the next day for the surgeries. We were able to scrub in with Dr. Fitzgerald on these procedures. This time, the patients received epidurals (no one received general anesthesia) and were draped off. With no power tools available, the removal of bone in the OR was a major challenge. Dr. Fitzgerald used a Gigli saw with two hemostats clipped to the end as handles on the patient that received a transmetatarsal amputation, for example. While the operating room still functioned like an American OR, it felt outdated and lacked many of the surgical instruments that American surgeons expect will be available during their procedures. Luckily, Dr. Fitzgerald was excellent at adapting and improvising to accomplish his goals with each surgery. Our day in the OR ended in true American fashion (delivery from Domino’s Pizza, the only American chain on the island).
Before and After Photos of the ulcer
Melanoma (before surgery)
Dr. Fitzgerald plans on returning to Port-Au-Prince in the fall to see some of these patients again, as well as find new patients to treat. We expect the culture shock will be less, but the rich experience we had there will carry through on his many future trips. We felt very fortunate that we were able to learn so much from Dr. Fitzgerald, Dr. Francius and the wound care nurses, and we also hope to return to Haiti one day in the future!