I would like to tell you four
stories. Four stories from my most recent trip in Haiti that I believe
encompasses both what this country is like and why I continue to come back time
after time. The first two stories I’m going to share are stories that happen
too often, however are not told often enough. They are stories that I wish I
didn’t have to tell. Stories I wish didn’t exist. But the sad fact is that
these stories do exist. And too often do we turn a blind eye and forget about
these stories. But what I’ve seen and experienced I cannot un-see. And most
importantly, I cannot stay silent and turn a blind eye to these stories. After
the first two stories, I promise the last two stories are much more uplifting.
These last two stories show why I continue to come back to this country and why
I believe there is still hope for this country.
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| Emergency Room at Bernard Mevs |
The
first story I’m going to share is about a 36 year old husband-to-be. This man
(whose name I won’t mention for obvious reasons) was all set to get married to
his fiancé in 2 weeks. As I’m sure many of us have done, he was spending the
afternoon with friends playing some pick-up basketball. Suddenly he began to
feel something unusual. In the middle of his game the entire right side of his
body suddenly became weak, half of his face began to droop, and he lost the
ability to speak coherently. Classic signs of a stroke. Realizing what he was
going through, he and his wife raced to our hospital for treatment. He arrived
into our emergency room less than an hour after the symptoms began, which was
incredibly impressive considering the traffic in Haiti. Our team quickly
realized that this was most likely a stroke patient. Now for those who don’t
know, there are two main types of strokes: ischemic and hemorrhagic. An
ischemic stroke means that there is a blood clot somewhere in the brain that is
blocking part of the brain from getting blood. A hemorrhagic stroke means that
there is a blood vessel bleeding out somewhere in the brain. Both types of stroke have
the potential of being fatal, however a drug called TPA, if given within the
first 3-4 hours of the onset of symptoms, can potentially reverse the effects
of an ischemic stroke. However if TPA is given and the stroke is hemorrhagic,
the patient will die. It is fairly easy to tell the difference between the two
types of strokes with a scan of the brain, called a CT scan. These scans are
very common in the United States and can be found in practically every
hospital. In Haiti however, our hospital has one of the only CT scanners in the
country. There are a few other scanners scattered throughout the country,
however none of them give as much detail as our hospital.
Now
that you have a little background information, back to the story. After
confirming that the patient was most likely suffering from a stroke our next
step was to get him a CT scan. The CT scan would be able to tell if his stroke
was ischemic, which is what we suspected. If it was, he could have been given
TPA and his symptoms would have likely decreased or even completely
disappeared. We could have then discharged him and he would have been on his
merry way to get married.
Unfortunately
it didn’t work out like that. When we tried to get him to CT, we were told that
the CT scanner wasn’t working. The air conditioner had failed in the scanner
and we couldn’t use it without the scanner overheating. There was no way to get
a CT scan of his head until the next morning, which was clearly past our 4 hour
window of delivering TPA. The only other option was to transfer him to another
hospital with the CT scanner so he could get one there. In the states that
would have been easy. Here though, there was nowhere nearby that had a CT
scanner. We were stuck. We suspected an ischemic stroke but there was no way to
verify that. We were now faced with an impossibly difficult question: Do we
give the patient TPA and risk him dying? Or do we not do anything and allow the
right side of his body to be paralyzed for the rest of his life? This is one of
the most difficult decisions to make. Eventually the doctors decided that they
couldn’t risk killing the patient by giving him TPA. So we did nothing. We sat
by helplessly watching his wife-to-be sitting by the bedside, holding his hand
while he attempted to move his right arm. He kept trying and trying and I kept hoping
that he’d somehow be able to move it. But it never happened. That’s when I
realized the saddest part of this whole situation. I realized the wedding they
were supposed to have would never happen. This man would never walk again. He
would never work again. He may not even make it out of a hospital ever again.
His life had been completely and abruptly shattered. All because the air
conditioner overheated and they couldn’t repair it until the morning. Someone
has to be held accountable for that. But who? You want to hold the repairman
accountable but when you’re getting paid less than $1/hour, what sort of
incentive do you have to come and repair the scanner? You want to hold the
hospital accountable for not having a backup plan but how is the hospital
supposed to have a backup plan and keep their prices low when they barely have
enough money to run at normal capacity? You want to hold the people paying
accountable for the hospital being so unprofitable but how can you hold someone
who makes $1/day accountable for paying when a CT scan costs $200? These are
questions I have no answer to. There is no simple answer to these questions. If
there was, these wouldn’t be questions.
So now
the moral question comes into play. Did we make the correct decision by not
giving the patient TPA? Doctor’s take a Hippocratic Oath to ‘do no harm’. If he
were to die, would the doctors have just done harm to the patient? It’s an
incredibly difficult question. One that has no clear correct answer. I will
leave it to you to answer the question for yourselves. My opinion: they made
the right call. It was a call they shouldn’t have had to make though
.
(A CT scan performed
the next day confirmed that the stroke was in fact ischemic)
This
brings me to my second story; this patient being significantly younger than the
patient in the first story. So young in fact that he didn’t even have a name
yet. And unfortunately he will never get a name. Haiti has one of the highest
infant mortality rates in the world at 55 per 1,000 live births. While this is
an incredibly high number, I have a problem with statistics; they’re not
personal. On this trip, that statistic just became personal.
 |
| Courtyard of Bernard Mevs |
It was around 10PM and I was about to head to
sleep. Before I went to bed though I walked to the emergency room where my
friend Kylie, who came with me, was working. The second I stepped into the
Emergency Room I noticed it was quite chaotic. I asked if they needed an extra
hand and they gladly accepted my help. After performing and ECG on one patient,
the nurse asked me to run across the courtyard and grab a suction unit from the
ICU because they were in the process of intubating a patient. After the doctor
successfully intubated the patient I brought the suction unit back to the ICU.
I decided I’d check back into the ER real quick to see if they needed anything
else. When I opened the door I noticed someone sitting to my left who I had not
noticed previously. He was very calmly sitting on a chair with no expression on
his face. He must have just gotten there, I thought. There was something weird
about the situation though. In his lap was a giant bucket, one of those that
kind of looked like a mini swimming pool, full of blankets. I decided to
investigate a little further and as I went over to him I saw exactly what I
didn’t want to see. Coming out of the bundle of blankets was a face not bigger
than my closed fist. Quickly I turned to the nurse and asked if she had noticed
this man sitting in the corner with a baby. A look of panic rushed across her
face and she said no. We quickly rushed over to treat this baby. As we
uncovered the baby we realized that it appeared blue. Immediately I ran and
grabbed one of the doctors on our trip. When I came back they already had the baby
lying on a table and were performing rescue breaths and compressions. Quickly I
joined in, helping wherever I could. This baby, which still had its umbilical
cord attached to it, was incredibly premature (about 25-28 weeks). We performed
rescue breaths and chest compressions on the baby and eventually we were able
to successfully resuscitate the baby. We quickly brought him to the NICU
(Neonatal Intensive Care Unit) where they prepared a bed for him. During this
whole time, we were manually breathing for the baby using a device called a BVM.
Unfortunately whenever we stopped, the baby’s oxygen saturation would drop,
meaning it was not breathing enough. Thankfully we were able to intubate the
baby and find a ventilator to put it on.
At this point our spirits were high. We had
just brought a baby back from the brink of death and we had a free ventilator
to put the baby on (there’s only 4 in the entire hospital). We began thinking
that this baby may actually have a fighting chance to survive. We starting
getting the ventilator ready only to have our spirits crushed. As we tried to
get the ventilator ready we realized that the ventilator doesn’t have a low
enough pressure setting to use on neonates. The respiratory therapist who was
on our trip tried every possible setting on the ventilator but every time we
attached the baby to the ventilator, its saturation would drop and we’d have
to BVM the baby again. Our spirits were broken. We had done everything possible
to give this baby a fighting chance and it was going to die because we didn’t
have a pediatric ventilator. We tried to brainstorm any possible solution but eventually
a silence came over the NICU. There was nothing more we could do. We knew what we had to do. We had to let this
baby die. We tried one last-ditch effort to put him on oxygen and give him IV
caffeine. This seemed to work, but we all knew it was a temporary fix. This
baby was going to die and there was nothing we could do about it. We told the
father, who was watching the entire thing and slowly, one by one, we left the
NICU, giving our condolences to the father. 3 hours of effort and the baby was
going to die because we didn’t have the resources. Sure enough, by morning the
baby was taken off the monitor and passed away. His official death certificate
may say that his cause of death was respiratory failure but this baby died of
something else. He died of inequality and poverty. The only reason that this
baby didn’t have a chance at surviving was because he was born in Haiti.
Often when dealing with death you
can justify it by saying “it was their time”, “they lived a good life” or
“there was nothing more we could do”. But how in the world do you justify an hour
old baby dying BECAUSE OF A LACK OF RESOURCES? This wasn’t God’s will. This
wasn’t it’s time to die. This baby didn’t have a chance to live. There is no
way of justifying the death of this baby. The saddest part of this all is that
this isn’t a rare story. Over 5% of babies never live to see their 1st
birthday. Imagine that. And it’s well known that number is underreported. The
only slight comfort that you can take in this is that if this baby was in the
states, it only would have had a 50-60% chance of survival because it was so
premature. But that’s a hell of a lot higher than the 0.001% chance it had in
Haiti. That may provide comfort to some, but not to me. There are no
(appropriate) words I can use to describe how sick that makes me. No one should
have to die solely because of where they were born.
 |
| Port Au Prince from above |
Now that I’ve told you about some
of the sad stories I’ve encountered in Haiti, I’d like to shift gears now and
end on a much more upbeat note. The first story I’d like to tell is one of the
few “wins” we were able to get while we were in Haiti. It was one of the few
times we were actually able to make a save.
It was around noon when it all
began. My dad and I were catching up with one of the employees we’ve become
close to, Jocelyn, and his son when I first heard the sirens. I looked back
over towards the gates just as the guard peered out to see what the sirens were
for. Instantly after he looked out he swung the gates open and in drove a truck
with the words ‘police’ on the sides. I immediately started heading on over and
told my dad that I’d wave him over if we needed him. They opened the back of
the truck, I peered in and took about a half of a look in the back and
instantly waved him over. It wasn’t even the patient that made me wave him
over. What made me wave him over was the blood. There was blood everywhere. It
was dripping from the patient onto the floor, creating a huge pool of blood
that was now dripping out of the car. Immediately we got a stretcher and pulled
the patient from the back of the truck onto our stretcher. With bloodied gloves
I helped push our patient into the Emergency Room so we could figure out where
he was bleeding from. Right away we hooked him up to the monitors and obtained
his vital signs. They weren’t very good. His pulse was normal, however he had
lost a great deal of blood and had a blood pressure around 80/50. We quickly
found that the bleeding was coming from two spots: a deep laceration on his
right arm as well as another one near the left side of his neck. My dad quickly
asked the prison doctor what happened, but unfortunately the doctor didn’t
speak any English. Luckily though he had spent 4 years studying medicine in
Cuba so he was completely fluent in Spanish. In Spanish I asked the doctor what
had happened. The doctor told me that this man was a prison guard and one of
the prisoners had tried to murder him with a “knife-like object”. He was
slashed in his right arm and near his left neck. The doctor approximated that
he had lost over a liter of blood, possibly close to two liters during the time
that he was slashed and 30 minutes later when he arrived at the gates. I quickly
told this to my dad and he decided that we needed to expose the lacerations in
order to see what we were up against. We exposed the one on the arm first. It
was a deep laceration but nothing that was immediately life-threatening. The
neck was next. As we took the bandaging off we began to get a sense of how much
blood there was. These bandages were soaked in blood. Eventually we fully
exposed the laceration and sure enough it was bleeding an impressive amount.
“Luckily” he was slashed right along the jaw line so it missed his jugular vein
and carotid artery entirely. A few centimeters down and this man would have
bled out in 60 seconds. It had still hit an artery though and there was still a
chance for him to bleed out. He needed a surgeon quickly. But there was no
surgeon on staff that day. They quickly made a few calls and got the surgeon to
start coming. It was still going to be awhile though. We were now faced with
the task of trying to stop the bleeding as much as possible until the surgeons
arrived. Unfortunately we didn’t have quite as many resources to do this as we
do in the states. So how do you stop an arterial bleed in Haiti with no trauma
dressings? Well with diapers of course! We quickly grabbed a clean diaper and I
immediately put pressure on his wound. About 15 minutes after starting to hold
the wound we got some bad news. Turns out there was a shooting in the area and
the one street the surgeons needed to use to get down to the hospital was
blocked off. A look of both panic and sadness swept over the patient’s face,
who was conscious the entire time. We started thinking about transferring him
to a different hospital, which was our only other option. Unfortunately we
couldn’t get ahold of the other hospital right away. Meanwhile even with my
best efforts of stopping the bleeding, our patient continued to lose blood.
After about 45 minutes of holding the wound the police, realizing the gravity
of the situation, offered to go get the surgeons from their house and bring
them back. They did so and finally, over an hour after initially putting
pressure on the wound the surgeons arrived. They quickly took a look at the
patient and began preparing the operating room. Half an hour later we began
wheeling the patient across the courtyard to the operating room. Once they were
ready we wheeled him into the operating room, all while Kylie and I continued
to hold pressure on his wound. They quickly intubated the patient and once the
surgeons had their tools in their hands, one of the surgeons told me to let go.
Immediately, like a geyser, blood began to spurt from the wound. The surgeons
quickly suctioned the wound, found the artery, and clamped it closed. Finally,
after nearly 2 hours of direct pressure the artery was clamped and my job was
done. With cramped and sore fingers I left the operating room and headed back
to the emergency room. About an hour later we got some much needed good news.
The surgery was successful and the patient was going to do just fine. It was a
much needed win at the end of a week with way too much sadness.
The last story I want to share is a
relatively short story. It has nothing to do with practicing medicine, however
it is one that gives me hope. It gives me hope not only for Haiti. It gives me
inspiration to push through and try to make a difference. It’s the story of a
few dedicated individuals armed with nothing but a dream who are making that
dream a reality.
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| First Responder class taught by EMPACT Haiti |
When I first started coming to
Haiti I worked with a number of Haitian EMTs. All of these EMTs began working
at the hospital as translators and later got trained as EMTs. There are a
number of them that I am close with but one in particular that I am very close
with, Pierre. When I first met Pierre I instantly realized how great of a medic
he was. He was not only incredibly knowledgeable, but he also cared. This trip
I had the honor of going across the road with him to visit an EMT/first
responder class that was taught by Pierre and a few of the other Haitian EMTs.
It was incredible to see a classroom packed full of students, both males and
females, excited to learn about how they can help others. The group that
teaches these EMT students is a group known as
EMPACT Haiti. They were founded
and are run by the EMTs that I work with in Haiti. To date they have trained
over 1,000 Haitians to be first responders and EMTs. Pierre had me stand up in
front of the class and provide some “words of inspiration” to them. Little did
they know, it was them who was inspiring me. Pierre and a number of other EMTs
are now also part of the first air ambulance service in Haiti. Seeing this gave
me such hope for this country and the people. It just goes to show that with a
dream and unwavering dedication, even in the face of failure and adversity,
anything can be achieved. That small moment made my connection to Haiti even
stronger and it gave me even more motivation to continue down a path of global
health.
Well there you have it. It was a
long post but hopefully this gave you a better idea of how complex of a
question it is when someone asks me “how was Haiti?” Haiti is an incredible country
but it is also full of sadness and tragedy.
I’m not going to end this post with a nice bow-tied message. I think the
message of this speaks for itself. Until my next adventure.
“Imagine all the people
Sharing all the world...
You may say I'm a
dreamer
But I'm not the only one
I hope someday you'll join us
And the world will live as one”
