Haiti Provides Lessons on Nurses, Resilience and Complaining
Toni Eyssallenne, M.D., Ph.D. (M '06, PhD '06), who is a fourth-year medicine-pediatrics resident at Jackson Memorial Hospital in Miami, went to Haiti, the homeland of her parents, within 48 hours of the January 12 earthquake. She joined a medical team there and eventually served as a chief of medicine in a field hospital during her three-week stay.
I have always wanted to work and live in Haiti. As a first generation Haitian-American raised in a proud family, the beauty of my people, culture and country was never in question for me. I had visited the island nation with both my mother and father when I was younger and remember being so moved by the poverty that was in juxtaposition with the rich history that I knew and loved. Before my father died, we had talked at length about going to Haiti and strategized to make our contributions to a country we would not forget. He would create businesses and jobs, and I would work on improving health care.
The University of Rochester School of Medicine and Dentistry helped me nurture my love affair with Haiti. Out of all the medical schools that I had the opportunity to attend, Rochester was the only one whose international medicine program included a site in Haiti. Being from southern Haiti, neither I nor my family had even heard of Borgne, a small town on the country's north coast. But I was excited to finally be on the road toward getting to know my country of origin better. Through my introduction to Rose-Marie Chierici, a professor of anthropology at the State University of New York at Geneseo and director of the Rochester-based nongovernmental organization called H.O.P.E. (Haiti Outreach Pwojè Espwa), I began the process of understanding the needs of impoverished Haitians not only in terms of health, but how the relationships between environment, politics, social structures, and culture influence these needs.
Borgne is an extremely poor and isolated town. Although I had seen poverty before, this was a full immersion and it affected me deeply. Despite the naked, pot-bellied children, dilapidated shacks, mothers in rags and men young and old fishing for a dwindling catch in the hot sun, every morning I was awakened not only by time-challenged roosters, but the beautiful sound of voices singing the praises of God, sincerely thanking Him for yet another day of life.
I spent my summers after my first and second years as a medical student in Borgne as an assistant laboratory technician in H.O.P.E.'s clinic and a Creole translator for American visitors. In my fourth year, I was fortunate enough to participate in a community survey that helped facilitate an agreement between the Ministry of Public Health and H.O.P.E.; the previously defunct government hospital in the town would now operate through a partnership between the two. Today, this hospital stands as the central health care institution in the region and serves a population of more than 100,000.
My interest in international medicine, particularly as it relates to Haiti and the Haitian people, drew me to do my internal medicine-pediatrics residency at Jackson Memorial Hospital/University of Miami in Florida. Fortuitously, the university had recently inaugurated a global health residency focused on international health and health disparities. The program bears the name of the late philanthropist Jay Weiss, who was dedicated to working for the underserved in South Florida. As a med-peds resident in this track, I have been able not only to continue my work as a volunteer physician in Borgne, but also have traveled to other countries, including India, Peru and the Dominican Republic, to examine their unique health problems and health care systems in the context of their social, environmental, political and cultural structures.
On January 12, I was preparing for my last trip to Borgne as a resident. In addition to working in the hospital as I had in the past, I was excited about finishing a family planning assessment project. I began to receive what seemed like hundreds of text messages about a 7.0 earthquake in Haiti. I couldn't believe it. Knowing the damage 5.0 and 6.0 earthquakes cause in the United States and knowing the condition of the majority of Haitian housing, I knew that a 7.0 earthquake was going to be devastating. And in Port-au-Prince, the heart and center of the entire country? A million thoughts ran through my head; my goodness, I still have family in Port-au-Prince! And friends! And friends that have family and friends in Port-au-Prince! An earthquake in Haiti? Why can't this country catch a break? Didn't we just go through four hurricanes in a row? WHAT?? A TSUNAMI WATCH TOO???
Thankfully there was no actual tsunami, but the magnitude of this cataclysm in terms of lives lost, displaced, and changed cannot be overstated. The next 24 hours were consumed with phone calls and emails trying to find a way to get to Haiti.
Barth Green, a neurosurgeon at the University of Miami and co-founder of Project Medishare, a non-governmental organization that works in Haiti's Central Plateau, chartered a private plane and was in Haiti in less than 24 hours after the earthquake with a surgical team. The United Nations had erected two tents where they had placed more than 200 injured people and they needed doctors. The Association for Haitian Physicians Abroad e-mailed a request for physician volunteers and I and a good friend from internal medicine were at this makeshift hospital by 11 p.m. on January 14. Little did I know that we, along with an ophthalmologist and another Haitian academic internist, would be the only doctors available to relieve the surgical crew that had been working non-stop for the last two days. We had no nurses and our medications were limited. Everyone was in pain. Everyone needed a new IV bag. Everyone needed immediate attention at the same time. Our triage system evolved from red and yellow dot stickers to writing on the patients to writing on scrap paper and taping it to the cot, or in some cases, to the patient. Sleep was an impossibility. How could you sleep? There was too much need. There were wounds that one would think only were created in Hollywood: crush injuries, open fractures, pelvic fractures, facial and internal traumas.
Graciously, physicians from Martinique came in those first few days and selected critical patients to evacuate to their island in order to help their northwestern neighbor. Notwithstanding political tensions, the Dominican Republic took in a few as well and those on death's door were evacuated to the United States. The Israeli military came in like ninjas and had a fully operational tertiary care hospital system in three days and took some of our patients too. Doctors, nurses and medics from Colombia and Portugal came to lend a hand. And as the days progressed, physician groups from all over the United States had come in. It was incredibly moving to see such an outpouring of support for this traumatized country.
We received new patients as fast as we evacuated, however. Patients were being dropped off by the dozens by ambulance, pickup truck or other vehicle. Children had been burned by boiling food, water, or oil in pots and pans overturned by the earthquake. Lungs were collapsing, pelvic fractures were causing urinary retention, and people of all ages were coming in unable to move, some just their legs, and others their arms too. We lost several patients that first week, some old, some young and all heartbreaking. And the amputations—how will they resume their lives? There are no wheelchair ramps or elevators, and barely any prosthetics. How will the market women travel to sell their wares now? They usually have to walk for miles and miles carrying pounds and pounds of merchandise. How will they support their families?
Unfortunately, these were questions that we couldn't think about that first week. One surgeon said it over and over: "We are in damage control." Save as many as you can as fast as you can any way you can. And those decisions are difficult.
The second week, the hospital moved from the United Nations base to a field in Haiti's domestic airport. It stood as the University of Miami Hospital in Haiti with an operating room, a pediatric and adult ward, ICU, wound care, x-ray machine and pharmacy. Physician and nurse volunteers of all specialties could be found working in these tents. Physical therapists worked sun-up to sundown showing these survivors how to walk again.
I spent three weeks in this hospital. My happiest moments were when, at one point, both tents burst into prayer, song and dance rejoicing in their love for God and His mercy on them, and when my 21-year-old, one-month postpartum patient with a broken back and broken pelvis walked down the aisle of the hospital with command of her walker and the smile of light that young Haitians are famous for.
After the dust settles and time has rolled on, it is so easy to for the world to forget. When the media has lost interest because there are no more opportunities for award winning photographs of despair and destruction, the suffering continues. Just the other day in my continuity clinic in Miami, a mother came in with her seven-week-old son after being hospitalized for a urinary tract infection. She was all smiles and was attentive as I gave her instructions on how to care for her baby. And then I asked the question that I have come to ask all my Haitian patients: is your family alright? Having had a casualty in my own family, I know the likelihood of an affirmative response is small. "No," she said as her eyes welled up with tears. She lost her mother and her two brothers.
Her original plans of going back to Haiti after her baby was born have been thwarted, and she had to send for her two other young children who up to this point were having normal lives. She is staying with her aging aunt now, is separated from her husband, and is faced with having to fend for herself and her three children alone in a country she doesn't know and with a language she doesn't speak. She then wiped her tears, took a deep breath, sat up straight and smiled as if to say: "We will be OK." I continue to be amazed... and proud.
Haiti has been through hell, and it continues to stand. A common theme throughout this tragedy has been the resilience of the Haitian people. I have always believed that Haiti has the ability to recover and I continue to hold on to that belief. In addition to the collaboration of Haitians in Haiti and abroad to make that a reality, we will need a government that will finally be willing to change for the sake of its people.
I have learned many things from this experience. The first is that nurses are truly a godsend. I learned that in a crisis, many people have the ability to be extraordinarily and genuinely selfless. And the biggest lesson that I took home is that if Haitian people, after all they have been through, can rejoice and be thankful for their lives in the face of extreme poverty, hurricanes, and their houses falling down and crushing their bones and taking out their loved ones, I have no reason to ever complain about anything ever again.
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