Some great links

It's been a while since I've posted so I apologize!


I just had to share these links.


The husband of one of the anesthesiologists I worked with is a film producer/editor and he put together a fantastic video about the volunteers.  Here is his link:


http://dpcrow.smugmug.com/Other/Haiti-Movie/11994337_Fdpqk#849960455_sPyYo






The other link is a compendium of all the photos taken by the Duke-Raleigh crew: 

http://dpcrow.smugmug.com/Other/Milot/11291961_wQCbe#792720883_4iVrG

 There are quite a few pics in here!


Enjoy!

An Interview with 100 beds for Haiti

I was interviewed by Cassidy Flanagan from the organization 100 beds for Haiti


http://100bedsforhaiti.com/


They are trying to give Sacre Coeur hospital 100 new hospital beds for their patients.


Please visit their website and get involved!   Thanks!







 1) You're an anesthesiologist working at York Hospital in Southern Maine; what brought you to CRUDEM and Hopital Sacre Coeur (HSC)?

I have always been interested in travel to developing countries and international medicine.  I have travelled extensively in Mexico, Costa Rica and Turkey.  I was evaluating several places to go for my next Medical volunteer trip when the Haitian earthquake happened.  I knew right away that I had to offer my services to the Haitians. For a disaster of that magnitude to happen to a country with no existing infrastructure?  What a catastrophe.  I saw all the news clips coming in and the suffering I observed in the Haitian people really affected me on a professional and on a human level.

I was connected with CRUDEM/Sacre Coeur through a connection at the American Society of Anesthesiologists (ASA).  I felt like my skills would be particularly useful there because they had operating rooms that were up and running.  Thus, I could do clinical anesthesia and spread out their workload a little bit.  I was able to get 2 weeks off from work thanks to my colleagues and I went down.

2) Have you ever done humanitarian or disaster relief work before?

I spent 5 weeks traveling around rural Turkey about ten years ago as an ER physician.  I helped teach the Turkish residents and Medical Students in eight or so different hospitals.  It was a great experience.

I have never done disaster relief on the scale that I found in Haiti.  I’m not sure many medical providers have!


3) What were some of your first impressions when you arrived in Milot and HSC?

Milot was actually much smaller than I expected.  It was a very tight-knit, “homey” sort of community.  Everyone was very welcoming in Milot. It was much cleaner than Cap Haitien, the city I flew into. Milot actually had some paved streets, a rarity in Haiti.

The first thing that really struck me about HSC when I arrived was how ORGANIZED the place was!  I was expecting chaos.  After all, they had to expand from 65 beds to 400+ in two weeks!   The OR area had been converted from 3 to 5 working OR/procedure areas. I was expecting I would be doing surgeries outside in tents!    The tents for patients had already been set up. The volunteer area had been expanded to hold all the extra volunteers.  It was very impressive.  It was a real, functional hospital in the middle of the poorest country in the Western Hemisphere.

   4)   Before you left for Haiti you set up your own blog,
 http://brewdocinhaiti.blogspot.com, reporting on your own experiences and observations working at HSC.  It was really moving to read your different entries starting a few days before you left to your return back to the U.S.  You also took quite a few photos of different patients both recovering and in during surgery.  What was it like to document your own experience on the ground?


Thanks!  I really enjoyed writing the blog.  It helped me decompress after the long, stressful days away from my family.  I wanted to share my own experiences down there to give people a sense about what it was really like to work there.  Most of what people see of Haiti on CNN or the other news channels definitely has a “spin” on it.  The news networks  are in the business of attracting viewers so they are going to find the most shocking or awe-inspiring stories to report on.  They aren’t going to talk about the different types of rice and beans the volunteers share with the patients and such... or the roosters that keep the volunteers up all night (laughing). 

The kids loved having their pictures taken.  Most of the pictures I took of the kids were with cards that my kids’ classes made for them.  They LOVED those cards!  Even the teens.  They were SO into those cards!



5) On average, how many patients did you see a day and about how many surgeries were able to be performed each day?




  Wow.  That’s hard to figure but I would say in an average day I personally did between five and eight cases. The OR was doing at least 30 cases a day.  I was there late February and they had done upwards of 800 cases for 2010.  Last year they did 1200 cases in the entire year.

6) As a doctor working in a hospital in the U.S. with access to some pretty advanced technology, how were you able to adept to technology you had available to you at HSC?  What were some of the most challenging aspect of diagnosing patients?



 In anesthesiology, the main concern was safety.  We tried to keep the anesthetics as safe as possible for the patients.  Since we did not have access to the most modern anesthesia machines, we tried to do regional anesthesia (spinals and nerve blocks) as much as possible.  Regional is pretty “low-tech” : although one of the Duke/Raleigh anesthesiologists that came down brought his own ultrasound for nerve blocks.  That was pretty slick! (laughing)

The thing I found the most challenging was not being able to get ( or find) lab results on my patients. I knew  they were ordered, but I couldn’t ever, for the life of me, find them.  That tends to make things challenging.  Your patient is hypotensive and tachycardic.  Is it a result of the spinal or is it because their Hemoglobin is 4? (Normal is 15)

7) You mention that Phillips Electronic donated a "fluoroscopy unit for 'real-time' X-rays in the operating room".  What did this mean for the OR?

That was huge.  We had the only fluoroscopy machine in all of Haiti!  A fluoroscopy machine lets the surgeon see immediate X-ray images intra-operatively.  When all the original, emergency repairs took place this was not available to the surgeons.  As a result, the orthopedists were taking their “best educated guesses” as to how the bones would line up best.  

Once they got the fluoro machine they could re-do the repairs with much better fixation and alignment for long term recovery.  We were getting 4-5 patients flown in daily from all over Haiti to have their fracture fixations revised.  The orthopedic team was absolutely pummeled when I was there.

8) You describe one patient, a 17-year old boy who among other injuries had a fractured skull with parts of the skull effectively dead from infection, and needed to be removed to prevent an even more serious infection like meningitis.  The decision to operate was a complicated one because this particular piece of the skull rested over a large vein that drains blood from the brain (so any sort of tear could cause immediate death) and you had only one unit of blood that you were unable to test for HIV.  How did you and your team evaluate this case, including the mitigating circumstances, and chose to operate?


Yeah, that was a tough one.  He was the nicest kid too. He was an orphan but had such a great attitude about everything.  

With him it came down to:  without the surgery, he was certainly going to die from an extension on the infection intra-cerebrally. There was a much smaller risk of tearing his sagittal sinus and an even smaller risk of contracting HIV from the blood transfusion.  So, even though the surgery and transfusion would entail some risk, “gonna die” trumps “slight risk of dying” to put it bluntly.  So we elected to proceed.  Luckily, he did fine and there were no complications.

9) Haiti has one of the world's highest HIV rates, did you find this to be an added challenge when treating patients?

We practice universal precautions with all our patients and assume “everyone could have HIV” in the US.  So it didn’t feel any different in Haiti, although I must confess I was I bit more wary down there.   The diseases I was more concerned about were malaria and tuberculosis (TB).  Several volunteers I talked with contracted malaria on previous visits.  That didn’t sound the least bit fun.

TB runs rampant in Haiti and it is, in fact, one of the leading infectious causes of death in Haiti.  We took care of numerous patients with TB and probably many more that are undiagnosed.  HIV is relatively hard to catch, TB is relatively easy to catch.

10)  One passage from your blog struck me as particularly moving--and in keeping with our 100 Beds for Haiti Campaign, I found extremely relevant:


“It is now 10 PM and having just transported our last patient of  the day on an army stretcher, across the dirt road, in the rain, to his current home in Tent #5 where he will spend the night with 50 other patients, I’m going to pass  out on my own cot. zzzzzzzzzzzzz”    


HSC has about 73 patient hospital beds, and is treating well over 300 patients.  Many of these patients are recovering in the Tent City set up across the road from the hospital, sleeping on cots; and, even you were sleeping on your own cot!  Can you describe your response to the condition you were working and living in?

Ha ha.  Yeah, I was pretty tired when I wrote that.  We all realized that when we were heading down there, it was not going to be “Club-Med” and our accommodations were going to be somewhat spartan.  We weren’t getting the best sleep in the world but none of us were complaining.  We knew it was as bad if not worse for the patients.  That patient that I described just had a revision of his lower leg external fixation device.  So Sam, a medical student and I carried him across the street in the pouring rain and we were all soaked.  The patient plopped himself down on his cot, KAPHLUMPHH!!  He and his family thanked us profusely.  All the other patients were peering out from their sheets to see what all the commotion was.  I couldn’t help think, “I have absolutely nothing to complain about”. But,  I really think he would have benefitted from a real hospital  bed.  The cots are far from the least comfortable thing to sleep on ( that prize goes to the luggage compartment floor in a Czech second class train)  but post fracture fixation patients do require a bit of malleability in their resting quarters.  They really need their fractures elevated and such.


11) Haiti has a long way to go on its own road to recovery but from your own experience and observations what does an increase in support and donations from professionals volunteering their time and skills to monetary donations mean in terms of immediate positive changes?

Haiti is totally dependent, at this point, on foreign aid and organizations. Sadly, the Haitian government has not figured out how to truly help the people of Haiti themselves yet.  If there is a silver lining to this earthquake, I hope it is that the Haitian government can begin to honestly work with foreign governments and aid organizations to re-invent Haiti’s infrastructure, schooling system and health care delivery.  The will to help in Haiti is definitely there!   In the meantime, Haiti will continue to benefit from people generous enough to donate their time and resources to help them rebuild their country.  Aid is the only way things are going to improve at this point.   The people of Haiti are phenomenal;  kind, generous, friendly, caring.  I’m already planning my next trip back there!  I love it!

Reflections and Re-entry

My last few days in Cap Haitien were spent walking through the city and striking up conversations with the 12-14 year old teens who would predictably latch onto me.  The chats were mostly light-hearted, talking about Haitian music

“ I love reggae!  Who’s your favorite Haitian reggae artist?”

“Bob Marley!”

“Bob Marley is not Haitian, he’s Jamaican!”

“No he’s NOT!!”

But the question often came up,  why weren’t they in school?

“ My family can’t afford it..”

“I don’t have enough money...”

“I live on the street, they won’t let me go...”  

The replies were as endless as the kids on the street.  I was floored.

“ But you need to learn to speak English or French. You need to learn math. ”

“YOU can teach me!”

Clearly their truancy was not from a lack of interest or a lack of eagerness to learn. They wanted to be in school.  Sadly, the system made it difficult for them to attend.  

 In  Haiti,  there is a tuition to cover the expenses of school.  It amounts to a fairly nominal  $200 or so, however this exceeds the annual income of many Haitian families.   Add to this the cost of a mandatory school uniform and remember that Haitian families with more than six children are not uncommon and the problem is clear.  Families in Haiti simply can’t afford to educate their children.

In the vicinity of Port-Au-Prince the problem is compounded by the fact that there aren’t any schools.  Nearly all of them were destroyed in the earthquake.  Some opportunistic schools have taken to having outdoor lectures under tarps, but these appear to be the exception, not the standard.

It is my opinion that the one change that could improve Haitian society more that any other would be an improvement of their education system.  Observe countries such as China, India or most of the “Asian Tiger” countries.  Thirty years ago their development indices were on par with Haiti’s.  Recently these countries have made great strides in development and are no longer referred to as “frontier” or “third-world”.  Their common denominator is that they put great emphasis on education and their educational systems.

I believe that if Haiti started to take its education system seriously and could allow all of its citizens to attain a quality education, it too would rise from its current depressed state.  Haiti could finally be freed from the bondage of foreign aid by the talents and technology of its own citizens.   

I have had a few days to reflect on taking care of the victims of the worst natural disaster of this century to date.  I don’t need to reiterate what wonderful people the Haitians are and what a horrible tragedy this was for them. 

 The following, however, are points that do seem to keep sticking in  my mind......

• I completely underestimated the physical and mental exhaustion I would experience working with disaster victims.
• Disaster work attracts truly unique individuals.  I was fortunate to be able to work with such a flexible, resourceful, adaptable and talented team of individuals.
• It is incredible, even in society’s darkest hours, how humans can retain the ability to smile, joke, sing, dance and aid one another.
• Even though this may sound cliché, sometimes it takes an experience such as mine in Haiti, to realize the relative insignificance of some of the things we get riled up about in our society.

As I write this, I am already planning when I can return to Haiti.  Haiti is an incredible place that needs a chance of a fair educational system for all  and an uncorrupt government to help it get on its feet.  

Bon chans Ayiti!

Back to Cap Haitien Again.

I ended up leaving Sacre Coeur a day early to relish the American comforts of an air conditioned room, a soft bed and no midnight roosters before heading back to the USA.  I’m staying at a charming little hotel in Cap Haitien called Mont Joli.  I highly recommend it to anyone who is coming down this way.  My wife asked me to describe Cap Haitien, the (I believe ) second largest city in Haiti.

Cap Haitien Harbor

Cap Haitien, is very, very dirty.  Piles of trash line the streets as well as the drainage ditches which run alongside the streets. The drainage ditches have become backed up from all the trash obstructing them filling them with a gooey, mossy, green sludge.   The roads are unpaved and very dusty.  Dog feces, flies and mosquitoes are everywhere.  It is very loud.  Humans unashamedly relieve themselves right in the middle of the street.  Most of the buildings are crumbling and disintegrating.  

Everywhere you walk 4 or 5 guys tag along beside you and tell you how hungry they are .  They ask why can’t you just spare a few dollars for them.   I had two young men follow me all the way up to the hotel entrance before the staff shooed them off. Not that I blame them, after all, the average Haitian wage amounts to about $20 a month!     

I haven’t been able to take many pictures because if you take your camera out on the streets here, you might as well put a big, red bullseye on your chest.

That being said, for reasons I can’t explain, I really like it here!  There is so much color and personality!  There is a vibrancy you just don’t see in US cities!  

People who have worked in Africa tell me this area is a lot like Nigeria.  They also say most of Africa has much better sanitation than Haiti does.  Although that does surprise me, I suppose it would not be hard to do!  Sanitation is clearly, as I see it, the major challenge for this country.

Tomorrow I head home.  I will be very excited to see my family, but I will miss it here.  For all its shortcomings,  Haiti really grew on me.  I have never met a tougher, more resilient people in all my years of traveling. I never once heard a Haitian complain about anything during my time here.  

It will be a few days before my next post.  It will take a few days to reflect and ingest this whole experience.  I do wish to send a thank you to York Hospital.  Hundreds of dollars of drugs and equipment were donated by the hospital and my colleagues were quick  to cover my calls and late-shifts in my absence.  THANK YOU!

Kreyòl Ayitien

"Creole is a language whose body is French but whose soul is African."

 -Aimé Césaire

Most people assume that Haitians speak French.  French, after all, is the official language of government and higher education in Haiti so it would make perfect sense to assume that to be the case.  In fact, only a small number of educated Haitians are able to hold a conversation in French.  The language of the people is called Haitian Creole or Kreyòl Ayitien.  To anyone who has heard Kreyòl, at first it sounds like a dialect of French spoken extremely fast.  But it doesn’t take long to realize that Kreyòl is certainly not French.   Most native French speakers admit they can’t understand hardly a word of Kreyòl . So how did this language evolve to be the real national language of Haiti?

In the 18th century, large numbers of slaves were brought to Haiti by the French.  Most came from Western Africa, from what is present day Nigeria, Togo, Benin, Burkina Faso, Ghana, Ivory Coast and Cameroon.   The main tribes that were selected to bring to Haiti included the Yoruba, Igbo, Ewe, Bakongo and Fon tribes .   The slaves from these tribes heard the French that was spoken by their masters and tried to assimilate the words and syntax into their own languages.  Gradually, a unique language evolved with a vocabulary that was mainly derived from French, but a grammatical structure, or syntax, that was distinctly African. 

Over the decades Kreyòl solidified its identity and became the language of the people.  For centuries it was solely a spoken language as most of the citizens of Haiti were illiterate.  It was only in the latter half of the 20th Century that written Kreyòl became standardized. An interesting side note is that Haitian Creole is very closely related to the French Creole of Louisiana and other creoles of the Caribbean.

Kreyòl has had a difficult path to establish itself as one of the national languages of Haiti.  Ever since the revolution, French has enjoyed much higher prestige in Haiti.  French has always been considered to be the language of the educated and of the elite in Haiti.  Over the years, lawmakers have consistently dismissed  Kreyòl as a direct link and reminder to the days in which Haitians lived in bondage. Kreyòl was not accepted as a literary language and until the mid- 20th Century there was no literature written in Kreyòl.   To this day all Haitian school instruction is mandated to be conducted in French.  This, despite the fact that most of the teachers are unable to speak proper French themselves.

I was able to teach myself a fair amount of Kreyòl in the few weeks before I left.  I am able to fairly adequately express my needs in Kreyòl...understanding the reply, however,  is a different story.  Kreyòl does tend to be fairly easy for English speakers thanks to the vocabulary ( 50% of English words have a French origin) and the mercifully simple grammar.  

For example,  nouns have no gender, and their plural is formed simply by adding yo after the word. The term for “a” or “an” is placed before the noun, the term for “the” is placed  after the noun.  There are only five pronouns that do not decline based on their function (eg: mwen can mean:  I, me, to me, from me, my or mine)   To form the negative, just put pa in front of the verb. Possession is shown by placing the person or thing possessed before the possessor (eg: kay mwen : my house,  kay ou : your house).

Here are a few phrases thanks to Bryant Freeman’s Survival Creole Copyright © 1990, 2002

Good morning!   Bonjou!

Good evening!  Bonswa!   

How are you? Kijan ou ye?

Not bad. M' Pa pi mal.

And yourself? E ou menm?

Great! Anfòm!

I’m getting along. M' ap kenbe.

Hang in there! Kenbe, pa lage!

Have a good trip! Bon vwayaj!

Bye-bye. Babay.

See you (God willing). N a wè pi ta (si Dye vle).

It has been great fun attempting to communicate with the Haitians in Kreyòl.  They are very enthusiastic teachers and when I attempt to speak Kreyòl with them the response is always the same.   Eske ou menm pale Kreyòl??  Do you really speak Creole??

For more information, please visit:

http://www.indiana.edu/~creole/creolenatllangofhaiti.html