In Haiti, Yale’s medical team learns to adapt
On arriving in Port-au-Prince with Yale’s second medical mission to Haiti, and observing firsthand the country’s poverty, the reaction of trauma surgeon Felix Y. Lui, MD, was that “decent medical care can’t possibly be delivered. … But then you meet the wonderful people here and you learn that compassionate care can be given in any condition.”
Lui was on a team of five physicians and five nurses who worked alongside Haitian colleagues for a week in March at the 700-bed Hôpital de l’Université d’Etat d’Haïti, the country’s largest hospital. The team was the second from Yale Medical Group, Yale School of Medicine and Yale-New Haven Hospital to provide aid after the January 12 earthquake that devastated Haiti. (A smaller team traveled to Hinche, a town in Haiti’s Central Plateau, in January.)
The second team was in Haiti from March 13 to 21 and was co-sponsored by a Yale College alumnus and Partners in Health, which has had a presence in Haiti for more than 20 years. In an e-mail message from Haiti, team leader Anthony J. Tomassoni, MD, assistant professor of surgery (emergency medicine), reported that conditions at the hospital were primitive. Brownouts and blackouts were common. Running water was unavailable for long stretches. Rats and roaches scurried about the hospital during rain storms. Team members had to adapt to the scarcity or absence of many basic medical supplies, and they described their frustrations in e-mails.
“I felt absolutely helpless,” wrote Anne Stevens, RN. “How is it fair that reusing IV bags and tubing is a standard of care? Since when is it acceptable to lay in a bed using a soiled old towel as a sheet? Why should a wife have to bag ventilate her intubated husband by herself? How long will it be before these people receive what they deserve? … But part of me, well, most of me feels like these people don’t need me. They need access to health care supplies, clean water, and sanitation.”
Team members were moved not just by the poverty, but by the compassion of the people they cared for.
“There is almost no patient without a loved one at their side constantly,” wrote trauma surgeon Dirk C. Johnson, MD. “They wash, feed, and change the patients. They go so far as to sleep on the ground underneath the bed so that they’re never alone. … Each night there seem to be more local doctors and nurses coming back to work. Despite whatever personal tragedy they have endured they show up to work and care for their countrymen. They may not have received a paycheck in months, but they keep showing up. This is the spirit that will lead to recovery.”
Added Susan B. Reynolds, RN, describing the patients’ family members, “They never complain that they are sleeping on the floor (that the rat just ran across) on a piece of cardboard. They don’t just care for their own loved ones, but also for the neighbors in the bed next door who may not have any family. Some are discharged but do not leave. You know that they probably have nowhere to go. A smile and soft touch go as far as the antibiotic they need desperately in order to heal.”
During the week in Haiti, the team worked in the hospital’s general wards. In one email, Tomassoni described a busy night: Lui and Johnson did an emergent c-section for a presumed eclamptic woman who arrested, but the infant was about 20 weeks and too young for effective resuscitation; John S. Giuliano Jr., MD, resuscitated several children; Gary V. Desir, MD, helped with several cases of acute and chronic renal failure.
“In this environment, where nothing is in adequate supply except your love and compassion, the rules are different,” Tomassoni wrote in response to a team member who questioned the effectiveness of her contributions in the face of overwhelming need. “You have shown incredible compassion and grown overnight to embrace these challenges. You made do, searched, traded and improvised to meet their needs. You held dying hands, mourning hands, and hugged your patients and their families in sorrow and in joy when small successes were won. The crisis is not passed yet. These people do need you, whether you’re here or at home. You have never succeeded better!”
The medical team also included Alicia A. Purzycki, RN; Kathryn E. Holley, RN; and Carrie L. Britton, RN.