On a UC Mission to Haiti, Practicing Medicine in its Purest Form

Members of the NSICU team, from left: Marie Lamut, RN; Judy Berra, RN; Heidi Salyer, RN, CNRN; Jordan Bonomo, MD; Linda Dempsey, RN, CNRN; Lauren Rosenberg, RN, CNRN; Debi Terrell, RN; Richard Curry III, MD; and Joanne Kash, RN.

For Jordan Bonomo, MD, the hardest part was watching his team cry.

During a one-week medical mission to Haiti, Dr. Bonomo and his team provided care to hundreds and saved countless lives. But they also witnessed sorrow, suffering and preventable death. They felt the breathtaking discomfort that comes with rationing healthcare, and they witnessed tragedies that, in America, could have been fixed in an instant.

“It’s supposed to hurt,” said Dr. Bonomo, a veteran of international medicine, during a break from his work as a neurocritical care specialist with UCNI and the Mayfield Clinic in the Neuroscience Intensive Care Unit (NSICU) at University Hospital. “And I had that conversation over and over with people. You’re crying because it’s the right thing to do. It’s different from environments you’ve been in previously, because you’re so helpless.”

Yet despite the emotional pain, nearly all of the 35 individuals Dr. Bonomo recruited for the Feb. 19-26 mission to Haiti’s earthquake-riven capital, Port-au-Prince, are on board to serve again.

“My experience in Haiti will be ever life-changing for me,” said Jennifer Jackson, RN, MSN, CNRN, Chief Nursing Officer at University Hospital. “I felt our team truly helped each person we touched — from teaching the breastfeeding moms the critical importance of drinking water while breastfeeding to running one of the most efficient clinic days the hospital had experienced. The UCNI staff demonstrated outstanding teamwork and made the unit and hospital proud.” “There were so many experiences that we took part in that were very different from what we do here,” said Heidi Salyer, RN, CNRN, Nurse Manager for the NSICU. “Yet at the same time you still have a major impact on the outcome.”

Dr. Bonomo, who has traveled on previous medical missions to Honduras, South Africa and Kenya, organized the Haiti trip through Project Medishare, a non-profit organization registered in Florida that was founded in 1994 by doctors from the University of Miami School of Medicine. Dr. Bonomo posted signs about the trip around the hospital and, in a span of four days, had a waiting list.

His team included nine providers from the NSICU (pictured above), trauma surgeons and emergency medicine residents. Jessica Wiles, RN, of University Hospital and Cincinnati Children’s Hospital Medical Center, and Nicole Harger, pharmacist for the Emergency Department, secured the group’s medications and vaccinations, which team members gave to each other. Team members purchased their own airline tickets and used vacation days to cover their time away.

The Port-au-Prince hospital — Bernard Mevs Hospital/Project Medishare – is Haiti’s only hospital dedicated to intensive care and trauma. It supports 45 adult and pediatric beds, two operating rooms and a triage bed by the hospital’s front gate.

“The hospital was operating at 100 percent capacity,” Dr. Bonomo said. “There was only one day when we had available beds. So you really had to choose. You had to choose when to discharge patients, so that you could allow someone else in to be resuscitated.

“It was honest, old-school medicine,” he continued. “You used your hands, you pushed on the belly, and when the belly needed to be opened and explored, you opened it and explored it. Our surgeons operated in a pretty austere environment, without blood available. You could get blood, but you had to go to the general hospital to get it, and someone from the patient’s family would have to donate the same number of units you were going to take.”

Dr. Bonomo recounted the story of a mother of two in her early 30s, who was brought to Bernard Mevs Hospital after seeking treatment at two others. She was febrile, septic and five months pregnant with a dead fetus, the umbilical cord protruding. No antibiotics had been given, and the administration of Pitocin had failed to induce labor. Because Bernard Mevs Hospital must restrict obstetric services, the team gave her antibiotics and called to arrange her official transfer to a women’s hospital, where she was ultimately refused at the gate by armed guards. Because of safety and logistics issues, she wasn’t able to return to Bernard-Mevs. Finally, she was taken to a Doctors without Borders hospital which, lacking surgical capability, provided what care they could, leaving the team with little hope for her survival.

“That was one of the cases that got to our team, especially the ER docs,” Dr. Bonomo said.

The team’s inability to provide obstetric services to the woman resulted from Haiti’s fragmented healthcare system, which remains shattered more than a year after the January 2010 earthquake.

“Our surgeons would have taken care of this woman, but we weren’t allowed to,” Dr. Bonomo said. “The hospital policy was that we do not do obstetrics. There was set criteria for what they could and could not manage. The fabric of healthcare in Haiti is a patchwork of small institutions doing specialty work. We were the intensive care and trauma hospital. We could take care of the sickest people in general, but we could not do OB. We did not have enough resources. So if you start to expand what the hospital tries to do, the whole hospital can collapse.”

“Learning to actually employ utilitarian reasoning and to consider the ethical situations in front of you is not something we are used to in America. It’s the rationing of healthcare in real time.”

Still, the rewards were real. The Sonosite Corporation donated a portable ultrasound machine to the team, enabling surgeons to save lives. Children were treated for seizures and hydrocephalus. Ms. Salyer worked to dispel the myth among nursing mothers that drinking water would turn their breast milk to water. And Haitian nurses were taught the difference between acute episodic hypertension and longstanding elevated blood pressure. “They didn’t want to give normal saline to patients who needed to be resuscitated but had a history of heart failure, because they knew that salt was bad for blood pressure,” Dr. Bonomo said.

Ms. Salyer experienced some culture shock upon returning to Cincinnati. “It’s a little challenging to come back and see the petty things that people get upset about, such as, ‘we don’t like the soap we’re using,’” she said. “‘Just be glad that you have soap,’ I think was my response yesterday. You have a new appreciation for a paper towel. That wasn’t an option in Haiti.”

Should all healthcare providers go abroad? There is no universal answer.

“I don’t think everyone is cut out for this,” Ms. Salyer said. “It’s physically, emotionally and mentally draining. Not everyone enters the healthcare field for the same reasons.”

“It’s easy to come back from a place like Haiti and think that you have some sort of moral authority to dictate what people ought to do with their lives,” Dr. Bonomo added. “The truth is you don’t. The fact is that we’re one of the wealthiest countries in the world, with resources that no one has ever imagined. Yes, you can probably find a week to go work in Haiti or any other underserved nation. Whether you choose to is up to you. It’s good for people to go if they can handle it. And if you go and you can’t handle it, you learn something about yourself that way too.”

Although three members of the team became ill and had to be temporarily quarantined for two days, those who took part in the mission came away healthy but changed.

“The bottom line is that we get as much out of it as our patients do,” Dr. Bonomo said. “I come back a more complete person, a better practitioner, maybe more of a human.

“When we pulled into the armored gates of the hospital the first day, people realized we’re not in Ohio anymore. But when we left, most people were in tears because they were sad to leave. There was a purity of purpose that doesn’t always happen in healthcare. It was medicine in its most honest form. You practice it because you care. You wash your hands because it’s the right thing to do, not because JCAHO (the certification team) is looking over your shoulder.”

— Cindy Starr

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