UC Health Team Haiti Eyes a Deepening Commitment

People pose for photo in hospital room

At the hospital, from left (standing): translator and hospital employee Jean Kensy Simbert, EMT, Sarah Winston, MD, and Margaret Spears, RN; from left, sitting: Eric Anderson, EMT-P, and Mallorie Boeing, RN. Photos courtesy of UC Health Team Haiti.

It wasn’t a one-time deal. The one-week medical mission to Haiti in 2011 didn’t turn out to be an experience of a lifetime that provided perspective, assuaged the conscience, and allowed Cincinnati clinicians to say they’d done their part. In January 2012 an even larger group went back, and they stayed twice as long. UC Health Team Haiti, it appears, is just getting started.

Jordan Bonomo, MD, a specialist in emergency medicine and neurocritical care at the UC Gardner Neuroscience Institute and a veteran of international medicine, and Jessica Wiles, RN, BSN, Clinical Education Program Developer in the Emergency Department at University Hospital, led 42 individuals* in the return trip to Port-au-Prince and Bernard Mevs Hospital/Project Medishare, Haiti’s only hospital dedicated to intensive care and trauma. The Cincinnati team was divided into two groups, with most members working one week between Jan. 7 and 21, but some working two. The doctors, nurses and paramedics came from UC Health, Cincinnati Children’s Hospital Medical Center and Good Samaritan Hospital. Team members purchased their own airline tickets and used vacation days to cover their time away.

Looking ahead, Dr. Bonomo said this week that he envisions not only a standing rotation of one- or two-week mission trips, but also opportunities for training Haitian clinicians. “They need us to come as educators,” he said. “I can imagine our efforts out of UC Health splitting into two groups: those who want to go and serve and be part of a mission, and those who want to teach and provide advanced training in, say, ultrasound. In Haiti they can use an ultrasound when no X-ray or CT is available. This may be how we make a broader and more lasting impact.

“We have so much to give,” he continued. “We go as a team, as friends, with the same academic model. It’s what we do here … there.”

Getting the team ready for a mission is something like readying a platoon for battle. For Ms. Wiles, the team’s coordinator, it’s a labor of love. “From administering vaccinations, anti-malarial drugs and HIV prophylaxis to gathering supplies and securing passports and documentation of licenses, the to-do list can seem endless,” Ms. Wiles said. “But at the end of the day I am tremendously grateful for the time and talent that our team dedicates to our missions, so the extra effort it takes to organize seems small in comparison to the gains.

“The more daunting challenge,” she added, “is the realization that many of our team members obtain their very first passport to attend this mission. Taking a group to a place like Haiti as their first experience outside the country doesn’t come without risk, but our team did a fantastic job adapting and embracing the Haitian culture.”

Nurses and doctors conduct surgery

This year UC Health Team Haiti found Bernard Mevs Hospital in better condition than the year before, but with still-humbling facilities that included 2 emergency department beds, 3 ICU beds, 9 medical beds, a 7-bed spinal cord unit, 2 ventilators, and a single, balky CT scanner that worked sporadically. There was no EEG machine with which to confirm that a patient’s seizures had stopped, and even IV tubes were in short supply. “You didn’t start an IV unless you were absolutely positive you’d get it,” said Sarah Barno, RN, a nurse in the Emergency Department at UC Health. “Nothing could be wasted.”

Meanwhile, two years after the catastrophic earthquake, heartbreaking triage continued to take place outside a front gate protected by heavily armed guards. Opeolu Adeoye, MD, a specialist in emergency medicine and neurocritical care at UCNI, would point to one patient – yes, you come in – and then to another – no, you cannot come in. Recalled Dr. Bonomo: “The hardest part was saying to someone, ‘You can’t come in,’ and hearing him respond in English, ‘Then where am I supposed to go?’ ”

In a city of 4 million, there was not enough room for all.

Nevertheless, members of UC Health Team Haiti treated hundreds of patients while also providing valuable education to hospital staff.

“I think for us to have this role as UC Health employees is very impressive,” Dr. Adeoye said. “We saw just about everything, including emergent operative cases. We saw abdominal perforations, gunshot wounds, surgeries, neurological cases, traumatic brain injury, status epilepticus, ischemic strokes.” The team’s patients included a 21-year-old American volunteer who was riding in the back of a truck outside Port-au-Prince while traveling to a mission project when he was shot and left bleeding.

Pooja Khatri, MD, Associate Professor of Neurology at UC and a physician at UCNI, discovered that she was the first neurologist to work at the hospital in several months. “Haiti reminded me of how much I enjoy being a doctor because there was so much to do and I felt so useful,” she said. “I had to think so differently. CT scans are taken for granted here. But in Haiti our scanner wasn’t dependable. Sometimes it worked, and sometimes it didn’t. So we didn’t know what was going on in people’s brains. Sometimes we had to make our best guesses.

“One patient in particular made me feel really useful. There was a question about whether he had a spinal cord injury, but after spending a lot of time with him I realized he did not have a spinal cord injury but rather an unusual complication of syphilis that we don’t usually see in the United States. I physically went into the pharmacy and shuffled through a box of antibiotics and was able to find the medicine he needed.”

At the end of each day, Dr. Khatri found herself tallying up how she had made a difference. “And part of me thought that was really egotistical,” she reflected. “But I realized I was also doing it because I was so sad about what was happening, and this was a way of coping. The hospital was so tiny, and you knew that outside the gates there were so many people we weren’t treating who were probably dying in the streets. I really thank Jordan Bonomo and Jessica Wiles for creating this opportunity for us and for enabling me to help in my small way.”

* * *

When members of the team gathered this week for a celebratory dinner, memories of the trip were still vivid. Here are a few more of them:

Ricky Jones, RN, Cardiovascular ICU at University Hospital: “I took care of one young woman every day. She was the same age as I am, 25. She had a 3-month-old baby, but she had been separated from the baby because she had severe cardiomyopathy. She pulled at my heartstrings because she was like the heart patients I have here. We had a connection. She hadn’t seen her baby in a month, and several members of our team worked it out so that the baby was brought to the hospital and they were reunited for a while. Even if she was the only person I was able to help, if she was only able to see her baby one more time, it was very worthwhile.”

Jenna Erwin, RN, formerly of Cincinnati Children’s: “I left Children’s to go to Africa for three months. After I came back, I had this opportunity to go to Haiti. I spent the last bit of my savings to go. I was struck by how much the people were willing to learn and by how much they wanted to learn. People there only go to get help when they’re on their deathbed, and we were empowering them to take control of their own lives, to ask questions, to embrace preventative medicine.”

Eric Anderson, EMT-P, Paramedic at UC Health: “In Haiti, the concept of disability does not exist. If you’re missing a leg in Haiti, you’re still treated as if you have two legs and there’s nothing wrong. You’re still trying to play soccer. They see the person as a whole rather than the missing parts.”

Mallorie Boening, RN, BSN, Cincinnati Children’s: “It was an exhilarating trip, and it made me appreciate what we have here – the monitors, IV pumps. There were little geckos and mice in the hospital.”

Sarah Barno, RN, Emergency Department Nurse at UC Health: “I was surprised that people who had been there before thought the hospital looked better.

Nurse holds baby

It was very overwhelming. When we left the airport, there were no lanes, no traffic rules, just lots of car horns. But you got used to it. I don’t like rodents, but again, I got used to it. We had a little brown mouse. People named him. If I go back I would take different medical supplies. We were short on things we take for granted here.”

Sarah Weatherspoon, MD, Pediatric Neurology Resident, Cincinnati Children’s: “There was a little girl, about 4 years old, who had fallen off a roof, which happens a lot there, surprisingly. She was sitting, talking, and then she was out. She had a head injury, we knew, because she had a big cut on her face. When people suffer a major injury in Haiti, they usually die. But the doctors were able to insert a breathing tube and sedate her. And when I walked in the next morning, she was asking for a hairbrush for her baby doll. Had they not been able to intubate her, she probably would have died. That was the story of hope that got me through all the sad stories of people who didn’t make it.”

 

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