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Published On May 3, 2010

CLINICAL CARE

Helping Haiti

The aftermath of the January 12 earthquake in Haiti had these medical bloggers pondering everything from the quiet courage of patients to wider issues in health care.

Washing Away

Adapted from correspondence, posted at massgeneral.org by Leila Hepp, a student in the nurse practitioner program at the MGH Institute of Health Professions who volunteered with Partners in Health

They never bothered me, the amputations, the pus amid squirts of blood. Not until she was dying, somnolent. Vacant eyes—no communication except to moan with pain. Then it happened: the shift.

I felt it. When this reality began to fade and another, brighter reality surfaced. I sensed movement away from the body. And I was feeling it with her, the woman with the above-the-knee amputation.

She was septic; we brought her to the operating room. Her flesh repelled me, and only now do I know why: because she was almost completely dead, and this was dead flesh. We irrigated the wound, following the dictum, “The solution to pollution is dilution.” But she died within the hour.

In two months, the rain will come...and with it, infection, gangrene, decay, flies. It will drench tent cities. The solution to pollution is dilution, the dilution of pollution, the water and mud, the ground is never diluted, the sea is polluted. The sewage, no sewer. Pigs in gutters in trash. Don’t go inside the buildings of the dead.

 

A Break from Bureaucracy

From a January 17 posting on Medscape by Connecticut neurologist Anthony Alessi, who volunteered at St. Damien’s Hospital and Orphanage

What makes this experience different is the total absence of bureaucracy. Notes are short and direct, documenting only information the next provider will need. No one is counting the number of details contained in the note to meet the appropriate level of coding for reimbursement. There are no phone calls to interrupt a patient visit or messages to handle at the end of the day, and none of the seemingly endless administrative meetings.

There is no “medical hierarchy,” and everyone’s opinion is valued. We will have to rely on our education, experience and ability to improvise in order to deliver effective care. Equipment and appropriate medications are lacking, so ingenuity must suffice.

 

In Search of a Future

Adapted from a January 29 posting on NYULMC HEART Blog by internal medicine physician Fritz Franois, who traveled to Haiti as part of New York University Langone Medical Center’s Haitian Effort and Relief Team

As I stood in front of the unit, a thin young man about 17 years old approached me. He briefly raised his open right hand in greeting, and nodded while reading my name tag.

Given the popularity of the name “Fritz” in Haiti, he quickly surmised my background and began speaking to me in Creole. After introducing himself as Jean-Marc, he asked for my assistance in securing a job at the hospital. I listened intently but then explained my limited role as a visiting volunteer. His disappointment was unmistakable.

As Jean-Marc walked away, I wondered whether a similar life with limited opportunities would have befallen me had I not gone to the United States at the age of 10. This was my first time back to Haiti...my first chance to reflect, on the ground, how different things could have been and to wonder how different things will be.

As a group, we were here to help repair broken limbs, overworked hearts, clogged kidneys, inflamed livers, drowning lungs, swollen bellies and infected wounds. But perhaps those whose suffering could most easily be alleviated—those representing Haiti’s future, those like Jean-Marc—we simply did not see at all.

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