Haiti – Photos Thanks to Anthony Karen

Trip Report – Dr. Peter Hession. Haiti, 2010

On January 12, 2010 at 4:53pm, a 7.0 magnitude earthquake struck the capital city of Haiti, Port Au Prince, and surrounding areas. Within minutes, over 150,000 Haitians were killed. 1.5 million were displaced from their homes and over 3 million people were in sudden need of emergency aid. Haiti was already the poorest country in the western hemisphere with over 80% of the population living below the poverty line and most surviving on less than $2 per day. A lack of infrastructure and construction codes contributed to one of the most devastating natural disasters in recent history.

In December, 2009, I was lucky enough to be invited by Tom Flood to accompany his organization, Surgical Volunteers International, with the help of Smile Train on a mission trip to Port Au Prince to repair cleft lips and palates. On January 12th, our plans changed. Within days of the earthquake, Tom assembled a team of health care providers from all over the United States. They included a plastic surgeon from San Diego, an orthopedist from North Carolina and his wife, an RN, a CRNA from New York and another from Dallas, nurses from Seattle and Houston, one of whom is a native Haitian, Tom who is a retired OR nurse, a professional photographer and bodyguard, and myself. I am an anesthesiologist, 5 months from the conclusion of my residency training in Dallas and I had never experienced anything like this before.

Tom worked tirelessly to arrange travel for the 10 of us to Haiti. Though he has become extremely experienced and capable of coordinating trips to third world countries, I suspect this trip posed a new challenge. The Port Au Prince airport was closed to commercial travel. There was no electricity in the city and the few hotels with generator power that were still open were full. Taxis were not running, rental cars were out of the question and hospitals had few to no supplies or electricity. Despite these odds, Tom coordinated commercial flights for 10 people from every corner of the United States to Miami, most arriving within an hour of each other. We met at the airport and drove 2 hours north to Ft. Pierce, home to Missionary Flights International, an organization that flies groups on mission trips all over the world. Here, we boarded a donated charter plane and 2 hours later, we landed in Haiti. We were greeted at the airport by an American named Lance who has lived in Haiti for 30 years. His home and car were not damaged and in a selfless act to help contribute to the relief effort, Lance provided us with transportation, food and shelter.

It was late in the day when we arrived in Port Au Prince, and we only had time to drop supplies off at Bernard Mev hospital and begin to set up for the week. The facility is well known to Surgical Volunteers Int. They have used it in the past on cleft lip trips, but the scene we witnessed when we arrived was far from familiar. Rotary International had set up a dozen tents in the courtyard for patients to sleep in. These were all full of Haitians, most of whom had suffered severe trauma during the earthquake and were recovering from emergent amputations. Others had closed fractures and had been placed in traction until a more permanent treatment could be provided. Still others laid on mattresses, outside on the ground with a wide array of medical and surgical conditions. It was immediately clear to everyone that we had our work cut out for us.

Dr.’s Bloem and Peters made rounds of all of the patients and identified those who would benefit from surgery. Others were placed in temporary traction, or had their traction improved and revised. Charts were started on patients and medical histories obtained. The operating rooms were prepared. Tom, Young and Emily (our two phenomenal CRNAs) brought equipment to provide general anesthesia, regional anesthesia, sedation, post operative pain medication, antibiotics, surgical instruments, dressing supplies, sutures, and the list goes on. Supplies for hundreds of patients were neatly packed into a half dozen trunks and checked all the way from the United States. The organization this required was mind boggling, but these three carried out their tasks with remarkable ease and efficiency. Within an hour, 2 fully stocked operating rooms, a recovery room and supply area were established and Bernard Mev was ready for surgery.

During the first 2-3 days after the earthquake, thousands of Haitians had amputated limbs. The majority of these operations were done quickly, without anesthesia and by under or unqualified people. These heroic measures saved countless lives but by our arrival on day 10, wounds were becoming infected. Stumps were done in a way that would not accommodate  prostheses or skin grafts and once again, thousands of patients needed surgery.

We began operating on day 2 and our surgeons worked tirelessly to help all of our patients. Wounds were debrided, stumps were closed, skin grafts were placed, and external fixation devices were placed on broken bones when possible. Our nurses, Kristi, Yvrose and Jacklyn changed hundreds of dressings. They worked harder than anyone in our group and knew every patient in the hospital backwards and forwards. They identified more people who would benefit from an operation, followed them all after surgery, administered medications, bathed them, changed bedding, delivered food and water, and perhaps most importantly, listened to their stories.

Throughout the city, there were hospitals and clinics set up by different relief organizations from all over the world. I met teams from France, Greece, Jamaica, Israel, the United States and others. The equipment and personnel at each facility differed greatly and for patients, it was difficult to know where to go. As the week went on, we noticed that word was spreading that Bernard Mev and its team of doctors and nurses was very well equipped. We had surgical capabilities, x-ray, medication, food for patients, and tents for them to sleep in. As patients were treated and discharged, more arrived. A nearby orphanage brought two severely dehydrated babies to the hospital to get IV fluids and medications. More than a dozen babies were born at the hospital during the week, including at set of twins that Tom helped deliver in the back of a truck outside the front gate. Two women were in active labor the night before our departure and the team stayed to help deliver their babies, both of whom were severely hypoxic and required resuscitation at the bedside

As I write this, I have been home for just 5 days but I have had some time to reflect on the experience. First and foremost, I am extremely sympathetic to the current situation in Haiti and the turmoil its people have endured. I was amazed to find smiles on the faces of our patients, many of whom had lost family members, friends, limbs, their homes and their way of life. I gained an appreciation for the ability of this culture to endure hardship. Not even this devastating earthquake that destroyed much of the country was able to rid them of their spirit. I am also tremendously grateful for the opportunity I had to work side by side a group of 9 incredible people. It was their selfless sense of sympathy and duty that brought this group together and I am humbled by their dedication to less fortunate. Finally, I am amazed by the outpouring of aid from all over the world and the generosity of people everywhere. Before January 12th, this tiny island country was little more than an afterthought to most but it suddenly found itself at the center of the world’s attention and with record speed and strength, the world responded.

I want to thank Tom Flood, Surgical Volunteers International, Smile Train and the wonderful members of this mission team that made this trip possible. It truly was a life changing, unforgettable experience

Peter Hession

Trip Report – Haiti (Nov 2009)

The Surgical Volunteers International November 2009 mission was relatively small, with seven professionals departing to Haiti:  Tom Flood, the director and organizer, an Anesthesiologist, a CNRA, a Plastic Surgeon and his office manager, a nurse, and myself, a plastic surgery resident.  Believing that missionary care should not be a surgical conveyer belt, Mr. Flood purposely makes his missionary groups small to provide the patient with individual, personal care.  The group’s small size also makes the mission for the members special — personable.

We arrive in Port Au Prince on Saturday night, and the following morning, three Haitian nurses and two Haitian nursing students join our group.  Interestingly, the three nurses were previously nursing students on Mr. Flood’s last Haiti mission, returning yet again to help their fellow Haitians.  That morning, we screen around sixty-five patients.  As mission’s purpose is mainly cleft lips and palates, we could only schedule forty of the sixty, as some patients required a higher level of care.  Mr. Flood makes plans for many of these remaining patients to return in February, 2010 – his next mission, when he will have a craniofacial expert.   That afternoon, after the screening, Mr. Flood takes us a tour of Port Au Prince, which is our first introduction to Haiti’s enchantingly beautiful culture, juxtaposed against its disturbingly abysmal poverty.

On day two, we operate.  Our facility is a quaintly small hospital with two operating rooms.  As expected, the equipment is rudimentary and supplies limited.  Yet the group’s members quickly show their expertise: amazing is the care quality they give, rivaling that in the United States.  The Anesthesiologist and Nurse Anesthetist work proficiently and efficaciously in concert, one turning over the first operating room while the other works with the surgeons in the second.  Their compulsively compassionate care insures no significant complications on our mission.  The patients expediently move from the operating room to the pre- and postoperative care area, where our nurse tends to not only their needs, but the concerns of their loved ones – providing total and complete care.  Our office manager organizes and governs the mission’s administrative functions, and with a myriad of checklists, she expeditiously dots all the I’s and crosses all the t’s.  She also adds a motherly touch to its members, insuring that we are fed and hydrated as we consume ourselves in patient care.  The Haitian nurses and nursing students work expeditiously, not only helping in surgical care, but also with translation and cultural intricacies.  I help the plastic surgeon, witnessing his deftly creative skill with the scalpel — a true master of his art.  More than just at surgery, he is a true Master of education, with the untold patience – he edifies and instructs, not just myself, but all those in his presence, especially the Haitian nurses and nursing students.  The entire group works together dynamically, united in its patient care goal.  Mr. Flood supervises the entire missionary process:  under his umbrella, there is no politics, no arguing, no conflict — only a unified purpose safe and efficacious patient care.

At night, we meet for dinner to discuss the day’s events and tomorrow’s plans.  Here, over dinner, I get to know the group’s members:  not just their medical knowledge and patient devotion, but who they are:  their interests, their beliefs – about their lives and their loved ones’ lives.  United by the uncommon trait of selflessly giving, and augmented by the trust each develops for the other during patient care, a strong bond increasingly develops among the small group’s members.  Respect, both professionally and ethically, grows each day, and friendships mature rapidly.  In a foreign country with the joint goal of helping those who suffer, compassion connects the group’s members, whose only reward is the knowledge of each others’ charitable humanity.  But I find myself entranced not just with the members’ humanity, but also their humility.

Not until I write this blog, performing research on the group’s members, do I appreciate their exceptional professional expertise.   Our plastic surgeon, humble in character but not in feat, is a decorated military veteran and highly published author in the plastic surgery literature. Participating in eight previous humanitarian missions, he is also a veteran at charity.  He was formerly Chief of Plastic Surgery at the Illinois Shriner’s Hospital for Crippled Children and an Associate Professor at Northwestern University Division of Plastic Surgery.  Our Anesthesiologist, with five previous missions and also published in his field, is Director of Pediatric Regional Anesthesia and Assistant Professor at the Workew Morgan Stanley Children’s Hospital of New York, Columbia University Department of Anesthesia.   Our nurse, who is actually a Nurse Supervisor at the University of Minnesota Community-University Health Care Center, is also missionary veteran, having completed eleven trips of charity.  Our CNRA, a member of the Department of Pediatric Anesthesia at Children’s Hospital of New York Columbia-Presbyterian Medical Center, is an expert at missionary pediatric anesthesia.   She has been on countless mission trips starting in 1992, completing four trips just to Haiti in 2009. She too is published, and her publications directly concern the topic of anesthetic care in developing countries — specifically the equipment and techniques to provide the safest, most efficacious missionary care.  Indeed, this mission’s members are unusually talented, yet surprisingly humble, humanitarians.

I cannot explain the sense of heightened being – a greater awareness of life’s purpose and a more grounded perspective:  the mission has greatly advanced me not just professionally, but spiritually emotionally.  With newfound direction, I understand our nurse’s words to me:  “on mission trips, you always get out of them more than you put into them.” I eagerly await my next chance to not join my colleagues and newfound friends on another mission; more generally, I look forward to my next chance to give to another.

Bauer

Egypt Trip Photos 2009

Photos Haiti Trip

Public Information : Mieux impliquer la société civile dans les politiques publiques

Mieux impliquer la société civile dans les politiques publiques

Le Cap-Haïtien a été l’hôte d’un atelier de formation, les 21 et 22 septembre, initiée au bénéficie de la société civile par la section Droits de l’homme de la MINUSTAH. Deux jours durant, une trentaine d’organisations œuvrant dans divers domaines, dont la protection de l’environnement, l’éducation, la santé et l’épanouissement des femmes ont appris comment s’impliquer davantage dans les politiques publiques du pays.

Pour les organisateurs, il s’agit de mieux outiller la population sur ses droits économiques, sociaux et culturels. Et ceci passe aussi par une meilleure compréhension des décisions gouvernementales. Ces dernières doivent, en effet, être en conformité avec les besoins et/ou aspirations de la population.

Les participants ont donc été invités à identifier et définir de façon précise les problèmes affectant le plus leurs communautés, ce afin d’y trouver les pistes de solution les plus appropriées.

Dans cette démarche, les bénéficiaires de la formation ont été invités à opter pour une approche inclusive, les opinions et intérêts des parties prenantes devant être pris en considération. «Un même problème peut être vu et affecter les gens de façon différente. Donc, la définition d’un problème public est une affaire de groupe», comme le fait remarquer Joseph Nzima Sany, consultant expert en politique publique et principal orateur de la rencontre.

La rencontre a également été l’occasion pour les participants d’identifier les opportunités de partenariat avec le Gouvernement, notamment dans la formulation des politiques publiques, de même que les difficultés y relatives. Et parmi ces dernières figurent « le manque d’accès aux documents pertinents, le haut niveau de technicité entravant la compréhension, ou le manque d’expertise au sein de l’organisation pour leur analyse… ».

Plusieurs pistes de solutions leur ont donc été proposées. Les participants ont en effet appris qu’ils ont la possibilité de « formuler des demandes écrites aux autorités » et ainsi solliciter des clarifications sur des documents, par exemple. En absence d’une documentation, ils peuvent opter pour des recherches ou des enquêtes.

En cas de nécessité, ils peuvent aussi recourir aux services d’un expert, ce afin de faciliter la lecture et l’analyse des documents. «Avant de pouvoir suivre une politique publique, il est primordial d’être bien documenté et savoir de quoi on parle », souligne le conférencier. Autre moyen d’action, le plaidoyer. Il s’agit de la possibilité offerte à eux de pouvoir recourir à la « diffusion d’information à la population, faire du lobbying auprès du gouvernement ou encore d’initier diverses actions de protestations telles des marches pacifiques ». Toute une panoplie d’actions leur permettant de pouvoir signifier leur désaccord par rapport à une (ou des) décision(s) n’entant pas dans l’intérêt de la population.

Autre élément souligné par M. Sany est que leur implication dans le processus décisionnel doit se faire dès le début. Et même dans le cas d’une implication tardive, elles doivent veiller à ce que le Gouvernement tienne ses engagements et exécute ses plans et décisions comme il convient. En effet, «les politiques publiques ont une incidence sur la vie des citoyens ».

Le suivi des politiques publiques

Initier une action de suivi relative à une politique publique suppose d’abord une analyse de son incidence sur les objectifs des organisations, de même que les avantages et /ou les difficultés qu’elle renferme. Aussi, les questions du genre : « s’adresse-t-elle à un problème prioritaire de la communauté ? Les programmes qui soutiendraient cette politique, s’appliqueront-ils dans ma communauté ? Quel impact aurions-nous en suivant cette politique ? » sont-elles nécessaires.

Toute stratégie de suivi, qui nécessite la création d’un réseau d’associations ou l’appui sur un réseau déjà existant, doit se baser sur une relation de confiance entre ses partenaires. Et pour sa bonne gestion, il importe d’harmoniser les intérêts et visions des concernés.

A l’issue de la rencontre, les participants n’ont pas caché leur satisfaction relative aux importantes notions acquises. Aussi, nombre d’entre eux ont-ils reconnu être désormais mieux outillés pour servir leurs communautés et entamer un dialogue plus effectif avec les autorités locales. «J’ai compris l’importance d’une société civile engagée, susceptible de porter les dirigeants à assumer leurs responsabilités et transformer certaines réalités du pays », comme témoigne  Delinse Jean, Membre du comité de la Convention Baptiste d’Haïti.

Une occasion également pour Mamotte Bien-Aimé, Présidente de l’Organisation des Femmes de Lafossette en Action (OFALA), de partager avec l’assistance comment les habitants de son quartier sont parfois victimes de violations de leurs droits de la part des autorités. «Les stratégies apprises d’évaluation et solution de problèmes permettront à mon organisation et à nos partenaires d’affronter ces questions de façon plus efficace, tout en suivant à la fois la mise en œuvre des politiques publiques existantes par les autorités concernées ».

Et dans la même lancée, certains participants se sont engagés à faire un suivi des politiques publiques contenues dans le Document de Stratégie Nationale pour la Croissance et la Réduction de la Pauvreté (2008-2010).  « A travers ce document et grâce à cet atelier, j’ai vu comment aider la population à faire face à ses besoins », souligne Remski Jasmin, Coordonnateur de l’Association des Professeurs de Mathématiques du Cap-Haïtien.

Le présent atelier se veut être un outil en faveur du respect, de manière progressive, des droits humains au niveau de la communauté haïtienne, en particulier les droits économiques, sociaux et culturels.

Une deuxième formation de deux jours aura lieu les 28 et 29 septembre prochains et porteront sur le monitoring des budgets et le suivi des politiques sociales par la société civile à l’intention des mêmes participants. Cette série de formations seront également initiées au profit de Ouanaminthe, Hinche, Jérémie et Petit-Gave.

Rédaction : Vincenzo Pugliese

Edition : Uwolowulakana Ikavi

Trip Report – Emily Hwang

After having a long desire to partake in medical missionary work, I was blessed to come across Surgical Volunteers International. The director, Thomas Flood, was kind enough to acquaint me through many phone calls and emails of what was to be expected and the caseload. After several anxious months of preparation, my first mission trip was in June of 2009 to Port Au Prince, Haiti, which was accomplished in partnership with Smile Train. Our team consisted of volunteers from Texas, Illinois, New York, Germany, and a few local Haitians. The cases included cleft lip and palate repair, burn scar reconstruction, and a hand and foot case. All of the patients fortunately did well without any complications. I do not know how to begin in describing the daily greetings of numerous patients and their families needing surgical treatment, the patient screenings, the dynamic setup of the operating room, and the impediments of existing equipment, the limited medical resources, and the many volunteers wanting to assist and learn from us. Everyone present was a constant delight and sought to love and unite each other, through this whole hearted free service to those who were undoubtedly in need. Further, this was truly a phenomenal experience of the Haitian culture, society, and struggles for survival. Our team even got to visit the Missionaries of Charity and was welcomed into two local orphanages. I felt that this trip has rewarded me immensely spiritually, emotionally, and professionally. In addition, many medical volunteers were reunited, as well as many new friends made. Above all else, the strong respect, trust, universal love and compassion, and collaborative dynamic between the team members were incredible. Each individual exuded a conduct governed by good judgment, flexibility, and a consideration of fellow team players, all serving a joint purpose which drew us all together. Since returning from Haiti, I am utterly convinced that these mission trips are a most beautiful experience and have committed myself to the duty. I must emphasize the gratitude and appreciation that I have for all those who have also been blessed to partake in such an opportunity. The greatest service that we can provide to humanity is giving care to those in most need and to defy human suffering, with a consideration for safety and efficiency of patient care. This can become a means to greater love and a greater generosity. Without any hesitation, I certainly long for my next visit and future trips and assured that a call is clearly heard and meant to be answered.

Yoo Eun Emily Hwang

Certified Registered Nurse Anesthetist

Trip Report – Dr. Michael Schafer

Surgical Volunteers International (SVI) undertook its first-ever trip to Haiti February 26 to March 10, 2009.  We were sponsored in part by Smile Train, and our host institution was the Baptist Mission Hospital in the mountain-top community of LaFermenthe, at the edge of Port au Prince.

There were 20 members on the team, including two OR nurses, one recovery-room nurse, 3 anesthesiologists and one nurse-anesthetist (CRNA); 2 pediatricians, one of whom joined the team from Cairo, Egypt, by way of New York; one OR technician/instrument specialist; two plastic surgeons; one student/documentarian/record-keeper;and  the team director who is also a nurse. We were helped in immeasurable ways by one young local man, Jude…, who acted as our ombudsman and general factotum, our driver and local liason person during our stay there. We were also joined by four young women who were recent graduates or in their last year of nurses’ training at a local teaching program.

We were joined for part of this mission trip by staff members from Smile Train in NYC, who had arranged for a visit by Chris Meloni and his wife Sherman to introduce them to the actual functioning of a team such as ours and to have a brief but meaningful first-hand experience of observing the huge screening pre-op clinic and the surgical procedures in the operating room.  Chris is widely known and respected as one of the main characters in the TV series Law and Order SVU. Both he and his wife were genuinely interested in and impressed with all they witnessed, and participated in a most touching manner in the evaluation and care for the many patients who had flocked to Baptist Mission Hospital.

The generosity of time and spirit of these two new friends to our team was abundant and genuine and was sincerely appreciated by SVI team members and our colleagues from Smile Train.

The actual travel to Haiti is relatively easy, with either a direct flight from NYC or connection in Miami from other points in the US; and then another 2 1//2-3 hr flight on to Port au Prince, and one is there…no jet-lag; in the same time-zone or 1-2 hours difference for most team members…all of which makes settling in and getting started quite easy.

As usual the first day was spent in evaluating patients who had been invited to present themselves at the hospital through notices in TV, radio, and through widespread mailings by Smile Train.  Each of these patients had some form of cleft lip and/or palate; and each had come hoping to have his or her or their child’s deformity corrected by this team from the USA.  There are only two plastic surgeons in all of Haiti; there is no team set up to evaluate or prescribe any type of care for patients born with these relatively birth defects of the nose, mouth and mid-face.

In the developed, industrialized countries of the world the incidence of this anomaly is now considered to be about 300 per 100,000 live births; in the less-developed parts of the world it is at least twice that common. Many factors are at play in occurrence of cleft lip and palate and related deformities, and these include genetic and heritable traits, nutrition (both maternal and fetal), teratogens such as street drugs and other medications, and spontaneous mutations of the genetic blueprint in the developing embryo or fetus.

One surgical case was performed early on that first day, prior to screening clinic, for demonstration and documentation of the set-up and performance of work during an actual surgical procedure…all team members participated and demonstrated their skills that make each one a valuable member of the team, and why this great adventure is such a team undertaking.

The next day, Sunday, was a free day and most team members took advantage of a city tour arranged by one of our “well-traveled” team members and led by a well-established and well-known local British ex-pat tour guide.  The day was spent in seeing the sights of Port au Prince and learning much of the history of Haiti.  It was a delightful and rewarding day…especially for the curio shoppers on the team.

The screening clinic had brought out about 120 patients, all of whom were seen and evaluated on one day.  As usual, there were a few with problems for which our team was not equipped, either in terms of magnitude of the issue or the appropriate need for other surgical specialties.  But for the most part patients who presented that day had problems of CL and P. An unusually high number of adults was in the crowd of patients seeking care, explained by the fact that there neither is nor has been any place in all of Haiti for work of this sort to be done; and these patients are too poor ever to have the possibility to go elsewhere for help.

Of those 120 patients seen, 75-80 of them were selected for the surgical schedule for the following week, each operating day destined to have 12-15 cases to be performed between the two surgeon/anesthesia/OR teams.  Unfortunately and unavoidably some patients had to be turned away, denied the care they had so anxiously awaited and for which they had so hopefully traveled to the clinic.  As much as possible alternate arrangements were made for these people, either by referring them to another hospital and another visiting team the following week, or the promise of their being first on the list for a return visit by our team within the next few months.

During the following work week 70 cases were accomplished, 50 children and about 20 adults, and of both groups almost all were primary repairs. The week passed quickly and uneventfully, surgically speaking, that is without catastrophe or adverse incident…all of which is the goal of these types of team ventures in other countries. Some of the patients with cleft lip repair were discharged home later the same day as their surgery; others, including those with repair of the palate, were sent home the following day, or in a few instances on the second day post-op.

The Baptist Mission Hospital was a most gracious host and their staff could not have been more cordial and accommodating.  They gave up their operating time and space for almost the entire week, and the administrator Mr. Jean Angus  was available every day to ensure that all went well and that any unexpected need was attended to.  On the final day this man made a most moving farewell speech to our group that brought many of us nearly to tears in its sincerity and appreciation of the value of our contributions to his community and other around the world where we travel and take our talents.

As with most places where we have been in the world of clinics and operating-rooms, there was the little “lady-in-charge” who knows where everything is and how to fix most things, and though not speaking English understands virtually everything said and quietly goes about getting her work (and some of ours) done.  In this case the OR-matriarch is  85 years old and has been at this job in this operating suite for the past 45 years…and seems set on being there for the next 45 as well.

The team members were invited guests at a lovely reception and dinner hosted by Smile Train prior to the work week; and were guests at a nice farewell dinner hosted by the local team on the last night in Haiti.

And so another wonderful mission experience came to an end.  New friends had been made, both within the medical team, and between our team and our local hosts, and amongst many local people with whom we worked and who helped out in various ways.

More than 70 patients and their families had been helped in a way immeasurable in its immediate impact and lasting value.  We often say that in an hour we change a life, not just of the child in question, but of the family and indeed of the community.  It is this undeniable fact that keeps many of the members of teams such as ours returning for more such trips.

And we do plan to return to Haiti…there is still much work to be done, some about which we already know, some about which we have yet to learn….but the work is there and the need is great and the love of this work keeps us all coming back.

Yours truly,

Dr. Michael Schafer