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.
Dr. Michael Schafer
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