A Return To Haiti: Project Medishare & Hospital Bernard Mevs

A Return To Haiti: Project Medishare & Hospital Bernard Mevs

 

I fondly remember 5 years ago when I came to Haiti with 4 other monsooners as we backpacked up from the capital city of Port-au-Prince to Cap-Haitien and gazed out from one of the most beautiful fortresses of colonial America.

 

 

I had a great crew to travel with back then.

 

 

And I have a great crew with me this week:

 

 

So I’ve returned to Haiti, this time with my fellow colleague and former nurse at Jacobi, Zach, to volunteer here for a week at Hospital Bernard Mevs, the only hospital with critical care capabilities for the capital city of Port-Au-Prince. We’re also joined by Vanora, a wound care expert who just recently graduated from medical school and is applying for a residency in Family Medicine. The efforts are through the non-profit and Florida-based Project Medishare, and one of the few organizations that promote sustainability in international disaster and critical care relief that I know of.

To work at their main hospital site, their resources allows them to accept only licensed medical professionals above a certain training level (so for residents, they take PGY-3 and above) who not only are capable of handling a critical medical situation during the first few golden minutes of resuscitation on their own, but also be able to teach — as well as have the humility to learn from — the local Haitian medical staff. And after speaking with my colleague and co-resident Dr. Shazia Rahman who volunteered here just last year, the only way I could know for sure if this would be a good fit for me was to try it out.

Either way, it’s good to be back.

 

A photo I took outside the airport 5 years ago
A photo outside the airport I took today

 

Upon arrival at Port-au-Prince (PAP) airport via a morning Jet Blue flight, we were picked up by our wonderful and superhuman Volunteer Coordinator Stacy, as well as our Haitian driver Philippe outside the airport and taken directly to the hospital and our living quarters inside the hospital compound.

 

 

Our dorm beds were more comfortable than I expected and we were informed beforehand to bring our own sheets and pillows (although they do offer fitted sheets if you need them and the group is small enough). I brought a sleeping bag liner with my inflatable travel pillows that did just fine — slept like a baby 9 hours every night!

 

 

Right outside our dorm room is the kitchen and dining area where we spent most of our time after work hours.

 

 

And on our rooftop, we got great views of Port-au-prince and our surrounding neighborhood.

 

 

Hospital Bernard Mevs itself is a gated compound facility (armed guards and all) that has an emergency room, 2 general inpatient units, a spinal/neuro inpatient unit, a medical intensive care unit, a pediatric intensive care unit, a neonatal intensive care unit, a pediatrics inpatient unit, and a separate Pediatrics ER.

For diagnostics, they have their own mobile CT Scanner which sends its images back to the United States via a PACS-like system for official readings. Unfortunately for us it was down the entire week we were here, which made for some interesting management decisions for our fair share of elderly head trauma, gunshot victims through the abdomen and pelvis, aortic dissection, pulmonary embolisms…

 

 

They have a single x-ray machine which can be made portable if absolutely necessary. All X-ray films are read by the doctor ordering them (which means it was me this week…); there are no radiologists on site to give you any official readings (eek!).

 

 

They can do all basic labs except blood gases (they have I-STATS but not cartridges for them):

 

 

And while I chose not to photograph areas with patients such as the inpatient units and the Adult ER, I was lucky enough to see and take photos of empty pediatric units that are currently being renovated.

To give you an idea of what the Adult ER is like (and where I’ll be working for the next week), it’s about the same size as the Pediatric ER you see here (fits about 3 beds and 3 chairs):

 

 

In addition to the Pediatrics ER, they’re renovating their Pediatrics Intensive Care Unit:

 

 

And their neonatal intensive care unit:

 

 

This is the world outside our hospital:

 

 

Every night we drove up somewhere for dinner, including upmarket Petionville:

 

 

On our day off (usually every Friday) we got a morning tour of central Port-Au-Prince, seeing where the earthquake dealt the most damage:

 

Remains of the former Palace

 

We drove to the famous tourist staple Hotel Oloffson for lunch and beer, where I did the same thing 5 years ago:

 

Today

 

Then it was a 40 minute drive up to Point De Vue (Observatoire), where we grabbed a beer and shisha overlooking all of Port-Au-Prince at The Lookout bar:

 

 

Afterwards we kicked back at Karibe Hotel for a spa massage and drinks by the pool. You can also head up to their rooftop bar Asu Rooftop Lounge for more upmarket drinks and dancing:

 

 

As for the actual medical volunteer work itself — I saved the best for last, but it’s also just in case some of you get queasy with the sight of blood and bodily fluids. You have been warned!

I started my week off putting in bilateral thoracentesis/pigtail chest tubes:

 

 

My second day took on 3 traumas: an electrocution, and 2 patients with gunshot wounds that arrived all at the same time. I had to make decisions on which patients I could send to the operating room based on our ultrasound findings since our CT Scanner was down:

 

 

My third involved an R/O thoracic aortic dissection with a widened mediastinum >8.5cm and a flap on my ultrasound of the thoracic and abdominal aorta — we had to send this guy out to an outside hospital for the CT (since ours was down all week). That was an ordeal to arrange.

  

 

I also got called in the middle of the night to work on multiple emergent cases in the Intensive Care Unit and the ER, so I would run down in nothing but my flip flops and pajamas (Shazia, you did warn me about this):

 

 

My fourth day involved intubating a SWAT police officer with a GCS of 7 that was found down at a crash site for an unknown amount of time at 2am in the morning. After intubating him I hopped in the ambulance to transport the patient to another hospital in Port-Au-Prince to get CT Scans, only to have a small argument with the technician to include the C-Spine after he initially refused to do any more than scan the head. We got both and transferred the patient back to our hospital for an ICU admission with neurosurgery.

And then my next and final day was ortho day where everyone came in with a significant OR-worthy fracture.

 

 

One had the largest “coffee bean” sign (aka volvulus) I’ve ever seen. I sent him straight to the OR.

 

 

Overall, this was a meaningful week where the most interesting cases weren’t necessarily the pathology, the clinical presentations or the acuity of our management, but rather the jiujitsu decision-making in more austere, resource-poor environments where I had to make calls regarding rationing care appropriately.

Although many of us think we’re all somewhat prepared for these kind of decisions after training at some of the rougher county programs in the United States, it’s very different when you’re actually put in the hot seat and making those decisions on your own. Yes, we may know what decisions to make, but do we know how and furthermore, are we comfortable with making them? Only actual experience such as this can give us the answers to those questions.

I truly am grateful for Project Medishare and Bernard Mevs Hospital for granting me the privilege to hit the ground running here and making these kind of decisions from minute one. You’ve instilled in me the humility of having to understand what goes on in the world of Emergency Medicine outside our bubbles and I cannot underestimate such an opportunity.

I also want to give a shout-out to Stacy, our coordinator, for going above and beyond to making sure all the volunteers were comfortable, safe, well-fed, well taken care of, loved, and entertained the entire time we were here. It was fitting we came during the middle of Mother’s Day celebrations in Haiti as you were like a mother to us all. Also big thanks to Jen, Sam, Raphael, Kency, Drs. Rivette (especially for the kind things you wrote!), Germain (for getting to hit the ground running on day 1), Gordon (for being the trauma magnet that you are!), Levequé (for letting me run the ER by myself for hours!), and Pontius (for being the best co-doctor to work with everyday!) for your kindness, professionalism, and warmth throughout this entire experience. There was never a bad moment and never an instance where I felt unsafe.

It has been a privilege to have worked with you all and I look forward to coming back soon. Much love.

Zach also had this to write:

Thank you so much to everyone that donated and made my trip to Haiti possible. I’m still processing all that I saw and experienced, but the trip was incredible, and I can honestly say that we made a difference.

We learned from the staff of Hospital Bernard Mevs and we shared with them our knowledge and experience as well. We worked on patients with spinal injuries, gunshot wounds, electrocutions, and congenital illnesses. We treated babies that were so malnourished, they required intensive care. We gave our blood, sweat and tears, and will be sure to return one day and do it all again.

Thank you again to Calvin D. Sun for organizing the trip, to the staff of Bernard Mevs . . . thank you so much.

 

- At time of posting in Port Au Prince, Haiti, it was 28 °C - Humidity: 69% | Wind Speed: 11km/hr | Cloud Cover: partly cloudy

 

Haiti’s Independence Day

Haiti’s Independence Day


 

Port-au-Prince, Haiti. Here I am!

And on your Independence Day (it’s January 1st) too!

 

Outside the airport

 

We’re currently staying at the Trinity Lodge in Delmas, a quieter suburb of Port-au-Prince, Haiti’s capital. I first have to give a shout out to Trinity Lodge, as it’s a fantastic place which service has been one of the most hospitable I’ve ever experienced in my travels.

So going into this trip and in my research on Google Maps, I had thought that Trinity Lodge was located conveniently in Port-au-Prince’s city center so that we would have an easy time walking around. Unfortunately when I arrived, I learned it was located in the far far outskirts of the capital; a taxi ride to the center would have costed about $50-$70 USD. This would have been way out of our initial budget. Despair intruded into my soul.

However, in the good fortune of choosing Trinity Lodge, the owner Daniel immediately offered us a free ride in his air-conditioned SUV to Port-au-Prince as well as a personal free tour of the city itself. He even took us to Hotel Oloffson to have a beer, while giving personal accounts of his time growing up here, and describing specific effects of the 2010 Earthquake.

With his company and our conversations on Haiti, the earthquake, his time studying in the USA, and traveling, it’s already been a serendipitous, fortunate occurrence to have Daniel as an integral part of our time here. Although it is well known that the Haitian people are generally warm and hospitable people, Daniel went above and beyond in taking care of us. If that’s also the case with the rest of the country, I’m sold on coming back.

That said, I also highly suggest that you check out Daniel’s community service work for Partners Worldwide in rebuilding post-Earthquake Haiti from the ground up. I also might work with Daniel in the future on expanding travel services for adventure-seekers in Haiti. See you back in NYC, Daniel!

 

Now there’s no question Haiti has borne the brunt of constant tragedy, especially given its last 40 years of political turmoil and an unimaginably devastating earthquake in 2010 that killed over 200,000 people. But although it remains in a state of disrepair, the amazing thing that I’ve already noticed in the first few hours is how the Haitian people have remained stoic and even kept up its cheerful disposition in the face of unthinkable hardship.

 

The rest of Port-au-Prince, however, remains in strong need of restoration. The promising news is that “tent city” has now been cleared by the NGOs, with those displaced each given $500 USD and a new place to live.

 

Champs de Mars: Where "tent city" used to be

 

The rest of Port-au-Prince however, still has a lot of room for progress.

 

A former movie theater

Another ruined movie theater

Fmr. (and multiple-exiled) President Aristide's forever unfinished bicentennial statue -- looking more like an oil rig than anything else.

Where the National Palace used to stand before the earthquake

The ruins of Notre Dame Cathedral

 

We also gallivanted around some of the side streets and markets:

 

 

We then had a beer and light snacks on the porch of Hotel Oloffson — Haiti’s most recognizable and most iconic hotel (especially for its gingerbread house design) and one of Lonely Planet’s most recommended activity to do while there.

 

The RAM band performs every Thursday at the hotel

 

After that we headed back to Delmas.

 

 

Given that Haiti is the only country in history that was founded as a direct result after a slave rebellion, Independence Day is widely celebrated by the Haitains. The only thing I saw happening in public on Haitian Independence Day, however, is that everything closes (it being a national holiday and all), a few fireworks are launched at night, and that everyone drinks Joumou, a pumpkin soup that serves as a historical tribute to the newly freed slaves; on one of their first orders of business after winning their freedom and independence, would drink the soup as it was a meal that had been forbidden to them by their former French masters before the revolution. 

Now pretty much everyone in Haiti drinks it on January 1st to celebrate.

 

 

Having been to about 5 countries and 4 different time zones in the last 48 hours, I’m going to pass out now. I think I nodded off at least 8 times during the course of writing this entry.

 

- At time of posting in Port-Au-Prince / Aeroport International, it was 30 °C - Humidity: 14% | Wind Speed: 5km/hr | Cloud Cover: few clouds

 

How Are The Kids?

How Are The Kids?

Before I post up my entry on Everest, I should mention our unexpected detour to Hindu Vidyapeeth (HVP) last night. HVP is a non-profit educational trust that enrolls Nepalese children from regions as far as Myanmar and provides them a quality education and prepares them for admission into international colleges.

We found out about it while in Pokhara. One of our fellow travelers that we met, Hannah (who claims she’s a descendant of Trotsky, no joke), had mentioned a volunteering service she did while in Patan and Dang. Since we were all happened to be on the same bus ride from hell, I asked if we could see this school in Patan since she was already heading back there. And since Patan is only a 20min taxi (~150 rupees) or bus (13 rupees) ride from Kathmandu, it was an easy commute over.

 

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By the end of the evening we were surrounded by scores of young children ages 6 to 16, and we took took part with them in their prayer and community assembly session. During assembly the children asked us pretty insightful questions (“how would you improve the Nepalese education system?”) while we asked questions like “what’s your favorite food?” I swear if I had more time to prepare….

 

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With us were official volunteers in the program, most of them coming from England, who had arrived a day earlier and were about to take on a 6 week program at schools in both Patan and faraway Dang. Therefore, Stephanie and I might as well have materialized out of thin air since we felt like we were those random “friends Hannah picked up from Pokhara earlier last night.”

But nevertheless, we were treated all the same as welcomed guests while we interacted with happily curious children who wanted to know our names and where we we came from.

 

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And of course, what kind of South Asian hospitality would there be without aunties and uncles piling food upon food for dinner? This was legit homecooked dhal baat. And it was absolutely delicious (finally got to eat with my hands again; it’s been too long being tied down by the superfluousness of utensils).

 

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After a fulfilling experience at the school and getting to interact (however briefly) with the children and administrators, we were on our way back to our hostel in Thamel, Kathmandu. They were kind enough even to drive us there. For anyone interested in a volunteering service abroad, definitely take a look into HVP. I don’t think you have to do it through a formal program — you can just contact them and offer your services and they’ll take care of the rest (including lodging and food provisions!).

The commitment can be anywhere from 2-6 months and you’ll get to see a side of Nepal few foreigners have the privilege of experiencing: https://www.hvp-nepal.org   And on an unrelated note, at the moment we were dropped off near our hostel in Thamel, we ran into a group of French travelers (whom we had met in Pokhara) who were also on the same bus ride from hell with us. When we got off the bus we had agreed to meet up later that night, but because of our unexpected detour to HVP, we gave up on that notion. But lo and behold, fate would have us reunited for drinks in Thamel anyways!

 

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- At time of posting in Kathmandu, it was 23 °C - Humidity: 83% | Wind Speed: 17km/hr | Cloud Cover: mostly cloudy

 

THE CLINIC IS OPEN

THE CLINIC IS OPEN

 

As of 12:00pm EST, Monday January 17th, the community free clinic we were building in Tijuana, Mexico has opened:

 

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Clinic Hallway

Screen shot 2011-01-17 at 12.20.03 PM

Inside the clinic - the community waiting room

Pharmacy room with medications donated by Mickey Heller and his family...All medication are free for patients.

The hallway

It's a big waiting room!

GRACIAS

Thanks for all your support!

 

- At time of posting in NYC, it was -4 °C - Humidity: 37% | Wind Speed: 8km/hr | Cloud Cover: partly cloudy

 

Goodbye Mexico!

Goodbye Mexico!

 

It’s a final goodbye to Mexico!

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Crossing the border from Mexico into the U.S.; yes they check for your passports to let you through. Very straightforward, but the traffic took 2 hours!

We crossed the border last night to meet up with one of our med school classmates as she graciously drove us around San Diego to get dinner at the famous In-N-Out joint. We were so tired though, and since we had a early morning flight to catch, the reunion was unfortunately short-lived.

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Back in San Diego: My first In-n-Out experience!

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taken about a few minutes ago. Jasmine on the left, Cula on the right

On our way back home!

 

- At time of posting in 10,000 ft. above sea level, it was -3 °C - Humidity: n/a | Wind Speed: 54km/hr | Cloud Cover: lots of clouds

 

Photo Shoot On The Roof

Photo Shoot On The Roof

 

As the roof came together, I couldn’t help myself to run up there and ask if anyone wanted a new profile picture for their facebooks. After all, it’s not very often we get to sit on top of a roof on a newly constructed clinic.

 

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Andrei

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Patty & Nilam

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Nilam

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Liam

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Guess who

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Ankur

 

As we pack up to go, I capture some last minute shots of the site, mostly of the children families brought as they thanked us:

 

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The remnants of our efforts:

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The Ying and Yang

And the surrounding landscapes around our site:

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After 3 nights and 4 days of construction, most of us whom never done this sort of thing before, we’ll look back one day and ask ourselves: “Did we really?”

Yeah, we did:

 

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It's up!

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- At time of posting in Tijuana, Mexico, it was 11 °C - Humidity: 54% | Wind Speed: 14km/hr | Cloud Cover: Cloudy