Haunted by Haiti

While working in Haiti during the last three decades I have been haunted.

With almost every patient that I have examined, I feel like I didn't do enough or that I did too much. But in order to work in Haiti, I think health care professionals need to reconcile that we are limited and weak human beings and the conditions in which we work are inhuman and disorienting.

And most Haitians forgive us when we walk away. Or when we shake our head and give them the the third best treatment because treatments one and two are not options in Haiti.

But I frequently stare at the next patient and don't see him because I am thinking of the last patient who is shuffling out of my "office". I am asking myself, "Was that the best you could do?"

All I can say in those circumstances, is "forgive me God".

Everyone working in Haiti needs to be gentle on themselves. But we need to do our best to speak and act for Haitians whom the world will soon begine to ignore again. Most importantly we need to try and help Haitians build a society which will never allow this travesty to happen again.

Below is an article from the New York Times that chronicles some of the "guilt trips" that foreign doctors are on right now after their recent medical experiences in Haiti.



February 13, 2010
Doctors Haunted by Haitians They Couldn’t Help
By DEBORAH SONTAG

PORT-AU-PRINCE, Haiti — The foreign doctors who performed the first amputations after the earthquake used hacksaws. They relied on vodka for sterilization, substituted local numbing for general anesthesia, jury-rigged tourniquets from rubber gloves. Working around the clock in improvised operating rooms, they sacrificed limbs and lost patients to injuries that are no longer supposed to be disabling or deadly.

Now back in their antiseptic, high-tech offices in the United States and elsewhere, the medical professionals who initially flew to Haiti’s rescue are haunted by their experiences, “overwhelmed by conflicting feelings of accomplishment and guilt,” as Dr. Louisdon Pierre described it.

They witnessed what Dr. Laurence J. Ronan of Massachusetts General Hospital described as a “mass casualty horror show.” They practiced what Dr. Dean G. Lorich of the Hospital for Special Surgery in Manhattan called “Civil War medicine.” They saved lives, probably by the thousands. But their accomplishments were limited by the circumstances, and then they left, uneasily, before conditions for doctors and patients alike started improving.

Most of the doctors interviewed said they were committed to returning to Haiti and to marshaling the medical community’s resources to deal with the thousands of Haitians who sustained permanently disabling injuries. The needs are staggering: from basic wound care to skin grafts, revision surgery, physical and occupational rehabilitation, prostheses and trauma therapy.

“Everything that everyone did during those first two heartbreaking weeks will have been for nothing if these patients don’t get continuing care,” said Dr. Elizabeth Bellino, a pediatrician based at Tulane University who worked in Haiti right after the earthquake.

In Uganda now on a project, Dr. Bellino, 34, said she closed her eyes and saw the beaming face of a 12-year-old Haitian boy named Mystil Jean Wesmer who ended up comforting her when she dissolved into tears. As she recounts it, Mystil smiled gently and, sensing that she was overwhelmed by the need around her at a field hospital run by Americans, said: “ ‘Go take care of the sicker kids. I’ll be O.K.’ ”

He himself was waiting to have his leg amputated.

“All he wanted to know was how he was going to walk to school and church,” Dr. Bellino said. “I said, ‘Well, we’ll figure that out.’ But now I’m so worried about him, about all the kids.”

Dr. Pierre, a Haitian-American who is the director of pediatric intensive care at the Brooklyn Hospital Center, said he thought constantly about the patients he left behind, too. Even as he plans his next trip — he and Dr. Stephen Carryl, the chairman of surgery at his hospital, will be returning with a prosthetics maker — a few memories plague him.

Back in Brooklyn, he still hears the loud, shrill cry of a mother at the moment her small son died of a raging infection on the lawn of a hospital in the Carrefour neighborhood. The mother and father, one child already lost to the earthquake, had implored Dr. Pierre to help their 4-year-old, who had been eviscerated by a concrete block and hurriedly stitched back together by a local doctor.

But the boy, lying in a crib under a tree, his heart rate racing, his breathing way too fast, was clearly suffering septic shock, and Dr. Pierre, equipped only with his stethoscope, could do nothing.

“I felt so helpless,” he said, and not long afterward, while he was deeply sedating another patient for surgery, he heard the wail that told of the boy’s death.

Later, amid the patients strewn across the hospital’s grounds, Dr. Pierre spotted a wrapped bundle in what appeared to be an abandoned incubator. The bundle, mewling, was a premature infant whose mother had died in childbirth. Dr. Pierre and a pediatric nurse from Brooklyn, Sharon Pickering, frantically tried to find a way to hydrate the baby.

“This is something we know how to do,” he said they told each other. Finally, they managed to insert a needle in a bone cavity and get the baby some fluids. But the next morning, Dr. Pierre found the incubator empty.

Such losses were shattering but it was hard to react at the time, the doctors said. There was too much to do, and the circumstances were disorienting. Dr. Lorich, an orthopedic trauma surgeon at the Hospital for Special Surgery, said it was hard to adjust to the grim reality of mass amputations. “I am in the habit of saving legs,” he said.

When his 13-member team from New York arrived at the Haitian Community Hospital, thousands of terribly injured Haitians lay on stretchers, boards, mattresses and the floor, among them tiny children with crushed legs, all by themselves.

The hospital had two functioning operating rooms, Dr. Lorich said, but the anesthesia machine did not work, the oxygen tanks were empty, there was no blood supply and the labs were not functioning. Still, the New York team plunged in, performing 40 amputations, 60 limb-saving operations and, to conclude three sleepless days, one Caesarean section — “a nice pink baby,” Dr. Lorich said.

The departure, however, was unsettling. Dr. Lorich’s team was exhausted, as were their supplies, but a flight that was supposed to be arriving with a fresh team of surgeons and nurses to replace them had been canceled. Outside the hospital, crowds seeking help pushed against barricaded doors, and they did not want the foreign doctors to abandon them. The doctors needed a military escort to leave.

In Uganda, three weeks away from her return to Haiti, Dr. Bellino said she could not stop wondering how the 12-year-old Mystil had fared after his amputation.

Through an uncle, the boy was found at the World Harvest Missions/New Life orphanage, where American volunteers are looking after wounded children who have been discharged from field hospitals.

Mystil was lying on a mattress on the concrete floor of a church with a roof damaged in the quake. On his plaid shirt he wore a SpongeBob sticker, which a volunteer said he had earned by doing several laps around a mango tree on his new crutches. Sarah Wimmer, a paramedic from Arizona, said that Mystil’s wound was healing well, and that he was receiving some physical and emotional therapy. When his stitches are removed, he will be sent home to his parents, who are living outside their cracked house, but he will be considered an outpatient, Ms. Wimmer said.

Reached in Africa, Dr. Bellino sighed. “I can breathe now,” she said after learning that Mystil was all right.

Lying on the mattress, with tired, sad eyes, Mystil had said he missed “Dr. Elizabeth.” Asked if he wanted the doctor to bring him anything when she returned to Haiti, Mystil said: “Toys, I guess. I know — a bicycle!”

Then, looking down at his bandaged stump, the boy slapped his forehead and buried his face in a pillow. “I forgot,” he said.