Reflections from Haiti: Chaos to Camaraderie

Doctor Stanley Frencher recounts recent experiences of working in a field hospital in the earthquake-ravaged nation of Haiti. But in the end, he ponders is the health care system of Haiti all that different from his home of inner-city Detroit?

Amazing. Beautiful. Picturesque. Inspiring. Not words one would associate with the earthquake-ravaged disaster occurring in Haiti. In contemplating the idea of going there, I certainly faced questions of why now, what can you really do, shouldn’t trained professionals only go, and is it safe? While all of these questions were important, the main one I kept in mind was who better to go? I’ve been working with a local grassroots organization that has grown to national prominence on a message of working with existing infrastructures and providing culturally appropriate health messages to African American men in barbershops. Through that work, we have developed a myriad of partnerships that enabled us to garner needed supplies ($30,000 worth), travel to Santo Domingo, Dominican Republic and then work with a local NGO to arrive at the Dominican/Haitian border.

In the Dominican, Pastor Prophet and Dean, a family medicine doctor from Oregon, recruited us from Good Samaritan Hospital in Jimani to a Haitian Christian Mission just a few miles across the border. Upon arriving there, we were immediately inundated with surgical patients and limited facilities to treat them. Fortunately, a local field hospital had recently been established a few miles away and a nurse at the Mission helped us coordinate transfer of several surgical patients to that new facility.

The Love-a-Child Field Hospital, as it was called, was phenomenal. It sat at top a hillside with amazing panoramic views of Haiti. There could not have been a more tranquil place for victims of a disaster to recover both physically and emotionally. The Field Hospital was well-organized by emergency department trained staff with disaster preparedness expertise. We managed over 300 patients, most of whom required surgery. Operation Smile provided surgical oversight and supplies. The Field Hospital received daily shipments from various donors including 1,000 tents, a satellite dish for high-speed internet, and negative pressure tents that could be used to replace the classroom-style operatories where surgical procedures are performed. We still lacked basic things like sufficient food, trash bags, biohazard containers, and enough crutches for the dozens of amputees and patients with fractures. Nonetheless, the camp was nothing like any clinic I’ve ever experienced.

I had only planned to stay a short time and return after gathering actionable information for our partner organizations, but had decided I was going to stay when I lost my passport. After some wrangling I was able to board a C-130 military plane and traveled home with dozens of Haitian evacuees.

As we look to how we are to rebuild and reform our own healthcare system, we rarely look to circumstances and areas of the world such as Haiti for inspiration. Certainly in the short-term, the world will be bringing aid to Haiti. But is there an opportunity for the world and even the United States to learn something from this tragedy. Not simply about how to manage a disaster. And not merely the moral lesson of being a good neighbor. But rather, truly learn substantive lessons about how should a healthcare system be constructed to perform well under normal circumstances and in dire ones.

Our healthcare system is no more ready for a disaster than it is a flu pandemic. The tragic circumstances I observed in Haiti were the result of not only fallen buildings, broken limbs, infected wounds, and lost lives, but also a failed healthcare infrastructure. Haitians, unaffected by the earthquake, flooded makeshift clinics and field hospitals for chronic disease care—hypertension, diabetes, pregnancy, and prostate enlargement. The very same problems of limited access and poor quality that I encountered in Haiti occur here in the US everyday. Ironically, the populations who seem to suffer most in the US resemble that of Haiti—poor and of African descent. Certainly these are not the only populations suffering here, but it further begs that question: why can’t we, in a country so prosperous, do better than Haiti? Now, many will argue that we have the best healthcare in the world. And they are right. We have the best care for those who can access it. For those who can’t, they might as well be in Haiti.

I began by saying that this experience inspired me. It has. Working in austere conditions with limited resources taught me the value of clinical judgment and the true meaning of care for patients. Seeing the camaraderie of multinational volunteers who worked tirelessly to do whatever it takes to care for patients inspired me. Caring for the wounds of children who underwent amputations, often with limited anesthesia, changed me. I always empathized deeply with my patients, but I find myself even more uncompromising when it comes to the systems within which we physicians work to provide that care. It can no longer be acceptable that some patients can have access to the best care in the world while others settle for whatever is available. That’s simply not right. There will undoubtedly be lessons to be learned as Haiti is rebuilt and I am now working with several organizations to undercover and disseminate those strategic lessons. The rebuilding process in Haiti will inform our own redevelopment and the reformation of healthcare in the United States.

by

Stanley Frencher, Jr., MD, MPH