Advancing Healthcare in Haiti

by Brendan Campbell, MD, MPH, Director of Pediatric Trauma at Connecticut Children’s

Dr. Brendan Campbell, pediatric surgeon at Connecticut Children’s Medical Center, and retiree Dr. Donald Hight, previous head of pediatric surgery, spent time in Haiti earlier this month. Below, Dr. Campbell shares what they learned, experienced and accomplished during their week long journey.

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Day 3:

The poverty and misery here is mind numbing. A profoundly malnourished baby dropped off here Saturday died this morning.

The first bright spot of the day was meeting Sister Anne. She’s an Irish nun from Dublin in her 70’s who’s making a real difference in the lives of many kids here. Her mission in Milot is nothing short of inspirational.

Monday will be our first OR day. We’re abandoning minimally invasive surgery, for maximally invasive surgery. Open gastrostomy tube placement, followed by an open Nissen fundoplication and G tube. Our third case came in to see us from an orphanage for “colostomy closure” with no records or history. First thing we did was look at the perineum: unrepaired anorectal malformation. Finally, a problem we can fix.

Second bright spot of the day came during our visit to a nearby orphanage. This 40 acre property has its own school and a plan for sustainable agriculture on site. The 45 kids who live there are very well cared for and will have opportunity.

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Day 4:

There is no shortage of pathology here, but it’s hard to anticipate the challenges that will trip you up. It would have been great to have a pediatric anesthesiologist from IAA to place IVs. A lack of IV access is one of the biggest impediments to providing care to children here, both surgical and otherwise.

The three ORs at Hopital Sacre Coeur have basic general supplies and instruments, but not much for children. In preparing for our first anorectal malformation case we needed some supplies (e.g, infant sized Foley, 6-0 silk suture) and were referred to a supply “bubble” in the compound where we’re staying. Inside this building is an incredible cache of supplies (surgical staplers, German made surgical instruments, lines, tubes, meds). We found what we needed, but there is currently not a system in place to match these supplies to the needs of the hospital, which is located right next door.

Hightlight of the day – My fellow colleague, Dr. Hight getting attacked by a goat walking home from the hospital (photo below is of the goat attack as it developed).

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Day 5:

After seven days in Milot we learned a great deal and hopefully accomplished some good. We saw more pediatric deaths in a one week than we see in six month stretches back home, and treated kids with conditions – like kwashiorkor, active tuberculosis, and advanced HIV infection – that are almost unheard of in the United States.

To function effectively in Haiti you have to reframe your clinical mindset, and function well outside of your usual comfort zone. Simple things aren’t so simple, and your diagnostic and treatment options are extremely limited. There are no anatomic pathology or microbiology services available. Poor quality old fashioned plain films are all you have for radiologic assessment. Flies in the operating room are commonplace, and you have no way of knowing what bacterial hazards lurk in the water that flows into the scrub sinks.

One of the cases we had illustrates some of the challenges clearly. A 4 year old fell 2 stories, and had a palpable skull fracture and cephalohematoma. His parents brought him in 5 hours after the injury and his GCS was 6. There was no CT scanner, neurosurgeon, or helicopter. We intubated him, then blindly managed his presumably elevated ICP with mannitol, sedation, and pressors. Then his left pupil blew. Principles of damage control neurosurgery would dictate that the next step would be to drill a burr hole on the ipsilateral side, but as a bridge to what?

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The healthcare team at Hopital Sacre Coeur does amazing things with extremely limited resources. The most valuable accomplishment provided by our team was continuing to build relationships with their physicians and providing education to their pediatric nurses who are eager to learn. From a pediatric general surgery perspective we now know what to expect, and how to do it better next time.

A special thanks to my surgical colleagues for their guidance, support, and harassment related to my various clinical dilemmas. And a special thanks to Dr. Hight who wasn’t quite sure what I had gotten him into at the outset, but who left Haiti strategizing about how to broaden our impact on the next trip.

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