Spencer McLean works with an American nurse practitioner to dispense medications at a mobile clinic at Cité Soleil.Courtesy Kimberly Carcary
After the catastrophic earthquake that rocked Haiti in 2010, Canadian orthopedic surgeon Andrew Furey started Team Broken Earth, a non-profit group that sends Canadian doctors, nurses and physiotherapists to work at Hospital Bernard Mevs in Port-au-Prince. The Canadian teams run the city's only trauma centre, train local health-care workers, provide medical supplies and are working to establish sustainable programs throughout rural Haiti.
In January, Spencer McLean, a fifth-year orthopedic surgery resident at the University of Calgary, travelled to Haiti as part of a Team Broken Earth mission. He kept a detailed diary of his experience. These excerpts provide a look at what happens on the ground with their work in Haiti.
January 14
I'm standing in my living room and it looks like I'm in an OR. Medical and surgical supplies are everywhere, intermixed with my clothes, Clif Bars, Pop-Tarts, electrolyte solutions, anti-malaria pills, a mosquito net, surgical scrubs, headlight, water bottle, hand sanitizer, bug spray, money belt, stethoscope. I force it all into two hockey bags. Bathroom scale says 98.3 pounds – I've 1.7 pounds to spare! Off to the airport.
January 15
We fly in on a direct flight from Montreal. As we descend, I see Haiti – a place oddly without trees. From the air, I pick out the shantytowns of Port-au-Prince. If our landing is any indication, Haiti is chaotic. The airport has a runway but no taxiway. Our plane lands, gets to the end of the runway and makes a U-turn to taxi back to the terminal. As we walk out to the Land Cruisers sent by the hospital, the 32-degree temps feel wonderful, although I'm sweating as I heft my giant hockey bags through crowds of people.
Our hospital is home to the only trauma centre in the city, covering a population of more than three million. That's mind-boggling by Canadian standards. The "trauma centre" is beat up, terribly equipped, small. Our initial reaction was, "Where are we?" The hospital has a two-bed emergency ward, two OR suites and a three- or four-bed ICU. The number of ICU beds changes daily as there are only three working ventilators in the country. Three armed guards stand at the gates of the hospital compound. Day and night, people walk up to the gates and the guards do a pre-emptive triage before letting patients through.
We've been here five hours and Dr. Marc Francis (who is working Emerg overnight) has had several major traumas, including a guy who drove his motorcycle head-on into a truck. His injuries include: possible tracheal disruption, pneumothorax, smashed mandible and maxilla, fractured/dislocated ankle. If he survives, he'll go into our ICU.
January 16
First full day and we've all had our eyes opened to the realities of Haiti. These people live in constant survival mode. A 17-year-old came in with a dislocated hip in the middle of the night. His wails woke us up as we slept in the hospital dorm. We reduced [manipulated] his hip and the young man walked out four hours later because he had to go to work or his family wouldn't eat. Incredible.
Today, we did a few surgeries where, in Canada, the patients would be in hospital a couple of nights and go home on fairly strong narcotics. Here, our patients go home about four hours after coming out of the OR with a prescription for Tylenol and Advil. One woman gave birth without any real painkillers and walked out with her baby a couple of hours later. It's an extremely opioid naive population.
January 17
[Orthopedic surgeon and team leader] Dr. Paul Duffy tracked me down midmorning and asked me to go to a clinic in one of the tent cities. I admit that I was a little nervous because we were going to the heart of Cité Soleil, the most dangerous part of Port-au-Prince. It's one of the biggest slums in the Western Hemisphere.
A few of us load into a "tap-tap" – a lavishly painted bus that's a type of public transit – and leave the compound. We drive past half-collapsed buildings, broken-down vehicles and people everywhere. We pass a canal filled with trash and sewage. The place smells like a dumpster full of meat that's been left under the summer sun. Truly, it stinks. Finally, we come to an area called Iron Market where, among fruit sellers and open sewage and garbage, there's a pharmacy with medication for us. We see women carrying massive loads on their heads, businessmen walking with their suits and briefcases, cripples hobbling along and traffic.
After we pick up the meds, we negotiate our way to the tent city where we set up a clinic in an old schoolhouse. Immediately, kids come out of the woodwork. They are jumping and singing and trying to hold our hands. They are adorable! I'm tasked with playing God and figuring out who the sickest 50 patients are amongst the hundreds who have lined up – who we can treat and who we have to send away. We only have three hours until we have to be out of there, because once the sun goes down, the area becomes very dangerous.
I spend about 15 minutes talking to a 17-year-old boy in broken French (on both our parts). He wants my glasses because he has trouble seeing the board at school. Even living in incomprehensible poverty there is a real human element and joie de vivre .
Today, I got a real sense of the poorest of the poor and I think we did some good. It feels like a drop in the ocean over all. Still, hopefully, there are 50 or so Haitians that will be better off this evening than they were this morning.
We're heading over to the UN now for the only real food I get each day.
January 18
This morning I started in the OR doing a revision femoral external fixator, usually the second-last option at home but routine here. It's like metal scaffolding that runs from the ankle to the thigh. In Canada, we usually nail it or put in plates and screws. As I was finishing, Dr. Duffy burst through the door, told me to scrub out STAT and go over to the local general hospital.
We arrive at a three-storey building that's missing its entire front facade. I thought it was closed but, no, this building is where the current orthopedic ward is. We walk inside, passing the hospital laundry drying in the sun on razor wire, to find row after row of ortho patients in all forms of traction or external fixation. It's very, very rudimentary treatment. We could easily have added 50 cases to our slate based on the patients there.
The most heartbreaking was a 15-month-old boy who has a broken tibia that has been sticking out of his skin for three months because his family can't afford to get treatment. We begged his mother to come over to our place to fix him, but she didn't trust us that we would provide care free of charge.
January 19
Starts out as any other day here: Wake up, and down my Gatorade, malaria pill, Pop-Tart, Clif Bar, instant coffee. After breakfast, I'm taking a shortcut through the ER when I find Dr. Ian Wishart looking for help. We have an hours-old neonate brought in by her mother. When the triage nurse sticks the pulse oximeter on the little tyke, it's not reading an O2 sat [oxygen saturation] or a heart rate. The kid is immediately taken from the mother's arms. Dr. Wishart assesses the baby, confirming that she isn't breathing and lacks a pulse. He immediately jumps into code blue mode. There's hell breaking loose because the nurses can't get an IV, the suction isn't working, the cardiac monitor isn't working and there's no neonatal intubation equipment around.
Dr. Wishart gets the intraosseous gun, which basically sticks a needle in the tibia to give fluids and meds. I run into the OR and I find Dr. Geoff Hawboldt (one of our anesthetists) and ask him urgently if they have a neonatal laryngoscope. He and Dr. John Arraf (another of our anesthetists) perk up with quizzical looks when I tell them why we need it. Dr. Hawboldt comes running with me. I resume chest compressions because the nurse is getting tired and, finally, they manage to intubate the kid. A couple rounds of epinephrine and 15 minutes of compressions later, we stop. We have a pulse and the baby is saturating well!! Amazing team effort as we saved this little girl's life.
That night, as we're having dinner at the UN, we get a text from the NICU nurse saying the babe had just died. Ten minutes later, we get another text from an ER nurse saying that she'd just delivered a healthy baby in the ER! Life and death in Haiti.
January 20
Being Sunday, most of the local staff was off so we had free rein of the OR. Boy, we worked and worked! Our team did four hip hemiarthroplasties; removed a breast tumour, a stomach tumour and a neck mass; fixed a broken hip and did some minor emergency cases. One of the Haitian orderlies, Taylor, confided in me that he has never worked so hard in a single day in his 11 years working at the hospital. That was echoed by one of the girls washing and sterilizing the equipment when she asked me in a forlorn voice, "Do you need this set again?" I said, "Nope, we're all done." At which point she just smiled.
As the day went on, we ran low on beds. We began to discharge them as soon as possible and watched them walk out. For those not ready to go home, we pooled some money to pay for an ambulance to send them back to the general hospital.
The Haitian people are remarkable. They either don't feel pain the same as we do or are much better at ignoring it. Back in Calgary, these patients would be in hospital a minimum of five to seven days and go home on some form of narcotic. Here, our first patient went home two hours post-op on Tylenol and ibuprofen after walking with our physiotherapist.
I really felt like we did something worthwhile today because five of our patients had been confined to bed for months. Today, every one walked out of the hospital. The granddaughter of one of our patients started crying because she thought she'd never see her grandmother walk again.
Tonight the UN was closed so we went to dinner at one of the local hotels called Visa Lodges. I'm pretty sure it's supposed to be "Vista Lodges" – it's up in the hills with a nice view. It was a chance to finally blow off some steam.
January 21
After yesterday's marathon, today dawned sunny and calm. We had only one case on the board – the ICU patient who showed up within hours of our arrival after ramming into a truck with his bike. He was a real team effort because our emergency docs and nurses resuscitated him the first night, the ICU nurses kept him alive throughout the week, and today all three of the surgical teams worked on him.
While I waited for my turn in the OR, I sat on the roof in the sun reading and watching the streets below – my first real downtime since we arrived. Some observations:
* It's amazing how much stuff Haitian women can carry on their heads.
* During the day, there are thousands of Haitians in the streets, just wandering. At night, everyone disappears. It's eerie.
* Every step along the way, people are skimming money; for example, it costs $1 (U.S.) for a banana and I know it's probably a few cents to buy it from the source.
January 22
We're on our way to the airport and just said goodbye to the dedicated Haitians that we worked with. We had an amazing week and did some good work. A dabbling of our team's surgical cases: cleft palate corrections, mastectomy for breast cancer, gastrectomy for stomach cancer, multiple broken bones fixed, dealing with complications from injuries sustained during the earthquake, hernia repairs, amputations and everything in between.
I have seen more humanity in despair than I thought could exist.
I'm craving chocolate milk and a hot shower.
Christina Frangou, a freelance writer and Dr. McLean's wife, compiled this piece from his diary.