Sunday February 19th
I'm sitting on the Sonoma County Airport Express as it slowly works its way up beautiful Park Presidio road along the Golden Gate park in San Francisco. The sun is shining on the park's verdant cypress and eucalyptus, ivy hugs the wall leading up to the MacArthur tunnel, and it's a cool 51 degrees. Days like this remind me that San Francisco is one of the world's great cities. I'm returning home after a week of celebration and relaxation in Puerto Rico and the British Virgin Islands, followed by a week of hard work in Port-Au-Prince, Haiti. Few times in my life have I spent more dissimilar weeks. In Puerto Rico we witnessed the joy and love of Andy and Janira joining in matrimony. Surfing, playing music, and sipping piña coladas filled the hours. And in the BVIs we set out with wind in our sails, rainbows at our stern, searching for pirate coves...and mostly trying not to crash. And then, there was a week of work in Haiti, which contrasted sharply with my sleeping-'til-late-morning island lifestyle.
Now I do realize that blogging about Haiti on a "Pierce In Africa" blog is taking a little artistic liberty. But not so much, really. I'm far from an expert on Haiti, but it felt more similar to my experiences in Africa than any other place I've worked. It was without a doubt a tough week. Leaving the small and very congested airport, a brief ride passed by tents still erected, I'm assuming, since shortly after the earthquake in January 2010. Hopital Bernard Mevs is amazingly easy to get to, about 10 minutes from the airport right along the main avenue. And that was all I saw of Port-Au-Prince, as we were basically under lockdown once we got to the hospital. Before the earthquake PAP was not the safest place to take a Sunday evening stroll, and this wasn't improved after the prison-break on the day of the quake.
Due to my recent island escapes of the week before, I arrived a day later than the rest of the team. Expecting to work in the trauma ER, I was a bit surprised when the first question posed to me by the head physician was, "Do you see kids?". Apparently there was no volunteer pediatrician scheduled this week, and the other family doc hadn't taken care of kids in a long time. I let them know that I was no pediatrician, but that I was happy to help and would do my best. My introductory rounds with local Port-Au-Prince physician, Dr. Renee Alce was a bit intimidating. The small ward had a capacity of about 13 kids (thankfully not more than that), and most of the cases weren't simple. There were premature infants trying to grow (I knew I should have paid more attention in NICU rounds), another infant septic on the strong IV medicine called dopamine to support blood pressure, an adolescent with an infected wound from a surgery that relieved the pressure of a swollen leg due to a football injury, multiple post-op infants with hydrocephalus (many cases of which can be attributed to previous meningitis), a few small children with vomiting and diarrhea, a kid with hemophilia who had bled into his knee and was receiving treatment for hemophilia and physical therapy for his now stiff and contracted knee. One adorable infant had fallen into a cooking pot of boiling water while being watched by her older sister, weeks later she finally received care, which included surgery to remove the thick, black eschars that had contracted the 3rd degree burn wounds. She was now getting twice a day painful dressing changes and was febrile, in need of another surgery to debride dead tissue. I knew I was over my head. But was there any other option? Thankfully there was a Haitian pediatrician, Dr. Bienamie, working from noon until 8pm, and Dr. Alce, the Haitian generalist interested in pediatrics, was very good and was present a lot of the time as well. I also was in phone contact with the American head internist/pediatrician who was in Miami that week. I ended up working from about 8 pm until after midday the following day, and even though I worked more than 100 hrs that week, it felt good, better than most 40 hr work weeks in the States. Sure we were working hard, but we were helping those that wouldn't otherwise have access to care. And there were no dull moments.
A few days into the week, a one month old previously term infant came in weighing about 3 pounds. The child had needed removal of part of her small intestine due to infarcted bowel in the first weeks of life, and now she wasn't able to absorb what she ate. She had severe dehydration and malnutrition, and looked shrunken, old and in agony. Her condition, know as short bowel syndrome, is difficult to treat in the US, at times needing a special concoction of nutrition through the vein, and even sometimes small bowel transplant. Here in Haiti, her chances of surviving are slim. One night she stopped breathing effectively and her heart rate fell. The team assembled and we did our best to breathe for her and use medications to help her heart pump stronger, also starting antibiotics for fear that a systemic bacterial infection might be the culprit of her new distress. From the look of things, I thought we'd be lucky if she made it long enough for the arrival of her mom the next morning. She surprised us by hanging in overnight and was still alive, though tenuously so, when our team left days later.
On Saturday, weary and in need of a good shower, I found it hard to believe that a week had already passed, and that our crew had only known each other for such a short time. Intense situations have a way of speeding the formation of relationships. I'm thankful for having met them and look forward to working with them again.
And the big question, which should be asked of every similar endeavor - did this help Haiti? This is usually a hard question for me to answer. I certainly benefited from the experience. I learned a lot about managing sick kids, and I got to do what I love. And I think some of the patients and Haitian medical students benefitted from my being there. But clearly we had a finger in the dyke, and it's up to someone else (like Haiti itself and groups like Partners In Health) to fix the chronic ailments of Haiti's health system. I'm grateful for the chance to have participated.