Sunday, October 12, 2014

Hospital Universitie Mirabalais

Hospital Universitie Mirabalais

I met Loune Viaud at the departure terminal at JFK while watching our own airport covered by the news – “JFK begins screening passengers from West Africa for fever.” She had just come from a clean water and sanitation conference in Washington D.C.. I asked her what Haiti was doing to prepare for Ebola. She looked at me, paused, and said, “Haiti is still figuring out how to deal with Cholera.”

The flight was seamless. The cloud cover was minimal as we descended over the Northern portion of Haiti. My left sided window seat afforded me an arial view of Cap Haitian, impressive mountains, and Mirabalais (which I had been checking out on google earth last week) and what appeared to be the Hospital Universitie Mirabalias.

I sat next to Amos Joseph an accountant returning from Quebec. I asked him if he thought Haiti had returned to pre-earthquake status. He said that he thought things had improved. He said the poverty and violence in Citi soleil has greatly reduced. He seemed optimistic so I decided to be too.

This landing was different then those I remember from 2009. There was no view of Citi Soleil the slum as we approached touch down. The runway was longer and perhaps oriented in a different direction. The actual airport was larger as well. The customs officer was skeptical of my passport’s lack of departure stamp and claim that I was on vacation. I of course left the country without an exit stamp in 2009. He let me by with the irritated skeptical (possibly even angry)  look of a man who had seen foreigners manipulate his country and flaunt their laws for years. I’m glad he didn’t unload any of this on me.

Loune had a driver waiting and was very approving of my lack of a checked bag. She told me there was a bus accident on Rt Nacional #3 last night that killed 33 at the scene, sent 11 critical pt’s by to Hospital Universitie Mirabalais (by truck bed or taxi) and that several of those had already died, but that it was good that I was coming. (of course at this stage in my training with no real trauma rotations under my belt I felt like I’d probably have little to contribute) She had the driver take her to her home, then sent me on toward Mirabalais.

We stopped on the road halfway through the 2 hour trip to see the overturned bus. I took a picture and jumped back in the car. Very easy to see how 33 people were dead at the scene. I arrived at the Hospital and met the ER director Shada who is an american ER doc who splits time between Brigham in Boston and HUM in Haiti. She gave me a tour of the considerable only 1.5 yr old hospital and its facilities: CT scanner with PACS online system, 2 –xray machines, Peds ward, Internal Med ward, outpatient primary care clinic, Oncology, 6 room surgical suite, ICU, and 8 private beds for especially contagious pt’s, and an administrative department with offices for all of the chiefs. Pt’s are charged about 1.25$ US to get a membership card to the hospital and then subsequent care is free explained Shada. I was told that the hospital is officially a MSPP (Haitian Government Hospital) Hospital which runs mainly on donations Partners in Health and the Clinton Foundation donate to the Haitian Government. The hospital hires almost exclusively Haitian docs and buys its own meds and supplies from US vendors (no second hand stuff more or less). I did bring a pack of 50 sutures to donate as a good faith gesture :) which apparently they were open to accepting after last night’s bus accident.

I met some of the ED residents – Jimmy, Brezil, and some of the GP’s Linda, Oxana, and Daniel the pediatrician. Everyone was very nice to me and pleased with my broken Kreyol…. which is returning a bit! Some of them are headed to ACEP in Chicago in 2 weeks which I’m excited about. Email addresses were exchanged.

I met Luther the American general surgeon from Arizona today. He has been living and working here for 1 year now. He was consulted on 2 pts… 1 with appendicitis vs appendiceal abscess… the other with cholecystitis vs obstructive choledocolithiasis. I joined him on his lunch break. We walked from the hospital to his house where his wife and 4 kids live and then on to the town market. His wife teaches at the local school where his kids attend. He responded to the hospital’s need for an experienced general surgeon and committed to living here for 2 years with his young family. Adorable kids. I admire families like Luther’s (My uncle Mike and aunt Nora’s too) who live abroad. What an experience for his little kids… chickens to chase, an abundance of outgoing Haitian kids as playmates, fluency at a young age.

I met Maxi the medical director of the hospital as well. He’s an OB/Gyn doctor who started working with Paul Farmer 20 or more years ago. He was pleased to meet me and chat about the state of healthcare in Haiti. He emphasized that they are looking to the next generation of young doctors to help support what they started in Haiti. Fundraising, training/expertise for their residency programs, and doctors willing to commit months at a time to work in Mirabalais. He gave me one of the hospital’s new English brochures advertising their training programs in IM, Peds, OB/GYN, family medicine, general surgery, and ER. He also mentioned the ER residency’s month long “visiting professor” program. Currently there are two American ED doctors here lecturing to the residents daily for this month and living at a guesthouse 500 yards from the hospital. I can think of a few ER attendings who would be perfect for such a month.

Tomorrow I’m told I’ll get to see the chaos of HUM on a Monday before I get picked up by a driver from the Notre Dame Haiti Lymphatic Filariasis Program and head to Leogane. It was an honor to be invited to visit Mirabalais in this fashion (especially as a D.O. from a non-Harvard affiliated institution) for which I’m grateful to Loune, Maxi, and Dr. Farmer. Perhaps I’ll be able to come back and do an elective rotation here.  Perhaps I’ll just be accompanying and be accompanied by the emergency medicine residents of Hospital Universitie Mirabalais over the next four years from afar while I’m in Chicago.

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