In For for the Long Haul: Reflection of a Pediatric ICU Specialist on Missions to Haiti

Returning from the fifth trip to Haiti since the earthquake, again I find it restorative to commit to pencil and paper my ruminations of the experience, witnessing once more the ‘Grand Canyon’ of health care disparity existing between the US and this land once called the pearl of the Antilles by the explorer of the new world. These lifetime experiences remain engraved in one’s memory. I look forward to a moment in the future when one recalls how far we have progressed, emerging from the afflictions of 2010; poverty, earthquake, hurricane, floods, cholera...I keep the hope alive!

 

Ten months after the earthquake we set out for an ongoing mission to develop the pediatric ICU that took birth in Diquini. This was three days before the anticipated elections, amidst a ravaging cholera epidemic. In spite of the apprehensions of many well wishers, the purpose of the mission was greater than the potential risks. Soon after landing in Port-au-Prince (PaP), we zipped through Cité Soleil, La Saline and made it to Carrefour in less than 15 minutes. This was in sharp contrast to our previous trips when 2 hours was barely enough to get us past the mob at the airport before facing parking lot style traffic. In anticipation of the elections, people felt it safer to stay away from hustle of downtown PaP.

I have to say, the overall scene appeared encouraging. The streets were no longer bunged with the debris of fallen concrete, the campus and parking lot of the Adventist Hospital was no longer littered with tents. We relaxed at the scene of two local boys and a missionary’s kid dribbling a makeshift soccer ball (soda bottle) in the vacant space.

Lots of activities were packed in the three days we spent in PaP. Among these were meetings with hospital administrators and physicians, conversations with the head nurse and staff nurses, cataloging supplies, gathering vital statistics, caring for patients with acute medical problems [a child with a prolonged convulsion and thriving premature newborns]. 


We were pleased to see that the ICU was being utilized by the nurses that we began training eight months ago. However according to my colleague Dr. Adeyinka, a pediatric ICU specialist from New York, this is nowhere near what we are used to. You see, we have recently completed the development of a $1.2M state of the art pediatric ICU in Brooklyn that took over five years but in reality, it’s not about the monitors, the equipment and how spacious the rooms will be here. It is heavily dependent on rigorous education and reinforcement. This is a process that will take more than five years.

When we left the ICU after our last mission in June, the unit was neatly arranged, supplies were labeled and orderly, the equipment was well functioning. Guerline (a pediatric ICU nurse practitioner) and I returned to find a room that represented a microcosm of the chaos that one often witnesses in the streets of Port-au-Prince. The nursing desk was a mess to say the least. Medications were to be found only through a rummage of papers, gloves, gauze, books, syringes and more. The electrical Intravenous pump that was donated several months ago was sidelined with the power cord nowhere to be found. The micro-drip was freely flowing based on a minute calculation. The two babies occupying the room appeared well taken care of, the monitors were well in place and the soft tone of the pulse oxymeters reminded us indeed that this, was the peds ICU. However, the other half of the room seemed like a storage room for IV poles, supply boxes and dirty incubators.

Nevertheless, the nurses were excited to see us back and displayed pride for the progress accomplished on behalf the premature babies and sick newborns that have graduated from the ICU. The mortality rate has decreased significantly and we have lost only two babies here since March says Ms. Yanick, the head nurse. The frustration that Guerline and I shared at the onset was quickly dissipated by the news of better outcomes than previously recorded at the hospital.

Reflecting on these facts, I recalled the statement of my professor Pietro (Peter) Marghellen during a recent Disaster Management course. Peter [an international expert in medical planning and incident management] made reference to the Maslovian pyramid stating that “In times of significant complex emergency or disaster, we revert to the base requirements of human needs - our physiological life support and physical safety become paramount..."

Populations often rely on the medical and health sector at times of duress. In the case of Haiti, the population has been stuck near the bottom strata of Maslow's "hierarchy of needs" where a great majority of the population remains focused on finding food, clean water, and comfortable sleeping arrangements. 

The health care providers as well are among those fending for basic physiological needs. In the words of one of the local nurses, "when are you (visitors) going to do something for us? We’ve seen lots of supplies and donations for the patients, but no one is looking out for our economical needs”.

In reality it will take a significant amount of commitment, effort, resources, and time to get us (Haiti) heading to the peak of this triangle. Simply trucking in supplies and millions of dollars may not suffice. In order to trek upward to the level of confidence, achievement, creativity, spontaneity, problem solving and the acceptance of facts, a lot of patience and endurance will have to be spent in the changing of attitudes and the mindset of two centuries of struggle to stabilize the base of the Maslovian triangle. I will go on record again saying that a better future for our brothers and sisters in Haiti is also dependent on the mobilization of the Diaspora. It is not known to many that there are more health care professionals of Haitian decent abroad than those serving in Haiti currently. We are in it for the long haul. 

I am proud to be associated with PULSE and its volunteers who are committed to the mission of establishing a higher level of acute care for the children of Haiti. The passion for this cause is palpable.

 

Louisdon Pierre, MD, FAAP.

Pediatric Intensivist, NY

P. Marghellan. Homeland Security Today - Preparedness and Security News - Now, Children, Repeat After Me...14 June 2010
Haitian Diaspora Forum: Contributing to a Strategic Plan for Reconstruction and Development in Haiti. March 21-23, 2010. R46-R53