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I’m on my way back from another week in Haiti.  I had many profound, disturbing, humbling and enlightening experiences. I thought I’d share a few here and try and put in words what you would experience if you made a similar trip.

Eye clinic

Eye clinic in Port-au-Prince.

First, I wanted to address the title of this post.  The “Third World” is actually an outdated and useless term, which came about after World War II to describe countries that neither belonged to NATO or the communist bloc.  This third group of countries were very often also poor and the two labels become synonymous. What the term does however, is lower these countries to a status unbefitting of the people living there.  There is no doubt that Haiti is poor, but to cast it and its people aside as being in a different world is unfair and detrimental to understanding their plight.  It takes around an hour to fly from Miami to Port-au-Prince, hardly a world away (remember when Haitians were crossing to Florida in rafts). In truth, they live in exactly the same world as the rest of us, that world just hasn’t given them as much to work with.  As a kid, I never wondered if my next meal was coming, or if I’d have access to clean water. The power was on 99.9% of the time, along with either the A/C or heat.  And if, God forbid, I or someone I knew got sick, I knew every possible treatment was available to them.  These all seemed to be my right as a human.  So when you see people who have little to no hope of achieving many of these basic rights, you can’t help but wonder what is going on in this world.

The good news is, I also saw hordes of people, mostly from the US and France, visiting on mission trips.  Most were with church groups building schools and churches, establishing water sources and doing ministering.  Everyone was jazzed about the difference they made and many talked about what they were planning for their next trip.  You can’t help but think with all this help coming, more than 3 years after the earthquake, it is only a matter time before momentum brings real change to Haiti. Just sending money to their government won’t help, just ask Somalia, Ethiopia, Sudan….

Just a couple of stories of patients I met.  I saw quite a few children with facial deformities due to tumors or hemangiomas, but also due to trauma.  Trauma was the theme of the visit.  This great young kid had been hit in the face by someone a few weeks earlier and had a persistently swollen right eye. I was worried about a foreign body.  During surgery, I encountered a hard mass against his eye and tenting the conjunctiva out where it appears red and swollen in the photo.  It turned out to be a chunk of bone that had been dislodged from inside his eye socket. No one had examined him thoroughly and this had been missed.

orbital fracture

Young man with medial orbital wall fracture

The same day, we saw two men in the ER who had been assaulted. One stabbed in the eye, the other shot through the cheek, with the eye being the exit wound.  Nearly every face we saw seemed to have some sort of scar.

facial trauma

Several cases of facial trauma

The young man with the stab wounds above had 4 1-0 sutures closing all his lacerations.  1-0 suture is usually used to close very thick tissues, such as the abdominal wall, not delicate structures like eyelids.  I removed them and replaced them with about forty 6-0 and 7-0 sutures.  The young woman above had numerous scars dating back to the earthquake, which split her eyelid in two and left it retracted.

post ops

Several post op patients

Her repair involved borrowing skin from her right upper eyelid to lengthen her left upper eyelid, as well as a full thickness resection of her scar and realignment of her eyelid margin.

The cases we did were all difficult, but the cases we couldn’t do were the hardest to deal with. We saw several patients with large growths emanating from various parts of their faces. They had saved money and paid for a CT scan (around $300, average monthly income is $60).  The scans showed invasive tumors filling their eye sockets and often extending into their brains.  Surgery was not an option.  When I’d recommend an oncology consult, the residents would shrug.  They knew that even with a consult, the treatment necessary would not be available in most cases. As one resident said when I asked her to explain to a patient what we were seeing, “tumors don’t go over well here, everyone knows they are going to die.”

orbital masses

Orbital masses

Anyone interested in helping us out, can either donate to CharityVision or contact our office. Every trip we identify a slew of instruments and supplies we need to offer better care.  Any help with attaining these supplies is greatly appreciated.  My retired partner, Dr. Call, and I have committed to having one of us visit every 3 months. The needs are seemingly endless.

I was invited to accompany Dr. Branson Call, my recently retired partner, to Port-au-Prince, Haiti in late spring of this year.  He has been traveling there on humanitarian missions for about 10 years making several visits per year.  In January of 2010, Dr. Call was in the operating room, getting ready to start surgery on a Haitian man when he says the floor started rolling and the lights went out.  All in the room hit the floor and for the next few minutes were tossed around, rolling into each other.  When they emerged from the building, the city was in chaos and scores of thousands had been killed.  A nearby nursing school had collapsed, killing some 30 nursing students.  Dr. Call spent the next few days treating trauma patients with the most meager of resources.  He eventually made his way out of Haiti on a bus to the Dominican Republic, where he reunited with his wife.  Over those few days he had no communication with his family back home, so their relief at his return was momentous.  I give you this background story so you can appreciate his dedication to Haiti and its people.

Dr. Call performing one of many operations in Haiti

Dr. Call performing one of many operations in Haiti

Our arrival was relatively uneventful.  We were delayed a day after tropical storm Isaac blew through the Caribbean and past south Florida.  The ride from the airport was eye-opening for someone who had little experience with the third world.  Throngs of people everywhere among houses reduced to rubble (or in the slow process of being reduced). Trash strewn streets framed arteries of people flowing in all directions or huddled in clotted masses around impromptu markets and street-side restaurants.  The energy was palpable, but felt like it was racing out in all directions, but accomplishing little.

waiting for water

Waiting for clean water in Port-au-Prince

We arrived at the hospital early Tuesday, a single story concrete building with visible cracks and rents in most of the walls.  A large crowd of people was assembled out front.  We pushed our way through the mass, past a metal gate and into a small courtyard ringed in short banana trees with a central awning and concrete half-wall seating.  A small meeting room and a few examination rooms also opened onto the courtyard with the small operating theater near the back of the plaza.  The facilities were Spartan, but adequate.

Young woman with anthrax scarring

Young woman with anthrax scarring

We quickly went to work seeing patients, many of whom had traveled some distance.  I was immediately struck by the amazing variety of pathology.  Most every case was far advanced, or what may be considered end-stage in the US.  Tumors that filled eye sockets, horrific scarring from previous anthrax infections, scarred eyelids with eyelashes curled in and abrading now opacified corneas, all seemed commonplace in this unfortunate group of patient.  A parade of children with small and large tumors was brought in. Some thankfully were benign dermoid tumors, scary in appearance but ultimately harmless.  Others were huge and disfiguring causing destruction of the eye or indicating a serious pervasive, likely life-threatening neoplasm.  When a young lady walked in with a simple drooping eyelid, I felt relieved that at least on case would be straight-forward.  I would later retract my enthusiasm.

Teenage girl with tumor

Teenage girl with large orbital tumor

Once we’d filled our day’s schedule, we headed to the operating room.  The Haitians are very curious when it comes to sterility and behavior in the OR.  They are almost fanatical about certain things, such as not wearing scrubs uncovered outside the OR, while they use the same gown throughout an entire day of surgery.  They often pass instruments back and forth between operating tables (we are operating simultaneously on two patients just a few feet apart) as long as they perceive the instruments haven’t been contaminated, but they are able to effectively reuse many items we would consider disposable, stretching the articles life far past it viable use.

The adventure in third-world surgery comes when the patient is prepped and ready.  As a surgeon, you quickly develop a plan in your mind based on the pattern of disease before you.  A ptosis surgery will require a skin incision, exposure of the levator aponeurosis via dissection through several delicate soft tissue layers and measured advancement of the eyelid muscle tendon to raise the height of the lid.  In an ideal situation you’ll have delicate instruments for the task. In Haiti we had a literal grab bag of old, dull and oversized instruments to choose from.  This turned straight-forward surgery into difficult surgery and difficult surgery into extremely difficult surgery.  After a few cases, you just accept the situation and muscle through, which is easy when you see the joy you bring to patients with no other hope.

Tumor excision

Tumor removal in young woman

After 3 days of case after case our time was done.  We packed up, boarded our plane and headed out.  On our drive to the airport we drove through the biggest tent city left from the 2010 earthquake.  USAID tarps held up with old boards random pieces of sheet metal went on for miles.  I was heading back to my house in the mountains with A/C, fresh water and warm beds.  We may have helped a few, but thousands more still need our help.  You can’t leave Haiti without already formulating a return plan in your mind.

Post-op patients

Post-op patients

 

Haitian residents

Haitian ophthalmology residents with Dr. Harris and Dr. Call