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R.I. doctors recount experiences in Haiti

01:00 AM EST on Thursday, February 4, 2010

By Felice J. Freyer

Journal Medical Writer

Even after he returned to work at Rhode Island Hospital last week, Dr. Christopher T. Born was still seeing, in his mind’s eye, “that little boy with that stump of his” — a 6-year-old boy whose leg, fractured and infected, had to be removed at a makeshift hospital in Port-au-Prince.

A strong memory that plastic surgeons Dr. Stephen Sullivan and Dr. Helena Taylor carried home from Haiti was that of a young man, an accounting student, whose jaw had been fractured in the earthquake. Lacking access to the plates and screws that they usually use for reconstructive surgery, they improvised a solution. It worked. The day the pair left Haiti, the young man, still swollen and bandaged, scribbled his thanks on a piece of paper.

And the image that follows Dr. Sachita Shah, an emergency doctor, is the 12-year-old girl displaying, without tears, her crushed hand. The surgeons removed it. But like so many of the patients Shah encountered in Haiti, the girl was eager to get better and move on with life, even a life with one hand.

The four doctors, all associated with Rhode Island Hospital, were among the volunteers who streamed into Haiti in the first couple of weeks after the Jan. 12 earthquake. And just as the memories of their patients linger, so, too, do the medical needs in Haiti, which are changing now in their nature, if not their urgency.

“It’s becoming less and less ‘We need acute surgery,’ ” says Shah, “and more and more ‘We need to rebuild the country.’ ”

“The people in Haiti are going to need continued support for a long time to come,” says Born.

Born, who is director of orthopedic trauma at Rhode Island Hospital, traveled to Haiti with the International Medical Surgical Response Team, a group organized by the Department of Homeland Security to quickly deploy civilian medical professionals in disasters.

When the 60 people in the team set up shop in a school, patients quickly lined up. Most had fractures and crush injuries. Some had wounds that were severely infected. If they were being treated in the United States, they’d be candidates for multiple surgeries. “In the post-quake Haiti,” Born says, “you kind of felt you had one shot.” So many a limb was amputated. Those that could be salvaged were stabilized with external devices.

“The medical legacy of this event is a multigenerational population of amputees,” Born says. “And in Third World countries, they don’t have prostheses, they can’t work. Most work is manual labor.”

Born was amazed and baffled by the Haitians’ stoic response to their multiple calamities. “The Haitians were noncomplaining,” he says. “It was hard to tell whether they were just shocked and depressed, whether it was their faith, whether they’ve been under duress for so long … they don’t have any expectations. Even the kids, the kids were unbelievable — cooperative, didn’t cry.”

While Born traveled with a disaster-relief agency, the other three doctors went to Haiti with an organization that has worked in that country for more than 20 years. Partners in Health joins with the local community to improve health care in impoverished nations. The organization has 10 hospitals operating in Haiti.

Taylor and Sullivan, a married couple, are plastic surgeons who correct congenital abnormalities and reconstruct faces after traumatic injury. Sullivan had spent a year working with Partners in Health in Haiti after he completed his training. When the earthquake struck, Rhode Island Hospital donated a planeload of equipment and supplies, and the couple’s colleagues covered their schedule so they could help out.

They worked at a Partners in Health hospital in Cange, about 90 minutes outside of Port-au-Prince. The hospital has always offered free care, and its reputation for quality drew injured legions. “They were coming by car, by bus, by wheelbarrow,” Taylor said. The hospital had more than double the usual number of patients. The church and school had been converted into inpatient wards.

Over nine days, Taylor, Sullivan, two Boston surgeons and a Haitian surgeon did about 120 operations.

“They are incredibly tough, with painful situations, emotionally and physically,” Taylor says of the Haitians. “That being said, they want and expect the best quality of care. ‘Would you be cutting my leg off if I was in Boston or Providence?’ ”

As with the student whose fractured jaw they repaired, Sullivan and Taylor say they could provide surprisingly good care even without all the equipment they have at home. “Most of the state-of-the-art fancy things we have — they’re nice, but they’re not necessary,” Sullivan says. “You really learn to be a surgeon … because you can’t rely on all the little gadgets and things that make it easier.”

“Haiti has always been forgotten, and it’s always been abandoned,” he added. “It took this absolutely horrific and devastating event to get the world to recognize Haiti.” The couple plan to return in April.

Shah, the emergency physician, also worked with Partners in Health, but she went to a coastal town called St. Marc. “It was pretty horrific,” she said. “Patients were lying on the ground on cardboard, on tattered blankets.” They filled two buildings that had been slated for demolition.

Shah and the others spent their first few hours triaging the patients — determining who would die first if they didn’t get surgery. Shah, who is not a surgeon, also helped patients get ready for surgery, administered antibiotics and cleaned wounds. After surgery, she was amazed by the patients’ fortitude.

“The day that the crutches came,” Shah recalls, “everybody was up. Everybody was out of bed, everybody was learning crutches. That will just stick with me forever. … There was just that urgency to get better. There was no wallowing.”

A 16-year-old girl, who needed an above-the-knee amputation, was eager to learn how to use crutches so she could get back to Port-au-Prince and reunite with her mother, who also had lost a leg.

To the surprise of the medical people, Shah said, a number of patients refused amputation, even after they were told that the limb could not be salvaged and the infection could turn fatal.

“They said being an amputee is like dying,” Shah explained. “There are no ramps, no wheelchairs, no crutches. Nobody will marry you. You can’t get a job.”

But Shah predicts that will change, because there will be so many amputees. “When they rebuild Port-au-Prince, they’re going to have to build it with ramps.”

Shah plans to return to Haiti later this month. She will contact all her patients, and not just to see how they’re doing. She expects to bring a supply of donated prostheses.

A chapel in Cange, Haiti, is converted into an inpatient ward. Two plastic surgeons associated with Rhode Island Hospital, Doctors Stephen Sullivan and Helena Taylor, were part of a team that performed about 120 operations over nine days.
Courtesy of Dr. Stephen Sullivan