One year after their last trip and two years after the January 2010 earthquake that leveled the country of Haiti, a team of UC faculty, physicians and nurses returned Port-au-Prince to volunteer at the nation’s only trauma hospital.
The 45-member group took supplies and equipment to the hospital, and they left with photos, stories and a plan for how to make the hospital more sustainable and how to help its physicians and nurses care for their patients in the future.
Supported by Project Medishare, a Florida nonprofit organization, the Bernard Mevs Hospital is Haiti’s only hospital dedicated to intensive care and trauma. It contains two basic operating rooms, a pediatric unit, a four-bed adult intensive care unit, a two-bed emergency room and a triage tent just inside the guarded gate.
UC’s team included physicians and advanced practice nurses from the departments of emergency medicine, surgery, anesthesiology, neurology and pediatrics, as well as nurses from UC Health University Hospital’s emergency department, surgical, neurological and cardiovascular intensive care units. The team also included nurses and respiratory therapists from Cincinnati Children’s Hospital Medical Center and an emergency medicine nurse practitioner from Good Samaritan Hospital.
Team members bought their own plane tickets and brought two suitcases—one for themselves, one to carry donated medical supplies—for their two-week trip. Half of the team came for the first week, half for the second, and a handful stayed the entire time.
"You take more than you leave from Haiti,” says Jordan Bonomo, MD, assistant professor of emergency medicine and neurocritical care and director of the division of critical care in University Hospital’s department of emergency medicine.. "It opens your eyes—you come home exhausted, but it’s a good kind of exhausted. It’s almost cleansing.”
He says the conditions in Haiti are still desperate for most of the population. Rubble litters the roads, residents have no secure running water and unemployment is almost 90 percent.
In that environment, managing the transportation and care of patients presents hurdle after hurdle.
"Bed count is a moving target,” says Bonomo. "There’s room for 12 beds at the hospital, but you can load it to 20. The ICU has the only four ventilators in Haiti, so whenever there’s a critically ill person on the island, you get a call asking if you can take them.
"It’s pretty complicated and hectic and, every once in a while, if the phones aren’t working, a pickup truck will just show up with a critically ill patient in it and you’ve got to figure out what to do.”
Supplies are also at a premium. The hospital almost never has blood at the ready during an operation. Instead, patients’ families and friends must donate blood at the Red Cross before they can be given a unit to take to the hospital.
But, amazingly, the team had a unit of blood available for one memorable case during the second week of the trip.
Fourth-year surgery resident Priya Prakash, MD, had arrived in the country just a day before when she learned of an emergent case coming to the hospital. Chad Esh, an American missionary worker, had been robbed at gunpoint and shot in the groin and, luckily, was riding in a truck with someone who witnessed the crime, spoke English and took the missionary to the hospital.
Working with fourth-year emergency medicine resident Brian Bales, MD, and assistant professor of emergency medicine Opeulu Adeoye, MD, the team used a portable ultrasound machine loaned from manufacturer Sonosite to find that Esh was bleeding internally.
"We were able to get him back to the OR within 10 minutes of him coming to the hospital,” remembers Prakash. "We had blood there and we had anesthesiologist Dr. Suzanne Bennet, who was amazing, keeping him alive while we were operating. We were in the operating room for about 10 hours, while at the same time we were trying to coordinate getting him evacuated back to the United States.”
The next day, Esh was flown to a hospital in Miami, where he’s made a full recovery. After the trip, the surgical team, which also included nurse anesthetist Matt Westerfield and surgery resident Gerard Baltazar, DO, reunited with Chad in his Miami hospital room.
"I think a lot of us came home trying to figure out what happened,” says Prakash. "If the circumstances weren’t right, this kid wouldn’t have survived.
"At UC, you have a lot of backup—but being the only surgery resident there, I was really put in a position to dig deep and figure out what I knew I was capable of doing and try to make the right decision. It was a position I wasn’t used to this early in my career at home, but it was a learning experience too.”
The portable ultrasound machine, loaned from manufacturer Sonosite, along with advanced cardiac monitoring technology donated by Cheetah medical, proved to be the most valuable tools team members brought with them. Armed with imaging tools and their advanced ultrasound training, the team was able to image many patients for a variety of conditions.
"Haiti is one of those places where, if you can do it, you have to do it, because no one else can,” says Bonomo.
With UC transplant surgeon Steven Rudich, MD, on the team one week, the hospital opened a new ward and trucked in patients from across the country needing complicated liver and biliary surgery.
But co-organizer and University Hospital registered nurse Jessica Wiles says the group’s most lasting contribution will be in sharing their education and training with the Haitian physician and nurses.
"From a nursing standpoint, the hospital’s staff has made leaps and bounds,” says Wiles. "I did four education sessions four times there for nursing assessment and priorities, but the staff just doesn’t have the tools or education materials there.”
To build on that training, Wiles and Bonomo are working to increase the frequency of the UC team’s trips to Bernard Mev—and to bring some of the Haitian physicians and nurses to UC for more advanced training and cultural exchange.
Says Bonomo, "We have a chance to lead our community by example, responding to our obligation to be a part of the global health care community. We have so much human capital here at UC—our expertise, passion and enthusiasm are things that many of us want to share with our Haitian colleagues.
"To a member, our team has come to care deeply about that hospital and its staff and patients. We can make a difference in Haiti—and it can be a lasting one with enough focus and time. I’m very proud of our team and of UC’s continued involvement in Haiti.”