(MIREBALAIS, HAITI - MAY 2014: A busy afternoon in the University Hospital emergency room.)
Thanks for your support of Partners In Health/Zanmi Lasante and our work to provide high-quality care at University Hospital in Mirebalais, Haiti! I am delighted to share the following update on our increased capacity to provide emergency care at the hospital's Emergency Department:
PIH/ZL is committed to making sure that every patient benefits from timely and effective care. We know that poverty puts Haitians at greater risk of needing emergency medicine – unmanaged chronic conditions, farming injuries, and increasing traffic accidents on newly improved roads are responsible for the high number of ER visits.
That is why PIH/ZL designed an integrated emergency department with the capacity to respond immediately to critically ill medical and trauma patients 24 hours a day. PIH/ZL recently introduced triage to the emergency room so that patients are prioritized by acuity rather than complaint. Staff are being trained to reassess patient flow and bed management to ensure maximal efficiency. Beginning just last month, University Hospital began offering its first residency and certification programs in emergency medicine.
The capacity of University Hospital to respond swiftly to emergencies is an indication of the overall health of University Hospital’s systems. The emergency department is a test of system functioning because it requires collaboration with blood banks and other specialists across departments. If trained staff and triage systems are not in place, the increasing number of patients with complex, trauma-related injuries, like Guerrier, will not survive.
Guerrier, 21, from Mirebalais
“I was in a tap-tap [local informal bus] on the way to PAP when the brakes stopped working. The car flipped on its side and during the crash I broke my neck. An ambulance arrived and brought me to the ER at University Hospital. I was in the ER from Thursday to Monday. On Monday afternoon I went down to PAP in an ambulance with Dr. Ward and Dr. Jacky. They put the collar on me and I returned to University Hospital the same day. I was able to return to my house the next day.
Now I sometimes get headaches on my right forehead but overall I don't have too much pain. I come for a consultation once a month and will take the collar off after three months, or earlier, if Dr. Luther says it is okay.
You never expect an accident like that to happen. I found really good care here, and I think this collar will help me return to the way I was before the accident. I'm in my last year of high school and hoping to go to university next year. I also love to play soccer and am hoping that one day I'll be able to play again.”
Guerrier came to University Hospital with severe spinal injuries. The emergency department quickly diagnosed his injuries using a CT scanner and determined that a halo collar was needed; but, University Hospital did not have the halo collar needed to begin treatment on hand. PIH/ZL procured two collars from Boston Children’s Hospital and located a Haitian neurosurgeon in Port-au-Prince (PAP) that could perform his life-saving surgery.
With support from partners and generous donors, Hôpital Universitaire de Mirebalais, in Mirebalais, Haiti, provides primary care services to about 185,000 people in Mirebalais and two nearby communities. But patients from a much wider area—all of central Haiti and areas in and around Port-au-Prince—can also receive secondary and tertiary care. We see as many as 700 patients every day in our ambulatory clinics. The hospital fills a huge void, locally and nationally, for people who previously had limited access to quality health care.
We invite you watch this short video for an inside look at the fully-functional teaching hospital here: http://www.pih.org/media/video-an-inside-look-at-hopital-universitaire-de-mirebalais
Thank you for accompanying Partners In Health in our work to improve health care for people in Haiti and around the world.
Patients with Broken Necks Heal at University Hospital in Haiti
Below is the story of a 48-year-old farmer who fell out of a tree while he was cutting a branch to sell as firewood. Because of your support, he was able to seek the care that he needed at University Hospital in Mirebalais. Thank you.
Marcenne Desanm, 48, from Savanette Cabral
I am a farmer who lives in Savanette Cabral. I have a wife and eight kids—seven are in primary school and one is in secondary school. I grow grain, corn, and plantains, and sell wood.
The accident occurred when I climbed a tree to cut off a branch to sell the wood. I stood on a lower branch and was sawing a branch above me. When the branch broke, it didn't fall on the ground; instead, it fell on me and crushed me in between the two branches. My stomach was bleeding and I was completely stuck. My wife saw me and cried for help; my neighbors then rushed to my assistance. They climbed the tree and pulled the branch off of me, but when they did this I fell backward onto the ground and broke my neck. I lost consciousness.
I live a two-hour walk from the closest road, so my neighbors had to put me on a stretcher and carry me to the road where the ambulance could meet them. I came to HUM and spent 13 days in the emergency room. They put a catheter in me and took care of my wounds where the branch had crushed me.
I went down to Bernard Mevs with Luther and Jacky and had the collar placed on my neck. I came back to the hospital and stayed for four more days. For the next few months while I am recovering I am renting a house in Cange, because my house in Savanette is too far from the road for me to walk to return for consultations. An ambulance now comes to pick me up at my rented house whenever I have an appointment and takes me home afterward. Two of my kids and my wife are staying with me too.
They took great care of me from the moment I arrived. God put me here with these doctors. I don't feel too bad anymore. I used to have problems sleeping, but now I just sleep sitting up or leaning on my hand, and it doesn't feel too bad. I can also now stand up from a chair by myself! I hope to return to work after the collar is taken off, but I will follow whatever instructions the doctors give me. I have so much hope in life now. I just hope that I will be able to continue working so that I can provide for my family.
Isemélie was the first patient at Haiti’s University Hospital to undergo surgery—a mastectomy to treat her breast cancer—and now her chemotherapy is almost complete.
Before her surgery in May, Isemélie was worried for her life. With the surgery, chemotherapy, and counseling, she and her family have hope that she can recover. Isemélie has just one more infusion. “I am looking forward to finishing chemotherapy so I can start working again to help my daughter pay for university,” she said.
This summer, PIH and our Haitian sister organization, Zanmi Lasante (ZL), transitioned oncology services from a crowded, inadequate space in Cange to University Hospital in Mirebalais, where more patients can receive cancer prevention, treatment, and education efforts that are integrated with other services at the hospital.
Between July and November, the cancer care team provided services to about 700 patients, illustrating a huge demand for cancer care in Haiti.
Despite the perception that cancer only affects people in wealthy countries, cancer actually causes more deaths in low- and middle-income countries. And while about 80 percent of the global burden of cancer is born by people in the developing world, just 5 percent of the world’s expenditures on cancer care happen there.
Partners In Health has been working to save lives and demonstrate that the disease is treatable in poor, rural areas.
PIH/ZL is the only provider of free oncology services in Haiti. While PIH/ZL has always cared for cancer patients, even with limited capacity for treatment, an interdisciplinary team has worked over the last three years to formalize and integrate services for patients with cancer while building their skills through training.
The move to University Hospital has allowed the cancer care team to treat more patients; the demand has shown the need for more cancer care across Haiti. Between July and September, most patients—64 percent—came from the Port-au-Prince area, and only 22 percent from central Haiti, many referred by PIH/ZL clinics or other providers.
In the same period, breast cancer was the most common diagnosis for oncology patients, at 40 percent, followed by cervical cancer, at 12 percent, according to data from University Hospital’s electronic medical record system.
The cancer care team, headed by Haitian oncology director Dr. Ruth Damuse, has worked hard to provide comprehensive care for cancer patients. Their work has been supported by partners including the Avon Foundation, the LIVESTRONG Foundation, and the Dana-Farber Cancer Institute, which helps develop treatment plans for PIH/ZL patients. The DFCI has also created a special fellowship enabling expert oncology nurses from Boston to work at the hospital in three-month rotations and train staff on administration of chemotherapy and wound care.
Cancer care at University Hospital addresses the many needs of patients, including:
Oncology social worker Oldine Deshommes described one patient’s experience with breast cancer:
“The first time I saw Mrs. A, she was crying. She felt humiliated because of her cancer. Her wound was infected and had a bad smell. She said even though she was not yet dead, she was ashamed to sit near others.
We talked about how she should not feel excluded from others, showing her that she is not responsible for her illness. We also talked about what she can do to get healthy; reminding her that she is not alone, that we are with her in this fight.
In our group sessions she talked about how she felt before coming to the support group. She actively participates in the groups, and it helps her see that she is not alone in experiencing changes to her life from cancer. She said she no longer feels lonely and she has made friends from the support group who encourage her.”
With support from Deshommes, Isemélie was able to delay her last round of chemo a couple of weeks, until January. She wanted to feel well for her daughter’s wedding.
We are thrilled to share the following story, posted on the Partners In Health website in October, when 14 Haitian physician trainees began their medical residencies at University Hospital in Mirebalais. Thanks to your support, University Hospital is now home to a promising new -- and growing -- workforce of specialized clinicians in Haiti.
On April 28, Dr. Paul Farmer stood before a microphone in a large conference room in Haiti's University Hospital.
Several days before, bomb blasts at the marathon in Boston, Massachusetts, had killed three people, but not a single person who made it to a hospital died. In that grim emergency, teaching hospitals made a difference, Farmer told the crowd.
“I love working at a great Boston teaching hospital, Brigham and Women’s. I love being able to train the next generation of physicians and nurses. And I want Haiti to have something like it, too,” Farmer said.
This month, University Hospital in Mirebalais, Haiti, took a significant step toward becoming the teaching hospital envisioned after Haiti’s 2010 earthquake, which devastated the country’s already-fragile medical infrastructure. On Oct. 1, the hospital’s first medical residents—all young Haitian doctors—began hands-on training in pediatrics, general surgery, and internal medicine.
The application process was intensive and merit-based: 238 people applied and took an entrance exam. Of those, 45 were interviewed, and 14 were selected. Class members hail from all over Haiti. Some studied at Haiti’s state medical school or private schools in Port-au-Prince; others went to the Dominican Republic. Some just graduated from medical school and completed their social service year; others have been practicing for a few years. By coincidence, the class is evenly split between men and women.
Dr. Jean-Louis Willy Fils, 29, from the northern city of Cap-Haïtien, has wanted to be a doctor for as long as he can remember. He describes surgery as his “true vocation,” so to be selected for a University Hospital residency was more than he hoped for.
“One year ago, I couldn't have even imagined learning surgery in a hospital with an international standard of quality, for the good reason that such a hospital didn't exist in the country yet,” Fils said. “That's the proof that great things can be done in Haiti.”
Over the next several years, these 14 doctors will receive instruction from Haitian and foreign physicians—some of whom are faculty at the same teaching hospital where Farmer trained and now teaches. The curriculum for their training was developed through special working groups and designed to follow the Accreditation Council for Graduate Medical Education International’s (ACGME-I) standards.
After completing orientation this month, residents will begin caring for patients as well as rotating in departments such as emergency medicine, TB/HIV clinic, and oncology. Each day, they will spend an hour in special education sessions for residents, and once or twice per week they will be on call throughout the night. They will also conduct research to improve the quality of care. The ACGME-I guidelines require they work no more than 80 hours a week, but they’ll probably come close.
"The residency program at University Hospital represents the most serious attempt, to my knowledge and during my lifetime, to systematically create a critical mass of Haitian physician specialists that will have the opportunity to be fully useful to all Haitians," said Dr. Pierre Paul, PIH senior advisor. He added that he and his physician colleagues have traditionally questioned the poor outcomes of Haiti's health sector, but now feel questioned themselves about their responsibility to improve health care in Haiti. "University Hospital and its new residency program stand as formidable evidence of the efforts that young Haitian health professionals are making to restore, in a sustainable way, hope and dignity in the future of health in Haiti."
As new classes of residents begin each fall, the number of physician trainees will double and triple. And the programs will expand to include other health professionals, such as nurse anesthetists and other nurse specialists, as well as more medical specialties—such as emergency medicine—which would be the first such training program in the country.
In addition to hands-on training, the curriculum includes lessons on social medicine and the root causes of disease, such as poverty, which have been part of PIH’s work since its early days in Haiti. The programs are designed to train and retain a new generation of doctors to the poor who work outside of Port-au-Prince, the traditional mecca for medical training.
“We envision a workforce of doctors, nurses, and other health professionals who are driven by medical excellence and committed to high-quality care for all Haitians,” said Michelle Morse, PIH deputy chief medical officer for Haiti. “The start of these residencies brings Haiti one step closer to this vision.”
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