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.”
Last month, there was a tap-tap accident in Saut d’Eau, Haiti – a community near Mirebalais. The victims from this crash were taken to University Hospital’s emergency department for treatment – a great example of Partners In Health/Zanmi Lasante staff providing essential emergency care to the communities around the hospital. In the past, patients from such an accident would likely have been transferred to Port-au-Prince for treatment, but with our new capabilities in Mirebalais, clinicians were able to treat them at University Hospital.
Thanks to your support, University Hospital is equipped with state-of-the-art medical technology that is saving lives every day. The article below, written by Partners In Health's Christian Hague, summarizes the story of one of the first emergency situations since the hospital began operating.
Emergency Department at University Hospital Treats Victims of Bus Crash
Each year, a three-day spiritual pilgrimage known as the Feast of Mount Carmel draws thousands of faithful to the town of Saut d’Eau in Haiti’s rural Central Plateau. The pilgrims come to bathe in the local waterfall where, over 150 years ago, the Virgin Mary reportedly appeared and began to heal the sick. They often come in the back of pickup trucks known as tap-taps that are crowded with passengers and can be dangerous on the area’s unpaved, winding roads. In past years, tap-tap accidents claimed many lives during the pilgrimage to Saut d’Eau.
When a tap-tap crashed in the nearby town of Morne Couleuvre during this year’s July pilgrimage, the injured were brought to the nearby Hôpital Universitaire d’Mirebalais, a new hospital operated jointly by Partners In Health, its Haitian sister organization Zanmi Lasante, and the Haitian Ministry of Health. The 300-bed hospital offers many services that were never before available in this area of the Central Plateau, including a CT scanner that was used with many accident victims to diagnose injuries. The volume of patients from the Morne Couleuvre bus accident flooded the hospital’s emergency ward, where PIH/ZL’s clinicians were able to successfully treat 14 patients suffering from a variety of traumatic injuries, including four people with serious head injuries, one with a critical cervical spine fracture, one with a femur fracture, and a variety of other minor injuries. With the combined efforts of the emergency and surgical teams and the availability of the CT scanner, which has dramatically improved diagnostic capacity, the patients were well cared for at University Hospital and only one patient needed to be transferred for further care.
Events like this highlight the essential services that University Hospital is providing to patients in the area around Mirebalais. Previously, the area lacked a large-scale medical facility to deal with high patient volume and provide essential emergency services, so patients often had to be transferred to the capitol in Port-au-Prince. “Having a modern and well-equipped emergency department and a highly trained team will dramatically improve our ability to reduce morbidity and mortality related to trauma in the Central Plateau,” says Dr. Regan Marsh, the Director of Emergency Services at University Hospital. “The ED physicians and nurses will be able to quickly assess, stabilize and manage both minor and major injuries – and have access to essential resources, such as bedside ultrasound and CT scan. We have already started trauma training for both the ED staff and surgeons and are continuing it now with one of our first visiting professors, who arrived in July 2013.”
It was by way of a joke that Dr. Paul Farmer introduced Ann Polaneczky to a crowded room at PIH’s Boston office. “What comes to my mind when I think of Ann, is stool,” Farmer said, causing the 24-year-old civil engineer to blush with pride. When the collective burst of laughter tamped down, Farmer qualified the punch line by expounding on the importance of Hôpital Universitaire de Mirebalais’ (HUM) wastewater treatment system, and how Polaneczky helped shape it. “The wastewater treatment system at Mirebalais, the guts of the hospital, is truly remarkable. It takes the wastewater, the gray water as it’s called, and runs it through a pretty sophisticated but easy-to-maintain system that gets checked every day,” Farmer said. “We never had that in Haiti—not just in a hospital, we never had it at any public-sector institution. It’s hard to know why these things are so significant without knowing how absent they are in a lot of places in the world. This system is just one example of how a modern hospital runs that’s worth getting to know.”With that sentiment in mind, we asked Polaneczky, PIH’s project engineer, to walk us through five of her favorite feats of engineering at HUM.
What it does: Every drop of wastewater produced at HUM—whether from a toilet, an operating room sink, or dirty laundry—passes through this low-energy, low-maintenance system. The water first enters a biological treatment process known as aerobic digestion in which naturally grown bacteria decompose organic waste and devour pathogenic organisms, such as Vibrio cholerae—the bacterium that causes cholera. From there, the water is treated with chlorine for further disinfection. Right now, the system can treat 50,000 gallons of wastewater per day to U.S. EPA standards. If needed, Polaneczky says, it can be expanded to treat 75,000 gallons a day. Why it’s important: The immediate benefit is that the system significantly reduces the threat of waterborne diseases, such as cholera and dysentery. But there’s a less tangible benefit that Polaneczky is keen on: “We want to show that it’s possible to treat wastewater in an efficient, economical, and sustainable way in Haiti and other low-resource countries,” she says. “This shows that it can be done.”
What it does: This school-bus-size machine allows HUM staff to properly dispose of biohazardous medical waste and used sharps, including syringes and scalpels. Polaneczky explains that the system meets U.S. EPA emission standards. How? The waste is burnt in a controlled fire in the machine’s first chamber. The resulting smoke is captured in a second chamber that reaches 1,000 degrees Celsius—similar to the temperature of liquid lava—and essentially gets vaporized. The end result is steam and a small pile of ash.Why it’s important: Properly disposing medical waste is critically important, yet many health care facilities in Haiti don’t have the necessary equipment to do so. It’s not uncommon for human waste to be mixed with sharps and garbage, and then burnt in crude devices or trash pits. The noxious fumes are bad for the environment and human health. As HUM integrates into Haiti’s health system, the incinerator may serve as a central location to dispose of medical waste produced at other PIH/ZL sites.
What it does: Polaneczky describes the fiber optic network as the “backbone of the hospital,” providing high-speed Internet access throughout the facility. A robust server package donated by HP optimizes it. High-tech and resilient, HUM’s IT system supports everything from patient registration to inventory management to digital radiography.Why it’s important: HUM is the first teaching hospital in central Haiti. When medical education and training begin, Haitian doctors can consult with partners in Boston and beyond as needed through video conferencing and other digital technology, which extend from the operating rooms to the hospital’s classrooms. On a day-to-day basis, the network improves efficiency and facilitates monitoring, evaluation, and quality improvement projects.
What it does: Behind the walls of HUM is a labyrinth of copper pipes and vacuum and air lines that ensures patients in need of oxygen have quick access to it—whether they’re undergoing surgery, being cared for in the emergency room, or in recovery. A major asset of HUM is that it has its own oxygen concentrator, a device that removes nitrogen from the air to produce medical-grade oxygen.Why it’s important: Without this system, we’d need to have bedside oxygen tanks available for any patient in need of oxygen, which is both expensive and logistically difficult. Additionally, suction and compressed air would need to be supplied for patients. Quick access to these oxygen and suction tubes allows us to deliver better care to more patients.
What it does: Given that HUM stretches over 200,000 square feet and includes a pharmacy that stores temperature-sensitive medications, effective climate control was a must. The hospital boasts four 12.5-ton rooftop cooling units and a separate 20-ton condenser for the pharmacy. In areas of the hospital where air conditioning would be a luxury, the designers opted for energy-efficient ceiling fans and elegant design that fosters natural air flow.Why it’s important: It’s not about just keeping cool. “The HVAC system supports infection control in operating rooms and allows us to preserve medical equipment,” Polaneczky says. HUM’s HVAC system, she explains, utilizes HEPA filtration and laminar flow, meaning the air is pushed from ceiling to floor rather than across a room, which minimizes the risk of surgical infections.
The following article written by Dan DeWitt was published by the Tampa Bay Times on January 9, 2013:
I don't blame anyone who has tuned out anniversary coverage of the catastrophic earthquake that destroyed large parts of Port-au-Prince, Haiti, on Jan. 12, 2010.
I don't even hold it against media outlets that there really hasn't been much coverage, at least so far.
That's because the one report I have read — by Deborah Sontag of the New York Times (tinyurl.com/dxchly3) — doesn't really read like a news story, but like a long, exhaustively researched version of the same old story.
Of the billions of dollars nations and aid agencies pledged for earthquake recovery, too much still sits in bank accounts or exists only as budgetary line items.
Too many earthquake victims still live under tarps. Too few live in solid homes. Very little has been done to bring lasting benefit to the people of Haiti.
It's enough to make a travesty of former President Bill Clinton's famous pledge to "build back better."
It's enough to make anyone cynical about the possibility that charity can help create a strong and independent country.
That's why you might want to click on pih.org, the website of Partners in Health, co-founded by Hernando High School grad — and 2008 Great Brooksvillian — Paul Farmer.
Its main post-earthquake project, a new teaching hospital in Mirebalais, 38 miles northeast of Port-au-Prince, was completed in October.
All the things that, according to the Times, have gone wrong with the recovery? In a lot of cases, it seems to me, Partners got them right.
Too much money has been spent — in some cases, out of necessity — on temporary fixes, Sontag wrote.
The hospital in Mirebalais, on the other hand, will bring the following, long-termbenefits: 300 beds for admitted patients, treatment rooms to handle as many as 500 outpatients per day, employment for about 1,000 people, including 175 community health care workers, and facilities to train future generations of doctors and nurses.
Overall, the Times story said, too much of the recovery money, and too many of the jobs, have been claimed by foreign aid workers; too much of the planning has excluded the Haitian government.
The American contractor who built the Partners hospital, meanwhile, volunteered his services and hired hundreds of paid Haitian construction workers. The expansion of the project — originally imagined as a small regional facility — was requested by the Haitian government. The government will be an equal partner in its operation for the first few years and eventually run it as a national hospital. All but a few of the previously mentioned long-term jobs — including for doctors and nurses — will go to Haitians.
Finally, Sontag tracked the depressing sums that had gone to administration rather than to directly help the earthquake victims. Partners' 2011 tax return, by contrast, shows that about 94 percent of the money it raised was poured into its central mission.
When the hospital was planned, there was a lot of emphasis on creating jobs and institutions outside of congested, chaotic Port-au-Prince, and there is now considerable criticism that much of the rebuilding money has been spent in areas that didn't need rebuilding, at least not because of the earthquake. The Mirebalais hospital has been held out as a prime example of this pattern.
And because of operations money yet to be released from a central recovery fund, the hospital won't be up and running for several more months.
So, yes, I guess you could include it in the long list of unkept post-earthquake promises.
But that's not the way it looks to me when I go to the website and see a modern, fully equipped hospital in a place where a little more than two years ago I saw workers lay a cornerstone in a muddy construction site.
I see a building that will do a huge amount for this community and country, including build pride and independence.
I see a structure that will — or should — shut the mouth of any cynic.
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