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.
Posted on 11/08/12
The white walls of l'Hôpital Universitaire de Mirebalais blazed in the hot sun Tuesday as crowds gathered for Partners In Health co-founder and World Bank President Jim Yong Kim’s visit to the newly built hospital.
The hospital grounds were filled with the residents of Mirebalais, local and national government officials, representatives of nongovernmental partner organizations, and staff of Zanmi Lasante, PIH's sister organization in Haiti. All were gathered for a ribbon-cutting ceremony to celebrate the end of the hospital’s construction phase. The hospital will officially open the first part of next year.
Kim’s visit marked a return to the area in which he, Dr. Paul Farmer, and Ophelia Dahl began the work of Partners In Health years ago.
“In 1988 I came to the Central Plateau for the first time, and I met Père Lafontant,” he told a small group just before the ceremony. “In the middle of very little else that was going on, we saw this wonderful hospital [in Cange], and the question that we asked during that first visit was what do the people of the Central Plateau deserve? The constant refrain from all around us was ‘you have to lower your expectations. Haiti is a difficult country to work in; there’s only so much you can do.’”
“I’m so proud to see that the government of Haiti, Zanmi Lasante, the community, and so many other people have answered the question by building this hospital,” he continued. “What the people of Haiti deserve is the best that we can possibly offer. As president of the World Bank Group, the lessons you have taught me—the people of the Central Plateau—will always be in my heart.”
Michel Joseph Martelly, president of the Republic of Haiti, addressed the crowd, along with Florence Guillaume, Haiti’s minister of health. They spoke in front of the hospital’s emergency room, on the driveway that ambulances will use to transport critically ill patients to HUM and then moved to the hospital’s front entrance for the ribbon-cutting.
“L'Hôpital Universitaire de Mirebalais will offer services that have no match anywhere else in Haiti,” said Dr. Pierre Paul, the hospital’s deputy director. “It is a practical example of the willingness to build something stronger and more sustainable—to build better.”
John Mason, 6/1/2012
In Mirebalais, Haiti, a cement laborer named Commie Brazil is wearing my AWP kneepads. Sporting cement dandruff and hauling a five-gallon bucket up a ladder in the sweltering sun, he pauses, staring at my pads before pointing to his knees. How could I resist that face? I wasn’t the only flooring installer to donate his kneepads – or tools – on a recent flooring trip to the new National Teaching Hospital of Mirebalais, 30 miles north of Port-au-Prince. We, the “Floorers Without Borders” or “the seamless flooring guys,” arrived in a foreign land on a mission to install 650 square yards of Forbo commercial sheet goods in five days. The team consisted of four union men from Detroit, seven from Boston and me, the non-union “Connecticut dude.”
Located in the Central Plateau of the mountainous Caribbean country, Mirebalais was untouched by the devastating 2010 earthquake. Still, the area has people living in poverty and dire conditions – inadequate health services, malnutrition and widespread unemployment – in the poorest country in the Western Hemisphere. Despite that language barrier and other obstacles – including an uneven concrete sub-floor, a malfunctioning hand-groover tool and Joseph, a Haitian helper who ignored repeated instructions not to roll the glueless vinyl areas – camaraderie and Yankee ingenuity prevailed. In the land of improvisation that is Haiti, where people used contact cement to repair their torn sneakers, we borrowed a wet saw to enlarge worn-down trowel teeth, and a dozen American tradesmen and our Haitian brothers collaborated to pull off the job.
“The floor came out great,” said Andrew Johnston, a hospital project coordinator. “It’s going to be so important for providing good quality care. It’s critical to making it a world-class facility.” The 180,000-square-foot, 320-bed hospital, due to open by July, will be a teaching facility for Haitian nurses, medical students and resident physicians. On any given day, more than 300 paid Haitian laborers, contractors and volunteers work at the hospital. A second flooring phase is scheduled for May. Dr. Paul Farmer runs the project. He is the founder of Partners in Health (PIH), a Boston-based international health and social justice organization. Farmer, who has been in Haiti since the mid-1980s, oversees a smaller hospital about 30 miles away. PIH paid all travel and hotel expenses for the flooring volunteers. The flooring excursion was organized by Troy Bickford, owner of Contract Flooring Installations in Boston and a member of Floor Coverers Union Local 2168. Bickford is a longtime friend of Jim Ansara, the hospital’s construction director, who called looking for flooring installers. Bickford put out a call to unions across the country where Chuck Shock, a Detroit retail storeowner, volunteered four employees, including his 28-year-old son, Tim. Both storeowners are members of the International Standards & Training Alliance (INSTALL).
After soliciting for tools and flooring materials from local and national distributors and manufacturers, Bickford had the shipment sent to Haiti. Forbo provided $110,000 worth of material at a tenth of the retail cost. Dal-Tile donated $250,000 worth of ceramic, and Laticrete pitched in with flooring products such as thin-set and grout. Bickford was unable to make the trip, but he sent seven men, including his brother, Joe, who ran the job along with company employee, Jorge DeBurgo, a 32-year flooring veteran. “I think it’s a great project,” said Troy Bickford. “You get to see how it helps a lot of people.” Nearly all the installers neglected to bring a Haitian Creole dictionary or phrase book and communicated mainly by smiling, nodding and using hand gestures. When that didn’t work, we talked louder. “Bale,” or sweep, was a favorite word. DeBurgo, 53, who speaks English, French, Spanish and Portuguese, served as a translator. Born in Cape Verde and raised in Senegal, he said he identified with the surrounding poverty and primitive conditions. When sections of the uneven concrete subfloor caused the only hand-groover to skip, DeBurgo made his own groover to gouge the vinyl seam. He drilled a hole in the end of a flat screwdriver, inserted a one-inch screw and tightened it with a nut. “Sometimes you have to improvise,” said DeBurgo.
The first day of the job brought the first dilemma. No flooring roller. The 150-pound roller, used to adhere the vinyl to the concrete, was still in transit from the USA. Our problems were solved because of the ingenuity of project coordinator John Chew. Using a PVC pipe filled with 150 pounds of cement, Chew made a 36” wide roller by sticking a steel rod through the center and attaching a metal handle. A carpenter later made a second, smaller 13” wide roller. “This thing will work great,” said Chew, posing next to his creation. The second day brought another temporary roadblock when we lost a half-day waiting while a PIH employee drove to Port-au-Prince to pick up a bonding agent to help the vinyl better adhere to the concrete. The 650-square-yard job called for vinyl to be installed in a 500-square-yard labor and delivery room plus smaller rooms throughout the hospital. We “hand-chopped” everything and the vinyl proved ideal: no pattern, thick, pliable and didn’t tear when pulled back. PIH assigned us a dozen Haitian laborers, none who spoke English nor had ever seen vinyl flooring before. Nearly all lived in the surrounding plywood or cinderblock homes, most the size of a small U-Haul trailer. They were without running water or indoor toilets and few had electricity. Our helpers proved hardworking, attentive and extremely curious (an installer bending down to make a cut usually attracted two or three Haitians, who crowded around on hands and knees).
Our assistants ranged in age from 20 to 35, except for Joseph, who at 59, was three years away from the country’s average life expectancy. They earned about $15 a day – a coup considering 80 percent of the people live on less than $2 a day. A Haitian supervisor, who spoke English, occasionally relayed our work instructions, and everyone followed directions to mainly sweep, pick up vinyl scraps, and do the heavy lifting, especially when it came to lugging the 350-pound vinyl rolls. By the third day our Haitian brothers no longer seemed content as helpers and gradually began veering into the installer’s role. Shortly after installers rolled out and cut the first sheets, Haitian Denoyer Clottler, 26, picked up a hook knife and began cutting vinyl. Fearing a miscue, an American installer reminded Clottler to let the installers do the cutting before asking him to put down the knife. He did, but not for long. “We do this. We do this,’’ said Detroit installer Andy Shock, repeating himself louder to a nodding, smiling Clottler. For the rest of the job, Clottler’s eagerness and determination to work with the vinyl fueled a helpers’ mutiny among his co-workers. One by one, sometimes under the watchful eyes of an installer, sometimes not, the Haitians mimicked the installers’ actions they’d seen over the past few days. As the Haitians’ confidence grew, so did the installers’ willingness to allow them to become more involved in installing. One Haitian was put in charge of caulking all inside corners. Another used a skiving tool to smooth off the excess weld on the curved areas of the flash-coving. When Boston’s Eric Bickford, 30, bent down to scribe an inside corner, a group of Haitians hovered as he glued and placed the vinyl together. A few minutes later a Haitian, surrounded by his peers, repeated the same maneuver under the watchful eyes of an American installer. Only Joseph seemed simply content rolling – and rolling. Clottler had the good fortune of working with Andy Shock, who showed him how to use the heat-welding gun. After spending a few hours watching Shock and handing him tools, the two switched roles with Clottler doing the welding and Shock the encouraging. “You can’t go too slow, keep it moving, you’ll burn the surface,” said Shock, the only installer on the job – and island – who owned his own $2,200 grooving tool. The last day on the job, Clottler arrived wearing new kneepads and a leather tool pouch an installer had given him. The pouch had a straight and hook knife, tape ruler and putty knife, gifts from Detroit installer Dan Breymann. Like a dozen of his co-workers he also was given a Laticrete t-shirt. “He’s the flooring dude now,” said Breymann, 31, who devised his own makeshift skiving tool by duct taping the ends of an 8” scraper blade. “If you really like something you pick it up quickly, like he did.” Through a translator, Clottler said he learned a lot about flooring and after the Americans left, he hoped he could find work, possibly at the soon-to-open hospital. DeBurgo’s view of the job reflected those of the group when he said, given the circumstances, he never thought the project could be completed in less than five days. “It was a wonderful experience,” he said. “Friendly people. It went a lot better than I ever expected.” Meanwhile, as the American installers collected their tools, Joseph the roller was asked to help outside where he used a pick to break rocks. As for his weeklong experience installing floors, Joseph smiled and had this to say: “I hope you return.”
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