By Patricia Ruze, MD
Posted on September 18, 2011 – This report is a summary of the experiences of Nancy Todd, RN, Sarah Maria, RN, and Patricia Ruze, MD, who provided medical aid to the Haitian earthquake victims in the Dominican Republic in January and early February 2010.
Like many Americans watching the aftermath of the horrific earthquakes in Haiti on television, my friends and family discussed how we, as middle-class American families, could possibly help the injured, homeless people, so far away. And my husband and I realized that for us, writing a check to the Red Cross or texting cash through Verizon was not enough. We would have to go there.
It’s not as if we were novices. After all, my husband and I spent the last seven years in Africa doing development work. That experience provided insights about profound suffering in developing countries, as well as a healthy cynicism about the humanitarian relief industry. And we would go with friends who were both deeply committed to providing assistance to Haitian victims and health-care professionals. Nancy Todd is an energetic nurse and a loving mother with a deep religious foundation. Although she had no experience in developing countries, her daughter, Traci, who accompanied us on this trip, has made multiple trips to the Dominican Republic for mission work. Sarah Maria, a British nurse, has many years of experience working with vulnerable populations. We were a team with experience and potential and work well together. It seemed like a good plan to use Nancy’s contacts with an evangelical mission in the Dominican Republic as a springboard to provide assistance to Haiti’s earthquake victims. On January 29 at Logan International Airport, we boarded a Jet Air flight bound for Santo Domingo, Dominican Republic. We carried $1,000 dollars in donated medical supplies and suitcases of dresses and face towels purchased on sale from JC Penny. We had about $5,000 dollars in cash—donations from family, friends, friends of friends, and colleagues, as well as the coin contributions from the Haiti Donation jar at the Concord prison, where the three of us work.
Still, we were emotionally unprepared for what we saw when we first arrived.
Once in the country, our travels proceeded with the help of the Grace and Peace missionary team, which has been based in Barahona for at least ten years. Karen and Bill Rumple provide dynamic leadership for this mission, an evangelical group whose primary work involves numerous service projects. Home base for Grace and Peace Mission is a large villa, still under construction in Barrio Cassandra, a poor area of Barahona.
Our destination was Barahona itself, a small city on the southeastern coast of the Dominican Republic three and a half hours east of the capital, Santo Domingo, and two hours southwest of Jimani, a major border town with Haiti. (The town of Jimani is thirty minutes from both Port-au-Prince and the earthquake’s epicenter.) Prior to our arrival, we had heard that the city hospital in Barahona was having difficulty providing care for Haitian earthquake victims. After meeting with the hospital administrator and the nursing staff, we identified about forty Haitian patients in the adult wards. Most of their medical problems were directly attributable to the earthquake. Some patients had had limbs cut off as they were released from under the rubble. These had not yet been surgically repaired with a flap necessary for tissue healing, despite the fact that more than three weeks had elapsed since the quake. Many patients had infected fasciotomies, huge open wounds, made by emergency response surgeons to relieve the pressure of compartment syndrome. There were many broken arms and legs, some having been repaired surgically, but many still awaiting treatment. There were several patients with broken pelvic bones. A majority of patients had not moved since they were first hospitalized right after the earthquake. As a result, decubitus ulcers developed in several of the patients. The smell of infection, urine, filth, desperation and hopelessness was nauseating. Most of these patients had arrived in the Dominican Republic immediately following the earthquake. Initially, they received some medical care at one of the hospitals at the border between the Dominican Republic and Haiti; however, these border hospitals were quickly overwhelmed, and patients were transferred to other hospitals within the Dominican Republic. It was rumored that a third year medical resident from the US was singlehandedly coordinating initial medical care at one large border hospital. At the Barahona hospital, Nancy, Sarah, and I cleaned wounds and changed dressings, assessed medical needs and addressed some of the needs described by the nurses and medical doctors. In addition, we were able to obtain crutches for several patients. I used some of my donors’ money to pay for a CT scan for a young girl with back pain and leg weakness. We helped the patients’ families change their bloodied sheets and clothing. We brought in mops and pails to clean patient rooms and bathrooms. We distributed medication. Several times, we provided patients with the most delicious mandarin oranges that I have ever tasted. Yet, more valuable than the care we provided, was patient advocacy. It is often difficult to get good medical care in public hospitals in a developing country. In many hospitals in Africa, patients often don’t get even basic care unless they have some family connections and some cash. Resources are limited and staffing is often inadequate. Generally, families provide most of the nursing care, including feeding, bathing, simple wound care, laundry, and management of urine and stool needs. Unfortunately, few of the Haitian earthquake victims have the resources to ensure good medical care. To make matters worse, they have difficulty communicating with their health care providers since Haitians speak Creole whereas the Dominican nurses and doctors speak Spanish. The majority of the patients that we saw had no idea what their specific medical problems were, the medicines they were getting, if any, or their prognoses and treatment plans. It is also no secret that the long standing ethnic tension continues to exist between the Dominicans and the Haitians. After two days on the hospital wards, the three of us felt heartbroken and hopeless—already one of the Haitian women on the ward had died from untreated gangrene. In response, we piled into the mission pickup and headed west to the border and over into Haiti to visit the Love a Child Rehabilitation Camp. Love a Child is a large refugee center which was established by foreign donors to address the post-operative needs for Haitian earthquake victims. The facility has a mandate to provide care for up to six months for seriously injured earthquake survivors. Patients receive high quality wound care, oral antibiotics and pain medications, good nutrition, and physical and occupational therapy. The order within the facility, abundance of supplies, and the cleanliness took us by surprise. Hundreds of identical, perfectly spaced, new blue domed tents were lined up within the security walls. Each tent housed a family with at least one injured Haitian. We heard that more than two hundred refugees are living in the medical part of the camp. There seemed to be almost as many volunteer staff. Groups of Americans in clean scrubs were milling around chatting and drinking Gatorade from Nalgene bottles. The patients’ casts and dressings were slick and immaculate. In a M.A.S.H. moment, a helicopter bringing in injured patients set many of these medical providers running. In another area of the camp, a woman was giving an educational session to a Haitian family about the importance of getting patients out of bed and walking. When I approached another woman for directions, we learned that her job in the tented camp was to facilitate the use of electronic medical records in the facility.
Nancy, Sarah and I were invited to volunteer at Love a Child. In fact, they were looking for nurses who could help get patients out of bed and teach self care. An internist like me, they said, would be useful for coordinating antibiotic administration in a particular unit of the camp. As a group, the three of us hesitated. While each one of us would have truly loved to be able to be busy and useful as part of an organized and efficient humanitarian effort, our Haitian patients in Barahona were the ones who really needed us. We got back in the truck and headed back over the border. Our next stop was the US funded surgical hospital, The Good Samaritan, based in Jimani, on the Dominican side of the border. Again, we were impressed with the efficiency, cleanliness, and the abundance of supplies. This is a trauma hospital with x-ray, fluoroscopy, multiple operating rooms and several floors of patient rooms. It is designed to handle an injured patient’s initial assessment, surgery and immediate post-op care. There were plastic surgeons, orthopedic surgeons and OB-GYNs. There was also a helicopter that provided transport to the USS Comfort for neurosurgery or intensive care, as well as transport to Love a Child for post-op patients needing rehabilitation. For at least the first two weeks following the earthquake, the Good Samaritan was teeming with patients and systems evolved for handling patients efficiently. By the time, we visited, patient flow seemed well under control; in fact, they seemed to have more doctors than they could use. Just prior to our arrival, twenty-two volunteer doctors had arrived unexpectedly. It wasn’t clear how and whether they could be put to work. Then, as we toured the facility, a luxury tour bus pulled in with thirty-nine medical providers from a Virginia medical school. These included medical students, many of whom were EMTs or paramedics, as well as their professors. Upon arrival from the US, they spent thirteen hours driving from the east coast of the Dominican Republic to volunteer. As they were being turned away by the director of the Good Samaritan, we pleaded with them to join us in Barahona for the night. We had been searching for some orthopedic medical expertise to assess and prioritize the Haitian patients in Barahona in order to get them to medical facilities where they could get the care they needed. The Virginia team spent the next seventy-two hours wrestling with the Regional Director of Health, the Provincial Director of Health, hospital administrators, the Haitian Consulate and the chief orthopedic surgeon attempting to get permission to transport the Haitian trauma patients to the International facilities at the border. It was difficult to understand the reluctance to release these patients. Clearly the Barahona hospital staff was already very busy with their usual work with Dominican patients. The hospital had limited resources and no expertise in trauma surgery. Additionally, many of the Haitian patients had already been discharged by their doctors.
Various reasons were offered as to why these patients were being held. One was that the Good Samaritan was overwhelmed with patients and couldn’t take any more. We knew this was untrue because I was in constant communication with the chief surgeon there. We also were told that transfer of the patients would reflect badly on the Dominican Republic. Moving these patients acknowledged sub-optimal care and demonstrated a lack of appreciation for the Dominican government, which had generously opened up their borders to care for Haitians in crisis. We also were told that it was just against policy to transfer patients to a hospital that was outside of the State Hospital system. Other rumors that came to light later included the two million pesos that this region had been given to care for the Haitians. Perhaps even more important were plans to build a rehabilitation hospital in this region of the Dominican Republic to serve the needs of the Haitian earthquake victims. Apparently $150,000 had been advanced by charitable groups with more to come, but this was dependent on keeping handicapped patients in this area of the Dominican Republic.
Eventually, four patients were given authorization to travel to Santo Domingo with the Virginia medical team. Their luxury tour bus was outfitted for patient transport, with black garbage bags over the seats backs to protect them from any wound drainage. One of the patients that we had been taking care of was part of this group. In her early twenties, she was on her own and had an open upper arm fracture which had not yet been surgically repaired. The bus then moved on to pick up the other three patients from another hospital. Upon arrival, the medical team was surprised to find that all of those patients had somehow disappeared. Apparently there was another bus that had picked them up previously. It was unclear where they have been taken. The medical team continued on to Santo Domingo with their sole patient.
It was then that we met Daniel, a Haitian-American human rights advocate. He is the International Coordinator for Heart to Heart Caribbean Ministry. Daniel joined us at the hospital for the next couple of days. After hearing the patients’ stories, he became determined to get them to a facility where their medical needs could be better met. He spent hours negotiating with the hospital administration, officials from the public health department and the Haitian consulate. Cash changed hands. Still it seemed that those in power would not allow these patients to leave the hospital. Daniel then found a brilliant solution. He arranged to meet the Haitian Consular Officer at the hospital. Daniel got there first. He asked patients and their families a few questions. Why are you still here? Aren’t you free citizens here legally, free to leave when you want? Where would you like to be? When the Haitian consular officer arrived, emotions were at the boiling point. The patient families nearly rioted, and the consular officer literally ran from the wards. She solicited help from Daniel, who told her that she needed to assist her fellow Haitians in transferring to a place where they could get better care. She obtained the required paperwork and organized several ambulances, including one donated by the military. The majority of the patients were transferred immediately to the Good Samaritan Hospital. Once there they were immediately surrounded by eager medical professionals who were ready to assess needs and provide care.
Unfortunately my story is not quite over. Later, I heard that the Haitian Consular Officer followed the ambulances to the border that night. After Daniel had left she entered the facility and told these patients that they were there illegally and that they needed to return to Barahona. Fortunately, the American medical professionals refused to release these very ill patients. When we left there were still about ten patients remaining in the Barahona hospital. One woman, Maria, had become special to me. Her right leg had been cut off, guillotine-style, to release her from the rubble of the earthquake. We had dressed and cleaned her stump all week, and the infection there had improved significantly. I admired her incredible strength and sense of humor. I noticed the nail polish on her left foot was precisely painted. I was impressed with her pedicure, and told her so. She explained to me how she had painted her nails on Monday for her university classes on Tuesday. Wednesday the earthquake buried her and she lost her right leg. The toenail polish on her left foot was somehow still almost perfect, and this brought tears to my eyes.
While I understand that these ten remaining patients have been moved to obtain care on the border, I fear for the many forgotten patients in other hospitals nearby in Barahona, and probably throughout the Dominican Republic. Perhaps they are still there. I have been inspired by the incredible generosity from individuals and from organizations around the world, and especially from the US. The financial resources donated to Haiti have been immense; however, while relief aid is being delivered to the medically needy in Haiti, the distribution is uneven and the motives that drive the various efforts are complex and sometimes difficult to understand. A great need for medical assistance remains, and will for a long time. We are grateful for the support we received from our community to be able to contribute directly to the effort.
Dr. Ruze is Medical Director at MCI-Concord in Massachusetts. Readers may contact her at patriciaruze@gmail.com.
