Cover Story
Help for Haiti
For some Minnesota doctors, the January 12 earthquake was a call to immediate action.
By Jeanne Mettner
On a frigid February evening, nearly 100 physicians crowded into a small conference room in Shriners Hospital for Children in St. Paul for a seminar on tropical and travel medicine sponsored by the University of Minnesota. Ordinarily, the monthly event would have included updates about tropical diseases affecting the four corners of the world. That night, however, the focus was on the experiences of a surgeon, hospitalist, and emergency-medicine physician who tended to victims of the January 12 earthquake in Haiti.
Almost immediately after the tremor, Minnesota doctors started receiving news about the destruction and the need for medical care. Some decided to pack up and go to the country while others remained behind filling in for their colleagues, gathering supplies, and raising money to help the cause. That evening at Shriners, the three physicians shared their personal stories, describing the devastation and showing slides that documented the realities—trucks delivering survivors who had yet to receive care for their two-week-old injuries, long lines of Haitians waiting to enter overheated makeshift clinics, patients with open-wound fractures and revision amputations performed to keep remaining limbs healthy, and even a baby delivered in the room where just hours earlier, physicians had reset his mother’s broken arm. A number of doctors traveled from Minnesota to work with nongovernment organizations in Haiti just days after the disaster. Here are the stories of four of these first responders.
Jennifer Halverson, M.D.
Jennifer Halverson had traveled to Haiti more than 15 times since the late 1990s, often to take part in medical missions. Soon after news of the temblor broke and just 30 minutes before she was scheduled to begin a shift in the ER, the 31-year-old fellow in pediatric emergency medicine at the University of Minnesota and Children’s Hospitals and Clinics found herself fielding Twitter feeds from friends in the country. They were trying to account for one another and were overwhelmed by what was happening. “I have so many friends that I consider family in Haiti,” she says. Halverson knew she had to do something.
After she struggled through her shift that night, her boss encouraged her to go help her friends. “I called him the next morning and asked him if he was serious, and when he gave the go-ahead, I started planning my departure,” she says.
Halverson became one of the first Minnesota physicians to travel to Haiti, arriving in Port-au-Prince five days after the earthquake struck. In addition to being able to offer medical help, Halverson speaks Creole, the language of Haiti, proficiently and knows how to negotiate the country’s complex interplay of commerce and culture. “I know how things work in the country—who to talk to to get things done, how to network, who the decision-makers are, where you can get supplies, and what will work and not work in terms of coordination of medical care,” she says. These skills, she discovered, would prove essential as she worked to create an infrastructure for medical care in post-disaster Haiti.
Halverson worked through Heartline Ministries, an organization that before the earthquake struck operated an orphanage and women’s center just outside Port-au-Prince. Through Humanitarian Parole, a process by which the Secretary of Homeland Security can grant temporary entry into the United States, Heartline was able to evacuate the children under its care and allocate space for a makeshift medical center with an emergency room, inpatient hospital, operating area, and pharmacy.
Under the direction of Halverson, Heartline Hospital was operating six days after the quake, staffed by four physicians (Halverson, an emergency medicine physician, a family physician, and an anesthesiologist), an orthopedic physician assistant, four nurses, a paramedic, two midwives, an emergency medical technician, and several translators. Volunteers have been staying anywhere from 10 days to six weeks or more since the facility got up and running.
Communicating by cell phone from Rincón, Puerto Rico (during a “semi-mandated” four-day rest period), Halverson recounted that first week with harried urgency: “We were scrounging; at one point, we were down to one vial of gentamicin, and we were going through up to 30 vials a day.” She told how they contacted people they knew in Haiti who might be able to secure a supply, as well as people in the United States and those working aboard the U.S. Navy hospital ship Comfort, which was stationed about a mile off the coast of Port-au-Prince. They were able to find enough of the antibiotic to continue their work. “Our goal of providing high-quality, first-world care is no different from what it would be in the U.S., but it looks different. Our patients sleep on rows of cots outside under tarps,” she says.
Most of the patients she treated had significant limb fractures and large, infected wounds. Others were brought to the hospital suffering from dehydration and respiratory infections, postpartum cardiomyopathy, acute malnutrition, gunshot wounds, even Guillian-Barré syndrome.
“To me one of the most emotional things initially was working on kids with injuries that had had no attention, no pain control, for weeks,” she explains. “Initially, I was working side by side with some of my best friends who live in Haiti and whom I know really well. And we had a lot of moments where we would look up and catch each other’s eye. It wasn’t anything that ever took me away from my work, but it was a moment of ‘This situation is just so wrong, but we just need to do whatever we can to make it right.’ Trying to deal with that sense of injustice of suffering was difficult. People were just going about their normal, every day lives, and those lives were suddenly turned completely upside down.”
Halverson initially planned to spend four weeks in Haiti. She ended up staying nine, seeing patients day and night. Her blog, sleepydoctor.blogspot.com, offers a glimpse into her days: the procedures she performed, the births she attended, the patients who died, and the people who now consider Heartline Hospital home.
“With all the talk about how devastating it is here, I had to set the record straight,” she says of her reason for taking time to write and post entries when there’s so much work to be done. “Yes, we see very difficult things from a medical standpoint, but we also see a lot of people helping each other out, a lot of healing and hope. I never want that perspective to get lost.”
Pete Melchert, M.D.
Pete Melchert worked alongside Halverson at Heartline Hospital for two-and-a-half weeks. He arrived in Haiti on January 27, a full 15 days after the quake hit Port-au-Prince, armed with wound-care supplies and several thousand dollars worth of donated medications. At the time, many of the victims in and around the neighborhoods of Cité du Soleil, Simone Pele, and Jérémie Wharf were still languishing in tent cities, their wounds untended and infected. “There were people lying on the ground under a tarp—children even—with these acute injuries that had not received any medical attention at all,” says Melchert, a 39-year-old internal medicine and pediatric hospitalist with Abbott Northwestern Hospital and Children’s Hospitals and Clinics in Minneapolis. “Even though there were field hospitals set up only a few miles from these victims, there were no forms of transport, no resources, no means to find the medical care that had been set up for them.”
It didn’t take long for the Heartline team to realize that if the sick and injured could not come to their makeshift hospital, the Heartline volunteers would have to go to them. Twice a day, medics would drive what Melchert describes as a “paddy wagon” into the tent cities to round up patients who needed medical evaluation. Once at Heartline Hospital, the ill and wounded would sit outside on folding chairs and wooden benches as the nurses triaged them to the appropriate area. Inside, patients lay on plastic tables for exams and procedures. “Except for grates, nothing was covering the windows, so all the rooms were open to the air. There were flies and other bugs, and once in a while a chicken would get in,” Melchert says. “As soon as the patients received their treatment, they would go right back outside for fear of an aftershock. The whole city was living outside, and I couldn’t blame them. Buildings and walls were still collapsing every few days, even weeks after the quake.” Of all the patients and staff who stayed overnight at the hospital/clinic, Melchert was the only one who slept indoors.
Like Halverson, Melchert saw a range of illnesses and injuries and had to treat them under difficult conditions. “Here in the United States, we are so reliant on diagnostics, and we had none of that. It was challenging but also very liberating to talk to the patient, examine them, come up with a treatment plan, and execute it,” he explains. “In a very efficient way, you were affecting their lives, and you weren’t spending a considerable amount of time documenting what you did to meet coding criteria and insurance reimbursement requirements. Everything I was doing was direct patient care and treatment—which is exactly why I went into medicine in the first place.”
As the medical director of a local nonprofit called Children’s Surgery International, Melchert has led medical teams on trips to West Africa, Peru, Mexico, and Haiti primarily to do cleft lip and palate reconstruction. That experience, coupled with his work as a hospitalist, helped prepare him for disaster-relief work in a developing country. Says Melchert: “I was comfortable doing things outside of my traditional role as a U.S. doctor, but it was still a challenge. I was a nurse, a doctor, an anesthesiologist, a surgeon, a wound-care technician, a friend, and a father to homeless, parentless children. I put in IVs, and I drew up and pushed medicine. Those are things I would never do in my daily work at home, but that’s what was required.”
At times, Melchert confesses, he felt overwhelming sadness. But the tears never came. Twice a day, a group of Haitian ministers held church services for the patients and families at Heartline. “It was hard to cry when the patients and their families were singing, their arms lifted up to the sky. The Haitians are so brave. In a place that seems so hopeless, they have indescribable, inexhaustible hope.”
Ken Guidera, M.D.
In his 25 years as an orthopedic surgeon, Ken Guidera has seen his share of disasters. During his military service, he was stationed in Korea as a medic. Following Hurricane Katrina, he went to New Orleans to work with the Red Cross. He also tended to victims just hours after the I-35W bridge collapsed in Minneapolis. But in his opinion, none of those experiences compared with what he was seeing on the news after the earthquake in Haiti. “I thought it was, for the first time in modern history, a true orthopedic emergency,” explains Guidera, who is chief of orthopedic surgery at Shriners Hospital. “Once I knew I had the support of my family and co-workers at Shriners, the decision to go really became a no-brainer.”
As a volunteer with the St. Paul-based nonprofit No Time for Poverty, which among other activities sends medical teams to Haiti, Guidera headed to the country on January 26, taking with him 70 pounds of cargo including bone fixation pins, screws, and plates. Within hours of his arrival, he was in the operating room of St. Damien’s Hospital, a pediatric facility located on the outskirts of Port-au-Prince. “When we got there, I was amazed at the chaos and the extreme surgical needs of the injured. It looked like a war zone, and I felt like we were in M.A.S.H.,” he says. The hospital, fortunately, had sustained only minor damage and was, by all appearances, functioning. The orthopedic surgeons put together an operating room to stabilize fractures, treat wounds, and perform amputation revisions. Guidera worked about 12 hours a day alongside other volunteers from the United States and Italy. “We were doing simple things that actually were big things: wound care, wound debridements, cast applications, dressing changes, and tons of surgery for things like long-bone fractures and soft-tissue losses,” he says. “We got back to basics—taking cold showers, sleeping on a mat in a tent, having Powerbars for lunch, and it was good. It made you appreciate what you have.”
During his weeklong stay at St. Damien’s, Guidera performed more than 60 surgeries in addition to seeing hundreds of outpatients. On his last day, he arrived at St. Damien’s and met the surgeons who would be replacing him. He looked on the hospital wall and saw the list of operating room cases scheduled over the next 24 hours. “The departing team looked at that board with nostalgia and jealousy,” Guidera says. “I mean, this is what we do; we’re surgeons, and we had to go home.”
But Guidera’s work in Haiti isn’t finished. In the next year, he plans to work with Shriners and the Illinois-based Association of Children’s Prosthetic-Orthotic Clinics to create a prosthetic and rehabilitation center in Haiti for the estimated 20,000 adults and children who lost arms and legs as a result of the earthquake.
“As is the case for so many people who go there, Haiti is now in my blood,” he says.
Brett Hendel-Paterson, M.D.
As Brett Hendel-Paterson watched the televised images of Haiti on January 12, he had a near-instinctive reaction: I must help. “My wife said I could go if I wanted, and she knew once I got the approval that I would be heading there,” recalls the HealthPartners internal medicine and pediatric hospitalist. Although he had never been involved in a disaster-relief operation, Hendel-Paterson believed his experience as a volunteer in India, Zimbabwe, and Uganda and his training in tropical medicine made him well-qualified to go. A fellow faculty member in the global health program at the University of Minnesota Medical School suggested he connect with St. Paul-based Worldwide Village, a nonprofit that focuses on helping citizens of impoverished nations.
He arrived in Haiti on February 1, after a 40-hour trip in which he and his fellow volunteers traveled by van from the Dominican Republic to Leogane, 30 km southwest of Port-au-Prince.
Although Leogane was less densely populated than Port-au-Prince, the destruction was more pronounced; nearly 90 percent of the buildings were flattened or uninhabitable. A team that included Hendel-Paterson, three other physicians, and six nurses worked out of the FSIL School of Nursing. Because the school’s buildings were too damaged to safely inhabit, every day they erected and tore down a makeshift clinic made of tarps in the U-shaped courtyard. “We didn’t really have an inpatient unit; the tents got so hot in the middle of the day that we couldn’t put people in them. So we basically treated everyone as outpatient cases, including the really sick patients,” Hendel-Paterson explains.
The team, which saw between 200 and 300 people a day and collaborated with a surgery group that had come with another organization, did follow-up care for surgical patients and treated others with suspected malaria, pneumonia, diarrhea, and respiratory illness. They also worked with the Japanese military, which shared the nursing school campus and had some basic laboratory and X-ray capabilities. The hospital’s supply system was initially disorganized. “We had a dearth of some supplies and an overabundance of others. We had 70 pairs of crutches, but we nearly ran out of antimalarial drugs. I paid out of pocket for antibiotics, and when I got to Haiti, I discovered they had plenty,” he says, explaining that he also had brought with him over-the-counter analgesics, surgical supplies, sutures, bandages, gloves, and even insulin vials.
Five days into his volunteer service, Hendel-Paterson himself became one of the clinic’s patients. Dehydrated from the heat and an unidentified intestinal ailment, he lay on a cot, receiving IV fluids. He describes what led to his illness: “It was hot, it was dusty; there was a lot of particulate matter in the air from the concrete dust and burning trash, and along with that came a lot of respiratory illness, fever, and infectious diseases that go along with living in close quarters. We’d do an amputation on a patient, monitor him overnight, and then release him to the street, not to homes but to these three-sided shelters that reached 108 degrees in the middle of the day,” he says. “The immediate inclination was to focus on the overwhelming needs of the Haitians, and that made it incredibly easy to forget about staying hydrated.”
Hendel-Paterson returned to Minnesota on February 10. The following morning, he woke up “feeling sad for Haiti.” And, he says, looking back at the photos he took is difficult. “I would get callous as I flipped through all the photos of the destruction, and then it would hit me: In any number of the buildings I was seeing, there was still someone’s loved one. So many people have been unable to find their family members.”
Overall, he believes he made a difference in the disaster-relief operations, but he is cautious in his assessment. “It wasn’t like I was this philanthropic doctor that went in and saved a bunch of lives; anyone with decent training could have gone and done the things that I did,” he says. “Obviously, the conditions under which we provided care were much tougher than in the U.S.; we simply operated, knowing that what we were offering was much better than nothing at all.” MM
Jeanne Mettner is a frequent contributor to Minnesota Medicine.
Proceed with Caution
Physicians often feel a sense of urgency to travel to disaster-stricken places such as Haiti to provide needed medical aid. But Michael Rock, M.D., a member of the Mayo Clinic Disaster Relief committee, which sent help to Indonesia after the 2004 tsunami and to New Orleans following Hurricane Katrina in 2005, urges well-intended physicians to exercise caution. “Simply going there by yourself or with a group of providers, as well-meaning and altruistic as it may be, may mean you end up being a liability for local security forces and even your own country’s military,” he says.
He advises physicians to only go under the direction of a government agency or reputable nongovernmental organization (NGO). To determine if an NGO is reliable, Rock says to make sure the following are in place: security; a supply chain for food and medication; access to food, water, and shelter; electricity and communication capabilities; appropriate sanitation; and a way to quickly leave the country.
William Stauffer, M.D., an associate professor in the University of Minnesota’s Division of Infectious Diseases and International Medicine who helps run the Medical School’s global health program, also encourages physicians to wait until the situation settles down before offering their services. “In two or three months, it won’t be on the front page and interest will wane,” he says of the disaster. “This crisis will persist and the need for medical assistance and capacity building will not disappear when the headlines do.”
If you would like to volunteer to help in Haiti, Rock, Stauffer, and others recommend working with the following agencies:
American Red Cross(www.redcross.org)
American Refugee Committee (www.arcrelief.org)
Medical Teams International (www.medicalteams.org)
No Time for Poverty (www.notimeforpoverty.org)
Pan American Health Organization and World Health Organization (http://new.paho.org)
Partners in Health (www.standwithhaiti.org)
Project Hope (www.projecthope.org)
U.S. Agency for International Development (www.usaid.gov)
World Wide Village (www.worldwidevillage.org)