TCU - Global Citizenship

Frog Docs in Haiti (Feb 8-15, 2014) by Ric Bonnell, M.D. (’96)

Dr Tony Hlavacek (’96) and I just returned from a medical mission to Haiti.  We both began working in this country in 2007, several years before the earthquake of 2010, after Tony’s brother, Chris Hlavacek (’99) had notified us about an orphanage he had visited there with many malnourished and sick kids.  Tony and I fell in love with the country and have led more than 20 combined trips over the last few years.  We helped start a clinic at the orphanage (www.canaanchristiancommunity.com)  that is now completely staffed by Haitian physicians and nurses.  I also recently started a Type 1 Diabetes center after my oldest adopted Haitian son got this disease and I discovered that many children in our region were dying undiagnosed and/or from lack of access to insulin. (www.kaymackenson.org)

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This particular trip included a surgical group from Missouri that first came to Haiti post-earthquake and now travel with me every year during the week after the SuperBowl.  This group is extremely dedicated to helping Haitians in need and performs dozens of surgeries on each trip. We decided to bring the group in early this time and spend the first three days on a remote mission to Isle de la Gonave, an island 12 miles off the west coast of Haiti.

I had travelled here twice previously and been struck by how these Haitians had even less access to care than those on the mainland.  The logistics in getting a large group to a remote setting can be daunting and involved arranging (and negotiating in advance) trucks, boats, cooks, interpreters, 4 wheel drive vehicles, food, etc.  Fortunately, my long time Haitian friends Pastor Henri Gaetjens and Edgard Miliace had worked on these issues for several months prior to our arrival and everything went relatively smooth.  They had hired a private boat for the crossing to avoid taking the once daily ferry that is always overcrowded and slow.  The boat accommodated all of our team with only a few getting seasick on the 1.5 hour voyage across.  We were amazed to see a traditional Haitian sailing boat with a pickup truck somehow placed across its stern.

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We unloaded our gear at the small port on the island into 3 awaiting 4 wheel drive trucks.  These took us on a rough two hour ride to a small village at the top of the mountains on the island.  Upon arrival we were somewhat overwhelmed to see 250 people waiting in line to see us.  They started cheering and singing as we unloaded our supplies.  We spent the first hour organizing the small church as a medical clinic.  We tied ropes across the room and hung sheets to create separate “rooms” for surgery, medical consults and a pharmacy.  During the first afternoon we saw 120 patients and performed 10 minor surgeries consisting primarily of removing cysts, lipomas and abscesses.  Every patient was given a dose of Albendazole to hopefully kill the hookworms and intestinal roundworms that are endemic in this region.  We brought a Haitian nurse from our pediatric clinic and used several of the older Haitian teenagers from the orphanage as translators.  Dinner that night was traditional rice, beans and chicken with creole sauce and we all slept relatively well on the concrete floor of the church.

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On Monday we worked from sunrise until sunset seeing 270 patients and performing another 20 minor surgeries.  There were five patients in need of more extensive surgery that we arranged to come to the mainland to see us later in the week.  We were pleased to see the last patient, who had been waiting for two days, just as we ran out of light.  The most common diagnoses were skin infections, diabetes, hypertension, dental abscesses, urinary tract infections and cataracts.  I saw two adults with severe external ear infections (similar to a bad swimmer’s ear) that had each been draining pus and causing severe pain for more than six months.  We did not see any cases of malaria, typhoid or cholera as it was low season for all of these.  The surgery patients were incredibly grateful as many had conditions fixed that they had lived with for 5-10 years.  We bought a live goat and ate it for dinner that night along with rice, beans and pickled onion condiment.  The village children all congregated at the front of the church that night and we spent over an hour singing and playing games with them.  Alarms went off at 0400 as we loaded into the trucks in dark and rode two hours down the mountains to catch the boats at dawn.  Unfortunately, the seas were already high and half the team got soaked on the way back from waves crashing over the front .  We used a whole bottle of the anti-emetic Zofran for the team and managed to not have any pukers despite the rough trip.

We arrived back at the hospital to find 50 people already waiting to see us.  The Haitian staff had started booking surgeries while we were gone and there were numerous other patients there as referrals from nearby Haitian clinics.  We ate a quick lunch, grabbed cold showers and headed over for a full day.  We did have to run a few chickens out of the hospital, but that is pretty standard.

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The highlights of that first day were three children brought down from the mountains with severe cases of tungiasis.  http://en.wikipedia.org/wiki/Tungiasis  This infection comes from tiny fleas that infest people who are barefoot and/or live in houses with dirt floors.  A previous medical team had travelled to this village and found almost 60% of the population affected.  They were able to remove many of the fleas under local anesthesia but had referred these children to us anticipating that they would need sedation due to the extent of their infestations.  I had never seen this particular infection previously in Haiti and had to read about the best course of treatment.  These fleas burrow under the skin and nails then engorge on blood swelling to the size of kernels of corn.  They then excrete thousands of eggs that can reinfest the host causing severe itching and pain. It is possible to kill them by smothering them with topical ointments or insecticides but the decaying bodies under the skin then often cause bacterial infections.  The best method is to remove the swollen fleas one by one using a scalpel, needle and forceps.  One poor child had to have general anesthesia as four doctors worked simultaneously on each of hands and feet for two hours removing over 200 burrowed fleas.  We also had to remove most of his toenails.  We finally finished the last case at midnight ending a long day that had begun at 0400 on the island.

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On Wednesday, Dr Tony set up a cardiology clinic with a portable echocardiogram that he had brought from his hospital in Charleston, SC.  Haitian children travelled from around the country to be evaluated.  Some were new diagnoses and others had previously had surgery in the U.S. or Dominican Republic and were there for a followup.  We saw two girls who had had their surgeries at Cook Children’s Hospital and lived with my family for a few months.  Fortunately, both were doing great with no signs that they needed additional medication or followup surgeries.  This was particularly great news for a 13 year girl named Judeline whom we feared had developed irreversible pulmonary hypertension after her surgery in 2012.  This condition is usually fatal without a heart lung transplant.  Tony was also able to reassure several families that their children did not have heart conditions and would be fine.  The surgery team took care of hernias, prostatectomies and a breast mass.

 

Thursday started with the arrival of a 22 year old Haitian farmer with his left arm in a homemade sling and bandaging around his head.  He had gotten attacked with a machete two days before after a fight with his neighbor over diverting water from a small stream to his crops.  The first blow went deep into his elbow snapping the bones in half.  The wound was still dirty and the bones clearly visible.  Fortunately for him, the second blow had less force since it was to his head, but it still managed to leave a 6 inch laceration through his scalp.  The orthopedic surgeon took him to the OR to clean out the wound and get him started on IV antibiotics before pinning the bones back together the following day.  The man couldn’t recall if he had ever had tetanus immunizations and we were very concerned about his risk for this based on the dirt in the wound and mechanism of injury.  Tetanus is not uncommon in Haiti and I had seen two cases in the past two years.  There was no tetanus shot or immunglobulin available at our hospital nor at surrounding facilities or pharmacies. A Haitian mother then showed up and begged us to travel with her 20 miles to the next town to see her 17 year old son in the regional hospital with heart failure.  Tony and I went with her and found the boy with shortness of breath, enlarged liver and severe swelling to his lower extremities.  Tony’s echo showed congestive heart failure with severe regurgitation from his mitral and aortic valves.  This was likely the result of rheumatic fever which can occur after untreated strep throat.  We advised the local Haitian staff on the optimal medical management and informed his mother of our findings.  The patient was placed on a Haitian registry for pediatric cardiac disease with the hope that he will be able to obtain surgery for two prosthetic valves.  While at this hospital, we ran into one of our Haitian clinic docs who was moonlighting in the emergency room.  He was able to “borrow” a tetanus shot for us that we hurriedly got to our machete patient.

Friday was our last clinic day and started off with the arrival of one of my favorite patients named Ruth.  She was born with an enlarged left leg that has continued to swell as she has grown.  This lymphovenous malformation cannot be treated with normal medications or surgery and her family was told several times by Haitian physicians and visiting missionary teams that nothing could be done.  I had been working on her case since meeting her the previous year and found that some children with similar conditions had responded to interventional radiology and/or an immunosuppressant drug called rapamycin.  Specialists at Dell Children’s Hospital in Austin, TX, had agreed to take her case and I was able to give the family the great news that they would be traveling to Texas in March for further evaluation using an MRI and treatment.

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This one week trip was a success with 21 major surgeries, 30 minor procedures and over 500 total patients seen.  We strive on each trip to work with and teach Haitian medical staff so that we will eventually “work ourselves out of a job” as medical missionaries.  We have largely succeeded with this goal at our two clinics but the demand for general and specialty surgeries still far exceeds what the few Haitians surgeons are able to provide.

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