Toronto Jewish Doctor Reports from Haiti

We recently received two reports from a volunteer, Dr. Mark Fenig, who we have helped sponsor and who is now providing relief support in Haiti.

Report 1:  Dr. Mark Fenig

Day two has been super-tiring. Despite docs and nurses and volunteers numbering over 70 there seems to be an endless amount of work. I flew here with 3 orthopedic surgeons, 2 anasthesiologists, 2 physiotherapists, and 4 nurses, 1 internist (and I’m and ER Doc). Our team is one of about ten from various States and Countries. Everyone works well together so things are running as efficiently as you could expect in such a resource poor environment.

As soon as I arrived I was assigned to the ER of this compound. The compound is made up of a hospital with a few “operating rooms” and an ICU, an orphanage that has been converted to an emergency department with 3 inpatient wards, and a large tent for post op care.

Most of the patients have sustained some sort of orthopedic injury and have infectious complications of their amputations, inserted pins, crush injuries, etc. the surgeons are working pretty hard. Patients are littered about, sleeping on bare mattresses in hallways and in the open air.

Today I took car of a handful of people: lady with two wound infections, one bad one under her scalp secondary to an injury she sustained when a cinder block fell on her head during the quake.  During my workup she was found to have a kidney infection and possibly malaria. She’s doing well now that she’s been started on medications.

Another lady showed up extremely jaundiced with a fever. We thought she’d have malaria too but instead she has pelvic inflammatory disease and hepatitis versus mono. I found a portable ultrasound machine and was able to work up several pregnant women and discharge them after some reassurance. There’s no Ob/gyn docs here so this week I’m probably among the most qualified to deal with this population. One of my last patients of the day was a very sweet, well appearing 6 year old that was trapped under a collapsed house for two days before she was pulled out. Her mother and sibling were crushed to death and her father is in the US. Her uncle cares for her now. Despite her terrible story I discharged her with just some Motrin for a bruise she sustained during the disaster. She is otherwise in one piece, has no metal pins or rods stuck in her extremities and she’s alive. She might be the luckiest girl I saw in our overcrowded compound today.

Report 2: Dr. Mark Fenig

Day three has been the best day so far. I was asked to be in charge of an extremely cramped ward of about 60 patients laying about an outdoor corridor and five cramped rooms with no ventilation or electricity.  Everyone was laying on bare mattresses and the vast majority had external fixation hardware in their legs and arms. Due to the lack of an x-Ray machine, patients cannot yet have rods put in their broken bones. There is one very old c-arm that had broken prior to our arrival (probably better this way since it looked looked like an old atari that would give the user a tumor after 20 min of use). I rounded on all the patients and began to sort out who still needed surgery, who still needs to be hospitalized and who is stable enough for transfer. Transferring is a huge problem since few hospitals are able to take dozens of sick, illegal Haitians with no home or living family off of our hands. Today we were able to ship out a bus-worth of patients and two helicopters came for two patients that were critically ill and needed more resources. Our hospital leadership spends a lot of time on the phone with US politicians trying to twist arms so that favors are called in from the state dept. These favors usually come in the form of a Dominican military med evac helicopter.

After rounds, we started to get an influx of new patients. Many were Haitians that crossed the border illegally to our border hospital and some Dominicans began looking for medical consultations as well. The town we are in is extremely impoverished and the locals hadn’t seen a doctor in decades. In order to help “decongest” the already overcrowded wards we decided to open an ER/minor med clinic. The hospital’s incident command liked the idea and I was awarded a storage room, three chairs, an interpreter, and an examination table. I signed out the daunting ward I was placed in charged of to a new doc and opened my clinic for business. My interpreter and I moved all the boxes of med supplies out of the way, mopped, put signs up, stocked the room with equipment, and then we began to treat patients. At first the petients flow was just a trickle, but by the afternoon there were always at least 4 patients waiting to be seen. I evaluated and treated patients with simple fungal infections, perforated ear drums, and I incised and drained some abscesses. I also wound up admitting a severely malnourished 13 month old boy who was anemic and had total body swelling. Another woman who had sustained crush injuries to her legs had been literally carried by a cousin for two weeks because she couldn’t walk. I admitted her for multiple fractures that were likely compound (open) fractures. A third women had to be admitted for hyperemesis gravidarum.

I was then notified that I had to return to Santo Domingo for my flight. This was to be the last transport for a while and my return flight is tomorrow. I had no choice but to pack up. Before doing so, I found a great family doc to take over the clinic (Dr. Jim). I spent my last hour training my interpreter to be a medical assistant so he could help run the clinic for the next few weeks. He was a fast learner and by the end of the hour he was doing the patient intakes himself including vital signs, urinalysis etc.

I had come with the agenda to leave something sustainable behind.

Despite my very short stay at the hospital I think I accomplished my mission.

Currently en route to Santo Domingo typing on my iPhone notepad. I hadn’t had a chance to internalize the dozens of horrific stories the patients told me. It’s starting to sink in now. Words can’t describe my team’s overwhelming sense of appreciation for what we have in North America, empathy for the survivors of families who were all crushed to death, and guilt for being on the winning end of the ovarian lottery.