Rush News Blog

Dr. Joel Augustin, a family practice physician at Rush University Medical Center, traveled back to his native country of Haiti on January 29th as a member of a medical relief team organized by the International Medical Corps. Here are his reflections on his two-week trip.

I was born in Haiti, and the last time I went to my country of birth was in 2001. I was eager, and anxious to go to Haiti with the team of seven health providers (three ER physicians, one family physician and three nurses from Rush and Northwestern) after the earthquake.

I was amazed by the level of solidarity demonstrated at all levels during the flight to Puerto Rico. When I ordered breakfast during the flight, the flight attendant from American Airlines refused to take my money, knowing I was part of the medical team going to Haiti. We landed in the Dominican Republic at about 6 p.m.; we were joined by two ER physicians from Stanford. We drove to Haiti the next day for about six hours.

When we arrived in Haiti on Saturday afternoon, I was shocked by the level of destruction and, yes, the level of poverty. We went to the State University Hospital where we met with Dr. David Ansell, the chief medical officer of Rush and a member of the first Rush group to travel to Haiti, who took some time to talk to us even though he was busy. I can safely say he was very happy to see us.

We met with International Medical Corps (IMC) staff on Saturday evening and started working the next day. Our team was divided: a group of seven (five ER physicians: Dr. Jamil Bayram, Rashid, Bernie, Jessica, Rebecca; two nurses: Lisa Pint and Celeste Michaels) were sent to the Hospital. Carmel, a transplant nurse also from Haiti who works at Northwestern, went to a mobile clinic at Boulos located in one of the poor area of the city. I went to Gressier which is a small town not too far from the epicenter. The two mobile clinics saw a total of about 2500 patients over a period of 1 and ½ weeks.

The Clinic

We operated our clinic at Gressier in the yard of the community clinic, because we were not sure whether it was structurally sound and safe. The clinic was well-rounded. Diana, a Family Physician, had been running it for the previous two weeks. An ER physician was part of the team as well. It functioned like a mini ER: three local Haitian nurses are in charge of the wounds and called one of us, mainly Diana at first, for suspicious wound, abscess etc. We were able to place a few soft casts. Two Haitian physicians trained in Cuba, a nurse from the community clinic, Diana, the ER Physician and I share the rest of the load.

After a couple of days, I replaced Diana, and a nurse practitioner, Beth, replaced the ER physician. We saw on average 250 patients a day. Most of the cases were chronic in nature with dermatosis, abdominal pain, gastroenteritis, hypertension, a few cases of diabetes. All children were treated for parasites. For many cases of fever, at first we treated for malaria and typhoid fever systematically. However, IMC was able to obtain a quick malaria test which was specific not very sensitive. We were able to diagnose many cases of malaria. However, since it was not very sensitive, we treated negative malaria test anyway on clinical grounds.

For team building at the end of each session, we met as a team to discuss how the day went, what we needed to do to improve the flow and what medicines we needed to refill. Restocking was an issue, sometimes we spent the rest of the afternoon looking for supplies.

The Human Aspect

• The patients were very grateful, saying if it was not for the international help more people would have died. The community clinic apparently has not served them well in the past and they were grateful for being seen and given some medications for free.
• The local staff reinforced that point at every opportunity; whether it was the driver or the translator for the team (each team has a translator). The driver has two college degrees and to support his family applied for the job with IMC and was hired. All staff members were very dedicated, caring, and doing their best to ease the work for us.
• The toll has been great on all of us. Some of us questioned the work in terms of how much impact we have considering the enormity of the situation. One thing that gave solace was the realization that the patients understood the rest of the world really cared about them. And you can’t measure that.

Impact of the Earthquake

I was very disappointed by the response of the University Hospital administration during my stay. There was a lack of leadership in coordinating the efforts of the international health teams. Local physicians and nurses were inconsistent in their work. That rests on the shoulder of the administration and the ministry of Health. By all accounts, the State University Hospital was not functional since March of last year because the residents, nurses have not been paid. In addition, many residents and attendings lost their lives during the earthquake. Haiti has been subjected regularly to natural disasters including four hurricanes in a period of two weeks in 2008. Yet, no emergency response team has been put in place to lead the way in cases of catastrophe. That being said here are some of the effects of the earthquake:

• Loss of many medical students including seniors as well as attendings leaving a big gap for the future of the health care in Haiti. The physician/population ratio was 1/10000. It will be worse.
• Worsening of the health care system
• With rising homelessness, hunger, there is a concern for epidemic.

It was a very emotional but very worthwhile trip. I saw resiliency, nobility, gratefulness which I think had a profound impact on all of us. Here is what I think could make a huge difference:

1. Help rebuild the Medical school library.
2. Facilitate regular trips for physicians lecturers to help with the education of future physicians.
3. Help facilitating the creation/training of a Haitian emergency response team possibly in collaboration with the Illinois School of Public Health.