Association of Haitian Physicians Abroad
(AMHE)
New York Chapter

Report on the Medical Mission to Justinien University zHospital
May 22 thxrough May 29, 2010

The second mission of the New York Chapter of the AMHE to Justinien University Hospital of Cap-Haitien of Haiti took place from May 23 through May 29, 2010.  The Association was represented by the President of the Chapter, Dr. Louis J. Auguste, who acted as the leader of the team.  This team included Dr. Marie-France Condé, pediatrician, Dr. Julius Garvey, Cardio-thoracic and Vascular surgeon and Dr. James Satterfield, General Surgeon.  As for the previous program, the main goal this time again was to support the education of the residents and the attending staff at the said institution.  This was in the form of daily rounds with the medical staff each morning and formal sit down lectures every afternoon from 1:00 PM to 5:00PM in surgery and from 1:00 to 3:00PM in Pediatrics.  A total of 15 lectures were given.  In addition, the surgeons scrubbed with the residents on several cases including an incarcerated inguinal hernia, a gunshot wound of the abdomen with colonic perforation, a take back of the same case for persistent bleeding from a lumbar artery, a ligation of the saphenous vein and perforators for a chronic venous ulcer.

The mission also included the gift of a significant load of medical equipment and surgical materials.  These were a vascular pocket Doppler, numerous vascular and thoracic surgery tools, an electro-cautery, prosthetic meshes, stapling devices, suture material, radio-contrast for angiography, medications, particularly antibiotics as well as dressing material and stoma appliances.  These gifts were courtesy of Dr. Garvey, Dr. Marc Kissin, Debra Jones of Covidien, Flushing Hospital Center, through the intervention of Dr. Satterfield, the private practice of Dr. Ziegelbaum and the generosity of private donors like Dr. Ronald Sanon, Mr. And Mrs. Andreis, Mrs. Lydia Rydiananarivo and Peter and Laura Hanley.  Cash donations were used to cover the charges for transportation of the donated drugs, materials and equipments, to help the patients defray the costs of tests that they could not afford otherwise and also to provide a financial assistance to the local staff that helped make the mission possible.

Several victims of the earthquake of January 12, 2010 were seen at different stages of recovery from their injuries, but they were mostly on the orthopedic service.  The unexpected finding of this visit was the great number of young female patients in their 30s, presenting with advanced arterial disease and non-healing diabetic ulcers, patients who previously had not been known to be diabetic and as a result were not previously under treatment.  The residents received extensive education about the management of diabetic ulcer and were given training in the use of the Doppler apparatus for the measurement of the ABIndex and the use of this parameter in prognosticating the possibility of salvaging a limb.  We noted during our stay that patients with uncontrolled diabetes were being treated with oral hypoglycemiants.  When asked, the residents confirmed that there was a shortage of insulin. There was also no heparin available for DVT prophylaxis. 

In the Pediatric Division, a large number of cases of meningitides were noted.  The work up most often consisted in a lumbar puncture and a cell count, with initiation of broad spectrum antibiotics.  A rudimentary microbiological laboratory was shown to the visiting staff, but it was not capable to perform sensitivity panels.  Dr. Condé felt that the residents could be thought how to do at least a Gram stain that could guide in the selection of antibiotics.  Dr. Condé also found many cases of dehydration with hypovolemic shock secondary to infectious gastro-enteritis. A program of public education would go a long way not only to encourage the parents to bring the children earlier to the hospital but also in reducing risky practices responsible for the high incidence of these illnesses.

In addition, since Justinien Hospital is a referring center for the surrounding communities, it is imperative to maintain a minimum of supplies in the nursery, such as readily available oxygen, a portable x-ray machine, two or three CPAP machines. For some unknown reason, Haemophilus influenza B (Hib) vaccine is not included in the routine vaccination schedule given by the Department of Health and this could account for the overwhelming number of cases of meningitides seen daily at Justinien.

We toured the other departments of the Hospital in preparation for the upcoming visit of the larger contingent of AMHE physicians next September.  We had a good discussion with Drs. Saint-Vilien and Gemma of the family medicine residency program.  They wished that we could provide them with some textbooks and we will do so in the very near future. In Radiology, we found out that the two fixed X-ray units were outdated and out of commission and that a portable unit was being used to do the basic plates. Thirdly, we visited the department of Obstetrics and Gynecology.  We were greeted at the door by a large sign announcing a work stoppage or slow down in protest against the poor sanitary condition in the maternity suite.  We promised to discuss the matter with the leadership of the hospital.

We were given the opportunity to visit the depot of drugs, materials and equipment of the Justinien Hospital.  The stock was largely depleted by the unexpected consumption resulting from the earthquake.  The hospital also received a large amount of donations, but according to the stock manager, they were often materials that were not needed at the hospital, like an old unusable sonography machine.  We asked that a copy of the inventory be sent on a regular basis to the New York Chapter of the AMHE.   An effort will be made to help meet the needs of the institution.

The four delegates of the AMHE met with the Scientific Committee of the Residents Corps, represented by Dr. Enioth Bright, Roger Arthur and Jory Désir, respectively president, vice-president and secretary of the Residents Council.  The goals of that scientific committee are to improve the quality of the residents’ education, to encourage scientific research within the institution, to establish contact with other centers of formation and to resume the publication of a journal for the Institution.  The residents’ committee cooperates with the Hospital-wide scientific committee.  A tangible result of this cooperation is the participation of the attending and resident staff in the monthly “Mercredi Medical” during which they have presented for example “an evaluation of the Perception of Prostate Cancer in the Community” and “a survey of Urinary Incontinence in the Female Patients.”  However if the interesting cases are plentiful, the opportunity, the facilities or the technology to properly work them up are often lacking.  The Residents’ Scientific Committee hopes that a partnership can be established with the AMHE investigators so that they can be mentored and guided through the development of a scientific research project, including formulation of a hypothesis, design of a protocol, accumulation of data, statistical analysis and preparation of conclusions, as well as preparation of an abstract and/or a full text for presentation or publication.  We informed the committee that the 2011 Annual Convention of the AMHE will most likely be held at Club Indigo in Haiti and that would provide a unique opportunity for them to present their research.

The residents were made aware of the exchange programs with the State University School of Medicine and the Residents of the HUEH, whereby these residents are invited to spend a two or three-month period at some hospitals in Brooklyn, particularly in Medicine and Anesthesiology.  The members of the AMHE promised to explore the possibility of their inclusion in the program.  They are looking for rotations particularly in a trauma center and many of them would not require any financial support during the rotation since they already have relatives or parents in the New York area.

Finally, the residents expressed the need to expand and modernize their library, which includes mostly books and magazines from the 1960s and the 1970s.  There is a great need for Reference Texts in all specialties. They also hope that Wireless Internet access can be made available within the Institution.

On the last day, the team went to Milot to visit the National Historic Park, which includes Sans-Souci Palace and its Chapel as well as the Citadel Fortress. On our way, we stopped by the Sacred Heart Hospital located in the same city.  This Hospital of 75 beds expanded to 320 beds in the aftermaths of the earthquake. The administrator, Mr. Tim Trainor, showed us the newly added services and facilities at the institution, including a brand new prosthetics and rehabilitation service already fitting some of the young amputees of the earthquake with artificial limbs.  He showed us an oxygen compression facility that renders the institution self-sufficient and can produce enough oxygen to supply the other hospital of the area at low or no cost.  This should be brought to the attention of the Justinien Hospital administration where often, children in respiratory distress have to be given prescriptions to go and buy oxygen.  Mr. Trainor also informed us that GE has been providing them with X-Rays machines, at the rate of 4 for one, meaning that whenever they ask for one machine, they are given four, to allow them to continue to operate if one unit is out of commission.  He suggested that he could give an extra unit to Justinien if they promised to properly take care of it.  Finally, he announced that soon they would build a bio mass energy plant that would transform garbage in electricity for the hospital. The excess of electricity could be sold to the neighboring localities. This issue was later discussed by our group with the presidential delegate, Mr. Georgemain Prophete, since Cap-Haitien seems to be drowning under piles and piles of garbage.  Furthermore, it seems that there was a possibility of cooperation between Sacred Heart Hospital and Justinien.

During our stay in Cap-Haitien, we were given the opportunity to visit a village created in the rural section of Chastenois, near the commune of Quartier Morin. The village counted 50 habitation units, each of them including a bed-room, a living room/dining room, a bathroom and a small kitchen.  Fifty more units were under construction.  An elementary school is part of the plan for the community. The project is for the most part supported by the organization “Food for the Poor.”  We made a distribution of 150 pens and pencils to the children and of shirts to the male adults.  However, it was clear to us that this project was doomed to fail, unless means for self-sustenance were provided to the community.  Our group will look into possibilities to create jobs and revenue producing activities. Some of the options include the creation of shops for hand embroidery, where the women could produce tablecloths, bed-spread, scarves and handkerchiefs that would be sold to visitors at Labadee or in concession stands in and around the Citadel, when the Royal Caribbean Project of bringing tourists to Milot comes to fruition.  These options will be discussed with the Presidential Delegate for their enactment.

Prior to leaving the hospital, the entire group had a face to face meeting with Dr. Jean Coq, Medical Director and Mr. Chavannes, Chief Administrator, to express our concerns and our recommendations for the improvement of the conditions at the hospital.  Our recommendations included that the patients in surgery be distributed more judiciously in the three rooms of the service, whereby the fresh post-operative patients as well as the clean cases could be kept in the first room and the last room would be used for the infected cases, including the infected foot and leg ulcers, why the large room in-between could receive the overflow of either section.  In addition, the administration should take responsibility for the equipment donated to the Hospital and not expect that the donor is going to continue to provide tracing papers for the EKG machines or test strips for the Glucometers forever.  It is also imperative that a decent environment be provided to the parturient. Finally, it is inconceivable that a mother be forced to go and buy oxygen for a child in respiratory distress.   The administrators listened, but cited their administrative dependence on Port-au-Prince as a cause of their apparent lack of response.  However, it would seem to us that with a bit of creativity and innovation things could be different. They could take advantage of the offers from Sacred Heart and could address the private sector for fund raising efforts and to create an emergency fund to solve the numerous issues that seem to plague the Hospital.  They could also reopen the Private Pavilion of 11 rooms, where paying patients could help make up for the shortfalls of the budget of the Department of Public Health and help pay for some of the expenses of maintaining a clean environment at the Hospital.

Submitted by : Louis J. Auguste, MD, FACS                        Marie-France Conde, MD