A pair of Haitian doctors face incredible struggles to become two of the first EM physicians in their country.
For five centuries, our tiny island nation has endured countless struggles. Stricken by colonialism, slavery, crippling debt, corrupt leadership, environmental devastation, extreme poverty, collapsing infrastructure and violent revolution, Haiti is still having a hard time finding its footing.
As easily the poorest country in the Western Hemisphere, 50% of our people live in poverty. More than 20% are crushed by extreme poverty. Centuries of abuse and isolation have created one of the world’s poorest economies. And yet we enjoy one of its richest cultures, which is wonderfully reflected in the proverbs of our native Creole language.
Proverb: Sa ki gen nan larivyè twòp pou batwèl.
Translation: What is at the river is too much for the paddle.
Meaning: There are too many problems for me to solve by myself.
On the morning of Jan. 12, 2010, another enormous problem was thrust upon the heap. At the time we were just young students traversing the corridors of our medical school, donning our pristine white coats, proud of the prestige they symbolized. We had no way of knowing what terrible fate was on the horizon. At 4:53 p.m., the earth violently shook again and again, gripping an entire nation in agonizing fear. At the time we could never have imagined the scale of the disaster. In a matter of moments, the earth had devoured a quarter million souls.
Miraculously, not one of our medical school students had a single scratch. Unfortunately, the inhabitants of the houses in the adjacent neighborhood were not so lucky. Shoddy construction practices are one unfortunate byproduct of extreme poverty.
Without hesitation, small groups of medical students and faculty rushed to help. Amidst the profound sadness of the post-apocalyptic setting and the anxiety caused by the dozens of seismic aftershocks, the gross inadequacies of proper emergency care and the total absence of specialized emergency physicians for a population of 10 million people became painfully obvious.
Proverb: Se apre batay yo konte blese.
Translation: It is only after the battle that we count the wounded.
Meaning: You get in the fight and do what must be done, whatever the odds.
Reliable data on the scope of the effects of the earthquake is hard to come by, but for a sense of the impacts, Doctors Without Borders alone treated 358,000 patients, performed 16,570 surgical procedures and assisted with 15,100 births during the 10 months following the quake. We will never know the full extent of the disaster and its response.
To this day, the national palace (our equivalent of the White House) still has not been rebuilt. The General Hospital, which once was among the country’s largest, was heavily damaged. Despite years of construction, it remains unfinished. The CDTI Hospital in Port-au-Prince, once the most advanced diagnostic and treatment center of the country, was also heavily damaged. It now lies in ruin, bankrupt along with so much of the country.
What we do know is that the earthquake left some indelible scars across Haiti.
Still, not all was lost. The glaring inadequacies of the country’s disaster preparedness resulted in an unprecedented outpouring of generosity and solidarity.
For us physicians, perhaps the most noteworthy of these developments was the 2013 opening of the University Hospital in the Central Plateau: The University Hospital of Mirebalais. The hospital was built and operated by the NGO Partners in Health/Zanmi Lasante, in partnership with the Haitian Ministry of Health. Partners In Health has worked in Haiti for over 30 years, collaborated with the Ministry of Health to start the first Emergency Medicine residency program in the country, and continues to actively support the growth of emergency medicine in Haiti.
This amazing hospital is where the next step of our journey took place. Fast forward to the summer of 2015. We were young doctors, freshly graduated from medical school, armed with an unshakeable faith and determination, and ready to face the harsh reality of providing healthcare in the Haitian medical community.
We had been accepted into the Emergency Medicine residency program at Mirebalais, which had quickly become the most prestigious university hospital in Haiti. Now we found ourselves with four other comrades as new PGY1 residents beginning our journey to become emergency physicians.
As part of the second cohort of doctors ever trained through Haiti’s first Emergency Medicine residency program, we were very proud to be among the pioneers in what we believe was the beginning of an essential emergency care revolution. Far from being inhibited by the anxiety and uncertainty often generated by an unprecedented adventure, we felt ourselves growing wings. We wholeheartedly accepted the challenge of working towards the emergence and recognition of Emergency Medicine within the landscape of other specialties in Haiti.
Proverb: Piti piti zwazo fè nich li.
Translation: Little by little, the bird builds its nest.
Meaning: Rome wasn’t built in a day. Great accomplishments happen slowly, through diligent effort and sacrifice.
We were supported and mentored not only by our program directors and local Haitian faculty, but also by a steady stream of kind and generous visiting professors, emergency physicians from abroad who were staying in our department in order to strengthen our knowledge and skills.
Under this expert tutelage, we tirelessly kept our focus on our common goals while trying to be the most professional, hardest workers in the hospital. We also made a concerted effort to develop camaraderie with the residents of the other specialties (surgery, OBGYN, pediatrics, internal medicine, etc). We gained their trust and respect, and three years seemed to pass in the blink of an eye. By the time we completed our program and graduated in October 2018, we had already started to see the fruits of our labor. The future looked bright!
Despite these positive developments, our challenges were far from over. In recent years our humble island nation has experienced further turmoil. Before we could meaningfully recover from the devastation of the 2010 earthquake, Hurricane Matthew, a Category 4 storm, ripped across our lands in 2016. Hundreds died. Thousands were injured. Nearly 1.5 million Haitians required immediate humanitarian aid. It was a disaster.
Billions of aid dollars flowed in. More than $50 million was earmarked for the rehabilitation of several public hospitals and other healthcare-related purposes. Among these was a $5 million trauma center in Port-au-Prince that never materialized, one of many promises that were not kept. Following reports of misuse and embezzlement of these funds by the governments (The PetroCaribe Affair), a series of anti-corruption protests swept across the island during the past 18 months. Some of these citizen uprisings paralyzed the entire country for weeks at a time. During these dark times, our already difficult EM work became much more complicated. Hospitals were forced to work with reduced staff, and ambulatory services were delayed or shut down entirely due to road blockages and violence in the streets.
Proverb: Se Degoute ki mennen Koule.
Translation: The river starts with small drops.
Meaning: Great things are done by a series of small actions brought together.
When adversity gives rise to doubt, we sometimes see on the horizon the North Star, which confirms that we have taken the right path. Amid the chaos of the citizen revolt, we received some welcomed good news this February. We had been awarded a “Faculty Development Scholarship” from EM:RAP GO (Global Outreach).
This program funded us to take a one-week training trip to New Orleans in May to take part in the prestigious “Emergency Medicine and Acute Care” course. We were just as excited about acquiring new knowledge as we were about meeting old friends like Dr. Billy Mallon, and also making new friends. It was just a week away from home, but bright spots like this in an otherwise dark sky are so impactful. They rejuvenate us and give us confidence that we have made the right choice to serve our fellow citizens in need of emergency medical care.
We are deeply committed to increasing access to emergency care in Haiti, especially for the most vulnerable. We put ourselves into it every day, one patient after another. There are now 12 emergency doctors trained at the University Hospital of Mirebalais who are currently working in Haiti. All of us trying to carry out our responsibility to build a strong specialty with all of the standard academic and administrative components required. The Haitian Society of Emergency Medicine and Disaster (Société Haïtienne de Médecine d’Urgence et de Catastrophe —SHAMUC), is the organization bringing us together and serving as a banner for the young discipline of Emergency Medicine, under which we are pioneers in Haiti.
Our profession requires us to continually improve and seek new knowledge. We have had the chance to meet extraordinary people during our journey who have guided us on this path. Some, like Partners In Health, have provided incredible support through state-of-the-art facilities for training and personal improvement. Others, like EMRAP GO, have provided us with free access to their online medical education platform (EM:RAP) and sponsored developmental trips for us to participate in scientific meetings such as the 2018 ACEP conference in San Diego.
These events provided us with fresh perspectives and new approaches to our overall practice, including a comprehensive review of the latest literature and an overview of the management of many common presentations in the ED.
Proverb: Bwa pi wo di li wè lwen, men grenn pwomennen di li wè plis pase l.
Translation: The tallest tree sees far, but the wandering seed sees more.
Meaning: Exploring the world unlocks possibilities not found at home.
These incredibly generous organizations contribute to our sense of purpose and nurture the unwavering faith we have for the future. While the first stone has now been laid at Mirebalais, we will not rest until our vision of seeing emergency medicine residencies replicated throughout the country, in every university hospital, is realized. It will undoubtedly be a long-term endeavor, possibly decades. However, it is a challenge that we embrace without hesitation. We strongly believe that the development of emergency medicine around the world is one of the levers that can reduce inequalities and move towards equity in access to health care.
We know a very long road lies before us. Our country has been torn apart. But this is what we do in Emergency Medicine: we put things back together. And we, two of the first pioneers of EM in Haiti, along with our many colleagues, are so very grateful to all of our friends who are helping us along the way.
Proverb: Se nan move tan ou konnen siw gen bon zanmi.
Translation: You get to discover who are your true friends when you are going through adversities.
Meaning: Hard times reveal your true friends.
Photo Credit: Valery Pierre Louis