Kim Wilson, a pediatrician at Martha Eliot Health Center, was originally on the Global Surgical team in Cange. But the day after arriving, she was rerouted back to Port-au-Prince, where the University hospital (HUEH) was desperately in need of clinicians to staff the pediatrics tents.
I initially came with the team to work on developing collaborations between Partners In Health’s (PIH) child health program and Children’s, as PIH is planning an expansion of their child health services. However, PIH is also helping to coordinate staffing for the pediatric tents at the general hospital in Port-au-Prince. Ideally, the pediatric tents are staffed by three pediatricians and 12 nurses, but as of this week, there were no pediatricians slated to be there. So Dr. Sophie Allende and I went down to help.
I didn’t quite know what to expect, and I had heard that the level of clinical acuity was quite high. But I was happy to work where there was a great need. We got to work right away. Sophie and I were working with four nurses from other institutions, a Haitian resident and two Haitian pediatric nurses. We covered the night shift, 7 p.m. to 7 a.m., looking after 70 to 80 patients (20 in a PICU tent, three full tents of general pediatrics and a NICU tent).
I feel enormous respect for the Haitian clinicians who’ve been doing this for months. The need for nursing care was endless, and we could really just meet the most urgent needs. We had kids admitted with severe dehydration, typhoid fever, pneumonia and sickle cell anemia. I learned a lot from working with the Haitian colleagues about infectious diseases that I had little experience with.
It was often frustrating to not have the supplies and medications we needed, and I learned more patience and flexibility. It was hard to see patients die for conditions we probably would have been able to treat more successfully back in the United States, but I feel like our team made a difference. There were some kids who wouldn’t have made it if we hadn’t been there to support the care.
Many of the staff were injured in the earthquake and have family members who were injured or killed. Many are now homeless and haven’t been paid in months. But they still come into work. It was incredibly inspiring. I learned as much as I taught, maybe more.
After two night shifts, I returned to Cange to continue my plans to set up a collaboration between Children’s and PIH to support their work in improving child health services here. Dr. Koji Nakashima, a PIH pediatrician who trained at Children’s, is working with Dr. Roman, a Haitian pediatrician, to build up pediatric care in the Central Plateau. While the hospital in Cange has a number of pediatricians, most of the surrounding hospitals don’t.
We traveled to Las Cohobas, a district hospital an hour away from Cange, and toured the facility. There are no pediatricians here. We are working on creating a global pediatric fellowship at Children’s, where fellows could come to a hospital, like this one, and work with PIH to teach general physicians how to implement child health protocols from the World Health Organization, called Integrated Management of Childhood Illness (IMCI). IMCI, which has been introduced in more than 75 countries around the world, aims to reduce death, illness and disability, and to promote improved child growth and development. PIH has also been working to expand access to more advanced pediatric specialty care, and we have been discussing ways Children’s staff might support these efforts.
Prevention and early detection of health problems is clearly the most effective way to improve child health and survival, whether you are working with the families at Martha Eliot Health Center or here in Haiti. Being here this week has again reinforced this to me. Early identification of common problems, like malnutrition, gastroenteritis and respiratory infection, would have prevented some of the severe illness and death we have seen this week. I hope that our future collaboration can help Haiti build a strong primary health system for these children and families.