For most children in the United States, seeing a pediatrician is an annual event. For other children, especially those with more complex problems, visits to pediatric subspecialists are common. But in many parts of the world seeing any type of doctor, pediatric specialist or not, is simply impossible.
Ever year eight million children die in developing nations where there are few or no doctors and nurses trained in pediatric care. What’s worse, many of these deaths are preventable. Public health initiatives that increase access to clean water and improve nutrition have done much to contain these numbers, but more needs to be done to provide quality health care to children all over the world.
This month marks the second anniversary of the January 2010 earthquake that devastated Port au Prince, killing more than a quarter million, injuring over 350,000, and leaving an estimated one million without shelter. Having gone there three times since then with groups from Children’s Hospital Boston to participate in the relief efforts, hardly a day goes by that I am not reminded of what I saw and lived during those weeks. Ranging from the truly horrible to inspiring and uplifting, many of the experiences were unlike any others I had had prior to setting foot in Haiti.
The first time I went was in May 2010 with a group that worked at the General Hospital along with Partners in Health. Conditions on the ground were utterly chaotic, and the disorganization made it difficult for foreign volunteers to work as we were accustomed to doing back home. This only added to our frustration at the discrepancy between the enormity of the challenges we faced and what we could (or could not do) to help. Many of those we cared for were suffering from the after-effects of injuries sustained in the earthquake, including chronic bone infections following amputations. A significant number of the children we saw were malnourished, their golden, frizzy hair and big bellies (often full of worms) helping us to make the diagnosis as soon as we saw them.
Others presented with routine medical and surgical problems which would have been straightforward in Boston but which were, in fact, very difficult to treat in Haiti because of the limited resources available and the lack of continuity of medical care. Perhaps the hardest of all was to repeatedly see children die from conditions and diseases which could have been prevented or treated back home, at little cost, and to be powerless to stop that from happening. On both the first and the second trips our teams cared for children who died from diphtheria. Previously widespread in the United States, it has not been reported here since 2003 thanks to widespread vaccination. However, diphtheria remains endemic in Haiti, and because most children do not have access to vaccinations, hundreds die from it there each year.
Michael Felber, RN, is a nurse at Children’s Hospital Boston. He spent two weeks as a medical volunteer in Haiti in March of 2010, in the aftermath of the earthquake that devastated the country. The following February he returned with a group of clinicians from the Global Surgery Program at Children’s, to work at a hospital founded by Partners In Health. While there he met a child who changed his understanding of the relationship between caregiver and patient. This is the second half of his story, for the first blog entry, click here.
It took two months to get Louveda to Boston. I communicated by phone and email with Sybill and David weekly. I was sure that it would eventually be possible to get her here, but I feared for her well being in the meantime. I work part-time at Shriners Burn Hospital, so I know of too many children who died waiting for their immigration paperwork to be processed.
I was working a night shift at Children’s Hospital Boston when Louveda finally arrived, accompanied by David. Jay, one of the nurses from the Children’s team, met her at the gate, brought her to the ambulance that would take her to Shriners Hospital. When I made my way to Shriners Hospital’s Acute Care Unit the next morning after my shift, I felt a wave of relief and gratitude when I saw her name on the board behind the nurse’s station.
She was frail but remarkably upbeat. It had been months since we had last seen each other, but she greeted me as if I had just stepped out for the afternoon, and told me she wanted to visit my house. She was clearly enjoying her new surroundings, but you could also sense her nervousness. She asked every new person she met if they were going to “take [her] skin.” She was still hugely protective of her wounds, and unsure of her new caregivers.
Michael Felber, RN, is a nurse at Children’s Hospital Boston. He spent two weeks as a medical volunteer in Haiti in March of 2010, in the aftermath of the earthquake that devastated the country. The following February he returned with a group of clinicians from the Global Surgery Program at Children’s, to work at a hospital founded by Partners In Health. While there he met a child who changed his understanding of the relationship between caregiver and patient.
In February of 2011 I spent a week working with a Children’s team in the village of Cange, in Haiti’s Central Plateau. The region has been served by Partners In Health and its Haitian sister organization Zanmi Lasante for over 25 years. Together they have built a hospital and a multitude of programs to improve health, education, agriculture and social services. Our goal was to collaborate with PIH and Zamni Lasante, in their development of surgical programs and medical education for Haiti.
Our first patient was Louveda, a sweet and articulate 12-year-old girl with severe burns on her thighs and abdomen from a kerosene lantern accident two months earlier. Both her parents had died in the past year so her 14-year-old sister, Anita, was her primary caretaker. (Since Louveda’s accident, the two girls lived at the hospital, sharing a single bed.) She was wrapped in wet, stained bandages. She tried to remain as still as possible because it hurt her to move. She said it was hard to rest because her bandages were hot and itchy.
With the help of the Haitian clinical staff we arranged for sedation in an operating room so we could change her dressings and assess and debride her wounds. We brought a stretcher to her bedside, and in a calm and mater of fact way she asked, “Am I dead?” It occurred to me that in the two months she had been in the main surgical ward of the hospital, an open room with about twenty other patients, she had seen others die and be removed on stretchers. And it was realistic to assume that she too would not survive her injuries. Despite it all she seemed calm. In the operating room she smiled and held my hand as she went to sleep.
While she slept we cut her bandages off with scissors. The smell and wounds were overwhelming. Her upper legs and stomach were covered with deep, angry red wounds. There was a pressure ulcer on her left ankle, nearly exposing bone. We washed her wounds and put her in a clean gown and fresh bandages. As the initial shock of her injuries wore off, we began thinking of a long-term plan for her.
The good news was she was medically stable, but that wouldn’t last. She was anemic and malnourished. (A common complication for burn patients because they tend to have greatly elevated nutritional needs.) Her body was compensating physically, but would not be able to do so indefinitely. Her breathing and pulse were too fast and her muscles and skin were wasting and breaking down. She needed nutritional support, blood, physical therapy and help for emotional trauma. And mostly she needed skin grafts to close her wounds. Her injuries were extensive but treatable, but not with the resources available in Cange at this time.