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Healing to Haiti

In January, 13 doctors and medical personnel from Allegheny General Hospital took their medical expertise to the people of earthquake-devastated Haiti. The team returned with experiences that will help improve the care they provide here.



They arrived late at night. Rumbling by truck through the shattered streets of Port-au-Prince, the earthquake-devastated capital of Haiti, they passed bodies left unburied and piles of rubble that barely resembled the buildings they once had been. Everywhere was chaos, and the city smelled like death.

As their truck continued on, they saw packs of wild dogs but few living people. Twelve days after the earthquake, curfews were in force to keep looters at bay. Arriving at Hope Hospital, 13 doctors and medical personnel from Pittsburgh's Allegheny General Hospital (AGH) expected to grab a few hours of sleep then to begin operating at sunrise. 

But Hope Hospital was a scene of destruction. German surgeons, already working for several days in the hospital's front rooms, told the Pittsburgh team members they could work in the rear, where the only real operating rooms were contained. But because this area had collapsed so badly, the Germans were unwilling to use it. Fault lines crisscrossed the walls, and aftershocks from the quake remained a danger. Setting up shop there would be crazy.

But the doctors were determined to save lives.

It had started as a mercy mission: Ten doctors and three medical personnel from Pittsburgh risked their safety to help victims of the earthquake that ravaged this Caribbean nation. But by the time they boarded their flight home four days later, it became a unique training experience-perhaps even life-changing. For these doctors, it redefined the way they practice medicine.

SAVING STRANGERS
Within days of the quake, the Bouchard family, of Sewickley, who helped engineer the rescue of the BRESMA orphans, offered to sponsor a flight and provide medical supplies. Dr. Mark Sangimino, a senior attending orthopaedic surgeon at AGH, and his wife, Dr. Laurie Sangimino, began working with Dr. James Blaugrund to recruit a team. Dr. Richard Ray, also a senior attending orthopaedic surgeon at AGH, decided to join the group. He knew there was a huge need for orthopaedic surgeons to save patients crushed by falling debris and was inspired by his residents' strong desire to go.

The group-a mix of physicians, surgeons, medical technicians and one med student-left Pittsburgh on Jan. 24. Quickly putting together a totally self-sufficient team that could perform surgery in a disaster area had been a monumental task. Now, on the ground in this chaotic situation, even harder work was about to begin.

COPING AMID CRISIS
Temporarily controlled by the U.S. Air Force, Toussaint Louverture International Airport had become the gathering place for aid workers and medical teams pouring in from around the globe. The group from AGH returned there from Hope Hospital, wading through crowds of well-intentioned strangers and thickets of misinformation.

Eventually they found a makeshift tent hospital run by the University of Miami, which had sprouted at one end of the airport. It was fully staffed, at least for the moment. But in a crisis, things change quickly. When morning came, several exhausted orthopaedic surgeons were suddenly packing to leave. "Their opportunity to go home came," says Ray, "and so we were needed."

The group had brought millions of dollars worth of equipment and supplies on their chartered flight. But it quickly became clear that despite their expensive cargo, they still lacked even the most basic things. There was no blood for transfusions. They had plaster for casts, but the tent hospital was running out of padding to put inside. The operating tables? They were picnic tables and metal folding tables.

"Our operating rooms were basically a tent with a plywood floor, and we didn't have full general anesthetics, so we did most procedures with sedation and nerve blocks," Ray says. "We could not operate on hip fractures, could not do internal fixation because we lacked the sterile conditions. But we could do wound care and external fixation."

Even paper was in short supply. "A patient's entire medical record consisted of whatever scrap of paper we could find and tape to their bed. Their information was written on their casts and bandages. We'd write it right on them," says Dr. Eric Johnson, a chief surgical resident who made the trip. "It was a different team of doctors practically every day, so that was the only way to maintain some kind of continuum of care."

Hundreds of injured people were lined up on cots, some nearing death. And yet there was no facility for running even basic lab tests. The doctors had only their eyes, their ears, their training and their instincts.

RAW MEDICINE
"Here," Ray says, sitting in his office building on Pittsburgh's North Side, "you can always order one more test, do one more thing to make sure you're absolutely perfect. Down there, you just can't."
Dr. Richard Ray, an orthopaedic surgeon at Allegheny General Hospital, led a team of doctors and medical personnel to Haiti in January during the aftermath of the earthquake that devastated the country.  --Photo by Becky Thurner BraddockRay, who started medical school in 1965, found himself using techniques he learned long before the digital age dawned. "A lot of my training had been in a sort of low-tech era," Ray says. In Haiti, "a lot of things we were doing and had to do were things that had been taught to me by older doctors when I was an intern. A lot of what we were doing went back three or four generations."

During the trip, the doctors diagnosed infections by sense of smell, matching the odor of wounds with the scents of bacteria they remembered from medical school. They had only sporadic use of an X-ray machine, so they often used their hands to determine how badly bones were misaligned. Cooperation was key. "My surgical team the first day consisted of me, and I had an O.R. nurse who was actually an obstetrics nurse from Florida, and my anesthesiologist was from the Czech Republic," says Johnson. They were helped by Haitian volunteers who had never seen surgery before.

"One of the most rewarding things," Ray says, "was seeing how quickly they were able to adjust, and to work faster and make decisions without all the backup technology we have here."

Physicians doubled as pharmacists. Anesthesiologists changed patients' bandages. "Everyone down there was willing to feed patients, change dressings, do pharmacy work or take X-rays-things you normally wouldn't be doing," says Dr. Mike Beckett, a chief orthopaedic surgery resident at AGH. "And nobody was like, 'I'm not doing that.'"

In surgical gowns, the heat during the day was extreme. There were flies. At night, sleep was difficult. Airplanes were taking off and landing just a few hundred yards away. Meals were little more than protein bars and snacks. Yet the group somehow kept itself focused and energized.

Still, there were heartbreaking moments. "We had people who came in that we couldn't save," says Johnson. "I was triaging children in large quantities with problems that we could treat at home." It was excruciating, he recalls, to "leave those kids behind and not have options that we could use to help them when we know that in America they were all treatable conditions." That was especially poignant for Beckett and Johnson, who both are new fathers. Beckett's 6-week-old daughter and Johnson's 1-year-old son awaited them in Pittsburgh.

CHANGED LIVES
How do you go from a climate-controlled, computer-operated urban American hospital into something close to a war zone and not come back changed? After improvising and scrambling, despairing and forging on, who are you when you return home? Are you the same doctor that your patients saw during their previous check-up? Not exactly, Johnson answers, though he struggles to figure out exactly how.

"You definitely don't take what you have for granted as much anymore," he says. "You realize what it's actually like to have absolutely nothing because you've seen a hospital now that has absolutely nothing. Everything was 'Do the best you can,' and so we saw that we could adapt. ... It's an aspect of your education that you just can't simulate here."

To hear the doctors tell it, every member of the group returned deeply grateful for the nurses, technicians, pharmacists and others who make it possible to give patients top-notch care. And they're thankful for the cutting-edge technology that, in Pittsburgh, is commonplace.

"Everyone kind of complains about our health-care system here, but I don't think people realize how lucky we are to have what we do. It's easy not to realize it here, but then you go to a place like that, and they have nothing," Beckett says. "And they pretty much had nothing before this earthquake happened."

Team members were also inspired by one another. In one-on-one interviews, Ray and members of his team invariably shifted focus from themselves to their colleagues. Several spoke of the tireless work done by Sangimino, a pediatric surgeon who not only treated many quake victims but also diagnosed a teenage cancer patient and lobbied officials to allow the boy into the U.S. for treatment.

WHAT NOW?
Four intense, life-changing days. All at once, they felt like decades and were gone in a flash. "We worked basically all day for two days," Ray says, "and then more new doctors came, and it was our time to go back."

Back in Pittsburgh now, they talk of another mission. It would be valuable, of course, for other doctors to share the experience, to understand that medicine, so sterile and controlled when practiced here, can still be so elemental and basic in another country. And many of the team members, Johnson says, are hungry to go back; it would be another chance to help Haitians still struggling to return to a normalcy that, by our standards, wasn't normal at all.

But for now, with no return date scheduled, these doctors are spending their days focused on the people of the Pittsburgh region. They're seeing patients here through fresh eyes and with a renewed sense of just how fully they can help.

Over and over, they will tell you they're not heroes. "We gained far more than we gave," Sangimino says, and he's not simply being polite. Think of it this way: One day, you may walk into a doctor's office or end up on an operating table yourself. If it's happening in Pittsburgh, one of these physicians may be the person assigned to your care. And the treatment you receive will be informed by, affected by-maybe even improved by-four January days spent in an unthinkable situation in a country that you've probably never seen and probably never will.

"When you initially go into medicine, you go in for all these altruistic reasons," Beckett reflects. "You can lose some of that in the day-to-day grind. You can become a little jaded."

That fleeting moment in Haiti, though, helped ground him. It also reminded him of why he does what he does-and what medicine can achieve even if your instruments are improvised, your sterile scrub water is scarce, and electricity isn't a given. As Beckett notes, "It sort of makes you think about all the reasons you're in medicine in the first place."

Melissa Rayworth writes about a mix of cultural issues-from sexual politics and popular culture to home design and parenting-for a variety of national news outlets, including The Associated Press and Babble.com. Her work regularly appears in publications and on Web sites across the globe, including The Washington Post, the Los Angeles Times and CNN.com. She also covers Pittsburgh's philanthropy and nonprofit community for Pop City Media. A Long Island native, she lives in Hampton Township with her husband and two sons.


Pediatric Surgeon Goes the Distance to Save Boy's Life
In the days after the earthquake, many foreign doctors flew to Haiti to save lives. For Haitians with serious medical problems unrelated to the quake, this created a unique situation: If they could get to the right place, they could perhaps be treated by world-class doctors for free. In a country struggling with extreme poverty, it was an unprecedented opportunity.

During the Allegheny General Hospital group's trip, a 15-year-old boy named Kenson Jean was brought to the tents where they were working. He was malnourished with one leg so swollen that he couldn't walk. Dr. Mark Sangimino quickly diagnosed the boy with cancer. In Haiti, he could not be saved. So Sangimino hopped on a mo-ped and began visiting government offices, pleading for permission to bring the boy and his guardian to Pittsburgh for treatment. He did everything possible-lobbying government officials in person and working the phones to reach high-ranking officials in both countries-to save him. As the AGH team's visit was ending, Sangimino was still fighting to rescue the boy. He flew home but kept on lobbying. Finally, approval came, and he returned to Haiti to pick up Kenson.

In Pittsburgh, Sangimino and a team of doctors, including a specialist in orthopaedic oncology, operated for seven hours. It wasn't possible to extract the tumor, so Kenson's leg had to be amputated to save his life. He is now recovering. Well-nourished and in stable condition, he is learning to use his prosthetic leg. Kenson gets stronger every day.

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