Going Home, Moving On

There was a clear sense of increased energy around the compound this morning. Not only was it Palm Sunday, but 23 earthquake victims were going home, and some degree of normalcy was slowly returning to Hospital Sacre Coeur.

The hospital was originally conceived to serve the population of Milot and the surrounding towns toward Cap Haitian. Care is on a fee for service basis, and families are responsible for daily care, including feeding their loved ones. They stay in the main hospital, and vendors position themselves at the entrance, selling drinks and meals. The hospital rates are $5 /day, but that is still difficult for many Haitians. You cannot have elective surgery or be discharged until you pay. Across the street, in the tents, by law the patients cannot be charged, and since many are without family, food is provided. There is running water for washing in the central courtyard. Needless to say, there is some quiet tension between the local population and the quake victims. The victims themselves are anxious to return to Port au Prince, and the local hospital staff, though wishing to help their countrymen, tended to be more responsive to their neighbors.

So there was mutual relief and a celebration when the brightly colored buses pulled up to the gate. All the patients were given a letter stating that their care was free and they were medically stable. Not all of them were fully ambulatory, and some would ideally have some revisions – but that could be figured out closer to home. The equivalent of the Red Cross provided basic hygiene packs, extra suitcases from Crudem volunteers were donated to pack, and the process began. We needed 3 buses for 23 patients, because many had family, walkers, and crutches. It took a couple of hours, but they eventually rumbled down the road to return to familiar surroundings, and try to rebuild.

Last night, I met with the hospital director, and we went through the census, both of the tents and the main hospital. “It is time to put the quake behind us, and get back to work.” He had completed renovation of a bright pediatrics ward, complete with a separate NICU, in anticipation of CRUDEM volunteers coming in a month to train the Haitian staff on neonatology. We would be able to get some of the children out of the tents and into the hospital. The remaining quake victims will have more room, and resources, such as bottled water, would be less strained. Consolidation of services, proximity of production to consumption, payor mix - all the issues I’ve been studying this year in Boston, were here in Milot.

Part of getting back to work, meant seeing the pent up demand by the local community for surgical services. So this morning we had clinic. By 830, over 130 patients were milling around the courtyard. We had three new surgeons arrive, and everybody took an exam room. The majority of the cases were straightforward - hydroceoles, hernias, breast masses, and the occasional gallstone. The younger surgeons asked if I could help them on that one, since it would have to be done the “old” way – open. The Haitians also want every lump and bump removed – not because of fear of cancer, but rather due to cultural mores I don’t completely understand. Evaluation and booking took 3-5 minutes. By the end of clinic, we had scheduled 6 cases in each of 2 rooms for each day. We still have the 3rd room for ortho and other quake related surgery. I’ll be playing traffic cop as well as surgeon this week.

I did have a chance to walk to Milot and experience my first Palm Sunday mass. People were dressed in their best and a few came into the church early to get a good seat. I only took one picture before the service to give you a sense of the naturally lit sanctuary. The band backing up the choir had drums, electric guitars, and a sole trumpeter who was warming up. I didn’t expect to recognize anything as the tunes had a definite island flavor. Then I heard the notes of “Amazing Grace.” It was only the first few bars, and I found myself again reflecting on the universality of the human experience. The noise outside increased, the bells began to ring, and suddenly the church was overwhelmed by families from the procession, carrying palms, and rapidly filling the pews. After a moment of quiet, the doors reopened and the priests and alter boys entered. I watched as the incense was lighted and placed around the alter. Words that were clearly Latin were uttered, and the congregation broke into Creole song. Here I was, a white Jewish kid from Ohio, being filled with a sense of hope and energy, just by being with my fellow man in their moment of community and prayer
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I started back shortly thereafter. It was cloudy and cooler today. As I was walking down the shaded cobblestone streets of Milot, my radio crackled. “Dr. Sax, Dr. Barnard (the local Haitian surgeon) is starting his incarcerated hernia in room 2. He’d like your help.”

I smiled at the thought of a straightforward general surgery case. It is time to get back to work, and for the people of Haiti, to some degree of a normal life.