Bringing It All Together

They say, “It takes a village to raise a child.” Over the last few weeks I have been fortunate to be part of a worldwide village of committed volunteers that has focused on getting Tania the advanced care she needs to have a chance at a full and rich life. I first told you her story when I was in Milot last month. She is a 23 year old, vibrant woman, who has had multiple recurrences of a benign but locally aggressive chest wall tumor. I knew we were working to get her treatment in the states. Many of the hospitals that had taken the brunt of Haitian patients after the quake were no longer able to provide the levels of care needed. I did an evaluation and medical summary while in Milot and made some calls. So did other volunteers throughout the world. Several weeks ago, she was accepted for treatment at Johns Hopkins. Needless to say, this was very meaningful to me, although I had little to do with the actual application.

The work then truly began. We needed visas and clearance from both the Haitian and the American authorities, transportation, and support when they arrived in Baltimore. Emails and scanned documents traversed the web 24/7. At last count, more than 20 volunteers, many who have never met, were focused on getting her care. The plan was for a private flight from Cap to Fort Lauderdale this past Saturday, followed by a commercial flight today. As of Thursday, the papers had still not been completed in Port au Prince. We were concerned that things would fall apart. But we all had faith, and it worked. Visas were flown from Port au Prince to Cap Haitian. Tania and her mother left yesterday and were flown by Ed and his son to the States. Currently, aboard a Southwest flight to Baltimore, are Tania and her Mom, assisted by the crew who have been briefed and were very happy to help. Tania and her mother will be met by other volunteers and members of the Baltimore Haitian community. She begins her evaluation at JHH Monday morning.


In another confluence of fate, I have just returned from Baltimore, where I have just joined the Hopkins alumni council, as well as continued my work as my medical school class agent. During that time, I saw the commitment of the organization to not only provide world class care and research, but also never forget their mission of increasing access to those in need. Tania’s care will cost Hopkins substantial resources, but it was clearly something they wanted to do. I also had the privilege of meeting many medical students in a career networking symposium, and was able to share perspectives. Not surprisingly, most were committed to volunteer work as part of their careers.



In the lobby of the Dome at Hopkins stands a statue of Jesus. Hopkins is not a faith based institution, and the story of the statue reflects the times of the hospital's opening. Although I am Jewish, I have always felt a sense of spirit when entering the dome. I can only imagine how Tania will feel, 1500 miles away from her home, when she enters this healing place and sees the figure.

I have been doing a lot of self reflection over the last year, as my life and career are taking some new directions. At times I was cynical about peoples’ motivations, but have been refocused by participating in experiences like Tania, and the support of great educational institutions and the next generation.

Not only does it take a village to raise a child, but it takes continued human connection and support to help that child reach full potential at every age.

It's Been a Good Week

It has been a tumultuous and exciting week both on the world scene and within the workings of CRUDEM and Hospital Sacre Coeur. In a previous blogs I spoke of both the trapped Chilean miners as well as a young woman with a recurrent phylloides tumor who I was trying to get transferred to the States for care. Over the last few days, successes have come on both fronts with a combination of teamwork, ingenuity, and self determination.


As I watched the rescue of the miners, I recalled Apollo 13 and the can do attitude that brought those men home from certain death. “Failure is not an option.” And watching a multinational team work together, improvise, and never give up, reinforced my optimism for the future. If there was ever a rebirth, this was it.
At the same time, a smaller miracle was unfolding in Milot. Working with physicians, nurses, the state department, and innumerable volunteers, it appears the Tania will have a chance for a normal life. She isn’t here yet, but a major academic medical center has accepted her for care, Southwest airlines helped coordinate travel for her mother and her, and Ed Constantine, a longtime CRUDEM supporter and pilot will be transporting her out of Haiti after delivering supplies from Florida. Churches, and the local Haitian community will provide support while she is stateside.



As you look on these pictures, see behind the smiles to the joy of new hope and a chance to embrace the future. And hopefully, reenergize yourself to reach your full potential.

Have a great week.

A New Priority

As current reality settles in at HSC, it is clear that the old ways of maintaining inventory and supplies will not jibe with the growing demand and complexity of services provided. I wrote of our difficulties during the immediate post quake period, when truckloads of supplies and equipment would arrive unannounced and a scramble to prioritize and store what we needed ensued. We also found that in many cases, hospitals, despite best intentions, had sent broken, outdated, and inoperative equipment. We also relied on an open barter system with surrounding facilities, without any documentation, but with an eye toward meeting the needs of the patients.



During my most recent visit, I was pleased to see a large concrete slab had been poured next to the mission house. I remember the local men clearing the land by hand and I learned that the pouring itself took place by the wheel barrel well into the night. The results will be the start of a large, computerized and climate controlled warehouse. And as fate would have it, my professional and humanitarian goals would again cross.
As part of my second year at HSPH, I will be working through a practicum - generation a business plan, optimizing an operation, or launching a service line. Given my current career transition, I did not have a home institution, but was welcomed by my colleagues at CRUDEM to join the effort and contribute to the process. Much had been done and a contract developed with Steve Bardos and the Humanitarian Software Foundation, to bring bar coding and inventory control to both the hospital and pharmacy. I am currently coordinating with my advisor an appropriate role in this complex process and will be bringing you new stories of how we will meet the needs of our patients and support the mission of the organization.



So the enclosed pictures may not be as heartwarming as the children I have cared for, but I am thrilled that we will be able to provide an oasis of functioning infrastructure in a country that has so little.

A Taste of Haiti in the City of "Chowdah"

It was grey, 60 degrees and a fine mist was falling over Boston last evening. Not at all like Milot, but Sacre Coeur was on my mind. I had finished my leadership course for the weekend, and stayed in town to support the CRUDEM foundation’s “Taste of Haiti,” being held at the site of “Cheers” on Beacon Street. It would be good to see many others that had volunteered, and perhaps a few familiar faces. Use of the 2nd floor had been donated by the owners, and waiters circulated with plantain appetizers, chicken and coconut, and meatballs, that I was assured were not goat. Corporate donors, many of whom had provided hundreds of thousands of dollars of equipment were acknowledged, and seemed honored to have been given the opportunity to help. I did have a chance to speak with Dr. Peter Kelly, the ophthalmologist who has driven this effort, and had the faith to make me Chief Medical Officer my second day in country. We spoke about the new mission and how to continue the momentum in growth of services. I thanked him again for the experience.

The program was brief and included this video.

http://vimeo.com/14338219

In it, you’ll see many of the patients whose stories I’ve shared with you, including remarkable young people who are regaining their independence thanks to the prosthetics lab. Even though I wasn’t there at the time of filming, every scene reignited emotions, sights, and smells. Around the room were framed paintings from some of the artists that hawked their wares along the street. A photographer who had studied with Ansel Adams had completed hauntingly beautiful black and white prints and a book of the patients, and their families. And we heard that the plans were to continue to support Haitian self sufficiency. The prostheses are now being made by men from Milot, and monthly CME courses have been created for the staff to bring them all up to date on treatment of diabetes, heart disease, and other public health issues. They will be cotaught with local nurses and physicians, and the knowledge base solidified.

As I left into the dark of the Boston night, there were sirens, noise, and restless activity. I got into my car, closed the door and sat for a moment. We are all drawn in different directions, and sometimes fate places you into opportunities that you would not have planned. The last year has been one of new experiences, a recalibration of my priorities, and a great deal of uncertainty. But it has also restored my faith in the inherent goodness of man, that we should lead from the heart, and that each of us has the capacity to transform the world, even as we find ourselves.

Adversity and Leadership

The range of human adaptability to adversity continues to astound me. I have been privileged through my professional life to work with patients who are dealing with debilitating illnesses and lead others by example. My recent trips to Haiti have taught me that one’s attitude to adversity can profoundly affect subsequent recovery. And as I watch the trapped Chilean miners work to ensure their own survival, I am inspired by their pragmatism, optimism, and faith.

This weekend in Boston, we are examining the differences between average and great leadership. Central to great leadership is flexibility, the willingness to challenge the status quo, and the ability to engage others toward a common vision. I can only imagine how the miners have organized themselves and allowed leaders to emerge based on the need at the time. In our own lives, we can lead, or be guided by others; work collaboratively or strike out on our own without guidance. During medical training there is an emphasis on individual accountability and perfection. One of the paradigm shifts that physician leaders find uncomfortable is the ambiguity inherent to the task of leading effectively. We all will make mistakes in our assessment of the situation and deal with adverse outcomes. How we learn to integrate those into our subsequent decisions, and not allow them to undermine our confidence, will be the mark of future success.

I am confident that the miners trapped 2500 feet down will be freed. They will have been active participants in leading each other and determining their future. When you are feeling overwhelmed or helpless in your current situation, look upon the confidence of these men and be reenergized. They will soon see the light of day and be symbolically reborn.

Compassion Fatigue

Katrina…Darfur….Haiti…Tsunamis…Jerry’s Kids…Homeless families…Oppressed women and minorities….

The list is endless and seems to be ever expanding. We are constantly exposed to images and stories of our fellow man who is suffering, and we feel a visceral tug that makes us uncomfortable or sad, energized or determined. As health care providers many of us struggle with the feelings of compassion for the ill and the realities of what we can and should do. With the internet and 24/7 instant global news, how easy is it to become overwhelmed by the suffering, and instead choose to withdraw and shut down.

I heard a new phrase several times this week - “compassion fatigue.” The first was in response to a young woman I saw in Milot with a recurrent fungating, locally invasive phyloides tumor of the breast. It had been excised multiple times, only to recur. She was in the tent, her dressings changed by family and volunteers. At age 23, she was otherwise in perfect health. In the States, she could undergo a wide resection and reconstruction, but the capacity was not available in Haiti. I spoke to several CRUDEM administrators who had arranged transfers of similar patients to several large academic institutions in the US. I filled out a report, took pictures, and made contact. Everyone was sympathetic but the story was the same – we are tired of dealing with the quake victims and others from out of the country that will require a huge outlay of resources, with no ability to pay, even a small amount. Although you could convince administrators and practitioners to give of themselves early in the disaster (and they did), the emotional bank was dry. I had to examine my own motivations as to whether I was doing the right thing even offering the hope of a resection. The jury is still out – I am using some personal connections with other institutions and caregivers that weren’t as involved initially who perhaps still have some emotional reserve.

Compassion fatigue also came up during sermons over the recent Jewish holidays. While we examine our own behaviors and their impact on others, we must also be sensitive to the emotional suffering of our fellow man, even if they have hurt us. Beyond that, in most religions, making amends includes charitable acts as a component of repentance. But with world suffering seemingly enveloping us, how do we feel, and yet not be overwhelmed? And when others are not compassionate toward us, is it because of their unwillingness, or their inability?

I know that as both a surgeon and a parent, I often struggled to let down the clinical barriers when dealing with my family’s illnesses. I remember one of my children showing me a cut and saying, “OK Dad, there’s blood, does it count?” Over the last year, with both my professional transitions and new experiences, I’ve also learned that there are endless opportunities to be compassionate. If you can’t do it all the time, it’s OK, as there are others whose bank is more full than yours. Appreciate the moment, and the satisfaction of relating to another’s suffering and trying to relieve it. Concentrate first on those around you that you love, so that they can be energized and supported. Then do what you can for the world.

And if you feel fatigue, take it as a sign that you’ve truly given of yourself. Rest, recharge, and refill. There’s plenty more to do, and the magnitude and variety of the list gives you endless opportunities.

Milot Managerie

We city dwellers don’t always appreciate the variety of animals that are seen in an agrigarian society. Our meat, eggs, and vegetables come neatly from the store and we seldom see our dinner in the flesh. Not so in Haiti. Animals are ubiquitous, both free ranging and domestic, controlled by a loose understanding of personal property and natural selection.




The chicken population has grown dramatically around the compound and the roosters still don’t understand that they shouldn’t start crowing until dawn. (I quickly adapted, and actually woke up my first night home to car traffic that normally would have been ignored.) My morning run crossed one of the many drainage ditches that also served as dumping grounds; boars rummaged for breakfast. The cows were skinny and grazed freely;
there were multiple donkeys and mules used for portage on the steep slippery slopes. Our local dogs follow us throughout the area, but know enough to stop at the door of the hospital or dining hall. The cats are clueless to boundaries, but seem to keep the mouse population down.


Although Haiti is surrounded by ocean, we had no seafood, and the meat served with dinner was chicken or goat.

Goat! Then I realized that I hadn’t seen our pet, Beeg, who I mentioned in the Passover blog…

Not to worry. As the population in the Mission House drew down, Beeg found a new home over by the machine shop. He has a new lady friend, Mme Bovier, and rumor has it, there’s a little Beeg on the way.




Although sometimes we all have trouble living together as humans, in Milot, the menageries is alive, well, and thriving.