Henri Ford - Professor of Surgery, Son of Haiti

Sunset Boulevard is worlds away from the spine jarring road between Cap Haitian and Milot. Yet, as I moved slowly toward Children’s Hospital of LA, I recognized that those two worlds would coalesce soon.

Parking in the garage, I took the brightly painted Giraffe elevators to the 8th floor and the department of Pediatric Surgery. There were many familiar names of colleagues with whom I’ve shared lab results and meals at various academic surgical meetings. The Chief of Surgery is one such colleague, Dr. Henri Ford.


I’ve known Henri for more than a decade, as our paths crossed at meetings and other groups. He was the President of a major surgical society and always projected a calm confidence and humility. I knew he was from the Caribbean, but it wasn’t until after the earthquake, that I realized his roots were in Port au Prince. I asked him if I could stop over, not to talk about recruitments and academic politics, but rather about Haiti. He readily agreed.

Henri’s father was both an AME minister and director of immigration in the government. His spiritual core, compelled him to speak out on occasion and this led to a visit from the Tonton Macoutes. Realizing that future opportunities for his family would be limited, he moved them to Brooklyn, where there were some relatives. Henri was 14, and spoke no English. His parents made it clear that English was to become his first language, and he spent many nights struggling through standard high school English texts. During summer school, he met a tutor who was a junior at Princeton. Seeing Henri’s determination and drive she encourage him to apply.

He was admitted with a full scholarship.

Rather than rest on this accomplishment, he continued to accel and fulfill the expectations for himself and his family. Harvard Medical School, residencies in General and then Pediatric Surgery, followed by a stellar academic career in Pittsburgh and now Los Angeles. But he never forgot his roots.


Henri travels back to Port several times a year. He led a group immediately after the quake and you may have seen him with Dr. Sanjay Gupta of CNN, working in primitive conditions. As Haiti moves beyond the one year anniversary, Henri continues to be involved in organizing medical care and working for stability.

We talked of our various experiences and the frustration of not being able to provide even basic levels of care. He shook his head telling me of finishing somewhat advanced neonatal surgery, only to have the child die when he left. We talked of the “Haitian Diaspora” where well intentioned and committed practitioners become frustrated and leave for other countries. I’ve spoken of Jerry Bernard, who learned laparoscopy in the states, but does not have the equipment in Milot. He is staying, as is his internist wife, but I’m afraid they are the exception.

Aid will not flow to Haiti until the government stabilizes and faith is restored. In an ideal situation, 9 regional hospitals will be built, one in each district, and residency programs will train the next generation of providers. Haiti can learn from its successful island neighbor, the Dominican Republic.

But after all the theoretical talk, and the hopes, we both concluded that it will be a long haul. Why do we keep pouring our souls into what seems like an endless hole? Henri was quiet for a moment, then softly said, “Until I returned to Haiti, I didn’t know my raison d’être” I nodded.

In that small office overlooking the Hollywood Hills, two middle aged academic surgeons, successful by many external measures, shared a moment of what they both knew was truly important. And despite the challenges, they will return to Haiti, do what they can, and carry on with faith for the future.

Beauty in a Time of Chaos

On the way to work today, I was listening to NPR discussing the current unrest in Egypt. Apparently, some of the intensity has died down, but there has sprung up a large tent city in the middle of downtown. Protests continue, but people are also finding other ways to channel their energy.

They are making art from the trash that has been discarded by the thousands of people that gathered.

I couldn’t find pictures on line, but the descriptions are pretty uplifting. One young man fashioned a plane from plastic cups and rags. Asked what it represented, he said it was the way that Mubarak would be leaving the country. Others created Egyptian flags from scraps. They expressed their energy through creative development.
Even in the aftermath of the quake, the street leading to Hospital Sacre Coeur was awash with color. Although the vendors could be a bit aggressive at times, the art was remarkable. It celebrated the past, and the bright colors reflected the light with hope for the future. Even the brick wall, where the water supply faucet was mounted, was transformed into a street scene.
You express yourself where you can.

I was returning, and wanted to keep a small reminder with me of the people of Milot. One of the artists gave me this simple woven bracelet. The markings have faded with wear. Some of the pieces were local stones that otherwise sat on the roadside. It’s just string and stones, yet it is more. We all can look at an object, but feel the emotion that goes with it.

Trash is in the eyes of the beholder. Find inherent beauty and hope wherever you can.

In the Public Eye

The mobile TV vans and Kleig lights began to clog the streets around the hospital. In a well practiced protocol, security kept them at a distance, to assure appropriate privacy for patients and staff. Given our location it is not uncommon for high profile individuals to be treated here. Maintaining a professional level of confidentiality is foremost, and is pushed by those sighting the public’s yearning to know.

Such is the conundrum of being in the public eye.

The media has a powerful influence on society. Governments use the ability to control information as a tool to control their citizens. In the US, we discuss the rights of a free press and numerous Supreme Court rulings have sided with this right. In the past, significant events could be withheld from the public, if it was felt that knowledge would be disruptive. President Grover Cleveland discovered a tumor in his jaw several months after inauguration. Given his cigar smoking history, it was no doubt malignant, and the doctors of the day recommended excision. Cleveland was concerned that knowledge of his illness would be disruptive to upcoming legislation dealing with a financial crisis. After a delay, he arranged to be treated aboard a friend’s yacht as it sailed up the East River. Nitrous oxide anesthesia was delivered, and historical accounts suggest concern on the part of the physicians, as the patient was a set up for what we now know was sleep apnea. The surgery was successful as was a prosthesis placed to reconstruct his jaw and allow him to speak normally. All this was kept secret from the press, and reportedly, even the vice president.

Could you imagine that today?

We are struggling with finding a balance of full disclosure of every known fact or supposition and the requirement that some things need to kept within a limited group to allow free and open discussion, leading to well thought out recommendations. The Watergate affair profoundly changed our trust of government and placed the press in the position of both reporter and influence agent. In all of my leadership courses, I am learning how to interact with media and others in the public eye. It is a different set of skills.

Those that are at risk of being subjected to the glare of the media are also able to turn that harsh light in a more positive direction. I spoke of the Thalians and their work in mental health. Celebrities and politicians have been able to turn attention to significant issues like Rowanda, US illiteracy, “Jerry’s Kids”, and Haiti.

In the year since the quake, we haven’t seen as many of the positive stories as we have the riots, corruption and tire burning. So let me take a minute to use this public eye to pass on some excerpts from an uplifting note from CRUEM president Dr. Peter Kelly who just returned from Sacre Coeur.

PHYSICAL PLANT

Our physical plant has expanded to include a new maintenance building/warehouse on the land by the nutrition center. This will house the maintenance department and housekeeping department as well as be a storage place for their supplies. Next to it is the prosthetic lab and solar powered water purification system. There is a garage and service pit for our vehicles as well. Our new laundry building is on the rear of this property and the oxygen generating equipment is in a building next to the generator building. There are 2 new generators outside the building waiting to be installed.
When I arrived there was a team of 20 volunteer electricians from California who were completing rewiring of our hospital. All of the supplies needed to do this were donated. These volunteers worked 16 hour days to complete this job without disrupting patient care.
A team from CRS arrived to discuss the addition to our lab. They feel that this can be completed by the end of February. Their opinion was that our lab was the best they had seen in Haiti and with our addition we will be able to perform testing that is not available elsewhere in Haiti.
CRS is also coordinating a network of Catholic hospitals in Haiti and we are part of that network. They are instituting a post graduate training program for nurses and physicians and will fund the renovation of our auditorium and provide the equipment to allow us to participate in this program. They will also fund the conversion of a room on our housing compound into a library with computers and internet access so the students have a place to study. Finally they will fund the conversion of our existing depot into a 2 story housing compound with rooms, bathrooms and common areas for 52 volunteers and students.
The reason we are able to convert our existing depot into housing is that we now have a large storage building called a sprung building that was donated and constructed behind mission house. This building is 60X100 feet and 30 feet high. We have shelving that extends to the ceiling and a forklift to enable us to move supplies. We have contracted with a bar coding company( thanks to a generous donation) to bar code all of our supplies. This will enable us to track our usage and needs. Representatives from the bar code company were at HSC this week beginning the training and implementation of this system. There were also volunteers helping with moving and organizing the supplies. We will be able to access this system by the internet so we can coordinate our donations and also volunteers can see what medications are available and what are needed for their trips.

EDUCATION

We held our first week long symposium in January. The topic was Diabetes Mellitus and we invited physicians and nurses from other hospitals to attend. We had speakers from the US and Haiti who were experts in Diabetes Mellitus. It was standing room only for every lecture and at the end of the week over 300 people were screened for Diabetes and Hypertension. It was a tremendous success thanks to the efforts of our education committee. We have 3 more symposia scheduled for this year. Emergency medicine/ ICU in March, neonatal care in May and pediatrics in June.
During the earthquake relief efforts it became apparent that their was a need for a nursing school and post graduate nurse practitioner program. We have been in discussion with Northeastern University, CRS, Malteser International and the Minister of Health to determine the feasibility of beginning these programs. We are hopeful that we will be able to work with the Catholic healthcare network in Haiti to begin construction sometime in the next year. Our goal is to ensure that these programs are sustainable before we begin construction. Until we are able to begin we have started a scholarship program to send 10 students a year to nursing school in Port au Prince. They will do their clinical training at HSC and will commit to returning to HSC when they complete their training. We had a testing and screening program in the fall to choose the 10 candidates from the town of Milot. They began their training in November with much excitement from the students as well as the town.
Finally we purchased land to the east of the hospital which can be used to expand the hospital and build new clinic areas and cafeteria for the staff. We are developing the plans for this expansion with the assistance of an architecture firm from Indianapolis who are donating their services. We will be beginning in March the public phase of a capital campaign to finance this expansion.

PATIENT CARE

The cholera outbreak seems to be decreasing. When I arrived there were 14 cholera patients. During the week it increased to 25 but had again decreased to the teens by the end of the week. The patients are arriving earlier so they can be controlled quicker and discharged sooner. Our public health teaching seems to be having an effect. The bulk of the care is being provided by our Haitian staff with volunteers working side by side. We try and adjust our staffing needs based on our volunteer numbers.
At the present we have 119 part time Haitian staff in addition to our 250 full time staff. Most of the part time staff are nurses and housekeeping. We currently have the following Haitian physician staff: 3 Internists, 1 General surgeon, 2 full time Family Physicians and 1 part time, 3 Pediatricians, 3 OB/Gyn, 2 General Practitioners, 3 Social residents, 1 part time Ophthalmologist. Another General surgeon will be starting in March and an Internist in February.

Perhaps this won’t raise network ratings as much as the latest riot or celebrity breakup, but in my book, it has a whole lot more impact on what we strive to be as people and a society.

Have a great week, and try to keep your mug shot off the front page.

Mental Illness from A Societal Perspective and a True Walk of Fame

He is a fixture outside the gates of Hospital Sacre Couer. A tall disheveled man, in his 50’s, he paces along the sidewalk, yelling obscenities, and gesturing wildly. The locals keep an eye on him, and by evening, he has disappeared, only to return the next day. I never felt concerned, and it appears that he has struck a peaceful coexistence with his fellow citizens.

A vivacious, eloquent English teacher, she began to forget names and addresses in her early 50’s, and rapidly developed early onset Alzheimer’s disease. Given her otherwise good health, she required nursing home care for 15 years until her death.

Another young man is introspective and well groomed. He sometimes laughs inappropriately, seems to have problems with impulse control, and understanding social norms. He has been diagnosed with Asperger’s syndrome, and his parents are at a loss of what to do.

A brilliant surgeon at the peak of his career suffers a bicycle accident. Despite a helmet, his brain is injured enough that it leads to a significant personality change. His ability to support and enjoy his 5 children is altered forever.

…and then there the Tuscon shooter, whose unclear need for recognition and driven by as yet unknown demons, killed and maimed many. How can he be included with the others?

Such is the broad spectrum of brain and mental illness. And along that continuum is how society chooses to deal with the victims.


In medical school we learned of French physician Philippe Pinel who supervised the unchaining of mentally ill patients in 1794 at La Salpêtrière, a large hospital in Paris. Pinel believed in treating mentally ill people with compassion and patience, rather than with cruelty and violence. Prior to that, the mentally ill were subjected to restraint and torture. In museums, I’ve examined trephines, used to drill holes in the skulls of the insane, in hopes of releasing the spirits. In some cases, the fortuitous draining of a traumatic subdural hematoma led to clinical improvement and reinforced this therapy.

The age of modern psychoanalysis began to bridge the gap between spiritual dogma and an appreciation of the complex responses of the human brain to outside stimuli, including trauma and abandonment. As we have gained the ability to watch the brain function in realtime, using functional MRI, addictions, schizophrenia, and depression are being redefined at a molecular level. New and more effective therapies will be developed.

Yet we all have twinges of discomfort when we see the homeless on the streets and wonder if they are just looking for their next drink. We debate gun control after shootings, without understanding that increasing social isolation may be the driving factor in these senseless events. We have no problem donating money for kids with cancer, but sometimes it is difficult to get behind calls to increase funding for mental health. As a society, we all suffer, yet it still remains in the shadows.

I park my car behind The Thalians building here at Cedars. The sidewalk out front has stars in it just like Hollywood Boulevard. Yet I didn’t recognize any of the names. When I went to the website, I learned that The Thalians was founded in 1955 by a group of young actors and allied professionals from the film industry who wanted to give back some of their blessings to the community. They met at actress Jayne Mansfield’s home to discuss how they could use their time, talent and energy to help children with mental health problems. Taking the name from Thalia, the Muse of Comedy and the Shepherdess of straying and lost lambs, the first Hollywood “celebrity” charity was born, and just four short years later, The Thalians Clinic for Emotionally Disturbed Children at Mt. Sinai Hospital was established. When Mt. Sinai and Cedars of Lebanon merged, The Thalians pledged $1 million toward the construction of the first building on the new campus, which was named in their honor: The Thalians Mental Health Center.

Each star represents a significant donor and from what I understand, the annual Thalians Ball is not to be missed, even if it wasn’t at The Playboy Mansion.



The way to eliminate darkness is to expose it to light. As you may have surmised, other than the Arizona vignette, all the people I mentioned, I know. Some are family members. Treating mental illness may not be as quick or dramatic as resecting a pancreatic tumor that encases the portal vein, but the long term return on investment for the patient, those they love, and society, can’t be underestimated.

In Haiti, there are few handguns, and the mentally ill would have a hard time wreaking large scale havoc with a machete. The US is different. Means for destruction are easily available. We can only hope that young men like the Columbine shooters and Loughner are recognized and helped before they explode again in violence.

Dr. King and "Baby Doc" 25 years later

“Wanted – charismatic leader for an oppressed population. Highly challenging position with success uncertain. Must understand a strongly ingrained culture of fear distrust, and intimidation. Unlikely to remain in position long enough to complete duties as assigned.”

Today we celebrate the 25th anniversary of Martin Luther King Day and pause to realize that Dr King’s dream continues in its struggle to reach full potential. In the more than 30 years, since his murder in Memphis, we have an opportunity and achievement gap, and it is not just the black population that suffers. Our country has become more divisive than in my memory, and it seems that we can only be drawn together by tragedies like the Tucson shootings, 9/11, or the occasional miracle like the USAir successful ditching in the Hudson. Dr. King spread energy and belief across all sectors of society and encouraged us to reach within ourselves to find the common core of our existence as one people. I am in awe of what he was able to do, and wonder where we would be now, had it not been for the bullets that ended his life, as well as that of RFK in 1968.

Another leader is back in the spotlight after 25 years – Jean-Claude “Baby Doc” Duvalier made a surprise return to Haiti, after his forced ouster an exile in France. Only 19 when he assumed the Presidency from his father, “Papa Doc,” he continued the oppressive style and corruption. Opponents routinely disappeared, and the sunglass wearing “Tonton Macoute” symbolized unrestrained power and terror. By the time he left, many believe he embezzled as much as $500 million. Arrest was threatened, if he returned.



Yet, last night, at the Port au Prince airport, he was met with cheering crowds and provided a police escort to his high end hotel.

Haiti remains essentially rudderless. Its elections have been seen as fraudulent, and it is unlikely that the runoff will be completed and certified before the current President Rene Preval’s term expires. It is likely Haiti will be without a president. Just as nature fills a vacuum, Duvalier’s exultant return is too coincidental to be happenstance. Why would the average Haitian support a dictator? Just as in Iraq, under Sadaam Hussein, things seemed to run better, even if there was rampant corruption. We will turn the other way, if it means that our children will have food, and the schools are safe. What is most sad about the Haitian situation, is that these descendents of freed slaves are oppressing their own breathren.. Dr King fought an open racism, the Haitian people have a far more insidious enemy.

My biggest fear is that the lack of a stable government will further thwart the influx of needed resources to rebuild Haiti as a nation. The work of organizations like CRUDEM will bring the occasional beam of light to the gloom, and their commitment will not waver. However, large scale involvement by the outside world will wait, until those committing their blood, sweat, and tears know that the help will reach those that need it.

I have spent time in Selma, Alabama, starting point of Dr King’s march to Montgomery. Mornings, I would run across the Edmond Pettus bridge. In the cool light of dawn, I could imagine the mounted police waiting on the east side to drive the marchers back. And in the wind, the sound of the people, black and white, of all religions, inspired to look beyond themselves.

“We shall overcome. We’ll walk hand in hand. We shall all be free. We are not afraid. We are not alone. The whole wide world around. We shall overcome, someday.”

Baby Doc, the world is watching, are you listening?

An Anniversary that I Wish We Didn't Have

One year ago, the long suffering Haitians were subjected to a disaster of unprecedented magnitude. Rather than wax philosophical, I thought it best to forward this note I received as a CRUDEM volunteer, from our President, Dr. Peter Kelly:


January 12, 2011
Dear Friends,
A year ago on January 12, 2010, Haiti endured the worst natural disaster ever to strike our hemisphere. The massive earthquake killed an estimated 230,000 people, injured over 300,000 and left over 1,600,000 homeless.

It got worse. A hurricane, floods and a devastating cholera outbreak ravaged this struggling and impoverished nation.
Over the past year, your generous support enabled CRUDEM/Hôpital Sacré Coeur to:
Treat over 1,000 earthquake victims and their families and perform over 800 surgeries to repair serious earthquake injuries
Install one of the first prosthetic labs in Haiti and fit 41 and counting prostheses
Treat over 1,100 cholera victims, almost a third of them children
Host over 1,600 medical and non-medical volunteers
Send almost $20 million in donated supplies for disaster relief.
All the while, CRUDEM/Hôpital Sacré Coeur continued to provide first class, tertiary care hospital services to the North region’s 225,000 residents.
In keeping with our commitment to put our our Haitian sisters and brothers first in line:

100 % of funds and supplies raised for Disaster Relief were sent to Hôpital Sacré Coeur.
CRUDEM/Hôpital Sacré Coeur has been in Haiti for 25 years, and that’s just the beginning. We are in it for the long haul. No matter the number of disasters or their daunting challenges, we will keep our vow to create a healthier Haiti, one dignified life at a time.
On behalf of the people of Haiti, thank you for your continued support! YOU have moved mountains and put countless men, women and children on firm footing.

May God bless you and your loved ones!
Sincerely,

Peter J. Kelly, M.D.
President
CRUDEM/Hôpital Sacré Coeur

Thank you all for your thoughts and support. May the light of a new and better year shine on the people of Haiti.

Harry

Planes, Trains, and Automobiles

“Get your kicks on Route 66”

Over the last four weeks I’ve traveled about 20,000 miles and experienced multiple Americas. From commercial aircraft flying from East to West and back, the driver’ s seat of an SUV cruising along the Arizona /Mexico border through border patrol checkpoints, or the Amtrak Acela, returning to Providence for dinner with a colleague, I appreciated the diversity of our country, and developed a greater understanding of the things that both divide and unite us.

I started my new position in LA January 1, and we had already packed the apartment in Providence in early December. There was the trip to Haiti, then a flight from Milot to Port au Prince to Kennedy, and then on LA so I could be fingerprinted for my license, find a rental property, and finalize the job details. Cars and Chester still needed to get from East to West, so a long drive was in order to arrive by December 28th. Finally, I was to come back to Boston, January 6th for my health care management course. I had made arrangements to catch up with Rich Goldberg, Chief of Psych at Rhode Island Hospital and the Miriam, and now SVP for Lifespan Network Development, who is a friend and fellow graduate of the Boston program.

You truly don’t realize the grandeur of this country until you drive from one end to the other. I’ve flown enough to have recognized landmarks and cities, appreciated the circular irrigation pattern in the high plains, and reveled in watching a thunderstorm from 36,000 feet, the cloud to cloud sparks lighting the night sky. But as Rhode Island faded in the mirror, I was looking forward to the trip down 95 and across Virginia, Tennessee and the South. Finding dog friendly hotels was easier than I thought and appreciating the rise in the terrain, the change in vegetation, and the new accents and voices on the radio made for a surrogate marker of the trip’s progress. Transitioning from bumper to bumper around New York to seeing no one else for miles around in the Bayous of Louisiana, I realized that we adapt to our environment, and develop attitudes and mores that work for that region. We bemoan the dissent in Congress and the narrow mindedness of those who live in other regions than ours, yet it became perfectly apparent why those differences occur. And I can only imagine what early settlers felt as they gazed across an endless dessert, and worried about survival.

Airplanes are efficient ways to travel, but the time warp doesn’t always give you a chance to appreciate how far you’ve gone. Most airports look the same, although a few have nice amenities (the rocking chairs in Charlotte.) On a trip from JFK to LAX, a former cast member of Saturday Night live, sat down in front of me, he was clearly fatigued and appreciated that his fellow travelers left him alone. From what I could tell, this New York – LA trip was repeated on a frequency similar to many of us traveling on a regular basis from Providence to New York. In five hours, we had crossed 2500 miles and 3 time zones. It was dark when we left, and dark when we landed. Quick and yet sterile. In some ways we’ve made flying so easy that it’s lost its adventure – but that’s for another blog.



Before moving to the East Coast, my experience with trains was going from Chicago to Canton, Ohio on the Broadway Limited, when I was in college – a completely different way to experience America. I would have flashbacks to “The Sting” and met quite a few unique personalities, who had plenty of time to talk in the bar. The Grand Stations built in the 30’s always make me think of my parents traveling, or young men in uniform, returning to their base. You would get snapshots of America, and I always remember the smell of jelly as we rolled through Orville Ohio, home of Smucker’s. Even today, the Acela is my preferred way to go to New York, although the food is a bit more like the airlines. I took Amtrak Sunday night from Boston to meet Rich. Walking up the steps at the Providence Station, I immediately thought about finding the car and heading back to the East Side. Took a minute to reorient, and I had a great dinner and chance to reflect on the past and the future. Train back that night, a plane to Baltimore yesterday to see Rachel, who just got back from France, and I’m currently following the sun back west on Delta. Hop in the car and will still get into the office.

BTW, the picture is of the Salton Sea from the car heading to LA. The light was perfect, and I stopped to capture the moment. Flown over it multiple times as the LAX departure corridor is right there, but I felt it in a different way, having driven over multiple days and thousands of miles. There are new opportunities in California – there are friends and family back East – and in between is an amazing collection of geography, cultures, and experiences that we call America.

Route 66 was the road to dreams from Chicago to California. On your bucket list should be a Coast to Coast drive. And let me know what new perspectives you find.