be brave now... and proud later facing haiti’strauma
TRANSCRIPT
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Be Brave Now...and Proud Latery Linda Ruterbories, ANP and Joanne Leblanc, BSN, RN
Facing Haitis Trauma
Haiti, the poorest country in the Western Hemisphere, hadhallenges long before the January 12th earthquake devastated the
sland. Konbit Sante, a nonprofit organization based in Portland,
Maine, has been dedicated to the medical needs of Haiti, specifically
orthern Haiti, since 2000. The organizations name comes from
wo Creole words konbit, which means working together and
ante, which means health. Konbit Sante works with local medical
rofessionals at the Justinian Hospital, a medical training facility in
Cap-Haitien. This location was not directly in the earthquake zone,
ut both the city and Justinian Hospital have welcomed and aided
he injured, displaced and lost.
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Members of the team arriving in Haiti for the rst time
were simply not prepared for the reality of the poverty
and the distressing living conditions.
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Forming the team
OA Centers for Orthopaedics CEO John Wipfler, learned of Konbit
antes plan to send a team to Haiti through Mary Anne Ringle, a
rogram specialist at Konbit Sante. Ringle previously worked for
Wipfler on the Maine Health and Finance Commission. Wipfler asked
he OA Centers physician board if there was interest in participating in
Konbit Santes team, and when the response was positive, OA, in
onjunction with Maine Medical Center, formed a seven-person
olunteer team. Team members included:
OA Centers for Orthopaedics
Matt Camuso, MD, Orthopaedic Trauma Surgeon
Linda Ruterbories, ANP, Director of OA Surgery Center
oanne Leblanc, RN, Director of Clinical Services
Maine Medical Center
Brad Cushing, MD, Chief of Surgery
amuel Broaddus, MD, Chief of Urology
March Truedsson, RN, wound care nurse
Marieta Atienza, RN, wound care nurse
OAs Ruterbories and Maine Medicals Broaddus spearheaded the
urgical and wound care team. Dr. Broaddus, who has been traveling
o Haiti since before Konbit Sante was formed, has been affiliated with
the non-profit since its inception. Since 1994, Dr. Broaddus has vi
northern Haiti nine times.
The team members believed they could offer services that
needed, and that the connections in place through Konbit Sante
the Justinian would expedite the teams missionto offer
colleagues at Justinian Hospital specific surgical services in orthop
and trauma care. The team also agreed that nurses with wound
expertise would be of particular value.
Culture shock
Members of the team arriving in Haiti for the first time were sim
not prepared for the reality of the poverty and the distressing li
conditions. The sheer mass of people surviving not just the earthqu
but an obviously status quo poverty, was a devastating sight. Frommoment of arrival through the teams departure, it was apparent
there was neither space nor resources to accommodate the
numbers of residents. It was clear that no public waste disposal sy
existed in the country. Garbage is simply left on the side of the ro
Occasionally its burned to create more space. Housing consis
one-room metal buildings with openings for windows and doors,
no coverings across the openings. Many of these homes are built
the mountainside. Mud slides are inevitable due to the weather and
tin homes are often swept away. Yet the most surprising contrast
team saw was that no matter how impoverished the people w
eteamarrivesinCap-Haitien.
Dr.PierreLouisandDr.MattCamusodiscusstheinstrumentsOAboughttoH
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Haitians in Cap-Haitien were consistently dressed in their Sunday
impeccably white and pressed. The Haitian people are proud of t
appearance no matter where they are going or what they are doing
A cultural reality that was more pleasant, visually, was Ha
transportation. The primary source of travel within the city is in
back of pickup trucks or on mopeds, three or four people at a time
greater distances the solution is both unique and colorful
somewhat unsettling as well. Haiti has no official transit system. L
distance travel is facilitated by individually-owned, brilliantly-col
and artfully decorated vehicles called Tap Taps. These vehicles, prim
buses, do not have schedules or regular destinations. There are no
belts and the roads are bumpy. The Tap Taps travel only when a ve
is full and they transport chickens and goats as well as humans
the same time. The name comes from the fact that passengers tap on
metal of the bus or truck to signal that they want to stop.
Establishing relationships
Understanding the importance of building relationships in Haiti
the key to the teams success. Dr. Broaddus, over his 16 year
volunteer experience in Haiti has established successful method
building relationships. His extensive experience gave the team valu
insights in breaking down language barriers and understanding cul
differences. Nate Nickerson, Executive Director of Konbit Sante
also spent considerable time immersed in the Haitian culture. He
the team through the process of making initial contact with Dr. P
Louis, the sole orthopaedic surgeon in Cap-Haitien.
Dr.Louisand Dr. Camusoinsurgery.
Haitian transportation called Tap Taps.
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Dr. Camuso partnered with Dr. Louis. Together, they performed
everal surgeries, including a difficult lower leg fracture repair on a
oung woman, a dancer, who refused to have her leg amputated despite
he difficult, long road ahead of her during recovery from her
evastating injury. Dr. Louis expressed his gratitude to Dr. Camuso for
roviding their facility with the modern fracture instrumentation and
mplants that the team brought with them from the United States. The
wo physicians spent several hours together, discussing cases as Dr. Louis
mastered his new tools. Dr. Camusos personality and his finesse within
he OR facilitated a trusting bond between the two surgeons. The team
elt that the goal, which was to provide assistance and surgical expertise
within limited resources, had been well met. Dr. Camusos expertise as
trauma surgeon was instrumental in preparing Dr. Louis by providing
im with the knowledge and training he would need to operate on cases
hat might otherwise have been seen as hopeless or inoperable.
Reflections
When it was time to leave Haiti and return to their regular jobs in theUnited States, the team experienced frustration and sadness. Although
much had occurred, it seemed to the team as though very little had been
ccomplished. They felt they could have done more, saved more, and
een more help. Limiting factors such as sterilization issues, inadequate
taffing resources, time constraints and the inability to perform as many
urgical procedures as were needed, contributed to the teams
epression. The consensus was that they had not, as hoped, really made
difference in the days they had been in Cap-Haitien. It was painful to
eave patients behind. As team members transitioned back into the land
f plenty, it was difficult to forget the faces of those patients and
roubling to realize they might never know the outcome of the surgeries
hat did take place.In an effort to offset the frustration and depression these thoughts
rought to the team, Nickerson made a point of expressing his gratitude
nd emphasizing the value of the visit. He made it clear that in spite of
he overwhelming and difficult reality of Haiti (before or since the
uake), the teams contributions were in fact, invaluable.
Future plans
n the short term, Haiti has been supplied with resources that were not
vailable to them prior to the earthquake. However, many
mprovements made prior to the tragedy are now complicated by an
nflux of short-term solutions that obscure many more substantial long-erm solutions. Even so, there is hope that as tragic as the situation is,
t may prove to have a silver lining. By bringing Haitians more options
or working together, (konbit) and improving the quality of living for
ts population through health (sante) and knowledge, long-term changes
will become more viable.
The goal of Konbit Sante is to participate in the creation of a
ystem that encourages the Haitian people to take care of their own,
hrough increased knowledge and the ongoing ability to improve skill
evels. There is a focus on high-impact solutions with minimal resource
equirements. That is, how do you learn to do things differently with
the same limited resources?
The number of people critically injured by the quak
overwhelming. Many of the patients at the Justinian were transpo
from Port-au-Prince to Cap-Haitien. Orthopaedic fractures and wo
were complex. Recovery for the injured will be long and ardu
complicated by a lack of rehabilitation medicine. Living in Haiti
challenge in and of itself; becoming a paraplegic or an amputee
result of the quake simply compounds the magnitude of survival.
The assessments completed by Konbit volunteers identified
needs to be addressed. However, they also illustrated that the
challenge, given the current reality, is to determine how to intro
and maintain the changes. Are the changes that need to take place
feasible in Haiti? Will those outside of Haiti continue to suppor
efforts that surely will need to continue for decades? The long-t
outcome of this catastrophic event is impossible to predict. Yet fo
OA and MMC team sponsored by Konbit Sante, the effort
collaboration and relationship building will continue. The team p
to return to Haiti in the fall of 2010.
Linda M. Ruterbories, ANP, is the Director of Surgical Services and
gram Development at OA. Joanne T. LeBlanc, BSN, RN, is the Dir
of Clinical Services.