What is happening in Haiti that you are not hearing about on the news
In a text message to a friend on Thursday, Rob, a visiting med student sums it up: “Things are insane, but only slightly more than usual”. Sometimes it takes a first time visitor to recalibrate my assessment of a situation.
I was called to the ER at 1am on Wednesday morning to take care of a patient. The ER is less than 100ft from my house. On my way over I hear machine guns in the distance. We hear gunfire regularly but I am surprised to hear it at that time of day. After resolving the issue in the ER, I come home and sleep for a few hours until 5:37am when Jacques our cast tech calls: “Doktè Scott – pa soti kouri maten an” – don’t go out for a run this morning. I ask why. “you will find out” he says in Kréyol. So I take it as a good excuse to relax and get a bit more sleep.
Only a few minutes later Patrick is at my door with the announcement that President Jovenal Moïse was assassinated a few hours earlier. He heard it on the radio – no further info was available. The day starts to unfold with silence and a general feeling of sadness, doom, and uncertainty.
People are told to shelter in place, but a few employees and our construction crew show up to work. I soon hear that the airport is closed and check FlightAware which shows that the American Airlines flight from FLL has turned around and is heading back to Florida.
We spend a good portion of the day checking the news, wondering what will happen, and reassuring friends and relatives that we are OK. The number of people concerned about our safety and well-being is truly remarkable. Initially friends on the east coast start texting me and then a short time later the west coast wakes up and another wave of messages arrives. By 10am my phone is going dead. The situation around us is uncertain but everyone should know that here on our campus things remain calm.
Only two determined patients showed up to the clinic on Wednesday. Our staff who worked the night before stayed on for the day shift because most of the day nurses were holding at home until more information became available. Our ER doctor stayed for another 24 hour shift which ended up being the 2nd of four continuous days and nights he worked at the hospital. The director of nursing and others on duty ended up working most of the week without being able to go home as well.
The last couple days of the week ended up being extremely busy. Most everyday we receive gunshot wounds in addition to motorcycle trauma and pedestrians who often become victims of the unruly traffic patterns. The MSF (Doctor’s Without Borders) hospital down the road temporarily closed almost two weeks ago after sustaining damages from gunfire. Fortunately no one inside was injured. That facility is located in the heart of Martissant which is the most feared hotspot for gang warfare. The only major route from all of southern Haiti into the center of Port au Prince also passes through this area and it has been impassable for most of the last month. This has made it extremely difficult for us to access oxygen, fuel and other essentials. Trips to and from the airport have mostly been impossible. Our driver Mr. Michel is always monitoring the situation and keeps us out of danger, albeit at the occasional expense of cancelled flights or changes in plans.
An overall update of the amazing and miraculous things that are happening here at Hôpital Adventiste is long overdue. This is a subject of its own and will be left for another post in the near future. But in the meantime know that in spite of all the strife, in spite of so much evil around us, and in spite of all the challenges, we continue to operate at full capacity. It is nothing short of miraculous that our generators continue to run without interruption, our oxygen supply continues to flow, and the patients we serve continue to receive amazing care. The recent events remind us all the more about the importance of continuing on in this work.
Good News at HAH
The Lord is my light and my salvation-
whom shall I fear?
The Lord is the stronghold of my life-
of whom shall I be afraid?
When the wicked advance against me to devour me,
it is my enemies and my foes who will stumble and fall.
Though an army besiege me, my heart will not fear;
though war break out against me,
even then will I be confident.
This is one of the many Psalms that we came particularly close to in the past few weeks. The joys and victories of working at a mission hospital in Haiti are occasionally disrupted by moments of angst and trouble. Life here is intense. Many emotions can be squeezed into small periods of time. Christmas was a particularly intense time for us. Irma and her father were kidnapped as most of you heard. Due to security concerns we took down the Haiti Bones website for a couple of weeks as it was more appropriate to defer any information to official church websites. Just as intense as the anxiety and sadness that we experienced during those 4 days and 4 nights was the relief and joy that succeeded. We embraced each other during and after this event like never before. We came closer to God and matured more in a few days than we would have during years of peace and convenience. We continue unwavering in our commitment to HAH and the work here in Haiti. We are taking additional measures to assure the safety of our foreign volunteers as well as our hospital staff. There certainly remain some inherent dangers to living and working in Haiti, but we are doing what we can to take proper precautions and allow hospital services to continue without disruption. We are still hosting short term volunteers on a limited basis and welcome those who understand the risks and benefits of serving in Haiti. Thank you to everyone for your continued support!
HAH is Not on Autopilot
The challenges of working in a foreign country where resources are limited and political strife continues to threaten may never allow us to be on autopilot or operating by remote control. Hôpital Adventiste d’Haiti is a complex machine and we are not on a short or easy journey. Strong headwinds slow us down and at times we have to navigate turbulence. Thankfully we have been blessed in so many ways this year which enables us to have the energy and resources needed to move forward in the right direction.
I love construction projects and we have had a lot of them lately. These help to reflect the quality of the care we give our patients and create a work environment that is effective and organized. We also have worked hard on a number of less visible projects this year which involve meetings, spreadsheets, and planning. All of these efforts are continually kept in context with our mission to continue the healing ministry of Jesus Christ by providing quality care to all classes of people. The end result is measured when you see patients rolling out of the operating room, clinics overflowing with people, and life changing differences taking place in the lives of those we serve.
A brief chronology of events over the last 6 months begins with our return to Haiti in early July several days after the PAP airport opened up. It had been closed for 4 months. C19 in Haiti peaked in late May and has since been relatively dormant. More recently we have only had a trickle of new cases and the per capita death rate is only about 1/50th of that in the US. Travel has been by and large trouble free without any significant restrictions between Haiti and the US. Although less than normal, we have still hosted students, orthopedic residents, and other visitors coming to volunteer at the hospital. Ironically you might be safer coming to Haiti now then if you stay home.
In August Tim and Annika Cleveland moved here from New Mexico to join our team. Tim is an orthotics and prosthetics technician and is restarting our O&P program in collaboration with the Loma Linda University School of O&P. This program previously existed for the first 5 years after the earthquake but eventually lost momentum due to financial constraints. Tim is talented in a number of areas and has been a huge help with our renovation projects and repairing all types of equipment around the hospital. Annika is an ICU nurse and clinical educator. Her skills are being put to use organizing our nursing department and launching our intensive care unit with Jorielyn which will hopefully become a reality in 2021. We have an amazing family of long-term volunteers, each with unique skills. Stay tuned for subsequent blog posts that will introduce you to them.
In September we moved our physical therapy department to the polyclinic building. In the masterplan this building will eventually be replaced by a new hospital ward. It was quite run down, but with a couple weeks of cleaning and painting we fixed it up as a temporary home for rehabilitation services which will include orthotics and prosthetics.
In October the dilapidated modular structure that housed PT was demolished and two shipping containers that were behind the building were moved into the volunteer housing area. Tim is working on turning these into two small container houses. This is all in preparation for the construction of a new rehab complex. We are now finalizing contracts for that project which we hope can start in early 2021.
In November Irma Henry our physical therapist, Corey Fuller LLU ortho surgeon and I took a trip to the Cure Hospital in Kijabe, Kenya. We taught a limb lengthening and deformity correction workshop for the Cure surgeons in order to train them on some specialized techniques using hexapod external fixators. During this time we operated on a number of difficult cases. Overall it was a rich learning experience for all of us. Cure currently operates about 8 children’s surgical hospitals mostly in Africa. Their mission to heal the sick and proclaim the kingdom of God is impressively implemented. It was an inspiration for us to work with their doctors and staff. Although the short trip was a bit exhausting, we returned with a renewed energy, set some new goals, and had a renewed sense of gratitude for some of the unique blessings that we have at our hospital.
Now in December the year is coming to a quick end. JT Haas and my dad came to work on our electrical system and data network. JT is an excellent electrician who has been here a number of times in the past. The complexities of running a mission hospital in the modern world require the expertise of many people. My grandfather working in Africa in the 1930’s only needed to know enough about electricity to turn on lightbulbs. Now we have issues to solve that involve 3 phase electricity, 200KV diesel generators, solar panels, lithium battery packs, inverters, and backup electrical systems to protect sensitive electronics, servers, and imaging equipment.
In addition to the rehab building project and creation of an ICU we have several other significant projects prioritized for the upcoming year. These include relocating the ortho clinic, creating a reception area in the front of the hospital, solar and backup power installation, employee bathhouse, and renovating our nurses stations and patient rooms. In addition, we are working on some less visible projects such as streamlining our stockroom and purchasing processes, quality improvement initiatives, health and wellness programs, and augmenting our spiritual life department. Most importantly we hope to take care of even more patients next year and allow our hospital to grow in volume and quality. This is not a fundraising appeal, but if you are looking for an opportunity to make a meaningful difference then we can help. You can be assured that your donation will be carefully used and bless the lives of many in need. See www.amistadinternational.org and designate Scott and Marni Nelson fund.
As you can see with all the great help and support of generous donors many exciting things are happening at Hôpital Adventiste d’Haïti. I would like to express my gratitude to all of you who are part of this effort. With all the setbacks of 2020 your generosity takes on an even greater significance.
Merry Christmas 🎄
On the afternoon of March 19 president Jovenal Moise of Haiti in a press conference announced the results of the first positive COVID test in Haiti. At that moment he declared the Port au Prince airport closed and not another commercial passenger airplane has landed since that time. I happened to be on a short now turned long trip to California where I had planned to work for a few days at Loma Linda University. After several attempts to return to Haiti and multiple reservations that continue to get delayed by the airlines I am still in California working on many hospital related projects, administrative initiatives, equipment acquisition and remote management of hospital renovations. Marni was in Haiti when the border was precipitously shut down and was able to return on a repatriation flight. So although many have expressed concern for us being displaced from our home in Haiti during the pandemic I assure you that no one needs to feel sorry for us at all. We have been graciously hosted in a beautiful and peaceful guest house of some good family friends in Redlands.
Most of the expatriate hospital staff returned to the states as there was mounting political unrest and threats towards foreigners that were viewed as vectors of the coronavirus. It was not without significant reluctance that the decision to bring foreign staff back to the United States was made. We have a wonderful team both foreign and local that despite being geographically separated have continued to work together in order that the medical outreach can continue at HAH. I continue to spend almost all of my time on HAH projects, meetings, planning, and acquiring needed equipment.
At present the number of COVID cases in Haiti is just under 4000 with 67 deaths which is quite low compared to other countries where the human immune system is more coddled than in the streets of Port au Prince. We certainly cannot attribute this low death rate to an advanced medical system that is accessible to all. At HAH an abundance of precautions have been taken and like many hospitals in the US, the census is low, outpatient clinics are slower than normal, and efficiency has declined significantly. This has had an obvious impact on revenue, which has mandated unpaid leave for many of our employees. Without government aid and personal resources this has created some incomprehensible challenges.
Jonathan Euler deserves great accolades for weathering the pandemic without missing a beat. He has remained in Haiti throughout and been a huge blessing to our hospital as well as the 15-20 workers who have been able to maintain employment during the last several months. With less than normal numbers of patients we have taken the opportunity to complete a few otherwise logistically difficult projects. We were able to shut down the food service for a several weeks in order to complete the remodeling of the kitchen. This has been a much needed project that included some electrical work, replacing a few appliances, some new tile, painting the walls and fixing lights and fans. The difference is dramatic and the cost for the entire kitchen and dining room makeover was less than what a kitchen remodel would cost at your house. The simplicity of the construction will make the kitchen easy to keep clean and maintain while standing up to the rigors of cooking hundreds of meals every day.
Another major project has been the resurfacing of the floor in the main corridor of the hospital. After great deliberation we decided that the practicality and look of the original green hospital tile was the best choice for this project. These tiles are made locally, are very robust and equal or less expensive than other options. The tiles are also less slippery and do not show dirt and imperfections like some of the more modern choices. The old flooring had withstood 40 years of abuse and been patched in various places. Our gurneys can now roll smoothly through the hallways without having to go over ½” drops where new and old tile converged. (No more yelps from our patients as they were jolted over these speed bumps while rolling down the hallway with fresh fractures.)
On the medical front Dr. Geneus has led the staff through appropriate protocols and precautions. A COVID ward has been established and hosted a handful of patients. Dr. Alexis has been doing excellent orthopedic work during my absence. He frequently sends me photos of complex external fixators and well done SIGN nails for patients with various deformities and traumatic injuries.
In order to help our employees and their families we are raising $10,000 in order to give each of our 200 employees a Covid Care Package. Each package will consist of approximately $50 of food and essential supplies that will help to feed their families for several weeks. This project is a team effort that includes: a select few hospital workers who will be volunteering their time to help put these packages together, Jonathan and Mackenson who are organizing the process, and the rest of us who are contributing financial resources. If you want to speak out for social justice without having to take to the streets with a picket, then go to www.amistadinternational.org and designate “Haiti Hospital Employee Fund” on the donation link to contribute to this project.
12 January, 2010
I finish a day of work at the Cure Hospital in Santo Domingo, jump on my motorcycle and head out for the evening commute. This involves winding in between gridlocked vehicles jumping the curb a few times and finding any small path to make the 2 mile commute a little more efficient. Horns are honking and buses are belching out black smoke. I stop by a café to answer a few emails before going home to see Marni and the boys. Suddenly the place begins to shake. In Santo Domingo it was already 5:53pm. (one time zone west of Haiti) My California roots keep me from acting overly alarmed in spite of the fact that a few others start to panic. It stops, I finish my business and then go home. When I arrive the answering machine is blinking indicating a message (amazing to think that land lines and answering machines were still a preferred form of communication 10 years ago). My friend from California called to ask if I was OK. Wow! What just happened? Could it be about that little shaker that I just felt? I turn on the news. They are talking about Haiti and showing some satellite images. There is no communication with anyone on the other side of our island. News reporters just keep repeating the same lines and we keep listening to it hoping to hear some new information. The worst is feared. Thousands likely dead.
I made many trips there before and know the challenges of life in Haiti. As an orthopaedic surgeon living just a couple hundred miles away there was no choice but to go. Should I go immediately or wait until we get more information and make a plan? Marni says to go. I have no choice. I gather my team and supplies at the Cure Hospital and by Thursday morning everything is in order for a chartered flight across the island. The Port au Prince airport is collapsed and things are getting chaotic. Just as we are about to leave Santo Domingo we get word that that the American military has seized control of PAP airport closed it to all inbound aircraft. We go anyway. We had no idea what would happen, where we would get our next meal, our next shower or where we would lay our head to rest. That was not really important. When we arrive our worst fears our confirmed. We stop by a few hospitals to assess the situation. There are hundreds of patients all over the place. They are all over the parking lot, all over the lawn, in the courtyards and a few brave ones in the hallways. Almost all of them are orthopedic cases. Some seriously injured, some dying, others already dead.
Today at HAH we had a service to remember that tragic day – one of the deadliest earthquakes in the history of mankind.
Every person in Haiti over about 13 years of age remembers exactly where they were at that moment. Almost all have friends and family who perished in that disaster that took the lives of more than 200,000. Unfortunately it sometimes takes a tragedy to remind us about what is most important in life. This is true for many of us on a personal level, but it was also true for Hôpital Adventiste d’Haiti. Prior to the earthquake this “mission” hospital, was suffering from financial issues, a declining reputation, and no ability to care for poor people. The last decade has brought unprecedented donations and expertise to our hospital. In the aftermath of the earthquake this allowed an outpouring of services for those with no means to pay. Now 10 years later this still remains a priority. In addition our hospital has provided services never before possible in Haiti and is now the most advanced center for orthopedics in the country. Our laboratory, imaging center, emergency room and operating room are also offering some of the best services in the country. I thank our staff for their compassion and their devotion. I thank our volunteers and I thank our donors for all that they have made possible. And most of all we can be thankful for God’s rich blessings on this hospital. As we enter the next decade I know that there are even greater blessings in store as long as we can continue to do our part.
There is a lot of exciting stuff going on at HAH. The Lord is blessing our feeble efforts in many ways. Jonathan and his men worked like a Formula 1 pit crew this month in order to move some major projects forward. Jonathan used my arrival from a 2 week trip to Loma Linda to motivate the team and they really impressed me. Many times after a trip arriving back can be a bit overwhelming but I have to say it was exciting to get back and see all the progress. In spite of my absence for two weeks surgical volume remained just below last month’s record high and exceeded all previous months. Here are a few November highlights.
New Record at HAH
During the month of October we performed more surgeries than ever in the recorded history of HAH.
Our staff crushed the previous record from April 2018 when we did 101 cases. (That was with the help of a high powered visiting team)
Last month we did 121 cases and these were all done by our own doctors and nurses. We did 63 ortho cases, 15 general surgery and the remainder mostly OB/Gyn. Now, in reality we have the capacity to do much more, but given the political situation in Haiti it is absolutely remarkable that our hospital is rising to new levels during these tumultuous times. Many other hospitals are barely functioning if at all. It is not easy to keep functioning when every bit of infrastructure around us is deteriorating. “Peyi Lok” or Operation Lockdown has been in full force throughout the country of Haiti this last month. Stores are mostly closed, public transportation is scarce, fuel is in short supply, utilities are even more unreliable than usual and gangsters have seized control of major thoroughfares.
Several times this past month we were down to just a few gallons of diesel fuel to keep our generators working.
But one way or another it all worked out.
The Lord’s blessing on our work here is palpable. Along with that I would like to put a big shout out to our staff who have kept working in spite of adversity. They have had to traverse burning roadblocks, avoid gunfire, and often come to work on foot due to lack of public transportation. Our head nurse had her phone robbed at gunpoint on her morning commute. The bandit held his gun to her chest on a busy street and told her to keep quiet and give him her phone. So she did.
It is impressive to see the commitment, unity and religious zeal that everyone has for the work at HAH. While strife outside our walls increases, stories of healing at HAH are multiplying. Credit does not only go to our OR staff but also to our administration and ancillary staff who do the behind the scenes work to source oxygen, fuel, food and other key supplies. The goal of the gangsters is to squeeze all commercial and government functions until the society implodes and the government steps down. This poses danger to the garbage truck dudes. Trash pickup lapsed for 4 weeks until Clarens our CFO was finally able to negotiate a deal with the city to haul off some rubbish. They came at 11pm on a Saturday night to do an undercover job in order to avoid the gangsters.
As one of the only fully functioning hospitals in Port au Prince, more and more people are coming to HAH during this humanitarian crisis. We are needed more than ever. Thanks to our staff, to our supporters and to God, HAH is setting new records.
New Limb Lengthening Technology Arrives in Haiti
Naika was born with a short leg. The condition is known as congenital femoral deficiency. There are all different levels of severity which affect not only the length of the bone but also the function of the knee and hip. For Naika the issue was not a huge problem when she was a little girl but these short legs stay in proportion meaning that the difference in length between her legs gets bigger as she gets bigger. Now at the age of 17 she has a leg length discrepancy of 3 inches and walks with a significant limp. This is not a common diagnosis but for one reason or another I have attracted quite a number of these challenging cases over the years.
Lengthening of bone especially for congenital issues is fraught with complications and not considered a mainstream part of our profession. Fortunately I have had some great mentors and for better or worse have had personal experience with a lot of the complications. As time goes on I have become better at avoiding them. Many times I am faced with scars and complications from previous failed attempts when these cases present. But Naika had never before had the resources to find treatment. This was a good thing.
I would never wish a congenital deformity on anyone, but I have to admit I was secretly excited about this case. It was a challenging one but not overwhelmingly so. A new implant was developed and became available in 2011 that revolutionized our ability to perform bone lengthening. This magnetically driven distraction rod negates the need for external fixation and is much better tolerated by patients. The price of these implants is about $19,000 and is sometimes difficult to get approved even by US insurance companies.
Thinking about how great it would be to be able to offer this treatment to Naika I sent a quick message with a photo of Naika to my Nuvasive sales rep Al Thomsen in San Diego. He said he would work on it. As good of a guy as Al is I did not get my hopes up. People have busy lives and Haiti is not always on one’s mind when trying to deal with first world problems.
But Al and his company got back to me in 2 weeks and said they would be happy to donate an implant and they would personally deliver it and participate in the case just as if we were at LLU!
The case was scheduled and airline tickets were purchased. Al did not waver when reading news reports about civil unrest and fiery protests in Port au Prince.
Since I have become the “go to” for any piece of broken equipment at HAH, two days before Al’s trip, I was faced with the need to replace a unique 1/2’’ copper union on our central oxygen system. This is a bit beyond what you would expect to find at Home Depot, but I called to see if Al could source the part. I followed with a text a few minutes later asking him to warn me when he was going to the store so I could be available for trouble shooting. He said he was already at the plumbing store. This was only 10 min after I had made the cold call request!
They did not have quite the right part so he went to another place and found it. But the pieces needed to be sweated together by a professional plumber. Five minutes after that he texted me that he met a plumber in the parking lot who donated his services on the back of his mobile plumbing truck and got the job done.
Al and Craig Decker from Nuvasive arrived well, minus the implants that were placed in a suitcase that went missing at the Port au Prince airport. Fortunately that situation got resolved, albeit with a bit of stress. The case went well. I won’t bore you with the details but if you are interested I previously published a short YouTube video of the Precice® Nail Surgical Technique. The plumbing part also fit perfectly and for the first time in 4 months our oxygen system was back up and running. I also found out that Al is an experienced electrician and he was able to help me install and fix a lot of other stuff.
A big part of the success of limb lengthening cases lies in proper physical therapy. In fact this is so important that at Loma Linda University many of our patients who are coming from distant locations to have this surgery performed are required to stay in town for 1-3 months during the lengthening process.
At HAH it is wonderful to have Dr. Irma Henry who trained at LLU and her capable team provide this same high level of rehab service. Naika is enrolled in PT 5x per week and working hard to maintain knee and hip motion in order to have the best result possible.
For Naika this is like a miracle. Many of us wonder why “miracles” don’t seem to happen like they did in Bible times, but I would argue that they actually do. Jesus commissioned the disciples to go out, proclaim the kingdom of God and perform miracles in His name. Today, those of us who were born with resources, and educated in the health care profession have a similar commission. To Naika, this is a miracle. Yes maybe we do understand how that magnetic gear works, and even atheists could perform the operation, but the miracle of new bone filling in the gap and building strength with time is not something that any of us can take credit for. Watch for follow up images of this modern day miracle in future posts.
THE WEEK IN PHOTOS:
Although our hospital continues to improve, the situation beyond our walls continues to deteriorate. The streets are a mess, protests and gangster control have locked down the country. Schools are closed until January, banks and businesses are only open intermittently and getting supplies is very difficult. Trips across town and airport transfers are made with trepidation. So far the ambulance has only suffered a few hits from rock throwers. All of this has significantly affected patient flow, but in spite of that, volume overall this year is up from previous and the hospital is surviving financially. We continue in our efforts to restore the hospital. On our campus people are working and getting paid for it. The work here provides jobs for people in need, teaches new skills, and gives a sense of accomplishment. We are all working with a sense of enthusiasm and loyalty for the mission of this institution. The result is a beautiful and peaceful environment where we can share God’s love, peace and healing power which is needed more than ever in this country.
Jonathan Euler and his crew are largely responsible for this. He and I watched a few youtube videos on how to make curbs before we launched the project. Normally curbs are not something that you probably have ever noticed but everyone is pretty excited about this as the job was quite a challenge
Hôpital Adventiste: Standing Strong Amidst Political Crisis
Monday I arrive at Port au Prince Aéroport Toussaint Louverture. Michel our hospital driver is running one hour late. Normally he is always on time but today he had to take a more circuitous route than normal to avoid the fiery barricades and mobs of people that have taken to the streets.
People are riled up because the president is trying to install a prime minister accused of a string of corrupt deals. Luckily I make it through customs OK with four heavy bags of equipment for the hospital. This was facilitated by an eager baggage handler who put my bags through an x-ray machine and quickly stacked them back on my cart while whispering something in my ear. I knew what it was about. As soon as we got around the corner he wanted $50USD. I smile and give him $10, which I justify as a tip for handling the bags rather than a bribe for customs. Before long Michel arrives, and we set out from the airport taking the back streets across town. Each time before making a turn Michel looks down the street to check for barricades. When we see smoke, flames, or mobs we take the alternate street, sometimes going in the desired direction. With minimal traffic on the road we arrive at the hospital a little faster than usual.
Jere Chrispens, our CEO is not able to fly to the US on Tuesday after a fire breaks out in the airport gift shop, coincidentally about the same time the president of Haiti is supposed to depart for the UN general assembly. Flights already in the sky out of JFK and FLL are diverted and all arrivals and departures are cancelled for 24h. This is great for me because I get an extra day to work with Jere on hospital administrative issues.
Wednesday arrives. The ortho clinic is almost empty except for all of the faithful moms who bring their babies each week to the clubfoot casting program. There is almost no public transportation, there are fuel shortages, and the economic situation only continues to deteriorate. But nothing can get in the way of a mom watching out for her baby. They might not have food or means for anything else in life but they still show up to the clubfoot clinic so their babies won’t grow up disabled, ridiculed and disregarded in an already challenging life. Thankfully most of our employees live close to the hospital and loyally show up for work, albeit in some cases having to bypass rock throwing and gunfire.
Thursday is unusually peaceful except for some trauma cases that arrive including a 6 year old girl with an elbow fracture. I specifically mention her for a few reasons. It’s not because the case is so rare or amazing, but I am excited that she showed up to our hospital only one day after suffering a type 3 supracondylar fracture (Type 3=bad). In the past our hospital has had a reputation of being elitist and inaccessible. When hospital finances were tight prices were raised and poor people were turned away. In addition to not taking care of the poor, hospital finances continued to struggle. It has not been easy to show how lowering prices and creating accessibility can actually improve hospital finances, not to mention our bigger reason for being here. But this is happening.
It is by a combination of factors, not the least of which are the blessings that come from generosity. We started something called “Pwogram Ijans Aksidan” which means something like program for urgent accidents. This is a package deal that gives a 75% discount to trauma cases that present less than one week from the time of injury. In the quest to give the best treatment to the most people with a set amount of resources it makes sense to take care of injuries soon after they occur. We have many cases that present months after injury with complications or neglect. Instead of coming to our hospital at the time of injury, they went elsewhere or nowhere at all because they could not afford our hospital. Now out of work for months having spent whatever they may have had elsewhere, they need help. So this little 6 year old girl shows up at our Salle d’Urgence (ER) with an acute injury and I am excited. Her dad was processed through our new financial counseling office, given an affordable price and she got a 20 minute operation that will avoid a lifetime of disability. Multiple factors have impeded this process from gaining traction, but finally we are seeing the fruits of our labor. We would love to give it all for free, but there are other implications to that… too complex for this discussion. In any case we now have a system to make treatment possible for all and to avoid turning people away. It still has glitches but these are getting less and less.
The political situation continues to escalate throughout the week with plans for the most massive destruction ever to take place on Friday. People are demanding that President Jovenal step down. He gives a small speech – at 2am on Friday, no one seems to pay attention. People are angry about double digit inflation, fuel shortages, no electricity and billions of dollars that are unaccounted for. They take to the streets. Banks are closed, schools are closed, all major businesses are closed and the city is locked down. I see a couple of major fires already burning downtown when I go for my 6am run. Fires, road blocks and destruction persist throughout the day.
At the hospital things are eerily calm but we are safe. We do surgery and then I have time to tend to my many other responsibilities. Finally Friday night arrives and I have enough time to enjoy dinner before getting called to the salle d’urgence.
On Sabbath afternoon I take a walk down by the bay with Patrick to visit some of our patients. The conditions down there would be shocking to even the hardiest of missionaries. We see Jervens who previously had a colostomy after getting clogged up on cement that he ate, we see Michena who had burn contractures on her foot, and Jackson who had a life threatening infection, all of whom were treated at our hospital. I hear repeatedly “Bonswa blan” (good afternoon white) “Mesi mwen blan” (thank you my white). Then they bring me to see a 3 day old baby. The parents again thank me profusely for saving the mother’s life and for their baby. At first I don’t know what they are talking about, I am an orthopedic surgeon. But then I realize they had come to the hospital with mom in distress a few days before. They had no money. So I directed them to our new financial counseling office and they got treated. The system is working!!