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American Academy of Ophthalmology
Dispatch from Haiti: Seven Days of Improvisation, Collaboration
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Philip R. Rizzuto, MD, FACs | Warren Alpert Medical of Brown University

March 2010

I cannot thank Richard Lee, MD, enough for giving me to opportunity to participate in the earthquake relief in Haiti. It is amazing how he orchestrated my transportation, safety and participation in and out of Haiti and the coordination of activities with the Haitian ophthalmologists. Following Dr. Johnson, Dr. Slonim, and Dr. Brennan is a tough act, but to have the opportunity to aid the Haitian people through the Bascom Palmer Eye Institute and University of Miami Medishare Program was truly a privilege.

“The smile on the patient’s face at the completion of the surgery was so rewarding.”

I contacted Bridgette Hudicort, our ophthalmology liaison, and we agreed to meet. For the next 36 hours I worked in the Medishare tent seeing patients in the small emergency room/area under a tent outside for routine ophthalmologic issues. There were several facial lacerations, corneal abrasions, corneal foreign bodies as well as acute visual changes. One gentleman had come in with acute loss of vision following an elbow to the eye the night before. It looked as though he had an old corneal scleral laceration and on further questioning, his vision had been poor since childhood but what little vision he had unfortunately was knocked out when he got hit the previous night. It sounded as though there was some sort of posterior segment pathology and, as chance would have it, I turned to my right and some young woman was lying on a stretcher having an abdominal ultrasound with a small portable ultrasound in the emergency room tent. When they were finished, I grabbed the handheld unit, did an impromptu ultrasound in the tent on this gentleman’s eye and noted a significant retinal detachment. I explained to the gentleman what was going on. This was the most difficult part of the whole time in Haiti since we were able to diagnose problems but in several instances were unable to implement treatment.

Throughout the weekend I participated in multiple wound debridements, scar revisions, advancement flaps, I reconstructed a left forearm, did a left-forearm flap with one of the plastic surgeons and saw a gentleman with a right ZMC fracture on whom, in the States, I could have done orbital reconstruction with plating but didn’t have any plates while there. Rummaging through the supplies in the OR, we found a set of arch bars and some wires and did mandibular maxillary fixation, correcting the malocclusion and stabilizing the fracture. The smile on the patient’s face at the completion of the surgery was so rewarding.

On Monday, I was picked up by the team of Haitian ophthalmologists, Bridgette Hudicort and François Rudicourt. These charming, intelligent caring women over the next five days became colleagues, teachers but more importantly friends and teammates in helping me work with the Haitian people.

On Monday we went to St. Damian Children’s Hospital near the American Embassy. This lovely old motel survived the earthquake without any damage, had two functioning operating rooms with scrub sinks and a talented staff of Italian anesthesiologists who were able to care for children safely and effectively. Our first patient was a young woman who had a severely scarred right lateral canthus from a lesion that had been excised previously that left her unable to open and close her eye. The three of us were able to reconstruct her lateral canthus, provide for excellent excursion of the eyelid and allow her to see again. Another bonus smile.

“All the surgeries were done ... with a desk lamp as illumination.”

From there we went to HUEH, the university hospital in Port au Prince, where I met two young residents. These two women were remarkably overworked but kind enough to allow me to participate in seeing patients. Over the next three days we examined patients, saw an unbelievable amount of textbook orbital malignancies, participated in lectures and scheduled several small surgeries in their outpatient OR. All the surgeries were done under local anesthesia and, as Dr. Slonim noted, with a desk lamp as illumination. As necessity is the mother of invention, I noted two operating room microscopes and re-oriented the oculars so that the lights were now pointing at our operative field so we did have some overhead lights. This was met with a bit of puzzlement and questioning by my Haitian operating room staff and I promptly showed them that the operating room microscopes could be put back into their typical operating position. It was a fascinating dynamic; at one point we were operating on a contracted upper lid to improve lagophthalmos, while five feet to our left, a Haitian ophthalmologist whom I had met was performing cataract surgery with an IA bottle and a 10cc syringe. Certainly a lot different from the typical ambulatory surgery facilities we see here in the States.

I met with Dr. Large and the other Haitian members of the ophthalmology community and gave them the equipment and supplies Dr. Lee had asked me to bring, as well as the donated material I was able to procure prior to my arrival. A major shipment of drops and medication was being held up in the States and I reassured Dr. Large that it would eventually make its way to him as soon as possible.

We did run into a little issue with the Medishare facility on Thursday, since the U.S. and Haitian airport security decided that they did not want people moving in and out of the Medishare compound via airport property. Since we did not have any other exit from the camp, this put us in a lockdown until a new entrance could be fashioned at the back of our compound the next day.

I had been in contact with Amy Chomsky from Vanderbilt and a colleague of hers, Monica Dyer, on the ground in Haiti, regarding a young boy - Walter Cadet - who was in need of an enucleation. He lived several hours away from Port Au Prince and with Bridgette and Francois’ input, we were able to orchestrate a surgery at St. Damian’s. He had an uncomplicated excellent enucleation with placement of an appropriately sized orbital implant that I was able to bring down with me through the generosity of Porex.

We then rounded on other children in St. Damien’s and saw patients with varied problems, including vitamin A deficiency, possible malaria and, unfortunately, a patient with microphthalmia.

I am very thankful to the people at Porex, who provided me with more than 30 orbital implants and conformers; the Lifecell group, which provided me with Alloderm grafting; the IOP group, which provided me with tutoplast, lacrimal instruments, fascialata; and the FCI Corp., which provided me with lacrimal instruments, stents, probes, all of which I left with my Haitian colleagues.

“Never did I think I would have the opportunity to ‘practice’ medicine the way I did. ... It was great to go back and do things I hadn’t done for years.”

On Friday, due to the “lockdown” and implementation of the gate we were restricted to the Medishare compound. The morning was spent in the supply tent organizing our sections. I found a major stash of glaucoma drops, antibiotics, tears and anti-inflammatory drops set aside and shelved them with the rest of the ophthalmic stuff... I contacted Bridgette and she met me Saturday a.m. prior to my departure to pick up a car load of the supplies. The Medishare facility maintained the lion's share of medication and I am sure that anything that is not used at the compound, the Haitian Ophthalmology Society can put to good use.

Throughout the day, the patients continued to arrive with significant traumas and acute problems, none being that ophthalmologically pressing.

I was recruited to participate in two craniotomies, one for a depressed skull fracture and one for subdural hematoma with a blown pupil. Fortunately, working with Dr. Nasharyan, a neurosurgeon from Princeton, myself and the Medishare group were able to decompress the subdural hematoma/subarachnoid hemorrhage and the young boy survived and was stable the next day. That Friday evening, a young girl came in with an old ruptured globe from the earthquake that had healed. She had no light perception and was in no acute distress. I contacted Bridgette and referred her for an evaluation. Despite the fact that Bridgette is a private ophthalmologist, she was more than happy to orchestrate her care.

Never did I think I would have the opportunity to “practice” medicine the way I did down in Haiti. I truly needed to harness all of my medical training and it was great to go back and do things I hadn’t done for years, participate in things I haven’t ever done, but, most importantly, do the things I was used to doing the best way I could for a people in such despair; all in an effort to improve the quality of life of a devastated population. I cannot compliment Bridgette and Francois more since their compassion, caring, heart and love of country was truly evident throughout the entire week I was there.

I, too, promised that I would go back and assist Bridgette and François, to try and get more done for the people of Haiti sometime later this year. They mentioned that the greatest need was to try and figure out how the Haitian people and physicians can best help themselves with all the outside support the country was receiving.

My only regret was that I was not able to do more in the seven days that I was there. Again, thanks to Richard Lee, who does an amazing job orchestrating this effort and for providing me the opportunity of a lifetime. I promise I will take very little for granted ever again.

 
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