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American Academy of Ophthalmology
Dispatch from Haiti: My Dear Haiti
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Kaz Soong, MD | W. K. Kellogg Eye Center of University of Michigan Medical School

May 2010

Haiti Cherie (My Dear Haiti)

Ayiti cheri pi bon peyi pase ou nanpwen
Fòk mwen te kite w pou mwen te kap konprann valè w....

Haiti Cherie, says Haiti is my beloved land
Oh I never knew that I have to leave you to understand
Just how much I miss the gallant Citadel,
Where days long ago, brave men served this country well.

Written in 1920 by Louis Achille Othello Bayard de Cayes, Haïti Cherie is a popular folk song which evokes memories of the land, the people, the Creole culture, and the proud history of Haiti. As my love of this fascinating country grew with each visit over the past decade, I realized that my feelings of affection for it were very much mirrored by these stirring, yet elegiac lyrics.

January 12th was a balmy workday with scattered clouds, typical of the dry season in Haiti. Downtown Port-au-Prince was bustling with the usual traffic and pedestrians in the late afternoon, when it was rocked by a 7.0-magnitude earthquake that lasted 35 second... a seemingly interminable half-minute of sheer terror that would forever change Haiti. Several of my Haitian friends recalled hearing an eerie prelude of thumps and low-pitched rumbles before seeing the buildings sway and sidewalks move, making it difficult to walk or stand.

That day started as another uneventful, chilly January clinic day at work for me in Michigan. I first learned of the earthquake late that evening while I was perusing the news on the internet; the true devastation and impact of the disaster, however, did not become apparent to me until two days later when more horrifying details emerged out of Haiti. The extent of devastation was unfathomable and unprecedented. More people would perish from this catastrophe than from the behemoth Pacific tsunami in 2004 or from the devastation of Hiroshima and Nagasaki combined.

The earthquake affected me on a very personal level; my dear Haiti was bleeding profusely. In its time of greatest need, I knew right away that I had to go back to help. For an agonizing and frustrating week, I lost touch with my Haitian friends and could not find a way to get into the country.

All commercial flights had been halted and my harried quest to find a wormhole through the layers of rigid bureaucracy and Byzantine protocol went nowhere. My friend, Dr. Eduardo Alfonso, chairman of Bascom Palmer Eye Institute (BPEI), learned of my plight and promptly invited me to join the University of Miami (UM) medical team at the field hospital in the outskirts of the Port-au-Prince airport. With the additional help of Dr. Richard Lee at the BPEI, I was able to get a UM/Medishare flight into Haiti ten days after the earthquake. We quipped that I was from UM anyway, albeit the University of Michigan.

The airspace over Port-au-Prince was replete with military and private cargo planes approaching the airport; my airplane circled for 30 minutes before it was finally given permission to land by the military air traffic controllers. As I was disembarking, I met the fatigued, sleep-deprived medical workers who were embarking for the return trip to Miami. I thanked them for their hard work and for helping Haiti. Among them was Dr. James Banta, staff ophthalmologist from BPEI.

During my five days at the field hospital, I saw only eight eye cases. None of them required surgery with the exception of one patient who had facial and orbital fractures. He underwent surgical repair by the facial plastic surgeons. Otherwise, most of my work was non-ophthalmological. I assisted the orthopedic surgeons with amputations, insertion of external fixation rods, reduction of closed fractures, and creation of spica casts for pelvic fractures in children. I assisted the radiologist taking X-rays on the scores of patients waiting in stretchers. The lines were always long and on some days we never were able to shorten the endless queues. The Siemens digital X-ray machine performed like a reliable workhorse in the hot environment, but its computer control would freeze up if the temperatures exceeded 90° F. When not doctoring, I emptied bedpans, fed patients, took out medical waste, and swept the floors, trying best to be useful. I felt privileged to be able to help in more ways than one. One Creole interpreter joked that I was a bayakou (a go-getter or gofer in polite company, but something more colorful and of questionable taste in Creole). My nickname became Dokte (Doctor) Jackie Chan for many of the Haitian workers and patients. I took that as a great compliment.

One afternoon, I went to the Israeli military field hospital under escort to pick up orthopedic supplies for the UM facility which had run low on many needed items. There, I noticed how the grounds were immaculately clean without a single cigarette butt or candy wrapper in sight. The Israelis even had a CT scanner and fully electronic medical records. I was both surprised and amused to see a female medical officer dressed as a clown entertaining the pediatric patients. Needless to say, I was thoroughly impressed by the excellent discipline, organization, preparedness, and ingenuity of the Israelis.

On the way back to the UM tent hospital, I witnessed the extent of the devastation first-hand as I was driven through the city. Much of downtown Port-au-Prince was in ruins and was unrecognizable to me.

A brisk stroll around the perimeter of the UM field hospital every morning became a relaxing routine for me. There, earthquake rescue crews and firefighters from more than 50 countries were encamped. They displayed a proud assortment of flags and spoke a polyglot of languages.

Poignant moments at the UM field hospital remain permanently etched in my memory. A weeping father stood by watching anxiously, pleading to me “souple anmwe” (please help), as his nine-year-old daughter, in full cardiac arrest was being resuscitated by the pediatrics team. Having lost five other children on the day of the earthquake, she was his last surviving child. Embracing him, I tried my best to offer emotional support, one father to another. The last I heard, the child survived.

An equally unforgettable moment was caring for a 21-year-old man with a C4-C5 neck fracture who continued to maintain a stoic sense of optimism and humor despite being rendered quadriplegic. He was fluent in French, Creole, English, and Spanish, but this young man’s bright future was now very uncertain. We improvised a rigid neck brace using cardboard, an old T-shirt, and rolled towels, and immobilized him securely to his stretcher with clothesline and duct-tape for the airlift to a Miami hospital.

On a happier note, the birth of healthy twins in the operating room gave us all an emotional high and temporary respite from the grim situation. Surgeons at the adjacent tables stopped briefly to applaud and whoop it up for this joyful occasion. We had population growth for a change!

Both the adult and pediatric patients endured pain and suffering in stoic silence. Some patients would sing hymns or repeat the Lord’s Prayer in Creole to overcome their anguish and hurt. Over the years, I learned that this braveness and dignity are typical of the proud Haitian culture. Perhaps we could learn from the Haitians.

In April I returned for another post-earthquake visit to Haiti, this time primarily to offer specialty eye care and resident education, and secondarily to do fact-finding for the American Academy of Ophthalmology in its plans to develop sustainable long-term strategic aid to Haitian ophthalmology. I was accompanied by Dr. Jeevak Lal, ophthalmologist and director of the World Eye Mission based in Michigan and Trinidad. Although we worked mainly at the University of Haiti Hospital, we also took care of eye patients at a large private ophthalmology clinic and at the UM tent hospital. The latter was noticeably less crowded than in January immediately after the earthquake; many of the injuries this time were from recent traffic accidents and violent assaults.

We saw many corneal ulcers, usually traumatic or infectious in origin, quite a few with underlying xerophthalmia due to severe pre-existing vitamin-A deficiency. We also saw retinoblastomas, large verrucous lesions of the conjunctiva totally obscuring the cornea (presumably from out of control papilloma viral infection), and advanced malignant conjunctival neoplasms, all perhaps reflecting the combined effects of genetic predisposition, high prevalence of HIV infection, and lack of access to medical care. There were also several cases of old earthquake-related injuries, pterygia, herpetic corneal infections, mature cataracts, and congenital pediatric eye diseases.

Port-au-Prince was crowded with warrens of tent communities without running water or sewage facilities. The tropical rainy season had just begun, bringing with it swarms of mosquitoes, flies, and rats. I am afraid the current situation may be a powderkeg and breeding ground of serious epidemic disease.

Unfortunately and not surprisingly, Haiti seems to be fading into the distant memory of the world again. It is disturbing and worrisome that the interest of the international press has waned to a trickle following the sensational media circus of the first two months following the earthquake. I also sense that the international community is becoming jaded and just plain “Haitied out.” I do sincerely hope that we can continue to sustain awareness and give support to Haiti.

Ayiti, kembe du! Espwa fe viv. Haïti Cherie!

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