June 2014 Trip

Background

In September 2013, we took our IWISH team on a whirlwind tour of 4 hospitals in 7 days in an effort to evaluate existing technology and identify voids in technology and training that would need to be addressed in the coming year. Because of the very specific goals and objectives for that trip, we invited Tom Parnin, the department chair of biotechnology from Trinity Health in Livonia Michigan, to render his expertise. Dr. Rebecca York, a chiropractor from Bay City Michigan, joined us as a means of trying to identify sustainable healthcare alternatives to allopathic/westernized medical strategies, which are rarely attainable to the average Haitian. We were once again blessed with the experience and talents of Jackie Horning (veteran missionary/anthropologist), Heidi Richards (trauma and surgical nurse practitioner) and Nichol Krupp (photojournalist). For the first time, we teamed up with ITECH, a charitable organization based at the University of Washington whose goals and objectives in Jeremie, Haiti are aligned with those of IWISH. Please refer to “Stories from the Field- September 2013 Update” for specific details of that trip.

June 2014: creating the team and heading out

The June 2014 trip was the “sister trip” to the September 2013 trip. Natalie Fettinger, daughter of my longtime colleague, Dr. Steve Fettinger, told her father that she wanted to go on a mission trip this summer, before entering med school in the fall. Since our current emphasis has been the optimization of the equipping and training of our Haitian colleagues with laparoscopic and hysteroscopic technology (his specialty), Steve offered to accompany our next IWISH mission, as long as we planned it during Natalie’s summer vacation, preferably after she completed her MCAT.

Because of the recent emphasis on anesthesia training and equipping at the outlying training facilities (with ITECH), we asked Angie Williamson to make a return visit with us. Tom Parnin had just come back from a “real vacation”, so he wasn’t in a position to be able to be away from work for another week, but we twisted his arm a bit and he gave up a long weekend to go to work in Haiti with us. Luckily Jackie Horning (veteran missionary/anthropologist), Heidi Richards (trauma and surgical nurse practitioner), and Nichol Krupp (photojournalist) were also all able to join us.

We left at the crack of dawn June 21st. The veterans sat with Natalie for lunch to prepare her for our flight into Port Au Prince.

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And here are Natalie and Steve Fettinger after they successfully passed through customs and the mad rush of people outside Port Au Prince International Airport. It’s a fairly stressful and awe-inspiring experience in and of itself, but it is exponentially better than it was pre-Quake and it was only the beginning for this amazingly spunky and brilliant pre-med collegiate goalie who is just at the beginning of her “path”.

Organizing Our Equipment

We flew into Port Au Prince, meeting Emanuel, our translator, our friend, who transported us to our guest house, where we unpacked and organized our equipment for our afternoon and evening with Dr. Hosty, Dr. Fettinger, Tom Parnin and Arisme (the local biomedical technician, learning from Tom) at Hopital Les Messie in Port Au Prince. There we prepared our equipment for our Sunday transport over the mountain to Jacmel.

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First Stop: Jacmel

Bus trips in underdeveloped countries are always “an adventure”. Generally, there is very little room and minimal, if any, air conditioning.   In this case, there was no A/C, because the van wouldn’t have been able to make it up the mountain with the A/C on. In June, the heat in Haiti is oppressive. On the way to Jacmel, there were lots of swerving roads up and down the mountains, making for a nauseating experience for my team, reminiscent of the elicited response from the trip to La Gonave on the “Jesus boat” last year.

 

Perhaps because there were so many “near-death” transitions on the way to Jacmel, we had an impromptu intergenerational discussion of the meaning of life and faith, right there in the bus. The elder Fettinger even shared his grandmother’s views on faith, which made me feel like she was watching over us, thank God, as we wove through the narrow roads in the mountains, stopping once for mangoes when the Haitian nurses needed a break due to the extremes of nausea. I loved to sit back and listen to the “young’uns” questioning the tenets of religion, as they should, with the response of each of the others, including the opinions of Emanuel, whose faith has brought him through so much adversity.

 

With all the objectives aligned, on this trip, we were finally seeing the results of our previous efforts coming to fruition. Tom Parnin helped us put all of our equipment together on location Saturday, Sunday and Monday and then had to return to his “real job” on Tuesday, leaving us much better off than we would have been had he not prioritized us for those few days!

Training and Partnerships in Jacmel

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On this trip we once again teamed up with ITECH, but this time we met in Jacmel for Sunday, Monday and Tuesday, where ITECH physicians and nurses came from Jeremie as well as Jacmel for an anesthesia seminar. Angie Williamson, CRNA from Covenant Healthcare, had accompanied us on our first post-quake mission previously, but we were finally prepared to have her come down with us again. She taught the seminar on airway management for general anesthesia and epidural catheter placement and utilization and then worked in the OR with the nurse anesthetists to solidify the details.

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We spent time in the operating room with both a third and first year OB resident in Jacmel and ran a colposcopy clinic with LEEP instruction and an infertility clinic with the OBGYN residents and nurse practitioners.

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Pictured above is the sonohysterography (an advanced ultrasound technique that we taught to the gynecologic providers) performed on an infertility patient with a uterine polyp that may be contributing to her condition.

Most importantly, we evaluated what technology they had and their immediate sustainability needs. Said needs are devastatingly vast, despite the fact that Jacmel is the second largest city in Haiti, one of the most affluent, AND a residency training facility for OB and family medicine.

We met with the CEO and CFO of ITECH, Dr Honore, as well as the Medical Director of the Jacmel medical facility to briefly discuss their objectives for the last two years of the ITECH grant.

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At the end of the three days in Jacmel, Dr. Bernine (ITECH family medicine physician) treated us to a beautiful sunset, ocean-side dinner, reminding us of the indescribable beauty that Haiti possesses. If you look closely you can see the artist selling his paintings in the background, but you also see the hungry Haitians watching as we eat our fish and plantains.

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This is the night I had my break down. Small children practiced the only English words they know, “please, miss, I am hungry.” And they really are hungry and the food really is so awesome. How can I eat when they are starving? Impossible!

Les Messie Hospital in Port Au Prince

After Jacmel, we returned to Port Au Prince, where we spent Wednesday and Thursday in the operating rooms at a small private hospital called Les Messie, where Dr. Hosty and Dr. Honore also have their private offices. At their offices, Dr. Anglade (pictured here with Dr. Hosty, Dr. Meti and several of the OBGYN nurses) taught the doctors and nurses how to use the fetal monitors that were donated previously. (Dr. Anglade learned these skills during an IWISH-sponsored trip to Michigan in 2011).

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She and Dr. Meti were then taught by Drs. Batsch (pictured here with Dr. Meti and the patient’s husband) and Dr. Hosty to do colposcopy and LEEP procedures. (Dr. Hosty had taken the IWISH-sponsored colposcopy course in Maryland in 2012 with Dr. Honore. Dr. Batsch had been available for the colposcopy instruction at Port Au Prince General in September, when the video colposcope was utilized for instruction with their residents).

Dr. Fettinger was able to perform the first hysteroscopy and laparoscopy at Les Messie with last minute connection supplies from Dr. Valerio/Port Au Prince General. Dr. Valerio is pictured here with Dr. Fettinger and one of the orthopedic surgeons. They are getting excited to use the equipment for arthroscopy.

The intraoperative photos were taken by Dr. Stryker, rather than by our professional, Nichol Krupp, but you get the idea. (More of her photos can be found in the photo gallery of this site.) Below is a hysteroscopic procedural picture of the uterine polyps that were removed. It was a sight to behold.

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The next series of images were taken during the laparoscopy, (including a gorgeous picture of the end of a beautiful fallopian tube seen during the procedure). Of course during these surgeries there is mutually beneficial professional banter (with and without translators) between staff, as seen below between Drs. Cassas (anesthesia) and gynecologists Fettinger, Hosty, Anglade, Valerio, Meti, and Batsch.

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We definitely need our operative instruments upgraded but what we currently have served as a basis for future surgeries. Angie Williamson, CRNA, worked again with nurse anesthetists from Jeremie (who took notes every minute that they could) during our PAP experience with Dr. Cassas (from the anesthesia department at Le Messie).

The Orphanages Story

While we were in Port au Prince, Jackie, Heidi and Niki were drawn to an orphanage where beautiful children were starving and listless. With the aid of their spunky and passionate interpreter, they went shopping and provided the orphanage with food and necessities and became inspired to formulate a sustainability protocol for orphanages in the communities we serve. I came back to the guest house all excited about the days’ medical miracles and saw the look on Heidi’s face. She was sprawled out on her bed, eyes red and swollen from hours of crying, but she had a HUGE grin on her face. She had found her path! Niki had made a facebook plea for funds and was answered in such a powerful way that they knew they were helping others find meaning in their lives as well. (Note: over $4000 was raised in about three days! A total of four orphanages were ultimately helped this trip.) [Click here for a full report from members of our team.]

Next Stop LaGonave

We flew to LaGonave on Friday. Although the operating rooms were closed, we were able to go to the hospital to see obstetrics patients, where we familiarized ourselves with the hand-held OB ultrasound created by Keith Krupp and his team of engineers.

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Unfortunately, the excitement of using the new technology was immediately overshadowed by the reality of Haitian obstetrics and neonatology. One of the women had a fetal demise and another had just had twins, one of which was quite obviously struggling to live. Angie and Heidi went to work on that little baby with the technical support of Sheila Rundell and Dr. Chai at Covenant in Saginaw. Unfortunately, the baby’s improvement was only transient, and that little baby took my team on a beautiful and awful roller coaster as she lived and died in the loving arms of her mother first and then our team, when she needed to be resuscitated several times, brought back to life and then finally succumbing, unresponsive to all the modern medicine we could provide.

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Every time I experience this reality in Haiti with a new team member, it gives me just a little glimpse of how life and death are processed by the Haitians. I find myself looking past the death, challenging myself to find a positive so that the negative won’t cause me to lose myself in the heartache. Likewise, we have seen where Haitian care providers seem to detach themselves from the dead, perhaps they can’t emotionally afford to mourn too long for the dead, or they would lose themselves to the sheer immensity of death and tragedy in Haiti, in comparison to the challenges of life, particularly in the medical profession. Instead, there are those who can dance, and sing and find the joy in the lives of their healthy children, many of them finding solace in their faith. After that emotional roller coaster, the team spent the rest of the day at designated orphanages and the “poor house” distributing food, clothes, medications, and soccer equipment as they assessed these facilities for potential means of providing them with sustainability.

 

A Reflection from Natalie Fettinger, Pre-Med student, IWISH volunteer

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A Haitian woman lay on the operating bed while a whirlwind of commotion roared around her. Tense voices, Creole and English, surged through the room. The American doctors frustratingly asked about the sterilized instruments, the irritated Haitian doctors replied harshly back, and the translator spoke anxiously between them. Among this chaos, I looked at the patient, not yet sedated, eyes wide with fear. I could not speak anything of meaning to her with the few words of Creole I knew. Instead I took her hand and looked into her eyes, hoping to let her know that it would be okay. I felt silly, trying to comfort a woman with solely a look.  I smiled at her, perhaps a bewildered smile, but a smile all the same—and then, she grinned widely back. I do not know if her smile was anesthesia-driven or if it was a sign that she understood my attempt to comfort her. Regardless, I was content knowing that I brought her relief.

 

This reminded me of a conversation that I had with my father when I first considered becoming a physician. I asked, “Why medicine?” He replied, “There is no greater sense of satisfaction than delivering a baby of an overjoyed couple who asked for your help to get pregnant. It is an indescribable exchange of gifts—the joy you bring, and the satisfaction you receive in that.” He reminded me that as a doctor, even while busy, there is always a minute to show compassion, a minute that may mean the world to the patient. Driven by my desire to bring such joy to others and my interest in applying the science of processes to solve problems, I set out to pursue a career in medicine.

 

The day after the Haitian surgery, I visited our patient. As soon as I saw her, we both had familiar grins across our faces. I handed her medicine and, in broken Creole, tried to ask how she was. She giggled at my attempt, and we both began to smile again knowing that while the extent of my Creole had run out, we were happy to be in the presence of each other. Despite our language and cultural differences, we had connected as humans. I realized that in these moments we exchanged gifts. I gave her a smile, joy, care, and medicine. With her return of a smile, she gave me satisfaction in knowing that I had touched her life, however small.