Penn Medicine in Haiti

Hospital in Haiti A makeshift hospital for earthquake victims in Haiti. To read excerpts from blog entries written by members of the Penn Medicine team, click here.

Even before the January earthquake in Haiti, citizens in that country had been suffering for decades in abject poverty, with a subpar infrastructure and little access to quality health care.

The 7.0 magnitude earthquake only amplified the country’s needs.
A team of Penn Medicine faculty and staff, working in cooperation with the nonprofit Partners In Health, hoped to change that—if only temporarily.

On Jan. 25, a nine-member team of orthopaedic and trauma surgeons, anesthesiologists, critical medical and surgical care nurses, OR and peri-operative nurses and OR technical specialists from Penn Medicine flew to Haiti to offer medical support to earthquake victims. While there, the team performed operations, set limbs, delivered much-needed medical supplies donated from Penn and tried to do some good in a country in desperate need of help.

“It’s a privilege to be able to take care of people in need. It’s a cornerstone of what it means to be a health care provider, or a physician or a nurse,” says Michael Ashburn, a professor of anesthesiology and critical care at Penn Medicine. Ashburn, also the director of the Division of Pain Medicine and Palliative Care in the Department of Anesthesiology, was the team leader during the Penn Medicine trip to Haiti. “This is a unique opportunity to get back to the care of what it means to be a health care professional.”

Once they arrived, the Penn Med team was stationed in the Partners In Health hospital complex in Cange, about two hours outside of Port-au-Prince. They dealt with patients who had open injuries left untreated for days or weeks, practicing with minimal equipment and at one point, even a flooded operating room. All in a country still without a power grid.

Ashburn, a former Army reservist who served in Operation Desert Storm as a group surgeon for a Special Forces unit, had some understanding of working in an austere environment. While at the University of Utah, Ashburn helped establish a relationship with the organization Operation Smile, which sent teams of anesthesia faculty and residents to serve in developing countries across the world.

Ashburn says he hopes the recent trip to Haiti is the beginning of a bigger partnership between Penn and that nation or the nonprofit Partners In Health. “[Haiti’s] school of medicine has been closed, their school of nursing has been devastated. One entire year of nurses was killed when the nursing school collapsed,” says Ashburn. “I’m hoping that we can figure out a way to identify a niche and be able to do some good.”

The Current recently sat down with Ashburn to discuss the team’s trip to and work in Haiti.

Q. How did you decide to go to Haiti?
A.
There was a large number of faculty and staff who raised their hands and offered to participate in this and future missions related to the catastrophe in Haiti. We were just the ones who were fortunate enough to be selected. Dr. William Schwab [professor of surgery and chief of the Division of Traumatology, Surgical Critical Care and Emergency Surgery] was responsible for the ultimate team selection and coordination with the chairs of the respective departments that were represented, but what I’ve been told is that the selection criteria was based on people’s past experience in providing medical care in an austere environment with a bias toward selecting leadership that had prior military experience whenever possible. ... This selection was going on right within a week or so of the earthquake. The reports that we got were ones of uncertainty, both with regard to the environment that we would be arriving in [and] personal security. ... Fortunately, once we arrived we felt safe and there was no risk, but you didn’t know when you were packing your bags.

Q. Had you been to Haiti before?
A.
No, I did not have any prior experience with Partners In Health or with Haiti. My prior work in developing countries was courtesy of the Army in southwest Asia, and in China and Russia, which in the ’90s were kind of, from a medicine point-of-view, the developing world. [With Operation Smile] we had sent teams to many places, including Bangladesh and Vietnam and the Balkans.

Q. How do you mentally prepare to hit the ground running in a devastated area such as Haiti?
A.
Two or three days before deployment, Partners In Health did tell us the specific hospital that we were going to go to and we were able to establish communications with the team that was already there, and teams that were working with Partners In Health and other hospitals in Haiti. Some of the information we got was erroneous or dated, some of it was not relevant to the location we found ourselves in, but for the most part, we had pretty good information and that became much more reliable and much richer within a day or so right before we left.
We knew we were going into a rustic environment. We went expecting to work hard and we knew that there were a fair number of people who might benefit from what we could do.

Q. Are there special bonds that form with people after you work together in these challenging situations?
A.
I’d like to think so. I really enjoyed the opportunity to get to know the people who were on the trip with me; I respect all of them a great deal. They’re very impressive individuals in that they work very hard, they didn’t focus on themselves, but rather focused on the reason we were there, which was to do what we could to try to care for others.

Q. The UPHS team was working extremely long hours there, and yet you found time to write your thoughts for the blog. Why was it important that you communicated what you were thinking and feeling?
A.
Sharing our experience with others was actually a fairly important part of what I was supposed to do as a team leader. I’m delighted that people got some benefit out of what was written and the photographs. I just wrote what I was feeling and what we were experiencing, what we were seeing. [To read excerpts from the blog, click here.] All those photographs were taken with my iPhone and [the entries were] tapped in with fingers, thus the misspellings. They were written on the fly and put in on the fly and I tried to put in one or two a day, as time permitted. Generally, we started rounding at 6 a.m. and I would usually try to write something after we started the first OR cases, and then I usually wrote something in the mid-to late-afternoon.

Q. How did you not get overwhelmed by the massive destruction?
A.
The short answer is the experience wasn’t about us. The experience was about trying to do some good for the people of Haiti, so we weren’t there to be overwhelmed. We weren’t there to be coddled. We weren’t there for ourselves. We were there for others. The other issue is that the Haitians themselves are an example of what needs to be done in this environment. Virtually every Haitian that we met, whether it was a physician or a nurse or a family member, had lost somebody. Many of the individuals that we worked side-by-side with while we were there had not really had time to grieve. They had to bury their loved ones and go back to work because there was such an overwhelming need.

Q. The UPHS team did incredible work down there, but the needs are still great. What would you like to say to people who wonder what they can do, how they can help?
A.
Haiti was set back by decades with this earthquake. ... They essentially continue to be on life support. When the rains start, all of these people who are living in tent cities are going to be living in mud. We’ve just created a generation of amputees. In addition to a quarter of a million people who died, others have lost the person or people [in their families] who were working. The ones who are left to survive in a very tough environment are now going to try to do that without an arm or legs, and as a result [they] are going to be less able to get gainful employment. And of course, they’re going to need ongoing medical care because they’re going to need prosthesis, and as they grow they’re going to need new prosthesis.
In spite of that, the Haitians don’t feel sorry for themselves. They’re incredibly resilient, and I was quite impressed with how lovely the people of Haiti are. I actually think that given an opportunity, Haiti can be rebuilt for the better and this community could flourish. It’s not going to be something that occurs tomorrow, it’s going to be a decades-long effort.

Q. Do you have any plans to go back?
A.
I would love to go back. Right now, there are many of us who are waiting to better understand what Penn’s institutional plans are with regard to a relationship to Partners In Health and with Haiti. I’m not in a position to speak on behalf on Penn. ...
There’s a continued broad interest in such service if and when Penn decides to take up that challenge.

Originally published on April 8, 2010