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Bascom Palmer Eye Institute

Reflection from Haiti, February 15, 2010

More than 1 month after the earthquake, the needs are still great

Excerpts from Dr. Chuck Slonim from Tampa, Florida who was invited to participate in Bascom Palmer’s Vision for Haiti Relief Missions.

Thanks to the Herculean efforts of Dr. Richard Lee of the Bascom Palmer Eye Institute, I was given the experience of a lifetime. I was asked to replace Bascom Palmer’s Dr. Tom Johnson, oculofacial plastic surgeon, who had just returned from Haiti. Anticipating that filling Tom’s shoes would be no easy task, I was excited to have the opportunity to serve the Haitian people.

Arrival at the Port-au-Prince airport at 11 p.m. was a bit chaotic. The fenced-in UM facility looked like a scene out of the M.A.S.H. television series. People were walking in every direction, each with a specific task or goal. Physical therapists were walking along side the physically handicapped. Patients or their family members were walking with loaded bedpans to be emptied into designated containers outside the gates. Transporters were moving patients on stretchers, wheelchairs or cots to the appropriate medical tent. What looked chaotic to me at first glance would later prove to be a well-oiled machine in the middle of a national disaster. University of Miami School of Medicine was not only representing all of the Florida colleges of medicine but also representing all of our nation’s colleges of medicine.

Dr. Lee had already arranged multiple oculoplastic activities for me before I arrived. I was quickly removed from the UM facility by the US Navy ophthalmologist, Captain Terence McGee MD, as a part of a prearranged rendezvous on the USNS Comfort. Under armed Navy security, we went to the shipping yards which had been destroyed by the earthquake and made functional by the Navy SeaBees (Construction Battalion). I was taken by boat to the USNS Comfort, a floating state-of-the-art medical/surgical 1000-bed hospital ship with 14 operating rooms.

A special 8 year old orphan named John Doe with xeroderma pigmentosa awaited. He had a massive biopsy-positive squamous cell carcinoma of the right orbit; a known complication of his disease which would require an orbital exenteration. He became a favorite of every person on the ship which projected me to “hero” status among the staff for just showing up to perform the operation. When I met him in the pediatric ward, he clung to me like a chimpanzee clinging to its mother. He was both HIV-positive and TB-positive. I immediately understood why he was the favorite of the ship. The exenteration was preceded by assisting Dr. McGee repair a corneal melt, repairing a traumatic lateral canthal avulsion, rounding on a variety of traumatic cranial nerve palsies and reviewing the CT scans of a 7-year old Haitian girl with a huge optic nerve glioma extending into the optic canal and chiasm. I consulted with the Navy neurosurgeon aboard the Comfort as to the proposed disposition of the girl. She was proptotic with no light perception. Her surgery could not be performed on the Comfort. She would be sent back to Port-au-Prince in the morning.

The next morning I was picked up by Dr. Bridgette Hudicourt, a local ophthalmologist and driven to the eye clinic at the Hôpital de L’Université D’État D’Haiti (HUEH). This was the university hospital in downtown Haiti. The hospital suffered severe earthquake damage and the facilities were moved into the streets under tents and in local buildings that didn’t suffer as much damage. The morgue was next door and the eye clinic was a block away. Our drive through the devastation of downtown Port-au-Prince truly overloaded my senses. Four of my five senses were immediately stimulated. I will never ever forget the sights, the sounds and the smells. I could even taste the dust. I was witnessing 3-dimensional devastation which totally overpowered the 2-dimensional news reports on television.

The surgeries that I performed were in no way routine. The University of Haiti’s HUEH’s make-shift operating rooms were open-aired with no air conditioning, no lights other than ceiling light bulbs, minimal sterilization and barely enough instruments to go around. During one of my exenterations, the suction was reduced to zero when I asked that a fan (more electricity from the same outlet) be turned on to keep me marginally cool and, at the same time, keep the flies away from the surgical wound. A small battery-powered night light used by a physician assistant from Ohio was used to illuminate my surgical field. This university hospital facility made the UM tent surgical facility look like Bascom Palmer’s surgery facility. The next 3 days were similar. One evisceration had to be performed under local anesthesia with no suction. A fly swatter on the mayo stand was standard equipment.

I was asked to bring some lectures to give to the local Haitian ophthalmologists. One ophthalmologist lost his life in the earthquake and 6-7 lost their offices or had significant damage to their equipment. The supplies and equipment that were sent from Bascom Palmer to the Haitian ophthalmologists were tremendously needed and deeply appreciated. They need a lot more.

I am now safe in my own home having operated this morning in my “taken for granted” operating room at my teaching hospital. Because of and through the efforts of Bascom Palmer and the University of Miami, my life has changed. I promised the Haitian ophthalmologists that I will be returning this summer. I will keep that promise. The patient thank you’s were more than enough payment for my services. However, most memorable was a Haitian TSA agent at Miami International Airport who was checking my identification before passing through security to go back to Tampa. She overheard me talking about my recent experiences with the person behind me in line. She asked if I was in Haiti and why. I told her that I was there and that I was a doctor. She stepped around from her podium with my passport in her hand and proceeded to give me a hug. She thanked me for what I did for her country. She returned behind the podium and said she had lost 11 family members in the earthquake. I was at a loss for words as tears filled my eyes. I slowly walked to the metal detector and couldn’t look back.

I cannot thank Dr. Richard Lee and the Bascom Palmer organization enough for allowing me the opportunity to participate in this life changing experience. Who would have thought that this 1 week would turn out to be one of the most impactful of my medical career?

Chuck Slonim MD FACS

Clinical Professor of Ophthalmology, University of South Florida College of Medicine, Tampa, FL
Clinical Associate Professor of Ophthalmology, University of Florida College of Medicine, Gainesville, FL