Reflection from Haiti, March 14, 2010
Excerpts from Dr. Philip R Rizzuto from Providence, Rhode Island who was invited to participate in Bascom Palmer’s Vision for Haiti Relief Missions.
I cannot thank Richard Lee 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 Drs. Johnson, Slonim and 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 transportation to the Medishare tent was a well-orchestrated process. Everyone working together made the transition easy. I can’t thank Ryan Isom, a resident at Bascom Palmer who met me at the airport to hand off the transportation suitcase Richard Lee provides, with insight into the Medishare facility. He informed me that as soon as I got there I needed to go to the back of the housing tent, grab a cot that was near a plywood walkway, near the hanging wall. This provided the best access to the latrine and showers in the back as well as it was the coolest part of the tent closest to the air conditioner. He could not have been more right. I promptly picked a 3 × 7 cot, set up my mosquito net, and was ready for work.
I contacted Bridgette Hudicort, our ophthalmology liaison in Port-Au-Prince and we agreed to meet on Monday. 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. 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, I learned 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 my 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 who 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 Haitian ophthalmologists, Bridgette Hudicort and François Rocourt. 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.
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.
From there we went to HUEH the university hospital in Port-Au-Prince where I met two young ophthalmology 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 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 5 feet to our left a Haitian ophthalmologist who I had met was performing cataract surgery with an IA bottle and a 10 cc syringe. Certainly a lot different than the typical ambulatory surgery facilities we see here in the states.
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 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 promised that I would go back and assist Bridgette and François, to try and get more done for the people of Haiti some time 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 7 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.
Philip R Rizzuto, MD FACS
Clinical Assistant Professor of Surgery
Warren Alpert Medical of Brown University