Healthcare is global. The human body does not vary according to land mass. Thus what could be so different about a surgical rotation in an underserved tropical country, as surgical rotation in Haiti?
I’m a medical student at the University of Science, Arts and Technology (USAT). I’m in my last year, I am doing a general surgery rotation with Dr. Ducheine. We spent the better part of this surgical rotation in New Jersey. Dr. Ducheine is on staff at the East Orange General Hospital and the Newark Beth Israel Medical Center (part of the RWJ Barnabas Health). In the last week ot the rotation we traveled to Haiti, Dr. Ducheine was preparing a medical mission to Haiti and also evaluating the roles of Non-Governmental Organizations versus public hospitals in the delivery of healthcare in the Northern part of Haiti.
Whereas, I had expected a difference in scenery, I did not anticipate any major difference from the “customary” operating room (OR) experience, such as I previously experienced during my obstetrics and gynecological rotation in the rural North Western region(s) of the United States, the state of Wyoming. As surgical procedures tend to be universal, however something quite different stood out during my operating room observations in Haiti.
“A commitment to care,” is what comes to mind, as I recall the scenes in the OR from one surgery to another. Whether it was a tibial reduction, a hernia repair, a cataract removal, or an open reduction of a mandibular fracture, the surgeons and residents arrive with their carefully pre-packaged tools and equipment. It was not “already set up and opened” as is customary in the United States. Walking into the OR empty-handed, and having all the required instruments and equipments, would be luxury here in Haiti. Having operating room “surgical preference card” from which the operating room staff can prepare and set up the operating room according to surgeon’s preference is an uncommonly rare oddity in Hopital Universitaire Justinien (Justinien Hospital(JH)), the tertiary public hospital in Cap Haitien. The Justinien Hospital is the second largest public hospital in Haiti. In JH, it seems that it is the responsibility of the surgeon and his team of residents to ensure that all items required for the surgery are available at time of surgery. Whereas, in the United States, this is the responsibility of the operating room nurse and scrub technician.
Operating during a power outage is the second notably amazing event I witnessed during my surgical case observations at the JH. In the United States, I would not anticipate losing electricity during surgery, even temporarily. In the rare instance that this would occur, there would usually be a back-up generator that turns on automatically. However, on that day, I interestingly observed the surgical team continue working without the overhead lights, during a power outage. They were un-phased. They kept working, as if nothing happened. This “blackout” period was brief, it was, however, impressive to watch them continue their procedure while maintaining focus on the subject at hand. It was the patient and the procedure that mattered. Their determination, the resiliency in overcoming adversity is testament to their commitment to care. I remain forever impressed and humbled at their dedication to their craft; the delivery of healthcare to an impoverished underserved population with very limited resources.
Remaining calm in the face of adversity is another learning opportunity observed at the JH. I observed an unfortunate incident where a resident accidentally injured the left palm with a drill during an orthopedic procedure. This incident occurred as there was some difficulty in the alignment of bony fractures prior to plating and inserting the necessary stabilizing screws. At the instant of the injury, the surgeon removed his gloves, left for the emergency room and returned minutes later. How does one spell dedication? The surgical team, in my humble opinion, displayed true grit. They maintained incredible focus on the patient, they continued the procedure to its conclusion. A dysfunctional battery power pack for the drill did not create a distraction for this team, the manual drill was casually removed from the sterile package. The manual drill worked just as well while one of the residents retrieved a back-up power supply.
As I left Haiti, two thoughts lingered for me. I wondered about the surgical site infection rate in Haiti as compared to the US? In addition, given the fact that motorcycles are a major source of transportation on the island, what is the ratio between surgeries due to trauma from motor vehicle accidents with respect to elective non-trauma related surgeries? How do the trauma related surgeries impact the cost of healthcare in Haiti? The answers, no matter what they are, do not detract from the respect and admiration I developed for the team of surgeons I met and came to greatly admire. This was definitely “Not just a surgical rotation.”