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Vishnu Hoff
“ISHI is returning to Haiti with a team of ten for an eight day mission to perform general surgery. This will be the third team we’ve sent to Haiti this year as part of our on-going commitment to helping the people get through continuing bad times, and we look forward to seeing how things have changed. Unfortunately, cholera and a hurricane have been added to the mix, so it’s likely to be heartbreaking, too. We’ll be posting observations “”from the field””, along with photos and videos, so please check back often. We welcome your comments and hope you’ll support our team members with positive thoughts. More soon!”,”Haiti, November 2010
Today is Friday, and I’m at home packing and prepping for ISHI’s third surgical mission to Haiti this year- we leave early tomorrow morning. This will be my first time to Haiti, ever, and I’m preparing myself mentally and emotionally for the fast-paced days ahead of me in a land ravaged by one misfortune after another. NPR just had a story on the growing cholera problem, Haiti’s first in over a hundred years- they say it’s the result of limited access to clean water combined with the likely re-introduction of the bacteria by aid workers from around the world.
I know I will see great poverty, desolation, homelessness and displacement, and disease, along with the usual colors and flavors of a vibrant culture, and I know that we will provide great relief for some people suffering from surgical disease, but I also know we may contribute to problems on some level. This is part of the calculation that we in humanitarian work make- does it make sense to fly in a team of outsiders? How will we decide who will benefit from our help? What level of care is enough (or too much)? How involved should we get with a community and how comfortable should we be in comparison with the people we’re working with? The questions and weighing of one aspect against another are endless, and there’s a point where one just has to make some well intended and decently informed choices, pack a bag, and get on an airplane, guided by instinct, experience, and chutzpah.
Tomorrow we board a plane with a team of talented surgeons, nurses and others, with supplies for the cholera clinics, and the perspective of two mission to the area under our belts!
Chantal M. Pyram, MD- ISHI volunteer
Saturday, November 13, 2010
‘where is Jesus in a place like this’? Interesting question posed by one of my volunteer colleagues. Being Haitian-American and this being my first time back in Haiti since the horrors of working here in January- I was taken aback. Do I feel disrespected or can I understand that viewpoint? Would I feel differently if this came from a Haitian person? Absolutely! As a people, we have been through a lot recently- hurricanes, earthquake then Tomas. Residents in Haiti have a reason to say it, but they never would. All they speak or sing about is God. Is that soo different than any other inner-city neighborhood in the States? No it’s not! Every ghetto is filled with tons of churches, because in times of need who else is there to turn to but God? Port-au-Prince in that sense is no different than Harlem or East Flatbush. Life isn’t easy and Jesus clearly exemplified that. Regardless of who He was, He still suffered at the hands of man. So who are we to complain about suffering, especially from natural disasters? Some of the suffering has been caused by man, but as Haitians we’re taught to bear the burden and move on. We are strong and resilient. One doesn’t have to be born in Haiti to learn that lesson, it’s in our blood! In agreement with one of my surgical colleagues who responded to this question, I feel Jesus is omnipresent for all who want to believe.
Emilia Wawszczyk, RN- ISHI volunteer
Sunday, November 14, 2010
It is 8 pm in Port au Prince. We are seated in the living room in Dr. Marquette’s house. It is hot and humid here. I sit and think about the images that I saw on our way from the airport to the hospital and to Dr. Marquette’s house- rubble, tent cities. Looking at the main roads, it appears as though cleanup has begun. 10 months yesterday after the earthquake, one would hope that some progress is being made, that the resources and money that was donated is being put to good use, in the hands of the people that need it most. That is debatable. One thing is certain- the plane was full of volunteers, which was comforting. I sat on a plane with a church group of 5 men who were there to do basically whatever needed to be done. They just wanted to help. Tthat is awesome. Thank God for good people in the world, people who for no other reason, than out of the goodness of their heart chose to come here to maybe make a difference in a few lives. As the house turns in for the night I sit and think about what life must be like in the streets of Port au Prince. How many people can really sleep soundly at night? How many children sleep alone tonight, with no one watching over them? how many women are afraid? It breaks my heart a lot actually knowing that this will probably not change for many years to come, maybe not even in my lifetime. A dim future to be faced with. No real chance for this generation of Haitians to come out of this disturbing situation. As Haiti embarks on an election of a new president in 2 weeks, with 15 candidates in the running, how many will have a plan, resources and courage to put forth change?? I wish Jhoselyn was here !!! I miss our talks, her loving, comforting heart next to me. Also..it is now 10:19 PM and the ROOSTER is going at it. he must be on Island time..
Emilia Wawszczyk, RN- ISHI volunteer
Monday, November 15, 2010
Day 2 Sunday 9 am church service, too bad it was in French. understood only a handful of words. Gotta get on that Rosetta Stone and study up my French as soon as I get home. Got a nice tour of the city saw a lot of the historic churches that are currently in ruins. Went to the hospital getting ready for hopefully a busy week with surgeries. That’s all for now PS: Kevin wrote half of this blog for me. he just got tired of me sitting here, with a blank page. THANX KEVIN. Also Vishnu is expecting a blog at 7 am sharp and you all know how Vishnu gets when Vishnu doesn’t get what he wants.
LEONARD!!!!! Wish you were here.... you would love it here...miss you... this mission is gonna be so great...ISHI is the best as you may already know :-) they are so organized...while I am horsing around right now, Charlie, Ziad and Vishnu are working on something . gotta love them..... I feel a little useless to them here...decision: back to school to get my NP so they can utilize me better...can’t wait to show you all the pictures.....
Vishnu Hoff- ISHI Co-Founder and Vice President
Monday, November 15, 2010
Intrepid ISHI volunteer Charlie, who joins us from Montreal, was inspired to teach a photography class to the children at the orphanage associated with the hospital where we’re operating. What a brilliant idea that was! These kids are so bright and so starved for stimulation; they came to life and soaked it all in, each clamoring to peer through the lens of his camera or to pose for their student photographers. It turns out that one serious looking twelve year old has been learning four languages, including Chinese, on his own, and another took charge of my video camera and demonstrated an almost immediate understanding of how to use its many buttons based on observing me- he organized some of the younger children and began shooting music videos.
Vishnu Hoff- ISHI Co-Founder and Vice President
Wednesday, November 17, 2010
By our usual standards, and certainly by our expectations for this particular mission, we’ve had fewer patients than we had hoped for, and today was a fine illustration of this situation. However, we made up for it by presenting an emergency room evaluation and post-op complications lecture for the local nursing and medical staff, and a lecture on basic anatomy and anatomical function to the 50+ children at the orphanage associated with the hospital where we’re doing our work. Both went over well, culminating in a pick-up basketball game between some of the surgeons and the children. Not exactly the model of efficient suffering for the better good, but an excellent way to blow off a little steam and to build some hopefully lasting relationships.
Tonight the team, with volunteer Zeina Wakim at the helm, is prepping the MANY presents we brought to distribute to a number of orphanages in the area. Tomorrow is a national holiday so we’ll spend the time providing some early Christmas cheer to those who have even less than the average Haitian in these hard times.
We’ve read news of “”civil unrest”” in Haiti but have seen so signs of it what-so-ever- to the contrary, we’ve been surprised at the apparent lack of hostility on the crowded and demolished streets, with traffic and pedestrians wending their way in an unguided procession through a self-made maze.
Charlie Khoury- ISHI volunteer
Wednesday, November 17, 2010
Abject misery, hopelessness, high unemployment. Very pious people, praying to voodoo gods and Jesus. Not all have been saved by Jesus, as one missionaries pointed out. One of the best gifts that Haiti could get would be to lose a little bit of the religious fervor that’s used by all political classes to stir its masses.
I don’t know if the poorer people are the more religious they become, or the more religious they are the poorer they become.
One very interesting fact: the large independent medical aid missions (Medecins Sans Frontieres, Red Cross) in Haiti are destroying the business of local hospitals by providing free medical help. Local Haitians clinics cannot compete, and are losing all their patients. That made us think a lot. So far ISHI isn’t in the same class as the large NGOs.
Very difficult to travel inside the city. Most of roads are dirt roads, with giant potholes, and from time to time, to add insult to injury, speed bumps.
Earthquake destroyed the PAP downtown where most of businesses were located. Thousands of jobs vanished overnight. Ministry of Taxes, as well as many other ministries, are a parking lot now. Voodoo beliefs are taken very seriously down here. Some rumors are going around that the earthquake was some voodoo interjection gone wrong.
Hot and sweaty days. Team is great. Regular frustration of operating in a developing country that moves at a different pace, people always smiling at our urgency... taking pride in reminding us all day long “”Ici c’est Haiti, c’est comme ca que ca marche””. I come from a country like that. I know what it is. Things are very slow, what takes us an hour, takes 6 here.
Haitians remind me of the Sudanese and Egyptian people; very good at analyzing world politics and conspiracies with elaborate concepts and words. Fatalism is a matter of fact, as seen in their stoicism in accepting their fate on face value.
Meanwhile Jesus is doing his best.
Asha Bale, MD- ISHI Co-Founder and Vice President
Thursday, November 18, 2010
It is our fifth day in Port au Prince and we’ve had a very eventful stay so far- Our team has done about 21 operations over the last three days, including hernia repairs, hydrocelectomies, hysterectomies and other operations. Patients are happy to meet us and thank us for coming to Haiti. Yesterday there was a young lady I saw who had come to the OR for excision of a 2 cm keloid on the left ear. She had explained to us that she had sustained burns to her face during a house fire (actually before the earthquake). Everything had healed except for the scar tissue around the ear. When we explained to her that removing the keloid might only be a temporary fix, and that it may grow back again, she asked us a lot of questions, and then eventually changed her mind about having the surgery. ‘Where do you live?’ we asked. She responded that she was from the Cap Haitien area; it had taken her 5 hours to get here. I know there is a hospital in Cap Haitien- it was the focus of a lot of discussions at surgical conferences recently because of the tremendous post-earthquake medical efforts there. I asked her why she came all the way to Port au Prince and her response was ‘I heard your American team was going to be here’ Wow. What a wonderful compliment to me, and to all of the American teams who have volunteered in Haiti over the years.
Thursday, November 18, 2010
Alongside King’s Hospital, in the same compound, is an elementary school, an orphanage and now a brand new Nursing school. We finished our operative schedule early so we had a chance to do some other things- Dr. Sifri gave a talk (in French of course) to the school kids about all of the organs in the body and how they work. A stethoscope was passed around and all of the children got a chance to listen to their own heartbeats. In the meantime, Emilia shared her experience as an ER nurse to a group of nurses from the hospital, teaching them the ABC’s of acute care assessment. King’s does not have an ER, but occasionally patients walk in the door with acute problems. So this talk was pretty relevant and appreciated. Next, Dr. Clarke spoke to the floor nurses about post-operative complications after abdominal surgery. The floors do not have sophisticated monitoring devices or protocols, as you can imagine, so the importance of early recognition of signs and symptoms of post-op mishaps was reviewed. I think the talk was well received, but some of the older nurses sat with their arms crossed, so it is hard to tell what they were thinking! One of the nurses wanted to know how one could recognize a patient with a retained lap pad or retained instrument post abdominal surgery! The discussion was a good one, focusing on the importance of pre and post procedure sponge and instrument counts. At the end of the day we visited the orphanage. There are about 36 children there or various ages. The ones I met were super smart and extremely well behaved and polite. ‘Take my photo! Take my photo!’ Smiling and curious, they quickly managed to usurp my camera phone from me and began taking photos of themselves in various poses! The little ones were laughing and pointing at the photos (which they were all examining on the small digital screen), amused with their poses and funny photos! In the meantime a side game of basketball was played- Sifri, Clarke and a small boy on team ISHI versus three teens on the other. I think the final score was 10 to 9- Sifri and Clarke passed the ball to the little boy, and he was a pretty good shot!!
Saturday, November 20, 2010
Saturday, my last day in Port au Prince before returning to the comforts of my home in NJ. We all packed up and said our goodbyes to the Michigan team that shared our accommodations and worked at the same hospital with us who were also returning home. Strangely we did not hit a lot of traffic on our way to the airport, unlike all our previous experiences driving in the city.
If a perfect healthcare system involves low cost, high access and high quality, then Haiti has none of these. Being an American surgeon in Haiti can be quite frustrating. Culturally, the pace is much slower. Patients are accustomed to waiting- doctors are in short supply and so when they prioritize the tasks for the day, the patient who needs an elective procedure may be last on the list, and it may take days to attend to him. All the while, he is admitted to the hospital, waiting his turn. Haitian patients are used to waiting. They wait for everything. Nothing gets done fast. Sometimes, it never even gets done. What we see as a great injustice is accepted as ‘life as usual’ by the patient and even the doctor. So when we try to achieve what we believe is the standard of care, the local staff doesn’t always understand, or share, our point of view. Yet, we must work with them, and involve them in our daily operations because that is part of the deal.
There were many ups and downs for our team this week, and it was not easy to assimilate into the Haitian healthcare system and provide the kind of care that we wanted to. The healthcare system in Haiti is a difficult one to volunteer in because the international response that was exhibited after the earthquake has caused Haitian hospital administrators and doctors to distrust foreign volunteers. Our ideas of efficiency in the OR, and what’s best for patient care, translate into American arrogance and unwillingness to collaborate with the local staff. You see, Americans providing free care to Haitians has caused financial difficulty for the local hospitals, which must charge patients for services if they want to be financially stable. So, while we think we are doing a great thing by volunteering our free services in an attempt to help the poorest locals, the local doctors are frustrated with us and want us to work by collaborating with them, instead of competing with them. That means no more free care by foreign teams in Haiti. But is that something we want to do? How can we still help the poorest Haitians get free access to surgical care under these conditions? Should there be free care? Who would get it? Who would give it?
Instead of taking a team to Haiti, should we just stay home and put together the money we spent for our airline tickets, our accommodations and other expenses, and send the money there? Would that help more Haitians than actually going over there and volunteering our time and skills for one week? It’s an interesting thought, and one that I don’t know the answer to. Certainly, the benefits reaped by me and my team would not be the same if we just wrote a check (the cross-cultural understanding, the exchange of knowledge, the deeply felt sympathy, the friendships, and letting the Haitians know that the outside world actually does care about them). And the concerns of mismanagement of funds, corruption and continued poor access for the people who need it the most would still apply. But would we be helping more people in the long run? If local hospitals flourished economically, then they would stay open- and that should improve access for everyone in that community, right? It is a difficult problem, but it’s worth thinking about because a self- sufficient healthcare system would be a great thing for Haitian people.
In any case, I’m hoping to be able to work in Haiti again soon. There are many needs- food, clean water, better sanitation systems, better schools, more jobs, more care for the elderly and orphaned children, improved access to healthcare, and all the other woes of all third world countries. I think every bit of help counts- and in whatever form it’s provided. Hopefully, Haiti will be able to stand on its own two feet someday, but there is still a long way to go.
Chia-Chi Wang, MD- ISHI volunteer
Thursday, November 25, 2010
Every morning on our way to the hospital, I looked for the signs of reconstruction in Port-au-Prince. Tents donated from around the world following the earthquake still stood along the dirt road that we traveled. The collapsed buildings and dust-covered vehicles deserted on the streets remain, the concrete foundations scattered in the midst of tents. Recovery from the quake is painfully slow despite the unprecedented aid pouring into this city that has yet to get a break.
Haitian people endure and live on.
A glimpse of normal life can be seen in children in school uniforms walking on the roads lined with the many merchants’ small stands. The streets were mostly filled with pedestrians competing with numerous “”tap-tap”” buses for space on the pothole filled roads.
I cannot help but think how frustrated Haitians must be today. Recovery and rebuilding of this city seems to need more than aid money- strong leadership is needed to effectively get the job done. The leadership, no doubt, has to be of Haitian origin that utilizes the foreign aid for its people, not for its political and/or monetary gain.
Thursday, November 25, 2010
This was a mission that showed me the gray areas in humanitarian work, and made me rethink how one carries out such work- did our transient presence benefit the needy, or those who were more fortunate in Haiti? There is no absolute answer.
On the day we landed in Port-au-Prince, I was taken aback when our team learned that the patients we were scheduled to operate on would be charged by the hospital for our services. Much time and direct communication was spent on our first day trying to figure out how this happened and how we could make it a free service. In the end, the problem was attributed to miscommunication between our team and the hosting Haitian doctor, who owns the hospital, and we were not able to persuade him to change his policy. Here lies the gray area in our work. I am not able to discern if this is a for- or not-for-profit hospital, and I feel my idea of humanitarian work is compromised when I deliver voluntary (free) services to those who can afford to pay, instead of to those who can’t afford medical care at all. I felt uncomfortable performing surgery knowing that the hospital demanded high fees from the patients for my voluntary service, but, in the end, I had to accept that these patients traveled long distances to come see us, the American doctors. I could not turn my back on them, despite my mixed feelings.
The Haitian doctor pointed out that free medical aid impedes the growth of local doctors. I do not believe that providing free care to those in need will affect the native medical establishments, privately or publicly owned. To say our free care will decrease local doctors’ business is to assume a significant number of Haitians who can afford medical care take advantage of free humanitarian aid. How presumptuous the assumption is! A lot of Haitians were already deprived before the earthquake. Foreign free medical service can only alleviate the local doctors’ burden of using their limited resources on the growing poor population.
This mission made me wonder if one should change his or her principles in delivering humanitarian aid. It is not so easy to draw a clear line here, and I suppose it depends on the situation that we face each time. Yet, the simplest core principle for me, as a surgeon, is to provide free medical/surgical care to those who cannot otherwise afford it. That should not be changed in any circumstances
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