Children’s Global Health: A return to Haiti

Michael Felber, RN, is a nurse at Children’s Hospital Boston. He spent two weeks as a medical volunteer in Haiti in March of 2010, in the aftermath of the earthquake that devastated the country. The following February he returned with a group of clinicians from the Global Surgery Program at Children’s, to work at a hospital founded by Partners In Health. While there he met a child who changed his understanding of the relationship between caregiver and patient.

Michael Felber and Louveda

In February of 2011 I spent a week working with a Children’s team in the village of Cange, in Haiti’s Central Plateau. The region has been served by Partners In Health and its Haitian sister organization Zanmi Lasante for over 25 years. Together they have built a hospital and a multitude of programs to improve health, education, agriculture and social services. Our goal was to collaborate with PIH and Zamni Lasante, in their development of surgical programs and medical education for Haiti.

Our first patient was Louveda, a sweet and articulate 12-year-old girl with severe burns on her thighs and abdomen from a kerosene lantern accident two months earlier. Both her parents had died in the past year so her 14-year-old sister, Anita, was her primary caretaker. (Since Louveda’s accident, the two girls lived at the hospital, sharing a single bed.) She was wrapped in wet, stained bandages. She tried to remain as still as possible because it hurt her to move. She said it was hard to rest because her bandages were hot and itchy.

With the help of the Haitian clinical staff we arranged for sedation in an operating room so we could change her dressings and assess and debride her wounds. We brought a stretcher to her bedside, and in a calm and mater of fact way she asked, “Am I dead?” It occurred to me that in the two months she had been in the main surgical ward of the hospital, an open room with about twenty other patients, she had seen others die and be removed on stretchers. And it was realistic to assume that she too would not survive her injuries. Despite it all she seemed calm. In the operating room she smiled and held my hand as she went to sleep.

While she slept we cut her bandages off with scissors. The smell and wounds were overwhelming. Her upper legs and stomach were covered with deep, angry red wounds. There was a pressure ulcer on her left ankle, nearly exposing bone. We washed her wounds and put her in a clean gown and fresh bandages. As the initial shock of her injuries wore off, we began thinking of a long-term plan for her.

The good news was she was medically stable, but that wouldn’t last. She was anemic and malnourished. (A common complication for burn patients because they tend to have greatly elevated nutritional needs.) Her body was compensating physically, but would not be able to do so indefinitely. Her breathing and pulse were too fast and her muscles and skin were wasting and breaking down. She needed nutritional support, blood, physical therapy and help for emotional trauma. And mostly she needed skin grafts to close her wounds. Her injuries were extensive but treatable, but not with the resources available in Cange at this time.

City street in Cange

I emailed a friend who works at Shriner’s Burn Hospital for Children in Boston. Within a day Shriner’s accepted her for free treatment.  It was great news, but with no parents or adult family members and no birth certificate or school records, the immigration process would be daunting. Luckily Sybill Hyppolite, the coordinator of Partners In Health’s Right to Health Care program, which specializes in helping patients who need medical treatment not available in their home countries, was coming to Cange the next day. I knew she would be crucial in getting Louveda to Boston to receive the treatment she so desperately needed.

For the rest of the week we continued daily dressing changes, working with Romero, the staff anesthesiologist, as well as the Haitian Operating Room nurses. We brought her Ensure to supplement her diet. Together with the Haitian ward nurses we instructed Anita on ways to keep her from lying on her ankle. With the help of Anita and the entire floor staff we encouraged her to walk more. The most difficult thing was getting her out of bed regularly because walking was painful and scary for her. I remembered her matter of factly asking if she had died the first day we met her. I imagine she still was not expecting to survive and didn’t see the value in trying to walk when it was so painful. The support of the Haitian nurses, whom she already knew and trusted, was invaluable in enlisting her cooperation.

At first she argued loudly about getting up. I told her she didn’t have to walk but at least needed to sit up. She protested, but soon began to enjoy watching the goings-on of the hospital around her. It wasn’t long before other patients and the nurses began encouraging her to walk. She argued with them, but we could see the tide turning. Soon she was up with her walker, looking pleased with herself. We came back later to get her up again. Again, protests, but this time she made it to the bathroom and back. I pulled out my Ipod and played a Wyclef album. She smiled and started moving to the music, and then stood up and danced with me for a few moments, grinning ear to ear. All around her patients and nurses clapped, laughed and cheered.

We tried to make her feel more like a child and less a patient. We surprised her after one dressing change with new sandals and scented soap from the street market outside the hospital compound. We tried to end her walks on the patio, where she could enjoy sitting in the fresh air with Anita and playing with other children. She loved listening to music, visiting and playing dress up.

Louveda enjoys dressing up. Here's some of her princess finery.

I was pleased with her progress, but knew she needed more specialized treatment to survive. Together with David Bayne, a medical student working with Partners In Health, we worked on a plan to keep her stable until her transfer to Boston. He secured an operating room and anesthesiologist for regular dressing changes. He walked with her and made sure she was getting Ensure. The Haitian physician supervising her care ordered a blood transfusion. I knew that David and the rest of the staff in Cange were going to be crucial in keeping her safe and healthy, and in keeping her spirits up.

When I said goodbye to Louveda and Anita I didn’t say anything about Boston. I didn’t want to make a promise I wasn’t certain I could keep. I told her she would be able to get better, but that she needed to keep eating and keep walking to do so. She cried a little, and asked me if I was ever coming back to Haiti. I told her I didn’t know. Beverly Small, one of the nurses on our team said that she visited Haiti every year. “If I am alive, please visit me,” she said.

It was the most hopeful thing I had heard her say all week.

I didn’t sleep much that night. It had rained in the evening. The air was hot and humid. I woke up restless several times, and kept imagining how itchy and uncomfortable she must have been in her wet dressings.

For the second part of Louveda’s story, click here.