Children’s Global Surgical team departs for Cange, Haiti

haitidayone_03202010_0193
Kathryn Barrett, RN, plays with a boy whose leg was fractured during the earthquake.

Melissa Jeltsen, a writer at Children’s Hospital Boston, is embedded with Children’s Global Surgical team at the Zanmi Lasante (ZL) Sociomedical Complex in the village of Cange, Haiti. The hospital complex, located two hours north of Port-au-Prince, offers medical care to people living in the Central Plateau. Led by John Meara, MD, DMD, MBA, the hospital’s plastic-surgeon-in-chief, Children’s Global Surgical team is spending a week in Cange, performing surgeries, wound care, general pediatrics and occupational and physical therapy. This is the team’s first mission.

The plane from Miami to Port-au-Prince was jammed to capacity with various aid groups, each identifiable by their matching t-shirts emblazoned with hopeful slogans. One read, “I’m going to Haiti, where are you going?” another, simply, “Restore. Rebuild. Redeem.” The nervous energy in the plane, manifesting in sporadic giggles, contrasted with the solemn manner of the Haitian man sitting next to me. He’d been in Miami, where his cousin lives, arranging to have his kids come to the United States. He was happy, he said, that we were coming to help Haiti. “So many dead,” he said, drawing a finger across his throat each time he repeated the phrase.

In Port-au-Prince, we were met by representatives from Partners in Health (PIH), a Boston-based nonprofit corporation with a long relationship with Haiti. We packed into a van and drove through the city.

On the road to Cange.
On the road to Cange.

It had been two months since the January 12 earthquake, and robust markets with everything from batteries and superglue to blue jeans and sugarcane lined the streets.

We headed north to a hospital complex in the village of Cange. The goal of this trip, which was planned before the earthquake, was to collaborate with PIH to expand Haiti’s capacity for surgical care. For years, Paul Farmer, MD, PhD, the co-founder of PIH, had discussed with John Meara, MD, Children’s chief of Plastic Surgery, the need for surgical care in Haiti. A team was assembled to come to Cange and work with Haitian clinicians to teach and perform surgeries. Since the earthquake, the mission of the trip changed slightly: Although the team will still perform surgical cases, wound care and physical and occupational therapy will also be high priorities.

After three hours in the van, we arrived at the hospital. Begun in 1985 as a small community clinic, the hospital now boasts two operating rooms, an infectious disease center and a women’s health clinic. With two schools and a church, the complex is the epicenter of Cange, and many village residents are also employees here. Three Children’s nurses—Bev Small, Meghan Weake and Kathryn Barrett—had arrived a few days earlier. They greeted us, looking tired but enthusiastic. While we ate dinner (a stew, fried plantains, rice and beans) the nurses updated us on what they’d been doing. The day before, Meg, an OR nurse, assisted in an amputation, the first she’d ever done. All three had kept extremely busy with dressing changes for the numerous patients with wounds.

Cassandra Mombrun, RN, assembles a box of supplies for wound care.
Cassandra Mombrun, RN, assembles a box of supplies for wound care.

After dinner, using flashlights, we went on a tour of the grounds. We visited the church, which had been turned into a makeshift ward after the earthquake. As the community was eager to have their place of prayer back, the staff was slowly transitioning patients out. Exhausted after a full day of traveling, we went to bed early. We woke up to the sounds of folding chairs being set up for church service (because the church was still in use as a clinic, the service was relocated to another smaller building). The complex was bustling with people dressed in their finest. Rows of seating were erected outside for the people who couldn’t fit indoors. The two-hour Episcopalian service was punctuated by choir songs. For kids and young adults without much entertainment, writing songs and practicing choir is a favorite pastime.

Because it was a Sunday, a day of rest, there were no surgeries scheduled. In the afternoon, the team went to the supply shed to organize and prepare for Monday. Halfway through the project, Meara received a message that an emergency trauma case just arrived, a 4-year-old who’d been in a car accident. Meara, anesthesiologists Craig McClain and Michael Angel, Johanne Jocelyn and some nurses promptly responded. Haitian nurses and certified registered nurse anesthetists (CRNA) worked side-by-side with the Children’s team in the operating room. After a few hours, the child was stabilized, but without access to a ventilator, he would need to be bagged all night.

This quiet rest day turned out to be more hectic than expected. Tomorrow, we’ll begin a full week of medical care.