Trip Report Dr Eric Jerome • April 25, 2010

Report of Dr Eric Jerome, AMHE coordinator, Week of April 25 2010

I landed at Toussaint Louverture International airport for my second tour of duty in Port-Au-Prince. The capital of Haiti is like Bagdad during the Gulf war or Dresden at the end of WWII. It looks like a sustained air bombardment had taken place.

My AMHE colleague Wiener Leblanc arrived one day earlier with Stacey Chamberlain from Chicago who was also staying at Quiqueya crisis Center. Three other members were already in Town, Ayman El Mohandes, Terry Huan, Michel Dodard . We were part of a graduate Medical Education group, a fact finding mission with a clear mandate to collect Ideas and report to a larger committee for Rebuilding Medical Education Group.

At the baggage claim section, I collected my suitcases filled with Dialysis supplies for the General Hospital. Customs agents did not bother. From the exit door, the sign AMHE Quisqueya was being held by a gentleman whose face seems to me familiar. He greeted me, loaded the pickup truck and we drove towards Delmas 75. He claimed he suffered from an eye ailment, retinis pigmentosa. He traveled and spent five months in Dominican Republic for treatment. However he ran out of money for surgery and returned to Port-au-Prince .With his vision getting worse, he consulted a Cuban doctor who arranged for him to take a trip to Cuba where he underwent an operation for his condition. He whispered he was happy to recover his vision, as we reached destination.

Good reception at the Quisqueya Crisis center created after the earthquake to house multiples international groups that have traveled to Haiti for humanitarian reasons. It was an extremely hot afternoon. I feel my brain shrinking due to sudden loss of water. Fortunately the group was to meet for special briefing at a different location.  We traveled toward the mountain side. We met two other member of the delegation at the house of a Haitian painter, a brother of Michel Dodard.  Sounds of small lizards and frogs reminded me we were far from the city. After some brainstorming for the week, Stacey and I returned to Quisqueya. I went to sleep on my air mattress until morning.  Four of us were on sleeping bags in the room.

At the donor conference the next morning, I met some friends and acquaintances. Our delegation composed of six individuals was invited as observers. We could not ask questions but just listen.
The minister of Health Dr Alex Larsen opened the conference by greeting everyone. He wished himself good luck for his challenging task. And the audience applauded. Then the General Director Dr Gabriel Thimothee presented an 18th month plan. He mentioned some hard statistics. After the earthquake, 30 out 49 hospitals were severely damaged with hundreds of thousands of people wounded, 4000 amputees, 1,300000 people without shelters and 600,000 escapees to the provinces.

The main idea was to strengthen MSSP while it is trying to decentralize the system. An 18 month plan was offered with a budget  close to 500 million dollars… The actual donors have not disbursed more ten millions.
During the Q And A section, the head of the Cuban delegation whose contribution was not listed on the slides presentation by MSSP forcefully intervened to outline the humanitarian work offered by the sister island to the rural areas of Haiti, since 1999. She mentioned a formation of a tripartite organization including Cuba, Venezuela and Brazil to continue to help. A spontaneous ovation arose!

I spoke with Dr Paul Farmer who was also an observer at the conference. He was also baffled by the limited amount of funds available to MSSP.   I met the departmental chief medical officer of the Grand Anse who gave us an overview of the medical situation in Jeremie and Anse d’Hainaut since I could not travel there.
The afternoon was dedicated to a visit of the General Hospital (HUEH. We brought some supplies to the Dialysis unit. Six of the Gambro machines given by Medecins Sans Frontierres (MSF) without the support of a dialysis technician obviously were out of service. The unit was back working with the BBraun German made machines parasitically dependent on a Dominican Republic technician from time to time. We visited the ER which seems to work efficiently with the support of IMC (International Medical Corps) and Partners in Health (PIH) who assure the night duty.

The OB-GYN residents are on strike for lack of payment. Internal Medicine service has not changed from the previous description of Dr Pulvirenti from Chicago. The Tuberculosis tents were dreadfully helpful at treating cases of pulmonary TB. And Megan Coffey is still working as a support Physician from California. AMHE continues to provide rotating specialists to those sections. HIV unit is back to External Clinics. The pediatric services were functioning under the tents. The Peds building should be marked yellow because of severe cracks visible even from the outside. It was built by the American Red cross in 1922. I feel this particular organization has collected enough money to rebuild it again.

We drove back to our compound the Quisqueya crisis Center. I paid a visit to a family member. Before going to sleep, I had my regular showers sub divo with the half moon as a witness. A German group in the compound was kind enough to provide me with supplies for the Hospital. We filled up two large busses with IV fluids, Antibiotics, Heparin, four by four, syringes, needles etc. That was a blessing with the difficulties to bring stuff directly from the US. Special thanks to Dr Hanns-Greog Heidecker. I spent more time in the TB tents with Dr Coffey and spoke to the nurses about their difficult work. The residents of internal medicine were better motivated to work. They pointed out the difficult time they had after the earthquake, no revenue, no house to live. The personal trauma was palpable. I explained to them my mere presence here was a sign of solidarity of AMHE and the overwhelming response of the world should be a boost to the moral. I spoke against the strike that I feel was not acceptable. And I promised to do an inquiry. MSSP did sign the order to pay, but the bureaucratic trajectory of the paper trail had not been designed to solve quickly the issue.

The next day we met with the Dean and the Assistant dean of the Medical school: the faculty of Medicine, Dr Gladys Prosper and Dr Doddley Severe. The pharaonic figure of our delegation Dr Ayman El Mohandes spelled out the purpose of the visit and the interactions were frank and appropriate. In the afternoon we chatted with the other Private Faculties. We had very forthright exchanges with Drs Genevieve Poitevien, Jean Cornelli and Hughes Henrys. Serious information was provided for a comprehensive approach to the medical schools problems. We drove to the JSI center and met with Dr Gerald Lerebourg and Dr Claude Surena. We spoke about the Haiti Health Care Facilities project with HHS. Public health was the subject on the table with five of our delegation since Michel Dodard had left early to Miami. Terry Huan and Carine Surena will be the point persons for an ad Hoc committee to examine the issue.

We met in the evening with the all crew in charge of MSSP, including the Health Minister Dr Alex Larsen, t he general director Dr Gabriel Thimothee, etc. We tackled many issues.The next morning the Quisqueya driver brought us back to the Airport.

-Rebuilding Medical Education seems to be an enormous initiative. At the 15th of March meeting in DHHS three groups were formed to deal with 1) Education 2) Graduate Medical Education 3) Infrastructures. This Medical Education mission will report to the larger group pending a meeting of all three groups in June 2010.
-HUEH needs more Human Resources to support the residents. AMHE has brought some supplies which is a small drop in a huge bucket. More will be necessary to meet the demands. Revenue is scarce because of high unemployment, 85% before the earthquake. By the time the patient relative finds cash to go to the nearest pharmacy, the medical condition may become hopeless. Human life has more value.
-International groups are leaving; we have to design a sustained effort in the Diaspora to maintain help to this country. If you have already volunteered, you ought to come back. If you have not done so, please go the website  and volunteer for Haiti.

Eric L. Jerome, MD FACP