Even before the devastation from the earthquake that struck on Jan. 12, medical supplies were scant and simply not available in some parts of Haiti, the most impoverished nation in the Western Hemisphere. Neurologists who traveled to the country saw first-hand the dire need for medications, medical personnel, and basic equipment.
“Unless you have been there to witness the poverty and disarray before the earthquake, it is hard to imagine the state of Haiti now,” said Norwich, CT, neurologist Anthony G. Alessi, MD, a 2004 Palatucci Advocacy Leadership Forum (PALF) graduate and subsequent mentor and advisor. Dr. Alessi has been to Haiti three times over the past 16 months as part of a medical team working with the Norwich-based Haitian Health Foundation (HHF), www.Haitianhealthfoundation.org.
He told Neurology Today that he is currently trying to get transportation to Haiti to serve at the HHF clinic in Jeremie located 280 kilometers from Port-au-Prince, where he has participated in medical missions in the past. He anticipates that many survivors will flee the capital city to surrounding areas like Jeremie.
“The area is already overcrowded and we need to start refugee planning measures as soon as possible,” Dr. Alessi said. As a volunteer neurologist for the HHF, he intends to care for patients with head injuries and seizures as well as provide basic care.
Dr. Alessi is not the only member of his family to have a special tie with Haiti. His 23-year-old daughter, Stephanie, who has just started medical school at St. George's University in nearby Grenada after having completed her master's degree in public health, recently returned from Jeremie. She had been there for six weeks working with the HHF under the supervision of their director of public health, going into rural, mountain villages for monthly health posts where she focused mainly on maternal health.
“A person who has lived in a developed country like the United States cannot fathom the living conditions that are commonplace in Haiti,” Stephanie said. Multiple people dwell in a very small house, typically made out of cement with a tin roof, although many others have houses made of mud, sticks, tree branches etc. as their only shelter. At the same time, roosters, chickens, rats, stray cats and dogs, and other disease-carrying animals share the same living space with them, she explained.
But Stephanie was impressed by the resiliency, strength, and hope of the Haitian people, calling it “nothing less than remarkable and awe-inspiring.” Their strong sense of community is evident in their everyday life, she said.
Both she and her father spoke of the distressing lack of infrastructure in Haiti. While Stephanie was living in Jeremie, there was a big fire in a downtown store and a Haitian friend of hers went to help put it out.
“In the United States, if a member of the general public were to go and put out a fire or save a life, they would be considered a hero and honored in some way,” she said. “But I learned that the fire department in this region sells their water, so they never have any on reserve to fight fires, which almost always must be put out by the local citizens exclusively.”
Stephanie is excited to complete her medical degree and return to Haiti to bring more meaningful medical relief. She has been in contact with the other American volunteers she had worked with who are still in Jeremie, and they've reported imminent food shortages to their area and the rest of the country because of the transportation challenges caused by the earthquake.
“Transportation throughout Haiti has always been a major problem due to the lack of paved roads, and this earthquake has worsened that situation,” she described.
A MISSION, A VOCATION
2010 PALF graduate Jeffrey K. Bigelow, MD, MPH, currently a third year neurology resident at Yale-New Haven Hospital, has been to Haiti four times. Between the ages of 19 and 21 he served as a Mormon missionary in Boston assigned to the Haitian community and became fluent in Haitian Creole. His experience ultimately influenced his decision to become a physician and sparked a desire to help the Haitian people.
He began to travel there in 2000 with an organization called Healing Hands for Haiti — www.healinghandsforhaiti.org — serving first as a translator at a clinic in Port-au-Prince treating Haitians with disabilities. He went back the following year to travel around the country and survey the situation of amputees, and then returned in 2003 as a first-year medical student to evaluate the potential for employment for rehabilitation technicians who were graduates of a teaching program.
During his most recent trip last May, he spent three weeks at the Hôpital Albert Schweitzer in the mountainous city of Deschapelles. Dr. Bigelow was the first neurologist ever to step foot in the 100-bed hospital, where he became part of the medical team caring primarily for patients with tuberculosis and HIV. He also saw outpatients with conditions such as seizures and strokes but had no access to EEG, EMG, or CT equipment.
No antiplatelet therapy could be administered to stroke patients because it was not known whether their strokes were hemorrhagic. The hospital pharmacy had a fluctuating medication supply, so that a patient who was prescribed carbamazepine, for example, could possibly be treated with diphenylhydantoin with the next refill.
Patients who were thought to have meningitis received antibiotics without lumbar punctures because analyzing CSF took too much time and resources. Although he had to rely on a history and physical to evaluate patients, the history, too, was often limited by patients' lack of understanding of the concept of time; Haitians from the mountainside were often unsure of exactly when they were born, and the time-sequence of how their symptoms developed was unimportant to them.
Dr. Bigelow spent his last week at an outpatient rehabilitation clinic in Port-au-Prince where, even if he prescribed an EEG or CT for patients with apparent advanced hydrocephalus, strokes, head or spinal trauma, most patients were unable to get transportation to the facility, much less afford the test. On the last weekend, he traveled to Casse, an isolated village in the mountainside that had not been visited by a physician in 200 years.
Care was frustratingly limited by a lack of supplies and treatments. Although the sickest diabetics or hypertensive patients could be started on some medication, there was no possibility of refills in the future.
Dr. Bigelow has received e-mails from some members of Healing Hands for Haiti, and knows that a large number of the staff is unaccounted for. Prior to the earthquake he had been planning a trip this May to help start an education program in the hurricane-ravaged city of Gonaives, but he now believes that more basic support will be needed. “When you have such a huge disaster, food, water and shelter trump all else,” he said, adding there will also be a great need for rehabilitation due to injuries from the earthquake.
Stay tuned for more stories and updates on neurology's efforts in response to the Jan. 12 earthquake: neurotodayonline.com.
HOW TO HELP
Haitian Health Foundation: www.Haitianhealthfoundation.org.
Healing Hands for Haiti: www.healinghandsforhaiti.org.
For more about the children's education program in Gonaives, where $400 can educate one child for a full year including tuition, books, uniforms, and meals: http://zionschildrenhaiti.blogspot.com.