Going Global

The Going Global blog is an opportunity for emergency physicians to share their experiences practicing and teaching outside the United States. Submit an article about your experience to EMN at emn@lww.com. Be sure to include a brief biography and photographs of the authors. Photos taken during time spent abroad are also welcome, and should be 300 dpi and in jpg, tif, or gif format.

This blog was started by the emergency medicine residents of Palmetto Health Richland in Columbia, SC, who travel the globe on medical missions. The program is under the direction of Thomas Cook, MD, who oversees one of more than 40 academic departments of emergency medicine that sponsors Global International Emergency Medicine Fellowships.

Wednesday, August 7, 2013

Lessons from Haiti: Don’t Take Hot Showers and Drinkable Water for Granted

By Scott Kurpiel, MD

Practicing medicine in Port-au-Prince, Haiti, was an amazing experience that gave me a tremendous amount of perspective on health care and life. I was fortunate as the trip leader to recruit a well-rounded team of health care professionals, including 10 nurses, six doctors, two EMTs, and one sports rehabilitation therapist. We worked in a gated hospital that was secured by armed guards. The complex contained Haiti’s only full-body CT scanner, which was only available from 9 a.m. to 5 p.m. Most patients were seen urgently, and were dispositioned from a two- to four-person triage tent.

Arriving at the airport.

Sick patients were stabilized and treated in a three-bed ED. The adult inpatient ward had 10-12 beds, and the adult ICU had five. The hospital campus also had an outpatient clinic space staffed by Haitian practitioners during business hours, a paralysis rehab ward, a two- to three-bed HIV inpatient area, and a 15-bed functional pediatric unit that included a NICU. Our team slept in bunk beds in a building next to the ED.

Enjoying coconut milk.

Haiti is an extremely impoverished nation, and its medical infrastructure is severely limited. Practicing emergency medicine there was challenging because supplies considered standard in the United States were not readily available. I had to make a sling out of a T-shirt after relocating a dislocated shoulder, for example, and a splint out of cardboard for a forearm fracture. We relied heavily on our clinical findings because the laboratory was extremely basic, and it could take up to three hours to get the results of a single assay test.

The decision to bring a borrowed portable ultrasound machine with me turned out to be a huge benefit, and it had a major impact in improving our diagnostic certainty. The ultrasound provided advanced imaging, and it was especially useful for the first few days when the hospital's only x-ray machine wasn’t working. I used the ultrasound machine to guide interventions, including peripheral intravenous access and thoracentesis for massive pleural effusion. It also shaped the disposition of more than over a dozen patients I treated. I used the ultrasound to diagnose intra-abdominal hemorrhage in a patient with low blood pressure and clinical signs of shock, and that prompted our Haitian surgeon to take the patient directly to the operating room without any additional workup. We later found that patient had a perforated gastric ulcer.

Many of the Haitian people were extremely appreciative and thankful for the service we provided. The families of admitted patients would routinely sleep on the hospital grounds to provide support and care for them, including bathing and feeding.

Local vendors sold mangos and fresh coconuts at the hospital.

I was happy to tour the city and countryside overlooking the Caribbean Sea. I was also able to see the city’s center that was hit hardest by the 2010 earthquake, including its cathedral.

City Cathedral damaged in the earthquake.


Haitian taxi.


The Caribbean.

The Haitian staff, including their EMTs, were extremely knowledgeable, interested in learning about new medical techniques, and were invaluable Creole translators. I had an amazing experience, and felt that I had a positive impact providing care and donating blood because blood bank reserves are constantly in critical shortage at the Haitian Red Cross. It’s difficult to imagine the extent of poverty in Port-au-Prince. I returned to the States feeling especially grateful for all of the opportunities that I’ve had, and took special note of the things that I frequently take for granted, including hot showers, drinkable tap water, and a stable political climate.

Dr. Kurpiel is emergency physician at Baylor University Medical Center in Dallas.