Haiti Mission Deepens Education of Fox Valley Resident

For Department of Family Medicine (DFM) Fox Valley resident Elizabeth Larson, MD, a recent medical mission to Haiti was a once-in-a-lifetime educational experience.

In the space of a week, she assisted with several thyroid, prostate, and hernia operations; removed a three-inch cutaneous horn from a patient's neck; treated a septic leg wound full of maggots; and even resuscitated three newborn babies. Most cases had happy endings, but one, sadly, did not.

Dramatic? Of course. Heroic? Not necessarily.

Because for Dr. Larson, this trip was not just about the knowledge she brought with her as a physician. It was more about the knowledge she took home—as a person.

An Ongoing Relationship with Hôpital Bon Samaritain

Dr. Larson spent the week of March 20, 2010, working at Hôpital Bon Samaritain (Good Samaritan Hospital) in Limbé, a small town on Haiti's northern peninsula.

She was accompanied by four other Wisconsin physicians—a general surgeon (also her father), a urologist, an otolaryngologist, and an anesthesiologist—plus several nurses.

The group is not affiliated with any organization, Dr. Larson said, nor were they directly responding to the earthquake that devastated Port-au-Prince earlier this year (although some of the physicians had been involved with that, too).

Rather, it's an informal group of colleagues who have been coming to Hôpital Bon Samaritain for at least the past five years to donate their time, expertise, and services.

Getting Down to Work

The work began first thing Monday morning, examining patients that the hospital had brought in for surgical consultation. Dr. Larson assisted with these and other clinic visits, and scrubbed into many of the operations.

"As a family medicine resident in the midst of a bunch of surgeons, I had the unique opportunity to pick and choose what I wanted to do," she said. "I could learn from the surgeons and also find my niche in family medicine to provide care that wasn't necessarily in their area of expertise."

Operations included partial thyroidectomies, hydrocele and hernia repair, large lipoma and other mass excisions (including that three-inch horn), and prostatectomies.

Dr. Larson said the cases were similar to those seen in the United States, but because people in Haiti don't have the same access to or quality of medical care, they were more numerous—and often more severe.

For example, some of the prostate patients' disease was so advanced that they had been living with indwelling Foley catheters. "In the US, you'd get the surgery for a much less severe problem," she said.

The medical tools available were also inconsistent at best. Dr. Larson said that the urologist had brought equipment to use with the hospital's donated laser machine, which enabled him to do prostatectomies much less invasively.

"Yet there was only an old piece of plastic sheeting and a three-gallon bucket to catch the fluid drain during the surgery. It was kind of a paradoxical picture."

A Very Different OB Experience

Dr. Larson, who has a specific interest in obstetrics, also got more hands-on experience with complex deliveries than a first-year resident would ever have in the States.

For example, she assisted in a breech delivery in which the baby was not breathing well after birth. She was surprised to find that there was no bag mask, oxygen, or warming blanket available, nor was there even a good place to put the baby during resuscitation.

Fortunately, with some help, that baby improved shortly. But the next day, Dr. Larson came into a delivery room and found a nurse trying to stimulate breathing in another newborn.

Dr. Larson found that the baby's heart rate was extremely low, so she performed chest compressions. A Haitian doctor then located an old ambu bag, so she could do positive pressure ventilation while he took over the compressions. As best as she could tell with the limited monitoring available, the baby recovered with no complications.

And the next day, another baby was born, this time with a rapid heartbeat and fluid in his trachea. Dr. Larson had to hunt down the suction machine from the operating room next door—while they were in surgery—and find a small catheter to clear the baby's airway.

Dr. Larson was struck by the apparent lack of transitional care for newborns, and she's not sure whether the reasons for this were due to educational, cultural, or language barriers.

"It was hard to tell whether the nurses just didn't have a lot of training, or whether they were stepping aside to let the visiting doctors handle the situation," she said.

Many Lessons Learned

For Dr. Larson, the trip was significant on many levels. "From a professional development standpoint, I can't underestimate how much I learned about maturing as a physician, disease processes, and patient care when you have limited resources."

Successfully resuscitating babies for the first time was also a huge confidence booster. Each time, Dr. Larson said it was better to jump into the fire than to do nothing, and each time she found her footing. "I was the only visiting doctor with any OB experience, so I became the leader," she said.

Unfortunately, one case did end tragically. A six-year-old boy undergoing hernia repair lost heart rate just a few minutes into the operation and died two days later. The team still isn't sure of the cause.

This was especially difficult for Dr. Larson, a mother of three who hadn't yet been involved in a case where a child was lost. "If we hadn't been there, he'd probably be alive today," she said.

"Usually you go into these situations thinking of it the other way around. It reminds you of how vulnerable we are as people and as doctors," she continued.

But this is precisely the kind of awareness doctors need, Dr. Larson says, and trips like this are a great way to find it. "We often have the attitude that we're going to give so much, but the truth is, we receive so much more in return."