I am a US trained Critical Care Paramedic. I have worked both as a street paramedic and a field training officer in a metropolitan area of 410,000 people and covering 1,368 sq mi. Some have said ‘you must have seen it all’, that’s not true. Every day brings the same and something a little different. You pull from past experiences to care for the current situation. The first time I was in Haiti was in July 2010, 6 months after the earthquake that devastated the country. It was for a week long mission surgical trip. It was then I learned I have definitely not seen it all. In February 2011, I moved to Haiti for a yearlong commitment.
I’ve been in Haiti for 8 months now and still am shocked and surprised by things. A few weeks ago, I was at the clinic around 8am when I was informed that there was a person just down the road who couldn’t walk and needed help. That was all the information we had. Luckily, our mission has been blessed with two ambulances so I took one of our Haitian nurses plus a visiting nurse and drove to out to see what we could do to help. Just like back home, you take your dispatched complaint and use it as a guide but don’t use it as the actual chief complaint. As we drove down the road scanning for the person in need we noted a small crowd of people on the right side less than a mile from the mission. There was no urgent waving or signs of distress from the people. As we got closer one of them looked up and saw us, then they waved us over. I stopped and blocked the scene with the ambulance, as I’ve always been taught but extra important in Haiti as there are minimal driving rules here. As I got out I noted about 6 people standing around someone laying on the edge of the road. The person laying there was someone we recognized from our mission church, a young male around 20 years old. So my “dispatched” complaint of a man down who could walk was right but with a twist. He had been walking at some point in the night when he was struck by a vehicle. It’s now 815am, it had been daylight for about 3 hours. The most obvious trauma was a left femur fracture; it was extremely swollen and deformed. There were also multiple lacerations and abrasions, some of the lacerations very deep. He was alert and talking to us. In the States we call this a “load and go” situation. We are about 5 minutes into our scene time when I noted the 6 people standing around had turned into a crowd of 40 as buses and cars stopped to see what was going on. This is another common thing that happens in Haiti. They are very curious and community oriented, they wanted to see if they knew the person and just what was going on. They are also not shy; this crowd was all within 1 foot of us trying to work. As I had someone go for the equipment we needed from the ambulance I tried to get our working space opened up some. This goes back to our scene safety training; I have a responsibility to myself, my partners and our patient to keep us safe. There is no 911here so we were getting no more help, no police for crowd control, no fire rescue for assistance in patient care. We finally got the patient loaded and I leave for the mission to grab an extra driver and have our doctors do a quick assessment before heading into Port-au-Prince for definitive care, surgery. In the back of the ambulance our nurses continue the assessment and start an IV. The patient is still alert and at his norm which is slightly confused. As I said, we were aware of who he was and that he had some mental type issues and was always confused as to time and place. What we saw was his normal. We contacted the closest facility that has a general and orthopedic surgeon and they stated that we could transport there after he was stabilized. With what we had, he was stable. Enroute again we did a more detailed exam. The only new injury found was 2-3 fractured ribs. It was determined that there was no respiratory compromise and his abdomen was soft and flat leading us to believe there was minimal to no internal bleeding in that area. On arrival at the facility, a doctor opened the doors of the ambulance and asked for an update. As I gave my report he stopped me and stated that the patient had a head injury and they could not take him. As I sat at the head of the patient and the doctor at the foot looking in, I advised him that we did not believe there was a head injury and what made him think there was. He pointed to the 1” laceration over the eyebrow and said there was an injury and the patient was not oriented. I advised that we knew this patient and that this was his normal mental status. I also noted that there were no other signs of head trauma. The doctor continued to argue that this was a head injury and he would not take the patient. Knowing that this is Haiti and he does not have to accept any patient, I knew arguing was keeping the patient away from possible care. We left for another facility. Enroute I was able to call the facility and was told they had no beds or room to put the patient. I pleaded for them to help us care for him and that he needed surgery to survive, they apologized but still could not take the patient. We made the decision to go to the main hospital in Port-au-Prince, General Hospital. This is the biggest hospital and one of the furthest for us to get to. They are also nothing like what we are used to in the States. There is no sense of urgency with the staff. They see the dead and dying daily here. During the trip down some of the worst roads you’ve ever seen in a city of 900,000 people, our patient started talking and actually making sense. This worried us, why the change in status? He looked up and started saying “Papa?” and looking very distant. I’ve seen this before and for those of us who work to saves lives we know it’s getting to be out of our hands when this happens. He starts to drift into unconsciousness. We arrive at General around 11am and I’m having a hard time getting the patient to wake. At General you don’t call ahead of time or give a radio report to anyone. You don’t bust through big doors into a pristine well lit area with doctors and nurses waiting to work just as hard as or harder than you were to save a life. You pull into this alley looking area, crowded with other people sick and hurt. You’re supposed to go get a dossier (medical chart) first, it’s like registering. That even applies to our case so I sent our Haitian nurse out first to get things started for us. As we got our patient ready to leave the ambulance I noticed his respiratory status changed for the worse, agonal. We were able to get him right into their triage area, an 11’x11’ room with a desk, a security guard, a nurse and a tech. Did they jump right up to begin resuscitative efforts? No, they casually looked at us waiting for an explanation. We explained in great effort the patient’s grave condition. The nurse got up and walked over to the patient and took a set of vitals, turned and said “He’s going to die.” We all looked at each other with this look of frustration and then watched in horror as they let him take his lasts breaths. They then stated that they had someone coming over to get him to the morgue. We never left the room, we had no sheet to cover the body and they offered no sheet to cover him. When the person arrived to take him to the morgue we again were shocked. We had to follow him to the morgue, as we rolled the patient on our gurney outside and down 3 blocks to the morgue building. When we arrived at the morgue, I found it non-refrigerated and numerous bodies in different stages of autopsy and or just lying on the floor. This is where they also placed our patient.
Things like this happen daily in Haiti. Medical missionaries, like me, and other healthcare professionals come to Haiti to bring our talents and to make small differences. It took a long time for Haiti to get this way and there is no easy fix. Haiti needs to see that there can be a different way, it can get better. For those of you hearing the call to serve, take a chance, for those of you that hear the call but for some reason can’t serve in the field, support those who can. It takes a wide variety of people and support to make change. This is only one story that tells you about why change is needed. If we all make some small changes they can add up to be something wonderful.