Residency Match Day

Residency Match Congratulations

 

On Friday, March 21st results of the National Resident Matching Program (NRMP) were released. MEDICC extends a hearty congratulations to the nine ELAM graduates who matched to residency programs in Family Medicine, Internal Medicine and Pediatrics this year. We’ve listed the graduates who wanted to share their good news publicly below. Please join us in sending them all a big ¡FELICIDADES!

Akua Brown (2011) – Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY
Nadra Crawford (2012) – Family Medicine, Contra Costa Regional Medical Center, Martinez, CA
Desta Ellis (2009) – Family Medicine, Kaweah Delta Health District, Visalia, CA
Jessica Standish (2012) – Family Medicine, Glendale, Adventist Medical Center, Glendale, CA
Jonas Telson (2013) – Family Medicine, Mid-Hudson Family Practice Residency, Kingston, NY
Janice Verbosky (2012) – Pediatrics, Woodhull Medical & Mental Health Center, Brooklyn, NY
Medina Vernon (2012) – Internal Medicine, Woodhull Medical & Mental Health Center, Brooklyn, NY

 

US Health Researchers Look to Cuba for Better Outcomes

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US Health Researchers look to Cuba for Better Outcomes: Team welcomed by Cuban Officials

By Joseph Vargas 

For many Americans, Cuba is perceived as a forbidden island associated with Soviet era revolutionary leaders mixed with distant memories of cold war politics that culminated in the Cuban missile crises of the 1960’s.  Although the country maintains its Communist ideology, Cuba has evolved from a bourgeois playground in the 1950’s to a vibrant and emerging developing Caribbean nation that has some of the region’s best health and disaster programs.

Eleven health care professionals were selected to be part of a research team to examine Cuba’s distinguished public health and advanced emergency disaster infrastructure. For most of the teams researchers, including HCA Health Promotion Division’s Joe Vargas, it was their second Cuban visit since their initial research visit in 2010. The 2-week research study was composed of a variety of health care individuals including emergency physician assistants, nurses, a pharmacist, a research scientist, public health officials, a firefighter, paramedics, and a medical equipment designer.

The trip was arranged through MEDICC, an Oakland-based non-profit organization that works to enhance cooperation among the Unites States, Cuban and global health communities to understand and learn how to foster better health outcomes.  They also served as the groups official academic advisors throughout the visit arranging meetings with Cuban officials at Hospitals, Clinics, Public Health Ministry, Red Cross, National Ambulance Service, Meteorological Institute, schools and community organizations.

Since the United States has not had diplomatic relations with Cuba and an embargo since the 1960’s, travel to Cuba is restricted to select permitted individuals.  Fortunately, this group was allowed special permission visas under the US Treasury Department general license for professional research that includes full-time health related professionals conducting research in Cuba.

Polyclinics: Cuba’s answer to community health

The research group followed a Cuban government approved itinerary that was rigorous and nonstop, covering three main cities on the island nation; Habana, Santa Clara, and Cienfuegos. The trip initiated with field visits to Havana’s unique and efficient public health clinics termed Polyclinics. The strategically placed clinics serve as a hub for the neighborhood that include a doctor/nurse team that live in the community and an accredited research and teaching center for medical, nursing and allied health science students. In addition to providing primary care at their office, the doctor/nurse team make visits to the homes of their patients to conduct health audits and home care visits. Secondary care is provided at the Polyclinic facility where there are specialists that include lab, x-ray, physical and occupational therapy, dental, acupuncture and other services not offered in the neighborhood medical office. Tertiary care is provided at larger hospitals in larger cities, like Havana, where surgery and other more specialized treatments are conducted including transplants.

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The polyclinics are responsible for about 80- 130 families in their catchment area. One unique requirement is that Polyclinics are required to continually monitor and routinely conduct a health assessment of the neighborhood population they are responsible for and transform the service offered by the clinic, based on these needs. As it was explained to the US researchers, if the data or health picture of the community indicates that there is an increase in a health issue like smoking, then services like cessation counseling sessions would be increased a few days a week. Likewise, if there is an increase in a communicable disease in the community, then extra campaigns, monitoring and education would be directed expeditiously within the community to deter further cases. Polyclinic officials commented that because of their lack of financial ability to purchase costly medical equipment and supplies, Cuba medical personnel rely intensely on primary prevention efforts because they understand this to be the most cost-effective alternative to prevent future medical complications.  A quick look at Cuba’s health indicators are a reflection of the strong preventive primary-care structure enacted for the last 40 years. Many of these numbers surpass or are equal to industrialized countries in the world. According to WHO, Cuba has one of the world’s highest life expectancies at 77 years (WHO, 2008).

Public Health’s Neighborhood Participatory Model

The research team was fortunate to be able to visit the National School of Public Health and talk with Cuban medical professionals about the Cuban Public Health system and their vast disaster experiences working in austere environments. Cuba has a history of sending large numbers of medical teams internationally that are affected by disasters including recent missions to Pakistan, Haiti, Chile, Peru and Indonesia. The two countries were able to exchange viewpoints of best practices in managing medical care and disaster preparedness to vulnerable populations. Both international teams agreed that preparedness must be viewed and embraced by the local people as a community wide effort, ensuring that everyone works collaboratively due to limited availability of health and emergency services during disasters. The US research team expressed particular interest in the success of the community participatory model where every Cuban whether young or old plays an essential role in their community’s health and quality of life. The team was able to see this in practice through their participation in a neighborhood meeting. At the core of these weekly meetings held in front of the elected neighborhood leaders residence is an opportunity for all residents to share any of their community concerns. Most importantly any residential issue from concerns of senior transportation to unsafe street lighting can be identified by any resident young or old and resolved through the neighborhood leader process.

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Universal Health Care: A Cuban Right

A prominent yet important lesson researchers had to comprehend was the repeated reference to universal health and the Cuban Constitution throughout the visit.  This is in reference to article 50 of the Cuban Constitution that stipulates that all Cubans are entitled to receive free medical care and to have their health protected.  It also details the government to provide medical and hospital care free of charge, including dental care, prophylactic services and access to specialized centers.  Other key and impressive components of the Constitution embrace preventive care, specifying that the State shall develop plans for health education, programs for periodic medical examinations, immunization and other preventive measures.

International Conference

The research team was also invited to attend the 2nd Annual Health and Disaster Conference in Habana, Cuba. The international conference consisted of workshops in mental health, risk-communication, international cooperation, communicable diseases and vulnerable populations. Workshop presenters included experts from Ecuador, Argentina, Chile, Mexico and Great Britain. As invited guest, the US delegation was invited to provide an impromptu presentation related to US disasters. The conference provided a unique opportunity for the US researchers to share earthquake preparedness plans for California’s high-risk fault areas. Conference attendees were captivated once they were introduced to the risk-reduction models and emergency procedures that the team has experience with. Most of the US team are also members of Disaster Medical Assistant Teams(D-MAT) in California and have responded to numerous national and international disasters. Several foreign press were present including Radio Habana and Cuban television to interview team members and spotlight the research visit and the findings of the US group. 

  

Early Disaster Training in Schools

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One of the most memorable visits was to Orlando Pantoja elementary school outside of Havana. Upon the arrival of the team the whole student body participated in a welcoming friendship song waving their uniform scarves from the balconies of the three story school building. To show their enthusiastic understanding of their disaster training, students from 3rd grade gave an impressive demonstration of first aid skills that included applying splints, neck collars and CPR. Faculty were equally proud to demonstrate that the lesson plans Vargas8include emergency and disaster preparedness as early as the first grade due to Cuba’s geographical exposure to numerous tropical storms. Random conversations and interviews with children throughout Cuba confirmed the children’s thorough command of these critical preparedness skills and knowledge. The group learned that this early institutionalization of disaster preparedness is extremely effective and reflected in data that indicates smaller numbers of fatalities related to major tropical storms in Cuba compared to other industrial countries with more financial resources.

To finalize the research visit, the group toured several medical facilities including a hospital, ambulance headquarters, emergency dispatch facilities, Red Cross, and meteorological institute.  At these facilities, the research team was able to get an inside account of Cuba’s robust primary prevention focused medical system and understand it’s critical ties to civil defense teams, meteorological and information sharing systems.

After their return to the US, the research team is currently processing information for submission to academic journals for publication and scheduling presentations to share their experiences in Cuba to interested organizations.

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World Health Organization,The World Health Report 2008: Primary Health Care Now More Than Ever. Geneva, 2008.

MD Pipeline to Community Service—One Student’s Dream

Fourth-year medical student Sarah Hernandez’s ultimate goal is to serve as a family physician in her hometown in Sacramento, California. Re-opening a medical clinic at a neighborhood center— where she and her family have volunteered and received services from—is her dream.  The eldest of three children from a single-parent household, she learned early in life the values of giving back to the community. 

Sarah explained, “I have committed to working in solidarity to create sustainable systems and programs tailored to heal damage suffered from environmental, social, political, and economic health determinants in my community, or wherever there is a need for my services.  I believe that health is a human-right to a harmonious well-being (spiritually, biologically, psychologically, and sociolSarah Hernandezogically) that is achieved on a personal and community level.”

A full scholarship to the Latin American Medical School (ELAM) in Havana offered Sarah a path to becoming a physician.  As a non-traditional medical student, she may not have had this opportunity to train as a doctor.  At ELAM she is receiving a medical education that emphasizes integration of clinical knowledge and skills with public health.  However, Sarah and other US ELAM graduates face formidable obstacles returning home, including their status as foreign medical graduates, extreme financial burdens, and unfamiliarity with residency placement procedures and the workings of fragmented US health care delivery.

Through MEDICC’s MD Pipeline to Community Service program, she has received support in the form of mentors, fellowships for medical exam preparatory courses, and summer placements in US medical facilities.  Through a Kaiser Permanente Community Benefit grant, Sarah and 14 other US ELAM students were matched with healthcare sites throughout Northern California in the summer of 2012 to gain critical US clinical experience. At her observership at Kaiser Permanente San Francisco, she spent a month in rotations, shadowing physicians, practicing note taking and presenting, and working through the differences between the Cuban and US healthcare system, such as style of oral presentations and electronic records systems.

Sarah remarked, “There are a lot of things to learn, but it pushes me to work harder and find those niches where I can apply my excellent Cuban medical education with my US clinical training…exposure to a US clinical setting is essential to my training and possible residency placements.”

MEDICC’s investment in medical students such as Sarah will result in a more diverse physician workforce better equipped to meet the needs of underserved communities around the country.  The social commitment; cultural competency; bilingual fluency; and orientation towards preventive, primary and community health care offered by this outstanding group of young physicians-in-training are precisely the attributes needed to tackle the nation’s profound healthcare and health equity challenges.

Cuba Graduates More Doctors for the World: Class of 2011 Includes 19 US Physicians

July 23, 2011, Havana–Following stirring choral offerings ranging from Ave Maria to We Are the World, 19 US medical students were among those awarded their degrees at today’s graduation of physicians, nurses and allied health professions of the Medical University of Havana’s Dr Salvador Allende Health Sciences Faculty.  The new US physicians are among 1396 international medical students graduating this week throughout Cuba who were enrolled in the full-scholarship Latin American Medical School (ELAM) program.  They all completed a bridging course and another two years of basic sciences study at ELAM’s main Havana campus, before fanning out to health sciences faculties across the country for their final four clinical years.

US Graduate Michael Woods

Here in Havana, Allende is one of the faculties celebrating graduations today, 22 countries represented in its Classof 2011, including Cuba and the USA. In his remarks, Allende’s Dean Dr Jorge Jimenez called them “worthy young men and women ready to do battle for health anywhere in the world.”

ELAM Rector Dr Juan Carrizo noted that, since the first ELAM students received their degrees in 2005, the program has graduated over 9900 MDs from the Americas, Africa and Asia. He praised those who made their medical studies possible, including the students themselves, their parents and professors, and former President Fidel Castro whose idea founded the ELAM program. “We owe ourselves to our vocation,” he reminded the graduates in closing, “to see people as patients, never clients, and to apply our knowledge, skills and commitment to help them.”  Dr Carrizo was among various speakers who paid tribute to the late Rev. Lucius Walker, director of the Inter-Religious Foundation for Community Organization (IFCO)/Pastors for Peace, whose work was vital to the US contingent of students, calling him a “courageous man of principles.”

MEDICC International Director Gail Reed was a guest at the graduation. She explained that MEDICC provides the ELAM program with latest-edition textbooks and carries out cooperation projects with students from Haiti, Honduras and the USA. MEDICC supports US graduates’ transition into medical practice through the MD Pipeline to Community Service, which awards fellowships to defray the costs of US board exams and preparatory courses, provides students and graduates with US physician mentors, coordinates clinical opportunities for students in US public hospitals and community health centers, and conducts outreach about ELAM to US residency programs. “Our heartiest congratulations go to these wonderful young people from across the United States,” she said. “And we want to let them know how much they are needed back home, where health disparities continue to plague our communities along lines of race, gender and income.”

Staying the Course in Haiti

Conner GorryBy Conner Gorry in Haiti

Predictably, the headlines have shifted away from post-quake Haiti. While millions wait for the billions pledged in March at the UN donor’s conference, emergency medical staff continue to retire from the country. For many Haitians, survival is uncertain. For others, death is inevitable. Tens of thousands of families still struggle for shelter, food, water, and a sense of safety. Even a modicum of security—a lock on a bathroom door, a clean bucket of water— is received as a small blessing in this most unearthly of circumstances.

A rather big blessing to come from this unprecedented disaster, however, is the emergence of new South-South partnerships to help rebuild the Haitian health system. In March, a tripartite accord between Haiti, Cuba, and Brazil was signed to this end, with Brazil pledging US$80 million—the South American country’s biggest international health cooperation commitment to date. The first stage of that cooperation provides for construction and equipping of 10 hospitals; four are already near completion. The second stage focuses on training health professionals to staff the Haitian public health system— a huge and pressing challenge considering Haiti has only 2.7 physicians for every 10,000 inhabitants, far shy of the minimum 25 recommended by the World Health Organization.

This effort is complemented by other South-South cooperation, including a commitment led by Venezuela under the Bolivarian Alliance for the People of the Americas (ALBA). This ongoing plan calls for the construction of 30 comprehensive health centers, 30 community hospitals with state-of-the-art technology, 30 physical therapy centers, a prosthetics factory and three medical equipment repair workshops. So far, 20 of the health centers, 28 of the hospitals and all the physical therapy centers—staffed by Cuban doctors and Latin American Medical School graduates—are already treating patients. All services are free of charge. The generosity of this commitment was highlighted by Dominican President Leonel Fernández at the recent World Summit for the Future of Haiti, where Cuba presented its emergency medical effort, valued at US$690 million, and results thus far.

Since 1998, through tropical storms, floods, social unrest, and now the hemisphere’s most deadly earthquake, Cuban health professionals have been providing free care throughout Haiti. A month after the January 12 quake, these Cuban doctors, nurses, and health technicians were joined by over 700 graduates and students of the Latin American Medical School from 27 countries. Each of these young professionals pledged to work in Haiti at least through the emergency phase. Many, however, committed to a year of service during which they have the option of obtaining their family medicine, internal medicine, or surgical specialty studying under Cuban professors.

On May 11, a ceremony was held on the outskirts of Havana for some of the ELAM-traineddoctors returning from Haiti. They were joined by colleagues from Brazil, Bolivia, Mexico and elsewhere, ELAM graduates who were about to depart for a year of service in Haiti. The group was received by a phalanx of Cuban dignitaries including Minister of Public Health c, Vice Minister Marcia Cobas, ELAM Rector Dr Juan Carrizo and Dr Midalys Castilla, ELAM Academic Vice Rector.

Haitian Health: Today’s Reality

The simple ceremony featured no speeches by the health officials, but rather the personal stories of the returning doctors.”Your life will be divided into before and after Haiti,” Dr Ana Rosa Santa Anna Tavares from Brazil told her colleagues about to depart. “I see things differently now.” According to these doctors, what they saw wasn’t always pretty—or reported.

“The epidemiological situation is very complicated. Families have no way to boil water. Children have no shoes,” said Dr Yesica Mendoza from Colombia. “You’re going to see diseases you’ve never seen before and you’ll have to go into the field, into people’s homes and tents, because patients don’t have the money to go to the hospital. The only cadaver I saw in Haiti was an 18-year old boy who wasn’t taken to the hospital because his family was too poor.” Dr Mendoza emphasized that this is why the Cuban-led contingent’s free treatment of patients is so important.

A Dream Come True

But the dire Haitian reality experienced by these ELAM graduates is tempered by their dedication and training. Equal parts science and conscience, the ELAM adheres to a socially responsible curriculum that combines an evidence-based medical education with a humanistic understanding of health as a right for all. This too, came through loud and clear as the doctors spoke.

“This is our dream…to work as doctors with people who need care,” said Dr Menendez. Another ELAM-trained doctor from Argentina echoed this sense of fulfillment and obligation: “Haiti has so many needs.

Minister Balaguer and Dr Carrizo with ELAM-trained doctors returning from and leaving for service in Haiti.

These people just can’t be abandoned.” The emotion was palpable in the auditorium as one doctor after another shared their feelings. “What future do these babies have? What will become of their lives? They deserve more. They deserve the best in the world,” said Dr Santa Anna Tavares.

“We had the most beautiful experiences working in the field,” the young Brazilian doctor continued. “The Haitians never, ever rejected us. We were always welcomed into their homes, invited to sit, and treated like family. You’ll see difficulties in Haiti,” she told her colleagues, “but you’ll also forge solutions.”

Like all of us in attendance that afternoon, the panel of Cuban dignitaries was visibly moved. Minister Balaguer leaned into the microphone: “You cannot imagine the satisfaction it gives us to see you applying your practical knowledge to improve the health of Haitians. Everything you’ve shared here nourishes our vision, gives us energy to transform the world. The world needs transformation and you are the ones capable of making it happen.”

Dr Hernán Ortega and Dr Asención Meza with the author.

For Dr Mendoza from Colombia, this wasn’t just rhetoric: “Haiti was an incredible learning experience for me, personally and professionally. I learned

Drs Yobana Carmenza, on the eve of her departure and Yesica Mendoza, just back from Haiti

that you have to look for tools and ways to make things work. I learned that if you knock on doors, those doors will open. In Haiti, I felt one step closer to my dream of changing the world.”


Redefining Health: From Cuba to California

Last week Medical Education Cooperation with Cuba (MEDICC) held an event celebrating the three-year Oakland-MEDICC project, Community Partnerships for Health Equity. Representatives from 6 community health organizations in Oakland traveled with MEDICC to Cuba, bringing back “Lessons Learned” to help improve health care and health access in Oakland. Over 100 bay area health professionals, faculty, funders and general public attended the event, which was held at Preservation Park on June 9th. Find out more about the Community Partnerships for Health Equity program here.

Redefining Health from Cuba to California

Diane Appelbaum US Director of MEDICC speaks at the forum

Making the Rounds: Hôpital Universitaire de la Paix


Conner Gorry

By Conner Gorry in Haiti

It’s not even 7:30 and already it’s hot and close as we board the bus for the circuitous, rubble-pocked ride to Hôpital Universitaire de la Paix. As the crow flies, it’s probably less than a mile from our tent camp to Port-au-Prince’s university teaching hospital, but weaving between vendors and tents pitched in the street, and then caught behind a tractor or backhoe, means it takes almost an hour to get to the front gate.

Canadian surgeon Dr Arthur Porte explains surgical techniques to Dr Valverde (ELAM) and Haitian medical student Xavier Kernizan.

I’m traveling with the Cuban medical team that will staff the ER for the next 24 hours, relieving other members of the Henry Reeve Contingent. My fellow passengers include nurses, lab technicians, family physicians and a few other specialists, like Dr Douglas

Valverde, an energetic orthopedic surgical resident who received his training at Cuba’s Latin American Medical School (ELAM). Costa Rican by birth, Dr Valverde is one of the more than 700 ELAM-trained health professionals making up the Cuban-led international team.

Haitians of all ages are waiting their turn at medical tents pitched in the courtyard when we arrive. Things are fairly well organized, which is a dramatic improvement over the situation in the days following January 12. Hôpital Universitaire de la Paix was at or near capacity when the earthquake struck; it was quickly overwhelmed as the tremors subsided and new patients made their way in droves to the facility.

“The courtyard was filled with wounded people. To cross it we had to step over and around them saying ‘excuse me, excuse me, excuse me’ the whole time,” Dr Wilsos Canton, a Haitian graduate of the ELAM told me. “The building was in decent condition, but there was no light and no water. We delivered babies using the lights on our cell phones. There were patients everywhere,” he tells me in that stoic, but compassionate way Haitians have. This image of the aftermath settles over our conversation.

In the Post Op, Post-Quake

I’m sure what I’ll see today at Hôpital de la Paix won’t compare to those first days and even weeks after the earthquake. Still, coming into the post operative ward where orthopedic resident Dr Valverde and  Cuban colleagues Dr Mariela Rodríguez and Dr Rafael Roque visit with patients, I’m rocked back on my heels.

Dr. Roque

Dr Rafael Roque of Havana cleans one of many wounds during his shift at the Hopital Universitaire de la Paix.

The heat in the 14-bed unit hovers over amputees of all ages, some moaning in what I imagine is pain mixed with frustration (and undoubtedly fear). This guttural chorus is joined by a clutch of women in the center of the room chanting and undulating, lost in energetic prayer. Daughters, girlfriends, nephews and neighbors wave kerchiefs and swaths of cardboard over their loved ones to keep the flies away. A piercing odor of human waste permeates the scene as an older woman, both legs cut off at the knee, talks to herself in a loud, stricken voice.

The first bed is occupied by one of Dr Valverde’s patients: a beautiful 18-year old who was hit by a car several days ago and presented with a broken femur. Although some of the 84 members of the Henry Reeve team working at this hospital speak Creole, Dr Valverde enlists translating help from one of the women who comes to pray for patients in this hospital several times a week. “She’s in pain and wants to know when you’ll operate,” the woman translates for us. Dr Valverde explains that they can’t operate until her femur is correctly re-aligned, something that without the proper traction equipment, will take a week—or more. The girl lets out a loud wail when this news is translated. Dr Valverde looks at me with wrinkled brow: “We rigged up this manual weight with a cinder block to help the healing process, but she’s obviously in a lot of pain.” He shifts her body a bit and adjusts the height of the block, asking via the translator if that felt better. It did.

We pass along the other beds, occupied by soft-eyed gentlemen

Surgeon Mariela Rodriguez

Surgeon Mariela Rodriguez of Holguín lends a hand in the Universitaire de la Paix ER.

paralyzed the instant their houses fell on them in the quake, and young laborers hit by trucks in the disorder that has gripped the Haitian capital since January 12. Trailing behind the trio of surgeons, I learn about complications seen in their daily work here, including infections, phantom limbs (patients feeling pain in their amputated limbs) and depression. Shortages of even basic supplies, despite international donations that continue to roll in, are also a challenge.

A Haitian surgeon and nurse team consults with Dr Rodríguez about another case. Once they’re out of ear shot, I ask about her experience as a female surgeon in this very masculine of settings. She tells me about her two years working in Cap-Haïtien in Cuba’s Comprehensive Health Program—the international program which has bolstered public health systems around the world since 1998, including Haiti’s.

“The hospital I worked in was founded in 1812. In nearly 200 years, I was the first female surgeon they’d ever had,” she explains to me in the laidback manner common to Cubans from the eastern provinces. “It wasn’t a problem that I was a woman, but I had to prove myself in the operating room. Once I did, we got busy.”

Emergency Room Snapshot

With the morning hours dwindling, Rodríguez, Roque, and Valverde shift their attention from the post-op recovery rooms to the hospital’s emergency area. They join colleagues from Nicaragua, Panama, and Cuba’s Villa Clara and Pinar del Río provinces, (all Henry Reeve members), to attend arrivals in the partially screened area with four metal beds. Haitian nurses and medical students lend a hand translating, among their other duties.

There is a steady stream of patients. As in most emergency rooms, (especially post-disaster in the Global South), most patients are extremely sick, including some who won’t see tomorrow. This is the prognosis for the emaciated anemic grandfather and the young woman in a pretty pink dress who has had a high fever for two weeks. Malaria will soon consume her. It’s not only the severity of the conditions these doctors see day after day that is disconcerting; it’s that many of them are preventable. That anguish is written on Dr Adac Mendoza’s face, the ELAM doctor attending the young woman.

Adac and young patient

Dr Adac Mendoza (ELAM) attends a young patient in the emergency "room" of Hopital Universitaire de la Paix

Accident victims and chronic disease are common in this ER, and between stitching a child’s split chin and taking the blood pressure of Haitian matrons, the doctors treat the aftershocks of natural disaster. A barefoot young boy hops over to the doctors with a badly infected wound on his left calf. Tears stream down his face as the gash is cleaned of dirt, stones, unidentifiable objects (glass? bread crusts? I can’t tell and neither can the attending physician), and finally necrotic tissue. He’s given a shot of antibiotics and told to come back in the evening for another injection, though the doctors admit they probably won’t see him again: transport is too scarce and life too precarious here in post-quake Haiti for many patients to pursue follow-up. Just then, an 18-year old girl staggers in and collapses on one of the metal beds. “She tried to poison herself,” her escort tells me in English. When I ask why, his response is as disturbing as it is vague: “she was sad.”

Improving Health is Collaborative

Like in all disaster response efforts, medical teams from around the world collaborate both formally and informally in Haiti. I’m not surprised then as a blond-haired, blue-eyed woman in hospital scrubs turns up in the emergency area asking to consult on a patient with Dr Valverde. Janice Centurione is a physiotherapist from St Joseph’s Hospital in Ontario, Canada. ‘St Jo’s’, she tells me, has been “sister hospitals” with the Hôpital de la Paix for the past 20 years in a pairing intended to “train Haitians to offer a standard of care.” This extends to specialty services and after examining Janice’s patient, Dr Valverde consults with Dr Arthur Porte, an orthopedic surgeon also from St Jo’s.

“This is my third time in Haiti, but I have no previous disaster response experience, so I was reluctant to come at first,” Dr Porte tells me while looking at an X-ray of the chronically dislocated finger he is about to correct surgically. Dr Valverde, Dr Porte, and Xavier Kernizan, a sixth-year medical student training in Haiti , discuss the incisions to be made and the aluminum finger splint they’ll use to immobilize it following surgery. It’s fascinating to watch the three—from different countries and cultures—collaborate.

“The circumstances are so difficult here in Haiti. Normally I can’t do the operation you’re proposing because we don’t have that type of splint,” Kernizan says to the Canadian surgeon. “Sure you can,” offers Dr Valverde. “You can use anything—sticks, tongue depressors, whatever—to immobilize it.” Dr Porte (who brought the splints, along with other higher-tech tools and materials from Canada) concurs. A Canadian OR nurse enters the anteroom, cutting the conversation short: “We’re ready to go doctor.” And with that, the trio vanishes into the operating theater.

preparing to operate

Douglas Valverde prepares to operate.

Following the quick, successful surgery, Dr Valverde tells me: “Working with the international teams here is a great learning experience. I can bounce ideas off the surgeons and they explain their techniques.” Heading back to the ER, Dr Valverde has a near skip in his step. “I love waking up and going to work in the morning.”

We’re met by a boy needing many stitches, including a severed vein that needs sewing, and Dr Valverde sets to work. Night is already falling, but the patients keep coming. “Another one?!” he asks when a young boy hops into the ER. But it’s his young patient from earlier with the infected wound, returning for his second antibiotic shot. The young surgeon compliments the boy for coming back as he finishes mending the vein of his current patient. “This was my most satisfying work in Haiti to date.”