News

1.10.2012

Two Years Later, UM’s Hospital in Haiti Nurtures a Small But Mighty Seed

Medical volunteers from the U.S. still fly in weekly, but Haiti’s only trauma, critical care and rehabilitation hospital is staffed by Haitian doctors and nurses. A new education center to train hundreds of health professionals is under construction. The pathology lab boasts state-of-the art instruments. Out-patient clinics for wound care, prosthetics, physical therapy and other unique services see 150 patients a day. And the nation’s first professional EMTs are responding to rescue calls.

Two years after Haiti’s catastrophic January 12, 2010, earthquake killed or maimed hundreds of thousands of people, there are growing signs that Barth Green, M.D., the professor and chair of neurosurgery and co-founder of Project Medishare who initiated the University’s unprecedented medical emergency response, is inching toward his long-held vision of creating a self-sufficient critical care and trauma network in the impoverished nation that didn’t even have an ambulance service before the disaster.

“Overall, we’ve accomplished what we set out to accomplish in the short term – in regards to setting up a trauma and critical care hospital that is run by Haitian doctors and nurses,’’ said Enrique Ginzburg, M.D., professor of surgery and a member of the four-man trauma team Green led to the capital of Port-au-Prince less than a day after the disaster. “But this remains a transition hospital and we haven’t accomplished the main goal, which was to build a modern, state-of-the art critical care and trauma hospital, and that is due to a lack of promised funding from donor nations.’’

For now, Ginzburg remains the international medical director of Hospital Bernard Mevs Project Medishare, the 50-bed successor to the 250-bed critical care and trauma hospital that Project Medishare and UM’s Global Institute for Community Health and Development opened under four large tents just nine days after the earthquake. But like Green and all the UM and Medishare volunteers who are committed to creating a sustainable health care infrastructure in Haiti, Ginzburg hopes to put himself out of his volunteer job, a goal the field hospital helped place on the horizon.

Staffed by medical volunteers from the Miller School of Medicine, every state and numerous countries, the tent hospital was dismantled and moved to Bernard Mevs six months after the quake, laying the foundation for the unique programs at the tiny hospital that, slowly but surely, are empowering Haitian doctors, nurses and other allied health care professionals to take care of their own. Operated by Jerry and Marlon Bitar, Haitian twins, surgeons and longtime Medishare partners, Bernard Mevs is playing such a pivotal role in Haiti that the American Red Cross just renewed its support – with a $3.6 million grant – to keep it afloat another year.

“Without the tent hospital, we wouldn’t have had the ability to do what we’re doing now. It seeded the systematic approach to trauma care,’’ said Gillian Hotz, Ph.D., associate research professor of neurosurgery and the international director for operations at Bernard Mevs, who like Ginzburg had never visited Haiti before the earthquake. “The tent hospital showed Haiti – and the world – that this is doable in your country. It enabled us to evolve into a brick and mortar trauma, critical care and rehabilitation hospital that sees 150 out-patients a day, performs 150 surgeries a month and, most importantly, trains Haitian doctors, nurses, and allied health care professionals in trauma and critical care.’’

For now, training occurs bedside – or on the street. For instance, a contingent of nurses from Jackson Memorial Hospital showed Bernard Mevs nurses how to care for patients with spinal cord injuries, and now Bernard Mevs boasts a comprehensive spinal cord injury unit staffed entirely by Haitian nurses.

With the help of EMPACT Northwest, a Seattle-based medical non-profit, Bernard Mevs recently graduated Haiti’s first class of professionally trained EMTs who are operating Haiti’s only coordinated rescue service from the hospital – in ambulances donated by the city of Miami Beach. The graduates literally trained on the street, responding to simulated emergencies staged by Haitian citizens who portrayed mothers whose babies suffered gashed heads, teens with gunshot wounds, and the like.

But Hotz is overseeing the construction of a three-story teaching and education center that, when completed in a few months, will add 30 medical/surgical beds to Bernard Mevs, as well as four high-tech classrooms, offices and an auditorium. That will enable Project Medishare, in conjunction with UM and its other partners, to train hundreds more Haitian health care providers, who in turn can train their colleagues, building the kind of work force that, in Green’s words, will “allow Haiti to transform from an entitlement island floating in a sea of NGOs to an independent nation with the capacity to take care of it own – ultimately ending the need for foreign medical assistance.’’

“Haiti’s not there yet,’’ said Green, whose Project Medishare has been delivering basic health services to Haiti’s central plateau for nearly two decades. “Bernard Mevs is tiny and there are 10 million people in Haiti, but we have created a little program in a little corner of Port-au-Prince that has the potential in the next year or two to be self-sustaining, which would be historic for Haiti.’’

For now, Bernard Mevs, like the nation, depends heavily on outside expertise and funding, which Green notes donor nations never delivered as promised. He hopes funding will come through and, by the third anniversary, the national trauma and critical care hospital modeled after Jackson Memorial’s Ryder Trauma Center will be under construction near the airport on land donated to Medishare.

In the meantime, just as UM was there in Haiti’s darkest hour, Green said, the University remains Haiti’s closest ally. “There really isn’t a department at the medical school that is not involved in some way in Haiti,’’ he said.

Among them:

David Andrews, M.D., associate professor of pathology who set up the pathology laboratory at the field hospital, remains director of Pathology and Laboratory Medicine at Bernard Mevs, and continues the painstaking process of implementing quality controls and establishing the panoply of basic lab functions in a place where records are still handwritten.

He is particularly buoyed by the recent hiring of a professional lab manager – a Haitian-American nurse and medical technologist from Jackson Memorial Hospital – and the addition of instruments to perform blood cultures and measure blood gases. Provided by AmeriCares, the blood culture instrument will help take the guesswork out of pinpointing infections, and the blood gas testing station, donated by Nova Biomedical, is vital to measuring the oxygen in the blood of patients on ventilators.

One of the early responders after the quake, John M. Macdonald, M.D., voluntary professor of dermatology and cutaneous surgery, is medical director of the Wound Program at Bernard Mevs, and with a Haitian physician has established a state-of-the art clinic to treat patients and train wound care technicians.

With help from Mike Kelley, M.B.A., vice chair for administration for the University of Miami Medical Group, Richard K. Lee, M.D., Ph.D., associate professor of ophthalmology, cell biology and anatomy, and neuroscience, is spearheading the effort to establish an ophthalmology clinic at Bernard Mevs, to be staffed by rotating ophthalmologists coordinated through Bascom Palmer Eye Institute, the Pan-American Association of Ophthalmology, and the American Academy of Ophthalmology. The clinic also will serve as a training ground for ophthalmology residents and the Haitian Society of Ophthalmology.

Representing the radiology department, Gary Danton, M.D., Ph.D., assistant professor of clinical radiology and director of the Radiology Residency Program, helped set up, test and develop protocols for the only 16-slice CT scanner in Haiti, donated to Bernard Mevs by Grammy award-winning musician Wyclef Jean’s Yele Haiti foundation. Next on Danton’s list: helping other UM faculty, Project Medishare and the University of Washington develop programs to train Haitian radiologists to read CTs and to provide CT interpretations until they are able to read the studies on their own.

And Robert Gailey, Ph.D., PT, associate professor of physical therapy, continues to change Haiti’s perception of disability as a dead end. With a grant from the Knights of Columbus, he and his team, and the Haitians they’re training, continue to fit children who lost limbs in the quake with prosthetic arms, hands, legs and feet – fabricated by adult amputees who are gaining valuable skills and a new future just two years after the deadliest earthquake in the Western Hemisphere shattered their world.

“We’re looking forward to handing over the torch and the responsibility to Haitians to do everything – from managing, staffing, operating and maintaining a hospital,” Green said. “We’re not there yet, but we’ve got to show Haitians that we are genuine, that we really care, that we will finish what we started. Historically, that has not occurred in Haiti.”

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