Expectations are a funny thing; even when you think you are keeping an open mind, it is impossible to come to a situation completely without expectations. And even when you accept that you don't know what to expect, you unconsciously plan based on the framework of past experience. The life you have lived forms a framework of consciousness you cannot erase.
While getting ready for 2 weeks of physical therapy aid in Haiti, I felt ready to be flexible and open to doing whatever was needed. But as soon as I got there, I saw signs of my own framework of experience.
When I learned that Spaulding Rehab Network had selected me to be one of the first three therapists to serve in Haiti, I was told we would be working at Haiti's State University Hospital: Hopital Universite d'Etat d'Haiti (HUEH), the largest public hospital in Haiti. We were told our role would be to support the staff in whatever way we could, as their lives had been so traumatically upended by the earthquake. Despite "having no expectations," my mind unconsciously supplied an idea of "hospital," both in structure and routines.
Upon arrival, I found a hospital where only one building was safe enough to house patients. The hospital had sustained significant damage in the earthquake: more than 50 percent of the campus buildings could not safely be used. The ruins of the nursing school (in which an entire class of nurses was crushed while taking an exam when the earthquake struck) still stood as a stark reminder of all that had been lost. Except for the patients in the internal medicine building, all other care was provided in tents: ICU, maternity, pediatrics, ER, infectious disease, post-op and general care. Nurses were in short supply, and most of the current staff of HUEH no longer had homes; they were now residents of tent cities that had become a ubiquitous part of the city's landscape. Partners In Health (PIH) and International Medical Corps were providing nurse and doctor coverage of ICU, ER, overnight shifts of internal medicine, and pediatrics.
The rules I knew of hospital care did not apply here: there was no referral system for those who needed therapy; the patients' medical records were sheets of paper taped together and guarded by each patient under his or her pillow--sometimes with X-ray films, as well. Because of the international nature of initial relief efforts, chart entries were a mix of English, French
and some Spanish. I learned that the Haitian healthcare system expects patients to supply their own linens, and families care for hygiene needs. Many patients had families who now had few resources for clean linens, or even a sheet at all. Even though the hospital did have a supply of linens, they were not distributing them because the infrastructure to collect and launder them was completely debilitated. I was
happy to incorporate so much family teaching into treatments, but was shocked and saddened to see so many patients with one or more family members sleeping on cardboard under the patient's bed.
Mobilizing PatientsEven though the rules and routine for acute care were different, the principles were the same: mobility rules all. Every patient I worked with was motivated for therapy, even though it was easily 100 degrees inside the tent. Actually, the chance to walk out of the tent to catch a breeze was a great incentive for getting out of bed.
One patient with an inoperable open book pelvic fracture was thrilled to get out of bed for the first time since his car accident 22 days earlier. Daily, we dependently lifted him into a recliner (miraculously found by the team of therapists before us and stored in a secret location) and pushed him out of the tent to sit in the shade of a tree to socialize amidst the flow of hospital hubbub.
|Inside one of the tents
Another expectation stemmed from knowing the earthquake had left an estimated 12,000 Haitians with new amputations. In anticipation of treating many patients with amputations and victims of orthopedic traumas, I assembled several HEP (in both French and English, with pictures because I couldn't find anything in Creole) geared for amputees. I brought ACE wraps and Thera-Band, and even disposable instant ice packs. By the end, the only people who had needed the ice packs were me and my colleagues--to cool ourselves enough to sleep in hot tents at night!
I found that, while there are many new amputees in Haiti, they are not the focus of care at HUEH. There were many people with post-earthquake amputations, but the large majority of these were independent with mobility already. In speaking with the staff at PIH and other professionals in various aide organizations, I learned that in the weeks following the earthquake, trauma victims fell into two categories: either their injuries were so severe that they succumbed, or they survived and left the hospital--if they had a place to go. That is a very big "if."
There are many international aid organizations who have already stepped in to address the need for amputee rehab and supply prosthetics. The Albert Schweitzer Foundation and PIH are doing remarkable work at the PIH Hospital facility in Cange. The amputees still at HUEH were mostly there because they had nowhere else to go and/or no one left to help them. By the time I arrived, most of those patients were mobile and receiving daily gait training and TherEx from the staff of Handicap International. The only patient I had with an amputation was Francine, a woman in her late 60s whose BKA wound was infected. In the 2 weeks we were there, my occupational therapy partner (who speaks fluent Creole) successfully advocated for her debridement, and I helped her start transferring to a chair and hop with a walker very short distances.
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