BC: Last night before leaving with Hector who replaced me!!
FC: Haiti 2012 Roby's experience with MSF
1: The opportunity to do volunteer work was on my mind for years, but when I retired in 2009 I began to explore it in more depth. I looked at several organizations and decided the organization would need to be highly organized to provide the facilities, back-up, and resources to practice Orthopaedics. I ended up favoring MSF as my first choice.
2: My on line application to MSF USA went in October 2011 and by December 2011 I had filled out several new forms and scheduled a telephone interview with New York. The interview was @ 40 minutes and asked questions about my motivation, experience with NGOs (Non-Government Organizations), living in primitive conditions, etc. In January I was invited to go to New York for a personal interview (at my own expense). That interview was a one hour experience and I was told they would let me know after considering all applicants if I was to be invited back for a three day orientation. Some 10 days or so later I was invited to come for three days in late May (at their expense) for what was described as Field Orientation. They also asked for references to call in the meantime (three MDs or executives with whom I had worked). I arrived and checked in to a nearby Hotel where I was booked by the New York Office and shared a room with a general surgeon who had just completed his fellowship at Dartmouth. The next morning 23 of us arrived at the USA office on 7th avenue and were photographed and then given seat assignments in the conference room. I was seated between two young women one an internist with a specialty in infectious disease from Tennessee and an operations officer from Oregon. We were asked to interview the person on our right and introduce them to the group.
3: We were told in the introductory remarks that only 12% of applicants made it to this phase and that some of us would not be going forward. Their were three intense days of orientation to MSF and group problem solving in small group formats which were monitored by one of the full time employees in the New York Office and I assume we were scored on our ability to interact and participate without being dominant or reactive in a small heterogeneous group (There were only 8 MDs in the group). The highlights of the three days in New York were watching the other people react with each other and to the scenarios they had us work through as small groups. In general there was a lighthearted approach to the group problems with many creative ideas put forth. The tone changed dramatically on the third day when we had a one hour session on kidnapping which began with each of us filling out a "Proof of Life" form to be used in case of abduction for ransom. | When we left we were told we would be contacted within a month to let us know if we were going to be assigned and where that might be. In two weeks I got a call and asked when I was available and that I would probably be going to NIgeria. In early August I received a call asking if I would go to Haiti in September for one | month to a hospital in Leogane run by MSF Swiss that was set up in 2010 with plans to turn over to local Haitians in 2014. After discussing with Libby, I accepted.
4: I got my instructions and directives for shots, medical clearance, and travel in order to be ready to leave on the 10th of September. I flew from MSP to Miami and Miami to Port Au Prince in one day and arrived at the airport @ 3:00 pm got my bag and went looking for a MSF vehicle which was to meet me. After searching around I found one some 100+ yds from the terminal exit and started the trip to the headquarters for MSF Swiss in Port Au Prince. The ride from the airport took over an hour to reach the headquarters building situated up on the mountain side and walled in with metal gates and razor wire on the walls (common to all the facilities I saw in Haiti). I was shown a room and a schedule for the next day and went to bed early in my first mosquito netted bed. The next day I had briefings all morning and was dispatched on the first leg of my trip at 1:00pm to another MSF facility on the margin of town (1+1/2 hours) then another vehicle to Leogane (1 hour) where I arrived and was met by the local grounds supervisor for the MSF compound for ex-patriots (all non-native workers were labeled "ex-pats") | My room and bed
5: Each bungalow had two separate rooms that were @ 8’x 10’ and a screened window with a door lock (to keep the tarantulas, cats and chickens out). There was a fan and a plastic chair and electric outlets. The long term ex-pats (6months) had a two roomed bungalow. There were two showers for men and two for women (no hot water, Temperature ).There were four latrine stalls. | Showers Latrines | Banana tree outside my hut
6: My first exposure to the ex-patriots began @ 5:00 pm when two young women entered the dining area and immediately greeted me in French with two kisses on the cheeks by each. By 6:00 pm there were some 17 in attendance for the weekly Tuesday night briefing which was all in French from which I understood virtually nothing. I then met the two Swiss surgeons that gave me a briefing (both spoke English). One was an Orthopedist from Zurich and one a general surgeon from Northern Switzerland.The population of ex-pats came from: Switzerland, France, Austria, Hungary, Portugal, Spain, Kenya, Argentina, Canada, Mexico, Algiers, but no one else from the USA for the next two weeks when a general surgeon from Maine arrived, which made my life much easier The population of ex-pats came from: Switzerland, France, Austria, Hungary, Portugal, Spain, Kenya, Argentina, Canada, Mexico, Algiers, but no one else from the USA for the next two weeks when a general surgeon from Maine arrived, which made my life much easier. | vvvv | My first few days were very isolated and lonely since I did not understand 1% of what was being said and this was a very convivial group who were having animated conversations (they were living together for months in a compound surrounded by razor wire and high walls and were not allowed to leave without signing out and in and could not leave after 5:30 without a driver and vehicle that reported by radio every 15 minutes)
7: During the month I was there the ex-patriots all made an effort to make me feel comfortable. Those that spoke English would engage me in conversation about my work and all were friendly and appreciated that I was “left out” in their social dialogue. They made regular efforts to include me in their social activities outside the compound, including Sunday excursions to the beach. | BB | Beach Visit on my Last Sunday | Birthday partiy for Ex-Pats 2/3 ages 25-35 yrs | List of ex-pats and their jobs | Area for dining and socializing
8: Work The first day on the job I went with the Swiss surgeons and followed them all day. The day was the same M-F starting at 7:30 rounds with all medical staff to report on the night before and hear any news from Hospital Director. 8:00 set-up OR schedule for the day and go to X-Ray to review previous days films. 8:30 ward rounds on 30-35 patients followed by OR cases and clinic patients Tuesday and Thursday clinics were follow-ups and would generally average 25-30 patients. The next day both surgeons from Switzerland left and I was alone for 14 days for all surgery, with the help of one or two Haitian general surgeons most of the time. My case load varied from day to day but averaged 6-8 cases per day, with two or three major open cases almost every day. I was in the hospital from 7:30 am to 6:30 pm five days a week and went back in the evening @ every third night. On the weekends regular hours were 8:00 to 2:00 on Saturday with emergency work around the clock. Sundays I made rounds and did whatever work needed to be done and generally had three to four hours each weekend day for reading or sleeping.
9: The hospital only admitted emergencies and Obstetric cases. No one paid for care. My case load was predominantly fractures of the forearm, tibia, foot, ankle and hand. There were many lacerations usually from machetes, and extremity abscesses. General surgery was restricted to acute abdomens, and strangulated hernias. | We had two ORs one of which was preserved for C-sections (there were >600 deliveries/month). If I had a closed reduction or a case that would be less than an hour I could use the C-section room if it were vacant, so many days I was running two rooms. OR staff was excellent and Anesthesia was very good. I usually had a local general surgeon assistant. Equipment was adequate but sparse. We had K-wires, an External Fixator set that was designed for the French Army, and most of the usual surgical instruments. We had no cast padding while I was there. We ran out of 4-0 monofilament sutures in the middle of a complex tendon repair (8 tendons and two nerves), but all in all we worked around the deficits.
10: Portable Operating Room light which I would always hit with my head while operating. They did have a digital x-Ray and films could be displayed in the OR | Self Explanatory Directions to the OB ward and an example of the colorful outfits most of the women wore
11: Supply tents for the operation | Central hall way with wards on each side for patients and benches in the hall for outpatients waiting for clinic or x-rays. A lost chicken was making rounds behind our group one morning.
12: Inside the Emergency Room one night where 6 patients arrived from one accident. the head nurse from the OR is kneeling with a child | More Shipping cartons and the back of the operating room on the left.
13: An empty bed in the ward with one of the skimpy mattresses. Some were a little larger | Most of the ambulances were pick up trucks, such as this one with a patient with a fractured femur
14: Delivery vehicle for supplies | Lunch being served to patients and care givers in the hall. They all had their own receptacles for food.
15: GENERAL OBSERVATIONS ON THE COUNTRY The streets of Port Au Prince (PAP) are bumper to bumper and during my three trips from the west of PAP to the East I saw one stoplight. The main streets were paved with two lanes and sidewalks. The side walks were occupied by street vendors selling fresh fruit, hot foods, radios, clothing, shoes etc., which put the pedestrian traffic in the street with the cars, buses, trucks and motor cycles. The streets in PAP that were paved had open streams running through as well as gigantic pot holes and heaves in the pavement. In the busier streets on the down hill side of town vendors with snacks and drinks filled the road between vehicles selling their wares, since the pace of traffic was slow enough for them to deliver into a bus or vehicle and get paid before traffic moved Public transport ranged from school bus size vehicles, to pick-ups with benches in the rear (most all of them had decorations with some religious theme, e.g. “sangre de christ”), to motor cycles and motor scooters. 90% of the vehicles were Japanese with Toyota well in the lead. MSF Toyotas had all doors locked as we traversed the city
16: Public transportation ranged from school bus size vehicles to pick-ups with benches in the rear bed (most of them colorfully decorated with some religious theme, e.g., Sangre de Christ"). The most ubiquitous transport was the motorcycle which usually carried two or three passengers. 90% of the vehicles were Japanese or Korean with Toyotas well in the lead.
17: Six Legs waiting to be rammed into the pavement, while all three huddle under an umbrella having just dodged a truck | A dry day just outside the entrance to the hospital ( on the left)
18: The street leading home from the hospital after a typical afternoon storm. | Inside court yard of MSF Swiss in PAP
19: Looking out from the MSF Swiss headquarters in Port Au Prince at the hillside where everyone lives above the ocean