In October of 2016 I had the opportunity to lead a medical team sent by the Seattle-King County Disaster Team (SKCDT) to the Grand Anse region of Western Haiti in the week following Hurricane Matthew. I have been to Haiti many times since 2009, including the week after the 2010 earthquake. In October we worked out of five different rural clinics, including one that I had been to several times in the village of Castillon. The damage was extensive. Most buildings in rural Haiti are simple structures built from wood and tin sheeting. These did very well in the 2010 earthquake. Many of these were completely destroyed or significantly damaged by the significant winds of the hurricane. The majority of the mango and coconut trees in the area were destroyed, in addition to the bean and corn crops. Coconuts and mangoes are a significant part of the Haitian diet and will not regrow for many years. Many banana trees were also destroyed; however these grow back quickly and can produce bananas a year after being broken off at ground level. Most of the injuries we saw were the result of falls or being hit by flying debris. Every person I spoke with in the town of Castillon had lost at least one family member to the hurricane. The clinic had lost its roof and walls. We held clinic in the ruins of the building under tarps in the pouring rain. Under the best of circumstances, the typical Haitian suffers from hypertension and anemia. The hurricane added insult to injury. Medical records and prescriptions were lost and the nutritional future looked bleak. A lack of fresh produce would force people to live off of staple foods like rice, beans, and salted fish. Much of this would need to be imported or donated.
Six months later in April of 2017 I returned to the same region, leading another team from SKCDT. This trip was based entirely out of the village of Castillon. The clinic had been rebuilt and construction of the village was still underway. Apparently the Mennonite church of America had donated a large quantity of tin sheeting and this was being put to good use. Over the week we were in Castillon, we saw three men build an entire large house using only one hand saw, one machete, one hammer, and nails. The underbrush had grown back, concealing the true state of the region from those who had not seen it in its prior incarnation. An area that used to be filled with fruit-bearing trees had less than ten percent still viable. My prior trips to Castillon had always been filled with large meals, rich in local fruits and vegetables. This trip we ate imported rice and beans, alongside some local corn. Malnutrition and anemia were much worse than I have ever seen there before. We saw many patients with hemoglobin levels in the range of 3.5-7 (normal 14-16). In the United States, these patients would all receive transfusions. In rural Haiti 12 hours by four-wheel drive truck from the capitol of Port Au Prince they receive three months of iron therapy and instructions to recheck after the completion of that therapy. Hypertension in Haiti is driven by a salt-rich diet. The hurricane increased dependence on salt-rich foods and the degree of hypertension seen across all age ranges was worse than I had ever seen. We saw many patients under the age of 30 with blood pressures as high as 290/140. Less than 10 percent of the 750 patients we saw that week had a normal blood pressure. Haiti already has the highest rates of stroke and renal failure in the Western hemisphere. This will only compound those issues. Our organization provides medication for patients year round and sends several teams yearly to each of three clinics. Clinic flow is very basic and charting is done on paper. An excellent lab can perform most basic screening exams as well as tests for malaria, HIV, and syphilis. It is not uncommon for each provider to see 75 to 100 patients per day with the assistance of local translators. We bring all our medication and supplies with us and travel light. If this sounds interesting to you, the team is always looking for paramedics, physicians, nurses, PAs, and NPs. Missions occur in February, April, June, and October and typically last 10 days. Please see www.skcdteam.org and contact any board member. You may also contact me directly through the PAFT website. The people of Haiti have put up with a lot over the last decade. Working with them helps me to see what practicing medicine should be about without all the modern hassles of EMRs, drug-seeking behavior, Press-Ganey scores, and The Joint Commission. It reaffirms the reasons I went into medicine and changes me every time I go. It can change you as well and help reignite a fire in you for the practice of medicine. Join me.
Emedpa PA, DHSc is an emergency medicine PA
He completed his doctoral program in 2015 with a research project based on improving the treatment of hypertension in Haiti.