be brave now... and proud later facing haiti’strauma

8/7/2019 Be Brave Now... and Proud Later Facing HaitisTrauma

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Be Brave Now...and Proud Latery Linda Ruterbories, ANP and Joanne Leblanc, BSN, RN

Facing Haitis Trauma

Haiti, the poorest country in the Western Hemisphere, hadhallenges long before the January 12th earthquake devastated the

sland. Konbit Sante, a nonprofit organization based in Portland,

Maine, has been dedicated to the medical needs of Haiti, specifically

orthern Haiti, since 2000. The organizations name comes from

wo Creole words konbit, which means working together and

ante, which means health. Konbit Sante works with local medical

rofessionals at the Justinian Hospital, a medical training facility in

Cap-Haitien. This location was not directly in the earthquake zone,

ut both the city and Justinian Hospital have welcomed and aided

he injured, displaced and lost.


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Members of the team arriving in Haiti for the rst time

were simply not prepared for the reality of the poverty

and the distressing living conditions.


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Forming the team

OA Centers for Orthopaedics CEO John Wipfler, learned of Konbit

antes plan to send a team to Haiti through Mary Anne Ringle, a

rogram specialist at Konbit Sante. Ringle previously worked for

Wipfler on the Maine Health and Finance Commission. Wipfler asked

he OA Centers physician board if there was interest in participating in

Konbit Santes team, and when the response was positive, OA, in

onjunction with Maine Medical Center, formed a seven-person

olunteer team. Team members included:

OA Centers for Orthopaedics

Matt Camuso, MD, Orthopaedic Trauma Surgeon

Linda Ruterbories, ANP, Director of OA Surgery Center

oanne Leblanc, RN, Director of Clinical Services

Maine Medical Center

Brad Cushing, MD, Chief of Surgery

amuel Broaddus, MD, Chief of Urology

March Truedsson, RN, wound care nurse

Marieta Atienza, RN, wound care nurse

OAs Ruterbories and Maine Medicals Broaddus spearheaded the

urgical and wound care team. Dr. Broaddus, who has been traveling

o Haiti since before Konbit Sante was formed, has been affiliated with

the non-profit since its inception. Since 1994, Dr. Broaddus has vi

northern Haiti nine times.

The team members believed they could offer services that

needed, and that the connections in place through Konbit Sante

the Justinian would expedite the teams missionto offer

colleagues at Justinian Hospital specific surgical services in orthop

and trauma care. The team also agreed that nurses with wound

expertise would be of particular value.

Culture shock

Members of the team arriving in Haiti for the first time were sim

not prepared for the reality of the poverty and the distressing li

conditions. The sheer mass of people surviving not just the earthqu

but an obviously status quo poverty, was a devastating sight. Frommoment of arrival through the teams departure, it was apparent

there was neither space nor resources to accommodate the

numbers of residents. It was clear that no public waste disposal sy

existed in the country. Garbage is simply left on the side of the ro

Occasionally its burned to create more space. Housing consis

one-room metal buildings with openings for windows and doors,

no coverings across the openings. Many of these homes are built

the mountainside. Mud slides are inevitable due to the weather and

tin homes are often swept away. Yet the most surprising contrast

team saw was that no matter how impoverished the people w

eteamarrivesinCap-Haitien.

Dr.PierreLouisandDr.MattCamusodiscusstheinstrumentsOAboughttoH


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Haitians in Cap-Haitien were consistently dressed in their Sunday

impeccably white and pressed. The Haitian people are proud of t

appearance no matter where they are going or what they are doing

A cultural reality that was more pleasant, visually, was Ha

transportation. The primary source of travel within the city is in

back of pickup trucks or on mopeds, three or four people at a time

greater distances the solution is both unique and colorful

somewhat unsettling as well. Haiti has no official transit system. L

distance travel is facilitated by individually-owned, brilliantly-col

and artfully decorated vehicles called Tap Taps. These vehicles, prim

buses, do not have schedules or regular destinations. There are no

belts and the roads are bumpy. The Tap Taps travel only when a ve

is full and they transport chickens and goats as well as humans

the same time. The name comes from the fact that passengers tap on

metal of the bus or truck to signal that they want to stop.

Establishing relationships

Understanding the importance of building relationships in Haiti

the key to the teams success. Dr. Broaddus, over his 16 year

volunteer experience in Haiti has established successful method

building relationships. His extensive experience gave the team valu

insights in breaking down language barriers and understanding cul

differences. Nate Nickerson, Executive Director of Konbit Sante

also spent considerable time immersed in the Haitian culture. He

the team through the process of making initial contact with Dr. P

Louis, the sole orthopaedic surgeon in Cap-Haitien.

Dr.Louisand Dr. Camusoinsurgery.

Haitian transportation called Tap Taps.


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Dr. Camuso partnered with Dr. Louis. Together, they performed

everal surgeries, including a difficult lower leg fracture repair on a

oung woman, a dancer, who refused to have her leg amputated despite

he difficult, long road ahead of her during recovery from her

evastating injury. Dr. Louis expressed his gratitude to Dr. Camuso for

roviding their facility with the modern fracture instrumentation and

mplants that the team brought with them from the United States. The

wo physicians spent several hours together, discussing cases as Dr. Louis

mastered his new tools. Dr. Camusos personality and his finesse within

he OR facilitated a trusting bond between the two surgeons. The team

elt that the goal, which was to provide assistance and surgical expertise

within limited resources, had been well met. Dr. Camusos expertise as

trauma surgeon was instrumental in preparing Dr. Louis by providing

im with the knowledge and training he would need to operate on cases

hat might otherwise have been seen as hopeless or inoperable.

Reflections

When it was time to leave Haiti and return to their regular jobs in theUnited States, the team experienced frustration and sadness. Although

much had occurred, it seemed to the team as though very little had been

ccomplished. They felt they could have done more, saved more, and

een more help. Limiting factors such as sterilization issues, inadequate

taffing resources, time constraints and the inability to perform as many

urgical procedures as were needed, contributed to the teams

epression. The consensus was that they had not, as hoped, really made

difference in the days they had been in Cap-Haitien. It was painful to

eave patients behind. As team members transitioned back into the land

f plenty, it was difficult to forget the faces of those patients and

roubling to realize they might never know the outcome of the surgeries

hat did take place.In an effort to offset the frustration and depression these thoughts

rought to the team, Nickerson made a point of expressing his gratitude

nd emphasizing the value of the visit. He made it clear that in spite of

he overwhelming and difficult reality of Haiti (before or since the

uake), the teams contributions were in fact, invaluable.

Future plans

n the short term, Haiti has been supplied with resources that were not

vailable to them prior to the earthquake. However, many

mprovements made prior to the tragedy are now complicated by an

nflux of short-term solutions that obscure many more substantial long-erm solutions. Even so, there is hope that as tragic as the situation is,

t may prove to have a silver lining. By bringing Haitians more options

or working together, (konbit) and improving the quality of living for

ts population through health (sante) and knowledge, long-term changes

will become more viable.

The goal of Konbit Sante is to participate in the creation of a

ystem that encourages the Haitian people to take care of their own,

hrough increased knowledge and the ongoing ability to improve skill

evels. There is a focus on high-impact solutions with minimal resource

equirements. That is, how do you learn to do things differently with

the same limited resources?

The number of people critically injured by the quak

overwhelming. Many of the patients at the Justinian were transpo

from Port-au-Prince to Cap-Haitien. Orthopaedic fractures and wo

were complex. Recovery for the injured will be long and ardu

complicated by a lack of rehabilitation medicine. Living in Haiti

challenge in and of itself; becoming a paraplegic or an amputee

result of the quake simply compounds the magnitude of survival.

The assessments completed by Konbit volunteers identified

needs to be addressed. However, they also illustrated that the

challenge, given the current reality, is to determine how to intro

and maintain the changes. Are the changes that need to take place

feasible in Haiti? Will those outside of Haiti continue to suppor

efforts that surely will need to continue for decades? The long-t

outcome of this catastrophic event is impossible to predict. Yet fo

OA and MMC team sponsored by Konbit Sante, the effort

collaboration and relationship building will continue. The team p

to return to Haiti in the fall of 2010.

Linda M. Ruterbories, ANP, is the Director of Surgical Services and

gram Development at OA. Joanne T. LeBlanc, BSN, RN, is the Dir

of Clinical Services.

be brave now... and proud later facing haiti’strauma

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