From June 18-July 6, Emory Medishare's faculty surgeons and anesthesiologists; medical students; surgery residents; and mid-level practitioners provided surgical care to residents of Haiti's Plateau Central, the poorest and most medically underserved region in the country. Despite such conditions as oppressive heat, an OR that functioned on a diesel generator, minimal lighting, intermittent power outages, and an autoclave mishap that required surgical instruments to be sterilized off the premises for the first two days of the trip, the team managed to perform 65-to-70 procedures.
"The types of things we take for granted in U.S. hospitals, like ORs with environmental controls, automated scrub sinks, and having enough basic supplies like surgical gloves, are not always the case in a country as impoverished as Haiti," says general surgeon Dr. Jahnavi Srinivasan, who has participated in Emory Medishare's summer trips to Haiti's L'Hôpital Sainte-Thérèse de Hinche since 2010. "It's as if the physical environment consistently conspires against the type of work we do. Compassion for those severely in need is what gets us there, but thinking on our feet and doing our best with not nearly enough is what makes it work."
Born as an affiliate of Project Medishare, a non-profit consortium of U.S. medical schools dedicated to providing comprehensive health and development services in Haiti, Emory Medishare made its first trip to Hinche in 2008. Beyond the objective of providing the highest quality treatment possible to a rural Haitian patient population that has little access to medical care, the heart of Emory Medishare is the interaction between faculty leaders, their resident assistants, and medical students, who receive credit for their involvement as a global surgery elective. Months before they set foot in Haiti, medical students have the responsibility of raising funds to finance the trips, making travel arrangements, recruiting physicians and staff, and stockpiling medical supplies and pharmaceuticals. On the ground, the 3rd and 4th year medical students meet patients at first presentation and diagnosis, follow them to the operating room, observe and assist on procedures, coordinate all facets of postoperative care, and provide for discharge.
In addition to the medical students and physician staff, the clinical teams include volunteer, Haitian expatriate ICU nurses from Emory University and Grady Memorial hospitals that assist with translating and caring for patients. "The nurses are great liaisons, not only because they speak the language, but because they share a cultural heritage with the patients and the hospital staff," Dr. Srinivasan says. "They are very focused on giving back to their people."
For the first week of the trip, Dr. Srinivasan and the medical students were joined by urologist Dr. Jeff Carney, Medishare-veteran and anesthesiologist Dr. Cinnamon Sullivan, anesthesiology resident Dr. Elizabeth Fuacher, and retired Emory professor and former pediatric surgery chief Dr. Richard Ricketts. "I'm always thinking of how we can involve other specialties in these trips," says Dr. Srinivasan. "Dr. Ricketts made it easy. He approached me at his retirement party and was very emphatic about volunteering. While we've been able to do many of the simple pediatric surgeries over the years, we just aren't used to routinely operating on children. Pediatric surgical care is scarce in Haiti, and Dr. Ricketts is just so fantastic. We were lucky to have him."
In addition to Dr. Carney, the staff for the second week included general surgery resident Dr. Blayne Sayed, general surgeons Dr. Joe Sharma (his third Medishare trip) and Dr. Carla Haack, anesthesiologist Dr. Grant Lynde, and anesthesiology resident Dr. Caitlin Sutton. The third and final week was devoted to surgery follow-up clinic and was supervised by Dr. Barbara Pettitt, director of medical student education for the Department of Surgery, with assistance from Dr. Haack and the 4th year medical students. Approximately 80% of the surgical patients from the prior two weeks returned to the hospital to be seen.
The most common procedures performed during the trip were inguinal hernia tissue repairs, open prostectomies, hydrocele repair, and removal of enlarged lipomas, cysts, benign soft tissue tumors, and other subcutaneous masses.
Dr. Srinivasan's desire to expose medical students and residents to global health issues has remained constant on her Medishare trips, though other motivations have shifted. "When I first started going, I was partially motivated by the idea of placing myself in an environment that would truly test my ability to rise to a challenge. These days, that's just a given. Now—and I believe I can speak for all of my colleagues—our passion is for the Haitian people and knowing that there is a population of patients who will benefit from care that they would be unlikely to receive if not for our us. It's great watching how that realization impacts our students, and it's wonderful to have the opportunity to mentor them through an experience that forms the foundation for a career in global health for many of them."
