Ryan Moore, MD Trip Report

Dr Ryan Moore is a PGY-5 Orthopaedic Surgery Resident at Loma Linda University Medical Center.  Ryan left for Haiti last month with less than 48 hours notice to assist Dr Nelson after Dr Syed's departure.  Ryan's service at Hopital Adventiste was greatly appreciated and he and his family are planning on private practice in Central California upon graduation at the end of this month.

Port-au-prince, aside from rubble everywhere and the tent camps which I never visited, seemed to be functioning like I would expect a third-world Caribbean nation to function.  The streets were lined with vendors of junk.  There was disorganized traffic weaving around piles of concrete and deep ruts in the road, blowing dust and exhaust into the air.  Straight-faced people appeared clean and neatly dressed despite their grungy surroundings.  Students in uniform were walking home from school, and people overall had the appearance that they were trying to find ways to be productive. 

At the hospital I was immediately put to work.  I think we completed three surgeries my first day before I was able to find a mosquito-net covered cot to call my own.  When the work was done, I prepared my bedding in the dark, and crashed for the night. 

The next morning after rounds we met for our morning orientation.  The “yellow-shirts” as the South Atlantic Adventist team was affectionately called were leading the volunteers in some good southern-style gospel worship.  Each morning they did this, and I must say- it was the highlight of my trip. 

On Saturday, since there was no scheduled surgery, a couple of us decided to figure out what was going on with the patients.  Teams of volunteers come and go, but the patients remain.  Care plans often disappear with the exiting team.  Two wonderful women came into my life that Saturday- both were nurses from Ukiah-  Tamara and Kristy. 

The three of us spent Saturday rounding on our patients.  To make a long story short, we found that there were issues.   Patients with bad infections were, on average, not receiving ordered antibiotics.  There were wounds requiring attention, but nobody knew what the plan was.  Of course there were the Haitian nurses.  But, when asked through an interpreter what the plan was for any given patient, you just received an annoyed stare.  The Haitian nurses, with some exceptions, seemed disengaged.

That being said, I think that they are interested in doing a good job.  They cover a lot of patients, with a one nurse to 12 patients ration (as opposed to 5 max on med/surg in California).  They also had the challenge of coordinating care with physicians who don’t speak Creole or French.  On top of that, they had to deal with shortages of medications in the pharmacy.  I think there was also confusion regarding the roles of volunteer nurses from the US and the Haitian nurses. 

A few of us were able to initiate an organized system for patient care on the floors, with Haitian nurses being the “charge” nurse, with a volunteer American nurse being there to help with whatever was needed.  We also did some training activities to help the Haitian nurses better understand some of the treatments that we were using.  I saw a spark in their expressions, and I must say that I think these nurses, if shown respect, and given training and resources, will be wonderful.

The hospital seems to be transitioning from a disaster response mode to a more sustainable model.  There are new staff members (such as Luke), who are there to help coordinate the revival of a healthy hospital system with appropriate integration of foreign volunteers.  At the same time there are the Haitian nationals who have been running the hospital for decades who may see American interference in their hospital system every bit as uninviting as the earthquake was. 

Thankfully there are long-term volunteers such as Dr Nelson and Luke who know through training and experience how to approach these situations, and what will work.  They are working in an extremely uncomfortable situation, motivated by convictions inspired by their faith.  I think many improvements will continue to be made through the efforts of these “full-timers”.  They were refreshing for me to work with, and they deserve our full support.