Do things with love

A contribution from Dr. Haack (general surgeon):
One of my favorite questions these days is “how do you define success?” One of my favorite answers: “Leave the place better than you found it.”

What are we really doing here??

We came to help, to operate, to teach and to learn. In theory, we are here to offer surgical intervention to those who might not be able to afford it under other circumstances. We bring our supplies and meds, we pay the hospital. We come with the intention to give, not take away. Alas, like in all complex situations, our understanding of the situation is incomplete, despite our best efforts. Patients still have to pay—because the hospital has to keep the lights on and we don’t truly know what it costs them to do that. Sometimes the cost estimated by hospital administration is far more than the patient can afford. While we are often able to work something out so the patient can have their surgery, what is the real cost to the patient? What do they have to sacrifice to have the operation? What does it mean to them? Giving a manual laborer the ability to earn a living might be worth the price, but is a lipoma? A mastectomy for unilateral gynecomastia in a young man? Perhaps the ability to go to the beach and take his shirt off or find someone to share his life with is priceless.
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While we come with supplies and the best intentions, our follow up is often inadequate to truly understand if those intentions accomplish what we hope. This year we were fortunate enough to get one-year follow up on a young adolescent man who was born with posterior urethral valves and underwent bilateral cutaneous ureterostomies in infancy. He leaked urine from his skin continuously and dropped out of school because he smelled like a wet diaper all the time. 

One year ago, he underwent an Indiana pouch, which is an extremely complex operation in this environment. His postoperative course was rocky to say the least. He developed an ileus and needed an NG tube for decompression—try managing a nasogastric tube without any wall suction available! Despite his difficult recovery, he got better and charmed the entire surgical team while he was at it.  At his discharge we were all wrapped around his little finger. When the word came that he had seen a local physician who told him his operation had failed and that he needed dialysis, hearts broke on all sides of the Caribbean. Arrangements were made to see him in Clinic as soon as possible. He and his mother made the long, long journey from the island of LaGonave to Pignon to generously share the news, in person, that he was thriving! He’s doing well in school, and his biggest complaint is that mom won’t let him play soccer. His workup indicates intact kidney function. Perhaps we can make a difference, one case at a time.
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This brings me to considering the aspect beyond humans- the environment. We are spoiled by our hosts this year- 24 hour power, toilets that flush, bottled water. Bottled water, while an incredible convenience, creates an unimaginable amount of waste in greater than 90 degree heat. Haiti struggles to manage basic needs, recycling is not an option locally- plastic gets burned. Yep- burned. That’s it. Well, this year, I am personally carrying all the recyclables we consumed back to Atlanta with me- a small portion of the waste generated by humans in their day to day lives. A minuscule, perhaps insignificant, dent in the amount of waste we dump into our Mother Earth every day, but I refuse to add to the problem if it within my power to do otherwise. I come to be part of the solution, not the problem. 

We did 37 cases this week, not including minor procedures and cases I scrubbed with the local surgeons—a C-section and a D&C: the beginning of one life and the end of another.

As I write this, the week 3 group is braiding each other’s hair, singing songs and dancing together. By that I mean that Dr. Paul Parker is braiding a medical student’s hair and Dr. Barb Pettit is regaling us with her formal vocalist training. A feeling of love pervades the group and takes us outside of our defined roles and comfort zones.
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Perhaps we will succeed in leaving it better after all....