Many Hands--

A contribution from Dr. Rajdev (general surgery resident), Dr. Sullivan (anesthesiologist), Dr. Srinivasan (general surgeon):
​“If you want to go fast, go alone. If you want to go far, go together.” – African Proverb
 
Collaboration is the name of the game down here in Pignon. The planning for this trip starts one full year in advance, beginning with a few attendings and a solid team of senior medical students. The team branches out from there, extending to PAs, OR nurses, ICU nurses, translators. But that’s just the Emory team--our other collaborators include Childspring International and the amazing team of nurses and doctors down here in Pignon. 

​One of the dilemmas we face we pursue global surgery is the fleeting nature of many of these efforts. Our intentions are good, but after the trip is over, we are often left wondering about whether our impact was a) lasting and b) positive. For the Emory Haiti Alliance, the move to Pignon has truly helped us sort through some of these ethical questions: Dr. Moise, the medical director of the hospital, has been in close contact with Dr. Srinivasan, Dr. Sharma, and the M4 Trip Leaders, collaborating on an lecture series for us to give while we are here. Dr. Roser (OMFS) was able to collaborate with a large group of Haitian dentists and oral surgeons to gather several patients waiting on repairs of old mandible fractures, and was also able to hold a symposium on his last day here. We have also remained in touch with Dr. Painson, a general surgeon who operates here for a week every month, to collaborate on patients he has evaluated and would like us to work up for laparoscopic cholecystectomies. All in all, the team at HBP has been incredibly gracious and welcoming towards us, and we have been working to build a strong, collaborative, cohesive relationship.

In the spirit of collaboration, tonight’s blog will be a joint effort featuring two of our faculty trip leaders, Dr. Cinnamon Sullivan and Dr. Jahnavi Srinivasan.

Notes from the Ether, by Dr. Sullivan
Every year I come down to Haiti with the Emory group I expect for somethings to have improved and some to have worsened. What a pleasant surprise to have nothing but improvements so far. Not only do I have two excited, smart anesthetists - Jason Birn, A.A. and Ann Wobler, A.A., the roads between Hinche and Pignon are better, thereʼs an ultrasound available, the food is still good, and our Haiti partners are truly cooperative.

While my work crush, Dr. Painson, isnʼt here this week I did reconnect with Dr. Jean-Charles. She graduated from anesthesia residency and as an attending has brought two anesthetist students, Jennifer and Zina, for us to teach. They handed me a list of topics and we have already started working our way through them. They stand with Jason and Ann during cases which allows our people to become educators.
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Speaking of learning new skills, Ann Wobler, A.A. did her first spinal today and it worked beautifully for the inguinal hernia repair. Sheʼs a natural. Meanwhile Jason tapped into his inner pediatric anesthetist, taking care of an eight-year-old having surgery under a spinal block. With a little propofol/ketamine sedation, anything is possible. 

Pignon in Perspective, by Dr. Srinivasan
​I don’t do social media.  I don’t blog.  I generally shy away from providing evidence on the internet of my day-to day going ons.  As I figure it, people who need to know, well they know.  I make this point first to set expectations that this may not be nearly as witty or entrancing as we’ve seen on this site already, but mostly to make the point that it takes a big deal for me to put this out there.  But Haiti is a big deal.
 
The first time I ever did global surgical work was when I first came to Haiti in 2010, about six months after the earthquake that would devastate the country for years to come.  We came to the most under-resourced part of a country that in and of itself is under-resourced.  Our goal was a continuation of an effort started two years earlier by two of my colleagues at Emory- teaching simple prostatectomies to local surgeons so that men forced to live their lives with the discomfort of indwelling catheters from prostatic hypertrophy could resume life without.  I was to lend support for any general surgical needs.  We brought with us, in addition to the urologist and anesthesiologist, several native Haitians who worked as ICU and scrub techs in Atlanta.
 
My appreciation for the country and for the work was instantaneous.  Most people who do global health work will tell you that superficially, there is an inherent romantic appeal to such efforts, but those who really dig in have their hearts stomped upon repeatedly.  Initially, this felt true.  Many individuals, particularly the grateful and wonderful patients, warmly embraced our team.  But over the course of the next few years, as we tried to build a sustainable relationship, we seemed to find a sense of irritation at our presence from the local hospital staff.  It was as if we were viewed as an invasive force that came to self-aggrandize and self-congratulate, but never truly integrate.  After years of fundraising, countless numbers of lives impacted positively via surgical cures, and numerous students taught, our crew of anesthesiologists, urologists, general surgeons, and nurses seemed to ask the same question every year.  “Are we making any long term impact, and if not, are we doing the right thing for Haiti?”
 
Every year we’d come back from our trip in July, take 3 weeks off, and return to fundraising in August to make the money to cover all our surgical supplies, personnel transport, and in country housing of our crew of medical professionals.  This group of people was, and is, bonded by a common inclination toward humanism for those most in need.  I could look at each of these individuals and see the best our species has to offer, but still come away empty with the thought that maybe we were acting more as invaders than colleagues.
 
Our one-month trip changed dramatically when we coupled with Hopital Bienfaisance in Pignon.  The leadership of the hospital, in the person of Guy Theodore and Evelyn Moise, are dedicated to deliberate integration of teams of physicians from abroad with their hospital personnel.  Their work with us feeds their long-term goal of providing infrastructure expansion to the hospital and education to employees who will remain in Haiti to take care of patients year round.
 
So now I find myself back in Haiti again for the eleventh time, at the end of a good day’s worth of work on the second week of the second year of our trip to Bienfaisance.  Now, however, I know we work with people and not around them.  Our week has planned ahead, outside of numerous more cases, an educational session on surgical nutrition, postoperative care and a laparoscopy referesher.  We also are set to integrate a trauma registry we have already piloted at four other hospitals in Haiti in Pignon so we can continue to collect data on how to best improve the survival of trauma patients seen in ERs based on regional needs. 
 
I’m happy to watch my baller anesthesia colleague Cinnamon Sullivan teach every Haitian student or anesthesia professional in her midst how to start the process of care with IV placement under ultrasound to spinal anesthesia with conscious sedation for hernias and urologic procedures.  I’m amused to watch the nurses and techs who come with us every year kid one another like they are siblings while they embrace the local hospital staff in their antics spreading their humor and affection.  I’m appreciative to watch my urology colleague Jeff Carney spread his passion for urologic care to the medical students without whom we could not run this trip.  I’m gratified to watch my senior surgery resident Priya Rajdev no longer require my help in the OR and take the place of me in teaching those junior to her. 
 
It’s obviously still hard work, and there’s a decent chance you’ve skipped through my laborious prose and determined that there it was a gift to humanity that I refrained from blogging.  If I’ve managed to drag you to this point, thanks for your forbearance.  I hope my ramblings give you some sense of our decade long effort to find a home in Haiti we believe gives the country as much as Haiti has given to us.
 
JKS