Dr. Heimerl's First Week in Port au Prince, Haiti

Written by John Heimerl, M.D., 3rd year pediatrics resident

Chapel at sunset on grounds of St. Damien's Pediatric Hospital; Port au Prince, Haiti.

Well, I have embarked on my seven-week experience in Haiti. I arrived on Monday, January 16.

My flight was slightly delayed in getting to Port au Prince, due to the airport controller delaying our landing.

This circumstance allowed for us to circle the island prior to landing, and I recalled my first year of medical school when we read Tracy Kidder's Mountains Beyond Mountains.

It is no mystery where he got the name for his book: there are mountains beyond each ridge of mountains. It sure is beautiful topography.

Most of the population lives in the coastal town of Port au Prince, but houses and huts are scattered among the deforested slopes of the mountain.

I can only imagine how far residents must travel for water and supplies, especially since there are very few visible roads.

We ended up landing after dark and headed to St. Damien's Pediatric Hospital, where I'll be rotating. I imagine the distance was not very far, but the stop-and-go traffic made it seem further. We eventually arrived.

I was greeted by Sister Judy at the entrance of the hospital and met the two attendings and residents from Brown University that I'll be staying with, who have agreed to take me under their wing for a couple of weeks.

Recently the hospital upgraded from canvas tents to prefabricated houses. The prefabs each have three rooms with a small communal space and bathroom. Oh--did I mention they are air-conditioned? (The only such place in the hospital.)

As with any working communal living situation, I was told of the short list of house rules and also told that this side of the house was against the labor ward, so to expect screaming at all hours of the night.

Nevertheless, I had a great first night's sleep.

On the following morning I got to work and began with observing the triage process. Patients begin assembling at 0645a.

From triage, patients are sent to various places depending on how they look, their chief complaints, and their temperature.

Some are sent home with Tylenol, others sent to the adjacent clinic to be evaluated, others are sent for further triage, to the malnutrition unit, or to the cholera tent, if they have severe diarrhea.

The sickest are sent directly to the emergency department. I am told this triage process continues throughout the day. 

The services are free.

The hospital, which serves kids 3 months to 12 years old, is a complete pediatric hospital with OR, Lab, XR, blood bank, NICU, an ICU (Critique), wards, oncology (the only such unit in Haiti) and ED (Urgents).

I will be spending most of my time in the Urgents, which also functions as a extended-stay unit; after evaluation, they may stay for several hours or for days.

The mornings are spent rounding, first on the patients who are boarding in the Urgents, then with the new patients.

Mostly we are seeing meningitis, pneumonia, sickle cell crisis, malaria and other tropical diseases. Mixed among these are the more routine pediatric admissions.

I've been spending the mornings this week working in the general wards. Each room has a name that corresponds to the painting outside it, so today I was in Balloons and Watermelon.

Each room houses around ten patients. Each day there are a couple of new patients who made it up from the Urgents. My rooms had kids with chronic heart disease, sickle cell, meningitis, and pneumonia.

January 10th marked the second anniversary of the Haiti earthquake.

You can see evidence of the destruction in the adjacent buildings and on the patients who have scars or are missing limbs.

I am told a large ceremony was held that day at the hospital. Saint Damien's was built in the early 2000s prior to the quake and, due to its Italian engineering, sustained minimal damage.

I am told there were some cracks in the cement walls. Most have been repaired, but in one hallway, they have left the damage exposed as a mural of remembrance.