Vitals: Spring 2016 – Perspectives: Global and Local Challenges

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Tiffany Chioma is a 3rd Year Emergency Medicine Resident at Alameda Health System

Dr. Tiffany Chioma Anaebere reflects on Haiti relief mission. She is a 3rd Year Emergency Medicine Resident at Alameda Health System – Highland Hospital in Oakland, CA

Soon after I placed a breathing tube in our very sick patient at Hospital Bernard Mevs in Port-au-Prince, Haiti, the Emergency Department team connected her to our last ventilator. Shortly thereafter, a flatbed truck pulled up. Inside was an older woman, unresponsive, on a bed of pillows in the bed of the truck. Her daughter sat with her and kept her covered with a blanket. When they arrived outside of the ED, I was called to assess her in the truck. After seeing her I knew she would need a breathing tube, ventilator, and CT scan of her brain.

The family explained to one of our Creole translators that we were the third hospital they visited that day and no one had space to help them. I stood outside, my mind racing, trying to troubleshoot how we could take care of her. I briefly excused myself, discussed the case with the other medical staff and made the tough decision to turn her away. We had no space and no life sustaining equipment left. I saw her daughter, disheartened, cover her up again with the blanket and they drove away.

I participated in a clinical elective funded by CIR in Haiti. The hospital is partnered with a non-profit called Project Medishare based in Miami, Florida. Bernard Mevs houses the country’s only critical care and trauma hospital, newborn and pediatric intensive care units, and various surgical subspecialties. They have CT scanning capabilities, an orthotics and prosthetics laboratory, and one of nation’s most advanced wound care programs. It also has pediatric and neurosurgical residency programs.

I worked primarily in the ED and Intensive Care Unit at the hospital. I was able to provide clinical care, ultrasound instruction, and teach medical students and residents how to manage many complex patients at once. People in Haiti, like many under-resourced nations, often seek medical care only when they are truly ill, which makes acuity exceptionally high. I encountered various Level 1 traumas and took care of patients with serious medical emergencies, including a 38-year-old female with severely elevated blood pressure who succumbed to a subarachnoid hemorrhage.

My Haiti experience came at a perfect time in my residency career. Earlier in my training, if I had the aforementioned encounter, it may have generated negative comparisons in my mind between the U.S. and Haitian healthcare systems. I may not have taken into account the unique circumstances around why certain decisions are made in the Haitian healthcare system.

Tiffany helping a patient at Hospital Bernard Mevs in Port-au-Prince, Haiti
Tiffany helping a patient at Hospital Bernard Mevs in Port-au-Prince, Haiti

Having worked in various clinical environments as an Emergency Medicine resident, I realize that every community has challenges in providing healthcare to patients, and though our problems in the U.S. may not be turning patients away, we suffer from other issues such as poor access to care in underserved communities, medication and treatment plan non-compliance, reliance on advance testing and stringent malpractice laws. With this in mind, it is easier to go abroad and be grateful for our medical advances here in the U.S., while maintaining a non-judgmental attitude.

My training and experience helped me recognize that despite medical limitations in Haiti, their medical professionals and the medical system are caring for their patients the best they can. I have always been interested in spending some part of my career working abroad, but was never quite sure the best way of going about it. The difficulty for clinicians who want to spend time abroad is negotiating how they will fulfill their professional interests in their home country. CIR funded a one-week clinical elective that was the perfect amount of time for me.

Applications will be available for the Haiti program in late summer and for other global deployments in early fall 2016.