July 31, 2012

A look at MSF's project in the burn unit at Drouillard Hospital in Port-au-Prince.

Haiti 2012 © Yann Libessart/MSF

A mother and child at the burn unit in MSF's Drouillard Hospital.

By Melissa Pracht

It’s mid-morning at MSF’s Drouillard Hospital, a sprawling, bustling facility situated next to Cité Soleil, one of the poorest neighborhoods in Port-au-Prince, Haiti’s capital. People with crutches, bandages, and external fixators used on bone fractures sit on benches near the entrance to the outpatient ward waiting for follow-up treatment. Family members speak softly to each other as cell phone ringtones go off constantly.

With the onset of spring, the mango trees on the hospital grounds are starting to bear fruit. The steady buzz of motor scooters dodging potholes and pedestrians on the street outside rises in volume each time the security gate rolls open. In one of these moments, a beat-up white car accelerates onto the grounds and comes to an abrupt stop in front of the triage station next to the emergency room. A door opens and a woman maneuvers herself out of the back seat holding her young daughter, who is naked. The girl’s face is blank with shock; her thin back is bright red with burns.

The mother takes a seat in a white plastic chair, her daughter still in her arms, and the doctor begins applying pads to the burns, following the blazing red wound that covers the child’s back and creeps over one shoulder onto her chest. “How was she burned, madame?” the doctor asks.

In a halting voice, the mother explains that they don’t have electricity or gas where they live and must use a portable coal stove for cooking. Earlier that morning, she says, “when I was climbing the stairs with the stove and the spaghetti in the boiling water, these things slipped and fell on her.”

The doctor calls for morphine to be prepared. One nurse takes the girl’s temperature, while another asks for information.

“What is the age?”
“Seven years old.”
“What is her name?”
Her mother hesitates, as if searching for the answer.
“Dattchina … Dattchina Sary Chérilus.”

Dattchina’s mother stands once again with her now-bandaged child clinging to her neck and walks the roughly 10 meters to the ER. The Haitian doctor who runs the ER, Josue Bince, directs her to lay Dattchina on a gurney. A nurse covers the girl with a hospital gown and readies the morphine.

“About 15 percent of the skin's surface area was burned,” Dr. Bince says. “We are going to prepare her for surgery. We’ll wash and clean the affected area, and then apply the ointment following the MSF protocol, and then she will be moved to the burn unit.”

Next to the gurney, her mother sits with her handbag in her lap, cellphone clutched in one hand, eyes wide with worry.

Everything is Connected

Outside the hospital grounds, the residents of Cité Soleil live in concrete block structures or in tent settlements. When they venture out, they have to pick their way along the roads, dodging speeding motor bikes and beat-up cars, trying to keep themselves or their children out of harm’s way. Nearly 40 percent of the hospital’s admissions stem from traffic accidents.

The lack of a functional sanitation system means the sides of the roads in poorer neighborhoods serve as dumping grounds. As a result, undulating hills of trash and effluvium host luxuriant pigs and skittish goats and small fires emanate toxic plumes of smoke. Conditions like these helped cholera spread like wildfire through the city’s slums in the fall of 2010, again last year, and, in all likelihood, in the year ahead, particularly when the rains come.

It’s now been more than two years since a 7.0-magnitude earthquake destroyed much of Port-au-Prince’s already fragile infrastructure and many of its homes. Large numbers of people who were displaced by the quake are still living tent settlements scattered across the city. Many others, like Dattchina and her mother, have only rudimentary housing with no facilities or services. In either case, families cook over open fires, use candles for light, and hope exposed electrical wires don’t become live at the wrong moment. It amounts to perfect conditions for fires and burn accidents.

MSF’s Drouillard Hospital is the only place in Port-au-Prince where people can receive free treatment for severe burns. Between May 2011 and May 2012, staff treated 428 such patients. On the morning Dattchina arrived, the hospital’s burn unit was already near capacity. The patients included four survivors of a fire in a tent settlement the previous day, two men electrocuted by live wires, and at least 15 children—among them one little girl whose dress had caught fire when she stepped over a candle and several children burned in kitchen accidents similar to Dattchina’s.

In addition to the burn unit, which receives referrals from all over the city, Drouillard provides orthopedic and abdominal surgery, internal medicine, pediatrics, physiotherapy, mental health services, and a 24-hour ER, all for free. The programs are aimed primarily at residents of Cité Soleil, but they attract people from all over the city who have no money to pay for health care.

Haiti 2012 © Yann Libessart/MSF

A boy recovering from severe burns, with his mother in Drouillard's burn unit.

It’s a broad scope of activities for an MSF project, but many of the services are interconnected: burn and surgery patients often require physiotherapy and mental health care. Inside the physio unit, for example, there was a baby whose fingers were severely burned when a candle fell and lit his bed on fire. He had already received treatment in the burn unit and was now receiving regular therapeutic massages.

“I do this to keep the skin on the burned hand flexible,” said Marie-Yalba Coriolan, a physiotherapist who works primarily with burn patients, as she rubbed ointment onto the baby fingers, pressing and kneading the finger joints while cooing to him. If he does not receive this therapy, she added, “the skin will get hard and the fingers will become difficult to move.”

Back in the burn unit itself, Pierre Joseph was kneeling next to a hospital bed, talking to two women flanking a two-and-a-half-year-old boy. Joseph, a psychologist, provides mental health care to any patient at Drouillard who needs it. The little boy in the bed had been badly burned across his arm and chest by boiling water that his aunt was using to prepare his bath. Joseph was helping the women deal with some very sensitive issues that surfaced due to the accident. The boy’s father had died during the earthquake and his mother had been unable to care and provide for him, so his aunt was raising him while his mother worked to earn money.

“Guilt is a subject that comes up pretty often,” Joseph said. He points out that many parents who end up caring for their children here are among the 80 percent of the population living below the poverty line. While trying to make money, usually by selling things on a small scale, they are likely to leave their youngest children in the care of children who are themselves only eight or ten years old, and accidents happen. “As a psychologist,” he explained, “you're there, above all else, to prepare the parents, in case there was negligence, so they know what to do to prevent this from happening to the child again.”

Haiti 2012 © Yann Libessart/MSF

Dattchina and her mother seek treatment for her burns.

Relatively Lucky

A nervous look on her face, Dattchina is rolled from the ER into a special operating room for burn patients. Her eyes scan the room as the nurse-anesthetist speaks to her kindly. In a whisper, Dattchina asks the nurse-anesthetist her name.

“We do almost everything for the burn patients in this operating room,” says surgeon Lunel Salomon. “We do the standard dressings. We often have to do amputations, tissue debridement. We do almost all surgical procedures that a burn patient may need here.”

Once the nurse-anesthetist puts Dattchina under full anesthesia, the surgery team begins the procedure. Three people hold her in position and the surgeon cleans, treats, and wraps her back, chest, and arms.  

“Before her,” says Dr. Salomon, “we had a patient who had very deep third-degree burns. For this child, the wound is not very deep. In theory, she should recover without any major problems. There should be very little scarring, perhaps some discoloration of the skin.”

Her eyes fluttering open, but still under the effects of anesthesia, Dattchina is rolled out of the surgery block and down the hallway towards the burn unit, where her mother will soon join her. Every two or three days a surgical team will clean her wounds and change the dressings while she heals. If all goes well, Dr. Salomon says, she should be able to go home within two weeks. In a ward full of children and adults who have all been casualties of a brutal, normalized neglect, the little girl may be one of the relatively luckier patients.And, in fact, nine days after Dattchina was admitted, she was discharged in good condition and her mother took her back home.

In addition to the hospital in Drouillard, MSF runs an 80-bed referral center for obstetric emergencies in Port-au-Prince’s Delmas 33 neighborhood and works in two operating theaters, the emergency department, and the pediatric and maternity wards of Choscal hospital in Cité Soleil, while also providing care to victims of sexual violence. MSF’s 40-bed stabilization center in Martissant offers maternity care, internal medicine, and mental health services, and MSF tends to wounds, performs orthopedic and reconstructive surgery, and, with Handicap International, offers physiotherapy and rehabilitative services in Sarthe. MSF also runs a 160-bed hospital in Léogâne, west of Port-au-Prince, focusing on trauma and obstetric emergencies and basic health care to women and infants, and teams throughout the country have treated well over 170,000 patients for cholera.

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