October 10, 2005
Until August 2005, 30-year old Renilde Kanyange, was the supervising operating nurse for Doctors Without Borders/Médecins Sans Frontières (MSF)'s program providing emergency surgical care in the Haitian capital of Port-au-Prince. Originally from Bujumbura, Burundi, she helped open the trauma center in December 2004. Since then, she and her colleagues have treated nearly 5,000 patients – more than 1,700 for violence-related injuries, including nearly 1,300 gunshot victims. Half of those treated for such injuries have been women, children, or elderly.
I came to Haiti on very short notice when the project first began. I was attending a medical training course in Paris when MSF asked me to go to Port-au-Prince as an operating room nurse. I went home to Burundi, told my parents, and packed my bags. I really didn't know what to expect. At the beginning, we had to deal with logistical challenges, like finding a hospital, and ordering surgical supplies and equipment to set up the operating room.
We were dealing with a lot of surgical trauma. On my two previous assignments in Burundi, I managed emergencies and surgery in the hospital, but those projects mainly dealt with elective surgery and internal pediatric medicine. In Haiti, when the patients reached us, they were in real distress and shock, and you didn't know if they were going to come out of it. You had to think very quickly and then get to work. You had to respond fast.
Often patients had lost a lot of blood and were extremely anemic when they arrived. There is a chronic shortage of blood in Haiti, and finding blood for transfusion was always a challenge. Since most of our patients were brought by the Haitian Red Cross or local taxis called "tap-taps," they were usually not accompanied by any potential donor. Many times, we had to ask the staff or literally anyone we can find to give blood.
"It's a question of speed and good reflexes"
Triaging patients was one of the toughest challenges. Everyone seemed to arrive at the same time, whether because of accidents or bullet or knife wounds, but it was impossible to do everything at once.
I particularly remember a patient who had been shot and his intestines were outside of his body. There was no need for an X-ray. As the operation was underway, another patient with a gunshot wound arrived. So what do you do when you have to answer the question: "Who will you save?" Sometimes our surgeon was busy in the operating room, other times both operating rooms were occupied. I needed to figure out the best way to do the fastest possible abdominal surgery. On May 28 – I remember the date well – we had 28 emergencies, including 10 gunshot wounds. All those 10 gunshot victims went into emergency surgery while the others were able to wait. We needed to save time and move as quickly as possible so that the surgical team could operate on the next patient.
In a trauma center, the operating room nurses need to be able to prepare a patient quickly for the surgeon. We often needed to set up a chest drain very quickly. Not everyone has worked in trauma, so we conducted training for minor procedures. In such situations, you have to find skilled people who don't hesitate. It's a question of speed and good reflexes. I've always worked as an operating room nurse, I'm used to a fast-paced environment. That's my specialty and I really like it.
At the beginning of the program, the Haitian staff knew about MSF as an independent humanitarian medical organization because MSF has worked in Haiti since 1991. But they were not necessarily familiar with MSF medical protocols. A big part of our responsibility was to help train them to ensure that we provide our patients with high-quality service and treatment. As in any organization, managing human resources is a challenge. We have around 150 employees and we needed to be careful about fatigue among the staff because we worked very hard.
Providing Care as Violence Increased
In March, we were treating on average three people with gunshot wounds every day. From May to July, this average went up to six per day. The type of violence we dealt with here was different from what I was facing in Burundi during the civil war.
What was shocking to all of us was the number of people wounded by fragmentation bullets. They are not like gunshot wounds from 38-caliber guns, and cause a much more severe wound, with substantial tissue loss. It was very challenging for surgeons because of the multiple injuries to several organs.
Violence has increased in Haiti. It was frightening, really, and scared everyone. Usually, the local staff would go home at 7 p.m., but eventually they said that even 7 p.m. was too unsafe for them and had to leave earlier. After 8 p.m., there's no one left on the street.
The Importance of Independence and Neutrality
Our national staff was also afraid because the Haitian National Police occasionally came into the clinic looking for people. They didn't always feel safe, and feared potential consequences. Sometimes our Haitian staff actually wondered how MSF managed to get access to places like Cité Soleil. "How did we get permission to enter?" they asked. The very fact that MSF teams went out to Cité Soleil asking simple questions like, "How can we help you?" seemed strange here.
Part of my role was to explain how MSF operates and what it means in our day-to-day operations to be an independent humanitarian organization. We take care of all those wounded in conflict situations. MSF is a neutral organization and we ask all parties of a conflict to respect civilians caught in the crossfire. This needed to be clear for everyone. This is why we did outreach to inform the general public and all the armed groups about our work. However, having been an MSF employee within my own country, I understood that foreigners have a very different perspective.
Everyone spoke to me in Creole, even my colleagues, thinking I am from Haiti. Often people didn't know about Burundi, and got very curious, asking a lot of questions about life over there, but also about how and when I started working with MSF. They wanted to know if the violence elsewhere was the same as in Haiti.
MSF has been present in Haiti since 1991, mainly providing assistance in the country's provinces or in response to natural disasters. In addition to the trauma center, today MSF also provides primary and maternal health care in the Decayette and Cité Soleil areas of Port-au-Prince as well as in Petite Rivière, Artibonite Department.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)