View from the ground in earthquake-ravaged Haiti

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It has been almost two months now that a magnitude 7.2 earthquake devastated Haiti, severely limiting an already damaged health care infrastructure.

Several international relief organizations responded, and among those who answered the call was Dr Robert Fuller, president of emergency medicine at UConn Health.

There would be 100 people waiting at the door hoping to be seen. – Dr Robert Fuller

Fuller is back after a three-week deployment with the International Medical Corps, which set up a medical clinic on a football field about 400 yards from an Aquin hospital. Aquin is a port town on the south coast of Haiti’s Tiburon Peninsula, not far from the epicenter.

“It’s known as a referral hospital for the region, a small hospital that could usually do surgeries, antenatal care, maternity care, caesarean sections, treatment for HIV, malnutrition, malaria – kind of ‘general hospital as well as a resource for those specialties needs, “Fuller says.” Because of the earthquake, one of its two main buildings could not be occupied.

When Fuller arrived in Aquin on September 9, IMC tents were already in place, not only on the football fields, but also in the hospital parking lot, intended for preoperative and postoperative care. The hospital operating rooms were functional, but the preoperative and postoperative areas were too damaged. Other habitable parts of the hospital such as conference rooms and non-clinical areas have been converted to inpatient rooms to begin to restore capacity.

Dr Robert Fuller (right), in his role as medical coordinator of an International Medical Corps tent clinic in Aquin, Haiti, visits a Haitian hospital to determine its potential referral capacity of patients in need of care more advanced. (Photo provided by the International Medical Corps)

Back at the soccer field, the tent clinic sometimes treated or sorted 170 people a day, Monday to Saturday. Fuller held the familiar role of the facility’s medical coordinator, which the previous week had been run by expatriate volunteers.

“On a typical day, I would meet the medical team around the same day, then around 8:15 am we would open the tents, open the vents and doors, turn on the generators, and there were 100 people waiting at the door. hoping to be seen, ”Fuller says. “A triage nurse was going through the crowd to determine who needed treatment first, who was sickest. I would work with a responsible nurse to set up staff for the tents, including translators, nurses, doctors and midwives to take care of the patients throughout the day.

Fuller would also arrange for the transfer of patients who needed more advanced care than what was available locally, a daunting task that has become a little less daunting over time.

“I had to find a place and figure out how to get them there – which was difficult, especially in the early days – and the last piece was to build a list of reliable resources, go through the countryside, find out who could do what,” says Fuller. “Gradually, the existing infrastructure began to recover with its capacity. Within two hours, I visited all the hospitals and health facilities to see what their capabilities were. Over the three weeks, little by little, the hospitals began to be able to do what they were doing, albeit in a slightly different way, the same line of service even if it was not the same structure.

At the same time, Fuller’s job was to recruit local nurses and doctors who could support the operation for the next few months, while avoiding poaching talent and creating staff shortages at other facilities. When he left on October 1, he had hired two doctors and six nurses. IMC still has a few supervisors in the field, with local providers providing most of the patient care.

“For more than 15 years, Dr. Fuller has been an integral part of International Medical Corps emergency response efforts in crisis areas around the world,” said Margaret Traub, Head of Global Initiatives at IMC. “We were fortunate to have Dr. Fuller returned to Haiti with us after the last earthquake, to help run our mobile field hospital near the epicenter. His prior knowledge of Haiti and its people has proven invaluable.

Fuller says the efforts have been well received by residents.

“The people of Aquin were very welcoming and very grateful,” Fuller says. “Even though we couldn’t provide them with what they needed, they really appreciated our presence. I was working with a translator, ending a conversation with a patient, and the translator was saying, “They want to thank you very much for being there, they appreciate it. Some had issues that we couldn’t help with, and even then they would always be grateful. “

Running water is a real privilege.

He describes the living conditions as “rough and tumbling,” with little relief from the heat, no air conditioning, no screens on the windows. He and many providers stayed at a local hostel, which had running water, although neither the water service nor the electricity was always reliable.

“The fans were going and it was pretty hot. Running water is a real privilege, ”Fuller says. “No one in this area has running water in their house. Everyone carries a big water bottle or yellow bucket, brings it to a hand pump to fill it up and take it home. Our water sometimes ran 12 hours a day which was a downside that puts you more in tune with the locals to experience their struggles. Still, it was a nice building, not damaged by the earthquake, and I felt quite comfortable going in and camping out on one of the balconies.

group portrait outside a clinic tent
Dr Robert Fuller (left) is one of a group of expatriate clinicians and local healthcare providers who run an International Medical Corps tent clinic in Haiti, where an earthquake damaged parts of the the country’s already fragile health infrastructure. (Photo provided by the International Medical Corps)

Fuller is no stranger to emergency care beyond the walls of the emergency department at UConn John Dempsey Hospital. On September 11, he was part of a UConn Health special operations unit dispatched to the World Trade Center site and participated in several IMC disaster responses, including the 2004 tsunami in Indonesia, another earthquake in Haiti in 2010, hurricane Thomas in St. Lucia in 2010, and the 2013 typhoon that hit the Philippines. This trip to Haiti was his first since the COVID-19 pandemic.

“This is the kind of thing I would normally respond to, and the COVID vaccine makes it possible to participate in these humanitarian missions again,” Fuller explains. “I find satisfaction in solving puzzles which are these complicated tasks. I feel like this is something I’m good at, and it’s gratifying to be able to help.

He says his experiences in such resource-constrained settings reveal marked differences in the way care is provided.

“I not only have to deal with the one problem that lies ahead, but think about the context and how that context influences all the medical decisions you have to make,” Fuller explains. “What if I move this patient to a new location, will the care be provided appropriately? Would the patient survive? Would they have access to food and water if they left their social network? Can we help the social network expand to reach their destination? Questions beyond the medical question. It’s interesting to think that there is so much movement on the ground, sometimes you come to the conclusion that the best place to get treatment is here at the tent hospital.

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