Haiti is no stranger to trauma – as we were reminded on Tuesday, when a power-line accident and the ensuing panic killed 16 people during Carnival celebrations in Port-au-Prince.
We need no reminding that Haiti is still recovering from a 2010 earthquake that killed as many as 300,000 people. During those catastrophic moments five years ago, it was hard to imagine a silver lining. But an important benefit did emerge – one, in fact, that may have saved some lives this week after the Carnival tragedy.
Before the earthquake, emergency medicine in Haiti was unreliable at best. Sometimes unattainable.
“There were many skilled physicians in Haiti,” says Dr. Toni Eyssallenne, a Haitian-American who’s an internal medicine and pediatrics specialist at the University of Miami and Bernard Mevs Hospital in Port-au-Prince. “But they were in a very frustrating, resource-poor setting.”
The disaster gave rise to improved trauma care in the western hemisphere’s poorest country. Today, if you suffer a heart attack or a bad road collision in Haiti, you have a better chance of getting proper treatment.
And a big reason for that change can be found not in Haiti but 700 miles away in Miami – inside a conference room at Jackson Memorial Hospital’s Ryder Trauma Center.
On a recent morning, Dr. Shailesh Garg, a trauma medicine fellow with Jackson and the University of Miami, sat in his scrubs surrounded by enough video screens on the wall to fill a sports bar. Through a webcam connection he was advising Dr. Kathleen Charles, a Haitian physician at Bernard Mevs.
Charles was monitoring a Haitian woman who’d sustained severe injuries in a car crash. But the patient was suddenly showing symptoms – “This morning she presented a high fever,” Charles told Garg – that were hard to diagnose there given the relative lack of access to equipment like CT scans.
“The fever might be from a pulmonary embolism,” Garg said, meaning a blood clot in the lungs. He turned out to be right.
“It helps a lot,” Charles said later by phone from Haiti. “He gave us the right clue.”
“I’m amazed at how well they manage,” Garg says of his Haitian colleagues. “Here we have all the resources, we can get anything done. If I had to [work in Haiti], I’d have such a tough time.”
Helping Haitian trauma doctors do more with what little they have is a central point of this "telemedicine" program, which the University of Miami's Miller School of Medicine set up two months ago with Bernard Mevs – Haiti’s only trauma and critical care hospital.
“What we’ve been able to do is provide them with creative alternatives,” says Dr. Barth Green, UM’s head of neurosurgery. In the case of a brain injury, for example, Green says UM doctors can advise the Haitians to “use a drill that’s used for orthopedics to open the skull” if they don’t have the “specially designed, super-duper 2015 drill we have here in Miami.”
Green is also co-founder of Project Medishare, which UM started two decades ago to assist Haiti’s threadbare medical system. Medishare’s presence after the 2010 earthquake – especially the 300-bed tent hospital it erected – was crucial. And it’s been no less important in helping Haitian clinics like Bernard Mevs build better trauma care.
But Green says it also became apparent that promoting Haitian doctors needed to be a stronger part of Medishare’s efforts.
“Training Haitians to take care of Haitians,” he says, “instead of talking to ourselves about how good we are.”
REAL-TIME MED SCHOOL
That led to the telemedicine campaign. More than just collegial consultation, Green calls it “real-time” medical school for Haitian MDs. Eyssallenne, who helped developed the program, agrees.
“It’s raised the bar,” she says. “It’s demonstrated to Haitian medical staff members that more can be done for reversible traumas. And that fosters hope.”
The University of Miami plans to carry that hope to other parts of Haiti soon by expanding telemedicine into the country’s rural interior. Internet and other communications technology challenges will be even bigger there than they are in Port-au-Prince. But UM doctors say “telehealth” technology – especially mobile tech – is advancing quickly.
And remote First World locales like the Florida Keys are benefiting as much as developing countries like Haiti.
“When they have a trauma in Key West, we often advise them what to do,” says Dr. Antonio Marttos, a trauma surgeon and head of UM’s Global e-Health. “Like if you have a patient who has a stroke in the Keys – they don’t have any neurosurgery in the Keys.”
That’s a reminder that in the session that starts next month, the Florida legislature will take up several bills to expand telemedicine in the state.
The bills’ supporters might now point to Haiti – where this week the UM-Bernard Mevs tele-connection is helping treat victims who were electrocuted or trampled during Tuesday’s Carnival chaos.