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Medical Relief Trip to Haiti University General Hospital- Eye Center
On Sunday Feb 14 I left JFK airport to Santo Domingo
with a 12 person healthcare team with
the Association of Haitian Physicians Abroad (www.amhe.org).
Daniel Laroche MD, Ophthalmology , Team Leader
Francois Dufresne MD, Internal Medicine Team Leader
Mario Nelson MD, Physical Medicine and Rehab
Daniel Hirsch MD, Pediatrics
Wesner Thenor Louis MD, Ob-Gyn
Duplan Auguste MD, Psychiatrist
Edgar Mandeville MD, Ob-Gyn
Martine Dufresne RN,
Betsy Pierre Louis RN,
Valincia Thomas RN,
Marie St Urbain RN
Marc Saget LPN
Margaline Lazarre RN

The following is a summary of my observations during the trip. I have asked all of the above team members to share their observations to pass on to the group. The plane will only take up to two bags weighing 50 lbs. I brought as many eye supplies instruments that I could carefully place in my bag that I would use for the trip, in addition to following the recommendations that were made for personal items to bring. The trip through Santo Domingo was straight forward but long (about 10 hours due to 1 flat tire that had to be repaired). As of the time I am writing this there a currently direct flights landing into Port au Prince. Once we were nearing the Haitian border we saw checkpoints on the other side of the road that were set up to stop any Haitians from crossing the border into the Dominican Republic. Once we got close to the border it became very congested with traffic secondary to many Dominican business selling goods to Haitians coming to the border to purchase food, water and supplies. Traffic at the border was about 1 hour. Once we got to immigration, they were so overwhelmed they just saw stopped our bus and once they saw were medical professional coming to assist they waved us in without processing us or stamping our passports. As were drove into Haiti you see a stark difference. At the border the roads were not paved with exposed marl on the road leaving clouds of white dust as vehicles go by. The nearby trees on the road were all white from the white dust. As we got away from the border the road became more paved, villages were seen with small business activity taking place with many supply buses loading materials to be brought towards the inner areas of the country. As we came closer to Port au Prince we started to notice many cracks in large buildings and some small buildings collapsed. When we got to Port-au Prince many buildings were collapsed, damaged on nearly every block. When we got to downtown Port au Prince nearly the whole down town area was destroyed. The people were remarkably resilient, some breaking down large rocks with hammers, removing large rocks by hand to remove the rubble to rebuild. There were some people struggling to survive looking through the rubble for anything that would help them survive. Many street vendors were setting up their shops and doing business in front the rubble. Many tent cities were seen in all of the public parks. There was only 1 crew of heavy machinery removing rubble from the streets that was from the US military. Clearly there will need to be additional international assistance to remove rubble and debris and begin reconstruction in such a way that it is safer and less congested. There continues to be a struggle for day to day survival on the streets of Port au Prince with the people still rummaging through to rubble for various items. We finally arrived at the General University Hospital . There we went to meet Dr. Lassegue the Director the Hospital whom warmly greeted us as the 5th medical team from AMHE that arrived and based on our specialties sent us to work with various specialists at the Hospital. I was introduced by the Medical Director, Dr. Pierre Pierre to Dr. Jean Claude Cadet the chair of Ophthalmology at the University. Dr. Cadet then gave me a tour of the eye department and pointed out the structural damage the hospital and clinic suffered a broken slit lamp that fell. I had been scheduled to have a meeting with the Haitian Society of Ophthalmology the following day to assess damage, short term and long term needs, see glaucoma patients the following day and give lectures on glaucoma, operate and teach residents the following two days. We stayed at the Quesquya Earthquake relief center run by Christian Relief International. We were warmly greeted, well treated, provided with safe housing in a classroom, shower and bathroom facilities, 2 meals a day, and free medical supplies that we could bring to the University Hospital.
Meeting with The Haitian Society of Ophthalmology 2-11-2010
Present Frantz Large MD, President Haitian Society of Ophthalmology(HSO), Bridgette Hudicourt MD Vice President, Pascal Pellisier Auguste, Carol Day MD, Jean Claude Cadet MD, Chuck Slomin MD (oculoplastic guest), Ritza Eugene MD, Francois Romain MD president of prevention of blindness committee, Florence Burr Raynaud MD.
Dr. Frantz Presented the Agenda.
Dr. Hudicourt made a presentation on what supplies were received by the HSO and from whom. They are still awaiting the mobile units from the American Academy of Ophthalmology and still assessing the damage from the earthquake. Mike Maingrette MD is to submit is separate report.
As of February, 14 SHO supplies received reported by Dr. Hudicourt were as follows:
Supplies from Dr Brennam and supply found in a piece of Luggage from DR LEE given by DR Slonim
Materiel trouvé dans une malle remise par Dr Slonim de la part du Dr Lee
2 PSL by Reichert slit lamp portables dans des boites
5 Zeiss loupes chirurgicales dans leurs boites
2 nidek portable indirect ophthalmoscopes
1 nidek portable indirect ophthalmoscope case
1 set of three lenses for the indirect ophthalmoscope
14 pairs of sun glasses
2 sciseaux vannas jetables (disposable)sterile
1 forcep Bonn jetable sterile
Une boite de fils 4-0 vicryl
Une boite de fisl 5-0 vicryl double aiguilles(needle)
5 fils de chromic 6-0 double aiguilles
17 disposables drapes with pouch ( champ chirurgical jetable)
4 flacons de vigamox
6 bouteilles d’ofloxacine Falcon
3 bouteilles de zymars
1 bouteille Iquix (levofloxacin)
3 Besivance (besifloxacin)
Plusieurs bouteilles d’anesthsie locales injectables expire en nov 2009
Dans deux sachets de plastic donner avec la malette;
In two plastic bags received with piece of luggage :
12 alcaines preopened
8 preopened dilating drops
6 Azasite ( azythromycin ophthalmic)
4 gentak ( gentamicine) ointment
2 polymicyn +neomycin and dexa ointment
4 open fluo drop open
Several small open tetracaine drops
4 7-0 chromic suture
8 4-0 silk double armed
3 5-0 prplene suture
20 drape holding
5 suture scissors
6 small tissue forceps
1 pack of 200 non sterile sponges
Febuary 16 th from Dr Laroche
Donation by Khoshla
2 iris spatula
1 chopper
1 y shape nucleus manipulator
6 mcpherson son forceps
6 rotators
10 canula
4 simco canula
10 jewelers forceps
5 needle holders
1 pairs of curve scissors
2 blepharostates
5 utrata
10 baraquer blepharostats
3 boxes of scalpel blades
Hundreds of eyedrops for washing out eyes, tears, some antibiotics, glaucoma medications, anesthestics donated by Dr. Laroche via donation of samples and a small supply from Alcon.
They are awaiting larger contributions of medication from pharmaceutical companies and have yet to receive any.
The group then reported the damage to eye care facilities in Port au Prince from the earthquake and they are as follows:
1) St. Vincent’s Eyecare Clinic, located at Rue des Casernes, Building was damaged but is still present. The patient area and exam area destroyed. The OR room was OK. All of the equipment including complete exam lane, supplies and OR equipment were stolen.
2) University Hospital in Port au Prince, 2 slit lamp damages, zeiss video camera damaged and non functional, eye clinic has extensive structural damage in the corners in nearly all exam rooms will need to be rebuild. There is a large that cannot be used for patient care and currently stores beds, due to structural damage. The eye ER area cannot be used due to a large tent for orthopedic rehab that was been placed in front of it. There is a functional conference room present that can seat approximately 50 people. Computers and Av equipment are several years old limiting internet communication and presentations with update video technology.
3) Dispensaire La Providence Catholic NGO, eye clinic completely destroyed, lost 2 slit lamps, exam lanes, tonometers, autorefractor, indirect ophthalmoscope, eyechart projector, direct ophthalmolscopes, trial lenses.
4) Grace Children Eye clinic located at Delmas 31, lost 2 slit lamps
5) Adventist Hospital, the eye clinic has been turned into a storage room for medicines for orthopedic injuries due to the high number of trauma injuries. Dr. Kerolle is in charge with Dr. Figaro.
6) Gressier Mission, optometrist, 4 lanes , an edging lab, with lenses and showroom not being used since the building is cracked not safe for evaluation, waiting for structural reinforcement of the walls before evaluation .
7) St. Croix Hospital, Leogane-1 exam lane not being used, room being used for quake rehab victims.
8) Siloe Eye Clinic in Petit Goave- Building destroyed, all eye equipment stolen including 2 exam lanes, 2 slit lamps, 1 autorefractor, lost of operating room and operating microscopes.
9) No information has been received yet from Jacmel
10) Frantz Large MD- Private practice, complete loss of eye private office including 1 exam lane, slip, tonometer, visual field.
11) Other private physicians have not been heard from and ongoing damage are being assessed.
Intermediate needs were also discussed due to the death of 1 ophthalmologist, the departure of at least 2-4 others from the island, and two ophthalmology residents left the country with no plans to return. The destruction of eye clinics and damage there will increase the needs to the other existing facilities. Currently the General Hospital eye clinic sees about 80 patients a day.
The HSO recommends seeking donations to replace the above damaged equipment.
The existing eye clinics currently have very old equipment. To assist with the shortage of manpower and increased eye needs of the nation the following recommendations were made:
1) Ophthalmologists will agree to spend a percentage of time seeing non private service patients. They need donations of equipment to replace the above lost and damaged equipment. Before the earthquake ophthalmologists spend about 10-25% of their time seeing non paying patients.
2) Public patients would be seen in mobile clinics visiting tent cities and/or spending some time seeing patients at a public hospital.
3) They will seek donations for the equipment below: B-scan, Fundus Camera, VF, SLT, Argon Laser. This will be placed in a location that all can share for private and public patients. By having limited expensive equipment at the university general hospital that would allow residents in training to learn the equipment, allow public patients to receive treatment, and all private attending to bring private patients to be serviced with the equipment. Mildred Olivier had previously donated a diode laser several years ago however no one was up to date as to the location and status of the Laser and maintenance record. A concern of security of new equipment was mentioned at the general hospital due to politics. A consideration was given to place some new equipment at another location (ie such as Dr. Frederique’s old practice to be used by all physicians for both private and public patients). (In my personal opinion, I think that the General Hospital Eye Center has many room s to secure equipment and that it is vital to have resident access to learn and train with the equipment, and allow private attending the opportunity to bring their patients to use the equipment as well.)
4) Most ophthalmologists perform extracapsular cataract extraction and are learning small incision ECCE and NOT phaco due to the expense of supplies to maintain the machines. Additional ongoing supplies of ECCE instruments and modern instruments would be helpful and educational materials, surgical training videos, and supplies to support the need for care of the public patients.
5) Donations of updated cataract and glaucoma surgical instruments would be helpful for all of the active surgical centers in Port au prince to treat both private and public patients.
6) Preferred practice patterns of same chart documentation to keep records and record a complete eye exam would be helpful to update all of the ophthalmologists whom have not been able to keep up to date with CME and outside travel to AAO or PAAO to the poor economy in Haiti for the past several years worsened by the earthquake.
7) Documentation of care to private and public patients will be performed.
8) They also request that a ophthalmic equipment repair specialist come to repair broken slit lamps and equipment. Some may not need to be thrown away.
9) The University General Hospital needs assistance with rebuilding the eye clinic damaged from the earthquake, equipment replacement/repair, file cabinets to assist with filing medical records that are currently in piles.
Currently there are 5 locations in the Port au Prince area where anterior eye surgery can take place. They are as follows:
University Hospital HUEH) : government run university hospital
Grace Children’s Hospital: NGO
Hopital de la Communauté Haitienne ( Haitian Community Hospital) : NGO
Dr. Taverne clinic, Private ASC
ORLO CLINIQUE 2 Or, private group of 5 ophthalmologists:
1- for non general anesthesia plastics/ pterygion’ OR in the hospital)
2- One set in Hopital du Canape Vert for cataracts/ Glaucoma
A continuous donation of ongoing supplies will be needed by industry to the support the eyecare of public patients whom cannot afford to pay for surgery. These patients will be identified by:
1) Patients seen at the General Hospital and other public hospitals whom cannot afford care.
2) Patients seen by private practitioners office whom cannot pay
3) Tent city screenings and referrals for eye exam
Dr. Florence Burr Reynaud will seek shipping abilities via Dr. Jean Robert Brutus 35588385.
The Haitian Society of Ophthalmology is seeking funds for website development, transport of supplies and shipping, customs cost in transfer of equipment.
The Haitian Society of Ophthalmology will be setting up a website to display pictures of destroyed offices, and equipment and demonstrate their role in patient care. Jacques Arpin came recommended to set up the website, he setup the website for AMHE (www.amhe.org)
The HSO would like physicians from the AAO and PAAO to rotate to Haiti for 1 week rotations to perform surgeries and give lectures and participate in teaching. There are two operating microscopes that are functional at the University Hospital General in Port au Prince. Transportation from Port au Prince Airport and housing will be provided by:
Jean Claude Cadet MD 509-342-11106
Carol Cadet MD 509-3411129
Florence Burr Reynaud MD, 509-37431912
The HSO is considering having fundraisers at the AAO, ASCRS, Vision Expo. They would have a fundraiser with a presentation updating the current needs in Haiti and thanking contributors. Gary Nader an artist from Miami has worked with the HSO in the past using art auctions to assist with fundraising. The name of Cheryl Coley was given to consider assisting. Cheryl Coley is an event planner in NY.
For CME the ophthalmologists will seek to register the ophthalmologists and residents for the ONE network with the AAO however some have been having problems doing this with password issues. There is a shortage of current text books and educational materials at the medical school and university Hospital. Educational items for those two facilities should be mailed to:
Service d’Ophtalmologie (Eye Department), Hopital de l’Universite d’Etat d’Haiti, Rue Monseigneur Guilloux, Port-au-Prince, Haiti, West Indies.
Societe Haitienne d’Ophtalmologie ,C/O Dr Claude Surena , Association Medicale Haitienne(Haitian Medical Association), 1 ere avenue du Travail, Port au Prince, Haiti
Experience of Dr. Laroche working at the University General Hospital:
On Wed Feb 17, I worked in the general eye clinic with 1 first year resident, 2nd year resident, 2 attendings. They saw approximately 80 patients. The equipment was quite outdated but functional. Some equipment was not available such as, occluders to check visual acuity, space for patient privacy, eye projectors were not functional, 1 slit lamp was functional, 2 were broken after falling from the earthquake, anterior segment exams were done with ophthalmoscopes in many cases, 1 tonometer was functional, no 4 mirror lenses were present except for the one I brought and taught the attending and residents how to use. No goniosol was available to evaluate glaucoma patients with a 3 mirror lens. I retrived some from my bag of supplies that I had brought with me. There was one 90 Diopter and 2.2 lens that was shared by the all of the staff. There were 3 direct ophthalmolscopes. There is one autorefractor present and functional. Visual fields were performed with a matrix visual field machine that was present and functional. 6 patients were identified and referred with severe glaucoma that were not adequately controlled with medical therapy with high IOP’s and without access to laser treatment, that were recommended to have glaucoma filtering surgery the following day. (I brought my surgical instruments, sutures, cannulas, blades, for glaucoma surgery and brought 10 Ahmed valves that were donated from New World Medical). Dr. Terry McGhee MD, the Director of Ophthalmology on the US Comfort came to the eye clinic and we greeted each other. We did not have much time to talk due the busy number of patients that were present. He did inform me that the US comfort would be leaving the following week and assured me that he would continue to work to help restore and strengthen eyecare Haiti. After the day clinic was complete a 2 hour lecture with surgical video was given in a conference room on “Fine Tuning the Diagnosis and Management of Glaucoma” . There were 15 ophthalmologists and residents present from the Port au Prince Area. The lecture was well received with several questions and answers about the difficult management of glaucoma in Haiti. Later that day I meet with Dr. Eric Jerome MD and Dr. Lassegue about how to best assist with the future needs of the hospital. It was clear that the needs continue to be great due to the shortage of physicians and nurses and needs of the patients and resident teaching. Dr. Lassegue welcomed additional medical teams coming down to working at the University General Hospital and recommended working through the AMHE whom he has had a long standing relationship with to simplify logistics of dealing with multiple organizations and leaders.
I also met with Dr. Edgar Mandeville and Wes Thenor, both Ob-GYN whom performed surgery in the main operating room and reported that there were challenges with flies in the OR (lack of closed room), no AC, malfunction of lighting, shortage of surgical supplies making surgery very difficult.
On Thursday February 18, there were some nurses and staff that did not show up or came late to work because it had rained very hard the night before. Many were homeless and or their tents and supplies became drenched. I went to the OR and began preparing for surgery with Dr. Eugene, Dr. Pascal and the residents. There were two microscopes. We used a Zeiss Microscope with teaching scope. Only one aspect of the microscope up-down focusing had to be done manually since the foot pedal focus did not work. The OR table was outdated with no ability to manipulate head or body position but we managed. We performed six surgeries that day, all trabeculectomies with 5-FU on patients referred by Dr. Ritza Eugenne, Dr. Pascal, and from the HUEH General Hospital. I performed the first one and Dr. Ritza Eugene performed the next 4 as I was teaching her to do the procedures. I performed the 6th Trabeculectomy and Dr. Pascal assisted observing the technique. The instruments were limited and supplemented by mine including the Kelly punch I had brought with me. Dr. Eugene was a quick learner with good hands and learned the technique well. Various attending physicians and residents were in and out throughout the day observing the surgery and asking questions. The OR staff can use additional up to date training with sterilization techniques. There is a shortage of sutures and canulas. There is no posterior segment surgery machine, no eraser electro cautery, or anterior vitrectomy machine.
Later that evening I met with approximately 20 members of the Haitian Society of Ophthalmology in Petionville. This town north of Port au Prince that did not sustain much damage and we ate at a nice restaurant called Papaye. This was the first time since the earthquake the ophthalmologists had come together. Some were so traumatized from personal and family loss that they still could not come. Many of the group shared their stories of loss and struggle to survive the deal with the challenges, trauma, and emotions. They were grateful for my providing an opportunity to get together for dinner to meet. They looked forward to receiving assistance to help rebuild eye care in Haiti. They have lost many patients whom died and family members whom died. They have provided care to many patients whom lost everything materially. Previously the average private patient paid $40 US for an ophthalmology consult. This was only obtained by about 50% of the patients. Another 25% paid less and another 25% were seen free. After the earthquake patients stopped coming to the eye MDS due to other survival needs. The number of patients that can pay for eyecare has diminished even more to 10-20%. At the University General Hospital the average fee for an eye exam is 50 cents US. Some ophthalmologists have left Haiti feeling that they can no longer even make a living under these circumstances. The financial resources are extremely limited. They hope the international community will assist them to deliver eyecare to all in Haiti. They all paid a tribute to Dr. Laguerre an ophthalmologist who died in the earthquake.
On Friday, February 19, I saw are post-op patients with Dr. Eugene and the residents and discussed post op care. I then operated on another patient with advanced glaucoma uncontrolled on meds with the residents. I then gave a talk on Ahmed valves in glaucoma management, Gonioscopy in Glaucoma and Glaucoma and Cataract Surgical Videos for the residents and attending. In the afternoon, I asked Dr. Cadet if it would be ok to give a financial contribution directly to the support staff of the eye clinic, understanding that they do not make much money and many are living on the street and have been through a lot. He stated it would be OK. I gave Dr. Cadet $1500 cash to distribute equally $50 to each of 30 nurses, techs and staff. They were extremely grateful, all coming into the conference room as a group to express their gratitude, singing a popular religious thank you song in the native language Creole, and all signed their names on a piece of paper with the HUEH hospital eye clinic stamp to give to me as a momento of the gift. I observed that what makes the Haitian people unique is not what they materially do not have but that they have preserved their culture, language, art, and identity despite the challenges over 200 years and demonstrate an unparalleled will, resilience and ability to survive extraordinary challenges.
Saturday we left Port au Prince for Santo Domingo to return home to NY. The bus ride was 7 hours from PAP to Santo Domingo. I believe that direct flights are now available from NY to PAP, Haiti.
Overall, there continues to be an overwhelming amount of medical are pathology present that is both earthquake related and non earthquake related that requires medical attention due to the shortage of physicians and nurses. In addition to the shortage of physician and nurses, many have been emotionally devastated from personal tragedies, making it difficult to deliver care at times. The patients, physicians and nurses are EXTREMELY grateful for the concern shown by the international community and the assistance provided by those visiting physicians and nurses. The residents are grateful for all the teaching. Implementation o f the above recommendations would go a long way to restore and improve eyecare in Haiti. I also recommend that specialty specific recommendations and interventions take place to restore and improve all medical care in Haiti. I also personally believe that the University Hospital in Port au Prince should be the flag ship location to rebuild, reequip, and support and teach from while also supporting other hospitals and private physicians whom also meet the needs of those unable to pay for care.
Some political solutions will also be required. In the streets of Port au Prince, if someone steals, this is crime that can punishable by death via vigilante. I never felt unsafe while I was in Haiti. There has to be political accountability at the level of government to not steal from the people. This should be punishable with severe consequences. There is also a centralization of wealth among a small group of families in Haiti not originally from Haiti that appears to have a strong hold on the economy not supporting competitive free trade. The business practices of these families should be transparent to ensure that they are fair and supportive of reconstructive efforts and not subverting reconstructive efforts.
Daniel Laroche MD
President, Empire State Medical Association
Director, Glaucoma Section, National Medical Association Ophthalmology Section
Member, American Academy of Ophthalmology
Member, American Glaucoma Society