Report of Dr Alix Dufresne: AMHE team leader on April 18th 2010

Dr Frances Schmidt and myself , we landed in Port-au-Prince on a sunny and hot Friday afternoon. And Dr Wesner Moise and nurse Andree Petitmat coming from Florida were waiting for us. The following day we were driven to Jacmel in thedistrict Les Orangers where the priest in charge of the area was waiting for us with about 100 patients. In two days, we saw 225 patients, many children with skin disease and eye infections.
Were also received invaluable help from DR Schmidt brother in law who served as a
registrar and from a local nurse-aid who took the patients vital signs. As expected, there were many cases of Diabetes and Hypertension,but also cases of scabies, malaria and acid-reflux. In fact on the second, day, we had to buy medications from al local pharmacy, mosttly vaginal cream and antacids. At some point a child had to receive IV hydration and some patients require psychological support graciously provided by Dr Moise.  Our nurse was checking the blood sugar level and distributing medications. We also went to work at the Hospital St Michel completely devastated,  We had the opprtunity to visit Leogane and Petit Goave, both towns were significantly affected.
On the monday, we stared a the University Hospital and after a warm welcome by
Dr Alix Lassegue, we went to the Internal Medicine department and we were struck by the level of desorganisation and the lack of supervison of the interns. Initially, the nursing staff was not very supportive, but thanks to the "savoir-faire" of our nurse, we were quickly made part of the team and overall, we had a productive week. We also spent a fairly good amount of time in the emergency department. This service is staffed 24 hours a day by 2 groups: International Medical Corps and PIH. There were attendings, nurses and supplies  so that the level of care was acceptable. We were also frequently called in consultation for difficult cases and we were impressed by the overall level of professionalism. Of course, our nurse who is ICU -trained took over the place  and performed a remarkable work.
At the present time, the emergency cases related to the earthquake are over and we had to deal with common pathologies including many cases of dilated cardiopathies and cerebrovascular accidents. We each had special  and difficult moments that marked our stay, but it is difficult to forget these kids who were blind just because of eye infections in Jacmel, the family of a lady in cardiogenic shock who had to rush outside to buy Dopamine, or this young patien with a head trauma and whose family had to pay to an outside lab $200 for a CT scan.
For future missions we would like to make the following recommendations
1- Be sure to include well qualified nurses, possibly ICU or CCU-trained
2- Expect to work at least 1 full week and if possible, include a trip in a rural area
3- At the University hospital, critical needs are the teaching of the interns and residents, that include daily roundings; the hospital has to have some emergency medications in stock and a supply of strips and lancets for glucometers.
4- there are now 2 functional EKG  and an echocardiography machine- we will need to train a personel to perform these different tests
5- The time has come to institute the concept of telemedecine so that from our different offices in the USA or Canada, we will be able to provide invalauble services.