Report of Dr Bernard Poulard, AMHE leader week of May 1st

Bernard Poulard Report
 
Fellows, 
 
Today was a real work day. I started the day at the home depot equivalent to secure some materials for the ORs and get the specs for the medicine ward. At the hospital, George Leconte (the administrator) and I met with Mrs. Thompson and Dr Edouard (chief of anesthesia). There is no surgery going on except for dire emergencies, only a cystostomy this afternoon while I was there. There was a lot of idle staff otherwise. They had the new residents for orientation in the different services. We stopped by the IMC quarters where they seem still better organized than most and we were given a tour of their area of responsibility which are the ED and the ICU. They have set up a well functioning service encompassing the 2 areas. They have close space on the first floor of the administration building. Triage is outside but with some protection from the heat and the elements. The ED and ICU are well staffed by rotating medical staff, nurses and docs from Boston. They would like to see more involvement by the local staff but... They provide coverage during the day, at night PIH relieves them. They are well stocked. Two issues are problematic: very few discharges from medicine so they have non icu cases blocking the flow and with the strike, they have to transfer the surgical cases to Medecins sans Frontieres. They want to start some transitions to local staff but it does not look very promising. 
We then met with Evan and Ms Thompson; unfortunately she was as always extremely in demand. Both she and Dr.Lassegue have everything on their plates and I do not see any help and very little delegation. They need some sous-chefs but money is tight... Evan is concerned that in 8-10 weeks most of the foreign assistance will be gone and the hospital will have to stand on its own two feet. He is anxious for the leadership of PIH to seal some formal ties with AMHE so we can officially present ourselves together. We discussed what we could bring to the table and what AMHE needs to continue. They would like to see the commitment for at least 2 weeks if not one month, they would like to work with the medical school and the medical education (post graduate) system. They see this vital to the success of their involvement with HUEH. They have been in talk with a number of medical establishments and I am sure that some of you are aware of them. Because of the changes on the grounds, they are endeavoring to fund the docs who work here @ $2,000 a month. I am sure the nurses will get some stipend too. As I said, they are working on it. They can help with the accommodations on the ground. They have to ramp up capacity to make it happen but they think they can do it. I mentioned our issue with the supply lines. They have limited means and have been beneficiary of generous help from organizations but they think they can expand capacity for that as well.  I mentioned our contact with the North Shore LIJ folks; he seems interested in pursuing an association with them as well as HHC. He thinks it will be a good idea to use the model the larger institutions have used for their volunteers: continue to pay their regular salaries while the staff is on the mission in Haiti. Evan will be sending an email to the AMHE and PIH leadership talking about those ideas. 
Megan Coffey is still there, I thanked her for her dedicated service. She has been there for more than 3 months now, that the longest stint I know of... 
We spent time with the Central Supply/Pharmacy. The staff was happy to show us around and talk about their work. They have lots of supplies but some seem to always be used up. The same meds we sent last time, they need now: Morphine, Omeprazole, anti seizure meds, Cipro, lasix, metformin, iv solutions etc... They may need some help to move the less requested stocks to places that need them. 
The ORs: The work is progressing but they are not ready yet. I will bring them the lamps tomorrow. They are missing one enclosure panel in one of the rooms. They need more electrical outlets, I will try to get them the multi-socket strings, but I could not find those appropriate for load. They are waiting for the sink for the OR and it will need to be painted. So someone else will be there for the ribbon cutting. 
Peds is still in the tents at the same location, and the pre-op and post op are also in the tents. I did not go into the forest. 
I am more convinced that the days ahead are going to test the commitment of our members to the cause. We may need to push the restart button to respond to the subacute phase. 
Tomorrow Leogane and finish up with HUEH. 
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This morning I picked up and delivered the items for the OR to Mr Laroche at the hospital. He is responsible for the maintenance of the facilities. He tells me that they do need an autoclave but not very high tech for ease of maintenance. 
One other thing we discussed is the insufficiency of O2 supply, George Leconte will be looking into the compressor issue. In addition we also saw very usable items needing simple repair that were left to rust outside. This made me think of a different approach to our effort. More on that later. I was given a list of the medicine that are used a lot but that tend to be in short supply: 
PO meds: Albuterol, Quinine, Furosemide, Lorazepan/Diazepam. 
IV : Any narcotic MS ideal, Paralytics succinylcholine ideal, anti-hypertensive Lobetalol ideal, anti-seizure phenobarbital, phenytoin, benzodiazepines lorazepam, diazepam, metronidazole, clindamycin, Unasyn, piperacillin 
urine pregnacy test kits, urine dips, Stylets for ET tubes (infant, peds, adult), ecg monitor leads, Ultrasound Gel, infant and peds nasal cannulas, non rebreather masks, ambu bag masks, suction catheters and all kind of IV fuids 
Ms Thompson told me that Dr Lauriston was coming to the hospital and asked me if I was going to wait for him. Is he in Haiti? 
I then went to Leogane to visit Ste Croix. The hospital has been closed since before the earthquake but they do maintain an ambulatory care and Emergency department. The physician in charge is Dr Gladys Memnon, she has been there a year and knows Lesly Kernizant well. I was given a tour of the defunct facility it used to be a real reference hospital but things happen. There is plan to rebuild it as a 200 bed hospital and it appears the funding is there. They have supplies and have some local Haitian staff working. There was a public health course being taught by the ministry of health to a group of about 50. They send their patients who need admission to the field hospital in BelVal a couple of mile northeast. I met the director Dr Coles. Extremely well set and well run mostly by volunteers from the states. They have a 8 bay ED, a fully equipped OR, a delivery OB wing, a medicine wing holds about 20, a peds area for nutrition, rehydration and a inpatient peds ward, a well stocked and well organized central supply. The area has full electricity and air conditioning. They have a pharmacist and a fully filled scheduled list of volunteers committed for two week stints till the end of July for now. They think thay will be there until Ste Croix is rebuilt. They did not have an anesthesiologist, two are coming on Saturday. Ironic those at HUEH were sitting idle because there were no surgeons... 
Back in P-au-P, I met with Dr Jean-Baptiste (adm dir CDTI- hopital du Sacre Coeur) and Dr Michel Theard. The conversation was about the private sector in Haiti. I also spoke with Dr Deverson (Groupe Sante Plus- HMO), they also are in conversation with PIH. It appears that the AMH has some work to do. But AMHE need be aware of the private health sector and listen and talk... 
I am flying to Fort Lauderdale tomorrow and will be back in NY on Sunday. By then I will have nothing else to say. 
See you all soon, 
jbp