MILOT, Haiti — When Dr. Rick Pitera, an anesthesiologist based in Livingston, N.J., left for Haiti days after a 7.0-magnitude earthquake leveled much of that nation’s capital, Port-au-Prince, friends and colleagues feared for his safety and tried to stop him.

It would be Pitera’s third trip to the Western Hemisphere’s poorest nation, and even the threat of earthquake aftershocks and social instability didn’t deter this father of three. Like many physicians and nurses who had previously volunteered their services at Hôpital Sacré Coeur in Milot, he felt an irresistible force pulling him back to a place where he could make a difference for patients at risk of dying from untreated injuries.

Within an hour of his arrival at Hôpital Sacré Coeur, Pitera was plunged into a desperate struggle that would transform one of Haiti’s best hospitals into an overflowing trauma ward.

As news spread about the arrival of additional U.S. physicians, patients arrived by road and helicopter, pushing the 74-bed facility to accommodate three times that number.

Under the best of circumstances, health care in Haiti is substandard, with many hospitals frequently closed and lacking adequate medical personnel and equipment to meet the needs of patients suffering from chronic health problems that U.S. physicians rarely see: malnutrition, dysentery, malaria, tetanus and tuberculosis.

Sacré Coeur is the exception.

Founded in 1986 by the Montreal Province of the Brothers of the Sacred Heart and supported by the Massachusetts-based Crudem Foundation and the Order of Malta, the hospital is open every day of the year and never turns away patients who cannot pay.

Dubbed Haiti’s version of the Mayo Clinic, it attracts teams of U.S. medical personnel that train and collaborate with Haitian physicians and nurses. But even a top hospital in Haiti must operate without a stable power supply and standard medical equipment — like MRIs and CT scanners — present in most Western hospitals.

Pitera was already acquainted with such challenges, but he soon confronted something much more daunting: a succession of agony-stricken patients with crushed limbs and other untreated traumatic injuries.

“Just before I arrived, four patients had been brought to us. Some were on the verge of death; there was a man whose crushed arm had been in a tourniquet for four days; another had been trapped in a building and had to be hacked out by Haitian doctors,” Pitera recalled.

His most agonizing moment came as he prepared to amputate the foot of a 7-year-old-girl who had lost both parents in the disaster. The girl was the same age as Pitera’s own daughter, and he wept as he recalled the procedure.

Transformation

Pitera had arrived with a small team of colleagues from St. Barnabas Medical Center in New Jersey, including general surgeon Dr. Stephen Fletcher, the Knight of Malta who had introduced Pitera to Haiti and inspired him to become a candidate for membership in the Order of Malta.

Soon, additional teams of orthopedic specialists arrived, but they came without an anesthesiologist. As the U.S. Navy and Coast Guard gradually accelerated patient airlifts from the capital, the number of operating rooms doubled to four. Pitera rushed from one surgery to the next, logging 20-hour days as the teams worked through much of the night, halting only when they ran out of sterilized instruments.

“Every physician and nurse broke down at some point during that week,” acknowledged Fletcher, now back at his New Jersey practice.

But the point of pride for Fletcher and his Haitian and American colleagues was the incredible feat they accomplished in the midst of desperate circumstances.

“In two and a half days, a hospital of 74 beds and two operating rooms was turned into a hospital with 300 beds and four to six operating rooms,” reported Fletcher. “Overnight, 50 people who had never met before worked together as a coordinated unit.”

As more medical teams arrived with anesthesiologists, Fletcher and Pitera took the opportunity to review logistics with Harold Previl, Sacré Coeur’s medical director. They orchestrated a rapid expansion of hospital beds and services.

The delivery room became a third operating room, and three examining rooms were turned into procedure rooms where limited surgeries could be performed. The once crowded patient waiting room was converted into a preoperative area.

When local schools remained closed, the physicians seized the opportunity to transform two schools into an emergency triage area, where arriving patients with life-threatening injuries and infections were singled out for immediate attention.

Before Fletcher and Pitera’s departure to the U.S., the two visited the town of Labadie — the Haitian port for the Royal Caribbean cruise line. Royal Caribbean quickly promised to reserve a portion of the holds of their ships for medical equipment and supplies. The hospital is just an hour by road from the port.

90 Visiting Medics
More recently, Sacré Coeur and the Crudem Foundation have worked to establish more stable accommodations for patients arriving with complications due to delays in treatment.

“The people arriving at our hospital are sicker than they were and require more intensive treatment,” reported Dr. Peter Kelly, president of the Crudem Foundation in a recent update for supporters and volunteers.

As of Feb. 3, the hospital had 340 patients. Kelly confirmed that 90 visiting medical personnel were on site and that Sacré Coeur would require about 50 volunteers a week for the next few months as it begins to address the new task of patient rehabilitation for amputees. A prosthetic clinic and physical therapy services will be developed by Dr. John Lovejoy, a Florida-based orthopedic surgeon who arrived with his son soon after the New Jersey team.

With Haitian students poised to return to their classrooms, Kelly welcomed the donation of a portable 300-bed hospital. The donation was arranged through Caritas Christi Hospital System in the Archdiocese of Boston and the New York-based American Association of Malta; the hospital will be constructed on land loaned by the mayor of Milot.

“We have become a referral hospital for all of Haiti and, as such, will need to provide more specialized care,” stated Kelly.

The push for additional equipment and funds to strengthen Sacré Coeur’s services will receive a boost from Fletcher and Pitera, who hope to raise funds for new anesthesia-monitoring equipment made by General Electric.

“Without adequate equipment, we end up delaying surgeries for children. Can you think of a worse situation than making a young girl in pain wait even longer for help?” said Pitera.

Though busy with his practice and family, his thoughts often return to Haiti, where the profound needs of patients have deepened his sense of personal and professional fulfillment, recalling to mind the reason why he chose medicine in the first place: to serve others and save lives.

“I’m not special. The work at Sacré Coeur just requires someone who is willing to put themselves in that situation,” he said. “The patients are still coming.”

Joan Frawley Desmond is a member of the Order of Malta and returned from a medical mission to Hôpital Sacré Coeur three days before the Jan. 12 earthquake.
More information is at crudem.org.