What a heart in hell is Haiti?

What joy and pain?

Unending rain

Love grown

From boiling soil

And endless toil

Small seed,

Hope entrained,

Rising refrain

Strong soul,

What beauty here,

Pure love from fear

From total black,

Deep night,

A blinding light.

Alexandra Lucas, 2016

How do you speak about something that touches the soul so deeply, that enters one’s heart so completely? What are the words that can express the pain and the joy of working in a medical clinic in Haiti? A land branded by slavery, revolution, oppression, tyranny, earthquakes and blood and yet a land of some of the most beautiful people in the world. Some of the strongest and best and brightest souls in the world live and work here, humbly giving all they have, every day, to help their people grow. Who among us could live this life and still work to give back? From extraordinary pain grows such extraordinary beauty.

For this editorial I will draw from my own experience, but this editorial is meant to discuss and introduce the absolute joys and yet also terror and fears of working in a medical mission in a troubled country. I have often wondered what true difference this small clinic in a small city can possibly make, but I would suggest that this work does change lives. One can never know which life that is saved or eased or improved may allow one of our patients to go out and work and help other lives in Haiti. One can never know who in the medical team will find their life changed through working in this small Haitian clinic.

I first went to Haiti on a medical mission as a very green and illprepared physician, fearful and inexperienced, but this trip, and the many after, changed my soul. With this editorial note I would like to share the absolute beauty of serving on a medical mission in Haiti through times of oppression, poverty, revolution, disease, danger and regrowth. Our small clinic site is in a small city, named Fort Liberte (Fte Liberte). Fte Liberte was the home, the beginning of a notorious and bloody slave revolt against the French plantation owners, hence the name Fte Liberte. This mission trip was originally established by a nurse from West Virginia, Laura Hayes, who was later joined by her husband, Dr. Rick Hayes, and also her children; they continue to go every year.

Jeri Platt, an artist from Columbus Ohio joined their group and then, with Rev. Lee Platt, formed a second mission group from Columbus Ohio (Figure 1). The Fte Liberte mission takes place in a church compound, a Baptist church established by a valiant group of Haitian ministers. Pastor Andre and his wife Mme. Justine established this church, building a strong community around the Jerusalem Baptist Church. Over the years they established a school, an orphanage and a medical clinic. This medical clinic brings in nurses, physicians and many volunteers from both the US and Canada. For many years our teams have also worked to provide and sustain ongoing education of the local physicians, such as Dr. Jovanelle, and one nurse, Miss Louisa, providing mentorship and also learning from the Haitian health workers about local conditions and disorders.

Figure 1: A group of Haitian women chatting outside the clinic – Portrait by Jeri Platt.

When I first travelled to Haiti to join this dedicated team, we travelled to a country with immense corruption in a pre-revolutionary state. Poverty and hunger and disease were everywhere. We saw patients in clinic and provided care and medications for free. The clinic was a set of dusty rooms in an old school with plywood boards set up on saw horses and rickety chairs. We had medications and supplies arranged in a back room on other plywood tables. If one wished to examine a patient’s abdomen, we moved the supplies and books and had the patient climb up on the tables. We saw patients who should have been in hospital, but the hospital was dirty and ill supplied, giving patients one meal every few days. Medications had to be purchased by family members, when possible, from small pharmacy shacks along nearby streets. Meals for patients were also brought by family members. After a day of work we would return to the church compound to sort meds and count supplies and hope to sleep in unbearable heat.

Our first clinic had no electricity, no labs, no lights, and no fans. Patients crowded the courtyard, often desperate for help. I remember one late afternoon when many still crowded in, with hopes to be seen, and a small sick baby was handed in to us through an open window so that we could help this young child. We saw septic children with scalded skin syndrome, severe diarrhea, pneumonia, congenital disorders, rheumatic heart disease, and adults with TB and malaria and a host of infectious and parasitic disorders, elephantiasis (Lymphatic Filariasis ), and the ever-present intestinal worms, anemia, hypertension and diabetes. And while overwhelmed, we did help a few, and then once well, these few had a chance to go out and help others.

One later year the medical trip took place during the period when the corrupt government of Jean Bertrand Aristede was overthrown. This revolution occurred while we were in Fte Liberte. At that time, people were destitute and hungry and often ill. We learned of the military coup when we walked up to a small store to purchase a twominute telephone card – no internet and no cell phone service were available there. We managed to leave one hour before the borders were closed. Subsequent trips saw the aftermath of UN troop deployment, earthquakes and cholera. The Jerusalem Baptist Church led their parishioners in song and prayer for years providing hope where many could and did and do despair.

Figure 2: Echocardiogram taken in clinic to diagnose symptoms of chest pain and shortness of breath. The echo and patient had to rest on the floor so the electrical cord from the outlet could reach (Portable echo donated by Heart Care Imaging, University of Florida Health / Shands Cardiology clinic).

But what stands out in all of this time, over the past 20 years of these missions, is the extraordinary courage of the people of Haiti. My first years there when the people were truly starving we heard the church members singing, practicing their hymns at 3 a.m. for church services. They came to clinic dressed in their best clothes with hand-sewn repairs and cleaned by hand in local rivers. The cooks prepared coffee on a charcoal stove for us in the back, making beans and rice and whatever local delicacies they could manage. We had homemade pizza and spam spaghetti and my favorite - a large turkey-like bird, fondly called “broiled condor.”

With time a separate group of volunteers built plywood examination tables and set up lights and fans that still run by generators when we are there working in the clinic. Regular nurses were also hired, as well as a local Haitian physician to maintain the clinic when no mission group is there. Dr. Jen Lucas arranged for a microscope donation, which we used to diagnosis a gram positive infection, although the microscope disappeared in the revolution. We have had portable echo machines donated through several sources over the past years and most recently our local University of Florida imaging group for the Cardiology Clinic loaned us an echo which we were able to use to assess cardiac function (Figure 2), valve disease, arrhythmias and even ascites and pregnancies. My older brother, Tom Lucas, an accomplished physician with the US State Department, joined our mission group one year with his wife, Georgia. Tom incidentally detected a pregnancy in one patient and our donated echo was used to diagnose twins. (Tommie Akin and Tammie Baylor with Heart Care Imaging, University of Florida Health / Shands Cardiology clinic arranged for the portable echo on loan for this past year’s clinic.)

Jeri Platt, who as I mentioned was the first to join the group from Columbus Ohio, has been documenting the trips both through photography and her paintings for many years (Figure 1). Jeri also began keeping records of all the patients seen and treated in the clinic in Fte Liberte. Jeri has served as pharmacy assistant, triage team, and even medical photographer. Her photographs have inspired paintings that capture some of the beauty of the Haitian people (Figure 1).

Members of this mission group grew and changed with each trip. I remember a series of emergency department (ED) physicians from Ohio State, initially brought in by Dr. Howie Werman, who gave extraordinary care, treating cerebral malaria and postpartum cardiomyopathy, secondary syphilis and many more severe disorders with a calm and efficient approach. Howie brought in Dr. Diane Gorgas and other ED physicians and fellows in training. Diane has now applied for and received a Fogarty grant and has secured a private industry charitable gift from Greif Industries in Delaware, Ohio, through the Office of Global Health at Ohio State University. With this funding, Diane has begun to teach and train local Haitians, nurses and assistants to independently learn to establish care for their people. I recall nurses treating young children with serious infections and burns. One nurse, Lynn Morrison, is a NICU trained nurse and returns every year to care for the infants. Another nurse practitioner was there one year, when I was the only physician along for that trip, and she detected a breast mass. We thought this was erosive cancer but treated the patient for possible infection, given the conditions in Haiti. This patient returned a year later, with her erosive mass healed. She had walked to the clinic just to thank us. Many diseases in our clinic in Fte Liberte present at stages almost never seen in developed countries. Howie often recalls a patient who was hyperthyroid with a heart rate of 130, exophthalmos and a large untreated goiter. Others came with abscesses and open weeping leg ulcers, which we were able to treat with intravenous (iv) and intramuscular (im) antibiotics. We did not have enough of either iv or im formulations to use just one antibiotic at that time. This patient with the open leg ulcers had only complained that he had leg pain. We saw enormous numbers of patients with diabetes and hypertension.

But the people who stand out most were those who came just to volunteer and help wherever they were able. One young man, Roy, who came with a nurse, Maria Hardcastle from London, Ontario, brought a water purification system to a place desperately needing clean water. Others mixed medications and took blood pressures, helping in triaging patients. Many helped run medications from the laterestablished pharmacy room or translated instructions to the patients. Others set up a system to allow patients their turn in clinic and also coordinated patient flow, a critical job in a bustling clinic. Others also monitored for intrusions. We have had superb pharmacists volunteer and carefully manage the medications we dispense. One amazing young woman, also from Ontario, came as a dental hygienist and cleaned teeth all day. She helped many, many children and adults with her efforts, avoiding tooth loss and training people in basic dental care. Others made sure each child and each pregnant mother got vitamins as well as small toys. Every trip, our clinic teams still give out toothbrushes and toothpaste along with toys to as many children as possible.

And the days never end at the clinic; we are surrounded by street kids and volunteers who help and translate for the clinic. Some of them we’ve eventually gotten to know. One translator grew up as an orphan in the church and has graduated medical school. He is now working on a Masters in Public Health in order to return to Haiti and improve local community health and sanitation conditions. Another former street child is completing medical school in the Dominican Republic, with help from donations. Many other students attend the church school and are supported through donations for their schoolbooks, uniforms, shoes and family.

Figure 3: Local fisherman out at dawn in the bay. Picture taken at Fte Liberte, 2016.

Lynn, our NICU nurse who has spent many hours exploring the local fort and shore near Fte Liberte, goes shell collecting in the early mornings. Lynn now takes me along on her morning walks, down to the bay to swim. We go for at least one morning swim every trip. The peace and beauty of Fte Liberte is, in my mind, best captured by one photograph I took this year of a local fisherman out in his boat at dawn (Figure 3). One cannot see the debris along the shore or the crumbling French fort, but rather one sees the hope and promise of early dawn in Haiti.

In all this is an extraordinary experience run by a group of extraordinary individuals. While all have been outstanding people, we are not able to name them all here. As health care providers, we have truly learned from the Haitian people the power of the human spirit and we may in truth gain more by working on these medical missions than we have ever given. In this medical work, we never know which life may be helped, healed or simply changed, allowing perhaps one person to change life in Haiti and helping one life may change many. This is the hope and promise of working in a medical clinic in a country such as Haiti.

My heart belongs to Haiti.